WorldWideScience

Sample records for primary concern due

  1. Hypokalemic paralysis due to primary hyperaldosteronism simulating gitelman′s syndrome

    Directory of Open Access Journals (Sweden)

    Kasifoglu Timucin

    2009-01-01

    Full Text Available Some diseases, such as Gitelman′s syndrome, Bartter′s syndrome, and primary hyperaldosteronism (Conn′s syndrome, may bear some similar clinical and laboratory findings. Their treatment modalities being different from one another, the need for a scrupulous diagnostic evaluation arises as far as clinical practice is concerned. In this report, we present a patient with Conn′s syndrome who was initially considered to have Gitelman′s syndrome due to displaying a few overlapping features of both diseases. We also give an account of the hardships encountered during the diagnostic evaluation.

  2. Frequency of primary amenorrhea due to chromosomal aberration

    International Nuclear Information System (INIS)

    Jabbar, S.

    2004-01-01

    Objective: To find out the frequency of primary amenorrhea due to chromosomal aberration and the different options available for management. Subjects and Methods: All patients with primary amenorrhea due to chromosomal aberrations were included in study. Patient's detailed history, general physical examination, presence or absence of secondary sexual characteristics, abdominal and pelvic examination finding were noted. Targeted investigations, including ultrasound, hormonal assay, buccal smear and karyotyping results were recorded. The management options were individually tailored with focus n psychological management. Results: Eighteen patients out of 30,000 patients were diagnosed as having primary amenorrhea. Six had primary amenorrhea due to chromosomal aberrations with the frequency of 0.02%. The age at presentation was 20 years and above in 50%. The most common cause was Turner's syndrome seen in 4 out of 6. The presenting symptoms were delay in onset of menstruation in 05 patients and primary infertility in 01 patient. Conclusion: Primary amenorrhea due to chromosomal aberration is an uncommon condition requiring an early and accurate diagnosis. Turner's syndrome is a relatively common cause of this condition. Management should be multi-disciplinary and individualized according to the patient's age and symptom at presentation. Psychological management is very important and counselling throughout treatment is recommended. (author)

  3. Diabetes due to recurrent pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Sumit Kumar Chakrabarti

    2013-01-01

    Full Text Available Acute pancreatitis due to hypercalcemia associated with hyperparathyroidism (HPT is not very common. We herein report a case of a 21-year-old woman, who presented with acute pancreatitis. She had a past history of recurrent nephrolithiasis. Subsequent evaluation revealed hypercalcemia (serum calcium: 12.6 mg/dL; low phosphate (2.9 mg/dL with elevated parathyroid hormone (PTH, 156.7 pg/mL and HbA1c (6.9%. Diagnosis of primary HPT (PHPT was made. Recurrent pancreatitis due to hypercalcemia may have resulted in diabetes mellitus.

  4. Revise of the law concerning prevention from radiation hazards due to radioisotopes, etc

    International Nuclear Information System (INIS)

    Sakamoto, Yoshiaki; Sendo, Muneaki

    2004-01-01

    The Law Concerning Prevention from Radiation Hazards due to Radioisotopes, etc. was revised in 2004. The regulation about disposal of RI waste was fixed at this revise of the law. Regulation of an application about the disposal of the RI waste was added to former radioactive waste control business. And regulation of confirmation of waste disposal by a regulation body was added. By this law revision, a necessary system for the RI waste disposal is ready. Furthermore, the Basic Safety Standard (BSS) and the following rationalization of related to regulation were introduced into the Law Concerning Prevention from Radiation Hazards due to Radioisotopes, etc. by this law revision. The regulation for a handling of radionuclides will be changed a lot due to the introduction of the BSS. (author)

  5. 18 CFR 2.400 - Statement of interpretation of waste concerning natural gas as the primary energy source for...

    Science.gov (United States)

    2010-04-01

    ... interpretation of waste concerning natural gas as the primary energy source for qualifying small power production... concerning natural gas as the primary energy source for qualifying small power production facilities. For purposes of deciding whether natural gas may be considered as waste as the primary energy source pursuant...

  6. Spelling Instruction in the Primary Grades: Teachers' Beliefs, Practices, and Concerns

    Science.gov (United States)

    Doyle, Antoinette; Zhang, Jing; Mattatall, Chris

    2015-01-01

    This study examined Canadian teachers' beliefs, practices and concerns about spelling instruction in the primary grades. Data from surveys (n = 56) indicated that most teachers believe that spelling is important and plan for spelling instruction. For most teachers, the spelling words and activities used, and the instructional resources they chose,…

  7. MRI evaluation of pituitary hyperplasia due to primary hypothyroidism

    International Nuclear Information System (INIS)

    Jiang Chunjing; Shu Jin'er; Li Huimin; Sheng Sanlan; Lu Jinhua

    2010-01-01

    Objective: To analyze the MRI manifestations of the pituitary hyperplasia due to primary hypothyroidism and to improve the differential diagnosis of secondary pituitary hyperplasia and pituitary tumors. Methods: The MRI findings of pituitary hyperplasia in 10 documented primary hypothyroidism patients (male 3, female 7; age range: 9-15 years) were reviewed. The pulse sequences using a 1.0T MR scanner included coronal and sagittal T 1 W, coronal T 2 W and coronal contrast-enhanced T 1 W in all patients. Results: The pituitary gland was markedly enlarged with mean height of 15.5 mm (11-23 mm). Central bulging of pituitary gland was seen in all 10 patients with mild displacement of the infundibulum in 3 and sellar enlargement in 5. All glands had homogeneous MR signal intensities and contrast enhancement. Conclusion: Pituitary hyperplasia due to primary hypothyroidism has characteristic MR features of central bulging with homogeneous signal intensities and contrast enhancement. (authors)

  8. A Preliminary Investigation into Parents' Concerns about Programming Education in Japanese Primary Schools

    Science.gov (United States)

    Maruyama, Yukiko; Kanoh, Hiroko; Adachi, Kinya

    2017-01-01

    To investigate parents' concerns about programming education in primary school, a preliminary online survey was carried out as a first step of the study. The result of the survey shows that parents seem to think that aim of programming education in primary school is not only learning coding. [For the complete proceedings, see ED579395.

  9. Tablets or scalpel: Pituitary hyperplasia due to primary hypothyroidism

    Directory of Open Access Journals (Sweden)

    Ahmed Imran Siddiqi, MBBS, MRCP

    2015-01-01

    Full Text Available We describe a patient with pituitary hyperplasia due to primary hypothyroidism. Pituitary hyperplasia and pituitary masses cannot be reliably differentiated on imaging alone, despite significant improvement in imaging quality in recent years.

  10. Privacy concerns of patients and nurse practitioners in primary care--an APRNet study.

    Science.gov (United States)

    Olsen, Douglas P; Dixon, Jane Karpe; Grey, Margaret; Deshefy-Longhi, Terry; Demarest, Jo Cecille

    2005-12-01

    This study explores and compares the privacy concerns of primary care nurse practitioners (NPs) and their patients. Privacy concerns were identified in separate focus groups of NPs and patients, and then parallel survey instruments were designed and administered to 27 NPs and 185 of their patients. All subjects were recruited through APRNet, a regional practice-based research network of NPs in southern New England encompassing 58 practices. Both groups demonstrated high levels of concern regarding privacy. While NPs and patients had similar levels of concern about most issues, there were some notable differences regarding breeches because of carelessness, disclosures for research, and which disorders require the most care in maintaining privacy. These results allow NPs to anticipate patient privacy concerns and to enhance trust in the clinical relationship. These results also indicate the need to educate patients regarding privacy rights and expectations.

  11. The dire need for primary care specialization in India: Concerns and challenges

    Directory of Open Access Journals (Sweden)

    Nafis Faizi

    2016-01-01

    Full Text Available Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000' in the past, and is committed to 'Universal Health Coverage' by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1 The dynamic and distinct nature of primary care as opposed to other medical specializations, (2 the intersection of primary care and public health which can be facilitated by such a specialization, and (3 research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.

  12. The dire need for primary care specialization in India: Concerns and challenges.

    Science.gov (United States)

    Faizi, Nafis; Khalique, Najam; Ahmad, Anees; Shah, Mohammad Salman

    2016-01-01

    Primary health care is an evidence-based priority, but it is still inadequately supported in many countries. Ironically, on one hand, India is a popular destination for medical tourism due to the affordability of high quality of health care and, on the other hand, ill health and health care are the main reasons for becoming poor through medical poverty traps. Surprisingly, this is despite the fact that India was committed to 'Health for All by 2000' in the past, and is committed to 'Universal Health Coverage' by 2022! Clearly, these commitments are destined to fail unless something is done to improve the present state of affairs. This study argues for the need to develop primary care as a specialization in India as a remedial measure to reform its health care in order to truly commit to the commitments. Three critical issues for this specialization are discussed in this review: (1) The dynamic and distinct nature of primary care as opposed to other medical specializations, (2) the intersection of primary care and public health which can be facilitated by such a specialization, and (3) research in primary care including the development of screening and referral tools for early diagnosis of cancers, researches for evidence-based interventions via health programs, and primary care epidemiology. Despite the potential challenges and difficulties, India is a country in dire need for primary care specialization. India's experience in providing low-cost and high quality healthcare for medical tourism presages a more cost-effective and efficient primary care with due attention and specialization.

  13. A prospective study of etiology of primary Amenorrhea with especial evaluation for non classic congenital adrenal hyperplasia due to 21 Hydroxylase deficiency

    Directory of Open Access Journals (Sweden)

    Moayeri H

    2002-07-01

    Full Text Available Amenorrhea, an absence of menses is a symptom that generally brings teenagers for evaluation. This study was undertaken to determine the etiology of primary amenorrhea with especial concern to non classic congential adrenal hyperplasia (NC-CAH-due 21 hydroxylase deficiency among female adolescents refered to clinics of Pediatric Endocrinology of Tehran and Iran University of Medical sciences and private office. One hundred and five female adolescents were studied. All patients were examined by pediatric endocrinologist.Routine lab tests, FSH, LH, prolactin, T4, TSH, 17-hydroxyprogesterone and in some cases ACTH Stimulation test for screening of NC-CAH due to 21 OH deficiency were performed. Chromosmal analysis, sonography of the ovaries and CT scan or MRI of the brain was performed in some of them. Forty-three patients (41% had ypergonaldotropic hypogonadism and sixty two patiens (59% ahd hypogonadotropic hypogonadism. Turner’s syndrome and constitutional delay of puberty were the most common causes of primary amenorrhea in our study. The frequency of primary amenorrhea in our study. The frequency of primary amenorrhea due to 21-OH deficient NC-CAH was 6.6% in overall (105 cases. This study shows that in a population with high incidence of consanguineous marriages, some rare genetic disorders such as 21 OH deficient NC-CAH are relatively common

  14. A Case of Primary Hyperparathyroidism due to Intrathyroidal Parathyroid Cyst

    Directory of Open Access Journals (Sweden)

    Yavuz Yalcin

    2014-01-01

    Full Text Available Parathyroid cysts constitute 0.08–3.41% of all parathyroid masses. Intrathyroidal parathyroid cysts, however, are rare conditions with only a few cases being reported. Most of the parathyroid cysts are found to be nonfunctional and functional cysts are generally thought to be due to cystic degeneration of parathyroid adenomas. A cystic, smooth contoured lesion of 24 × 19 × 16 mm was observed in left thyroid lobe of a 76-year-old woman during ultrasonography which was performed as routine workup for primary hyperparathyroidism. It was defined as a cystic thyroid nodule at first. Tc99m sestamibi scintigraphy was performed to see any parathyroid lesions, but no radioactive uptake was observed. Intact parathormone (iPTH level was found to be >600 pg/mL in cyst aspiration fluid. Left lobectomy was performed, with a diagnosis of primary hyperparathyroidism due to functional parathyroid cyst. Serum iPTH level was decreased >50% postoperatively and histopathological evaluation was consistent with an encapsulated parathyroid adenoma with a cystic center. Parathyroid cysts are among rare causes of primary hyperparathyroidism. Diagnosis is made by markedly increased iPTH level in cyst fluid and observation of parathyroid epithelium lining the cyst wall.

  15. Knowledge, attitudes, and practices of 1,985 Buddhist monks in Thailand concerning family planning, sterilization and primary health care.

    Science.gov (United States)

    Muangman, D; Hirunraks, A

    1983-12-01

    Pretested questionnaires were used with 2000 Buddhist monks in 4 regions of Thailand to learn about the monks' characteristics and background, their attitudes on family planning and primary health care, and their knowledge, attitudes, and practices concerning sterilization with a focus on vasectomy. Randomly selected, the monks were individually interviewed using well trained local teachers with the staff from the Faculty of Public Health, Mohidol University acting as field supervisors. There were completed data on 1985 monks. 95% of the monks were single whith the average age of 28. The majority had only 4 years of education and an agriculture background. The mass media channels of radio and newspapers could reach about half of them. The majority were well informed about population problems and gave strong backing to the family planning policy of the Thai government. 79% stated that family planning practices are not sinful. They also had positive attitudes toward small families and the spacing of childred in the 1st year of marriage and after delivery of the 1st child. The majority wanted to be trained in primary health care and were willing to use their wats as health depots. The monks were well informed about oral contraceptives (OCs), the IUD, condoms, and male and female sterilization methods. Vasectomy cases were very small. This might be due to their large number being single. A large number had nevative attitudes toward vasectomy. The monks thought men were afraid of sexual impotence post-vasectomy. During monkhood might be the best time to give these young men more correct information concerning family planning and primary health care, for they would have enough time to learn and think positively. After 3 months are over, about 2/3 of these monks will leave their priesthood and probably marry and have childred. If they have had short training in family planning and primary health care, they will be prepared to provide primary health care services to their

  16. 76 FR 72756 - Finding That the Islamic Republic of Iran Is a Jurisdiction of Primary Money Laundering Concern

    Science.gov (United States)

    2011-11-25

    ... Money Laundering Concern AGENCY: The Financial Crimes Enforcement Network (``FinCEN''), Treasury. ACTION... that the Islamic Republic of Iran is a jurisdiction of primary money laundering concern. DATES: The... PATRIOT Act''), Public Law 107-56. Title III of the USA PATRIOT Act amends the anti- money laundering...

  17. [Primary hyperaldosteronism due to unilateral adrenal hyperplasia with surgical resolution].

    Science.gov (United States)

    Rubio-Puchol, O; Garzón-Pastor, S; Salom-Vendrell, C; Hernández-Mijares, A

    Unilateral adrenal hyperplasia is a rare cause of primary hyperaldosteronism (around a 3%) that has surgical treatment. A case of a patient with hypertension resistant to conventional therapy in treatment with 7 drugs who presented with primary hyperaldosteronism due to unilateral adrenal hyperplasia is presented. A left adrenalectomy was performed, and the patient had a good clinical response, with no need of any drug after 2 years of surgery. Unilateral adrenal hyperplasia is a different entity and it is not an asymmetric variant of the bilateral adrenal hyperplasia. In the study of patients with primary hyperaldosteronism and imaging tests with absence of adenoma is a diagnosis that must be considered before cataloguing patients with bilateral adrenal hyperplasia and start a medical treatment, because unilateral adrenal hyperplasia would have a surgical resolution. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents

    Science.gov (United States)

    Saffan, Abdulrahman Al; AlHobail, Sultan; Bin Salem, Fares; AlFuraih, AlBara; AlTamimi, Mohammad

    2016-01-01

    Background and Aim. Esthetic concerns in primary teeth have been studied mainly from the point of view of parents. The aim of this study was to study compare the opinions of children aged 5–8 years to have an opinion regarding the changes in appearance of their teeth due to dental caries and the materials used to restore those teeth. Methodology. A total of 107 children and both of their parents (n = 321), who were seeking dental treatment, were included in this study. A tool comprising a questionnaire and pictures of carious lesions and their treatment arranged in the form of a presentation was validated and tested on 20 children and their parents. The validated tool was then tested on all participants. Results. Children had acceptable validity statistics for the tool suggesting that they were able to make informed decisions regarding esthetic restorations. There was no difference between the responses of the children and their parents on most points. Zirconia crowns appeared to be the most acceptable full coverage restoration for primary anterior teeth among both children and their parents. Conclusion. Within the limitations of the study it can be concluded that children in their sixth year of life are capable of appreciating the esthetics of the restorations for their anterior teeth. PMID:27446212

  19. The Influence of RSG-GAS Primary Pump Operation Concerning the Rise Water Level of Reactor Pool in 15 MW Reactor Power

    International Nuclear Information System (INIS)

    Djunaidi

    2004-01-01

    The expansion of air volume in the delay chamber shows in rise water level of reactor pool during the operation. The rises of water level in the reactor pool is not quite from the expansion of air volume in the delay chamber, but some influence the primary pump operation. The purpose evaluated of influence primary pump is to know the influence primary pump power concerning the rise water level during the reactor operation. From the data collection during 15 MW power operation in the last core 42 the influence of primary pump operation concerning the rise water level in the reactor pool is 34.48 % from the total increased after operation during 12 days. (author)

  20. Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

    Science.gov (United States)

    Wood, M E; Flynn, B S; Stockdale, A

    2013-01-01

    Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

  1. Parental concerns in parents of children attending pre- and primary school: analysis of the Portuguese population by District

    Directory of Open Access Journals (Sweden)

    Susana Algarvio

    Full Text Available Objective: In this study, our aim was to assess and analyze parental concerns by Portuguese District. Methods: The participants were 3842 parents of children between 3 and 10 years old, attending preschool and primary school, from 820 public schools in 18 Portuguese Districts. Parents completed a sociodemographic questionnaire, and a Parental Concerns Scale, composed by 5 subscales, family and school problems; feeding, sleep and physical complaints; preparation; fears; and negative behaviors. Results: Portuguese parents concerned about all the dimensions considered in this study. The highest level of concern was obtained in family and school problems, and the lowest level of concern about their children’s fears. There were significant differences between Districts, parents from Porto and Bragança showed the highest levels of concern. Parents from Coimbra, Évora, Beja e Portalegre, presented the lowest levels of concern. Conclusion: Parental concerns are an aspect of general parenting and must be considered by health professionals to promote healthier parents-children relationships. Geographic differences should be further investigated.

  2. Cushing syndrome in a young woman due to primary pigmented nodular adrenal disease.

    Science.gov (United States)

    Hackman, Kathryn L; Davis, Anna L; Curnow, Paul A; Serpell, Jonathan W; McLean, Catriona A; Topliss, Duncan J

    2010-01-01

    To report a case of Cushing syndrome due to apparently sporadic primary pigmented nodular adrenal disease in a young woman. We describe the clinical, biochemical, radiologic, and histologic findings of Cushing syndrome due to the rare condition of primary pigmented nodular adrenal disease. A 30-year-old woman presented with a 2-year history of worsening itch without rash over her shoulders and arms and weight gain, particularly around the abdomen and face. Careful questioning did not elicit any history of exogenous glucocorticoid use (systemic or topical), including hydrocortisone. On examination, the patient had a slightly rounded and plethoric face, a small buffalo hump, central adiposity, and thin skin with a few small striae on her inner thighs. No features of the Carney complex were observed. Investigations showed hypercortisolism with suppressed corticotropin and normal adrenal imaging despite documentation of enlarged adrenal glands at removal. High-dose dexamethasone administration was followed by a decrease in urinary free cortisol excretion rather than a paradoxical rise as previously reported in primary pigmented nodular adrenal disease. No mutations were detected in the PRKAR1A gene. Primary pigmented nodular adrenal disease should be suspected in patients with corticotropin-independent Cushing syndrome who have normal adrenal imaging. The role of genetic testing in apparently sporadic cases is not established, but cumulative experience may be helpful in defining the frequency of PRKAR1A mutations.

  3. Overvaluation of shape and weight in adolescents with anorexia nervosa: does shape concern or weight concern matter more for treatment outcome?

    Science.gov (United States)

    Byrne, Catherine E; Kass, Andrea E; Accurso, Erin C; Fischer, Sarah; O'Brien, Setareh; Goodyear, Alexandria; Lock, James; Le Grange, Daniel

    2015-01-01

    Overvaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); however, limited research has evaluated the clinical utility of differentiating between weight versus shape concerns. Understanding differences in these constructs may have important implications for AN treatment given the focus on weight regain. This study examined differences in treatment outcome between individuals whose primary concern was weight versus those whose primary concern was shape in a randomized controlled trial of treatment for adolescent AN. Data were drawn from a two-site randomized controlled trial that compared family-based treatment and adolescent focused therapy for AN. Chi-square tests and logistic regression analyses were conducted. Thirty percent of participants presented with primary weight concern (n = 36; defined as endorsing higher Eating Disorder Examination (EDE) Weight Concern than Shape Concern subscale scores); 60 % presented with primary shape concern (n = 72; defined as endorsing higher EDE Shape Concern than Weight Concern scores). There were no significant differences between the two groups in remission status at the end of treatment. Treatment did not moderate the effect of group status on achieving remission. Results suggest that treatment outcomes are comparable between adolescents who enter treatment for AN with greater weight concerns and those who enter treatment with greater shape concerns. Therefore, treatment need not be adjusted based on primary weight or primary shape concerns.

  4. 77 FR 31434 - Finding That JSC CredexBank Is a Financial Institution of Primary Money Laundering Concern

    Science.gov (United States)

    2012-05-25

    ... CredexBank is a financial institution of primary money laundering concern. DATES: The finding made in... Law 107-56. Title III of the USA PATRIOT Act amends the anti- money laundering provisions of the Bank..., to promote prevention, detection, and prosecution of international money laundering and the financing...

  5. Hypertrichosis due to primary hypothyroidism.

    OpenAIRE

    Stern, S R; Kelnar, C J

    1985-01-01

    A 10 year old girl with hypertrichosis associated with primary hypothyroidism that resolved after 6 months' replacement treatment with thyroxine is reported. It is important to consider the diagnosis of hypothyroidism in children with abnormal hairiness or distribution of body hair.

  6. A national probability survey of American Medical Association gynecologists and primary care physicians concerning menopause.

    Science.gov (United States)

    Singh, Betsy; Liu, Xiao-Dong; Der-Martirosian, Claudia; Hardy, Mary; Singh, Vijay; Shepard, Neil; Gandhi, Sonal; Khorsan, Raheleh

    2005-09-01

    This survey intended to clarify physicians' understanding of the issues surrounding women, menopause, alternative medicine, and drug therapy for the treatment of menopause. This study was designed as a national probability sample survey of primary care physicians and gynecologists nationwide. Its focus was to identify major concerns and issues identified by patients about menopause and perceived communication with effectiveness how to communicate with their patients. Physicians were also asked to rate their comfort level in recommending the use of herbal remedies and which herbal remedy they felt comfortable recommending to interested patients. Data indicated that a patient's complaint about menopausal symptoms was the most common factor leading to discussion of menopausal issues with physicians (91%) and that the primary concern to the patient was management of menopausal symptoms. Other factors were controversies about hormone replacement therapy, long-term health implications of menopause, and hormone replacement therapy. Eighty percent of the physician found confusing messages with regard to menopause to be the most challenging aspect in patient communication. The second most challenging issue is "inconclusive data about hormone replacement therapy" (56%). Seventy-six percent of the physicians found "showing sympathy" to be the most important factor for the physicians to communicate effectively with patients, whereas "being honest and open" was the most important patient attitude cited for the same purpose. When it comes to herbal therapy for menopause symptom control, only 4% of the physicians indicated that none of their patients take any remedies. Only 18% were not very comfortable in discussing or recommending herbal therapies, whereas the rest ranged from fairly comfortable to completely comfortable. This study has provided data with regard to physician understanding of menopause treatment options and their primary interaction with patients on this issue

  7. Qualitative interview study of parents' perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care

    NARCIS (Netherlands)

    Halls, Amy; Van'T Hoff, Catherine; Little, Paul; Verheij, Theo; Leydon, Geraldine M.

    2017-01-01

    Objective To explore parents' perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care. Design Qualitative semistructured interview study. Setting UK primary care. Participants 23 parents of children aged 6 months to 10 years

  8. The regulations for enforcing the law concerning prevention from radiation hazards due to radioisotopes

    International Nuclear Information System (INIS)

    1978-01-01

    These provisions are established on the basis of and to enforce the ''Law for the prevention of radiation hazards due to radioisotopes'' and the Enforcement Order for the ''Law concerning the prevention of radiation hazards due to radioisotopes''. The Regulation includes the definitions of terms, applications for the permission of the use of radioisotopes, standards on usage, obligation of measurement, persons in charge of radiation, etc. Terms are explained, such as persons engaging in radiation works, persons who enter at any time the control areas, radiation facilities, maximum permissible exposure dose, cumulative dose, maximum permissible cumulative dose, maximum permissible concentration in the air, maximum permissible concentration in water and maximum permissible surface density. The applications for permission in written forms are required for the use, sale and abandonment of radioisotopes. Radioisotopes or the apparatuses for generating radiation shall be used in the using facilities. The measurement of radiation dose rate, particle flux density and contamination due to radioisotopes shall be made with radiation-measuring instruments. At least one person shall be chosen as the chief radiation-handling person in each factory, establishment, selling office or abandoning establishment by a user, a trademan or a person engaged in abandonment of radioisotopes. The forms for the application for permission, etc. are attached. (Okada, K.)

  9. A concern about the crack propagation rate of PWSCC which obtained from the investigation on primary coolant leakage portion of the reactor vessel head in Ohi 3

    International Nuclear Information System (INIS)

    Totsuka, Nobuo; Fukumura, Takuya

    2010-01-01

    There will be some concern about the content presented in the paper entitled 'Primary Coolant Leakage Path Research of Reactor Vessel Head Penetration' published in INSS JOURNAL of 2008, which may lead to misunderstanding about the PWSCC crack propagation rate, that is, the rate written in the paper seems to be faster than those reported by the previous studies. It is considered that such misunderstanding will be due to a sentence in the abstract of the paper. Therefore, we will revise a part of the abstract and explain about the outline of the paper again. (author)

  10. Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues

    Directory of Open Access Journals (Sweden)

    Shepherd Robin

    2006-04-01

    Full Text Available Abstract Background Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues. Methods This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536 who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger. Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis. Results Approximately 3/100 (3% answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1. Increasing age reduced likelihood of gambling concerns – logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99 p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p Conclusion Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.

  11. Association between PM2.5 and primary care visits due to asthma attack in Japan: relation to Beijing's air pollution episode in January 2013.

    Science.gov (United States)

    Yamazaki, Shin; Shima, Masayuki; Yoda, Yoshiko; Oka, Katsumi; Kurosaka, Fumitake; Shimizu, Shigeta; Takahashi, Hironobu; Nakatani, Yuji; Nishikawa, Jittoku; Fujiwara, Katsuhiko; Mizumori, Yasuyuki; Mogami, Akira; Yamada, Taku; Yamamoto, Nobuharu

    2014-03-01

    In January 2013, extremely high concentrations of fine particles (PM2.5) were observed around Beijing, China. In Japan, the health effects of transboundary air pollution have been a matter of concern. We examined the association between the levels of outdoor PM2.5 and other air pollutants with primary care visits (PCVs) at night due to asthma attack in Himeji City, western Japan. A case-crossover study was conducted in a primary care clinic in Himeji City, Japan, involving 112 subjects aged 0-80 years who visited the clinic due to an asthma attack between 9 p.m. and 6 a.m. during the period January-March, 2013. Daily concentrations of particulate matter, ozone, nitrogen dioxide, and some meteorological elements were measured, and a conditional logistic regression model was used to estimate the odds ratios (OR) of PCVs per unit increment in air pollutants or meteorological elements. Of the 112 subjects, 76 (68 %) were aged asthma attack at night. A positive relation between ozone and PCVs due to asthma attack was detected. The OR per 10 ppb increment in daily mean ozone the day before the visit was 2.31 (95 % confidence interval 1.16-4.61). These findings do not support an association between daily mean concentration of PM2.5 and PCVs at night. However, we did find evidence suggesting that ozone is associated with PCVs.

  12. The state of enforcement of the Law Concerning Prevention from Radiation Hazards Due to Radioisotopes, etc

    International Nuclear Information System (INIS)

    1978-01-01

    In recent years, the uses of radioisotopes and radiation generators have advanced remarkably in Japan. The establishments utilizing them are on rapid increase in industries, medicine, research and education. Furthermore, since the types of usage are more diversified, the kinds of radioisotopes and their quantities are also increasing. In this connection, The Law Concerning Prevention from Radiation Hazards Due to Radioisotopes, etc. has been in force for about twenty years. Under the current situation in this field, importance of the administration concerning enforcement of The Law is ever rising. In the Science and Technology Agency, in view of the occurrence of accidents in certain enterprises, starting in fiscal 1974, various measures have been taken. As the state of enforcement of The Law, the following matters are presented; the establishments using, selling and disposing of radioisotopes, etc. up to fiscal 1977 (in tables); and variety of governmental measures taken by the Agency. (Mori, K.)

  13. Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient

    Directory of Open Access Journals (Sweden)

    Mohapatra S

    2009-01-01

    Full Text Available Primary cutaneous aspergillosis is a rare entity, usually caused by A. fumigatus and A. flavus . Here, we present such a case, manifested by ulceration due to A. niger, which remained undiagnosed for a prolonged period. The immunological status was intact, although the patient had associated severe fungal infection. Recurrence of the lesion occurred despite repeated anti-fungal therapies. Anti fungal testing was done based on the broth dilution (M-38A, NCCLS, USA method. The culture isolate was found to be sensitive to fluconazole and amphotericin B. Continuation of antifungal therapy improved the symptoms, reducing the size of the lesion.

  14. Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis.

    Science.gov (United States)

    Jain, Monica; Krasne, David L; Singer, Frederick R; Giuliano, Armando E

    2017-02-01

    Parathyromatosis is a rare condition consisting of multiple nodules of benign hyperfunctioning parathyroid tissue scattered throughout the neck and superior mediastinum. As a potential cause of recurrent or persistent hyperparathyroidism, parathyromatosis is a challenging condition to diagnose and treat. The optimal evaluation and management of patients with parathyromatosis is not well established. The reported case involves a patient who was initially diagnosed with primary hyperparathyroidism. The diagnosis of Type 1 parathyromatosis was made after the patient developed recurrent hyperparathyroidism with hypercalcemia and osteoporosis 17 years after the initial operation and underwent two additional operations. The majority of parathyromatosis cases are diagnosed in the setting of secondary hyperparathyroidism. Consensus regarding the preoperative diagnosis and evaluation is lacking due to the paucity of cases of this rare clinical entity. Management involves complete surgical extirpation of all identifiable rests of parathyroid tissue. Intra-operative parathyroid hormone level monitoring and frozen section examination are excellent tools that could increase the rates of initial operative success. Despite this, long-term disease remission is rare, and medical therapy, including calcimimetics and bisphosphonates, may be required for postoperative or non-operative management.

  15. Emotions in primary care: Are there cultural differences in the expression of cues and concerns?

    Science.gov (United States)

    Schouten, Barbara C; Schinkel, Sanne

    2015-11-01

    This study compared native-Dutch and Turkish-Dutch patients' expressions of emotional cues/concerns and GPs' responses to these cues/concerns. Relations between patient's cues/concerns and GPs' perceptions of the patient's health complaint were examined too. 82 audiotaped encounters with native-Dutch and 38 with Turkish-Dutch GP patients were coded using the VR-CoDES and VR-CoDES-P. Patients filled out a survey before each consultation to assess their cultural identification, Dutch language proficiency and health-related variables. GPs filled out a survey after each consultation to assess their perceptions of the patient's health complaint. Turkish-Dutch patients expressed more cues than native-Dutch patients, which was explained by higher worries about their health and worse perceived general health. GPs responded more often with space-providing responses to Turkish-Dutch patients compared to native-Dutch patients. Turkish-Dutch patients' cue expression strongly influenced GPs' perceptions about the presence of psychosocial problems. Migrant patient-related factors influence the amount of emotional cue expression in primary care. GPs perceive these cues as indicating the presence of psychosocial problems and provide space for patients to elaborate on their emotional distress. GPs should be trained in using more affective communication techniques to enhance elicitation of the underlying reasons for migrant patients' enhanced emotional cue expression. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Constraints on the perturbed mutual motion in Didymos due to impact-induced deformation of its primary after the DART impact

    Science.gov (United States)

    Hirabayashi, Masatoshi; Schwartz, Stephen R.; Yu, Yang; Davis, Alex B.; Chesley, Steven R.; Fahnestock, Eugene G.; Michel, Patrick; Richardson, Derek C.; Naidu, Shantanu P.; Scheeres, Daniel J.; Cheng, Andrew F.; Rivkin, Andrew S.; Benner, Lance A. M.

    2017-12-01

    Binary near-Earth asteroid (65803) Didymos is the target of the proposed NASA Double Asteroid Redirection Test (DART), part of the Asteroid Impact & Deflection Assessment (AIDA) mission concept. In this mission, the DART spacecraft is planned to impact the secondary body of Didymos, perturbing mutual dynamics of the system. The primary body is currently rotating at a spin period close to the spin barrier of asteroids, and materials ejected from the secondary due to the DART impact are likely to reach the primary. These conditions may cause the primary to reshape, due to landslides or internal deformation, changing the permanent gravity field. Here, we propose that if shape deformation of the primary occurs, the mutual orbit of the system would be perturbed due to a change in the gravity field. We use a numerical simulation technique based on the full two-body problem to investigate the shape effect on the mutual dynamics in Didymos after the DART impact. The results show that under constant volume, shape deformation induces strong perturbation in the mutual motion. We find that the deformation process always causes the orbital period of the system to become shorter. If surface layers with a thickness greater than ∼0.4 m on the poles of the primary move down to the equatorial region due to the DART impact, a change in the orbital period of the system and in the spin period of the primary will be detected by ground-based measurement.

  17. Multiple hepatic abscesses due to Yersinia enterocolitica infection secondary to primary haemochromatosis

    DEFF Research Database (Denmark)

    Bergmann, T K; Vinding, K; Hey, H

    2001-01-01

    A case of hepatic abscesses due to Yersinia enterocolitica in an immunocompetent male is presented. Re-examination after 3 months showed that the patient had primary haemochromatosis. Treatment with repeated phlebotomies was instituted. Two years after the patient was first admitted to hospital. 17...... showed that prior to this case only 45 cases of hepatic abscess secondary to Yersinia enterocolitica have been registered. Of the 45 reported cases, 64% had underlying haemochromatosis and 29% had diabetes mellitus. The overall mortality was 31%. Mortality before 1987 was 60% (n = 20) and since 1987...

  18. Child oral health concerns amongst parents and primary care givers in a Sure Start local programme.

    Science.gov (United States)

    Daly, B; Clarke, W; McEvoy, W; Periam, K; Zoitopoulos, L

    2010-09-01

    To conduct an oral health promotion needs assessment amongst parents and primary care givers of pre-school children in a South East London Sure Start Local Programme (SSLP). To explore the oral health concerns and oral health literacy with regard to children's oral health amongst parents and primary care givers in a South East London SSLP. A qualitative study using four in-depth focus groups with a purposive sample of 20 participants. Data were analysed using the framework method. The SSLP was identified as an important source of information, support and social interaction for participants. Participants rated the informal networks of the programme as equally authoritative as other formal sources of information. Oral health concerns included: introducing healthy eating, establishing tooth brushing, teething and access to dental care. While participants had adequate knowledge of how to prevent oral disease they cited many barriers to acting on their knowledge which included: parents' tiredness, lack of confidence in parenting skills, confusing information, widespread availability of sugary foods and drinks, and lack of local child friendly dentists. Parenting skills and the social support provided by the SSLP appeared to be integral to the introduction of positive oral health behaviours. SSLPs were seen as a trusted source of support and information for carers of pre-school children. Integration of oral health promotion into SSLPs has the potential to tap into early interventions which tackle the wider support needs of carers of pre-school children while also supporting the development of positive oral health behaviours.

  19. Hypercalcemia due to Primary Hepatic Lymphoma

    Directory of Open Access Journals (Sweden)

    Andrew Hsu

    2016-01-01

    Full Text Available A 65-year-old female with a history of mixed connective tissue disease and pulmonary fibrosis on azathioprine, hydroxychloroquine, and prednisone (osteoporosis on teriparatide presented with a 1-month history of hypercalcemia. After discontinuation of teriparatide, the patient’s hypercalcemia persisted. Further evaluation revealed primary hepatic lymphoma as the source of her hypercalcemia.

  20. Mental Health Concerns: Veterans & Active Duty

    Science.gov (United States)

    ... dialing 1-800-273-8255 and pressing 1. Mental Health Concerns There are three primary mental health concerns ... care or call 911. How Will Asking for Mental Health Treatment Affect My Career? Military personnel have always ...

  1. Risk communication concerning welding fumes for the primary preventive care of welding apprentices in southern Brazil.

    Science.gov (United States)

    Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Vaz, Joana Cezar

    2015-01-19

    This study's aim was to assess the perceptions of welding apprentices concerning welding fumes being associated with respiratory and cardiovascular disorders and assess the implementation of risk communication as a primary prevention tool in the welding training process. This quasi-experimental, non-randomized study with before-and-after design was conducted with 84 welding apprentices in Southern Brazil. Poisson Regression analysis was used. Relative Risk was the measure used with a 95% confidence interval and 5% (p ≤ 0.05) significance level. Significant association was found between perceptions of worsened symptoms of respiratory disorders caused by welding fumes and educational level (p = 0.049), the use of goggles to protect against ultraviolet rays (p = 0.023), and access to services in private health facilities without insurance coverage (p = 0.001). Apprentices younger than 25 years old were 4.9 times more likely to perceive worsened cardiovascular symptoms caused by welding fumes after risk communication (RR = 4.91; CI 95%: 1.09 to 22.2). The conclusion is that risk communication as a primary preventive measure in continuing education processes implemented among apprentices, who are future welders, was efficacious. Thus, this study confirms that risk communication can be implemented as a primary prevention tool in welding apprenticeships.

  2. Microbicide research in developing countries: have we given the ethical concerns due consideration?

    Science.gov (United States)

    Moodley, Keymanthri

    2007-09-19

    HIV prevention research has been fraught with ethical concerns since its inception. These concerns were highlighted during HIV vaccine research and have been elaborated in microbicide research. A host of unique ethical concerns pervade the microbicide research process from trial design to post-trial microbicide availability. Given the urgency of research and development in the face of the devastating HIV pandemic, these ethical concerns represent an enormous challenge for investigators, sponsors and Research Ethics Committees (RECs) both locally and internationally. Ethical concerns relating to safety in microbicide research are a major international concern. However, in the urgency to develop a medically efficacious microbicide, some of these concerns may not have been anticipated. In the risk-benefit assessment of research protocols, both medical and psycho-social risk must be considered. In this paper four main areas that have a potential for medical and/or psycho-social harm are examined. Male partner involvement is controversial in the setting of covert use of microbicides. However, given the long-term exposure of men to experimental products, this may be methodologically, ethically and legally important. Covert use of microbicides may impact negatively on relationship dynamics leading to psychosocial harm to varying extents. The unexpectedly high rates of pregnancy during clinical trials raise important methodological and ethical concerns. Enrollment of adolescents without parental consent generates ethical and legal concerns that must be carefully considered by RECs and trial sites. Finally, paradoxical outcomes in recent trials internationally have advanced the debate on the nature of informed consent and responsibility of researchers to participants who become HIV positive during or after trials. Phase 3 microbicide trials are an undisputed research and ethical priority in developing countries. However, such trials must be conducted with attention to both

  3. Association of ambient air pollution and meteorological factors with primary care visits at night due to asthma attack.

    Science.gov (United States)

    Yamazaki, Shin; Shima, Masayuki; Yoda, Yoshiko; Oka, Katsumi; Kurosaka, Fumitake; Shimizu, Shigeta; Takahashi, Hironobu; Nakatani, Yuji; Nishikawa, Jittoku; Fujiwara, Katsuhiko; Mizumori, Yasuyuki; Mogami, Akira; Yamada, Taku; Yamamoto, Nobuharu

    2013-09-01

    The association of outdoor air pollution and meteorological elements with primary care visits at night due to asthma attack was studied. A case-crossover study was conducted in a primary care clinic in Himeji City, Japan. The subjects were 956 children aged 0-14 years who visited the clinic with an asthma attack between the hours of 9 p.m. and 6 a.m. Daily concentrations of particulate matter, ozone, nitrogen dioxide, and a number of meteorological elements were measured, and a conditional logistic regression model was used to estimate odds ratios (ORs) of primary care visits per unit increment of air pollutants or meteorological elements. The analyses took into consideration the effects of seasonality. Of the 956 children, 73 (7.6 %) were aged asthma attack at night in the spring or summer was found. An inverse relation between suspended particulate matter and primary care visits due to asthma attack was detected in the winter. ORs in the summer per degree increment in daily mean temperature was 1.31 [95 % confidential interval (CI) 1.09-1.56], and ORs in the autumn per hourly increment in daily hours of sunshine was 0.94 (95 % CI 0.90-0.99). The findings of our study fail to support any association between daily mean concentration of air pollutant and primary care visits at night. However, we did find evidence indicating that certain meteorological elements may be associated with primary care visits.

  4. Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization.

    Science.gov (United States)

    Wang, George Sam

    2017-03-01

    An "unintended consequence" of marijuana legalization is the impact on the pediatric population. From prenatal exposure to unintentional childhood exposures, through concerns of adolescence abuse and marijuana use for medicinal indications in children, marijuana exposure can affect pediatric patients at every stage in childhood. Regardless of the stage or reason of exposure, concerns exist about short-term and long-term consequences in a child's physical and mental health. The use of cannabidiol (CBD) may have some benefit for the treatment of epilepsy, but emphasis needs to be on rigorous clinical trials to evaluate efficacy and safety. As more states allow both medical and recreational marijuana, availability and prevalence of use will likely increase and more surveillance and research is needed to evaluate the consequences on the pediatric population.

  5. ATYPICAL PRIMARY HYPERPARATHYROIDISM DUE TO HYPOVITAMINOSIS D.

    Science.gov (United States)

    Gaţu, Alina-Andreea; Velicescu, C; Novac, Roxana; Mogoş, Voichiţa; Brănişteanu, D D

    2015-01-01

    Vitamin D deficiency is nowadays very common in the general population and also in patients with primary hyperparathyroidism. Hypovitaminosis D may modify the clinical features and the severity of primary hyperparathyroidism. We present the case of a 75-year-old woman with a 10 year history of nephrolithiasis and severe osteoporosis, with multiple fragility fractures. Her bone and kidney status required a more thorough metabolic assessment. Despite minimal changes in serum calcium and phosphate levels, parathyroid hormone (PTH) level was markedly elevated. Ultrasound and specific Sesta-MIBI scintigraphy diagnosed and localized a left parathyroid adenoma. Vitamin D assessment showed levels in the range of hypovitaminosis. Vitamin D deficiency may mask hypercalcemia despite high serum PTH levels, and does not seem to diminish but on the contrary increases the risk of kidney lithiasis, as well as the deleterious effects of hyperparathyroidism on bone.

  6. Primary oculomotor nerve palsy due to mild head injury. Report of two cases

    International Nuclear Information System (INIS)

    Katsuno, Makoto; Kobayashi, Shiro; Yokota, Hiroyuki; Teramoto, Akira

    2008-01-01

    Two patients with primary oculomotor nerve palsy due to direct mild head injury are reported. They presented with internal ophthalmoplegia, dilated nonreactive pupils, and very mild disturbance in consciousness. Except for the persistent oculomotor nerve palsy, both the patients recovered fully within one week. Neither demonstrated a history that was suggestive of a cause for their oculomotor nerve palsy. Initial CT scans demonstrated localized subarachnoid hemorrhage around the brain stem. One of the patients had sustained a fracture of the anterior clinoid process. As the underlying pathophysiologic mechanism underlying the oculomotor nerve palsy we suspected mild injury to the pupillomotor fibers at the anterior petroclinoidal ligament and that of the pupillary fibers at the posterior petroclinoidal ligament. We speculate that these perforating fibers at the anterior petroclinoidal ligament acted as a fulcrum due to downward displacement of the brainstem at the time of impact. (author)

  7. Qualitative interview study of parents' perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care.

    Science.gov (United States)

    Halls, Amy; Van't Hoff, Catherine; Little, Paul; Verheij, Theo; Leydon, Geraldine M

    2017-09-15

    To explore parents' perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care. Qualitative semistructured interview study. UK primary care. 23 parents of children aged 6 months to 10 years presenting with LRTI in primary care. Thematic analysis of semistructured interviews (either in person or by telephone) conducted with parents to explore their experiences and views on their children being prescribed antibiotics for LRTI. Four major themes were identified and these are perspectives on: (1) infection, (2) antibiotic use, (3) the general practitioner (GP) appointment and (4) decision making around prescribing. Symptomatic relief was a key concern: the most troublesome symptoms were cough, breathing difficulty, fever and malaise. Many parents were reluctant to use self-care medication, tended to support antibiotic use and believed they are effective for symptoms, illness duration and for preventing complications. However, parental expectations varied from a desire for reassurance and advice to an explicit preference for an antibiotic prescription. These preferences were shaped by: (1) the age of the child, with younger children perceived as more vulnerable because of their greater difficulty in communicating, and concerns about rapid deterioration; (2) the perceived severity of the illness; and (3) disruption to daily routine. When there was disagreement with the GP, parents described feeling dismissed, and they were critical of inconsistent prescribing when they reconsult. When agreement between the parent and the doctor featured, parents described a feeling of relief and legitimation for consulting, feeling reassured that the illness did indeed warrant a doctor's attention. Symptomatic relief is a major concern for parents. Careful exploration of expectations, and eliciting worries about key symptoms and impact on daily life will be needed to help parents understand when a no antibiotic

  8. Mandibular unilateral fusion in primary dentition

    Directory of Open Access Journals (Sweden)

    Neena Eregowda

    2017-01-01

    Full Text Available Fusion is a developmental anomaly which occurs due to a union of one or more adjacent teeth during morphodifferentiation of the dental germs. The prevalence of tooth fusion is estimated at 0.5%–2.5% in the primary dentition. These anomalies may be unilateral or bilateral and may affect either dentition although the deciduous teeth are more commonly affected. Early diagnosis of such condition is important because it may cause clinical problems, such as esthetic concerns, and caries. This report describes a case of unilateral fusion of the primary mandibular lateral incisor and canine and aims to evaluate any associated pathology.

  9. Investigation of the present management status of calibration source based on the law concerning prevention of radiation hazards due to radioisotopes

    International Nuclear Information System (INIS)

    Takahashi, Yasuyuki; Igarashi, Hiroshi; Hirano, Kunihiro; Kawaharada, Yasuhiro; Igarashi, Hitoshi; Murase, Ken-ya; Mochizuki, Teruhito

    2007-01-01

    An amendment concerning the enforcement of the law on the prevention of radiation hazards due to radioisotopes, etc., and the medical service law enforcement regulations were promulgated on June 1, 2005. This amendment concerned international basic safety standards and the sealing of radiation sources. Sealed radiation sources ≤3.7 MBq, which had been excluded from regulation, were newly included as an object of regulation. Investigation of the single photon emission computed tomography (SPECT) system instituted in hospitals indicated that almost all institutions adhere to the new amendment, and the calibration source, the checking source, etc., corresponding to this amendment were maintained appropriately. Any institutions planning to return sealed radioisotopes should refer to this report. (author)

  10. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Abdominal and Interventional Imaging, Paris (France); Morel, Olivier [Hopital Lariboisiere-APHP-GHU Nord et Universite Diderot-Paris 7, Department of Obstetrics, Paris (France)

    2009-09-15

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  11. Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland; Morel, Olivier

    2009-01-01

    The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE). Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps were treated with TAE. TAE was indicated because of intractable bleeding that could not be controlled with uterotonic drugs, blood transfusion, attempted suturing and packing in all patients. Postdelivery perineal examination showed cervical or vaginal tears in all women and associated paravaginal hematoma in four. Angiography revealed extravasation of contrast material in six patients. TAE performed with gelatin sponge allowed to control the bleeding in all patients. Cervical and vaginal suturing was made possible and successfully achieved in the six women who had failed suturing attempts before TAE. Paravaginal hematoma was successfully evacuated in four patients in whom it was present after TAE. No complications related to TAE were noted. We conclude that in women with severe primary postpartum hemorrhage due to genital tract laceration after operative delivery with forceps, TAE is effective and safe for stopping the bleeding and helps genital tract suturing and evacuation of hematoma. (orig.)

  12. Comparison between Primary Teacher Educators' and Primary School Teachers' Beliefs of Primary Geography Education Quality

    Science.gov (United States)

    Bent, Gert Jan; Bakx, Anouke; den Brok, Perry

    2016-01-01

    In this study teacher educators' beliefs concerning primary geography education have been investigated and compared with primary school teachers' beliefs. In this study 45 teacher educators and 489 primary school teachers completed a questionnaire, and nine teacher educators have been interviewed as well. It has been found that teacher educators…

  13. Micropapillary Lung Cancer with Breast Metastasis Simulating Primary Breast Cancer due to Architectural Distortion on Images

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Kyung Ran; Hong, Eun Kyung; Lee, See Yeon [Center for Breast Cancer, National Cancer Center, Goyang (Korea, Republic of); Ro, Jae Yoon [The Methodist Hospital, Weill Medical College of Cornell University, Houston (United States)

    2012-03-15

    A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.

  14. The law concerning prevention from radiation hazards due to radioisotopes

    International Nuclear Information System (INIS)

    1984-01-01

    The law regulates uses, sales and disposal of radioisotopes, uses of radiation generating apparatuses, disposal of materials contaminated with radioisotopes, and so on, in accordance with the Atomic Energy Fundamental Act, for public safety. Covered are the following: permission for and notification of the uses and permission for businesses selling and disposing of radioisotopes, and approval of designs concerning radiation hazard prevention mechanisms, obligations of the users and business enterprises selling and disposing of radioisotopes, the licensed engineers of radiation, organs, etc. for confirmation of the mechanisms, punitive provisions, and so on. (Mori, K.)

  15. Panhypopituitarism with empty sella a sequel of pituitary hyperplasia due to chronic primary hypothyroidism.

    Science.gov (United States)

    Dutta, Deep; Maisnam, Indira; Ghosh, Sujoy; Mukhopadhyay, Pradip; Mukhopadhyay, Satinath; Chowdhury, Subhankar

    2012-12-01

    Asymptomatic reversible pituitary hyperplasia is common in patients with untreated primary hypothyroidism. Occurrence of empty sella (ES) in this scenario is extremely rare (only three reports till the date) and panhypopituitarism has not been reported in such patients. We report a 27 year man with severe short stature (height-133 cm; standard deviation score-7.36) and delayed puberty who had symptoms suggestive of hypothyroidism along with chronic persistent headache since 6 years of age. Pituitary imaging done for headache at 11 years age showed pituitary hyperplasia. He was diagnosed of primary hypothyroidism for the 1(st) time at 21 year age, a diagnosis which was likely missed for 15 years. Levothyroxine therapy leads to resolution of all symptoms and a height gain of 28 cm over last 6 years. Evaluation for lack of progression of puberty along with chronic nausea, vomiting, fatigue and weight loss for the last 1 year revealed secondary hypocortisolism (9 am cortisol-4.8 mcg/dl; ACTH-3.2 pg/ml), growth hormone deficiency (IGF-1: 65 ng/ml; normal: 117-325 ng/ml) and hypogonadotrophic hypogonadism (9 am testosterone: 98 ng/dl; [280-1500] LH-0.01 mIU/L [1.14-5.75]) with ES on magnetic resonance imaging (MRI) brain. Uncontrolled thyrotroph hyperplasia due to chronic untreated primary hypothyroidism for 15 years may have been damaging the adjacent corticotrophs, somatotrophs and gonadotrophs resulting in panhypopituitarism and empty sella. This is perhaps the first report of panhypopituitarism with empty sella syndrome developing in a patient with pituitary hyperplasia, a sequel of chronic untreated primary hypothyroidism.

  16. Panhypopituitarism with empty sella a sequel of pituitary hyperplasia due to chronic primary hypothyroidism

    Directory of Open Access Journals (Sweden)

    Deep Dutta

    2012-01-01

    Full Text Available Asymptomatic reversible pituitary hyperplasia is common in patients with untreated primary hypothyroidism. Occurrence of empty sella (ES in this scenario is extremely rare (only three reports till the date and panhypopituitarism has not been reported in such patients. We report a 27 year man with severe short stature (height-133 cm; standard deviation score-7.36 and delayed puberty who had symptoms suggestive of hypothyroidism along with chronic persistent headache since 6 years of age. Pituitary imaging done for headache at 11 years age showed pituitary hyperplasia. He was diagnosed of primary hypothyroidism for the 1 st time at 21 year age, a diagnosis which was likely missed for 15 years. Levothyroxine therapy leads to resolution of all symptoms and a height gain of 28 cm over last 6 years. Evaluation for lack of progression of puberty along with chronic nausea, vomiting, fatigue and weight loss for the last 1 year revealed secondary hypocortisolism (9 am cortisol-4.8 mcg/dl; ACTH-3.2 pg/ml, growth hormone deficiency (IGF-1: 65 ng/ml; normal: 117-325 ng/ml and hypogonadotrophic hypogonadism (9 am testosterone: 98 ng/dl; [280-1500] LH-0.01 mIU/L [1.14-5.75] with ES on magnetic resonance imaging (MRI brain. Uncontrolled thyrotroph hyperplasia due to chronic untreated primary hypothyroidism for 15 years may have been damaging the adjacent corticotrophs, somatotrophs and gonadotrophs resulting in panhypopituitarism and empty sella. This is perhaps the first report of panhypopituitarism with empty sella syndrome developing in a patient with pituitary hyperplasia, a sequel of chronic untreated primary hypothyroidism.

  17. Transjugular intrahepatic porto-systemic stent-shunt for therapy of bleeding esophageal varices due to extramedullary hematopoiesis in primary myelofibrosis: a case report.

    Science.gov (United States)

    Phillip, Veit; Berger, Hermann; Straub, Melanie; Saugel, Bernd; Treiber, Matthias; Einwächter, Henrik; Schmid, Roland M; Huber, Wolfgang

    2012-01-01

    Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Therapy of variceal bleeding by TIPS insertion was successful. During a 29-month follow-up, no hepatic failure, hepatic encephalopathy, or further variceal bleeding episode occurred. TIPS placement is a well-established procedure for the treatment of complications due to portal hypertension mainly due to liver cirrhosis. This report illustrates that TIPS placement can also be a promising treatment option in patients with primary myelofibrosis and portal hypertension due to extramedullary hematopoiesis. Copyright © 2012 S. Karger AG, Basel.

  18. NARCISSISM AND CONCERN: THE RELATIONSHIP OF SELF-OBJECT NEEDS AND NARCISSISTIC SYMPTOMS WITH HEALTHY AND PATHOLOGICAL CONCERN.

    Science.gov (United States)

    Friedemann, Yael; Tolmacz, Rami; Doron, Yonit

    2016-03-01

    While concern and narcissism seem to be contradictory in nature, clinical evidence and theoretical writings on pathological forms of concern--tracing their origin to deficiencies in early relationships with primary caretakers--suggest that the actual relationship between these two characteristics might be much more complicated. We respond to a study aimed to add empirical data to the clinical and theoretical knowledge examined the relationships between self-object functions, types of narcissism and pathological concern. The findings of the study showed that pathological concern was positively associated with self-object needs and that this association was mediated by covert narcissism. Our discussion focuses on the developmental and psychodynamic sources of pathological concern, as well as its significance in the intrapersonal and interpersonal domains.

  19. Weaning Time in Preterm Infants: An Audit of Italian Primary Care Paediatricians.

    Science.gov (United States)

    Baldassarre, Maria Elisabetta; Di Mauro, Antonio; Pedico, Annarita; Rizzo, Valentina; Capozza, Manuela; Meneghin, Fabio; Lista, Gianluca; Laforgia, Nicola

    2018-05-15

    According to the 2016 Italian National Institute of Statistics (Istat) data in Italy, about 6.7% of all newborns are born prematurely. Due to the lack of data on current complementary feeding in preterm infants in Italy, the aim of the survey was to evaluate individual attitudes of primary care paediatricians, concerning the introduction of complementary foods in preterm infants. An internet-based survey was conducted among primary care paediatricians, working in Italy, regarding (1) timing of the introduction of complementary foods to preterm newborns; (2) type of complementary foods introduced; (3) vitamin D and iron supplementations. A total of 347 primary care Italian paediatricians answered the questionnaire; 44% of responders based the timing of the introduction of solid food exclusively on an infant's age, 18% on an infant's neurodevelopmental status and 4% on the body weight; the remaining 34% based the timing on two or more of these aspects. The type of complementary foods did not comply with an evidence-based sequence; 98% of participants promoted vitamin D supplementation and 89% promoted iron supplementation with great diversity in timing and doses. Due to limited evidence, there is a great heterogeneity in the attitudes of primary care paediatricians concerning the introduction of complementary foods to preterm newborns. Further research is needed to provide evidence-based guidelines regarding weaning preterm newborns.

  20. The regulations for enforcing the law concerning prevention from radiation hazards due to radioisotopes

    International Nuclear Information System (INIS)

    1979-01-01

    The regulations are wholly revised under the law concerning prevention from radiation hazards due to radioisotopes and the provisions of the order for enforcing the law. Basic concepts and terms are defined, such as: employee engaged in radiation work; person regularly entering into the controlled area; the maximum permissible exposure dose; accumulative dose; the maximum permissible accumulative dose; the maximum permissible concentration in the air; the maximum permissible concentration under water; the maximum permissible surface density. The application for permission of the uses shall be made according to the form attached and include as appendix following documents: copy of register of the applicant legal person; plane drawings of the works or the enterprise and their surroundings in reduced scales and with directions, centering on facilities in use, of storage and disposal, etc. The report of the uses shall list name and address of the user, object and method of the uses, and include as annex copy of register of the user legal person and papers explaining the expected date of beginning and the period of the uses, etc. Standards of the uses, refilling, storage, transport and disposal are in detail stipulated. Specified measures shall be taken for measurement, prevention of radiation hazards, finding out of persons injured by radiation and others. (Okada, K.)

  1. Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial.

    Science.gov (United States)

    Livaudais-Toman, Jennifer; Karliner, Leah S; Tice, Jeffrey A; Kerlikowske, Karla; Gregorich, Steven; Pérez-Stable, Eliseo J; Pasick, Rena J; Chen, Alice; Quinn, Jessica; Kaplan, Celia P

    2015-12-01

    To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. From June 2011-August 2012, we enrolled women from two clinics, aged 40-74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1-2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19-2.23). A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. ClinicalTrials.gov identifier NCT01830933. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: A randomized, controlled trial

    Science.gov (United States)

    Livaudais-Toman, Jennifer; Karliner, Leah S.; Tice, Jeffrey A.; Kerlikowske, Karla; Gregorich, Steven; Pérez-Stable, Eliseo J.; Pasick, Rena J.; Chen, Alice; Quinn, Jessica; Kaplan, Celia P.

    2015-01-01

    Purpose To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. Methods From June 2011–August 2012, we enrolled women from two clinics, aged 40–74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1–2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. Results 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19–2.23). Conclusions A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. Trial Registration ClinicalTrials.gov identifier NCT01830933. PMID:26476466

  3. Generalized peritonitis due to perforated diverticulitis: Hartmann's procedure or primary anastomosis?

    Science.gov (United States)

    Trenti, Loris; Biondo, Sebastiano; Golda, Thomas; Monica, Millan; Kreisler, Esther; Fraccalvieri, Domenico; Frago, Ricardo; Jaurrieta, Eduardo

    2011-03-01

    Hartmann's procedure (HP) still remains the most frequently performed procedure for diffuse peritonitis due to perforated diverticulitis. The aims of this study were to assess the feasibility and safety of resection with primary anastomosis (RPA) in patients with purulent or fecal diverticular peritonitis and review morbidity and mortality after single stage procedure and Hartmann in our experience. From January 1995 through December 2008, patients operated for generalized diverticular peritonitis were studied. Patients were classified into two main groups: RPA and HP. A total of 87 patients underwent emergency surgery for diverticulitis complicated with purulent or diffuse fecal peritonitis. Sixty (69%) had undergone HP while RPA was performed in 27 patients (31%). At the multivariate analysis, RPA was associated with less post-operative complications (P clinical anastomotic leakage and needed re-operation. RPA can be safely performed without adding morbidity and mortality in cases of diffuse diverticular peritonitis. HP should be reserved only for hemodynamically unstable or high-risk patients. Specialization in colorectal surgery improves mortality and raises the percentage of one-stage procedures.

  4. Salivary gland hypofunction in tyrosylprotein sulfotransferase-2 knockout mice is due to primary hypothyroidism.

    Science.gov (United States)

    Westmuckett, Andrew D; Siefert, Joseph C; Tesiram, Yasvir A; Pinson, David M; Moore, Kevin L

    2013-01-01

    Protein-tyrosine sulfation is a post-translational modification of an unknown number of secreted and membrane proteins mediated by two known Golgi tyrosylprotein sulfotransferases (TPST-1 and TPST-2). We reported that Tpst2-/- mice have mild-moderate primary hypothyroidism, whereas Tpst1-/- mice are euthyroid. While using magnetic resonance imaging (MRI) to look at the thyroid gland we noticed that the salivary glands in Tpst2-/- mice appeared smaller than in wild type mice. This prompted a detailed analysis to compare salivary gland structure and function in wild type, Tpst1-/-, and Tpst2 -/- mice. Quantitative MRI imaging documented that salivary glands in Tpst2-/- females were (≈) 30% smaller than wild type or Tpst1-/- mice and that the granular convoluted tubules in Tpst2-/- submandibular glands were less prominent and were almost completely devoid of exocrine secretory granules compared to glands from wild type or Tpst1-/- mice. In addition, pilocarpine-induced salivary flow and salivary α-amylase activity in Tpst2-/- mice of both sexes was substantially lower than in wild type and Tpst1-/- mice. Anti-sulfotyrosine Western blots of salivary gland extracts and saliva showed no differences between wild type, Tpst1-/-, and Tpst2-/- mice, suggesting that the salivary gland hypofunction is due to factor(s) extrinsic to the salivary glands. Finally, we found that all indicators of hypothyroidism (serum T4, body weight) and salivary gland hypofunction (salivary flow, salivary α-amylase activity, histological changes) were restored to normal or near normal by thyroid hormone supplementation. Our findings conclusively demonstrate that low body weight and salivary gland hypofunction in Tpst2-/- mice is due solely to primary hypothyroidism.

  5. Salivary gland hypofunction in tyrosylprotein sulfotransferase-2 knockout mice is due to primary hypothyroidism.

    Directory of Open Access Journals (Sweden)

    Andrew D Westmuckett

    Full Text Available Protein-tyrosine sulfation is a post-translational modification of an unknown number of secreted and membrane proteins mediated by two known Golgi tyrosylprotein sulfotransferases (TPST-1 and TPST-2. We reported that Tpst2-/- mice have mild-moderate primary hypothyroidism, whereas Tpst1-/- mice are euthyroid. While using magnetic resonance imaging (MRI to look at the thyroid gland we noticed that the salivary glands in Tpst2-/- mice appeared smaller than in wild type mice. This prompted a detailed analysis to compare salivary gland structure and function in wild type, Tpst1-/-, and Tpst2 -/- mice.Quantitative MRI imaging documented that salivary glands in Tpst2-/- females were (≈ 30% smaller than wild type or Tpst1-/- mice and that the granular convoluted tubules in Tpst2-/- submandibular glands were less prominent and were almost completely devoid of exocrine secretory granules compared to glands from wild type or Tpst1-/- mice. In addition, pilocarpine-induced salivary flow and salivary α-amylase activity in Tpst2-/- mice of both sexes was substantially lower than in wild type and Tpst1-/- mice. Anti-sulfotyrosine Western blots of salivary gland extracts and saliva showed no differences between wild type, Tpst1-/-, and Tpst2-/- mice, suggesting that the salivary gland hypofunction is due to factor(s extrinsic to the salivary glands. Finally, we found that all indicators of hypothyroidism (serum T4, body weight and salivary gland hypofunction (salivary flow, salivary α-amylase activity, histological changes were restored to normal or near normal by thyroid hormone supplementation.Our findings conclusively demonstrate that low body weight and salivary gland hypofunction in Tpst2-/- mice is due solely to primary hypothyroidism.

  6. Public concerns and alternative nuclear power systems

    International Nuclear Information System (INIS)

    Mayo, L.H.

    1980-02-01

    The basic task undertaken in this study was to assess the relative public acceptability of three general types of nuclear power systems as alternatives to the existing Light Water Reactor (LWR) system. Concerns registered toward nuclear power constituted the basic data for this assessment. The primary measure adopted for determining the significance of concerns was the degree of difficulty posed by the concern to the nuclear power decisional structure in the establishment and maintenance of norms to control risks or to advance intended energy objectives. Alleviations or exacerbations of concern resulting from particular attributes of alternative systems were measured from an LWR baseline

  7. Anti-MOG antibody-positive ADEM following infectious mononucleosis due to a primary EBV infection: a case report.

    Science.gov (United States)

    Nakamura, Yoshitsugu; Nakajima, Hideto; Tani, Hiroki; Hosokawa, Takafumi; Ishida, Shimon; Kimura, Fumiharu; Kaneko, Kimihiko; Takahashi, Toshiyuki; Nakashima, Ichiro

    2017-04-19

    Anti-Myelin oligodendrocyte glycoprotein (MOG) antibodies are detected in various demyelinating diseases, such as pediatric acute disseminated encephalomyelitis (ADEM), recurrent optic neuritis, and aquaporin-4 antibody-seronegative neuromyelitis optica spectrum disorder. We present a patient who developed anti-MOG antibody-positive ADEM following infectious mononucleosis (IM) due to Epstein-Barr virus (EBV) infection. A 36-year-old healthy man developed paresthesia of bilateral lower extremities and urinary retention 8 days after the onset of IM due to primary EBV infection. The MRI revealed the lesions in the cervical spinal cord, the conus medullaris, and the internal capsule. An examination of the cerebrospinal fluid revealed pleocytosis. Cell-based immunoassays revealed positivity for anti-MOG antibody with a titer of 1:1024 and negativity for anti-aquaporin-4 antibody. His symptoms quickly improved after steroid pulse therapy followed by oral betamethasone. Anti-MOG antibody titer at the 6-month follow-up was negative. This case suggests that primary EBV infection would trigger anti-MOG antibody-positive ADEM. Adult ADEM patients can be positive for anti-MOG antibody, the titers of which correlate well with the neurological symptoms.

  8. A study of work changes due to cancer in tumor-free primary-treated cancer patients. A NOCWO study.

    Science.gov (United States)

    Gudbergsson, Saevar Berg; Fosså, Sophie D; Dahl, Alv A

    2008-10-01

    The goal of this study is to explore the characteristics of tumor-free cancer survivors (CSs) who after their primary treatment were still working but made work changes due to cancer and compare them to survivors who did not. The sample consisted of 431 CSs (219 females with breast cancer, 212 males with testicular (N = 150) or prostate cancer (N = 62)) diagnosed 2-6 years prior to the study. All CSs had good prognosis and had returned to work after primary treatment. All CSs filled in a mailed questionnaire covering demography, morbidity, life style, mental distress, fatigue, quality of life and job strain. Seventy-two CSs (17%) had made work changes due to cancer during the observation period, and 359 (83%) had not. Among CSs who made work changes, significantly more were females; they showed significantly poorer physical and mental work ability, worked fewer hours per week, reported more comorbidity, and had lower physical and mental quality of life and more neuroticism, compared to the nonchange group. Work changes were moderately correlated with current work ability. The majority of CSs did not report any work changes due to cancer during the 2-6-year observation period, which is an encouraging finding. A minority had done work changes, and this group consisted mainly of women and was also characterized by poorer physical and mental quality of life and poorer mental work ability due to cancer. The issue of work changes and work ability should be considered in the follow-up of cancer survivors.

  9. The order for enforcing the law concerning prevention from radiation hazards due to radioisotopes

    International Nuclear Information System (INIS)

    1977-01-01

    The radioactive isotopes stipulated in Item 2, Article 2 of the Law Concerning Prevention from Radiation Hazards due to Radisotopes (hereinafter referred to as the Law) are the isotopes emitting radiation, their compounds, and those containing these isotopes or compounds. The radiation-generating apparatuses in Item 3, Article 2 of the Law are cyclotron, synchrotron, synchrocyclotron, linear accelerator, betatron, Van de Graaff accelerator, Cockcroft Walton accelerator, the apparatuses generating radiation by accelerating charged particles, which are designated by the Director of the Science and Technology Agency as necessary for preventing radiation injuries. Those who want to use, sell or dispose of radioactive isotopes should file applications for approval or notices with required documents. The approval should be obtained for each factory or place of business. The amount of completely sealed radioactive isotopes specified by the cabinet order stipulated in Item 1, Article 3-2 of the Law is 100 m curie per factory or place of business. Those who are going to change the approved items of the use, sale or disposal of radioactive isotopes should file applications. The amount of radioactive isotopes specified by the cabinet order stipulated in Item 5, Article 10 of the Law is 10 curies. Controlled areas, facilities for using, refilling, and storing isotopes, refilling and disposing wastes should meet the stipulated standards. (Rikitake, Y.)

  10. 30 CFR 250.302 - Definitions concerning air quality.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Definitions concerning air quality. 250.302... Definitions concerning air quality. For purposes of §§ 250.303 and 250.304 of this part: Air pollutant means..., pursuant to section 109 of the Clean Air Act, national primary or secondary ambient air quality standards...

  11. Sexual concerns among kidney transplant recipients.

    Science.gov (United States)

    Muehrer, Rebecca J; Lanuza, Dorothy M; Brown, Roger L; Djamali, Arjang

    2014-11-01

    Little is known about the specific sexual concerns of kidney transplant (KTx) recipients. The primary objectives of this study were to: (i) describe the importance of sexuality to KTx recipients; (ii) investigate the sexual concerns of KTx recipients; and (iii) examine the relationship between sexual concerns and quality of life (QOL). A secondary objective was to examine potential sexual concern differences by gender, pre-transplant dialysis status, and donor type. This study employed a cross-sectional, descriptive, correlational design. Sexual concerns were identified using the Sexual Concerns Questionnaire, which contains seven subscales. QOL was measured with the SF-8 and the QOL Uniscale. Nearly 73% of subjects rated sexuality as important. Subscales indicating highest area of sexual concerns were communication with healthcare providers about sexuality (Mean (M) = 2.70) and sexual pleasure concerns (M = 2.45). Higher concern ratings regarding health consequences of sexual activity, quality of sexual relationship, sexual pleasure, sexual functioning problems, and pessimistic beliefs about treatment were significantly, inversely related to QOL. Women had significantly higher scores on the Sexual Pleasure and Communication with Healthcare Providers subscales than men. This study reports the sexual concerns of KTx recipients' who are an average of four yr since surgery, and the relationship of these concerns to QOL. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Understanding community traits - understanding public concerns

    International Nuclear Information System (INIS)

    Wlodarczyk, T.

    2003-01-01

    No two communities are alike. Therefore, one should not expect that public concerns and socio-economic effects of a proposed undertaking would be the same everywhere. Public concerns and the potential for social and economic effects of nuclear waste management facilities in one community will be different from those in another because communities differ in their fundamental sociological and economic traits. Research and experience with various types of nuclear and hazardous waste management facilities, generating stations and other energy developments across Canada and the United States indicate that an analysis of only a few key community traits can yield a more thorough understanding of the ways in which a community might perceive and respond to a project, the kinds of concerns that might dominate the public agenda, and the types of socio-economic effects that will be of primary concern. (author)

  13. Modifying effect of age on the association between ambient ozone and nighttime primary care visits due to asthma attack.

    Science.gov (United States)

    Yamazaki, Shin; Shima, Masayuki; Ando, Michiko; Nitta, Hiroshi

    2009-01-01

    We examined the association between short-term exposure to outdoor air pollution and nighttime primary care visits due to asthma attack. We also investigated the modifying effects of age on this association. A case-crossover study was conducted at a primary care clinic in metropolitan Tokyo. The subjects were 308 children aged 0-14 years and 95 adolescents and adults aged 15-64 years. All subjects made visits to the clinic for an asthma attack at between 7 PM and 12 AM. Data on hourly concentrations of particulate matter with a 50% cut-off aerodynamic diameter asthma attack in warmer months; the association was greater among preschool children.

  14. Parental concerns and control in feeding of 9 to 12-year-old children in a primary school in Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Noor, Azimah M; Leelavathi, M; Shamsul, Azhar S; Hizlinda, T; Khairani, O; Fatimah, A

    2012-04-01

    Body weight of children is affected by many factors including food habits which are influenced by their parents. Studies in the West have shown that parents tend to control child feeding in response to their child's weight status. The aim of this study was to assess Malaysian parental concerns about child weight and the control they exert on child feeding. This cross-sectional study was conducted on parents and their children aged 9 to 12 years from a primary school in Kuala Lumpur. The weight status of the children was classified according to the body mass index-for-age growth chart. Parental concerns about child weight and control in child feeding was assessed using the adapted Malay version of Child Feeding Questionnaire. A total of 204 parents participated in this study. The study found that being a female served as a protective factor against becoming overweight (OR: 0.28, CI: 0.13-0.62). Parents with overweight children were significantly older (OR: 1.08, CI: 1.01-1.15), concerned about their child's weight (OR: 2.77, CI: 1.49-5.12) and controlled their child's feeding by restricting food intake (OR: 2.70, CI: 1.30-5.60). They were less likely to pressure their children to eat (OR: 0.32, CI: 0.19-0.56). Parents from the low income group were more likely to have underweight children (OR: 4.15, CI: 1.28-13.47). There was significant difference in level of parental concern across differing child weight status. Parents with overweight children were likely to be more concerned about their child's weight, tending to control their feeding. In contrast, parents with underweight children did not exert control on their feeding.

  15. Emotions in primary care: are there cultural differences in the expression of cues and concerns?

    NARCIS (Netherlands)

    Schouten, B.C.; Schinkel, S.

    2015-01-01

    OBJECTIVE: This study compared native-Dutch and Turkish-Dutch patients' expressions of emotional cues/concerns and GPs' responses to these cues/concerns. Relations between patient's cues/concerns and GPs' perceptions of the patient's health complaint were examined too. METHODS: 82 audiotaped

  16. Acute abdomen due to primary omental torsion: case report.

    Science.gov (United States)

    Tsironis, Apostolos; Zikos, Nikolaos; Bali, Christina; Pappas-Gogos, George; Koulas, Spiridon; Katsamakis, Nikolaos

    2013-01-01

    Primary torsion of the greater omentum is an uncommon cause of acute abdominal pain that mainly affects adults in their fourth or fifth decade. It was first described by Eitel in 1899. Since then, more than 300 cases have been reported in the published literature. Clinical presentation and imaging findings are often of limited value in the diagnosis of primary omental torsion (POT). The patients usually undergo laparotomy for "acute appendicitis" or acute abdomen of poorly defined origin. To provide a detailed description of this rare cause of acute abdomen. We report a case of POT in a woman of reproductive age and discuss contemporary methods in diagnosis and management of the condition. Nowadays, laparoscopy is a safe and effective approach for the diagnosis and management of POT, with the advantages of reduced postoperative pain and hospital stay. Conservative management has also been advocated by some authors in selected patients with a preoperative diagnosis of POT based on computed tomography findings. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Graves' disease associated with infectious mononucleosis due to primary Epstein-Barr virus infection: report of 3 cases.

    Science.gov (United States)

    Akahori, Hiroshi; Takeshita, Yumie; Saito, Reina; Kaneko, Shuichi; Takamura, Toshinari

    2010-01-01

    Although the etiology of Graves' disease is still not clear, it is generally suggested that environmental factors such as infections contribute to the development of Graves' disease. We report here three cases of Graves' disease which presented simultaneously with infectious mononucleosis due to primary EBV infection. Acute EBV infection might play an important role in the onset of Graves' disease. These three women complained of a sore throat or neck pain, resembling subacute thyroiditis. In the case of thyrotoxicosis accompanied by sore throat or neck pain, Graves' disease must be distinguished from subacute thyroiditis.

  18. Special nutritional concerns for the female athlete.

    Science.gov (United States)

    Gabel, Kathe A

    2006-06-01

    Inadequate dietary intake is the primary nutritional concern of today's female athlete. As these athletes fail to consume enough energy to support the physical demands of training, they become at risk for disordered eating, amenorrhea, and osteoporosis, conditions collectively identified as the female athlete triad. This review addresses nutritional concerns of the female athlete, identification of those at risk, relationship of energy intake to menstrual irregularities, and recently identified chronic diseases associated with the female athlete triad. Strategies are offered to prevent harmful behaviors leading to the comorbidities associated with inadequate dietary intakes.

  19. Six questions about translational due diligence.

    Science.gov (United States)

    Selinger, Evan

    2010-04-28

    To maintain stable respect and support, translational research must be guided by appropriate ethical, social, legal, and political concerns and carry out culturally competent practices. Considering six key questions concerning due diligence will enable the translational research community to examine critically how it approaches these endeavors.

  20. Anti-neutrophil cytoplasmic antibody-associated vasculitis associated with infectious mononucleosis due to primary Epstein-Barr virus infection: report of three cases.

    Science.gov (United States)

    Yamaguchi, Makoto; Yoshioka, Tomoki; Yamakawa, Taishi; Maeda, Matsuyoshi; Shimizu, Hideaki; Fujita, Yoshiro; Maruyama, Shoichi; Ito, Yasuhiko; Matsuo, Seiichi

    2014-02-01

    Although the aetiology of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis remains unclear, it is generally believed that environmental factors such as infections contribute to its development of ANCA-associated vasculitis. Prior Epstein-Barr virus (EBV) infection is reported to be a trigger of systemic vasculitis. We herein report three cases of ANCA-associated vasculitis presenting with infectious mononucleosis due to primary EBV infection. The causal link between the two pathologies could not be proved, but primary EBV infection may play a role in the initiation or exacerbation of ANCA-associated vasculitis. Future studies are necessary to determine the interaction between these diseases conditions.

  1. Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Rosaria M. Ruggeri

    2010-01-01

    Full Text Available A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml, but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4 due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1 primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2 it was associated with a brown tumor of unusual location (right supra-acetabular region.

  2. Benefits and concerns surrounding the cultivation of genetically ...

    African Journals Online (AJOL)

    Concerns about genetically modified (GM) foods are necessary; however, in Africa concerns are hindering the progress of agricultural practices. Due to lack of education and awareness, it is necessary for African Governments to emphasize the numerous benefits and future prospects of GM food, through education and well ...

  3. Driving and dementia: Efficient approach to driving safety concerns in family practice.

    Science.gov (United States)

    Lee, Linda; Molnar, Frank

    2017-01-01

    To provide primary care physicians with an approach to driving safety concerns when older persons present with memory difficulties. The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. One of the most challenging aspects of dementia care is the assessment of driving safety. Drivers with dementia are at higher risk of motor vehicle collisions, yet many drivers with mild dementia might be safely able to continue driving for several years. Because safe driving is dependent on multiple cognitive and functional skills, clinicians should carefully consider many factors when determining if cognitive concerns affect driving safety. Specific findings on corroborated history and office-based cognitive testing might aid in the physician's decisions to refer for comprehensive on-road driving evaluation and whether to notify transportation authorities in accordance with provincial reporting requirements. Sensitive communication and a person-centred approach are essential. Primary care physicians must consider many factors when determining if cognitive concerns might affect driving safety in older drivers. Copyright© the College of Family Physicians of Canada.

  4. Online access to doctors' notes: patient concerns about privacy.

    Science.gov (United States)

    Vodicka, Elisabeth; Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

    2013-09-26

    Offering patients online access to medical records, including doctors' visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors' notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. To identify patients' attitudes toward privacy when given electronic access to their medical records, including visit notes. The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded "don't know") reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded "don't know") reported less

  5. Informed consent: attitudes, knowledge and information concerning prenatal examination

    DEFF Research Database (Denmark)

    Dahl, Katja; Kesmodel, Ulrik; hvidman, lone

    2006-01-01

    Background: Providing women with information enabling an informed consent to prenatal examinations has been widely recommended. Objective: The primary purpose of this review is to summarise current knowledge of the pregnant woman's expectations and attitudes concerning prenatal examinations, as w...

  6. Balloon dilatation in children for oesophageal strictures other than those due to primary repair of oesophageal atresia, interposition or restrictive fundoplication

    International Nuclear Information System (INIS)

    Fasulakis, Stephen; Andronikou, Savvas

    2003-01-01

    Balloon dilatation of the oesophagus in children has been performed predominantly for treating strictures, which are the result of primary repair of oesophageal atresia, interposition surgery or restrictive Nissen's fundoplication. Reports of the use of this technique for alternative causes of stricture are few. To report our experience and success with balloon dilatation of strictures due to caustic ingestion, achalasia, oesophagitis, congenital stenosis, and epidermolysis bullosa (EB) and to make comparisons with our treatment of patients with primary repair of oesophageal atresia (OA), as well as with reports in the English language literature. Retrospective review of fluoroscopically guided balloon oesophageal dilatation procedures in 19 patients over a 5-year period, and comparison of those performed for OA repair complications with those due to other diseases. The average radiation dose, per procedure, was calculated by a medical physicist. Ten patients had strictures as a result of primary repair of OA. Three patients had stricture as a result of EB, two from achalasia, two from caustic injury, one due to an oesophageal web and one from reflux oesophagitis. Our results show that the technique can also be curative for the last group and that it may be used intermittently to alleviate symptoms in ongoing diseases. We have not experienced any complications and have also calculated that, even with prolonged use of multiple procedures, the radiation exposure is comparable to other radiological techniques. Patients with alternative causes for oesophageal stricture may be treated to resolution within 2 years using balloon dilatation. Ongoing diseases such as EB require ongoing dilatation, but balloon dilatation of strictures has been successful in alleviating swallowing difficulty. Patients with stricture from OA repair sometimes need ongoing dilatation. Radiation exposure for multiple procedures, over an extended period, is comparable to that from a single

  7. Balloon dilatation in children for oesophageal strictures other than those due to primary repair of oesophageal atresia, interposition or restrictive fundoplication

    Energy Technology Data Exchange (ETDEWEB)

    Fasulakis, Stephen [Royal Children' s Hospital, Melbourne (Australia); Andronikou, Savvas [Royal Children' s Hospital, Melbourne (Australia); Department of Paediatric Radiology, Red Cross Children' s Hospital, Klipfontein Road, Rondebosch, 7700, Cape Town (South Africa)

    2003-10-01

    Balloon dilatation of the oesophagus in children has been performed predominantly for treating strictures, which are the result of primary repair of oesophageal atresia, interposition surgery or restrictive Nissen's fundoplication. Reports of the use of this technique for alternative causes of stricture are few. To report our experience and success with balloon dilatation of strictures due to caustic ingestion, achalasia, oesophagitis, congenital stenosis, and epidermolysis bullosa (EB) and to make comparisons with our treatment of patients with primary repair of oesophageal atresia (OA), as well as with reports in the English language literature. Retrospective review of fluoroscopically guided balloon oesophageal dilatation procedures in 19 patients over a 5-year period, and comparison of those performed for OA repair complications with those due to other diseases. The average radiation dose, per procedure, was calculated by a medical physicist. Ten patients had strictures as a result of primary repair of OA. Three patients had stricture as a result of EB, two from achalasia, two from caustic injury, one due to an oesophageal web and one from reflux oesophagitis. Our results show that the technique can also be curative for the last group and that it may be used intermittently to alleviate symptoms in ongoing diseases. We have not experienced any complications and have also calculated that, even with prolonged use of multiple procedures, the radiation exposure is comparable to other radiological techniques. Patients with alternative causes for oesophageal stricture may be treated to resolution within 2 years using balloon dilatation. Ongoing diseases such as EB require ongoing dilatation, but balloon dilatation of strictures has been successful in alleviating swallowing difficulty. Patients with stricture from OA repair sometimes need ongoing dilatation. Radiation exposure for multiple procedures, over an extended period, is comparable to that from a single

  8. Depressive Disorders in Primary Health Care

    OpenAIRE

    Vuorilehto, Maria

    2008-01-01

    The Vantaa Primary Care Depression Study (PC-VDS) is a naturalistic and prospective cohort study concerning primary care patients with depressive disorders. It forms a collaborative research project between the Department of Mental and Alcohol Research of the National Public Health Institute, and the Primary Health Care Organization of the City of Vantaa. The aim is to obtain a comprehensive view on clinically significant depression in primary care, and to compare depressive patients in prima...

  9. Demand-Side Contribution to Primary Frequency Control With Wind Farm Auxiliary Control

    DEFF Research Database (Denmark)

    Gomez-Lazaro, Emilio; Munoz-Benavente, Irene; Hansen, Anca Daniela

    2014-01-01

    Maintaining a close balance between power generation and demand is essential for sustaining the quality and reliability of a power system. Currently, due to increased renewable energy generation, frequency deviations and power fluctuations of greater concern are being introduced to the grid...... to the primary frequency control together with an auxiliary frequency control, which is carried out by variable-speed wind turbines through an additional control loop that synthesizes virtual inertia. We have evaluated both the suitability of these two additional control actions counteracting frequency deviation...

  10. Upgradation of design features of primary coolant pumps of Indian 220 MWe PHWR

    International Nuclear Information System (INIS)

    Sharma, S.S.; Mhetre, S.G.; Manna, M.M.

    1994-01-01

    Evolution in the design features of Primary Coolant Pump (PCP) had started in fifties for catering to stringent specification requirements of reactor coolant systems of larger capacity reactors of various kinds. Primary coolant pumps of PWR and PHWR are employed for circulating radioactive, pressurized hot water in a circuit consisting of reactor (heat source) and steam generator (heat sink). As primary coolant pump capacity decides the station capacity, larger capacity primary coolant pumps have been evolved. Since primary coolant pump pressure containing parts are part of Primary Heat Transport system envelope, the parts are designed, manufactured, inspected and tested in accordance with the applicable system guidelines. Flywheel is mounted on the motor shaft for increasing mass moment of inertia of pump motor rotor to meet the coast down requirements of reactor cooling system under Class-IV electrical power supply failure. Due to limited accessibility of the PCP (PCP installed in shut down accessible area), quick maintenance, condition monitoring, reliable shaft seal system/bearing system aspects have been of great concern to reactor owners and pump manufacturers. In this paper upgradation of design features of RAPS, MAPS and NAPS primary coolant pumps have been covered. (author). 4 figs., 1 tab

  11. IMPORTANT CONCERN INVESTMENT MANAGEMENT

    Directory of Open Access Journals (Sweden)

    SINTEA (ANGHEL LUCICA

    2014-06-01

    Full Text Available The issue of probabilities, uncertainties and risks has concerned society since ancient times. By probability we can see the possible realization of an act or event under certain conditions. Uncertainty is caused by emotional status of the decision maker due to more subjective factors or to the knowledge to achieve an objective. Risk is a combination of the two elements characterized by a possible description of probabilities under insecurity uncertainty conditions.

  12. Community-based health insurance knowledge, concern ...

    African Journals Online (AJOL)

    Community-based health insurance knowledge, concern, preferences, and financial planning for health care among informal sector workers in a health district of Douala, Cameroon. ... This is mainly due to the lack of awareness and limited knowledge on the basic concepts of a CBHI by this target population. Solidarity ...

  13. Transjugular Intrahepatic Porto-Systemic Stent-Shunt for Therapy of Bleeding Esophageal Varices Due to Extramedullary Hematopoiesis in Primary Myelofibrosis: A Case Report

    OpenAIRE

    Phillip, Veit;Berger, Hermann;Straub, Melanie;Saugel, Bernd;Treiber, Matthias;Einwächter, Henrik;Schmid, Roland M.;Huber, Wolfgang

    2016-01-01

    Background: Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. Patient and Methods: We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Results: Therapy of variceal bleeding ...

  14. Reasons for extraction in primary teeth among 5-12 years school children in Haryana, India- A cross-sectional study.

    Science.gov (United States)

    Bansal, Mohit; Gupta, Nidhi; Gupta, Preety; Arora, Vikram; Thakar, Sahil

    2017-04-01

    Due to high prevalence of oral diseases extraction of primary teeth is a common and a major concern in developing countries. These teeth are given least importance as they are believed to shed off automatically, thus leading to serious problems like crowding and malocclusion. A cross sectional study was carried out among children aged 5 to 12 years among 1347 children. The data was recorded on a prestructured questionnaire. Reasons for extraction of teeth were based on Kay and Blinkhorn criteria. 20.4% children were having tooth loss due to various reasons. The main reason for extraction was found to be caries in 64.3% followed by trauma in maxillary teeth among 43.02% of children. Presence of early loss of primary teeth result in occlusal disturbances and space loss among children. Hence, proper treatment regimens must be followed by the dental professionals and should be the need of the hour. Key words: Extraction, children, primary teeth, caries.

  15. Concerns about Breast Cancer, Pain, and Fatigue in Non-Metastatic Breast Cancer Patients Undergoing Primary Treatment

    Directory of Open Access Journals (Sweden)

    Chelsea R. Amiel

    2016-08-01

    Full Text Available Women diagnosed with breast cancer often endorse psychosocial concerns prior to treatment, which may influence symptom experiences. Among these, low perceived social support relates to elevated fatigue. Those with low social support perceptions may also experience a greater sense of rejection. We sought to determine if social rejection concerns post-surgery predict fatigue interference 12 months later in women with non-metastatic breast cancer. Depressive symptoms and pain severity after completion of adjuvant therapy (six months post-surgery were examined as potential mediators. Women (N = 240 with non-metastatic breast cancer were recruited 2–10 weeks post-surgery. Multiple regression analyses examined relationships among variables adjusting for relevant covariates. Greater rejection concerns at study entry predicted greater fatigue interference 12 months later (p < 0.01. Pain severity after adjuvant therapy partially mediated the relationship between social rejection concerns and fatigue interference, with significant indirect (β = 0.06, 95% CI (0.009, 0.176 and direct effects (β = 0.18, SE = 0.07, t(146 = 2.78, p < 0.01, 95% CI (0.053, 0.311. Therefore, pain levels post-treatment may affect how concerns of social rejection relate to subsequent fatigue interference. Interventions targeting fears of social rejection and interpersonal skills early in treatment may reduce physical symptom burden during treatment and into survivorship.

  16. Improving Obesity Prevention and Management in Primary Care in Canada.

    Science.gov (United States)

    Campbell-Scherer, Denise; Sharma, Arya Mitra

    2016-09-01

    Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve.

  17. The detection of climate change due to the enhanced greenhouse effect

    Science.gov (United States)

    Schiffer, Robert A.; Unninayar, Sushel

    1991-01-01

    The greenhouse effect is accepted as an undisputed fact from both theoretical and observational considerations. In Earth's atmosphere, the primary greenhouse gas is water vapor. The specific concern today is that increasing concentrations of anthropogenically introduced greenhouse gases will, sooner or later, irreversibly alter the climate of Earth. Detecting climate change has been complicated by uncertainties in historical observations and measurements. Thus, the primary concern for the GEDEX project is how can climate change and enhanced greenhouse effects be unambiguously detected and quantified. Specifically examined are the areas of: Earth surface temperature; the free atmosphere (850 millibars and above); space-based measurements; measurement uncertainties; and modeling the observed temperature record.

  18. The detection of climate change due to the enhanced greenhouse effect

    International Nuclear Information System (INIS)

    Schiffer, R.A.; Unninayar, S.

    1991-01-01

    The greenhouse effect is accepted as an undisputed fact from both theoretical and observational considerations. In Earth's atmosphere, the primary greenhouse gas is water vapor. The specific concern today is that increasing concentrations of anthropogenically introduced greenhouse gases will, sooner or later, irreversibly alter the climate of Earth. Detecting climate change has been complicated by uncertainties in historical observations and measurements. Thus, the primary concern for the GEDEX project is how can climate change and enhanced greenhouse effects be unambiguously detected and quantified. Specifically examined are the areas of: Earth surface temperature; the free atmosphere (850 millibars and above); space-based measurements; measurement uncertainties; and modeling the observed temperature record

  19. Functioning of primary health care in opinion of managers of primary health care units.

    Science.gov (United States)

    Bojar, I; Wdowiak, L; Kwiatosz-Muc, M

    2006-01-01

    The aim of the research is to get to know opinions of primary health care managers concerning working of primary health care and concerning quality of medical services offered by family doctors out-patient clinics. The research among managers of primary health care units took place in all out-patient clinics in Lublin province. Research instrument was survey questionnaire of authors own construction. Results were statistically analyzed. From 460 surveys sent, 108 questionnaires were accepted to analysis. Majority of managers of out-patient clinics of primary health care is satisfied with the way and the quality of work of employed staff. In opinion of 71.3% of managers access to family doctor services is very good. Availability of primary health care services is better estimated by managers of not public units. The occupied local provide comfortable work for the staff in opinion of 78.5% of surveyed managers of out-patient clinics. Managers estimate the level of their services as very good (37.96%) and good (37.96%) comparing to other such a subjects present in the market. Internal program of improving quality is run in 22% of out-patient clinics, which were investigated. Managers of primary health care units assess the quality of their services as good and very good. They estimate positively the comfort and politeness in serving patients as well as technical status of equipment and the lodging. They assess availability of their services as very good. Large group of managers of family doctors practices recognizes neighborhood practices as a competitors.

  20. A case report of hyperaldosteronism due to aldosteronoma

    Directory of Open Access Journals (Sweden)

    Rabiy Hashemi M

    1997-08-01

    Full Text Available Primary hyperaldosteronism is one of the few causes of hypertension that can be cured by surgery. Primary hyperaldosteronism is caused by adrenocortical adenoma or hyperplasia. It is important to differentiate between adrenal adenoma and hyperplasia because the preferred treatments are different. In all patients with new-onest or worsening hypertension the primary hyperaldosteronism should be considered as an etiology. Patients with primary hyperaldosteronism classically have hypertension with spontaneous hypokalemia. The serum sodium concentration is usually normal in patients with primary aldosteronism who are not taking diuretics. Weakness, fatigue, paresthesia, tetany and even paralysis may develop. Renin and angiotensin II are suppressed in both forms of primary hyperaldosteronism due to feedback. Polyuria may develop secondary to vasopressin resistance from chronic hyperkaliuria. Hypertension or eclampsia during pregnancy is common in women with primary hyperaldosteronism. Case report: A 42-years-old woman presented with headache, severe hypertension, general weakness, easy fatigability, vertigo, palpitation, visual disorders and nocturia. She had a past history of eclampsia 10 years ago. In laboratory investigation there was hypokalemia, elevated serum aldosterone, low renin activity and hyperkaliuria. In abdominal CT-scan there was a hypodense mass measuring 2 cm in diameter in her left adrenal gland. The patient had primary hyperaldosteronism due to aldosteronoma.

  1. Biosynthesis of Various Steroids in vitro by Isolated Adrenal Cells in Primary Aldosteronism, Cushing's Syndrome, and Adrenogenital Syndrome due to Adrenocortical Adenoma

    OpenAIRE

    MIZUNO, SHIGERU; FUNAHASHI, HIROOMI

    1981-01-01

    To a further understanding of the role of steroid hormones in adrenal disorders, we have prepared free cell system of adrenal cells, using adrenal tissues that had been removed by operation from (i) cases of Cushing's syndrome due to adrenocortical adenoma or adrenocortical hyperplasia, (ii) a case of primary aldosteronism, and (iii) a patient with virilizing adrenal tumor. Twelve important steroid hormones were measured, such as pregnenolone, cortisol and aldosterone, which were produced by ...

  2. Characteristics of Sissi primary beam

    International Nuclear Information System (INIS)

    Nghiem, P.; Payet, J.; Tkatchenko, A.

    1994-01-01

    This study concerns the definition of the Sissi primary beam characteristics. The calculations have been carried out in two steps : -a study of primary and secondary order with the help of BETA matrix code -a study of superior orders with the help of ZGOUBI code which is able to take into consideration the measured fields and in which the movement equations are integrated numerically. (O.L.). 9 figs., 3 tabs

  3. Can We Identify Parents Who Do Not Verbally Share Concerns for Their Children's Development?

    Science.gov (United States)

    Eremita, Matthew; Semancik, Eileen; Lerer, Trudy; Dworkin, Paul H

    2017-04-01

    We aimed to identify characteristics of parents who do not voice developmental concerns when prompted by their children's nurse and/or primary care provider (PCP), despite reporting concerns on parent-completed questionnaires. We reviewed 376 medical records of children seen for a 9-month well-child visit in an urban pediatric clinic between September 2011 and December 2012 for sociodemographic variables hypothesized to affect parents' sharing of developmental concerns: the child's birth order and gender; parents' education level, employment, relationship status, and primary language; and family size and racial/ethnic background. The target population was parents who reported concerns on the Parents' Evaluation of Developmental Status (PEDS), a routinely administered, parent-completed screening questionnaire. We subdivided parents who reported concerns on the PEDS (N = 86) based on whether they voiced developmental concerns when prompted by their children's nurse and/or PCP. Two-sided Fisher's exact tests and logistic regression evaluated the relationship between sociodemographic variables and parents' voicing of developmental concerns. Only parent education approached significance, as parents with less than a high school education (children's development than parents with at least a high school degree or equivalent (≥HS) (63% compared to 35%, p = .056). Univariate logistic regression analysis showed that parents with Parents with low educational attainment may be more likely to not verbally share their developmental concerns. For children of such parents, early detection of developmental delay may be strengthened by use of written questionnaires.

  4. Models of Students' Thinking Concerning the Greenhouse Effect and Teaching Implications.

    Science.gov (United States)

    Koulaidis, Vasilis; Christidou, Vasilia

    1999-01-01

    Primary school students (n=40) ages 11 and 12 years were interviewed concerning their conceptions of the greenhouse effect. Analysis of the data led to the formation of seven distinct models of thinking regarding this phenomenon. (Author/CCM)

  5. Primary cultures of astrocytes

    DEFF Research Database (Denmark)

    Lange, Sofie C; Bak, Lasse Kristoffer; Waagepetersen, Helle S

    2012-01-01

    During the past few decades of astrocyte research it has become increasingly clear that astrocytes have taken a central position in all central nervous system activities. Much of our new understanding of astrocytes has been derived from studies conducted with primary cultures of astrocytes...... subsequently found in vivo. Nevertheless, primary cultures of astrocytes are an in vitro model that does not fully mimic the complex events occurring in vivo. Here we present an overview of the numerous contributions generated by the use of primary astrocyte cultures to uncover the diverse functions...... of astrocytes. Many of these discoveries would not have been possible to achieve without the use of astrocyte cultures. Additionally, we address and discuss the concerns that have been raised regarding the use of primary cultures of astrocytes as an experimental model system....

  6. Renal failure due to primary amyloidosis: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Ramon Andrade Bezerra de Mello

    Full Text Available CONTEXT: Primary amyloidosis, also known as AL amyloidosis, is commonly caused by clonal expansion of plasma cells in the bone marrow, thereby segregating light chains of clonal immunoglobulin that settle in tissues in the form of insoluble amyloid fibrils. The aim of this study was to report a case of primary amyloidosis with renal failure, diagnosed in Hospital São João, Porto, Portugal, focusing on the diagnostic difficulties and presenting a literature review. CASE REPORT: A 68-year-old Caucasian man was admitted to the Internal Medicine Department of the hospital with a condition of anasarca and nephrotic syndrome. After performing a renal biopsy that tested positive using Congo red and immunohistochemistry, lambda light chain amyloidosis was diagnosed. This evolved into terminal renal disease, which led to hemodialysis and several episodes of urinary and catheter infections. He was started on chemotherapy, consisting of bortezomib 0.7 mg/m² and dexamethasone 40 mg in six cycles. This led to clinical improvement, stabilization of the illness and good tolerance of the treatment. CONCLUSION: Amyloidosis is a rare entity that is difficult to diagnose. This is because of the unspecific early clinical manifestations of the disease. The hypothesis of amyloidosis is only considered when specific organ failure occurs. This case consisted of primary amyloidosis with involvement of the kidneys as an initial presentation of the disease and its difficulties were shown, going from the clinical approach to the final diagnosis.

  7. Study of environmental concerns: offshore oil and gas drilling and production

    Energy Technology Data Exchange (ETDEWEB)

    Baker, R

    1978-01-01

    Material on the environmental concerns associated with offshore drilling and production activities has been synthesized with Department of Fisheries and Environment files on specific projects, these being the primary information source. Recommendations to resolve these concerns have also been provided. Most of the environmental concerns identified in this study are traceable to specific weaknesses in offshore drilling and production procedures and management systems. Hardware weaknesses are seldom of central importance. Areas of concern include the gradual deposition of pollutants from rigs, underwater pipelines and onshore ancillary structures, and the quality of the following: action plans to deal with oil spills, standards for safety and anti-pollution equipment, information provided on the environmental hazards in offshore drilling and production areas, environmental impact assessments, and communication links between those having environmental concerns and expertise (including the public-at-large) and those who make the decisions regarding offshore oil and gas development.

  8. French experience concerning expansion compensating devices on the primary systems of nuclear reactors

    International Nuclear Information System (INIS)

    Vrillon, B.; Raynal, A.

    1980-01-01

    French experience in the use of large expansion bellows in the presence of hot sodium is extremely limited. This stems from the 'pool' structure of the primary circuit, adopted in France to eliminate the need to solve expansion problems affecting the primary piping of loop reactors. Furthermore, until the present time, the use of bellows on secondary circuits has neither been implemented nor considered. A few bellows nevertheless exist on the Phenix and Super-Phenix reactors, and these perform separation functions, for example, between sodium at different temperature and/or pressures, or tightness functions in gaseous environment at the component penetrations in the slabs. The dimension criteria applied to these bellows are the general rules for structural dimensioning. Since they do not form part of a circuit wall, they do not need to be discussed. Note, however, that these components have not raised any particular problems thus far. Expansion bellows exist in France on the primary circuits of certain nuclear reactors of the natural uranium/graphite/gas type. These reactors have been in operation for many years, and some lessons can be drawn from this experience in the use of bellows in representative conditions on power reactor circuits. Liquid sodium raises specific problems with respect to circuit operation and material behavior. However, many problems in the use of bellows are independent of the fluid conveyed in the circuits. This is why the experience gained with gas type power reactors appears to be useful in considering the possible future use of bellows on sodium reactor circuits

  9. 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.

  10. The development of hazardous waste management as a state policy concern

    International Nuclear Information System (INIS)

    Herzik, E.B.

    1992-01-01

    Hazardous waste management has become a primary concern of state governments. This concern is relatively recent, with state governments assuming a leading role in hazardous waste policy development and implementation only in the past decade. This article outlines the scope of the hazardous waste problem to which state governments must respond. The scope of the problem is then linked to changing public perceptions and intergovernmental relationships to explain the expanding state government policy role in hazardous waste management. 15 refs., 1 tab

  11. WMPO project issues and public concerns

    International Nuclear Information System (INIS)

    Vieth, D.L.

    1984-01-01

    The Governor of Nevada was notified in 1983 that the Yucca Mountain site is a potentially acceptable site for a nuclear waste storage site. A series of public hearings held produced nearly 400 comments on issues concerning the site nomination. Areas of primary public concern are the impact of the proposed nuclear site on tourism, transportation, and socioeconomic impact on adjacent communities. Results of recent studies showed no impact of high-level waste transport on tourism in the Las Vegas area and on analysis of data accumulated over the 25 to 30 years that high-level radioactive wastes have been transported on Nevada highways showed that no one has been evacuated from their home as the result of an accident involving radioactive waste. A comparison of the possible effects of construction of a nuclear waste storage facility at the Yucca mountain site with the effects of Nevada Test Site indicate that the impact on communities will be minimal

  12. Hypertension in the course of primary aldosteronism during pregnancy

    Directory of Open Access Journals (Sweden)

    Magdalena Wyskida

    2015-02-01

    Full Text Available Hypertension is one of the most common cardiovascular diseases during pregnancy. Primary hyperaldosteronism (PHA is the most frequent endocrinological, secondary cause of hypertension, rarely diagnosed in pregnant women. In the available literature about 50 cases of PHA in pregnant women have been described. PHA is often a cause of resistant hypertension. PHA can cause life-threatening complications both for the pregnant woman and the fetus. Diagnosis of PHA in pregnancy is difficult due to the antagonistic effect of progesterone on aldosterone, physiological increase of aldosterone release during gestation and frequent normokalaemic clinical course. Typical pharmacological treatment of PHA is limited due to the anti‑androgenic effect of spironolactone, lack of data concerning the safety of eplerenone and limited access to amiloride in Poland. Surgical treatment is a therapeutic option only in early pregnancy. This paper presents the current state of knowledge on diagnostic methods and treatment of PHA in pregnant women and a systematic review of cases described in the literature.

  13. Primary decomposition of torsion R[X]-modules

    Directory of Open Access Journals (Sweden)

    William A. Adkins

    1994-01-01

    Full Text Available This paper is concerned with studying hereditary properties of primary decompositions of torsion R[X]-modules M which are torsion free as R-modules. Specifically, if an R[X]-submodule of M is pure as an R-submodule, then the primary decomposition of M determines a primary decomposition of the submodule. This is a generalization of the classical fact from linear algebra that a diagonalizable linear transformation on a vector space restricts to a diagonalizable linear transformation of any invariant subspace. Additionally, primary decompositions are considered under direct sums and tensor product.

  14. Upgrading primary heat transport pump seals

    International Nuclear Information System (INIS)

    Graham, T.; Metcalfe, R.; Rhodes, D.; McInnes, D.

    1995-01-01

    Changes in the operating environment at the Bruce-A Nuclear Generating Station created the need for an upgraded Primary Heat Transport Pump (PHTP) seal. In particular, the requirement for low pressure running during more frequent start-ups exposed a weakness of the CAN2 seal and reduced its reliability. The primary concern at Bruce-A was the rotation of the CAN2 No. 2 stators in their holders. The introduction of low pressure running exacerbated this problem, giving rapid wear of the stator back face, overheating, and thermocracking. In addition, the resulting increase in friction between the stator and its holder increased stationary-side hysteresis and thereby changed the seal characteristic to the point where interseal pressure oscillations became prevalent. The resultant increased hysteresis also led to hard rubbing of the seal faces during temperature transients. An upgraded seal was required for improved reliability to avoid forced outages and to reduce maintenance costs. This paper describes this upgraded 'replacement seal' and its performance history. In spite of the 'teething' problems detailed in this paper, there have been no forced outages due to the replacement seal, and in the words of a seal maintenance worker at Bruce-A, 'it allows me to go home and sleep at night instead of worrying about seal failures.' (author)

  15. State of enforcement of the law concerning prevention from radiation hazards due to radio-isotopes

    International Nuclear Information System (INIS)

    1977-01-01

    In view of the recent advance of radiation utilization in many fields, the situation as of the end of fiscal 1976 under the law is described. The statistics on the number of enterprises concerning radioisotope usage, sales and waste-treatment are first given. Then, the measures taken by the Science and Technology Agency to improve radiation hazard prevention are explained, and cooperation with other governmental offices, efforts by the enterprises, steps taken for the enterprises of nondestructive testing, hospitals, universities, etc., and restudy on the law are described. (Mori, K.)

  16. Teachers' Stages of Concern for Media Literacy Education and the Integration of MLE in Chinese Primary Schools

    Science.gov (United States)

    Zhang, Hui; Zhu, Chang; Sang, Guoyuan

    2014-01-01

    Media literacy is an essential skill for living in the twenty-first century. School-based instruction is a critical part of media literacy education (MLE), while research on teachers' concerns and integration of MLE is not sufficient. The objective of this study is to investigate teachers' stages of concern (SoC), perceived need, school context,…

  17. Going Concern eller Concerned Going

    DEFF Research Database (Denmark)

    Haraszuk, Anni; Hartmann, Stig

    2012-01-01

    Højsæsonen for revision af årsrapporter 2011 er på trapperne; men hvordan håndterer revisorer egentlig going concern i praksis - i en tid præget af stejle op- og nedture?......Højsæsonen for revision af årsrapporter 2011 er på trapperne; men hvordan håndterer revisorer egentlig going concern i praksis - i en tid præget af stejle op- og nedture?...

  18. Exploring emotions and the shared decision-making process in pediatric primary care

    Directory of Open Access Journals (Sweden)

    Francesca Dicé

    2016-12-01

    Full Text Available This paper aims to identify conversational interaction patterns in pediatrics with a focus on the shared decision-making process and dialogue about emotions in doctor–patient relationships. We documented conversations in 163 visits by 168 children in pediatric primary care; we observed, audiorecordered, transcribed and analyzed them with specific instruments of analysis of doctor patient relationship. Our survey was conducted in four pediatric primary care practices and 15 health providers were involved. The data collection period lasted three months and was undertaken twice a week on days. We analyzed visits with Verona Coding Definitions of Emotional Sequences (VR-CoDES and Observing Patient Involvement in Shared Decision Making (OPTION instruments. Frequencies of emotions’ signals (cues/concerns obtained using VR-CoDES were analyzed and compared with the OPTION ratings. We documented 318 cues/concerns for parents and 167 for children. The relationship between cues/concerns and Healthcare Providers responses was strongest in dialogues between parents and pediatricians. The conversational patterns focused on the procedures of the care, with little opportunities of dialogue about emerging emotions. We also observed limited possibilities for participant involvement, especially by children, due to several difficulties integrating dialogue about emotions and concordance processes. The conversations seemed to be characterized by rarity of shared decision making or attention to the informational value of children’s emotions. It could be useful to implement psychological interventions to achieve an enrichment of the dialogue between participants, helping them to incorporate emotions into conversations and to recognize decisional competences, necessary to concordance processes.

  19. Accessibility and use of Primary Health Care: how conclusive is the social-economical situation in Antwerp?

    Science.gov (United States)

    Philips, H; Rotthier, P; Meyvis, L; Remmen, R

    2015-04-01

    The percentage of households that delays medical assistance due to financial reasons is slowly increasing. Moreover, some groups of the population do not ever find their way to primary health care and end up unnecessarily in the emergency department or with specialists. This study wants to examine how primary health care can be made accessible to these groups. In this study, we aim to discover whether in a city such as Antwerp primary health care is accessible to everyone. The statistics were collected from the Health Care Survey done by the Welfare Services Antwerp in cooperation with the City of Antwerp. The questions were asked in three different ways: a postal questionnaire, a telephone questionnaire and a face-to-face interview. We determined that people who live on social welfare delay medical help due to financial reasons more frequently than the global Antwerp population. They often do not have a regular general practitioner (GP). Especially single parents, house-wives and house-husbands, job-seekers, incapacitated people unable to work, unskilled workers and foreigners are among the vulnerable groups where accessibility to primary health care is a concern. If we hope to improve the accessibility of primary health care, we must first and foremost inform the above-mentioned groups of the insurability and how this is applied. When this is fulfilled, it will be easier for the GP to receive this vulnerable group within the primary care system, so that the help of specialized care, which is often unnecessary, can be reduced.

  20. Dynamic Modelling with "MLE-Energy Dynamic" for Primary School

    Science.gov (United States)

    Giliberti, Enrico; Corni, Federico

    During the recent years simulation and modelling are growing instances in science education. In primary school, however, the main use of software is the simulation, due to the lack of modelling software tools specially designed to fit/accomplish the needs of primary education. In particular primary school teachers need to use simulation in a framework that is both consistent and simple enough to be understandable by children [2]. One of the possible area to approach modelling is about the construction of the concept of energy, in particular for what concerns the relations among substance, potential, power [3]. Following the previous initial research results with this approach [2], and with the static version of the software MLE Energy [1], we suggest the design and the experimentation of a dynamic modelling software—MLE dynamic-capable to represent dynamically the relations occurring when two substance-like quantities exchange energy, modifying their potential. By means of this software the user can graphically choose the dependent and independent variables and leave the other parameters fixed. The software has been initially evaluated, during a course of science education with a group of primary school teachers-to-be, to test the ability of the software to improve teachers' way of thinking in terms of substance-like quantities and their effects (graphical representation of the extensive, intensive variables and their mutual relations); moreover, the software has been tested with a group of primary school teachers, asking their opinion about the software didactical relevance in the class work.

  1. Primary data collection in health technology assessment.

    Science.gov (United States)

    McIsaac, Michelle L; Goeree, Ron; Brophy, James M

    2007-01-01

    This study discusses the value of primary data collection as part of health technology assessment (HTA). Primary data collection can help reduce uncertainty in HTA and better inform evidence-based decision making. However, methodological issues such as choosing appropriate study design and practical concerns such as the value of collecting additional information need to be addressed. The authors emphasize the conditions required for successful primary data collection in HTA: experienced researchers, sufficient funding, and coordination among stakeholders, government, and researchers. The authors conclude that, under specific conditions, primary data collection is a worthwhile endeavor in the HTA process.

  2. Cosmic-ray antimatter - A primary origin hypothesis

    Science.gov (United States)

    Stecker, F. W.; Protheroe, R. J.; Kazanas, D.

    1983-01-01

    The present investigation is concerned with the possibility that the observed cosmic-ray protons are of primary extragalactic origin, taking into account the significance of the current antiproton data. Attention is given to questions regarding primary antiprotons, antihelium fluxes, and the propagation of extragalactic cosmic rays. It is concluded that the primary origin hypothesis should be considered as a serious alternative explanation for the cosmic-ray antiproton fluxes. Such extragalactic primary origin can be considered in the context of a baryon symmetric domain cosmology. The fluxes and propagation characteristics suggested are found to be in rough agreement with the present antiproton data.

  3. Risk interrelationship among multiple primary tumors

    Science.gov (United States)

    Safi, Mohammed; Sun, Xiuhua; Wang, Lifen; Zhang, Xinwei; Song, Jicheng; Ameen, Mohammed

    2018-01-01

    Abstract Rationale: Along with advanced management in oncology, great progress has been recently achieved in the studies of multiple primary tumors. Several reports have studied the coexistence between lymphoma and either renal cell carcinoma (RCC) or Warthin tumor. However, the level of coexistence between these cases remains unclear due to the absence of a distinct link between them. Patient concerns: We present a unique case of multiple primary tumors (lymphoma, RCC, and Warthin tumor) in an 80-year-old man and a review of the literature on the coexistence of RCC with lymphoma and lymphoma with Warthin tumor. Diagnosis: With a history of RCC, the patient had a freely movable lump under his left ear, and the pathological report indicated Hodgkin lymphoma and Warthin tumor. Intervention: RCC and Warthin tumor of the patient were surgically treated, followed by 2 cycles (14 days per cycle) of Epirubicin 40 mg day 1, Bleomycin 8 mg day 1, Vincristine 2 mg day 1, and Dacarbazine 500 mg day 1. The chemotherapy protocol was then changed to Epirubicin 40 mg day 1, Vincristine 2 mg day 1, and Dacarbazine 500 mg day 1 for 7 cycles. Outcomes: After the last day of chemotherapy, the patient showed a complete response. Lessons: To the best of our knowledge, this paper is the first to report a case of multiple primary tumors with a complete response. For their early detection, favorable prognosis, and correlation identification, we suggest a transitive relation between these coexisting tumors. Therefore, similar studies should be conducted. PMID:29642151

  4. Providers' perceptions of parental concerns about HPV vaccination.

    Science.gov (United States)

    Perkins, Rebecca B; Clark, Jack A

    2013-05-01

    Parental resistance is often posited to explain low rates of human papillomavirus (HPV) vaccine uptake. We sought to describe providers' perceptions of parents' attitudes towards HPV vaccination. Thirty-four providers from four federally qualified community health centers participated in semi-structured interviews related to their experiences discussing HPV vaccination with low-income and minority parents. Providers found that parents were eager to prevent cancer in their daughters. Safety concerns and feeling that vaccination was unnecessary for virgins were reasons for declining vaccination. Providers found that immigrants from low-resource settings were more receptive to HPV vaccination than White middle-class parents due both to personal experience with vaccine-preventable diseases and cervical cancer and more realistic impressions of their children's sexual activity. Immigrants from low-resource settings may be particularly receptive to HPV vaccination, while White middle-class parents may be more likely to defer vaccination due to concerns about safety or sexual issues.

  5. Spontaneous Thrombosis of a Bicuspid Aortic valve due to Primary Antiphospholipid Syndrome

    Directory of Open Access Journals (Sweden)

    Sarah Farrell

    2010-08-01

    Full Text Available We present the case of a 51-year-old man who was admitted as an emergency with spontaneous thrombosis of the aortic valve and ascending aorta. At operation he was found to have a congenitally bicuspid aortic valve and subsequent investigation revealed primary antiphospholipid syndrome. He underwent successful removal of the thrombus combined with mechanical replacement of the aortic valve.

  6. Some Behaviorial Science Measurement Concerns and Proposals.

    Science.gov (United States)

    Nesselroade, John R; Molenaar, Peter C M

    2016-01-01

    Primarily from a measurement standpoint, we question some basic beliefs and procedures characterizing the scientific study of human behavior. The relations between observed and unobserved variables are key to an empirical approach to building explanatory theories and we are especially concerned about how the former are used as proxies for the latter. We believe that behavioral science can profitably reconsider the prevailing version of this arrangement because of its vulnerability to limiting idiosyncratic aspects of observed/unobserved variable relations. We describe a general measurement approach that takes into account idiosyncrasies that should be irrelevant to the measurement process but can intrude and may invalidate it in ways that distort and weaken relations among theoretically important variables. To clarify further our major concerns, we briefly describe one version of the measurement approach that fundamentally supports the individual as the primary unit of analysis orientation that we believe should be preeminent in the scientific study of human behavior.

  7. Primary care in a new era: disillusion and dissolution?.

    Science.gov (United States)

    Sandy, Lewis G; Schroeder, Steven A

    2003-02-04

    The current dilemmas in primary care stem from 1) the unintended consequences of forces thought to promote primary care and 2) the "disruptive technologies of care" that attack the very function and concept of primary care itself. This paper suggests that these forces, in combination with "tiering" in the health insurance market, could lead to the dissolution of primary care as a single concept, to be replaced by alignment of clinicians by economic niche. Evidence already exists in the marketplace for both tiering of health insurance benefits and corresponding practice changes within primary care. In the future, primary care for the top tier will cater to the affluent as "full-service brokers" and will be delivered by a wide variety of clinicians. The middle tier will continue to grapple with tensions created by patient demand and bureaucratic systems but will remain most closely aligned to primary care as a concept. The lower tier will become increasingly concerned with community health and social justice. Each primary care specialty will adapt in a unique way to a tiered world, with general internal medicine facing the most challenges. Given this forecast for the future, those concerned about primary care should focus less on workforce issues and more on macro health care financing and organization issues (such as Medicare reform); appropriate training models; and the development of a conception of primary care that emphasizes values and ethos, not just function.

  8. Biomass stakeholder views and concerns: Environmental groups and some trade association

    Energy Technology Data Exchange (ETDEWEB)

    Peelle, E.

    2000-01-01

    This exploratory study of the views and concerns of 25 environmental organizations found high interest and concern about which biomass feedstocks would be used and how these biomass materials would be converted to energy. While all favored renewable energy over fossil or nuclear energy, opinion diverged over whether energy crops, residues, or both should be the primary source of a biomass/bioenergy fuel cycle. About half of the discussants favored biomass ``in general'' as a renewable energy source, while the others were distributed about equally over five categories, from favor-with-conditions, uncertain, skeptical, opposed, to ``no organizational policy.''

  9. Biomass stakeholder views and concerns: Environmental groups and some trade associations

    International Nuclear Information System (INIS)

    Peelle, E.

    2000-01-01

    This exploratory study of the views and concerns of 25 environmental organizations found high interest and concern about which biomass feedstocks would be used and how these biomass materials would be converted to energy. While all favored renewable energy over fossil or nuclear energy, opinion diverged over whether energy crops, residues, or both should be the primary source of a biomass/bioenergy fuel cycle. About half of the discussants favored biomass ''in general'' as a renewable energy source, while the others were distributed about equally over five categories, from favor-with-conditions, uncertain, skeptical, opposed, to ''no organizational policy.''

  10. Treating opioid dependence. Growing implications for primary care.

    Science.gov (United States)

    Krantz, Mori J; Mehler, Philip S

    2004-02-09

    Almost 3 million Americans have abused heroin. The most effective treatment for this concerning epidemic is opioid replacement therapy. Although, from a historical perspective, acceptance of this therapy has been slow, growing evidence supports its efficacy. There are 3 approved medications for opioid maintenance therapy: methadone hydrochloride, levomethadyl acetate, and buprenorphine hydrochloride. Each has unique characteristics that determine its suitability for an individual patient. Cardiac arrhythmias have been reported with methadone and levomethadyl, but not with buprenorphine. Due to concerns about cardiac risk, levomethadyl use has declined and the product may ultimately be discontinued. These recent safety concerns, specifics about opioid detoxification and maintenance, and new federal initiatives were studied. Opioid detoxification has a role in both preventing acute withdrawal and maintaining long-term abstinence. Although only a minority of eligible patients are engaged in treatment, opioid maintenance therapy appears to offer the greatest public health benefits. There is growing interest in expanding treatment into primary care, allowing opioid addiction to be managed like other chronic illnesses. This model has gained wide acceptance in Europe and is now being implemented in the United States. The recent Drug Addiction Treatment Act enables qualified physicians to treat opioid-dependent patients with buprenorphine in an office-based setting. Mainstreaming opioid addiction treatment has many advantages; its success will depend on resolution of ethical and delivery system issues as well as improved and expanded training of physicians in addiction medicine.

  11. 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.…

  12. Dynamics of the public concern and risk communication program implementation.

    Science.gov (United States)

    Zaryabova, Victoria; Israel, Michel

    2015-09-01

    The public concern about electromagnetic field (EMF) exposure varies due to different reasons. A part of them are connected with the better and higher quality of information that people receive from science, media, Internet, social networks, industry, but others are based on good communication programs performed by the responsible institutions, administration and persons. Especially, in Bulgaria, public concern follows interesting changes, some of them in correlation with the European processes of concern, but others following the economic and political processes in the country. Here, we analyze the dynamics of the public concern over the last 10 years. Our explanation of the decrease of the people's complaints against EMF exposure from base stations for mobile communication is as a result of our risk communication program that is in implementation for >10 years.

  13. Reply by the Federal Government to a question concerning new primary energy sources raised in the Bundestag

    Energy Technology Data Exchange (ETDEWEB)

    Matthoefer, H [Bundesministerium fuer Forschung und Technologie, Bonn (F.R. Germany)

    1976-06-01

    A question raised in the Bundestag concerning new primary energy sources was answered by the Federal Minister for Science and Technology in his letter dated June 2, 1976; the letter called attention to the Federal Government's energy program of September 1973 which, instead of promoting research almost exclusively on the nuclear sector as used to be the case, aims at a purposeful and comprehensive promotion by the state of non-nuclear energy research as well in the FRG. Solar energy seems to have the best chance in the FRG of being utilized in an industrial way, applying low-temperature collectors to recover heat for heating and hot water preparation; 28 million DM have been invested so far. Despite the fact that the technical potential of wind power in the FRG would cover almost 75% of the present electricity demand, only plants with a small kW range are being developed at the moment as the question of energy storage is still open; 0.3 million DM have been granted so far. The utilization of geothermal power can only be of interest for the FRG on the basis of the hot-dry-rock method; drilling work is carried out in the Eifel district investigating geothermal gradients: 1.25 million DM have been granted so far. In 1976 the projects mentioned above have been allotted research funds amounting to 20 million DM. Energy from running/tidal waters is utilized in the FRG to 90% so far, but this only accounts for 6.7% of the gross electricity generation. Therefore, its importance for the energy supply of the FRG will decrease when the energy demand increases.

  14. What factors mediate the relationship between global self-worth and weight and shape concerns?

    Science.gov (United States)

    Murphy, Edel; Dooley, Barbara; Menton, Aoife; Dolphin, Louise

    2016-04-01

    The primary aim of this study was to investigate whether the relationship between global self-worth and weight concerns and global self-worth and shape concerns was mediated by pertinent body image factors, while controlling for gender and estimated BMI. Participants were 775 adolescents (56% male) aged 12-18years (M=14.6; SD=1.50). Mediation analysis revealed a direct and a mediated effect between global self-worth and two body image models: 1) weight concerns and 2) shape concerns. The strongest mediators in both models were physical appearance, restrained eating, and depression. Partial mediation was observed for both models, indicating that body image factors which span cognitive, affective, and behavioral constructs, explain the association between global self-worth and weight and shape concerns. Implications for future research, weight and shape concern prevention and global self-worth enhancement programs are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Breast abscess due to Actinomyces europaeus.

    Science.gov (United States)

    Silva, W A; Pinheiro, A M; Jahns, B; Bögli-Stuber, K; Droz, S; Zimmerli, S

    2011-06-01

    Actinomyces europaeus was first described in 1997 as a new species causing predominantly skin and soft-tissue infections. Mastitis due to A. europaeus is an unusual condition. This article reports a case of primary breast abscess caused by A. europaeus in a postmenopausal woman.

  16. Enhancement of fatigue crack growth rates in pressure boundary materials due to light-water-reactor environments

    International Nuclear Information System (INIS)

    VanDerSluys, W.A.; Emanuelson, R.H.

    1988-01-01

    The high level of reliability required of the primary-coolant pressure boundary in a nuclear reactor system leads to a continuing interest in the interaction among the coolant, pressure boundary materials, and service loadings. One area of concern involves the possible enhancement of the growth rate of fatigue cracks due to the coolant. Advances have occurred recently toward a better understanding of the variables influencing the material/environment interactions and methods of addressing this interaction. Sulfur now appears to be one of the principal agents responsible for the observed enhancement of the fatigue crack growth rates in light-water-reactor (LWR) environments. This paper presents the results of investigations on the effect of sulfur in the steel, bulk water environment, and at the crack tip

  17. Genetics Home Reference: primary ciliary dyskinesia

    Science.gov (United States)

    ... primary ciliary dyskinesia also have year-round nasal congestion and a chronic cough. Chronic respiratory tract infections ... likely due to abnormal cilia in the fallopian tubes. Another feature of primary ciliary dyskinesia is recurrent ...

  18. Concerning the primary and secondary objectives in robot task definition - the "learn from humans" principle

    NARCIS (Netherlands)

    Potkonjak, V.; Tzafestas, S.; Kostic, D.

    2000-01-01

    This paper is concerned with the trajectory definition in robot tasks. Although very often ignored, the specification of robot motion is not the first step in the definition of a robot task. The task definition starts with the description of the final outcome, i.e. with the specification of the job

  19. Behavioral medicine interventions for adult primary care settings: A review.

    Science.gov (United States)

    Funderburk, Jennifer S; Shepardson, Robyn L; Wray, Jennifer; Acker, John; Beehler, Gregory P; Possemato, Kyle; Wray, Laura O; Maisto, Stephen A

    2018-06-07

    Health care organizations are embracing integrated primary care (IPC), in which mental health and behavioral health are addressed as part of routine care within primary care settings. Behavioral medicine concerns, which include health behavior change and coping with medical conditions, are common in primary care populations. Although there are evidence-based behavioral interventions that target a variety of behavioral medicine concerns, integrated behavioral health providers need interventions that are sufficiently brief (i.e., ≤6 appointments) to be compatible with IPC. We conducted a literature review of published studies examining behavioral interventions that target prevalent behavioral medicine concerns and can feasibly be employed by IPC providers in adult primary care settings. A total of 67 published articles representing 63 original studies met eligibility criteria. We extracted data on the behavioral interventions employed, results comparing the active intervention to a comparison group, general fit with IPC, and methodological quality. The vast majority of studies examined brief interventions targeting sleep difficulties and physical activity. The most commonly employed interventions were derived from cognitive-behavioral therapy and motivational interviewing. Outcomes were generally statistically significantly in favor of the active intervention relative to comparison, with highly variable methodological quality ratings (range = 0-5; M = 2.0). Results are discussed in relation to the need for further evidence for brief behavioral interventions targeting other behavioral medicine concerns beyond sleep and physical activity, as well as for more specificity regarding the compatibility of such interventions with IPC practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  20. Incidence and significance of Multiple Primary Malignant Neoplasms

    International Nuclear Information System (INIS)

    Choi, Eun Kyung; Cho, Moon June; Ha, Sung Whan; Park, Charn Il; Bang, Young Ju; Kim, Noe Kyung

    1986-01-01

    To know the three questions about multiple primary cancers: 1) what are the characteristics of persons having multiple primary cancer? 2) Dose presence of a single primary concern after the susceptibility to multiple primary cancers? 3) Dose the location of one multiple primary cancer influence the site of others?, we analysed 121 cases of multiple primary malignant neoplasms registered in Seoul National University Hospital during 8years from July 1978 to August 1986. Of 121 cases, double primary malignant neoplasms were 119 cases and triple were 2 cases. The incidence of multiple primary malignant neoplasms was 0.7%. The metachronous tumor(> 6 months) was found in 70 cases and the median time between the first and the second was 32 months. The most commonly associated tumors were stomach and primary liver carcinoma. Cervix and Lung cancer, Stomach and Rectal cancer, Stomach and Esophagus cancer were also commonly associated

  1. Weight gain and the risk of knee replacement due to primary osteoarthritis: a population based, prospective cohort study of 225,908 individuals.

    Science.gov (United States)

    Apold, H; Meyer, H E; Nordsletten, L; Furnes, O; Baste, V; Flugsrud, G B

    2014-05-01

    To study the association between weight gain and the risk of knee replacement (KR) due to primary osteoarthritis (OA), and to evaluate whether the association differs by age. 225,908 individuals from national health screenings with repeated measurements of height and weight were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Cox proportional hazard regression was used to calculate sex-specific relative risks (RR) of KR according to change in Body Mass Index (BMI) and weight, corresponding analyses were done for age categories at first screening. During 12 years of follow up, 1591 participants received a KR due to primary OA. Men in the highest quarter of yearly change in BMI had a RR of 1.5 (95% confidence interval (CI) 1.1-1.9) of having a KR compared to those in the lowest quarter. For women the corresponding RR was 2.4 (95% CI 2.1-2.7). Men under the age of 20 at the first screening had a 26% increased risk for KR per 5 kg weight gain, for women the corresponding increase was 43%. At older age the association became weaker, and in the oldest it was lost. Weight gain increases the risk for later KR both in men and women. The impact of weight gain is strongest in the young, at older age the association is weak or absent. Our study suggests that future OA may be prevented by weight control and that preventive measures should start at an early age. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  2. Piping Flexibility Analysis of the Primary Cooling System of TRIGA 2000 Bandung Reactor due to Earthquake

    International Nuclear Information System (INIS)

    Rahardjo, H.P.

    2011-01-01

    Earthquakes in a nuclear installation can overload a piping system which is not flexible enough. These loads can be forces, moments and stresses working on the pipes or equipment. If the load is too large and exceed the allowable limits, the piping and equipment can be damaged and lead to overall system operation failure. The load received by piping systems can be reduced by making adequate piping flexibility, so all the loads can be transmitted homogeneously throughout the pipe without load concentration at certain point. In this research the analysis of piping stress has been conducted to determine the size of loads that occurred in the piping of primary cooling system of TRIGA 2000 Reactor, Bandung if an earthquake happened in the reactor site. The analysis was performed using Caesar II software-based finite element method. The ASME code B31.1 arranging the design of piping systems for power generating system (Power Piping Code) was used as reference analysis method. Modeling of piping systems was based on the cooling piping that has already been installed and the existing data reported in Safety Analysis Reports (SARs) of TRIGA 2000 reactor, Bandung. The quake considered in this analysis is the earthquake that occurred due to the Lembang fault, since it has the Peak Ground Acceleration (PGA) in the Bandung TRIGA 2000 reactor site. The analysis results showed that in the static condition for sustain and expansion loads, the stress fraction in all piping lines does not exceed the allowable limit. However, during operation moment, in dynamic condition, the primary cooling system is less flexible at sustain load, expansion load, and combination load and the stress fraction have reached 95,5%. Therefore a pipeline modification (re-routing) is needed to make pipe stress does not exceed the allowable stress. The pipeline modification was carried out by applied a gap of 3 mm in the X direction of the support at node 25 and eliminate the support at the node 30, also a

  3. Energy decisions reframed as justice and ethical concerns

    Science.gov (United States)

    Sovacool, Benjamin K.; Heffron, Raphael J.; McCauley, Darren; Goldthau, Andreas

    2016-05-01

    All too often, energy policy and technology discussions are limited to the domains of engineering and economics. Many energy consumers, and even analysts and policymakers, confront and frame energy and climate risks in a moral vacuum, rarely incorporating broader social justice concerns. Here, to remedy this gap, we investigate how concepts from justice and ethics can inform energy decision-making by reframing five energy problems — nuclear waste, involuntary resettlement, energy pollution, energy poverty and climate change — as pressing justice concerns. We conclude by proposing an energy justice framework centred on availability, affordability, due process, transparency and accountability, sustainability, equity and responsibility, which highlights the futurity, fairness and equity dimensions of energy production and use.

  4. Assessment of damage potential to the TMI-2 lower head due to thermal attack by core debris

    International Nuclear Information System (INIS)

    Cronenberg, A.W.; Behling, S.R.; Broughton, J.M.

    1986-06-01

    Camera inspection of the Three Mile Island Unit 2 (TMI-2) inlet plenum region has shown that approximately 10 to 20 percent of the core material loading may have relocated to the lower plenum. Although vessel integrity was maintained, a question of primary concern is ''how close to vessel failure'' did this accident come. This report summarizes the results of thermal analyses aimed at assessing damage potential to the TMI-2 lower head and attached instrument penetration tubes due to thermal attack by hot core debris. Results indicate that the instrument penetration nozzles could have experienced melt failure at localized hot spot regions, with attendant debris drainage and plugging of the instrument lead tubes. However, only minor direct thermal attack of the vessel liner is predicted

  5. Health-related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer a review

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind

    2012-01-01

    , physical, social, role and sexual function seemed to be impaired for a varying time after surgery. All the studies had methodical problems due to small sample size (12-44 patients) and different points of time for the assessment of HRQoL (12.3-47 months) which made it difficult to determine the period...... studies concerning surgery for primary advanced or recurrent rectal cancer and describing methods used for measuring HRQoL were considered. Results Seven studies were identified including two prospective longitudinal, three cross-sectional and two based on qualitative data. Global quality of life...

  6. Psychiatric symptomatology and personality in a population of primary care patients

    Directory of Open Access Journals (Sweden)

    Maja Biała

    2014-06-01

    Full Text Available introduction and objective. Psychiatric disorders (and their high rates of prevalence in primary care have been widely analyzed, but the problem of underdiagnosis remains unresolved. This becomes increasingly more important in rural health centres in the face of lack of epidemiological data from these centres. The aim of this study is focused on the relationship between general health, psychiatric symptomatology and personality characteristics in the context of an adequate diagnosis. materials and methods. 518 primary care patients in 6 Polish urban clinical centres were studied using (in order of administration: a sociodemographic questionnaire, the General Health Questionnaire (GHQ-28 and Eysenck Personality Questionnaire (EPQ-R. results. The investigated sample was representative for urban primary care patients. The findings confirmed a significant association between neuroticism and general health. The strongest relation with current functioning and mental distress of the patients (GHQ general score was observed in case of symptoms of anxiety and insomnia. The symptoms of depression may be the most difficult to identify (psychiatric symptoms assessed using GHQ sub-scales. conclusions. According to the GHQ assumptions and confirmed by the presented study, sub-threshold psychiatric symptomatology affects the functioning of primary care patients and their general health. This correlates with personality factors. Improving adequacy of diagnosis becomes extremely important, as it may often be the only chance for appropriate therapy of mental problems for people living in rural areas due to lower availability of specialistic mental services. Further epidemiological studies concerning rural primary care and prevalence of the spectrum of mental disorders need to be conducted.

  7. Facebook and body image concern in adolescent girls: A prospective study.

    Science.gov (United States)

    Tiggemann, Marika; Slater, Amy

    2017-01-01

    The primary aim of the study was to examine the relationship across time between Facebook use and body image concern in adolescent girls. A sample of 438 girls in the first two years (Years 8 and 9) of high school (aged 13-15 years) at Time 1 completed questionnaire measures of Facebook consumption and body image concerns, and again two years later (Time 2). Facebook involvement increased substantially over the two year time period. Body image concerns also increased. Number of Facebook friends was found to prospectively predict the observed increase in drive for thinness. On the other hand, internalization and body surveillance prospectively predicted the observed increase in number of Facebook friends. It was concluded that Facebook "friendships" represent a potent sociocultural force in the body image of adolescent girls. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:80-83). © 2016 Wiley Periodicals, Inc.

  8. 78 FR 24584 - Imposition of Special Measures Against Halawi Exchange Co. as a Financial Institution of Primary...

    Science.gov (United States)

    2013-04-25

    ... financial institution operating outside of the United States that is of primary money laundering concern... international money laundering and the financing of terrorism. Regulations implementing the BSA appear at 31 CFR..., class of transaction, or type of account is of ``primary money laundering concern,'' to require domestic...

  9. Maternal morbidity and mortality due to primary PPH-experience at ayub teaching hospital abbottabad

    International Nuclear Information System (INIS)

    Naz, H.; Sarwar, I.; Nisa, A.U.

    2008-01-01

    Postpartum Haemorrhage (PPH) remains a significant cause of maternal mortality and morbidity like hypovolemic shock, anaemia, multi organ failure, consumptive coagulopathy, disseminated intra vascular coagulation (DIC), blood transfusion related complications and hysterectomy leading to loss of childbearing potential. The present study was conducted to determine the frequency of PPH and the associated maternal morbidity at the Department of Gynaecology Unit B, Ayub Teaching Hospital Abbottabad. The study was carried out in the Department of Obstetrics and Gynaecology Unit B of the Ayub teaching Hospital Abbottabad from 18th April 2006 to 17 July 2006. The study population included all cases admitted with primary PPH during the study period. For calculation of frequencies, the total number of deliveries in the setting during the study period was used. All subjects underwent a complete obstetrical clinical workup comprising of history, general physical examination, abdominal and pelvic examination, relevant laboratory investigations. The maternal condition was assessed and managed according to established hospital protocols which included both pharmacological and surgical intervention. All maternal complications were noted and recorded on pre-designed proformas. Data was entered and analyzed by computer. A total of 50 cases of primary PPH were recorded during the study period. The frequency of PPH was calculated as 7.1%. The major cause of PPH was uterine atony found in 29 (58%) cases, followed by cervical, vaginal and perineal tears in 12 (24%) cases. Initially all patients were managed pharmacologically followed by surgical intervention. Subtotal (haemostatic) hysterectomy was performed in 10 (20%) cases. Maternal morbidity was detected in 31 (62%) of cases; the major morbidities were DIC in 3 (6%) cases. Acute renal failure in 3 (6%) patients and shock in 2 (9.9%) cases and anaemia in 20 (90.1%) cases. The study concludes that the frequency of primary PPH in this

  10. Case report: Management of severe posterior open bite due to primary failure of eruption.

    LENUS (Irish Health Repository)

    Mc Cafferty, J

    2010-06-01

    Primary failure of tooth eruption (PFE) is a rare condition affecting any or all posterior quadrants. Unilateral involvement of maxillary and mandibular quadrants causes a dramatic posterior open bite that requires complex management strategies.

  11. 77 FR 27381 - Financial Crimes Enforcement Network: Customer Due Diligence Requirements for Financial...

    Science.gov (United States)

    2012-05-10

    ...-AB15 Financial Crimes Enforcement Network: Customer Due Diligence Requirements for Financial... concerning customer due diligence requirements for financial institutions. DATES: Written comments on the... customer due diligence requirements for financial institutions.\\1\\ FinCEN received several comments on the...

  12. Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

    Science.gov (United States)

    Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

    2010-04-01

    To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  13. Environmental impact statements concerning final deposition of spent nuclear fuels a.o

    International Nuclear Information System (INIS)

    Larsen, B.; Schibbye, K.; Andersson, Johan; Norrby, S.; Timm, T.; Haegg, C.; Johansson, Gunnar

    1995-02-01

    Five governmental authorities concerned in licensing a swedish nuclear waste repository have outlined recommendations for what should be covered by an environmental impact statement, i.e. defined which laws should be applied, tried to develop a consensus on the handling the EIS in the licensing procedure, to identify potential problems due to prevailing (or non-existing) rules on EIS especially concerning roles and conflicts of objective

  14. Concern for Lost Income Following Donation Deters Some Patients From Talking to Potential Living Donors.

    Science.gov (United States)

    Rodrigue, James R; Schold, Jesse D; Mandelbrot, Didier A; Taber, David J; Phan, Van; Baliga, Prabhakar K

    2016-12-01

    Some living kidney donors report lost income during recovery from surgery. Little is known about whether concern for living donor's lost income affects the decision to undergo donation evaluation and the willingness of transplant candidates to discuss living kidney donation (LKD) with others. To examine whether transplant patients were told by potential donors about lost income concerns and whether patients chose not to discuss LKD with others due to lost income concerns. Kidney transplant patients (185 wait-listed candidates, 171 deceased donor recipients, and 100 live donor recipients) at 2 centers completed a questionnaire to assess whether concern about donor's lost income was a consideration in discussion about LKD with others. One-third (32%) were told by a family member/friend that they were willing to donate but were concerned about potential lost income. The majority of those who expressed financial concern (64%) did not initiate donation evaluation. Many patients (42%) chose not to discuss living donation with a family member/friend due to concern about the impact of lost income on the donor. In the multivariable model, lower annual household income was the only statistically significant predictor of both having a potential donor expressing lost income concern and choosing not to talk to someone because of lost income concern. Findings from the current study underscore how concern about income loss for living donors may affect decision-making by both transplant candidates and potential donors.

  15. 76 FR 9403 - Finding That the Lebanese Canadian Bank SAL Is a Financial Institution of Primary Money...

    Science.gov (United States)

    2011-02-17

    ... Bank SAL Is a Financial Institution of Primary Money Laundering Concern AGENCY: Financial Crimes...'') is a financial institution of primary money laundering concern. DATES: The finding made in this... Law 107-56. Title III of the USA PATRIOT Act amended the anti- money laundering provisions of the Bank...

  16. The security concern on internet banking adoption among Malaysian banking customers.

    Science.gov (United States)

    Sudha, Raju; Thiagarajan, A S; Seetharaman, A

    2007-01-01

    The existing literatures highlights that the security is the primary factor which determines the adoption of Internet banking technology. The secondary information on Internet banking development in Malaysia shows a very slow growth rate. Hence, this study aims to study the banking customers perception towards security concern and Internet banking adoption through the information collected from 150 sample respondents. The data analysis reveals that the customers have much concern about security and privacy issue in adoption of Internet banking, whether the customers are adopted Internet banking or not. Hence, it infers that to popularize Internet banking system there is a need for improvement in security and privacy issue among the banking customers.

  17. Rapid Assessment of Stakeholder Concerns about Public Health. An Introduction to a Fast and Inexpensive Approach Applied on Health Concerns about Intensive Animal Production Systems.

    Science.gov (United States)

    Kraaij-Dirkzwager, Marleen; van der Ree, Joost; Lebret, Erik

    2017-12-11

    To effectively manage environmental health risks, stakeholders often need to act collectively. Stakeholders vary in their desire to act due to many factors, such as knowledge, risk perception, interests, and worldviews. Understanding their perceptions of the issues at stake is crucial to support the risk governance process. Even though concern assessment is a pivotal element of risk governance, few tools for rapid assessment are reported in the literature. We tested a rapid and relatively cheap approach, taking the Dutch debate on Intensive Animal Production Systems (IAPS) and health as an example. Dutch policy-oriented publications on IAPS and health and ten semi-structured in-depth interviews with a variety of stakeholders were analyzed to identify stakeholders and concerns involved in the Dutch debate about IAPS and health. Concerns were mapped and a stakeholder network was derived. Three classes of concerns were recognized in the discussions about IAPS and health: concerns related to health risks, concerns regarding the activity causing the risks (IAPS), and concerns about the process to control the risks. The notions of 'trust' and 'scientific uncertainty' appeared as important themes in the discussions. Argumentation based on concerns directly related to health risks, the activity causing the risk (IAPS), and its risk management can easily become muddled up in a societal debate, limiting the development of effective action perspectives. Acknowledging these multiple stakeholder concerns can clarify the positions taken by stakeholders and allow for more and other action perspectives to develop.

  18. Rapid Assessment of Stakeholder Concerns about Public Health. An Introduction to a Fast and Inexpensive Approach Applied on Health Concerns about Intensive Animal Production Systems

    Directory of Open Access Journals (Sweden)

    Marleen Kraaij-Dirkzwager

    2017-12-01

    Full Text Available To effectively manage environmental health risks, stakeholders often need to act collectively. Stakeholders vary in their desire to act due to many factors, such as knowledge, risk perception, interests, and worldviews. Understanding their perceptions of the issues at stake is crucial to support the risk governance process. Even though concern assessment is a pivotal element of risk governance, few tools for rapid assessment are reported in the literature. We tested a rapid and relatively cheap approach, taking the Dutch debate on Intensive Animal Production Systems (IAPS and health as an example. Dutch policy-oriented publications on IAPS and health and ten semi-structured in-depth interviews with a variety of stakeholders were analyzed to identify stakeholders and concerns involved in the Dutch debate about IAPS and health. Concerns were mapped and a stakeholder network was derived. Three classes of concerns were recognized in the discussions about IAPS and health: concerns related to health risks, concerns regarding the activity causing the risks (IAPS, and concerns about the process to control the risks. The notions of ‘trust’ and ‘scientific uncertainty’ appeared as important themes in the discussions. Argumentation based on concerns directly related to health risks, the activity causing the risk (IAPS, and its risk management can easily become muddled up in a societal debate, limiting the development of effective action perspectives. Acknowledging these multiple stakeholder concerns can clarify the positions taken by stakeholders and allow for more and other action perspectives to develop.

  19. Primary care for opioid use disorder

    Directory of Open Access Journals (Sweden)

    Mannelli P

    2016-08-01

    Full Text Available Paolo Mannelli,1 Li-Tzy Wu1–41Department of Psychiatry and Behavioral Sciences, 2Department of Medicine, 3Duke Clinical Research Institute, Duke University Medical Center, 4Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USARecent reports on prescription opioid misuse and abuse have described unprecedented peaks of a national crisis and the only answer is to expand prevention and treatment, including different levels of care.1 Nonetheless, concerns remain about the ability of busy primary care settings to manage problem opioid users along with other patients. In particular, proposed extensions of buprenorphine treatment, a critically effective intervention for opioid use disorder (OUD, are cautiously considered due to the potential risk of misuse or abuse.2 General practitioners are already facing this burden daily in the treatment of chronic pain, and expert supervision and treatment model adjustment are needed to help improve outcomes. Approximately 20% of patients in primary care have noncancer pain symptoms, with most of them receiving opioid prescriptions by their physicians, and their number is increasing.3 Pain diagnoses are comparable in severity to those of tertiary centers and are complicated by significant psychiatric comorbidity, with a measurable lifetime risk of developing OUD.4,5 Some primary care physicians report frustration about opioid abuse and diversion by their patients; support from pain specialists would improve their competence, the quality f their performance, and the ability to identify patients at risk of opioid misuse.6 Thus, buprenorphine treatment should not be adding to a complex clinical scenario. To this end, the promising models of care emphasize the integration of medical with psychological and pharmacological expertise for the management of OUD. 

  20. Children's Behavioral Adjustment in Pre-Primary Schools in Tanzania : A Multilevel Approach

    NARCIS (Netherlands)

    Shavega, Theresia J.; Brugman, Daniel; van Tuijl, Cathy

    2014-01-01

    Research Findings: The present study concerns children's behavioral adjustment in the context of pre-primary schools in Tanzania. Twenty teachers and 320 children from 20 pre-primary schools participated in the study. Teacher-child relationships, children's behavioral adjustment, and teachers'

  1. Psychological treatment of social anxiety disorder improves body dysmorphic concerns.

    Science.gov (United States)

    Fang, Angela; Sawyer, Alice T; Aderka, Idan M; Hofmann, Stefan G

    2013-10-01

    Social anxiety disorder and body dysmorphic disorder are considered nosologically distinct disorders. In contrast, some cognitive models suggest that social anxiety disorder and body dysmorphic disorder share similar cognitive maintenance factors. The aim of this study was to examine the effects of psychological treatments for social anxiety disorder on body dysmorphic disorder concerns. In Study 1, we found that 12 weekly group sessions of cognitive-behavioral therapy led to significant decreases in body dysmorphic symptom severity. In Study 2, we found that an attention retraining intervention for social anxiety disorder was associated with a reduction in body dysmorphic concerns, compared to a placebo control condition. These findings support the notion that psychological treatments for individuals with primary social anxiety disorder improve co-occurring body dysmorphic disorder symptoms. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Parental concerns towards children and adolescents with epilepsy in Sri Lanka--Qualitative study.

    Science.gov (United States)

    Murugupillai, Roshini; Wanigasinghe, Jithangi; Muniyandi, Ravi; Arambepola, Carukshi

    2016-01-01

    Social, cultural, psychological and many other factors significantly impact the lives of epileptic children and their families. Parental concerns towards their children are less known in south Asian children with epilepsy. We aimed to identify the parental concerns regarding their children and adolescents with epilepsy in Sri Lanka. We carried out qualitative study in 3 districts of Sri Lanka, comprising 16 in-depth interviews with parents of children and adolescents with epilepsy and 3 focus group discussions with primary caregivers of epileptic children and key informants (schoolteachers, public health staffs). Content analysis of the interview data was performed. Parental concerns were spread among seven themes that emerged from the content analysis. These concerns were about the child's functioning in areas such as physical, behavioural, psychological and social, education, concerns related to anti-epileptic therapy and epilepsy as a disease. Parents were more concerned about their child's safety, educational achievements and future prospects in terms of employment and marriage. Unpredictability of seizures, fear of stigma and unawareness of epilepsy were the main reasons voiced by the parents for having such concerns. Increased concern and perception of vulnerability was seen among parents whose children had epilepsy and co-morbid illness. Parental concerns towards their children and adolescents show a multidimensional construct. Unpredictability of seizures, fear of stigma and unawareness of epilepsy were identified as key influential factors in moulding the parental concerns. Copyright © 2015. Published by Elsevier Ltd.

  3. Modelling categorical data to identify factors influencing concern for the natural environment in Iran.

    Science.gov (United States)

    Parizanganeh, Abdolhossein; Lakhan, V Chris; Yazdani, Mahmoud; Ahmad, Sajid R

    2011-10-01

    Loglinear modelling techniques were used to identify the interactions and interrelationships underlying categorical environmental concern data collected from 9062 respondents in Iran. After fitting various loglinear models to the data, the most parsimonious model highlighted that a combination of interacting factors, namely educational attainment, age, gender, and residential location were responsible for influencing personal concern for the environment. Although high educational attainment had a close correspondence with high concern for the environment the loglinear results, when visualized with a geographical information system, demonstrated wide spatial variations in educational attainment and concern for the environment. Nearly two-thirds of the respondents were not highly educated, and were therefore not highly concerned for the environment. The finding that both rural and urban male and female respondents in the 15-24 years age category, with 10-12 years of education, had the strongest interaction with personal concern for the environment could be beneficial for policy planners to utilize education as the primary instrument to enhance environmental governance and prospects for sustainable development. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. 78 FR 34169 - Notice of Finding That Liberty Reserve S.A. Is a Financial Institution of Primary Money...

    Science.gov (United States)

    2013-06-06

    ... Reserve S.A. Is a Financial Institution of Primary Money Laundering Concern AGENCY: Financial Crimes... is of primary money laundering concern. DATES: The finding referred to in this notice was effective... money laundering and the financing of terrorism. Regulations implementing the BSA appear at 31 CFR...

  5. Primary Meningeal Rhabdomyosarcoma

    Directory of Open Access Journals (Sweden)

    Manisha Palta

    2011-01-01

    Full Text Available Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13. Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC systemic therapy.

  6. Primary meningeal rhabdomyosarcoma.

    Science.gov (United States)

    Palta, Manisha; Riedel, Richard F; Vredenburgh, James J; Cummings, Thomas J; Green, Scott; Chang, Zheng; Kirkpatrick, John P

    2011-01-01

    Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy.

  7. Primary Meningeal Rhabdomyosarcoma

    Science.gov (United States)

    Palta, Manisha; Riedel, Richard F.; Vredenburgh, James J.; Cummings, Thomas J.; Green, Scott; Chang, Zheng; Kirkpatrick, John P.

    2011-01-01

    Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy. PMID:21772793

  8. A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context.

    Science.gov (United States)

    Kirkland, Katherine; Sherman, Mya; Covert, Hannah; Barlet, Grace; Lichtveld, Maureen

    Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels. This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health. The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues. The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories. This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

  9. Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

    Science.gov (United States)

    Smith, Patrick D; Boyd, Cynthia; Bellantoni, Julia; Roth, Jill; Becker, Kathleen L; Savage, Jessica; Nkimbeng, Manka; Szanton, Sarah L

    2016-02-01

    To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote

  10. Public Information Programmes on Risks Due to Radon. Annex V

    International Nuclear Information System (INIS)

    2015-01-01

    Public concern about radon is generally lower than public concern about other comparable risks, or about much lower risks such as those associated with artificial radiation. The public tends to be most concerned about hazards that are: (a) Human made rather than natural; (b) Imposed by a human agency rather than arising by chance; (c) Able to cause harm to groups rather than individuals; (d) Obvious, immediate and ‘dread’ rather than covert, delayed and familiar. None of the four above mentioned factors that would increase concern apply to radon, and a study has found that householders often deny that a health risk exists. For this reason, public information programmes are necessary for the risks due to radon to be taken seriously

  11. Early identification in primary health care of people at risk for sick leave due to work-related stress - study protocol of a randomized controlled trial (RCT).

    Science.gov (United States)

    Holmgren, Kristina; Sandheimer, Christine; Mårdby, Ann-Charlotte; Larsson, Maria E H; Bültmann, Ute; Hange, Dominique; Hensing, Gunnel

    2016-11-25

    Early identification of persons at risk of sickness absence due to work-related stress is a crucial problem for society in general, and primary health care in particular. Tho date, no established method to do this exists. This project's aim is to evaluate whether systematic early identification of work-related stress can prevent sickness absence. This paper presents the study design, procedure and outcome measurements, as well as allocation and baseline characteristics of the study population. The study is a two-armed randomized controlled trial with follow-up at 3, 6 and 12 months. Non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers (PHCC) were eligible to participate. At baseline work-related stress was measured by the Work Stress Questionnaire (WSQ), combined with feedback at consultation, at PHCC. The preventive intervention included early identification of work-related stress by the WSQ, GP training in the use of WSQ, GP feedback at consultation and finding suitable preventive measures. A process evaluation was used to explore how to facilitate future implementation and structural use of the WSQ at the PHCC. The primary outcome to compare the preventive sick leave intervention by the general practitioner (GP) versus treatment as usual is sick leave data obtained from the Swedish Social Insurance Agency register. Early screening for sick leave due to work-related stress makes it possible not only to identify those at risk for sick leave, but also to put focus on the patient's specific work-related stress problems, which can be helpful in finding suitable preventive measures. This study investigates if use of the WSQ by GPs at PHCCs, combined with feedback at consultation, prevents future sickness absence. ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.

  12. 78 FR 24593 - Notice of Finding That Kassem Rmeiti & Co. For Exchange Is a Financial Institution of Primary...

    Science.gov (United States)

    2013-04-25

    .... For Exchange Is a Financial Institution of Primary Money Laundering Concern AGENCY: Financial Crimes... United States that is of primary money laundering concern. DATES: The finding referred to in this notice... the anti- money laundering provisions of the Bank Secrecy Act (``BSA''), codified at 12 U.S.C. 1829b...

  13. Assessing primary care in Austria: room for improvement.

    Science.gov (United States)

    Stigler, Florian L; Starfield, Barbara; Sprenger, Martin; Salzer, Helmut J F; Campbell, Stephen M

    2013-04-01

    There is emerging evidence that strong primary care achieves better health at lower costs. Although primary care can be measured, in many countries, including Austria, there is little understanding of primary care development. Assessing the primary care development in Austria. A primary care assessment tool developed by Barbara Starfield in 1998 was implemented in Austria. This tool defines 15 primary care characteristics and distinguishes between system and practice characteristics. Each characteristic was evaluated by six Austrian primary care experts and rated as 2 (high), 1 (intermediate) or 0 (low) points, respectively, to their primary care strength (maximum score: n = 30). Austria received 7 out of 30 points; no characteristic was rated as '2' but 8 were rated as '0'. Compared with the 13 previously assessed countries, Austria ranks 10th of 14 countries and is classified as a 'low primary care' country. This study provides the first evidence concerning primary care in Austria, benchmarking it as weak and in need of development. The practicable application of an existing assessment tool can be encouraging for other countries to generate evidence about their primary care system as well.

  14. Zika virus: Current concerns in India

    Directory of Open Access Journals (Sweden)

    Sumit Bhardwaj

    2017-01-01

    Full Text Available With confirmation of Zika virus (ZIKV presence in India, screening of a large number of febrile illness samples yielded only four positive cases. In this review, we address the current concern with context to India. The possible reasons for low level of Zika prevalence in India have been discussed, by extracting some probable explanations from previous experience of chikungunya virus-vector model/studies. In the current context, it is hypothesized that Indian mosquito strains have lower susceptibility gradient/threshold for ZIKV. The very low positivity in the humans also indicates low levels of mosquito-human-mosquito transmission cycle. There is also a need to look for the existence of any such animal cycle/sylvatic involvement in India. The recently detected four cases in India show local transmission of ZIKV suggesting that ZIKV might have been present in India since long time. The earlier vector-virus relationship studies with chikungunya suggested that in due course of time, ZIKV might become a major public health concern in the future.

  15. [Multiple primary colorectal cancer: Clinical aspects].

    Science.gov (United States)

    Soldatkina, N V; Kit, O I; Gevorkyan, Yu A; Milakin, A G

    to define some clinical characteristics of synchronous and metachronous colorectal cancer (CRC). The investigation was concerned with the data of 150 patients with T1-4N0-2M0-1 multiple primary CRC. The clinical, biological, and morphological characteristics of synchronous and metachronous tumors were analyzed. Multiple primary tumors were 6.01% of all the cases of CRC. There was a preponderance of synchronous CRC (63.75%) with the tumor localized in the sigmoid colon and rectum. In women, synchronous colorectal tumors were more often concurrent with breast tumors; metachronous ones were detected after treatment for genital tumors. In men, synchronous colorectal tumors were more frequently concurrent with kidney cancer; metachronous ones were identified after treatment for gastric cancer. The found characteristics of multiple primary colorectal tumors may be taken in account in programs for both primary diagnosis and follow-up after treatment for malignant tumors, which will be able to improve the early detection of cancer patients and their treatment results.

  16. Injury due to thorotrast

    International Nuclear Information System (INIS)

    Mori, Takesaburo

    1976-01-01

    A synthetic study was performed on some of those to whom Thorotrast had been injected, in Japan. In the epidemiological study of 147 war woundeds to whom Thorotrast had been injected, it was noted that the Thorotrast injection increased the mortality rate and the incidences of malignant hepatic tumor, liver cirrhosis, and hematological diseases. Clinical study of 44 of them showed that the Thorotrast injection resulted in liver and hematopoietic hypofunctions. Analysis of the dissection of the injected area in 118 cases showed malignant hepatic tumor in 63.5%, liver cirrhosis in 14.4% and hematological diseases in 10.2%. The total of the three types of disease was 88.1%. Histological classification showed that of the malignant hepatic tumors due to Thorotrast, hepatobiliary cancer and hemangioendothelioma of the liver were frequent. By the comparison of the absorbed dose in the liver of the malignant hepatic tumors due to Thorotrast with that of the cancers developed in animal experiments, it was noted that the carcinogenic dose was a mean of 2,000 - 3,000 rad by accumulated dose. It was elucidated that carcinogenesis and fibrination were primary in injury due to Thorotrast, i.e., late injury due to Thorotrast, and that the increase in the accumulated dose in rogans and the increase of the local dose due to the gigantic growth of Thorotrast granules in organs greatly influenced carninogenesis and fibrination. (Chiba, N.)

  17. Skin cancer concerns and genetic risk information-seeking in primary care.

    Science.gov (United States)

    Hay, J; Kaphingst, K A; Baser, R; Li, Y; Hensley-Alford, S; McBride, C M

    2012-01-01

    Genomic testing for common genetic variants associated with skin cancer risk could enable personalized risk feedback to motivate skin cancer screening and sun protection. In a cross-sectional study, we investigated whether skin cancer cognitions and behavioral factors, sociodemographics, family factors, and health information-seeking were related to perceived importance of learning about how (a) genes and (b) health habits affect personal health risks using classification and regression trees (CART). The sample (n = 1,772) was collected in a large health maintenance organization as part of the Multiplex Initiative, ranged in age from 25-40, was 53% female, 41% Caucasian, and 59% African-American. Most reported that they placed somewhat to very high importance on learning about how genes (79%) and health habits (88%) affect their health risks. Social influence actors were associated with information-seeking about genes and health habits. Awareness of family history was associated with importance of health habit, but not genetic, information-seeking. The investment of family and friends in health promotion may be a primary motivator for prioritizing information-seeking about how genes and health habits affect personal health risks and may contribute to the personal value, or personal utility, of risk information. Individuals who seek such risk information may be receptive to interventions aimed to maximize the social implications of healthy lifestyle change to reduce their health risks. Copyright © 2011 S. Karger AG, Basel.

  18. Total hip arthroplasty revision due to infection: a cost analysis approach.

    Science.gov (United States)

    Klouche, S; Sariali, E; Mamoudy, P

    2010-04-01

    The treatment of total hip arthroplasty (THA) infections is long and costly. However,the number of studies in the literature analysing the real cost of THA revision in relation to their etiology, including infection, is limited. The aim of this retrospective study was to determine the cost of revision of infected THA and to compare these costs to those of primary THA and revision of non-infected THA. We performed a retrospective cost analysis for the year 2006 using an identical analytic accounting system in each hospital department (according to internal criteria) based on allotment of direct costs and receipts for each department. From January to December 2006, 424 primary THA, 57 non-infected THA revisions and 40 THA revisions due to infection were performed. The different cost areas of the patient's treatment were identified.This included preoperative medical work-up, medicosurgical management during hospital stay,a second stay in an orthopedic rehabilitation hospital (ORH) and post-hospitalisation antibiotic therapy after revision due to infection, as well as home-based hospitalisation (HH) costs, if this was the selected alternative option. We used the national health insurance fee schedule found in the "Common classification of medical procedures" and the "General nomenclature of professional procedures" applicable in France since September 1, 2005. Hospital costs included direct costs (hospital overhead costs) and indirect costs, (medical, surgical, technical settings and net general service expenses). The calculation of HH costs and ORH costs were based on the average daily charge of these departments. The cost of primary THA was used as the reference.We then compared our surgical costs with those found for the corresponding comparable hospital stay groups (Groupes homogènes de séjour). The average hospital stay (AHS) was 7.5 +/- 1.8 days for primary THA, 8.9 +/- 2.2 days for non-infected revisions and 30.6 +/- 14.9 days for revisions due to infection

  19. Primary Hypothyroidism With Markedly High Prolactin

    Directory of Open Access Journals (Sweden)

    MOHD SALEEM ANSARI

    2016-04-01

    Full Text Available Secondary Pituitary enlargement due to primary hypothyroidism is not a common manifestation. The loss of thyroxin feedback inhibition in primary hypothyroidism causes overproduction of thyroid-releasing hormone (TRH, which results in secondary pituitary enlargement.TRH has a weak stimulatory effect on lactotroph cells of pituitary, so mild to moderate rise in prolactin (PRL level is expected. We report a 67 years old female who presented with a large pituitary mass and very high level of TSH with a significant rise in PRL level. In this case the diagnosis of seller mass was challenging, it was difficult to distinguish between pituitary prolactinoma and primary hypothyroidism with secondary pituitary hyperplasia. The thyroid hormone replacement proved that hyperprolactinemia was due to hyperplasia of the pituitary gland.Hence, the correct diagnosis and thyroid hormone therapy can prevent unnecessary treatment with dopamine agonist.

  20. Perceived risk of mental health problems in primary care

    Directory of Open Access Journals (Sweden)

    Constança ePaúl

    2015-11-01

    Full Text Available In the face of limited resources and an ageing population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalisation, hospitalisation and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care. We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community (RISC to rank perceived risk of mental health concerns (including neurocognitive and mood disorders from 1 (mild to 3 (Severe. The mean age of the 4499 people assessed was 76.3 years (sd=7.3 and 2645 (58.8% were female. According to the primary care team 1616 (35.9% were perceived to have mental health concerns of whom 847 (52.4% were mild, 559 (34.6% were moderate and 210 (13% were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR=2.22, 95% CI 1.83-2.69 for institutionalisation; OR=1.66, 95% CI 1.41-1.94 for hospitalisation; OR=1.69, 95% CI 1.42-2.01 for death. These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

  1. NetGirls: the Internet, Facebook, and body image concern in adolescent girls.

    Science.gov (United States)

    Tiggemann, Marika; Slater, Amy

    2013-09-01

    The primary aim of the study was to examine the relationship between Internet exposure and body image concern in adolescent girls, with a particular focus on the social networking site of Facebook. A sample of 1,087 girls in the first two years (Years 8 and 9) of high school (aged 13-15 years) completed questionnaire measures of Internet consumption and body image concerns. The overwhelming majority of girls (95.9%) had access to the Internet in their home. Time spent on the Internet was significantly related to internalization of the thin ideal, body surveillance, and drive for thinness. Further, 75% of the girls had a Facebook profile, and spent an average of 1.5 hours there daily. Facebook users scored significantly more highly on all body image concern measures than non-users. It was concluded that the Internet represents a potent socio-cultural medium of relevance to the body image of adolescent girls. Copyright © 2013 Wiley Periodicals, Inc.

  2. Primary Open-Angle Glaucoma and Serum Lipids

    Directory of Open Access Journals (Sweden)

    Suzana Pavljašević

    2009-02-01

    Full Text Available The aim of this paper was to prove the relation between serum lipid values (cholesterol, trig- lyceride, low density cholesterol, high density cholesterol and primary open -angle glaucoma. The study includes two patient groups: 50 patients with primary open-angle glaucoma and 50 patients without this disease. However, all 100 patients were tested for serum lipid values. The research covered a period of six months (from May to December 2007.. Primary open-angle glaucoma was diagnosed with intraocular pressure values (between 20,1 and 25,6 mm Hg measured with Schiotz tonometry. The visual field changes were confirmed with Goldmann perimetry. The gonioscopies were done for diagnosis confirmation. The serum lipid values were confirmed with enzymatic colorimetry in vitro method. U-test (Mann-Witney-Wilcox test and t-test, as nonparametric tests, were used for statistical evaluations. The cholesterol mean value in the test group was 6,14 mol/dm1 (3,20-8,10 mol/dm3 whereas in the control group it was 5,96 mol/dm3 (2,70-8,80 mol/dm3. U-test was with negative ranks (z=-0,83 AS=0,678. The triglyceride mean value in the test group was 2,38 mol/dm3 (0,84-11,73 mol/m3 and in the control group it was 2,04 mol/dm3 (0,63-5,89 mol/dm3. U-test was with positive ranks (z=0,950 AS=0,342. High density cholesterol was average in the test group with 1,45 mol/dm3 (0,71-3,40 mol/dm3 and in the control group 1,40 mol/m3 (0,80-3,20 mol/dm3. Low density cholesterol in the test group was 3,98 mol/m3 (1,82-6,49 mol/m3 and in the control group 4,08 mol/m3 (2,69-5,69 mol/m3. These results had positive ranks according to U-test. Serum lipid values could be one of predictable factors in primary open-angle glaucoma diagnosis. Due to the patient age, cholesterol values, as common factors in primary open-angle glaucoma and atherosclerosis genesis, could be concern in the same aetiology based on dyslipidaemia as well.

  3. Epide·miology of non-fatal injuries due to external causes in ...

    African Journals Online (AJOL)

    1991-04-20

    Apr 20, 1991 ... as well as information concerning spatial and temporal details ... In 1984, trauma was the leading cause of potential years of life .... making up the Soweto primary health care system, because they treated ... no longer than 24 hours before being interviewed. .... projected disability and projected time off work.

  4. Phonic Attenuation due to Screen-Barriers

    Directory of Open Access Journals (Sweden)

    Vasile Bacria

    2011-10-01

    Full Text Available The technique of noise decreasing admits two basic approaches: an active approach and a passive one. In the frame of passive method one can count the employment of screen-barriers. In this paper we present some considerations on sound attenuation due to screen-barriers emphasizing the elements which influence it. The elucidation of these elements is made by measurements. The obtained results can be applied in every other practical situation concerning the protection against noise.

  5. Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

    LENUS (Irish Health Repository)

    Agyapong, Vincent Israel Opoku

    2012-04-17

    Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

  6. Collection of laws and ordinances concerning regulation of atomic energy, 1989 edition. 1989 ed.

    International Nuclear Information System (INIS)

    1989-01-01

    The collection of the laws and ordinances concerning the regulation of atomic energy, 1989 edition, was published by the Nuclear Safety Bureau, Science and Technology Agency. First, the abbreviated expressions of 56 laws and ordinances are shown. The contents are divided into Part 1: Fundamental laws and ordinances, Part 2: Regulation of nuclear source materials, nuclear fuel materials and nuclear reactors, Part 3: Prevention of radiation injuries due to radioactive isotopes and others, and Part 4: Related laws and ordinances. In Part 1, Atomic Energy Fundamental Act, Act of Institution of Atomic Energy Commission and Nuclear Safety Commission of Japan, Law Concerning the Technical Standard for Prevention of Radiation Injuries and 9 others are included. In Part 2, Law Concerning Regulation of Nuclear Source Materials, Nuclear Fuel Materials and Nuclear Reactors and 45 others are included. In Part 3, Law Concerning Prevention of Radiation Injuries Due to Radioisotopes and Others and 25 others are included. In Part 4, Electricity Enterprises Act, Road Transport and Vehicles Act, Ships' Safety Law, Labor Safety and Hygiene Law, Japan Atomic Energy Research Institute Law and 29 others are included. The contents are those as of November 30, 1988. (Kako, I.)

  7. Radioisotopes in the primary circuit of a fast reactor

    International Nuclear Information System (INIS)

    Berlin, M.; Cauvin, M.

    1976-01-01

    In the frame of the research performed to understand the behaviour of the radioactive isotopes of iodine in the primary coolant circuit of fast reactor, a simple theoretical model is proposed. Results concerning PHENIX and RAPSODIE are given

  8. Estimating Global Burden of Disease due to congenital anomaly

    DEFF Research Database (Denmark)

    Boyle, Breidge; Addor, Marie-Claude; Arriola, Larraitz

    2018-01-01

    OBJECTIVE: To validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal...... the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention....

  9. Efficacy and safety of vedolizumab as a treatment option for moderate to severe refractory ulcerative colitis in two patients after liver transplant due to primary sclerosing cholangitis

    Directory of Open Access Journals (Sweden)

    Raúl Vicente Olmedo-Martín

    Full Text Available Vedolizumab is a humanized IgG1 monoclonal antibody that selectively blocks the lymphocyte integrin α4β7 and prevents its interaction with endothelial adhesion molecules and subsequent transmigration to the gastrointestinal tract. The drug was approved in 2014 for the induction and maintenance treatment of ulcerative colitis and moderate to severe Crohn's disease that is refractory or intolerant to conventional treatment with corticoids and immunosuppressants and/or anti-TNFα drugs. However, inflammatory bowel disease has a variable behavior following liver transplant. One third of patients with ulcerative colitis associated with primary sclerosing cholangitis are expected to deteriorate despite receiving immunosuppression to prevent rejection. There is limited experience with anti-TNFα agents in patients with inflammatory bowel disease in the setting of liver transplantation and the studies to date involve a limited number of cases. The efficacy and safety data of vedolizumab in this situation are unreliable and very preliminary. We present two cases with the aim to present the efficacy and safety of vedolizumab after one year of treatment in two patients who underwent a transplant due to primary sclerosing cholangitis. One case had de novo post-transplant ulcerative colitis refractory to two anti-TNFα drugs (golimumab and infliximab. The other patient had a colostomy due to fulminant colitis and developed severe ulcerative proctitis refractory to infliximab after reconstruction with an ileorectal anastomosis.

  10. Reduced empathic concern leads to utilitarian moral judgments in trait alexithymia.

    Science.gov (United States)

    Patil, Indrajeet; Silani, Giorgia

    2014-01-01

    Recent research with moral dilemmas supports dual-process model of moral decision making. This model posits two different paths via which people can endorse utilitarian solution that requires personally harming someone in order to achieve the greater good (e.g., killing one to save five people): (i) weakened emotional aversion to the prospect of harming someone due to reduced empathic concern for the victim; (ii) enhanced cognition which supports cost-benefit analysis and countervails the prepotent emotional aversion to harm. Direct prediction of this model would be that personality traits associated with reduced empathy would show higher propensity to endorse utilitarian solutions. As per this prediction, we found that trait alexithymia, which is well-known to have deficits in empathy, was indeed associated with increased utilitarian tendencies on emotionally aversive personal moral dilemmas and this was due to reduced empathic concern for the victim. Results underscore the importance of empathy for moral judgments in harm/care domain of morality.

  11. Reduced empathic concern leads to utilitarian moral judgments in trait alexithymia

    Directory of Open Access Journals (Sweden)

    Indrajeet ePatil

    2014-05-01

    Full Text Available Recent research with moral dilemmas supports dual-process model of moral decision making. This model posits two different paths via which people can endorse utilitarian solution that requires personally harming someone in order to achieve the greater good (e.g., killing one to save five people: (i weakened emotional aversion to the prospect of harming someone due to reduced empathic concern for the victim; (ii enhanced cognition which supports cost-benefit analysis and countervails the prepotent emotional aversion to harm. Direct prediction of this model would be that personality traits associated with reduced empathy would show higher propensity to endorse utilitarian solutions. As per this prediction, we found that trait alexithymia, which is well-known to have deficits in empathy, was indeed associated with increased utilitarian tendencies on emotionally aversive personal moral dilemmas and this was due to reduced empathic concern for the victim. Results underscore the importance of empathy for moral judgments in harm/care domain of morality.

  12. Pediatric oncologists' attitudes towards involving adolescents in decision-making concerning research participation.

    NARCIS (Netherlands)

    Vries, M.C. de; Wit, J.M.; Engberts, D.P.; Kaspers, G.J.L.; Leeuwen, E. van

    2010-01-01

    BACKGROUND: Various regulations and guidelines stipulate the importance of involving adolescents in decision-making concerning research participation. Several studies have shown that in the context of pediatric oncology this involvement is difficult to achieve due to emotional stress, the complexity

  13. Emissions of volatile organic compounds during the ship-loading of petroleum products: Dispersion modelling and environmental concerns.

    Science.gov (United States)

    Milazzo, Maria Francesca; Ancione, Giuseppa; Lisi, Roberto

    2017-12-15

    Emissions due to ship-loading of hydrocarbons are currently not addressed neither by the Directive on the integrated pollution prevention or by other environmental regulations. The scope of this study is to point towards the environmental and safety concerns associated with such emissions, even if proper attention has not been given to this issue until now. In order to achieve this goal, the modelling of the emission volatile organic compounds (VOC), due to ship-load operations at refineries has been made by means of the definition of a simulation procedure which includes a proper treatment of the hours of calm. Afterwards, a quantitative analysis of VOC dispersion for an Italian case-study is presented with the primary aims: (i) to develop and verify the validity of the approach for the modelling of the emission sources and of the diffusion of these contaminants into the atmosphere by a proper treatment of the hours of calm and (ii) to identify their contribution to the total VOC emitted in a typical refinery. The calculated iso-concentration contours have also been drawn on a map and allowed the identification of critical areas for people protecting by the adoption of abatement solutions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Perturbation of baseline thermal stress in the Mound 9516 Shipping Package primary containment vessel

    International Nuclear Information System (INIS)

    Sansalone, K.H.F.

    1995-01-01

    Full-capacity loading of heat sources into the Mound 9516 Shipping Package primary containment vessel (PCV) results in temperature gradients which are symmetric, due to the axisymmetry of the package design. Concern over the change in thermal gradients (and therefore, stress) in the PCV due to sub-capacity loading led to the analytical examination of this phenomenon. The PCVs are cylindrical in shape and are loaded into the package such that they and all containment components are concentrically arranged along a common longitudinal axis. If the design full-capacity loading of the PCVs in this package assumes the axisymmetric (or more precisely, cyclicly symmetric) arrangement of its heat-producing contents, then sub-capacity loading implies that in many cases, the load arrangement could be asymmetric with respect to the longitudinal axis. It is then feasible that the departure from heat load axisymmetry could perturb the nominal thermal gradients so that thermally-induced stress within the PCV might increase to levels deemed unacceptable. This study applies Finite Element analysis (FEA) to the problem and demonstrates that no such unacceptable thermal stress increase occurs in the PCV material due to the asymmetric arrangement of contents. copyright 1995 American Institute of Physics

  15. Data concerning the development of the energy economy of the Federal Republic of Germany in 1981

    Energy Technology Data Exchange (ETDEWEB)

    1982-07-01

    After an introductory survey concerning international and national energy policy in 1981 there follow statistics, tables and graphs concerning the balance of primary energy, the structure of energy consumption, the import and export of energy sources, as well as the development of the market (amount produced, utilisation, prices) especially for black coal, brown coal, mineral oil, electricity and gas. To extend these data referring to the Federal Republic of Germany and to compare them the most important energy data of the world are represented.

  16. European Consensus on Primary Prevention of Coronary Heart Disease.

    Science.gov (United States)

    Assmann, G

    1988-07-01

    The European Consensus on Primary Prevention of Coronary Heart Disease has recommended that providing care for individuals at particular risk for coronary artery disease (CAD) requires case finding through medical examinations in primary care, hospital and employment health examination settings. Decisions concerning management of elevated lipid levels should be based on overall cardiovascular risk. The goal of reducing cholesterol levels through risk reduction can ultimately be accomplished only with the implementation of health education efforts directed toward all age groups and actions by government and supranational agencies, including adequate food labelling to identify fat content, selective taxation to encourage healthful habits and wider availability of exercise facilities. Only measures directed at the overall population can eventually reach the large proportion of individuals at mildly to moderately increased risk for CAD. The European Policy Statement on the Prevention of Coronary Heart Disease recognizes that the question of lipid elevation as a risk factor for CAD involves assessment, not only of cholesterol level alone, but also of triglycerides and the HDL cholesterol lipid fraction. Five specific categories of dyslipidemia have been identified, with individualized screening and treatment strategies advised for each. It is the consensus of the study group panel members that these procedures are both practical and feasible. They begin the necessary long term process to reduce the unacceptably high levels of morbidity and mortality due to CAD throughout the European community.

  17. Factors associated with airway colonisation and invasion due to ...

    African Journals Online (AJOL)

    Factors associated with airway colonisation and invasion due to Klebsiella spp. ... for nosocomial infections which occurred more conunonly with antibiotic-resistant organisms. ... acute community-acquired chest infections, and nosocomial chest infections. Primary acute conununity-acquired pneumonia was unconunon.

  18. Primary medullary hemorrhage in a patient with coagulopathy due to alcoholic cirrhosis: A case report.

    Science.gov (United States)

    Shen, Guangxun; Gao, Yu; Lee, Kwee-Yum; Nan, Guangxian

    2018-04-01

    Mild-to-moderate alcoholic cirrhosis of the liver is related to spontaneous intracerebral hemorrhage (ICH). In terms of spontaneous brainstem hemorrhage, pontine is considered as the most common site in contrast to medulla oblongata where the hemorrhage is rarely seen. This rare primary medullary hemorrhage has been attributed so far to vascular malformation (VM), anticoagulants, hypertension, hemorrhagic transformation, and other undetermined factors. Herein, we describe a 53-year-old patient with 35-year history of alcohol abuse was admitted for acute-onset isolated hemianesthesia on the right side. He was normotensive on admission. A neurological examination revealed isolated hemihypoaesthesia on the right side. He had no history of hypertension, and viral hepatitis, and nil use of anticoagulants. Brain computed tomography (CT) image demonstrated hemorrhagic lesion in dorsal and medial medulla oblongata which was ruptured into the fourth ventricle. Brain magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) demonstrated no evidence of VM. The laboratory tests implied liver dysfunction, thrombocytopenia, and coagulation disorders. Abdominal ultrasound, and CT image showed a small, and nodular liver with splenomegaly, suggestive of moderate alcoholic cirrhosis. Liver protection therapy and the management of coagulation disorders. After 14 days, he was discharged with mild hemianesthesia but with more improved parameters in laboratory tests. At the 6-month follow-up, brain MRI, MRA, and non-contrast MRI showed no significant findings except for a malacic lesion. We conclude that the patient had alcoholic cirrhosis with coagulopathy, and this may have resulted in primary medullary hemorrhage. This is a first case to report alcoholic cirrhosis as etiology of primary medullary hemorrhage.

  19. Ethnic differences in ecological concerns: Spanish-speaking Hispanics are more concerned than others

    International Nuclear Information System (INIS)

    Burger, Joanna; Greenberg, Michael

    2006-01-01

    We postulated that environmental concern encompasses a wide range of different issues, often lumping pollution with habitat loss (or land use) and ecological resources (fish and wildlife). In this paper, we compare perceptions about a range of environmental and ecological resource issues, and explore ethnic/racial differences. We surveyed 1513 residents of New Jersey about 'environmental concerns', using both general environmental questions (two questions: How serious are environmental problems in New Jersey? Are you concerned about the loss of open space?) and ecological resource questions (12 questions: e.g., how important is planting trees in your neighborhood, how concerned are you about loss of breeding and feeding habitat for fish and birds?) in New Jersey. Not all concerns were rated equally. For the ecological questions, there were no ethnic differences in concerns over preserving areas around water supplies, loss of places to hunt and fish, and loss of places for quiet walks and cycling, but there were for the other 9 ecological concerns. For eight of these nine concerns, Spanish-speaking Hispanics were more concerned than others (including English-speaking Hispanics). We divided the ecological resources into three categories: ecological services (clean water and safety), ecological resources (fish and wildlife), and recreational services. The strongest correlates of people's association with enlarging and enhancing recreational services were Spanish-speaking Hispanics, who are supportive of regulations and believe local government is not doing enough for environmental problems. People concerned about the loss of ecological resources and open space believe the federal government and the state are not doing enough for the environment, were non-Hispanic White, want continued environmental regulations, were longer-term residents, were high school graduates, and were older (45-54 years). People interested in ecological services were college-educated, non

  20. Concerned with computer games

    DEFF Research Database (Denmark)

    Chimiri, Niklas Alexander; Andersen, Mads Lund; Jensen, Tine

    2018-01-01

    In this chapter, we focus on a particular matter of concern within computer gaming practices: the concern of being or not being a gamer. This matter of concern emerged from within our collective investigations of gaming practices across various age groups. The empirical material under scrutiny...... was generated across a multiplicity of research projects, predominantly conducted in Denmark. The question of being versus not being a gamer, we argue, exemplifies interesting enactments of how computer game players become both concerned with and concerned about their gaming practices. As a collective...... of researchers writing from the field of psychology and inspired by neo-materialist theories, we are particularly concerned with (human) subjectivity and processes of social and subjective becoming. Our empirical examples show that conerns/worries about computer games and being engaged with computer game...

  1. Primary Teachers' Attitudes toward Science: A New Theoretical Framework

    Science.gov (United States)

    van Aalderen-Smeets, Sandra I.; Walma van der Molen, Juliette H.; Asma, Lieke J. F.

    2012-01-01

    Attention to the attitudes of preservice and inservice primary teachers toward science is of fundamental importance to research on primary science education. However, progress in this field of research has been slow due to the poor definition and conceptualization of the construct of primary teachers' attitude toward science. This poor theoretical…

  2. Impartial third-party interventions in captive chimpanzees: a reflection of community concern.

    Directory of Open Access Journals (Sweden)

    Claudia Rudolf von Rohr

    Full Text Available Because conflicts among social group members are inevitable, their management is crucial for group stability. The rarest and most interesting form of conflict management is policing, i.e., impartial interventions by bystanders, which is of considerable interest due to its potentially moral nature. Here, we provide descriptive and quantitative data on policing in captive chimpanzees. First, we report on a high rate of policing in one captive group characterized by recently introduced females and a rank reversal between two males. We explored the influence of various factors on the occurrence of policing. The results show that only the alpha and beta males acted as arbitrators using manifold tactics to control conflicts, and that their interventions strongly depended on conflict complexity. Secondly, we compared the policing patterns in three other captive chimpanzee groups. We found that although rare, policing was more prevalent at times of increased social instability, both high-ranking males and females performed policing, and conflicts of all sex-dyad combinations were policed. These results suggest that the primary function of policing is to increase group stability. It may thus reflect prosocial behaviour based upon "community concern." However, policing remains a rare behaviour and more data are needed to test the generality of this hypothesis.

  3. Impartial third-party interventions in captive chimpanzees: a reflection of community concern.

    Science.gov (United States)

    von Rohr, Claudia Rudolf; Koski, Sonja E; Burkart, Judith M; Caws, Clare; Fraser, Orlaith N; Ziltener, Angela; van Schaik, Carel P

    2012-01-01

    Because conflicts among social group members are inevitable, their management is crucial for group stability. The rarest and most interesting form of conflict management is policing, i.e., impartial interventions by bystanders, which is of considerable interest due to its potentially moral nature. Here, we provide descriptive and quantitative data on policing in captive chimpanzees. First, we report on a high rate of policing in one captive group characterized by recently introduced females and a rank reversal between two males. We explored the influence of various factors on the occurrence of policing. The results show that only the alpha and beta males acted as arbitrators using manifold tactics to control conflicts, and that their interventions strongly depended on conflict complexity. Secondly, we compared the policing patterns in three other captive chimpanzee groups. We found that although rare, policing was more prevalent at times of increased social instability, both high-ranking males and females performed policing, and conflicts of all sex-dyad combinations were policed. These results suggest that the primary function of policing is to increase group stability. It may thus reflect prosocial behaviour based upon "community concern." However, policing remains a rare behaviour and more data are needed to test the generality of this hypothesis.

  4. Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach

    OpenAIRE

    Geldmacher, David S.; Kerwin, Diana R.

    2013-01-01

    Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease.

  5. Mapping ecosystem service indicators in a Great Lakes estuarine Area of Concern

    Science.gov (United States)

    Estuaries provide multiple ecosystem services from which humans benefit. Currently, thirty-six Great Lakes estuaries in the United States and Canada are designated as Areas of Concern (AOCs) due to a legacy of chemical contamination, degraded habitat, and non-point-source polluti...

  6. 38 CFR 38.618 - Findings concerning commission of a capital crime where a person has not been convicted due to...

    Science.gov (United States)

    2010-07-01

    ... commission of a capital crime where a person has not been convicted due to death or flight to avoid... of a capital crime where a person has not been convicted due to death or flight to avoid prosecution... committed a Federal or State capital crime of which he or she was not convicted due to death or flight to...

  7. Gender bias in primary education a theoretical analysis

    Directory of Open Access Journals (Sweden)

    Róbert Osaďan

    2013-11-01

    Full Text Available For decades, gender bias and inequity have remained extensive issues in nearly all societies in the world. During the past years, the effects of these issues have extended to one of the most important facets in our society - the education sector. Although this may not be immediately shocking, a lot of researchers as well as concerned educators and parents believe otherwise. As a matter of fact, a myriad of studies and research projects have already proven that gender discrimination, bias, and other related issues in sexuality actually exist in most primary schools throughout the globe. These literary materials present vital points that provide the initiative for primary school educators, school administrators, and other parents to become aware of the gender issues, which significantly affect the school performance and achievement of the concerned students, most of them being girls. Also, a number of studies have identified gender bias agents and their contributions in the worsening of the problem. Obviously, this problem needs to be addressed by the people most empowered - the educators. There is no question whether or not primary school teachers possess the knowledge to circumvent this bias inside their classrooms. The true concern is when they will actually start to apply crucial measures to resolve and get rid of gender bias. Once they eliminate their own prejudices about their students in terms of gender- related issues, they will be able to provide each of their pupils the right and proper education that the children deserve to get. And if all students obtain fair educational treatment, academic excellence and competence will merely be two of the countless benefits they can get.

  8. Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.

    Science.gov (United States)

    Wright, R Eric; Reed, Nia; Carnes, Neal; Kooreman, Harold E

    2016-01-01

    Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death. As the primary gatekeepers to the medications contributing to this epidemic, it is critical to understand the views of licensed health care professionals. In this study, we examine health care professionals' concern regarding prescription drug abuse in their communities and the impact their concern has had on their prescribing and dispensing practices. An online survey of licensed health care providers. Conducted in Indiana. This study was a state-wide evaluation of Indiana's prescription drug monitoring program. The questionnaire asked respondents how concerned they were about prescription drug abuse in their community. Variation in the level of concern was examined using ordinary least squares regression and information about the respondents' demographic background and clinical experience. In addition, we used logistic regression to examine whether concern was associated with changing prescribing and/or dispensing behavior. The majority of providers indicated they were "moderately" or "extremely concerned" about prescription drug abuse in their communities. The level of concern, however, varied significantly by profession, with pharmacists, physicians, nurse practitioners/physician assistants being more concerned than dentists. Additional analyses indicate that providers with higher levels of concern were those who also reported recently changing their prescribing and/or dispensing behavior. The voluntary nature and geographical focus of the study limits the generalizability of the findings. Concern about prescription drug abuse is generally high across the major health care professions; however, a significant minority of providers, particularly among dentists, expressed little or no concern about the epidemic. Increasing health care providers' general level of concern about prescription drug abuse may be an effective public health tool for

  9. Exploring Intercultural Awareness in the Primary Modern Language Classroom: The Potential of the New Model of European Language Portfolio Developed by the Irish Modern Languages in Primary Schools Initiative (MLPSI)

    Science.gov (United States)

    Rantz, Frederique; Horan, Pascaline

    2005-01-01

    This paper reflects a key concern for teacher trainers: how can primary language teachers promote the development of intercultural awareness among their pupils? It addresses the concept of intercultural awareness as it applies to young learners and refers more specifically to the context of the Irish primary classroom and its curriculum. It argues…

  10. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

    Science.gov (United States)

    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  11. Evaluation of primary coolant leaks and assessment of detection methods

    International Nuclear Information System (INIS)

    Cassette, P.; Giroux, C.; Roche, H.; Seveon, J.J.

    1986-01-01

    A review of the French PWR situation concerning primary coolant leaks is presented, including a description of operating technical specifications, of the collecting system of primary coolant leakage into the containment and of the detection methods. It is mainly based on a compilation over three years, 1981 to 1983, of almost all actual leaks, their natures, causes, consequences and methods used for their detection. By analysing these data it is possible to evaluate the efficiency of the primary coolant leak detection system and the problems raised by compliance with the criteria defined in the operating technical specifications

  12. Evaluation of primary coolant leaks and assessment of detection methods

    International Nuclear Information System (INIS)

    Cassette, P.; Giroux, C.; Roche, H.; Seveon, J.J.

    1984-11-01

    A review of French PWR situation concerning primary coolant leaks is presented, including a description of operating technical specifications, of the collecting system of primary coolant leakage into the containment and of the detection methods. It is mainly based on a compilation over three years, 1981 to 1983, of almost all occurred leaks, their natures, causes, consequences and methods used for their detection. By analysing these data it is possible to evaluate the efficiency of the primary coolant leak detection system and the problems raised by the compliance with the criteria defined in the operating technical specifications

  13. "Ingraham v. Wright" and the Decline of Due Process.

    Science.gov (United States)

    Clark, Gerard J.

    1978-01-01

    Suggests that the constitutional questions in "Ingraham vs Wright" lend credence to a concern that the Court is seeking to eliminate all due process intervention outside of the incorporation and privacy cases and to limit even these cases to defenses of a criminal prosecution. Available from Suffolk University Law Review Office, 41…

  14. Persisting rise in referrals during labor in primary midwife-led care in The Netherlands

    NARCIS (Netherlands)

    Offerhaus, P.M.; Hukkelhoven, C.W.P.M.; Jonge, A. de; Pal-de Bruin, K.M. van der; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

    2013-01-01

    Background: There are concerns about the Dutch maternity care system, characterized by a strict role division between primary and secondary care. The objective of this study was to describe trends in referrals and in perinatal outcomes among labors that started in primary midwife-led care. Methods:

  15. Simulation of carbon sputtering due to molecular hydrogen impact

    International Nuclear Information System (INIS)

    Laszlo, J.

    1993-01-01

    Simulated results are compared to experimental data on the sputtering yield of carbon due to atomic and to molecular hydrogen impact. The experimental sputtering yields of carbon (graphite) due to low energy hydrogen bombardment have been found to be higher than the simulated ones. Efforts are made to obtain high enough simulated yields by considering the formation of dimer, H 2 and D 2 molecules in the primary beam. The molecular beam model applies full neutralization and full dissociation at the surface. The simulation of sputtering yields of target materials up to Z 2 ≤ 30 is also included for the low primary energy regime for deuterium projectiles. It is found that, although the sputtering yields really tend to increase, the effect of molecule formation in the beam in itself cannot be made responsible for the deviation between measured and simulated sputtering yields. (orig.)

  16. Propagation error simulations concerning the CLIC active prealignment

    CERN Document Server

    Touzé, T; Missiaen, D

    2009-01-01

    The CLIC1 components will have to be prealigned within a thirty times more demanding tolerance than the existing CERNmachines. It is a technical challenge and a key issue for the CLIC feasibility. Simulations have been undertaken concerning the propagation error due to the measurement uncertainties of the prealignment systems. The uncertainties of measurement, taken as hypothesis for the simulations, are based on the data obtained on several dedicated facilities. This paper introduces the simulations and the latest results obtained, as well as the facilities.

  17. Photodynamic therapy for multiple primary lung cancer

    International Nuclear Information System (INIS)

    Konaka, C.; Okunaka, T.; Sakai, H.; Furukawa, K.; Hayata, Y.; Kato, H.

    1992-01-01

    In recent years, multiple primary lung cancers have been reported with greater frequency. As for the treatment of multiple primary lung cancer, operative excision is usually difficult for all lesions due to problems of pulmonary function. PDT is a good therapeutic modality in the treatment of multiple primary lung cancer, especially central type lung cancer, for preservation of lung function. Since 1980, 50 patients of endoscopically-evaluated early stage lung cancers have been treated with PDT at Tokyo Medical College. Within this group, 16 patients were classified as having multiple primary lung cancers. This paper evaluates the effectiveness of PDT in the treatment of these patients with multiple primary bronchogenic carcinoma. (author). 6 refs., 2 tabs

  18. Mobile phones and health concerns

    International Nuclear Information System (INIS)

    Vaikuntam, Shreenivas; Pushparaja

    2003-01-01

    As Mobile Cellular phone ownership grows throughout the developed as well as the developing world, concerns about the health risks due to radio frequency emissions from the mobile phone base stations and due to usage of mobile handsets are slowly growing. This article has a look at the concepts used in the mobile phone technology, the power outputs from base stations and mobile handsets, the quantities Specific Energy Absorption Rate (SAR) and power density as a means to assess the effects on biological tissue. The precautionary approach to manage the health risks from mobile phones by specifying exposure guidelines is explored. Having surveyed the relevant epidemiological surveys and finding them inconclusive, NRPB, United Kingdom's national regulatory body has issued exposure guidelines based on the potential of RF radiation to cause illness or injury through heating of body tissues. USA's Federal Communications Commission (FCC) limits are also listed for comparison. ICNIRP has issued two-tier guidelines, differentiating between occupational and public exposure. The public exposure limits are kept at one-fifth of the occupational exposure limits. The evidence till date, suggests that exposure to RF radiation below NRPB and ICNIRP limits do not cause adverse effects to the general population. However, the gaps in our knowledge warrant a precautionary approach. (author)

  19. Paternal understanding of menstrual concerns in young women.

    Science.gov (United States)

    Girling, Jane E; Hawthorne, Samuel Cj; Marino, Jennifer L; Nur Azurah, Abdul G; Grover, Sonia R; Jayasinghe, Yasmin L

    2018-04-12

    No studies have specifically considered paternal understanding of menstruation. This study aimed to establish the degree of understanding of fathers of adolescent girls with menstrual symptoms relative to mothers. This is a cross-sectional survey-based study. Adolescent patients attending an outpatient gynaecology clinic for dysmenorrhoea and/or heavy menstrual bleeding (HMB) and their parents were invited to complete surveys. 60 surveys were completed (24/40 daughters, 20/40 mothers, 16/40 fathers). Surveys aimed to test parents' understanding of menstrual symptoms and potential medications, as well as fathers' concerns with their daughters' health. The fathers' knowledge of menstrual symptoms was poorer than mothers, although most knew HMB (93%) and mood swings (87%). Many parents answered 'don't know' or did not answer questions about potential consequences of medications, although parents were clearly concerned about side effects. Most fathers (80%) were open to discussing menstrual concerns with daughters; however, only 52% of daughters were open to such discussions. Of fathers, 80% felt sympathetic/concerned, 53% helpless and 13% frustrated when daughters were in pain. When asked about impacts, 93% of fathers (79% of mothers) were worried about their daughter's welfare and 60% (21%) about schooling. We present the first insight into fathers' knowledge of their daughters' menstrual health. Overall, parents have an incomplete picture of menstrual symptoms. Even in this cohort, which could be expected to be well informed due to their daughters' attendance at a tertiary hospital, it is clear that further knowledge would assist them caring for their daughters. Copyright © 2018. Published by Elsevier Inc.

  20. Standard Setting as Psychometric Due Process: Going a Little Further Down an Uncertain Road.

    Science.gov (United States)

    Cizek, Gregory J.

    The concept of due process provides an analogy for the process of standard setting that emphasizes many of the procedural and substantive elements of the process over technical and statistical concerns. Surely such concerns can and should continue to be addressed. However, a sound rationale for standard setting does not rest on this foundation.…

  1. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns

    Directory of Open Access Journals (Sweden)

    Maziar Moradi-Lakeh

    2015-10-01

    Full Text Available In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP, was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016. It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME affiliated hospitals, reduce out-of-pocket (OOP payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as powerful and influential stakeholders potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes should be addressed through proper revision(s while nontechnical concerns (which are derived from conflicting interests must be responded through clarification and providing transparent information. The

  2. Ballet-Related Content in Music Education in the First Cycle of Primary Education

    Directory of Open Access Journals (Sweden)

    Stergulec Tjaša

    2013-09-01

    Full Text Available This paper deals with the integration of ballet-related content into music lessons in the first cycle of primary education. It seeks to outline some current findings concerning the positive impact of dance and classical ballet on integrated child development and the results of an empirical research study the objective of which was to compare the ability of primary school pupils aged six to nine years to perform a simple ballet choreography against that of ballet school pupils and to examine pupils’ attitude towards classical ballet. For this end, we prepared additional ballet-related content in 2011 and incorporated it into classroom practice with students attending Fran Korun Koželjski Music School in Velenje and pupils attending the first and the third grades of Franc Rozman Stane Primary School in Maribor. To compare the performance of one and the other we used specific evaluation criteria, while we obtained pupils’ feedback on ballet lessons by means of a short questionnaire. It was established that children did possess the ability as well as the desire to practice classical ballet. The executions of the ballet choreography by both groups were comparable, and the only difference noticed regarded the physical ability, body coordination, and spatial coordination criteria, which were not fully achieved by the primary school pupils. Due to the positive influence of the activity on the integrated development of children and the children’s positive reaction, it is necessary to incorporate as many ballet-related subject matter as possible into music education.

  3. Primary lymphocytic lymphoma of lacrimal gland.

    Science.gov (United States)

    Romero-Caballero, M D; Lozano-García, I; Gómez-Molina, C; Gil-Liñán, A I; Arcas, I

    2017-02-01

    We report a case of primary small-cell lymphocytic lacrimal gland lymphoma in a male diagnosed with primary antiphospholipid syndrome. These rare lymphomas are usually presented in the clinic as disseminations secondary to chronic lymphocytic leukaemia, and the primary site is rare in the orbit. Non-Hodgkin lymphomas are a heterogeneous group of tumours. Although treatment in the IE stage is usually radiotherapy, due to its association with antiphospholipid syndrome, systemic treatment with rituximab was administered. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. The primary processes by impact of ionizing radiations with water

    International Nuclear Information System (INIS)

    Znamirovschi, V.; Mastan, I.; Cozar, O.

    1976-01-01

    The problem concerning primary processes in radiolysis of water is discussed. The results on the excitation and ionization of water molecule, dissociation of the parent-molecular ion of water and dissociation of excited molecule of water are presented. (author)

  5. CO2: EDF's competitiveness is due to nuclear power

    International Nuclear Information System (INIS)

    Anon.

    2003-01-01

    The CO 2 emissions of EDF group (EDF-France + EDF-energy (UK) + Hidrocantabrico (Spain) + EnBW (Germany)) soared by 53% in 2002 which is due to the purchase of british and spanish electricity sub-companies using fossil energies. Despite this sharp increase EDF remains one of the most competitive electricity companies in Europe concerning greenhouse gas emissions. EDF group is the first electricity company in Europe, it generates 22% of the electricity produced in E.U and contributes to CO 2 emissions with a rate of 101 Kg CO 2 /MWh which 3 times less than the average rate of 20 other European companies (358 Kg CO 2 /MWh). This result is due to the large part of nuclear power in the French energy mix. The best electricity companies as far as CO 2 emissions are concerned are Statkraft (Norway) with 0 Kg CO 2 /MWh (100% hydrology) and British-energy (U.K) with 75 Kg CO 2 /MWh (75% nuclear power). At the other end we have the DEI company (Greece) with 863 Kg CO 2 /MWh (100% lignite). (A.C.)

  6. Toward interdependence: Implementation of cooperative learning in primary schools

    NARCIS (Netherlands)

    Krol-Pot, K.

    2005-01-01

    The present dissertation concerns the implementation of cooperative learning in Dutch primary schools. The focus was on the process of implementation in four experimental schools and on the outcomes at the levels of the school, the teacher and the student. Chapters 1, 2, and 3 constitute the

  7. Primary amebic meningoencephalitis due to Naegleria fowleri in a South American tapir.

    Science.gov (United States)

    Lozano-Alarcón, F; Bradley, G A; Houser, B S; Visvesvara, G S

    1997-05-01

    Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris are known to cause fatal central nervous system (CNS) disease in human beings. N. fowleri causes acute, fulminating primary amebic meningoencephalitis (PAM), which generally leads to death within 10 days. Acanthamoeba spp. and B. mandrillaris cause chronic granulomatous amebic encephalitis, which may last for 8 weeks. Acanthamoeba spp. and B. mandrillaris also cause CNS disease in animals. N. fowleri, however, has been described only in human beings. This report is the first of PAM in an animal, a South American tapir. Dry cough, lethargy, and coma developed in the animal, and its condition progressed to death. At necropsy, lesions were seen in the cerebrum, cerebellum, and lungs. The CNS had severe, suppurative meningoencephalitis with many neutrophils, fibrin, plasma cells, and amebas. Amebas were 6.5 microns to 9 microns in diameter and had a nucleus containing a large nucleolus. Amebas in the sections reacted with a monoclonal antibody specific for N. fowleri in the immunofluorescent assay and appeared bright green.

  8. The Changing Roles of Science Specialists during a Capacity Building Program for Primary School Science

    Science.gov (United States)

    Herbert, Sandra; Xu, Lihua; Kelly, Leissa

    2017-01-01

    Science education starts at primary school. Yet, recent research shows primary school teachers lack confidence and competence in teaching science (Prinsley & Johnston, 2015). A Victorian state government science specialist initiative responded to this concern by providing professional learning programs to schools across Victoria. Drawing on…

  9. Depression in obese patients with primary fibromyalgia: the mediating role of poor sleep and eating disorder features.

    Science.gov (United States)

    Senna, Mohammed K; Ahmad, Hamada S; Fathi, Warda

    2013-03-01

    Depression is a prominent feature in fibromyalgia syndrome. Patients with fibromyalgia syndrome who are obese, with poor sleep quality, and those who have recurrent episodes of binge eating are at greater risk to develop depression. The aim of this cross-sectional study was to examine the hypothesis that the relationship between obesity and depression in patients with primary fibromyalgia syndrome is mediated by poor sleep, binge eating disorder (BED), and weight and shape concern. This study included 131 patients with primary fibromyalgia syndrome. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index, Beck Depression Inventory-II, Eating Disorder questionnaire, and Fibromyalgia Impact Questionnaire. Body mass index (BMI) provided the primary indicator of obesity. Sobel test showed that the conditions for complete mediation were satisfied on the weight and shape concern as mediator between BMI and depression because the association between BMI and depression score became insignificant after controlling of weight and shape concern. However, since the association between BMI and depression remained significant after BED and poor sleep score were controlled, thus for both mediators, the conditions for partial mediation on the depression were satisfied. The findings suggest that in patients with primary fibromyalgia syndrome, weight and shape concern, BED, and poor sleep quality are important mediators of the relationship between obesity and depression. We suggest that a greater focus on these mediators in depression treatment may be indicated.

  10. Parents' concerns regarding the growth characteristics of their adolescents: a qualitative inquiry in Iran.

    Science.gov (United States)

    Cheraghi, Mohammad Ali; Rezasoltani, Parvaneh; Vedadhir, AbouAli; Taghizadeh, Ziba; Samadanifard, Seyyed Hossein

    2018-12-01

    In recent times, parents have become increasingly concerned, both subjectively and objectively, about their adolescents' body height/weight growth. Parent-adolescent interactions about this issue and the potential socio-psychological consequences of such interactions should be considered as an important influencing factor on the future of adolescents' sexual and reproductive health. To achieve a greater understanding of such concerns, it is necessary to further elucidate parents' experiences on this topic, so as to expand the existing literature. This study aimed to explain the perceptions of parents' concerns regarding their adolescents' growth characteristics in the socio-cultural context of Iran as a transitional society. This paper is part of a larger qualitative study designed using the Constructivist Grounded Theory Methodology (CGTM). We conducted open-ended intensive interviews with eleven parents individually and recruited them through purposeful and theoretical sampling from a teaching hospital, community, and a primary school in Tehran with theoretical sampling variation in terms of teenagers' age, sex, and birth order, place of residence, parents' occupation and education, and the self-reported socio-economic status. Using the analytical procedures of the CGTM, we performed analyses. In the findings, the concept of 'living with constant sense of uncertainty' emerged from the subcategories including 'feeling existing and potential concern about expected minimum and maximum bio-positions of growth,' 'feeling potential concern about biological health consequences,' 'feeling potential concern about the emergence of early/late maturity signs,' 'feeling potential concern about adolescent's emotional threat,' 'feeling concerned about future employment, education, marriage, and fertility,' and 'feeling potential concern about the society's view'. These findings suggest that parents are living with a constant sense of uncertainty about their teens' growth

  11. [Usefullness of intraoperatory parathyroid hormone measurement in surgical management of primary hyperparathyroidism due to a parathyroid adenoma].

    Science.gov (United States)

    Obiols, Gabriel; Catalán, Roberto; Alasà, Cristian; Baena, Juan Antonio; Fort, José Manuel; Gémar, Enrique; Mesa, Jordi

    2003-09-13

    Surgical neck exploration of the 4 parathyroid glands is quite an aggressive procedure for most patients with primary hyperparathyroidism (PHPT) due to a parathyroid adenoma. Intraoperatory measurement of parathyroid hormone (PTH) seems to be a useful tool for the management of these cases, allowing the use of minimally invasive surgical techniques with a lower morbidity. Our aims was to assess the usefulness of PTH intraoperatory measurement for the surgical management of PHPT. We studied 27 consecutive patients, diagnosed with PHPT secondary to parathyroid adenoma. Localization studies included neck ultrasonography and Tc-MIBI scintigraphy. PTH at the stage of anesthesia induction as well as 5 and 10 minutes after the removal of the adenoma was determined. A PTH decrement greater than 50% at 10 minutes was considered as curative. PTH was measured by an immunoluminometric method (Advantage, Nichols). In all cases, calcium levels were normal 24 hours after the operation, and therefore all them were considered as cured. PTH levels decreased more than 50% in all patients. In one case, PTH levels remained high after the exeresis of a preoperatively localized lesion. The pathologic study confirmed that it was a normal parathyroid gland. We then continued the surgical exploration which eventually allowed us to find a contralateral adenoma. A further PTH measurement showed an over 50% decrease. Therefore, PTH was predictive of surgical success in all 28 measurements. Intraoperatory determination of PTH is useful for the surgical management of PHPT and it could allow the use of minimally invasive surgical techniques.

  12. Retrospection concerning the sugar beet protection on Fundulea zone, district Calarasi, Romania

    Directory of Open Access Journals (Sweden)

    Doncila Anton I.

    2006-01-01

    Full Text Available The paper represents a synthesis concerning sugar beet protection in the specific conditions (soil and climatic of Fundulea zone. The presented aspects refer to the beet diseases, pests and weeds (primary and secondary concerning economic importance since these organisms are continually limiting root and sugar yields. At the same time, it refers to the present control possibilities, the aim being the efficiancy and environmental demands. The basis of the synthesis are main data and results obtained at the Institute (in experimental fields and demonstration plots, during 1982-2003 (the Institute was founded in 1981 about natural infections and infestations without treatments. It contains three parts (pathogens, pests, weeds and has original pictures enclosed in the annex: some symptoms of pathogen and pests attacks, weed control and other aspects such as herbicides fitotoxity strangled roots, Cuscuta as a parasitic plant etc.

  13. Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

    Directory of Open Access Journals (Sweden)

    Liddy Clare

    2009-06-01

    Full Text Available Abstract Background The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Methods Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Results Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface

  14. Primary care in Caribbean Small Island Developing States

    Directory of Open Access Journals (Sweden)

    J.D. Kranenburg

    2015-05-01

    Full Text Available Caribbean Small Island Developing States (SIDS made good process on improving the health of their populations; but concerns exist when it comes to meeting changing health needs. Due to remoteness and limited resources it is difficult to respond to high rates of non-communicable diseases (NCDs. Furthermore, little is known about how primary care (PC is organised and how this responds to current health issues. This study focused on gaining insights in the organisation of PC of Caribbean SIDS based on currently available literature. This literature review was an explorative multiple case study, where structure of PC and health status of 16 Caribbean SIDS were reviewed using available scientific and grey literature between the years 1997 and 2014. Thirty documents were used to analyse 20 indicators for the dimensions “Structure of Primary Care” and “Health Status”. Results were mapped in order to identify if there is a possible relation between structures of PC to the health of the populations. When reviewing the structure of PC, the majority of information was available for “Economic conditions of PC” (78% and the least information was available for “Governance of PC” (40%. With regards to health status, all islands show improvements on “Life expectancy at birth” since 2007. In contrast, on average, the mortality due to NCDs did not improve. Saint Lucia performs best on “Structure of PC”. The British Virgin Islands have the best health status. When both dimensions were analysed, Saint Lucia performs best. There is still little known on the responsiveness of PC of Caribbean SIDS to NCDs. There is a need for elaborate research on: (1 If and how the functioning of these health systems relate to the health status; (2 What islands can learn from an analysis over time and what they can learn from cross-island analysis; and (3 Filling the gaps of knowledge which currently exist within this field of research.

  15. Depressive disorder due to craniopharyngioma.

    Science.gov (United States)

    Spence, S A; Taylor, D G; Hirsch, S R

    1995-01-01

    Secondary causes of depression are legion, and must always be considered in patients presenting with features atypical of primary idiopathic depressive disorder. The case described is that of a middle-aged woman presenting initially with a major depressive disorder who was subsequently found to have a craniopharyngioma, leading to a revised diagnosis of mood disorder due to the tumour. Some features of the presentation might have led to earlier diagnosis had their localizing significance been recognized. Diencephalic lesions should always be considered in patients presenting with the hypersomnic-hyperphagic variant of depressive disorder. Images Figure 1 PMID:8544149

  16. Primary orbital squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Ana L. Campos Arbulú

    2017-02-01

    Full Text Available Primary orbital squamous cell carcinoma is a rare entity. There is little published literature. We report a case of primary squamous cell carcinoma of the orbital soft tissues. Surgical resection offered the best treatment for the patient. Complete resection of the lesion was achieved. The patient received adjuvant radiotherapy due to the proximity of the lesion to the surgical margins. Surgical treatment is feasible and should be considered as part of the surgeon's arsenal. However, therapeutic decisions must be made on a case-by-case basis

  17. Senior military officers' educational concerns, motivators and barriers for healthful eating and regular exercise.

    Science.gov (United States)

    Sigrist, Lori D; Anderson, Jennifer E; Auld, Garry W

    2005-10-01

    The increasing trend of overweight in the military, the high cost of health care associated with overweight, and the failure to meet some Healthy People 2000 objectives related to diet identify the need for more appropriate nutrition and fitness education for military personnel. The purpose of this study was to assess senior military officers' concerns on various health topics, educational preferences for nutrition and health topics, eating habits, and barriers and motivators for eating healthfully and exercising regularly. The survey was completed by 52 resident students at the U.S. Army War College. Fitness, weight, and blood cholesterol were top health concerns, and respondents wanted to know more about eating healthfully on the run. The primary barrier to eating healthfully and exercising regularly was lack of time, whereas health and appearance were top motivators. Health interventions for this population should include their topics of concern and should address perceived barriers and motivators.

  18. 48 CFR 752.219-8 - Utilization of small business concerns and small disadvantaged business concerns.

    Science.gov (United States)

    2010-10-01

    ... business concerns and small disadvantaged business concerns. 752.219-8 Section 752.219-8 Federal... AND CONTRACT CLAUSES Texts of Provisions and Clauses 752.219-8 Utilization of small business concerns and small disadvantaged business concerns. The Foreign Assistance Act calls for USAID to give small...

  19. A theoretical approach to sputtering due to molecular ion bombardment, 1

    International Nuclear Information System (INIS)

    Karashima, Shosuke; Ootoshi, Tsukuru; Kamiyama, Masahide; Kim, Pil-Hyon; Namba, Susumu.

    1981-01-01

    A shock wave model is proposed to explain theoretically the non-linear effects in sputtering phenomena by molecular ion bombardments. In this theory the sputtering processes are separated into two parts; one is due to linear effects and another is due to non-linear effects. The treatment of the linear parts is based on the statistical model by Schwarz and Helms concerning a broad range of atomic collision cascades. The non-linear parts are treated by the model of shock wave due to overlapping cascades, and useful equations to calculate the sputtering yields and the dynamical quantities in the system are derived. (author)

  20. Stress corrosion cracking of irradiated stainless steels in primary water: experimental studies and model development in the FP7 PERFECT IP

    International Nuclear Information System (INIS)

    Van Dyck, S.

    2009-01-01

    The long term behaviour of the internal structures, surrounding the core of nuclear reactors, is a concern within the general framework of plant life management. Due to their positioning in the reactor, the internal structures of a pressurised water reactor (PWR) receive a high neutron irradiation dose during their exposure to the primary environment. The irradiation induced changes in the material and environment may cause or accelerate stress corrosion cracking of stainless steel internals, otherwise insensitive to stress corrosion in primary environment. This phenomenon of irradiation assisted stress corrosion cracking (IASCC) is currently not well quantified. At this stage, the understanding of the underlying mechanisms of IASCC is qualitative at best and no systematic database and descriptive model are available for IASCC in PWR conditions. Since 2004, a concerted European effort is ongoing within the framework 7 PERFECT integrated project to investigate and model IASCC

  1. Maternal Concern for Child Undereating.

    Science.gov (United States)

    Brown, Callie L; Pesch, Megan H; Perrin, Eliana M; Appugliese, Danielle P; Miller, Alison L; Rosenblum, Katherine; Lumeng, Julie C

    To describe features of maternal concern for her child undereating; examine maternal and child correlates of maternal concern for undereating; and determine whether maternal concern for undereating is associated with feeding practices. This was a cross-sectional analysis of an observational study with 286 mother-child dyads (mean child age, 71 months). Maternal concern for undereating was assessed using a semistructured interview. Mothers completed questionnaires to assess picky eating, food neophobia, and feeding practices. Feeding practices were further assessed using videotaped mealtime observations. Logistic regression was used to assess the association of maternal and child characteristics with maternal concern for undereating. Regression was used to assess the association of maternal concern for undereating with feeding practices, controlling for covariates. Over a third of mothers (36.5%) expressed concern that their child does not eat enough. Correlates of concern for undereating included child body mass index z-score (BMIz; odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.43-0.77) and picky eating (OR = 2.41; 95% CI, 1.26-4.59). Maternal concern for undereating was associated with greater reported pressure to eat (relative risk [RR] = 1.97; 95% CI, 1.55-2.50), greater observed bribery (OR = 2.63; 95% CI, 1.50-4.60), and higher observed pressure (OR = 1.90; 95% CI, 1.08-3.36) during mealtimes. Mothers of children who are picky eaters and have a lower BMIz are more likely to be concerned that their children do not eat enough, and maternal concern for undereating is associated with pressuring and bribing children to eat. Pediatricians might address maternal concern for undereating by advising feeding practices that do not involve pressure and bribery, particularly among healthy weight children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  2. Concern as motivation for protection: an investigation of mothers' concern about daughters' breast cancer risk.

    Science.gov (United States)

    Neuberger, Lindsay; Silk, Kami J; Yun, Doshik; Bowman, Nicholas David; Anderson, Jennifer

    2011-11-01

    The present study surveyed mothers with daughters (N = 386) to investigate how mothers' concern about their daughters' breast cancer risk influenced intentions to engage in preventive behaviors. Using protection motivation theory as a framework, self-efficacy, response efficacy, and level of concern were posited to influence protective behavioral intention in distinct ways. Results from regression analyses indicate that self-efficacy, response efficacy, and mothers' concern are significant predictors of intentions to engage in preventive behaviors with daughters. In addition, a content analysis of mothers' open-ended reasons for their concern about their daughters' breast cancer risk yield a list of specific concerns and trends that vary by concern level and individual comment valence. The authors discuss implications for incorporating mothers' concerns into breast cancer prevention messages as a novel strategy for campaign designers.

  3. Concern as Motivation for Protection: An Investigation of Mothers’ Concern About Daughters’ Breast Cancer Risk

    Science.gov (United States)

    NEUBERGER, LINDSAY; SILK, KAMI J.; YUN, DOSHIK; BOWMAN, NICHOLAS DAVID; ANDERSON, JENNIFER

    2012-01-01

    The current study surveyed mothers with daughters (N=386) to investigate how mothers’ concern about their daughters’ breast cancer risk influenced intentions to engage in preventive behaviors. Using Protection Motivation Theory as a framework, self-efficacy, response efficacy and level of concern were posited to influence protective behavioral intention in distinct ways. Results from regression analyses indicate that self-efficacy, response efficacy, and mothers’ concern are significant predictors of intentions to engage in preventive behaviors with daughters. Additionally, a content analysis of mothers’ open-ended reasons for their concern about their daughters’ breast cancer risk yield a list of specific concerns as well as trends that vary by concern level and individual comment valence. Implications for incorporating mothers’ concerns into breast cancer prevention messages are discussed as a novel strategy for campaign designers. PMID:22070448

  4. Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach

    Science.gov (United States)

    Kerwin, Diana R.

    2013-01-01

    Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease. Data Sources: References were obtained via search using keywords Alzheimer’s disease AND primary care OR collaborative care OR case finding OR caregivers OR guidelines. Articles were limited to English language from January 1, 1990, to January 1, 2013. Study Selection: Articles were reviewed and selected on the basis of study quality and pertinence to this topic, covering a broad range of data and opinion across geographical regions and systems of care. The most recent published guidelines from major organizations were included. Results: Practice guidelines contained numerous points of consensus, with most advocating a central role for the primary care physician in the detection, diagnosis, and treatment of Alzheimer’s disease. Review of the literature indicated that optimal medical and psychosocial care for people with Alzheimer’s disease and their caregivers may be best facilitated through collaborative models of care involving the primary care physician working within a wider interdisciplinary team. Conclusions: Evidence-based guidelines assign the primary care physician a critical role in the care of people with Alzheimer’s disease. Research on models of care suggests the need for an appropriate medical/nonmedical support network to fulfill this role. Given the diversity and breadth of services required and the necessity for close coordination, nationwide implementation of team-based, collaborative care programs may represent the best option for improving care standards for patients with Alzheimer’s disease. PMID:24392252

  5. Leisure time physical activity and the risk of hip or knee replacement due to primary osteoarthritis: a population based cohort study (The HUNT Study).

    Science.gov (United States)

    Johnsen, Marianne Bakke; Hellevik, Alf Inge; Baste, Valborg; Furnes, Ove; Langhammer, Arnulf; Flugsrud, Gunnar; Nordsletten, Lars; Zwart, John Anker; Storheim, Kjersti

    2016-02-16

    The relationship between leisure time physical activity (LPA) and hip and knee OA and subsequent joint replacement has not yet been clearly defined. Some studies have found the risk of knee replacement (TKR) to increase with high levels of LPA, while others have found no overall relationship to either TKR or hip replacement (THR). The aim was to investigate the association between LPA and the risk of severe end-stage OA, defined as THR or TKR due to primary OA, in a large population-based cohort. Participants in the Nord-Trøndelag Health Study (HUNT) were followed prospectively to identify THR and TKR using the Norwegian Arthroplasty Register. Self-reported LPA was classified as inactive, low, moderate or high. The Cox proportional hazards model was used to calculate hazard ratios (HRs) according to levels of LPA with adjustments for confounding variables. Analyses were performed by age (<45, 45-59 and ≥60 years) and sex. A total of 66 964 participants (mean age 46.8 years (SD 16.3) were included in the analyses. We identified 1636 THRs and 1016 TKRs due to primary OA during 17.0 years (median) of follow-up. High LPA was significantly associated with THR for women <45 years (HR 1.78, 95 % CI 1.08-2.94) and men between 45-59 years (HR 1.53, 95 % CI 1.10-2.13) at baseline. A significant trend was found only among women < 45 years at baseline (p = 0.02). We found that LPA was significantly associated with TKR for women only (HR 1.45, 95 % CI 1.03-2.04). No measures of LPA were associated with TKR for men. In this population-based study, high level of LPA was associated with increased risk of THR where a significant trend of LPA was seen among women <45 years at baseline. For TKR, high LPA was associated with increased risk only in women. In contrast to previous studies, this study shows a possible association between high LPA and the risk of THR.

  6. The Needs and Concerns of Students during the Sport Management Internship Experience

    Science.gov (United States)

    Stratta, Terese M. Peretto

    2004-01-01

    To date, no empirical studies have examined the sport management internship from students' perspectives. Due to this void in the literature, the purpose of this study was to examine the needs and concerns of students when accessing and completing internships. Rather than relying solely on sport management professionals to determine the parameters…

  7. Sjögren syndrome presenting with hypopotassemic periodic paralysis due to renal tubular acidosis

    Science.gov (United States)

    Ataoglu, Esra Hayriye; Demir, Betul; Tuna, Mazhar; Çavus, Bilger; Cetin, Faik; Temiz, Levent Umit; Ozturk, Savas; Yenigun, Mustafa

    2012-01-01

    Summary Background: Sjögren syndrome (SS) is an autoimmune-lymphoproliferative disorder characterized by mononuclear cell infiltration of exocrine glands. Clinically, Sjögren syndrome (SS) has a wide spectrum, varying from autoimmune exocrinopathy to systemic involvement. There have been few cases reporting that primary SS developed with distal renal tubular acidosis clinically. Case Report: Here, we present a case with primary Sjögren syndrome accompanied by hypopotassemic paralysis due to renal tubular acidosis. Severe hypopotassemia, hyperchloremic metabolic acidosis, alkaline urine and disorder in urinary acidification test were observed in the biochemical examination of the 16-year-old female patient, who had applied to our clinic for extreme loss of muscle force. After the examinations it was determined that the patient had developed Type 1 RTA (distal RTA) due to primary Sjögren syndrome. Potassium and alkaline replacement was made and an immediate total recovery was achieved. Conclusions: Hypopotassemic paralysis due to primary Sjögren syndrome is a rare but severe disorder that could lead to death if not detected early and cured appropriately. Thus, effective treatment should be immediately initiated in cases where severe hypopotassemia is accompanied by metabolic acidosis, and the cases should also be examined for extraglandular involvement of SS. PMID:23569525

  8. Primary care physician decision making regarding referral for bariatric surgery

    DEFF Research Database (Denmark)

    Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild

    2017-01-01

    the decision to refer patients for surgery. Only 9% of the respondents indicated that bariatric surgery should be the primary treatment option for severe obesity in the future. Conclusion: Danish PCPs express severe concerns about surgical and medical complications following bariatric surgery. This might...

  9. Bridgman's concern

    International Nuclear Information System (INIS)

    Graham, R.A.

    1993-01-01

    In 1956 P.W. Bridgman published a letter to the editor in the Journal of Applied Physics reporting results of electrical resistance measurements on iron under static high pressure. The work was undertaken to verify the existence of a polymorphic phase transition at 130 kbar (13 GPa) reported in the same journal and year by the Los Alamos authors, Bancroft, Peterson and Minshall for high pressure, shock-compression loading. In his letter, Bridgman reported that he failed to find any evidence for the transition. Further, he raised some fundamental concerns as to the state of knowledge of shock-compression processes in solids. Later it was determined that Bridgman's static pressure scale was in error, and the shock observations became the basis for calibration of pressure values in static high pressure apparatuses. In spite of the error in pressure scales, Bridgman's concerns on descriptions of shock-compression processes were perceptive and have provided the basis for subsequent fundamental studies of shock-compressed solids. The present paper, written in response to receipt of the 1993 American Physical Society Shock-Compression Science Award, provides a brief contemporary assessment of those shock-compression issues which were the basis of Bridgman's 1956 concerns

  10. With Due Consideration: Australian Human Service Practitioners' Understandings of Confidentiality and Disclosure Obligations in Regard to Cases Concerning Gambling-Related Theft

    Science.gov (United States)

    Patford, Janet; Tranent, Peter

    2013-01-01

    Preserving confidentiality is problematic for human service practitioners if they know that a client is seriously harming a third party or could do so in the future. The present study concerned financial harm, as generated by gambling-related theft. Clients who disclose gambling-related theft potentially create a dilemma for practitioners, who may…

  11. Basic Substantive Law for Paralegals: Contracts, Torts, and Due Process.

    Science.gov (United States)

    Marcin, Raymond B.

    Part of the paralegal, or legal assistant, training materials prepared by the National Paralegal Institution under a Federal grant, the text comprises an overview of the basic legal concepts usually found in introductory law courses concerning contracts, torts, and the due process area of constitutional law. Part 1, Contracts, covers: definition,…

  12. Acute renal failure due to mesangial proliferative glomerulonephritis in a pregnant woman with primary Sjögren's syndrome.

    Science.gov (United States)

    Adam, Fatma Ulku; Torun, Dilek; Bolat, Filiz; Zumrutdal, Aysegul; Sezer, Siren; Ozdemir, Fatma Nurhan

    2006-02-01

    The most common form of renal involvement in Sjögren's syndrome (SS) is tubulointerstitial nephritis. Renal dysfunction is usually mild and subclinical. Glomerulonephritis (GMN) is rare in patients with SS. We report a 28-year-old multigravida patient with primary Sjögren's syndrome (pSS) and associated manifestations, who presented with acute renal failure in the 20th week of her fifth pregnancy. The complaints and clinical findings, positive Schirmer's test, findings of dry eye on ophthalmologic examination, and the salivary gland biopsy were compatible with SS. The patient exhibited no other clinical or laboratory findings indicative of other collagenous disease and/or rheumatoid arthritis. She refused renal biopsy, hesitating for fear of fetal loss; thus, based on the clinical and laboratory findings indicating rapidly progressive GMN and vasculitis, prednisolone, plasmapheresis, and one dose of cyclophosphamide were administered during the pregnancy. Hemodialysis five times weekly was performed. At the 28th week of gestation, she underwent a cesarean section due to early rupture of membranes and fetal distress. A healthy male boy was delivered. The renal biopsy performed 2 weeks after labor revealed mesangial proliferative glomerulonephritis. After the fourth cyclophosphamide treatment, her urinary output increased and she was discharged from the hemodialysis program. She remains in follow-up at our outpatient clinic free of hemodialysis for 4 months. This is the first report of mesangial proliferative GMN requiring dialysis in a pregnant pSS patient that has featured good maternal and fetal outcomes.

  13. The European language portfolio (ELP in Slovenian primary education: the teachers’ perspective

    Directory of Open Access Journals (Sweden)

    Urška Sešek

    2014-12-01

    Full Text Available The European Language Portfolio (ELP is a unique, pan-European language learning material, aimed at supporting life-long language learning and the development of learner autonomy and intercultural competences. The article outlines the ELP's origins, structure and functions, and its impact on foreign language learning and teaching in Europe. Of the Slovenian ELP models, the two intended for primary school have been the most widely-implemented. Their implementation was the subject of a three-year study, in the context of a national piloting project involving over 600 learners and 100 teachers, held in 2008 and 2009. Due to the complexity and scope of the study, this article focuses on the perspective of the teachers, as carriers of pedagogical innovation. The results show that the two versions of ELP validated for Slovenian primary schools are judged by the teachers as being quality materials which are well-adapted to the learners. This pilot period yielded a number of positive effects in both teaching and learning, most notably more communicative and learner-centered instruction formats, and an increase in the learners' motivation and self-assessment skills. The main concern was strained lesson planning, due to the fact that the ELP was not integrated into the curriculum. Overall, the study shows that, of the two parallel functions of the ELP, the documenting of language learning and achievement is more readily embraced, while the self-assessment and self-directedness aspects involve a paradigm shift, which would require further sustained and widely-supported implementation. This would enable the full unfolding of the ELP's great potential for the promotion of language and intercultural competences and lifelong learning in Slovenia and in Europe.

  14. Molecular-beam studies of primary photochemical processes

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Y.T.

    1982-12-01

    Application of the method of molecular-beam photofragmentation translational spectroscopy to the investigation of primary photochemical processes of polyatomic molecules is described. Examples will be given to illustrate how information concerning the energetics, dynamics, and mechanism of dissociation processes can be obtained from the precise measurements of angular and velocity distributions of products in an experiment in which a well-defined beam of molecules is crossed with a laser.

  15. Molecular-beam studies of primary photochemical processes

    International Nuclear Information System (INIS)

    Lee, Y.T.

    1982-12-01

    Application of the method of molecular-beam photofragmentation translational spectroscopy to the investigation of primary photochemical processes of polyatomic molecules is described. Examples will be given to illustrate how information concerning the energetics, dynamics, and mechanism of dissociation processes can be obtained from the precise measurements of angular and velocity distributions of products in an experiment in which a well-defined beam of molecules is crossed with a laser

  16. Systems approach to detect and evaluate contaminants of emerging concern in the Great Lakes

    Science.gov (United States)

    The release of chemicals of emerging concern threatens near shore health in the Great Lakes, particularly in regions already suffering from degradation of water and environmental quality due to past and present anthropogenic activities. Critical issues remain in delisting Areas ...

  17. Nuclear primary energy carriers. Short version

    Energy Technology Data Exchange (ETDEWEB)

    Jaeck, W

    1978-04-01

    Basing on our present knowledge the following energy sources for energy supply must be taken into consideration in the long term: regenerative energy sources, fission energy gained by breeder reactors, nuclear fusion. While regenerative energy sources were treated at full length in the study 'Energy Sources for Tomorrow' the present study specifies the other two energy options. The availability and the reliability of nuclear primary energy carrier supply is described in detail and the conversion systems available or still being developed are investigated with regard to their specific consumption of primary energy. Topical questions concerning the proliferation stability of the fuel cycles and techniques are subject to the INFCE program. With reference to the nuclear energy documentation activities of the Federal Government this study is supposed to supply further fundamental material on nuclear primary energy carriers, consumption and readiness for application. Thus it will contribute to the question: 'Is nuclear energy an option which guarantees energy supply in the long term for the Federal Republic of Germany'. (orig.) 891 UA 892 ARA.

  18. Nuclear primary energy carriers. Pt. 1

    International Nuclear Information System (INIS)

    1978-04-01

    Basing on our present knowledge the following energy sources for energy supply must be taken into consideration in the long term: regenerative energy sources, fission energy gained by breeder reactors, nuclear fusion. While regenerative energy sources were treated at full length in the study 'Energy Sources for tomorrow' the present study specifies the other two energy options. The availability and the reliability of nuclear primary energy carrier supply is described in detail and the conversion systems available or still being developed are investigated with regard to their specific consumption of primary energy. Topical questions concerning the proliferation stability of the fuel cycles and techniques are subject to the INFCE programme. With reference to the nuclear energy documentation activities of the Federal Govenment this study is supposed to supply further fundamental material on nuclear primary energy carriers, consumption and readiness for application. Thus it will contribute to the question: 'Is nuclear energy an option which guarantees energy supply in the long term for the Federal Republic of Germany'. (orig.) [de

  19. The Death of the Concerned Intellectual?

    Directory of Open Access Journals (Sweden)

    Chongyi Feng

    2005-08-01

    Full Text Available This paper offers a definition of the intellectual covering both professional and moral dimensions: An intellectual is a specialist who creates and communicates symbolised knowledge as means of living, and hopefully intervenes in social and political affairs in the name of universal values, truth and justice. "Symbolised knowledge" is used in the definition to avoid the confusion with other forms of knowledge derived from direct personal experience in production and life. The purpose of using "specialist" as the subject term is to exclude those categories such politicians, soldiers and business people who exercise political, military, financial and other forms of power instead of intellectual power in their social function. This paper argues that there are many roles played by intellectuals, and the social location and function of intellectuals can be fundamentally different in different societies. When production and communication of knowledge are taken as the primary concern of intellectuals, ‘the death of the concerned intellectual’ becomes an unwarranted anxiety, because there is no reason to believe that knowledge and truth will no longer be pursued and valued by humankind. Political marginalisation of critical intellectuals, where it is a reality, seems to be caused not so much by the lack of power of intellectuals as by the lack of solidarity among intellectuals to fight for a common cause. The problem lies as much in the lack of enthusiasm among intellectuals to transcend the boundaries of their professional relevance and intervene in broad social and political issues, as in institutional structures consuming too much energy and time of the intellectuals and seducing them to give up their social responsibilities for personal career.

  20. Primary care providers' lived experiences of genetics in practice.

    Science.gov (United States)

    Harding, Brittany; Webber, Colleen; Ruhland, Lucia; Dalgarno, Nancy; Armour, Christine M; Birtwhistle, Richard; Brown, Glenn; Carroll, June C; Flavin, Michael; Phillips, Susan; MacKenzie, Jennifer J

    2018-04-26

    To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners' additional concerns included cost, distance, and poor patient engagement. PCPs' perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.

  1. Existential concerns about death

    DEFF Research Database (Denmark)

    Moestrup, Lene

    2014-01-01

    Background Research suggests that addressing dying patients’ existential concerns can help improve their quality of life. Common existential conditions, such as a search for meaning and considerations about faith, are probably intensified in a palliative setting and existential concerns about death...... are likewise intensified when patients face their impending death. Knowledge of modern, secular existential concerns about death is under-researched, and therefore, it is difficult to develop and implement specifically targeted support to dying patients. Aim The aim of this paper is to present the results from...... a qualitative field study illuminating the variety of dying patients´ existential concerns about their impending death. Method Data was generated through ethnographic fieldwork comprising 17 semi-structured interviews with dying patients and 38 days of participant observation at three Danish hospices. Results...

  2. An Estimate of Attributable Cases of Alzheimer Disease and Vascular Dementia due to Modifiable Risk Factors: The Impact of Primary Prevention in Europe and in Italy

    Directory of Open Access Journals (Sweden)

    Flavia Mayer

    2018-02-01

    Full Text Available Background: Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD, while 15.8% are considered to be due to vascular dementia (VaD. In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. Aims: To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. Methods: Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR was estimated for AD and VaD. Results: In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. Conclusion: A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention.

  3. An Estimate of Attributable Cases of Alzheimer Disease and Vascular Dementia due to Modifiable Risk Factors: The Impact of Primary Prevention in Europe and in Italy.

    Science.gov (United States)

    Mayer, Flavia; Di Pucchio, Alessandra; Lacorte, Eleonora; Bacigalupo, Ilaria; Marzolini, Fabrizio; Ferrante, Gianluigi; Minardi, Valentina; Masocco, Maria; Canevelli, Marco; Di Fiandra, Teresa; Vanacore, Nicola

    2018-01-01

    Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD), while 15.8% are considered to be due to vascular dementia (VaD). In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR) was estimated for AD and VaD. In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention.

  4. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

    Science.gov (United States)

    Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

    2015-08-31

    In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of

  5. The Association between Social Media Use and Eating Concerns among U.S. Young Adults

    Science.gov (United States)

    Sidani, Jaime E.; Shensa, Ariel; Hoffman, Beth; Hanmer, Janel; Primack, Brian A.

    2016-01-01

    Background Although the etiology of eating concerns is multi-factorial, exposure to media messages is considered to be a contributor. While traditional media, such as television and magazines, have been examined extensively in relation to eating concerns risk, the influence of social media has received relatively less attention. Objective To examine the association between social media use and eating concerns in a large, nationally representative sample of young adults. Design Cross-sectional survey. Participants/setting Participants were 1765 young adults ages 19-32 years, who were randomly selected from a national probability-based online non-volunteer panel. Outcome measures An eating concerns scale was adapted from two validated measures: the SCOFF Questionnaire and the Eating Disorder Screen for Primary Care (ESP). Social media use (including Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit) was assessed using both volume (time per day) and frequency (visits per week). Statistical analyses To examine associations between eating concerns and social media use, ordered logistic regression was used, controlling for all covariates. Results Compared to those in the lowest quartile, participants in the highest quartiles for social media volume and frequency had significantly greater odds of having eating concerns (adjusted odds ratio [AOR] = 2.18, 95% CI = 1.50 - 3.17 and AOR = 2.55, 95% CI = 1.72 - 3.78, respectively). There were significant positive overall linear associations between the social media use variables and eating concerns (P social media use and eating concerns in a nationally-representative sample of young adults ages 19 to 32 years. This association was apparent whether social media use was measured as volume or frequency. Further research should assess the temporality of these associations. It would also be useful to examine more closely the influence of specific characteristics of social media

  6. BARRIERS TO THE UTILIZATION OF PRIMARY CARE SERVICES FOR MENTAL HEALTH PROLEMS

    Directory of Open Access Journals (Sweden)

    KHAIRANI O

    2010-01-01

    Full Text Available Objective: To study the barriers toward the utilization of primary care services for mental health problems among adolescents in a secondary school in Hulu Langat, Selangor, Malaysia. Methods: This was a cross-sectional study conducted in July 2008 at a secondary school in Hulu Langat, Selangor. The respondents were selected using randomised cluster sampling among Form Four and Form Five students. Students were given self-administered questionnaire, consisting socio-demographic data and questions on their help-seeking barrier and behaviour. Help-seeking behaviour questions assess the use of medical facility and help-seeking sources. The formal help seeking sources include from teachers, counsellors and doctors. The informal help-seeking sources include from friends,parents and siblings. Results: A total of 175 students were included in the study. None of the students admitted of using the primary health care services for their mental health problems. Majority of the students were not aware of the services availability in the primary health care (97.1%. More than half of them thought the problems were due to their own mistakes (55.4% and the problems were not that serious (49.1%. With regard to perception of the primary health care services, (43.2% of the students were worried about confidentiality, half of them were concerned about other people’s perception especially from their family members(44.6% and friends (48.6%. Minority of them (10.8% thought that nobody can help them. Few of them thought smoking(3.4%, alcohol (3.4% and recreational drugs (1.1% can solve their emotional problems. Conclusion: One of the major barriers identified in the students’ failure to use the health care facilities was their unawarenessof the availability of the service for them in the community. Thus there is a need to promote and increase their awareness onthis issue.

  7. Parents’ concerns regarding the growth characteristics of their adolescents: a qualitative inquiry in Iran

    Science.gov (United States)

    Vedadhir, AbouAli; Taghizadeh, Ziba; Samadanifard, Seyyed Hossein

    2018-01-01

    ABSTRACT In recent times, parents have become increasingly concerned, both subjectively and objectively, about their adolescents' body height/weight growth. Parent-adolescent interactions about this issue and the potential socio-psychological consequences of such interactions should be considered as an important influencing factor on the future of adolescents' sexual and reproductive health. To achieve a greater understanding of such concerns, it is necessary to further elucidate parents' experiences on this topic, so as to expand the existing literature. This study aimed to explain the perceptions of parents' concerns regarding their adolescents' growth characteristics in the socio-cultural context of Iran as a transitional society. This paper is part of a larger qualitative study designed using the Constructivist Grounded Theory Methodology (CGTM). We conducted open-ended intensive interviews with eleven parents individually and recruited them through purposeful and theoretical sampling from a teaching hospital, community, and a primary school in Tehran with theoretical sampling variation in terms of teenagers' age, sex, and birth order, place of residence, parents' occupation and education, and the self-reported socio-economic status. Using the analytical procedures of the CGTM, we performed analyses. In the findings, the concept of 'living with constant sense of uncertainty' emerged from the subcategories including 'feeling existing and potential concern about expected minimum and maximum bio-positions of growth,' 'feeling potential concern about biological health consequences,' 'feeling potential concern about the emergence of early/late maturity signs,' 'feeling potential concern about adolescent's emotional threat,' 'feeling concerned about future employment, education, marriage, and fertility,' and 'feeling potential concern about the society's view'. These findings suggest that parents are living with a constant sense of uncertainty about their teens

  8. Speaking Turkish in Belgian primary schools: teacher beliefs versus effective consequences

    NARCIS (Netherlands)

    Ağırdağ, O.; Jordens, K.; Van Houtte, M.

    2014-01-01

    In this mixed-method study, we explore teachers’ beliefs concerning the use of the Turkish language by Turkish children in Belgian primary schools, and we compare these findings with the effective consequences of language maintenance. The qualitative analyses revealed that teachers have very

  9. Medications for the Risk Reduction of Primary Breast Cancer in Women

    Science.gov (United States)

    ... This final recommendation statement does not apply to women who have a history of blood clots, stroke, or “mini-stroke” (when ... of Primary Breast Cancer in Women If a woman has a family history of breast cancer or is concerned about her ...

  10. Hypophysiary hyperplasia secondary to primary hypothyroidism

    International Nuclear Information System (INIS)

    Garcia, Jorge; Polania, Diana Ligia; Builes, Carlos Alfonso

    2005-01-01

    This is a 43 years old woman, complaining of galactorhea, headache and hyperprolactinaemia. A large macro adenoma of the pituitary with extensive suprasellar extension and displacement of the optic chiasm was detected on MRI and primary hypothyroidism was found. After treatment with levothyroxine for four months, her TSH and prolactin levels returned to normal, her symptoms improved and a marked shrinkage of the selar lesion was observed. The visual fields returned to normal. This is a case of pituitary hyperplasia due to primary hypothyroidism

  11. Radiation Safety in the Neonatal Intensive Care Unit: Too Little or Too Much Concern?

    Directory of Open Access Journals (Sweden)

    Cheng-Chung Yu

    2010-12-01

    Full Text Available With rising numbers of extremely premature infants in the neonatal intensive care unit (NICU who require multiple radiologic examinations for their complex medical conditions, concerns the risk of radiation exposure become a more prevalent issue. The biological effects from cumulative doses of both primary and secondary radiation can be particularly troubling for very premature babies due to their inherent sensitivity to both iatrogenic and environmental insults. Similarly, radiologic studies performed in the NICU pose potentially significant exposure risks to caretakers and to the families of patients often present in the NICU during these examinations. The purpose of this article is to critically review the available literature regarding current exposure rates in the NICU, address the validity of radiation exposure concerns, and suggest areas for improvement. With few exceptions, studies reveal that there were only low doses of radiation derived from any single radiographic examination in standard NICUs and that the radiation dosage used was in compliance with recommendations made by the Commission of European Communities (EC and International Commission on Radiological Protection (ICRP. However, there were wide variations in the radiation dose per single examination (mean entrance skin doses ranged from 15 to 73.6 μGy and in the frequency (mean ranged from 3.2 to 31 examinations per infant of those examinations. Studies also reported low secondary exposure rates from scatter radiation to others present in the NICU during radiographic examinations. Key to limiting unnecessary radiation exposure in the NICU is the employment of proper radiation techniques and safety measures. Thus, adhering to recommendations made by the EC and ICRP can help to reduce the anxiety of patients' families and medical staff regarding their risks from the effects of ionizing radiation in the NICU.

  12. Helping behavior induced by empathic concern attenuates anterior cingulate activation in response to others' distress.

    Science.gov (United States)

    Kawamichi, Hiroaki; Yoshihara, Kazufumi; Sugawara, Sho K; Matsunaga, Masahiro; Makita, Kai; Hamano, Yuki H; Tanabe, Hiroki C; Sadato, Norihiro

    2016-01-01

    Helping behavior is motivated by empathic concern for others in distress. Although empathic concern is pervasive in daily life, its neural mechanisms remain unclear. Empathic concern involves the suppression of the emotional response to others' distress, which occurs when individuals distance themselves emotionally from the distressed individual. We hypothesized that helping behavior induced by empathic concern, accompanied by perspective-taking, would attenuate the neural activation representing aversive feelings. We also predicted reward system activation due to the positive feeling resulting from helping behavior. Participant underwent functional magnetic resonance imaging while playing a virtual ball-toss game. In some blocks ("concern condition"), one player ("isolated player") did not receive ball-tosses from other players. In this condition, participants increased ball-tosses to the isolated player (helping behavior). Participants then evaluated the improved enjoyment of the isolated player resulting from their helping behavior. Anterior cingulate activation during the concern condition was attenuated by the evaluation of the effect of helping behavior. The right temporoparietal junction, which is involved in perspective-taking and the dorsal striatum, part of the reward system, were also activated during the concern condition. These results suggest that humans can attenuate affective arousal by anticipating the positive outcome of empathic concern through perspective-taking.

  13. Intensity-Modulated Radiation Therapy for Primary Brain Tumors

    Institute of Scientific and Technical Information of China (English)

    Zhong-min Wang

    2004-01-01

    Radiation therapy has been used to treat primary brain tumors as standard primary and/or adjunctive therapies for decades. It is difficult for conventional radiotherapy to deliver a lethal dose of radiation to the tumors while sparing surrounding normal brain due to complicated structures and multifunction in human brain. With the understanding of radiation physics and computer technology, a number of novel and more precise radiotherapies have been developed in recent years. Intensity modulated radiotherapy (IMRT) is one of these strategies. The use of IMRT in the treatment of primary brain tumors is being increasing nowadays. It shows great promise for some of primary brain tumors and also presents some problems, This review highlights current IMRT in the treatment of mainly primary brain tumors.

  14. Interim report on the special research project 'exposure to environmental radiation due to nuclear facilities'

    International Nuclear Information System (INIS)

    1981-03-01

    This special research project was started in 1978 as five-year plan. The purposes are to clarify the aspect of radiation exposure in human bodies due to the radioactive substances brought into the environment regarding the utilization of atomic energy, its mechanism and various factors affecting it, and to contribute to the evaluation of exposure dose, the reduction of radiation exposure, the conditions of locating nuclear facilities and the improvement of the method of disposing radioactive wastes. In addition to the fields treated in the previous special research project, the experimental research concerning the metabolism of environmental radioactive nuclides in bodies, namely the problem of the peculiarity of radioactive nuclide kinetics in infants and fetuses different from adults and the possibility of causing the changes in the intake and metabolism of nuclides in foods by the difference in their states of existence, was newly included. Also the research concerning the method of evaluating the absorbed dose in human organs at the time of irradiation outside and inside bodies in a new subject. Accordingly, this special research project is composed of (1) the research concerning the radionuclide kinetics in the environment, (2) the research concerning the radionuclide kinetics in bodies, (3) the research concerning the measurement and evaluation of dose absorbed in internal organs due to environmental radiation, and (4) the research concerning the monitoring of low level environmental radiation. The results obtained so far are reported. (Kako, I.)

  15. The Association between Social Media Use and Eating Concerns among US Young Adults.

    Science.gov (United States)

    Sidani, Jaime E; Shensa, Ariel; Hoffman, Beth; Hanmer, Janel; Primack, Brian A

    2016-09-01

    The etiology of eating concerns is multifactorial, and exposure to media messages is considered to be a contributor. Although traditional media, such as television and magazines, have been examined extensively in relation to eating concerns risk, the influence of social media has received relatively less attention. To examine the association between social media use and eating concerns in a large, nationally representative sample of young adults. Cross-sectional survey. Participants were 1,765 young adults aged 19 to 32 years who were randomly selected from a national probability-based online nonvolunteer panel. An eating concerns scale was adapted from two validated measures: the SCOFF Questionnaire and the Eating Disorder Screen for Primary Care. Social media use (including Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit) was assessed using both volume (time per day) and frequency (visits per week). To examine associations between eating concerns and social media use, ordered logistic regression was used, controlling for all covariates. Compared with those in the lowest quartile, participants in the highest quartiles for social media volume and frequency had significantly greater odds of having eating concerns (adjusted odds ratio 2.18, 95% CI 1.50 to 3.17 and adjusted odds ratio 2.55, 95% CI 1.72 to 3.78, respectively). There were significant positive overall linear associations between the social media use variables and eating concerns (P<0.001). The results from this study indicate a strong and consistent association between social media use and eating concerns in a nationally representative sample of young adults aged 19 to 32 years. This association was apparent whether social media use was measured as volume or frequency. Further research should assess the temporality of these associations. It would also be useful to examine more closely the influence of specific characteristics of social media use

  16. Teaching Computation in Primary School without Traditional Written Algorithms

    Science.gov (United States)

    Hartnett, Judy

    2015-01-01

    Concerns regarding the dominance of the traditional written algorithms in schools have been raised by many mathematics educators, yet the teaching of these procedures remains a dominant focus in in primary schools. This paper reports on a project in one school where the staff agreed to put the teaching of the traditional written algorithm aside,…

  17. Reusability of coded data in the primary care electronic medical record : A dynamic cohort study concerning cancer diagnoses

    NARCIS (Netherlands)

    Sollie, Annet; Sijmons, Rolf H.; Helsper, Charles W.; Numans, Mattijs E.

    Objectives: To assess quality and reusability of coded cancer diagnoses in routine primary care data. To identify factors that influence data quality and areas for improvement. Methods: A dynamic cohort study in a Dutch network database containing 250,000 anonymized electronic medical records (EMRs)

  18. Experiences from Loviisa Nuclear Power Station concerning the decontamination of steam generators and primary system components

    International Nuclear Information System (INIS)

    Jaernstroem, R.

    1989-01-01

    Loviisa 1 and 2 are 465 MWe PWR units of the Soviet type VVER-440. Loviisa 1 has been in commercial operation since spring 1977 and Loviisa 2 from the beginning of 1980. Decontamination of primary circuit components - even big ones as steam generators - can be performed in an efficient and quick way with good results and resonable expences. Total costs for decontamination of the two steam generators including planning, construction, documentation, operation, chemicals etc. did not rise above 100,000.00 dollars. (author) 6 figs., 2 tabs

  19. Neurodevelopmental toxicity risks due to occupational exposure to industrial chemicals during pregnancy

    DEFF Research Database (Denmark)

    Julvez, Jordi; Grandjean, Philippe

    2009-01-01

    Exposure to neurotoxic chemicals is of particular concern when it occurs during early development. The immature brain is highly vulnerable prenatally and is therefore at risk due to occupational exposures incurred by pregnant women. A systematic search of the literature has been performed...... by occupational health researchers and practitioners from the need to protect pregnant workers. Due to the vulnerability of the brain during early development, a precautionary approach to neurodevelopmental toxicity needs to be applied in occupational health....

  20. Medical Students Raising Concerns.

    Science.gov (United States)

    Druce, Maralyn R; Hickey, Andrea; Warrens, Anthony N; Westwood, Olwyn M R

    2016-09-16

    After a number of high-profile incidents and national reports, it has become clear that all health professionals and all medical students must be able to raise concerns about a colleague's behavior if this behavior puts patients, colleagues, or themselves at risk.Detailed evidence from medical students about their confidence to raise concerns is limited, together with examples of barriers, which impair their ability to do so. We describe a questionnaire survey of medical students in a single-center, examining self-reported confidence about raising concerns in a number of possible scenarios. Thematic analysis was applied to comments about barriers identified.Although 80% of respondents felt confident to report a patient safety issue, students were less confident around issues of probity, attitude, and conduct. This needs to be addressed to create clear mechanisms to raise concerns, as well as support for students during the process.

  1. Cracking in reinforced concrete structures due to imposed deformations

    Energy Technology Data Exchange (ETDEWEB)

    Nagy, A.

    1997-04-01

    This thesis is concerned with modeling of the cracking process in reinforced concrete due to imposed deformations. Cracking is investigated both at early ages, during hydration, and at mature age when the final properties of the concrete are reached. One of the most important material characteristics of the concrete at early ages, the Young`s modulus is determined by means of a dynamic method called the resonance frequency method. 40 refs

  2. A primary care-based health needs assessment in inner city Dublin.

    LENUS (Irish Health Repository)

    O'Kelly, C M

    2012-02-01

    BACKGROUND: In 2001, a primary care-based health needs assessment (HNA) in South Inner City of Dublin identified high levels of morbidity and widespread and frequent use of primary care and specialist hospital services as particular concerns. AIMS: This study aims to determine the primary care health needs of a local community, from the perspective of service users and service providers. METHODS: A similar methodology to our 2001 HNA was adopted, involving semi-structured interviews with a convenience sample of patients attending two general practices and key informants regarding local health issues and health service utilisation. RESULTS: High levels of morbidity and chronic illness were found. A correlation between the local environment and ill-health was identified, as well as high utilisation of primary care services in the area. CONCLUSION: The establishment of a Primary Care Team would begin to address the health needs of the community.

  3. ORAL ADMINISTRATION OF EXOGENOUS LACTASE IN TABLETS FOR PATIENTS DIAGNOSED WITH LACTOSE INTOLERANCE DUE TO PRIMARY HYPOLACTASIA.

    Science.gov (United States)

    Francesconi, Carlos Fernando de Magalhães; Machado, Marta Brenner; Steinwurz, Flavio; Nones, Rodrigo Bremer; Quilici, Flávio Antonio; Catapani, Wilson Roberto; Miszputen, Sender Jankiel; Bafutto, Mauro

    2016-01-01

    Primary hypolactasia is a common condition where a reduced lactase activity in the intestinal mucosa is present. The presence of abdominal symptoms due to poor absorption of lactose, which are present in some cases, is a characteristic of lactose intolerance. Evaluate the efficacy of a product containing exogenous lactase in tablet form compared to a reference product with proven effectiveness in patients with lactose intolerance. Multicentre, randomized, parallel group, single-blind, comparative non-inferiority study. One hundred twenty-nine (129) adult lactose intolerance patients with hydrogen breath test results consistent with a diagnosis of hypolactasia were randomly assigned to receive the experimental product (Perlatte(r) - Eurofarma Laboratórios S.A.) or the reference product (Lactaid(r) - McNeilNutritionals, USA) orally (one tablet, three times per day) for 42 consecutive days. Data from 128 patients who actually received the studied treatments were analysed (66 were treated with the experimental product and 62 with the reference product). The two groups presented with similar baseline clinical and demographic data. Mean exhaled hydrogen concentration tested at 90 minutes after the last treatment (Day 42) was significantly lower in the experimental product treated group (17±18 ppm versus 34±47 ppm) in the per protocol population. The difference between the means of the two groups was -17 ppm (95% confidence interval [95% CI]: -31.03; -3.17). The upper limit of the 95% CI did not exceed the a priori non-inferiority limit (7.5 ppm). Secondary efficacy analyses confirmed that the treatments were similar (per protocol and intention to treat population). The tolerability was excellent in both groups, and there were no reports of serious adverse events related to the study treatment. The experimental product was non-inferior to the reference product, indicating that it was an effective replacement therapy for endogenous lactase in lactose intolerance

  4. Public concerns and behaviours towards solid waste management in Italy.

    Science.gov (United States)

    Sessa, Alessandra; Di Giuseppe, Gabriella; Marinelli, Paolo; Angelillo, Italo F

    2010-12-01

    A self-administered questionnaire investigated knowledge, perceptions of the risks to health associated with solid waste management, and practices about waste management in a random sample of 1181 adults in Italy. Perceived risk of developing cancer due to solid waste burning was significantly higher in females, younger, with an educational level lower than university and who believed that improper waste management is linked to cancer. Respondents who had visited a physician at least once in the last year for fear of contracting a disease due to the non-correct waste management had an educational level lower than university, have modified dietary habits for fear of contracting disease due to improper waste management, believe that improper waste management is linked to allergies, perceive a higher risk of contracting infectious disease due to improper waste management and have participated in education/information activities on waste management. Those who more frequently perform with regularity differentiate household waste collection had a university educational level, perceived a higher risk of developing cancer due to solid waste burning, had received information about waste collection and did not need information about waste management. Educational programmes are needed to modify public concern about adverse health effects of domestic waste.

  5. How much due diligence is enough? (in oil and gas property transactions)

    International Nuclear Information System (INIS)

    Edie, D.C.

    1999-01-01

    The issue of due diligence for oil and gas property transactions was discussed, with particular emphasis on how to find an appropriate balance between cost and protection (risk aversion) within an available time period. The paper focused primarily on oil and gas reserves transactions comprised of petroleum and natural gas rights, leases, operating and title documents, tangibles and the regulatory authorizations needed to acquire, hold and operate these assets. Various concerns related to gas processing plants and pipeline facilities were also treated. Issues of due diligence that should always be raised were emphasized. These are: (1) acceptability of the purchaser to the Alberta Energy and Utilities Board or other regulators as an operator for the purposes of transfer of well and facility licenses, (2) assessment of the purchaser's financial status for environmental liabilities relating to the assets following closing, (3) in an asset swap, property due diligence will be the same for both parties, and (4) where the assets are sold in exchange for stock, the purchaser should at least address concerns about the purchaser's liquidity, the purchaser's underlying asset value, and necessary regulatory authorizations to issue the stock. 10 refs

  6. An Overview of the EPRI PWR Primary Chemistry Program

    International Nuclear Information System (INIS)

    Perkins, David; Fruzzetti, Keith; Haas, Carey; Wells, Dan

    2012-09-01

    Primary chemistry controls continue to evolve, impacting long term equipment reliability goals, optimized core designs, and radiation dose management practices. Chemistry initiatives include increased primary system pH (T) , zinc injection, and optimization of primary system hydrogen concentration. Nevertheless, utilities are faced with ever changing challenges as fuel vendors continue to optimize core power densities coupled with longer operating cycles and material replacement efforts. These challenges must be collaboratively addressed by the plant chemists, engineers, and operators. Operational chemistry has changed dramatically over the years with increased primary pH (T) programs requiring some utilities to operate with up to 6 ppm lithium or slightly higher. Coupled with primary pH (T) program optimization, are ongoing EPRI research efforts attempting to develop an optimized hydrogen control program balancing material issues associated with primary water stress corrosion cracking (PWSCC) crack growth rate against fuel concerns associated with increased hydrogen concentrations. One of the most significant primary chemistry changes that effectively balances the demands of materials, fuels, chemistry and dose management strategies is zinc injection into the primary coolant. Since 1994 when Farley initiated zinc injection, zinc injection has been successfully injected at over 70 pressurized water reactors world-wide. Combining operational chemistry with shutdown chemistry controls provides the plant chemist with a technically based and balanced approach to fuel and material integrity as well as dose management strategies. Shutdown chemistry has continually evolved since the 1970's when the chemist was primarily concerned with fission products. Now the chemist must manage corrosion product release, and support Outage Management and Radiation Protection through the performance of a controlled shutdown. In part, this change was driven as plant materials evolved

  7. The Perceived Credibility of Scientific Claims, Paranormal Phenomena, and Miracles among Primary Teacher Students: A Comparative Study.

    Science.gov (United States)

    Keranto, Tapio

    2001-01-01

    Presents data collected concerning scientific, religious, and magic-occult connections from Finnish, Estonian, and Michigan primary teacher students to answer questions such as Do we find any differences between the credibility estimates?, Are there any differences between primary teacher students raised in different societies and educated in…

  8. Third sector primary care for vulnerable populations.

    Science.gov (United States)

    Crampton, P; Dowell, A; Woodward, A

    2001-12-01

    This paper aims to describe and explain the development of third sector primary care organisations in New Zealand. The third sector is the non-government, non-profit sector. International literature suggests that this sector fulfils an important role in democratic societies with market-based economies, providing services otherwise neglected by the government and private for-profit sectors. Third sector organisations provided a range of social services throughout New Zealand's colonial history. However, it was not until the 1980s that third sector organisations providing comprehensive primary medical and related services started having a significant presence in New Zealand. In 1994 a range of union health centres, tribally based Mäori health providers, and community-based primary care providers established a formal network -- Health Care Aotearoa. While not representing all third sector primary care providers in New Zealand, Health Care Aotearoa was the best-developed example of a grouping of third sector primary care organisations. Member organisations served populations that were largely non-European and lived in deprived areas, and tended to adopt population approaches to funding and provision of services. The development of Health Care Aotearoa has been consistent with international experience of third sector involvement -- there were perceived "failures" in government policies for funding primary care and private sector responses to these policies, resulting in lack of universal funding and provision of primary care and continuing patient co-payments. The principal policy implication concerns the role of the third sector in providing primary care services for vulnerable populations as a partial alternative to universal funding and provision of primary care. Such an alternative may be convenient for proponents of reduced state involvement in funding and provision of health care, but may not be desirable from the point of view of equity and social cohesion

  9. The Perceived Stigma of Mental Health Services Among Rural Parents of Children With Psychosocial Concerns

    OpenAIRE

    Polaha, Jodi; Williams, Stacey L.; Heflinger, Craig Anne; Studts, Christina R.

    2015-01-01

    Objective To examine parents’ perceptions of stigma regarding mental health services for their child, consider stigma in the context of novel service delivery settings (e.g., telehealth, primary care, and schools), and evaluate stigma with other factors known to influence service access. Methods 347 caregivers of children with psychosocial concerns completed surveys regarding their perceptions of stigma, service delivery settings, and barriers to care. Results Parents endorsed low levels of s...

  10. Existing Smog in Lahore, Pakistan: An Alarming Public Health Concern.

    Science.gov (United States)

    Riaz, Ramsha; Hamid, Khizar

    2018-01-25

    Lahore, the second-largest and most polluted city in Pakistan, has been plagued by a heavy blanket of smog recently. The ever-growing urbanization and industrialization have contributed to the worsening air quality of the city. Smog, being hazardous to health, is leading to a rapid sprout in multiple health-related problems, as well as raising concerns about the long-term deleterious effects on public health. The current situation is expected to worsen due to the lack of an active action plan from the government's side and a failure of concerned authorities to take note of the urgency of the situation. Hence, we aim to highlight this pressing issue in the light of previously published articles, to alert the relevant authorities regarding the detrimental consequences smog can have on public health and urge them to take immediate action to avoid further damage.

  11. A rare case of primary amenorrhea

    Directory of Open Access Journals (Sweden)

    Himadri Bal

    2016-01-01

    Full Text Available Crytomenorrhea arises usually due to the imperforate hymen, sometimes due to vaginal septum, rarely due to cervical agenesis. Here, we present a case of primary amenorrhea resulting from cervical agenesis in a 38-year-old woman. She presented with primary amenorrhea and cyclic lower abdominal pain. She had undergone some surgery 5 years back, details of which were not available. On examination secondary sexual characters were normal, per abdomen there was an 18 weeks size firm abdominopelvic mass. Local vaginal examination showed a blind vaginal pouch. A clinical diagnosis of hematometra due to transverse vaginal septum was made. However, magnetic resonance imaging pelvis suggested hematometra with cervical stenosis. The patient was taken up for examination under anaesthesia (EUA and exploratory laparotomy. On opening the abdomen uterus found to be enlarged with dense adhesions all around and signs of endometriosis. Extensive adhesiolysis revealed bilateral chocolate cysts of ovaries with hematosalpinges and peritubal adhesions. Hysterotomy and drainage of tarry contents were followed by an exploration of the uterine cavity. The lower pole ended blindly with no evidence of any cervix. Peroperative diagnosis of cervical agenesis leading to hematometra and endometriosis was made. A subtotal hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination confirmed ovarian endometriosis and adenomyosis of uterus. Though reconstructive surgery for cervical dysgenesis has been successful in some cases, hysterectomy is generally recommended for cervical agenesis.

  12. [Primary headache and depression].

    Science.gov (United States)

    Gesztelyi, Gyöngyi

    2004-11-28

    Primary headaches--mainly tension-type headache and migraine--affect a significant portion of the population. Depression is also highly prevalent. The co-existence of a primary headache and depression in the same patient therefore might be a coincidence due to the high prevalence of these conditions, but there might be a causal relationship between them, or headaches and depression might have a common background. This review of the literature summarizes the features of the relationship between primary headaches and depression. Depression is more prevalent in headache patients than in the headache-free population. Prospective epidemiological studies suggest a common genetic, biochemical or environmental background behind primary headaches and depression. This theory is supported by the role of the same neurotransmitter systems (mostly serotonin and dopamine) in headaches as well as in depression. Comorbid depression is associated with female gender, higher age, and higher frequency of headaches. Most depression inventories--questionnaires used to screen for the severity of depressive symptoms--contain transdiagnostic items, therefore their use in their original form is limited in organic diseases: due to the somatic items they might overestimate the severity of depression. When examining a headache patient special attention should be paid to the recognition of comorbid depression. The diagnosis of suspected mood disorder could be supported by using simple screening methods, such as the original or the abbreviated versions of standard depression inventories, but the final diagnosis of major depression needs psychiatric evaluation. Quality of life of the headache patient is affected not only by the characteristics of pain (frequency, duration, severity) but also by the disability caused by headache and the associating mood disorder. Recognizing coexisting mood disorder and disability helps to make the best treatment choice for the acute and preventive treatment of

  13. Gender-related differences in student achievements in primary teacher education.

    NARCIS (Netherlands)

    Geerdink, G.; Bergen, T.C.M.; Dekkers, H.

    2007-01-01

    It was primarily the feminisation of primary education that spurred the research project reported on here. Feminisation is not only caused by the small percentage of male students opting for primary teacher training but also due to the relatively large percentage of male students in a teacher

  14. [Increasing participation of primary care in the management of people with human immunodeficiency virus: hospital care professionals express their views].

    Science.gov (United States)

    Ortega López, Angela; Morales Asencio, José Miguel; Rengel Díaz, Cristóbal; Peñas Cárdenas, Eloísa María; González Rodríguez, María José; Prado de la Sierra, Rut

    2014-04-01

    To determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care. Qualitative study using in-depth interviews. Infectious Diseases Unit in the University Hospital "Virgen de la Victoria" in Málaga. Health professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants. Convenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants. Hospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients. Physicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  15. Weight, shape, and muscularity concerns in male and female adolescents: Predictors of change and influences on eating concern.

    Science.gov (United States)

    Hoffmann, Svenja; Warschburger, Petra

    2017-02-01

    The purpose of this study was to examine the impact of age and weight status on adolescents' body dissatisfaction and its change over 20 months in a gender-comparing design. The influence of body image concern on eating concern was also investigated. In a prospective study, 675 male and female adolescents aged 12-16 were assessed using self-report questionnaires on weight, shape, muscularity, and eating concerns. Height and weight measurements were taken by trained personnel. Data were analyzed using structural equation modeling. Analyses of latent means revealed more pronounced weight/shape concern in females than males and more pronounced muscularity concern in males than females. Weight/shape concern increased in females over time, whereas muscularity concern remained stable in both genders. Baseline levels of weight/shape concern could be predicted by age and weight status in females and by weight status in males. The only predictor of change in weight/shape concern was weight status in males. Baseline levels of muscularity concern could be predicted by age in females and by weight status in males. Similar effects were found for changes in muscularity concern in both genders. Increases in weight/shape and muscularity concern were associated with more pronounced eating concern. The results confirm gender differences in distinctive facets of body image concern and its prediction. The relevance of increase in body image concern in adolescents is underlined by its association with eating concern in both genders. Further explanatory variables for change in body dissatisfaction should be examined in future studies. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:139-147). © 2016 Wiley Periodicals, Inc.

  16. Factors that contribute to the body image concern of female college students.

    Science.gov (United States)

    Silva, Wanderson Roberto; Dias, Juliana Chioda Ribeiro; Maroco, João; Campos, Juliana Alvares Duarte Bonini

    2015-01-01

    To estimate the contribution of sociodemographic and labor variables and body mass index to body image concern. In order to estimate body image concern, the Body Shape Questionnaire (BSQ) and the Weight Concerns Scale (WCS) were applied. A confirmatory factor analysis of scales was carried out. The reason χ2 by degree of freedom ratio (χ2/df ), Comparative Fit Index (CFI), Normed Fit Index (NFI), and root mean square error of approximation (RMSEA) were used. Convergent validity was assessed through the average variance extracted and composed reliability and the internal consistency through standardized Cronbach's alpha coefficient (α). A structural model was developed, and the body image concern was the second-order main construct. The model appropriation was evaluated based on the goodness-of-fit indices. The z test was used to estimate the significance of trajectories (β) using a 5% significance level. Totally, 595 female college students participated in the study, with a mean age of 20.42 ± 2.44 years. The entire model, with the inclusion of all independent variables, showed unsatisfactory adjustment and was refined. The final model presented a satisfactory adjustment (χ2/df = 5.75; CFI = 0.87; NFI = 0.85; RMSEA = 0.09) with inclusion of medication use because of studies (β = 0.08; p = 0.04), academic performance (β = 0.09; p = 0.02), economic class (β = 0.08; p = 0.03), and body mass index (β = 0.44; p concern. Medication use due to studies, academic performance, economic class and body mass index significantly contribute to body image concern.

  17. Cosmetic Concerns Among Men.

    Science.gov (United States)

    Handler, Marc Zachary; Goldberg, David J

    2018-01-01

    Men are interested in reducing signs of aging, while maintaining a masculine appearance. A chief concern among men is maintenance of scalp hair. Men are also concerned with reducing under eye bags and dark circles. The concern of feminization is of significant importance. Neuromodulators remain the most common cosmetic procedure performed in men. Men often prefer a reduction in facial rhytids, as opposed to elimination of the lines. Softening facial lines in men is meant to maintain an appearance of wisdom, without appearing fragile. Men also wish to maintain a taut jawline and a slim waist and reduce breast tissue. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Positional Concerns and Institutions

    DEFF Research Database (Denmark)

    Landes, Xavier

    2013-01-01

    that invoking envy or subjective well-being is not fully satisfying for regulating positional concerns. More compelling reasons seem, in complement with efficiency, to be related to considerations for equality. In other words, if institutions could have strong reasons to pay attention to and regulate positional...... their implications for economics, positional concerns imply important normative dimensions. There have been presumed to be a symptom of envy, reduce people’s happiness, and create problems of social interaction or economic inefficiencies. Individuals are, for instance, prone to pick states of the world that improve...... concerns, it would be in virtue of their impact on the social product and individuals’ conditions of living....

  19. Teacher Concerns and Teacher Life Stages

    Science.gov (United States)

    Mok, Yan Fung

    2005-01-01

    This article examines teaching concerns at successive life stages among teachers with up to twenty years' or more teaching experience. Three concern stages are discerned. Nine common concern factors were found from factor-analysing thirty-three concern items. Results show that student discipline, relations with students, and students' learning and…

  20. How to capture patients’ concerns and related changes: Comparing the MYCaW questionnaire, semi-structured interview and a priority list of outcome areas

    DEFF Research Database (Denmark)

    Ostenfeld-Rosenthal, Ann; Johannessen, Helle

    2014-01-01

    as rehabilitation after colorectal cancer, a sub-sample of 31 participants completed the MYCaW questionnaire and the priority list and were interviewed before, during and after the treatment period. Setting Treatments were provided in healers’ clinics in Denmark. Main outcome measures For each participant......Objectives To compare the capacity of the MYCaW questionnaire, a priority list of concerns covered by validated questionnaires, and semi-structured interviews to identify patients’ personalized concerns and related changes. Design In a pragmatic trial on the effectiveness of energy healing...... experience with the treatment, while concerns stated in interviews and the priority list remained stable throughout the study; (2) emotional concerns were reported more often in interviews than in MYCaW, physical concerns were predominant in MYCaW, and quality of life was marked as a primary concern most...

  1. High-grade primary pulmonary leiomyosarcoma

    Directory of Open Access Journals (Sweden)

    Rodrigo Afonso da Silva Sardenberg

    2011-12-01

    Full Text Available Primary sarcomas of the lung are rare and account for 0.5% of all primary lung tumors. There were approximately 300 cases described in the literature as of 2006. All histologic types of sarcoma were described, and the most common intrathoracic types reported were angiosarcoma, leiomyosarcoma, fibrosarcoma, hemangiopericytoma, and rhabdomyosarcoma. The biological behavior of these tumors is not well-known due to their low frequency. Leiomyosarcomas represent one of the most common subtypes encountered in the lungs, and usually occur during the sixth decade, with male predominance. Although the frequency of metastatic disease is not related to tumor size, prognosis was reported to be poorer in high-grade tumors. In comparison with other sarcomas, survival after complete resection of pulmonary leiomyosarcoma was reported as longer. We report on a patient with primary leiomyosarcoma originating from the bronchus with complete resection and long-term follow-up.

  2. Fairness and nanotechnology concern.

    Science.gov (United States)

    McComas, Katherine A; Besley, John C

    2011-11-01

    Research suggests that fairness perceptions matter to people who are asked to evaluate the acceptability of risks or risk management. Two separate national random surveys (n = 305 and n = 529) addressed Americans' concerns about and acceptance of nanotechnology risk management in the context of the degree to which they view scientists and risk managers as fair. The first survey investigated general views about scientists across four proposed dimensions of fairness (distributional, procedural, interpersonal, and informational). The results show that respondents who believe that the outcomes of scientific research tend to result in unequal benefits (distributional fairness) and that the procedures meant to protect the public from scientific research are biased (procedural fairness) were more concerned about nanotechnology. Believing scientists would treat them with respect (interpersonal fairness) and ensure access to information (informational fairness) were not significant predictors of concern. The second study also looked at these four dimensions of fairness but focused on perceptions of risk managers working for government, universities, and major companies. In addition to concern, it also examined acceptance of nanotechnology risk management. Study 2 results were similar to those of study 1 for concern; however, only perceived informational fairness consistently predicted acceptance of nanotechnology risk management. Overall, the study points to the value of considering fairness perceptions in the study of public perceptions of nanotechnology. © 2011 Society for Risk Analysis.

  3. Lower respiratory tract infections in the elderly: Prognostic studies in primary care

    NARCIS (Netherlands)

    Bont, J.

    2008-01-01

    Lower respiratory tract infections (LRTI) are among the most common diseases presented in primary care. When the general practitioner (GP) diagnoses an LRTI he or she is confronted with important clinical dilemmas concerning treatment and prognosis. Especially elderly are of importance, as the

  4. A simple clinical coding strategy to improve recording of child maltreatment concerns: an audit study.

    Science.gov (United States)

    McGovern, Andrew Peter; Woodman, Jenny; Allister, Janice; van Vlymen, Jeremy; Liyanage, Harshana; Jones, Simon; Rafi, Imran; de Lusignan, Simon; Gilbert, Ruth

    2015-01-14

    Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording. To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records. Clinical audit of rates of maltreatment-related coding before January 2010-December 2011 and after January-December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code 'Child is cause for concern'. A total of 25,106 children aged 0-18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording. Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern. We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1-1.6), child protection procedures (RR 1.4; 95% CI 1.1-1.6) and cause for concern (RR 2.5; 95% CI 1.8-3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation. This simple coding strategy improved clinician's recording of maltreatment-related concerns in a small sample of practices with some 'buy-in'. Further research should investigate how recording can best support the doctor-patient relationship. HOW THIS FITS IN: Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial under-recording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns

  5. Anaesthetic Implications in Primary Hyperparathyroidism with Severe Hypercalcaemia; a Case Report

    Directory of Open Access Journals (Sweden)

    Pranav Bansal

    2013-07-01

    Full Text Available Primary hyperparathyroidism is a rare endocrinal disorder of excess production of parathormone. A wide array of presenting symptoms may occur from parathormone induced hypercalcaemia leading to nephrolithiasis, osteoporosis, muscle weakness and cardiac arrhythmias. We present a case of young female who presented with non union of an operated fracture femur and generalized bony pains and frequent complaints of vomiting, polyuria and polydipsia. She was diagnosed to have primary hyperparathyroidism with hypercalcaemia and underwent parathyroidectomy. The potential perioperative problems and anaesthetic concerns require a focused management and are discussed.

  6. Older Americans and AIDS: Transmission Risks and Primary Prevention Research Needs.

    Science.gov (United States)

    Catania, Joseph A.; And Others

    1989-01-01

    Growing number of Acquired Immune Deficiency Syndrome (AIDS) cases among older Americans is of increasing concern. In context of primary prevention, reviews findings that bear on modes of human immunodeficiency virus (HIV) transmission (blood transfusions, sexual) among older individuals and knowledge of magnitude of the AIDS problem represented…

  7. Reusability of coded data in the primary care electronic medical record: A dynamic cohort study concerning cancer diagnoses.

    Science.gov (United States)

    Sollie, Annet; Sijmons, Rolf H; Helsper, Charles; Numans, Mattijs E

    2017-03-01

    To assess quality and reusability of coded cancer diagnoses in routine primary care data. To identify factors that influence data quality and areas for improvement. A dynamic cohort study in a Dutch network database containing 250,000 anonymized electronic medical records (EMRs) from 52 general practices was performed. Coded data from 2000 to 2011 for the three most common cancer types (breast, colon and prostate cancer) was compared to the Netherlands Cancer Registry. Data quality is expressed in Standard Incidence Ratios (SIRs): the ratio between the number of coded cases observed in the primary care network database and the expected number of cases based on the Netherlands Cancer Registry. Ratios were multiplied by 100% for readability. The overall SIR was 91.5% (95%CI 88.5-94.5) and showed improvement over the years. SIRs differ between cancer types: from 71.5% for colon cancer in males to 103.9% for breast cancer. There are differences in data quality (SIRs 76.2% - 99.7%) depending on the EMR system used, with SIRs up to 232.9% for breast cancer. Frequently observed errors in routine healthcare data can be classified as: lack of integrity checks, inaccurate use and/or lack of codes, and lack of EMR system functionality. Re-users of coded routine primary care Electronic Medical Record data should be aware that 30% of cancer cases can be missed. Up to 130% of cancer cases found in the EMR data can be false-positive. The type of EMR system and the type of cancer influence the quality of coded diagnosis registry. While data quality can be improved (e.g. through improving system design and by training EMR system users), re-use should only be taken care of by appropriately trained experts. Copyright © 2016. Published by Elsevier B.V.

  8. 12 CFR 347.106 - Going concerns.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Going concerns. 347.106 Section 347.106 Banks... INTERNATIONAL BANKING § 347.106 Going concerns. Going concerns. If a bank acquires an equity interest in a foreign organization that is a going concern, no more than 5 percent of either the consolidated assets or...

  9. Radioactive sedimentary deposits concerning the coasts of the Camargue

    International Nuclear Information System (INIS)

    2000-01-01

    CRII-RAD has detected abnormal levels of radioactivity on some beaches situated near the Espiguette lighthouse in the south-east coast of France. This document presents the in-situ measurements performed by IPSN. These results confirm a relevant increase of gamma radiation in sedimentary deposits. Chemical analyses have shown that this radioactivity is due to potassium 40 and radionuclides from thorium and uranium series. There is no doubt about the natural origin of this radioactivity but thorough geo-chemical studies are necessary to see whether these radioactive sands are a consequence of nearby industrial activities concerning ore dressing. (A.C.)

  10. The effect of pump cavitation on the design of the primary pumps for C.F.R

    International Nuclear Information System (INIS)

    Worster, R.C.

    1976-01-01

    In the design appraisal of the sodium pumps for the primary circuit of the proposed 1300 MW(e) CFR it has been recognised that cavitation, its effects and its control, is the outstanding hydraulic design problem. Careful consideration of this problem and of the possible effects of pump cavitation on the performance of other reactor systems has led to the conclusion that it is more prudent at present to specify pumps with zero cavitation at normal full speed operating conditions. Under abnormal operation it may be necessary to reduce the pumps' speed to prevent cavitation in the pumps or associated equipment. The principal reasons for this decision were uncertainties concerning the possibility of erosion due to limited cavitation in sodium and the possibility of pump cavitation noise interfering with acoustic detection of malfunctioning of reactor components or of boiling in the reactor core

  11. Small bowel perforation due to fish bone: A case report

    Directory of Open Access Journals (Sweden)

    Huseyin Pulat

    2015-09-01

    Full Text Available Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen. Keywords: Foreign body, Small intestine, Perforation

  12. STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER.

    Science.gov (United States)

    Freed, Christopher R; Hansberry, Shantisha T; Arrieta, Martha I

    2013-09-01

    To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

  13. 78 FR 24596 - Notice of Finding That Halawi Exchange Co. Is a Financial Institution of Primary Money Laundering...

    Science.gov (United States)

    2013-04-25

    ... Exchange Co. Is a Financial Institution of Primary Money Laundering Concern AGENCY: Financial Crimes... a financial institution operating outside the United States that is of primary money laundering...-56. Title III of the USA PATRIOT Act amends the anti- money laundering provisions of the Bank Secrecy...

  14. Radioactive waste below regulatory concern

    International Nuclear Information System (INIS)

    Neuder, S.M.

    1987-01-01

    The U.S. Nuclear Regulatory Commission (NRC) published two notices in the Federal Register concerning radioactive waste below regulatory concern. The first, a Commission Policy Statement and Implementation Plan published August 29, 1986, concerns petition to exempt specific radioactive waste streams from the regulations. The second, an Advanced Notice of Proposed Rulemaking published Decemger 2, 1986, addresses the concept of generic rulemaking by the NRC on radioactive wastes that are below regulatory concern. Radioactive waste determined to be below regulatory concern would not be subject to regulatory control and would not need to go to a licensed low-level radioactive waste disposal site. The Policy Statement and Implementation Plan describe (1) the information a petitioner should file in support of a petition to exempt a specific waste stream, (2) the decision criteria the Commission intends to use for judging the petition, and (3) the internal administrative procedures to use be followed in order to permit the Commission to act upon the petition in an expedited manner

  15. Art as Social Concern

    Science.gov (United States)

    Hodge, Stephanie

    2010-01-01

    In this article, the author describes how her eleventh- and twelfth-grade portfolio class used art as a social concern through a sketchbook and a linoleum print. Students thumbed through copies of the "New York Times" to find an article that described a modern-day social concern. Students were assigned to choose an article, summarize it, and come…

  16. Social, Psychological and Health Concerns of People Living with HIV/AIDS in Mysore District, Karnataka.

    Science.gov (United States)

    Sebastian, Shibu Thomas; Siddanna, Sunitha

    2016-03-01

    One of the significant health and social problem the world facing today is Acquired immune deficiency syndrome (AiDS). The patients affected with HIV and their family may face various psychosocial problems during diagnosis and treatment due to the stigma associated with this disease. The objective of the study was to identify social, psychological and health concerns of people living with HIV/AIDS (PLWHA) and its association with the demographic factors in Mysore District, Karnataka, India. A questionnaire based study was conducted among 194 participants in Mysore District, Karnataka state who were receiving care and support services. A 22-item questionnaire provided information regarding social, psychological and health concerns of PLWHA in Mysore district. A general linear regression model was used for assessing the predictors of social, psychological and health concerns. The main social concern was that of "Fear of Losing a loved one" whereas the main psychological concern was "Too much worry", "No cure for AIDS" was the highly rated health concern. Males had more social, psychological and health concerns when compared to females but was not statistically significant. Employed people were having fewer psychological concerns when compared to unemployed people. Unemployed people were having fewer health concerns than employed people. For every unit increase in age there were fewer social and health concerns and both these findings were statistically significant. PLWHA in the present study reported that they were concerned about social, psychological and health issues in spite of the fact they were attending counseling. Health care workers, including those in public health sector should be educated about the importance of these factors that influence the health of the population they are caring for.

  17. Criteria for the selection of PEC primary circuit structural material

    International Nuclear Information System (INIS)

    Antoni, R.; Brunori, G.; Maesa, S.; Scibona, G.; Tomassetti, G.

    1977-01-01

    The choice of the structural materials is generally a compromise between the project requirements, the characteristics (mechanical and environmental) of the materials and the available technology to construct the various parts of the components. The criteria of selection of structural materials for the primary circuit of fast reactor are reported. The criteria concern both general and utilization aspects

  18. Predictors of mortality within 1 year after primary ovarian cancer surgery

    DEFF Research Database (Denmark)

    Sjøland, Mette Ørskov; Iachina, Maria; Sørensen, Rikke Guldberg

    2016-01-01

    System. PARTICIPANTS: 2654 women who underwent surgery due to a diagnosis of primary ovarian cancer. OUTCOME MEASURES: Overall survival and predictors of mortality within 0-180 and 181-360 days after the primary surgery. Examined predictors were age, preoperative American Society of Anesthesiologists...

  19. Frequency of temporomandibular joint dysfunction with clicking symptom due to primary molar premature loss in children aged 6-12 years old

    Directory of Open Access Journals (Sweden)

    Riana Hestu Laksitowati

    2009-03-01

    Full Text Available Temporomandibular joint dysfunction with clicking symptom is sound “click” when open and close the mouth. The purpose of this study was to obtain the description of the frequency of temporomandibular joint dysfunction with clicking symptom caused by premature loss of primary molar teeth in children aged 6-12 years old at SDIT Imam Bukhari. The study was a descriptive survey, 136 students as samples were taken by purposive sampling technique. Premature loss of primary molar teeth examined by checking up the first and second primary molars upper and lower jaw using the hand mirror and explorer. Temporomandibular joint dysfunction examined by palpation and using a stethoscope. The result of this study showed that from 136 students having premature loss there are 49 students (36,03% had temporomandibular joint dysfunction with clicking symptom. The conclusion of this study indicates that more than one-fourth students at SDIT Imam Bukhari with premature loss of primary molar teeth had temporomandibular joint dysfunction with clicking symptom.

  20. Primary shield displacement and bowing

    International Nuclear Information System (INIS)

    Scott, K.V.

    1978-01-01

    The reactor primary shield is constructed of high density concrete and surrounds the reactor core. The inlet, outlet and side primary shields were constructed in-place using 2.54 cm (1 in) thick steel plates as the forms. The plates remained as an integral part of the shields. The elongation of the pressure tubes due to thermal expansion and pressurization is not moving through the inlet nozzle hardware as designed but is accommodated by outward displacement and bowing of the inlet and outlet shields. Excessive distortion of the shields may result in gas seal failures, intolerable helium gas leaks, increased argon-41 emissions, and shield cooling tube failures. The shield surveillance and testing results are presented

  1. A web of gaps: a discussion of research strands concerning Global South families with a disabled child.

    Science.gov (United States)

    Hunt, Xanthe; Watermeyer, Brian

    2017-01-01

    In low- and middle-income countries (LMICs), limited access to a range of supports means that families often carry primary responsibility for the care of a disabled child. The impact of this responsibility is poorly understood. To present a selective review, critique, and comparison of the prominent areas of research aimed at understanding families with disabled children in the Global South. We compare and critically discuss prominent bodies of literature concerning the family-disability-poverty nexus in LMICs. Three prominent bodies of literature concerned with families with a disabled child in LMICs are reviewed. These were selected based on their relative prevalence in a large review of the literature, and comprise (1) work concerning quality of life (FQOL) of families with a disabled child; (2) interventions aimed at supporting families with a disabled child in LMICs; and (3) the ways in which culture mediates the families' experience of disability. FQOL research points to poverty as a primary source of family distress, and directs our focus towards families' own expertise in coping with their circumstances. Intervention literature from LMICs highlights the family as the unit of analysis and praxis concerning disabled children, and reminds us of the contextual factors which must be considered when working with their families. Culturally oriented research on poverty, disability, and the family nuances our understanding of the locally-determined priorities of families with a disabled child in LMICs. All three research strands carry benefits, limitations and gaps. The complexity of understanding families with a disabled child in LMICs comes to the fore, directing us away from narrow application of any single theoretical or research framework. Future researchers may draw on insights provided here in creating a more integrated approach.

  2. The Emergence of Inclusive Exploratory Talk in Primary Students' Peer Interaction

    Science.gov (United States)

    Rajala, Antti; Hilppo, Jaakko; Lipponen, Lasse

    2012-01-01

    In this study, we examine a prominent type of classroom talk, exploratory talk, in primary school peer interactions. Exploratory talk has been shown to be productive in facilitating problem solving and fostering school achievement. However, within the growing body of research concerning exploratory talk, the relation between exploratory talk and…

  3. Evaluation of bone loss due to primary occlusal trauma in two experimental models of occlusal overload

    OpenAIRE

    LOPES, Ana Cristina Távora de Albuquerque; TÉO, Mirela Anne Quartaroli; CORRÊA, Mônica Grazieli; ISHIKIRIAMA, Bella Luna Colombini; CAMPOS, Mirella Lindoso Gomes

    2016-01-01

    Abstract Introduction Primary occlusal trauma (OT) is an injury of the periodontium with normal height as a result of occlusal forces which exceed their adaptive capacity. Objective To evaluate, histometrically, the alveolar bone loss in the furcation region of rats experimentally submitted to 2 models of occlusal overload. Material and method 45 animals randomly divided into 3 groups: Occlusal Interference (OI, n = 15) - fixing an orthodontic wire segment on the occlusal surface of the fi...

  4. Supernumerary Teeth in Primary Dentition and Early Intervention: A Series of Case Reports

    OpenAIRE

    Bahadure, Rakesh N.; Thosar, Nilima; Jain, Eesha S.; Kharabe, Vidhi; Gaikwad, Rahul

    2012-01-01

    Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition. Mesiodens is the most common type of supernumerary teeth but rarely seen in lower arch. Early recognition and diagnosis of supernume...

  5. In situ monitoring of primary roofbolts at underground coal mines in the USA

    OpenAIRE

    Spearing, A.J.S.; Hyett, A.

    2014-01-01

    Primary roof support represents the first line of defence against rock-related falls of ground in underground mines, and improper utilization or misunderstanding of the applicability and behaviour of primary support can be costly from a safety standpoint. This is a major concern for underground mines, as roof support is the single most costly expense from a mining operational perspective. This is further backed by the evidence that, in the USA, hundreds of injuries and fatalities still occur ...

  6. Cardiovocal syndrome – A rare presentation of primary pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Om Shankar

    2014-05-01

    Full Text Available Primary pulmonary hypertension is a well known entity with characteristic features more common in females presenting commonly with dyspnea. However primary pulmonary hypertension presenting as hoarseness of voice is rare occurring most likely due to compression of left recurrent laryngeal nerve between normal aorta and dilated tense pulmonary artery. Here we are presenting a case of 19 year old boy with primary pulmonary hypertension who presented with hoarseness of voice as predominant symptom.

  7. HYDRONEPHROSIS IN THE GOAT DUE TO NEOPLASIA. A CASE REPORT.

    Science.gov (United States)

    The clinical history, gross and microscopic necropsy findings are presented in a case of hydronephrosis in a goat due to a primary neoplasm of the...urinary tract. The neoplasm, a transitional cell adenocarcinoma, had interfered with urine flow to a degree that hydronephrosis and subsequent uremia resulted. Metastases were found in the regional lymph nodes and lungs. (Author)

  8. Primary intraocular chondrosarcoma in a dog

    Directory of Open Access Journals (Sweden)

    E. Perlmann

    2013-12-01

    Full Text Available A five-year-old male Cocker Spaniel was presented for evaluation of the right eye due to discomfort, abundant purulent discharge and progressive enlargement of the eyeball. The owner revealed that the right eye has appeared to be inflamed and smaller then the left eye for years. Ophthalmic examination revealed corneal perforation, buphthalmia and conjuctival hyperemia. Enucleating was performed due to signs of endophthalmitis and ocular discomfort. Histopathology revealed a multilobulated proliferation of chondrocytes producing hyaline cartilage with occasional pleomorphism and binucleate cells. A diagnosis of primary intraocular chondrosarcoma was done.

  9. A simple clinical coding strategy to improve recording of child maltreatment concerns: an audit study

    Directory of Open Access Journals (Sweden)

    Andrew Peter McGovern

    2015-01-01

    Full Text Available Background Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC and National Institute for Health and Clinical Excellence (NICE but there is evidence of substantial under-recording.Aim To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records.Design and Setting Clinical audit of rates of maltreatment-related coding before January 2010–December 2011 and after January–December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code ‘Child is cause for concern’. A total of 25,106 children aged 0–18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording.Method Outcomes were recording of 1 any maltreatment-related codes, 2 child protection proceedings and 3 child was a cause for concern.Results We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1–1.6, child protection procedures (RR 1.4; 95% CI 1.1–1.6 and cause for concern (RR 2.5; 95% CI 1.8–3.4 after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation.Conclusion This simple coding strategy improved clinician’s recording of maltreatment-related concerns in a small sample of practices with some ‘buy-in’. Further research should investigate how recording can best support the doctor–patient relationshipHow this fits in Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC and National Institute for Health and Clinical Excellence (NICE, but there is evidence of substantial underrecording. We describe a simple clinical coding

  10. Concerns Girls Have about Puberty

    Science.gov (United States)

    ... Stages Listen Español Text Size Email Print Share Concerns Girls Have About Puberty Page Content Article Body Girls have pubertal concerns and worries, too, including: Breast Development Some girls ...

  11. Are empathy and concern psychologically distinct?

    Science.gov (United States)

    Jordan, Matthew R; Amir, Dorsa; Bloom, Paul

    2016-12-01

    Researchers have long been interested in the relationship between feeling what you believe others feel-often described as empathy-and caring about the welfare of others-often described as compassion or concern. Many propose that empathy is a prerequisite for concern and is therefore the ultimate motivator of prosocial actions. To assess this hypothesis, the authors developed the Empathy Index, which consists of 2 novel scales, and explored their relationship to a measure of concern as well as to measures of cooperative and altruistic behavior. A series of factor analyses reveal that empathy and concern consistently load on different factors. Furthermore, they show that empathy and concern motivate different behaviors: concern for others is a uniquely positive predictor of prosocial action whereas empathy is either not predictive or negatively predictive of prosocial actions. Together these studies suggest that empathy and concern are psychologically distinct and empathy plays a more limited role in our moral lives than many believe. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  12. Parents' concern about their children's weight.

    Science.gov (United States)

    Lampard, Amy M; Byrne, Susan M; Zubrick, Stephen R; Davis, Elizabeth A

    2008-01-01

    Firstly, to investigate the degree of concern parents feel about their children's weight (parental concern). Secondly, to identify factors that influence this concern, and to test a model of parental concern using structural equation modeling. A total of 347 non-overweight, overweight, and obese children (aged 6-13; Mean = 9.5, SD = 1.8) and their parents. Children and their parents attended an assessment session during which they were weighed and measured. Parents were administered a structured interview, which included the Eating Disorder Examination, and completed the Pediatric Quality of Life Inventory (parent proxy), and the Children's Body Image Scale. Eighty-two percent of parents of overweight children, and 18% of parents of obese children reported little parental concern. Higher parental concern was associated with higher child Body Mass Index, less parental underestimation of child body size, and lower child health-related quality of life. Interventions targeting childhood obesity should aim to optimise parental concern by reducing parents' underestimation of child body size and increasing their awareness of the effects of overweight and obesity on children's health and quality of life.

  13. A Survey of Registered Dietitians' Concern and Actions Regarding Climate Change in the United States.

    Science.gov (United States)

    Hawkins, Irana W; Balsam, Alan L; Goldman, Robert

    2015-01-01

    Dietary choices are a tool to reduce greenhouse gas emissions. While registered dietitians are on the front lines of food and nutrition recommendations, it is unclear how many are concerned with climate change and take action in practice in the United States. We explored concern about climate change among registered dietitians, and identified factors that may influence practice-related behaviors. Our study population included a random sample of all registered dietitians credentialed in the United States. Primary data were gathered using a cross-sectional survey. Of the 570 survey responses, 75% strongly agreed or agreed that climate change is an important issue while 34% strongly agreed or agreed that dietitians should play a major role in climate change mitigation strategies. Thirty-eight percent engaged in activities that promoted diet as a climate change mitigation strategy. Vegetarian (p = 0.002) and vegan dietitians (p = 0.007) were significantly more likely than non-vegetarian and non-vegan dietitians to engage in activities that promoted diet as a climate change mitigation strategy. Overall, concern for climate change among dietitians varied significantly by the region of the country in which the dietitian resided, and awareness that animal products are implicated in climate change. Registered dietitians in the United States are concerned with climate change. However, there is a discrepancy between concern and practice-based actions. These results suggest the need for educational and experiential opportunities connecting climate change mitigation to dietetics practice.

  14. A survey of Registered Dietitians’ concern and actions regarding climate change in the United States.

    Directory of Open Access Journals (Sweden)

    Irana W. Hawkins

    2015-07-01

    Full Text Available Dietary choices are a viable solution to reduce greenhouse gas emissions. While Registered Dietitians are on the front lines of food and nutrition recommendations, it is unclear how many are concerned with climate change and take action in practice in the United States. We explored concern about climate change amongst Registered Dietitians, and identified factors that may influence practice-related behaviors. Our study population included a random sample of all Registered Dietitians credentialed in the United States. Primary data was gathered using a cross-sectional survey. Of the 570 survey responses, 75% strongly agreed or agreed that climate change is an important issue while 34% strongly agreed or agreed that dietitians should play a major role in climate change mitigation strategies. Thirty-eight percent engaged in activities that promoted diet as a climate change mitigation strategy. Vegetarian (p=0.002 and vegan dietitians (p=0.007 were significantly more likely than non-vegetarian and non-vegan dietitians to engage in activities that promoted diet as a climate change mitigation strategy. Overall, concern for climate change amongst dietitians varied significantly by the region of the country in which the dietitian resided, and awareness that animal products are implicated in climate change. Registered Dietitians in the United States are concerned with climate change. However, there is a discrepancy between concern and practice-based actions. These results suggest the need for educational and experiential opportunities connecting climate change mitigation to dietetics practice.

  15. Primary Sjogren's syndrome presenting as Acute Flaccid Quadriplegia:

    OpenAIRE

    Singhvi, J.P.; Ganguli, Anirban; Kaur, Bramhjyot

    2010-01-01

    Primary Sjogren's Syndrome presenting as quadriplegia and respiratory involvement due to renal tubular acidosis causing hypokalemia is rare and the significance of managing such case with potassium citrate instead of potassium chloride is highlighted.

  16. Barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients.

    Science.gov (United States)

    Mosher, Catherine E; Winger, Joseph G; Hanna, Nasser; Jalal, Shadia I; Fakiris, Achilles J; Einhorn, Lawrence H; Birdas, Thomas J; Kesler, Kenneth A; Champion, Victoria L

    2014-07-01

    This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients (N=165) at two medical centers in the Midwestern United States. Lung cancer patients completed an assessment of anxiety and depressive symptoms, mental health service use, barriers to using these services, and preferences for addressing emotional concerns. Only 45% of distressed patients received mental health care since their lung cancer diagnosis. The most prevalent patient-reported barriers to mental health service use among non-users of these services (n=110) included the desire to independently manage emotional concerns (58%) and inadequate knowledge of services (19%). In addition, 57% of distressed patients who did not access mental health services did not perceive the need for help. Seventy-five percent of respondents (123/164) preferred to talk to a primary care physician if they were to have an emotional concern. Preferences for counseling, psychiatric medication, peer support, spiritual care, or independently managing emotional concerns also were endorsed by many patients (range=40-50%). Older age was associated with a lower likelihood of preferring to see a counselor. Findings suggest that many distressed lung cancer patients underuse mental health services and do not perceive the need for such services. Efforts to increase appropriate use of services should address patients' desire for autonomy and lack of awareness of services. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Diuretics in primary hypertension - Reloaded.

    Science.gov (United States)

    Mishra, Sundeep

    Diuretics have long been cherished as drugs of choice for uncomplicated primary hypertension. Robust mortality and morbidity data is available for diuretics to back this strategy. Off-late the interest for diuretics has waned off perhaps due to availability of more effective drugs but more likely due to perceived lack of tolerance and side-effect profile of high-dose of diuretics required for mortality benefit. Low-dose diuretics particularly thiazide diuretics are safer but lack the mortality benefit shown by high-dose. However, indapamide and low dose chlorthalidone have fewer side-effects but continue to provide mortality benefit. Copyright © 2016. Published by Elsevier B.V.

  18. Early concern and disregard for others as predictors of antisocial behavior

    Science.gov (United States)

    Rhee, Soo Hyun; Friedman, Naomi P.; Boeldt, Debra L.; Corley, Robin P.; Hewitt, John. K.; Knafo, Ariel; Lahey, Benjamin B.; Robinson, JoAnn; Van Hulle, Carol A.; Waldman, Irwin D.; Young, Susan E.; Zahn-Waxler, Carolyn

    2012-01-01

    Background Prediction of antisocial behavior is important given its adverse impact on both the individuals engaging in antisocial behavior and society. Additional research identifying early predictors of future antisocial behavior, or antisocial propensity, is needed. The present study tested the hypothesis that both concern for others and active disregard for others in distress in toddlers and young children predict antisocial behavior during middle childhood and adolescence. Methods A representative sample of same-sex twins (N = 956) recruited in Colorado was examined. Mother-rated and researcher-observed concern and disregard for others assessed at age 14 to 36 months were examined as predictors of parent- (age 4 to 12), teacher- (age 7 to 12), and self-reported (age 17) antisocial behavior. Results Observed disregard for others predicted antisocial behavior assessed by three different informants (parents, teachers, and self), including antisocial behavior assessed 14 years later. It also predicted a higher-order antisocial behavior factor (β = .58, p concern for others. Mother-rated disregard for others predicted parent-reported antisocial behavior. Contrary to predictions, neither mother-rated nor observed concern for others inversely predicted antisocial behavior. Results of twin analyses suggested that the covariation between observed disregard for others and antisocial behavior was due to shared environmental influences. Conclusions Disregard for others in toddlerhood/early childhood is a strong predictor of antisocial behavior in middle childhood and adolescence. The results suggest the potential need for early assessment of disregard for others and the development of potential interventions. PMID:23320806

  19. Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers

    Directory of Open Access Journals (Sweden)

    Siegel RS

    2011-12-01

    Full Text Available Rebecca S Siegel, Daniel P DicksteinPediatric Mood, Imaging, and NeuroDevelopment Program, EP Bradley Hospital, East Providence, RI, USAAbstract: Anxiety disorders are the most prevalent mental health concern facing adolescents today, yet they are largely undertreated. This is especially concerning given that there are fairly good data to support an evidence-based approach to the diagnosis and treatment of anxiety, and also that untreated, these problems can continue into adulthood, growing in severity. Thus, knowing how to recognize and respond to anxiety in adolescents is of the utmost importance in primary care settings. To that end, this article provides an up-to-date review of the diagnosis and treatment of anxiety disorders geared towards professionals in primary care settings. Topics covered include subtypes, clinical presentation, the etiology and biology, effective screening instruments, evidence-based treatments (both medication and therapy, and the long-term prognosis for adolescents with anxiety. Importantly, we focus on the most common types of anxiety disorders, often known as phobias, which include generalized anxiety disorder, social anxiety/social phobia, separation anxiety disorder, panic disorder, and specific phobias. In summary, anxiety is a common psychiatric problem for adolescents, but armed with the right tools, primary care providers can make a major impact.Keywords: anxiety disorders, adolescents, presentation, etiology, assessment, treatment, primary care

  20. Future premature mortality due to O3, secondary inorganic aerosols and primary PM in Europe--sensitivity to changes in climate, anthropogenic emissions, population and building stock.

    Science.gov (United States)

    Geels, Camilla; Andersson, Camilla; Hänninen, Otto; Lansø, Anne Sofie; Schwarze, Per E; Skjøth, Carsten Ambelas; Brandt, Jørgen

    2015-03-04

    Air pollution is an important environmental factor associated with health impacts in Europe and considerable resources are used to reduce exposure to air pollution through emission reductions. These reductions will have non-linear effects on exposure due, e.g., to interactions between climate and atmospheric chemistry. By using an integrated assessment model, we quantify the effect of changes in climate, emissions and population demography on exposure and health impacts in Europe. The sensitivity to the changes is assessed by investigating the differences between the decades 2000-2009, 2050-2059 and 2080-2089. We focus on the number of premature deaths related to atmospheric ozone, Secondary Inorganic Aerosols and primary PM. For the Nordic region we furthermore include a projection on how population exposure might develop due to changes in building stock with increased energy efficiency. Reductions in emissions cause a large significant decrease in mortality, while climate effects on chemistry and emissions only affects premature mortality by a few percent. Changes in population demography lead to a larger relative increase in chronic mortality than the relative increase in population. Finally, the projected changes in building stock and infiltration rates in the Nordic indicate that this factor may be very important for assessments of population exposure in the future.

  1. Erectile dysfunction among diabetic patients in Saudi Arabia: A hospital-based primary care study

    Directory of Open Access Journals (Sweden)

    Yousef A Al-Turki

    2007-01-01

    Conclusions: Complete (severe and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.

  2. Feasibility and validity of the self-administered computerized assessment of mild cognitive impairment with older primary care patients.

    Science.gov (United States)

    Tierney, Mary C; Naglie, Gary; Upshur, Ross; Moineddin, Rahim; Charles, Jocelyn; Jaakkimainen, R Liisa

    2014-01-01

    We investigated whether a validated computerized cognitive test, the Computerized Assessment of Mild Cognitive Impairment (CAMCI), could be independently completed by older primary care patients. We also determined the optimal cut-off for the CAMCI global risk score for mild cognitive impairment against an independent neuropsychological reference standard. All eligible patients aged 65 years and older, seen consecutively over 2 months by 1 family practice of 13 primary care physicians, were invited to participate. Patients with a diagnosis or previous work-up for dementia were excluded. Primary care physicians indicated whether they, the patient, or family had concerns about each patient's cognition. A total of 130 patients with cognitive concerns and a matched sample of 133 without cognitive concerns were enrolled. The CAMCI was individually administered after instructions to work independently. Comments were recorded verbatim. A total of 259 (98.5%) completed the entire CAMCI. Two hundred and forty-one (91.6%) completed it without any questions or after simple acknowledgment of their question. Lack of computer experience was the only patient characteristic that decreased the odds of independent CAMCI completion. These results support the feasibility of using self-administered computerized cognitive tests with older primary care patients, given the increasing reliance on computers by people of all ages. The optimal cut-off score had a sensitivity of 80% and specificity of 74%.

  3. Concerns Boys Have about Puberty

    Science.gov (United States)

    ... Size Email Print Share Concerns Boys Have About Puberty Page Content Article Body Boys have pubertal concerns ... just part of growing up. Involuntary Erections During puberty, boys get erections spontaneously, without touching their penis ...

  4. Supernumerary teeth in primary dentition and early intervention: a series of case reports.

    Science.gov (United States)

    Bahadure, Rakesh N; Thosar, Nilima; Jain, Eesha S; Kharabe, Vidhi; Gaikwad, Rahul

    2012-01-01

    Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition. Mesiodens is the most common type of supernumerary teeth but rarely seen in lower arch. Early recognition and diagnosis of supernumerary teeth is important to prevent further complications in permanent dentition. Four cases of supernumerary teeth with mesiodens in upper and lower arch in primary dentition and their management have been discussed.

  5. Supernumerary Teeth in Primary Dentition and Early Intervention: A Series of Case Reports

    Directory of Open Access Journals (Sweden)

    Rakesh N. Bahadure

    2012-01-01

    Full Text Available Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition. Mesiodens is the most common type of supernumerary teeth but rarely seen in lower arch. Early recognition and diagnosis of supernumerary teeth is important to prevent further complications in permanent dentition. Four cases of supernumerary teeth with mesiodens in upper and lower arch in primary dentition and their management have been discussed.

  6. CGRP in human models of primary headaches

    DEFF Research Database (Denmark)

    Ashina, Håkan; Schytz, Henrik Winther; Ashina, Messoud

    2018-01-01

    experiments are likely due to assay variation; therefore, proper validation and standardization of an assay is needed. To what extent CGRP is involved in tension-type headache and cluster headache is unknown. CONCLUSION: Human models of primary headaches have elucidated the role of CGRP in headache...... pathophysiology and sparked great interest in developing new treatment strategies using CGRP antagonists and antibodies. Future studies applying more refined human experimental models should identify biomarkers of CGRP-induced primary headache and reveal whether CGRP provocation experiments could be used......OBJECTIVE: To review the role of CGRP in human models of primary headaches and to discuss methodological aspects and future directions. DISCUSSION: Provocation experiments demonstrated a heterogeneous CGRP migraine response in migraine patients. Conflicting CGRP plasma results in the provocation...

  7. ORAL ADMINISTRATION OF EXOGENOUS LACTASE IN TABLETS FOR PATIENTS DIAGNOSED WITH LACTOSE INTOLERANCE DUE TO PRIMARY HYPOLACTASIA

    Directory of Open Access Journals (Sweden)

    Carlos Fernando de Magalhães FRANCESCONI

    Full Text Available ABSTRACT Background Primary hypolactasia is a common condition where a reduced lactase activity in the intestinal mucosa is present. The presence of abdominal symptoms due to poor absorption of lactose, which are present in some cases, is a characteristic of lactose intolerance. , Objective Evaluate the efficacy of a product containing exogenous lactase in tablet form compared to a reference product with proven effectiveness in patients with lactose intolerance. Methods Multicentre, randomized, parallel group, single-blind, comparative non-inferiority study. One hundred twenty-nine (129 adult lactose intolerance patients with hydrogen breath test results consistent with a diagnosis of hypolactasia were randomly assigned to receive the experimental product (Perlatte(r - Eurofarma Laboratórios S.A. or the reference product (Lactaid(r - McNeilNutritionals, USA orally (one tablet, three times per day for 42 consecutive days. Results Data from 128 patients who actually received the studied treatments were analysed (66 were treated with the experimental product and 62 with the reference product. The two groups presented with similar baseline clinical and demographic data. Mean exhaled hydrogen concentration tested at 90 minutes after the last treatment (Day 42 was significantly lower in the experimental product treated group (17±18 ppm versus 34±47 ppm in the per protocol population. The difference between the means of the two groups was -17 ppm (95% confidence interval [95% CI]: -31.03; -3.17. The upper limit of the 95% CI did not exceed the a priori non-inferiority limit (7.5 ppm. Secondary efficacy analyses confirmed that the treatments were similar (per protocol and intention to treat population. The tolerability was excellent in both groups, and there were no reports of serious adverse events related to the study treatment. Conclusion The experimental product was non-inferior to the reference product, indicating that it was an effective

  8. Identification of major cardiovascular events in patients with diabetes using primary care data

    NARCIS (Netherlands)

    Pouwels, Koen Bernardus; Voorham, Jaco; Hak, Eelko; Denig, Petra

    2016-01-01

    Background: Routine primary care data are increasingly being used for evaluation and research purposes but there are concerns about the completeness and accuracy of diagnoses and events captured in such databases. We evaluated how well patients with major cardiovascular disease (CVD) can be

  9. Recurrent Syncope due to Esophageal Squamous Cell Carcinoma

    OpenAIRE

    Casini, Alessandro; Tschanz, Elisabeth; Dietrich, Pierre-Yves; Nendaz, Mathieu

    2011-01-01

    Syncope is caused by a wide variety of disorders. Recurrent syncope as a complication of malignancy is uncommon and may be difficult to diagnose and to treat. Primary neck carcinoma or metastases spreading in parapharyngeal and carotid spaces can involve the internal carotid artery and cause neurally mediated syncope with a clinical presentation like carotid sinus syndrome. We report the case of a 76-year-old man who suffered from recurrent syncope due to invasion of the right carotid sinus b...

  10. Enhanced J/psi suppression due to gluon depletion

    OpenAIRE

    Hwa, R. C.; Pisut, J.; Pisutova, N.

    1997-01-01

    The nonlinear effect of gluon depletion in the collision of large nuclei can be large. It is due to multiple scatterings among comoving partons initiated by primary scattering of partons in the colliding nuclei. The effect can give rise to substantial suppression of $J/\\psi$ production in very large nuclei, even if the linear depletion effect is insignificant for the collisions of nuclei of smaller sizes. This mechanism offers a natural explanation of the enhanced suppression in the Pb-Pb dat...

  11. Management of primary headache in emergency services of Santos and surrounding towns

    Directory of Open Access Journals (Sweden)

    Yara Dadalti Fragoso

    Full Text Available OBJECTIVES: Primary headaches are often seen by Clinicians on duty at Emergency Services. We have investigated the treatment of such patients by 43 medical doctors who have been working at Emergency Services in the city of Santos and surrounding towns for many years. RESULTS: We confirmed the high prevalence of primary headaches in Emergency Services. There seem to be diagnosis difficulties concerning differentiating attacks of migraine and tension type headache. We also observed that IV dipirone was the most frequently prescribed treatment for patients with primary headaches in this study. There is no protocol in the literature which recommends IV dipirone for the treatment of migraine attacks or other primary headaches. CONCLUSION: It would be advisable to perform controlled double blind studies in order to verify the advantages of IV dipirone in the treatment of intense attacks primary headaches. We concluded that headache management recycling programs could be of interest for doctors who regularly work at Emergency Services.

  12. Academic retainer medicine: an innovative business model for cross-subsidizing primary care.

    Science.gov (United States)

    Lucier, David J; Frisch, Nicholas B; Cohen, Brian J; Wagner, Michael; Salem, Deeb; Fairchild, David G

    2010-06-01

    Retainer-medicine primary care practices, commonly referred to as "luxury" or "concierge" practices, provide enhanced services to patients beyond those available in traditional practices for a yearly retainer fee. Adoption of retainer practices has been largely absent in academic health centers (AHCs). Reasons for this trend stem primarily from ethical concerns, such as the potential for patient abandonment when physicians downsize from larger, traditional practices to smaller, retainer-medicine practices.In 2004, the Department of Medicine at Tufts Medical Center developed an academic retainer-medicine primary care practice within the Division of General Medicine that not only generates financial support for the division but also incorporates a clinical and business model that is aligned with the mission and ethics of an academic institution.In contrast to private retainer-medicine practices, this unique business model addresses several of the ethical issues associated with traditional retainer practices-it does not restrict net access to care and it neutralizes concerns about patient abandonment. Addressing the growing primary care shortage, the model also presents the opportunity for a retainer practice to cross-subsidize the expansion of general medicine in an academic medical setting. The authors elucidate the benefits, as well as the inherent challenges, of embedding an academic retainer-medicine practice within an AHC.

  13. Financial incentive schemes in primary care

    Directory of Open Access Journals (Sweden)

    Gillam S

    2015-09-01

    Full Text Available Stephen Gillam Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK Abstract: Pay-for-performance (P4P schemes have become increasingly common in primary care, and this article reviews their impact. It is based primarily on existing systematic reviews. The evidence suggests that P4P schemes can change health professionals' behavior and improve recorded disease management of those clinical processes that are incentivized. P4P may narrow inequalities in performance comparing deprived with nondeprived areas. However, such schemes have unintended consequences. Whether P4P improves the patient experience, the outcomes of care or population health is less clear. These practical uncertainties mirror the ethical concerns of many clinicians that a reductionist approach to managing markers of chronic disease runs counter to the humanitarian values of family practice. The variation in P4P schemes between countries reflects different historical and organizational contexts. With so much uncertainty regarding the effects of P4P, policy makers are well advised to proceed carefully with the implementation of such schemes until and unless clearer evidence for their cost–benefit emerges. Keywords: financial incentives, pay for performance, quality improvement, primary care

  14. Archiving Primary Data: Solutions for Long-Term Studies.

    Science.gov (United States)

    Mills, James A; Teplitsky, Céline; Arroyo, Beatriz; Charmantier, Anne; Becker, Peter H; Birkhead, Tim R; Bize, Pierre; Blumstein, Daniel T; Bonenfant, Christophe; Boutin, Stan; Bushuev, Andrey; Cam, Emmanuelle; Cockburn, Andrew; Côté, Steeve D; Coulson, John C; Daunt, Francis; Dingemanse, Niels J; Doligez, Blandine; Drummond, Hugh; Espie, Richard H M; Festa-Bianchet, Marco; Frentiu, Francesca; Fitzpatrick, John W; Furness, Robert W; Garant, Dany; Gauthier, Gilles; Grant, Peter R; Griesser, Michael; Gustafsson, Lars; Hansson, Bengt; Harris, Michael P; Jiguet, Frédéric; Kjellander, Petter; Korpimäki, Erkki; Krebs, Charles J; Lens, Luc; Linnell, John D C; Low, Matthew; McAdam, Andrew; Margalida, Antoni; Merilä, Juha; Møller, Anders P; Nakagawa, Shinichi; Nilsson, Jan-Åke; Nisbet, Ian C T; van Noordwijk, Arie J; Oro, Daniel; Pärt, Tomas; Pelletier, Fanie; Potti, Jaime; Pujol, Benoit; Réale, Denis; Rockwell, Robert F; Ropert-Coudert, Yan; Roulin, Alexandre; Sedinger, James S; Swenson, Jon E; Thébaud, Christophe; Visser, Marcel E; Wanless, Sarah; Westneat, David F; Wilson, Alastair J; Zedrosser, Andreas

    2015-10-01

    The recent trend for journals to require open access to primary data included in publications has been embraced by many biologists, but has caused apprehension amongst researchers engaged in long-term ecological and evolutionary studies. A worldwide survey of 73 principal investigators (Pls) with long-term studies revealed positive attitudes towards sharing data with the agreement or involvement of the PI, and 93% of PIs have historically shared data. Only 8% were in favor of uncontrolled, open access to primary data while 63% expressed serious concern. We present here their viewpoint on an issue that can have non-trivial scientific consequences. We discuss potential costs of public data archiving and provide possible solutions to meet the needs of journals and researchers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Characteristic properties of large subgroups in primary abelian groups

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    1. Introduction. The main purpose of this article is to study the relations between the structures of primary abelian groups and their ..... Case 2. γ − 2 exists. Let Gγ −1 be a direct summand of Gγ . We remark, in connection with Case 1, that any pγ −1. -high subgroup of Gγ is isomorphic to Gγ −1. As far as Case 2 is concerned, ...

  16. Hydraulic root water uptake models: old concerns and new insights

    Science.gov (United States)

    Couvreur, V.; Carminati, A.; Rothfuss, Y.; Meunier, F.; Vanderborght, J.; Javaux, M.

    2014-12-01

    Root water uptake (RWU) affects underground water dynamics, with consequences on plant water availability and groundwater recharge. Even though hydrological and climate models are sensitive to RWU parameters, no consensus exists on the modelling of this process. Back in the 1940ies, Van Den Honert's catenary approach was the first to investigate the use of connected hydraulic resistances to describe water flow in whole plants. However concerns such as the necessary computing when architectures get complex made this approach premature. Now that computing power increased dramatically, hydraulic RWU models are gaining popularity, notably because they naturally produce observed processes like compensatory RWU and hydraulic redistribution. Yet major concerns remain. Some are more fundamental: according to hydraulic principles, plant water potential should equilibrate with soil water potential when the plant does not transpire, which is not a general observation when using current definitions of bulk or average soil water potential. Other concerns regard the validation process: water uptake distribution is not directly measurable, which makes it hard to demonstrate whether or not hydraulic models are more accurate than other models. Eventually parameterization concerns exist: root hydraulic properties are not easily measurable, and would even fluctuate on an hourly basis due to processes like aquaporin gating. While offering opportunities to validate hydraulic RWU models, newly developed observation techniques also make us realize the increasing complexity of processes involved in soil-plant hydrodynamics, such as the change of rhizosphere hydraulic properties with soil drying. Surprisingly, once implemented into hydraulic models, these processes do not necessarily translate into more complex emerging behavior at plant scale, and might justify the use of simplified representations of the soil-plant hydraulic system.

  17. [Addison's disease : Primary adrenal insufficiency].

    Science.gov (United States)

    Pulzer, A; Burger-Stritt, S; Hahner, S

    2016-05-01

    Adrenal insufficiency, a rare disorder which is characterized by the inadequate production or absence of adrenal hormones, may be classified as primary adrenal insufficiency in case of direct affection of the adrenal glands or secondary adrenal insufficiency, which is mostly due to pituitary or hypothalamic disease. Primary adrenal insufficiency affects 11 of 100,000 individuals. Clinical symptoms are mainly nonspecific and include fatigue, weight loss, and hypotension. The diagnostic test of choice is dynamic testing with synthetic ACTH. Patients suffering from chronic adrenal insufficiency require lifelong hormone supplementation. Education in dose adaption during physical and mental stress or emergency situations is essential to prevent life-threatening adrenal crises. Patients with adrenal insufficiency should carry an emergency card and emergency kit with them.

  18. Knowledge, perceptions, and behaviors of adults concerning nonalcoholic beverages suggest some lack of comprehension related to sugars.

    Science.gov (United States)

    Rampersaud, Gail C; Kim, Hyeyoung; Gao, Zhifeng; House, Lisa A

    2014-02-01

    Key recommendations in the 2010 Dietary Guidelines for Americans and US Department of Agriculture's MyPlate are to reduce the intake of added sugars, particularly from sugar-sweetened beverages, and drink water instead of "sugary" beverages. However, little is known about consumer knowledge, perceptions, and behaviors regarding sugars in beverages. We hypothesized that consumers would have limited or inaccurate knowledge of the sugars in beverages and that their beverage consumption behaviors would not reflect their primary concerns related to sugars in beverages. An online survey was completed by 3361 adults 18 years and older residing throughout the United States. Water was consumed in the highest amounts followed by (in descending amounts) other beverages (includes coffee and tea), added sugar beverages, milk, diet drinks, and 100% fruit juice and blends. Participants primarily associated the term "sugary" with beverages containing added sugars; however, almost 40% identified 100% fruit juice as sugary. Some participants misidentified the types of sugars in beverages, particularly with respect to milk and 100% fruit juices. Generally, beverage choices were consistent with stated concerns about total, added, or natural sugars; however, less than 40% of participants identified added sugars as a primary concern when choosing beverages despite public health recommendations to reduce the intake of added sugars and sugar-sweetened beverages. Results suggest that there may be a considerable level of consumer misunderstanding or confusion about the types of sugars in beverages. More consumer research and education are needed with the goal of helping consumers make more informed and healthy beverage choices. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Forms of concern: toward an intersubjective perspective.

    Science.gov (United States)

    Tolmacz, Rami

    2013-09-01

    The growing interest in the issue of concern, which appeared relatively late in psychoanalytical literature, resulted in several distinctions. Winnicott distinguished between concern as an expression of guilt and concern as a manifestation of joy, Brenman Pick distinguished between real concern and spurious concern, and Bowlby distinguished between sensitive and compulsive caregiving. The basic concepts of Buber's dialogical philosophy and intersubjective approaches in psychoanalysis have created fertile ground for the study of concern, and enabled us to conceptualize these distinctions in a way that has heretofore been lacking in psychoanalytical thought.

  20. Caffeinated alcohol beverages: a public health concern.

    Science.gov (United States)

    Attwood, Angela S

    2012-01-01

    Consumption of alcohol mixed with caffeinated energy drinks is becoming popular, and the number of pre-mixed caffeinated alcohol products on the worldwide market is increasing. There is public health concern and even occasional legal restriction relating to these drinks, due to associations with increased intoxication and harms. The precise nature and degree of the pharmacological relationship between caffeine and alcohol is not yet elucidated, but it is proposed that caffeine attenuates the sedative effects of alcohol intoxication while leaving motor and cognitive impairment unaffected. This creates a potentially precarious scenario for users who may underestimate their level of intoxication and impairment. While legislation in some countries has restricted production or marketing of pre-mixed products, many individuals mix their own energy drink-alcohol 'cocktails'. Wider dissemination of the risks might help balance marketing strategies that over-emphasize putative positive effects.

  1. The antimicrobial effectiveness of 25% propolis extract in root canal irrigation of primary teeth.

    Science.gov (United States)

    Verma, Manjesh Kumar; Pandey, Ramesh Kumar; Khanna, Richa; Agarwal, Jyotsna

    2014-01-01

    The choice of irrigating solution used in root canals of primary teeth is complicated by their complex morphology and paucity of associated literature. Propolis is a natural product that has gained interest in this context due to its antibacterial effectiveness against several endodontic pathogens. The present study was undertaken to assess the potential of water-soluble 25% propolis extract against microorganisms present in root canals of primary teeth during endodontic procedures. The child patients in the age group of 4-7 years with radiographic evidence of carious pulp exposure were included in the study. Definitive selection was done after gaining access into the pulp chamber and root canals of the selected teeth. The clinical and radiographic evidence of pathosis was ruled out for inclusion in the study. The selected teeth were divided into two groups randomly. In Group A 0.9% isotonic saline and in Group B 25% extract water-soluble propolis were used as irrigating solution, respectively. The bacterial samples were collected both pre- and post-irrigation and were transferred for microbial assay. STAISTISTICAL ANALYSIS: Wilcoxon matched signed rank test was used to compare the pre-and post-irrigation bacterial counts. Mann-Whitney test was used to compare the mean change (pre-post) in bacterial colony counts of groups in the study. Antimicrobial effectiveness of 25% water-soluble extract of propolis in the root canals of primary teeth was confirmed in the present study. The reduction in the mean bacterial colony counts of all the isolated bacteria was noticed higher in Group B than Group A. The results of the present study have confirmed that the antibacterial effectiveness of water-soluble extract of propolis in the root canals of primary teeth in vivo. Considering the low toxicity concerns and antibacterial effectiveness, water-soluble extract of 25% propolis can be advocated as a root canal irrigant in endodontic treatment of primary teeth.

  2. The antimicrobial effectiveness of 25% propolis extract in root canal irrigation of primary teeth

    Directory of Open Access Journals (Sweden)

    Manjesh Kumar Verma

    2014-01-01

    Full Text Available Context: The choice of irrigating solution used in root canals of primary teeth is complicated by their complex morphology and paucity of associated literature. Propolis is a natural product that has gained interest in this context due to its antibacterial effectiveness against several endodontic pathogens. Aim: The present study was undertaken to assess the potential of water-soluble 25% propolis extract against microorganisms present in root canals of primary teeth during endodontic procedures. Settings and Design: The child patients in the age group of 4-7 years with radiographic evidence of carious pulp exposure were included in the study. Definitive selection was done after gaining access into the pulp chamber and root canals of the selected teeth. The clinical and radiographic evidence of pathosis was ruled out for inclusion in the study. Materials and Methods: The selected teeth were divided into two groups randomly. In Group A 0.9% isotonic saline and in Group B 25% extract water-soluble propolis were used as irrigating solution, respectively. The bacterial samples were collected both pre- and post-irrigation and were transferred for microbial assay. Staististical Analysis: Wilcoxon matched signed rank test was used to compare the pre-and post-irrigation bacterial counts. Mann-Whitney test was used to compare the mean change (pre-post in bacterial colony counts of groups in the study. Results: Antimicrobial effectiveness of 25% water-soluble extract of propolis in the root canals of primary teeth was confirmed in the present study. The reduction in the mean bacterial colony counts of all the isolated bacteria was noticed higher in Group B than Group A. Conclusion: The results of the present study have confirmed that the antibacterial effectiveness of water-soluble extract of propolis in the root canals of primary teeth in vivo. Considering the low toxicity concerns and antibacterial effectiveness, water-soluble extract of 25% propolis

  3. Primary Care Practice Transformation and the Rise of Consumerism.

    Science.gov (United States)

    Shrank, William H

    2017-04-01

    Americans are increasingly demanding the same level of service in healthcare that they receive in other services and products that they buy. This rise in consumerism poses challenges for primary care physicians as they attempt to transform their practices to succeed in a value-based reimbursement landscape, where they are rewarded for managing costs and improving the health of populations. In this paper, three examples of consumer-riven trends are described: retail healthcare, direct and concierge care, and home-based diagnostics and care. For each, the intersection of consumer-driven care and the goals of value-based primary care are explored. If the correct payment and connectivity enablers are in place, some examples of consumer-driven care are well-positioned to support primary care physicians in their mission to deliver high-quality, efficient care for the populations they serve. However, concerns about access and equity make other trends less consistent with that mission.

  4. Turkish Student Teachers' Concerns about Teaching

    Science.gov (United States)

    Boz, Yezdan

    2008-01-01

    The purpose of this study was to examine the teaching concerns of Turkish student teachers and how these concerns differ among year groups within the teacher education programme. Data were collected from 339 student teachers using the Teacher Concerns Checklist. Analysis of the data, including both descriptive statistics and multivariate analysis…

  5. 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

  6. 77 FR 59747 - Repeal of the Final Rule Imposing Special Measures and Withdrawal of the Findings of Primary...

    Science.gov (United States)

    2012-10-01

    ... Money Laundering Concern of November 25, 2003, issued pursuant to 31 U.S.C. 5318A of the Bank Secrecy... amends the anti-money laundering provisions of the BSA, codified at 12 U.S.C. 1829b, 12 U.S.C. 1951-1959..., or type of account is of ``primary money laundering concern,'' to require domestic financial...

  7. Exposure to air pollution and meteorological factors associated with children's primary care visits at night due to asthma attack: case-crossover design for 3-year pooled patients.

    Science.gov (United States)

    Yamazaki, Shin; Shima, Masayuki; Yoda, Yoshiko; Oka, Katsumi; Kurosaka, Fumitake; Shimizu, Shigeta; Takahashi, Hironobu; Nakatani, Yuji; Nishikawa, Jittoku; Fujiwara, Katsuhiko; Mizumori, Yasuyuki; Mogami, Akira; Yamada, Taku; Yamamoto, Nobuharu

    2015-05-03

    We examined the association of outdoor air pollution and meteorological parameters with primary care visits (PCVs) at night due to asthma attack. A case-crossover study was conducted in a primary care clinic in Himeji City, Japan. Participants were 1447 children aged 0-14 years who visited the clinic with an asthma attack from April 2010 until March 2013. Daily concentrations of air pollutants and meteorological parameters were measured. PCVs at night due to asthma attack. A conditional logistic regression model was used to estimate ORs of PCVs per unit increment of air pollutants or meteorological parameters (the per-unit increments of particulate matter with an aerodynamic diameter ≤2.5 µm (PM₂.₅) and ozone were 10 μg/m(3) and 10 ppb, respectively). Analyses took into consideration the effects of seasonality. We noted an association between PCVs and daily ozone levels on the day before a PCV (OR=1.17; 95% CI 1.01 to 1.35; p=0.04), as well as between PCVs and 3-day mean ozone levels before a PCV (OR=1.29; 95% CI 1.00 to 1.46; p=0.04), from April until June. We also observed an association between PCVs and daily PM₂.₅ levels on the day before a PCV from December until March (OR=1.16; 95% CI 1.01 to 1.33; p=0.05). Meteorological parameters, such as hours of sunshine from September until November, atmospheric pressure from April until June, and temperature from April until August, were also found to be associated with PCVs. The findings in the present study supported an association between ozone and PCVs and suggest that certain meteorological items may be associated with PCVs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. The Nature of Institutional Heteronormativity in Primary Schools and Practice-Based Responses

    Science.gov (United States)

    DePalma, Renee; Atkinson, Elizabeth

    2010-01-01

    Concern for school-based homophobia is increasing, yet there is a tendency to focus on individual incidents of homophobic bullying rather than the cultural and institutional factors supporting them. We analyse ways in which institutional heteronormativity operates in primary schools and report results from our research in UK schools that…

  9. Zirconia crowns for rehabilitation of decayed primary incisors: an esthetic alternative.

    Science.gov (United States)

    Ashima, G; Sarabjot, K Bhatia; Gauba, K; Mittal, H C

    2014-01-01

    Esthetic management of extensively decayed primary maxillary anterior teeth requiring full coronal coverage restoration is usually challenging to the pediatric dentists especially in very young children. Many esthetic options have been tried over the years each having its own advantages, disadvantages and associated technical, functional or esthetic limitations. Zirconia crowns have provided a treatment alternative to address the esthetic concerns and ease of placement of extra-coronal restorations on primary anterior teeth. The present article presents a case where grossly decayed maxillary primary incisors were restored esthetically and functionally with ready made zirconia crowns (ZIRKIZ, HASS Corp; Korea). After endodontic treatment the decayed teeth were restored with zirconia crowns. Over a 30 months period, the crowns have demonstrated good retention and esthetic results. Dealing with esthetic needs in children with extensive loss of tooth structure, using Zirconia crowns would be practical and successful. The treatment described is simple and effective and represents a promising alternative for rehabilitation of decayed primary teeth.

  10. Environmental burden of acute respiratory infection and pneumonia due to indoor smoke in Dhading.

    Science.gov (United States)

    Dhimal, M; Dhakal, P; Shrestha, N; Baral, K; Maskey, M

    2010-04-01

    ARI and pneumonia is one of the major public health problems in Nepal which always ranks highest position among the top ten diseases. One of the risk factor of ARI and pneumonia is indoor smoke from kitchen where primary source of cooking is solid biomass fuel. This study was carried out in order to estimate the burden of ARI and pneumonia due to indoor smoke. ARI and pneumonia was chosen as it is one of the significant public health problem among under five children in Nepal and responsible for high number of premature deaths. A cross-sectional study was conducted in Dhading district. Multistage cluster sampling technique was used for data collection considering ward as a cluster. The environmental burden of ARI and pneumonia due to indoor smoke was calculated using the WHO Environmental Burden of Disease Series. About 87 percent of households were using solid biomass fuel as a primary source of fuel. The under five children exposed to solid fuel use was 41313. The total 1284 Disability Adjusted Life Years were lost due to ARI and pneumonia and about 50 percent of it was attributed by Indoor smoke in household. The solid biomass fuel was primary source of energy for cooking in Dhading district which is attributing about 50 percent of burden of ARI and pneumonia among under five children.

  11. Physician privacy concerns when disclosing patient data for public health purposes during a pandemic influenza outbreak.

    Science.gov (United States)

    El Emam, Khaled; Mercer, Jay; Moreau, Katherine; Grava-Gubins, Inese; Buckeridge, David; Jonker, Elizabeth

    2011-06-09

    Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been argued that the public good should supersede an individual's right to privacy. The precise nature of these provider privacy concerns, and whether they are diluted in the context of a pandemic are not known. Our objective was to understand the privacy barriers which could potentially influence family physicians' reporting of patient-level surveillance data to public health agencies during the Fall 2009 pandemic H1N1 influenza outbreak. Thirty seven family doctors participated in a series of five focus groups between October 29-31 2009. They also completed a survey about the data they were willing to disclose to public health units. Descriptive statistics were used to summarize the amount of patient detail the participants were willing to disclose, factors that would facilitate data disclosure, and the consensus on those factors. The analysis of the qualitative data was based on grounded theory. The family doctors were reluctant to disclose patient data to public health units. This was due to concerns about the extent to which public health agencies are dependable to protect health information (trusting beliefs), and the possibility of loss due to disclosing health information (risk beliefs). We identified six specific actions that public health units can take which would affect these beliefs, and potentially increase the willingness to disclose patient information for public health purposes. The uncertainty surrounding a pandemic of a new strain of influenza has not changed the privacy concerns of physicians about disclosing patient data. It is important to address these concerns to ensure reliable reporting during future outbreaks.

  12. Design criteria of primary coolant chemistry in SMART-P

    International Nuclear Information System (INIS)

    Choi, Byung Seon; Kim, Ah Young; Kim, Seong Hoon; Yoon, Ju Hyeon; Zee, Sung Qunn

    2005-01-01

    SMART-P differs significantly from commercially designed PWRs. Materials inventories used in SMART-P differ from that at PWRs. All surfaces of the primary circuit with the primary coolant are either made from or plated with stainless steel. The material of steam generator (SG) is also different from that of the standard material of the commercially operating PWRs: titanium alloy for the steam generator tubes. Also, SMART-P primary coolant technology differs from that in PWRs: ammonia is used as a pH raising agent and hydrogen formed due to radiolytic processes is kept in specific range by ammonia dosing. Nevertheless, main objectives of the SMART-P primary coolant are the same as at PWRs: to assure primary system pressure boundary integrity, fuel cladding integrity and to minimize out-of-core radiation buildup. The objective of this work is to introduce the design criteria for the primary water chemistry for SMART-P from the viewpoint of the system characteristics and the chemical design concept

  13. LGBT Caregiver Concerns

    Science.gov (United States)

    LGBT CAREGIVER CONCERNS IMPORTANT CONSIDERATIONS FOR LGBT CAREGIVERS LGBT CAREGIVER CONSIDERATIONS As a caregiver for someone with Alzheimer’s disease, you will face various challenges. Some are common among all ...

  14. Ethical issues in bipolar disorders pedigree research: privacy concerns, informed consent, and grounds for waiver.

    Science.gov (United States)

    Parker, Lisa S

    2002-02-01

    Focusing on bipolar disorders research, this article considers ethical issues of informed consent and privacy arising in genetic pedigree research at two stages: the construction of tentative pedigrees to determine family eligibility for study and, subsequently, the enrollment of subjects in and conduct of the family study. Increasing concern to protect the privacy of family members of primary subjects or probands, following ethical controversy over a survey study at Virginia Commonwealth University, has led some researchers and Institutional Review Boards (IRBs) to apply informed consent requirements to those represented on a tentative pedigree at the initial stage of research. This article analyzes the possible benefits, risks, and burdens to prospective subjects of seeking prospective consent for pedigree construction at this initial stage. It argues that the likely risk-benefit ratio favors granting a waiver of consent requirements for this stage of pedigree research and presents grounds for IRBs to grant such a waiver. The article closes by considering particular ethical concerns that should be addressed in the informed consent discussion when enrolling subjects in pedigree studies of bipolar disorder, including concerns about subjects' competence to consent, management of interim and incidental findings, and issues particular to psychiatric research.

  15. Do Privacy Concerns Matter for Millennials?

    DEFF Research Database (Denmark)

    Fodor, Mark; Brem, Alexander

    2015-01-01

    data have raised the question, if location data are considered as sensitive data by users. Thus, we use two privacy concern models, namely Concern for Information Privacy (CFIP) and Internet Users’ Information Privacy Concerns (IUIPC) to find out. Our sample comprises of 235 individuals between 18...... and 34 years (Generation C) from Germany. The results of this study indicate that the second-order factor IUIPC showed better fit for the underlying data than CFIP did. Overall privacy concerns have been found to have an impact on behavioral intentions of users for LBS adoption. Furthermore, other risk...

  16. A twin study of body dysmorphic concerns.

    Science.gov (United States)

    Monzani, B; Rijsdijk, F; Anson, M; Iervolino, A C; Cherkas, L; Spector, T; Mataix-Cols, D

    2012-09-01

    Dysmorphic concern refers to an excessive preoccupation with a perceived or slight defect in physical appearance. It lies on a continuum of severity from no or minimal concerns to severe concerns over one's appearance. The present study examined the heritability of dysmorphic concerns in a large sample of twins. Twins from the St Thomas UK twin registry completed a valid and reliable self-report measure of dysmorphic concerns, which also includes questions about perceived body odour and malfunction. Twin modelling methods (female twins only, n=3544) were employed to decompose the variance in the liability to dysmorphic concerns into additive genetic, shared and non-shared environmental factors. Model-fitting analyses showed that genetic factors accounted for approximately 44% [95% confidence intervals (CI) 36-50%] of the variance in dysmorphic concerns, with non-shared environmental factors and measurement error accounting for the remaining variance (56%; 95% CI 50-63%). Shared environmental factors were negligible. The results remained unchanged when excluding individuals reporting an objective medical condition/injury accounting for their concern in physical appearance. Over-concern with a perceived or slight defect in physical appearance is a heritable trait, with non-shared environmental factors also playing an important role in its causation. The results are relevant for various psychiatric disorders characterized by excessive concerns in body appearance, odour or function, including but not limited to body dysmorphic disorder.

  17. The Surgical Nosology In Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care

    Science.gov (United States)

    Gruen, Russell L; Knox, Stephanie; Britt, Helena; Bailie, Ross S

    2004-01-01

    Background The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties. Methods A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice. Results A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists. Conclusion Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging

  18. Attitudes of Arab and Jewish patients toward integration of complementary medicine in primary care clinics in Israel: a cross-cultural study.

    Science.gov (United States)

    Ben-Arye, Eran; Karkabi, Khaled; Karkabi, Sonia; Keshet, Yael; Haddad, Maria; Frenkel, Moshe

    2009-01-01

    The purpose of this cross-cultural study was to evaluate patient perspectives on complementary and alternative medicine (CAM) integration within primary care clinics. It is one of the first multiethnic studies to explore patients' perspectives on the best model for integrating CAM into the conventional care setting. We developed a 13-item questionnaire that addresses issues of CAM use, expectations from the primary care physicians concerning CAM, and attitudes toward CAM integration within a patient's primary care clinic. We constructed the questionnaire with cross-cultural sensitivity concerning the core concepts of CAM and traditional medicine in both the Arab and Jewish communities in northern Israel. Data for statistical analysis were obtained from 3840 patients attending seven primary care clinics. Of the 3713 respondents who were willing to identify their religion, 2184 defined themselves as Muslims, Christians, or Druze and 1529 as Jews. Respondents in the two groups were equally distributed by sex but differed significantly by age, education, self-rated religiosity, and self-reported chronic diseases in their medical background. Respondents in the two groups reported comparable overall CAM use during the previous year, but the Arab respondents reported more use of herbs and traditional medicine. Respondents in both groups stated that their primary expectation from a family physician concerning CAM was to refer them appropriately and safely to a CAM practitioner. Respondents in both groups greatly supported a theoretical scenario of CAM integration into primary medical care. However, Arab respondents were more supportive of the option that non-physician CAM practitioners would provide CAM rather than physicians.

  19. Criticality safety concerns of uranium deposits in cascade equipment

    International Nuclear Information System (INIS)

    Plaster, M.J.

    1996-01-01

    The Paducah and Portsmouth Gaseous Diffusion Plants enrich uranium in the 235 U isotope by diffusing gaseous uranium hexafluoride (UF 6 ) through a porous barrier. The UF 6 gaseous diffusion cascade utilized several thousand open-quotes stagesclose quotes of barrier to produce highly enriched uranium (HEU). Historically, Portsmouth has enriched the Paducah Gaseous Diffusion Plant's product (typically 1.8 wt% 235 U) as well as natural enrichment feed stock up to 97 wt%. Due to the chemical reactivity of UF 6 , particularly with water, the formation of solid uranium deposits occur at a gaseous diffusion plant. Much of the equipment operates below atmospheric pressure, and deposits are formed when atmospheric air enters the cascade. Deposits may also be formed from UF 6 reactions with oil, UF 6 reactions with the metallic surfaces of equipment, and desublimation of UF 6 . The major deposits form as a result of moist air in leakage due to failure of compressor casing flanges, blow-off plates, seals, expansion joint convolutions, and instrument lines. This report describes criticality concerns and deposit disposition

  20. Comparing primary energy attributed to renewable energy with primary energy equivalent to determine carbon abatement in a national context.

    Science.gov (United States)

    Gallachóir, Brian P O; O'Leary, Fergal; Bazilian, Morgan; Howley, Martin; McKeogh, Eamon J

    2006-01-01

    The current conventional approach to determining the primary energy associated with non-combustible renewable energy (RE) sources such as wind energy and hydro power is to equate the electricity generated from these sources with the primary energy supply. This paper compares this with an approach that was formerly used by the IEA, in which the primary energy equivalent attributed to renewable energy was equated with the fossil fuel energy it displaces. Difficulties with implementing this approach in a meaningful way for international comparisons lead to most international organisations abandoning the primary energy equivalent methodology. It has recently re-emerged in prominence however, as efforts grow to develop baseline procedures for quantifying the greenhouse gas (GHG) emissions avoided by renewable energy within the context of the Kyoto Protocol credit trading mechanisms. This paper discusses the primary energy equivalent approach and in particular the distinctions between displacing fossil fuel energy in existing plant or in new plant. The approach is then extended provide insight into future primary energy displacement by renewable energy and to quantify the amount of CO2 emissions avoided by renewable energy. The usefulness of this approach in quantifying the benefits of renewable energy is also discussed in an energy policy context, with regard to increasing security of energy supply as well as reducing energy-related GHG (and other) emissions. The approach is applied in a national context and Ireland is case study country selected for this research. The choice of Ireland is interesting in two respects. The first relates to the high proportion of electricity only fossil fuel plants in Ireland resulting in a significant variation between primary energy and primary energy equivalent. The second concerns Ireland's poor performance to date in limiting GHG emissions in line with its Kyoto target and points to the need for techniques to quantify the potential

  1. Stereotype confirmation concerns predict dropout from cognitive behavioral therapy for social anxiety disorder.

    Science.gov (United States)

    Johnson, Suzanne; Price, Matthew; Mehta, Natasha; Anderson, Page L

    2014-08-19

    There are high attrition rates observed in efficacy studies for social anxiety disorder, and research has not identified consistent nor theoretically meaningful predictors of dropout. Pre-treatment symptom severity and demographic factors, such as age and gender, are sometimes predictive of dropout. The current study examines a theoretically meaningful predictor of attrition based on experiences associated with social group membership rather than differences between social group categories--fear of confirming stereotypes. This is a secondary data analysis of a randomized controlled trial comparing two cognitive behavioral treatments for social anxiety disorder: virtual reality exposure therapy and exposure group therapy. Participants (N = 74) with a primary diagnosis of social anxiety disorder who were eligible to participate in the parent study and who self-identified as either "African American" (n = 31) or "Caucasian" (n = 43) completed standardized self-report measures of stereotype confirmation concerns (SCC) and social anxiety symptoms as part of a pre-treatment assessment battery. Hierarchical logistic regression showed that greater stereotype confirmation concerns were associated with higher dropout from therapy--race, age, gender, and pre-treatment symptom severity were not. Group treatment also was associated with higher dropout. These findings urge further research on theoretically meaningful predictors of attrition and highlight the importance of addressing cultural variables, such as the experience of stereotype confirmation concerns, during treatment of social anxiety to minimize dropout from therapy.

  2. Evidence-based medicine in primary care: qualitative study of family physicians

    Directory of Open Access Journals (Sweden)

    Dantas Guilherme

    2003-05-01

    Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  3. Evidence-based medicine in primary care: qualitative study of family physicians.

    Science.gov (United States)

    Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G

    2003-05-09

    The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  4. Mediation and Due Process Procedures in Special Education: An Analysis of State Policies. Final Report. Project FORUM.

    Science.gov (United States)

    Ahearn, Eileen M.

    This survey of 50 states and 3 of 10 non-state U.S. jurisdictions concerning state due process procedures focuses mainly on the use of mediation as a form of dispute resolution that offers an alternative to due process hearings in special education. A background section discusses the definition of mediation and the mediation process. Survey…

  5. Conception of elevated temperature structures. Creep and notion of primary stress

    International Nuclear Information System (INIS)

    Roche, Roland; Jakubowicz, Henri.

    1978-04-01

    As an introduction, it is shown that primary and secondary stresses are introduced for taking into account the stress redistribution in ductile materials. But in the creep range, materials are not always ductile and fast fracture can occurs. Besides, stress redistribution due to creep effect is different of plastic redistribution. Therefore the primary stress must be different in the creep range and correction is needed to the conventional values of primary stress. The study of a simple example (parallele bars) gives a practical expression of the correcting factor to be applied to the primary stress [fr

  6. The Association Between Medicolegal and Professional Concerns and Chest Pain Admission Rates.

    Science.gov (United States)

    Brooker, Julie A; Hastings, Jeffrey W; Major-Monfried, Hannah; Maron, Chad P; Winkel, Maia; Wijeratne, H R Sagara; Fleischman, William; Weingart, Scott; Newman, David H

    2015-07-01

    For patients in whom acute coronary syndrome (ACS) is a concern, disposition decisions are complex and multifactorial and have traditionally been a source of considerable variation. An important factor in disposition decisions for these patients may be physician-perceived medicolegal risk and related professional concerns. The study aim was to determine, at the point of care, how much less frequently physicians report that they would admit possible ACS patients if there was either zero or a defined medicolegal risk. This was a point-of-care emergency physician survey. Research assistants approached physicians at or immediately following the moment of disposition decisions for patients who were being admitted for ACS. The primary outcome measures were the proportion of physicians reporting that patients would not have been admitted if medicolegal issues were of no concern and the proportion of physicians reporting that patients would not have been admitted if there was an "acceptable miss rate" of 1% to 2% for ACS patients. During the 3-month study period, 576 patients were admitted to an inpatient unit or to the ED observation protocol. Physicians were approached in 271 cases, and 259 surveys were completed. When presented with hypothetical zero medicolegal risk, physicians answered that they would not have admitted the patients in 30% of cases. With a hypothetical 1% to 2% acceptable miss rate, physicians indicated that they would not have admitted the patients in 29% of the cases. ED medicolegal and professional concerns may substantially increase admissions for possible ACS. An acceptable miss rate or a zero medicolegal risk environment could potentially lead to a major reduction in admissions that physicians feel to be clinically unnecessary. © 2015 by the Society for Academic Emergency Medicine.

  7. Future Premature Mortality Due to O3, Secondary Inorganic Aerosols and Primary PM in Europe — Sensitivity to Changes in Climate, Anthropogenic Emissions, Population and Building Stock

    Science.gov (United States)

    Geels, Camilla; Andersson, Camilla; Hänninen, Otto; Lansø, Anne Sofie; Schwarze, Per E.; Ambelas Skjøth, Carsten; Brandt, Jørgen

    2015-01-01

    Air pollution is an important environmental factor associated with health impacts in Europe and considerable resources are used to reduce exposure to air pollution through emission reductions. These reductions will have non-linear effects on exposure due, e.g., to interactions between climate and atmospheric chemistry. By using an integrated assessment model, we quantify the effect of changes in climate, emissions and population demography on exposure and health impacts in Europe. The sensitivity to the changes is assessed by investigating the differences between the decades 2000–2009, 2050–2059 and 2080–2089. We focus on the number of premature deaths related to atmospheric ozone, Secondary Inorganic Aerosols and primary PM. For the Nordic region we furthermore include a projection on how population exposure might develop due to changes in building stock with increased energy efficiency. Reductions in emissions cause a large significant decrease in mortality, while climate effects on chemistry and emissions only affects premature mortality by a few percent. Changes in population demography lead to a larger relative increase in chronic mortality than the relative increase in population. Finally, the projected changes in building stock and infiltration rates in the Nordic indicate that this factor may be very important for assessments of population exposure in the future. PMID:25749320

  8. Future Premature Mortality Due to O3, Secondary Inorganic Aerosols and Primary PM in Europe — Sensitivity to Changes in Climate, Anthropogenic Emissions, Population and Building Stock

    Directory of Open Access Journals (Sweden)

    Camilla Geels

    2015-03-01

    Full Text Available Air pollution is an important environmental factor associated with health impacts in Europe and considerable resources are used to reduce exposure to air pollution through emission reductions. These reductions will have non-linear effects on exposure due, e.g., to interactions between climate and atmospheric chemistry. By using an integrated assessment model, we quantify the effect of changes in climate, emissions and population demography on exposure and health impacts in Europe. The sensitivity to the changes is assessed by investigating the differences between the decades 2000–2009, 2050–2059 and 2080–2089. We focus on the number of premature deaths related to atmospheric ozone, Secondary Inorganic Aerosols and primary PM. For the Nordic region we furthermore include a projection on how population exposure might develop due to changes in building stock with increased energy efficiency. Reductions in emissions cause a large significant decrease in mortality, while climate effects on chemistry and emissions only affects premature mortality by a few percent. Changes in population demography lead to a larger relative increase in chronic mortality than the relative increase in population. Finally, the projected changes in building stock and infiltration rates in the Nordic indicate that this factor may be very important for assessments of population exposure in the future.

  9. The role of primary care physicians in the Israel Defense Forces: a self-perception study.

    Science.gov (United States)

    Zimlichman, Eyal; Mandel, Dror; Mimouni, Francis B; Vinker, Shlomo; Kochba, Ilan; Kreiss, Yitshak; Lahad, Amnon

    2005-03-01

    The health system of the medical corps of the Israel Defense Force is based primarily upon primary healthcare. In recent years, health management organizations have considered the primary care physician responsible for assessing the overall health needs of the patient and, accordingly, introduced the term "gatekeeper." To describe and analyze how PCPs in the IDF view their roles as primary care providers and to characterize how they perceive the quality of the medical care that they provide. We conducted a survey using a questionnaire that was mailed or faxed to a representative sample of PCPs. The questionnaire included demographic background, professional background, statements on self-perception issues, and ranking of roles as a PCP in the IDF. Statements concerning commitment to the patient were ranked higher than statements concerning commitment to the military organization. Most physicians perceive the quality of the medical care service that they provide as high; they also stated that they do not receive adequate continuous medical education. Our survey shows that PCPs in the IDF, like civilian family physicians, perceive their primary obligation as serving the needs of their patients but are yet to take on the full role of "gatekeepers" in the IDF's healthcare system. We conclude that the Medical Corps should implement appropriate steps to ensure that PCPs are prepared to take on a more prominent role as "gatekeepers" and providers of high quality primary medical care.

  10. Awareness, concern, and communication between physicians and patients on bone health in cancer.

    Science.gov (United States)

    Tripathy, Debu; Durie, Brian G M; Mautner, Beatrice; Ferenz, Krag S; Moul, Judd W

    2014-06-01

    This study aims to explore physician-patient communications about bone metastases and cancer treatment-induced bone loss (CTIBL). The study utilizes online survey of patients with breast cancer, prostate cancer, and multiple myeloma, and the physicians who treat them. Even though 69 and 48 % of patients with nonmetastatic breast and prostate cancer aware of treatment-induced bone loss, only 39 and 23 %, respectively, were concerned about bone loss. Yet, 62 and 71 % of oncologists treating breast and prostate cancer felt that their patients were concerned. Among patients with metastatic breast and prostate cancer, two thirds had not discussed treatment for bone metastases with their doctor; when discussed, 88 and 91 % of discussions were initiated by the doctor, usually prior to initiating treatment. Most myeloma patients (77 %) had discussed treatment options with their physicians; 99 % of hematologists reported discussing treatment of bone disease with patients. Physicians are primary sources of information to patients regarding bone health. There is a gap between what physicians assume their patients know about bone health and the patients' perceptions, presenting a need for systematic awareness and education.

  11. Safety studies concerning nuclear power reactors

    International Nuclear Information System (INIS)

    Bailly, Jean; Pelce, Jacques

    1980-01-01

    The safety of nuclear installations poses different technical problems, whether concerning pressurized water reactors or fast reactors. But investigating methods are closely related and concern, on the one hand, the behavior of shields placed between fuel and outside and, on the other, analysis of accidents. The article is therefore in two parts based on the same plan. Concerning light water reactors, the programme of studies undertaken in France accounts for the research carried out in countries where collaboration agreements exist. Concerning fast reactors, France has the initiative of their studies owing to her technical advance, which explains the great importance of the programmes under way [fr

  12. Primary Peritoneal Hydatid Cyst Presenting as Ovarian Cyst Torsion: A Rare Case Report

    OpenAIRE

    Gandhiraman, Kavitha; Balakrishnan, Renukadevi; Ramamoorthy, Rathna; Rajeshwari, Raja

    2015-01-01

    Hydatid cyst disease is a zoonotic disease caused by Echinococcus granulosus, E.multilocularis or E.Vogli. The most common primary site is liver (75%) followed by lungs (5-15%) and other organs constitute 10-20%. Peritoneal hydatid cysts are very rare especially primary peritoneal hydatid. Secondary peritoneal hydatid cysts are relatively common, which usually occurs due to rupture of primary hepatic hydatid cyst. We present a rare case of large primary peritoneal hydatid cyst misdiagnosed as...

  13. EPRI PWR primary water chemistry guidelines revision

    International Nuclear Information System (INIS)

    McElrath, Joel; Fruzzetti, Keith

    2014-01-01

    EPRI periodically updates the PWR Primary Water Chemistry Guidelines as new information becomes available and as required by NEI 97-06 (Steam Generator Program Guidelines) and NEI 03-08 (Guideline for the Management of Materials Issues). The last revision of the PWR water chemistry guidelines identified an optimum primary water chemistry program based on then-current understanding of research and field information. This new revision provides further details with regard to primary water stress corrosion cracking (PWSCC), fuel integrity, and shutdown dose rates. A committee of industry experts, including utility specialists, nuclear steam supply system (NSSS) and fuel vendor representatives, Institute of Nuclear Power Operations (INPO) representatives, consultants, and EPRI staff collaborated in reviewing the available data on primary water chemistry, reactor water coolant system materials issues, fuel integrity and performance issues, and radiation dose rate issues. From the data, the committee updated the water chemistry guidelines that all PWR nuclear plants should adopt. The committee revised guidance with regard to optimization to reflect industry experience gained since the publication of Revision 6. Among the changes, the technical information regarding the impact of zinc injection on PWSCC initiation and dose rate reduction has been updated to reflect the current level of knowledge within the industry. Similarly, industry experience with elevated lithium concentrations with regard to fuel performance and radiation dose rates has been updated to reflect data collected to date. Recognizing that each nuclear plant owner has a unique set of design, operating, and corporate concerns, the guidelines committee has retained a method for plant-specific optimization. Revision 7 of the Pressurized Water Reactor Primary Water Chemistry Guidelines provides guidance for PWR primary systems of all manufacture and design. The guidelines continue to emphasize plant

  14. Single fatherhood due to cancer.

    Science.gov (United States)

    Yopp, Justin M; Rosenstein, Donald L

    2012-12-01

    Cancer is a leading cause of widowed fatherhood in the USA. Fathers whose spouses have died from cancer constitute a potentially vulnerable population as they adjust to their role as sole or primary caregiver while managing their own grief and that of their children. The importance of addressing the psychological needs of widowed fathers is underscored by data showing that father's coping and emotional availability are closely tied to their bereaved children's mental health. Surprisingly, scant attention has been given to the phenomenon of widowed fatherhood with virtually no clinical resources or research studies devoted to fathers who have lost their wives to cancer. This commentary highlights key challenges facing this underserved population of widowers and calls for development of research agendas and clinical interventions for single fathers due to cancer. Copyright © 2011 John Wiley & Sons, Ltd.

  15. Employing the Five-Factor Mentoring Instrument: Analysing Mentoring Practices for Teaching Primary Science

    Science.gov (United States)

    Hudson, Peter; Usak, Muhammet; Savran-Gencer, Ayse

    2009-01-01

    Primary science education is a concern around the world and quality mentoring within schools can develop pre-service teachers' practices. A five-factor model for mentoring has been identified, namely, personal attributes, system requirements, pedagogical knowledge, modelling, and feedback. Final-year pre-service teachers (mentees, n = 211) from…

  16. Primary Hepatosplenic Large B-Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    M.R. Morales-Polanco

    2008-03-01

    Full Text Available Diffuse large B-cell lymphoma is the most common form of lymphoma. It usually begins in the lymph nodes; up to 40% may have an extranodal presentation. According to a definition of primary extranodal lymphoma with presentation only in extranodal sites, there are reports of large B-cell lymphomas limited to liver or spleen as separate entities, and to date there have been only three documented cases of primary hepatosplenic presentation. This paper reports a fourth case. Due to a review of the literature and the clinical course of the case reported, we conclude that primary hepatosplenic large B-cell lymphoma has been found predominantly in females older than 60 years. The patients reported had <2 months of evolution prior to diagnosis, prominent B symptoms, splenomegaly in three and hepatomegaly in two, none with lymph node involvement. All had thrombocytopenia and abnormal liver function tests; three had anemia and elevated serum lactic dehydrogenase levels, two with hemophagocytosis in bone marrow. Because of the previously mentioned data, it can be stated that primary hepatosplenic lymphoma is an uncommon and aggressive form of disease that requires immediate recognition and treatment.

  17. Al-Anon family groups' newcomers and members: Concerns about the drinkers in their lives.

    Science.gov (United States)

    Timko, Christine; Cronkite, Ruth; Laudet, Alexandre; Kaskutas, Lee Ann; Roth, Jeffrey; Moos, Rudolf H

    2014-01-01

    Despite Al-Anon's widespread availability and use, knowledge is lacking about the drinkers in attendees' lives. We filled this gap by describing and comparing Al-Anon newcomers' and members' reports about their "main drinker" (main person prompting initial attendance). Al-Anon's World Service Office mailed a random sample of groups, yielding completed surveys from newcomers (N = 362) and stable members (N = 265). Newcomers' and members' drinkers generally were comparable. They had known their drinker for an average of 22 years and been concerned about his or her's drinking for 9 years; about 50% had daily contact with the drinker. Most reported negative relationship aspects (drinker gets on your nerves; you disagree about important things). Newcomers had more concern about the drinker's alcohol use than members did, and were more likely to report their drinkers' driving under the influence. Drinkers' most frequent problem due to drinking was family arguments, and most common source of help was 12-step groups, with lower rates among drinkers of newcomers. Concerns spurring initial Al-Anon attendance were the drinker's poor quality of life, relationships, and psychological status; goals for initial attendance reflected these concerns. The drinker's alcohol use was of less concern in prompting initial Al-Anon attendance, and, accordingly, the drinker's reduced drinking was a less frequently endorsed goal of attendance. Family treatments for substance use problems might expand interventions and outcome domains beyond abstinence and relationship satisfaction to include the drinker's quality of life and psychological symptoms and in turn relieve concerns of family members. © American Academy of Addiction Psychiatry.

  18. The impact of sexuality concerns on teenage pregnancy: a consequence of heteronormativity?

    Science.gov (United States)

    Thomas Farrell, C; Clyde, Alexis; Katta, Madhuri; Bolland, John

    2017-01-01

    In countries such as the USA, a substantial percentage of teenage pregnancies are intentional, and desire for pregnancy increases risk. Black US Americans have been found to be less accepting of homosexuality than their non-Black peers, which may result in minority ethnic teenagers demonstrating heterosexual orientation through attempting pregnancy. Young, socioeconomically disadvantaged African Americans were surveyed longitudinally regarding attitudes about their sexuality, pregnancy intentions and other psychosocial factors. Young people who reported being somewhat concerned about their sexual orientation were nearly four times more likely to report attempting pregnancy compared to those who were not at all concerned. This relationship held true while accounting for the significant effect of religion, sense of community, hopelessness and numerous demographic factors. The current study suggests that uncertainty regarding sexual orientation, potentially due to social stigma, may impact pregnancy attempts among young Black people from disadvantaged communities.

  19. Calculation of cobalt-60 primary and scatter dose in layered heterogeneous phantoms using primary and scatter dose spread arrays

    International Nuclear Information System (INIS)

    Iwasaki, Akira

    1993-01-01

    A method of making 60 Co γ-ray primary and scatter dose spread arrays in water is described. The primary dose spread array is made using forward and backward primary dose spread equations (h 1 and h 2 ), where both equations contain a laterally spread primary dose equation (G), made from measured dose data in a cork phantom. The scatter dose spread array is made using differential scatter-maximum ratio (dSMR) and differential backscatter factor (dBSF) equations (k 1 and k 2 ), where both equations are made to be continuous on the boundary. Primary and scatter dose calculations are performed along the beam axis in layered cork heterogeneous phantoms. It is found, even for 60 Co γ-rays, that when a small tumor in the lung is irradiated with a field that just surrounds the tumor, the beam entrance surface and lateral side of the tumor may obtain no therapeutic dose, because of loss of longitudinal and lateral electronic equilibrium, and when a large tumor in the lung is irradiated with a field just surrounding the tumor, the lateral side of the tumor may obtain no therapeutic dose due to loss of lateral electronic equilibrium. (author)

  20. Primary anastomosis or ostomy in necrotizing enterocolitis?

    Science.gov (United States)

    Haricharan, Ramanathapura N; Gallimore, Jade Palazzola; Nasr, Ahmed

    2017-11-01

    In neonates requiring operation for necrotizing enterocolitis (NEC), the complications due to enterostomy (ES) and the need for another operation to restore continuity have prompted several surgeons to employ primary anastomosis (PA) after resection as the operative strategy of choice. Our objective was to compare primary anastomosis to stoma formation in this population using systematic review and meta-analysis. Publications describing both interventions were identified by searching multiple databases. Appropriate studies that reported outcomes after PA and ES for NEC were included for analysis that was performed using the MedCalc3000 software. Results are reported as odds ratios (OR, 95% CI). No randomized trials were identified. Twelve studies were included for the final analysis. Neonates who underwent PA were associated with significantly less risk of mortality when compared to those who underwent ES (OR 0.34, 95% CI 0.17-0.68, p 0.002), possibly due to differences in severity of NEC. Although the types of complications in these groups were different, there was no significant difference in risk of complication (OR 0.86, 0.55-1.33, p 0.50). In neonates undergoing an operation for severe NEC, there is no significant difference in the risk of complications between primary anastomosis and enterostomy. A definitive suggestion cannot be made regarding the choice of one operative strategy over another.

  1. Dermatitis due to Mixed Demodex and Sarcoptes Mites in Dogs

    Directory of Open Access Journals (Sweden)

    B. Sudhakara Reddy

    2014-01-01

    Full Text Available In dogs, dermatitis due to mixed mite infestation is rare. During the five-year period of study, two dogs were identified suffering from dermatitis due to mixed Demodex and Sarcoptes mites. Upon clinical examination dogs had primary and secondary skin lesions on face, around the ears, chin, neck, fore limbs and lateral abdomen. Microscopic examination of skin scrapings revealed Demodex and Sarcoptes mites. Both dogs were treated with daily oral ivermectin at 100 to 400 μg/kg body weight as incremental doses, external application of amitraz and supportive treatments with topical antimicrobial shampoo. After completion of forty-two days of therapy, dogs were recovered from the dermatitis.

  2. Empathic concern drives costly altruism

    Science.gov (United States)

    FeldmanHall, Oriel; Dalgleish, Tim; Evans, Davy; Mobbs, Dean

    2015-01-01

    Why do we self-sacrifice to help others in distress? Two competing theories have emerged, one suggesting that prosocial behavior is primarily motivated by feelings of empathic other-oriented concern, the other that we help mainly because we are egoistically focused on reducing our own discomfort. Here we explore the relationship between costly altruism and these two sub-processes of empathy, specifically drawing on the caregiving model to test the theory that trait empathic concern (e.g. general tendency to have sympathy for another) and trait personal distress (e.g. predisposition to experiencing aversive arousal states) may differentially drive altruistic behavior. We find that trait empathic concern – and not trait personal distress – motivates costly altruism, and this relationship is supported by activity in the ventral tegmental area, caudate and subgenual anterior cingulate, key regions for promoting social attachment and caregiving. Together, this data helps identify the behavioral and neural mechanisms motivating costly altruism, while demonstrating that individual differences in empathic concern-related brain responses can predict real prosocial choice. PMID:25462694

  3. Hartmann's Procedure or Primary Anastomosis for Generalized Peritonitis due to Perforated Diverticulitis: A Prospective Multicenter Randomized Trial (DIVERTI).

    Science.gov (United States)

    Bridoux, Valerie; Regimbeau, Jean Marc; Ouaissi, Mehdi; Mathonnet, Muriel; Mauvais, Francois; Houivet, Estelle; Schwarz, Lilian; Mege, Diane; Sielezneff, Igor; Sabbagh, Charles; Tuech, Jean-Jacques

    2017-12-01

    About 25% of patients with acute diverticulitis require emergency intervention. Currently, most patients with diverticular peritonitis undergo a Hartmann's procedure. Our objective was to assess whether primary anastomosis (PA) with a diverting stoma results in lower mortality rates than Hartmann's procedure (HP) in patients with diverticular peritonitis. We conducted a multicenter randomized controlled trial conducted between June 2008 and May 2012: the DIVERTI (Primary vs Secondary Anastomosis for Hinchey Stage III-IV Diverticulitis) trial. Follow-up duration was up to 18 months. A random sample of 102 eligible participants with purulent or fecal diverticular peritonitis from tertiary care referral centers and associated centers in France were equally randomized to either a PA arm or to an HP arm. Data were analyzed on an intention-to-treat basis. The primary end point was mortality rate at 18 months. Secondary outcomes were postoperative complications, operative time, length of hospital stay, rate of definitive stoma, and morbidity. All 102 patients enrolled were comparable for age (p = 0.4453), sex (p = 0.2347), Hinchey stage III vs IV (p = 0.2347), and Mannheim Peritonitis Index (p = 0.0606). Overall mortality did not differ significantly between HP (7.7%) and PA (4%) (p = 0.4233). Morbidity for both resection and stoma reversal operations were comparable (39% in the HP arm vs 44% in the PA arm; p = 0.4233). At 18 months, 96% of PA patients and 65% of HP patients had a stoma reversal (p = 0.0001). Although mortality was similar in both arms, the rate of stoma reversal was significantly higher in the PA arm. This trial provides additional evidence in favor of PA with diverting ileostomy over HP in patients with diverticular peritonitis. ClinicalTrials.gov Identifier: NCT 00692393. Copyright © 2017. Published by Elsevier Inc.

  4. Information and interaction : influencing drug prescribing in Swedish primary care

    OpenAIRE

    Stålsby Lundborg, Cecilia

    1999-01-01

    Aim The studies concern drug information and continuing education on drug treatment, focusing on doctors' prescribing in primary care in Sweden. The long-term aim has been to develop educational models accepted by the doctors, and to develop and apply means of evaluating the education. Methods Data have been collected from the study populations mainly through questionnaires and dispensed prescriptions, i.e., quantitative data. In addition, qualitative interview data w...

  5. Basics of primary immunodeficiencies

    Directory of Open Access Journals (Sweden)

    Claudia Hernández-Martínez

    2016-05-01

    Full Text Available Primary immunodeficiencies (PID are a heterogeneous group of inherited disorders, the etiology are the defects in the development or function of the immune system. The principal PID manifestations are the infections in early age, malignancy and diseases of immune dysregulation as autoimmunity and allergy. PIDs are genetics disorders and most of them are inherited as autosomal recessive, also this group of diseases is more prevalent in males and in childhood. The antibody immunodeficiency is the PID more common in adults. The more frequent disorders are the infections in the respiratory tract, abscesses, candidiasis, diarrhea, BCGosis etc. Initial approach included a complete blood count and quantification of immunoglobulins. The delay in diagnosis could be explained due to a perception that the recurrent infections are normal process or think that they are exclusively of childhood. The early diagnosis of PID by primary care physicians is important to opportune treatment and better prognosis.

  6. Managing patients with concerns about workplace reproductive hazards.

    Science.gov (United States)

    Frazier, L M; Jones, T L

    2000-01-01

    To find out who uses an occupational reproductive consultation service, what proportion of patients have different types of workplace exposures, and what hypotheses can be generated about barriers to implementing medically necessary job modifications to promote reproductive health. A case series study was conducted by reviewing medical records at two occupational health clinics. 51 patients (1 man and 50 women) were seen, 10 of whom wished to discuss a future pregnancy and 41 of whom were pregnant. Pregnant women worked with a mean of 15.5 different chemicals, and patients were also concerned about ionizing radiation, biological hazards, electromagnetic fields, and ultraviolet light. Pregnant women made clinic visits at a mean gestational age of 10.9 weeks. Only one man used the service, suggesting a lack of knowledge about possible paternal contributions to adverse reproductive outcomes. Many pregnant women visited the clinic too late to prevent harm from exposure to some teratogens, so preconception counseling may be of benefit. Cases are presented that illustrate ways in which the primary care provider can assist the patient who may be exposed to reproductive hazards.

  7. Evaluation of teachers' performance of vision screening in primary

    African Journals Online (AJOL)

    Dr. Petronilla

    Evaluation of Teachers' Performance of Vision Screening in Primary. School Children in Port ... teachers can effectively perform vision screening in school children using ..... may be due to variations in methodology and definitions used, as this ...

  8. Primary and Reflected Compaction Waves in a Foam Rod Due to an Axial Impact by a Small Mass

    Directory of Open Access Journals (Sweden)

    D. Karagiozova

    Full Text Available AbstractThe propagation of compaction waves in a stationary foam block subjected to an impact by a small mass is studied in order to examine the mechanism of compaction within the primary and reflected stress waves. The analysis is focused on aluminium strain rate insensitive foam that exhibits strain hardening under quasistatic compression. A theoretical approach is applied using a uniaxial model of compaction in which the compacted strains, being functions of the velocity variation, are not predefined but are obtained as a part of the solution. The present approach allows one to obtain the strain histories and strain distributions within the primary compaction wave as well as within the reflected wave, which propagates in a media with non-uniform density increasing monotonically in the direction of loading. FE simulations considering aluminium based foam Cymat with density 411.5 kg/m3 are carried out in order to verify the proposed theoretical model. A comparison between the impact velocity attenuation predicted by the present model and classical Rigid Perfectly-Plastic Locking material model for cellular materials is discussed.

  9. Perceived risk of mental health problems in primary care.

    LENUS (Irish Health Repository)

    2015-01-01

    In the face of limited resources and an aging population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalization, hospitalization and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care (PC). We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community to rank perceived risk of mental health concerns (including neurocognitive and mood disorders) from 1 (mild) to 3 (severe). The mean age of the 4499 people assessed was 76.3 years (SD = 7.3) and 2645 (58.8%) were female. According to the PC team 1616 (35.9%) were perceived to have mental health concerns of whom 847 (52.4%) were mild, 559 (34.6%) were moderate and 210 (13%) were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR = 2.22, 95% CI 1.83-2.69 for institutionalization; OR = 1.66, 95% CI 1.41-1.94 for hospitalization; OR = 1.69, 95% CI 1.42-2.01 for death). These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

  10. Health-related Quality of Life after complex rectal surgery for primary advanced rectal cancer and locally recurrent rectal cancer

    DEFF Research Database (Denmark)

    Thaysen, Henriette Vind

    2013-01-01

    postoperative morbidity, Health-related Quality of Life (HRQoL) is an important issue. The overall aim of this thesis was therefore to evaluate HRQoL in patients with PARC and LRRC treated with COMP-RCS and curative intent. In study I a review of the literature was undertaken to provide an overview of HRQo......Advances in the treatment of rectal cancer, have made it possible to perform complex rectal cancer surgery (COMP-RCS) with curative intent in patients with primary advanced rectal caner (PARC) and local recurrent rectal cancer (LRRC). Due to the complexity of the treatment and its high...... in the study was 164 (86%) patients treated with standard rectal cancer surgery (STAN-RCS). The Danish version showed satisfactory psychometric properties for the scales concerning body image, sexual functioning, male sexual problems and defecations problems. Reduced psychometric properties were found...

  11. prevalence and determinants of stunting among primary school

    African Journals Online (AJOL)

    conducted. An interviewer-administered questionnaire was used to collect information on respondents' and parents' .... Authority and were stratified into urban and rural categories. Based on the population of primary four ..... underestimated. Primarily because some of our respondents were excluded due to lack of parental.

  12. Addressing the primary care physician shortage in an evolving medical workforce

    Directory of Open Access Journals (Sweden)

    Lakhan Shaheen E

    2009-05-01

    Full Text Available Abstract Background Primary care physicians have been shown to play an important role in the general health of the communities in which they serve. In spite of their importance, however, there has been a decrease in the number of physicians interested in pursuing primary care fields, while the proportion of specialists continues to increase. The prediction of an overall physician shortage only augments this issue in the US, where this uneven distribution is particularly evident. As such, serious effort to increase the number of practicing primary care physicians is both necessary and beneficial for meeting this country's health care needs. Discussion There are several factors at play which contribute to the decrease in the number of practicing physicians in primary specialties. Lifestyle concerns, such as schedule and income, as well as the lack of prestige associated with this field seem to be among the most prevalent reasons cited for the diminishing interest. Multifaceted concerns such as these, however, are difficult to adequately invalidate; doing so would not only require a great deal research, but also a good deal of time – a resource which is in short supply given the current physician shortage being faced. Thus, a more immediate solution may lie in the increased recruitment and continued support of those individuals who are already associated with primary care service. This is particularly relevant given the Association of American Medical College's goal of increasing medical school enrollment by 15% over the next 10 years. Several groups have been shown to be large contributors to primary care in the US. Here, we focus on three such groups: minority students, International Medical Graduates (IMGs and Osteopathic Physicians (DOs. Although these groups are highly diverse individually, they all share the distinction of being underutilized in regard to the current primary care shortages faced. Thus, through more fully accentuating these

  13. Metabolic syndrome as a risk factor for total hip or knee replacement due to primary osteoarthritis: a prospective cohort study (the HUNT study and the Norwegian Arthroplasty Register).

    Science.gov (United States)

    Hellevik, Alf Inge; Johnsen, Marianne Bakke; Langhammer, Arnulf; Baste, Valborg; Furnes, Ove; Storheim, Kjersti; Zwart, John Anker; Flugsrud, Gunnar Birkeland; Nordsletten, Lars

    2018-01-01

    Biochemical changes associated with obesity may accelerate osteoarthritis beyond the effect of mechanical factors. This study investigated whether metabolic syndrome and its components (visceral obesity, hypertension, dyslipidemia and insulin resistance) were risk factors for subsequent total hip replacement (THR) or total knee replacement (TKR) due to primary osteoarthritis. In this prospective cohort study, data from the second survey of the Nord-Trøndelag Health Study 2 (HUNT2) were linked to the Norwegian Arthroplasty Register for identification of the outcome of THR or TKR. The analyses were stratified by age (<50, 50-69.9 and ≥70 years) and adjusted for gender, body mass index, smoking, physical activity and education. Of the 62,661 participants, 12,593 (20.1%) were identified as having metabolic syndrome, and we recorded 1,840 (2.9%) THRs and 1,111 (1.8%) TKRs during a mean follow-up time of 15.4 years. Cox regression analyses did not show any association between full metabolic syndrome and THR or TKR, except in persons <50 years with metabolic syndrome who had a decreased risk of THR (hazard ratio [HR] 0.58, 95% CI 0.40-0.83). However, when including only participants whose exposure status did not change during follow-up, this protective association was no longer significant. Increased waist circumference was associated with increased risk of TKR in participants <50 years (HR 1.62, 95% CI 1.10-2.39) and 50-69.9 years (HR 1.43, 95% CI 1.14-1.80). Hypertension significantly increased the risk of TKR in participants <50 years (HR 1.38, 95% CI 1.05-1.81), and this risk was greater for men. This study found an increased risk of TKR in men <50 years with hypertension and persons <70 years with increased waist circumference. Apart from this, neither metabolic syndrome nor its components were associated with increased risk of THR or TKR due to primary osteoarthritis.

  14. Changing the lens: widening the approach to primary care research.

    Science.gov (United States)

    Checkland, Kath

    2003-10-01

    After years of being shielded from most of the managerial and organisational changes in health care, primary care is going through a period of change in many countries. Much of the research that has been done in primary care, in common with that in secondary care, puts at the centre of its methodology the concept of professionalism. However, there are other ways of theorising medical work, and using a wider range of theoretical 'lenses' when planning research into the impact of change will enhance and enrich that research. Viewing primary care physicians as 'workers', concerned, like other workers, with constructing understanding of what they do that helps them cope with pressures and uncertainties, shifts the focus of research questions away from issues of professional status towards the practical ways in which they deal with change in their local contexts. Research using this theoretical approach may be able to explain phenomena that other, more broad-brush approaches cannot.

  15. CT-Guided, Ethanol Sympatholysis for Primary Axillary–Palmar Hyperhidrosis

    Energy Technology Data Exchange (ETDEWEB)

    Tsitskari, Maria, E-mail: mariadote@hotmail.com [American Medical Center, Vascular & Interventional Radiology (Cyprus); Friehs, Gerhard, E-mail: gerhardf@amc.com.cy; Zerris, Vassilis, E-mail: vassilisz@amc.com.cy [American Medical Center, Neurosurgery (Cyprus); Georgiades, Christos, E-mail: g-christos@hotmail.com [Johns Hopkins Hospital, Vascular & Interventional Radiology (United States)

    2016-12-15

    PurposePrimary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis.Materials and MethodsNine consecutive patients with axillary–palmar hyperhidrosis were treated between 2013 and 2015. CT-guided sympathetic block was performed in the outpatients at T-2, T-3, and T-4, bilaterally using alcohol under local anesthesia. Immediate postprocedure CT was obtained to assess the complications as per Common Terminology Criteria for Adverse Events, version 4. Technical success and clinical success were recorded. Primary and secondary efficacy were assessed by phone and clinical visits; mean follow-up was 12 months (6–26 months). Descriptive statistics was used to report the outcomes.ResultsOne procedure was aborted due to eyelid ptosis after lidocaine injection. All other eight patients (5:3, F:M) (median age 32) had immediate cessation of sweating. Two major complications (pneumothorax, one requiring a chest tube) occurred. Two patients recurred with unilateral and one with bilateral symptoms. One of the unilateral recurrence and the bilateral recurrence patients was retreated successfully. Median follow-up was 1 year. No cases of Horner’s or compensatory hyperhidrosis were observed.ConclusionsCT-guided EtOH sympatholysis for axillary/palmar primary hyperhidrosis is feasible. Technical failure rate was 11 %. Primary and secondary efficacy are 75 and 94 %, respectively, to a median follow-up of 1 year. Risk profile appears favorable. Despite a small sample size, results confirm feasibility and encourage a larger study.

  16. An Ethnographic Study of Disciplinary and Pedagogic Practices in a Primary Class

    Science.gov (United States)

    Iyer, Suvasini

    2013-01-01

    The article presents an ethnographic study conducted in a class in a government-run primary school in Delhi. It was found that a chief concern in the school was that of disciplining children. In the observed class, this took the shape of controlling children's bodies and motor movements. It is argued that through disciplining, teachers were…

  17. Going Concern i revisionsprocessen [del 1

    DEFF Research Database (Denmark)

    Hartmann, Stig; Haraszuk, Anni

    2012-01-01

    Nærværende artikel er den første af to planlagte, der vil blive bragt i Revision & Regnskabsvæsen. Det er artiklernes overordnede ide at besvare følgende spørgsmål: Hvad er nøgleelementerne i god revisorskik anno 2012 i forhold til Going Concern vurdering i revisionsprocessen? Hvordan eksekveres...... god revisorskik i forhold til Going Concern i 2012 samt 2013 og fremadrettet? Hvem er nøgleinteressenterne og hvilken roller spiller de i udviklingen af god revisorskik, indenfor Going Concern i erklæringer med høj grad af sikkerhed? Hvordan kan revisionsvirksomhedens interne kvalitetsstyringssystem...... designes i forhold til Going Concern for at leve op til god revisorskik, samtidigt med at revisor skal drive en fornuftig forretning?...

  18. X-linked primary ciliary dyskinesia due to mutations in the cytoplasmic axonemal dynein assembly factor PIH1D3.

    NARCIS (Netherlands)

    Olcese, C.; Patel, M.P.; Shoemark, A.; Kiviluoto, S.; Legendre, M.; Williams, H.J.; Vaughan, C.K.; Hayward, J.; Goldenberg, A.; Emes, R.D.; Munye, M.M.; Dyer, L.; Cahill, T.; Bevillard, J.; Gehrig, C.; Guipponi, M.; Chantot, S.; Duquesnoy, P.; Thomas, L.; Jeanson, L.; Copin, B.; Tamalet, A.; Thauvin-Robinet, C.; Papon, J.F.; Garin, A.; Pin, I.; Vera, G.; Aurora, P.; Fassad, M.R.; Jenkins, L.; Boustred, C.; Cullup, T.; Dixon, M.; Onoufriadis, A.; Bush, A.; Chung, E.M.; Antonarakis, S.E.; Loebinger, M.R.; Wilson, R.; Armengot, M.; Escudier, E.; Hogg, C.; Amselem, S.; Sun, Z.; Bartoloni, L.; Blouin, J.L.; Mitchison, H.M.; Schmidts, M.; et al.,

    2017-01-01

    By moving essential body fluids and molecules, motile cilia and flagella govern respiratory mucociliary clearance, laterality determination and the transport of gametes and cerebrospinal fluid. Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder frequently caused by non-assembly of

  19. Learned Helplessness in Inclusive Music Classrooms: Voices of Hong Kong Primary Schools Music Teachers

    Science.gov (United States)

    Wong, Marina Wai-yee; Chik, Maria Pik-yuk

    2015-01-01

    In Hong Kong, inclusive education is concerned with educating all students, including those who are categorised as having special educational needs (SEN). This qualitative study reports three challenges faced by primary schools music teachers required to implement inclusive education. The first two challenges echo those reported…

  20. Concerns about the implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van Domburg, Ron T; Theuns, Dominic A M J

    2005-01-01

    Patients with an implantable cardioverter defibrillator (ICD) are at increased risk of anxiety disorders. In turn, anxiety has been identified as a precipitant of ventricular arrhythmias. Anxiety may in part be attributed to concerns about the ICD firing, but the relationship between ICD concerns......, psychological morbidity, and shocks has not been systematically investigated. We examined the relative importance of experienced shocks versus subjective concerns about the ICD as determinants of anxiety and depressive symptoms in ICD patients....

  1. Response to ONS/EH-OA concerns

    International Nuclear Information System (INIS)

    Rice, P.D.

    1991-01-01

    The DOE's independent Office of Nuclear Safety (ONS) conducted an independent assessment of WSRC's readiness for K-Reactor restart. DOE-ONS identified six areas of concern, with specific findings in each area. The six concerns deal with: (1) Technical Specification surveillance, (2) human factors issues, (3) emergency lighting, (4) fire protection issues, (5) the Unreviewed Safety Question process, and (6) the critique process. This report addresses each of these six concerns and Westinghouse's actions to resolve them

  2. Measurements and simulations of the radiation exposure to aircraft crew workplaces due to cosmic radiation in the atmosphere

    International Nuclear Information System (INIS)

    Beck, P.; Latocha, M.; Dorman, L.; Pelliccioni, M.; Rollet, S.

    2007-01-01

    As required by the European Directive 96/29/Euratom, radiation exposure due to natural ionizing radiation has to be taken into account at workplaces if the effective dose could become more than 1 mSv per year. An example of workers concerned by this directive is aircraft crew due to cosmic radiation exposure in the atmosphere. Extensive measurement campaigns on board aircraft have been carried out to assess ambient dose equivalent. A consortium of European dosimetry institutes within EURADOS WG5 summarized experimental data and results of calculations, together with detailed descriptions of the methods for measurements and calculations. The radiation protection quantity of interest is the effective dose, E (ISO). The comparison of results by measurements and calculations is done in terms of the operational quantity ambient dose equivalent, H*(10). This paper gives an overview of the EURADOS Aircraft Crew In-Flight Database and it presents a new empirical model describing fitting functions for this data. Furthermore, it describes numerical simulations performed with the Monte Carlo code FLUKA-2005 using an updated version of the cosmic radiation primary spectra. The ratio between ambient dose equivalent and effective dose at commercial flight altitudes, calculated with FLUKA-2005, is discussed. Finally, it presents the aviation dosimetry model AVIDOS based on FLUKA-2005 simulations for routine dose assessment. The code has been developed by Austrian Research Centers (ARC) for the public usage (http://avidos.healthphysics.at. (authors)

  3. Physical appearance concerns are uniquely associated with the severity of steroid dependence and depression in anabolic-androgenic steroid users.

    Science.gov (United States)

    Griffiths, Scott; Jacka, Brendan; Degenhardt, Louisa; Murray, Stuart B; Larance, Briony

    2018-02-27

    Emerging research suggests that the sub-population of anabolic-androgenic steroid (AAS) users who experience physical appearance concerns may suffer greater psychological dysfunction than other sub-populations, including users with athletic or occupational concerns. Thus, among current AAS users, we sought to determine whether, and to what extent, social physique anxiety-an established measure of appearance concern-was associated with psychological dysfunction. Interviews were conducted with a sample of 74 male AAS users living in Australia. Users completed self-report instruments of the severity of AAS dependence, depression, hazardous and risky drinking, use of non-AAS illicit drugs, psychological side-effects due to AAS use and abnormal test results due to AAS use. Multivariate analyses revealed that greater social physique anxiety was uniquely associated with more severe symptoms of both AAS dependence and depression. Moreover, the effect size of these relationships was large. Social physique anxiety was not associated with hazardous or risky drinking, non-AAS illicit drug use, psychological side-effects or abnormal test results. Limitations notwithstanding, the study is consistent with the notion that AAS users who experience appearance concerns are at heightened risk of co-morbid psychological dysfunction. Given trends indicating an increase in the prevalence of AAS use in Australia and elsewhere, the findings suggest that health-care systems may need to consider prioritising the sub-population of AAS users who experience appearance concerns. Further investigation of the clinical syndrome of AAS dependence is required, including its relation to body image and eating disorders. © 2018 Australasian Professional Society on Alcohol and other Drugs.

  4. Primary tuberculosis of the breast manifested as abscess: a rare case report.

    Science.gov (United States)

    Gupta, Samita; Singh, Vikram J; Bhatia, Gaurav; Dhuria, Kshitiz

    2014-01-01

    Primary breast tuberculosis is a rare entity. We are reporting a case of primary breast tuberculosis, which presented as breast abscess. On histopathology, it was diagnosed as breast tuberculosis. Aspiration cytology was not done due breast abscess. Patient was put on anti-tubercular drugs. In follow up, after 3 months patient condition was improved.

  5. Resilience of Science Teaching Philosophies and Practice in Early Career Primary Teaching Graduates

    Science.gov (United States)

    Bartholomew, Rex; Anderson, Dayle; Moeed, Azra

    2012-01-01

    There has been recent concern over the variable quality of science teaching in New Zealand primary schools. One reason suggested has been the relatively low levels of science education components in initial teacher education (ITE) programmes. This paper follows a cohort of recent teacher graduates from a science education course in their ITE…

  6. Digital Media in Primary Schools: Literacy or Technology? Analyzing Government and Media Discourses

    Science.gov (United States)

    Pereira, Sara; Pereira, Luís

    2015-01-01

    This article examines the political and the media discourses concerning the Portuguese governmental program responsible for delivering a laptop named "Magalhães" to all primary school children. The analysis is based on the official documents related to the launch and development of the initiative as well as the press coverage of this…

  7. Prediction of primary vs secondary hypertension in children.

    Science.gov (United States)

    Baracco, Rossana; Kapur, Gaurav; Mattoo, Tej; Jain, Amrish; Valentini, Rudolph; Ahmed, Maheen; Thomas, Ronald

    2012-05-01

    Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. © 2012 Wiley Periodicals, Inc.

  8. Failed surgery in primary hyperparathyroidism - what has changed with time.

    Science.gov (United States)

    Wirowski, D; Goretzki, P E; Schwarz, K; Lammers, B J; Dotzenrath, C; Röher, H-D

    2013-06-01

    Advanced preoperative imaging of parathyroid adenomas and intraoperative parathyroid hormone determination optimized the results in the surgical treatment of primary hyperparathyroidism patients. We asked, whether reasons for failure have changed during the last 25 years.We retrospectively analyzed operations for persistent primary hyperparathyroidism in our department between 2001 and 2011 (n=67), and compared these results to our experience between 1986 and 2001 (n=80).From 2001 to 2011, 765 primary hyperparathyroidism patients were operated on at our department. All but 4 patients were cured (761/765, 99.5%). 67 operations were performed for persistent primary hyperparathyroidism. Main reasons for failure were a misdiagnosed sporadic multiple gland disease in our own patients (18/29, 62.1%), and an undetected solitary adenoma in patients referred to us after -initial operation in another hospital (22/38, 57.9%) (statistically significant). From 1986 to 2001 (1 105 primary hyperparathyroidism patients), main indications for re-operation due to persistent disease were an undiagnosed sporadic multiple gland disease in our own patients (15/24, 62.5%), and a missed solitary adenoma in patients being operated on primarily somewhere else (38/56, 67.9%) (statistically significant).Comparing our experience in 147 patients with persistent primary hyperparathyroidism being operated on between 2001-2011 and 1986-2001, not much has changed with the modern armamentarium of improved preoperative imaging or intraoperative biochemical control. Whereas sporadic multiple gland disease was the most common reason for unsuccessful surgery in experienced hands, other units mainly failed due to an undetected solitary adenoma. Re-operations for persistent primary hyperparathyroidism performed by us were successful in 93.8% (2001-2011) and 96.0% (1986-2001), respectively. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

  9. Glaucoma Patient-Reported Concerns and Associated Factors.

    Science.gov (United States)

    Mogil, Rachel S; Tirsi, Andrew; Lee, Jung Min; Tello, Celso; Park, Sung Chul

    2017-06-01

    To assess the character and degree of concerns of glaucoma patients and identify demographic/clinical factors affecting the concerns. Prospective cross-sectional study. A questionnaire that addressed patients' concerns was administered to consecutive glaucoma patients. Severity of concern was scored with a scale of 0-5 in order of increasing severity. Age, sex, intraocular pressure, visual field (VF) mean deviation (MD), number of antiglaucoma medications, history of glaucoma surgery, and employment status were recorded. Questionnaire results of 152 patients (mean VF MD, -8.03 ± 7.86 dB [better eye] and -16.06 ± 10.22 dB [worse eye]; mean age, 69 ± 14 years) were analyzed. Severity of concern was greatest for general eyesight (2.92/5.00) and visual symptoms (2.78/5.00), followed by activities (2.20/5.00) and socioeconomic factors (2.13/5.00), and then ocular symptoms (1.69/5.00) (P factors correlated with VF MD of the better eye (r = -0.245; P = .003) and age (r = -0.260; P = .001). Glaucoma patients reported varied degrees of concern regarding items associated with quality of life. Certain items may be more concerning than others. Severity of some concerns increased with more severe VF loss, prior glaucoma surgery, or younger age. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Biomass application for heating primary schools in Portugal

    International Nuclear Information System (INIS)

    Pires, A.; Cordeiro, M.

    2000-01-01

    The use of renewable energies for heating the schools, hospitals, public and agricultural buildings and even houses must constitute a principal option instead a second choice. The life quality of the people, in this case the students of primary schools, must be concern for all the people whose working in the energy subject. All the people must be aware that the life quality must be tried by the use of the renewable energies and in this case the biomass. This work pretends to be a good contribution for using of this type of energy. (Author)

  11. Modelling information dissemination under privacy concerns in social media

    Science.gov (United States)

    Zhu, Hui; Huang, Cheng; Lu, Rongxing; Li, Hui

    2016-05-01

    Social media has recently become an important platform for users to share news, express views, and post messages. However, due to user privacy preservation in social media, many privacy setting tools are employed, which inevitably change the patterns and dynamics of information dissemination. In this study, a general stochastic model using dynamic evolution equations was introduced to illustrate how privacy concerns impact the process of information dissemination. Extensive simulations and analyzes involving the privacy settings of general users, privileged users, and pure observers were conducted on real-world networks, and the results demonstrated that user privacy settings affect information differently. Finally, we also studied the process of information diffusion analytically and numerically with different privacy settings using two classic networks.

  12. Supports and Concerns for Teacher Professional Growth During the Implementation of a Science Curriculum Innovation

    Science.gov (United States)

    Peers, Cheryl (Shelley) E.; Diezmann, Carmel M.; Watters, James J.

    2003-02-01

    Internationally, considerable reform in science education is occurring which promotes constructivist philosophies and advocates constructivist-inspired pedagogical strategies that are new to many teachers. This paper reports on the supporting factors necessary for teacher professional growth and the issues of concern that were evident during one primary teacher''s successful implementation of a unit of work based on a draft of a new state-wide science syllabus which proposes such approaches. One researcher (CEP) provided guidance during the writing and implementation of the unit through professional development workshops complemented by ongoing collegial support. The analysis of the teacher''s practice reveals that professional growth required a willingness of the teacher to engage with change and modify his professional practice. The support factors for teacher growth consisted of an appropriate program of professional development, teacher understanding of the elements of the curriculum innovation, and successful experiences in implementing new approaches. In contrast, the issues of concern were: the adequacy of support for planning including the time required to understand the innovation and make changes to teaching practice; science equipment; teacher knowledge; classroom management strategies; and ways to cope with change. Understanding of these support factors and issues of concern is vital for the successful implementation of science curriculum innovations.

  13. Patients' and clinicians' experiences and perceptions of the primary care management of insomnia: qualitative study.

    Science.gov (United States)

    Davy, Zowie; Middlemass, Jo; Siriwardena, Aloysius N

    2015-10-01

    Insomnia is common leading to patients with sleep problems often presenting to primary care services including general practice, community pharmacies and community mental health teams. Little is known about how health professionals in primary care respond to patients with insomnia. We aimed to explore health professionals' and patients' experiences and perceptions of the management of insomnia in primary care. We used a qualitative design and thematic approach. Primary care in Nottinghamshire and Lincolnshire. We undertook focus groups and one-to-one interviews with a purposive sample of health professionals and adults with insomnia. We interviewed 28 patients and 23 health professionals. Practitioners focused on treating the cause of insomnia rather than the insomnia itself. They described providing stepped care for insomnia, but this focused on sleep hygiene which patients often disregarded, rather than cognitive behavioural therapy for insomnia (CBT-I). Practitioners were ambivalent towards hypnotic drugs but often colluded with patients to prescribe to avoid confrontation or express empathy. Patients sometimes took hypnotics in ways that were not intended, for example together with over-the-counter medication. Practitioners and patients were sometimes but not always concerned about addiction. Practitioners sometimes prescribed despite these concerns but at other times withdrew hypnotics abruptly without treating insomnia. Both patients and practitioners wanted more options and better training for the management of insomnia in primary care. A better understanding of the current approaches and difficulties in the management of insomnia will help to inform more therapeutic options and health professional training. © 2013 John Wiley & Sons Ltd.

  14. Association of self-reported cognitive concerns with mobility in people with lower limb loss.

    Science.gov (United States)

    Kelly, Valerie E; Morgan, Sara J; Amtmann, Dagmar; Salem, Rana; Hafner, Brian J

    2018-01-01

    This study tested the hypothesis that greater perceived cognitive concerns are associated with worse mobility in a cohort of prosthesis users with lower limb loss (LLL). We performed a secondary analysis of cross-sectional self-report data from a volunteer sample of people with LLL due to dysvascular and non-dysvacular causes. Perceived cognitive difficulties were assessed using the Quality of Life in Neurological Disorders Applied Cognition - General Concerns (Neuro-QoL ACGC). Mobility was measured with the Activities-Specific Balance Confidence Scale (ABC) and the Prosthetic Limb Users Survey of Mobility (PLUS-M). Simple linear regressions examined univariate relationships between cognitive concerns and mobility. Multiple linear regression analyses included demographic and amputation-related variables that could influence this relationship. Analysis of data from 1291 people with LLL demonstrated that greater cognitive concerns, measured by the Neuro-QoL ACGC, were associated with poorer perceived mobility, measured by both ABC and PLUS-M instruments. This relationship remained statistically significant after adjusting for demographic and amputation-related factors. These results suggest that greater cognitive concerns are associated with worse mobility among a broad range of people with LLL. An improved understanding of this relationship is critical for optimizing rehabilitation outcomes for this population. Implications for rehabilitation Rehabilitation for people with lower limb loss (LLL) typically focuses on physical impairments and mobility limitations, but cognition is increasingly recognized to have an impact on functional outcomes. Greater perceived cognitive concerns are associated with poorer mobility among a broad range of people with LLL, even when adjusting for demographic and amputation-related factors. Cognitive status can impact relevant rehabilitative outcomes, including mobility, and should be considered when planning prosthetic and therapeutic

  15. Approach to a child with primary immunodeficiency

    Directory of Open Access Journals (Sweden)

    Özge Yılmaz

    2010-09-01

    Full Text Available Primary immunodeficiencies are clinically and epidemiologically important, despite their low prevalence, due to the associated risk of high morbidity and mortality. Most commonly encountered primary immunodeficiencies include humoral immune system deficiencies, cellular immune system defects, combined immunodeficiencies, phagocyte system defects, complement system defects. Classical clinical findings of immunodeficiencies include recurrent, severe infections which do not respond to treatment or which progress with complications as well as tendency to develop infections with low virulence microorganisms. Moreover, they may present with autoimmunity, autoinflammatory or hemaphagocytic syndromes. Congenital diseases usually start in early childhood and lead to morbidity and mortality. Therefore, early diagnosis may be life saving and allow increasing quality of life, genetic counseling or prenatal diagnosis. Considering primary immunodeficiencies more frequently in differential diagnosis and early immunological evaluation would lead to early diagnosis of these patients and allow them to reach early treatment or preventive measures.

  16. Examining the Influence of Cost Concern and Awareness of Low-cost Health Care on Cancer Screening among the Medically Underserved.

    Science.gov (United States)

    Best, Alicia L; Strane, Alcha; Christie, Omari; Bynum, Shalanda; Wiltshire, Jaqueline

    2017-01-01

    African Americans suffer a greater burden of mortality from breast, cervical, and colorectal cancers than other groups in the United States. Early detection through timely screening can improve survival outcomes; however, cost is frequently reported as a barrier to screening. Federally qualified health centers (FQHCs) provide preventive and primary care to underserved populations regardless of ability to pay, positioning them to improve cancer screening rates. The purpose of this study was to examine the influence of concern about health care cost (cost concern) and awareness of low-cost health care (awareness) on cancer screening among 236 African Americans within an FQHC service area using self-report surveys. Multiple logistic regression indicated that awareness was positively associated with cervical and colorectal cancer screening, while cost concern was negatively associated with mammography screening. Results indicate that improving awareness and understanding of low-cost health care could increase cancer screening among underserved African Americans.

  17. How can clinician-educator training programs be optimized to match clinician motivations and concerns?

    Science.gov (United States)

    McCullough, Brendan; Marton, Gregory E; Ramnanan, Christopher J

    2015-01-01

    Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Review of medical education literature using the terms "attitudes", "motivations", "physicians", "teaching", and "undergraduate medical education" resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education.

  18. An overview of actions concerning life management of nuclear power plants in Argentina

    International Nuclear Information System (INIS)

    Savino, E.; Versaci, R.A.

    1998-01-01

    The main activities concerning reorganisation of nuclear activities in Argentina are presented. This includes the activities related to the main technical areas, namely pressure vessel and piping; heat exchangers; fuel channels and reactor inner components. The main objectives was to develop and to store knowledge on performance, safety and life extension of critical components of power reactors. Main priority subjects were: changes of properties due to irradiation; mechanical properties; post-irradiation inspection of components and microstructure

  19. Primary hypothyroidism mimicking a pituitary macroadenoma: regression after thyroid hormone replacement therapy

    International Nuclear Information System (INIS)

    Eom, Ki Seong; Kim, Jong Moon; Kim, Tae Young; See-Sung, Choi; Kim, Jong Duck

    2009-01-01

    We report a 9-year-old girl with pituitary hyperplasia due to primary hypothyroidism. She presented with growth arrest, abnormal thyroid function studies, and a pituitary mass on MRI. With thyroxine therapy, the pituitary mass regressed and her symptoms resolved. Primary hypothyroidism should be considered in the differential diagnosis of solid mass lesions of the pituitary gland. (orig.)

  20. Primary hypothyroidism mimicking a pituitary macroadenoma: regression after thyroid hormone replacement therapy

    Energy Technology Data Exchange (ETDEWEB)

    Eom, Ki Seong; Kim, Jong Moon; Kim, Tae Young [Wonkwang University School of Medicine, Department of Neurosurgery, Iksan (Korea); See-Sung, Choi [Wonkwang University School of Medicine, Department of Radiology, Iksan (Korea); Kim, Jong Duck [Wonkwang University School of Medicine, Department of Pediatrics, Iksan (Korea)

    2009-02-15

    We report a 9-year-old girl with pituitary hyperplasia due to primary hypothyroidism. She presented with growth arrest, abnormal thyroid function studies, and a pituitary mass on MRI. With thyroxine therapy, the pituitary mass regressed and her symptoms resolved. Primary hypothyroidism should be considered in the differential diagnosis of solid mass lesions of the pituitary gland. (orig.)

  1. Proactive Conservation Program: Species of Concern :: NOAA Fisheries

    Science.gov (United States)

    Invertebrates & Plants Species of Concern Threatened & Endangered Health & Stranding Marine Mammals : Species of Concern Species of Concern List | Grants and Technical Resources/Links bluefin tuna Bluefin Tuna (Thunnus thynnus) Photo: NOAA Species of Concern are those species about which we have some

  2. Prevention of Alzheimer disease: The roles of nutrition and primary care.

    Science.gov (United States)

    Bane, Tabitha J; Cole, Connie

    2015-05-15

    Risk factors for developing Alzheimer disease include hypercholesterolemia, hypertension, obesity, and diabetes. Due to lack of effective treatments for Alzheimer disease, nutrition and primary prevention becomes important.

  3. Coping experience of health concerns and physical disability for older Chinese people: A qualitative, descriptive study.

    Science.gov (United States)

    Mei, He; Turale, Sue

    2017-12-01

    In this qualitative, descriptive study, we explored the perspectives of older, community-dwelling Chinese people regarding their experiences of coping with a physical disability and their health concerns. Twenty participants were interviewed in-depth, and data were analyzed using content analysis. Five themes with 13 subthemes emerged that described older people's experiences of coping with health concerns and disability: (i) ignoring health concerns; (ii) managing self; (iii) seeking medical help; (iv) living with physical disability; and (v) relying on limited resources. Most participants did not have sufficient access to health services due to physical disability and financial deficits, so they tended to ignore their health conditions or tackle them independently before seeking medical help. At the same time, they were impacted on by social and cultural factors. Policies are required that offer more resources to community-dwelling people with disabilities in China. © 2017 John Wiley & Sons Australia, Ltd.

  4. No Matter How I Think, It Already Hurts: Self-Stigmatized Feelings and Face Concern of Chinese Caregivers of People with Intellectual Disabilities

    Science.gov (United States)

    Yang, Xue

    2015-01-01

    This study used mixed-methods design to explore internalized self-stigma among family caregivers (ISFC) of people with intellectual disability (ID) in China, where face culture and collective emotions are emphasized. A total of 120 primary caregivers of people with ID were assessed for ISFC, face concern and psychological distress at the survey…

  5. Selective mutism: are primary care physicians missing the silence?

    Science.gov (United States)

    Schwartz, Richard H; Freedy, Alicia S; Sheridan, Michael J

    2006-01-01

    To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual IV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRIs, and early intervention are viable treatment options. Early diagnosis is key to preventing long-term effects of this condition.

  6. Radioactive 55Fe contamination in the primary circuit of WWER-440

    International Nuclear Information System (INIS)

    Ruskov, T.; Ruskov, R.; Dobrevski, I.; Konnova, S.; Zaharieva, N.; Menut, P.

    2001-01-01

    The isotope 55 Fe generation in the steel construction materials of the reactor and the mechanism of internal irradiation and blood affection by the 55 Fe are briefly discussed in this paper. The paper also presents the results from calculation of direct generation of 55 Fe due to neutron irradiation of different iron-contained parts of the reactor system such as the steel shell of the reactor core, the core basket, the steel shaft of the reactor vessels. Calculations are performed with specially developed program code DIRGEN. Another type of contamination, considered in the paper is due to the corrosion of materials and erosion-dissolution processes in the primary circuit of WWER with their subsequent deposition-precipitation on the inner surface of the primary circuit. The real time calculations of the 55 Fe activity are performed, by using of the updated computer code MIGA-RT. The obtained results show that the 55 Fe activity deposition on the inner surfaces of the primary circuits reaches the values of 103 kBq/cm 2 for the reactor core surfaces and 102 kBq/cm 2 for the out-of-core surfaces. The activity values are in one order of magnitude higher than the corresponding activity values due to 60 Co buildup

  7. A Mathematical Model Of Ageing In Man Due To Gene Loss | Mbah ...

    African Journals Online (AJOL)

    Aging is as a result of dysfunction of the body mechanisms due to failure of one organelle, tissue, component or the other. In man there is a pointer towards gene loss as a primary cause of ageing. In this paper we develop a mathematical model describing changes in gene efficiency or gene failure. This model is used to ...

  8. Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden

    Directory of Open Access Journals (Sweden)

    Nilsson Gunnar H

    2006-11-01

    Full Text Available Abstract Background Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden. Methods Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses. Results In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified. Conclusion Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home.

  9. Health effects of freshwater bathing among primary school children; Design for a randomised exposure study

    NARCIS (Netherlands)

    Asperen IA van; Medema GJ; Havelaar AH; Borgdorff MW; CIE; MGB

    1997-01-01

    To study the health effects of bathing in freshwaters that meet current water quality standard, large epidemiological studies are needed. A design is presented of a study among primary school children, that aims to evaluate current water quality standard. The study concerns a randomised exposure

  10. Going Concern Disclosure for Local Governments

    Directory of Open Access Journals (Sweden)

    Nancy Chun Feng

    2017-07-01

    Full Text Available Going concern opinions (GCOs indicate that auditors have significant doubt about an entity’s ability to continue operation one year after the financial statement date. This study addresses the following research questions: What are the factors that motivate auditors to issue GCOs to governmental entities? Does a governmental entity disclose going concern uncertainty in the footnotes or the MD&A section of annual financial reports (AFRs either the year before or the year when the entity receives a GCO? To what extent does the entity disclose the GCO factors used by auditors? We find that auditors most often cited two reasons, “Deficiency in Funds” and “Losses or Revenue Declines,” accounting for the majority of reasons given for a going concern opinion. Further, the disclosure is most likely to be in the notes to the AFRs. In addition, we find that going concern reporting varies by auditor type (state auditors vs. public accounting firms, government size, and government type. We also find some evidence that going concern disclosures improve after the enactment of GASB No. 56. The results of our study should be of interest to stakeholders’ interested in lead indicators of fiscal distress.

  11. Primary HPV testing recommendations of US providers, 2015.

    Science.gov (United States)

    Cooper, Crystale Purvis; Saraiya, Mona

    2017-12-01

    To investigate the HPV testing recommendations of US physicians who perform cervical cancer screening. Data from the 2015 DocStyles survey of U.S. health care providers were analyzed using multivariate logistic regression to identify provider characteristics associated with routine recommendation of primary HPV testing for average-risk, asymptomatic women ≥30years old. The analysis was limited to primary care physicians and obstetrician-gynecologists who performed cervical cancer screening (N=843). Primary HPV testing for average-risk, asymptomatic women ≥30years old was recommended by 40.8% of physicians who performed cervical cancer screening, and 90.1% of these providers recommended primary HPV testing for women of all ages. The screening intervals most commonly recommended for primary HPV testing with average-risk, asymptomatic women ≥30years old were every 3years (35.5%) and annually (30.2%). Physicians who reported that patient HPV vaccination status influenced their cervical cancer screening practices were almost four times more likely to recommend primary HPV testing for average-risk, asymptomatic women ≥30years old than other providers (Adj OR=3.96, 95% CI=2.82-5.57). Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25years old. The association between provider recommendation of primary HPV testing and patient HPV vaccination status may be due to anticipated reductions in the most oncogenic HPV types among vaccinated women. Published by Elsevier Inc.

  12. Confidentiality Concerns and Sexual and Reproductive Health Care Among Adolescents and Young Adults Aged 15-25.

    Science.gov (United States)

    Copen, Casey E; Dittus, Patricia J; Leichliter, Jami S

    2016-12-01

    Data from the National Survey of Family Growth •About 7% of persons aged 15-25 would not seek sexual or reproductive health care because of concerns that their parents might find out about it. •For females aged 15-17 and 18-25, those who had confidentiality concerns were less likely to receive sexual and reproductive health services in the past year compared with those without these concerns. •Less than one-half of teenagers aged 15-17 (38.1%) spent some time alone in the past year during a visit with a doctor or other health care provider without a parent, relative, or guardian in the room. •Teenagers aged 15-17 who spent some time alone during a visit with a health care provider were more likely to have received sexual or reproductive health services in the past year compared with those who had not. Confidentiality concerns can impact adolescent and young adults' access to sexual and reproductive health services (1-4). Young people who are covered by their parents' private health insurance may be deterred from obtaining these services due to concerns that their parents might find out about it (2). Similarly, confidentiality concerns may arise because youth seeking such services may not have time alone during a visit with a health care provider (4). This report describes two measures related to confidentiality concerns and sexual and reproductive health care. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

  13. Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit.

    Science.gov (United States)

    Salzmann-Erikson, Martin

    2018-06-22

    Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness. © 2018 Australian College of Mental Health Nurses Inc.

  14. Posttraumatic stress disorder: Often missed in primary care.

    Science.gov (United States)

    Williams, Adrienne A

    2017-10-01

    DeSean W, a 47-year-old man, returned to his primary care clinic with a new complaint of epigastric burning that had been bothering him for the past 4 months. He had tried several over-the-counter remedies, which provided no relief. He also remained concerned--despite assurances to the contrary at previous clinic visits--that he had contracted a sexually-transmitted disease (STD) after going to a bar one night 4 to 5 months ago. At 2 other clinic visits since that time, STD test results were negative. At this current visit, symptoms and details of sexual history were unchanged since the last visit, with the exception of the epigastric pain. When asked if he thought he had contracted an STD through a sexual encounter the night he went to the bar, he emphatically said he would not cheat on his wife. Surprisingly, given his concern, he avoided further discussion on modes of contracting an STD. The physician prescribed ranitidine 150 mg bid for the epigastric burning and explained, once more, the significance of the STD test results. However, he also decided to further examine Mr. W's concern about STDs and the night he may have contracted one. HOW WOULD YOU PROCEED WITH THIS PATIENT?

  15. Investigating Power System Primary and Secondary Reserve Interaction under High Wind Power Penetration

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Yingchen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tan, Jin [National Renewable Energy Lab. (NREL), Golden, CO (United States); Krad, Ibrahim [National Renewable Energy Lab. (NREL), Golden, CO (United States); Yang, Rui [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Ela, Erik [Electric Power Research Inst. (EPRI), Knoxville, TN (United States)

    2016-12-01

    Power system frequency needs to be maintained close to its nominal value at all times to successfully balance load and generation and maintain system reliability. Adequate primary frequency response and secondary frequency response are the primary forces to correct an energy imbalance at the second-to-minute level. As wind energy becomes a larger portion of the world's energy portfolio, there is an increased need for wind to provide frequency response. This paper addresses one of the major concerns about using wind for frequency regulation: the unknown factor of the interaction between primary and secondary reserves. The lack of a commercially available tool to model this has limited the energy industry's understanding of when the depletion of primary reserves will impact the performance of secondary response or vice versa. This paper investigates the issue by developing a multi-area frequency response integration tool with combined primary and secondary capabilities. The simulation is conducted in close coordination with economical energy scheduling scenarios to ensure credible simulation results.

  16. Personal and social factors that influence pro-environmental concern and behaviour: a review.

    Science.gov (United States)

    Gifford, Robert; Nilsson, Andreas

    2014-06-01

    We review the personal and social influences on pro-environmental concern and behaviour, with an emphasis on recent research. The number of these influences suggests that understanding pro-environmental concern and behaviour is far more complex than previously thought. The influences are grouped into 18 personal and social factors. The personal factors include childhood experience, knowledge and education, personality and self-construal, sense of control, values, political and world views, goals, felt responsibility, cognitive biases, place attachment, age, gender and chosen activities. The social factors include religion, urban-rural differences, norms, social class, proximity to problematic environmental sites and cultural and ethnic variations We also recognize that pro-environmental behaviour often is undertaken based on none of the above influences, but because individuals have non-environmental goals such as to save money or to improve their health. Finally, environmental outcomes that are a result of these influences undoubtedly are determined by combinations of the 18 categories. Therefore, a primary goal of researchers now should be to learn more about how these many influences moderate and mediate one another to determine pro-environmental behaviour. © 2014 International Union of Psychological Science.

  17. Turner syndrome with primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Jungmee Park

    2013-06-01

    Full Text Available Turner syndrome has multiple comorbidities such as osteoporosis, obesity, diabetes, hypothyroidism, and hypertension. As they are treatable conditions in Turner syndrome, early recognition and proper treatment should be needed. We report on a 23-year-old woman with Turner syndrome who presented with severe osteoporosis and hypercalcemia. Laboratory tests showed elevated levels of serum calcium and parathyroid hormone. Dual-energy X-ray absorptiometry showed severe osteopo-rosis (z score, -3.5. Ultrasound and 99mTc scintigraphy of parathyroid glands showed an adenoma in the right inferior gland. She was diagnosed with primary hyperparathyroidism due to an adenoma of the parathyroid gland. After excision of the adenoma, the patient's serum calcium and parathyroid hormone levels returned to normal. Although only a few cases of Turners syndrome with primary hyperparathyroidism have been reported, hyperparathyroidism should be considered in cases of Turner syndrome with severe osteoporosis and hypercalcemia.

  18. Modern Languages and Interculturality in the Primary Sector in England, Greece, Italy and Spain.

    Science.gov (United States)

    Cerezal, Fernando

    1997-01-01

    Addresses concerns and issues regarding modern language teaching and learning at primary schools in Greece, Italy, Spain, and England. It focuses on the optimal age for learning and acquiring languages and to the educational reforms which have been undertaken in each country relating to early modern language teaching and learning and…

  19. Long-term criticality safety concerns associated with surplus fissile material disposition

    International Nuclear Information System (INIS)

    Choi, J.S.

    1995-01-01

    A substantial inventory of surplus fissile material would result from ongoing and planned dismantlement of US and Russian nuclear weapons. This surplus fissile material could be dispositioned by irradiation in nuclear reactors, and the resulting spent MOx fuel would be similar in radiation characteristics to regular LWR spent UO2 fuel. The surplus fissile material could also be immobilized into high-level waste forms, such as borosilicate glass, synroc, or metal-alloy matrix. The MOx spent fuel, or the immobilized waste forms, could then be directly disposed of in a geologic repository. Long-term criticality safety concerns arise because the fissile contents (i.e., Pu-239 and its decay daughter U-235) in these waste forms are higher than in LWR spent UO2 fuel. MOx spent fuel could contain 3 to 4 wt% of reactor-grade plutonium, compared to only 0.9 wt% of plutonium in LWR spent UO2 fuel. At some future time (tens of thousand of years), when the waste forms had deteriorated due to intruding groundwater, the water could mix with the long-lived fissile materials to form into a critical system. If the critical system is self-sustaining, somewhat like the natural-occurring reactor in OKLO, fission products produced could readily be available for dissolution and release out to the accessible environment, adversely affecting public health and safety. This paper will address ongoing activities to evaluate long-term criticality safety concerns associated with disposition of fissile material in a geologic setting. Issues to be addressed include the identification of a worst-case water-intrusion scenario and waste-form geometries which present the most concern for long-term criticality safety; and suggests of technical solutions for such concerns

  20. COMPARATIVE ANALYSIS OF PRIMARY REPAIR VERSUS RESECTION AND ANASTOMOSIS IN JEJUNOILEAL PERFORATIONS IN SOUTHERN ODISHA

    Directory of Open Access Journals (Sweden)

    Charan Panda

    2017-11-01

    Full Text Available BACKGROUND Small intestinal perforation remains a major issue in this region of study. Most often, it is caused by either infections due to typhoid, tuberculosis or traumatic due to blunt or penetrating injuries. The mortality reported is related to various factors including age, delayed treatment, sepsis at presentation and inadequate treatment due to lack of resources. Management is therefore complex not only with regards to choose the most suitable surgical treatment, but also as regards an early diagnosis of complications, which is difficult in absence of diagnostic modalities that are often not available. The aim of the study is to compare primary repair versus intestinal resection and anastomosis in case of jejunoileal perforations due to various aetiologies. MATERIALS AND METHODS 60 patients with acute peritonitis underwent emergency laparotomy. Aetiology, number of perforations, size of perforations, site of perforations, surgical procedure undertaken and postoperative complications were recorded. The patients were divided into two groups according to the surgical procedure adapted at laparotomy; primary repair and intestinal resection and anastomosis. Clinical data, intraoperative findings and complications were evaluated and compared. RESULTS 40 out of 60, we found jejunoileal perforations, gastroduodenal in 20 patients. 23 had undergone primary repair and 17 resection and anastomosis. Postoperative complications were compared among both groups in relation to various factors. Conclusion was drawn as to prefer, which surgery in which group of patients. CONCLUSION In our study, detailed analysis of the complication pattern shows primary closure is associated with less number of complications in traumatic cases and resection and anastomosis is associated with lesser complications in infective cases. Primary closure is less complicated for single perforations as compared to multiple perforations. Resection and anastomosis is less

  1. Is primary care ready to embrace e-health? A qualitative study of staff in a London primary care trust

    Directory of Open Access Journals (Sweden)

    Rishi Mannan

    2006-06-01

    Conclusions At the time of the study the systems that form part of NHS Connecting for Health, apart from the Quality Management and Analysis System (QMAS, were not implemented across the PCT. All the practices in the study acknowledged the benefits new technology would bring to the workplace, but there were also some common concerns, which suggest that staff working in primary care practices are not ready for e-health. Successful implementation of the NHS Connecting for Health programme rests on identifying, acknowledging and overcoming these concerns. A different approach might be required for those practices that have made very little progress in using email or moving towards an electronic patient record. This study suggests that a mistrust of technology and fears as to the heavy initial workload involved in becoming fully computerised have dissuaded some practices from embracing e-health. If NHS Connecting for Health is to be a success, implementation teams might need to focus initially on practices that have been reluctant to use technology to support both clinical care and the day-to-day work of the practice.

  2. Privacy concerns in smart cities

    OpenAIRE

    van Zoonen, Liesbet

    2016-01-01

    textabstractIn this paper a framework is constructed to hypothesize if and how smart city technologies and urban big data produce privacy concerns among the people in these cities (as inhabitants, workers, visitors, and otherwise). The framework is built on the basis of two recurring dimensions in research about people's concerns about privacy: one dimensions represents that people perceive particular data as more personal and sensitive than others, the other dimension represents that people'...

  3. Prestressing of reinforcing bars in concrete slabs due to concrete expansion induced by Alkali-Silica Reaction

    DEFF Research Database (Denmark)

    Gustenhoff Hansen, Søren; Antonio Barbosa, Ricardo; Hoang, Linh Cao

    2017-01-01

    Alkali-silica reactions (ASR) in concrete bridges have been a major concern worldwide for many decades. In Denmark, several bridges are severely damaged due to ASR and over 600 bridges have the potential to develop ASR in the future. The majority of these bridges are slab-bridges. Despite the many...... cases, experimental research on structural safety and residual load carrying capacity of ASR-damaged bridges is limited. As ASR causes severe cracks in the concrete, which may affect the concrete compressive and tensile strength, concerns have been directed towards the residual shear capacity. Yet...

  4. Beta dose due to monazite sands of Kerala

    International Nuclear Information System (INIS)

    Massand, O.P.; Venkataraman, G.; Dhairyawan, M.P.

    1977-01-01

    The heavy black mineral sands of the sea coast of Kerala in India contain patches of monazite in concentrations varying between 0.5 to 5%. Monazite contains about 9.5% of thorium oxide (ThO 2 ) and 0.35% of uranium oxide (U 3 O 8 ). The high natural background radiation of this area had been a matter of concern and reports on the measured gamma radiation levels have appeared. The dose contribution due to beta rays emitted by the materials in the sand has been calculated using Loevinger's formula. The annual beta dose is of the order of 4200 mrad and 740 mrad at a height of 5 and 200 cm respectively from ground level. (author)

  5. System influences on work disability due to low back pain

    DEFF Research Database (Denmark)

    Bartys, Serena; Frederiksen, Pernille; Bendix, Tom

    2017-01-01

    Work disability due to low back pain is a significant global health concern. Current policy and practice aimed at tackling this problem is largely informed by the biopsychosocial model. Resultant interventions have demonstrated some small-scale success, but they have not created a widespread...... and disability benefits), healthcare and family systems (spouse/partner/close others) can act as obstacles to work participation for those with low back pain. Systematic searches of several scientific and grey literature sources were conducted, resulting in 1762 records. Following a systematic exclusion process...

  6. A snapshot of the organization and provision of primary care in Turkey

    Science.gov (United States)

    2011-01-01

    Background This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. Methods The WHO Primary Care Evaluation Tool was implemented in two provinces (Bolu and Eskişehir) in Turkey in 2007/08. The Tool consists of three parts: a national questionnaire concerning the organisation and financing of primary care; a questionnaire for family doctors; and a questionnaire for patients who visit a family health centre. Results Primary care has just recently become an official health policy priority with the introduction of a family medicine scheme. Although the supply of family doctors (FDs) has improved, they are geographically uneven distributed, and nationwide shortages of primary care staff remain. Coordination of care could be improved and quality control mechanisms were lacking. However, patients were very satisfied with the treatment by FDs. Conclusions The study provides an overview of the current state of PC in Turkey for two provinces with newly introduced family medicine, by using a structured approach to evaluate the essential functions of PC, including governance, financing, resource generation, as well as the characteristics of a "good" service delivery system (as being accessible, comprehensive, coordinated and continuous). PMID:21542904

  7. Primary Care Provider Views About Usefulness and Dissemination of a Web-Based Depression Treatment Information Decision Aid.

    Science.gov (United States)

    Beaulac, Julie; Westmacott, Robin; Walker, John R; Vardanyan, Gohar

    2016-06-08

    Decisions related to mental health are often complex, problems often remain undetected and untreated, information unavailable or not used, and treatment decisions frequently not informed by best practice or patient preferences. The objective of this paper was to obtain the opinions of health professionals working in primary health care settings about a Web-based information decision aid (IDA) for patients concerning treatment options for depression and the dissemination of the resources in primary care settings. Participants were recruited from primary care clinics in Winnipeg and Ottawa, Canada, and included 48 family physicians, nurses, and primary care staff. The study design was a qualitative framework analytic approach of 5 focus groups. Focus groups were conducted during regular staff meetings, were digitally recorded, and transcripts created. Analysis involved a content and theme analysis. Seven key themes emerged including the key role of the primary care provider, common questions about treatments, treatment barriers, sources of patient information, concern about quality and quantity of available information, positive opinions about the IDA, and disseminating the IDA. The most common questions mentioned were about medication and side effects and alternatives to medication. Patients have limited access to alternative treatment options owing to cost and availability. Practitioners evaluated the IDA positively. The resources were described as useful, supportive of providers' messages, and accessible for patients. There was unanimous consensus that information needs to be available electronically through the Internet.

  8. Alarming signs and symptoms in febrile children in primary care: an observational cohort study in The Netherlands.

    Directory of Open Access Journals (Sweden)

    Gijs Elshout

    Full Text Available CONTEXT: Febrile children in primary care have a low risk for serious infection. Although several alarming signs and symptoms are proposed to have predictive value for serious infections, most are based on research in secondary care. The frequency of alarming signs/symptoms has not been established in primary care; however, in this setting differences in occurrence may influence their predictive value for serious infections. OBJECTIVE: To determine the frequency of alarming signs/symptoms in febrile children in primary care. DESIGN: Observational cohort study. Clinical information was registered in a semi-structured way and manually recoded. SETTING: General practitioners' out-of-hours service. SUBJECTS: Face-to-face patient contacts concerning children (aged ≤16 years with fever were eligible for inclusion. MAIN OUTCOME MEASURES: Frequency of 18 alarming signs and symptoms as reported in the literature. RESULTS: A total of 10,476 patient contacts were included. The frequency of alarming signs/symptoms ranged from n = 1 (ABC instability; 40°C as reported by the parents; 12.9% to 8,647 contacts (parental concern; 82.5%. CONCLUSION: Although the prevalence of specific alarming signs/symptoms is low in primary care, ≥50% of children have one or more alarming signs/symptoms. There is a need to determine the predictive value of alarming signs/symptoms not only for serious infections in primary care, but as well for increased risk of a complicated course of the illness.

  9. The law concerning prevention from radiation hazards due to radioisotopes

    International Nuclear Information System (INIS)

    1977-01-01

    Based on the gist of the Atomic Energy Basic Law (Law No. 186, 1955), this Law regulates the use, sale, disposal and other handling of radioactive isotopes, use of radiation-generating apparatuses, disposal and other handling of matters contaminated by radioactive isotopes, thereby aims at the prevention of radiation injuries and securing the safety of the public. The radioactive isotopes referred to in this Law are the isotopes emitting radiation such as phosphorus-32 and cobalt-60, their compounds, and those containing such isotopes and compounds. The radiation-generating apparatuses referred to in this Law are the apparatuses generating radiation by accelerating charged particles such as cyclotron and synchrotron. Those who want to use the radioactive isotopes and radiation-generating apparatuses must file applications and obtain approval of the Director of the Science and Technology Agency. Those who want to use sealed radioactive isotopes of the amount less than that stipulated by the Cabinet Order, those who want to sell and those who want to dispose of radioactive isotopes or matters contaiminated thereby as occupation should file notices and obtain approval of the Director of the Science and Technology Agency. Said Director should not approve such notices unless they meet the required specification, and when he approves such notices, he issues licenses. (Rikitake, Y.)

  10. Mixing Bayes and empirical Bayes inference to anticipate the realization of engineering concerns about variant system designs

    International Nuclear Information System (INIS)

    Quigley, John; Walls, Lesley

    2011-01-01

    Mixing Bayes and Empirical Bayes inference provides reliability estimates for variant system designs by using relevant failure data - observed and anticipated - about engineering changes arising due to modification and innovation. A coherent inference framework is proposed to predict the realization of engineering concerns during product development so that informed decisions can be made about the system design and the analysis conducted to prove reliability. The proposed method involves combining subjective prior distributions for the number of engineering concerns with empirical priors for the non-parametric distribution of time to realize these concerns in such a way that we can cross-tabulate classes of concerns to failure events within time partitions at an appropriate level of granularity. To support efficient implementation, a computationally convenient hypergeometric approximation is developed for the counting distributions appropriate to our underlying stochastic model. The accuracy of our approximation over first-order alternatives is examined, and demonstrated, through an evaluation experiment. An industrial application illustrates model implementation and shows how estimates can be updated using information arising during development test and analysis.

  11. E-books: nurse faculty use and concerns.

    Science.gov (United States)

    Abell, Cathy H; Garrett-Wright, Dawn

    2014-01-01

    The purpose of this study was to identify nurse educators' stage of concern regarding e-books and examine relationships between stage of concern and demographic variables. The use of e-books is growing, and nursing faculty must be prepared to use this evolving technology. A descriptive design was used with a convenience sample of 50 nurse educators attending a professional conference. Data were collected using a demographic questionnaire and the Stages of Concern (SoC) questionnaire. Sixty-four percent of participants' first high stage was Stage 0 (awareness); 22 percent had a first high stage of Stage 1 (informational). Using ordinal regression, no statistical significance was noted with the highest Stage of Concern and age (p = .431) or experience as a nurse educator (p = .893). Findings indicate low usage, faculty concerns, and the need for ongoing education regarding e-books.

  12. Acute and regressive scleroderma concomitant to an acute CMV primary infection.

    Science.gov (United States)

    Goulabchand, Radjiv; Khellaf, Lakhdar; Forestier, Amandine; Costes, Valerie; Foulongne, Vincent; le Quellec, Alain; Guilpain, Philippe

    2014-12-01

    To describe the pathophysiological mechanisms involving cytomegalovirus (CMV) primary infection and natural killer (NK) cell expansion in the development of localized scleroderma. A 43-year-old woman presented acute erythematous discoloration and skin thickening concerning face, neck, trunk, abdomen, and the four limbs, predominantly in proximal areas. Our case did not respond to systemic sclerosis criteria diagnosis. However, skin and muscle biopsy revealed early scleroderma associated with capillary thrombi, and tissue infiltration with NK cells (CD56+/Granzyme B). Scleroderma was attributed to CMV primary infection responsible for cytolytic hepatitis (7-fold over the limit) and circulating NK cell excess. After 6 months of prednisone and a 2-year follow-up, a complete resolution of symptoms was observed. Our observation suggests a potential triggering role of CMV primary infection in the development of scleroderma. Histological features from our observation addresses the role of CMV and NK cells in the development of endothelial damage and fibrotic process. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Suboptimal palliative sedation in primary care: an exploration.

    Science.gov (United States)

    Pype, Peter; Teuwen, Inge; Mertens, Fien; Sercu, Marij; De Sutter, An

    2018-02-01

    Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs. The research team defined suboptimal palliative sedation as a time interval until deep sleep >1.5 h and/ or >2 awakenings after the start of the unconsciousness. Descriptive statistics were calculated on the quantitative data. Thematic analysis was used to analyse interview transcripts. We registered 63 palliative sedations in 1181 home deaths, 27 forms were completed. Eleven palliative sedations were suboptimal: eight due to the long time span until deep sleep; three due the number of unintended awakenings. GPs' interview analysis revealed two major themes: the shifting perception of failure and the burden of responsibility. Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.

  14. TIME LOAD UPON STUDENTS IN PRIMARY EDUCATION

    Directory of Open Access Journals (Sweden)

    Borce Kostov

    2016-12-01

    Full Text Available Time load upon students is a central issue in the context of the overall load placed upon students. Most authors dealing with the issue of load upon students mainly approach this issue from the aspect of the time the students need to respond to the requirements posed by the school and otherwise concerning school. Such load is called time load. In our research, we investigated exactly this kind of time load placed upon students in the nine-year primary education in Macedonia. The main goal of our research was getting insight what is the students’ time load like and how big it is.

  15. SCC of Alloy 600 components in PWR primary loop

    International Nuclear Information System (INIS)

    Gomez-Briceno, Dolores; Lapena, Jesus; Castano, M. Luisa; Blazquez, Fernando

    2002-01-01

    Full text: Cracking due to PWSCC in PWR CRDM nozzles and other VHP nozzles fabricated from Alloy 600 is not a new issue. In 1991, a leak was discovered on one CRDM nozzle at Bugey 3 PWR plant in France. The cause of the cracking was identified as primary water stress corrosion cracking. From then, similar cracks have been found in other European and USA PWR plants. The cracks were predominantly axial in orientation and it was accepted that CRDM nozzles and weld cracking in PWR was not a immediate safety concern. However, this consideration has to be reassessed in light of the recent identification of circumferential cracking in CRDM nozzles at Oconee Nuclear Station Unit 2 and 3 along with axial cracking in the Alloy 182 J-groove welds at these two units and at Oconee Nuclear Station 1 and Arkansas Nuclear One Unit 1. Alloy 600 susceptibility in primary water has received an enormous research effort for many years since the Alloy 600 steam generators tube degradation started. A significant amount of information is available to characterise the susceptibility of Alloy 600. However, Alloy 600 susceptibility is strongly dependent on the heat thermomechanical history and both the crack initiation time and the crack growth rate data obtained from representative materials of the VHP nozzles seem to be necessary for the structural integrity assessment of cracking nozzles. An extensive experimental program has been performed at CIEMAT, to study the behaviour of Alloy 600 VHP nozzles in PWR primary conditions. Crack initiation and crack propagation tests have been performed using different types of products (forged bar, tube, plate and steam generator tubing). Long duration crack initiation tests have been carried out, at 330 deg. C and 360 deg. C in water and at 400 deg. C in steam, using ten Alloy 600 heats with yield strength ranging from 291 MPa to 489 MPa. The influence of several parameters (grain boundary carbide distribution, grain size and yield strength) on crack

  16. Primary vesicoureteral reflux in Blacks with posterior urethral valves: Does it occur?

    International Nuclear Information System (INIS)

    Nancarrow, P.A.; Lebowitz, R.L.

    1988-01-01

    Primary vesicoureteral reflux (VUR) is thought to be largely independent of obstruction. Therefore, in patients with urethral obstruction due to posterior urethral valves (PUV) the occurrence of VUR is coincidental. In addition, primary VUR is reported to be uncommon in black children. If these two premises are correct, then primary VUR should be rare in black males with PUV. To test this hypothesis, we reviewed the medical records and radiographs of 43 males with PUV. Twenty-one of the 37 non-black males with PUV had VUR, of which 67% was primary and 33% was secondary. Three of the six Blacks with PUV had VUR of which none was primary and all was secondary. Thus, Blacks with PUV lend credence to the theory that primary VUR is not caused by obstruction and support the observation that primary VUR is rare in black children, even those with PUV. (orig.)

  17. Changes in adipose tissue stromal-vascular cells in primary culture due to porcine sera

    International Nuclear Information System (INIS)

    Jewell, D.E.; Hausman, G.J.

    1986-01-01

    This study was conducted to determine the response of rat stromal-vascular cells to pig sea. Sera were collected from unselected contemporary (lean) and high backfat thickness selected (obese) pigs. Sera from obese pigs were collected either by exsanguination or cannulation. sera from lean pigs during the growing phase (45 kg) and the fattening phase (100-110 kg) were collected. Stromal-vascular cells derived rom rat inguinal tissue were cultured on either 25 cm 2 flasks, collagen-coated coverslips or petri dishes. Cell proliferation was measured by [ 3 H]-thymidine incorporation during the fourth day of culture. Coverslip cultures were used for histochemical analysis. Petri dish cultures were used for analysis of Sn-glycerol-3-phosphate dehydrogenase (GPDH) activity. All cells were plated for 24 hours in media containing 10 fetal bovine sera. Test media contained 2.5, 5.0, 10.0% sera. Sera from obese pigs increased GPDH activity and fat cell production when compared to the lean controls. The increased concentration of sera increased esterase activity and lipid as measured with oil red O. The sera from obese pigs collected at slaughter stimulated more fat cell production than obese sera collected by cannulation. These studies show there are adipogenic factors in obese pigs sera which promote fat cell development in primary cell culture

  18. Prevalence of overweight and obesity among primary school ...

    African Journals Online (AJOL)

    The prevalence of childhood overweight and obesity is increasing at an alarming rate worldwide and has implications for a variety of diseases. This has been due to various causes such as poor nutrition, inactivity or both. The purpose of this study was to establish the prevalence of overweight and obesity among primary ...

  19. [Primary prevention of coronary thrombosis by antithrombotic agents].

    Science.gov (United States)

    Milon, H; Lantelme, P; Khettab, F; Mestre-Fernandes, C; Lasserre-Remy, S

    2001-11-01

    At the start of the eighties, in the wake of the good results obtained with aspirin in secondary prevention, two studies were launched aimed at testing the effect of aspirin on the primary prevention of myocardial infarction. The results published in 1988 and 1989 were divergent: the study conducted by British doctors showed no benefit with aspirin, that conducted by American doctors showed a very distinct benefit concerning myocardial infarction but no advantage for cerebral vascular accidents. Besides, in both studies an additional risk of haemorrhagic cerebral vascular accident was described. Methodological reasons were the origin of these facts, but it resulted in a certain confusion as to the practical conduct to adopt. Ten years later it is much more clear after the publication of three supplementary trials. The benefits of aspirin in terms of prevention of myocardial infarction are certain and considerable, at the price of a haemorrhagic risk equally certain but moderate. On the other hand, questions remain concerning the preventive effect of aspirin on cerebral vascular accidents and also on the expected benefits in the female sex. In practice, the prescription of aspirin with the objective of primary prevention must take into account the absolute benefit which can be expected. This is a function of the individual absolute risk before treatment which therefore signifies an evaluation based on the risk factors. Only subjects exposed to a substantial risk before treatment are likely to benefit from aspirin. For the others, the risks linked with aspirin could counterbalance its preventive advantages.

  20. [Clinical analysis of 138 multiple primary cancers diagnosed of digestive system malignant tumor initially].

    Science.gov (United States)

    Lyu, J M; Xiong, H C; Wu, B; Zhou, X Q; Hu, J

    2018-02-23

    Objective: To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods: From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results: 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient' prognosis was radical treatment to every primary cancer.

  1. Concerning background from calorimeter ports

    International Nuclear Information System (INIS)

    Digiacomo, N.J.

    1985-01-01

    Any detector system viewing a port or slit in a calorimeter wall will see, in addition to the primary particles of interest, a background of charged and neutral particles and photons generated by scattering from the port walls and by leakage from incompletely contained primary particle showers in the calorimeter near the port. The signal to noise ratio attainable outside the port is a complex function of the primary source spectrum, the calorimeter and port design and, of course, the nature and acceptance of the detector system that views the port. Rather than making general statements about the overall suitability (or lack thereof) of calorimeter ports, we offer here a specific example based on the external spectrometer and slit of the NA34 experiment. This combination of slit and spectrometer is designed for fixed-target work, so that the primary particle momentum spectrum contains higher momentum particles than expected in a heavy ion colliding beam environment. The results are, nevertheless, quite relevant for the collider case

  2. New developments in seismic analysis of primary and secondary systems

    International Nuclear Information System (INIS)

    Gupta, A.K.

    1984-01-01

    Primary and secondary systems often must be analyzed using decoupled models. This paper presents recent advances made at NCSU in the seismic analysis of these systems. Algorithms are presented by which coupled mode shapes and frequencies can be evaluated without performing a new eigenvalue solution, given the mode shapes and frequencies of the decoupled models. Simple and accurate equations are presented to predict changes in frequencies and responses. With the coupled mode shapes and frequencies, one can obtain any primary or secondary response directly from the input spectrum. Alternatively, one can develop instructure spectra at various locations in the primary system accounting for the primary-secondary system interaction. Correlation between the support motions is also generated. Equations are presented for evaluating complex mode shapes and frequencies of coupled systems when due to unequal damping values of primary and secondary systems, the coupled system becomes nonproportionally damped. Recent progress, in case of tuned systems is also reported

  3. What risks are Chinese people concerned about?

    Science.gov (United States)

    Xie, Xiaofei; Wang, Mei; Xu, Liancang

    2003-08-01

    The aim of this study is to investigate public perceived risk on various issues in present-day China. Two surveys were conducted in urban China in 1996 and 1998. In the first survey, risk perceptions of different occupational groups are compared. Gender differences within each occupational group are also analyzed. In the second survey, participants with diverse employment status were recruited. The overall risk rankings of both surveys indicate great concern with risks that threaten national stability and economic development, and less concern with high-technology risk such as threat from a nuclear power plant. It is also found that employees from high-profit firms are more concerned about macroscopic catastrophic risks, whereas laid-off workers and employees from money-losing enterprises are more concerned about daily life or self-concerned risks. The importance of actual exposure to risk, mass media coverage, culture, and psychometric dimensions are discussed.

  4. Environmental Concern in School-Age Children.

    Science.gov (United States)

    Malkus, Amy J.; Musser, Lynn M.

    This study examined the relationship between children's environmental concern and grade, sex, environmental attitudes and behaviors, perceived competencies, and manifest anxiety. A total of 138 children in grades 1, 3, and 5 were interviewed and completed scales that measured childhood concerns, attitudes toward the environment, self perception,…

  5. Engaging with primary schools: Supporting the delivery of the new curriculum in evolution and inheritance.

    Science.gov (United States)

    Kover, Paula X; Hogge, Emily S

    2017-10-01

    The official school regulator in England (OFSTED) recently reported that the delivery of science lessons has been significantly diminished in many primary schools. There is concern that the lack of good quality science in school can reduce the recruitment of young scientists, and the level of science literacy among the general public. We believe university scientists and undergraduate students can have a significant impact in the delivery of science in primary schools. However, a relatively small proportion of scientists engage with young children to improve curricular primary school science education. Here, we argue that long term engagement with primary schools can produce significant impact for the scientist's research, schools, and society. As an example, we describe our experience developing teaching materials for the topic of "Evolution and inheritance"; highlighting possible pitfalls and perceived benefits, in hope of encouraging and facilitating other scientists to engage with primary schools. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. From efficacy to effectiveness and beyond: what next for brief interventions in primary care?

    Directory of Open Access Journals (Sweden)

    Amy eO'Donnell

    2014-08-01

    Full Text Available Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However lack of understanding about their ‘active ingredients’ and concerns over the extent to which current approaches remain faithful to their original theoretical roots, has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base in order to assess the extent to which it has achieved the four key levels of intervention research: efficacy; effectiveness; implementation; and demonstration.Methods: Narrative overview based on:(1 results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare;(2 synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare.Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption.Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across

  7. Copy number variation analysis of matched ovarian primary tumors and peritoneal metastasis.

    Directory of Open Access Journals (Sweden)

    Joel A Malek

    Full Text Available Ovarian cancer is the most deadly gynecological cancer. The high rate of mortality is due to the large tumor burden with extensive metastatic lesion of the abdominal cavity. Despite initial chemosensitivity and improved surgical procedures, abdominal recurrence remains an issue and results in patients' poor prognosis. Transcriptomic and genetic studies have revealed significant genome pathologies in the primary tumors and yielded important information regarding carcinogenesis. There are, however, few studies on genetic alterations and their consequences in peritoneal metastatic tumors when compared to their matched ovarian primary tumors. We used high-density SNP arrays to investigate copy number variations in matched primary and metastatic ovarian cancer from 9 patients. Here we show that copy number variations acquired by ovarian tumors are significantly different between matched primary and metastatic tumors and these are likely due to different functional requirements. We show that these copy number variations clearly differentially affect specific pathways including the JAK/STAT and cytokine signaling pathways. While many have shown complex involvement of cytokines in the ovarian cancer environment we provide evidence that ovarian tumors have specific copy number variation differences in many of these genes.

  8. [The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care].

    Science.gov (United States)

    Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa

    2017-06-01

    In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.

  9. Migration assay on primary culture isolated from patient's primary breast cancer tissue

    Directory of Open Access Journals (Sweden)

    ED Yuliana

    2014-12-01

    , and SDF-1 (1 .104 when the same test wasrun with 3 x 105 breast cancer cells.Discussion: Breast cancer tissue collected using incisional biopsies hao better chance togrow in primary culture than those collected using core biopsies, possibly due to the differencein the amount of tissue extracted. Consistent with previous research, patient's breast cancercells was shown to migrate more towards the chemokine ligand SDF-1, as compared to controlmedium and FBS. The number of breast cancer cells run in the BCA also affected the result ofthe migration assay, where 1 x 10s cells showed a superiority as compared to 3 x 105 cells inshowing the migration difference between the different experimental conditions.MKA, Volume 37, Nomor.Supl. 2, November 2014ED Yulian dkk"Migration assay on primary culture isolated from patient's primary breast cancer tissueConclusions: This study encourages and facilitates future research to study migration the intrinsic characteristic of individualized patient's breast cancer as well as to assess the change in migration characteristic of breast cancer cells after an in vivo treatment in human.

  10. Women trafficking: causes, concerns, care!

    Science.gov (United States)

    Khowaja, Shaneela Sadaruddin; Tharani, Ambreen Jawed; Agha, Ajmal; Karamaliani, Rozina Sherali

    2012-08-01

    Pakistan is both a country of origin and destination as far as women trafficking is concerned. Poverty, gender discrimination, lack of education, and ignorance about legal rights are some of the underlying causes. Available data suggest several areas of concern, like, for instance: direct health effects, maladaptive coping leading to the use of illicit drugs, and inaccessibility to healthcare facilities. Therefore, numerous interventions would be required at three levels: the prevention of trafficking, the protection of victims and the prosecution of the traffickers.

  11. Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

    Science.gov (United States)

    Shi, Leiyu; Lee, De-Chih; Liang, Hailun; Zhang, Luwen; Makinen, Marty; Blanchet, Nathan; Kidane, Ruth; Lindelow, Magnus; Wang, Hong; Wu, Shaolong

    2015-11-30

    Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by

  12. Collections of laws and ordinances concerning radiation injury prevention as of July 24, 1981

    International Nuclear Information System (INIS)

    Tsuruta, Takao

    1981-01-01

    There are laws, government and ministerial ordinances and notifications, each of them bears a definite role, and the contents of the legal regulation on a certain range of matter are determined by their close interrelation and mutual supplementation. Many laws and ordinances concerning atomic energy also form a legal system under such mutual relation. The Atomic Energy Act is positioned at its top, and the main part related to radiation injury prevention comprises a law, two ordinances, a regulation and a notification. Such relationship of individual laws and ordinances is mostly shown in lower rank laws and ordinances. In Chapter 1 of this book, the Atomic Energy Act and the government ordinance concerning the definition of nuclear fuel materials, nuclear raw materials, nuclear reactors and radiation are described. In Chapter 2, the law concerning prevention of radiation injuries due to radiactive isotopes and others, the ordinances and eight notifications closely related to them are collected. In Chapter 3, other related laws and ordinances are gathered. To understand the laws and ordinances synthetically and systematically, the provisions of different laws and ordinances, which are mutually related, are arranged together showing their relation. (Kako, I.)

  13. Bilateral primary motor cortex circuitry is modulated due to theta burst stimulation to left dorsal premotor cortex and bimanual training.

    Science.gov (United States)

    Neva, Jason L; Vesia, Michael; Singh, Amaya M; Staines, W Richard

    2015-08-27

    Motor preparatory and execution activity is enhanced after a single session of bimanual visuomotor training (BMT). Recently, we have shown that increased primary motor cortex (M1) excitability occurs when BMT involves simultaneous activation of homologous muscles and these effects are enhanced when BMT is preceded by intermittent theta burst stimulation (iTBS) to the left dorsal premotor cortex (lPMd). The neural mechanisms underlying these modulations are unclear, but may include interhemispheric interactions between homologous M1s and connectivity with premotor regions. The purpose of this study was to investigate the possible intracortical and interhemispheric modulations of the extensor carpi radials (ECR) representation in M1 bilaterally due to: (1) BMT, (2) iTBS to lPMd, and (3) iTBS to lPMd followed by BMT. This study tests three related hypotheses: (1) BMT will enhance excitability within and between M1 bilaterally, (2) iTBS to lPMd will primarily enhance left M1 (lM1) excitability, and (3) the combination of these interventions will cause a greater enhancement of bilateral M1 excitability. We used single and paired-pulse transcranial magnetic stimulation (TMS) to quantify M1 circuitry bilaterally. The results demonstrate the neural mechanisms underlying the early markers of rapid functional plasticity associated with BMT and iTBS to lPMd primarily relate to modulations of long-interval inhibitory (i.e. GABAB-mediated) circuitry within and between M1s. This work provides novel insight into the underlying neural mechanisms involved in M1 excitability changes associated with BMT and iTBS to lPMd. Critically, this work may inform rehabilitation training and stimulation techniques that modulate cortical plasticity after brain injury. Copyright © 2015. Published by Elsevier B.V.

  14. Primary Parallel Isolated Boost Converter with Bidirectional Operation

    DEFF Research Database (Denmark)

    Hernandez Botella, Juan Carlos; Mira Albert, Maria del Carmen; Sen, Gökhan

    2012-01-01

    This paper presents a bidirectional dc/dc converter operated with batteries both in the input and output. Primary parallel isolated boost converter (PPIBC) with transformer series connection on the high voltage side is preferred due to its ability to handle high currents in the low voltage side. ...... and output battery banks with a defined ramp....

  15. Primary care management of food allergy and food intolerance.

    Science.gov (United States)

    Garzon, Dawn Lee; Kempker, Tara; Piel, Pamela

    2011-12-16

    The incidence of food allergies is steadily increasing. Due to potentially life-threatening complications, it is important that primary care providers recognize and appropriately manage these disorders. This article includes a discussion of the current evidence-based guidelines for the diagnosis, screening, and management of food allergies.

  16. Financial equilibrium with career concerns

    Directory of Open Access Journals (Sweden)

    Amil Dasgupta

    2006-03-01

    Full Text Available What are the equilibrium features of a financial market where a sizeable proportion of traders face reputational concerns? This question is central to our understanding of financial markets, which are increasingly dominated by institutional investors. We construct a model of delegated portfolio management that captures key features of the US mutual fund industry and embed it in an asset pricing framework. We thus provide a formal model of financial equilibrium with career concerned agents. Fund managers differ in their ability to understand market fundamentals, and in every period investors choose a fund. In equilibrium, the presence of career concerns induces uninformed fund managers to churn, i.e., to engage in trading even when they face a negative expected return. Churners act as noise traders and enhance the level of trading volume. The equilibrium relationship between fund return and net fund flows displays a skewed shape that is consistent with stylized facts. The robustness of our core results is probed from several angles.

  17. Concern for older parts

    International Nuclear Information System (INIS)

    Titus, E.; Spink, T.; Cookson, B.; Tenera, L.P.

    1992-01-01

    For the last half decade, regulatory expectations of the procurement process for nuclear commercial-grade safety-related materials have increase. The changes have been driven by concern for fraudulent or misrepresented parts and the loss of original equipment manufacturers. The industry responded to these concerns by developing improved procurement programs that changed how parts were specified and received and provided for verification of attributes that were critical to the successful performance of safety functions(s). Like its counterparts, Duquesne Light Company (DLCo), Beaver Valley power station began applying these enhanced requirements to procurements initiated after January 1, 1990, in response to the Nuclear Management and Resources Council initiative on dedication. Procurements prior to this data were not subject to the new requirements

  18. Performance analysis of spectrum sensing with multiple status changes in primary user traffic

    KAUST Repository

    Tang, Liang

    2012-06-01

    In this letter, the impact of primary user traffic with multiple status changes on the spectrum sensing performance is analyzed. Closed-form expressions for the probabilities of false alarm and detection are derived. Numerical results show that the multiple status changes of the primary user cause considerable degradation in the sensing performance. This degradation depends on the number of changes, the primary user traffic model, the primary user traffic intensity and the signal-to-noise ratio of the received signal. Numerical results also show that the amount of degradation decreases when the number of changes increases, and converges to a minimum sensing performance due to the limited sensing period and primary holding time. © 2012 IEEE.

  19. Skin Cancer Concerns in People of Color: Risk Factors and Prevention

    Science.gov (United States)

    Gupta, Alpana K; Bharadwaj, Mausumi; Mehrotra, Ravi

    2016-01-01

    Background: Though people of color (POC) are less likely to become afflicted with skin cancer, they are much more likely to die from it due to delay in detection or presentation. Very often, skin cancer is diagnosed at a more advanced stage in POC, making treatment difficult. The purpose of this research was to improve awareness regarding skin cancers in people of color by providing recommendations to clinicians and the general public for early detection and photo protection preventive measures. Methods: Data on different types of skin cancers were presented to POC. Due to limited research, there are few resources providing insights for evaluating darkly pigmented lesions in POC. Diagnostic features for different types of skin cancers were recorded and various possible risk factors were considered. Results: This study provided directions for the prevention and early detection of skin cancer in POC based on a comprehensive review of available data. Conclusions: The increased morbidity and mortality rate associated with skin cancer in POC is due to lack of awareness, diagnosis at a more advanced stage and socioeconomic barriers hindering access to care. Raising public health concerns for skin cancer prevention strategies for all people, regardless of ethnic background and socioeconomic status, is the key to timely diagnosis and treatment. PMID:28125871

  20. [Construction vs. development: the source of our misunderstandings concerning the beginning of life].

    Science.gov (United States)

    Stith, Richard

    2008-01-01

    This essay argues that the failure of our public debates over abortion and embryo-destructive research is due, to a large extent, not to different valuation of individual human life but to different conceptions and intuitions concerning the process of gestation, one group treating the process as construction and another treating it as development. These two incompatible models of reproduction are shown to explain the various positions commonly encountered in these life-related debates. Finally, the historical, theoretical, and intuitive strengths of each model are examined.