Development of a participatory Management approach of the Committee for Basic Education School under the Nongbualamphu Primary Educational Service Area Office 2

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Jirayu Prommajak

2016-10-01

Full Text Available This study aimed: 1 study the present state and adverse conditions of administration with the participation of the basic education in schools. 2 Development of a participatory Management approach of the Committee for Basic Education school under the Nongbualamphu Primary Educational Service Area Office 2. Split data into 2 phases. Phase 1: The sample used for this research consisted of 128 members of the committee on basic education in school under the Nongbualamphu Primary Educational Service Area Office 2. Selected by using stratified random sampling. Instruments used included a set of rating scale questionnaires. Phase 2: Data from the interviews using a structured questionnaire and focus group discussion. The basic statistics used for analyzing the collected data were percentage, means and standard deviation. The results of this study were as follows: 1. On the present state administration with the participation of the basic education commission in schools underunder the Nongbualamphu Primary Educational Service Area Office 2 overall participation in management is moderate. Considering the individual aspects, found that the academic administration overall participation in management and budget management were moderate. The personnel management and general and administrative overall participation in management at a high level. 2. Adverse conditions of administration with the participation of the school board for basic education in schools underunder the Nongbualamphu Primary Educational Service Area Office 2 overall in a high level. Considering the individual aspects, found that the school board in basic education is desirable to participate in the management of all aspects. 3. Development of a participatory management approach of the committee for basic education school under the Nongbualamphu Primary Educational Service Area Office 2 is a developmental process management principles PDCA, 5 steps. Step 1: Creating a common understanding Step

Implication of the displacement of the T1 primary target in the west area at the CERN SPS

CERN Document Server

Gatignon, L

1999-01-01

As soon as the transfer line T12 for proton injection into the LHC must be installed, the T1 primary target has to be at least partly dismantled, as its shielding would block the passage of the beam. Even though the installation of T12 is only foreseen for later, in view of sharing of workload related to the SLI project, it is preferred to move the primary production target T1 for the West Area to its new position already in the shutdown 1999/2000. The new position of the target requires major modifications of support structures in TCC6, of the transfer line towards T1 and of a more than 500 metres long section of the H3 secondary beam in the West Area, all to be completed in the 1999/2000 shutdown. To allow the work to be finished in time, part of it (including some civil engineering in TT4) is already done in the 1998/99 shutdown. In this memo the necessary modifications are described, cost estimates are given and a planning is provided.

[Professional quality of life in workers of the Toledo primary care health area].

Science.gov (United States)

Villarín Castro, A; Méndez García, T; Zuzuárregui Gironés, M S; Sánchez Serrano, S; Conejo Ocaña, R

2015-01-01

To determine the professional quality of life in the workers of the Toledo Primary Care Health Area and to analyse its components. Descriptive, cross-sectional study, performed on workers of the Toledo Primary Care Health Area with an online self-administered questionnaire. age, sex, health centre, professional group, seniority, management experience, collaboration in working groups, employment situation, and the PQL-35 professional quality of life questionnaire. A total of 430 completed questionnaires were received (45.3%), of which 68.4% were women. The mean age was 47.7±8.6 years old. Mean seniority was 21.5±9.7 years. PQL-35 results were: perception of management support 4.8±1.5; perception of workload 6.2±1.3; intrinsic motivation 7.9±1.1; job disconnection capacity 6.3±2.6; and professional quality of life 5.2±2.1. Gender differences were found in perception of management support (4.5±1.5 in males vs 4.9±1.5 in females; P=.031) and professional quality of life (4.9±2.0 vs 5.3±2.1; p=.044). Depending on the professional group, differences were found in the perception of workload (6.4±1.1 in physicians, 6.3±1.3 in nurses, 5.9±1.6 in non-sanitary professionals, and 5.3±1.2 in support units professionals; Pquality of life in the workers of the Toledo Primary Care Health Area is similar to that of other Spanish Health Areas, even in a time of economic crisis. The intrinsic motivation of the professionals is very high, in contrast with their high perception of workload and their low perception of management support. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Ambient Levels of Primary and Secondary Pollutants in a Residential Area: Population Risk and Hazard Index Calculation over a Three Years Study Period

OpenAIRE

S. Al-Salem; A. Al-Fadhlee

2007-01-01

This paper aims at presenting data collected over the period of three years (2004-2006) in a residential area in the state of Kuwait. The data collected include ambient levels of primary and secondary pollutants with a number of metrological parameters. A series of unfiltered and filtered concentration roses were plotted to determine the predominant sources as well as the prevailing winds affecting the area under investigation. Local and international air quality regulations were cross refere...

Unequal socioeconomic distribution of the primary care workforce: whole-population small area longitudinal study.

Science.gov (United States)

Asaria, Miqdad; Cookson, Richard; Fleetcroft, Robert; Ali, Shehzad

2016-01-19

To measure changes in socioeconomic inequality in the distribution of family physicians (general practitioners (GPs)) relative to need in England from 2004/2005 to 2013/2014. Whole-population small area longitudinal data linkage study. England from 2004/2005 to 2013/2014. 32,482 lower layer super output areas (neighbourhoods of 1500 people on average). Slope index of inequality (SII) between the most and least deprived small areas in annual full-time equivalent GPs (FTE GPs) per 100,000 need adjusted population. In 2004/2005, inequality in primary care supply as measured by the SII in FTE GPs was 4.2 (95% CI 3.1 to 5.3) GPs per 100,000. By 2013/2014, this SII had fallen to -0.7 (95% CI -2.5 to 1.1) GPs per 100,000. The number of FTE GPs per 100,000 serving the most deprived fifth of small areas increased over this period from 54.0 to 60.5, while increasing from 57.2 to 59.9 in the least deprived fifth, so that by the end of the study period there were more GPs per 100,000 need adjusted population in the most deprived areas than in the least deprived. The increase in GP supply in the most deprived fifth of neighbourhoods was larger in areas that received targeted investment for establishing new practices under the 'Equitable Access to Primary Medical Care'. There was a substantial reduction in socioeconomic inequality in family physician supply associated with national policy. This policy may not have completely eliminated socioeconomic inequality in family physician supply since existing need adjustment formulae do not fully capture the additional burden of multimorbidity in deprived neighbourhoods. The small area approach introduced in this study can be used routinely to monitor socioeconomic inequality of access to primary care and to indicate workforce shortages in particular neighbourhoods. http://creativecommons.org/licenses/by/4.0. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

The English Education in Primary Schools in Minor Ethnic Areas in Western China--Taking Leshan City as an Example

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Bing, Wang

2016-01-01

As we all know, China is a country with many ethnic minorities mainly living in the northeastern and southwestern China. The English education in the primary schools in these areas is an important issue. The article analyzes the status quo of English education in primary schools in minor ethnic areas, taking the Leshan city, a western one as an…

The silent partners? Leading parental involvement in primary schools in areas experiencing educational inequality.

OpenAIRE

O'Reilly, Siobhan

2012-01-01

This research project explored and examined parental involvement in two primary school with an emphasis on ‘leading’ this involvement. Both schools were situated in designated DEIS Urban Band 1 areas in Dublin. DEIS Urban Band 1 schools are identified as areas of high levels of socioeconomic disadvantage. The project was contextualised within the current national policy which has committed to parents as partners in their child’s education and the evidence from international literature clearly...

Administrative Strategies of School Management Effectiveness, Buriram Office of Primary Educational Service Area 4

Directory of Open Access Journals (Sweden)

Khanintipparat Prommaraj

2017-09-01

Full Text Available The objectives of this research were 1 to study the current and the expected Conditions of school management effectiveness, Buriram Office of Primary Educational Service Area 4 and 2 to construct administrative strategies of such schools. Eighty of directors, board chairpersons, teachers and parents were sampled. The instruments for data collection were 5-level rating scale questionnaires with the IOC value between 0.60–1.00 and the reliability value of 0.88 and in-depth interview forms. Quantitative data were analyzed by computer and qualitative data were inductively analyzed. The findings were as follows: 1. The current conditions school management effectiveness, Buriram Office of Primary Educational Service Area 4 was moderate while the expected conditions was high. By means of expected condition can be listed from high to low were atmosphere and environment management, administration, learning management and participation. 2. Strategies for effective management of schools under the Office of Educational Service Area 4 consists of four elementary Bachelor’s strategy is the first strategic development, management efficiency. 2 learners develop strategies to meet educational standards. Strategy 3: create an atmosphere and environment conducive to development. Strategy 4 and the joint cooperation of network.

The burden of polyparasitism among primary schoolchildren in rural and farming areas in Zimbabwe.

Science.gov (United States)

Midzi, N; Sangweme, D; Zinyowera, S; Mapingure, M P; Brouwer, K C; Munatsi, A; Mutapi, F; Mudzori, J; Kumar, N; Woelk, G; Mduluza, T

2008-10-01

A cross-sectional study was conducted in Zimbabwe among 1303 primary schoolchildren from a rural (53.3%) and a commercial farming area (46.7%) to determine the prevalence of co-infection by helminths and Plasmodium falciparum. Urine was examined on three successive days using the filtration method. Two stool specimens were processed using the Kato-Katz method and a third specimen was processed using the sedimentation method. Plasmodium falciparum was diagnosed from thick blood films. The prevalence of Schistosoma haematobium in the rural and farming areas was 66.8% and 52.3%, respectively, and for S. mansoni the prevalence was 12.4% and 22.7%, respectively. Plasmodium falciparum, hookworms, Ascaris lumbricoides and Trichuris trichiura occurred only in the farming area, with a prevalence of 27.9%, 23.7%, 2.1%, 2.3%, respectively. Co-infection and triple infection with schistosomes, P. falciparum and soil-transmitted helminths occurred in the commercial farming area only. Hookworm and S. mansoni infections were associated with P. falciparum malaria (P<0.001, OR=2.48, 95% CI 1.56-3.93 and P=0.005, OR=1.85, 95% CI 1.20-2.87, respectively). Overlap of helminths with malaria is a concern among primary schoolchildren and incorporating helminth control in programmes aiming to control malaria will improve funding and increase the efficiency of control for neglected tropical diseases in identified co-endemic settings.

Undergraduate Students' Perceptions of the Mathematics Courses Included in the Primary School Teacher Education Program

Science.gov (United States)

Serin, Mehmet Koray; Incikabi, Semahat

2017-01-01

Mathematics educators have reported on many issues regarding students' mathematical education, particularly students who received mathematics education at different departments such as engineering, science or primary school, including their difficulties with mathematical concepts, their understanding of and preferences for mathematical concepts.…

Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area.

Science.gov (United States)

Westerdahl, Christina; Bergenfelz, Anders; Isaksson, Anders; Nerbrand, Christina; Valdemarsson, Stig

2011-03-01

To evaluate the prevalence of primary aldosteronism (PA) in newly diagnosed and untreated hypertensive patients in primary care using the aldosterone/renin ratio (ARR), and to assess clinical and biochemical characteristics in patients with high and normal ARR. Patient survey study. A total of 200 consecutive patients with newly diagnosed and untreated hypertension from six primary health care centres in Sweden were included. ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was 65. Patients with an increased ARR were considered for confirmatory testing with the fludrocortisone suppression test (FST), followed by adrenal computed tomographic radiology (CT) and adrenal venous sampling (AVS). Of 200 patients, 36 patients had an ARR > 65. Of these 36 patients, 11 patients had an incomplete aldosterone inhibition during FST. Three patients were diagnosed with an aldosterone producing adenoma (APA) and eight with bilateral adrenal hyperplasia (BHA). Except for moderately lower level of P-K in patients with an ARR > 65 and in patients with PA, there were no biochemical or clinical differences found among hypertensive patients with PA compared with patients without PA. Eleven of 200 evaluated patients (5.5%) were considered to have PA. The diagnosis of PA should therefore be considered in newly diagnosed hypertensive subjects and screening for the diagnosis is warranted.

33 CFR 125.15 - Access to waterfront facilities, and port and harbor areas, including vessels and harbor craft...

Science.gov (United States)

2010-07-01

..., and port and harbor areas, including vessels and harbor craft therein. 125.15 Section 125.15....15 Access to waterfront facilities, and port and harbor areas, including vessels and harbor craft....09 to those waterfront facilities, and port and harbor areas, including vessels and harbor craft...

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland.

Science.gov (United States)

Stenius-Ayoade, Agnes; Haaramo, Peija; Erkkilä, Elisabet; Marola, Niko; Nousiainen, Kirsi; Wahlbeck, Kristian; Eriksson, Johan G

2017-06-21

Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9-20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5-9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4-10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3-31.2) and SUDs (11.5, 95% CI 5.7-23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study.

Science.gov (United States)

Ford, John A; Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P; Steel, Nick

2018-01-01

We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Older people's experience can be understood within the context of a patient perceived set of unwritten rules or social contract-an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals' described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.

Apparatus and method for mapping an area of interest

Science.gov (United States)

Staab, Torsten A. Cohen, Daniel L.; Feller, Samuel [Fairfax, VA

2009-12-01

An apparatus and method are provided for mapping an area of interest using polar coordinates or Cartesian coordinates. The apparatus includes a range finder, an azimuth angle measuring device to provide a heading and an inclinometer to provide an angle of inclination of the range finder as it relates to primary reference points and points of interest. A computer is provided to receive signals from the range finder, inclinometer and azimuth angle measurer to record location data and calculate relative locations between one or more points of interest and one or more primary reference points. The method includes mapping of an area of interest to locate points of interest relative to one or more primary reference points and to store the information in the desired manner. The device may optionally also include an illuminator which can be utilized to paint the area of interest to indicate both points of interest and primary points of reference during and/or after data acquisition.

Primary collector wall local temperature fluctuations in the area of water-steam phase boundary

Energy Technology Data Exchange (ETDEWEB)

Matal, O.; Klinga, J.; Simo, T. [Energovyzkum Ltd., Brno (Switzerland)

1995-12-31

A limited number of temperature sensors could be installed at the primary collector surface in the area of water - steam phase boundary. The surface temperatures as well WWER 440 steam generator process data were measured and stored for a long time and off-line evaluated. Selected results are presented in the paper. (orig.). 2 refs.

Primary collector wall local temperature fluctuations in the area of water-steam phase boundary

Energy Technology Data Exchange (ETDEWEB)

Matal, O; Klinga, J; Simo, T [Energovyzkum Ltd., Brno (Switzerland)

1996-12-31

A limited number of temperature sensors could be installed at the primary collector surface in the area of water - steam phase boundary. The surface temperatures as well WWER 440 steam generator process data were measured and stored for a long time and off-line evaluated. Selected results are presented in the paper. (orig.). 2 refs.

Regional structural differences across functionally parcellated Brodmann areas of human primary somatosensory cortex.

Science.gov (United States)

Sánchez-Panchuelo, Rosa-María; Besle, Julien; Mougin, Olivier; Gowland, Penny; Bowtell, Richard; Schluppeck, Denis; Francis, Susan

2014-06-01

Ultra-high-field (UHF) MRI is ideally suited for structural and functional imaging of the brain. High-resolution structural MRI can be used to map the anatomical boundaries between functional domains of the brain by identifying changes related to the pattern of myelination within cortical gray matter, opening up the possibility to study the relationship between functional domains and underlying structure in vivo. In a recent study, we demonstrated the correspondence between functional (based on retinotopic mapping) and structural (based on changes in T2(⁎)-weighted images linked to myelination) parcellations of the primary visual cortex (V1) in vivo at 7T (Sanchez-Panchuelo et al., 2012b). Here, we take advantage of the improved BOLD CNR and high spatial resolution achievable at 7T to study regional structural variations across the functionally defined areas within the primary somatosensory cortex (S1) in individual subjects. Using a traveling wave fMRI paradigm to map the internal somatotopic representation of the index, middle, and ring fingers in S1, we were able to identify multiple map reversals at the tip and base, corresponding to the boundaries between Brodmann areas 3a, 3b, 1 and 2. Based on high resolution structural MRI data acquired in the same subjects, we inspected these functionally-parcellated Brodmann areas for differences in cortical thickness and MR contrast measures (magnetization transfer ratio (MTR) and signal intensity in phase sensitive inversion recovery (PSIR) images) that are sensitive to myelination. Consistent area-related differences in cortical thickness and MTR/PSIR measurements were found across subjects. However these measures did not have sufficient sensitivity to allow definition of areal boundaries. Copyright © 2013 Elsevier Inc. All rights reserved.

Numerical Treatment of Two-phase Flow in Porous Media Including Specific Interfacial Area

KAUST Repository

El-Amin, Mohamed

2015-06-01

In this work, we present a numerical treatment for the model of two-phase flow in porous media including specific interfacial area. For numerical discretization we use the cell-centered finite difference (CCFD) method based on the shifting-matrices method which can reduce the time-consuming operations. A new iterative implicit algorithm has been developed to solve the problem under consideration. All advection and advection-like terms that appear in saturation equation and interfacial area equation are treated using upwind schemes. Selected simulation results such as pc–Sw–awn surface, capillary pressure, saturation and specific interfacial area with various values of model parameters have been introduced. The simulation results show a good agreement with those in the literature using either pore network modeling or Darcy scale modeling.

EVALUATION OF PRIMARY PRODUCTIVITY AT THE WILDLIFE PROTECTED AREA, "NEVADO DE TOLUCA" MEXICO, DURING THE DRY SEASON

Directory of Open Access Journals (Sweden)

J. Martínez-Hernández

2014-08-01

Full Text Available This is the first report on grassland primary productivity for the wildlife protected area Nevado de Toluca (APFF Nevado de Toluca. We evaluated three communities in this area during dry season: Loma Alta, La Peñuela y Agua Blanca. Following Hodgson (1994, for this study we used exclusion cages. Vegetation was cut every 28 days during a five months sampling period. A randomized block design was used, where the blocks represented the grassland communities and the different months constituted treatments. The month of September showed the higher production (610.3 kg/ha DM. No significant differences were observed among communities (P >0.05. In conclusion, these communities have similar low primary productivity through the evaluation dry season months, which in addition was found lower in comparison to other areas, therefore livestock grazing in this region should be limited this season.

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study

Science.gov (United States)

Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P.; Steel, Nick

2018-01-01

Objective We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Methods Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Findings Older people’s experience can be understood within the context of a patient perceived set of unwritten rules or social contract–an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals’ described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Conclusion Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service. PMID:29509811

Prevalence of head lice infestation and pediculicidal effect of permethrine shampoo in primary school girls in a low-income area in southeast of Iran.

Science.gov (United States)

Soleimani-Ahmadi, Moussa; Jaberhashemi, Seyed Aghil; Zare, Mehdi; Sanei-Dehkordi, Alireza

2017-07-24

Head lice infestation is a common public health problem that is most prevalent in primary school children throughout the world, especially in developing countries including different parts of Iran. This study aimed to determine the prevalence and risk factors associated with head lice infestation and pediculicidal effect of 1% permethrin shampoo in primary schools girls of Bashagard County, one of the low socioeconomic areas in southeast of Iran. In this interventional study six villages with similar demographical situations were selected and randomly assigned into intervention and control areas. In each area 150 girl students aged 7-12 years were selected randomly and screened for head lice infestation by visual scalp examination. In intervention area, treatment efficacy of 1% permethrin shampoo was evaluated via re-examination for infestation after one, two, and three weeks. Pre-tested structured questionnaire was used to collect data on socio-demographic and associated factors of head lice infestation. The prevalence of head lice infestation was 67.3%. There was significant association between head lice infestation and school grade, family size, parents' literacy, bathing facilities, frequency of hair washing, and use of shared articles (p shampoo for head lice treatment was 29.2, 68.9, and 90.3% after the first, second, and third weeks, respectively. The head lice infestation is a health problem in primary school girls of Bashagard County. Improvement of socioeconomic status and providing appropriate educational programs about head lice risk factors and prevention can be effective for reduction of infestation in this area. This trial has been registered and approved by Hormozgan University of Medical Sciences ethical committee (Trial No.764). Trial registration date: March 17 2014.

Nitrogen-controlled intra- and interspecific competition between Populus purdomii and Salix rehderiana drive primary succession in the Gongga Mountain glacier retreat area.

Science.gov (United States)

Song, Mengya; Yu, Lei; Jiang, Yonglei; Lei, Yanbao; Korpelainen, Helena; Niinemets, Ülo; Li, Chunyang

2017-06-01

In this study, intra- and interspecific competition were investigated in early successional Salix rehderiana Schneider and later-appearing Populus purdomii Rehder under non-fertilized (control) and nitrogen (N)-fertilized conditions in the Hailuogou glacier retreat area. Our aim was to discover whether N is a key factor in plant-plant competition and whether N drives the primary succession process in a glacier retreat area. We analyzed differences in responses to intra- and interspecific competition and N fertilization between P. purdomii and S. rehderiana, including parameters such as biomass accumulation, nutrient absorption, non-structural carbohydrates, photosynthetic capacity, hydrolysable amino acids and leaf ultrastructure. In the control treatments, S. rehderiana individuals subjected to interspecific competition benefited from the presence of P. purdomii plants, as indicated by higher levels of biomass accumulation, photosynthetic capacity, N absorption, amino acid contents and photosynthetic N-use efficiency. However, in the N-fertilized treatments, P. purdomii individuals exposed to interspecific competition benefited from the presence of S. rehderiana plants, as shown by a higher growth rate, enhanced carbon gain capacity, greater amino acid contents, and elevated water-use efficiency, whereas the growth of S. rehderiana was significantly reduced. Our results demonstrate that N plays a pivotal role in determining the asymmetric competition pattern among Salicaceae species during primary succession. We argue that the interactive effects of plant-plant competition and N availability are key mechanisms that drive primary succession in the Gongga Mountain glacier retreat area. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Expanded emergency medical services for the provision of primary care in remote rural areas.

Science.gov (United States)

Mccabe, S

2000-05-01

It is now widely recognised that a potential recruitment crisis is looming in the provision of primary care physicians for remote rural areas of the United Kingdom. Anecdotal evidence suggests that rural registrar, associate and principal vacancies are becoming increasingly difficult to fill and for many rural GPs locums are an impossible dream. Many practitioners are no longer prepared to work in areas where out-of-hours cooperatives are not available. We are now faced with the very real possibility that in some remote areas of the Scottish Highlands and Islands the recruitment of suitable GPs may no longer be possible. So what are the alternatives? In October 1999 I visited a community in the mountains of northern New Mexico which has had to deal with this very problem.

Scabies among primary schoolchildren in Egypt: sociomedical environmental study in Kafr El-Sheikh administrative area

Directory of Open Access Journals (Sweden)

Hegab DS

2015-02-01

Full Text Available Doaa Salah Hegab,1 Abdullah Mahfouz Kato,1 Ibrahim Ali Kabbash,2 Ghada Maged Dabish3 1Department of Dermatology and Venereology, Faculty of Medicine, 2Department of Public Health and Community, Faculty of Medicine, 3Faculty of Medicine, Tanta University, Tanta, Egypt Background/objectives: Scabies is a major global public health issue that might affect people from all socioeconomic levels. The primary contributing factors in contracting scabies seem to be poverty and overcrowded living conditions. Scabies often spreads among schoolchildren quite rapidly, owing to their close contact and overcrowding within the schools. However, limited information is available about its risk factors and the socioeconomic correlates among schoolchildren in Egypt. This study aimed to assess the prevalence of scabies and its risk factors among primary schoolchildren in Kafr El-Sheikh administrative area, Egypt. Methods: This cross-sectional descriptive study was performed on primary schoolchildren in urban and rural areas of Kafr El-Sheikh administrative area. A predesigned questionnaire was used for data collection from the randomly selected 2,104 children, and clinical dermatological examination was done for them. Results: Out of 2,104 children studied, there were 92 cases of scabies with a prevalence of 4.4%. The prevalence of scabies infestation in male students was 3.9%, while it was 4.8% in females, with no statistical significance. The results showed significant variations in the risk of scabies infestation by factors such as residence, paternal education and occupation, maternal education, sleeping with others, having animals at home, dealing with animals outside the house, type of building for living, family history of itchy rash, and sharing clothes with others. Conclusion: In our community, scabies is still an important health problem affecting schoolchildren, especially in rural areas. It is characterized by a complex web of causation, particularly poor

[Brodmann Areas 8 and 9 Including the Frontal Eye Field].

Science.gov (United States)

Watanabe, Masataka

2017-04-01

Based on cytoarchitectonic analyses, Brodmann assigned numbers 8 and 9 to certain areas of the dorsal and medial prefrontal cortex (PFC) in humans and monkeys. Petrides and Pandya re-analyzed the cytoarchitectures of the human and monkey PFCs, and proposed slightly different brain maps for both species. They assigned numbers 8, 9 and 9/46 to the areas that were originally named areas 8 and 9. Areas 8 and 9 have both lateral and medial regions respectively. The lateral area 8 is important for conditional discrimination learning. The frontal eye field which occupies the most caudal region of area 8, is responsible for visual attention and control of eye movements. The lateral area 9 and area 9/46 are functionally similar to area 46 and play important roles in executive control. The dorsomedial prefrontal cortex (DMPFC) comprises the medial regions of areas 8 and 9 and is related to "Theory of Mind" and social cognition. The DMPFC is also known to show "default mode of brain activity" (i.e., more activity during rest than during cognitive task).

Ipsilateral corticotectal projections from the primary, premotor and supplementary motor cortical areas in adult macaque monkeys: a quantitative anterograde tracing study

Science.gov (United States)

Fregosi, Michela; Rouiller, Eric M.

2018-01-01

The corticotectal projection from cortical motor areas is one of several descending pathways involved in the indirect control of spinal motoneurons. In non-human primates, previous studies reported that cortical projections to the superior colliculus originated from the premotor cortex and the primary motor cortex, whereas no projection originated from the supplementary motor area. The aim of the present study was to investigate and compare the properties of corticotectal projections originating from these three cortical motor areas in intact adult macaques (n=9). The anterograde tracer BDA was injected into one of these cortical areas in each animal. Individual axonal boutons, both en passant and terminaux, were charted and counted in the different layers of the ipsilateral superior colliculus. The data confirmed the presence of strong corticotectal projections from the premotor cortex. A new observation was that strong corticotectal projections were also found to originate from the supplementary motor area (its proper division). The corticotectal projection from the primary motor cortex was quantitatively less strong than that from either the premotor or supplementary motor areas. The corticotectal projection from each motor area was directed mainly to the deep layer of the superior colliculus, although its intermediate layer was also a consistent target of fairly dense terminations. The strong corticotectal projections from non-primary motor areas are in position to influence the preparation and planning of voluntary movements. PMID:28921678

[Clinical bioethics for primary health care].

Science.gov (United States)

González-de Paz, L

2013-01-01

The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Satellite remote sensing for estimating leaf area index, FPAR and primary production. A literature review

International Nuclear Information System (INIS)

Boresjoe Bronge, Laine

2004-03-01

Land vegetation is a critical component of several biogeochemical cycles that have become the focus of concerted international research effort. Most ecosystem productivity models, carbon budget models, and global models of climate, hydrology and biogeochemistry require vegetation parameters to calculate land surface photosynthesis, evapotranspiration and net primary production. Therefore, accurate estimates of vegetation parameters are increasingly important in the carbon cycle, the energy balance and in environmental impact assessment studies. The possibility of quantitatively estimating vegetation parameters of importance in this context using satellite data has been explored by numerous papers dealing with the subject. This report gives a summary of the present status and applicability of satellite remote sensing for estimating vegetation productivity by using vegetation index for calculating leaf area index (LAI) and fraction of absorbed photosynthetically active radiation (FPAR). Some possible approaches for use of satellite data for estimating LAI, FPAR and net primary production (NPP) on a local scale are suggested. Recommendations for continued work in the Forsmark and Oskarshamn investigation areas, where vegetation data and NDVI-images based on satellite data have been produced, are also given

Satellite remote sensing for estimating leaf area index, FPAR and primary production. A literature review

Energy Technology Data Exchange (ETDEWEB)

Boresjoe Bronge, Laine [SwedPower AB, Stockholm (Sweden)

2004-03-01

Land vegetation is a critical component of several biogeochemical cycles that have become the focus of concerted international research effort. Most ecosystem productivity models, carbon budget models, and global models of climate, hydrology and biogeochemistry require vegetation parameters to calculate land surface photosynthesis, evapotranspiration and net primary production. Therefore, accurate estimates of vegetation parameters are increasingly important in the carbon cycle, the energy balance and in environmental impact assessment studies. The possibility of quantitatively estimating vegetation parameters of importance in this context using satellite data has been explored by numerous papers dealing with the subject. This report gives a summary of the present status and applicability of satellite remote sensing for estimating vegetation productivity by using vegetation index for calculating leaf area index (LAI) and fraction of absorbed photosynthetically active radiation (FPAR). Some possible approaches for use of satellite data for estimating LAI, FPAR and net primary production (NPP) on a local scale are suggested. Recommendations for continued work in the Forsmark and Oskarshamn investigation areas, where vegetation data and NDVI-images based on satellite data have been produced, are also given.

Stunting and zinc deficiency among primary school children in rural areas with low soil zinc concentrations in Jiangsu Province, China

NARCIS (Netherlands)

Qin, Yu; Boonstra, A.; Zhao, J.; Wu, M.; Hu, X.; Kok, F.J.

2009-01-01

OBJECTIVE: To assess stunting and zinc deficiency among primary school children in north rural area of Jiangsu Province with low soil zinc concentrations, eastern part of China. METHODS: Two data collection rounds were conducted. In the first data collection round, 2268 primary school children aged

Disrupted modular organization of primary sensory brain areas in schizophrenia

Directory of Open Access Journals (Sweden)

Cécile Bordier

Full Text Available Abnormal brain resting-state functional connectivity has been consistently observed in patients affected by schizophrenia (SCZ using functional MRI and other neuroimaging techniques. Graph theoretical methods provide a framework to investigate these defective functional interactions and their effects on the organization of brain connectivity networks. A few studies have shown altered distribution of connectivity within and between functional modules in SCZ patients, an indication of imbalanced functional segregation ad integration. However, no major alterations of modular organization have been reported in patients, and unambiguous identification of the neural substrates affected remains elusive. Recently, it has been demonstrated that current modularity analysis methods suffer from a fundamental and severe resolution limit, as they fail to detect features that are smaller than a scale determined by the size of the entire connectivity network. This resolution limit is likely to have hampered the ability to resolve differences between patients and controls in previous studies. Here, we apply Surprise, a novel resolution limit-free approach, to study the modular organization of resting state functional connectivity networks in a large cohort of SCZ patients and in matched healthy controls. Leveraging these important methodological advances we find new evidence of substantial fragmentation and reorganization involving primary sensory, auditory and visual areas in SCZ patients. Conversely, frontal and prefrontal areas, typically associated with higher cognitive functions, appear to be largely unaffected, with changes selectively involving language and speech processing areas. Our findings support the hypothesis that cognitive dysfunction in SCZ may involve deficits occurring already at early stages of sensory processing. Keywords: Schizophrenia, Surprise, Asymptotical surprise, Functional connectivity, Community detection, Modularity, Graph theory

Modelling of the local chemistry in stagnant areas in the PWR primary circuit

International Nuclear Information System (INIS)

Reid, Rick; Fruzzetti, Keith; Ahluwalia, Al; Summe, Alex; Dame, Cecile; Schmitt, Kyle

2014-01-01

MRP-236 demonstrated a correlation between stagnant or low flow conditions and stress corrosion cracking (SCC) of stainless steel components in the PWR primary system. Of the approximately 140 SCC events documented (affecting 15 different components), 83% involved stagnant or low flow conditions that were likely to be associated with chemical environments different from the well mixed bulk coolant. The chemistry in such locations is typically not monitored, and sampling is difficult or impossible. Actions to improve chemistry in regions of low or no coolant flow, such as flushing, cycling of components and imposition of more stringent make up water chemistry controls affect both operational costs and outage schedules. Similarly, design changes to improve flow in affected areas are costly or impracticable. Improving the understanding of the factors controlling chemistry in such areas and development of the capability to predict typical and worst case conditions will allow an informed assessment of procedural actions and/or design changes to improve local chemistry and thereby reduce SCC susceptibility. A project was undertaken to develop a model to predict local chemistry conditions in stagnant locations. The model comprises the iterative application of the EPRI MULTEQ solution chemistry equilibrium code and standard thermodynamic relationships to predict local chemistry conditions considered likely to have been present at the surfaces of components when SCC was initiated. The starting chemistry conditions are based on PWR primary system chemistry from different plant maneuvers (e.g., startup and shutdown conditions). The model was applied to three example components where SCC has occurred in the field. The selected components were: control rod drive mechanism canopy seals; valve drain lines; and reactor vessel o-ring leak-off lines. This paper provides a summary of the model and predicted local chemistry conditions that develop for the three example component as a

Specialists meeting on properties of primary circuit structural materials including environmental effects

Energy Technology Data Exchange (ETDEWEB)

NONE

1977-07-01

The Specialists Meeting on Properties of Primary Circuit Structural Materials of LMFBRs covered the following topics: overview of materials program in different countries; mechanical properties of materials in air; fracture mechanics studies - component related activities; impact of environmental influences on mechanical properties; relationship of material properties and design methods. The purpose of the meeting was to provide a forum for exchange of information on structural materials behaviour in primary circuit of fast breeder reactors. Special emphasis was placed on environmental effects such as influence of sodium and irradiation on mechanical properties of reactor materials.

Specialists meeting on properties of primary circuit structural materials including environmental effects

International Nuclear Information System (INIS)

1977-01-01

The Specialists Meeting on Properties of Primary Circuit Structural Materials of LMFBRs covered the following topics: overview of materials program in different countries; mechanical properties of materials in air; fracture mechanics studies - component related activities; impact of environmental influences on mechanical properties; relationship of material properties and design methods. The purpose of the meeting was to provide a forum for exchange of information on structural materials behaviour in primary circuit of fast breeder reactors. Special emphasis was placed on environmental effects such as influence of sodium and irradiation on mechanical properties of reactor materials

Primary schools, markets and choice: studying polarization and the core catchment areas of schools

OpenAIRE

Harris, R J; Johnston, RJ

2007-01-01

In this paper we distinguish polarization from other conceptions of segregation by conceiving the former as a local phenomenon. To this end we argue that evidence for any school-level separation of ethnic groups must be sought and contextualised within the local markets within which schools operate. By determining the ‘core catchment’ areas of primary schools from geographical micro-data reporting where pupils reside and which school they attend within the study region of Birmingham, England,...

Inhalation of primary motor vehicle emissions: Effects of urbanpopulation and land area

Energy Technology Data Exchange (ETDEWEB)

Marshall, Julian D.; McKone, Thomas E.; Nazaroff, William W.

2004-06-14

Urban population density can influence transportation demand, as expressed through average daily vehicle-kilometers traveled per capita (VKT). In turn, changes in transportation demand influence total passenger vehicle emissions. Population density can also influence the fraction of total emissions that are inhaled by the exposed urban population. Equations are presented that describe these relationships for an idealized representation of an urban area. Using analytic solutions to these equations, we investigate the effect of three changes in urban population and urban land area (infill, sprawl, and constant-density growth) on per capita inhalation intake of primary pollutants from passenger vehicles. The magnitude of these effects depends on density-emissions elasticity ({var_epsilon}{sub e}), a normalized derivative relating change in population density to change in vehicle emissions. For example, if urban population increases, per capita intake is less with infill development than with constant-density growth if {var_epsilon}{sub e} is less than -0.5, while for {var_epsilon}{sub e} greater than -0.5 the reverse is true.

Enhanced peripheral visual processing in congenitally deaf humans is supported by multiple brain regions, including primary auditory cortex

Directory of Open Access Journals (Sweden)

Gregory D. Scott

2014-03-01

Full Text Available Brain reorganization associated with altered sensory experience clarifies the critical role of neuroplasticity in development. An example is enhanced peripheral visual processing associated with congenital deafness, but the neural systems supporting this have not been fully characterized. A gap in our understanding of deafness-enhanced peripheral vision is the contribution of primary auditory cortex. Previous studies of auditory cortex that use anatomical normalization across participants were limited by inter-subject variability of Heschl’s gyrus. In addition to reorganized auditory cortex (cross-modal plasticity, a second gap in our understanding is the contribution of altered modality-specific cortices (visual intramodal plasticity in this case, as well as supramodal and multisensory cortices, especially when target detection is required across contrasts. Here we address these gaps by comparing fMRI signal change for peripheral versus perifoveal visual stimulation (11-15° vs. 2°-7° in congenitally deaf and hearing participants in a blocked experimental design with two analytical approaches: a Heschl’s gyrus region of interest analysis and a whole brain analysis. Our results using individually-defined primary auditory cortex (Heschl’s gyrus indicate that fMRI signal change for more peripheral stimuli was greater than perifoveal in deaf but not in hearing participants. Whole-brain analyses revealed differences between deaf and hearing participants for peripheral versus perifoveal visual processing in extrastriate visual cortex including primary auditory cortex, MT+/V5, superior-temporal auditory and multisensory and/or supramodal regions, such as posterior parietal cortex, frontal eye fields, anterior cingulate, and supplementary eye fields. Overall, these data demonstrate the contribution of neuroplasticity in multiple systems including primary auditory cortex, supramodal and multisensory regions, to altered visual processing in

Key Performance Indicators for Primary Schools.

Science.gov (United States)

Strand, Steve

Focusing mostly on their application for primary schools, this document describes the educational key performance indicators (KPI) employed by the Wendsworth, England, Local Educational Authority (LEA). Indicators are divided into 3 areas, educational context, resource development, and outcomes. Contextual indicators include pupil mobility, home…

Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area.

Science.gov (United States)

Rodríguez Cristóbal, Juan José; Panisello Royo, Josefa Ma; Alonso-Villaverde Grote, Carlos; Pérez Santos, José Ma; Muñoz Lloret, Anna; Rodríguez Cortés, Francisca; Travé Mercadé, Pere; Benavides Márquez, Francisca; Martí de la Morena, Pilar; González Burgillos, Ma José; Delclós Baulies, Marta; Bleda Fernández, Domingo; Quillama Torres, Elida

2010-03-18

The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting. ClinicalTrials.gov Identifier: NCT01006213.

Multidisciplinary Practice Experience of Nursing Faculty and Their Collaborators for Primary Health Care in Korea

Directory of Open Access Journals (Sweden)

Mi Ja Kim, PhD, RN, FAAN

2008-03-01

Conclusion: Teamwork should be included in all health professions' curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide.

Morphometric analysis of feedforward pathways from the primary somatosensory area (S1 of rats

Directory of Open Access Journals (Sweden)

A.L. de Sá

2016-01-01

Full Text Available We used biotinylated dextran amine (BDA to anterogradely label individual axons projecting from primary somatosensory cortex (S1 to four different cortical areas in rats. A major goal was to determine whether axon terminals in these target areas shared morphometric similarities based on the shape of individual terminal arbors and the density of two bouton types: en passant (Bp and terminaux (Bt. Evidence from tridimensional reconstructions of isolated axon terminal fragments (n=111 did support a degree of morphological heterogeneity establishing two broad groups of axon terminals. Morphological parameters associated with the complexity of terminal arbors and the proportion of beaded Bp vs stalked Bt were found to differ significantly in these two groups following a discriminant function statistical analysis across axon fragments. Interestingly, both groups occurred in all four target areas, possibly consistent with a commonality of presynaptic processing of tactile information. These findings lay the ground for additional work aiming to investigate synaptic function at the single bouton level and see how this might be associated with emerging properties in postsynaptic targets.

[Introduction of capillary glycosylated haemoglobin determination in a Primary Care Health Area: Multicentre study of the evolution of patients with type 2 diabetes mellitus].

Science.gov (United States)

Núñez-Sánchez, M Á; Cervantes-Cuesta, M Á; Brocal-Ibañez, P; Salmeron-Arjona, E; León-Martínez, L P; Cerezo-Sanmartin, M

The aim of this study was to evaluate the efficiency of a joint intervention that included educational components, self-assessment, and information to optimise diabetes control through the introduction of instant capillary glycosylated haemoglobin (HbA1c) determination in Primary Care. A multicentre prospective descriptive study was carried out over 3years in 10Primary Care Centres of the Area VII Murcia East. At the end of the study there were 804 patients with type 2 diabetes (DM2). Patients were divided into 4 groups based on initial values of HbA1c, and if changes in their treatment were needed. HbA1c, body mass index, and blood pressure were monitored. A financial assessment was also performed on the impact of the implementation of a protocol to measure instant capillary RESULTS: A significant reduction was observed in HbA1c values. The initial HbA1c mean value was 7.4±1.4%, which decreased to a final value of 6.9±1.0% (P<.001). At the end of the study, 71.4% of patients included reached diabetic control objectives. In addition, the financial assessment demonstrated that the implementation of this diabetes control system led to a decrease of the 24.7% in spending on glucose strips after the first year of study in Area VII Murcia Health Service. The introduction of capillary HbA1c determination in Primary Care has demonstrated to improve diabetes control and the efficiency of the health personnel. Furthermore, a reduction in the health costs of patients with DM2 was also shown. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

CY15 Livermore Computing Focus Areas

Energy Technology Data Exchange (ETDEWEB)

Connell, Tom M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Cupps, Kim C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); D' Hooge, Trent E. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Fahey, Tim J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Fox, Dave M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Futral, Scott W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gary, Mark R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Goldstone, Robin J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hamilton, Pam G. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Heer, Todd M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Long, Jeff W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Mark, Rich J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Morrone, Chris J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Shoopman, Jerry D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Slavec, Joe A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Smith, David W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Springmeyer, Becky R [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Stearman, Marc D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Watson, Py C. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2015-01-20

The LC team undertook a survey of primary Center drivers for CY15. Identified key drivers included enhancing user experience and productivity, pre-exascale platform preparation, process improvement, data-centric computing paradigms and business expansion. The team organized critical supporting efforts into three cross-cutting focus areas; Improving Service Quality; Monitoring, Automation, Delegation and Center Efficiency; and Next Generation Compute and Data Environments In each area the team detailed high level challenges and identified discrete actions to address these issues during the calendar year. Identifying the Center’s primary drivers, issues, and plans is intended to serve as a lens focusing LC personnel, resources, and priorities throughout the year.

Training teachers to teach mental health skills to staff in primary care settings in a vast, under-populated area.

Science.gov (United States)

Goldberg, D P; Gask, L; Zakroyeva, A; Proselkova, E; Ryzhkova, N; Williams, P

2012-12-01

Background The Arkhangelsk Oblast is an area the size of France with a sparsely distributed population. The existing primary care staff have had very little training in the management of mental health disorders, despite the frequency of these disorders in the population. They requested special teaching on depression, suicide, somatisation and alcohol problems. Methods An educational intervention was developed in partnership with mental health and primary care staff in Russia, to develop mental health skills using established, evidence-based methods. After a preliminary demonstration of teaching methods to be employed, a 5-day full-time teaching course was offered to trainers of general practitioners and feldshers. Results The findings are presented by providing details of improvements that occurred over a 3-month period in four areas, namely depression in primary care, somatic presentations of distress, dealing with suicidal patients, and alcohol problems. We present preliminary data on how the training has generalised since our visits to Archangelsk. Conclusions Teachers who are used to teaching by didactic lectures can be taught the value of short introductory talks that invite discussion, and mental health skills can be taught using role play. The content of such training should be driven by perceived local needs, and developed in conjunction with local leaders and teachers within primary care services. Further research will be needed to establish the impact on clinical outcomes.

DOPA, a Digital Observatory for Protected Areas including Monitoring and Forecasting Services

Science.gov (United States)

Dubois, Gregoire; Hartley, Andrew; Peedell, Stephen; de Jesus, Jorge; Ó Tuama, Éamonn; Cottam, Andrew; May, Ian; Fisher, Ian; Nativi, Stefano; Bertrand, Francis

2010-05-01

The Digital Observatory for Protected Areas (DOPA) is a biodiversity information system currently developed as an interoperable web service at the Joint Research Centre of the European Commission in collaboration with other international organizations, including GBIF, UNEP-WCMC, Birdlife International and RSPB. DOPA is designed to assess the state and pressure of Protected Areas (PAs) and to prioritize them accordingly, in order to support decision making and fund allocation processes. To become an operational web service allowing the automatic monitoring of protected areas, DOPA needs to be able to capture the dynamics of spatio-temporal changes in habitats and anthropogenic pressure on PAs as well as the changes in the species distributions. Because some of the most valuable natural ecosystems and species on the planet cover large areas making field monitoring methods very difficult for a large scale assessment, the automatic collection and processing of remote sensing data are processes at the heart of the problem. To further be able to forecast changes due to climate change, DOPA has to rely on an architecture that enables it to communicate with the appropriate modeling web services. The purpose of this presentation is to present the architecture of the DOPA with special attention to e-Habitat, its web processing service designed for assessing the irreplaceability of habitats as well as for the modeling of habitats under different climate change scenarios. The use of open standards for spatial data and of open source programming languages for the development of the core functionalities of the system are expected to encourage the participation of the scientific community beyond the current partnerships and to favour the sharing of such an observatory which could be installed at any other location. Acknowledgement: Part of this work is funded under the 7th Framework Programme by the EuroGEOSS (www.eurogeoss.eu) project of the European Commission. The views

Prehypertension and hypertension among young Indonesian adults at a primary health care in a rural area

Directory of Open Access Journals (Sweden)

Felix F. Widjaja

2013-02-01

Full Text Available Background: Prehypertension and hypertension were related with many complications of nearly every organ, but often neglected by young adults in rural area. This research was done to observe the prevalence of prehypertension and hypertension among young adult in a primary health care of rural area at Cicurug, Sukabumi District, West Java.Methods: This cross-sectional study was done in Cicurug Public Health Center, Sukabumi District, West Java. The subjects were consecutively recruited from the outpatient clinic on Monday until Saturday in September 2012,18–25 years old, not pregnant nor having shock. They were interviewed about their age, gender, physical activity, sitting hours, smoking habit, alcohol consumption, and family history and examined by trained health professionals (weight, height, body mass index [BMI], systolic and diastolic blood pressure.Results: From 111 young adults, 34.2% had prehypertension and 17.1% had hypertension. Within sex groups, the prevalence of prehypertension was higher in females, whereas hypertension was occurred more in males. Neither of family history from mother nor father were associated with prehypertension and hypertension compared with normotension. Total activity was not associated with prehypertension (OR = 2.6; p = 0.052 and hypertension (OR = 1.758; p = 0.498. BMI was associated with hypertension (OR = 3.354; p = 0.041 and not associated with prehypertension (OR = 2.343; p = 0.099.Conclusion: Prevalence of prehypertension and hypertension were relatively high among young adult in primary health care of rural area. Intervention to prevent further complications needs to be done early with lifestyle modification because blood pressure is associated with modifiable risk factors, such as BMI and total activity. (Med J Indones. 2013;22:39-45Keywords: Hypertension, prehypertension, rural area, young adult

Validating the accuracy of GIS-based accessibility analysis in determining public primary health care demand in metropolitan areas: conference presentation

CSIR Research Space (South Africa)

Mokgalaka, H

2014-07-01

Full Text Available selected for the analysis are mainly those that offered public primary health care services and acted as first point of contact with the health service delivery system. Attached to the facility data are attribute data indicating the capacity...-Based Accessibility Analysis in Determining Public Primary Health Care Demand in Metropolitan Areas Hunadi Mokgalaka July 2014 Contents • Service access planning • GIS-based accessibility analysis • Key challenges to application • Methodology...

Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol.

Science.gov (United States)

Loignon, Christine; Hudon, Catherine; Boudreault-Fournier, Alexandrine; Dupéré, Sophie; Macaulay, Ann C; Pluye, Pierre; Gaboury, Isabelle; Haggerty, Jeannie L; Fortin, Martin; Goulet, Émilie; Lambert, Mireille; Pelissier-Simard, Luce; Boyer, Sophie; de Laat, Marianne; Lemire, Francine; Champagne, Louise; Lemieux, Martin

2013-03-11

Ensuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the healthcare system in the development of research interventions. The aim of this project is to stimulate changes in healthcare organizations and practices by encouraging collaboration between care teams and people living in poverty. Our objectives are twofold: 1) to identify actions required to promote the adoption of professional practices oriented toward social competence in primary care teams; and 2) to examine factors that would encourage the inclusion of people living in poverty in the process of developing social competence in healthcare organizations. This study will use a participatory action research design applied in healthcare organizations. Participatory research is an increasingly recognized approach that is helpful for involving the people for whom the research results are intended. Our research team consists of 19 non-academic researchers, 11 academic researchers and six partners. A steering committee composed of academic researchers and stakeholders will have a decision-making role at each step, including knowledge dissemination and recommendations for new interventions. In this project we will adopt a multiphase approach and will use a variety of methods, including photovoice, group discussions and interviews. The proposed study will be one of only a few using participatory research in primary care to foster changes aimed at enhancing quality and access to care for people living in poverty. To our knowledge this will be the first study to use photovoice in healthcare organizations to promote new interventions. Our project includes partners who are targeted for practice changes and improvements in delivering primary care to persons living in poverty

The relationship between BMI and dietary intake of primary school children from a rural area of South Africa: The Ellisras longitudinal study

NARCIS (Netherlands)

Van Den Ende, C.; Twisk, J.W.R.; Monyeki, K.D.

2014-01-01

Objectives: To investigate the relationship between dietary intake and BMI of primary school children from a rural area of South Africa cross-sectionally. Both under and over nutrition remain major health problems in South Africa. In rural areas, where especially undernutrition leads to child

Retrofitting the Low Impact Development Practices into Developed Urban areas Including Barriers and Potential Solution

Science.gov (United States)

Shafique, Muhammad; Kim, Reeho

2017-06-01

Low impact development (LID)/green infrastructure (GI) practices have been identified as the sustainable practices of managing the stormwater in urban areas. Due to the increasing population, most of the cities are more developing which results in the change of natural area into impervious areas (roads, buildings etc.). Moreover, urbanization and climate change are causing many water-related problems and making over cities unsafe and insecure. Under these circumstances, there is a need to introduce new stormwater management practices into developed cities to reduce the adverse impacts of urbanization. For this purpose, retrofitting low impact development practices demands more attention to reduce these water-related problems and trying to make our cities sustainable. In developed areas, there is a little space is available for the retrofitting of LID practices for the stormwater management. Therefore, the selection of an appropriate place to retrofitting LID practices needs more concern. This paper describes the successfully applied retrofitting LID practices around the globe. It also includes the process of applying retrofitting LID practices at the suitable place with the suitable combination. Optimal places for the retrofitting of different LID practices are also mentioned. This paper also highlights the barriers and potential solutions of retrofitting LID practices in urban areas.

Retrofitting the Low Impact Development Practices into Developed Urban areas Including Barriers and Potential Solution

Directory of Open Access Journals (Sweden)

Shafique Muhammad

2017-06-01

Full Text Available Low impact development (LID/green infrastructure (GI practices have been identified as the sustainable practices of managing the stormwater in urban areas. Due to the increasing population, most of the cities are more developing which results in the change of natural area into impervious areas (roads, buildings etc.. Moreover, urbanization and climate change are causing many water-related problems and making over cities unsafe and insecure. Under these circumstances, there is a need to introduce new stormwater management practices into developed cities to reduce the adverse impacts of urbanization. For this purpose, retrofitting low impact development practices demands more attention to reduce these water-related problems and trying to make our cities sustainable. In developed areas, there is a little space is available for the retrofitting of LID practices for the stormwater management. Therefore, the selection of an appropriate place to retrofitting LID practices needs more concern. This paper describes the successfully applied retrofitting LID practices around the globe. It also includes the process of applying retrofitting LID practices at the suitable place with the suitable combination. Optimal places for the retrofitting of different LID practices are also mentioned. This paper also highlights the barriers and potential solutions of retrofitting LID practices in urban areas.

Improvement of auditory hallucinations and reduction of primary auditory area's activation following TMS

International Nuclear Information System (INIS)

Giesel, Frederik L.; Mehndiratta, Amit; Hempel, Albrecht; Hempel, Eckhard; Kress, Kai R.; Essig, Marco; Schröder, Johannes

2012-01-01

Background: In the present case study, improvement of auditory hallucinations following transcranial magnetic stimulation (TMS) therapy was investigated with respect to activation changes of the auditory cortices. Methods: Using functional magnetic resonance imaging (fMRI), activation of the auditory cortices was assessed prior to and after a 4-week TMS series of the left superior temporal gyrus in a schizophrenic patient with medication-resistant auditory hallucinations. Results: Hallucinations decreased slightly after the third and profoundly after the fourth week of TMS. Activation in the primary auditory area decreased, whereas activation in the operculum and insula remained stable. Conclusions: Combination of TMS and repetitive fMRI is promising to elucidate the physiological changes induced by TMS.

The impact of family planning on primary school enrolment in sub-national areas within 25 African countries.

Science.gov (United States)

Longwe, Abiba; Smits, Jeroen

2013-06-01

We study how the availability and use of family planning services in African countries influences the family planning situation of households and through this the educational participation of young children. A district panel dataset is used for 441 urban and rural areas within 233 districts of 25 countries. Path analysis shows that a decrease in the number of births is associated with an increase in educational participation in the area. The number of births is negatively associated with acceptance, knowledge and actual use of contraceptives in the area. As reversed causality and selection bias seem unlikely, the identified relationship probably is at least partially causal. Hence, investments in family planning services in poor areas are not only important because they allow women to plan their births better, but also because they may lead to higher primary enrolment rates and thus contribute to the region's future economic growth.

[Accidents with biological material in health care workers in 2 primary health care areas (1990-1999)].

Science.gov (United States)

Hernández Navarrete, M J; Montes Villameriel, F J; Solano Bernad, V M; Sánchez Matienzo, D; del Val García, J L; Gil Montalbán, E; Arribas Llorente, J L

2001-09-15

To find out the exposures with biological material in health care workers in primary health care, registered in the biological accidents database from Preventive Medicine Service in Miguel Servet Universitary Hospital of Zaragoza. Descriptive study of a retrospective cohort. SITE: Primary health care, Areas II and V of Zaragoza.Participants. Workers in this areas, distributed by: physician, nursing staff, auxiliary, orderly, housekeeping staff, others. Data of: workers, accident, serologic source, worker protection and vaccinal status of hepatitis B. The incidence of accidents was 26 (period 1997-1999). Most proportion of accidents were declared by nursing (78%). The highest occupational incidence was in auxiliary (63 ). In 90,1% of the cases, the accident was needlestick injury. The source was known in 67,7% of cases. The accidents occurred in hands in 96,8% of cases, and only one third of workers carried gloves. Results obtained are similar with previous studies about this event. We must insist on the need to declare these accidents, providing more information and accessibility for the declaration to worker. Moreover, we must insist on the correct application in the health care field of the standard precautions, because almost 50% of accidents are evitable, and to increase hepatitis B vaccination covertures.

[Morbidity observed in a health area: Impact on professionals and funding].

Science.gov (United States)

de Miguel, Pablo; Caballero, Isabel; Rivas, Francisco Javier; Manera, Jaime; de Vicente, María Auxiliadora; Gómez, Ángel

2015-05-01

To analyze morbidity, in the context of a health area, and broken down by health centre, of patients who made contact with healthcare services, in order to propose an adjustment to finance the payment per capita. A descriptive study of morbidity observed in citizens assigned a health area during year 2010. SITE: Health Area 9. Autonomous Community of Madrid. Formed by the municipalities of Fuenlabrada, Humanes, and Moraleja de Enmedio. All levels of health care included. All citizens with health card assigned to a health center in the area who has maintained contact with the public health service's own area. Coded contact of patients are grouped using the Population Grouping Clinical Risk 3M TM Software (CRG). Each patient is included in a homogeneous and exclusive group with a numerical morbidity and clinical sense. Through the health card is known primary care centre, physician, age and sex. The distribution of morbidity is obtained by primary care centre, primary care physician, age and sex analyzing differences and combinations. It was found that the average values of the population morbidity are different in each primary care centre. In order to maintain the principle of equity in health care, it is suggested that an adjustment is made to the per capita payment based on the morbidity rate of the population. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

75 FR 4138 - Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas...

Science.gov (United States)

2010-01-26

... DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas, Minnesota, Missouri, Nebraska, Oklahoma, and Texas) AGENCY... the Federal Advisory Committee Act, 5 U.S.C. App. (1988) that a meeting of the Area 5 Taxpayer...

75 FR 39330 - Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas...

Science.gov (United States)

2010-07-08

... DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas, Minnesota, Missouri, Nebraska, Oklahoma, and Texas) AGENCY... Federal Advisory Committee Act, 5 U.S.C. App. (1988) that a meeting of the Area 5 Taxpayer Advocacy Panel...

75 FR 62629 - Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas...

Science.gov (United States)

2010-10-12

... DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas, Minnesota, Missouri, Nebraska, Oklahoma, and Texas) AGENCY... the Federal Advisory Committee Act, 5 U.S.C. App. (1988) that a meeting of the Area 5 Taxpayer...

75 FR 10864 - Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas...

Science.gov (United States)

2010-03-09

... DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas, Minnesota, Missouri, Nebraska, Oklahoma, and Texas) AGENCY... Federal Advisory Committee Act, 5 U.S.C. App. (1988) that a meeting of the Area 5 Taxpayer Advocacy Panel...

75 FR 47061 - Open Meeting of the Area 5 Taxpayer Advocacy Panel (including the states of Iowa, Kansas...

Science.gov (United States)

2010-08-04

... DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 5 Taxpayer Advocacy Panel (including the states of Iowa, Kansas, Minnesota, Missouri, Nebraska, Oklahoma, and Texas) AGENCY... the Federal Advisory Committee Act, 5 U.S.C. App. (1988) that a meeting of the Area 5 Taxpayer...

75 FR 55404 - Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas...

Science.gov (United States)

2010-09-10

... DEPARTMENT OF THE TREASURY Internal Revenue Service Open Meeting of the Area 5 Taxpayer Advocacy Panel (Including the States of Iowa, Kansas, Minnesota, Missouri, Nebraska, Oklahoma, and Texas) AGENCY... the Federal Advisory Committee Act, 5 U.S.C. App. (1988) that a meeting of the Area 5 Taxpayer...

A Small Disc Area Is a Risk Factor for Visual Field Loss Progression in Primary Open-Angle Glaucoma: The Glaucoma Stereo Analysis Study.

Science.gov (United States)

Kitaoka, Yasushi; Tanito, Masaki; Yokoyama, Yu; Nitta, Koji; Katai, Maki; Omodaka, Kazuko; Nakazawa, Toru

2018-01-01

The Glaucoma Stereo Analysis Study, a cross-sectional multicenter collaborative study, used a stereo fundus camera (nonmyd WX) to assess various morphological parameters of the optic nerve head (ONH) in glaucoma patients. We compared the associations of each parameter between the visual field loss progression group and no-progression group. The study included 187 eyes of 187 patients with primary open-angle glaucoma or normal-tension glaucoma. We divided the mean deviation (MD) slope values of all patients into the progression group (field progression and patient characteristics or each ONH parameter were analyzed with Spearman's rank correlation coefficient. The MD slope averages in the progression group and no-progression group were -0.58 ± 0.28 dB/year and 0.05 ± 0.26 dB/year, respectively. Among disc parameters, vertical disc width (diameter), disc area, cup area, and cup volume in the progression group were significantly less than those in the no-progression group. Logistic regression analysis revealed a significant association between the visual field progression and disc area (odds ratio 0.49/mm 2 disc area). A smaller disc area may be associated with more rapid glaucomatous visual field progression.

Developing Guidelines to Enhance Students Desirable Characteristics for Schools under the Office of Udornthani Primary Education Service Area 1

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Aroonsiri Janlon

2017-09-01

Full Text Available The purposes of this research were 1 to study the elements and indicators students desirable characteristics for schools ; 2 to study the present condition and the desirable of students desirable characteristics for schools ; and 3 to develop guidelines to enhance students desirable characteristics for schools under the office of Udornthani primary education service area 1. Research and development. Method was divided into three phases for the purposes of research. The samples were 296 teachers and school administrators, using stratified random sampling. Instruments used were questionnaire, assessment elements and indicators, interview form and assessment guidelines. Data were analyzed using mean, standard devitation and modified priority needs index. Research findings were as follows: 1. There were 3 elements of students desirable characteristics for schools consisted of discipline, learning and commitment to work. Discipline consisted of four indicators, learning consisted of indicators and commitment to work consisted of two indicators. 2. The current situation of students desirable characteristics for schools under the office of Udornthani primary education service area 1, overall at a high level, considering each element, discipline was the highest, followed by learning and the lowest was commitment to work as well. In desirable situation the same relults on the current situation. 3. Guidelines to enhance students desirable characteristics for schools under the office of Udornthani primary education service area 1 consisted of 7 guidelines: 1 the policy clearly ; 2 providing specialized committees ; 3 creating a common understanding ; 4 targeting clearly ; 5 the environmental moral ; 6 supervision, monitoring and evaluation ; and 7 creating a network of parents and the community.

Investigation the opinions of the primary science teachers toward practice of teaching and learning activities in science learning area

Science.gov (United States)

Chamnanwong, Pornpaka; Thathong, Kongsak

2018-01-01

In preparing a science lesson plan, teachers may deal with numerous difficulties. Having a deep understanding of their problems and their demands is extremely essential for the teachers in preparing themselves for the job. Moreover, it is also crucial for the stakeholders in planning suitable and in-need teachers' professional development programs, in school management, and in teaching aid. This study aimed to investigate the primary school science teachers' opinion toward practice of teaching and learning activities in science learning area. Target group was 292 primary science teachers who teach Grade 4 - 6 students in Khon Kaen Province, Thailand in the academic year of 2014. Data were collected using Questionnaire about Investigation the opinions of the primary science teachers toward practice of teaching and learning activities in science learning area. The questionnaires were consisted of closed questions scored on Likert scale and open-ended questions that invite a sentence response to cover from LS Process Ideas. Research findings were as follow. The primary science teachers' level of opinion toward teaching and learning science subject ranged from 3.19 - 3.93 (mean = 3.43) as "Moderate" level of practice. The primary school science teachers' needs to participate in a training workshop based on LS ranged from 3.66 - 4.22 (mean = 3.90) as "High" level. The result indicated that they were interested in attending a training course under the guidance of the Lesson Study by training on planning of management of science learning to solve teaching problems in science contents with the highest mean score 4.22. Open-ended questions questionnaire showed the needs of the implementation of the lesson plans to be actual classrooms, and supporting for learning Medias, innovations, and equipment for science experimentation.

Evolution of a Family Nurse Practitioner Program to Improve Primary Care Distribution

Science.gov (United States)

Andrus, Len Hughes; Fenley, Mary D.

1976-01-01

Describes a Family Nurse Practitioner Program that has effectively improved the distribution of primary health care manpower in rural areas. Program characteristics include selection of personnel from areas of need, decentralization of clinical and didactic training sites, competency-based portable curriculum, and circuit-riding institutionally…

Measurements and simulation of forest leaf area index and net primary productivity in Northern China.

Science.gov (United States)

Wang, P; Sun, R; Hu, J; Zhu, Q; Zhou, Y; Li, L; Chen, J M

2007-11-01

Large scale process-based modeling is a useful approach to estimate distributions of global net primary productivity (NPP). In this paper, in order to validate an existing NPP model with observed data at site level, field experiments were conducted at three sites in northern China. One site is located in Qilian Mountain in Gansu Province, and the other two sites are in Changbaishan Natural Reserve and Dunhua County in Jilin Province. Detailed field experiments are discussed and field data are used to validate the simulated NPP. Remotely sensed images including Landsat Enhanced Thematic Mapper plus (ETM+, 30 m spatial resolution in visible and near infrared bands) and Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER, 15m spatial resolution in visible and near infrared bands) are used to derive maps of land cover, leaf area index, and biomass. Based on these maps, field measured data, soil texture and daily meteorological data, NPP of these sites are simulated for year 2001 with the boreal ecosystem productivity simulator (BEPS). The NPP in these sites ranges from 80 to 800 gCm(-2)a(-1). The observed NPP agrees well with the modeled NPP. This study suggests that BEPS can be used to estimate NPP in northern China if remotely sensed images of high spatial resolution are available.

Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients

Science.gov (United States)

Shinoura, Nobusada; Midorikawa, Akira; Yamada, Ryoji; Hana, Taijun; Saito, Akira; Hiromitsu, Kentaro; Itoi, Chisato; Saito, Syoko; Yagi, Kazuo

2013-01-01

Background: We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions. Methods: We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection. Results: Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor. Conclusions: Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor. PMID:24381792

[Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

Science.gov (United States)

Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

2017-10-01

The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

Cinema Sessions in Primary Care

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Francisco Ignacio MORETA-VELAYOS

2016-04-01

Full Text Available For a long time films have been used in teaching and at various levels of professional training  and more specifically in the medical area. In this case, through the description of a project developed in a Primary Care Health Center, we intend to justify the use of movies as a tool that could ease, the sometimes difficult task of continued education among Primary Care professionals. We propose different aspects of everyday practice in which cinema can be potentially useful, as well as the way to include it in the Plan of Continued Education of the Centre and its accreditation.Films and issues discussed in each session, and the project evaluation, are detailed.

Factors affecting the local control of stereotactic body radiotherapy for lung tumors including primary lung cancer and metastatic lung tumors

International Nuclear Information System (INIS)

Hamamoto, Yasushi; Kataoka, Masaaki; Yamashita, Motohiro

2012-01-01

The purpose of this study was to identify factors affecting local control of stereotactic body radiotherapy (SBRT) for lung tumors including primary lung cancer and metastatic lung tumors. Between June 2006 and June 2009, 159 lung tumors in 144 patients (primary lung cancer, 128; metastatic lung tumor, 31) were treated with SBRT with 48-60 Gy (mean 50.1 Gy) in 4-5 fractions. Higher doses were given to larger tumors and metastatic tumors in principle. Assessed factors were age, gender, tumor origin (primary vs. metastatic), histological subtype, tumor size, tumor appearance (solid vs. ground glass opacity), maximum standardized uptake value of positron emission tomography using 18 F-fluoro-2-deoxy-D-glucose, and SBRT doses. Follow-up time was 1-60 months (median 18 months). The 1-, 2-, and 3-year local failure-free rates of all lesions were 90, 80, and 77%, respectively. On univariate analysis, metastatic tumors (p<0.0001), solid tumors (p=0.0246), and higher SBRT doses (p=0.0334) were the statistically significant unfavorable factors for local control. On multivariate analysis, only tumor origin was statistically significant (p=0.0027). The 2-year local failure-free rates of primary lung cancer and metastatic lung tumors were 87 and 50%, respectively. A metastatic tumor was the only independently significant unfavorable factor for local control after SBRT. (author)

Phytotherapy in primary health care

Science.gov (United States)

Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

2014-01-01

OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

Leaders, leadership and future primary care clinical research

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Qureshi Nadeem

2008-09-01

Full Text Available Abstract Background A strong and self confident primary care workforce can deliver the highest quality care and outcomes equitably and cost effectively. To meet the increasing demands being made of it, primary care needs its own thriving research culture and knowledge base. Methods Review of recent developments supporting primary care clinical research. Results Primary care research has benefited from a small group of passionate leaders and significant investment in recent decades in some countries. Emerging from this has been innovation in research design and focus, although less is known of the effect on research output. Conclusion Primary care research is now well placed to lead a broad re-vitalisation of academic medicine, answering questions of relevance to practitioners, patients, communities and Government. Key areas for future primary care research leaders to focus on include exposing undergraduates early to primary care research, integrating this early exposure with doctoral and postdoctoral research career support, further expanding cross disciplinary approaches, and developing useful measures of output for future primary care research investment.

Primary Pulmonary Plasmacytoma with Diffuse Alveolar Consolidation: A Case Report

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Zohreh Mohammad Taheri

2010-01-01

Full Text Available Solitary extramedullary plasmacytomas are plasma cell tumors that tend to develop in mucosa-associated lymphoid tissues including the sinonasal or nasopharyngeal regions. Primary plasmacytoma of the lung is exceedingly rare and often presents as a solitary mass or nodule in mid-lung or hilar areas and diagnosed after resection. Herein, we report a case of primary pulmonary plasmacytoma that presented with diffuse alveolar consolidation and diagnosed by transbronchial lung biopsy.

Energy secretary's priorities include San Francisco area research projects

CERN Multimedia

Widener, A

2003-01-01

"Bay Area research labs got a big boost Monday when the Secretary of Energy unveiled his priorities for major research projects his agency hopes to fund over the next two decades. Among the agency's 28 top priorities are a major computer expansion and an experiment examining the expanding universe that could be housed at Lawrence Berkeley Lab and a powerful X-ray laser planned for the Stanford Linear Accelerator Center" (1 page).

Problems and Guidelines of Strategy Implementation in Basic Educational Institutions under the Supervision of KhonKaen Primary Educational Service Area Office 4

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Sasiwan Tonkanya

2016-09-01

Full Text Available The research aimed to 1 study problems of strategy implementation in basic educational institutions under Khonkaen Primary Educational Service Area Office 4 ; and 2 propose the guidelines for strategy implementation in basic educational institutions under Khonkaen Primary Educational Service Area Office 4. The study was carried out in 2 phases. In phase 1, it focused on the study and analysis of the strategic implementation problems and phase 2 studied the best practice schools. The informants for the interview in phase 1 comprised 6 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized schools. They were selected by the use of purposive sampling technique. The population in the study of the strategic implementation problems in basic educational institutions in phase 1 consisted of 543 school administrators and teachers who were involved in strategy implementation from 181 schools under Khonkaen Primary Educational Service Area Office 4 in academic year 2014. The study samples were 217 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized schools under Khonkaen Primary Educational Service Area Office 4. The samples were selected by the use of stratified sampling technique. The informants of the phase 2 study were 6 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized best practice schools obtained from purposive sampling technique. The research instruments used for data collection consisted of 2 sets of questionnaires. The Set 1 questionnaire was the 5-point Likert scale on the levels of the problems in implementation with item discrimination at 0.60 – 1.00 and reliability of the whole questionnaire at .9359. The questionnaire contained 3 parts with 65 items. The Set 2 questionnaire comprised 2 parts with 10 items regarding

Integrated model of primary and secondary eye care for underserved rural areas: The L V Prasad Eye Institute experience

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Gullapalli N Rao

2012-01-01

Full Text Available Blindness is a major global public health problem and recent estimates from World Health Organization (WHO showed that in India there were 62 million visually impaired, of whom 8 million are blind. The Andhra Pradesh Eye Disease Study (APEDS provided a comprehensive estimate for prevalence and causes of blindness for the state of Andhra Pradesh (AP. It also highlighted that uptake of services was also an issue, predominantly among lower socio-economic groups, women, and rural populations. On the basis of this analysis, L V Prasad Eye Institute (LVPEI developed a pyramidal model of eye care delivery. This article describes the LVPEI eye care delivery model. The article discusses infrastructure development, human resource development, and service delivery (including prevention and promotion in the context of primary and secondary care service delivery in rural areas. The article also alludes to opportunities for research at these levels of service delivery and the amenability of the evidence generated at these levels of the LVPEI eye health pyramid for advocacy and policy planning. In addition, management issues related to the sustainability of service delivery in rural areas are discussed. The article highlights the key factors required for the success of the LVPEI rural service delivery model and discusses challenges that need to be overcome to replicate the model. The article concludes by noting the potential to convert these challenges into opportunities by integrating certain aspects of the existing healthcare system into the model. Examples include screening of diabetes and diabetic retinopathy in order to promote higher community participation. The results of such integration can serve as evidence for advocacy and policy.

Tomographic findings of lobar consolidation in primary pulmonary tuberculosis

International Nuclear Information System (INIS)

Pereira, Bruno Alberto Falcao; Macedo, Solange Goncalves David de; Penna, Claudia Renata Rezende

2009-01-01

Objective: To describe tomographic findings of lobar consolidation as early manifestation of primary pulmonary tuberculosis. Materials and methods: The present study was developed at Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil, in the period between 2002 and 2006, retrospectively evaluating tomographic findings in four children aged from 3 to 14 months with lobar consolidation as an early manifestation of primary pulmonary tuberculosis. Results: The most frequently found radiological pattern was lobar consolidation with calcifications, cavitation and intermingle necrotic areas, associated with bulging fissure. Signs of bronchogenic dissemination and lymph node enlargement were observed in all of the four children. Consolidation with a pseudotumor aspect and masslike effect was observed in one case. Conclusion: The cases included in the present study have demonstrated that primary pulmonary tuberculosis manifested as lobar consolidation presents typical tomographic images such as cavitation, hypodense areas and calcifications intermingled with consolidation. The association with lymph node enlargement with central necrosis and signs of bronchogenic dissemination reinforce the diagnosis of tuberculosis. (author)

A Small Disc Area Is a Risk Factor for Visual Field Loss Progression in Primary Open-Angle Glaucoma: The Glaucoma Stereo Analysis Study

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Yasushi Kitaoka

2018-01-01

Full Text Available Purpose. The Glaucoma Stereo Analysis Study, a cross-sectional multicenter collaborative study, used a stereo fundus camera (nonmyd WX to assess various morphological parameters of the optic nerve head (ONH in glaucoma patients. We compared the associations of each parameter between the visual field loss progression group and no-progression group. Methods. The study included 187 eyes of 187 patients with primary open-angle glaucoma or normal-tension glaucoma. We divided the mean deviation (MD slope values of all patients into the progression group (<−0.3 dB/year and no-progression group (≧−0.3 dB/year. ONH morphological parameters were calculated with prototype analysis software. The correlations between glaucomatous visual field progression and patient characteristics or each ONH parameter were analyzed with Spearman’s rank correlation coefficient. Results. The MD slope averages in the progression group and no-progression group were −0.58 ± 0.28 dB/year and 0.05 ± 0.26 dB/year, respectively. Among disc parameters, vertical disc width (diameter, disc area, cup area, and cup volume in the progression group were significantly less than those in the no-progression group. Logistic regression analysis revealed a significant association between the visual field progression and disc area (odds ratio 0.49/mm2 disc area. Conclusion. A smaller disc area may be associated with more rapid glaucomatous visual field progression.

Muscle layer histopathology and manometry pattern of primary esophageal motility disorders including achalasia.

Science.gov (United States)

Nakajima, N; Sato, H; Takahashi, K; Hasegawa, G; Mizuno, K; Hashimoto, S; Sato, Y; Terai, S

2017-03-01

Histopathology of muscularis externa in primary esophageal motility disorders has been characterized previously. We aimed to correlate the results of high-resolution manometry with those of histopathology. During peroral endoscopic myotomy, peroral esophageal muscle biopsy was performed in patients with primary esophageal motility disorders. Immunohistochemical staining for c-kit was performed to assess the interstitial cells of Cajal (ICCs). Hematoxylin Eosin and Azan-Mallory staining were used to detect muscle atrophy, inflammation, and fibrosis, respectively. Slides from 30 patients with the following motility disorders were analyzed: achalasia (type I: 14, type II: 5, type III: 3), one diffuse esophageal spasm (DES), two outflow obstruction (OO), four jackhammer esophagus (JE), and one nutcracker esophagus (NE). ICCs were preserved in high numbers in type III achalasia (n=9.4±1.2 cells/high power field [HPF]), compared to types I (n=3.7±0.3 cells/HPF) and II (n=3.5±1.0 cells/HPF). Moreover, severe fibrosis was only observed in type I achalasia and not in other types of achalasia, OO, or DES. Four of five patients with JE and NE had severe inflammation with eosinophilic infiltration of the esophageal muscle layer (73.8±50.3 eosinophils/HPF) with no epithelial eosinophils. One patient with JE showed a visceral myopathy pattern. Compared to types I and II, type III achalasia showed preserved ICCs, with variable data regarding DES and OO. In disorders considered as primary esophageal motility disorders, a disease category exists, which shows eosinophilic infiltration in the esophageal muscle layer with no eosinophils in the epithelium. © 2016 John Wiley & Sons Ltd.

Validation on groundwater flow model including sea level change. Modeling on groundwater flow in coastal granite area

International Nuclear Information System (INIS)

Hasegawa, Takuma; Miyakawa, Kimio

2009-01-01

It is important to verify the groundwater flow model that reproduces pressure head, water chemistry, and groundwater age. However, water chemistry and groundwater age are considered to be influenced by historical events. In this study, sea level change during glacial-interglacial cycle was taken into account for simulating salinity and groundwater age at coastal granite area. As a result of simulation, salinity movement could not catch up with sea level changes, and mixing zone was formed below the fresh-water zone. This mixing zone was observed in the field measurement, and the observed salinities were agreed with simulated results including sea level change. The simulated residence time including sea level change is one-tenth of steady state. The reason is that the saline water was washed out during regression and modern sea-water was infiltrated during transgression. As mentioned before, considering sea level change are important to reproduce salinity and helium age at coastal area. (author)

[Waste water management in a health area: environmental hygiene in primary care].

Science.gov (United States)

García Cuadrado, J; Contessotto Spadetto, C; Pereñiguez Barranco, J E; Fuster Quiñonero, D; Paricio Núñez, P

1992-01-01

Within the scope of the programmes to be developed by the primary health care parties, we consider it interesting to investigate the sewage management in our health area because of its impact on the population health and welfare and the main socioeconomic local activities: agriculture and tourism. We carry out an epidemiological descriptive study: we review the most important structural and functional characteristics of the sewage depuration and collection in the municipality of S. Javier (Murcia). The evaluation of the collected data made it obvious that deficiencies exist in the collection system as well as in the sewage processing; both deficiencies were shown in some places of the locality and in particular periods of the year, with a consequent risk of environmental contamination and enteric diseases transmission among population and summer holidaymakers. A positive corrective action on the installations by the organisms responsible for the local sanitation as a response to these conclusions, which we informed due time, constitutes a good stimulant to go on investigating this question of such a great sanitary and general interest, which is almost unknown in medical literature.

Primary studies of trace quantities of green vegetation in Mono Lake area using 1990 AVIRIS data

Science.gov (United States)

Chen, Zhi-Kang; Elvidge, Chris D.; Groeneveld, David P.

1992-01-01

Our primary results in Jasper Ridge Biological Preserve indicate that high spectral resolution Airborne Visible/Infrared Imaging Spectrometer (AVIRIS) data may provide a substantial advantage in vegetation, based on the chlorophyll red edge feature from 700-780 nm. The chlorophyll red edge was detected for green vegetation cover as low as 4.8 percent. The objective of our studies in Mono Lake area is to continue the experiments performed in Jasper Ridge and to examine the persistence of red edge feature of trace quantities of green vegetation for different plant communities with non-uniform soil backgrounds.

Nematocarcinus Milne Edwards, 1881 (Crustacea, Decapoda) from Southwestern Atlantic, including the Southern Mid-Atlantic Ridge area.

Science.gov (United States)

Cardoso, Irene A; Burukovsky, Rudolf N

2014-11-26

The deep sea shrimp genus Nematocarcinus Milne Edwards, 1881 includes 47 species, ten of them have been recorded from the Atlantic Ocean. Herein, material sampled during three scientific projects (REVIZEE Central Fishery project; Campos Basin Deep Sea Environmental Project; Evaluation of Environmental Heterogeneity in the Campos Basin) made in the Southwestern Atlantic, off Brazil, is examined. In addition, material sampled from the South Mid Atlantic Ridge (MAR-ECO Project) was also examined. Four species are recorded for the first time to the southwestern Atlantic Ocean including Mid Atlantic Ridge area: Nematocarcinus faxoni Burukovsky, 2001; N. gracilipes Filhol, 1884; N. rotundus Crosnier & Forest, 1973 and N. tenuipes Spence-Bate, 1888.

Use of the Cumbrian coastal area

International Nuclear Information System (INIS)

1991-12-01

The primary objective of the research was to establish the recreational usage made of the Cumbrian coastal area. Observations of the numbers of adults and children in each area included in the study were undertaken, as well as an interview survey among adults which identified patterns of use by different groups. The interview survey comprised 7070 interviews, 80% of which were with residents of, rather than visitors to, Cumbria. Additional investigations and analyses were conducted to: determine hours of occupancy at coastal areas; observe usage made of particular areas outside the locations and times of the main survey; assess the usage made of coastal areas and inland waterways by members of the public likely to be excluded from the main study (eg. bird watchers, water-sport participants). (author)

Primary teachers' subject matter knowledge: decimals

Science.gov (United States)

Ubuz, Behiye; Yayan, Betül

2010-09-01

The main objective of this study was to investigate primary teachers' subject matter knowledge in the domain of decimals and more elaborately to investigate their performance and difficulties in reading scale, ordering numbers, finding the nearest decimal and doing operations, such as addition and subtraction. The difficulties in these particular areas are analysed and suggestions are made regarding their causes. Further, factors that influence this knowledge were explored. The sample of the study was 63 primary teachers. A decimal concepts test including 18 tasks was administered and the total scores for the 63 primary teachers ranged from 3 to 18 with a mean and median of 12. Fifty per cent of the teachers were above the mean score. The detailed investigation of the responses revealed that the primary teachers faced similar difficulties that students and pre-service teachers faced. Discrepancy on teachers' knowledge revealed important differences based on educational level attained, but not the number of years of teaching experience and experience in teaching decimals. Some suggestions have been made regarding the implications for pre- and in-service teacher training.

Audit of antenatal services in primary healthcare centres in Jos ...

African Journals Online (AJOL)

Introduction: Maternal mortality remains a big challenge in developing countries including Nigeria where the figures are amongst the highest in the world. The Nigerian government's response in providing primary healthcare centres (PHCs) in all local government areas is commendable but access to quality antenatal care is ...

Preliminary assessment of the computer-based Taenia solium educational program 'The Vicious Worm' on knowledge uptake in primary school students in rural areas in eastern Zambia.

Science.gov (United States)

Hobbs, Emma C; Mwape, Kabemba Evans; Van Damme, Inge; Berkvens, Dirk; Zulu, Gideon; Mambwe, Moses; Chembensofu, Mwelwa; Phiri, Isaac Khozozo; Masuku, Maxwell; Bottieau, Emmanuel; Devleesschauwer, Brecht; Speybroeck, Niko; Colston, Angela; Dorny, Pierre; Willingham, Arve Lee; Gabriël, Sarah

2018-03-01

The zoonotic helminth Taenia solium is endemic in Zambia, causing human (taeniasis and (neuro)cysticercosis) and pig (porcine cysticercosis) diseases with high health, social and economic burdens. We aimed to evaluate the impact of a health educational program intended to lead to powerful and cumulative improvements in knowledge, attitudes and practices that decrease parasite transmission and disease occurrence. Half-day health education workshops were conducted in three primary schools in the highly endemic Eastern Province of Zambia, using the computer-based T. solium educational program 'The Vicious Worm'. Questionnaires were administered before and after the educational component to determine the program's impact on knowledge uptake in primary school students. In total, 99 students participated: 38 males and 61 females, with a median age of 14 years (range 10-18 years). Baseline general knowledge of T. solium, including awareness of the different human and pig disease states, and disease diagnosis, treatment and prevention, was quite high (average score 62%) and consistent across all three study areas. Participants' knowledge had significantly increased after the educational component, particularly regarding parasite transmission and disease prevention. Preliminary assessment of 'The Vicious Worm' indicates it is an effective tool for the short-term T. solium education of primary school students in Zambia. Follow-up studies are planned to assess the longer term impact of the program on knowledge uptake in the study neighbourhoods. Inclusion of tailored 'The Vicious Worm' educational workshops should be considered in integrated cysticercosis control programs in endemic areas of sub-Saharan Africa. © 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Assessment of Offshore Wind Energy Leasing Areas for the BOEM Massachusetts Wind Energy Area

Energy Technology Data Exchange (ETDEWEB)

Musial, W. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Parker, Z. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Fields, M. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Scott, G. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Elliott, D. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Draxl, C. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2013-12-01

The U.S. Department of Energy's (DOE) National Renewable Energy Laboratory (NREL), under an interagency agreement with the Bureau of Ocean Energy Management (BOEM), is providing technical assistance to identify and delineate leasing areas for offshore wind energy development within the Atlantic Coast Wind Energy Areas (WEAs) established by BOEM. This report focuses on NREL's development of three delineated leasing area options for the Massachusetts (MA) WEA and the technical evaluation of these leasing areas. The overarching objective of this study is to develop a logical process by which the MA WEA can be subdivided into non-overlapping leasing areas for BOEM's use in developing an auction process in a renewable energy lease sale. NREL worked with BOEM to identify an appropriate number of leasing areas and proposed three delineation alternatives within the MA WEA based on the boundaries announced in May 2012. A primary output of the interagency agreement is this report, which documents the methodology, including key variables and assumptions, by which the leasing areas were identified and delineated.

Bringing transcranial mapping into shape: Sulcus-aligned mapping captures motor somatotopy in human primary motor hand area

DEFF Research Database (Denmark)

Raffin, Estelle; Pellegrino, Giovanni; Di Lazzaro, Vincenzo

2015-01-01

Motor representations express some degree of somatotopy in human primary motor hand area (M1HAND), but within-M1HAND corticomotor somatotopy has been difficult to study with transcranial magnetic stimulation (TMS). Here we introduce a “linear” TMS mapping approach based on the individual shape...... of the central sulcus to obtain mediolateral corticomotor excitability profiles of the abductor digiti minimi (ADM) and first dorsal interosseus (FDI) muscles. In thirteen young volunteers, we used stereotactic neuronavigation to stimulate the right M1HAND with a small eight-shaped coil at 120% of FDI resting...

Supplementary motor area and primary auditory cortex activation in an expert break-dancer during the kinesthetic motor imagery of dance to music.

Science.gov (United States)

Olshansky, Michael P; Bar, Rachel J; Fogarty, Mary; DeSouza, Joseph F X

2015-01-01

The current study used functional magnetic resonance imaging to examine the neural activity of an expert dancer with 35 years of break-dancing experience during the kinesthetic motor imagery (KMI) of dance accompanied by highly familiar and unfamiliar music. The goal of this study was to examine the effect of musical familiarity on neural activity underlying KMI within a highly experienced dancer. In order to investigate this in both primary sensory and motor planning cortical areas, we examined the effects of music familiarity on the primary auditory cortex [Heschl's gyrus (HG)] and the supplementary motor area (SMA). Our findings reveal reduced HG activity and greater SMA activity during imagined dance to familiar music compared to unfamiliar music. We propose that one's internal representations of dance moves are influenced by auditory stimuli and may be specific to a dance style and the music accompanying it.

PREVALENCE AND RISK FACTORS OF OBESITY IN PRIMARY SCHOOL IN URBAN AND RURAL AREAS

Directory of Open Access Journals (Sweden)

Made Ratna Dewi

2013-10-01

Full Text Available Normal 0 false false false IN X-NONE X-NONE Obesity has become a continous increasing global health problem. Obesity can happen in adult population and also on children as well as teenagers. There are several factors that influence the occurrence of obesity. The aim of this study is to determine the prevalence and risk factors for obesity in primary school children in urban and rural areas. A cross sectional study was conducted with a total sample of 241 pupils in several elementary schools. Anthropometric status determine using body mass index for age and obesity stated if measurement exceed ?95th percentile based on CDC 2000. Analysis data perform with the Pearson Chi-square, Fisher's Exact Test, and logistic regression. A P value of <0.05 was considered significant. This study showed the prevalence of obesity was 15%. The prevalence of obesity in urban areas was 21% and rural areas was 5%. The result showed risk of obesity multiplied by 3.8 times in urban children as they had a habit of "snacking" had risk of suffering obesity by 3.4 times (95% CI 1.2 to 9.0. Children who had habit of having fast food more than 2 times per week had the more risk of obesity by 5 times (95% CI 1.9 to 13.5. Mothers education in urban areas as a protective factor. Conclusion of this study show that the prevalence of obesity in urban areas is 21% and 5% in rural areas. “Snacking” habit and eating fast food more than 2 times per week increase the risk of obesity in urban areas, while in rural areas no risk factors consider significant for obesity. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso

Primary Progressive Aphasia

Science.gov (United States)

... which cause different symptoms. Semantic variant primary progressive aphasia Symptoms include these difficulties: Comprehending spoken or written ... word meanings Naming objects Logopenic variant primary progressive aphasia Symptoms include: Having difficulty retrieving words Frequently pausing ...

Prevalence of dental fluorosis among primary school children in rural areas of Chidambaram taluk, Cuddalore district, Tamil Nadu, India

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Saravanan S

2008-01-01

Full Text Available Background: Fluorosis is one of the common but major emerging areas of research in the tropics. It is considered endemic in 17 states of India. However, the Cuddalore district of Tamil Nadu is categorised as a fluorosis non-endemic area. But clinical cases of dental fluorosis were reported in the field practice area of Department of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram. Since dental fluorosis has been described as a biomarker of exposure to fluoride, we assessed the prevalence and severity of dental fluorosis among primary school children in the service area. Materials and Methods: Children studying in six primary schools of six villages in the field practice area of Rural Health Centre of Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Every child was clinically examined at the school by calibrated examiners with Dean′s fluorosis index recommended by WHO (1997. Chi-square test, Chi-square trend test and Spearman′s rank correlation coefficient test were used for statistical analysis. Results: Five hundred and twenty-five 5- to 12-year-old school children (255 boys and 270 girls were surveyed. The overall dental fluorosis prevalence was found to be 31.4% in our study sample. Dental fluorosis increased with age P < 0.001, whereas gender difference was not statistically significant. Aesthetically objectionable dental fluorosis was found in 2.1% of the sample. Villages Senjicherry, Keezhaperambai and Kanagarapattu revealed a community fluorosis index (CFI score of 0.43, 0.54 and 0.54 with 5.6%, 4.8% and 1.4% of objectionable dental fluorosis, respectively. Correlation between water fluoride content and CFI values in four villages was noted to be positively significant. Conclusion: Three out of six villages studied were in ′borderline′ public health significance (CFI score 0.4-0.6. A well-designed epidemiological investigation can be undertaken to evaluate the risk factors

LGBTQ Youth's Perceptions of Primary Care.

Science.gov (United States)

Snyder, Barbara K; Burack, Gail D; Petrova, Anna

2017-05-01

Despite published guidelines on the need to provide comprehensive care to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth, there has been limited research related to the deliverance of primary health care to this population. The goals of this study were to learn about LGBTQ youth's experiences with their primary care physicians and to identify areas for improvement. Youth attending 1 of 5 community-based programs completed a written questionnaire and participated in a focus group discussion regarding experiences at primary care visits, including topics discussed, counselling received, and physician communication. Most of the youth did not feel their health care needs were well met. The majority acknowledged poor patient-provider communication, disrespect, and lack of discussions about important topics such as sexual and emotional health. Participants cited concerns about confidentiality and inappropriate comments as barriers to care. Youth expressed a strong desire to have physicians be more aware of their needs and concerns.

How sequestration cuts affect primary care physicians and graduate medical education.

Science.gov (United States)

Chauhan, Bindiya; Coffin, Janis

2013-01-01

On April 1, 2013, sequestration cuts went into effect impacting Medicare physician payments, graduate medical education, and many other healthcare agencies. The cuts range from 2% to 5%, affecting various departments and organizations. There is already a shortage of primary care physicians in general, not including rural or underserved areas, with limited grants for advanced training. The sequestration cuts negatively impact the future of many primary care physicians and hinder the care many Americans will receive over time.

Water quality studied in areas of unconventional oil and gas development, including areas where hydraulic fracturing techniques are used, in the United States

Science.gov (United States)

Susong, David D.; Gallegos, Tanya J.; Oelsner, Gretchen P.

2012-01-01

Domestic oil and gas production and clean water are critical for economic growth, public health, and national security of the United States. As domestic oil and gas production increases in new areas and old fields are enhanced, there is increasing public concern about the effects of energy production on surface-water and groundwater quality. To a great extent, this concern arises from the improved hydraulic fracturing techniques being used today, including horizontal drilling, for producing unconventional oil and gas in low-permeability formations.

Determinants of undernutrition among primary school children residing in slum areas of a Nigerian city.

Science.gov (United States)

Ndukwu, C I; Egbuonu, I; Ulasi, T O; Ebenebe, J C

2013-01-01

Undernutrition remains the largest contributor to the global disease burden. Different factors affecting the nutritional status of children need to be studied to determine those to be targeted in a country like Nigeria, characterized by widespread poverty and inequitable distribution of wealth. This study was aimed at ascertaining the relationship between prevailing socioeconomic and environmental factors, and the nutritional status of children residing in a typical urban slum. A cross-sectional descriptive study of 788 children aged 6-12 years selected by stratified, multistage random sampling method from public primary schools in slum and non-slum areas of Onitsha was carried out. Their nutritional status was determined using anthropometric measures. The socioeconomic and environmental variables of interest were analyzed to determine their relationship with undernutrition in the children. Socioeconomic status was the major determinant of nutritional status in this study. Poor housing also affected the nutritional status of the slum children who were significantly from poorer families than those residing in non-slum areas (χ2 = 66.69, P = 0.000). This study highlights the need for an effective nutrition program targeted at school children in urban slums surrounded by factors predisposing them to undernutrition.

Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas.

Science.gov (United States)

Sheringham, Jessica; Asaria, Miqdad; Barratt, Helen; Raine, Rosalind; Cookson, Richard

2017-04-01

Objectives Reducing health inequalities is an explicit goal of England's health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age-sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in

Assessment of Offshore Wind Energy Leasing Areas for the BOEM New Jersey Wind Energy Area

Energy Technology Data Exchange (ETDEWEB)

Musial, W.; Elliott, D.; Fields, J.; Parker, Z.; Scott, G.; Draxl, C.

2013-10-01

The National Renewable Energy Laboratory (NREL), under an interagency agreement with the U.S. Department of the Interior's Bureau of Ocean Energy Management (BOEM), is providing technical assistance to identify and delineate leasing areas for offshore wind energy development within the Atlantic Coast Wind Energy Areas (WEAs) established by BOEM. This report focuses on NREL's development and evaluation of the delineations for the New Jersey (NJ) WEA. The overarching objective of this study is to develop a logical process by which the New Jersey WEA can be subdivided into non-overlapping leasing areas for BOEM's use in developing an auction process in a renewable energy lease sale. NREL identified a selection of leasing areas and proposed delineation boundaries within the established NJ WEA. The primary output of the interagency agreement is this report, which documents the methodology, including key variables and assumptions, by which the leasing areas were identified and delineated.

Exploring Simple Algorithms for Estimating Gross Primary Production in Forested Areas from Satellite Data

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Ramakrishna R. Nemani

2012-01-01

Full Text Available Algorithms that use remotely-sensed vegetation indices to estimate gross primary production (GPP, a key component of the global carbon cycle, have gained a lot of popularity in the past decade. Yet despite the amount of research on the topic, the most appropriate approach is still under debate. As an attempt to address this question, we compared the performance of different vegetation indices from the Moderate Resolution Imaging Spectroradiometer (MODIS in capturing the seasonal and the annual variability of GPP estimates from an optimal network of 21 FLUXNET forest towers sites. The tested indices include the Normalized Difference Vegetation Index (NDVI, Enhanced Vegetation Index (EVI, Leaf Area Index (LAI, and Fraction of Photosynthetically Active Radiation absorbed by plant canopies (FPAR. Our results indicated that single vegetation indices captured 50–80% of the variability of tower-estimated GPP, but no one index performed universally well in all situations. In particular, EVI outperformed the other MODIS products in tracking seasonal variations in tower-estimated GPP, but annual mean MODIS LAI was the best estimator of the spatial distribution of annual flux-tower GPP (GPP = 615 × LAI − 376, where GPP is in g C/m2/year. This simple algorithm rehabilitated earlier approaches linking ground measurements of LAI to flux-tower estimates of GPP and produced annual GPP estimates comparable to the MODIS 17 GPP product. As such, remote sensing-based estimates of GPP continue to offer a useful alternative to estimates from biophysical models, and the choice of the most appropriate approach depends on whether the estimates are required at annual or sub-annual temporal resolution.

Primary Prevention of Cardiovascular Disease

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Danny J. Eapen, MD

2016-09-01

Full Text Available Cardiovascular disease (CVD is the leading cause of death worldwide. This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors. Dietary modification, weight loss, exercise, and tobacco use cessation are specific areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level. Specific areas requiring management include dyslipidemia, hypertension, physical activity, diabetes, aspirin use, and alcohol intake. These preventive efforts have major public health implications. As the global population continues to grow, health care expenditures will also rise, with the potential to eventually overwhelm the health care system. Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals, communities, and nations.

The distribution feature of size-fractionated chlorophyll a and primary productivity in Prydz Bay and its north sea area during the austral summer

Institute of Scientific and Technical Information of China (English)

刘子琳; 陈忠元

2003-01-01

The investigation of size-fractionated chlorophyll a and primary productivity were carried out in three longitudinal sections (63°-69°12′S, 70°30′E, 73°E and 75(30′E) at December 18 -26, 1998 and January 12 -18, 1999 in Prydz Bay and its north sea area, Antarctica. The results showed that surface chlorophyll a concentration were 0.16 - 3.99 μg dm -3. The high values of chlorophyll a concentration ( more than 3.5 μg dm -3 ) were in Prydz Bay and in the west Ladies Bank. The average chlorophyll a concentration at sub-surface layer was higher than that at surface layer; its concentration at the deeper layers of 50 m decreased with increasing depth and that at 200 m depth was only 0.01 -0.95 μg dm-3. The results of size-fractionated chlorophyll a showed that the contribution of the netplanktion to total chlorophyll a was 56% , those of the nanoplankton and the picoplankton were 24% and 20% respectively in the surveyed area. The potential primary productivity at the euphotic zone in the surveyed area was 0. 11 - 11.67 mgC m-3 h -1 and average value was 2.00 ±2.80 mgC m-3h-1. The in-situ productivity in the bay and the continental shelf was higher and that in the deep-sea area was lower. The assimilation number of ted primary productivity show that the contribution of the netplanktion to total productivity was 58% , those of the nanoplankton and the picoplankton were 26% and 16% respectively. The cell abundance of phytoplankton was 1. 6 + 103 - 164. 8 + 103 cell dm-3 in the surface water.

Blueprint for an Undergraduate Primary Care Curriculum.

Science.gov (United States)

Fazio, Sara B; Demasi, Monica; Farren, Erin; Frankl, Susan; Gottlieb, Barbara; Hoy, Jessica; Johnson, Amanda; Kasper, Jill; Lee, Patrick; McCarthy, Claire; Miller, Kathe; Morris, Juliana; O'Hare, Kitty; Rosales, Rachael; Simmons, Leigh; Smith, Benjamin; Treadway, Katherine; Goodell, Kristen; Ogur, Barbara

2016-12-01

In light of the increasing demand for primary care services and the changing scope of health care, it is important to consider how the principles of primary care are taught in medical school. While the majority of schools have increased students' exposure to primary care, they have not developed a standardized primary care curriculum for undergraduate medical education. In 2013, the authors convened a group of educators from primary care internal medicine, pediatrics, family medicine, and medicine-pediatrics, as well as five medical students to create a blueprint for a primary care curriculum that could be integrated into a longitudinal primary care experience spanning undergraduate medical education and delivered to all students regardless of their eventual career choice.The authors organized this blueprint into three domains: care management, specific areas of content expertise, and understanding the role of primary care in the health care system. Within each domain, they described specific curriculum content, including longitudinality, generalism, central responsibility for managing care, therapeutic alliance/communication, approach to acute and chronic care, wellness and prevention, mental and behavioral health, systems improvement, interprofessional training, and population health, as well as competencies that all medical students should attain by graduation.The proposed curriculum incorporates important core features of doctoring, which are often affirmed by all disciplines but owned by none. The authors argue that primary care educators are natural stewards of this curriculum content and can ensure that it complements and strengthens all aspects of undergraduate medical education.

Primary sinonasal tuberculosis in north-west Pakistan

International Nuclear Information System (INIS)

Nawaz, G.; Khan, M.R.

2004-01-01

Objective: To record the frequency of primary involvement of nose and paranasal sinuses with tuberculosis in today's situation in the north-west region of Pakistan. Patients and Methods: A total of ten cases of primary sinonasal tuberculosis were included. The inclusion criteria were biopsy and acid-fast bacilli (AFB) examination after Ziel Neelsen (ZN) staining. Patients were put on anti-tuberculous chemotherapy. Response to the therapy and compliance of the patients were studied through follow up. Patients were admitted and offered surgical treatment wherever needed. Results: The primary sinonasal tuberculosis affected mainly young adults (18-60 years), both genders almost equally. Majority (80%) of the patients belonged to far-flung rural areas and all (100%) were poor. More frequent presenting features were granular lesion and mass in the nose (40%), epistaxis (30%), septal perforation (30%), external deformity (30%), palpable cervical lymph nodes (30%) and others. All the cases were diagnosed microscopically. Compliance to treatment was not good. Conclusion: The incidence of primary tuberculosis of nose and paranasal sinuses has risen in the recent past. The patients manifested no evidence of pulmonary tuberculosis. (author)

The complex scenario of obesity, diabetes and hypertension in the area of influence of primary healthcare facilities in Mexico.

Science.gov (United States)

Alcalde-Rabanal, J E; Orozco-Núñez, E; Espinosa-Henao, O E; Arredondo-López, A; Alcayde-Barranco, L

2018-01-01

Among non-communicable chronic diseases (NCCD), diabetes and hypertension are the main cause of adult mortality worldwide. Among the members of the Organization for Economic Cooperation and Development, Mexico is first in prevalence of diabetes and second in obesity. To face this problematic situation of NCCDs the Ministry of Health declared a national epidemiological alert against the overweight, obesity and diabetes. The target of this study is to characterize the status of obesity, diabetes and hypertension in the adult population in the area of influence of primary health facilities located in high social marginality areas. We conducted a cross-sectional observational study and used a convenience sample. A survey was conducted on a population of 18 years old and above in four primary health facilities in four Mexican States. The survey explored sociodemographic characteristics, the presence of chronic diseases, the access to healthcare services, risk factors and life styles. We also applied a complementary questionnaire to 20% of the participants, in order to explore food consumption during the last week and physical activity (International Physical Activity Questionnaire). We based our analysis on descriptive statistics and logistic multivariate regression to analyze factors associated with diabetes and hypertension. 73% (n = 7531, CI 0.72-0.74) percent of the population reported being diabetic, hypertensive and/or overweight. The majority of them receive healthcare in public health services. People over 40 years old, are 11 times more probable of living with diabetes and 8.7 times more probable of living with hypertension. Both conditions affect mostly women, whose main activity is to be a housewife. People who have lunch and dinner out of home are more likely to develop diabetes. People who perform intense physical activity are less likely to live with hypertension. According to the self-report, more than 70% of adult population living in areas with high

Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients

Directory of Open Access Journals (Sweden)

Marie Dorow

2018-05-01

Full Text Available Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1 investigate treatment preferences for depression including internet-based interventions and (2 examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences.Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences.Results: Patients had a mean age of 43.9 years (SD = 13.8 and more than two thirds (68.6% were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy.Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions.

Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study

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Martin-Lujan Francisco

2011-11-01

Full Text Available Abstract Background There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice. Methods Design Multicentre randomized clinical trial with an intervention and a control group. Setting 12 primary care centres in the province of Tarragona (Spain. Subjects of study 600 current smokers aged between 35 and 70 years with a cumulative habit of more than 10 packs of cigarettes per year, attended in primary care for any reason and who did not meet any of the exclusion criteria for the study, randomly assigned to structured intervention or standard clinical attention. Intervention Usual advice to quit smoking by a general practitioner as well as a 20-minute personalized visit to provide detailed information about spirometry results, during which FEV1, FVC, FEF 25-75% and PEF measurements were discussed and interpreted in terms of theoretical values. Additional information included the lung age index (defined as the average age of a non-smoker with the same FEV1 as the study participant, comparing this with the chronological age to illustrate the pulmonary deterioration that results from smoking. Measurements Spirometry during the initial visit. Structured interview questionnaire administered at the primary care centre at the initial visit and at 12-month follow-up. Telephone follow-up interview at 6 months. At 12-month follow-up, expired CO was measured in patients who claimed to have quit smoking. Main variables Smoking cessation at 12 months. Analysis Data will be analyzed on the basis of "intention to treat" and the unit of analysis will be the individual smoker. Expected results Among active smokers treated in primary care we anticipate significantly higher smoking cessation in the

Study on Net Primary Productivity over Complicated Mountainous Area based on Multi-Source Remote Sensing Data

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Guan, X.; Shen, H.; Li, X.; Gan, W.

2017-12-01

Mountainous area hosts approximately a quarter of the global land surface, with complex climate and ecosystem conditions. More knowledge about mountainous ecosystem could highly advance our understanding of the global carbon cycle and climate change. Net Primary Productivity (NPP), the biomass increment of plants, is a widely used ecological indicator that can be obtained by remote sensing methods. However, limited by the defective characteristic of sensors, which cannot be long-term with enough spatial details synchronously, the mountainous NPP was far from being understood. In this study, a multi-sensor fusion framework was applied to synthesize a 1-km NPP series from 1982 to 2014 in mountainous southwest China, where elevation ranged from 76m to 6740m. The validation with field-measurements proved this framework greatly improved the accuracy of NPP (r=0.79, prun-off. What is more, it was indicated that the NPP variation showed three distinct stages at the year break-point of 1992 and 2002 over the region. The NPP in low-elevation area varied almost triple more drastic than the high-elevation area for all the three stages, due to the much greater change rate of precipitation. In summary, this study innovatively conducted a long-term and accurate NPP study on the not understood mountainous ecosystem with multi-source data, the framework and conclusions will be beneficial for the further cognition of global climate change.

Teaching Chemistry in Primary Science: What Does the Research Suggest?

Science.gov (United States)

Skamp, Keith

2011-01-01

The new Australian national science curriculum includes chemistry content at the primary level. Chemistry for young students is learning about changes in material stuff (matter) and, by implication, of what stuff is made. Pedagogy in this area needs to be guided by research if stepping stones to later learning of chemical ideas are to facilitate…

Forming Entrepreneurial Mindsets? Preliminary Evidence of Teaching Practices from Primary Schools in a Developing Area in South America

Directory of Open Access Journals (Sweden)

Maria Auxiliadora N. Figueiredo-Nery

2008-08-01

Full Text Available Over the past few years there has been a renewed interest by governments, companies and academics in the role of entrepreneurship in innovation and economic growth. There has also been a proliferation of studies on education for entrepreneurship in industrialised and developing countries. However, by addressing ‘entrepreneurship’ in terms of SMEs and high-tech start-ups, they overlook: (i the blurring distinctions between entrepreneurial and managerial capitalism, (ii an erosion of the Schumpeterian dichotomy between large and small firms, and (iii the growing importance of entrepreneurial management within companies as a source for economic growth. Additionally, ‘entrepreneurship’ tends to be taught as a stand-alone topic in higher education and business/non-business courses. Empirical studies related to entrepreneurship education within primary schools, especially in least developed locations in developing countries, are largely missing in this field. Drawing on first-hand empirical evidence from primary schools in a developing area in South America, this paper examines the incidence and functioning of pedagogic practices potentially related to the initial formation of entrepreneurial mindsets. The findings show that, despite some efforts, the researched schools suffered from, not surprisingly, inadequate physical conditions and, most importantly, teachers’ unawareness and deficient qualification related to the adoption of these techniques. These problems seemed to prevent children from developing important features of their initial entrepreneurial mindsets. Thus, if companies and countries want to secure their sources of revolutionary ideas and continuous and des-continuous innovation, they need to have a long-term commitment to continuously develop and nurture the seeds for their future innovative knowledge bases. Specifically, a comprehensive, long-term, geographically and socially inclusive perspective on entrepreneurship

Practice Guidelines for Primary Care of Acute Abdomen 2015.

Science.gov (United States)

Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi

2016-01-01

Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Sun-Protection Habits of Primary Students in a Coastal Area of Greece

Directory of Open Access Journals (Sweden)

M. Saridi

2012-01-01

Full Text Available Aim. The aim of the present study was to record habits and attitudes of primary school students in Greece regarding sun-protection measures. Materials and Methods. 2,163 students with an average age of 9.9 (±1.1 years, studying in 14 schools of a Greek region, constituted our sample. The SPSS 17.0 software was used for the statistical analysis and significance level was set to P≤0.05. Results. Our sample had an equal gender distribution. 16% of the students belonged to the high-risk group, 70.2% of the participants lived 0–5 km away from the sea (urban area, 84.2% of the students were Greek, and 15.8% had non-Greek nationality. Half of the participants said they wear a hat when under the sun and 72% of them said they use sunscreen. 33.1% of the students said they had a sunburn last summer. Greek students as well as those who lived near the sea had better behaviour patterns regarding sun protection. Finally, children who did not use a sunscreen systematically had suffered sunburns more often than the rest. Conclusions. Health education programmes are necessary for students and parents/teachers alike, in order to raise awareness about everyday sun protection.

Sun-Protection Habits of Primary Students in a Coastal Area of Greece

International Nuclear Information System (INIS)

Saridi, M.; Toska, A.; Rekleiti, M.; Liachopoulou, A.; Wozniak, G.; Kalokairinou, A.; Birbas, K.; Souliotis, K.

2012-01-01

The aim of the present study was to record habits and attitudes of primary school students in Greece regarding sun-protection measures. Materials and Methods. 2,163 students with an average age of 9.9 (±1.1) years, studying in 14 schools of a Greek region, constituted our sample. The SPSS 17.0 software was used for the statistical analysis and significance level was set toρ≤0.05. Results. Our sample had an equal gender distribution. 16% of the students belonged to the high-risk group, 70.2% of the participants lived 0-5 km away from the sea (urban area), 84.2% of the students were Greek, and 15.8% had non-Greek nationality. Half of the participants said they wear a hat when under the sun and 72% of them said they use sunscreen. 33.1% of the students said they had a sunburn last summer. Greek students as well as those who lived near the sea had better behaviour patterns regarding sun protection. Finally, children who did not use a sunscreen systematically had suffered sunburns more often than the rest. Conclusions. Health education programmes are necessary for students and parents/teachers alike, in order to raise awareness about everyday sun protection.

Morbidity pattern and personal hygiene in children among private primary school in urban area: are the trends changing?

Science.gov (United States)

Mhaske, Mayavati S; Khismatrao, Deepak S; Kevin, Fernandez; Pandve, Harshal T; Kundap, Ritesh P

2013-07-01

School health is an important intervention as a great deal of research tells us that schools can have a major effect on children's health, by teaching them about health and promoting healthy behaviors. The aim of this study is to determine common health problems and assess personal hygiene status among primary school children. A cross-sectional study was conducted in academic years 2009-2010 and 2010-2011, with three health check-up camps organized in private primary school of Pune city. A total of 450 students were assessed for health problems and composite score of personal hygiene status was calculated ranging from 0 to 5 by examination of hairs, nails, skin and clothes. Proportions calculated with application of Chi-square test and Pearson co-efficient applied to observe the relation between two quantitative variables. Out of 450 students examined, 56.2% were boys and 43.8% were girls with age ranging from 5 to 10 years. The major morbidities observed were dental caries (65.1%), upper respiratory tract infections (38.2%), ear wax (29.9%) and myopia (10.0%). Mean hygiene score was significantly higher in girls (4.32) than boys (3.95) and poor hygiene observed in older boys. Increasing myopia and poor dental hygiene denotes a changing morbidity pattern in private primary school of the urban area. The hygiene status of the girls is significantly better than boys.

Researching primary engineering education: UK perspectives, an exploratory study

Science.gov (United States)

Clark, Robin; Andrews, Jane

2010-10-01

This paper draws attention to the findings of an exploratory study that critically identified and analysed relevant perceptions of elementary level engineering education within the UK. Utilising an approach based upon grounded theory methodology, 30 participants including teachers, representatives of government bodies and non-profit providers of primary level engineering initiatives were interviewed. Three main concepts were identified during the analysis of findings, each relevant to primary engineering education. These were pedagogic issues, exposure to engineering within the curriculum and children's interest. The paper concludes that the opportunity to make a real difference to children's education by stimulating their engineering imagination suggests this subject area is of particular value.

What? Me? Teach Dance? Background and Confidence of Primary Preservice Teachers in Dance Education across Five Countries

Science.gov (United States)

Russell-Bowie, Deirdre E.

2013-01-01

In primary schools across many countries, dance is now included within the arts key learning area with its own outcomes and content. But as future teachers of dance and other art forms, how do preservice generalist primary teachers perceive their background and confidence in relation to dance and dance education? This study investigates the…

Reforming Victoria's primary health and community service sector: rural implications.

Science.gov (United States)

Alford, K

2000-01-01

In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

Technology of surface wastewater purification, including high-rise construction areas

Science.gov (United States)

Tsyba, Anna; Skolubovich, Yury

2018-03-01

Despite on the improvements in the quality of high-rise construction areas and industrial wastewater treatment, the pollution of water bodies continues to increase. This is due to the organized and unorganized surface untreated sewage entry into the reservoirs. The qualitative analysis of some cities' surface sewage composition is carried out in the work. Based on the published literature review, the characteristic contamination present in surface wastewater was identified. The paper proposes a new technology for the treatment of surface sewage and presents the results of preliminary studies.

Groundwater quality in the Mojave area, California

Science.gov (United States)

Dawson, Barbara J. Milby; Belitz, Kenneth

2012-01-01

Groundwater provides more than 40 percent of California’s drinking water. To protect this vital resource, the State of California created the Groundwater Ambient Monitoring and Assessment (GAMA) Program. The Priority Basin Project of the GAMA Program provides a comprehensive assessment of the State’s groundwater quality and increases public access to groundwater-quality information. Four groundwater basins along the Mojave River make up one of the study areas being evaluated. The Mojave study area is approximately 1,500 square miles (3,885 square kilometers) and includes four contiguous groundwater basins: Upper, Middle, and Lower Mojave River Groundwater Basins, and the El Mirage Valley (California Department of Water Resources, 2003). The Mojave study area has an arid climate, and is part of the Mojave Desert. Average annual rainfall is about 6 inches (15 centimeters). Land use in the study area is approximately 82 percent (%) natural (mostly shrubland), 4% agricultural, and 14% urban. The primary crops are pasture and hay. The largest urban areas are the cities of Victorville, Hesperia, and Apple Valley (2010 populations of 116,000, 90,000 and 69,000, respectively). Groundwater in these basins is used for public and domestic water supply and for irrigation. The main water-bearing units are gravel, sand, silt, and clay derived from surrounding mountains. The primary aquifers in the Mojave study area are defined as those parts of the aquifers corresponding to the perforated intervals of wells listed in the California Department of Public Health database. Public-supply wells in the Mojave study area are completed to depths between 200 and 600 feet (18 to 61 meters), consist of solid casing from the land surface to a depth of 130 to 420 feet (40 to 128 meters), and are screened or perforated below the solid casing. Recharge to the groundwater system is primarily runoff from the mountains to the south, mostly through the Mojave River channel. The primary sources

Gender equality in primary immunisation

Directory of Open Access Journals (Sweden)

Deepak S Khismatrao

2015-01-01

Full Text Available Context: Immunization, a well-known and effective method of preventing childhood illnesses is basic service under primary health care. Most surveys in India measure primary immunization coverage and quality, but no "Gender Equality." Aims: Assess "Gender Equality" in primary immunization with reference to coverage, quality, and place of immunization. Settings and Design: Cross-sectional survey in a primary health center, Pune, Maharashtra using World Health Organization 30-cluster sampling method with 14 beneficiaries (7 girls and 7 boys to be selected from each cluster. Instead of 420 children, data collected for 345 children, as requisite numbers of children were not available in low population villages and also children whose mothers were not present during survey were excluded. Materials and Methods: Vaccination data collected from either records and/or history by mother. Children born on or between 13-09-2009 and 13-09-2010, were included. Statistical Analysis Used: SPSS 14.01 version with Chi-square as test of significance. Results: Of the study population, 171 (49.6% were females and 174 (50.4% males. A total of 64.1% children had immunization records with female proportion 69.0% and males 59.2%. Primary immunization coverage was 80.0%, with female proportion 82.5% and males 77.6%. One male child was completely unimmunized and remaining partially immunized, with unaware of schedule and illness of child being major reasons for partial immunization. There was no gender wise statistically significant difference observed in Primary Immunization with reference to coverage, quality, and place of immunization. Conclusions: Immunization coverage is nearing 85% benchmark with major contribution from Universal Immunization Program. Gender Equality observed in primary immunization. Preservation of immunization records by community and timely vaccinations are areas for improvement.

Assessment of Primary Representational Systems with Neurolinguistic Programming: Examination of Preliminary Literature.

Science.gov (United States)

Dorn, Fred J.; And Others

1983-01-01

Reviews the inconsistent findings of studies on neurolinguistic programing and recommends some areas that should be examined to verify various claims. Discusses methods of assessing client's primary representational systems, including predicate usage and eye movements, and suggests that more reliable methods of assessing PRS must be found. (JAC)

Histogram analysis parameters of dynamic contrast-enhanced magnetic resonance imaging can predict histopathological findings including proliferation potential, cellularity, and nucleic areas in head and neck squamous cell carcinoma.

Science.gov (United States)

Surov, Alexey; Meyer, Hans Jonas; Leifels, Leonard; Höhn, Anne-Kathrin; Richter, Cindy; Winter, Karsten

2018-04-20

Our purpose was to analyze possible associations between histogram analysis parameters of dynamic contrast-enhanced magnetic resonance imaging DCE MRI and histopathological findings like proliferation index, cell count and nucleic areas in head and neck squamous cell carcinoma (HNSCC). 30 patients (mean age 57.0 years) with primary HNSCC were included in the study. In every case, histogram analysis parameters of K trans , V e , and K ep were estimated using a mathlab based software. Tumor proliferation index, cell count, and nucleic areas were estimated on Ki 67 antigen stained specimens. Spearman's non-parametric rank sum correlation coefficients were calculated between DCE and different histopathological parameters. KI 67 correlated with K trans min ( p = -0.386, P = 0.043) and s K trans skewness ( p = 0.382, P = 0.045), V e min ( p = -0.473, P = 0.011), Ve entropy ( p = 0.424, P = 0.025), and K ep entropy ( p = 0.464, P = 0.013). Cell count correlated with K trans kurtosis ( p = 0.40, P = 0.034), V e entropy ( p = 0.475, P = 0.011). Total nucleic area correlated with V e max ( p = 0.386, P = 0.042) and V e entropy ( p = 0.411, P = 0.030). In G1/2 tumors, only K trans entropy correlated well with total ( P =0.78, P =0.013) and average nucleic areas ( p = 0.655, P = 0.006). In G3 tumors, KI 67 correlated with Ve min ( p = -0.552, P = 0.022) and V e entropy ( p = 0.524, P = 0.031). Ve max correlated with total nucleic area ( p = 0.483, P = 0.049). Kep max correlated with total area ( p = -0.51, P = 0.037), and K ep entropy with KI 67 ( p = 0.567, P = 0.018). We concluded that histogram-based parameters skewness, kurtosis and entropy of K trans , V e , and K ep can be used as markers for proliferation activity, cellularity and nucleic content in HNSCC. Tumor grading influences significantly associations between perfusion and histopathological parameters.

The Practice Guidelines for Primary Care of Acute Abdomen 2015.

Science.gov (United States)

Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi

2016-01-01

Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines [all clinical questions (CQs) and recommendations are shown in supplementary information]. A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on 9 subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

Primary explosives

Energy Technology Data Exchange (ETDEWEB)

Matyas, Robert; Pachman, Jiri [Pardubice Univ. (Czech Republic). Faculty of Chemical Technology

2013-06-01

The first chapter provides background such as the basics of initiation and differences between requirements on primary explosives used in detonators and igniters. The authors then clarify the influence of physical characteristics on explosive properties, focusing on those properties required for primary explosives. Furthermore, the issue of sensitivity is discussed. All the chapters on particular groups of primary explosives are structured in the same way, including introduction, physical and chemical properties, explosive properties, preparation and documented use.

Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.

Science.gov (United States)

Esmail, Aneez; Valderas, Jose M; Verstappen, Wim; Godycki-Cwirko, Maciek; Wensing, Michel

2015-09-01

This paper is an introduction to a supplement to The European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009-2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement.

TA-60-1 Heavy Equipment Shop Areas SWPPP Rev 2 Jan 2017-Final

Energy Technology Data Exchange (ETDEWEB)

Burgin, Jillian Elizabeth [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-02-07

The primary activities and equipment areas at the facility that are potential stormwater pollution sources include; The storage of vehicles and heavy equipment awaiting repair; or repaired vehicles waiting to be picked up; The storage and handling of oils, anti-freeze, solvents, degreasers, batteries and other chemicals for the maintenance of vehicles and heavy equipment; and Equipment cleaning operations including exterior vehicle wash-down. Steam cleaning is only done on the steam cleaning pad area located at the north east end of Building 60-0001.

Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of bangalore city using cluster sampling and lot quality assurance sampling techniques.

Science.gov (United States)

K, Punith; K, Lalitha; G, Suman; Bs, Pradeep; Kumar K, Jayanth

2008-07-01

Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Population-based cross-sectional study. Areas under Mathikere Urban Health Center. Children aged 12 months to 23 months. 220 in cluster sampling, 76 in lot quality assurance sampling. Percentages and Proportions, Chi square Test. (1) Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2) Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

Characterizing a neurodegenerative syndrome: primary progressive apraxia of speech.

Science.gov (United States)

Josephs, Keith A; Duffy, Joseph R; Strand, Edythe A; Machulda, Mary M; Senjem, Matthew L; Master, Ankit V; Lowe, Val J; Jack, Clifford R; Whitwell, Jennifer L

2012-05-01

Apraxia of speech is a disorder of speech motor planning and/or programming that is distinguishable from aphasia and dysarthria. It most commonly results from vascular insults but can occur in degenerative diseases where it has typically been subsumed under aphasia, or it occurs in the context of more widespread neurodegeneration. The aim of this study was to determine whether apraxia of speech can present as an isolated sign of neurodegenerative disease. Between July 2010 and July 2011, 37 subjects with a neurodegenerative speech and language disorder were prospectively recruited and underwent detailed speech and language, neurological, neuropsychological and neuroimaging testing. The neuroimaging battery included 3.0 tesla volumetric head magnetic resonance imaging, [(18)F]-fluorodeoxyglucose and [(11)C] Pittsburg compound B positron emission tomography scanning. Twelve subjects were identified as having apraxia of speech without any signs of aphasia based on a comprehensive battery of language tests; hence, none met criteria for primary progressive aphasia. These subjects with primary progressive apraxia of speech included eight females and four males, with a mean age of onset of 73 years (range: 49-82). There were no specific additional shared patterns of neurological or neuropsychological impairment in the subjects with primary progressive apraxia of speech, but there was individual variability. Some subjects, for example, had mild features of behavioural change, executive dysfunction, limb apraxia or Parkinsonism. Voxel-based morphometry of grey matter revealed focal atrophy of superior lateral premotor cortex and supplementary motor area. Voxel-based morphometry of white matter showed volume loss in these same regions but with extension of loss involving the inferior premotor cortex and body of the corpus callosum. These same areas of white matter loss were observed with diffusion tensor imaging analysis, which also demonstrated reduced fractional anisotropy

Primary colorectal lymphoma: spectrum of imaging findings with pathologic correlation

International Nuclear Information System (INIS)

Lee, Hyun Ju; Han, Joon Koo; Kim, Tae Kyoung; Kim, Young Hoon; Kim, Ah Young; Kim, Kyoung Won; Choi, Ja Young; Choi, Byung Ihn

2002-01-01

Primary colorectal lymphoma is a very uncommon disease; therefore, it has received little attention in the radiology literature. Moreover, imaging features of newly described pathologic subtypes have not been reported such as low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue and peripheral T-cell lymphoma that involves colorectal area. We retrospectively reviewed double-contrast barium enema and CT scans in the patients with primary colorectal lymphoma. In this article the radiologic appearances of primary colorectal lymphoma are categorized into focal lesion and diffuse lesion. Focal lesion includes polypoid mass, circumferential infiltration with smooth mucosal surface, circumferential infiltration with extensive ulceration, cavitary mass, mucosal nodularity, and mucosal fold thickening. Diffuse lesion includes diffuse ulcerative lesion and diffuse nodular lesion. Peripheral T-cell lymphomas that involve the colon manifested as either a diffuse or focal segmental lesion and showed extensive mucosal ulceration. These findings are similar to those of Crohn's disease or tuberculous colitis and are different from those of previously reported colorectal lymphoma. Low-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue manifest as multiple mucosal nodularity. The imaging features of primary colorectal lymphoma are quite variable and overlap with other colonic pathology; however, it is important for radiologists to know the imaging features of primary colorectal lymphoma with their pathologic correlation. (orig.)

Re-Engineering Primary School Teachers for Sustainable ...

African Journals Online (AJOL)

engineer primary school teachers for sustainable development in Onitsha North Local Government Area. Three research questions and a hypothesis were formulated to guide the study. Descriptive survey research design was used. 300 primary ...

Encampment of Communities in War-affected Areas and its Effect on ...

African Journals Online (AJOL)

The paper sought to assess the effect of encampment on the livelihood security and reproductive health needs of IDPs in war affected areas of northern Uganda. The research design was exploratory and descriptive in nature and was largely qualitative, although a small amount of quantitative data are included. Primary and ...

Area 5 influences excitability within the primary motor cortex in humans.

Directory of Open Access Journals (Sweden)

Azra Premji

Full Text Available In non-human primates, Brodmann's area 5 (BA 5 has direct connectivity with primary motor cortex (M1, is largely dedicated to the representation of the hand and may have evolved with the ability to perform skilled hand movement. Less is known about human BA 5 and its interaction with M1 neural circuits related to hand control. The present study examines the influence of BA 5 on excitatory and inhibitory neural circuitry within M1 bilaterally before and after continuous (cTBS, intermittent (iTBS, and sham theta-burst stimulation (sham TBS over left hemisphere BA 5. Using single and paired-pulse TMS, measurements of motor evoked potentials (MEPs, short interval intracortical inhibition (SICI, and intracortical facilitation (ICF were quantified for the representation of the first dorsal interosseous muscle. Results indicate that cTBS over BA 5 influences M1 excitability such that MEP amplitudes are increased bilaterally for up to one hour. ITBS over BA 5 results in an increase in MEP amplitude contralateral to stimulation with a delayed onset that persists up to one hour. SICI and ICF were unaltered following TBS over BA 5. Similarly, F-wave amplitude and latency were unaltered following cTBS over BA 5. The data suggest that BA 5 alters M1 output directed to the hand by influencing corticospinal neurons and not interneurons that mediate SICI or ICF circuitry. Targeting BA 5 via cTBS and iTBS is a novel mechanism to powerfully modulate activity within M1 and may provide an avenue for investigating hand control in healthy populations and modifying impaired hand function in clinical populations.

Functional magnetic resonance imaging of the primary motor cortex

Indian Academy of Sciences (India)

Functional magnetic resonance imaging (fMRI) studies have been performed on 20 right handed volunteers at 1.5 Tesla using echo planar imaging (EPI) protocol. Index finger tapping invoked localized activation in the primary motor area. Consistent and highly reproducible activation in the primary motor area was observed ...

Mechanisms of growth inhibition of primary prostate epithelial cells following gamma irradiation or photodynamic therapy include senescence, necrosis, and autophagy, but not apoptosis

International Nuclear Information System (INIS)

Frame, Fiona M.; Savoie, Huguette; Bryden, Francesca; Giuntini, Francesca; Mann, Vincent M.; Simms, Matthew S.; Boyle, Ross W.; Maitland, Norman J.

2015-01-01

In comparison to more differentiated cells, prostate cancer stem-like cells are radioresistant, which could explain radio-recurrent prostate cancer. Improvement of radiotherapeutic efficacy may therefore require combination therapy. We have investigated the consequences of treating primary prostate epithelial cells with gamma irradiation and photodynamic therapy (PDT), both of which act through production of reactive oxygen species (ROS). Primary prostate epithelial cells were cultured from patient samples of benign prostatic hyperplasia and prostate cancer prior to treatment with PDT or gamma irradiation. Cell viability was measured using MTT and alamar blue assay, and cell recovery by colony-forming assays. Immunofluorescence of gamma-H2AX foci was used to quantify DNA damage, and autophagy and apoptosis were assessed using Western blots. Necrosis and senescence were measured by propidium iodide staining and beta-galactosidase staining, respectively. Both PDT and gamma irradiation reduced the colony-forming ability of primary prostate epithelial cells. PDT reduced the viability of all types of cells in the cultures, including stem-like cells and more differentiated cells. PDT induced necrosis and autophagy, whereas gamma irradiation induced senescence, but neither treatment induced apoptosis. PDT and gamma irradiation therefore inhibit cell growth by different mechanisms. We suggest these treatments would be suitable for use in combination as sequential treatments against prostate cancer

fMRI-vs-MEG evaluation of post-stroke interhemispheric asymmetries in primary sensorimotor hand areas.

Science.gov (United States)

Altamura, Claudia; Torquati, Kahtya; Zappasodi, Filippo; Ferretti, Antonio; Pizzella, Vittorio; Tibuzzi, Francesco; Vernieri, Fabrizio; Pasqualetti, Patrizio; Landi, Doriana; Del Gratta, Cosimo; Romani, Gian-Luca; Maria Rossini, Paolo; Tecchio, Franca

2007-04-01

Growing evidence emphasizes a positive role of brain ipsilesional (IL) reorganization in stroke patients with partial recovery. Ten patients affected by a monohemispheric stroke in the middle cerebral artery territory underwent functional magnetic resonance (fMRI) and magnetoencephalography (MEG) evaluation of the primary sensory (S1) activation via the same paradigm (median nerve galvanic stimulation). Four patients did not present S1 fMRI activation [Rossini, P.M., Altamura, C., Ferretti, A., Vernieri, F., Zappasodi, F., Caulo, M., Pizzella, V., Del Gratta, C., Romani, G.L., Tecchio, F., 2004. Does cerebrovascular disease affect the coupling between neuronal activity and local haemodynamics? Brain 127, 99-110], although inclusion criteria required bilateral identifiable MEG responses. Mean Euclidean distance between fMRI and MEG S1 activation Talairach coordinates was 10.1+/-2.9 mm, with a 3D intra-class correlation (ICC) coefficient of 0.986. Interhemispheric asymmetries, evaluated by an MEG procedure independent of Talairach transformation, were outside or at the boundaries of reference ranges in 6 patients. In 3 of them, the IL activation presented medial or lateral shift with respect to the omega-shaped post-rolandic area while in the other 3, IL areas were outside the peri-rolandic region. In conclusion, despite dissociated intensity, the MEG and fMRI activations displayed good spatial consistency in stroke patients, thus confirming excessive interhemispheric asymmetries as a suitable indicator of unusual recruitments in the ipsilesional hemisphere, within or outside the peri-rolandic region.

Urbanization in the US: land use trends, impacts on forest area, projections, and policy considerations

Science.gov (United States)

Ralph Alig

2010-01-01

Since World War II, socio-economic drivers of US urbanization such as population totals and personal income levels have increased substantially. Human land use is the primary force driving changes in forest ecosystem attributes including forest area, which is the focus of this paper. The percentage of the US population residing in urban areas is higher than that in...

Abnormal cortical synaptic plasticity in primary motor area in progressive supranuclear palsy.

Science.gov (United States)

Conte, Antonella; Belvisi, Daniele; Bologna, Matteo; Ottaviani, Donatella; Fabbrini, Giovanni; Colosimo, Carlo; Williams, David R; Berardelli, Alfredo

2012-03-01

No study has yet investigated whether cortical plasticity in primary motor area (M1) is abnormal in patients with progressive supranuclear palsy (PSP). We studied M1 plasticity in 15 PSP patients and 15 age-matched healthy subjects. We used intermittent theta-burst stimulation (iTBS) to investigate long-term potentiation (LTP) and continuous TBS (cTBS) to investigate long-term depression (LTD)-like cortical plasticity in M1. Ten patients underwent iTBS again 1 year later. We also investigated short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) in M1 with paired-pulse transcranial magnetic stimulation, tested H reflex from upper limb flexor muscles before and after iTBS, and measured motor evoked potential (MEP) input-output (I/O) curves before and after iTBS. iTBS elicited a significantly larger MEP facilitation after iTBS in patients than in healthy subjects. Whereas in healthy subjects, cTBS inhibited MEP, in patients it significantly facilitated MEPs. In patients, SICI was reduced, whereas ICF was normal. H reflex size remained unchanged after iTBS. Patients had steeper MEP I/O slopes than healthy subjects at baseline and became even more steeper after iTBS only in patients. The iTBS-induced abnormal MEP facilitation in PSP persisted at 1-year follow-up. In conclusion, patients with PSP have abnormal M1 LTP/LTD-like plasticity. The enhanced LTP-like cortical synaptic plasticity parallels disease progression.

Community health worker in hard-to-reach rural areas of Myanmar: filling primary health care service gaps.

Science.gov (United States)

Sommanustweechai, Angkana; Putthasri, Weerasak; Nwe, Mya Lay; Aung, Saw Thetlya; Theint, Mya Min; Tangcharoensathien, Viroj; Wynn, San Shway

2016-10-21

Myanmar is classified as critical shortage of health workforce. In responses to limited number of trained health workforce in the hard-to-reach and remote areas, the MOH trained the Community Health Worker (CHW) as health volunteers serving these communities on a pro bono basis. This study aimed to assess the socio-economic profiles, contributions of CHW to primary health care services and their needs for supports to maintain their quality contributions in rural hard to reach areas in Myanmar. In 2013, cross-sectional census survey was conducted on all three groups of CHW classified by their training dates: (1) prior to 2000, (2) between 2000 and 2011, and (3) more recently trained in 2012, who are still working in 21 townships of 17 states and regions in Myanmar, using a self-administered questionnaire survey in the Burmese language. The total 715 CHWs from 21 townships had completely responded to the questionnaire. CHWs were trained to support the work of midwives in the sub-centres and health assistant and midwives in rural health centres (RHCs) such as community mobilization for immunization, advocates of safe water and sanitation, and general health education and health awareness for the citizens. CHWs were able to provide some of the services by themselves, such as treatment of simple illnesses, and they provided services to 62 patients in the last 6 months. Their contributions to primary health care services were well accepted by the communities as they are geographically and culturally accessible. However, supports from the RHC were inadequate in particular technical supervision, as well as replenishment of CHW kits and financial support for their work and transportation. In practice, 6 % of service provided by CHWs was funded by the community and 22 % by the patients. The CHW's confidence in providing health services was positively associated with their age, education, and more recent training. A majority of them intended to serve as a CHW for more than

Primary ectopic frontotemporal extradural craniopharyngioma

Directory of Open Access Journals (Sweden)

Reza Pourkhalili

2016-01-01

Full Text Available We present a case of primary ectopic frontotemporal extradural craniopharyngioma. Primary ectopic craniopharyngiomas are very rare and have been reported involving the fourth ventricle, infrasellar region, lateral ventricle, temporal area, cerebellopontine angle, clivus, corpus callosum, and prepontine cistern. There was just 1 case of craniopharyngioma previously presented in the literature, with nearly same location as the presenting case.

Intestinal helminth infections among primary school pupils in ...

African Journals Online (AJOL)

A study was carried out to determine the prevalence of intestinal helminth infections among primary school pupils in Ekwulumili Community, Nnewi South Local Government Area, Anambra State, Nigeria, between April and July 2012. Five primary schools were involved in the study namely, Bethel Nursery and Primary ...

Harnessing Geographic Information Systems (GIS) to enable community-oriented primary care.

Science.gov (United States)

Bazemore, Andrew; Phillips, Robert L; Miyoshi, Thomas

2010-01-01

Despite growing acceptance and implementation of geographic information systems (GIS) in the public health arena, its utility for clinical population management and coordination by leaders in a primary care clinical health setting has been neither fully realized nor evaluated. In a primary care network of clinics charged with caring for vulnerable urban communities, we used GIS to (1) integrate and analyze clinical (practice management) data and population (census) data and (2) generate distribution, service area, and population penetration maps of those clinics. We then conducted qualitative evaluation of the responses of primary care clinic leaders, administrators, and community board members to analytic mapping of their clinic and regional population data. Practice management data were extracted, geocoded, and mapped to reveal variation between actual clinical service areas and the medically underserved areas for which these clinics received funding, which was surprising to center leaders. In addition, population penetration analyses were performed to depict patterns of utilization. Qualitative assessments of staff response to the process of mapping clinical and population data revealed enthusiastic engagement in the process, which led to enhanced community comprehension, new ideas about data use, and an array of applications to improve their clinical revenue. However, they also revealed barriers to further adoption, including time, expense, and technical expertise, which could limit the use of GIS and mapping unless economies of scale across clinics, the use of web technology, and the availability of dynamic mapping tools could be realized. Analytic mapping was enthusiastically received and practically applied in the primary care setting, and was readily comprehended by clinic leaders for innovative purposes. This is a tool of particular relevance amid primary care safety-net expansion and increased funding of health information technology diffusion in these

Multidisciplinary practice experience of nursing faculty and their collaborators for primary health care in Korea.

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Kim, Mi Ja; Chung, Hyang-In Cho; Ahn, Yang Heui

2008-03-01

This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government's support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other's territory and expertise. Teamwork should be included in all health professions' curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health

Geostatistical and GIS analysis of the spatial variability of alluvial gold content in Ngoura-Colomines area, Eastern Cameroon: Implications for the exploration of primary gold deposit

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Takodjou Wambo, Jonas Didero; Ganno, Sylvestre; Djonthu Lahe, Yannick Sthopira; Kouankap Nono, Gus Djibril; Fossi, Donald Hermann; Tchouatcha, Milan Stafford; Nzenti, Jean Paul

2018-06-01

Linear and nonlinear geostatistic is commonly used in ore grade estimation and seldom used in Geographical Information System (GIS) technology. In this study, we suggest an approach based on geostatistic linear ordinary kriging (OK) and Geographical Information System (GIS) techniques to investigate the spatial distribution of alluvial gold content, mineralized and gangue layers thicknesses from 73 pits at the Ngoura-Colomines area with the aim to determine controlling factors for the spatial distribution of mineralization and delineate the most prospective area for primary gold mineralization. Gold content varies between 0.1 and 4.6 g/m3 and has been broadly grouped into three statistical classes. These classes have been spatially subdivided into nine zones using ordinary kriging model based on physical and topographical characteristics. Both mineralized and barren layer thicknesses show randomly spatial distribution, and there is no correlation between these parameters and the gold content. This approach has shown that the Ngoura-Colomines area is located in a large shear zone compatible with the Riedel fault system composed of P and P‧ fractures oriented NE-SW and NNE-SSW respectively; E-W trending R fractures and R‧ fractures with NW-SE trends that could have contributed significantly to the establishment of this gold mineralization. The combined OK model and GIS analysis have led to the delineation of Colomines, Tissongo, Madubal and Boutou villages as the most prospective areas for the exploration of primary gold deposit in the study area.

Consanguinity and primary immunodeficiencies.

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Al-Herz, Waleed; Aldhekri, Hasan; Barbouche, Mohamed-Ridha; Rezaei, Nima

2014-01-01

Primary immunodeficiencies (PIDs) are a heterogeneous group of genetic disorders caused by defects in the immune system that predispose patients to infections, autoimmune diseases, lymphoproliferation and malignancies. Most PIDs are inherited in an autosomal recessive pattern; therefore, they are more common in areas with high rates of consanguineous marriage. Reports about PIDs from these areas have demonstrated a peculiar prevalence of more severe forms of diseases compared to other regions, and patients born to consanguineous parents have increased rates of morbidity and mortality compared to other patients. Individuals at high risk of having a child with a PID who wish to have a healthy child have limited options, these include prenatal diagnosis and pre-implantation genetic diagnosis. However, these options require a collaborative team of specialists and may not always be implemented due to geographic, religious, financial or social factors. The recent introduction of newborn-screening programs for a number of T and B lymphocyte deficiencies will facilitate early diagnosis and therapeutic interventions, which may include hematopoietic stem cell transplantation and intravenous immunoglobulin treatment. There is a need for the implementation of strategies to increase public awareness of the health risks associated with consanguineous marriage. It should be stressed that genetic counseling should be an important component of the care of patients with PIDs as well as their families. © 2014 S. Karger AG, Basel.

Medication safety programs in primary care: a scoping review.

Science.gov (United States)

Khalil, Hanan; Shahid, Monica; Roughead, Libby

2017-10-01

Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome

Primary Energy of the District city and Suburb

Science.gov (United States)

Pitonak, Anton; Lopusniak, Martin; Bagona, Miloslav

2017-10-01

In member states of the European Union, portion of buildings in the total consumption of energy represents 40 %, and their share in CO2 emissions represents 35 %. Taking into account the dependence of the European Union on import of energy, this represents a large quantity of energy and CO2 in spite of the fact that effective solutions for the reduction of energy demand of buildings exist. The European Union adopted three main commitments for fulfilment of criteria by year 2020 in the 20-20-20 Directive. Based on this Directive Slovakia declares support for renovating the building stock. The goal of the paper was to prove that renovation of the building stock is environmentally and energy preferably as construction of new buildings. In the paper, the settlement unit with the suburban one were compared. Both territories are dealt with in Kosice city, in Slovakia. The settlement units include apartment dwelling houses, amenities, parking areas and green. Suburban part contains family houses. The decisive factor for the final assessment of the buildings was global indicator. Global indicator of the energy performance is primary energy. The new building must meet minimum requirements for energy performance and it must be classified to energy class A1 since 2016, and to energy class A0 since 2020. The paper analyses the effects of the use of different resources of heat considering the global indicator. Primary energy was calculated and based on comparable unit. The primary energy was accounted for on the built-up area, area corresponding to district city and suburb, number of inhabitants. The study shows that the lowest values of global indicator are achieved by using wood. The highest values of global indicator are achieved by using electricity or district heating as an energy source. The difference between the highest and lowest value is 87 %. Primary energy based on inhabitant is 98 % lower in settlement unit compared to the suburban one.

Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of Bangalore city using cluster sampling and lot quality assurance sampling techniques

Directory of Open Access Journals (Sweden)

Punith K

2008-01-01

Full Text Available Research Question: Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? Objective: To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Study Design: Population-based cross-sectional study. Study Setting: Areas under Mathikere Urban Health Center. Study Subjects: Children aged 12 months to 23 months. Sample Size: 220 in cluster sampling, 76 in lot quality assurance sampling. Statistical Analysis: Percentages and Proportions, Chi square Test. Results: (1 Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2 Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

Application of smart phone and supporting set for fundus imaging in primary hospital of rural area

Directory of Open Access Journals (Sweden)

Yong-Feng Jing

2018-01-01

Full Text Available AIM: To describe the application of smart phone and supporting set for acquiring fundus images with slitlamp examination and non-contact lens in primary hospital of the rural area. METHODS: The supporting set for smart phone was purchased from taobao and securely connected to the ocular lens of slitlamp microscopy. The fundus photos were imaged with assistance of non-contact slitlamp lens from Volk. RESULTS: High quality images of various retinal diseases could be successfully taken with smart phone and supporting set by slitlamp examination. The fundus images were send to patients with Wechat as medical records or used for telconsultant. CONCLUSION: High resolution smart phones are wildly used nowadays and supporting sets are very accessible; thus high quality of images could be obtained with minimal cost in rural hospitals. The digital fundus images will be beneficial for medical record and rapid diagnosis with telconsultant.

Participation of primary motor cortex area 4a in complex sensory processing: 3.0-T fMRI study.

Science.gov (United States)

Terumitsu, Makoto; Ikeda, Kotaro; Kwee, Ingrid L; Nakada, Tsutomu

2009-05-06

The precise movement of human fingers requires continuous and reciprocal interaction between motor and sensory systems. Similar to other primates, there is double representation of the digits and wrists within the human primary motor cortex (M1), which are generally referred to as area 4 anterior (M1-4a) and area 4 posterior (M1-4p). In this high-field (3.0 T) functional magnetic resonance imaging (fMRI) study, we hypothesized that M1-4p is more important for initiation of motion, whereas M1-4a is important for execution of a given motion involving more complex sensoriomotor interaction. We investigated M1-4a and M1-4p activation associated with two representative motor tasks, namely, finger tapping (voluntary motion, VM) and passive finger movement accomplished by continuous pressure (passive motor, PM), and two representative sensory stimulations, namely, simple stimulation of flutter vibration (simple sensory, SS), and complex stimulation by a row of pins moving either vertically or horizontally (complex sensory, CS). Both M1-4a and M1-4p were activated in both motor tasks, VM and PM. M1-4p was not activated by either of the two sensory tasks, whereas M1-4a was activated by CS but not by SS. Analysis of the center of gravities (COG) of the activated areas showed that VM and PM moved COG towards M1-4p and 3a. SS moved COG towards somatosensory cortex Brodmann areas 1, 2, and 3b, whereas CS towards M1-4a. The result clearly showed that M1-4a represents the area of secondary motor execution, which actively participates in CS processing.

[Cortical Areas for Controlling Voluntary Movements].

Science.gov (United States)

Nakayama, Yoshihisa; Hoshi, Eiji

2017-04-01

The primary motor cortex is located in Brodmann area 4 at the most posterior part of the frontal lobe. The primary motor cortex corresponds to an output stage of motor signals, sending motor commands to the brain stem and spinal cord. Brodmann area 6 is rostral to Brodmann area 4, where multiple higher-order motor areas are located. The premotor area, which is located in the lateral part, is involved in planning and executing action based on sensory signals. The premotor area contributes to the reaching for and grasping of an object to achieve a behavioral goal. The supplementary motor area, which occupies the mesial aspect, is involved in planning and executing actions based on internalized or memorized signals. The supplementary motor area plays a central role in bimanual movements, organizing multiple movements, and switching from a routine to a controlled behavior. Thus, Brodmann areas 4 and 6 are considered as central motor areas in the cerebral cortex, in which the idea of an action is transformed to an actual movement in a variety of contexts.

Differentiation of Enhancing Glioma and Primary Central Nervous System Lymphoma by Texture-Based Machine Learning.

Science.gov (United States)

Alcaide-Leon, P; Dufort, P; Geraldo, A F; Alshafai, L; Maralani, P J; Spears, J; Bharatha, A

2017-06-01

Accurate preoperative differentiation of primary central nervous system lymphoma and enhancing glioma is essential to avoid unnecessary neurosurgical resection in patients with primary central nervous system lymphoma. The purpose of the study was to evaluate the diagnostic performance of a machine-learning algorithm by using texture analysis of contrast-enhanced T1-weighted images for differentiation of primary central nervous system lymphoma and enhancing glioma. Seventy-one adult patients with enhancing gliomas and 35 adult patients with primary central nervous system lymphomas were included. The tumors were manually contoured on contrast-enhanced T1WI, and the resulting volumes of interest were mined for textural features and subjected to a support vector machine-based machine-learning protocol. Three readers classified the tumors independently on contrast-enhanced T1WI. Areas under the receiver operating characteristic curves were estimated for each reader and for the support vector machine classifier. A noninferiority test for diagnostic accuracy based on paired areas under the receiver operating characteristic curve was performed with a noninferiority margin of 0.15. The mean areas under the receiver operating characteristic curve were 0.877 (95% CI, 0.798-0.955) for the support vector machine classifier; 0.878 (95% CI, 0.807-0.949) for reader 1; 0.899 (95% CI, 0.833-0.966) for reader 2; and 0.845 (95% CI, 0.757-0.933) for reader 3. The mean area under the receiver operating characteristic curve of the support vector machine classifier was significantly noninferior to the mean area under the curve of reader 1 ( P = .021), reader 2 ( P = .035), and reader 3 ( P = .007). Support vector machine classification based on textural features of contrast-enhanced T1WI is noninferior to expert human evaluation in the differentiation of primary central nervous system lymphoma and enhancing glioma. © 2017 by American Journal of Neuroradiology.

Green tribology: principles, research areas and challenges.

Science.gov (United States)

Nosonovsky, Michael; Bhushan, Bharat

2010-10-28

In this introductory paper for the Theme Issue on green tribology, we discuss the concept of green tribology and its relation to other areas of tribology as well as other 'green' disciplines, namely, green engineering and green chemistry. We formulate the 12 principles of green tribology: the minimization of (i) friction and (ii) wear, (iii) the reduction or complete elimination of lubrication, including self-lubrication, (iv) natural and (v) biodegradable lubrication, (vi) using sustainable chemistry and engineering principles, (vii) biomimetic approaches, (viii) surface texturing, (ix) environmental implications of coatings, (x) real-time monitoring, (xi) design for degradation, and (xii) sustainable energy applications. We further define three areas of green tribology: (i) biomimetics for tribological applications, (ii) environment-friendly lubrication, and (iii) the tribology of renewable-energy application. The integration of these areas remains a primary challenge for this novel area of research. We also discuss the challenges of green tribology and future directions of research.

Plasmacytoma Mimicking Mediastinal Parathyroid Tumour in a Patient with Primary Hyperparathyroidism

Directory of Open Access Journals (Sweden)

Jubbin Jagan Jacob

2007-04-01

Full Text Available The association of monoclonal gammopathies with primary hyperparathyroidism is well documented. Many case reports have documented the coexistence of primary hyperparathyroidism and multiple myeloma. The cause of this relationship is not known. We report the case of a 49-year-old gentleman who was treated for primary hyperparathyroidism. His initial preoperative nuclear scan had shown persistent activity and retention of tracer in the retrosternal region in addition to the discrete hot spot in the region of the lower pole of the left lobe of the thyroid. During surgery, the enlarged left inferior parathyroid gland was removed. In addition, the retrosternal area was also explored and found to be normal. Ten months later, he developed a mass in the region of the manubrium sternii which was proven to be a plasmacytoma. We review the literature for similar cases and suggest hypotheses for a possible association. In conclusion, coexisting plasma cell dyscrasias including plasmacytoma should be considered in patients with primary hyperparathyroidism.

Brain tumor - primary - adults

Science.gov (United States)

... Vestibular schwannoma (acoustic neuroma) - adults; Meningioma - adults; Cancer - brain tumor (adults) ... Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, ...

Tech Area II: A history

Energy Technology Data Exchange (ETDEWEB)

Ullrich, R. [Ktech Corp., Albuquerque, NM (United States)

1998-07-01

This report documents the history of the major buildings in Sandia National Laboratories` Technical Area II. It was prepared in support of the Department of Energy`s compliance with Section 106 of the National Historic Preservation Act. Technical Area II was designed and constructed in 1948 specifically for the final assembly of the non-nuclear components of nuclear weapons, and was the primary site conducting such assembly until 1952. Both the architecture and location of the oldest buildings in the area reflect their original purpose. Assembly activities continued in Area II from 1952 to 1957, but the major responsibility for this work shifted to other sites in the Atomic Energy Commission`s integrated contractor complex. Gradually, additional buildings were constructed and the original buildings were modified. After 1960, the Area`s primary purpose was the research and testing of high-explosive components for nuclear weapons. In 1994, Sandia constructed new facilities for work on high-explosive components outside of the original Area II diamond-shaped parcel. Most of the buildings in the area are vacant and Sandia has no plans to use them. They are proposed for decontamination and demolition as funding becomes available.

The Impact of a Primary Care Education Program Regarding Cancer Survivorship Care Plans: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

Science.gov (United States)

Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Feldstein, David A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J

2017-09-20

Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.

Avian Monitoring and Risk Assessment at the San Gorgonio Wind Resource Area

Energy Technology Data Exchange (ETDEWEB)

Anderson, R.; Tom, J.; Neumann, N.; Erickson, W. P.; Strickland, M. D.; Bourassa, M.; Bay, K. J.; Sernka, K. J.

2005-08-01

The primary objective of this study at the San Gorgonio Wind Resource Area was to estimate and compare bird utilization, fatality rates, and the risk index among factors including bird taxonomic groups, wind turbine and reference areas, wind turbine sizes and types, and geographic locations. The key questions addressed to meet this objective include: (1) Are there any differences in the level of bird activity, called ''utilization rate'' or ''use'', with the operating wind plant and within the surrounding undeveloped areas (reference area)?; (2) Are there any differences in the rate of bird fatalities (or avian fatality) within the operating wind plant or the surrounding undeveloped areas (reference area)?; (3) Does bird use, fatality rates, or bird risk index vary according to the geographic location, type and size of wind turbine, and/or type of bird within the operating wind plant and surrounding undeveloped areas (reference area)?; and (4) How do raptor fatality rates at San Gorgonio compare to other wind projects with comparable data?

Development and evolution of the vertebrate primary mouth

Science.gov (United States)

Soukup, Vladimír; Horácek, Ivan; Cerny, Robert

2013-01-01

The vertebrate oral region represents a key interface between outer and inner environments, and its structural and functional design is among the limiting factors for survival of its owners. Both formation of the respective oral opening (primary mouth) and establishment of the food-processing apparatus (secondary mouth) require interplay between several embryonic tissues and complex embryonic rearrangements. Although many aspects of the secondary mouth formation, including development of the jaws, teeth or taste buds, are known in considerable detail, general knowledge about primary mouth formation is regrettably low. In this paper, primary mouth formation is reviewed from a comparative point of view in order to reveal its underestimated morphogenetic diversity among, and also within, particular vertebrate clades. In general, three main developmental modes were identified. The most common is characterized by primary mouth formation via a deeply invaginated ectodermal stomodeum and subsequent rupture of the bilaminar oral membrane. However, in salamander, lungfish and also in some frog species, the mouth develops alternatively via stomodeal collar formation contributed both by the ecto- and endoderm. In ray-finned fishes, on the other hand, the mouth forms via an ectoderm wedge and later horizontal detachment of the initially compressed oral epithelia with probably a mixed germ-layer derivation. A very intriguing situation can be seen in agnathan fishes: whereas lampreys develop their primary mouth in a manner similar to the most common gnathostome pattern, hagfishes seem to undergo a unique oropharyngeal morphogenesis when compared with other vertebrates. In discussing the early formative embryonic correlates of primary mouth formation likely to be responsible for evolutionary–developmental modifications of this area, we stress an essential role of four factors: first, positioning and amount of yolk tissue; closely related to, second, endoderm formation during

Barriers to primary care responsiveness to poverty as a risk factor for health.

Science.gov (United States)

Bloch, Gary; Rozmovits, Linda; Giambrone, Broden

2011-06-29

Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage. One to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes. This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty. While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty. The consistent

Bryophyte-Cyanobacteria Associations during Primary Succession in Recently Deglaciated Areas of Tierra del Fuego (Chile)

Science.gov (United States)

Arróniz-Crespo, María; Pérez-Ortega, Sergio; De los Ríos, Asunción; Green, T. G. Allan; Ochoa-Hueso, Raúl; Casermeiro, Miguel Ángel; de la Cruz, María Teresa; Pintado, Ana; Palacios, David; Rozzi, Ricardo; Tysklind, Niklas; Sancho, Leopoldo G.

2014-01-01

Bryophyte establishment represents a positive feedback process that enhances soil development in newly exposed terrain. Further, biological nitrogen (N) fixation by cyanobacteria in association with mosses can be an important supply of N to terrestrial ecosystems, however the role of these associations during post-glacial primary succession is not yet fully understood. Here, we analyzed chronosequences in front of two receding glaciers with contrasting climatic conditions (wetter vs drier) at Cordillera Darwin (Tierra del Fuego) and found that most mosses had the capacity to support an epiphytic flora of cyanobacteria and exhibited high rates of N2 fixation. Pioneer moss-cyanobacteria associations showed the highest N2 fixation rates (4.60 and 4.96 µg N g−1 bryo. d−1) very early after glacier retreat (4 and 7 years) which may help accelerate soil development under wetter conditions. In drier climate, N2 fixation on bryophyte-cyanobacteria associations was also high (0.94 and 1.42 µg N g−1 bryo. d−1) but peaked at intermediate-aged sites (26 and 66 years). N2 fixation capacity on bryophytes was primarily driven by epiphytic cyanobacteria abundance rather than community composition. Most liverworts showed low colonization and N2 fixation rates, and mosses did not exhibit consistent differences across life forms and habitat (saxicolous vs terricolous). We also found a clear relationship between cyanobacteria genera and the stages of ecological succession, but no relationship was found with host species identity. Glacier forelands in Tierra del Fuego show fast rates of soil transformation which imply large quantities of N inputs. Our results highlight the potential contribution of bryophyte-cyanobacteria associations to N accumulation during post-glacial primary succession and further describe the factors that drive N2-fixation rates in post-glacial areas with very low N deposition. PMID:24819926

Bryophyte-cyanobacteria associations during primary succession in recently Deglaciated areas of Tierra del Fuego (Chile).

Science.gov (United States)

Arróniz-Crespo, María; Pérez-Ortega, Sergio; De Los Ríos, Asunción; Green, T G Allan; Ochoa-Hueso, Raúl; Casermeiro, Miguel Ángel; de la Cruz, María Teresa; Pintado, Ana; Palacios, David; Rozzi, Ricardo; Tysklind, Niklas; Sancho, Leopoldo G

2014-01-01

Bryophyte establishment represents a positive feedback process that enhances soil development in newly exposed terrain. Further, biological nitrogen (N) fixation by cyanobacteria in association with mosses can be an important supply of N to terrestrial ecosystems, however the role of these associations during post-glacial primary succession is not yet fully understood. Here, we analyzed chronosequences in front of two receding glaciers with contrasting climatic conditions (wetter vs drier) at Cordillera Darwin (Tierra del Fuego) and found that most mosses had the capacity to support an epiphytic flora of cyanobacteria and exhibited high rates of N2 fixation. Pioneer moss-cyanobacteria associations showed the highest N2 fixation rates (4.60 and 4.96 µg N g-1 bryo. d-1) very early after glacier retreat (4 and 7 years) which may help accelerate soil development under wetter conditions. In drier climate, N2 fixation on bryophyte-cyanobacteria associations was also high (0.94 and 1.42 µg N g-1 bryo. d-1) but peaked at intermediate-aged sites (26 and 66 years). N2 fixation capacity on bryophytes was primarily driven by epiphytic cyanobacteria abundance rather than community composition. Most liverworts showed low colonization and N2 fixation rates, and mosses did not exhibit consistent differences across life forms and habitat (saxicolous vs terricolous). We also found a clear relationship between cyanobacteria genera and the stages of ecological succession, but no relationship was found with host species identity. Glacier forelands in Tierra del Fuego show fast rates of soil transformation which imply large quantities of N inputs. Our results highlight the potential contribution of bryophyte-cyanobacteria associations to N accumulation during post-glacial primary succession and further describe the factors that drive N2-fixation rates in post-glacial areas with very low N deposition.

Within-digit functional parcellation of Brodmann areas of the human primary somatosensory cortex using functional magnetic resonance imaging at 7 tesla.

Science.gov (United States)

Sanchez-Panchuelo, Rosa M; Besle, Julien; Beckett, Alex; Bowtell, Richard; Schluppeck, Denis; Francis, Susan

2012-11-07

The primary somatosensory cortex (S1) can be subdivided cytoarchitectonically into four distinct Brodmann areas (3a, 3b, 1, and 2), but these areas have never been successfully delineated in vivo in single human subjects. Here, we demonstrate the functional parcellation of four areas of S1 in individual human subjects based on high-resolution functional MRI measurements made at 7 T using vibrotactile stimulation. By stimulating four sites along the length of the index finger, we were able to identify and locate map reversals of the base to tip representation of the index finger in S1. We suggest that these reversals correspond to the areal borders between the mirrored representations in the four Brodmann areas, as predicted from electrophysiology measurements in nonhuman primates. In all subjects, maps were highly reproducible across scanning sessions and stable over weeks. In four of the six subjects scanned, four, mirrored, within-finger somatotopic maps defining the extent of the Brodmann areas could be directly observed on the cortical surface. In addition, by using multivariate classification analysis, the location of stimulation on the index finger (four distinct sites) could be decoded with a mean accuracy of 65% across subjects. Our measurements thus show that within-finger topography is present at the millimeter scale in the cortex and is highly reproducible. The ability to identify functional areas of S1 in vivo in individual subjects will provide a framework for investigating more complex aspects of tactile representation in S1.

PRIMARY PALLIATIVE CARE? - Treating terminally ill cancer patients in the primary care sector

DEFF Research Database (Denmark)

Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Olesen, Frede

BACKGROUND. Palliative care for cancer patients is an important part of a GP's work. Although every GP is frequently involved in care for terminally ill cancer patients, only little is known about how these palliative efforts are perceived by the patients and their families, a knowledge...... that is vital to further improve palliative care in the primary sector.AIM. The aim of the study was to analyse the quality of palliative home care with focus on the GP's role based on evaluations by relatives of recently deceased cancer patients and professionals from both the primary and secondary health care...... approach.RESULTS. The analyses revealed several key areas, e.g.: 1) How to take, give and maintain professional responsibility for palliative home care. 2) A need for transparent communication both among primary care professionals and among professionals across the primary/secondary interface. 3...

Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

Science.gov (United States)

Laraque-Arena, Danielle; Frintner, Mary Pat; Cull, William L

2016-01-01

To examine whether resident characteristics and experiences are related to practice in underserved areas. Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All

[Community health in primary health care teams: a management objective].

Science.gov (United States)

Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex

2016-12-01

To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Should All Patients Be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?

Science.gov (United States)

Rozell, Joshua C; Courtney, Paul M; Dattilo, Jonathan R; Wu, Chia H; Lee, Gwo-Chin

2016-09-01

Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care. We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions. During this 9-month period, 115 patients (14.3%) required hospitalization >3 days and 16 (1.99%) were readmitted within 90 days. Univariate analysis demonstrated that preoperative narcotic use, heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and liver disease were more likely to require hospitalization >3 days. In multivariate analysis, CKD and COPD were independent risk factors for LOS >3 days. A Charlson comorbidity index >5 points was associated with increased LOS and readmissions. Patients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

Influence of hydrazine primary water chemistry on corrosion of fuel cladding and primary circuit components

International Nuclear Information System (INIS)

Iourmanov, V.; Pashevich, V.; Bogancs, J.; Tilky, P.; Schunk, J.; Pinter, T.

1999-01-01

Earlier at Paks 1-4 NPP standard ammonia chemistry was in use. The following station performance indicators were improved when hydrazine primary water chemistry was introduced: occupational radiation exposures of personnel; gamma-radiation dose rates near primary system components during refuelling and maintenance outages. The reduction of radiation exposures and radiation fields were achieved without significant expenses. Recent results of experimental studies allowed to explain the mechanism of hydrazine dosing influence on: corrosion rate of structure materials in primary coolant; behaviour of soluble and insoluble corrosion products including long-life corrosion-induced radionuclides in primary system during steady-state and transient operation modes; radiolytic generation of oxidising radiolytic products in core and its corrosion activity in primary system; radiation situation during refuelling and maintenance outages; foreign material degradation and removal (including corrosion active oxidant species) from primary system during abnormal events. Operational experience and experimental data have shown that hydrazine primary water chemistry allows to reduce corrosion wear and thereby makes it possible to extend the life-time of plant components in primary system. (author)

Cleanup procedures at the Nevada Test Site and at other radioactively contaminated sites including representative costs of cleanup and treatment of contaminated areas

International Nuclear Information System (INIS)

Talmage, S.S.; Chilton, B.D.

1987-09-01

This review summarizes available information on cleanup procedures at the Nevada Test Site and at other radioactively contaminated sites. Radionuclide distribution and inventory, size of the contaminated areas, equipment, and cleanup procedures and results are included. Information about the cost of cleanup and treatment for contaminated land is presented. Selected measures that could be useful in estimating the costs of cleaning up radioactively contaminated areas are described. 76 refs., 16 tabs

Glial tumors in brodmann area 6: spread pattern and relationships to motor areas.

Science.gov (United States)

Shah, Komal B; Hayman, L Anne; Chavali, Lakshmi S; Hamilton, Jackson D; Prabhu, Sujit S; Wangaryattawanich, Pattana; Kumar, Vinodh A; Kumar, Ashok J

2015-01-01

The posterior frontal lobe of the brain houses Brodmann area 4, which is the primary motor cortex, and Brodmann area 6, which consists of the supplementary motor area on the medial portion of the hemisphere and the premotor cortex on the lateral portion. In this area, safe resection is dependent on accurate localization of the motor cortex and the central sulcus, which can usually be achieved by using thin-section imaging and confirmed by using other techniques. The most reliable anatomic landmarks are the "hand knob" area and the marginal ramus of the cingulate sulcus. Postoperatively, motor deficits can occur not only because of injury to primary motor cortex but also because of injury to the supplementary motor area. Unlike motor cortex injury, the supplementary motor area syndrome is transient, if it occurs at all. On the lateral hemisphere, motor and language deficits can also occur because of premotor cortex injury, but a dense motor deficit would indicate subcortical injury to the corticospinal tract. The close relationship of the subcortical motor fibers and premotor cortex is illustrated. In contrast to the more constant landmarks of the central sulcus and marginal ramus, which aid in preoperative localization, the variable interruptions in the precentral and cingulate sulci of the posterior frontal lobe seem to provide "cortical bridges" for spread of infiltrating gliomas. (©)RSNA, 2015.

Plutonium focus area: Technology summary

International Nuclear Information System (INIS)

1996-03-01

To ensure research and development programs focus on the most pressing environmental restoration and waste management problems at the U.S. Department of Energy (DOE), the Assistant Secretary for the Office of Environmental Management (EM) established a working group in August 1993 to implement a new approach to research and technology development. As part of this approach, EM developed a management structure and principles that led to creation of specific focus areas. These organizations were designed to focus scientific and technical talent throughout DOE and the national scientific community on major environmental restoration and waste management problems facing DOE. The focus area approach provides the framework for inter-site cooperation and leveraging of resources on common problems. After the original establishment of five major focus areas within the Office of Technology Development (EM-50), the Nuclear Materials Stabilization Task Group (NMSTG, EM-66) followed EM-50's structure and chartered the Plutonium Focus Area (PFA). NMSTG's charter to the PFA, described in detail later in this book, plays a major role in meeting the EM-66 commitments to the Defense Nuclear Facilities Safety Board (DNFSB). The PFA is a new program for FY96 and as such, the primary focus of revision 0 of this Technology Summary is an introduction to the Focus Area; its history, development, and management structure, including summaries of selected technologies being developed. Revision 1 to the Plutonium Focus Area Technology Summary is slated to include details on all technologies being developed, and is currently planned for release in August 1996. The following report outlines the scope and mission of the Office of Environmental Management, EM-60, and EM-66 organizations as related to the PFA organizational structure

Development of a Knowledge Management Model for the Development of a Quality Public Sector Management System for the Office of the Primary Educational Service Area

Science.gov (United States)

Khotbancha, Wijitra; Chantarasombat, Chalard; Sriampai, Anan

2015-01-01

The objectives of this research were: 1) to study the current situation and problem of Knowledge Management of the office of the primary education service area, 2) to develop a Knowledge Management model, 3) to study the success of the implementation of the Knowledge Management system. There were 25 persons in the target group. There were 2 kinds…

Electronic health records and support for primary care teamwork

Science.gov (United States)

Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A.; Scholle, Sarah Hudson

2015-01-01

Objective Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Methods Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. Results EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Discussion Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. Conclusions EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. PMID:25627278

Electronic health records and support for primary care teamwork.

Science.gov (United States)

O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson

2015-03-01

Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Prevalence of refractive error in malay primary school children in suburban area of Kota Bharu, Kelantan, Malaysia.

Science.gov (United States)

Hashim, Syaratul-Emma; Tan, Hui-Ken; Wan-Hazabbah, W H; Ibrahim, Mohtar

2008-11-01

Refractive error remains one of the primary causes of visual impairment in children worldwide, and the prevalence of refractive error varies widely. The objective of this study was to determine the prevalence of refractive error and study the possible associated factors inducing refractive error among primary school children of Malay ethnicity in the suburban area of Kota Bharu, Kelantan, Malaysia. A school-based cross-sectional study was performed from January to July 2006 by random selection on Standard 1 to Standard 6 students of 10 primary schools in the Kota Bharu district. Visual acuity assessment was measured using logMAR ETDRS chart. Positive predictive value of uncorrected visual acuity equal or worse than 20/40, was used as a cut-off point for further evaluation by automated refraction and retinoscopic refraction. A total of 840 students were enumerated but only 705 were examined. The prevalence of uncorrected visual impairment was seen in 54 (7.7%) children. The main cause of the uncorrected visual impairment was refractive error which contributed to 90.7% of the total, and with 7.0% prevalence for the studied population. Myopia is the most common type of refractive error among children aged 6 to 12 years with prevalence of 5.4%, followed by hyperopia at 1.0% and astigmatism at 0.6%. A significant positive correlation was noted between myopia development with increasing age (P <0.005), more hours spent on reading books (P <0.005) and background history of siblings with glasses (P <0.005) and whose parents are of higher educational level (P <0.005). Malays in suburban Kelantan (5.4%) have the lowest prevalence of myopia compared with Malays in the metropolitan cities of Kuala Lumpur (9.2%) and Singapore (22.1%). The ethnicity-specific prevalence rate of myopia was the lowest among Malays in Kota Bharu, followed by Kuala Lumpur, and is the highest among Singaporean Malays. Better socio-economic factors could have contributed to higher myopia rates in the

F-Area Seepage Basins Groundwater Monitoring Report: Volume 1, Third and fourth quarters 1994

International Nuclear Information System (INIS)

Chase, J.A.

1994-03-01

Isoconcentration/isoactivity maps included in this report indicate both the concentration/activity and extent of the primary contaminants in each of the three hydrostratigraphic units. Geologic cross sections indicate both the extent and depth of contamination of the primary contaminants in all of the hydrostratigraphic units during the second half of 1994. Water-level maps indicate that the groundwater flow rates and directions at the F-Area Seepage Basins have remained relatively constant since the basins ceased to be active in 1988

Illness absenteeism rates in primary and secondary schools in 2013-2014 in England: was there any impact of vaccinating children of primary-school age against influenza?

Science.gov (United States)

Green, H K; Brousseau, N; Andrews, N; Selby, L; Pebody, R

2016-09-09

A phased introduction of routine influenza vaccination of healthy children was recommended in the UK in 2012, with the aim of protecting both vaccinated children and the wider population through reducing transmission. In the first year of the programme in 2013-2014, 4- to 11-year-olds were targeted in pilot areas across England. This study assesses if this was associated with school absenteeism, an important societal burden of influenza. During the spring 2014 term when influenza predominantly circulated, the proportion of absence sessions due to illness was compared between vaccination pilot and non-pilot areas for primary schools (to measure overall impact) and secondary schools (to measure indirect impact). A linear multilevel regression model was applied, adjusting for clustering within schools and potential school-level confounders, including deprivation, past absenteeism, and ethnicity. Low levels of influenza activity were reported in the community in 2013-2014. Primary schools in pilot areas had a significantly adjusted decrease in illness absenteeism of 0·05% relative to non-pilot schools; equivalent to an average of 4 days per school. In secondary schools, there was no significant indirect impact of being located in a pilot area on illness absenteeism. These insights can be used in conjunction with routine healthcare surveillance data to evaluate the full benefits of such a programme.

Lung Parenchymal Assessment in Primary and Secondary Pneumothorax.

Science.gov (United States)

Bintcliffe, Oliver J; Edey, Anthony J; Armstrong, Lynne; Negus, Ian S; Maskell, Nick A

2016-03-01

The definition of primary spontaneous pneumothorax excludes patients with known lung disease; however, the assumption that the underlying lung is normal in these patients is increasingly contentious. The purpose of this study was to assess lung structure and compare the extent of emphysema in patients with primary versus secondary spontaneous pneumothorax and to patients with no pneumothorax in an otherwise comparable control group. We identified patients treated for pneumothorax by screening inpatient and outpatient medical records at one medical center in the United Kingdom. From this group, 20 patients had no clinically apparent underlying lung disease and were classified as having a primary spontaneous pneumothorax, and 20 patients were classified as having a secondary spontaneous pneumothorax. We assembled a control group composed of 40 subjects matched for age and smoking history who had a unilateral pleural effusion or were suspected to have a thoracic malignancy and had a chest computed tomography scan suitable for quantitative analysis. Demographics and smoking histories were collected. Quantitative evaluation of low-attenuation areas of the lung on computed tomography imaging was performed using semiautomated software, and the extent of emphysema-like destruction was assessed visually. The extent of emphysema and percentage of low-attenuation areas was greater for patients with primary spontaneous pneumothorax than for control subjects matched for age and smoking history (median, 0.25 vs. 0.00%; P = 0.019) and was also higher for patients with secondary pneumothorax than those with primary spontaneous pneumothorax (16.15 vs. 0.25%, P pneumothorax who smoked had significantly greater low-attenuation area than patients with primary pneumothorax who were nonsmokers (0.7 vs. 0.1%, P = 0.034). The majority of patients with primary spontaneous pneumothorax had quantifiable evidence of parenchymal destruction and emphysema. The exclusion of patients

[Health literacy in patients with heart failure treated in primary care].

Science.gov (United States)

Santesmases-Masana, Rosalia; González-de Paz, Luis; Real, Jordi; Borràs-Santos, Alicia; Sisó-Almirall, Antoni; Navarro-Rubio, Maria Dolors

2017-01-01

The level of health literacy is examined, as well as its conditioning factors in patients with heart failure who are seen routinely in a Primary Health Care Area. A multicentre cross-sectional study. 10 Primary care centres from the metropolitan area of Barcelona. Patients diagnosed with heart failure. to have visited the Primary Health Care centre in the last year, being able to arrive at the primary care setting independently, and voluntarily participation. Health Literacy Survey-European Union - Questionnaire (HLS-EU-Q) and Spanish version of the European Heart Failure Self-care Behaviour Scale. An analysis was made of the relationships between health literacy, self-care practices, sociodemographic, and clinical variables using ANOVA test and a multiple linear regression model. The study included 318 patients (51.2% women) with a mean age of 77.9±8.7 years. The index of health literacy of 79.6% (n=253) of the participants indicated problems in understanding healthcare information. Health literacy level was explained by academic level (P<.001), the extent of heart failure (P=.032), self-care, and age (P<.04).The academic level explained 61.6% of the health of literacy (95% bootstrap: 44.58%; 46.75%). In patients with stable heart failure, it is important to consider all factors that help patients to understand the healthcare information. Health literacy explains patient self-care attitude in heart failure. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

Science.gov (United States)

Metz, Anneke M

2017-01-01

Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating

Factors influencing turnover intention among primary care doctors: a cross-sectional study in Chongqing, China.

Science.gov (United States)

Wen, Tong; Zhang, Yan; Wang, Xue; Tang, Guo

2018-02-13

The intention to leave a job, known as turnover intention, among primary care doctors has a significant impact on primary health care service delivery. We investigated primary care doctors' turnover intention and analysed associated factors involved in primary health facilities in Chongqing, China. A total of 440 doctors were interviewed, they were selected using a multi-stage stratified random sampling method. The survey instrument was a self-administered questionnaire which assessed socio-demographic and work-related characteristics, job satisfaction and turnover intention. The data were analysed using χ 2 test, one-way analysis of variance, exploratory factor analysis and linear regression analysis. Our study found that 42.3% of the primary care doctors we sampled in Chongqing, China, intended to resign. Location, age, job title, doctor's position level, work pressure and job satisfaction were associated with turnover intention. Job satisfaction included both employment-related job satisfaction (including "your chance of promotion", "your rate of pay" and two other items) and satisfaction with the job itself (including "the freedom to choose your own method of working", "your job safety" and two other items). Improving job satisfaction, in terms of salary, promotion and job safety, is crucial for reducing turnover intention among primary care doctors. Therefore, we suggest that the government increase its financial investment in primary care facilities, especially in less-developed areas, and reform incentive mechanisms to improve the job satisfaction of primary care doctors. The government should consider policies such as establishing a social pension programme for village-level doctors and providing more opportunities for job promotion among primary care doctors, especially township-level doctors. Attention should also be paid to the impact of rapid urbanization, which could lead to increased workload or increased opportunities for career development, thus

Numerical Treatment of Two-phase Flow in Porous Media Including Specific Interfacial Area

KAUST Repository

El-Amin, Mohamed; Meftah, R.; Salama, Amgad; Sun, Shuyu

2015-01-01

-matrices method which can reduce the time-consuming operations. A new iterative implicit algorithm has been developed to solve the problem under consideration. All advection and advection-like terms that appear in saturation equation and interfacial area equation

Primary stabbing headache.

Science.gov (United States)

Pareja, Juan A; Sjaastad, Ottar

2010-01-01

Primary stabbing headache is characterized by transient, cephalic ultrashort stabs of pain. It is a frequent complaint with a prevalence of 35.2%, a female preponderance, and a mean age of onset of 28 years (Vågå study). Attacks are generally characterized by moderate to severe, jabbing or stabbing pain, lasting from a fraction of a second to 3s. Attack frequency is generally low, with one or a few attacks per day. The paroxysms generally occur spontaneously, during daytime. Most patients exhibit a sporadic pattern, with an erratic, unpredictable alternation between symptomatic and non-symptomatic periods. Paroxysms are almost invariably unilateral. Temporal and fronto-ocular areas are most frequently affected. Attacks tend to move from one area to another, in either the same or the opposite hemicranium. Jabs may be accompanied by a shock-like feeling and even by head movement - "jolts" -or vocalization. On rare occasions, conjunctival hemorrhage and monocular vision loss have been described as associated features. Primary stabbing headache may concur, synchronously or independently, with other primary headaches. In contrast to what is the case in adults, in childhood it is not usually associated with other headaches. Treatment is rarely necessary. Indomethacin, 75-150 mg daily, may seem to be of some avail. Celecoxib, nifedipine, melatonin, and gabapentin have been reported to be effective in isolated cases and small series of patients. The drug studies need corroboration. Copyright © 2011 Elsevier B.V. All rights reserved.

Mathematical modeling of atmospheric fine particle-associated primary organic compound concentrations

Science.gov (United States)

Rogge, Wolfgang F.; Hildemann, Lynn M.; Mazurek, Monica A.; Cass, Glen R.; Simoneit, Bernd R. T.

1996-08-01

An atmospheric transport model has been used to explore the relationship between source emissions and ambient air quality for individual particle phase organic compounds present in primary aerosol source emissions. An inventory of fine particulate organic compound emissions was assembled for the Los Angeles area in the year 1982. Sources characterized included noncatalyst- and catalyst-equipped autos, diesel trucks, paved road dust, tire wear, brake lining dust, meat cooking operations, industrial oil-fired boilers, roofing tar pots, natural gas combustion in residential homes, cigarette smoke, fireplaces burning oak and pine wood, and plant leaf abrasion products. These primary fine particle source emissions were supplied to a computer-based model that simulates atmospheric transport, dispersion, and dry deposition based on the time series of hourly wind observations and mixing depths. Monthly average fine particle organic compound concentrations that would prevail if the primary organic aerosol were transported without chemical reaction were computed for more than 100 organic compounds within an 80 km × 80 km modeling area centered over Los Angeles. The monthly average compound concentrations predicted by the transport model were compared to atmospheric measurements made at monitoring sites within the study area during 1982. The predicted seasonal variation and absolute values of the concentrations of the more stable compounds are found to be in reasonable agreement with the ambient observations. While model predictions for the higher molecular weight polycyclic aromatic hydrocarbons (PAH) are in agreement with ambient observations, lower molecular weight PAH show much higher predicted than measured atmospheric concentrations in the particle phase, indicating atmospheric decay by chemical reactions or evaporation from the particle phase. The atmospheric concentrations of dicarboxylic acids and aromatic polycarboxylic acids greatly exceed the contributions that

Primary amenorrhea: diagnosis and management.

Science.gov (United States)

Marsh, Courtney A; Grimstad, Frances W

2014-10-01

Puberty is a defining time of many adolescents' lives. It is a series of events that includes thelarche, pubarche, and menarche. Primary amenorrhea is the absence of menarche. There are numerous etiologies including outflow tract obstructions, gonadal dysgenesis, and anomalies of the hypothalamic axis. This review's aims are to define primary amenorrhea and describe the various causes, their workups, associated comorbidities, and treatment options. At the end, a generalist should be able to perform an assessment of an adolescent who presents with primary amenorrhea and, if warranted, begin initial treatment.

Global net primary production and heterotrophic respiration for 1987

Energy Technology Data Exchange (ETDEWEB)

Hunt, R.E. Jr.; Piper, S.C.; Nemani, R. [Univ. of Montana, Missoula, MT (United States)]|[Scripps Institute of Oceanography, La Jolla, CA (United States)] [and others

1995-06-01

An ecosystem process model, BIOME-BGC, was parameterized and used to simulate the actual net primary production and heterotrophic respiration using daily climatic data, land cover type, leaf area index gridded to 1{degree} latitude by 1{degree} longitude grid cells for the year 1987. Global net primary production was 52 Pg C. These estimates were validated directly by two different methods. First, the grid cells were aggregated and used as inputs to a 3D atmospheric transport model, to compare CO{sub 2} station data with predictions. We simulated the intra-annual variation of atmospheric CO{sub 2} well for the northern hemisphere, but not for the southern hemisphere. Second, we calculated the net {sup 13}C uptake of vegetation, which is a function of water use efficiency. The {sup 13}C/{sup 12}C ratios agreed with measured data, indicating a strong limitation of global primary processes by the hydrologic cycle, especially precipitation. These are different from other global carbon models as we can simulate the year-to-year variation of climate, including El Nino, on the global carbon cycle.

An Agent-Based Model for Addressing the Impact of a Disaster on Access to Primary Care Services.

Science.gov (United States)

Guclu, Hasan; Kumar, Supriya; Galloway, David; Krauland, Mary; Sood, Rishi; Bocour, Angelica; Hershey, Tina Batra; van Nostrand, Elizabeth; Potter, Margaret

2016-06-01

Hurricane Sandy in the Rockaways, Queens, forced residents to evacuate and primary care providers to close or curtail operations. A large deficit in primary care access was apparent in the immediate aftermath of the storm. Our objective was to build a computational model to aid responders in planning to situate primary care services in a disaster-affected area. Using an agent-based modeling platform, HAZEL, we simulated the Rockaways population, its evacuation behavior, and primary care providers' availability in the aftermath of Hurricane Sandy. Data sources for this model included post-storm and community health surveys from New York City, a survey of the Rockaways primary care providers, and research literature. The model then tested geospatially specific interventions to address storm-related access deficits. The model revealed that areas of high primary care access deficit were concentrated in the eastern part of the Rockaways. Placing mobile health clinics in the most populous census tracts reduced the access deficit significantly, whereas increasing providers' capacity by 50% reduced the deficit to a lesser degree. An agent-based model may be a useful tool to have in place so that policy makers can conduct scenario-based analyses to plan interventions optimally in the event of a disaster. (Disaster Med Public Health Preparedness. 2016;10:386-393).

Computation of aquatic primary production: Extended formalism to include effect of angular and spectral distribution of light

Digital Repository Service at National Institute of Oceanography (India)

Sathyendranath, S.; Platt, T.

and utilization by algal cells. Neglecting the effect of angular distribution on the light absorbed by phytoplankton can lead to underestimation of primary production. For the stations studied as examples, the minimum correction required is 5-l3% for daily, column...

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, ... selected from each of the ten wards in the LGA using multistage sampling technique. ..... Knowledge of HIV/AIDS Insurance Companies in Lagos State.

A Holistic Approach Including Biological and Geological Criteria for Integrative Management in Protected Areas.

Science.gov (United States)

Peña, Lorena; Monge-Ganuzas, Manu; Onaindia, Miren; De Manuel, Beatriz Fernández; Mendia, Miren

2017-02-01

Biodiversity hotspots and geosites are indivisible parts of natural heritage. Therefore, an adequate spatial delimitation and understanding of both and their linkages are necessary in order to be able to establish conservation policies. Normally, biodiversity hotspots are a typical target for those policies but, generally, geosites are not taken into account. Thus, this paper aims to fill this gap by providing an easily replicable method for the identification and integration of the geosites and the biodiversity hotspots in a Network for Integrative Nature Conservation that highlights their linkages. The method here presented has been applied to Urdaibai Biosphere Reserve situated in southeastern of the Bay of Biscay. The obtained results indicate that some geosites that are not directly related with biodiversity hotspots remain unprotected. Thus, from the study carried out, it can be stated that we conserving just the biodiversity hotspots is not enough to conserve the whole natural heritage of a protected area, as some plots interesting due to their relevant geoheritage remain unprotected. Therefore, it is necessary to fully integrate geosites into the planning documents of protected areas as a part of an ecosystem approach. The ecosystem approach recognizes the integrity of abiotic and biotic elements in nature conservation policies. Moreover, the proposed framework and the innovative methodology can be used as an easy input to identify priority areas for conservation, to improve the protected areas conservation planning, and to demonstrate the linkages between biodiversity hotspots and geosites.

A Holistic Approach Including Biological and Geological Criteria for Integrative Management in Protected Areas

Science.gov (United States)

Peña, Lorena; Monge-Ganuzas, Manu; Onaindia, Miren; De Manuel, Beatriz Fernández; Mendia, Miren

2017-02-01

Biodiversity hotspots and geosites are indivisible parts of natural heritage. Therefore, an adequate spatial delimitation and understanding of both and their linkages are necessary in order to be able to establish conservation policies. Normally, biodiversity hotspots are a typical target for those policies but, generally, geosites are not taken into account. Thus, this paper aims to fill this gap by providing an easily replicable method for the identification and integration of the geosites and the biodiversity hotspots in a Network for Integrative Nature Conservation that highlights their linkages. The method here presented has been applied to Urdaibai Biosphere Reserve situated in southeastern of the Bay of Biscay. The obtained results indicate that some geosites that are not directly related with biodiversity hotspots remain unprotected. Thus, from the study carried out, it can be stated that we conserving just the biodiversity hotspots is not enough to conserve the whole natural heritage of a protected area, as some plots interesting due to their relevant geoheritage remain unprotected. Therefore, it is necessary to fully integrate geosites into the planning documents of protected areas as a part of an ecosystem approach. The ecosystem approach recognizes the integrity of abiotic and biotic elements in nature conservation policies. Moreover, the proposed framework and the innovative methodology can be used as an easy input to identify priority areas for conservation, to improve the protected areas conservation planning, and to demonstrate the linkages between biodiversity hotspots and geosites.

Management of primary-to-secondary leaks at Loviisa nuclear power plant

Energy Technology Data Exchange (ETDEWEB)

Mohnsen, B.; Jaenkaelae, K. [IVO International Ltd, Vantaa (Finland)

1995-12-31

The Loviisa Nuclear power plant consisting of two VVER-440 type press water reactor units has been in commercial operation since the late 1970`s. Specific features for VVER-440 reactors are six primary loops with horizontal steam generators and main gate valves. The structure of the horizontal steam generators construction may cause a large primary to secondary leak in case of a break in the cover of the primary collector. An accident where two primary collector covers opened totally and two covers opened partly took place in Rovno, Ukraine January 1982. Primary to secondary leaks are one of the main contributors to the core melt frequency in VVER reactors according to the Loviisa 1 Probabilistic Safety Assessment. The high core damage contribution has set requirements for the development of effective means to cope with all sizes of primary to secondary leaks in the steam generator. A concept for all leak sizes has been developed for Loviisa 1 and 2. The solution includes four main areas which are a new steam generator leakage monitoring system based on nitrogen-16 measurement, an upgraded pressurizer spray system, an increased emergency cooling water reserve and an automated isolation of the defected steam generator.

Management of primary-to-secondary leaks at Loviisa nuclear power plant

International Nuclear Information System (INIS)

Mohnsen, B.; Jaenkaelae, K.

1995-01-01

The Loviisa Nuclear power plant consisting of two VVER-440 type press water reactor units has been in commercial operation since the late 1970's. Specific features for VVER-440 reactors are six primary loops with horizontal steam generators and main gate valves. The structure of the horizontal steam generators construction may cause a large primary to secondary leak in case of a break in the cover of the primary collector. An accident where two primary collector covers opened totally and two covers opened partly took place in Rovno, Ukraine January 1982. Primary to secondary leaks are one of the main contributors to the core melt frequency in VVER reactors according to the Loviisa 1 Probabilistic Safety Assessment. The high core damage contribution has set requirements for the development of effective means to cope with all sizes of primary to secondary leaks in the steam generator. A concept for all leak sizes has been developed for Loviisa 1 and 2. The solution includes four main areas which are a new steam generator leakage monitoring system based on nitrogen-16 measurement, an upgraded pressurizer spray system, an increased emergency cooling water reserve and an automated isolation of the defected steam generator

Management of primary-to-secondary leaks at Loviisa nuclear power plant

Energy Technology Data Exchange (ETDEWEB)

Mohnsen, B; Jaenkaelae, K [IVO International Ltd, Vantaa (Finland)

1996-12-31

The Loviisa Nuclear power plant consisting of two VVER-440 type press water reactor units has been in commercial operation since the late 1970`s. Specific features for VVER-440 reactors are six primary loops with horizontal steam generators and main gate valves. The structure of the horizontal steam generators construction may cause a large primary to secondary leak in case of a break in the cover of the primary collector. An accident where two primary collector covers opened totally and two covers opened partly took place in Rovno, Ukraine January 1982. Primary to secondary leaks are one of the main contributors to the core melt frequency in VVER reactors according to the Loviisa 1 Probabilistic Safety Assessment. The high core damage contribution has set requirements for the development of effective means to cope with all sizes of primary to secondary leaks in the steam generator. A concept for all leak sizes has been developed for Loviisa 1 and 2. The solution includes four main areas which are a new steam generator leakage monitoring system based on nitrogen-16 measurement, an upgraded pressurizer spray system, an increased emergency cooling water reserve and an automated isolation of the defected steam generator.

The primary immune response to Vaccinia virus vaccination includes cells with a distinct cytotoxic effector CD4 T-cell phenotype.

Science.gov (United States)

Munier, C Mee Ling; van Bockel, David; Bailey, Michelle; Ip, Susanna; Xu, Yin; Alcantara, Sheilajen; Liu, Sue Min; Denyer, Gareth; Kaplan, Warren; Suzuki, Kazuo; Croft, Nathan; Purcell, Anthony; Tscharke, David; Cooper, David A; Kent, Stephen J; Zaunders, John J; Kelleher, Anthony D

2016-10-17

Smallpox was eradicated by a global program of inoculation with Vaccinia virus (VV). Robust VV-specific CD4 T-cell responses during primary infection are likely essential to controlling VV replication. Although there is increasing interest in cytolytic CD4 T-cells across many viral infections, the importance of these cells during acute VV infection is unclear. We undertook a detailed functional and genetic characterization of CD4 T-cells during acute VV-infection of humans. VV-specific T-cells were identified by up-regulation of activation markers directly ex vivo and through cytokine and co-stimulatory molecule expression. At day-13-post primary inoculation with VV, CD38highCD45RO+ CD4 T-cells were purified by cell sorting, RNA isolated and analysed by microarray. Differential expression of up-regulated genes in activated CD4 T-cells was confirmed at the mRNA and protein levels. We compared analyses of VV-specific CD4 T-cells to studies on 12 subjects with primary HIV infection (PHI). VV-specific T-cells lines were established from PBMCs collected post vaccination and checked for cytotoxicity potential. A median 11.9% CD4 T-cells were CD38highCD45RO+ at day-13 post-VV inoculation, compared to 3.0% prior and 10.4% during PHI. Activated CD4 T-cells had an up-regulation of genes related to cytolytic function, including granzymes K and A, perforin, granulysin, TIA-1, and Rab27a. No difference was seen between CD4 T-cell expression of perforin or TIA-1 to VV and PHI, however granzyme k was more dominant in the VV response. At 25:1 effector to target ratio, two VV-specific T-cell lines exhibited 62% and 30% cytotoxicity respectively and CD107a degranulation. We show for the first time that CD4 CTL are prominent in the early response to VV. Understanding the role of CD4 CTL in the generation of an effective anti-viral memory may help develop more effective vaccines for diseases such as HIV. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Development of Guidelines for Mentoring Internal Supervision for the Schools under Roi-Et Office of Primary Education Service Area 2

Directory of Open Access Journals (Sweden)

Natchana Sahunil

2017-06-01

Full Text Available The research aimed to 1 study the factors and indicators of mentoring internal supervision for schools, 2 study the current state and the desirable state of mentoring internal supervision for schools, and 3 study the guidelines on the operation of mentoring internal supervision for the schools under Roi-Et Office of Primary Education Service Area 2. The research was divided into 3 phases. In phase 1 the informants comprised 5 certified experts. In phase 2 the sample comprised 488 government teachers under Roi-Et Office of Primary Education Service Area 2, btained through multi-stage random sampling. In phase 3 the informants comprised school directors, school deputy directors and supervisor teachers under Roi-Et Office of Primary Education Service Area 2, totally 9 persons. The research instruments onsisted of 1 a questionnaire having the discrimination from 0.34 to 0.79 and the total reliability of 0.87, 2 a structured interview form, and 3 a suitability and feasibility assessment form for the guidelines on the operation of mentoring internal supervision. The analysis of data employed percentage, the mean and standard deviation. The results are as follows: 1. There are 4 factors of the guidelines on mentoring internal supervision for schools. They are: preparation of mentoring supervision, with 12 indicators ; management of mentoring supervision, with 12 indicators ; operation of mentoring supervision, with 14 indicators ; and evaluation of mentoring supervision, with 10 indicators, all of which had been evaluated by the experts as, on the whole, very suitable. 2. The current state of the mentoring internal supervision for schools, on the whole and factor by factor, was in the moderate level in every factor. Meanwhile, the desirable state of mentoring internal supervision for schools, on the whole, was in the high level. When considered factor by factor, the factor with the highest mean is management of mentoring supervision. The factor with

Environmental factors associated with primary care access among urban older adults.

Science.gov (United States)

Ryvicker, Miriam; Gallo, William T; Fahs, Marianne C

2012-09-01

Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels. Supply quartiles varied in primary care use (visit within the past 12 months), racial and socio-economic composition, and perceived neighborhood safety and social cohesion. Primary care use did not differ significantly after controlling for compositional factors. Individuals who used a community clinic or hospital outpatient department for most of their care were less likely to have had a primary care visit than those who used a private doctor's office. Stratified multivariate models showed that within the lowest-supply quartile, public transit users had a higher odds of primary care use than non-transit users. Moreover, a higher score on the perceived neighborhood social cohesion scale was associated with a higher odds of primary care use. Within the second-lowest quartile, nonwhites had a lower odds of primary care use compared to whites. Different patterns of disadvantage in primary care access exist that may be associated with - but not fully explained by - local primary care supply. In lower-supply areas, racial disparities and inadequate primary care infrastructure hinder access to care. However, accessibility and elder-friendliness of public transit, as well as efforts to improve social cohesion and support, may facilitate primary care access for individuals living in low-supply areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

COMPARATIVE STUDY OF NUTRITIONAL STATUS OF PRIMARY SCHOOL CHILDREN IN URBAN AREA OF JHANSI

Directory of Open Access Journals (Sweden)

Ranjana Singh

2010-06-01

Full Text Available The present study is an attempt to find out the nutritional status including anthropometric assessment. A cross -sectional study was conducted in primary section of two governments and Iwo convent schools of Jhansi city during the study period of march 1999 to feb2000.Selected school children (n=840 aged 5-11 years, 453 children from municipal school and 387 children from convent school comprised the study material. Following results were observed -out of total children surveyed, 52.98% were male and rests 4 7.02% were females. Hindu formed majority (70.90% of children in both types of schools. Mean height and weight of boys and girls were higher than ICMR standards in both type of school. The mean mid arm circumference of all girls and boys from both type of schools had higher value than the ICMR standards but did not come up to WOLANSKI standard. Statistical analysis-percentage, mean, chi-square test.

Optimal catchment area and primary PCI centre volume revisited

DEFF Research Database (Denmark)

Schoos, Mikkel Malby; Pedersen, Frants; Holmvang, Lene

2015-01-01

AIMS: The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres...

Quality of after-hours primary care in the Netherlands: a narrative review.

Science.gov (United States)

Giesen, Paul; Smits, Marleen; Huibers, Linda; Grol, Richard; Wensing, Michel

2011-07-19

Many Western countries are seeking an organizational model for after-hours primary care that is safe, efficient, and satisfactory for patients and health care professionals. Around the year 2000, Dutch primary care physicians (PCPs) reorganized their after-hours primary care and shifted from small rotation groups to large-scale PCP cooperatives. This article provides a narrative review of studies on a range of issues about after-hours primary care in the Netherlands, including experiences of health care professionals and patients, patient-safety incidents, adherence to practice guidelines, waiting times, and quality of telephone triage. Physicians expressed high satisfaction with PCP cooperatives; their workload decreased, and job satisfaction increased compared with the situation before the reorganization. In general, patients were also satisfied, but areas for improvement included telephone consultations, patient education, and distance to a pharmacy. A study identified patient-safety incidents in 2.4% of all contacts, of which most did not result in harm to patients. The average adherence to clinical guidelines by physicians was 77%, with lowest adherence scores for prescribing antibiotics and treatment in emergency cases. The average waiting time for home visits was 30 minutes. Seventy percent of patients with life-threatening problems were visited within the time target of 15 minutes. Telephone triage by nurses had positive effects on care efficiency by increasing the proportion of telephone consultations and decreasing the proportion of clinic consultations and home visits. The after-hours primary care system in the Netherlands might set an example for other countries struggling to find a good solution for the problems they encounter with after-hours primary care. Future developments in the Netherlands include integration and extensive collaboration with the accident and emergency departments of hospitals, in which PCPs take care of self-referring patients.

Primary school teacher's knowledge and attitudes toward children with epilepsy.

Science.gov (United States)

Abulhamail, Albaraa S; Al-Sulami, Fahad E; Alnouri, Mouneeb A; Mahrous, Najeeb M; Joharji, Dima G; Albogami, Maha M; Jan, Mohammed M

2014-04-01

Primary school teacher's knowledge and attitudes toward epilepsy can have significant impact on the performance and psycho-social development of the child with epilepsy. Our objectives were to study teacher's knowledge and attitudes and identify areas in which further teacher training and education are required. A stratified random sample survey involving a group of primary school teachers in Jeddah, Saudi Arabia included private/public schools designated for male and female students. A structured 37-item questionnaire was used to examine their demographics, knowledge, attitudes, and experience with epilepsy. Six hundred and twenty primary school teachers working in public (58%) or private (42%) schools were included with ages ranging between 21 and 59 years (mean 36). Most teachers (79%) were of Saudi Arabian nationality and 66% had a college or university degree. Their years of experience ranged from 1 to 35 (mean 13.5). Only 17% of the teachers felt very well informed about epilepsy. Teachers with higher education were more likely to have good knowledge (p=0.009). Teachers of Saudi nationality were also more likely to report good knowledge, independent of their educational level (p=0.013). Overall, teachers with good knowledge were less likely to have negative attitudes including minding to have an epileptic child in their class (p=0.028) or thinking that they should be placed in a special classroom (p=0.029). Primary school teacher's knowledge about epilepsy needs improvements. Their attitudes correlated highly with their knowledge. Educational campaigns about epilepsy are needed to develop a well informed and tolerant community. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Primary Myelofibrosis

Science.gov (United States)

... attack is higher. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis . Symptoms of polycythemia vera include headaches and a feeling of fullness below the ribs on the left ...

Female Leadership Dilemmas in Primary Schools: A Case Study of ...

African Journals Online (AJOL)

Female Leadership Dilemmas in Primary Schools: A Case Study of Primary Schools in Harare Province in Zimbabwe. ... Zimbabwe Journal of Educational Research ... The study sought to explore dilemmas faced by female school leaders in primary schools in Kambuzuma, Warren Park and Kuwadzana areas of Harare ...

[Neuroanatomy of the Parietal Association Areas].

Science.gov (United States)

Kobayashi, Yasushi

2016-11-01

The parietal association cortex comprises the superior and inferior parietal lobules, the precuneus and the cortices in the intraparietal, parietooccipital and lunate sulci. By processing somatic, visual, acoustic and vestibular sensory information, the parietal association cortex plays a pivotal role in spatial cognition and motor control of the eyes and the extremities. Sensory information from the primary and secondary somatosensory areas enters the superior parietal lobule and is transferred to the inferior parietal lobule. Visual information is processed through the dorsal visual pathway and it reaches the inferior parietal lobule, the intraparietal sulcus and the precuneus. Acoustic information is transferred posteriorly from the primary acoustic area, and it reaches the posterior region of the inferior parietal lobule. The areas in the intraparietal sulcus project to the premotor area, the frontal eye fields, and the prefrontal area. These areas are involved in the control of ocular movements, reaching and grasping of the upper extremities, and spatial working memory. The posterior region of the inferior parietal lobule and the precuneus both project either directly, or indirectly via the posterior cingulate gyrus, to the parahippocampal and entorhinal cortices. Both these areas are strongly associated with hippocampal functions for long-term memory formation.

Savannah River Plant engineering and design history. Volume 4: 300/700 Areas & general services and facilities

Energy Technology Data Exchange (ETDEWEB)

1957-01-01

The primary function of the 300 Area is the production and preparation of the fuel and target elements required for the 100 Area production reactors. Uranium slugs and lithium-aluminium alloy control and blanket rods are prepared in separate structures. Other facilities include a test pile, a physics assembly laboratory, an office and change house, an electrical substation, and various service facilities such as rail lines, roads, sewers, steam and water distribution lines, etc. The 700 Area contains housing and facilities for plant management, general plant services, and certain technical activities. The technical buildings include the Main Technical Laboratory, the Waste Concentration Building, the Health Physics Headquarters, and the Health Physics Calibration building. Sections of this report describe the following: development of the 300-M Area; selection and description of process; design of main facilities of the 300 Area; development of the 700-A Area; design of the main facilities of the 700 Area; and general services and facilities, including transportation, plant protection, waste disposal and drainage, site work, pilot plants, storage, and furniture and fixtures.

Traffic flow wide-area surveillance system definition

Energy Technology Data Exchange (ETDEWEB)

Allgood, G.O.; Ferrell, R.K.; Kercel, S.W.; Abston, R.A.; Carnal, C.L. [Oak Ridge National Lab., TN (United States); Moynihan, P.I. [Jet Propulsion Lab., Pasadena, CA (United States)

1994-11-01

Traffic Flow Wide-Area Surveillance (TFWAS) is a system for assessing the state of traffic flow over a wide area for enhanced traffic control and improved traffic management and planning. The primary purpose of a TFWAS system is to provide a detailed traffic flow description and context description to sophisticated traffic management and control systems being developed or envisioned for the future. A successful TFWAS system must possess the attributes of safety, reconfigurability, reliability, and expandability. The primary safety premise of TFWAS is to ensure that no action or failure of the TFWAS system or its components can result in risk of injury to humans. A wide variety of communication techniques is available for use with TFWAS systems. These communication techniques can be broken down into two categories, landlines and wireless. Currently used and possible future traffic sensing technologies have been examined. Important criteria for selecting TFWAS sensors include sensor capabilities, costs, operational constraints, sensor compatibility with the infrastructure, and extent. TFWAS is a concept that can take advantage of the strengths of different traffic sensing technologies, can readily adapt to newly developed technologies, and can grow with the development of new traffic control strategies. By developing innovative algorithms that will take information from a variety of sensor types and develop descriptions of traffic flows over a wide area, a more comprehensive understanding of the traffic state can be provided to the control system to perform the most reasonable control actions over the entire wide area. The capability of characterizing the state of traffic over an entire region should revolutionize developments in traffic control strategies.

Coupled orbit-attitude motion of high area-to-mass ratio (HAMR) objects including efficient self-shadowing

Science.gov (United States)

Früh, Carolin; Jah, Moriba K.

2014-02-01

This paper shows the effect of self-shadowing on the coupled attitude-orbit dynamics of objects with high area-to-mass ratios (HAMR) in simulating standard multi layer insulation materials (MLI) as tilted single rigid sheets. Efficient and computationally fast self-shadowing methods have been developed. This includes an approximate self-shadowing method and a rapid exact self-shadowing method. Accuracy considerations are made and the effect of a chosen tessellation is shown. The coupled orbit-attitude perturbations of solar radiation pressure and Earth gravity field are taken into account. The results are compared to the attitude-orbit dynamics, when neglecting self-shadowing effects. An averaged physical shadow-map model is developed and compared to the full self-shadowing simulation. The combined effect of solar radiation pressure and self-shadowing leads to a rapid spin-up of the objects, even though they have uniform reflection properties. As a result, the observed brightness of these objects is subject to rapid changes.

Evidence of functional connectivity between auditory cortical areas revealed by amplitude modulation sound processing.

Science.gov (United States)

Guéguin, Marie; Le Bouquin-Jeannès, Régine; Faucon, Gérard; Chauvel, Patrick; Liégeois-Chauvel, Catherine

2007-02-01

The human auditory cortex includes several interconnected areas. A better understanding of the mechanisms involved in auditory cortical functions requires a detailed knowledge of neuronal connectivity between functional cortical regions. In human, it is difficult to track in vivo neuronal connectivity. We investigated the interarea connection in vivo in the auditory cortex using a method of directed coherence (DCOH) applied to depth auditory evoked potentials (AEPs). This paper presents simultaneous AEPs recordings from insular gyrus (IG), primary and secondary cortices (Heschl's gyrus and planum temporale), and associative areas (Brodmann area [BA] 22) with multilead intracerebral electrodes in response to sinusoidal modulated white noises in 4 epileptic patients who underwent invasive monitoring with depth electrodes for epilepsy surgery. DCOH allowed estimation of the causality between 2 signals recorded from different cortical sites. The results showed 1) a predominant auditory stream within the primary auditory cortex from the most medial region to the most lateral one whatever the modulation frequency, 2) unidirectional functional connection from the primary to secondary auditory cortex, 3) a major auditory propagation from the posterior areas to the anterior ones, particularly at 8, 16, and 32 Hz, and 4) a particular role of Heschl's sulcus dispatching information to the different auditory areas. These findings suggest that cortical processing of auditory information is performed in serial and parallel streams. Our data showed that the auditory propagation could not be associated to a unidirectional traveling wave but to a constant interaction between these areas that could reflect the large adaptive and plastic capacities of auditory cortex. The role of the IG is discussed.

Medics in Primary School

Science.gov (United States)

Press, Colin

2003-01-01

Some time ago a flyer on "Medics in Primary School" came the author's way. It described a programme for making placements in primary schools available to medical students. The benefits of the program to medical students and participating schools were highlighted, including opportunities to develop communication skills and demystify…

Observation and simulation of net primary productivity in Qilian Mountain, western China.

Science.gov (United States)

Zhou, Y; Zhu, Q; Chen, J M; Wang, Y Q; Liu, J; Sun, R; Tang, S

2007-11-01

We modeled net primary productivity (NPP) at high spatial resolution using an advanced spaceborne thermal emission and reflection radiometer (ASTER) image of a Qilian Mountain study area using the boreal ecosystem productivity simulator (BEPS). Two key driving variables of the model, leaf area index (LAI) and land cover type, were derived from ASTER and moderate resolution imaging spectroradiometer (MODIS) data. Other spatially explicit inputs included daily meteorological data (radiation, precipitation, temperature, humidity), available soil water holding capacity (AWC), and forest biomass. NPP was estimated for coniferous forests and other land cover types in the study area. The result showed that NPP of coniferous forests in the study area was about 4.4 tCha(-1)y(-1). The correlation coefficient between the modeled NPP and ground measurements was 0.84, with a mean relative error of about 13.9%.

Incidence of primary hypothyroidism in patients exposed to therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland

Directory of Open Access Journals (Sweden)

B A Laway

2012-01-01

Full Text Available Introduction: Hypothyroidism is a known consequence of external-beam radiotherapy to the neck encompassing a part or whole of the thyroid gland. In this non-randomized prospective study, we have tried to evaluate the response of the thyroid gland to radiation by assessing thyroid function before irradiation and at regular intervals after irradiation. Aims and Objectives: The aim of this study were to assess in the cancer patients, who were exposed to the therapeutic external beam radiation, where radiation portals include a part or whole of the thyroid gland: the incidence of primary hypothyroidism, the time required to become hypothyroid, any relation between the total dose for the development of hypothyroidism, and whether there are any patient or treatment-related factors that are predictive for the development of hypothyroidism, including the use of concurrent chemotherapy. Materials and Methods: This non-randomized, prospective study was conducted for a period of 2 years in which thyroid function was assessed in 59 patients (cases of head and neck cancer, breast cancer, lymphoma patients and other malignancies, who had received radiotherapy to the neck region. 59 euthyroid healthy patients (controls were also taken, who had not received the neck irradiation. These patients/controls were assessed periodically for 2 years. Results: The incidence of hypothyroidism after external beam radiation therapy (EBRT to neck where radiation portals include part or whole of the thyroid gland was 16.94%, seven cases had subclinical hypothyroidism (11.86% and three cases had clinical hypothyroidism (5.08%. Mean time for development of hypothyroidism was 4.5 months. There was no effect of age, gender, primary tumor site, radiation dose and chemotherapy, whether neoadjuvant or concurrent with the development of hypothyroidism. Conclusion: In summary, we found that thyroid dysfunction is a prevalent, yet easily treatable source of morbidity in patients

The Effects of a Family Support Program Including Respite Care on Parenting Stress and Family Quality of Life Perceived by Primary Caregivers of Children with Disabilities in Korea

Science.gov (United States)

Sung, Minjung; Park, Jiyeon

2012-01-01

In this study, a family support program was carried out for primary caregivers of children with disabilities. The program included respite care, recreation programs, counseling, and social support coordination based on individual needs of each family. In order to verify the intervention effects, parenting stress and family quality of life were…

Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection.

Science.gov (United States)

Axelsson, Lars; Nyman, Jan; Haugen-Cange, Hedda; Bove, Mogens; Johansson, Leif; De Lara, Shahin; Kovács, Anikó; Hammerlid, Eva

2017-06-10

Head and neck cancer of unknown primary (HNCUP) is rare and prospective studies are lacking. The impact of different prognostic factors such as age and N stage is not completely known, the optimal treatment is not yet established, and the reported survival rates vary. In the last decade, human papilloma virus (HPV) has been identified as a common cause of and important prognostic factor in oropharyngeal cancer, and there is now growing interest in the importance of HPV for HNCUP. The aim of the present study on curatively treated HNCUP was to investigate the prognostic importance of different factors, including HPV status, treatment, and overall survival. A search for HNCUP was performed in the Swedish Cancer Registry, Western health district, between the years 1992-2009. The medical records were reviewed, and only patients with squamous cell carcinoma or undifferentiated carcinoma treated with curative intent were included. The tumor specimens were retrospectively analyzed for HPV with p16 immunostaining. Sixty-eight patients were included. The mean age was 59 years. The majority were males, and had N2 tumors. Sixty-nine percent of the tumors were HPV positive using p16 staining. Patients who were older than 70 years, patients with N3-stage tumors, and patients with tumors that were p16 negative had a significantly worse prognosis. The overall 5-year survival rate for patients with p16-positive tumors was 88% vs 61% for p16-negative tumors. Treatment with neck dissection and postoperative radiation or (chemo) radiation had 81 and 88% 5-year survival rates, respectively. The overall and disease-free 5-year survival rates for all patients in the study were 82 and 74%. Curatively treated HNCUP had good survival. HPV infection was common. Independent prognostic factors for survival were age over 70 years, HPV status and N3 stage. We recommend that HPV analysis should be performed routinely for HNCUP. Treatment with neck dissection and postoperative radiation or

H-Area Seepage Basins Groundwater Monitoring Report: Volume 1, Third and Fourth quarters 1994

International Nuclear Information System (INIS)

Chase, J.A.

1994-03-01

Isoconcentration/isocactivity maps included in this report indicate both the concentration/activity and extent of the primary contaminants in each of the three hydrostratigraphic units during the second half of 1994. Geologic cross sections indicate both the extent and depth of contamination of the primary contaminants in all of the hydrostratigraphic units during the second half of 1994. Water-level maps indicate that the groundwater flow rates and directions at the H-Area Seepage Basins have remained relatively constant since the basins ceased to be active in 1988

Essential drugs in primary health centres of north central Nigeria ...

African Journals Online (AJOL)

To assess the availability of essential drugs and the perceptions of clients on drugs situation in the primary health centres of Tafa Local Government Area, north central Nigeria. Checklist consisting ofminimum drugs expected in a generic primary health centre developed by the National Primary Health Care Development ...

Mass media and marketing communication promoting primary and secondary cancer prevention.

Science.gov (United States)

Hannon, Peggy; Lloyd, Gareth P; Viswanath, K; Smith, Tenbroeck; Basen-Engquist, Karen; Vernon, Sally W; Turner, Gina; Hesse, Bradford W; Crammer, Corinne; von Wagner, Christian; Backinger, Cathy L

2009-01-01

People often seek and receive cancer information from mass media (including television, radio, print media, and the Internet), and marketing strategies often inform cancer information needs assessment, message development, and channel selection. In this article, we present the discussion of a 2-hour working group convened for a cancer communications workshop held at the 2008 Society of Behavioral Medicine meeting in San Diego, CA. During the session, an interdisciplinary group of investigators discussed the current state of the science for mass media and marketing communication promoting primary and secondary cancer prevention. We discussed current research, new research areas, methodologies and theories needed to move the field forward, and critical areas and disciplines for future research.

Patient ethnicity and the identification of anxiety in elderly primary care patients.

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Kim, Yeowon A; Morales, Knashawn H; Bogner, Hillary R

2008-09-01

To examine the role of ethnicity and primary care physician (PCP) identification of anxiety in older adults. A cross-sectional survey conducted between 2001 and 2003. Primary care offices in the Baltimore, Maryland, area. A sample of 330 adults aged 65 and older from Maryland primary care practices with complete information on psychological status and physician assessments. PCPs were asked to rate anxiety on a Likert scale. Patient interviews included measures of psychological status and patient use of psychotropic medications. Older black patients were less likely than older white patients to be identified as anxious (unadjusted odds ratio (OR)=0.34, 95% confidence interval (CI)=0.18-0.64) and less likely to be taking psychotropic medications (unadjusted OR=0.40, 95% CI=0.20-0.81). In multivariate models that controlled for potentially influential characteristics including depression and anxiety symptoms, the association between identification (OR=0.30, 95% CI=0.15-0.61) with patient ethnicity remained significantly unchanged. PCPs were less likely to identify older black Americans as anxious than white patients. An understanding of the role of ethnicity in the identification of anxiety is important for the screening and management of anxiety in elderly people.

Evaluation of school health instruction in public primary schools in ...

African Journals Online (AJOL)

Evaluation of school health instruction in public primary schools in Bonny Local Government Area, Rivers state. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Background: Effective school health instruction in primary schools is ...

Using Geographic Information Systems (GIS) to understand a community's primary care needs.

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Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

2010-01-01

A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

The United States Chiropractic Workforce: An alternative or complement to primary care?

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Davis Matthew A

2012-11-01

Full Text Available Abstract Background In the United States (US a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation’s primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians. Methods We used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types. Results According to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson’s correlation 0.17, p-value  Conclusion These findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access.

Developing a universal reading comprehension intervention for mainstream primary schools within areas of social deprivation for children with and without language-learning impairment: a feasibility study.

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McCartney, Elspeth; Boyle, James; Ellis, Sue

2015-01-01

Some children in areas of social deprivation in Scotland have lower reading attainment than neighbouring children in less deprived areas, and some of these also have lower spoken language comprehension skills than expected by assessment norms. There is a need to develop effective reading comprehension interventions that fit easily into the school curriculum and can benefit all pupils. A feasibility study of reading comprehension strategies with existing evidence of efficacy was undertaken in three mainstream primary schools within an area of social deprivation in west central Scotland, to decide whether further investigation of this intervention was warranted. Aims were to measure comprehension of spoken language and reading via standardised assessments towards the beginning of the school year (T1) in mainstream primary school classrooms within an area of social deprivation; to have teachers introduce previously-validated text comprehension strategies, and to measure change in reading comprehension outcome measures towards the end of the year (T2). A pre- and post-intervention cohort design was used. Reading comprehension strategies were introduced to staff in participating schools and used throughout the school year as part of on-going reading instruction. Spoken language comprehension was measured by TROG-2 at T1, and reading progress by score changes from T1 to T2 on the WIAT-II(UK) -T reading comprehension scale. Forty-seven pupils in five classes in three primary schools took part: 38% had TROG-2 scores below the 10(th) centile. As a group, children made good reading comprehension progress, with a medium effect size of 0.46. Children with TROG-2 scores below the 10(th) centile had lower mean reading scores than others at T1 and T2, although with considerable overlap. However, TROG-2 did not make a unique contribution to reading progress: children below the 10(th) centile made as much progress as other children. The intervention was welcomed by schools, and the

[Primary cutaneous B-cell lymphomas: study of 22 cases].

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Martín Carrasco, Pablo; Morillo Andújar, Mercedes; Pérez Ruiz, Carmen; de Zulueta Dorado, Teresa; Cabrera Pérez, Rocío; Conejo-Mir, Julián

2016-09-02

Primary cutaneous B-cell lymphoma (CBCL) is a very low prevalence neoplasm and constitutes 25% of all primary cutaneous lymphomas. Our objective was to discover the epidemiological, clinic and histologic characteristics of CBCL in our area. Retrospective descriptive study with patients with histologic diagnosis of CBCL followed up in our department between 2004 and 2015. Twenty-two patients with CBCL were included; 65% were men and 35% were women. Follicle centre lymphoma was the most common subtype (41%). Only 3 cases presented with node involvement and one with bone marrow invasion. Five recurrences were detected and one patient died because of the CBCL. This is one of the first CBCL series in theSpanish population. The incidence, sex, age, subtype distribution, clinical features and immunohistochemical patterns are very similar to those of the other series. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Analysis on Residents’ Travel Activity Pattern in Historic Urban Areas: A Case Study of Historic Urban Area of Yangzhou, China

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Mao Ye

2013-01-01

Full Text Available Travel behaviors and activity patterns in the historic urban area of a city are expected to be different from the overall situations in the city area. The primary objective of this study is to analyze the residents’ travel activity patterns in historic urban area. Based on survey data conducted in the historic urban area of Yangzhou, the travel activities of local residents in a whole day were classified into five types of patterns. The multinomial logit (MNL model was developed to evaluate the impacts of explanatory variables on the choices of activity patterns. The results showed that the choice of activity pattern was significantly impacted by five contributing factors including the gender, age, occupation, car ownership, and number of electric bikes in household. The other variables, which were the family population, preschoolers, number of conventional bikes in household, motorcycle ownership, and income, were found to be not significantly related to the choice of activities. The results of this study from historic urban area were compared to findings of previous studies from overall urban area. The comparison showed that the impacts of factors on activity pattern in the historic urban area were different from those in the overall area. Findings of this study provide important suggestions for the policy makings to improve the traffic situations in historic urban areas of cities.

Telemedicine and primary health: The virtual doctor project Zambia

OpenAIRE

Mupela, Evans; Mustarde, Paul; Jones, Huw

2011-01-01

This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach d...

Email communication at the medical primary-secondary care interface: a qualitative exploration.

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Sampson, Rod; Barbour, Rosaline; Wilson, Philip

2016-07-01

There is little published research into the influence of email communication between primary and secondary care clinicians on patient care. To explore the use of email communication between clinicians across the primary- secondary care interface, and how this may relate to patient care. A qualitative study involving primary and secondary care services in the NHS Highland Health Board area, Scotland. Ten GPs and 12 hospital consultants were purposively sampled to reflect diversity. Eligible clinicians were invited to take part in a semi-structured interview. Data were analysed using a thematic analysis approach. Key themes that emerged for clinicians included general perceptions of email; using email in practice (managing workload, impact on patient journeys, and 'quick answers'); system issues (variability and governance); relational aspects; and email skills. Email communication between primary and secondary care clinicians generally has a positive impact on patient access to specialist expertise. Governance issues around the use of clinical email need to be defined. There may currently be a two-tier health service for those patients (and their GPs) requiring 'quick answers'. © British Journal of General Practice 2016.

Diabetes management in an Australian primary care population.

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Krass, I; Hebing, R; Mitchell, B; Hughes, J; Peterson, G; Song, Y J C; Stewart, K; Armour, C L

2011-12-01

Worldwide studies have shown that significant proportions of patients with type 2 diabetes (T2DM) do not meet targets for glycaemic control, blood pressure (BP) and lipids, putting them at higher risk of developing complications. However, little is known about medicines management in Australian primary care populations with T2DM. The aim of this study was to (i) describe the management of a large group of patients in primary care, (ii) identify areas for improvement in management and (iii) determine any relationship between adherence and glycaemic, BP and lipid control. This was a retrospective, epidemiological study of primary care patients with T2DM diabetes, with HbA(1c) of >7%, recruited in 90 Australian community pharmacies. Data collected included demographic details, diabetes history, current medication regimen, height, weight, BP, physical activity and smoking status. Of the 430 patients, 98% used antidiabetics, 80% antihypertensives, 73% lipid lowering drugs and 38% aspirin. BP and all lipid targets were met by only 21% and 14% of the treated patients and 21% and 12% of the untreated patients respectively. Medication adherence was related to better glycaemic control (P = 0.04). An evidence-base prescribing practice gap was seen in this Australian primary care population of T2DM patients. Patients were undertreated with antihypertensive and lipid lowering medication, and several subgroups with co-morbidities were not receiving the recommended pharmacotherapy. Interventions are required to redress the current evidence-base prescribing practice gap in disease management in primary care. © 2011 Blackwell Publishing Ltd.

Utility of linking primary care electronic medical records with Canadian census data to study the determinants of chronic disease: an example based on socioeconomic status and obesity.

Science.gov (United States)

Biro, Suzanne; Williamson, Tyler; Leggett, Jannet Ann; Barber, David; Morkem, Rachael; Moore, Kieran; Belanger, Paul; Mosley, Brian; Janssen, Ian

2016-03-11

Electronic medical records (EMRs) used in primary care contain a breadth of data that can be used in public health research. Patient data from EMRs could be linked with other data sources, such as a postal code linkage with Census data, to obtain additional information on environmental determinants of health. While promising, successful linkages between primary care EMRs with geographic measures is limited due to ethics review board concerns. This study tested the feasibility of extracting full postal code from primary care EMRs and linking this with area-level measures of the environment to demonstrate how such a linkage could be used to examine the determinants of disease. The association between obesity and area-level deprivation was used as an example to illustrate inequalities of obesity in adults. The analysis included EMRs of 7153 patients aged 20 years and older who visited a single, primary care site in 2011. Extracted patient information included demographics (date of birth, sex, postal code) and weight status (height, weight). Information extraction and management procedures were designed to mitigate the risk of individual re-identification when extracting full postal code from source EMRs. Based on patients' postal codes, area-based deprivation indexes were created using the smallest area unit used in Canadian censuses. Descriptive statistics and socioeconomic disparity summary measures of linked census and adult patients were calculated. The data extraction of full postal code met technological requirements for rendering health information extracted from local EMRs into anonymized data. The prevalence of obesity was 31.6 %. There was variation of obesity between deprivation quintiles; adults in the most deprived areas were 35 % more likely to be obese compared with adults in the least deprived areas (Chi-Square = 20.24(1), p primary health care interventions and services.

Using Primary Source Documents.

Science.gov (United States)

Mintz, Steven

2003-01-01

Explores the use of primary sources when teaching about U.S. slavery. Includes primary sources from the Gilder Lehrman Documents Collection (New York Historical Society) to teach about the role of slaves in the Revolutionary War, such as a proclamation from Lord Dunmore offering freedom to slaves who joined his army. (CMK)

An Online Q-learning Based Multi-Agent LFC for a Multi-Area Multi-Source Power System Including Distributed Energy Resources

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H. Shayeghi

2017-12-01

Full Text Available This paper presents an online two-stage Q-learning based multi-agent (MA controller for load frequency control (LFC in an interconnected multi-area multi-source power system integrated with distributed energy resources (DERs. The proposed control strategy consists of two stages. The first stage is employed a PID controller which its parameters are designed using sine cosine optimization (SCO algorithm and are fixed. The second one is a reinforcement learning (RL based supplementary controller that has a flexible structure and improves the output of the first stage adaptively based on the system dynamical behavior. Due to the use of RL paradigm integrated with PID controller in this strategy, it is called RL-PID controller. The primary motivation for the integration of RL technique with PID controller is to make the existing local controllers in the industry compatible to reduce the control efforts and system costs. This novel control strategy combines the advantages of the PID controller with adaptive behavior of MA to achieve the desired level of robust performance under different kind of uncertainties caused by stochastically power generation of DERs, plant operational condition changes, and physical nonlinearities of the system. The suggested decentralized controller is composed of the autonomous intelligent agents, who learn the optimal control policy from interaction with the system. These agents update their knowledge about the system dynamics continuously to achieve a good frequency oscillation damping under various severe disturbances without any knowledge of them. It leads to an adaptive control structure to solve LFC problem in the multi-source power system with stochastic DERs. The results of RL-PID controller in comparison to the traditional PID and fuzzy-PID controllers is verified in a multi-area power system integrated with DERs through some performance indices.

Contributing to the wellbeing of primary health care workers in PNG.

Science.gov (United States)

Davy, Carol

2007-01-01

The purpose of this paper is to investigate how organisational frames of reference, which are neither not appropriately communicated nor supported, affect the wellbeing of workers. A review of the literature is used to develop a new model linking ambiguous frames of reference with reduced levels of workers' wellbeing. This is then tested using data collected in a study involving primary health care workers in Papua New Guinea (PNG). This paper finds that, for these particular workers, the model linking ambiguous frames of reference and reduced worker wellbeing is valid. The paper shows that there is a need for further research into a variety of areas including the importance of frames of reference to worker wellbeing, the significance of reference groups to organisational frames of reference and the consequences of reduced worker wellbeing in developing countries. In this paper, recommendations for changes to current PNG primary health care management practices, including ensuring the support for as well as communicating the organisational frame of reference, are discussed. The paper shows that the experiences of these particular primary health care workers not only demonstrates the validity of the new model but also brings a unique perspective to the field of worker wellbeing, which up until now has been dominated by research conducted in western countries.

The commercial food landscape: outdoor food advertising around primary schools in Australia.

Science.gov (United States)

Kelly, Bridget; Cretikos, Michelle; Rogers, Kris; King, Lesley

2008-12-01

Food marketing is linked to childhood obesity through its influence on children's food preferences, purchase requests and food consumption. We aimed to describe the volume and nature of outdoor food advertisements and factors associated with outdoor food advertising in the area surrounding Australian primary schools. Forty primary schools in Sydney and Wollongong were selected using random sampling within population density and socio-economic strata. The area within a 500 m radius of each school was scanned and advertisements coded according to pre-defined criteria, including: food or non-food product advertisement, distance from the school, size and location. Food advertisements were further categorised as core foods, non-core foods and miscellaneous drinks (tea and coffee). The number of advertisements identified was 9,151, of which 2,286 (25%) were for food. The number of non-core food advertisements was 1,834, this accounted for 80% of food advertisements. Soft drinks and alcoholic beverages were the food products most commonly advertised around primary schools (24% and 22% of food advertisements, respectively). Non-core food products were twice as likely to be advertised close to a primary school (95 non-core food advertisements per km(2) within 250 m vs. 46 advertisements per km(2) within 250-500 m). The density of non-core food advertisements within 500 m of primary schools, and the potential for repeated exposure of children to soft drink and alcoholic beverage advertisements in particular, highlights the need for outdoor food marketing policy intervention. Outdoor advertising is an important food marketing tool that should be considered in future debates on regulation of food marketing to children.

Multicentric primary extramammary Paget disease: a Toker cell disorder?

Science.gov (United States)

Hashemi, Pantea; Kao, Grace F; Konia, Thomas; Kauffman, Lisa C; Tam, Christine C; Sina, Bahram

2014-07-01

Toker cells are epithelial clear cells found in the areolar and nipple areas of the breast, vulvar region, and other apocrine gland-bearing areas of the skin. Toker cells have been implicated in the pathogenesis of clear cell papulosis, cutaneous hamartoma with pagetoid cells, and rare cases of primary extramammary Paget disease (EMPD) but not in secondary EMPD with underlying adenocarcinoma. The pathogenesis of primary EMPD is not well defined. We report a case of multicentric primary EMPD with evidence of Toker cell proliferation and nonaggressive biologic behavior in a 63-year-old white man. A detailed description of the morphologic and biologic features of Toker cells and their possible carcinogenetic links also are discussed. Based on the observation and follow-up of our patient, we hypothesize that multicentric primary EMPD starts with Toker cell hyperplasia and can potentially evolve to carcinoma in the genital region.

Evaluation of factors inhibiting effective performance of primary ...

African Journals Online (AJOL)

Therefore, the following are the factors that are inhibiting the productivity of the primary school teachers in Oyo state, Nigeria, viz: lack of motivation on the ... Headmasters or the local government education area officers in cash or kind and illegal deduction from primary school teacher's salary on the account of bank charges.

Ultracool dwarf benchmarks with Gaia primaries

Science.gov (United States)

Marocco, F.; Pinfield, D. J.; Cook, N. J.; Zapatero Osorio, M. R.; Montes, D.; Caballero, J. A.; Gálvez-Ortiz, M. C.; Gromadzki, M.; Jones, H. R. A.; Kurtev, R.; Smart, R. L.; Zhang, Z.; Cabrera Lavers, A. L.; García Álvarez, D.; Qi, Z. X.; Rickard, M. J.; Dover, L.

2017-10-01

We explore the potential of Gaia for the field of benchmark ultracool/brown dwarf companions, and present the results of an initial search for metal-rich/metal-poor systems. A simulated population of resolved ultracool dwarf companions to Gaia primary stars is generated and assessed. Of the order of ˜24 000 companions should be identifiable outside of the Galactic plane (|b| > 10 deg) with large-scale ground- and space-based surveys including late M, L, T and Y types. Our simulated companion parameter space covers 0.02 ≤ M/M⊙ ≤ 0.1, 0.1 ≤ age/Gyr ≤ 14 and -2.5 ≤ [Fe/H] ≤ 0.5, with systems required to have a false alarm probability methodology and simulations, our initial search uses UKIRT Infrared Deep Sky Survey and Sloan Digital Sky Survey to select secondaries, with the parameters of primaries taken from Tycho-2, Radial Velocity Experiment, Large sky Area Multi-Object fibre Spectroscopic Telescope and Tycho-Gaia Astrometric Solution. We identify and follow up 13 new benchmarks. These include M8-L2 companions, with metallicity constraints ranging in quality, but robust in the range -0.39 ≤ [Fe/H] ≤ +0.36, and with projected physical separation in the range 0.6 < s/kau < 76. Going forward, Gaia offers a very high yield of benchmark systems, from which diverse subsamples may be able to calibrate a range of foundational ultracool/sub-stellar theory and observation.

TEACHERS’ TRAINING FOR SOCIAL AND EDUCATIONAL ACTIVITY IN CONDITIONS OF MOUNTAIN AREA PRIMARY SCHOOL

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Leonida Pesotskaya

2015-04-01

Full Text Available The article reveals the question of using of the method of coaching in preparation of the students to the managerial activity in the sphere of preschool education in mountain areas. The necessity of preparation under the modern conditions of social-economic development of mountain areas has been proved. The content of the article generalizes basic contradictions between the necessity and reality. The definition of the main points of the research has been given. The attention is accentuated on the basic principles of management and on the notion “coaching” in the process of management of preschool education in mountain area. Coaching includes partnership, potential revealing, effectiveness. Methodology of coaching is based on the principle that the person naturally is sufficiently talented and owns great potential, which isn’t realized fully. An important condition of this approach is valuable, respectful attitude of the participants of polylogue to one another. Basic theoretical regulations of the coaching approach have been determined. In the context of selection of teching technologies on the basis of coaching approach, the method “reflexive team” has been briefly revealed. It is determined that coaching is a style of management, transformed culture: if the authoritarian style is substituted into coaching, then the hierarchy changes from the support of blaming and ridiculing to the objective evaluation, all-hands activity changes to strategic planning. Coaching approach will allow optimizing the structure of economic activity of a separate preschool educational establishment. The attention is accentuated at the fact, that using coaching with the students at the lessons as a style of management of preschool education, will let future managers of preschool educational establishments to form the skills of behavior in critical situations of mountain area, to enrich their activity with the new means of performing, to develop professional

An Aerial Radiological Survey of the Nevada Test Site - Area 10 Corrective Action Unit 367

International Nuclear Information System (INIS)

Lyons, Craig

2010-01-01

A series of aerial radiological surveys were conducted over the Sedan, Uncle, and Ess ground zero areas in Area 10. The surveys were performed in November 2009 utilizing a large array of helicopter mounted sodium iodide detectors. The purpose of the survey was to update the previous radiological survey levels of the environment and surrounding areas of the ground zeros. Gross Counts, inferred exposure rates, man-made activity, and Americium-241 activity, as calculated from the aerial data are presented in the form of isopleth maps superimposed on imagery of the surveyed areas. In addition, spectral products are included that identify Cesium-137, Americium-241 and Cobalt-60 as the primary radionuclides present within the survey area.

Tomographic findings of lobar consolidation in primary pulmonary tuberculosis; Aspectos tomograficos da consolidacao lobar na tuberculose pulmonar primaria

Energy Technology Data Exchange (ETDEWEB)

Pereira, Bruno Alberto Falcao [Hopital Europeen Georges Pompidou, Paris (France); Macedo, Solange Goncalves David de [Hospital Municipal Jesus, Rio de Janeiro, RJ (Brazil). Setor de Pneumologia; Nogueira, Renata do Amaral [Clinica de Diagnostico por Imagem (CDPI), Rio de Janeiro, RJ (Brazil). Setor de Pediatria; Castiel, Lola Celeste Pantoja [Clinica Radiologica Dr. Samuel Castiel, Porto Velho, RO (Brazil); Penna, Claudia Renata Rezende [Hospital Municipal Jesus, Rio de Janeiro, RJ (Brazil). Servico de Radiologia Pediatrica], e-mail: cr-penna@uol.com.br

2009-03-15

Objective: To describe tomographic findings of lobar consolidation as early manifestation of primary pulmonary tuberculosis. Materials and methods: The present study was developed at Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil, in the period between 2002 and 2006, retrospectively evaluating tomographic findings in four children aged from 3 to 14 months with lobar consolidation as an early manifestation of primary pulmonary tuberculosis. Results: The most frequently found radiological pattern was lobar consolidation with calcifications, cavitation and intermingle necrotic areas, associated with bulging fissure. Signs of bronchogenic dissemination and lymph node enlargement were observed in all of the four children. Consolidation with a pseudotumor aspect and masslike effect was observed in one case. Conclusion: The cases included in the present study have demonstrated that primary pulmonary tuberculosis manifested as lobar consolidation presents typical tomographic images such as cavitation, hypodense areas and calcifications intermingled with consolidation. The association with lymph node enlargement with central necrosis and signs of bronchogenic dissemination reinforce the diagnosis of tuberculosis. (author)

Primary breast tuberculosis: diagnostic and therapeutic dilemmas.

Science.gov (United States)

Hiremath, Bharati V; Subramaniam, Narayana

2015-01-01

To review the diagnostic and therapeutic challenges associated with treating isolated primary breast tuberculosis through discussion of our series of seven cases. Although breast is an uncommon site of occurrence of tuberculosis and isolated primary breast tuberculosis is an even rarer entity, its importance lies in distinguishing it from more common pathologies like abscesses or malignancy and avoiding unnecessary erroneous surgical intervention. The spectrum and presentation is wide and varied and we present our experience in managing seven such cases. A retrospective analysis of all the cases of histopathologically proven primary breast tuberculosis in the last three years at M.S. Ramaiah Hospital (2012-2014) was done. Analysis was in terms of mode of presentation, clinical features, diagnostic modalities used for evaluation and confirmation of the diagnosis, medical treatment and surgical intervention, if any. Special emphasis was placed on dilemmas in diagnosis and difficulties encountered during treatment. All cases were followed up till cure. Patients most commonly presented with a breast abscess, painful breast lumps and recurrent abscesses. Other foci of tuberculosis were ruled out in all of these patients. Majority were treated exclusively with anti-tubercular therapy (although regimens varied), but those with abscesses underwent incision and drainage. All cases were treated and followed up till cure. The challenges associated with primary breast tuberculosis are multiple, including which anti-tubercular therapy regimen to use, when to surgically intervene (as the breast is a cosmetically important area) and treating atypical mycobacteria. We provide a detailed discussion of the challenges we faced and review of literature.

Elucidation of primary metabolic pathways in Aspergillus species: orphaned research in characterizing orphan genes.

Science.gov (United States)

Andersen, Mikael Rørdam

2014-11-01

Primary metabolism affects all phenotypical traits of filamentous fungi. Particular examples include reacting to extracellular stimuli, producing precursor molecules required for cell division and morphological changes as well as providing monomer building blocks for production of secondary metabolites and extracellular enzymes. In this review, all annotated genes from four Aspergillus species have been examined. In this process, it becomes evident that 80-96% of the genes (depending on the species) are still without verified function. A significant proportion of the genes with verified metabolic functions are assigned to secondary or extracellular metabolism, leaving only 2-4% of the annotated genes within primary metabolism. It is clear that primary metabolism has not received the same attention in the post-genomic area as many other research areas--despite its role at the very centre of cellular function. However, several methods can be employed to use the metabolic networks in tandem with comparative genomics to accelerate functional assignment of genes in primary metabolism. In particular, gaps in metabolic pathways can be used to assign functions to orphan genes. In this review, applications of this from the Aspergillus genes will be examined, and it is proposed that, where feasible, this should be a standard part of functional annotation of fungal genomes. © The Author 2014. Published by Oxford University Press.

Quality Assessment in the Primary care

Directory of Open Access Journals (Sweden)

Muharrem Ak

2013-04-01

Full Text Available -Quality Assessment in the Primary care Dear Editor; I have read the article titled as “Implementation of Rogi Kalyan Samiti (RKS at Primary Health Centre Durvesh” with great interest. Shrivastava et all concluded that assessment mechanism for the achievement of objectives for the suggested RKS model was not successful (1. Hereby I would like to emphasize the importance of quality assessment (QA especially in the era of newly established primary care implementations in our country. Promotion of quality has been fundamental part of primary care health services. Nevertheless variations in quality of care exist even in the developed countries. Accomplishment of quality in the primary care has some barriers like administration and directorial factors, absence of evidence-based medicine practice lack of continuous medical education. Quality of health care is no doubt multifaceted model that covers all components of health structures and processes of care. Quality in the primary care set up includes patient physician relationship, immunization, maternal, adolescent, adult and geriatric health care, referral, non-communicable disease management and prescribing (2. Most countries are recently beginning the implementation of quality assessments in all walks of healthcare. Organizations like European society for quality and safety in family practice (EQuiP endeavor to accomplish quality by collaboration. There are reported developments and experiments related to the methodology, processes and outcomes of quality assessments of health care. Quality assessments will not only contribute the accomplishment of the program / project but also detect the areas where obstacles also exist. In order to speed up the adoption of QA and to circumvent the occurrence of mistakes, health policy makers and family physicians from different parts of the world should share their experiences. Consensus on quality in preventive medicine implementations can help to yield

[Internal Exposure Levels of PAHs of Primary School Students in Guangzhou].

Science.gov (United States)

Su, Hui; Zhao, Bo; Zhang, Su-kun; Liu, Shan; Ren, Ming-zhong; Li, Jie; Shi, Xiao-xia

2015-12-01

In order to investigate the internal exposure levels of polycyclic aromatic hydrocarbons (PAHs) in primary school students of Guangzhou, the research collected urine of 78 and 86 primary school students from two primary schools in the summer of 2014, one school located in the ordinary residential area and the other in the industrial area. The contents of 10 kinds of OH-PAHs were tested by the rapid liquid chromatography coupled to triple quadruple tandem mass spectrometry. The results showed that the concentrations of total OH-PAHs in primary school students in the residential zone ranged from 0.83 µmol · mol⁻¹ to 80.63 µmol · mol⁻¹, while those in industrial area ranged from 1.06 µmol · mol⁻¹ to 72.47 µmol · mol⁻¹. The geometric average concentrations were 6.18 µmol · mol⁻¹ and 6.47 µmol · mol⁻¹, respectively, and there was no statistical significance between them (P > 0.05). Comparison of the exposure levels of different components of PAHs in the two areas found that all the OH-PAHs had no significant difference except for the levels of 1- OHP (P transportation emissions.

Ape Behavior in Two Alternating Environments: Comparing Exhibit and Short-Term Holding Areas

DEFF Research Database (Denmark)

Ross, Stephen R.; Wagner, Katherine E.; Schapiro, Steven J.

2010-01-01

be balanced with the desire to maintain enriching and naturalistic exhibit enclosures that benefit ape residents and attract the visiting public. In these settings, examinations of ape behavior and welfare typically focus exclusively on activity in the primary exhibit area. However, physical, social...... and sensory experiences unique to each area may shape different patterns of behavior. In the current study, zoo-living chimpanzees and gorillas were moved each day from exhibit areas to off-exhibit holding areas for a short duration as a part of regular management procedures. Behavioral data indicated species......-specific reactions to the holding area, including increased aggression and self-directed behavior by chimpanzees and increased activity and prosocial behavior among gorilla subjects. Both species showed more feeding-foraging behavior while in the exhibit enclosure. Results suggest that holding areas may not meet all...

Teachers' Job Dislike Areas: Implications for Operational Modifications

Directory of Open Access Journals (Sweden)

S. 'Tayo Subair

2016-08-01

Full Text Available Teaching is the act, practice and occupation of a teacher. A teacher is a person who provides education for learners at a school or other place of formal education. The use of teacher in this study is conceptualized to involve all cadres of instructors and teaching team from primary and junior secondary (basic education to senior secondary school. The study examined the areas of job dislikes among teachers with their attendant implications for practice. Using a self-designed and pilot-tested questionnaire, data were collected from a random sample of 3,000 teachers drawn from Lagos, Ogun, and Osun states in the Southwestern geopolitical zone of the country. Specifically, 400 primary and 600 secondary school teachers were drawn from each state. The data were analyzed using simple percentage. It was found that teachers job dislike areas though differ but were within seven areas thus: writing lesson notes (98.5%, marking subject attendance register (98%, disciplining of students in school (90%, and serving as members of committees (78.9%. Other dislike areas include taking students out of school for extramural activities (73.3%, partaking in co-curricular activities in the school (60.3% and examination invigilation (59.1% as areas of common dislike and capable of inhibiting the satisfaction levels of teachers.Furthermore, it was found that differences exist in job dislikes between male and female teachers. The common job dislikes among male were non-interest in marking of scripts and invigilation of examinations whereas the female showed dislikes for serving as committee members and as year tutors.Thus, it was recommended that: some modifications in the operational approaches of classroom teachers (such as deemphasizing lesson note writing and marking of subject attendance register would be required. Teachers should also be financially encouraged via allowances for all other activities outside teaching.

Intra-tumoural vessel area estimated by expression of epidermal growth factor-like domain 7 and microRNA-126 in primary tumours and metastases of patients with colorectal cancer

DEFF Research Database (Denmark)

Hansen, T. F.; Nielsen, Boye Schnack; Jakobsen, Anders

2015-01-01

factor-like domain 7 (EGFL7) and microRNA-126 (miRNA-126) in primary tumours from patients with stage II-IV colorectal cancer (CRC) and in paired samples of primary tumours, regional lymph node metastases and distant metastases. Methods: A total of 126 patients were included. Analyses were performed...

Combined constraints on global ocean primary production using observations and models

Science.gov (United States)

Buitenhuis, Erik T.; Hashioka, Taketo; Quéré, Corinne Le

2013-09-01

production is at the base of the marine food web and plays a central role for global biogeochemical cycles. Yet global ocean primary production is known to only a factor of 2, with previous estimates ranging from 38 to 65 Pg C yr-1 and no formal uncertainty analysis. Here, we present an improved global ocean biogeochemistry model that includes a mechanistic representation of photosynthesis and a new observational database of net primary production (NPP) in the ocean. We combine the model and observations to constrain particulate NPP in the ocean with statistical metrics. The PlankTOM5.3 model includes a new photosynthesis formulation with a dynamic representation of iron-light colimitation, which leads to a considerable improvement of the interannual variability of surface chlorophyll. The database includes a consistent set of 50,050 measurements of 14C primary production. The model best reproduces observations when global NPP is 58 ± 7 Pg C yr-1, with a most probable value of 56 Pg C yr-1. The most probable value is robust to the model used. The uncertainty represents 95% confidence intervals. It considers all random errors in the model and observations, but not potential biases in the observations. We show that tropical regions (23°S-23°N) contribute half of the global NPP, while NPPs in the Northern and Southern Hemispheres are approximately equal in spite of the larger ocean area in the South.

Non-traditional Manifestations of Primary Hyperparathyroidism

Science.gov (United States)

Walker, Marcella Donovan; Rubin, Mishaela; Silverberg, Shonni J.

2012-01-01

Classical primary hyperparathyroidism was previously a multi-systemic, symptomatic disorder not only with overt skeletal and renal complications, but also with neuropsychological, cardiovascular, gastrointestinal and rheumatic effects. The presentation of primary hyperparathyroidism has evolved and today most patients are “asymptomatic”. Osteitis fibrosa cystica is rarely seen today and nephrolithiasis is less common. Gastrointestinal and rheumatic symptoms are not part of the clinical spectrum of modern PHPT. It remains unclear whether neuropsychological symptoms and cardiovascular disease, neither of which are currently indications for recommending parathyroidectomy, are part of the modern phenotype of primary hyperparathyroidism. A number of observational studies suggest that mild PHPT is associated with depression, decreased quality of life, and changes in cognition but limited data from randomized, controlled trials have not indicated consistent benefits after surgery. The increased cardiovascular morbidity and mortality in severe PHPT has not been definitively demonstrated in mild disease, though there is some evidence for more subtle cardiovascular abnormalities, such as increased vascular stiffness, among others. Results from observational studies that have assessed the effect of parathyroidectomy upon cardiovascular health have been conflicting. The single randomized controlled trial in this area did not demonstrate that parathyroidectomy was beneficial. Despite recent progress in these areas, more data from rigorously designed studies are needed in order to better inform the clinical management of patients with asymptomatic primary hyperparathyroidism. PMID:23374740

Development of microbial community during primary succession in areas degraded by mining activities

Czech Academy of Sciences Publication Activity Database

Harantová, L.; Mudrák, Ondřej; Kohout, Petr; Elhottová, D.; Frouz, J.; Baldrian, J.

2017-01-01

Roč. 28, č. 8 (2017), s. 2574-2584 ISSN 1085-3278 Institutional support: RVO:67985939 Keywords : plant‐soil interactions * postmining sites * primary succession Subject RIV: EH - Ecology, Behaviour OBOR OECD: Ecology Impact factor: 9.787, year: 2016

Primary Geography in Australia: Pre-Service Primary Teachers' Understandings of Weather and Climate

Science.gov (United States)

Lane, Rod

2015-01-01

Recent curriculum introductions and revisions on a global scale have highlighted the importance of primary teachers' content knowledge in geography and the lack of research in this area (Catling, 2014). This has become a particular focus in Australia with the introduction of the "Australian Curriculum: Geography" in 2013 and the…

Vision first? The development of primary visual cortical networks is more rapid than the development of primary motor networks in humans.

Directory of Open Access Journals (Sweden)

Patricia Gervan

Full Text Available The development of cortical functions and the capacity of the mature brain to learn are largely determined by the establishment and maintenance of neocortical networks. Here we address the human development of long-range connectivity in primary visual and motor cortices, using well-established behavioral measures--a Contour Integration test and a Finger-tapping task--that have been shown to be related to these specific primary areas, and the long-range neural connectivity within those. Possible confounding factors, such as different task requirements (complexity, cognitive load are eliminated by using these tasks in a learning paradigm. We find that there is a temporal lag between the developmental timing of primary sensory vs. motor areas with an advantage of visual development; we also confirm that human development is very slow in both cases, and that there is a retained capacity for practice induced plastic changes in adults. This pattern of results seems to point to human-specific development of the "canonical circuits" of primary sensory and motor cortices, probably reflecting the ecological requirements of human life.

Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns

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Yang Seo Park

2012-09-01

Full Text Available BackgroundPediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG in pediatric hand burns, based on long-term observation periods and existing studies.MethodsFrom January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed.ResultsThe mean age of the patients was 24.4 months (range, 8 to 94 months, consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%. During the observation, 25 cases underwent corrective operations with an average period of 40.6 months.ConclusionsIn the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

Strengthening "the Foundations" of the Primary School Curriculum

Science.gov (United States)

Duncombe, Rebecca; Cale, Lorraine; Harris, Jo

2018-01-01

The low status of the foundation subjects (e.g. Music and Physical Education (PE)) in English primary schools is well documented. Using PE as an illustrative example, a thematic analysis of 51 PE trainee students' assignments, based on their perceptions of a two-week experience in a primary school, highlighted a number of areas of concern (e.g.…

Impact on Primary Care Access Post-Disaster: A Case Study From the Rockaway Peninsula.

Science.gov (United States)

Sood, Rishi K; Bocour, Angelica; Kumar, Supriya; Guclu, Hasan; Potter, Margaret; Shah, Tanya B

2016-06-01

Assess Hurricane Sandy's impact on primary care providers' services in the Rockaways. In-person surveys were conducted in 2014. A list of 46 health care sites in the area of interest was compiled and each site was called to offer participation in our survey. Respondents included physicians and practice administrators who remained familiar with Sandy-related operational challenges. Of the 40 sites that opted in, most had been in their current location for more than 10 years (73%) and were a small practice (1 or 2 physicians) before Hurricane Sandy (75%). All but 2 (95%) had to temporarily close or relocate. All sites experienced electrical problems that impacted landline, fax, and Internet. Less than one-quarter (n = 9) reported having a plan for continuity of services before Hurricane Sandy, and 43% reported having a plan poststorm. The majority (80%) did not report coordinating with other primary care stakeholders or receiving support from government agencies during the Sandy response. Hurricane Sandy significantly disrupted access to primary care in the Rockaways. Severe impact to site operations and infrastructure forced many practices to relocate. Greater emergency response and recovery planning is needed, including with government agencies, to minimize disruptions of access to primary care during disaster recovery. (Disaster Med Public Health Preparedness. 2016;10:492-495).

Primary Headaches and School Performance-Is There a Connection?

Science.gov (United States)

Genizi, J; Guidetti, V; Arruda, M A

2017-07-01

Headache is a common complaint among children and adolescents. School functioning is one of the most important life domains impacted by chronic pain in children. This review discusses the epidemiological and pathophysiological connections between headaches and school functioning including a suggested clinical approach. The connection between recurrent and chronic headache and learning disabilities might be psychosocial (fear of failure) or anatomical (malfunctioning of the frontal and prefrontal areas). Only few population-based and clinical studies were done and good studies are still needed in order to understand the complex relationship better. However, relating to our patients' learning and school performance, history is crucial when a child with primary headaches is evaluated. Learning disabilities seem to have a high prevalence among children with primary headache syndromes especially migraine. The connection between the two is complex and might be either part of a common brain pathophysiology and/or a consequence of poor quality of life.

A Cursory Look at Primary School Libraries and Utilization in Ado ...

African Journals Online (AJOL)

The study is a survey of primary school libraries and usage in Ado- EkitiLocal Government Area of Ekiti State, Nigeria. Ten primary schools wereselected for the study. They represented three categories of primary schoolsin the State as follows: Government owned Public Schools State UniversalBasic Education Board ...

Initiatives towards Carbon Neutrality in the Helsinki Metropolitan Area

Directory of Open Access Journals (Sweden)

Karna Dahal

2016-07-01

Full Text Available Carbon neutrality represents one climate strategy adopted by many cities, including the city of Helsinki and the Helsinki metropolitan area in Finland. This study examines initiatives adopted by the Helsinki metropolitan area aimed at reducing energy-related carbon emissions and achieving carbon neutrality through future actions. Various sectorial energy consumption rates per year and carbon emissions from various sectors within the city of Helsinki and the metropolitan area were extracted from an online database and re-calculated (in GWh, MWh/inhabitant and MtCO2e, KtCO2e/inhabitant. We employed a backcasting scenario method to explore the various carbon reduction measures in the Helsinki metropolitan area. About 96% of the emissions produced in the Helsinki metropolitan area are energy-based. District heating represents the primary source of emissions, followed by transportation and electricity consumption, respectively. We also found that accomplishing the carbon reduction strategies of the Helsinki metropolitan area by 2050 remains challenging. Technological advancement for clean and renewable energy sources, smart policies and raising awareness resulting in behavioral changes greatly affect carbon reduction actions. Thus, strong political commitments are also required to formulate and implement stringent climate actions.

Measuring the attractiveness of rural communities in accounting for differences of rural primary care workforce supply.

Science.gov (United States)

McGrail, Matthew R; Wingrove, Peter M; Petterson, Stephen M; Humphreys, John S; Russell, Deborah J; Bazemore, Andrew W

2017-01-01

Many rural communities continue to experience an undersupply of primary care doctor services. While key professional factors relating to difficulties of recruitment and retention of rural primary care doctors are widely identified, less attention has been given to the role of community and place aspects on supply. Place-related attributes contribute to a community's overall amenity or attractiveness, which arguably influence both rural recruitment and retention relocation decisions of doctors. This bi-national study of Australia and the USA, two developed nations with similar geographic and rural access profiles, investigates the extent to which variations in community amenity indicators are associated with spatial variations in the supply of rural primary care doctors. Measures from two dimensions of community amenity: geographic location, specifically isolation/proximity; and economics and sociodemographics were included in this study, along with a proxy measure (jurisdiction) of a third dimension, environmental amenity. Data were chiefly collated from the American Community Survey and the Australian Census of Population and Housing, with additional calculated proximity measures. Rural primary care supply was measured using provider-to-population ratios in 1949 US rural counties and in 370 Australian rural local government areas. Additionally, the more sophisticated two-step floating catchment area method was used to measure Australian rural primary care supply in 1116 rural towns, with population sizes ranging from 500 to 50 000. Associations between supply and community amenity indicators were examined using Pearson's correlation coefficients and ordinary least squares multiple linear regression models. It was found that increased population size, having a hospital in the county, increased house prices and affluence, and a more educated and older population were all significantly associated with increased workforce supply across rural areas of both countries

Does quality influence utilization of primary health care? Evidence from Haiti.

Science.gov (United States)

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Assessment of anthropometric parameters including area of the psoas, area of the back muscle, and psoas-vertebra distance as indices for prediction of vertebral fracture

International Nuclear Information System (INIS)

Suzuki, Tamotsu; Morita, Masahumi; Mabuchi, Kiyoshi

2005-01-01

We assessed some anthropometric parameters as indices for the prediction of vertebral compression fracture. We measured the area of the total cross section, area of the back muscle, area of the psoas, area of subcutaneous fat tissue, ratio of the right and left area of the psoas, psoas-vertebra distance, the mediolateral length of the back muscle, anteroposterior length of the back muscle, the mediolateral length of the psoas, and anteroposterior length of the psoas, on computed tomography images. Logistic regression analysis was performed in order to test the correlation between each anthropometric parameter and the incidence of fracture. The odds ratio corresponding to one standard deviation of each parameter was calculated. The ratio of center and anterior vertebral heights and the ratio of center and posterior vertebral heights were measured from the positioning image. The smaller value of these was defined as the vertebral height ratio value. Vertebral height ratio was used as the parameter directly related to vertebral fracture. The subjects for research were 25 women with vertebral compression fracture and 36 women without fracture. Vertebral height ratio had a significant correlation with area of the psoas (correlation coefficient, r=0.609 p<0.001), area of the back muscle (r=0.547 p<0.001), and the psoas-vertebra distance (r=-0.523 p<0.001) in the anthropometric parameters. The odds ratios of the area of the psoas (odds ratio, OR:0.18, 95% confidence interval, CI:0.43 to 0.08), area of the back muscle (OR:0.13, 95% CI:0.37 to 0.05), and the psoas-vertebra distance (OR:3.01, 95% CI:6.22 to 1.46) were high. The odds ratio of the mediolateral length of the psoas (OR:0.34, 95% CI:0.67 to 0.18), and the left-to-right area ratio of the psoas (OR:0.41, 95% CI:0.76 to 0.22) were rather high. However, the vertebral height ratio had no significant correlation with the left-to-right area ratio of the psoas. It was considered that area of the psoas, area of the back

MR findings of primary scalp mass

International Nuclear Information System (INIS)

Kim, Jee Eun; Hwang, Hee Young; Park, Sung Hye; Kim, Young Chae; Lee, Young Suk

1996-01-01

To evaluate the diagnostic value of MRI, we compared MR images of primary scalp mass with pathological findings. Eight cases in seven patients who had presented primary scalp mass during the previous three years were evaluated by MRI and confirmed with surgical excision and pathologic evaluation. 0.38T(Resonex 4000, USA) MRI was used and all MR images were analysed retrospectively. Eight pathologically confirmed cases consisted of three cases of epidermal cysts, one of steatocystoma simplex, three of neurofibromatosis and one of lymphangioma. All epidermal cysts were located in the occipital area and showed a higher signal intensity than CSF in T1WI, and proton density and variable signal intensity in T2WI. The Steatocystoma showed a signal iniensity similar to fat in T1WI and proton density and a lower signal intensity than fat in T2WI. Neurofibromatosis accounted for three cases in two neurofibromatosis patients;one was located in the right parieto-occipital area and accompanied by hematoma and skull defect; two cases were located in the occipital and posterior cervical area of the same patient. The masses showed a higher signal intensity than muscle in T1WI and hyper or isointensity in T2WI with well enhancement. The lymphangioma showed a signal intensity similar to CSF in all pulse sequences and contained a fat component. MRI is a useful modality for evaluating primary scalp mass

Structure of receptive fields in a computational model of area 3b of primary sensory cortex.

Science.gov (United States)

Detorakis, Georgios Is; Rougier, Nicolas P

2014-01-01

In a previous work, we introduced a computational model of area 3b which is built upon the neural field theory and receives input from a simplified model of the index distal finger pad populated by a random set of touch receptors (Merkell cells). This model has been shown to be able to self-organize following the random stimulation of the finger pad model and to cope, to some extent, with cortical or skin lesions. The main hypothesis of the model is that learning of skin representations occurs at the thalamo-cortical level while cortico-cortical connections serve a stereotyped competition mechanism that shapes the receptive fields. To further assess this hypothesis and the validity of the model, we reproduced in this article the exact experimental protocol of DiCarlo et al. that has been used to examine the structure of receptive fields in area 3b of the primary somatosensory cortex. Using the same analysis toolset, the model yields consistent results, having most of the receptive fields to contain a single region of excitation and one to several regions of inhibition. We further proceeded our study using a dynamic competition that deeply influences the formation of the receptive fields. We hypothesized this dynamic competition to correspond to some form of somatosensory attention that may help to precisely shape the receptive fields. To test this hypothesis, we designed a protocol where an arbitrary region of interest is delineated on the index distal finger pad and we either (1) instructed explicitly the model to attend to this region (simulating an attentional signal) (2) preferentially trained the model on this region or (3) combined the two aforementioned protocols simultaneously. Results tend to confirm that dynamic competition leads to shrunken receptive fields and its joint interaction with intensive training promotes a massive receptive fields migration and shrinkage.

Structure of Receptive Fields in a Computational Model of Area 3b of Primary Sensory Cortex

Directory of Open Access Journals (Sweden)

Georgios eDetorakis

2014-07-01

Full Text Available In a previous work, we introduced a computational model of area 3b which is built upon the neural field theory and receives input from a simplified model of the index distal finger pad populated by a random set of touch receptors(Merkell cells. This model has been shown to be able to self-organize following the random stimulation of the finger pad model and to cope, to some extent, with cortical or skin lesions. The main hypothesis of the model is that learning of skin representations occurs at the thalamo-cortical level while cortico-cortical connections serve a stereotyped competition mechanism that shapes the receptive fields. To further assess this hypothesis and the validity of the model, we reproduced in this article the exact experimental protocol of DiCarlo et al. that has been used to examine the structure of receptive fields in area 3b of the primary somatosensory cortex. Using the same analysis toolset, the model yields consistent results, having most of the receptive fields to contain a single region of excitation and one to severalregions of inhibition. We further proceeded our study using a dynamic competition that deeply influences the formation of the receptive fields. We hypothesized this dynamic competition to correspond to some form of somatosensory attention that may help to precisely shape the receptive fields. To test this hypothesis, we designed a protocol where an arbitrary region of interest is delineated on the index distal finger pad and we either (1 instructed explicitly the model to attend to this region (simulating an attentional signal (2 preferentially trained the model on this region or (3combined the two aforementioned protocols simultaneously. Results tend to confirm that dynamic competition leads to shrunken receptive fields and its joint interaction with intensive training promotes a massive receptive fields migration and shrinkage.

Healthcare is primary

Directory of Open Access Journals (Sweden)

Raman Kumar

2015-01-01

Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

Primary care ... where?

Science.gov (United States)

Adcock, G B

1999-07-01

Corporate-based nurse managed centers are not the national norm. More prevalent is the use of an occupational health or physician-directed medical model of care. The author describes how a 14-year-old primary care center at a North Carolina computer software company is just "business as usual" when viewed in the context of the company's philosophy, goals, and culture. Included are considerations for nurse practitioners interested in the successful transplantation of this primary care model to other settings.

Transcranial direct current stimulation on primary sensorimotor area has no effect in patients with drug-naïve restless legs syndrome: a proof-of-concept clinical trial.

Science.gov (United States)

Koo, Yong Seo; Kim, Sung Min; Lee, Chany; Lee, Byeong Uk; Moon, Ye Ji; Cho, Yong Won; Im, Chang-Hwan; Choi, Jeong Woo; Kim, Kyung Hwan; Jung, Ki-Young

2015-02-01

To evaluate the efficacy of transcranial direct current stimulation (tDCS) in people with drug-naïve restless legs syndrome (RLS). A two-week, double-blind, randomized, sham-controlled trial was performed. Thirty-three females with RLS were recruited. Participants received five sessions of tDCS using cathodal, anodal or sham stimulation. They were assessed at baseline (T0), three days (T1) and 13 days (T2) after the end of tDCS. Primary outcomes included the International RLS Group Rating Scale (IRLS) and the Clinical Global Impressions-Improvement (CGI-I). Secondary outcomes included the Patient Global Impression scale, the Pittsburgh Sleep Quality Index, the Medical Outcome Study sleep subscales, and the Beck Depression Inventory. Objective neurophysiological changes were assessed using event-related desynchronization/synchronization (ERD/ERS) of electroencephalography. The changes in the IRLS scores, as well as the responder rate in the CGI-I scale, did not differ significantly among the groups. There was also no significant difference in any of the secondary outcome measures and ERD/ERS among the groups. Transcranial direct current stimulation with electrodes on the sensorimotor areas showed no significant effect in people with drug-naïve RLS. Copyright © 2014 Elsevier B.V. All rights reserved.

Primary health care and public policy.

Science.gov (United States)

Mangelsdorf, K L; Luna, J; Smith, H L

1988-01-01

The health problems of Ecuador are similar to those in other developing countries where the standard of living is low, and housing and sanitation are inadequate. Women, children, and those living in rural areas are those most severely affected. National policy has been to attempt to increase access to health care in rural areas through the construction of new facilities and the appointment of highly paid medical staff. However, little attention was paid to sociocultural factors, which caused the peasantry to reject the medical care system, or to problems of internal efficiency which inhibited utilization. Since the 1970s various national and international organizations have attempted to implement primary health care (PHC) through the use of trained community health workers (CHWs). The primary problems faced by the CHWs were shortages of medicines and supplies, an almost total lack of supervision, and lack of transportation available to take staff to isolated villages. The poor supervision is blamed for the 17% drop out rate among CHWs since 1980. Independent PHC programs have also been established in Ecuador by voluntary organizations. These work best when coordinated with governmental programs, in order to allow monitoring and to avoid the duplication of services. Problems with the establishment of PHC programs in Ecuador will continue, as the government has no clear cut policy, and difficulties financing on a broad national scale. Other problems include the absence of effective supervision and logistical support for even small pilot programs, and inconsistencies in the training and role definition for CHWs. These problems need to be met in the implementation of a national PHC policy.

The Emerging Role of Social Work in Primary Health Care: A Survey of Social Workers in Ontario Family Health Teams.

Science.gov (United States)

Ashcroft, Rachelle; McMillan, Colleen; Ambrose-Miller, Wayne; McKee, Ryan; Brown, Judith Belle

2018-05-01

Primary health care systems are increasingly integrating interprofessional team-based approaches to care delivery. As members of these interprofessional primary health care teams, it is important for social workers to explore our experiences of integration into these newly emerging teams to help strengthen patient care. Despite the expansion of social work within primary health care settings, few studies have examined the integration of social work's role into this expanding area of the health care system. A survey was conducted with Canadian social work practitioners who were employed within Family Health Teams (FHTs), an interprofessional model of primary health care in Ontario emerging from a period of health care reform. One hundred and twenty-eight (N = 128) respondents completed the online survey. Key barriers to social work integration in FHTs included difficulties associated with a medical model environment, confusion about social work role, and organizational barriers. Facilitators for integration of social work in FHTs included adequate education and competencies, collaborative engagement, and organizational structures.

Improving Communication About Serious Illness in Primary Care: A Review.

Science.gov (United States)

Lakin, Joshua R; Block, Susan D; Billings, J Andrew; Koritsanszky, Luca A; Cunningham, Rebecca; Wichmann, Lisa; Harvey, Doreen; Lamey, Jan; Bernacki, Rachelle E

2016-09-01

The Institute of Medicine recently called for systematic improvements in clinician-led conversations about goals, values, and care preferences for patients with serious and life-threatening illnesses. Studies suggest that these conversations are associated with improved outcomes for patients and their families, enhanced clinician satisfaction, and lower health care costs; however, the role of primary care clinicians in driving conversations about goals and priorities in serious illness is not well defined. To present a review of a structured search of the evidence base about communication in serious illness in primary care. MEDLINE was searched, via PubMed, on January 19, 2016, finding 911 articles; 126 articles were reviewed and selected titles were added from bibliography searches. Review of the literature informed 2 major topic areas: the role of primary care in communication about serious illness and clinician barriers and system failures that interfere with effective communication. Literature regarding the role that primary care plays in communication focused primarily on the ambiguity about whether primary care clinicians or specialists are responsible for initiating conversations, the benefits of primary care clinicians and specialists conducting conversations, and the quantity and quality of discussions. Timely and effective communication about serious illness in primary care is hampered by key clinician barriers, which include deficits in knowledge, skills, and attitudes; discomfort with prognostication; and lack of clarity about the appropriate timing and initiation of conversations. Finally, system failures in coordination, documentation, feedback, and quality improvement contribute to lack of conversations. Clinician and system barriers will challenge primary care clinicians and institutions to meet the needs of patients with serious illness. Ensuring that conversations about goals and values occur at the appropriate time for seriously ill patients will

Computerized tomographic evaluation of primary brain tumors

Energy Technology Data Exchange (ETDEWEB)

Choi, Jin Ok; Lee, Jong Soon; Jeon, Doo Sung; Kim, Hong Soo; Rhee, Hak Song [Presbyterian Mediacal center, Cheonju (Korea, Republic of); Kim, Jong Deok [Inje Medical College, Paik Hospital, Pusan (Korea, Republic of)

1985-10-15

In a study of primary brain tumors 104 cases having satisfactory clinical, operative and histological proofs were analyzed by computerized tomography at Presbyterian Medical Center from May, 1982 to April 1985. The results were as follows: 1. The male to female ratio of primary brain tumor was 54 : 46. 2. The 2nd decade group (26%) was the most prevalent age group, followed by the 5th decade (16.3%), 1st decade (14.4%) , 3rd decade (12.5%), 4th decade (11.5%), 6th decade (10.6%), 7th decade (8.7%) in that order. 3. The incidence of primary brain tumors was found to be: glioma 64 cases (61.6%) among the GM, the most frequent 17 cases (16.3%), followed by meningioma 12 cases (11.5%), pituitary adenoma 10 cases (9.6%), craniopharyngioma 6 cases (5.8%), pinealoma and germinoma 3 cases (2.9%) respectively, and dermoid cyst 2 cases (1.9%) in that order. 4. The location of the primary brain tumors were as follows: cb. hemisphere (49%) of these 24.5% in parietal region, 11.9% in temporal region, 9.7% in frontal region, 3.0% in occipital region: juxtasella area (16.3%), cerebellar hemisphere (8.7%), parapineal and intraventricle (7.7%) respectively, cerebello-pontine angle area (5.8%), vermis and 4th ventricular region (4.8%). 5. There were no remarkable differences in the findings of pre- and post-contrast CT scanning of primary brain tumors computed with others.

Primary production of tropical marine ecosystems

Digital Repository Service at National Institute of Oceanography (India)

Bhattathiri, P.M.A.

Among tropical marine ecosystems estuaries are one of the highly productive areas and act as a nursery to large number of organisms. The primary production in most of the estuaries is less during the monsoon period. Post-monsoon period shows...

Device for extracting steam or gas from the primary coolant line leading from a reactor pressure vessel to a straight through boiler or from the top primary boiler chamber of a water-cooled nuclear reactor

International Nuclear Information System (INIS)

Schatz, K.

1982-01-01

In such a nuclear reactor, a steam or gas cushion can form when the primary system is refilled, which can cause blocking of the natural circulation or filling of the system in the area of the hot primary coolant pipe or in the top primary boiler chamber. In order to remove such a steam or gas cushion, a ventilation pipe starting from the bend of the primary coolant line is connected to the feed pipe for introducing water into the primary system. The feed pipe is designed on the principle of the vacuum pump in the area of the opening of the ventilation pipe. There is a sub-pressure in the ventilation pipe, which makes it possible to extract the steam or gas. After mixing in the area of the opening, the steam condenses or is distributed with the gas in the primary coolant. (orig.) [de

Head and neck: treatment of primary and relapsed nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Wang, C.C.

1995-01-01

Purpose/Objective: Nasopharyngeal carcinoma (NPC) is not a common malignancy of the head and neck in the United States and presents a great challenge to the radiation oncologists in this country. Its management is radiotherapeutic and technically demanding and calls for careful treatment techniques to include the primary and the lymphatic drainage areas to high doses while sparing the neighboring organs such as the spinal cord, eyes, temporal lobes and midrain. This refresher course will review the clinical course, pattern of spread with manifestations of various neurologic syndromes of the disease. The radiotherapeutic management of primary lesion will be discussed in detail including the treatment techniques, placement of the irradiation portals, dose levels, etc. Treatment results as reported in the literature as well as those achieved at the MGH will be presented. Special emphasis will be placed on the routine use of intracavitary implant to boost the primary site and its technical aspects. Relapsed NPC after previous radiation therapy presents a difficult problem in management, but can be re-irradiated with occasional success by observing careful technique and fractionated intracavitary brachytherapy and the local control rates will be briefly covered. Recurrent disease in the neck will be managed by neck dissection. Xerostomia is undesirable and common sequelae following radical radiation therapy for NPC. Efforts are being made to decrease its magnitude by using higher energies of photons, i.e. 10 MV to spare a portion of the parotid glands with some promising results. Because of the unique location of the primary lesion, currently a modified BID program (MBID) is used and its techniques and treatment concept are discussed

Safety analysis--200 Area Savannah River Site: Separations Area operations Building 211-H Outside Facilities. Supplement 11, Revision 1

Energy Technology Data Exchange (ETDEWEB)

1993-01-01

The H-Area Outside Facilities are located in the 200-H Separations Area and are comprised of a number of processes, utilities, and services that support the separations function. Included are enriched uranium loadout, bulk chemical storage, water handling, acid recovery, general purpose evaporation, and segregated solvent facilities. In addition, services for water, electricity, and steam are provided. This Safety Analysis Report (SAR) documents an analysis of the H-Area Outside Facilities and is one of a series of documents for the Separations Area as specified in the SR Implementation Plan for DOE order 5481.1A. The primary purpose of the analysis was to demonstrate that the facility can be operated without undue risk to onsite or offsite populations, to the environment, and to operating personnel. In this report, risks are defined as the expected frequencies of accidents, multiplied by the resulting radiological consequences in person-rem. Following the summary description of facility and operations is the site evaluation including the unique features of the H-Area Outside Facilities. The facility and process design are described in Chapter 3.0 and a description of operations and their impact is given in Chapter 4.0. The accident analysis in Chapter 5.0 is followed by a list of safety related structures and systems (Chapter 6.0) and a description of the Quality Assurance program (Chapter 7.0). The accident analysis in this report focuses on estimating the risk from accidents as a result of operation of the facilities. The operations were evaluated on the basis of three considerations: potential radiological hazards, potential chemical toxicity hazards, and potential conditions uniquely different from normal industrial practice.

Safety analysis--200 Area Savannah River Site: Separations Area operations Building 211-H Outside Facilities. Supplement 11, Revision 1

International Nuclear Information System (INIS)

1993-01-01

The H-Area Outside Facilities are located in the 200-H Separations Area and are comprised of a number of processes, utilities, and services that support the separations function. Included are enriched uranium loadout, bulk chemical storage, water handling, acid recovery, general purpose evaporation, and segregated solvent facilities. In addition, services for water, electricity, and steam are provided. This Safety Analysis Report (SAR) documents an analysis of the H-Area Outside Facilities and is one of a series of documents for the Separations Area as specified in the SR Implementation Plan for DOE order 5481.1A. The primary purpose of the analysis was to demonstrate that the facility can be operated without undue risk to onsite or offsite populations, to the environment, and to operating personnel. In this report, risks are defined as the expected frequencies of accidents, multiplied by the resulting radiological consequences in person-rem. Following the summary description of facility and operations is the site evaluation including the unique features of the H-Area Outside Facilities. The facility and process design are described in Chapter 3.0 and a description of operations and their impact is given in Chapter 4.0. The accident analysis in Chapter 5.0 is followed by a list of safety related structures and systems (Chapter 6.0) and a description of the Quality Assurance program (Chapter 7.0). The accident analysis in this report focuses on estimating the risk from accidents as a result of operation of the facilities. The operations were evaluated on the basis of three considerations: potential radiological hazards, potential chemical toxicity hazards, and potential conditions uniquely different from normal industrial practice

Equity Gains in Bangladesh Primary Education

Science.gov (United States)

Chowdhury, A. Mushtaque R.; Nath, Samir R.; Choudhury, Rasheda K.

2003-11-01

Although equity is a desirable objective of any form of development intervention, including education, not many studies dwell upon this important area. Information on related trends is even more rare. This essay uses field-level data from Bangladesh to examine equity levels and trends in primary education, including enrolment and quality of learning, focusing on equity for different gender, urban or rural, economic and ethnic groups. The study shows that while some disparity between girls and boys has been eliminated, girls are still far behind boys in terms of learning achievement. Children belonging to poorer families and ethnic minority groups lag behind the respective dominant groups in terms of both enrolment and learning achievement. At the same time, there have been some improvements for hitherto excluded groups such as rural girls and children of the poor. These changes are attributed mainly to 'positive discriminatory' steps taken by the government and non-governmental organizations in favour of such groups. If this trend continues, Bangladesh can look forward to establishing itself as a more equitable society than it is now.

[Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area].

Science.gov (United States)

Llor, Carles; Boada, Albert; Pons-Vigués, Mariona; Grenzner, Elisabet; Juvé, Rosa; Almeda, Jesús

2018-01-01

The information available on antibiotic resistance patterns are generally based on specimens from hospitalised individuals. This study was aimed at evaluating the antibiotic resistance rate of nasal carriage strains of Staphylococcus aureus and Streptococcus pneumoniae in healthy individuals, in accordance with age and gender, attended in Primary Care Centres (PCC). Cross-sectional study. Seven PCC in the Barcelona area. Healthy nasal carriers aged 4years or more who did not present with any sign of infectious disease, and had not taken any antibiotic or had been hospitalised in the previous 3months. A total of 3,969 nasal swabs valid for identification were collected between 2010 and 2011 and were sent to one central microbiological laboratory for isolation of both pathogens. Resistance to common antibiotics was determined on the basis of the current European Committee on Antimicrobial Susceptibility Testing guidelines on cut-off points. The prevalence of methicillin-resistant S.aureus was 1.3% (95%CI: 0.5-2.1%), with resistance rates of 87.1% to phenoxymethylpenicillin and 11.6% to azithromycin, with no significant differences with age and gender. A total of 2.4% (95CI%: 0.1-4.7%) of the pneumococcal strains were highly resistant to both phenoxymethylpenicillin and macrolides, whereas the highest resistance rates were to cefaclor (53.3%), followed by tetracycline (20%) and cefuroxime (12.1%). These pathogens have lower resistance rates in the community than in the hospital setting. Primary Care physicians must be more aware of the current antimicrobial resistance, in order to ensure prudent use of antibiotics. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Aspirin overutilization for the primary prevention of cardiovascular disease

Directory of Open Access Journals (Sweden)

VanWormer JJ

2014-12-01

Full Text Available Jeffrey J VanWormer,1 Aaron W Miller,2 Shereif H Rezkalla3 1Center for Clinical Epidemiology and Population Health, 2Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, USA; 3Department of Cardiology, Marshfield Clinic, Marshfield, WI, USA Background: Aspirin is commonly used for the primary prevention of cardiovascular disease (CVD in the US. Previous research has observed significant levels of inappropriate aspirin use for primary CVD prevention in some European populations, but the degree to which aspirin is overutilized in the US remains unknown. This study examined the association between regular aspirin use and demographic/clinical factors in a population-based sample of adults without a clinical indication for aspirin for primary prevention.Methods: A cross-sectional analysis was performed using 2010–2012 data from individuals aged 30–79 years in the Marshfield Epidemiologic Study Area (WI, USA. Regular aspirin users included those who took aspirin at least every other day.Results: There were 16,922 individuals who were not clinically indicated for aspirin therapy for primary CVD prevention. Of these, 19% were regular aspirin users. In the final adjusted model, participants who were older, male, lived in northern Wisconsin, had more frequent medical visits, and had greater body mass index had significantly higher odds of regular aspirin use (P<0.001 for all. Race/ethnicity, health insurance, smoking, blood pressure, and lipid levels had negligible influence on aspirin use. A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently.Conclusion: There was evidence of aspirin overutilization in this US population without CVD. Older age and more frequent provider visits were the strongest predictors of inappropriate aspirin use. Obesity was the only significant

Patients' perspectives on the medical primary-secondary care interface: systematic review and synthesis of qualitative research.

Science.gov (United States)

Sampson, Rod; Cooper, Jamie; Barbour, Rosaline; Polson, Rob; Wilson, Philip

2015-10-15

To synthesise the published literature on the patient experience of the medical primary-secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients' perspectives of the medical primary-secondary care interface. International primary-secondary care interface. EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science & Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature. Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients' perspectives of the medical primary-secondary care interface. The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary-secondary care interface from the patients' perspective emerged: barriers to care, communication, coordination, and 'relationships and personal value'. Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface. PROSPERO CRD42014009486. 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.

Community perception of quality of (primary health care services in a rural area of Limpopo Province, South Africa: a qualitative study

Directory of Open Access Journals (Sweden)

T-AB Mashego

2005-09-01

Full Text Available The aim of the study was to survey perceptions of quality of (primary health care services provided in rural communities in the Limpopo province. Ten focus groups discussions were held with community members chosen by convenience from public places from four villages in the central region of the Limpopo Province. The sample included 42 women and 34 men (76 participants. Results indicated perceived quality discussed within the following categories: (1 conduct of staff (reception, communication, discrimination, care and compassion, respect for privacy, (2 technical care (examination, explanation of treatment, responsiveness, treatment outcomes, (3 health care facility, (4 health care organisation, (5 drugs (availability, explanation, effectiveness, payment, and (6 waiting time. The findings suggest some satisfaction with free basic and preventive health care and social services provided but there is a need to look closely into the interpersonal dimension of the services provided, provision of medication with adequate explanation to patients on the medication given, and on structural aspects, there is need for the government to give support to the clinics to provide adequate services. Improving drug availability, interpersonal skills (including attitudes towards patients and technical care have been identified as the three main priorities for enhancing perceived quality of primary health care and health policy action.

Egg positive rate of Enterobius vermicularis of primary school children in Geoje island

Science.gov (United States)

Kim, Bong Jin; Lee, Bo Young; Chung, Hyun Kee; Lee, Young Sun; Lee, Kun Hee; Chung, Hae Jin

2003-01-01

The status of pinworm (Enterobius vermicularis) egg positive rate of primary school children in Geoje island was investigated by using adhesive cellotape anal swap method, in September, 2002. Total egg positive rates of E. vermicularis were 9.8% (74/754) and those of male and female were 10.8% and 8.7%, respectively. Among three schools examined, Myeongsa primary school showed the highest egg positive rate (12.6%) followed by Yeoncho [9.8% (26/266)] and Geoje [9.1% (35/385)]. As for the age groups, the 2nd grade had the highest egg positive rate (15.3%), whereas the 5th grade showed the lowest egg positive rate (2.6%). The above result led us to confirm that the egg positive rates of E. vermicularis in primary school children in Geoje island were not significantly different from the those in the whole country including urban and rural areas, showing more than 10%. PMID:12666734

The Harvard Medical School Academic Innovations Collaborative: transforming primary care practice and education.

Science.gov (United States)

Bitton, Asaf; Ellner, Andrew; Pabo, Erika; Stout, Somava; Sugarman, Jonathan R; Sevin, Cory; Goodell, Kristen; Bassett, Jill S; Phillips, Russell S

2014-09-01

Academic medical centers (AMCs) need new approaches to delivering higher-quality care at lower costs, and engaging trainees in the work of high-functioning primary care practices. In 2012, the Harvard Medical School Center for Primary Care, in partnership with with local AMCs, established an Academic Innovations Collaborative (AIC) with the goal of transforming primary care education and practice. This novel two-year learning collaborative consisted of hospital- and community-based primary care teaching practices, committed to building highly functional teams, managing populations, and engaging patients. The AIC built on models developed by Qualis Health and the Institute for Healthcare Improvement, optimized for the local AMC context. Foundational elements included leadership engagement and development, application of rapid-cycle process improvement, and the creation of teams to care for defined patient populations. Nineteen practices across six AMCs participated, with nearly 260,000 patients and 450 resident learners. The collaborative offered three 1.5-day learning sessions each year featuring shared learning, practice coaches, and improvement measures, along with monthly data reporting, webinars, and site visits. Validated self-reports by transformation teams showed that practices made substantial improvement across all areas of change. Important factors for success included leadership development, practice-level resources, and engaging patients and trainees. The AIC model shows promise as a path for AMCs to catalyze health system transformation through primary care improvement. In addition to further evaluating the impact of practice transformation, expansion will require support from AMCs and payers, and the application of similar approaches on a broader scale.

Nurses' perceptions of mental healthcare in primary-care settings in Kenya.

Science.gov (United States)

Mendenhall, Emily; Isaiah, Gitonga; Nelson, Bernadette; Musau, Abednego; Koon, Adam D; Smith, Lahra; Mutiso, Victoria; Ndetei, David

2018-04-01

Kenya maintains an extraordinary treatment gap for mental health services because the need for and availability of mental health services are extraordinarily misaligned. One way to narrow the treatment gap is task-sharing, where specialists rationally distribute tasks across the health system, with many responsibilities falling upon frontline health workers, including nurses. Yet, little is known about how nurses perceive task-sharing mental health services. This article investigates nurses' perceptions of mental healthcare delivery within primary-care settings in Kenya. We conducted a cross-sectional study of 60 nurses from a public urban (n = 20), private urban (n = 20), and public rural (n = 20) hospitals. Nurses participated in a one-hour interview about their perceptions of mental healthcare delivery. Nurses viewed mental health services as a priority and believed integrating it into a basic package of primary care would protect it from competing health priorities, financial barriers, stigma, and social problems. Many nurses believed that integrating mental healthcare into primary care was acceptable and feasible, but low levels of knowledge of healthcare providers, especially in rural areas, and few specialists, would be barriers. These data underscore the need for task-sharing mental health services into existing primary healthcare in Kenya.

Primary infertility (image)

Science.gov (United States)

Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy ... to do so through unprotected intercourse. Causes of infertility include a wide range of physical as well ...

Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish Highlands.

Science.gov (United States)

Richards, Helen M; Farmer, Jane; Selvaraj, Sivasubramaniam

2005-01-01

Many westernised countries face ongoing difficulties in the recruitment and retention of health professionals in remote and rural communities. Predictors of rural working have been identified by the international literature, and include: the individual having been born or educated in a rural location; exposure to rural healthcare during training; access to continuing professional education; good relationships with peers; spousal contentedness; adoption of a rural 'lifestyle'; successful integration into local communities; and educational opportunities for children. However, those themes remain unverified in the UK. The present study aimed to ascertain whether the internationally identified determinants of recruitment and retention of the rural health workforce apply in the Highlands of Scotland, which includes the most sparsely populated area of the UK mainland, as well as an urban area. In 2003, a questionnaire was sent to all 2070 primary healthcare professionals working in the Highlands (which makes up one-third of Scotland's land area (9800 square miles) and has just 4% of the country's population (209,000)). Approximately one-quarter of the Highland's population live in Inverness. The area is ideal for investigating the rural workforce due to its population sparsity and the inclusion of small towns and Inverness, allowing urban/rural comparisons. The questionnaire asked about places of birth and education; intentions to stay/leave current location; professional isolation; access to amenities; and perceptions of belonging to the local community. The response rate was 53%. Compared with respondents working in urban areas, those working in rural areas were more likely to have been born in rural areas. Professionals living in rural areas were more likely to have been born outside Scotland and to have completed their secondary education and professional training outside Scotland, compared with those living in urban areas. Approximately one-third (34%) had lived in

Primary Geography Education in China: Past, Current and Future

Science.gov (United States)

Xuan, Xiaowei; Duan, Yushan; Sun, Yue

2015-01-01

In China, geography education in primary schools (grades 1 to 6) has not been emphasized, although some scholars have done research in this area. In order to deepen the understanding of primary geography education in China, this paper examines its history, current situation, and future trends. The authors used the method of document analysis and…

Competition and rural primary care programs.

Science.gov (United States)

Ricketts, T C

1990-04-01

Rural primary care programs were established in areas where there was thought to be no competition for patients. However, evidence from site visits and surveys of a national sample of subsidized programs revealed a pattern of competitive responses by the clinics. In this study of 193 rural primary care programs, mail and telephone surveys produced uniform data on the organization, operation, finances, and utilization of a representative sample of clinics. The programs were found to compete in terms of: (1) price, (2) service mix, (3) staff availability, (4) structural accessibility, (5) outreach, and (6) targeting a segment of the market. The competitive strategies employed by the clinics had consequences that affected their productivity and financial stability. The strategies were related to the perceived missions of the programs, and depended heavily upon the degree of isolation of the program and the targeting of the services. The competitive strategy chosen by a particular program could not be predicted based on service area population and apparent competitors in the service area. The goals and objectives of the programs had more to do with their competitive responses than with market characteristics. Moreover, the chosen strategies may not meet the demands of those markets.

Methotrexate for primary biliary cirrhosis

DEFF Research Database (Denmark)

Giljaca, Vanja; Poropat, Goran; Stimac, Davor

2010-01-01

Methotrexate has been used to treat patients with primary biliary cirrhosis as it possesses immunosuppressive properties. The previously prepared version of this review from 2005 showed that methotrexate seemed to significantly increase mortality in patients with primary biliary cirrhosis. Since...... that last review version, follow-up data of the included trials have been published....

Wide-area situation awareness in electric power grid

Science.gov (United States)

Greitzer, Frank L.

2010-04-01

Two primary elements of the US energy policy are demand management and efficiency and renewable sources. Major objectives are clean energy transmission and integration, reliable energy transmission, and grid cyber security. Development of the Smart Grid seeks to achieve these goals by lowering energy costs for consumers, achieving energy independence and reducing greenhouse gas emissions. The Smart Grid is expected to enable real time wide-area situation awareness (SA) for operators. Requirements for wide-area SA have been identified among interoperability standards proposed by the Federal Energy Regulatory Commission and the National Institute of Standards and Technology to ensure smart-grid functionality. Wide-area SA and enhanced decision support and visualization tools are key elements in the transformation to the Smart Grid. This paper discusses human factors research to promote SA in the electric power grid and the Smart Grid. Topics that will be discussed include the role of human factors in meeting US energy policy goals, the impact and challenges for Smart Grid development, and cyber security challenges.

FFTBM and primary pressure acceptance criterion

International Nuclear Information System (INIS)

Prosek, A.

2004-01-01

When thermalhydraulic computer codes are used for simulation in the area of nuclear engineering the question is how to conduct an objective comparison between the code calculation and measured data. To answer this the fast Fourier transform based method (FFTBM) was developed. When the FFTBM method was developed the acceptance criteria for primary pressure and total accuracy were set. In the recent study the FFTBM method was used for accuracy quantification of RD-14M large LOCA test B9401 calculations. The blind accuracy analysis indicated good total accuracy while the primary pressure criterion was not fulfilled. The objective of the study was therefore to investigate the reasons for not fulfilling the primary pressure acceptance criterion and the applicability of the criterion to experimental facilities simulating heavy water reactor. The results of the open quantitative analysis showed that sensitivity analysis for influence parameters provide sufficient information to judge in which calculation the accuracy of primary pressure is acceptable. (author)

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

Data.gov (United States)

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

Risk management of infrastructure development in border area Indonesia - Malaysia

Science.gov (United States)

Fitri, Suryani; Trikariastoto, Reinita, Ita

2017-11-01

Border area is geographically adjacent to neighboring countries with the primary function of maintaining state sovereignty and public welfare. Area in question is part of the provinces, districts or cities that directly intersect with national boundaries (or territory) and / or that have a functional relationship (linkage) and has a strategic value for the state. The border area is considered strategic because it involves the national lives of many people in terms of the interests of political, economic, social and cultural as well as defense and security (poleksosbudhankam) both located on land, sea or air. The border area is geographically adjacent to neighboring countries with the primary function of maintaining state sovereignty and public welfare. Area in question is part of the provinces, districts or cities that directly intersect with national boundaries (or territory) and / or that have a functional relationship (linkage) and has a strategic value for the state. To realize the necessary research on the development of the area, based on good practices from other countries some of the city that can meet all these challenges and at least can be applied with minor changes / adjustments. Furthermore, the application must be supported by the availability of funds. This study to discuss about any problems either obstacles or things that drive to develop function becomes an ideal border area with major support infrastructure for housing, transportation, energy availability, and distribution of clean water which will strengthen in its function which consists of five pillars, namely: central community service; trade and distribution center; financial center; tourism center; related to the field of community development. Articulation between key stakeholders such as government, private, and community is a major concern in this study, including in determining the appropriate financing schemes. The results of this study will be recommended to the government to improve

Health care in rural areas.

Science.gov (United States)

Nath, L M

1994-02-01

In India, although the health care system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary health care centers. This problem has been compounded by the separation of health care and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own health care system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary health care because they fulfill a need not met by the primary health care staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit.

FLOODPLAIN, STEWART COUNTY (AND INCORPORATED AREAS)

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, PUTNAM COUNTY (AND INCORPORATED AREAS)

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, FRANKLIN PARISH (AND INCORPORATED AREAS)

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, VERNON PARISH (AND INCORPORATED AREAS)

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, DEKALB COUNTY (AND INCORPORATED AREAS)

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

Including Migrant Worker Children in the Learning and Social Context of the Rural Primary School

Science.gov (United States)

Hamilton, Paula

2013-01-01

Many of the larger towns and cities within the UK have long experienced a cosmopolitan mix of cultures, resulting in ethnically and linguistically diverse schools. However, the wider expansion of the European Union in 2004 has brought about significant changes and challenges for many schools, particularly for those in more rural areas. This…

Variation in primary site resection practices for advanced colon cancer: a study using the National Cancer Data Base.

Science.gov (United States)

Healy, Mark A; Pradarelli, Jason C; Krell, Robert W; Regenbogen, Scott E; Suwanabol, Pasithorn A

2016-10-01

Treatment of metastatic colon cancer may be driven as much by practice patterns as by features of disease. To optimize management, there is a need to better understand what is determining primary site resection use. We evaluated all patients with stage IV cancers in the National Cancer Data Base from 2002 to 2012 (50,791 patients, 1,230 hospitals). We first identified patient characteristics associated with primary tumor resection. Then, we assessed nationwide variation in hospital resection rates. Overall, 27,387 (53.9%) patients underwent primary site resection. Factors associated with resection included younger age, having less than 2 major comorbidities, and white race (P primary tumor resection rates ranged from 26.0% to 87.8% with broad differences across geographical areas and hospital accreditation types. There is statistically significant variation in hospital rates of primary site resection. This demonstrates inconsistent adherence to guidelines in the presence of conflicting evidence regarding resection benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

[Meanings and methods of territorialization in primary health care].

Science.gov (United States)

Pessoa, Vanira Matos; Rigotto, Raquel Maria; Carneiro, Fernando Ferreira; Teixeira, Ana Cláudia de Araújo

2013-08-01

Territorially-based participative analytical methodologies taking the environmental question and work into consideration are essential for effective primary health care. The study analyzed work and environment-related processes in the primary health care area and their repercussions on the health of workers and the community in a rural city in Ceará, whose economy is based on agriculture for export,. It sought to redeem the area and the proposal of actions focused on health needs by the social subjects through the making of social, environmental and work-related maps in workshops within the framework of action research. Examining the situation from a critical perspective, based on social participation and social determination of the health-disease process with regard to the relations between production, environment and health, was the most important step in the participative map-making process, with the qualitative material interpreted in light of discourse analysis. The process helped identify the health needs, the redemption of the area, strengthened the cooperation between sectors and the tie between the health of the worker and that of the environment, and represented an advance towards the eradication of the causes of poor primary health care services.

Prevalence of Intestinal Protozoans among Schoolchildren in Suburban Areas near Yangon, Myanmar.

Science.gov (United States)

Kim, Min-Jae; Jung, Bong-Kwang; Cho, Jaeeun; Kim, Deok-Gyu; Song, Hyemi; Lee, Keon-Hoon; Cho, Seon; Htoon, Thi Thi; Tin, Htay Htay; Chai, Jong-Yil

2016-06-01

Although intestinal protozoans are common etiologies of diarrhea, few studies have been conducted in Myanmar. This study planned to investigate the prevalence of Giardia lamblia, Entamoeba coli, Entamoeba histolytica, and Endolimax nana among schoolchildren and their guardians in suburban areas near Yangon, Myanmar. We performed a cross-sectional survey among schoolchildren and their guardians from 7 primary schools in South Dagon and Hlaing Thar Yar districts, Yangon, Myanmar. Stool samples were observed with a microscope after concentration technique and iodine staining. Total 821 stool samples, including 556 from schoolchildren and 265 from guardians, were examined. The median age was 6 years old for schoolchildren and 36 years old for guardians. A 53.1% of the school children and 14.6 % of the guardians were males. The overall prevalence of each intestinal protozoan species was as follows: 3.4% (28/821) for G. lamblia; 3.5% (29/821) for E. coli; 1.2% (10/821) for E. histoytica, and 3.0% for E. nana. This study showed that intestinal protozoans are common in primary schoolchildren and their guardians in suburban areas near Yangon, Myanmar. Health interventions, such as hand washing education, improvement of sanitation, and establishment of water purification systems are urgently needed in this area.

Development of microbial community during primary succession in areas degraded by mining activities

Czech Academy of Sciences Publication Activity Database

Harantová, Lenka; Mudrák, O.; Kohout, Petr; Elhottová, Dana; Frouz, J.; Baldrian, Petr

2017-01-01

Roč. 28, č. 8 (2017), s. 2574-2584 ISSN 1085-3278 R&D Projects: GA ČR(CZ) GA15-11635S Institutional support: RVO:61388971 ; RVO:60077344 Keywords : plant-soil interactions * postmining sites * primary succession Subject RIV: EE - Microbiology, Virology; EE - Microbiology, Virology (BC-A) OBOR OECD: Microbiology; Microbiology (BC-A) Impact factor: 9.787, year: 2016

Other primary headaches

Directory of Open Access Journals (Sweden)

Anish Bahra

2012-01-01

Full Text Available The ′Other Primary Headaches′ include eight recognised benign headache disorders. Primary stabbing headache is a generally benign disorder which often co-exists with other primary headache disorders such as migraine and cluster headache. Primary cough headache is headache precipitated by valsalva; secondary cough has been reported particularly in association with posterior fossa pathology. Primary exertional headache can occur with sudden or gradual onset during, or immediately after, exercise. Similarly headache associated with sexual activity can occur with gradual evolution or sudden onset. Secondary headache is more likely with both exertional and sexual headache of sudden onset. Sudden onset headache, with maximum intensity reached within a minute, is termed thunderclap headache. A benign form of thunderclap headache exists. However, isolated primary and secondary thunderclap headache cannot be clinically differentiated. Therefore all headache of thunderclap onset should be investigated. The primary forms of the aforementioned paroxysmal headaches appear to be Indomethacin sensitive disorders. Hypnic headache is a rare disorder which is termed ′alarm clock headache′, exclusively waking patients from sleep. The disorder can be Indomethacin responsive, but can also respond to Lithium and caffeine. New daily persistent headache is a rare and often intractable headache which starts one day and persists daily thereafter for at least 3 months. The clinical syndrome more often has migrainous features or is otherwise has a chronic tension-type headache phenotype. Management is that of the clinical syndrome. Hemicrania continua straddles the disorders of migraine and the trigeminal autonomic cephalalgias and is not dealt with in this review.

Restructuring primary care for performance improvement.

Science.gov (United States)

Fawcett, Kenneth J; Brummel, Stacy; Byrnes, John J

2009-01-01

Primary care practices can no longer consider ongoing quality assessment and management processes to be optional. There are ever-increasing demands from any number of interested parties for objectively measured proof of outcomes and quality of care. Primary Care Partners (PCP), a 16-site ambulatory affiliate of the Spectrum Health system in Grand Rapids, Michigan, began such a continuous quality improvement (CQI) effort in 2005. The intent was to develop an ongoing systematic process that would raise its performance potential and improve patient outcomes in the areas of chronic disease management and preventive services. This article describes the partnerships PCP established, specific benchmarks and measurements used, processes utilized, and results to date. This could be used as a roadmap for other primary care systems that are working to establish CQI in their daily operations.

Root canal morphology of primary molars: a micro-computed tomography study.

Science.gov (United States)

Fumes, A C; Sousa-Neto, M D; Leoni, G B; Versiani, M A; da Silva, L A B; da Silva, R A B; Consolaro, A

2014-10-01

This was to investigate the root canal morphology of primary molar teeth using micro-computed tomography. Primary maxillary (n = 20) and mandibular (n = 20) molars were scanned at a resolution of 16.7 μm and analysed regarding the number, location, volume, area, structured model index (SMI), area, roundness, diameters, and length of canals, as well as the thickness of dentine in the apical third. Data were statistically compared by using paired-sample t test, independent sample t test, and one-way analysis of variance with significance level set as 5%. Overall, no statistical differences were found between the canals with respect to length, SMI, dentine thickness, area, roundness, and diameter (p > 0.05). A double canal system was observed in the mesial and mesio-buccal roots of the mandibular and maxillary molars, respectively. The thickness in the internal aspect of the roots was lower than in the external aspect. Cross-sectional evaluation of the roots in the apical third showed flat-shaped canals in the mandibular molars and ribbon- and oval-shaped canals in the maxillary molars. External and internal anatomy of the primary first molars closely resemble the primary second molars. The reported data may help clinicians to obtain a thorough understanding of the morphological variations of root canals in primary molars to overcome problems related to shaping and cleaning procedures, allowing appropriate management strategies for root canal treatment.

INCA project for investigation of primary cosmic radiation spectrum

International Nuclear Information System (INIS)

Aleksandrov, K.V.; Erlykin, A.D.; Zhdanov, G.B.

2002-01-01

The scientific purposes of the INCA project and application of the ionization-neutron calorimeter for direct measurements of the cosmic rays spectrum and composition in the knee area and the primary electrons spectrum by 10 14 - 10 13 eV are discussed. The new effective method for the primary electrons and protons separation with the complex rejection coefficient of 10 -5 - 10 -6 is proposed for studying the primary electrons spectrum by E e > 1 TeV. The experimental and calculation data are in good agreement [ru

Suicidal ideation in German primary care

NARCIS (Netherlands)

Wiborg, J.F.; Gieseler, D.; Lowe, B.

2013-01-01

OBJECTIVE: To examine suicidal ideation in a sample of German primary care patients. METHODS: We conducted a cross-sectional study and included 1455 primary care patients who visited 1 of 41 general practitioners (GPs) working at 19 different sites. Suicidal ideation and psychopathology were

Primary production in the Kattegat - past and present

DEFF Research Database (Denmark)

Richardson, K.; Heilmann, Jens

1995-01-01

data collected during the period 1984-1993 are calculated using the method employed in the 1950s. It is concluded that primary production in the Kattegat has increased from less than 100 g C m(-2) y(- 1) to about 200 g C m(-2) y(-1) since the 1950s. This increase is not seen during the winter months...... to be responses to increases in primary production. However, for most areas, there are insufficient data to demonstrate whether or not increases in primary production have actually occurred. In this study, the evidence for increased primary production in the Kattegat is examined by comparing primary production...... measurements from the 1950s and measurements made in the period 1984-1993. The methods employed during the two periods differ considerably. These differences and how they may affect the validity of a comparison of the results from the studies carried out in two periods are addressed. The primary production...

State Primary Stroke Center Policies in the US: Rural Health Issues.

NARCIS (Netherlands)

Slade, C.; O'Toole, Laurence J.; Rho, E.

2012-01-01

Objective: To explore the relationship between state primary stroke center (PSC) designation policy implementation and access to optimal stroke care for residents of rural areas. Materials and Methods: Primary data were collected during the period September 2008–August 2009. Following content

Treatment of relapse in herpes simplex on labial and facial areas and of primary herpes simplex on genital areas and "area pudenda" with low-power He-Ne laser or Acyclovir administered orally

Science.gov (United States)

Velez-Gonzalez, Mariano; Urrea-Arbelaez, Alejandro; Nicolas, M.; Serra-Baldrich, E.; Perez, J. L.; Pavesi, M.; Camarasa, J. M.; Trelles, Mario A.

1996-01-01

Sixty patients (greater than 16 yrs old) suffering primary or relapse genital herpes simplex viruses (HSV) and relapse labial HSV were appointed for this study. Three or more relapses were experienced per year. Patients (under treatment) were divided into two groups (distribution areas), corresponding to either labial herpes or genital herpes. These groups were sub-divided into 3 groups. The total number of labial or facial HSV patients was 36 (10 in group 1, 12 in group 2, 14 in group 3) and 24 for genital, buttocks, or 'area pudenda' HSV patients (6 in group 1, 8 in group 2, 10 in group 3). The design was a randomized, double- blind study. The setting was hospital and outpatient. The patients diagnosed as having the HVS disease were sent to the dermatology department and were assigned to a group at random. Treatment was begun as follows: During the treatment signs and symptoms were assessed and after the treatment, the relapses were also assessed (biochemical and hematological tests before and after the treatment) and the diagnosis of the HSV type I and II. The statistical evaluation of the results was performed and carried out with the SPSS and BMDP program. The relapses of the herpes infection in the lips and the face were significantly reduced (p less than 0.026) in patients treated with laser He-Ne and laser He-Ne plus Acyclovir. The interim between the relapses also increased significantly (p less than 0.005) in relation with the group treated with Acyclovir. The duration of the herpetic eruptions was clearly reduced in all locations in patients treated with laser He-Ne plus Acyclovir. No differences were noted between patients treated with laser He-Ne only or Acyclovir only. Therefore it is probable that therapeutic synergism took place. In relation with this, laser He-Ne shows the same therapeutic efficacy as Acyclovir taken orally. The association of Acyclovir and laser Ne-Ne could be an alternative method for the treatment of HSV in the face. The number

Primary Breast Tuberculosis Presenting as a Lump: A Rare Modern ...

African Journals Online (AJOL)

mammary area. A 25. year.old female, presented with a lump in the breast and infra.mammary area. She was having off and on fever without any other complaints. There was no positive family history. Primary breast tuberculosis was diagnosed on fine ...

Enhanced peripheral visual processing in congenitally deaf humans is supported by multiple brain regions, including primary auditory cortex

OpenAIRE

Scott, Gregory D.; Karns, Christina M.; Dow, Mark W.; Stevens, Courtney; Neville, Helen J.

2014-01-01

Brain reorganization associated with altered sensory experience clarifies the critical role of neuroplasticity in development. An example is enhanced peripheral visual processing associated with congenital deafness, but the neural systems supporting this have not been fully characterized. A gap in our understanding of deafness-enhanced peripheral vision is the contribution of primary auditory cortex. Previous studies of auditory cortex that use anatomical normalization across participants wer...

Proceedings: Primary water stress corrosion cracking: 1989 EPRI remedial measures workshop

International Nuclear Information System (INIS)

Gorman, J.A.

1990-04-01

A meeting on ''PWSCC Remedial Measures'' was organized to give those working in this area an opportunity to share their results, ideas and plans with regard to development and application of remedial measures directed against the primary water stress corrosion cracking (PWSCC) phenomenon affecting alloy 600 steam generator tubes. Topics discussed included: utility experience and strategies; nondestructive examination (NDE) methods for PWSCC; technical topics ranging from predictive methods for occurrence of PWSCC to results of corrosion tests; and services provided by vendors that can help prevent the occurrence of PWSCC or can help address problems caused by PWSCC once it occurs

Prenatal care utilization for mothers from low-income areas of New Mexico, 1989-1999.

Directory of Open Access Journals (Sweden)

Michael A Schillaci

2010-09-01

Full Text Available Prenatal care is considered to be an important component of primary health care. Our study compared prenatal care utilization and rates of adverse birth outcomes for mothers from low- and higher-income areas of New Mexico between 1989 and 1999.Prenatal care indicators included the number of prenatal care visits and the first month of prenatal care. Birth outcome indicators included low birth weight, premature birth, and births linked with death certificates. The results of our study indicated that mothers from low-income areas started their prenatal care significantly later in their pregnancies between 1989 and 1999, and had significantly fewer prenatal visits between 1989 and 1997. For the most part, there were not significant differences in birth outcome indicators between income groupings.These findings suggest that while mothers from low-income areas received lower levels of prenatal care, they did not experience a higher level of adverse birth outcomes.

Food security assessment in the coastal area of Demak Regency

Science.gov (United States)

Harini, R.; Handayani, H. N.; Ramdani, F. R.

2018-04-01

Food security is an issue of national and global level. Food is a basic human need to live. Without food will threaten human life. This research was conducted in coastal area of Demak Regency. This research is to understand the potential of human resources, natural resources and assess the level of food security of coastal communities. The data used are primary data through interviews with the local community. Also used Secondary data from government agencies. Data analysis used qualitative and quantitative descriptive methods through graphs, tables and maps. The results showed that potential of human resources in Demak coastal area (Wedung, Purworejo, and Sidogemah villages) is low. It can be indicated from education level of respondents in Demak are elementary school and junior high school. Beside, total households income are about 2-4 million. This study found that the households sampled are 90% is food insecured households. The most of households in Demak coastal area are about 90% households include on insecurity food category.

Primary extracranial vertebral artery aneurysms.

Science.gov (United States)

Morasch, Mark D; Phade, Sachin V; Naughton, Peter; Garcia-Toca, Manuel; Escobar, Guillermo; Berguer, Ramon

2013-05-01

Extracranial vertebral artery aneurysms are uncommon and are usually associated with trauma or dissection. Primary cervical vertebral aneurysms are even rarer and are not well described. The presentation and natural history are unknown and operative management can be difficult. Accessing aneurysms at the skull base can be difficult and, because the frail arteries are often afflicted with connective tissue abnormalities, direct repair can be particularly challenging. We describe the presentation and surgical management of patients with primary extracranial vertebral artery aneurysms. In this study we performed a retrospective, multi-institutional review of patients with primary aneurysms within the extracranial vertebral artery. Between January 2000 and January 2011, 7 patients, aged 12-56 years, were noted to have 9 primary extracranial vertebral artery aneurysms. All had underlying connective tissue or another hereditary disorder, including Ehler-Danlos syndrome (n=3), Marfan's disease (n=2), neurofibromatosis (n=1), and an unspecified connective tissue abnormality (n=1). Eight of 9 aneurysms were managed operatively, including an attempted bypass that ultimately required vertebral ligation; the contralateral aneurysm on this patient has not been treated. Open interventions included vertebral bypass with vein, external carotid autograft, and vertebral transposition to the internal carotid artery. Special techniques were used for handling the anastomoses in patients with Ehler-Danlos syndrome. Although endovascular exclusion was not performed in isolation, 2 hybrid procedures were performed. There were no instances of perioperative stroke or death. Primary extracranial vertebral artery aneurysms are rare and occur in patients with hereditary disorders. Operative intervention is warranted in symptomatic patients. Exclusion and reconstruction may be performed with open and hybrid techniques with low morbidity and mortality. Copyright © 2013 Elsevier Inc. All rights

Prevalence of geohelminth in soil and primary school children in ...

African Journals Online (AJOL)

A study of geohelminthes infections among primary school children aged 8 to 13 years was conducted in four selected primary schools in Panda Development Area, Karu LGA, Nasarawa State, Nigeria. Out of four hundred and eighty (480) soil samples collected from the four schools, 314 (82.63) were found to be positive ...

Gravity Cues Embedded in the Kinematics of Human Motion Are Detected in Form-from-Motion Areas of the Visual System and in Motor-Related Areas.

Science.gov (United States)

Cignetti, Fabien; Chabeauti, Pierre-Yves; Menant, Jasmine; Anton, Jean-Luc J J; Schmitz, Christina; Vaugoyeau, Marianne; Assaiante, Christine

2017-01-01

The present study investigated the cortical areas engaged in the perception of graviceptive information embedded in biological motion (BM). To this end, functional magnetic resonance imaging was used to assess the cortical areas active during the observation of human movements performed under normogravity and microgravity (parabolic flight). Movements were defined by motion cues alone using point-light displays. We found that gravity modulated the activation of a restricted set of regions of the network subtending BM perception, including form-from-motion areas of the visual system (kinetic occipital region, lingual gyrus, cuneus) and motor-related areas (primary motor and somatosensory cortices). These findings suggest that compliance of observed movements with normal gravity was carried out by mapping them onto the observer's motor system and by extracting their overall form from local motion of the moving light points. We propose that judgment on graviceptive information embedded in BM can be established based on motor resonance and visual familiarity mechanisms and not necessarily by accessing the internal model of gravitational motion stored in the vestibular cortex.

Innovation in Management Plans for Community Conserved Areas: Experiences from Australian Indigenous Protected Areas

Directory of Open Access Journals (Sweden)

Jocelyn Davies

2013-06-01

Full Text Available Increasing attention to formal recognition of indigenous and community conserved areas (ICCAs as part of national and/or global protected area systems is generating novel encounters between the customary institutions through which indigenous peoples and local communities manage these traditional estates and the bureaucratic institutions of protected area management planning. Although management plans are widely considered to be important to effective management of protected areas, little guidance has been available about how their form and content can effectively reflect the distinctive socio-cultural and political characteristics of ICCAs. This gap has been particularly apparent in Australia where a trend to rapidly increased formal engagement of indigenous people in environmental management resulted, by 2012, in 50 indigenous groups voluntarily declaring their intent to manage all or part of their estates for conservation in perpetuity, as an indigenous protected area (IPA. Development and adoption of a management plan is central to the process through which the Australian Government recognizes these voluntary declarations and invests resources in IPA management. We identified four types of innovations, apparent in some recent IPA plans, which reflect the distinctive socio-cultural and political characteristics of ICCAs and support indigenous people as the primary decision makers and drivers of knowledge integration in IPAs. These are (1 a focus on customary institutions in governance; (2 strategic planning approaches that respond to interlinkages of stewardship between people, place, plants, and animals; (3 planning frameworks that bridge scales by considering values and issues across the whole of an indigenous people's territory; and (4 varied communication modes appropriate to varied audiences, including an emphasis on visual and spatial modes. Further research is warranted into how governance and management of IPAs, and the plans that

Geophysical investigations in the 100 Areas: Fiscal year 1991 through December 1993

Science.gov (United States)

Mitchell, T. H.

1994-09-01

The geophysical investigations identified in this document were conducted by the Westinghouse Hanford Company (WHC) Surface Geophysics Team, Geophysics Group, between October, 1991 and December, 1993. The investigations supported 100-Area activities for the Resource Conservation and Recovery Act of 1976 (RCRA) and the Comprehensive Environmental Response, Compensations and Liability Act of 1980 (CERCLA). The primary intent of this document is to provide a general map location and the associated document number for investigations that have been conducted as of December, 1993. The results of the individual investigations are not included here. The results of all of these investigations have been previously reported individually in WHC supporting documents. The investigations conducted during Fiscal Year (FY) 1992 are summarized in a single WHC document, WHC-SD-EN-TI-204, Rev. O. A brief summary of some of the successful applications of geophysics in the 100-Areas is included.

Tolerable and Inclusive Learning Spaces: An Evaluation of Policies and Specifications for Physical Environments That Promote Inclusion in Turkish Primary Schools

Science.gov (United States)

Erkilic, Mualla; Durak, Selen

2013-01-01

Inclusive education (IE), which calls for equal opportunities for students with diverse abilities in the achievement of knowledge, has been developed as a central pedagogical strategy in primary schools worldwide, including those in Turkey. Besides educators, the issue of IE becomes an important discussion area among designers who question the…

THE CHARACTERISTICS OF SMALL FIRMS THAT SERVE AS OWNERS’ “PRIMARY EMPLOYMENT”

Directory of Open Access Journals (Sweden)

HALIL DINCER KAYA

2017-02-01

Full Text Available Our objective in this study is to examine the relation between firm characteristics and entrepreneurship as “primary employment”. What type of small firms are organized in a way to promote “primary employment”? In order to achieve that objective, we compare firm characteristics in high “primary employment” U.S. states versus in low “primary employment” states. We use the “United States Small Business Friendliness Survey” done by Kauffman Foundation and Thumptack.com in 2013. Our nonparametric tests show that in the states where relatively high percentage of owners have their business as “primary employment” (i.e. “high primary employment states”, firms tend to be limited in their operational area (i.e. operate only in that state although their sales are less local (meaning that they focus on other areas in their state rather than their own locale. In these states, while more firms are in the “home maintenance and repair” industry, fewer firms operate in the “events” industry. We also find that there is no significant difference between high- and low-primary employment states in terms of firm age and firm size. We advise policymakers to use these findings when formulating policies that support entrepreneurship as “primary employment”.

Exploring the outcomes in studies of primary frozen shoulder

DEFF Research Database (Denmark)

Rodgers, Sara; Brealey, Stephen; Jefferson, Laura

2014-01-01

PURPOSE: In our study we explored the need to define a core outcome set for primary frozen shoulder. METHODS: We investigated the outcomes used by studies included in a systematic review of the management of primary frozen shoulder; surveyed which primary outcome measures health care professionals...... and 104 respondents, respectively) were most often cited by health care professionals as the primary outcome measure that should be used. Searches identified one paper that included patients' views. Outcomes of importance to patients were pain at night, general pain, reduced mobility (resulting...

Teaching Primary Science: How Research Helps

Science.gov (United States)

Harlen, Wynne

2010-01-01

The very first edition of "Primary Science Review" included an article entitled "Teaching primary science--how research can help" (Harlen, 1986), which announced that a section of the journal would be for reports of research and particularly for teachers reporting their classroom research. The intervening 24 years have seen…

Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

Directory of Open Access Journals (Sweden)

Beekman Aartjan TF

2007-03-01

Full Text Available Abstract Background Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries. Methods/design This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36. Discussion In this study, an American model to enhance care for patients with a

Family physician perspectives on primary immunodeficiency diseases

Directory of Open Access Journals (Sweden)

Jordan eOrange

2016-03-01

Full Text Available Primary immunodeficiency diseases (PID include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed family practice physicians, of whom 44% reported following ≥1 patient with a PID. Selective immunoglobulin A (IgA, deficiency (21%, and chronic granulomatous disease (11% were most common and were followed by significantly more subspecialist immunologists (P<.0001. Use of intravenously administered Ig, and live viral vaccinations across PID was significantly different (P<.0001. Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4% vs. 79% of subspecialist immunologists, P<.0001. Family practice physicians will likely encounter patients with a PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care.

Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis.

Science.gov (United States)

Raymond Guilbault, Ryan William; Vinson, Joseph Alexander

2017-01-01

Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.

Muscle area of knee O.A

International Nuclear Information System (INIS)

Suzuki, Nobuharu; Onozawa, Toshihiro; Shibata, Minoru; Yamasita, Izumi; Kitsunai, Isamu; Asano, Akira

1983-01-01

The cross sectional area of the thigh muscles were studied by means of C.T. scan. Twelve normal knees, twelve primary knee O.A. knees, and six R.A. knees were examined. The cross sectional area of the Quadriceps femoris decreased significantly in the patient of the knee O.A. although flexors did not decrease. We discussed the etiology of the knee O.A. from this result. (author)

Pharmacist medication reviews to improve safety monitoring in primary care patients.

Science.gov (United States)

Gallimore, Casey E; Sokhal, Dimmy; Zeidler Schreiter, Elizabeth; Margolis, Amanda R

2016-06-01

Patients prescribed psychotropic medications within primary care are at risk of suboptimal monitoring. It is unknown whether pharmacists can improve medication safety through targeted monitoring of at risk populations. Access Community Health Centers implemented a quality improvement pilot project that included pharmacists on an integrated care team to provide medication reviews for patients. Aims were to determine whether inclusion of a pharmacist performing medication reviews within a primary care behavioral health (PCBH) practice is feasible and facilitates safe medication use. Pharmacists performed medication reviews of the electronic health record for patients referred for psychiatry consultation. Reviews were performed 1-3 months following consultation and focused on medications with known suboptimal monitoring rates. Reviews were documented within the EHR and routed to the primary care provider. Primary outcome measures were change in percentage up-to-date on monitoring and AIMS assessment, and at risk of experiencing drug interaction(s) between baseline and 3 months postreview. Secondary outcome was provider opinion of medication reviews collected via electronic survey. Reviews were performed for 144 patients. Three months postreview, percentage up-to-date on recommended monitoring increased 18% (p = .0001), at risk for drug interaction decreased 20% (p improved safety monitoring of psychotropic medications. Results identify key areas for improvement that other clinics considering integration of similar pharmacy services should consider. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care

Science.gov (United States)

Verstappen, Wim; Gaal, Sander; Bowie, Paul; Parker, Diane; Lainer, Miriam; Valderas, Jose M.; Wensing, Michel; Esmail, Aneez

2015-01-01

ABSTRACT Background: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. Objective: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. Methods: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. Results: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Conclusion: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement. PMID:26339841

A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care.

Science.gov (United States)

Verstappen, Wim; Gaal, Sander; Bowie, Paul; Parker, Diane; Lainer, Miriam; Valderas, Jose M; Wensing, Michel; Esmail, Aneez

2015-09-01

Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. To outline a research agenda for patient safety improvement in primary care in Europe and beyond. The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement.

300 Area Disturbance Report

Energy Technology Data Exchange (ETDEWEB)

LL Hale; MK Wright; NA Cadoret

1999-01-07

The objective of this study was to define areas of previous disturbance in the 300 Area of the U.S. Department of Energy (DOE) Hanford Site to eliminate these areas from the cultural resource review process, reduce cultural resource monitoring costs, and allow cultural resource specialists to focus on areas where subsurface disturbance is minimal or nonexistent. Research into available sources suggests that impacts from excavations have been significant wherever the following construction activities have occurred: building basements and pits, waste ponds, burial grounds, trenches, installation of subsurface pipelines, power poles, water hydrants, and well construction. Beyond the areas just mentioned, substrates in the' 300 Area consist of a complex, multidimen- sional mosaic composed of undisturbed stratigraphy, backfill, and disturbed sediments; Four Geographic Information System (GIS) maps were created to display known areas of disturbance in the 300 Area. These maps contain information gleaned from a variety of sources, but the primary sources include the Hanford GIS database system, engineer drawings, and historic maps. In addition to these maps, several assumptions can be made about areas of disturbance in the 300 Area as a result of this study: o o Buried pipelines are not always located where they are mapped. As a result, cultural resource monitors or specialists should not depend on maps depicting subsurface pipelines for accurate locations of previous disturbance. Temporary roads built in the early 1940s were placed on layers of sand and gravel 8 to 12 in. thick. Given this information, it is likely that substrates beneath these early roads are only minimally disturbed. Building foundations ranged from concrete slabs no more than 6 to 8 in. thick to deeply excavated pits and basements. Buildings constructed with slab foundations are more numerous than may be expected, and minimally disturbed substrates may be expected in these locations. Historic

Effect of Testosterone on Neuronal Morphology and Neuritic Growth of Fetal Lamb Hypothalamus-Preoptic Area and Cerebral Cortex in Primary Culture.

Directory of Open Access Journals (Sweden)

Radhika C Reddy

Full Text Available Testosterone plays an essential role in sexual differentiation of the male sheep brain. The ovine sexually dimorphic nucleus (oSDN, is 2 to 3 times larger in males than in females, and this sex difference is under the control of testosterone. The effect of testosterone on oSDN volume may result from enhanced expansion of soma areas and/or dendritic fields. To test this hypothesis, cells derived from the hypothalamus-preoptic area (HPOA and cerebral cortex (CTX of lamb fetuses were grown in primary culture to examine the direct morphological effects of testosterone on these cellular components. We found that within two days of plating, neurons derived from both the HPOA and CTX extend neuritic processes and express androgen receptors and aromatase immunoreactivity. Both treated and control neurites continue to grow and branch with increasing time in culture. Treatment with testosterone (10 nM for 3 days significantly (P < 0.05 increased both total neurite outgrowth (35% and soma size (8% in the HPOA and outgrowth (21% and number of branch points (33% in the CTX. These findings indicate that testosterone-induced somal enlargement and neurite outgrowth in fetal lamb neurons may contribute to the development of a fully masculine sheep brain.

Water Pollution Prediction in the Three Gorges Reservoir Area and Countermeasures for Sustainable Development of the Water Environment.

Science.gov (United States)

Li, Yinghui; Huang, Shuaijin; Qu, Xuexin

2017-10-27

The Three Gorges Project was implemented in 1994 to promote sustainable water resource use and development of the water environment in the Three Gorges Reservoir Area (hereafter "Reservoir Area"). However, massive discharge of wastewater along the river threatens these goals; therefore, this study employs a grey prediction model (GM) to predict the annual emissions of primary pollution sources, including industrial wastewater, domestic wastewater, and oily and domestic wastewater from ships, that influence the Three Gorges Reservoir Area water environment. First, we optimize the initial values of a traditional GM (1,1) model, and build a new GM (1,1) model that minimizes the sum of squares of the relative simulation errors. Second, we use the new GM (1,1) model to simulate historical annual emissions data for the four pollution sources and thereby test the effectiveness of the model. Third, we predict the annual emissions of the four pollution sources in the Three Gorges Reservoir Area for a future period. The prediction results reveal the annual emission trends for the major wastewater types, and indicate the primary sources of water pollution in the Three Gorges Reservoir Area. Based on our predictions, we suggest several countermeasures against water pollution and towards the sustainable development of the water environment in the Three Gorges Reservoir Area.

[Frequent attendance in a Primary Health Care District].

Science.gov (United States)

Menéndez Granados, Nicolás; Vaquero Abellán, Manuel; Toledano Estepa, Manuel; Pérez Díaz, Manuel Modesto; Redondo Pedraza, Rosa

2017-10-09

To describe the distribution of frequent attenders (FA) through the different primary care practices in Cordoba-Guadalquivir Health District (Córdoba, Spain). An ecological study was performed, including data from 2011 to 2015. Defining FA as those subjects who made12 or more appointments per year; independently analysed for nursing, general practice and paediatrics. Prevalence of frequent attendance and FA/professional ratio were used as dependent variables. Demographic characteristics from district population, number of health professionals and use of general facilities were also examinated. Aiming to understand FA distribution, primary health settings were classified according to facility size and environmental location (urban, suburban and rural). The mean prevalence for FA was 10.86% (0.5 SE) for nursing; general practice 21.70% (0.7 SE) and for paediatrics 16.96% (0.7 SE). FA/professional ratios for the different professional categories were: 101.07 (5.0 SE) for nursing, 239.74 (9.0 SE) for general practice and 159.54 (9.8 SE) for paediatrics. A major part of primary health care users make a high number of consultations. From this group, women overuse nursing and general practitioner services more compared to men. A higher prevalence of FAs was observed in smaller settings, in rural areas. Although taking the FAs:professional ratio as the bar, medium-size practices are more highly overused. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Primary antiphospholipid syndrome presenting with homonymous quadrantanopsia.

Science.gov (United States)

Yang, Hee Kyung; Moon, Ki Won; Ji, Min Jung; Han, Sang Beom; Hwang, Jeong-Min

2018-06-01

To report a case of primary antiphospholipid syndrome presenting with isolated homonymous superior quadrantanopsia. A 50-year-old Korean man presented with subjective visual disturbance for 1 month. Visual field testing showed a right homonymous superior quadrantanopsia. Brain magnetic resonance imaging (MRI) revealed an old infarct in his left occipital lobe and multiple lesions in other areas of the brain. Laboratory tests showed a marked increase in serum anti-β2 glycoprotein I antibody, which remained elevated after 12 weeks. He was diagnosed with primary antiphospholipid syndrome and started anticoagulation therapy. This is the first case report of primary antiphospholipid syndrome presenting with isolated homonymous quadrantanopsia. Antiphospholipid syndrome should be considered as a differential diagnosis in patients with homonymous visual field defects accompanying multiple cerebral infarcts.

Possible directions in the strategy of continuous education of primary teachers

Directory of Open Access Journals (Sweden)

Cvjetićanin Stanko

2012-09-01

Full Text Available Modern concepts of education include the continuous development of primary teachers in all areas of natural, social and mathematical sciences. The obtained results were selected and differentiated facilities for further education of teachers within the model of professional development. Analysis of teachers' knowledge was made on the basis of results obtained using surveys. The study involved 60 primary teachers from Serbia. A descriptive analytical method, as well as a method of modeling was used. Survey was the research technique used. Results show that teachers are not sufficiently connecting and jointly implementing the contents of natural sciences and mathematics, because they lack a sufficient level of knowledge. It is necessary for them to further educate in the field of integrating the content of natural sciences and mathematics, scientific method and its applications (particularly in mini-projects as well as in the application of quantitative experiments. This would affect the quality of teaching, their professional competence, as well as it would affect their lifelong education.

Composite analysis for solid waste storage area 6

International Nuclear Information System (INIS)

Lee, D.W.

1997-09-01

The composite analysis (CA) provides an estimate of the potential cumulative impacts to a hypothetical future member of the public from the Solid Waste Storage Area 6 (SWSA 6) disposal operations and all of the other sources of radioactive material in the ground on the ORR that may interact with contamination originating in SWSA 6.The projected annual dose to hypothetical future member of the public from all contributing sources is compared to the primary dose limit of 100 mrem per year and a dose constraint of 30 mrem per year. Consistent with the CA guidance, dose estimates for the first 1000 years after disposal are emphasized for comparison with the primary dose limit and dose constraint.The current land use plan for the ORR is being revised, and may include a reduction in the land currently controlled by DOE on the ORR. The possibility of changes in the land use boundary is considered in the CA as part of the sensitivity and uncertainty analysis of the results, the interpretation of results, and the conclusions

Differences in the use of spirometry between rural and urban primary care centers in Spain.

Science.gov (United States)

Márquez-Martín, Eduardo; Soriano, Joan B; Rubio, Myriam Calle; Lopez-Campos, Jose Luis

2015-01-01

The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas. An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance. Although the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], Pspirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents. This study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these areas.

Structural and functional evaluation of cortical motor areas in Amyotrophic Lateral Sclerosis.

Science.gov (United States)

Cosottini, Mirco; Pesaresi, Ilaria; Piazza, Selina; Diciotti, Stefano; Cecchi, Paolo; Fabbri, Serena; Carlesi, Cecilia; Mascalchi, Mario; Siciliano, Gabriele

2012-03-01

The structural and functional data gathered with Magnetic Resonance Imaging (MRI) techniques about the brain cortical motor damage in Amyotrophic Lateral Sclerosis (ALS) are controversial. In fact some structural MRI studies showed foci of gray matter (GM) atrophy in the precentral gyrus, even in the early stage, while others did not. Most functional MRI (fMRI) studies in ALS reported hyperactivation of extra-primary motor cortices, while contradictory results were obtained on the activation of the primary motor cortex. We aimed to investigate the cortical motor circuitries in ALS patients by a combined structural and functional approach. Twenty patients with definite ALS and 16 healthy subjects underwent a structural examination with acquisition of a 3D T1-weighted sequence and fMRI examination during a maximal force handgrip task executed with the right-hand, the left-hand and with both hands simultaneously. The T1-weighted images were analyzed with Voxel-Based Morphometry (VBM) that showed several clusters of reduced cortical GM in ALS patients compared to controls including the pre and postcentral gyri, the superior, middle and inferior frontal gyri, the supplementary motor area, the superior and inferior parietal cortices and the temporal lobe, bilaterally but more extensive on the right side. In ALS patients a significant hypoactivation of the primary sensory motor cortex and frontal dorsal premotor areas as compared to controls was observed. The hypoactivated areas matched with foci of cortical atrophy demonstrated by VBM. The fMRI analysis also showed an enhanced activation in the ventral premotor frontal areas and in the parietal cortex pertaining to the fronto-parietal motor circuit which paralleled with disease progression rate and matched with cortical regions of atrophy. The hyperactivation of the fronto-parietal circuit was asymmetric and prevalent in the left hemisphere. VBM and fMRI identified structural and functional markers of an extended

F-Area Seepage Basins groundwater monitoring report -- third and fourth quarters 1993

International Nuclear Information System (INIS)

Butler, C.T.

1994-03-01

During the second half of 1993, the groundwater at the F-Area Seepage Basins (FASB) was monitored in compliance with Module 3, Section C, of South Carolina Hazardous Waste Permit SC1-890-008-989, effective November 2, 1992. The monitoring well network is composed of 87 FSB wells screened in the three hydrostratigraphic units that make up the uppermost aquifer beneath the FASB. A detailed description of the uppermost aquifer is included in the Resource Conservation and Recovery Act Part B post-closure care permit application for the F-Area Hazardous Waste Management Facility submitted to the South Carolina Department of Health and Environmental Control (SCDHEC) in December 1990. Beginning in the first quarter of 1993, the standard for comparison became the SCDHEC Groundwater Protection Standard (GWPS) specified in the approved F-Area Seepage Basins Part B permit. Currently and historically, gross alpha, nitrate, nonvolatile beta, and tritium are among the primary constituents to exceed standards. Numerous other radionuclides and hazardous constituents also exceeded the GWPS in the groundwater at the FASB during the second half of 1993, notably aluminum, iodine-129, and zinc. The elevated constituents are found primarily in Aquifer Zone 2B 2 and Aquifer Zone 2B 1 wells. However, several Aquifer Unit 2A wells also contain elevated levels of constituents. Isoconcentration/isoactivity maps included in this report indicate both the concentration/activity and extent of the primary contaminants in each of the three hydrostratigraphic units. Water-level maps indicate that the groundwater flow rates and directions at the FASB have remained relatively constant since the basins ceased to be active in 1988

Primary Productivity (PP_Master)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — This data set included primary production for each subregion in the study (Georges Bank, Gulf of Maine, Southern New England, Middle Atlantic Bight) . The data came...

Insomnia (primary) in older people

OpenAIRE

Alessi, Cathy; Vitiello, Michael V

2011-01-01

Up to 40% of older adults have insomnia, with difficulty getting to sleep, early waking, or feeling unrefreshed on waking. The prevalence of insomnia increases with age. Other risk factors include medical and psychiatric illnesses, psychological factors, stress, daytime napping, and hyperarousal.Primary insomnia is a chronic and relapsing condition that may increase the risks of accidents.Primary insomnia is chronic insomnia without specific underlying medical, psychiatric, or other sleep ...

An aerial radiological survey of the Tonopah Test Range including Clean Slate 1,2,3, Roller Coaster, decontamination area, Cactus Springs Ranch target areas. Central Nevada

International Nuclear Information System (INIS)

Proctor, A.E.; Hendricks, T.J.

1995-08-01

An aerial radiological survey was conducted of major sections of the Tonopah Test Range (TTR) in central Nevada from August through October 1993. The survey consisted of aerial measurements of both natural and man-made gamma radiation emanating from the terrestrial surface. The initial purpose of the survey was to locate depleted uranium (detecting 238 U) from projectiles which had impacted on the TTR. The examination of areas near Cactus Springs Ranch (located near the western boundary of the TTR) and an animal burial area near the Double Track site were secondary objectives. When more widespread than expected 241 Am contamination was found around the Clean Slates sites, the survey was expanded to cover the area surrounding the Clean Slates and also the Double Track site. Results are reported as radiation isopleths superimposed on aerial photographs of the area

Progress in the last decade in our understanding of primary progressive aphasia

Directory of Open Access Journals (Sweden)

Ratnavalli Ellajosyula

2010-10-01

Full Text Available Primary progressive aphasia (PPA is a focal neurodegeneration of the brain affecting the language network. Patients can have isolated language impairment for years without impairment in other areas. PPA is classified as primary progressive nonfluent aphasia (PNFA, semantic dementia (SD, and logopenic aphasia, which have distinct patterns of atrophy on neuroimaging. PNFA and SD are included under frontotemporal lobar degenerations. PNFA patients have effortful speech with agrammatism, which is frequently associated with apraxia of speech and demonstrate atrophy in the left Broca′s area and surrounding region on neuroimaging. Patients with SD have dysnomia with loss of word and object (or face meaning with asymmetric anterior temporal lobe atrophy. Logopenic aphasics have word finding difficulties with frequent pauses in conversation, intact grammar, and word comprehension but impaired repetition for sentences. The atrophy is predominantly in the left posterior temporal and inferior parietal regions. Recent studies have described several progranulin mutations on chromosome 17 in PNFA. The three clinical syndromes have a less robust relationship to the underlying pathology, which is heterogeneous and includes tauopathy, ubiquitinopathy, Pick′s disease, corticobasal degeneration, progressive supranuclear palsy, and Alzheimer′s disease. Recent studies, however, seem to indicate that a better characterization of the clinical phenotype (apraxic, agrammatic, semantic, logopenic, jargon increases the predictive value of the underlying pathology. Substantial advances have been made in our understanding of PPAs but developing new biomarkers is essential in making accurate causative diagnoses in individual patients. This is critically important in the development and evaluation of disease-modifying drugs.

Prenatal Care Utilization for Mothers from Low-Income Areas of New Mexico, 1989–1999

Science.gov (United States)

Schillaci, Michael A.; Waitzkin, Howard; Carson, E. Ann; Romain, Sandra J.

2010-01-01

Background Prenatal care is considered to be an important component of primary health care. Our study compared prenatal care utilization and rates of adverse birth outcomes for mothers from low- and higher-income areas of New Mexico between 1989 and 1999. Methodology/Principal Findings Prenatal care indicators included the number of prenatal care visits and the first month of prenatal care. Birth outcome indicators included low birth weight, premature birth, and births linked with death certificates. The results of our study indicated that mothers from low-income areas started their prenatal care significantly later in their pregnancies between 1989 and 1999, and had significantly fewer prenatal visits between 1989 and 1997. For the most part, there were not significant differences in birth outcome indicators between income groupings. Conclusions/Significance These findings suggest that while mothers from low-income areas received lower levels of prenatal care, they did not experience a higher level of adverse birth outcomes. PMID:20862298

Trends in primary surgical and radiation therapy for localized breast cancer in the detroit metropolitan area 1973-1992

International Nuclear Information System (INIS)

Chuba, Paul J.; Simon, Michael S.

1997-01-01

Purpose: The purpose of this report is to describe trends in primary surgical and radiation therapy for localized breast cancer from 1973 through 1992 among residents of the Detroit Metropolitan area. Methods and Materials: Data on surgical and radiation therapy procedures for women with local stage breast cancer were obtained from the population-based Metropolitan Detroit Cancer Surveillance System (MDCSS). Results: Women age 75 years and older were treated less aggressively than younger women (< age 75) as evidenced by higher rates of simple mastectomy or no treatment among older women. Younger women (< age 75) were more likely to have had optimal breast conservation therapy which consisted of partial mastectomy, axillary lymph node dissection (ALND), and radiation therapy, than were women who were older than 75. Partial mastectomy has increased proportionally from 4% of all breast cancer surgeries in the time period 1973 to 1977, to 39% of all surgeries from 1988 through 1992. Conclusion: A marked difference in surgical treatment of breast cancer exists for younger vs. older women. Despite changes in surgical treatment trends for breast cancer, a large proportion of women who are candidates for conservative therapy continue to undergo mastectomy

FLOODPLAIN, WORTH COUNTY, GEORGIA and INCORPORATED AREAS

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, DARKE COUNTY, OHIO, AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, MILLER COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, CLINCH COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, BAKER COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, EARLY COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, ATKINSON COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, COFFEE COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, MARION COUNTY, OHIO, AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, AUGUSTA COUNTY, USA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, SEMINOLE COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, THOMAS COUNTY, GEORGIA and INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, PIERCE COUNTY, WISCONSIN, AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, TOOELE COUNTY, UTAH (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, VAN BUREN COUNTY (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, GLOUCESTER COUNTY, VA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, POINTE COUPEE PARISH (AND INCORPORATED AREAS)

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, COLQUITT COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, BERRIEN COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — he Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, BLOUNT COUNTY AND INCORPORATED AREAS, ALABAMA

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, COOK COUNTY, GA AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, MACON COUNTY, TENNESSEE and INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, COFFEE COUNTY AND INCORPORATED AREAS, ALABAMA

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

FLOODPLAIN, WOOD COUNTY, OHIO, AND INCORPORATED AREAS

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Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns

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Yang Seo Park

2012-09-01

Full Text Available Background Pediatric hand burns are a difficult problem because they lead to serious handdeformities with functional impairment due to rapid growth during childhood. Therefore,adequate management is required beginning in the acute stage. Our study aims to establishsurgical guidelines for a primary full-thickness skin graft (FTSG in pediatric hand burns, basedon long-term observation periods and existing studies.Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. Weretrospectively studied the clinical course and treatment outcomes based on the patients’medical records. The patients’ demographics, age, sex, injury site of the fingers, presence ofweb space involvement, the incidence of postoperative late deformities, and the duration ofrevision were critically analyzed.Results The mean age of the patients was 24.4 months (range, 8 to 94 months, consisting of141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 yearson average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 tothree fingers, and 22 to more than three. Among these cases, 70 were burns that included aweb space (33.3%. During the observation, 25 cases underwent corrective operations withan average period of 40.6 months.Conclusions In the volar area, primary full-thickness skin grafting can be a good indicationfor an isolated injured finger, excluding the web spaces, and injuries of less than three fingersincluding the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a goodindication. However, if the donor site is insufficient and the wound is large, split-thicknessskin grafting can be considered.

Interprofessional practice in primary care: development of a tailored process model

Directory of Open Access Journals (Sweden)

Stans SEA

2013-04-01

Full Text Available Steffy EA Stans, JG Anita Stevens, Anna JHM Beurskens Research Center of Autonomy and Participation for Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands Purpose: This study investigated the improvement of interprofessional practice in primary care by performing the first three steps of the implementation model described by Grol et al. This article describes the targets for improvement in a setting for children with complex care needs (step 1, the identification of barriers and facilitators influencing interprofessional practice (step 2, and the development of a tailored interprofessional process model (step 3. Methods: In step 2, thirteen qualitative semistructured interviews were held with several stakeholders, including parents of children, an occupational therapist, a speech and language therapist, a physical therapist, the manager of the team, two general practitioners, a psychologist, and a primary school teacher. The data were analyzed using directed content analysis and using the domains of the Chronic Care Model as a framework. In step 3, a project group was formed to develop helpful strategies, including the development of an interprofessional process through process mapping. Results: In step 2, it was found that the most important barriers to implementing interprofessional practice related to the lack of structure in the care process. A process model for interprofessional primary care was developed for the target group. Conclusion: The lack of a shared view of what is involved in the process of interprofessional practice was the most important barrier to its successful implementation. It is suggested that the tailored process developed, supported with the appropriate tools, may provide both professional staff and their clients, in this setting but also in other areas of primary care, with insight to the care process and a clear representation of "who should do what, when, and how." Keywords

Radiochemical surveillance of KNK primary sodium

International Nuclear Information System (INIS)

Stamm, H.-H.; Stade, K.Ch.

1987-05-01

Radiochemical surveillance of the KNK primary sodium has been performed now for 15 years with 953 effective full-power days. The overflow method used for sodium sampling proved to be reliable. Different crucible materials have been used for different analytical tasks. The amount of radionuclides in the primary system has not given restrictions to plant operation at any time. On-line gamma spectroscopy on pipings and components of the primary circuits was accomplished in reactor downtimes. Activity depositions on the walls were dominated by Ta-182 after KNK I operation. Main deposited activities at KNK II were Mn-54 (fresh core) and after operation with failed fuel Cs-137, in cover gas areas together with Zn-65. Efficient experimental radionuclide traps for the removal of Mn-54, Zn-65 and Cs-137 from the primary coolant were tested successfully. The dose rates on primary pipes and components of KNK I and KNK II were lower by an order of magnitude compared to water-cooled reactors. This is in good agreement with experiences from LMFBR's in other countries. The resulting average yearly accumulated personal dose rate was 0.21 man-Sv at KNK, compared to 3.9 man-Sv at German light-water-cooled power reactors

Analysis and decision document in support of acquisition of steam supply for the Hanford 200 Area

Energy Technology Data Exchange (ETDEWEB)

Brown, D.R.; Daellenbach, K.K.; Hendrickson, P.L.; Kavanaugh, D.C.; Reilly, R.W.; Shankle, D.L.; Smith, S.A.; Weakley, S.A.; Williams, T.A. (Pacific Northwest Lab., Richland, WA (United States)); Grant, T.F. (Battelle Human Affairs Research Center, Seattle, WA (United States))

1992-02-01

The US Department of Energy (DOE) is now evaluating its facility requirements in support of its cleanup mission at Hanford. One of the early findings is that the 200-Area steam plants, constructed in 1943, will not meet future space heating and process needs. Because the 200 Area will serve as the primary area for waste treatment and long-term storage, a reliable steam supply is a critical element of Hanford operations. This Analysis and Decision Document (ADD) is a preliminary review of the steam supply options available to the DOE. The ADD contains a comprehensive evaluation of the two major acquisition options: line-term versus privatization. It addresses the life-cycle costs associated with each alternative, as well as factors such as contracting requirements and the impact of market, safety, security, and regulatory issues. Specifically, this ADD documents current and future steam requirements for the 200 Area, describes alternatives available to DOE for meeting these requirements, and compares the alternatives across a number of decision criteria, including life-cycle cost. DOE has currently limited the ADD evaluation alternatives to replacing central steam plants rather than expanding the study to include alternative heat sources, such as a distributed network of boilers or heat pumps. Thirteen project alternatives were analyzed in the ADD. One of the alternatives was the rehabilitation of the existing 200-East coal-fired facility. The other twelve alternatives are combinations of (1) coal- or gas-fueled plants, (2) steam-only or cogeneration facilities, (3) primary or secondary cogeneration of electricity, and (4) public or private ownership.

Primary care training and the evolving healthcare system.

Science.gov (United States)

Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

2012-01-01

With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.

Understanding partnership practice in primary health as pedagogic work: what can Vygotsky's theory of learning offer?

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Hopwood, Nick

2015-01-01

Primary health policy in Australia has followed international trends in promoting models of care based on partnership between professionals and health service users. This reform agenda has significant practice implications, and has been widely adopted in areas of primary health that involve supporting families with children. Existing research shows that achieving partnership in practice is associated with three specific challenges: uncertainty regarding the role of professional expertise, tension between immediate needs and longer-term capacity development in families, and the need for challenge while maintaining relationships based on trust. Recently, pedagogic or learning-focussed elements of partnership practice have been identified, but there have been no systematic attempts to link theories of learning with the practices and challenges of primary health-care professionals working with families in a pedagogic role. This paper explores key concepts of Vygotsky's theory of learning (including mediation, the zone of proximal development, internalisation, and double stimulation), showing how pedagogic concepts can provide a bridge between the policy rhetoric of partnership and primary health practice. The use of this theory to address the three key challenges is explicitly discussed.

Projections to early visual areas V1 and V2 in the calcarine fissure from parietal association areas in the macaque.

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Elena eBorra

2011-06-01

Full Text Available Non-extrastriate projections to area V1 in monkeys, now demonstrated by several anatomical studies, are potential substrates of physiologically documented multisensory effects in primary sensory areas. The full network of projections among association and primary areas, however, is likely to be complex and is still only partially understood. In the present report, we used the anterograde tracer biotinylated dextran amine to investigate projections to areas V1 and V2 from subdivisions of the parietal association cortex in macaque. Parietal cortex was chosen to allow comparisons between projections from this higher association area and from other previously reported areas. In addition, we were interested in further elucidating pathways to areas V1 and V2 from parietal areas, as potentially contributing to attention and active vision. Of eight cases, three brains had projections only to area V2, and the five others projected to both areas V1 and V2. Terminations in area V1 were sparse. These were located in supragranular layers I, II, upper III; occasionally in IVB; and in layer VI. Terminations in V2 were denser, and slightly more prevalent in the supragranular layers. For both areas, terminations were in the calcarine region, corresponding to the representation of the peripheral visual field. By reconstructions of single axons, we demonstrated that four of nine axons had collaterals, either to V1 and V2 (n=1 or to area V1 and a ventral area likely to be TEO (n=3. In area V1, axons extended divergently in layer VI as well as layer I. Overall, these and previous results suggest a nested connectivity architecture, consisting of multiple direct and indirect recurrent projections from association areas to area V1. Terminations in area V1 are not abundant, but could be potentiated by the network of indirect connections.

Safety of treatments for primary Sjogren's syndrome

NARCIS (Netherlands)

van Nimwegen, Jolien F.; Moerman, R. V.; Smitt, Nicole Sillevis; Brouwer, Elisabeth; Bootsma, Hendrika; Vissink, Arjan

2016-01-01

Introduction: Primary Sjogren's syndrome (pSS) is a disabling auto-immune disease, affecting exocrine glands and several organs.Areas covered: In this review we analyze the safety of therapies used in pSS. Symptomatic treatment is widely applied due to the good supportive effect and good safety

Challenges to the Israeli healthcare system: attracting medical students to primary care and to the periphery.

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Weissman, Charles; Zisk-Rony, Rachel Yaffa; Avidan, Alexander; Elchalal, Uriel; Tandeter, Howard

2018-05-29

The greatest challenges facing healthcare systems include ensuring a sufficient supply of primary care physicians and physicians willing to work in rural or peripheral areas. Especially challenging is enticing young physicians to practice primary care in rural/peripheral areas. Identifying medical students interested in primary care and in residencies in Israel's periphery should aid the healthcare leadership. It may be particularly important to do so during the clinical years, as this is the stage at which many future physicians begin to crystallize their specialty and location preferences. Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University - Hadassah School of Medicine, from 2010 to 2016, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and whether one-time monetary grants authorized in the 2011 physicians' union contract would attract students to residencies in the periphery. Completed questionnaires were returned by 511 of 740 (69%) students. Ninety-eight (19%) were interested in a primary care residency, 184 (36%) were unsure and 229 (45%) were not interested. Students interested in primary care were significantly less interested in specialties that perform procedures/surgeries and in joining a medical school faculty, while being more inclined towards specialties dealing with social problems, controllable lifestyles and working limited hours. The percentage of students interested in primary care was stable during the study period. Forty-eight of the students indicated interest in residencies in the country's periphery, and 42% of them were also interested in primary care residencies. Overall, only 3.7% of students were interested in both a primary care residency and a residency in the periphery. Thirty percent of the students indicated that the monetary incentives tempted them to consider a residency in the periphery. Fifty-three percent of these students reported

Effect of education and training on patient referral by public primary ...

African Journals Online (AJOL)

A quasi-experimental study was carried out to determine the effect of health education and training on the Knowledge,attitude and practices of patient referral by primary health care workers in Mushin and Surulere Local Government Areas of Lagos State of Nigeria. Material and method: A total sample of 170 primary health ...

A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon.

Science.gov (United States)

El-Jardali, Fadi; Alameddine, Mohamad; Jamal, Diana; Dimassi, Hani; Dumit, Nuhad Y; McEwen, Mary K; Jaafar, Maha; Murray, Susan F

2013-09-30

Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P job satisfaction and their intent to stay. This study reveals poor retention of nurses in rural and underserved

Primary Surgery vs Radiotherapy for Early Stage Oral Cavity Cancer.

Science.gov (United States)

Ellis, Mark A; Graboyes, Evan M; Wahlquist, Amy E; Neskey, David M; Kaczmar, John M; Schopper, Heather K; Sharma, Anand K; Morgan, Patrick F; Nguyen, Shaun A; Day, Terry A

2018-04-01

Objective The goal of this study is to determine the effect of primary surgery vs radiotherapy (RT) on overall survival (OS) in patients with early stage oral cavity squamous cell carcinoma (OCSCC). In addition, this study attempts to identify factors associated with receiving primary RT. Study Design Retrospective cohort study. Setting National Cancer Database (NCDB, 2004-2013). Subjects and Methods Reviewing the NCDB from 2004 to 2013, patients with early stage I to II OCSCC were identified. Kaplan-Meier estimates of survival, Cox regression analysis, and propensity score matching were used to examine differences in OS between primary surgery and primary RT. Multivariable logistic regression analysis was performed to identify factors associated with primary RT. Results Of the 20,779 patients included in the study, 95.4% (19,823 patients) underwent primary surgery and 4.6% (956 patients) underwent primary RT. After adjusting for covariates, primary RT was associated with an increased risk of mortality (adjusted hazard ratio [aHR], 1.97; 99% confidence interval [CI], 1.74-2.22). On multivariable analysis, factors associated with primary RT included age ≥70 years, black race, Medicaid or Medicare insurance, no insurance, oral cavity subsite other than tongue, clinical stage II disease, low-volume treatment facilities, and earlier treatment year. Conclusion Primary RT for early stage OCSCC is associated with increased mortality. Approximately 5% of patients receive primary RT; however, this percentage is decreasing. Patients at highest risk for receiving primary RT include those who are elderly, black, with public insurance, and treated at low-volume facilities.

Place of residence and primary treatment of prostate cancer: examining trends in rural and nonrural areas in Wisconsin.

Science.gov (United States)

Cetnar, Jeremy P; Hampton, John M; Williamson, Amy A; Downs, Tracy; Wang, Dian; Owen, Jean B; Crouse, Byron; Jones, Nathan; Wilson, J Frank; Trentham-Dietz, Amy

2013-03-01

To determine whether rural residents were at a disadvantage compared with urban residents with regard to the receipt of curative therapy for prostate cancer. Using the Breast and Prostate Cancer Data Quality and Patterns of Care Study II, patients with prostate cancer who were diagnosed in 2004 were identified. Registrars reviewed the medical records of randomly selected patients with incident prostate cancer (n = 1906). The patients' residential address was geocoded and linked to the census tract from the 2000 U.S. Census. The place of residence was defined as rural or nonrural according to the census tract and rural-urban commuting area categorization. The distance from the residence to the nearest radiation oncology facility was calculated. The odds ratio and 95% confidence intervals associated with receipt of noncurative treatment was calculated from logistic regression models and adjusted for several potential confounders. Of the incident patients, 39.1% lived in urban census tracts, 41.5% lived in mixed tracts, and 19.4% lived in rural tracts. Hormone-only or active surveillance was received by 15.4% of the patients. Relative to the urban patients, the odds ratio for noncurative treatment was 1.01 (95% confidence interval 0.59-1.74) for those living in mixed tracts and 0.96 (95% confidence interval 0.52-1.77) for those living in rural tracts. No association was found for noncurative treatment according to the Rural-Urban Commuting Area categorization. The linear trend was null between noncurative treatment and the distance to nearest radiation oncology facility (P = .92). The choice of curative treatment did not significantly depend on the patient's place of residence, suggesting a lack of geographic disparity for the primary treatment of prostate cancer. Copyright © 2013 Elsevier Inc. All rights reserved.

The Coming Primary Care Revolution.

Science.gov (United States)

Ellner, Andrew L; Phillips, Russell S

2017-04-01

The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.

Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients.

Science.gov (United States)

Weijs, Peter J M; Looijaard, Wilhelmus G P M; Dekker, Ingeborg M; Stapel, Sandra N; Girbes, Armand R; Oudemans-van Straaten, H M; Beishuizen, Albertus

2014-01-13

Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm2 for females and 170 cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables. This study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m2. Muscle area for females was significantly lower than that for males (102 ± 23 cm2 versus 158 ± 33 cm2; P muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P muscle mass appeared as primary predictor, not sex. Low skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not

SCHOOL AND OUT-OF-SCHOOL PHYSICAL ACTIVITY OF CHILDREN IN RURAL AREAS

Directory of Open Access Journals (Sweden)

Robert Podstawski

2014-08-01

Full Text Available Purpose : The aim of the study was to assess the level of school and out-of-school physical activity of children living in rural area at the early stage of their education. Material : The research was conducted in 2009 at primary school in Świętajno (a village. The study group consisted of 42 girls and 44 boys from the 1 st, 2 nd and 3 rd grade of primary school, aged 7-10. The children were chosen by means of a purposeful selection and surveyed by a questionnaire consisting of five open-ended and five closed-ended questions. Results : The research showed that the children living in the rural area at the early stage of their education eagerly participated in the classes of physical education held at school. The most popular physical activities among the children included: games and plays with the ball and other equipment, running, gymnastics (among girls and matches and competitions (among boys. The outdoor physical activities in which the children were involved outside of school were spontaneous and unorganized including mainly cycling, roller-skating, skating or skiing. Conclusions : A marginal percentage of children participated in out-of-school sports trainings or other physical education-oriented classes (e.g. swimming lessons. A relatively high percentage of children devoted a great deal of their free time to watching television, DVDs or playing on the computer.

Mars mission program for primary students: Building student and teacher skills in science, technology, engineering and mathematics

Science.gov (United States)

Mathers, Naomi; Pakakis, Michael; Christie, Ian

2011-09-01

The Victorian Space Science Education Centre (VSSEC) scenario-based programs, including the Mission to Mars and Mission to the Orbiting Space Laboratory, utilize methodologies such as hands-on applications, immersive learning, integrated technologies, critical thinking and mentoring. The use of a scenario provides a real-life context and purpose to what students might otherwise consider disjointed information. These programs engage students in the areas of maths and science, and highlight potential career paths in science and engineering. The introduction of a scenario-based program for primary students engages students in maths and science at a younger age, addressing the issues of basic numeracy and science literacy, thus laying the foundation for stronger senior science initiatives. Primary students absorb more information within the context of the scenario, and presenting information they can see, hear, touch and smell creates a memorable learning and sensory experience. The mission also supports development of teacher skills in the delivery of hands-on science and helps build their confidence to teach science. The Primary Mission to the Mars Base gives primary school students access to an environment and equipment not available in schools. Students wear flight suits for the duration of the program to immerse them in the experience of being an astronaut. Astronauts work in the VSSEC Space Laboratory, which is transformed into a Mars base for the primary program, to conduct experiments in areas such as robotics, human physiology, microbiology, nanotechnology and environmental science. Specialist mission control software has been developed by La Trobe University Centre for Games Technology to provide age appropriate Information and Communication Technology (ICT) based problem solving and support the concept of a mission. Students in Mission Control observe the astronauts working in the space laboratory and talk to them via the AV system. This interactive

Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

Science.gov (United States)

Worrall, A; Rea, J N; Ben-Shlomo, Y

1997-01-04

To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. Inner city group practice with a socioeconomically diverse population. 382 male and female subjects of all ages, with a total of 1296 person years of observation. Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

An explorative study of factors contributing to the job satisfaction of primary care midwives.

Science.gov (United States)

Warmelink, J Catja; Hoijtink, Kirsten; Noppers, Marloes; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

2015-04-01

the main objectives of our study was to gain an understanding of how primary care midwives in the Netherlands feel about their work and to identify factors associated with primary care midwives׳ job satisfaction and areas for improvement. a qualitative analysis was used, based on the constructivist/interpretative paradigm. Three open-ended questions in written or online questionnaire, analysed to identify factors that are linked with job satisfaction, were as follows: 'What are you very satisfied with, in your work as a midwife?', 'What would you most like to change about your work as a midwife?' and 'What could be improved in your work?'. 20 of the 519 primary care practices in the Netherlands in May 2010 were included. at these participating practices 99 of 108 midwives returned a written or online questionnaire. in general, most of the participating primary care midwives were satisfied with their job. The factors positively associated with their job satisfaction were their direct contact with clients, the supportive co-operation and teamwork with immediate colleagues, the organisation of and innovation within their practice group and the independence, autonomy, freedom, variety and opportunities that they experienced in their work. Regarding improvements, the midwives desired a reduction in non-client-related activities, such as paperwork and meetings. They wanted a lower level of work pressure, and a reduced case-load in order to have more time to devote to individual clients׳ needs. Participants identified that co-operation with other partners in the health care system could also be improved. our knowledge, our study is the first explorative study on factors associated with job satisfaction of primary care midwives. While there are several studies on job satisfaction in health care; little is known about the working conditions of midwives in primary care settings. Although the participating primary care midwives in the Netherlands were satisfied with their

Correlation between patients' reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC).

Science.gov (United States)

Kaneko, Makoto; Ohta, Ryuichi; Nago, Naoki; Fukushi, Motoharu; Matsushima, Masato

2017-09-13

The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system. We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density. We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems. This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan

Role of informal care providers in home based long term care in diabetes mellitus at Kaiwara Primary Health Center area, Karnataka, India

Directory of Open Access Journals (Sweden)

Arjunan Isaac

2011-06-01

Full Text Available Objective: To find the prevalence of diabetics, identify informal care providers for them in Kaiwara Primary Health Center (PHC area, assess the level of knowledge and skills of an informal care provider in home based long term care and improve the level of knowledge and skill of the informal care provider through a structured training capsule. Methods: A cross sectional and an interventional study was conducted on diabetics and their informal care providers in Kaiwara PHC area. Data were collected using pre-tested, structured questionnaire by an interview method. A structured training capsule was developed and implemented. Evaluation of the knowledge and skills was assessed at the beginning and at the end of the training. Student ’s paired/unpaired ‘t ’ tests and correlation analysis were done. Results: Improvement scores were calculated by subtracting the pre-evaluation scores from the post-evaluation scores. The mean improvement scores was (2.66暲0.32 and was statistically significant (P<0.001. No significant difference in mean values was found in the knowledge and skills scores in relation to the socio-demographic variables in the study. Conclusions: Knowledge and skills component of the informal care provider in home based care of diabetes could be perceived as a “felt need ”.

The added value of C-reactive protein measurement in diagnosing pneumonia in primary care

DEFF Research Database (Denmark)

Minnaard, Margaretha C; de Groot, Joris A H; Hopstaken, Rogier M

2017-01-01

BACKGROUND: C-reactive protein (CRP) is increasingly being included in the diagnostic work-up for community-acquired pneumonia in primary care. Its added diagnostic value beyond signs and symptoms, however, remains unclear. We conducted a meta-analysis of individual patient data to quantify...... to a basic signs-and-symptoms prediction model was assessed. Outcome measures were improvement in discrimination between patients with and without pneumonia in primary care and improvement in risk classification, both within the individual studies and across studies. RESULTS: Authors of 8 eligible studies (n...... = 5308) provided their data sets. In all of the data sets, discrimination between patients with and without pneumonia improved after CRP measurement was added to the prediction model (extended model), with a mean improvement in the area under the curve of 0.075 (range 0.02-0.18). In a hypothetical cohort...

Audiovisual Modulation in Mouse Primary Visual Cortex Depends on Cross-Modal Stimulus Configuration and Congruency.

Science.gov (United States)

Meijer, Guido T; Montijn, Jorrit S; Pennartz, Cyriel M A; Lansink, Carien S

2017-09-06

The sensory neocortex is a highly connected associative network that integrates information from multiple senses, even at the level of the primary sensory areas. Although a growing body of empirical evidence supports this view, the neural mechanisms of cross-modal integration in primary sensory areas, such as the primary visual cortex (V1), are still largely unknown. Using two-photon calcium imaging in awake mice, we show that the encoding of audiovisual stimuli in V1 neuronal populations is highly dependent on the features of the stimulus constituents. When the visual and auditory stimulus features were modulated at the same rate (i.e., temporally congruent), neurons responded with either an enhancement or suppression compared with unisensory visual stimuli, and their prevalence was balanced. Temporally incongruent tones or white-noise bursts included in audiovisual stimulus pairs resulted in predominant response suppression across the neuronal population. Visual contrast did not influence multisensory processing when the audiovisual stimulus pairs were congruent; however, when white-noise bursts were used, neurons generally showed response suppression when the visual stimulus contrast was high whereas this effect was absent when the visual contrast was low. Furthermore, a small fraction of V1 neurons, predominantly those located near the lateral border of V1, responded to sound alone. These results show that V1 is involved in the encoding of cross-modal interactions in a more versatile way than previously thought. SIGNIFICANCE STATEMENT The neural substrate of cross-modal integration is not limited to specialized cortical association areas but extends to primary sensory areas. Using two-photon imaging of large groups of neurons, we show that multisensory modulation of V1 populations is strongly determined by the individual and shared features of cross-modal stimulus constituents, such as contrast, frequency, congruency, and temporal structure. Congruent

Effective Connectivity Hierarchically Links Temporoparietal and Frontal Areas of the Auditory Dorsal Stream with the Motor Cortex Lip Area during Speech Perception

Science.gov (United States)

Murakami, Takenobu; Restle, Julia; Ziemann, Ulf

2012-01-01

A left-hemispheric cortico-cortical network involving areas of the temporoparietal junction (Tpj) and the posterior inferior frontal gyrus (pIFG) is thought to support sensorimotor integration of speech perception into articulatory motor activation, but how this network links with the lip area of the primary motor cortex (M1) during speech…

Problems of culture of written expression in primary school

Directory of Open Access Journals (Sweden)

Zlatić Marina V.

2014-01-01

Full Text Available This paper investigates the issue of the culture of written expression in primary school students. Starting from the fact that teaching practices increasingly points to the fact that knowledge of rules of writing in primary school students presents the weakest link in teaching Serbian language, we sought to describe the problem, point to the possible causes, propose measures and illustrate all this on concrete examples of students' essays. Our microinvestigation showed that primary school students display considerably poorer mastery of rules of writing than previously thought, to the extent that it presents a serious obstacle in language teaching as well as in other areas of educational process.

H-Area Seepage Basins groundwater monitoring report

International Nuclear Information System (INIS)

1992-09-01

During second quarter 1992, tritium, nitrate, nonvolatile beta, total alpha-emitting radium (radium-224 and radium-226), gross alpha, mercury, lead, tetrachloroethylene, arsenic, and cadmium exceeded the US Environmental Protection Agency Primary Drinking Water Standards (PDWS) in groundwater samples from monitoring wells at the H-Area Seepage Basins (HASB) at the Savannah River Plant. This report gives the results of the analyses of groundwater from the H-Area Seepage Basin

Electromyography (EMG) analysis on impact of classroom chair and table usage among primary school students in Perlis

Science.gov (United States)

Jing, Ewe Hui; Shan, Lim Shaiu; Effendi, M. S. M.; Rosli, Muhamad Farizuan

2017-09-01

The existing design of primary school classroom chair and table had brought low back pain, neck pain and shoulder pain problems respectively among students in primary school. The purpose of this study is to relate the electromyography (EMG) analysis with the most critical area of the body during sitting and writing. Six male and six female primary school students from SK Seri Perlis with no back pain, neck pain and shoulder pain problems involved were invited as respondents in this study. EMG experiment was carried out by first determined the critical point at T9 and L3 from thoracic and lumbar segment respectively for ECG electrode placement and performed with a series of sitting trials for analysis. The sitting trials performed were slouch to lumbopelvic sitting and slouch to thoracic sitting follow by instruction. Next, the electrode placement was identified at C2-C3 on cervical spine for neck and at midpoint between C7 to the lateral edge of acromion spanning for shoulder respectively. These points were identified for a series of writing task performing for the EMG analysis. There were two type of writing task which included writing by looking at the whiteboard and paper placed on the table. The subjects were instructed to rest during the experiment when necessary. During lumbopelvic sitting posture, the average muscle activation on lumbar area was at the highest peak. The peak indicated that there was critical effect from the experimental finding. The performance of writing task from whiteboard gave rise a higher impact on neck muscle while writing task from paper had a greater impact on shoulder muscle. The critical affected muscle on these areas was proven on these written tasks. The EMG experiment showed that the existing design of primary school classroom chair and table had brought impact on lumbar, neck and shoulder towards the students who were using. A future recommendation suggests that to redesign primary school classroom chair and table which

Primary multifocal osseous lymphoma in a child

Energy Technology Data Exchange (ETDEWEB)

Sato, Takashi S.P. [University of Iowa, Carver College of Medicine, Iowa City, IA (United States); Ferguson, Polly J. [University of Iowa, Department of Pediatrics, Iowa City, IA (United States); Khanna, Geetika [Washington University, Mallinckrodt Institute of Radiology, St Louis, MO (United States)

2008-12-15

We report a case of primary multifocal osseous lymphoma in a 6-year-old girl presenting with multifocal osteolytic lesions without systemic symptoms or identifiable non-osseous primary tumor. The differential diagnoses for such a presentation include histiocytosis X, chronic recurrent multifocal osteomyelitis, acute lymphoblastic leukemia, metastatic disease, and primary bone lymphoma. Although non-Hodgkin lymphoma is common in the pediatric population, its presentation as a primary bone tumor, especially with multifocal disease, is extremely rare and is frequently misdiagnosed. We hope that awareness of this entity will help radiologists achieve timely diagnosis and intervention. (orig.)

Primary care research conducted in networks: getting down to business.

Science.gov (United States)

Mold, James W

2012-01-01

This seventh annual practice-based research theme issue of the Journal of the American Board of Family Medicine highlights primary care research conducted in practice-based research networks (PBRNs). The issue includes discussion of (1) theoretical and methodological research, (2) health care research (studies addressing primary care processes), (3) clinical research (studies addressing the impact of primary care on patients), and (4) health systems research (studies of health system issues impacting primary care including the quality improvement process). We had a noticeable increase in submissions from PBRN collaborations, that is, studies that involved multiple networks. As PBRNs cooperate to recruit larger and more diverse patient samples, greater generalizability and applicability of findings lead to improved primary care processes.

Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition.

Science.gov (United States)

Alberts, Mark J; Latchaw, Richard E; Jagoda, Andy; Wechsler, Lawrence R; Crocco, Todd; George, Mary G; Connolly, E S; Mancini, Barbara; Prudhomme, Stephen; Gress, Daryl; Jensen, Mary E; Bass, Robert; Ruff, Robert; Foell, Kathy; Armonda, Rocco A; Emr, Marian; Warren, Margo; Baranski, Jim; Walker, Michael D

2011-09-01

The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.

Pacemaker Primary Curriculum; Lesson Book Level B.

Science.gov (United States)

Ross, Dorothea M.; Ross, Sheila A.

This lesson book, which is the second in a four-level program for young children with learning difficulties, describes the purpose of and equipment and procedures for teaching lessons in the following subjects areas on the primary grade level: arithmetic, reading, vocabulary, listening, planning, problem solving, social behavior, art, music, and…

Pacemaker Primary Curriculum; Lesson Book Level C.

Science.gov (United States)

Ross, Dorothea M.; Ross, Sheila A.

This lesson book, which is the third in a four-level program for young children with learning difficulties, describes the purpose of and equipment and procedures for teaching lessons in the following subject areas on the primary grade level: arithmetic, reading, vocabulary, spelling, printing, listening, planning, problem solving, social behavior,…

Pacemaker Primary Curriculum; Lesson Book Level D.

Science.gov (United States)

Ross, Dorothea M.; Ross, Sheila A.

This lesson book, which is the last in a four-level program for young children with learning difficulties, describes the purpose of and equipment and procedures for teaching lessons in the following subject areas on the primary level: arithmetic, reading, vocabulary, spelling, printing, listening, planning and problem solving, social behavior,…

Reframing Primary Curriculum through Concepts of Place

Science.gov (United States)

Power, Kerith; Green, Monica

2014-01-01

Australian curricula name "sustainability" as a key priority area with implications for preparing pre-service teachers. In the research that generated this paper, we asked: How can framing teaching through space and place inform pre-service teachers' pedagogical thinking and practice? In new third year Bachelor of Education (primary)…

Incidence and Outcomes of Patients With Oral Cavity Squamous Cell Carcinoma and Fourth Primary Tumors: A Long-term Follow-up Study in a Betel Quid Chewing Endemic Area.

Science.gov (United States)

Adel, Mohamad; Liao, Chun-Ta; Lee, Li-Yu; Hsueh, Chuen; Lin, Chien-Yu; Fan, Kang-Hsing; Wang, Hung-Ming; Ng, Shu-Hang; Lin, Chih-Hung; Tsao, Chung-Kan; Huang, Shiang-Fu; Kang, Chung-Jan; Fang, Ku-Hao; Wang, Yu-Chien; Chang, Kai-Ping; Fang, Tuan-Jen; Yang, Lan Yan; Yen, Tzu-Chen

2016-03-01

The aim of this study was to explore the incidence and outcomes of patients with oral cavity squamous cell carcinoma (OSCC) and fourth primary tumors (PTs) in a betel-chewing endemic area.We retrospectively examined the records of 1836 OSCC patients who underwent radical tumor resection between 1996 and 2014. The outcome measures included the incidence and number of multiple PTs, the main risk factors, and their associations with overall survival (OS).Of the 1836 patients, 1400 (76.3%) had a single PT, 344 (18.7%) a second PT, 67 (3.6%) a third PT, and 25 (1.4%) a fourth PT. Univariate analyses (log-rank test) identified the following factors as significantly associated with a fourth PT: simultaneous first and second PTs, betel quid chewing, buccal subsite, and pT3-4 status. After allowance for the potential confounding effect of other risk factors, all of these factors retained their independent prognostic significance in stepwise multivariate analyses, the only exception being betel chewing. The incidences of second, third, and fourth PTs at 5 and 10 years were 20.2%/34.6%, 4.0%/8.6%, and 1.0%/2.3%, respectively. The 5 and 10-year OS rates (calculated from the diagnosis of each PTs) for patients with a single, second, third, and fourth PTs were 68%/61%, 43%/37%, 45%/39%%, and 30%/30%, respectively (P betel quid-chewing endemic area. Long-term survival rates of patients treated with radical surgery seems acceptable, being 4-fold higher than their counterparts.

What are gender-based challenges facing Free Primary Education ...

African Journals Online (AJOL)

Rural teachers' views: What are gender-based challenges facing. Free Primary Education in Lesotho .... resulted in high levels of poverty amongst women, particularly in rural areas. Women ...... Lesotho demographics profile 2010. Available at ...

Plastic Debris Occurrence, Convergence Areas and Fin Whales Feeding Ground in the Mediterranean Marine Protected Area Pelagos Sanctuary: A Modeling Approach

Directory of Open Access Journals (Sweden)

Maria Cristina Fossi

2017-05-01

Full Text Available The Mediterranean Sea is greatly affected by marine litter. In this area, research on the impact of plastic debris (including microplastics on biota, particularly large filter-feeding species such as the fin whale (Balaenoptera physalus, is still in its infancy. We investigated the possible overlap between microplastic, mesoplastic and macrolitter accumulation areas and the fin whale feeding grounds in in a pelagic Specially Protected Area of Mediterranean Importance (SPAMI: the Pelagos Sanctuary. Models of ocean circulation and fin whale potential habitat were merged to compare marine litter accumulation with the presence of whales. Additionally, field data on microplastics, mesoplastics, and macrolitter abundance and cetacean presence were simultaneously collected. The resulting data were compared, as a multi-layer, with the simulated distribution of plastic concentration and the whale habitat model. These data showed a high occurrence of microplastics (mean: 0.082 items/m2, STD ± 0.079 items/m2 spatial distribution agreed with our modeling results. Areas with high microplastic density significantly overlapped with areas of high macroplastic density. The most abundant polymer detected in all the sampling sites was polyethylene (PE, suggesting fragmentation of larger packaging items as the primary source. To our knowledge, this is the first study in the Pelagos Sanctuary in which the simulated microplastic distribution has been confirmed by field observations. The overlap between the fin whale feeding habitat and the microplastic hot spots is an important contribution for risk assessment of fin whale exposure to microplastics.

Dimensions of the local health care environment and use of care by uninsured children in rural and urban areas.

Science.gov (United States)

Gresenz, Carole Roan; Rogowski, Jeannette; Escarce, José J

2006-03-01

Despite concerted policy efforts, a sizeable percentage of children lack health insurance coverage. This article examines the impact of the health care safety net and health care market structure on the use of health care by uninsured children. We used the Medical Expenditure Panel Survey linked with data from multiple sources to analyze health care utilization among uninsured children. We ran analyses separately for children who lived in rural and urban areas and assessed the effects on utilization of the availability of safety net providers, safety net funding, supply of primary care physicians, health maintenance organization penetration, and the percentage of people who are uninsured, controlling for other factors that influence use. Fewer than half of uninsured children had office-based visits to health care providers during the year, 8% of rural and 10% of urban children visited the emergency department at least once, and just over half of children had medical expenditures or charges during the year. Among uninsured children in rural areas, living closer to a safety net provider and living in an area with a higher supply of primary care physicians were positively associated with higher use and medical expenditures. In urban areas, the supply of primary care physicians and the level of safety net funding were positively associated with uninsured children's medical expenditures, whereas the percentage of the population that was uninsured was negatively associated with use of the emergency department. Uninsured children had low levels of utilization over a range of different health care provider types and settings. The availability of safety net providers in the local area and the safety net's capacity to serve the uninsured influence access to care among children. Possible measures for ensuring access to health care among uninsured children include increasing the density of safety net providers in rural areas, enhancing funding for the safety net, and policies

Primary care physician perceptions of the nurse practitioner in the 1990s.

Science.gov (United States)

Aquilino, M L; Damiano, P C; Willard, J C; Momany, E T; Levy, B T

1999-01-01

To evaluate factors associated with primary care physician attitudes toward nurse practitioners (NPs) providing primary care. A mailed survey of primary care physicians in Iowa. Half (N = 616) of the non-institutional-based, full-time, primary care physicians in Iowa in spring 1994. Although 360 (58.4%) responded, only physicians with complete data on all items in the model were used in these analyses (n = 259 [42.0%]). There were 2 principal dependent measures: physician attitudes toward NPs providing primary care (an 11-item instrument) and physician experience with NPs in this role. Bivariate relationships between physician demographic and practice characteristics were evaluated by chi 2 tests, as were both dependent variables. Ordinary least-squares regression was used to determine factors related to physician attitudes toward NPs. In bivariate analyses, physicians were significantly more likely to have had experience with an NP providing primary care if they were in pediatrics or obstetrics-gynecology (78.3% and 70.0%, respectively; P < .001), had been in practice for fewer than 20 years (P = .045), or were in practices with 5 or more physicians. The ordinary least-squares regression indicated that physicians with previous experience working with NPs providing primary care (P = .01), physicians practicing in urban areas with populations greater than 20,000 but far from a metropolitan area (P = .03), and general practice physicians (P = .04) had significantly more favorable attitudes toward NPs than did other primary care physicians. The association between previous experience with a primary care NP and a more positive attitude toward NPs has important implications for the training of primary care physicians, particularly in community-based, multidisciplinary settings.

Structure-Function Correlation Using Confocal Laser Ophthalmoscope in Primary Open-Angle Glaucoma and Pseudoexfoliative Glaucoma.

Science.gov (United States)

Pappas, Theofanis; Founti, Panayiota; Yin, Xiang Jun; Koskosas, Archimidis; Anastasopoulos, Eleftherios; Salonikiou, Angeliki; Kilintzis, Vasilios; Antoniadis, Antonios; Ziakas, Nikolaos; Topouzis, Fotis

2016-04-01

To compare Heidelberg Retina Tomograph (HRT) optic disc parameters and structure-function correlation between primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). Prospective, observation case series. A total of 54 POAG and 33 PEXG cases, consecutively recruited from a University Glaucoma Service, underwent a comprehensive ophthalmic examination, including HRT optic disc imaging. Glaucoma definition required the presence of both structural and functional damage. One eye per subject was included in the analysis. T test, Mann-Whitney U test, and analysis of covariance were used to compare HRT parameters between POAG and PEXG, adjusting for age, mean deviation (MD) in the visual field, intraocular pressure, and disc area. The correlation between HRT and MD was assessed in each group. Cup area (P=0.048), height variation contour (P=0.016), and cup/disc area ratio (P=0.023) were higher in POAG, whereas the mean retinal nerve fiber layer thickness (P=0.048), retinal nerve fiber layer cross-section area (P=0.044), and rim area (P=0.048) were lower in POAG, compared with PEXG. The correlation of HRT parameters with MD was significant only in the POAG group. At a similar level of functional damage, POAG subjects presented with more pronounced structural damage than PEXG subjects. The correlation between HRT and visual field parameters was more evident in POAG, compared with PEXG.

Mental health and burnout in primary and secondary school teachers in the remote mountain areas of Guangdong Province in the People's Republic of China

Directory of Open Access Journals (Sweden)

Zhang L

2014-01-01

Full Text Available Lulu Zhang,1 Jingping Zhao,1 Huaqing Xiao,3 Hongbo Zheng,2 Yaonan Xiao,3 Miaoyang Chen,3 Dingling Chen31Mental Health Institute of the Second Xiangya Hospital, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan, 2Department of Psychiatry, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 3Department of Psychiatry, Luoding Dagang Hospital, Luoding, Guangdong, People's Republic of ChinaBackground: A growing number of studies have shown that education is a work context in which professionals (teachers seem likely to suffer from burnout that may be associated with low levels of mental health. Although there is a demonstrated need to improve the mental health and burnout levels among teachers, little is known about their mental health status, particularly with respect to graduating class teachers in remote mountain areas with undeveloped economies. The purpose of this study was to survey mental health and burnout among graduating class teachers in remote mountain areas and to examine the influence of moderating variables.Methods: We conducted a multilevel analysis of 590 graduating class teachers from 42 primary and secondary schools in remote mountain areas of Guangdong province in the People's Republic of China. The outcome variable of self-reported mental health was measured by the Symptom Checklist-90 (SCL-90, and burnout was measured by the Chinese Maslach Burnout Inventory for primary and secondary school teachers.Results: The status of both mental health and burnout among the respondents was significantly more troubling than the national norm used as a reference (P<0.05 or P<0.01. Each factor in the SCL-90 had a significant correlation with burnout (P<0.01. All factors of the SCL-90 were entered into the regression equation for each dimension of burnout (P<0.01. The factor having the greatest impact on emotional exhaustion and

Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model.

Science.gov (United States)

Sandoval, Brian E; Bell, Jennifer; Khatri, Parinda; Robinson, Patricia J

2017-12-12

Primary care continues to be at the center of health care transformation. The Primary Care Behavioral Health (PCBH) model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. This article reviews the link between the PCBH model of service delivery and health care services quality improvement, and provides guidance for initiating PCBH model clinical pathways for patients facing depression, chronic pain, alcohol misuse, obesity, insomnia, and social barriers to health.

Unimodal primary sensory cortices are directly connected by long-range horizontal projections in the rat sensory cortex

Directory of Open Access Journals (Sweden)

Jimmy eStehberg

2014-09-01

Full Text Available Research based on functional imaging and neuronal recordings in the barrel cortex subdivision of primary somatosensory cortex (SI of the adult rat has revealed novel aspects of structure-function relationships in this cortex. Specifically, it has demonstrated that single whisker stimulation evokes subthreshold neuronal activity that spreads symmetrically within gray matter from the appropriate barrel area, crosses cytoarchitectural borders of SI and reaches deeply into other unimodal primary cortices such as primary auditory (AI and primary visual (VI. It was further demonstrated that this spread is supported by a spatially matching underlying diffuse network of border-crossing, long-range projections that could also reach deeply into AI and VI. Here we seek to determine whether such a network of border-crossing, long-range projections is unique to barrel cortex or characterizes also other primary, unimodal sensory cortices and therefore could directly connect them. Using anterograde (BDA and retrograde (CTb tract-tracing techniques, we demonstrate that such diffuse horizontal networks directly and mutually connect VI, AI and SI. These findings suggest that diffuse, border-crossing axonal projections connecting directly primary cortices are an important organizational motif common to all major primary sensory cortices in the rat. Potential implications of these findings for topics including cortical structure-function relationships, multisensory integration, functional imaging and cortical parcellation are discussed.

Floodplain Mapping, Marion County, Kansas and Incorporated Areas

Data.gov (United States)

Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

Tree differences in primary and secondary growth drive convergent scaling in leaf area to sapwood area across Europe

NARCIS (Netherlands)

Petit, Giai; Arx, von Georg; Kiorapostolou, Natasa; Lechthaler, Silvia; Prendin, Angela Luisa; Anfodillo, Tommaso; Caldeira, Maria C.; Cochard, Hervé; Copini, Paul; Crivellaro, Alan; Delzon, Sylvain; Gebauer, Roman; Gričar, Jožica; Grönholm, Leila; Hölttä, Teemu; Jyske, Tuula; Lavrič, Martina; Lintunen, Anna; Lobo-do-Vale, Raquel; Peltoniemi, Mikko; Peters, Richard L.; Robert, Elisabeth M.R.; Roig Juan, Sílvia; Senfeldr, Martin; Steppe, Kathy; Urban, Josef; Camp, Van Janne; Sterck, Frank

2018-01-01

Trees scale leaf (AL) and xylem (AX) areas to couple leaf transpiration and carbon gain with xylem water transport. Some species are known to acclimate in AL: AX balance in response to climate conditions, but whether trees of different species acclimate in AL: AX in similar ways over their entire

[Family Health Teams in Ontario: Ideas for Germany from a Canadian Primary Care Model].

Science.gov (United States)

Ulrich, Lisa-R; Pham, Thuy-Nga Tia; Gerlach, Ferdinand M; Erler, Antje

2017-07-11

The German healthcare system is struggling with fragmentation of care in the face of an increasing shortage of general practitioners and allied health professionals, and the time-demanding healthcare needs of an aging, multimorbid patient population. Innovative interprofessional, intersectoral models of care are required to ensure adequate access to primary care across a variety of rural and urban settings into the foreseeable future. A team approach to care of the complex multimorbid patient population appears particularly suitable in attracting and retaining the next generation of healthcare professionals, including general practitioners. In 2014, the German Advisory Council on the Assessment of Developments in the Health Care System highlighted the importance of regional, integrated care with community-based primary care centres at its core, providing comprehensive, population-based, patient-centred primary care with adequate access to general practitioners for a given geographical area. Such centres exist already in Ontario, Canada; within Family Health Teams (FHT), family physicians work hand-in-hand with pharmacists, nurses, nurse practitioners, social workers, and other allied health professionals. In this article, the Canadian model of FHT will be introduced and we will discuss which components could be adapted to suit the German primary care system. © Georg Thieme Verlag KG Stuttgart · New York.

Evaluation of the Volatility Basis-Set Approach for Modeling Primary and Secondary Organic Aerosol in the Mexico City Metropolitan Area

Science.gov (United States)

Tsimpidi, A. P.; Karydis, V. A.; Pandis, S. N.; Zavala, M.; Lei, W.; Molina, L. T.

2007-12-01

Anthropogenic air pollution is an increasingly serious problem for public health, agriculture, and global climate. Organic material (OM) contributes ~ 20-50% to the total fine aerosol mass at continental mid-latitudes. Although OM accounts for a large fraction of PM2.5 concentration worldwide, the contributions of primary and secondary organic aerosol have been difficult to quantify. In this study, new primary and secondary organic aerosol modules were added to PMCAMx, a three dimensional chemical transport model (Gaydos et al., 2007), for use with the SAPRC99 chemistry mechanism (Carter, 2000; ENVIRON, 2006) based on recent smog chamber studies (Robinson et al., 2007). The new modeling framework is based on the volatility basis-set approach (Lane et al., 2007): both primary and secondary organic components are assumed to be semivolatile and photochemically reactive and are distributed in logarithmically spaced volatility bins. The emission inventory, which uses as starting point the MCMA 2004 official inventory (CAM, 2006), is modified and the primary organic aerosol (POA) emissions are distributed by volatility based on dilution experiments (Robinson et al., 2007). Sensitivity tests where POA is considered as nonvolatile and POA and SOA as chemically reactive are also described. In all cases PMCAMx is applied in the Mexico City Metropolitan Area during March 2006. The modeling domain covers a 180x180x6 km region in the MCMA with 3x3 km grid resolution. The model predictions are compared with Aerodyne's Aerosol Mass Spectrometry (AMS) observations from the MILAGRO Campaign. References Robinson, A. L.; Donahue, N. M.; Shrivastava, M. K.; Weitkamp, E. A.; Sage, A. M.; Grieshop, A. P.; Lane, T. E.; Pandis, S. N.; Pierce, J. R., 2007. Rethinking organic aerosols: semivolatile emissions and photochemical aging. Science 315, 1259-1262. Gaydos, T. M.; Pinder, R. W.; Koo, B.; Fahey, K. M.; Pandis, S. N., 2007. Development and application of a three- dimensional aerosol

The Institutional Sustainability in Protected Area Tourism-Case Studies of Jiuzhaigou National Scenic Area, China and New Forest National Park, United Kingdom

OpenAIRE

Xu, Feifei; Fox, Dorothy; Zhang, J.; Cheng, S.

2014-01-01

This article considers sustainable tourism development in two protected areas, Jiuzhaigou National Scenic Area in China and the New Forest National Park in the United Kingdom. An inductive approach is used to explore the "fourth component" of sustainable tourism development that is institutional sustainability. Primary data from in-depth interviews, together with a range of secondary data sources, are analyzed to understand the governance and management of each area. These reveal that whilst ...

ORGANIZATIONAL JUSTICE AT REGIONAL BOARDING PRIMARY SCHOOLS: SİNOP CASE

OpenAIRE

Elife (DOĞAN) KILIÇ

2013-01-01

Regional boarding primary schools (RBPSs) are established as a solution toincrease the equality of opportunity in rural areas of Turkey. Necessities of thestudents in these schools such as; accommodation, nourishment, clothing, learningmaterials, pocket money and etc. are supplied by Ministry of National Education.Teachers’ responsibilities and duties differ in some degree at these schools whencompared to other general public primary schools. Keeping guard on students atnights and on weekends...

Youth Restiveness in Niger Delta rural areas: Lesson for .Contemporary Nigerian Society

Science.gov (United States)

Nlerum, F. E.

2012-12-01

This study reviewed the youth restiveness in Niger Delta rural areas as lesson for the contemporary Nigerian society. The study was based on secondary sources of information. The study identified youths in the area as people between the ages of 15 ñ 40 years. Youths possess viable characteristics for rural development which if mismanaged results into restiveness. The study showed that the primary causes of youth restiveness in the area were proliferation of arms, misuse of the military to suppress protests, misappropriation of benefits from crude oil, youth unemployment and environmental degradation. Consequences of youth restiveness among others included loss of life and properties, rural-urban migration of the farm families, breeding defective future leaders, disruption of oil and gas activities and food insecurity. In order to eradicate youth restiveness, the contemporary Nigeria society should check the rate of arm proliferation, misuse of the military to suppress youth protests, misappropriation of benefits accruing to the communities, youth unemployment and environmental degradation.

Primary gastric melanoma: case report of a rare malignancy

Directory of Open Access Journals (Sweden)

Alexander Augustyn

2015-03-01

Full Text Available We report the case of a 64-year-old white male who presented to his primary care physician with complaints of fatigue. Physical exam was unremarkable and laboratory studies revealed profound anemia, for which the patient received a transfusion. Esophagogastroduodenoscopy revealed a bleeding mass in the proximal stomach that was histologically determined to be malignant melanoma, with immunohistochemical staining demonstrating positivity for SOX10, S100, MART-1, and HMG-45. After an extensive dermatological exam no other primary lesion was identified. Whole body positron emission tomography (18-FDG-PET/CT demonstrated pathologic uptake only in the area of the proximal stomach. For this reason, primary gastric melanoma was suspected in this patient. The patient underwent subtotal gastrectomy with mass excision followed by Roux-en-Y reconstruction. Very few cases of primary gastric melanoma have been reported. We report this case and present diagnostic criteria for primary non-cutaneous melanoma and discuss potential non-surgical therapies.

[Identification of health outcome indicators in Primary Care. A review of systematic reviews].

Science.gov (United States)

Olry de Labry Lima, A; García Mochón, L; Bermúdez Tamayo, C

Outcome measures are being widely used by health services to assess the quality of health care. It is important to have a battery of useful performance indicators with high validity and feasibility. Thus, the objective of this study is to perform a review of reviews in order to identify outcome indicators for use in Primary Care. A review of systematic reviews (umbrella review) was carried out. The following databases were consulted: MedLine, EMBASE, and CINAHL, using descriptors and free terms, limiting searches to documents published in English or Spanish. In addition, a search was made for free terms in different web pages. Those reviews that offered indicators that could be used in the Primary Care environment were included. This review included a total of 5 reviews on performance indicators in Primary Care, which consisted of indicators in the following areas or clinical care processes: in osteoarthritis, chronicity, childhood asthma, clinical effectiveness, and prescription safety indicators. A total of 69 performance indicators were identified, with the percentage of performance indicators ranging from 0% to 92.8%. None of the reviews identified performed an analysis of the measurement control (feasibility or sensitivity to change of indicators). This paper offers a set of 69 performance indicators that have been identified and subsequently validated and prioritised by a panel of experts. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

strategies for improving supervisory skills for effective primary ...

African Journals Online (AJOL)

Elizabeth

certain basic concepts such as inspection and supervision, the responsibility of supervisors, relevant areas in ... Strategies For Improving Supervisory Skills For Effective Primary Education In Nigeria. Enaigbe A. P. 236 ... book, attendance book etc. 6) Managerial Skills: These are skills on time management, good use.

Molecular Heterogeneity in Primary Breast Carcinomas and Axillary Lymph Node Metastases Assessed by Genomic Fingerprinting Analysis

Science.gov (United States)

Ellsworth, Rachel E; Toro, Allyson L; Blackburn, Heather L; Decewicz, Alisha; Deyarmin, Brenda; Mamula, Kimberly A; Costantino, Nicholas S; Hooke, Jeffrey A; Shriver, Craig D; Ellsworth, Darrell L

2015-01-01

Molecular heterogeneity within primary breast carcinomas and among axillary lymph node (LN) metastases may impact diagnosis and confound treatment. In this study, we used short tandem repeated sequences to assess genomic heterogeneity and to determine hereditary relationships among primary tumor areas and regional metastases from 30 breast cancer patients. We found that primary carcinomas were genetically heterogeneous and sampling multiple areas was necessary to adequately assess genomic variability. LN metastases appeared to originate at different time periods during disease progression from different sites of the primary tumor and the extent of genomic divergence among regional metastases was associated with a less favorable patient outcome (P = 0.009). In conclusion, metastasis is a complex process influenced by primary tumor heterogeneity and variability in the timing of dissemination. Genomic variation in primary breast tumors and regional metastases may negatively impact clinical diagnostics and contribute to therapeutic resistance. PMID:26279627