Wood, M E; Flynn, B S; Stockdale, A
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.
Stern, S R; Kelnar, C J
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.
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.
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.)
Gaţu, Alina-Andreea; Velicescu, C; Novac, Roxana; Mogoş, Voichiţa; Brănişteanu, D D
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.
Ahmed Imran Siddiqi, MBBS, MRCP
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.
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)
Jiang Chunjing; Shu Jin'er; Li Huimin; Sheng Sanlan; Lu Jinhua
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)
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.
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.
Sumit Kumar Chakrabarti
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.
Sakamoto, Yoshiaki; Sendo, Muneaki
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)
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.)
Jain, Monica; Krasne, David L; Singer, Frederick R; Giuliano, Armando E
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.
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.)
Maruyama, Yukiko; Kanoh, Hiroko; Adachi, Kinya
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.
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.
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.)
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.)
Tsironis, Apostolos; Zikos, Nikolaos; Bali, Christina; Pappas-Gogos, George; Koulas, Spiridon; Katsamakis, Nikolaos
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.
Olsen, Douglas P; Dixon, Jane Karpe; Grey, Margaret; Deshefy-Longhi, Terry; Demarest, Jo Cecille
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.
Doyle, Antoinette; Zhang, Jing; Mattatall, Chris
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,…
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
Wang, George Sam
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.
... 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...
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.)
Faizi, Nafis; Khalique, Najam; Ahmad, Anees; Shah, Mohammad Salman
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.
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.
Muangman, D; Hirunraks, A
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
Daly, B; Clarke, W; McEvoy, W; Periam, K; Zoitopoulos, L
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.
Schouten, Barbara C; Schinkel, Sanne
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.
Cezar-Vaz, Marta Regina; Bonow, Clarice Alves; Vaz, Joana Cezar
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.
Singh, Betsy; Liu, Xiao-Dong; Der-Martirosian, Claudia; Hardy, Mary; Singh, Vijay; Shepard, Neil; Gandhi, Sonal; Khorsan, Raheleh
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
... 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...
Saffan, Abdulrahman Al; AlHobail, Sultan; Bin Salem, Fares; AlFuraih, AlBara; AlTamimi, Mohammad
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
Schouten, B.C.; Schinkel, S.
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
Hackman, Kathryn L; Davis, Anna L; Curnow, Paul A; Serpell, Jonathan W; McLean, Catriona A; Topliss, Duncan J
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.
... 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...
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.
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)
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.
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.
Bergmann, T K; Vinding, K; Hey, H
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...
Katsuno, Makoto; Kobayashi, Shiro; Yokota, Hiroyuki; Teramoto, Akira
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)
Potkonjak, V.; Tzafestas, S.; Kostic, D.
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
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.
Dutta, Deep; Maisnam, Indira; Ghosh, Sujoy; Mukhopadhyay, Pradip; Mukhopadhyay, Satinath; Chowdhury, Subhankar
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.
Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F
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.
Totsuka, Nobuo; Fukumura, Takuya
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)
Vrillon, B.; Raynal, A.
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
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
Westmuckett, Andrew D; Siefert, Joseph C; Tesiram, Yasvir A; Pinson, David M; Moore, Kevin L
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.
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.
Hay, J; Kaphingst, K A; Baser, R; Li, Y; Hensley-Alford, S; McBride, C M
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.
Conti Cuesta, F; Baena Parejo, M I; Pinzón Pulido, S A
This study describes the opinion of the veterinarians in Andalusia regarding the organization and management of their professional practice and pinpoints solutions to the problems found for the purpose of providing planning and management aspects in view of the reforms undertaken in the Andalusian Health Service Strategy Plan. Descriptive opinion poll employing a questionnaire filled out by each individual among all of the Primary Care (PC) veterinarians in Andalusia (including those who have been currently employed who possess at least one year's experience, except substitutes). A description was provided of their personal traits, their opinion of the management-related factors involved in their professional practice. A description was also provided of the suggestions for improving the problems found to exist. Over 70% said they were aware of the objectives, although only the coordinators found them to be clearly motivating the practice. Their opinion was that the indicators of activity neither include any quality-related criteria nor afford the possibility of evaluating the activity they are carrying out. They believed that the contributions from other members of the multidisciplinary team improve their work and are in favor of continuing their involvement therein. They were satisfied with doing their work (the coordinators to a greater degree). They found the productivity pay to be too low and not useful as regards providing them with any incentive. They were not satisfied with the training with which they are provided and thought that what they are offered is far less than their other colleagues in the health care field. Most were of the opinion that they should remain under the authority of the Andalusian Health Service. This group prefers to continue working for the same organization, but improving the following management aspects: training offer, practice incentives and activity indicators.
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.
Rosaria M. Ruggeri
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.
Trenti, Loris; Biondo, Sebastiano; Golda, Thomas; Monica, Millan; Kreisler, Esther; Fraccalvieri, Domenico; Frago, Ricardo; Jaurrieta, Eduardo
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.
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
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.
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.
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
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
Mansilha, C; Carvalho, A; Guimarães, P; Espinha Marques, J
Water quality alterations due to forest fires may considerably affect aquatic organisms and water resources. These impacts are cumulative as a result of pollutants mobilized from fires, chemicals used to fight fire, and postfire responses. Few studies have examined postfire transport into water resources of trace elements, including the polycyclic aromatic hydrocarbons (PAH), which are organic pollutants produced during combustion and are considered carcinogenic and harmful to humans. PAH are also known to adversely affect survival, growth, and reproduction of many aquatic species. This study assessed the effects of forest wildfires on groundwater from two mountain regions located in protected areas from north and central Portugal. Two campaigns to collect water samples were performed in order to measure PAH levels. Fifteen of 16 studied PAH were found in groundwater samples collected at burned areas, most of them at concentrations significantly higher than those found in control regions, indicating aquifer contamination. The total sum of PAH in burned areas ranged from 23.1to 95.1 ng/L with a median of 62.9 ng/L, which is one- to sixfold higher than the average level measured in controls (16.2 ng/L). In addition, in control samples, the levels of light PAH with two to four rings were at higher levels than heavy PAH with five or six rings, thus showing a different profile between control and burned sites. The contribution of wildfires to groundwater contamination by PAH was demonstrated, enabling a reliable assessment of the impacts on water quality and preparation of scientifically based decision criteria for postfire forest management practices.
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
Mc Cafferty, J
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.
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.
Halls, Amy; Van'T Hoff, Catherine; Little, Paul; Verheij, Theo; Leydon, Geraldine M.
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
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
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.
Takahashi, Yasuyuki; Igarashi, Hiroshi; Hirano, Kunihiro; Kawaharada, Yasuhiro; Igarashi, Hitoshi; Murase, Ken-ya; Mochizuki, Teruhito
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)
LOPES, Ana Cristina Távora de Albuquerque; TÉO, Mirela Anne Quartaroli; CORRÊA, Mônica Grazieli; ISHIKIRIAMA, Bella Luna Colombini; CAMPOS, Mirella Lindoso Gomes
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...
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.
Shen, Guangxun; Gao, Yu; Lee, Kwee-Yum; Nan, Guangxian
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.
Naz, H.; Sarwar, I.; Nisa, A.U.
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
Yamazaki, Shin; Shima, Masayuki; Ando, Michiko; Nitta, Hiroshi
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.
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
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.
Matthoefer, H [Bundesministerium fuer Forschung und Technologie, Bonn (F.R. Germany)
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.
Jewell, D.E.; Hausman, G.J.
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
Lozano-Alarcón, F; Bradley, G A; Houser, B S; Visvesvara, G S
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.
Full Text Available Abstract Background Mefloquine is a clinically important antimalaria drug, which is often not well tolerated. We critically reviewed 516 published case reports of mefloquine adverse effects, to clarify the phenomenology of the harms associated with mefloquine, and to make recommendations for safer prescribing. Presentation We postulate that many of the adverse effects of mefloquine are a post-hepatic syndrome caused by primary liver damage. In some users we believe that symptomatic thyroid disturbance occurs, either independently or as a secondary consequence of the hepatocellular injury. The mefloquine syndrome presents in a variety of ways including headache, gastrointestinal disturbances, nervousness, fatigue, disorders of sleep, mood, memory and concentration, and occasionally frank psychosis. Previous liver or thyroid disease, and concurrent insults to the liver (such as from alcohol, dehydration, an oral contraceptive pill, recreational drugs, and other liver-damaging drugs may be related to the development of severe or prolonged adverse reactions to mefloquine. Implications We believe that people with active liver or thyroid disease should not take mefloquine, whereas those with fully resolved neuropsychiatric illness may do so safely. Mefloquine users should avoid alcohol, recreational drugs, hormonal contraception and co-medications known to cause liver damage or thyroid damage. With these caveats, we believe that mefloquine may be safely prescribed in pregnancy, and also to occupational groups who carry out safety-critical tasks. Testing Mefloquine's adverse effects need to be investigated through a multicentre cohort study, with small controlled studies testing specific elements of the hypothesis.
Ana Cristina Távora de Albuquerque LOPES
Full Text Available 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 first lower molar; Occlusal Overload (OO, n = 15 - wearing of the cusps of the lower contralateral molars, the second and third molars next to the first molar that had its dimensions maintained; Negative Control (NC, n = 15 - evaluation of the initial dimensions of the periodontal ligament (PL. Five animals / group were sacrificed after 14, 21 and 28 days. Result Intergroup evaluation showed significant bone loss in OI (p0.05. The thickness of the PL remained stable in NC (p>0.05. Conclusion OI and OO were effective in the experimental reproduction of OT, and OI promoted greater alveolar bone loss compared to OO, showing that the impact of occlusal overload in OI increased the extent of the OT injury.
Full Text Available This case report describes a 37-year-old female who was admitted to our Emergency Department because of shortness of breath. On physical examination, she had dyspnea and tachycardia and blood pressure was 80/50 mmHg with a pulsus paradoxus of 22 mmHg. Neck veins were distended, heart sounds were distant, and dullness was found on both lung bases. Her chest X-ray revealed bilateral pleural effusion and cardiomegaly. On both computed tomography and echocardiography the heart was of normal size and a large pericardial effusion was noted. The echocardiogram showed signs of impending tamponade, so the patient underwent an emergent pericardiocentesis. No infectious etiology was found and she was assumed to have viral pericarditis and was treated accordingly. However, when the pericardial effusion recurred and empirical therapy for tuberculosis failed, a pericardial window was performed. A typical staining pattern for mesothelioma was found on her pericardial biopsy specimen. Since no other mesodermal tissue was affected, a diagnosis of primary malignant pericardial mesothelioma was made. Chemotherapy was not effective and she passed away a year after the diagnosis was made. This case highlights the difficulties in diagnosing this uncommon disease in patients that present with the common finding of pericardial effusion.
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)
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.)
Fargeaudou, Yann; Soyer, Philippe; Sirol, Marc; Dref, Olivier le; Boudiaf, Mourad; Dahan, Henri; Rymer, Roland; Morel, Olivier
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.)
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)
Zhang, Hui; Zhu, Chang; Sang, Guoyuan
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,…
Akahori, Hiroshi; Takeshita, Yumie; Saito, Reina; Kaneko, Shuichi; Takamura, Toshinari
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.
Gudbergsson, Saevar Berg; Fosså, Sophie D; Dahl, Alv A
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.
Chelsea R. Amiel
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.
Nakamura, Yoshitsugu; Nakajima, Hideto; Tani, Hiroki; Hosokawa, Takafumi; Ishida, Shimon; Kimura, Fumiharu; Kaneko, Kimihiko; Takahashi, Toshiyuki; Nakashima, Ichiro
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.
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)
Sollie, Annet; Sijmons, Rolf H; Helsper, Charles; Numans, Mattijs E
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.
Halls, Amy; Van't Hoff, Catherine; Little, Paul; Verheij, Theo; Leydon, Geraldine M
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
... 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...
Parro Moreno, Ana; Serrano Gallardo, Pilar; Ferrer Arnedo, Carmen; Serrano Molina, Lucía; de la Puerta Calatayud, M Luisa; Barberá Martín, Aurora; Morales Asencio, José Miguel; de Pedro Gómez, Joan
To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. Cross-sectional, analytical, observational study. Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Obiols, Gabriel; Catalán, Roberto; Alasà, Cristian; Baena, Juan Antonio; Fort, José Manuel; Gémar, Enrique; Mesa, Jordi
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.
Adam, Fatma Ulku; Torun, Dilek; Bolat, Filiz; Zumrutdal, Aysegul; Sezer, Siren; Ozdemir, Fatma Nurhan
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.
Patford, Janet; Tranent, Peter
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…
Francesconi, Carlos Fernando de Magalhães; Machado, Marta Brenner; Steinwurz, Flavio; Nones, Rodrigo Bremer; Quilici, Flávio Antonio; Catapani, Wilson Roberto; Miszputen, Sender Jankiel; Bafutto, Mauro
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
Neva, Jason L; Vesia, Michael; Singh, Amaya M; Staines, W Richard
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.
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
Noor, Azimah M; Leelavathi, M; Shamsul, Azhar S; Hizlinda, T; Khairani, O; Fatimah, A
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.
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.
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.
Martin, Christian; Chahine, Pierre; Veyret, Charles; Richard, Céline; Prades, Jean Michel; Pouget, Jean François
The aim of this study is to appreciate the incidence of patients with isolated conductive hearing loss with normal drum due to superior semicircular canal dehiscence (SCD). It is a prospective radiological study. Two hundred and seventy-two patients with a normal drum suffering from isolated unilateral or bilateral conductive or mixed hearing loss were included in a prospective radiological study. A high resolution computerized tomography (HRCT) was performed in all the patients. Those who were found to have a unilateral or bilateral SCD underwent further etiological, clinical, audiologic evaluation. Ten patients with conductive or mixed hearing loss were found to have a unilateral or bilateral SCD. The disease was bilateral in five cases, and most often associated with a dehiscence of the tegmen tympani on both sides, supporting the theory of the congenital nature of the disease. There was no clear correlation between symptoms and the size of the SCD. Because patients were not suffering from incapacitating vestibular symptoms, they were not operated for surgical occlusion of the SCD, and were referred to a hearing aid specialist to improve hearing. Conductive or mixed hearing loss due to SCD is relatively frequent, justifying in our opinion that a systematic HRCT be carried out before surgery of any patient with conductive hearing loss.
Phillip, Veit; Berger, Hermann; Straub, Melanie; Saugel, Bernd; Treiber, Matthias; Einwächter, Henrik; Schmid, Roland M; Huber, Wolfgang
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.
Jo, Jong Chull; Roh, Kyung Wan; Yune, Young Gill; Kang, Dong Gu; Kim, Hho Jhung
A barge crashed into a moored oil tanker at about 7:15 a.m., Dec. 12, 2007, dumping around 10,500 tons of crude oil into the sea in Korea. The incident took place about 15 kilometers northwest of Manripo beach in South Chungcheong where is Korea's west coast in the Yellow Sea. In a few days, the oil slicks spread to the northern and southern tips of the Taean Peninsula by strong winds and tides. As time went the spilled oil floating on the surface of sea water was volatilized to become tar-balls and lumps and drifted far away in the southern direction. 13 days after the incident, some of oil slicks and tar lumps were observed to flow in the service water intake at the Younggwang nuclear power plants (NPPs) operating 6 reactors, which are over 150 km away from the incident spot in the southeastern direction. According to the report by the Younggwang NPPs, a total weight 83 kg of tar lumps was removed for about 3 days. Oil spills in the sea can happen in any country or anytime due to human errors or mistakes, wars, terrors, intentional dumping of waste oils, and natural disasters like typhoon and tsunami. In fact, there have been 7 major oil spills over 10,000 tons that have occurred around the world since 1983. As such serious oil spill incidents may happen near the operating power plants using the sea water as ultimate heat sink. To ensure the safe operation of nuclear reactors it is required to evaluate the potential for loss of decay heat removal function of nuclear reactors due to the spilled oils flowing in the service water intake, from which the service water is pumped. Thus, Korea Institute of Nuclear Safety identified this problem as one of the important safety. When an incident of crude oil spill from an oil carrier occurs in the sea near the nuclear power plants, the spilled oil can be transported to the intake pit, where all service water pumps locate, by sea current and wind drift (induced) current. The essential service water pumps take the service
Jo, Jong Chull; Roh, Kyung Wan; Yune, Young Gill; Kang, Dong Gu; Kim, Hho Jhung [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)
A barge crashed into a moored oil tanker at about 7:15 a.m., Dec. 12, 2007, dumping around 10,500 tons of crude oil into the sea in Korea. The incident took place about 15 kilometers northwest of Manripo beach in South Chungcheong where is Korea's west coast in the Yellow Sea. In a few days, the oil slicks spread to the northern and southern tips of the Taean Peninsula by strong winds and tides. As time went the spilled oil floating on the surface of sea water was volatilized to become tar-balls and lumps and drifted far away in the southern direction. 13 days after the incident, some of oil slicks and tar lumps were observed to flow in the service water intake at the Younggwang nuclear power plants (NPPs) operating 6 reactors, which are over 150 km away from the incident spot in the southeastern direction. According to the report by the Younggwang NPPs, a total weight 83 kg of tar lumps was removed for about 3 days. Oil spills in the sea can happen in any country or anytime due to human errors or mistakes, wars, terrors, intentional dumping of waste oils, and natural disasters like typhoon and tsunami. In fact, there have been 7 major oil spills over 10,000 tons that have occurred around the world since 1983. As such serious oil spill incidents may happen near the operating power plants using the sea water as ultimate heat sink. To ensure the safe operation of nuclear reactors it is required to evaluate the potential for loss of decay heat removal function of nuclear reactors due to the spilled oils flowing in the service water intake, from which the service water is pumped. Thus, Korea Institute of Nuclear Safety identified this problem as one of the important safety. When an incident of crude oil spill from an oil carrier occurs in the sea near the nuclear power plants, the spilled oil can be transported to the intake pit, where all service water pumps locate, by sea current and wind drift (induced) current. The essential service water pumps take the
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.,
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
Bridoux, Valerie; Regimbeau, Jean Marc; Ouaissi, Mehdi; Mathonnet, Muriel; Mauvais, Francois; Houivet, Estelle; Schwarz, Lilian; Mege, Diane; Sielezneff, Igor; Sabbagh, Charles; Tuech, Jean-Jacques
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.
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.
Yamaguchi, Makoto; Yoshioka, Tomoki; Yamakawa, Taishi; Maeda, Matsuyoshi; Shimizu, Hideaki; Fujita, Yoshiro; Maruyama, Shoichi; Ito, Yasuhiko; Matsuo, Seiichi
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.
García-Talavera Espín, N V; López-Ruiz, A; Nuñez Sánchez, Ma Á; Meoro Avilés, A; Sánchez Cañizares, C; Romero López-Reinoso, H; López Olivar, Ma D; Lapaz Jorge, Ma Á; Guirao Sastre, J Ma; San Eustaquio Tudanca, F; Soriano Palao, J
Type 2 Diabetes Mellitus is a serious health problem. In the year 2030 it will affect 366 million people around the world. Evaluate the effectiveness of a mixed intervention and reducing the amount and seriousness of acute complications in diabetics from our Health Area. Protocols of action as well as information documents were produced. Diabetes Unit coordinated educational activities in the different support levels of the Area VII of Murcia. Information talks were provided for the people in charge of the Diabetes Unit in every Care Center and Service of the Health Area. Personalized training was provided for patients treated in the different Care levels. The study comprised three stages. Information leaflets were spread and talks offered to the patient regarding in house handling of hypo and hyper glycemia. A reduction of 39% of the emergencies due to acute non complicated diabetes was achieved, as well as a reduction of 47.6% of hospital admissions. There was a reduction of 67.8% of the amount of total hospital stays for the group of patients under 35 years who were admitted into the hospital due to type 1 or 2 diabetes mellitus that didn't show any complications (GRD295). There was a reduction of more than thirty percent in the emergencies due to acute decompensations in the disease and a significant reduction in the avoidable hospital stays in the young adult, thus improving the patients' life quality and reducing the social cost of the diabetic patient.
Ter-Ovanessian, Benoît; Deleume, Julien; Cloué, Jean-Marc; Andrieu, Eric
Highlights: ► IG damage occurred on Ni-base alloys during exposure at high temperature water. ► Two characterization methods yield a tomographic analysis of this IG damage. ► Connected or isolated intergranular oxygen/oxide penetrations are quantified. ► Such quantitative description provides information on IGSCC susceptibility. - Abstract: Two nickel-based alloys, alloy 718 and alloy 600, known to have different resistances to IGSCC, were exposed to a simulated PWR primary water environment at 360 °C for 1000 h. The intergranular oxidation damage was analyzed in detail using an original approach involving two characterization methods (Incremental Mechanical Polishing/Microcopy procedure and SIMS imaging) which yielded a tomographic analysis of the damage. Intergranular oxygen/oxide penetrations occurred either as connected or isolated penetrations deep under the external oxide/substrate interface as far as 10 μm for alloy 600 and only 4 μm for alloy 718. Therefore, assessing this damage precisely is essential to interpret IGSCC susceptibility.
Phillip, Veit;Berger, Hermann;Straub, Melanie;Saugel, Bernd;Treiber, Matthias;Einwächter, Henrik;Schmid, Roland M.;Huber, Wolfgang
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 ...
MIZUNO, SHIGERU; FUNAHASHI, HIROOMI
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 ...
Full Text Available It has previously been shown that acoustic overstimulation induces cell death and extensive cell loss in key structures of the central auditory pathway. A correlation between noise-induced apoptosis and cell loss was hypothesized for the cochlear nucleus and colliculus inferior. To determine the role of cell death in noise-induced cell loss in thalamic and cortical structures, the present mouse study (NMRI strain describes the time course following noise exposure of cell death mechanisms for the ventral medial geniculate body (vMGB, medial MGB (mMGB, and dorsal MGB (dMGB and the six histological layers of the primary auditory cortex (AI 1–6. Therefore, a terminal deoxynucleotidyl transferase dioxyuridine triphosphate nick-end labeling assay (TUNEL was performed in these structures 24 h, 7 days, and 14 days after noise exposure (3 h, 115 dB sound pressure level, 5–20 kHz, as well as in unexposed controls. In the dMGB, TUNEL was statistically significant elevated 24 h postexposure. AI-1 showed a decrease in TUNEL after 14 days. There was no statistically significant difference between groups for the other brain areas investigated. dMGB’s widespread connection within the central auditory pathway and its nontonotopical organization might explain its prominent increase in TUNEL compared to the other MGB subdivisions and the AI. It is assumed that the onset and peak of noise-induced cell death is delayed in higher areas of the central auditory pathway and takes place between 24 h and 7 days postexposure in thalamic and cortical structures.
Apold, Hilde; Meyer, Haakon E; Nordsletten, Lars; Furnes, Ove; Baste, Valborg; Flugsrud, Gunnar B
Osteoarthritis (OA) of the knee is a common and disabling condition. We wanted to investigate the modifiable risk factors Body Mass Index (BMI) and physical activity, using knee replacement (KR) as a marker for severely symptomatic disease, focusing on the interaction between these risk factors. 315,495 participants (mean age 43.0 years) from national health screenings were followed prospectively with respect to KR identified by linkage to the Norwegian Arthroplasty Register. Data were analysed by Cox proportional hazard regression. During 12 years of follow up 1,323 individuals received KR for primary OA. There was a dose-response relationship between BMI and heavy labour, and later KR. Comparing the highest versus the lowest quarter of BMI, the relative risk was 6.2 (95% CI: 4.2-9.0) in men and 11.1 (95% CI: 7.8-15.6) in women. Men reporting intensive physical activity at work had a relative risk of 2.4 (95% CI: 1.8-3.2) versus men reporting sedentary activity at work, the corresponding figure in women being 2.3 (95% CI: 1.7-3.2). The effect of BMI and physical activity at work was additive. The heaviest men with the most strenuous work had a RR of 11.7 (95% CI: 5.9-23.1) compared to the ones with the lowest BMI and most sedentary work. For women the corresponding RR was 15.8 (95% CI: 8.2-30.3). There was no association between physical activity during leisure and KR. We found that a high BMI and intensive physical activity at work both contribute strongly to the risk of having a KR. As the two risk factors seem to act independently, people with strenuous physical work with a high BMI are at particularly high risk for severely disabling OA of the knee, and should be targeted with effective preventive measures.
Pérez Aceves, Eva; Pérez Cristóbal, Mario; Espinola Reyna, Gerardo A; Ariza Andraca, Raul; Xibille Fridmann, Daniel; Barile Fabris, Leonor A
Pulmonary hemorrhage (PH) occurs in 2-5% of SLE patients, and is associated with a high mortality rate (79-90%). Diagnostic criteria for this complication include: 1) Pulmonary infiltrates, with at least ¾ of lung tissue involved in a chest x ray, 2) Acute respiratory failure, 3) A decrease of 3g/dL or more in hemoglobin levels. PH might lead to organized pneumonia, collagen deposition, and pulmonary fibrosis which in time might cause changes in pulmonary function tests with either restrictive or obstructive patterns. To evaluate the existence of abnormalities in pulmonary function tests after a PH episode. We included patients with SLE and primary vasculitis that developed PH. During the acute episode, we measured SLEDAI in SLE patients, five factor score in microscopic polyangiitis (MPA) and Birmingham Vasculitis Activity Store (BVAS) in granulomatosis with polyangiitis (GPA) (Wegener). We determined the number of PH events, treatment, and ventilator assistance requirements and correlated its association with abnormal pulmonary function tests. We included 10 patients, 7 with SLE, 2 with MPA and 1 with GPA (Wegener). The mean activity measures were: SLEDAI 20.4 ± 7.5, FFS 2, and BVAS 36. Treatment consisted in methylprednisolone (MPD) in 3 patients, MPD plus cyclophosphamide (CY) in 6 patients, and MPD, CY, IV immunoglobulin, and plasmapheresis in one patient. Five patients required ventilatory support. We found abnormalities in pulmonary function tests in 8 patients, three had an obstructive pattern and five a restrictive pattern; 2 patients did not show any change. We did not find a significant association with any of the studied variables. PH might cause abnormalities in pulmonary function tests and prolonged immunosuppressive treatment could be required. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Wang, Qi, E-mail: email@example.com; Xiong, Bin, E-mail: firstname.lastname@example.org; Zheng, ChuanSheng, E-mail: email@example.com; Liang, Ming, E-mail: firstname.lastname@example.org; Han, Ping, E-mail: email@example.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)
ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.
Fasulakis, Stephen; Andronikou, Savvas
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
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)
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
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.
Holmgren, Kristina; Sandheimer, Christine; Mårdby, Ann-Charlotte; Larsson, Maria E H; Bültmann, Ute; Hange, Dominique; Hensing, Gunnel
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.
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.
Mayer, Flavia; Di Pucchio, Alessandra; Lacorte, Eleonora; Bacigalupo, Ilaria; Marzolini, Fabrizio; Ferrante, Gianluigi; Minardi, Valentina; Masocco, Maria; Canevelli, Marco; Di Fiandra, Teresa; Vanacore, Nicola
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.
Haraszuk, Anni; Hartmann, Stig
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?...
Beijers, Lian; Jeronimus, Bertus F; Turner, Erick H; de Jonge, Peter; Roest, Annelieke M
Objectives: This study aimed to determine the presence of spin in papers on positive randomised clinical trials (RCTs) of antidepressant medication for anxiety disorders by comparing concerns expressed in the Food and Drug Administration (FDA) reviews with those expressed in the published paper.
Apold, H; Meyer, H E; Nordsletten, L; Furnes, O; Baste, V; Flugsrud, G B
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.
Geels, Camilla; Andersson, Camilla; Hänninen, Otto; Lansø, Anne Sofie; Schwarze, Per E; Skjøth, Carsten Ambelas; Brandt, Jørgen
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.
Geels, Camilla; Andersson, Camilla; Hänninen, Otto; Lansø, Anne Sofie; Schwarze, Per E.; Ambelas Skjøth, Carsten; Brandt, Jørgen
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
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.
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
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
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.
Johnsen, Marianne Bakke; Hellevik, Alf Inge; Baste, Valborg; Furnes, Ove; Langhammer, Arnulf; Flugsrud, Gunnar; Nordsletten, Lars; Zwart, John Anker; Storheim, Kjersti
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.
Hellevik, Alf Inge; Johnsen, Marianne Bakke; Langhammer, Arnulf; Baste, Valborg; Furnes, Ove; Storheim, Kjersti; Zwart, John Anker; Flugsrud, Gunnar Birkeland; Nordsletten, Lars
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.
Nagata, Keiko; Okuno, Keisuke; Ochi, Marika; Kumata, Keisuke; Sano, Hitoshi; Yoneda, Naohiro; Ueyama, Jun-Ichi; Matsushita, Michiko; Kuwamoto, Satoshi; Kato, Masako; Murakami, Ichiro; Kanzaki, Susumu; Hayashi, Kazuhiko
Various autoantibodies have been reported to be detected during the progression of infectious mononucleosis. We observed a case of infectious mononucleosis due to Epstein-Barr virus primary infection for 2 months, and noticed the transiently increased titer of thyrotropin receptor autoantibodies detected at the acute phase on the 3rd day after admission. At that time, real-time quantitative PCR also revealed the mRNA expressions of an immediate early lytic gene, BZLF1, and a latent gene, EBNA2. The expression of BZLF1 mRNA means that Epstein-Barr virus infects lytically, and EBNA2 protein has an important role in antibody production as well as the establishment of Epstein-Barr virus latency. These results suggest that Epstein-Barr virus lytic infection is relevant to thyrotropin receptor autoantibody production. Thyrotropin receptor autoantibodies stimulate thyroid follicular cells to produce excessive thyroid hormones and cause Graves' disease. Recently, we reported the thyrotropin receptor autoantibody production from thyrotropin receptor autoantibody-predisposed Epstein-Barr virus-infected B cells by the induction of Epstein-Barr virus lytic infection in vitro. This case showed in vivo findings consistent with our previous reports, and is important to consider the pathophysiology of Graves' disease and one of the mechanisms of autoimmunity.
Geldmacher, David S.; Kerwin, Diana R.
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.
Full Text Available Alf Inge Hellevik,1,2 Marianne Bakke Johnsen,3,4 Arnulf Langhammer,1 Valborg Baste,5 Ove Furnes,6,7 Kjersti Storheim,3,4 John Anker Zwart,3,4 Gunnar Birkeland Flugsrud,2 Lars Nordsletten2,4 1The HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, 2Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, 3Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, 4Faculty of Medicine, University of Oslo, Oslo, 5Uni Research Health, Bergen, 6The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, 7Department of Clinical Medicine, Institute of Medicine and Dentistry, University of Bergen, Bergen, Norway Objective: 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.Design: 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.Results: 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
This series of A-level social biology topic books responds to the changing demands of social biology syllabuses, with each text dealing with a particular area of interest. Although the series is primarily intended for students of A-level social biology, the books will appeal to students studying a wide range of biological subjects at A-level. Environmental Concerns covers topics common to several A-level human and social biology syllabuses. It is particularly relevant to the human ecology and conservation options. The text focuses on the social and economic implications of current ecological issues as well as the basic biological concepts involved. It deals with the causes, effects and prevention of atmospheric and water pollution as well as with the disruption of ecosystems by changes in land use. The conflict of interests between conservation and exploitation is discussed, along with management techniques including the controversial method of culling to maintain diversity. The moral and aesthetic aspects of conservation and management are emphasised throughout, in addition to the scientific background of these techniques.
Kerwin, Diana R.
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
Spiekerkoetter, U.; Huener, G.; Baykal, T.; Demirkol, M.; Duran, M.; Wanders, R.; Nezu, J.; Mayatepek, E.
A family of Turkish origin with primary systemic carnitine deficiency in the father and his two sons is described. In all three individuals, the same homozygous mutation in the OCTN2 gene (R471H) was present and carnitine uptake in fibroblasts was deficient. Whereas one boy became symptomatic with a
Riana Hestu Laksitowati
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.
Madhu, N.V.; Jyothibabu, R.; Maheswaran, P.A.; Jayaraj, K.A.; Achuthankutty, C.T.
The surface waters of the northeastern Arabian Sea sustained relatively high chlorophyll a (average 0.81+ or -0.80 mg m sup(-3)) and primary production (average 29.5+ or -23.6 mgC m sup(-3)d sup(-1)) during the early spring intermonsoon 2000...
SINTEA (ANGHEL LUCICA
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.
Carlé, Allan; Pedersen, Inge Bülow; Knudsen, Nils
CONTEXT: Primary overt autoimmune hypothyroidism is often divided into primary idiopathic hypothyroidism with thyroid atrophy (Ord's disease) and hypothyroidism with goitre (Hashimoto's disease). OBJECTIVE: The aim of the present study was to characterize the two subtypes of disease. DESIGN...... program including thyroid ultrasonography and measurements of thyroid autoantibodies. Of the 144 patients investigated (58% of all invited), 139 were compared with 556 sex-, age-, and region-matched controls from the cohort. RESULTS: Patients had lower median (11.6 ml vs. 13.5 ml, P = 0.001) and a more...... dispersed distribution of thyroid volumes compared with controls (P thyroid volume showed a Gaussian distribution in both males and females with no bimodal pattern. Nearly all patients had measurable thyroid autoantibodies, but with increasing thyroid volume (quartile I, II, III, and IV...
... 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 ...
Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.
Ul Islam, Salman; Ahmed, Muhammad Bilal; Shehzad, Adeeb; Ul-Islam, Mazhar; Lee, Young Sup
Most of the drugs are metabolized in the liver by the action of drug metabolizing enzymes. In hepatocellular carcinoma (HCC), primary drug metabolizing enzymes are severely dysregulated, leading to failure of chemotherapy. Sorafenib is the only standard systemic drug available, but it still presents certain limitations, and much effort is required to understand who is responsive and who is refractory to the drug. Preventive and therapeutic approaches other than systemic chemotherapy include vaccination, chemoprevention, liver transplantation, surgical resection, and locoregional therapies. This review details the dysregulation of primary drug metabolizing enzymes and drug transport proteins of the liver in HCC and their influence on chemotherapeutic drugs. Furthermore, it emphasizes the adoption of safe alternative therapeutic strategies to chemotherapy. The future of HCC treatment should emphasize the understanding of resistance mechanisms and the finding of novel, safe, and efficacious therapeutic strategies, which will surely benefit patients affected by advanced HCC. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
Peppa, Melpomeni; Papaxoinis, Georgios; Xiros, Nikolaos; Raptis, Sotirios A; Economopoulos, Theofanis; Hadjidakis, Dimitrios
Pituitary metastasis occurs rarely in cancer patients and often remains undiagnosed. However, early detection and appropriate treatment can improve the patient's quality of life and possibly prolong survival. Herein, we describe the case of a 52-year-old woman with panhypopituitarism caused by metastases to the hypothalamus and pituitary from primary breast cancer. She had a 5-year history of breast cancer with metastases to the bones 1.5 years after initial diagnosis and mastectomy. She presented with severe headaches, generalized fatigue, dizziness, hypotension, difficulties with balance and coordination, polyuria, and polydipsia. Laboratory work-up revealed panhypopituitarism (central diabetes insipidus; hypothyroidism; and low prolactin, gonadotrophin, and adrenocorticotropic hormone levels), and magnetic resonance imaging confirmed the pituitary and hypothalamic involvement. She received hormone replacement therapy, radiation therapy of the sella turcica and suprasellar lesion, and chemotherapy, with significant improvement of her clinical status, but she died 15 months later.
Lazanu, Sorina; Lazanu, Ionel
Full text: Silicon detectors will represent an important option for the next generation of experiments in high energy physics, for astroparticle and nuclear experiments, where the requirements to operate long time in high radiation environments will represent a major problem. After the long-time operation in high radiation fields, the bulk displacement damage produces the following effects at the device level: increase of the leakage current, decrease of the satisfactory Signal/Noise ratio, increase of the effective carrier concentration, and thus of the depletion voltage, decrease of the charge collection efficiency up to unacceptable levels. In this contribution we investigate the new perspective in understanding the fundamental phenomena in silicon and implications for the degradation of the characteristics of detectors given by the consideration of the existence of the new primary defect: fourfold coordinated defect, Si FFCD , with a lower value of the formation energy by comparison with the 'classically' known vacancies and interstitials. Predicted by Goedecker and co-workers, its characteristics were indirectly determined by Lazanu and Lazanu. The correlation between the rate of generation of primary defects, material composition and observable effects is investigated considering different growth technologies and resistivities (up to tens of kΩcm) as time and fluence dependencies. This allows to estimate the expected behaviour of the materials and detectors in concrete environments at the next generations of high energy physics experiments as SLHC or VLHC for example. This new defect could represent the elementary block for new extended defects and in principle it could generate local amorphization of the semiconductor. Its existence and characteristics in other semiconductors is also investigated. (author)
Andersen, Kim Francis; Albrecht-Beste, Elisabeth
-so-called brown tumors. These benign, osteolytic lesions may demonstrate FDG-avidity on (18)F-FDG PET/CT, and as such are misinterpreted as skeletal metastases. Regression of the lesions may occur following successful treatment. We present a case demonstrating the diagnostic work-up and follow-up of a patient...... with PHPT due to parathyroid carcinoma and with presence of brown tumors on (18)F-FDG PET/CT, visualizing the possible role of this imaging modality in the evaluation of treatment response in these patients....
Grum-Schwensen, Birgitte; Klingelhöfer, Jörg; Grigorian, Mariam
significantly reduced the metastatic burden in lungs of PyMT-induced mammary tumors. In S100A4(+/+) PyMT mice, massive leukocyte infiltration at the site of the growing tumor at the stage of malignant transition was associated with increased concentration of extracellular S100A4 in the tumor microenvironment......Interactions between tumor and stroma cells are essential for the progression of cancer from its initial growth at a primary site to its metastasis to distant organs. The metastasis-stimulating protein S100A4 exerts its function as a stroma cell-derived factor. Genetic depletion of S100A4...... monolayers. In vivo, the presence of S100A4(+/+), but not S100A4(-/-), fibroblasts significantly stimulated the attraction of T lymphocytes to the site of the growing tumor. Increased levels of T cells were also observed in the premetastatic lungs of tumor-bearing mice primed to metastasize by S100A4...
O'Sullivan, Michael; Rap, Alex; Reddington, Carly; Spracklen, Dominick; Buermann, Wolfgang
The global terrestrial carbon sink has increased since the start of this century at a time of rapidly growing carbon dioxide emissions from fossil fuel burning. Here we test the hypothesis that increases in atmospheric aerosols from fossil fuel burning have increased the diffuse fraction of incoming solar radiation and the efficiency of photosynthesis leading to increased plant carbon uptake. Using a combination of atmospheric and biospheric models, we find that changes in diffuse light associated with fossil fuel aerosol emission accounts for only 2.8% of the increase in global net primary production (1.221 PgC/yr) over the study period 1998 to 2007. This relatively small global signal is however a result of large regional compensations. Over East Asia, the strong increase in fossil fuel emissions contributed nearly 70% of the increased plant carbon uptake (21 TgC/yr), whereas the declining fossil fuel aerosol emissions in Europe and North America contributed negatively (-16% and -54%, respectively) to increased plant carbon uptake. At global scale, we also find the CO2 fertilization effect on photosynthesis to be the dominant driver of increased plant carbon uptake, in line with previous studies. These results suggest that further research into alternative mechanisms by which fossil fuel emissions could increase carbon uptake, such as nitrogen deposition and carbon-nitrogen interactions, is required to better understand a potential link between the recent changes in fossil fuel emissions and terrestrial carbon uptake.
Full Text Available Abstract Background Chromosome changes in the bone marrow (BM of patients with persistent cytopenia are often considered diagnostic for a myelodysplastic syndrome (MDS. Comprehensive cytogenetic evaluations may give evidence of the real pathogenetic role of these changes in cases with cytopenia without morphological signs of MDS. Results Chromosome anomalies were found in the BM of three patients, without any morphological evidence of MDS: 1 an acquired complex rearrangement of chromosome 21 in a boy with severe aplastic anaemia (SAA; the rearrangement caused the loss of exons 2–8 of the RUNX1 gene with subsequent hypoexpression. 2 a constitutional complex rearrangement of chromosome 21 in a girl with congenital thrombocytopenia; the rearrangement led to RUNX1 disruption and hypoexpression. 3 an acquired paracentric inversion of chromosome 1, in which two regions at the breakpoints were shown to be lost, in a boy with aplastic anaemia; the MPL gene, localized in chromosome 1 short arms was not mutated neither disrupted, but its expression was severely reduced: we postulate that the aplastic anaemia was due to position effects acting both in cis and in trans, and causing Congenital Amegakaryocytic Thrombocytopenia (CAMT. Conclusions A clonal anomaly in BM does not imply per se a diagnosis of MDS: a subgroup of BM hypoplastic disorders is directly due to chromosome structural anomalies with effects on specific genes, as was the case of RUNX1 and MPL in the patients here reported with diagnosis of SAA, thrombocytopenia, and CAMT. The anomaly may be either acquired or constitutional, and it may act by deletion/disruption of the gene, or by position effects. Full cytogenetic investigations, including a-CGH, should always be part of the diagnostic evaluation of patients with BM aplasia/hypoplasia and peripheral cytopenias.
María Consuelo Paredes Suárez
primary health care in Maracaibo municipality, Zulia State, Venezuela during January 2006-2008. The target group included all patients attending to the dentist office for dental extraction in the maxilla, and the sample consisted of the 38 patients suffering from bucco-sinus communication as a complication of dental extraction, including only the iatrogenic-traumatic ones, those provoked in accidents and those associated with other pathologies. Data were collected from the individual clinical histories and in a form arranged to this purpose. Absolute numbers and percentages, tables and statistical graphics were arranged to understand the results better. Female sex and ages from 35 to 59 in both sexes were the most affected. The exodontias of the first and second left superior molar showed the highest incidence, iatrogenic-traumatic communications prevailed in frequency. Immediate bucco-sinus communications represented de majority and medical-surgical treatment was the most successful therapeutic method used. The diversity of criteria regarding the diagnosis and treatment of this dental complication as well as the inappropriate management in primary health care must be considered. The immediate strategy to train Comprehensive Dentists is significant to seek out common points, join criteria and define therapeutic behaviors.
Alario, Anthony F; Pizzirani, Stefano; Pirie, Christopher G
PURPOSE To describe histologic anterior segment changes in eyes affected with primary lens displacement (PLD) and secondary glaucoma. METHODS Histologic sections stained with H&E from canine eyes enucleated because of PLD and secondary glaucoma were examined. RESULTS Thirteen eyes from 12 patients were evaluated. Four dogs were castrated males and eight spayed females. Median age was 8 years of age (range 3-13). Breeds included seven terriers and five other breeds. All eyes examined demonstrated varying degrees of inflammation involving the iris and cleft. Mononuclear and melanophagic infiltration of the cleft was found in all specimens. Four globes also showed polymorphonuclear infiltrate. Pre-iridal fibrovascular membranes were clearly identified in 10 of 13 eyes. Total inflammatory score was significantly greater in all globes examined compared with an age-matched group of normal dogs. The posterior pigmented iris epithelium demonstrated a consistent pattern of hyperplasia and/or hypertrophy and cystic degeneration, more prominent in the more central regions. In some cases, hyperplasia was of greatest severity in the mid-iris and associated with thinning or flattening of the pupillary region. CONCLUSIONS These results suggest that lens instability may be associated with chronic inflammation and secondary glaucoma. Mechanical irritation from an unstable lens may result in hypertrophy and/or hyperplasia of the posterior pigmented iris epithelium and subsequent cellular exfoliation and release of melanin. An inflammatory reaction directly or indirectly related to melanin release may obstruct the outflow pathways ultimately leading to glaucoma and loss of vision. Use of topical steroids may be warranted in dogs with PLD. © 2012 American College of Veterinary Ophthalmologists.
Anatoly P Sobolev
Full Text Available Ethylene regulates a myriad physiological and biochemical processes in ripening fruits and is accepted as the ripening hormone for the climacteric fruits. However, its effects on metabolome and resulting fruit quality are not yet fully understood, particularly when some of the ripening-associated biochemical changes are independent of ethylene action. We have generated a homozygous transgenic tomato genotype (2AS-AS that exhibits reduced ethylene production as a result of impaired expression of 1-aminocyclopropane-1-carboxylate synthase 2 gene by its antisense RNA and had a longer shelf life. Double transgenic hybrid (2AS-AS x 579HO developed through a genetic cross between 2AS-AS and 579HO (Mehta et al., 2002 lines resulted in significantly higher ethylene production than either the WT or 2AS-AS fruit. To determine the effects of reduced ethylene and introgression of higher polyamines’ trait, the metabolic profiles of ripening fruits from WT (556AZ, 2AS-AS, and 2AS-AS x 579HO lines were determined using 1H-NMR spectroscopy. The levels of Glu, Asp, AMP, Adenosine, Nucl1 and Nucl2 increased during ripening of the WT fruit. The increases in Glu, Asp, and AMP levels were attenuated in 2AS-AS fruit but recovered in the double hybrid with higher ethylene and polyamine levels. The ripening-associated decreases in Ala, Tyr, Val, Ile, Phe, malate and myo-inositol levels in the 2AS-AS line were not reversed in the double hybrid line suggesting a developmental/ripening regulated accumulation of these metabolites independent of ethylene. Significant increases in the levels of fumarate, formate, choline, Nucl1 and Nucl2 at most stages of ripening fruit were found in the double transgenic line due to introgression with higher-polyamines trait. Taken together these results show that the ripening-associated metabolic changes are both ethylene dependent and independent, and that the fruit metabolome is under the control of multiple regulators, including
The Occupational Health and Safety (OHS) Act requires that every employer shall ensure the health and safety of workers in the workplace. Issues regarding the practices at workplaces and how they should reflect the standards of due diligence were discussed. Due diligence was described as being the need for employers to identify hazards in the workplace and to take active steps to prevent workers from potentially dangerous incidents. The paper discussed various aspects of due diligence including policy, training, procedures, measurement and enforcement. The consequences of contravening the OHS Act were also described
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.)
Chimiri, Niklas Alexander; Andersen, Mads Lund; Jensen, Tine
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...
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…
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
Handler, Marc Zachary; Goldberg, David J
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.
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....
Druce, Maralyn R; Hickey, Andrea; Warrens, Anthony N; Westwood, Olwyn M R
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.
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...
University of New Hampshire — A Hydrologic Area of Concern (HAC) is a land area surrounding a water source, which is intended to include the portion of the watershed in which land uses are likely...
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 ...
Muehrer, Rebecca J; Lanuza, Dorothy M; Brown, Roger L; Djamali, Arjang
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.
McComas, Katherine A; Besley, John C
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.
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.)
An enquiry based on a standardised questionnaire into knowledge, awareness and preferences concerning the care of familial hypercholesterolaemia among primary care physicians in the Asia-Pacific region: the “Ten Countries Study”
Pang, Jing; Hu, Miao; Lin, Jie; Miida, Takashi; Nawawi, Hapizah M; Park, Jeong Euy; Wu, Xue; Ramli, Anis S; Kim, Ngoc Thanh; Kwok, See; Gonzalez-Santos, Lourdes E; Su, Ta-Chen; Truong, Thanh Huong; Soran, Handrean; Yamashita, Shizuya; Tomlinson, Brian; Watts, Gerald F
Objective To determine physicians’ knowledge, awareness and preferences regarding the care of familial hypercholesterolaemia (FH) in the Asia-Pacific region. Setting A formal questionnaire was anonymously completed by physicians from different countries/regions in the Asia-Pacific. The survey sought responses relating to general familiarity, awareness of management guidelines, identification (clinical characteristics and lipid profile), prevalence and inheritance, extent of elevation in risk of cardiovascular disease (CVD) and practice on screening and treatment. Participants Practising community physicians from Australia, Japan, Malaysia, South Korea, Philippines, Hong Kong, China, Vietnam and Taiwan were recruited to complete the questionnaire, with the UK as the international benchmark. Primary outcome An assessment and comparison of the knowledge, awareness and preferences of FH among physicians in 10 different countries/regions. Results 1078 physicians completed the questionnaire from the Asia-Pacific region; only 34% considered themselves to be familiar with FH. 72% correctly described FH and 65% identified the typical lipid profile, with a higher proportion of physicians from Japan and China selecting the correct FH definition and lipid profile compared with those from Vietnam and Philippines. However, less than half of the physician were aware of national or international management guidelines; this was significantly worse than physicians from the UK (35% vs 61%, p<0.001). Knowledge of prevalence (24%), inheritability (41%) and CVD risk (9%) of FH were also suboptimal. The majority of the physicians considered laboratory interpretative commenting as being useful (81%) and statin therapy as an appropriate cholesterol-lowering therapy (89%) for FH management. Conclusions The study identified important gaps, which are readily addressable, in the awareness and knowledge of FH among physicians in the region. Implementation of country-specific guidelines and
Frankel, Christian; Ossandón, José; Pallesen, Trine
Despite the recent fall-out of finance, confidence in the market does not seem to be diminishing, but, on the contrary, market mechanisms are becoming key instruments to deal with core contemporary collective concerns, including global warming, education, environmental pollution, supply of energy......, quality of education, poverty and health care (Mirowski 2013). Recent research within STS has started to focus on such kind of arrangements and in this presentation we will critically engage with this literature. Our main results are twofold. On the one hand, we recognize there are important conceptual...... tools already available - such as 'matters of public concern' (Marres 2007) and 'hybrid forums' (Callon et al. 2001; Callon 2009)- that help in framing the particularity of these arrangements. On the other hand, previous STS-market research notions developed mostly in the field of finance studies cannot...
Titus, E.; Spink, T.; Cookson, B.; Tenera, L.P.
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
Martin Heidegger's thought-provoking essay "The Question Concerning Technology" (1977a) placed technology at the heart of philosophy. Heidegger tried to show that the essence of technology provokes humans to think about the world in a very dangerous way. Yet if we follow Heidegger's analysis...... of technology, what role does that ascribe to philosophy? To be able to understand the programmatic scope of Heidegger's question ‘concerning' technology, we need to see it as inseparable from his famous thesis about the end of philosophy (1977c) and what he considers to be the ideal kind of thinking. However......, by doing so, we will in the end realize two important things. First, that Heidegger's declaration of the end of philosophy in fact also means the end of anything we can meaningfully call thinking. Second, that Heidegger's own thinking is completely different from his own ideal of thinking. Our question...
Moestrup, Lene; Hansen, Helle Ploug
psychology or Kübler-Ross’ theory about death stages. The complex concerns might be explained using Martin Heidegger’s phenomenological thinking. We aimed to illuminate dying patients´ existential concerns about the impending death through a descriptive analysis of semi-structured interviews with 17 cancer...... patients in Danish hospices. The main findings demonstrated how the patients faced the forthcoming death without being anxious of death but sorrowful about leaving life. Furthermore, patients expressed that they avoided thinking about death. However, some had reconstructed specific and positive ideas about...... afterlife and made accurate decisions for practical aspects of their death. The patients wished to focus on positive aspects in their daily life at hospice. It hereby seems important to have ongoing reflections and to include different theoretical perspectives when providing existential support to dying...
Auriol, Emmanuelle; Friebel, Guido; Pechlivanos, Lambros
We investigate how changes in the commitment power of a principal affect cooperation among agents who work in a team. When the principal and her agents are symmetrically uncertain about the agents' innate abilities, workers have career concerns. Then, unless the principal can commit herself to long-term wage contracts, an implicit sabotage incentive emerges. Agents become reluctant to help their teammates. Anticipating this risk, and in order to induce the desired level of cooperation, the pr...
Goyer, R A
Over the 20-year period since the first issue of Environmental Health Perspectives was published, there has been considerable progress in the understanding of the potential toxicity of exposure to lead. Many of these advances have been reviewed in published symposia, conferences, and review papers in EHP. This brief review identifies major advances as well as a number of current concerns that present opportunities for prevention and intervention strategies. The major scientific advance has be...
El Ansari, Walid; Dibba, Emily; Stock, Christiane
AIMS: This cross-sectional study aimed to determine the socio-demographic, lifestyle and well-being variables that are associated with body image concerns (BIC) and whether these associations differed between female and male students. METHODS: A cross-sectional survey; 3,706 undergraduate students...... (2,699 females, 765 males) from seven universities in the UK completed a self-administered questionnaire that assessed socio-demographic, lifestyle, well-being and BIC based on the Body Shape Questionnaire developed by Cooper et al. Multifactorial logistic regression analysis examined the odds ratios...
In China, there is an old saying:food is the first necessity of humans. The main concern of the Chinese used to be the security of the food supply rather than the safety of the food itself. However,after a long time fighting food shortages,China became self-sufficient in food in 1995. At this time, the country began for the first time to regulate food safety. Yet China has still not established a legal systern efficient in ensuring this safety. Many problems are rooted in the administration regime and China's priority of economic development.
from Machala to Piedras. A less-than-adequate road connects Piedras to Loja . The age of the automobile has not fully arrived in Ecuador and, although...virus from the arthropod and simian reservoirs is not known. 16. Plague. Plague occurs in two provinces of Ecuador : Lojas and Chim- borazo. The disease is...27-01-1960 1 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Health Data Concerning Ecuador 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d
Mayer, M.; Hawse, M.L.; Maloney, P.J. [eds.
The anthology takes a humanistic look at coal mining in Illinois. One of its goals is to increase public awareness of coal in American society; it also seeks to enhance understanding of the historical aspects of coal and to study the impact of coal on mining families. Many of the 25 selections in the anthology come from Coal Research Center publications, `Concerning coal` and `Mineral matters`. Articles are arranged in three parts entitled: life in the mining community; mining in folklore, story telling, literature, art and music; and technology as it affected the people of the coal fields. 117 refs., 25 photos. 1 map.
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.
Concerned for humanity club
Join the Comité International de Soutien à Adlène Hicheur Since October 8, 2009 our colleague Adlène Hicheur, a French-Algerian physicist working in LHCb has been arrested and then held in a French prison under suspicion of terrorism linked with AQMI. No material proof has been presented, only exchanges of messages on some forum sites suspected of Islamism have been mentioned. Adlène has continuously denied any link with AQMI and lives in a Kafkaesque situation since 14 mois. His lawyer has several times asked for his release and these requests have been turned down. As Adlène’s colleagues, we have been chocked by his arrest and are deeply concerned by the prolongation of his detention for his future in particle physics, even if he will be recognized innocent. Few Concerned-club members and colleagues have created an International committee to support Adlène in his defense presently having 65 members. We invite you t...
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)
Increased concern about global climate change is leading to an examination of options for reducing the emissions of gases believed to be the principal contributors to the Greenhouse Effect. Carbon dioxide is believed to be the largest contributor to such an effect, and the use of fossil fuels is the largest source of carbon dioxide emissions. geothermal energy is likely to receive increased attention in the years ahead as a way to reduce emissions of CO 2 . Several countries in Asia and the Pacific already have active geothermal programs. The Philippines have the second-largest installed geothermal capacity in the world. Japan and New Zealand have used geothermal energy for several decades. The present and future contributions of geothermal energy to the overall energy supply and reductions in carbon dioxide emissions in Asia and the Pacific are discussed in this paper
Thorsen, Line Marie
In the wake of Hurricane Katrina in 2005 and the tsunami that hit Japan in 2011, several artists turned their practices towards the subject of disaster support. Drawing on the philosophy of Bruno Latour, I argue that these artistic practices come to articulate and represent the multitude of concerns interwoven with disaster. ...
Thelen, Peggy; Cameron, Elizabeth Ann
Food-allergy awareness and management have only lately come to the forefront in early childhood settings, although advocacy organizations have been working on the issue for more than a decade. A national poll (C.S. Mott Children's Hospital 2009) asked parents with children in early education settings if they were aware of what their program does…
Sabunddjian, Gaiane; Andrade, Delvonei Alves de
This work presents the simulation, with RELAP5/MOD.3.2.2G code, of the postulate accident with loss of coolant in the primary circuit for large break (LBLOCA), which is described in Chapter 15 of the Final Safety Analysis Report of Angra 2 FSAR. The accident consists basically of the total break of the cold leg (Loop 20) of Angra 2 Plant. The rupture area considered is 4418 cm 2 , which represents 100% of the primary circuit pipe flow area. The Emergency Core Cooling System (ECCS) efficiency is also verified for this accident. In this simulation, failure and repair criteria are adopted for the ECCS components, in order to verify the system operation, in carrying out its function as expected by the project to preserve the integrity of the reactor core and to guarantee its cooling. LBLOCA accidents are characterized by a fast blowdown in the primary circuit to values that the low pressure injection system is activated and then, followed by the water injection by the accumulators. The thermal-hydraulic processes inherent to the accident phenomenon, such as hot leg vaporization and consequently core vaporization causing an inappropriate flow distribution in the reactor core, can lead to a reduction in the core liquid level, until the ECCS is capable to reflood it. It is important to point out that the results do not represent an independent calculation for the licensing process, but a calculation to give support to the qualification process of Angra 2 transient basic nodalization (author)
After a fundamental consideration of the concept of responsibility and 'long-term responsibility' for late sequelae, the problems of an ehtical assessment of risks were illustrated: The concept of risk itself poses three problems - predicting the probability of occurrence, assessing the damage = subjective classification of the degree of damage, determining whether the advantages outweigh the risks. It is not possible to weigh the advantages and risks against each other without assessing the goals and the priorities which have been set. Here ethics is called for, because it concerns itself with the reasonableness of evaluative decisions. Its task is to enable us to become aware of and comprehend our system of values in all of its complexity in reference to real life. Ethics can only fulfill its task if it helps us to adopt an integral perspective, i.e. if it centers on the human being. 'One must assess all technical and economic innovations in terms of whether they are beneficial to the development of mankind on a long-term basis. They are only to be legitimized insofar as they prove themselves to be a means of liberating mankind and contributing to his sense of dignity and identity, as a means of bringing human beings together and encouraging them to care for one another, and as a means of protecting the natural basis of our existence. (orig./HSCH) [de
Gabel, Kathe A
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.
Vaikuntam, Shreenivas; Pushparaja
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)
Hirata, Daniel Massami
This work applies the methodology of probabilistic safety assessment level 1 to the research reactor IEA-R1 IPEN-CNEN/SP. Two categories of identified initiating events of accidents in the reactor are studied: loss of flow and loss of primary coolant. Among the initiating events, blockage of flow channel and loss of cooling fluid by major pipe rupture in the primary circuit are chosen for a detailed analysis. The event tree technique is used to analyze the evolution of the accident, including the actuation or the fail of actuation of the safety systems and the reactor damages. Using the fault tree the reliability of the following reactor safety systems is evaluated: reactor shutdown system, isolation of the reactor pool, emergency core cooling system (ECCS) and the electric system. Estimative for the frequency of damage to the reactor core and the probability of failure of the analyzed systems are calculated. The estimated values for the frequencies of core damage are within the expected margins and are of the same order of magnitude as those found for similar reactors. The reliability of the reactor shutdown system, isolation of the reactor pool and ECCS are satisfactory for the conditions these systems are required. However, for the electric system it is suggested an upgrade to increase its reliability. (author)
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 ...
Dahl, Katja; Kesmodel, Ulrik; hvidman, lone
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...
... 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 ...
... 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 ...
Full Text Available Lung cancer is the leading cause of death worldwide. High mortality comes out mainly of the fact that majority of the cases are diagnosed in advanced stadium. An expanded diagnostics of precancerous conditions would certainly contribute to lowering the mortality rate. Many of the molecular changes accompanying the multistep cancer development could be observed using the immunohistochemistry method. In this paper we describe the morphology and cell cycle proteins immunoexpression of the novel probable preinvasive lesion - bronchiolar columnar cell dysplasia (BCCD. Thirty cases of BCCD selected out of 193 patients population, treated for primary non-small cell lung cancer were investigated. Loss of P16INK4a protein was observed in 70% of all cases and was statistically significant in patients with adenocarcinoma. Two cases show abnormal cytoplasmic localization of this protein. TP53 protein accumulates in 26.7% of all BCCD. Rb protein was active in 48.3% of the BCCD cases. In two cases we observed differentiation of the cells composing BCCD into multilayer epithelium of the squamous type, which occurs with formation of desmosomes. We suppose that BCCD may be preneoplastic lesion leading to adenocarcinoma as well as to peripheral squamous cell lung cancer.
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.
Bent, Gert Jan; Bakx, Anouke; den Brok, Perry
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…
Three principles that the U.S. must follow in order to maintain its present way of life are stated: practice of energy conservation; substitution of the more plentiful fuels for the scarce; and development of synthetic fuels and unconventional energy sources. After describing the organizing of the energy agencies and reviewing the history of the nuclear power program in the U.S., the author then discusses the public's concern for nuclear energy which includes radioactive discharges, reactor safety, high-level wastes, and shipment of radioactive materials. He refers to the study by Dr. Norman C. Rasmussen released in 1974, which indicates that the likelihood of a person living in the general vicinity of a reactor being injured in any one year in a reactor accident is one chance in 150 million as compared to his chance of being injured in an automobile accident in that same year as one in 130. On a broader societal viewpoint, if there were 100 reactors operating in the U.S., one individual of the 15 million inhabitants living in the vicinity of these reactors might be killed and two individuals might be injured every 25 years as compared to 1.5 million injuries and 55,000 fatalities in 1974 due to automobile accidents. The author concludes that public acceptance of nuclear power will depend on whether these plants, after a reasonable maturing period, deliver the reliable, economic, and safe power that has been proclaimed
... 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...
... of periods - primary Images Primary amenorrhea Normal uterine anatomy (cut section) Absence of menstruation (amenorrhea) References Bulun SE. The physiology and pathology of the female reproductive axis. In: ...
Byrne, Catherine E; Kass, Andrea E; Accurso, Erin C; Fischer, Sarah; O'Brien, Setareh; Goodyear, Alexandria; Lock, James; Le Grange, Daniel
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.
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.
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
Nesselroade, John R; Molenaar, Peter C M
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.
In 1978 the concept of primary health care was adopted by 116 countries at Alma Ata, yet the negative impact of structural readjustment programs in Africa and South America could be felt due to the cuts in expenditures on health, education, and social matters. The result is a resurgence of communicable diseases such as malaria and tuberculosis. Another factor in this resurgence is extreme poverty. In 1994 over 1000 people died in Rajasthan, India, of a malaria epidemic, and during the same time in Delhi over 300 deaths were attributed to hemorrhagic dengue fever. Malariogenic and tuberculous conditions continue to flourish owing to distorted development patterns and commercialization of medical care as public health and community health services are being replaced by profit-oriented curative care, 80% of which is in private hands. This has resulted in spiraling medical care costs and rural indebtedness. Socioeconomic deprivation in developing countries threatens TB control. Factors contributing to the spread of TB were established in 1899 and are still valid in India and other developing countries: TB contamination of air, inadequate food, overcrowded dwelling, and low state of physical health. Even in developed countries TB is on the rise: there were 172 cases in 1991 in England vs. 305 cases in 1993, half of them among immigrants. The increase occurred in the poorest 30% of the population. The World Bank is providing loans for a revised TB and malaria strategy, and the Disability Adjusted Life Year has been used to identify the greatest burden of diseases. On the other hand, the Indian National Health Policy has not been revised since 1983. Priority must be given to those living in extreme poverty to curb the resurgence of once controlled diseases.
Primary acute conununity-acquired pneumonia was unconunon. ... organisms such as Klebsiella spp. are frequent causes of nosocomial infections."o The larrer ... Accepted 11 Sep 1992. recognised cause of community-acquired Gram-nega-.
Oki, Kenji; Yamane, Kiminori; Sakashita, Yu; Kamei, Nozomu; Watanabe, Hiroshi; Toyota, Naoyuki; Shigeta, Masanobu; Sasano, Hironobu; Kohno, Nobuoki
A 50-year-old male patient with a 15-year history of hypertension was referred to our hospital for evaluation of bilateral adrenal tumors. No Cushingoid features were observed. Computed tomographic scan showed 10-mm masses in each adrenal gland. Preoperative endocrinological examinations revealed autonomous cortisol and aldosterone secretion in this patient. The results of a subsequent adrenal venous catheterization study were consistent with the presence of a left cortisol-producing tumor and a right aldosterone-producing tumor. A left partial adrenalectomy was performed initially, but cortisol and aldosterone over-secretion persisted. Accordingly, the patient underwent a right adrenalectomy. Pathological examination of the resected specimens, including immunohistochemical analysis, demonstrated that both adenomas possibly produced cortisol and aldosterone. This is an extremely rare case of bilateral adrenal tumors, in which the left adrenocortical tumor produced and secreted cortisol or both cortisol and aldosterone and the right one produced and secreted both aldosterone and cortisol, as confirmed by clinical findings and pathological studies using immunohistochemical analysis.
Spence, S A; Taylor, D G; Hirsch, S R
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
Khowaja, Shaneela Sadaruddin; Tharani, Ambreen Jawed; Agha, Ajmal; Karamaliani, Rozina Sherali
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.
van Zoonen, Liesbet
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'...
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 ...
Full Text Available Dacryops is a lacrimal ductal cyst. It is known that it can cause globe displacement, motility restriction, and proptosis because of the mass effect. Diplopia due to dacryops has not been reported previously. Here, we present a 57-year-old man with binocular horizontal diplopia that occurred during left direction gaze due to dacryops.
Lange, Sofie C; Bak, Lasse Kristoffer; Waagepetersen, Helle S
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....
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
Mesut Özkaya; Kadir Gis; Ali Çetinkaya
Hemochromatosis is an iron storage disease. Panhypopituitarism is a clinical condition in which the anterior pituitary hormones are deficient. Herein, we report a rare case of panhypopituitarism due to hemochromatosis. Turk Jem 2013; 17: 125-6
Vermeule, Cornelius Adrian
In the textbooks, procedural due process is a strictly judicial enterprise; although substantive entitlements are created by legislative and executive action, it is for courts to decide independently what process the Constitution requires. The notion that procedural due process might be committed primarily to the discretion of the agencies themselves is almost entirely absent from the academic literature. The facts on the ground are very different. Thanks to converging strands of caselaw ...
Matyas, Robert; Pachman, Jiri [Pardubice Univ. (Czech Republic). Faculty of Chemical Technology
The first chapter provides background such as the basics of initiation and differences between requirements on primary explosives used in detonators and igniters. The authors then clarify the influence of physical characteristics on explosive properties, focusing on those properties required for primary explosives. Furthermore, the issue of sensitivity is discussed. All the chapters on particular groups of primary explosives are structured in the same way, including introduction, physical and chemical properties, explosive properties, preparation and documented use.
Jacobsen, S; Jensen, L T; Foldager, M
Serum concentrations of procollagen type III aminoterminal peptide have previously been reported to be low in some patients with primary fibromyalgia and the aim of this study was to determine if such patients differ clinically from primary fibromyalgia patients with normal levels of procollagen...... type III aminoterminal peptide. Subjective symptoms, tender points and dynamic muscle strength in 45 women with primary fibromyalgia were related to serum concentrations of procollagen type III aminoterminal peptide. Patients with low serum concentrations of procollagen type III aminoterminal peptide...... concentrations of procollagen type III aminoterminal peptide of primary fibromyalgia patients are connected to the disease impact....
Nielsen, Annemette; Michaelsen, Kim F.; Holm, Lotte
Background/objectives:To investigate and analyze differences in parental concerns during earlier and later phases of complementary feeding.Subject/methods:Eight focus group interviews were conducted with 45 mothers of children aged 7 or 13 months. Deductive and inductive coding procedures were ap......:10.1038/ejcn.2013.165....
FeldmanHall, Oriel; Dalgleish, Tim; Evans, Davy; Mobbs, Dean
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
E.A. van Zoonen (Liesbet)
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
Suggests that school safety is an issue that concerns all students. Discusses how the staff of the Rockwood South (Missouri) "RAMpage" covered the shootings at Columbine High School in a 14-page issue and in follow-up issues. Suggests that the student newspaper covered the controversial topic in an appropriate, tasteful manner. (RS)
Validity is concerned with the clarification and justification of the intended interpretations and uses of observed scores. It has not been easy to formulate a general methodology set of principles for validation, but progress has been made, especially as the field has moved from relatively limited criterion-related models to sophisticated…
Sugiyama, Kumiya; Cho, Tatsurai; Tatewaki, Masamitsu; Onishi, Shogo; Yokoyama, Tatsuya; Yoshida, Naruo; Fujimatsu, Takayoshi; Hirata, Hirokuni; Fukuda, Takeshi; Fukushima, Yasutsugu
We report a rare case of anaphylaxis due to caffeine intake. A 27-year-old woman suffered her first episode of anaphylaxis and a positive skin prick test suggested that the anaphylaxis was due to an IgE-mediated hypersensitivity reaction to caffeine. She was diagnosed with caffeine allergy and has not had an allergic reaction after avoiding foods and drinks containing caffeine. Although caffeine is known to have antiallergic effects, this case shows that caffeine can be an allergen and cause ...
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
Holder-Perkins, Vicenzio; Wise, Thomas N.; Williams, Darren E.
The medically unexplained complaint is often a symptom of hypochondriacal concerns. Patients with hypochondriasis may be managed with either naive realism or consideration of morbid categorization or via dimensional assessment of illness beliefs and behaviors. Naive realism will foster focus somatization and promote regression as well as lead to needless tests and treatments. Attention to categorical entities such a major depression or anxiety disorders will alert the clinician to comorbid psychiatric disorders that respond to traditional psychiatric treatments. Finally, by assessing the domains of illness behaviors such as disease conviction, beliefs in organic versus psychological causes, and denial, the clinician can document and then confront abnormal cognitive schema that revolve around somatic concerns that are a proxy for psychosocial difficulties. PMID:15014644
Holder-Perkins, Vicenzio; Wise, Thomas N.; Williams, Darren E.
The medically unexplained complaint is often a symptom of hypochondriacal concerns. Patients with hypochondriasis may be managed with either naive realism or consideration of morbid categorization or via dimensional assessment of illness beliefs and behaviors. Naive realism will foster focus somatization and promote regression as well as lead to needless tests and treatments. Attention to categorical entities such a major depression or anxiety disorders will alert the clinician to comorbid ps...
Today social networking sites play an important role and inexpensive way to maintain existing relationships and present oneself. However, the increasing use of online sites give rise to privacy concerns and risks. All Internet sites are also under attack from phishers, fraudsters, and spammers. They aim to steal user information and expose users to unwanted spam. They have so many resources at their disposal.This paper studies the awareness of college students regarding the privacy in Faceboo...
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.
Friedemann, Yael; Tolmacz, Rami; Doron, Yonit
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.
This rule is established under the provisions of the law on the prevention of radiation injuries by radioisotopes, and the former ordinance No. 14, 1958, is hereby totally amended. Radioisotopes under the law are the isotopes which emit radiation, and of which the concentration exceeds the levels defined by the Director General of the Science and Technology Agency, their compounds or the substances containing these compounds, excluding those defined in the atomic energy act and other particular laws. The apparatuses fitted with radioisotopes under the law are electron capture detectors for gas chromatography. The radiation emitting installations under the law are cyclotron, synchrotron, synchro-cyclotron, linear accelerator, betatron, Van de Graaff accelerator, Cockcroft-Walton's accelerator, etc. The permission of usage under the law shall be obtained for each works or enterprise. Persons who intend to get the permission shall file the application for them attaching the documents describing expected period of usage and other papers specified by the Director General. The total quantity of radioisotopes sealed tightly for each works or enterprise under the law shall be 100 milli-curie. The design of apparatus for the prevention of radiation injuries, the capacities of storage facilities regularly inspected, the period of regular inspection, the confirmation of transport and disposal and fees to be paid, etc. are defined, respectively. (Okada, K.)
Full Text Available This article is part of a first year doctoral research regarding the current state of knowledge in environmental sustainability, energy economics and their impact on European enterprises. As the current changes and modifications of the German energy economics system are observed by people all around the globe, the current paper analyzes what has been said until now in the scientific literature on character of the new strategy for energy consumption and production in Germany and its impact on environmental and social sustainability. With the help of two questionnaire-based surveys conducted in 2013 and 2014 through the German DIHK1, German enterprises were surveyed in order to: identify potential differences and similarities between the two periods, identify the effects of the energy transition on companies’ profitability, and analyze these effects and compare the results in terms of potential trend developments. The research findings confirmed that changes in the energy system affect not only the environmental sustainability only, but also the economy, in some cases even independent of the stage in which the changing system of the economy presently is.
FAA has a history of computer security weaknesses in a number of areas, including its physical security management at facilities that house air traffic control (ATC) systems, systems security for both operational and future systems, management struct...
Those who want to use, sell or dispose of radioactive isotopes as occupation should file applications for approval attached with the required documents. Those who want to change the approved items of use, sale or disposal of radioactive isotopes should file applications for approval. The number of documents for the application of approval are one original and four duplicates. The use, refilling, storage, transportation and disposal of radioactive isotopes should be carried out in accordance with the specified standards, respectively. Radiation dose rate, density of particle fluxes, and the state of contamination caused by radioactive isotopes should be measured in the specified places at the specified frequency, and the records of such measurements should be kept. Prevention of radiation injuries including the measures for finding those who suffer from radiation injuries and the measures for those who underwent or might undergo radiation injuries should be carried out in accordance with the respective specifications. (Rikitake, Y.)
The department for medical monitoring of the staff employed at the Institute has performed 21395 medical check-ups of the personnel employed in the Institute and individuals who applied for different posts. Some new methods for laboratory analyses specific for personnel exposed to radiation were introduced. The activities of the department were fulfilled according to the plan
Yopp, Justin M; Rosenstein, Donald L
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.
Harding, David; Rouse, Ted
Most companies do a thorough job of financial due diligence when they acquire other companies. But all too often, deal makers simply ignore or underestimate the significance of people issues in mergers and acquisitions. The consequences are severe. Most obviously, there's a high degree of talent loss after a deal's announcement. To make matters worse, differences in decision-making styles lead to infighting; integration stalls; and productivity declines. The good news is that human due diligence can help companies avoid these problems. Done early enough, it helps acquirers decide whether to embrace or kill a deal and determine the price they are willing to pay. It also lays the groundwork for smooth integration. When acquirers have done their homework, they can uncover capability gaps, points of friction, and differences in decision making. Even more important, they can make the critical "people" decisions-who stays, who goes, who runs the combined business, what to do with the rank and file-at the time the deal is announced or shortly thereafter. Making such decisions within the first 30 days is critical to the success of a deal. Hostile situations clearly make things more difficult, but companies can and must still do a certain amount of human due diligence to reduce the inevitable fallout from the acquisition process and smooth the integration. This article details the steps involved in conducting human due diligence. The approach is structured around answering five basic questions: Who is the cultural acquirer? What kind of organization do you want? Will the two cultures mesh? Who are the people you most want to retain? And how will rank-and-file employees react to the deal? Unless an acquiring company has answered these questions to its satisfaction, the acquisition it is making will be very likely to end badly.
Verlecar, X.N.; Parulekar, A.H.
Photosynthetic production in the oceans in relation to light, nutrients and mixing processes is discussed. Primary productivity in the estuarine region is reported to be high in comparison to coastal and oceanic waters. Upwelling phenomenon...
... Neoplasia Type 1 Thyroid Disease & Pregnancy Primary Hyperparathyroidism Prolactinoma National Hormone and Pituitary Program (NHPP): Information for ... qualified health care provider nearby. Eating, Diet, and Nutrition Eating, diet, and nutrition have not been shown ...
... attack is higher. Patients also have an increased risk of acute myeloid leukemia or primary myelofibrosis . Symptoms of polycythemia vera include headaches and a feeling of fullness below the ribs on the left ...
ALL parents hope their children will grow up healthy and clever. To provide children with good health care and education early on and to mold them into talented people who will be able to contribute toward the next century is the mission of China’s development program for children. In order to implement the "National Program of Action for Child Development in China in the 1990s," to mobilize all walks of life to become concerned with the health of mothers and children and the fate of the next generation, as well as to improve the quality
Daugbjerg, Carsten; Swinbank, Alan
The transfer of some decision-making authority from the domestic to the supranational arena as a result of the establishment of the World Trade Organization (WTO) in 1995 potentially changed domestic policy dynamics. The WTO agreements reflect the trade policy concerns addressed in the Uruguay...... Round in the late 1980s and early 1990s. This article applies and adapts historical institutionalism to explain how international organizations may constrain and facilitate certain domestic policy options. It demonstrates that, while the WTO legal framework has become more receptive of environmental...
Bucheli, Thomas D
Natural toxins such as mycotoxins or phytotoxins (bioactive compounds from fungi and plants, respectively) have been widely studied in food and feed, where they are stated to out-compete synthetic chemicals in their overall human and animal toxicological risk. A similar perception and awareness is yet largely missing for environmental safety. This article attempts to raise concern in this regard, by providing (circumstantial) evidence that phytotoxins in particular can be emitted into the environment, where they may contribute to the complex mixture of organic micropollutants. Exposures can be orders-of-magnitude higher in anthropogenically managed/affected (agro-)ecosystems than in the pristine environment.
Palta, Manisha; Riedel, Richard F.; Vredenburgh, James J.; Cummings, Thomas J.; Green, Scott; Chang, Zheng; Kirkpatrick, John P.
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
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.
Palta, Manisha; Riedel, Richard F; Vredenburgh, James J; Cummings, Thomas J; Green, Scott; Chang, Zheng; Kirkpatrick, John P
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.
Falk, Michael C; Chassy, Bruce M; Harlander, Susan K; Hoban, Thomas J; McGloughlin, Martina N; Akhlaghi, Amin R
Recent advances in agricultural biotechnology have highlighted the need for experimental evidence and sound scientific judgment to assess the benefits and risks to society. Nutrition scientists and other animal biologists need a balanced understanding of the issues to participate in this assessment. To date most modifications to crop plants have benefited producers. Crops have been engineered to decrease pesticide and herbicide usage, protect against stressors, enhance yields and extend shelf life. Beyond the environmental benefits of decreased pesticide and herbicide application, consumers stand to benefit by development of food crops with increased nutritional value, medicinal properties, enhanced taste and esthetic appeal. There remains concern that these benefits come with a cost to the environment or increased risk to the consumer. Most U.S. consumers are not aware of the extent that genetically modified foods have entered the marketplace. Consumer awareness of biotechnology seems to have increased over the last decade, yet most consumers remain confused over the science. Concern over the impact on the safety of the food supply remains low in the United States, but is substantially elevated in Europe. Before a genetically engineered crop is introduced into commerce it must pass regulatory scrutiny by as many as four different federal regulatory bodies to ensure a safe food supply and minimize the risk to the environment. Key areas for more research are evaluation of the nutritional benefits of new crops, further investigation of the environmental impact, and development of better techniques to identify and track genetically engineered products.
Silva, W A; Pinheiro, A M; Jahns, B; Bögli-Stuber, K; Droz, S; Zimmerli, S
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.
Full Text Available In the article analysis of the discrepancies in the production process for selected products in a company producing candles was carried out. Using the Pareto-Lorenzdiagram and the FMEA method the most essential areas having influence on the production of candles were shown. Apart from factors connected with the manufacturing side of the process, factors of the labour organization and requirements concerning the quality of material were also noted. An appropriate quality of equipment constitutes one of the essential conditions of production process functioning and this directly influences manufacturing possibilities of the enterprise. A synthesis of immaterial factors that influence the production of the enterprise, taking into consideration conditions of functioning the production system, was also carried out. The set of factors selected for description was the fourteenth Toyota management principle. Respondents were asked to provide answers which could bring the best improvements.
Mohmmad Younus Wani
Full Text Available Nanotechnology deals with the construction of new materials, devices, and different technological systems with a wide range of potential applications at the atomic and molecular level. Nanomaterials have attracted great attention for numerous applications in chemical, biological, and industrial world because of their fascinating physicochemical properties. Nanomaterials and nanodevices are being produced intentionally, unintentionally, and manufactured or engineered by different methods and released into the environment without any safety test. Nantoxicity has become the subject of concern in nanoscience and nanotechnology because of the increasing toxic effects of nanomaterials on the living organisms. Nanomaterials can move freely as compared to the large-sized particles; therefore, they can be more toxic than bulky materials. This review article delineates the toxic effects of different types of nanomaterials on the living organisms through different sources, like water, air, contact with skin, and the methods of determinations of these toxic effects.
Population investment is a major topic in the studies of population and economic relations. In this particular area, numerous theoretical and practical problems are still in need of solution. Concerning the problem of population concept, there are three different approaches: (1) to determine the definition of population investment from the relationship between the population growth and the capital from national income used for investment, including investment in the newly increased population and investment in the entire population; (2) to explain population investment from the economic viewpoint that people are producers; and (3) to explain population investment from the expense needed to change a simple labor force to a skillful labor force. The expenses include educational costs, maintanance spending, wages needed to compensate workers in labor, costs for workers to master and learn modern scientific techniques to be used for production, and the costs of keeping a young labor force in the next generation.
Casado de Frías, Enrique
In the last years there has been a growing interest in chilhood obesity in all developed countries. There is a great concern that is prevalence has raised 2-3 fold during the last 20 years. In the spanish chilhood population the obesity prevalence is estimated around 13%. Of note also, a number of other pathologies develop concomitantly with obesity during chilhood. These include type 2 diabetes, a range of respiratory problems, a metabolic syndrome, liver steatosis and seudotumor cerebri among others. Taking for granted that chilhood obesity in its roots is an exogenous disorder, preventive interventions should focus on modifying those ethiologies, improving the ways and nature of chilhood nutrition and its social and ludic behaviours.
Leonard, J.F. [Department of Energy, Washington, DC (United States)
The U.S. Department of Energy (DOE) recently initiated a complete review of the DOE High Efficiency Particulate Air (HEPA) Filter Program to identify areas for improvement. Although this process is currently ongoing, various issues and problems have already been identified for action that not only impacts the DOE HEPA filter program, but potentially the national and international air cleaning community as well. This paper briefly reviews a few of those concerns that may be of interest, and discusses actions initiated by the DOE to address the associated issues and problems. Issues discussed include: guidance standards, in-place testing, specifications, Test Facilities, portable units, vacuum cleaners, substitute aerosols, filter efficiencies, aging/shelf life/service life, fire suppression, handbook, Quality Products List (QPL), QA testing, and evaluations.
Jensen, Per Anker; Varano, Mattia
carried out for buyers or sellers involved in real estate transactions. It can also be part of mergers including real estate and other assets or part of facilities management outsourcing. This paper is based on a case study and an interview survey of companies involved in TDD consulting in Denmark......Technical Due Diligence (TDD) as an evaluation of the performance of constructed facilities has become an important new field of practice for consultants. Before the financial crisis started in autumn 2008 it represented the fastest growing activity in some consulting companies. TDD is mostly...... and Italy during 2009. The research identifies the current practice and compares it with the recommended practice in international guidelines. The current practice is very diverse and could in many cases be improved by a more structured approach and stricter adherence to international guidelines. However...
Gamble, Janet; Balbus, John; Berger, Martha; Bouye, Karen; Campbell, Vince; Chief, Karletta; Conlon, K.; Crimmins, Allison; Flanagan, Barry; Gonzalez-Maddux, C.; Hallisey, E.; Hutchins, S.; Jantarasami, L.; Khoury, S.; Kiefer, M.; Kolling, J.; Lynn, K.; Manangan, A.; McDonald, M.; Morello-Frosch, R.; Hiza, Margaret; Sheffield, P.; Thigpen Tart, K.; Watson, J.; Whyte, K.P.; Wolkin, A.F.
Climate change is already causing, and is expected to continue to cause, a range of health impacts that vary across different population groups in the United States. The vulnerability of any given group is a function of its sensitivity to climate change related health risks, its exposure to those risks, and its capacity for responding to or coping with climate variability and change. Vulnerable groups of people, described here as populations of concern, include those with low income, some communities of color, immigrant groups (including those with limited English proficiency), Indigenous peoples, children and pregnant women, older adults, vulnerable occupational groups, persons with disabilities, and persons with preexisting or chronic medical conditions. Planners and public health officials, politicians and physicians, scientists and social service providers are tasked with understanding and responding to the health impacts of climate change. Collectively, their characterization of vulnerability should consider how populations of concern experience disproportionate, multiple, and complex risks to their health and well-being in response to climate change. Some groups face a number of stressors related to both climate and non-climate factors. For example, people living in impoverished urban or isolated rural areas, floodplains, coastlines, and other at-risk locations are more vulnerable not only to extreme weather and persistent climate change but also to social and economic stressors. Many of these stressors can occur simultaneously or consecutively. Over time, this “accumulation” of multiple, complex stressors is expected to become more evident1 as climate impacts interact with stressors associated with existing mental and physical health conditions and with other socioeconomic and demographic factors.
The New Brunswick Market Design Committee will address environmental concerns within the context of the new energy policy and market rules for the newly restructured electric power industry. The new rules that come with power restructuring will in some ways facilitate environmental protection but they can also complicate it. With open access markets, it will be possible to coordinate evolving energy frameworks with current environmental objectives. Restructuring provides an opportunity to create incentives and guidelines to operate in an environmentally sustainable manner, as suggested in the New Brunswick Energy Policy, White Paper which outlines green pricing, the development of a provincial Climate Change Action Plan, and promotion of alternative energy. The Market Design Committee examined the environmental concerns listed within the White Paper that pertain to the generation and transmission of electricity. These include the integration of energy and environmental policy. Other issues addressed in this report were trans-boundary and global air emissions, the development of a provincial climate change action plan, and a federal-provincial climate change framework agreement. New Brunswick will encourage the development of pilot studies that demonstrate the benefits of renewable and alternative technologies and that help promote the market to manufacture, sell and maintain renewable and alternative technologies in small-scale on-site power generation. This report also discussed the 4 key air pollutants for which specific treatment has been defined, including sulphur dioxide, nitrogen oxides, mercury and carbon dioxide. Recommendations for reducing these emissions include the use of renewable energy sources, the use of lower carbon fuels, increased efficiency of power transmission/generation/distribution systems, reducing power demand by the industrial sector, and promoting energy efficient building codes. 34 refs., 1 tab
Nghiem, P.; Payet, J.; Tkatchenko, A.
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
Attwood, Angela S
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.
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.
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.
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...
Rowan, S.S.; Fitzsimmons, D.
This paper presents the fact and the fiction of consumer reactions to indoor air quality (IAQ). Now that the cat is out of the bag that IAQ is a problem, it's amazing to note the gyrations made to ignore the problem. The gyrations are logical, to a point, only to become illogical. A person's health and well-being are primary goals of our society's laws and regulations (i.e., protection of public health). However, public attitudes, reactions, and decisions are limiting factors to successful implementation of IAQ program elements. The authors look at some major sources of IAQ problems and the scientific, prescriptive solutions contained in our programs. They share some of the reactions to the IAQ measures. How is the homeowner reacting? What is the psychological impact? Does anyone care about the legal implications? The results of this pilot study allowed them to identify consumer preferences, and in many cases, identify underlying rationales. In turn, this information was compared to existing IAQ utility program elements. It allowed them to evaluate program elements within the context of consumer reaction and identify which elements were accomplishing desired/intended reactions, and which were not. Several utility program redesign recommendations are provided. This paper also includes some of the results of the National IAQ committee whose purpose is to propose IAQ items for the Uniform Building Code as it relates to the focus of this paper. Although this paper is based on experiences in the Pacific Northwest, the authors believe people are people, no matter where they live. Thus, you should find these lessons are of universal value
The benefits and concerns about treating foods with ionizing radiation are reviewed. Radioactivity cannot be induced in foods by treatment with gamma rays from 137 Cs or 60 Co, X-ray sources of 5 MeV or lower energy, or electrons of 10 MeV or lower energy. The evidence supports the safety and efficacy of using ionizing radiation for insect disinfestation of grains; dried spices, vegetables and fruits; and fresh fruit. Species and dose dependent phytotoxic and vitamin changes may occur in some fruits at greater doses than currently approved by the U.S. Food and Drug Administration. Irradiation can inactivate protozoan or helminth parasites and significantly decrease the probability of viable food-borne bacterial pathogens in fish, poultry, and red meats. The titers of amino acids, fatty acids, and vitamins of chicken meat sterilized by thermal, electron-beam, or gamma radiation are presented. On the whole, the data support the safely and efficacy of the process
In this series, the Bulletin aims to explain the role of the Ombuds at CERN by presenting practical examples of misunderstandings that could have been resolved by the Ombuds if he had been contacted earlier. Please note that, in all the situations we present, the names are fictitious and used only to improve clarity. Phil* was a candidate for a position in a different group from the one he had been working for. After his board had taken place, Phil asked for an appointment with the Ombuds. In his opinion, the interview went reasonably well. However Phil had some concerns as he had heard that there was no point in him applying as another candidate will get the position. He had decided to apply anyway, encouraged by other people, with the hope that he would get a good rating that could help him get a position in the future, if he didn't get present one. During the interview he was asked some questions that could only have been answered by candidates with experience related ...
Johnson, Robert J; Ettlinger, Carl F; Shealy, Jasper E
There are many commonly discussed myths about ski safety that are propagated by industry, physicians, and skiers. Through a review of the literature concerning 12 such topics, this article demonstrates that the following are untrue: (1) Broken legs have been traded for blown-out knees. (2) If you know your DIN (a slang term for release indicator value), you can adjust your own bindings. (3) Toe and heel piece settings must be the same to function properly. (4) Formal ski instruction will make you safer. (5) Very short skis do not need release bindings. (6) Spending a lot of money on children's equipment is not worth the cost. (7) Children need plenty of room in ski boots for their growing feet. (8) If you think you are going to fall, just relax. (9) Exercise can prevent skiing injuries. (10) Lower release settings can reduce the risk of anterior cruciate ligament injury. (11) Buying new ski equipment is safer than renting. (12) Skiing is among the most dangerous of activities. It is important for the skiing public, physicians, and all those interested in improving skiing safety to verify the measures they advocate. The statements analyzed here are simply untrue and have the potential to cause harm if taken as fact by those exposed to these unsupported opinions.
Mok, Yan Fung
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…
... 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...
... 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 ...
Massaut, V.; Dadoumont, J.
The article discusses experience acquired in the framework of the dismantling of the Belgian Reactor 3 (BR3). The BR3 is the first pressurised water reactor built in Europe and its operation stopped in 1987. In December 1989, an agreement was concluded between the European Commission and SCK·CEN to start the dismantling of the BR3 as a pilot project for the development and the demonstration of dismantling techniques. The BR3 dismantling project was particularly successful and involved several world premieres such as the full decontamination of the primary circuit of a PWR, the remote-handled cutting and the dismantling of the reactor vessel and the establishing of a workshop for advanced decontamination of reactor components in view of the free release of decontaminated materials. The article discusses technical aspects as well as issues related to the financing of the dismantling of nuclear power reactors. Different mechanisms that are applied for ensuring that the cost of dismantling is secured are discussed.
Braam, R.L.; Pieters, G.F.F.M.; Thien, Th.
Three patients diagnosed with primary hypertension suddenly developed hard-to-treat blood pressure after several years of stable blood pressure. One patient, a man aged 48 years, had developed a renal artery stenosis, which had not been present five years earlier. The other two patients, a man aged
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.
Hyperthyroidism is characterised by high levels of serum thyroxine and triiodothyronine, and low levels of thyroid-stimulating hormone (TSH). Thyrotoxicosis is the clinical effect of high levels of thyroid hormones, whether or not the thyroid gland is the primary source.The main causes of hyperthyroidism are Graves' disease, toxic multinodular goitre, and toxic adenoma.About 20 times more women than men have hyperthyroidism.
The analytical programme developed by the firm I.B.M. for ECAP electronic circuits, operated initially on the IBM 1620 computer with a certain limitation on the size of the network studied, but already equipped from the conversational angle (type-writer). The IBM 360 computers made it possible to increase the size of the network treated to 50 nodes and 200 branches, but the conversational aspect was suppressed in the ECAP 360 version. With a view to making use of the possibilities of hybrid computers, we have adapted this latter version to the EAI 8400 computer. Without diminishing it in any way, we have modified it so as to provide it with conversational characteristics by using the computers control panel; to give it still further flexibility we have made it possible to record curves during the calculation operation, and to obtain a division of the printed results. To obtain the curves, use was made of analog digital converters of the interface of the hybrid unit EAI 8900 of which the EAI 8400 computer represents the numerical section. The modifications made concern in particular the A.C. analysis and the transient analysis. They facilitate and complete the input of the data; they allow modifications to be made for the calculation of these analyses; they also improve the presentation of the results and facilitate their interpretation. They constitute finally the version ECASAC, i.e. the programme ECAP 360 made conversational by use of a type-writer, with automatic output of the curves. (author) [fr
Observational Study of Platelet Reactivity in Patients Presenting With ST-Segment Elevation Myocardial Infarction Due to Coronary Stent Thrombosis Undergoing Primary Percutaneous Coronary Intervention: Results From the European PREvention of Stent Thrombosis by an Interdisciplinary Global European Effort Registry.
Godschalk, Thea C; Byrne, Robert A; Adriaenssens, Tom; Malik, Nikesh; Feldman, Laurent J; Guagliumi, Giulio; Alfonso, Fernando; Neumann, Franz-Josef; Trenk, Dietmar; Joner, Michael; Schulz, Christian; Steg, Philippe G; Goodall, Alison H; Wojdyla, Roman; Dudek, Dariusz; Wykrzykowska, Joanna J; Hlinomaz, Ota; Zaman, Azfar G; Curzen, Nick; Dens, Jo; Sinnaeve, Peter; Desmet, Walter; Gershlick, Anthony H; Kastrati, Adnan; Massberg, Steffen; Ten Berg, Jurriën M
High platelet reactivity (HPR) was studied in patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) undergoing immediate percutaneous coronary intervention (PCI). HPR on P2Y 12 inhibitors (HPR-ADP) is frequently observed in stable patients who have experienced ST. The HPR rates in patients presenting with ST for immediate PCI are unknown. Consecutive patients presenting with definite ST were included in a multicenter ST registry. Platelet reactivity was measured before immediate PCI with the VerifyNow P2Y 12 or Aspirin assay. Platelet reactivity was measured in 129 ST patients presenting with STEMI undergoing immediate PCI. HPR-ADP was observed in 76% of the patients, and HPR on aspirin (HPR-AA) was observed in 13% of the patients. HPR rates were similar in patients who were on maintenance P2Y 12 inhibitor or aspirin since stent placement versus those without these medications. In addition, HPR-ADP was similar in patients loaded with a P2Y 12 inhibitor shortly before immediate PCI versus those who were not. In contrast, HPR-AA trended to be lower in patients loaded with aspirin as compared with those not loaded. Approximately 3 out of 4 ST patients with STEMI undergoing immediate PCI had HPR-ADP, and 13% had HPR-AA. Whether patients were on maintenance antiplatelet therapy while developing ST or loaded with P2Y 12 inhibitors shortly before undergoing immediate PCI had no influence on the HPR rates. This raises concerns that the majority of patients with ST have suboptimal platelet inhibition undergoing immediate PCI. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Zaryabova, Victoria; Israel, Michel
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.
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.
Koulaidis, Vasilis; Christidou, Vasilia
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)
... with any comments or concerns. February 17, 2011 Sex and prevention concerns for positive people Facebook Twitter ... partner, and vice versa. The reality of safer sex You put yourself at risk for infections through ...
A questionnaire survey was conducted in order to examine characteristics of death concern of nursing, medical and general students and to campare death concern levels of nursing students across grade levels. There were 539 valid responses of the students
Concerns and Discomforts of Pregnancy - Varicose Veins Varicose veins are enlarged veins you may see on your ... Healthy Roads Media project www. healthyroadsmedia. org English - Concerns and Discomforts of Pregnancy (Varicose Veins) Last reviewed ...
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…
The law defines the basic system of indemnification of nuclear damage by the operation of reactors to protect sufferers and help the sound development of atomic energy business. The operation of reactors means hereunder the operation of reactors, processing, reprocessing and the uses of nuclear fuel materials as well as transport, storage and disposal of nuclear fuel materials or things contaminated by them, which accompany with those procedures. The nuclear damage signifies injuries due to functions of fission of nuclear fuel materials or radiation or poisonous functions of things contaminated by them. When nuclear damage happens by the operation of reactors, the atomic energy enterpriser concerned shall indemnify the damage. Atomic energy undertakers shall not operate reactors without taking measures for compensation. The measures shall be the conclusion of nuclear damage compensation insurance contracts and indemnification contracts or the deposit. The amount of less than yen 10 milliards specified by the order and acknowledged by the Director General of Science and Technology Agency shall be allotted to the compensation by these measures for each works, enterprise or nuclear ship. The government shall assist atomic energy enterprisers to indemnify, when such compensation surpasses the amount assigned and the support is considered necessary. (Okada, K.)
Maharajan, Mari Kannan; Ranjan, Aruna; Chu, Jian Feng; Foo, Wei Lim; Chai, Zhi Xin; Lau, Eileen YinYien; Ye, Heuy Mien; Theam, Xi Jin; Lok, Yen Ling
The Zika virus outbreaks highlight the growing importance need for a reliable, specific and rapid diagnostic device to detect Zika virus, as it is often recognized as a mild disease without being identified. Many Zika virus infection cases have been misdiagnosed or underreported because of the non-specific clinical presentation. The aim of this review was to provide a critical and comprehensive overview of the published peer-reviewed evidence related to clinical presentations, various diagnostic methods and modes of transmission of Zika virus infection, as well as potential therapeutic targets to combat microcephaly. Zika virus is mainly transmitted through bites from Aedes aegypti mosquito. It can also be transmitted through blood, perinatally and sexually. Pregnant women are advised to postpone or avoid travelling to areas where active Zika virus transmission is reported, as this infection is directly linked to foetal microcephaly. Due to the high prevalence of Guillain-Barre syndrome and microcephaly in the endemic area, it is vital to confirm the diagnosis of Zika virus. Zika virus infection had been declared as a public health emergency and of international concern by the World Health Organisation. Governments and agencies should play an important role in terms of investing time and resources to fundamentally understand this infection so that a vaccine can be developed besides raising awareness.
Smith, Brian E.; Roelen, Alfred L. C.; den Hertog, Rudi
The Future Aviation Safety Team (FAST) is a multidisciplinary international group of aviation professionals that was established to identify possible future aviation safety hazards. The principle was adopted that future hazards are undesirable consequences of changes, and a primary activity of FAST became identification and prioritization of possible future changes affecting aviation. Since 2004, FAST has been maintaining a catalogue of "Areas of Change" (AoC) that could potentially influence aviation safety. The horizon for such changes is between 5 to 20 years. In this context, changes must be understood as broadly as possible. An AoC is a description of the change, not an identification of the hazards that result from the change. An ex-post analysis of the AoCs identified in 2004 demonstrates that changes catalogued many years previous were directly implicated in the majority of fatal aviation accidents over the past ten years. This paper presents an overview of the current content of the AoC catalogue and a subsequent discussion of aviation safety concerns related to these possible changes. Interactions among these future changes may weaken critical functions that must be maintained to ensure safe operations. Safety assessments that do not appreciate or reflect the consequences of significant interaction complexity will not be fully informative and can lead to inappropriate trade-offs and increases in other risks. The FAST strongly encourages a system-wide approach to safety risk assessment across the global aviation system, not just within the domain for which future technologies or operational concepts are being considered. The FAST advocates the use of the "Areas of Change" concept, considering that several possible future phenomena may interact with a technology or operational concept under study producing unanticipated hazards.
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 . 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 . Following the previous initial research results with this approach , and with the static version of the software MLE Energy , 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.
Campbell-Scherer, Denise; Sharma, Arya Mitra
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.
Vodicka, Elisabeth; Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G
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
Monzani, B; Rijsdijk, F; Anson, M; Iervolino, A C; Cherkas, L; Spector, T; Mataix-Cols, D
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.
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.
Graham, T.; Metcalfe, R.; Rhodes, D.; McInnes, D.
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)
Pedersen, Susanne S.; van Domburg, Ron T; Theuns, Dominic A M J
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....
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
Bailly, Jean; Pelce, Jacques
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
Fodor, Mark; Brem, Alexander
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...
... 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...
Perkins, Rebecca B; Clark, Jack A
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.
van den Bos, Paul
Purpose: The purpose of this paper is to address the concerns of beginning university teachers about learning to teach in the context of an induction programme. Design/methodology/approach: The author asked 162 beginning teachers at Dutch universities of applied sciences to express their concerns
Van Heerden, RP
Full Text Available This study focuses on the security concerns of IPv6. We make a broad introduction to IPv6 then briefly look at the differences between the IPv6 and IPv4 protocols, their known vulnerabilities and identify some security concerns when implementing IPv...
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,…
Van Heerden, RP
Full Text Available This study focuses on the security concerns of IPv6. A broad introduction to IPv6 is made then briefly the differences between the IPv6 and IPv4 protocols are looked at, their known vulnerabilities and this identifies some security concerns when...
Chronic diarrhea: A concern after gallbladder removal? I had my gallbladder removed six months ago, and I'm still having diarrhea. Is this ... mild diarrhea after cholecystectomy is not cause for concern, but speak to your doctor if you are ...
Fang, Angela; Sawyer, Alice T; Aderka, Idan M; Hofmann, Stefan G
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.
Xie, Xiaofei; Wang, Mei; Xu, Liancang
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.
Loring, David W; Larrabee, Glenn J; Meador, Kimford J; Lee, Gregory P
We performed principal component analysis (PCA) of the Epilepsy Foundation Concerns Index scale in 189 patients undergoing evaluation for epilepsy surgery. We identified a five-factor solution in which there were no varimax-rotated factors consisting of fewer than two questions. Factor 1 reflects affective impact on enjoyment of life, Factor 2 reflects general autonomy concerns, Factor 3 reflects fear of seizure recurrence, Factor 4 reflects concern of being a burden to one's family, and Factor 5 reflects a perceived lack of understanding by others. Multiple regression using the Quality of Life in Epilepsy--89 question version; Minnesota Multiphasic Personality Inventory--2; Wechsler Adult Intelligence Scale--third edition; and verbal and visual memory tests as predictors demonstrated a different pattern of association with the factor and summary scores. We conclude that the Epilepsy Foundation Concerns Index is multidimensional, and using a global score based on all items may mask specific concerns that may be relevant when applied to individual patients.
Estimation of maximum pressure in small containments of PWR reactors due to loss of coolant accident in primary circuit; Estimativa da pressao maxima em contencoes de reatores PWR de pequeno porte devido a um acidente de perda de refrigerante no circuito primario
Mendes Neto, Teofilo [Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, SP (Brazil); Moreira, Joao Manoel Losada [Centro Tecnologico da Marinha em Sao Paulo (CTMSP), SP (Brazil)
This work studies the problem of containment pressurization after a LOCA in reactors with small containment free volumes. The relationship between the reactor power and the containment free volume is described with the ratio between the volumes of the primary circuit and of the containment. The maximum pressure in a containment, following a LOCA, obtained after a correlation based on large containment PWR, is around 185 psia for a primary circuit and containment volumes ratio of 0.025. For the same problem, calculations with the CONTEMPT-LT code produced a maximum pressure of 162 psia. The behavior of the temperature after a LOCA to the containment, as a function of the ratio between the primary circuit and containment volume, is such that it increases reaching asymptotically to a maximum; differently, the pressure increases almost linearly with the ratio of volumes. (author)
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
Safi, Mohammed; Sun, Xiuhua; Wang, Lifen; Zhang, Xinwei; Song, Jicheng; Ameen, Mohammed
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
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.
Baldassarre, Maria Elisabetta; Di Mauro, Antonio; Pedico, Annarita; Rizzo, Valentina; Capozza, Manuela; Meneghin, Fabio; Lista, Gianluca; Laforgia, Nicola
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.
Jordan, Matthew R; Amir, Dorsa; Bloom, Paul
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).
Lampard, Amy M; Byrne, Susan M; Zubrick, Stephen R; Davis, Elizabeth A
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.
The Powder River Basin in northeastern Wyoming is one of the most active areas of coalbed natural gas (CBNG) development in the western United States. This resource provides clean energy but raises environmental concerns. Primary among these is the disposal of water that is co-produced with the gas during depressurization of the coal seam. Beginning with a few producing wells in Wyoming's Powder River Basin (PRB) in 1987, CBNG well numbers in this area increased to over 13,600 in 2004, with projected growth to 20,900 producing wells in the PRB by 2010. CBNG development is continuing apace since 2004, and CBNG is now being produced or evaluated in four other Wyoming coal basins in addition to the PRB, with roughly 3500-4000 new CBNG wells permitted statewide each year since 2004. This is clearly a very valuable source of clean fuel for the nation, and for Wyoming the economic benefits are substantial. For instance, in 2003 alone the total value of Wyoming CBNG production was about $1.5 billion, with tax and royalty income of about $90 million to counties, $140 million to the state, and $27 million to the federal government. In Wyoming, cumulative CBNG water production from 1987 through December 2004 was just over 380,000 acre-feet (2.9 billion barrels), while producing almost 1.5 trillion cubic feet (tcf) of CBNG gas statewide. Annual Wyoming CBNG water production in 2003 was 74,457 acre-feet (577 million barrels). Total production of CBNG water across all Wyoming coal fields could total roughly 7 million acre-feet (55.5 billion barrels), if all of the recoverable CBNG in the projected reserves of 31.7 tcf were produced over the coming decades. Pumping water from coals to produce CBNG has been designated a beneficial water use by the Wyoming State Engineer's Office (SEO), though recently the SEO has limited this beneficial use designation by requiring a certain gas/water production ratio. In the eastern part of the PRB where CBNG water is generally of good
McIsaac, Michelle L; Goeree, Ron; Brophy, James M
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.
Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas
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
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
... and Drugs" Home | Contact Us Special Concerns for Seniors Clostridium difficile - an introduction Clostridium difficile (“C. diff”) ... see APUA’s contribution to CDC’s Vital Signs campaign . Seniors are especially at risk People over the age ...
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A spill of uranium- and radium-contaminated water from a reservoir at the Key Lake Mine in northern Saskatchewan in early January 1984 created extensive public concern. Now attention is being focussed on the issue of worker safety
Analytical methods developed by EPA to identify and measure certain contaminants of emerging concern. These methods are not approved under 40 CFR Part 136, but may be of interest to regulated entities, permitting authorities, and the public.
Mokhtar, Mohd Faiz; Omar, Badrul; Nor, Nik Hisyamudin Muhd; Pauzi, Nur Fazlinda Mohd; Hasan, Sulaiman; Mohamed, W. A. Wan
Environment concern is one important aspect for supply chain sustainability (SCS). Nowadays, company's activities give a lot of impact on the environment. Through these activities, there are other SCS issue of environment were identified. In this paper, the proposed SCS issue of environmental concern will be determined from Corporate Sustainability Report (CSR). Using a total weightage of 0.333 (after dividing into three aspects of sustainability), each proposed issues will be classified according to the company activities in order to determined weightage for each issue. Those weightages then will be used in developing of score metric for SCS in design phase. Result shows that the carbon footprint is the major concern for SCS of environment while environmental management system is a lowest concern for SCS environment.
Nanotechnology in sustainable agriculture: Present concerns and future aspects. ... of those living in developing countries face daily food shortages as a result of ... applications in agricultural, food, and water safety that could have significant ...
... Text Size Email Print Share Health Concerns for Gay and Lesbian Teens Page Content Article Body Sexual activity Most teens, whether they are gay, lesbian, bisexual , or straight, are not sexually active. ...
Kappes, Andreas; Faber, Nadira S; Kahane, Guy; Savulescu, Julian; Crockett, Molly J
An optimistic learning bias leads people to update their beliefs in response to better-than-expected good news but neglect worse-than-expected bad news. Because evidence suggests that this bias arises from self-concern, we hypothesized that a similar bias may affect beliefs about other people's futures, to the extent that people care about others. Here, we demonstrated the phenomenon of vicarious optimism and showed that it arises from concern for others. Participants predicted the likelihood of unpleasant future events that could happen to either themselves or others. In addition to showing an optimistic learning bias for events affecting themselves, people showed vicarious optimism when learning about events affecting friends and strangers. Vicarious optimism for strangers correlated with generosity toward strangers, and experimentally increasing concern for strangers amplified vicarious optimism for them. These findings suggest that concern for others can bias beliefs about their future welfare and that optimism in learning is not restricted to oneself.
Hartmann, Stig; Haraszuk, Anni
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?...
The Comprehensive Oncologic Emergencies Research Network (CONCERN) was established in March 2015 with the goal to accelerate knowledge generation, synthesis and translation of oncologic emergency medicine research through multi-center collaborations.
Isolated systolic hypertension: A health concern? Is having a high top number (systolic) blood pressure, but a normal bottom number (diastolic) ... mm Hg, you have a common type of high blood pressure called isolated systolic hypertension. Isolated systolic hypertension can ...
Bibanov, T. P.
Lenin demonstrated his concern for youth and their education by exposing tsarism, initiating numerous plans and programs for improving the system of upbringing and education, and by emphasizing the importance of youth in the revolutionary struggle. (JB)
science, the first-order concern of philosophy is coming into ... intuition in space and time through its four branches ... medium for communication, the transmission of knowledge, ..... people their range of consciousness of truth, their ontology,.
With the emergence of physical activity programs geared specifically to senior citizens, family physicians will increasingly be called on to provide advice or approval concerning their patients' suitability for participation. In addition, family physicians have been identified as having a key role to play in the promotion of exercise for sedentary older adults. To assist the family practitioner in advising elderly patients concerning safe exercise patterns, this article discusses the document...
Kappes, A.; Faber, N. S.; Kahane, G.; Savulescu, J.; Crockett, M. J.
An optimistic learning bias leads people to update their beliefs in response to better-than-expected good news but neglect worse-than-expected bad news. Because evidence suggests that this bias arises from self-concern, we hypothesized that a similar bias may affect beliefs about other people’s futures, to the extent that people care about others. Here, we demonstrated the phenomenon of vicarious optimism and showed that it arises from concern for others. Participants predicted the likelihood...
Although modern offices have traditionally been thought to be among the safest places to work, over the past few years office workers have become concerned that video display terminals could be causing a variety of health problems. Extensive testing has occurred in many countries to determine if VDTs emit hazardous levels of ionizing or non-ionizing radiation. Results of these surveys suggest that radiation emissions are not of concern but that ergonomic factors in the office environment may need to be improved
Rabiy Hashemi M
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.
Murphy, Edel; Dooley, Barbara; Menton, Aoife; Dolphin, Louise
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.
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 ...
Sharma, S.S.; Mhetre, S.G.; Manna, M.M.
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
Neuberger, Lindsay; Silk, Kami J; Yun, Doshik; Bowman, Nicholas David; Anderson, Jennifer
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.
NEUBERGER, LINDSAY; SILK, KAMI J.; YUN, DOSHIK; BOWMAN, NICHOLAS DAVID; ANDERSON, JENNIFER
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
Nancy Chun Feng
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.
Eremita, Matthew; Semancik, Eileen; Lerer, Trudy; Dworkin, Paul H
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.
Rodrigue, James R; Schold, Jesse D; Mandelbrot, Didier A; Taber, David J; Phan, Van; Baliga, Prabhakar K
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.
Riaz, Ramsha; Hamid, Khizar
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.
Sovacool, Benjamin K.; Heffron, Raphael J.; McCauley, Darren; Goldthau, Andreas
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.
Grant, C.S.; Carpenter, P.; van Heerden, J.A.; Hamberger, B.
We retrospectively reviewed the clinical features, methods of diagnosis and localization, and results of treatment in 105 patients with primary aldosteronism seen between 1969 and 1981. Coincident with the use of computed tomography (CT), 131 I-6-beta-iodomethyl norcholesterol scans (NP-59), and postural response studies, the study group was temporally divided into pre-1976 and post-1976 groups, and subdivided into groups with aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) due to bilateral adrenal hyperplasia. Our results indicate that aldosterone postural response studies and CT differentiate and localize APA and IHA reliably. Adrenalectomy is a safe and effective treatment for APA, whereas medical treatment alone is preferable for IHA
Meijler, D P M; van Mossevelde, P W J; van Beek, R H T
Two children were admitted to a medical centre due to dehydration after an oral injury and the extraction of a tooth. One child complained of "mouth broken". Dehydration is the most common water-electrolyte imbalance in children. Babies and young children are prone to dehydration due to their relatively large body surface area, the high percentage extracellular fluid, and the limited ability of the kidneys to conserve water. After the removal ofa tooth, after an oral trauma or in case of oral discomfort, a child is at greater risk of dehydration by reduced fluid and food intake due to oral pain and/or discomfort and anxiety to drink. In those cases, extra attention needs to be devoted to the intake of fluids.
Belgium is an attractive country to work in, not just for doctors but for all Spanish workers, due to it having the headquarters of European Union. The health job allure is double; on the one hand, the opportunity to find a decent job, and on the other, because it is possible to develop their professional abilities with patients of the same nationality in a health system with a different way of working. The Belgium health care system is based on security social models. Health care is financed by the government, social security contributions, and voluntary private health insurance. Primary care in Belgium is very different to that in Spain. Citizens may freely choose their doctor (general practitioner or specialist) increasing the lack of coordination between primary and specialized care. This leads to serious patient safety problems and loss of efficiency within the system. Belgium is a European country with room to improve preventive coverage. General practitioners are self-employed professionals with free choice of setting, and their salary is linked to their professional activity. Ambulatory care is subjected to co-payment, and this fact leads to great inequities on access to care. The statistics say that there is universal coverage but, in 2010, 14% of the population did not seek medical contact due to economic problems. It takes 3 years to become a General Practitioner and continuing medical education is compulsory to be revalidated. In general, Belgian and Spaniards living and working in Belgium are happy with the functioning of the health care system. However, as doctors, we should be aware that it is a health care system in which access is constrained for some people, and preventive coverage could be improved. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Murugupillai, Roshini; Wanigasinghe, Jithangi; Muniyandi, Ravi; Arambepola, Carukshi
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.
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
Mankind now enjoys many benefits from nuclear-related technologies. There is, however, growing concern in many OECD countries that nuclear education and training is decreasing, perhaps to problematic levels. This booklet, a summary of the full report, conveys the results of a pioneering survey on nuclear education and training in almost 200 organisations in 16 countries. The current situation is presented and causes for concern are examined. Recommendations are made as to the actions governments, academia and industry must take in order to assure that crucial present requirements are met and future options are not precluded. (authors)
Koch, Alexander; Morgenstern, Albrecht
concerns arise. The effects of career concerns can both be 'good' (enhancing incentives for effort in developing ideas) and 'bad' (preventing voluntary coordination). Our model shows how a firm can take these conflicting forces into account through the design of its explicit incentive system and the way......A firm's innovation process requires employees to develop novel ideas and to coordinate with each other to turn the tacit knowledge embodying these ideas into better products and services. Such work outcomes provide signals about employees' abilities to the labor market, and therefore career...
Wistoft, Karen; Qvortrup, Lars
and behavioral mental health interventions, while the latter defines wellbeing in positive terms with a focus on wellbeing as the result of learning and with pedagogical interventions that only indirectly can support the individual’s learning activity. The former sees wellbeing as the result of a “wellbeing cure......The article concerns the current discourses concerning well-being with the point that it is important to make a distinction between a healthcare oriented discourse and a learning oriented discourse. The former defines wellbeing in negative terms and looks at causally oriented aspects of wellbeing......”, while the latter sees wellbeing as the result of wellbeing learning processes....
Koch, Alexander; Morgenstern, Albrecht
To innovate, firms require their employees to develop novel ideas and to coordinate with each other to turn these ideas into products, services or business strategies. Because the quality of implemented designs that employees are associated with affects their labor market opportunities, career...... concerns arise that can both be ‘good’ (enhancing incentives for effort in developing ideas) and ‘bad’ (preventing voluntary coordination). Depending on the strength of career concerns, either group-based incentives or team production are optimal. This finding provides a possible link between the increased...
Baldacchino, G.; Vigneron, G.; Pommeret, St.
We have studied the impact of temperature on the water radiolysis formation rate of the hydrous electron in presence of selenate di-anion SeO 4 2+ . We have used a high temperature (up to 500 Celsius degrees) optical cell coupled to the electron accelerator Alienor. It appears that the capture of the hydrous electron by selenate follows an Arrhenius law till the sub-critical range, beyond this range the kinetics of the reaction seems more erratic. We have also studied the capture of the hydrous electron by methyl-viologen (MV 2+ ) at 20 and 380 Celsius degrees. It seems that at high temperature more hydrous electrons are produced, it might be interpreted as a consequence of the shift toward the right of the following equilibrium reaction: OH - + H . ↔ e - (aq) + H 2 O. All these results need to be confirmed. (A.C.)
Ana L. Campos Arbulú
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
Krantz, Mori J; Mehler, Philip S
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.
Leichner, Edward C.; Blackstone, Sidney
This article addresses due process requirements in the nonrenewal and dismissal of tenured and nontenured teachers. The Georgia Fair Dismissal Law is used as a basis for discussing the grounds for teacher dismissal. Dismissal grounds discussed are 1) incompetency; 2) insubordination; 3) willful neglect of duties; 4) immorality; 5) inciting,…
Bateman, David F.
William is 9 years of age, residing with his parent within the boundaries of an unnamed district ("the District"). As a student with autism he is eligible for special education programming and services. There was one issue presented for this due process hearing: What was the appropriate program and placement for him for the 2008-2009 school year?…
Kraaij-Dirkzwager, Marleen; van der Ree, Joost; Lebret, Erik
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.
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.
Clark, Gerard J.
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…
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,…
Burger, Joanna; Greenberg, Michael
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
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
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.)
Touzé, T; Missiaen, D
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.
Sessa, Alessandra; Di Giuseppe, Gabriella; Marinelli, Paolo; Angelillo, Italo F
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.
Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary
Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…
In this study, environmental concern has been conceptualised as the manifestation of attitudes that are directed at behavioural intentions of active personal involvement in caring about environmental matters. Based on a critique of theoretical approaches towards understanding the formation of environmental attitudes, ...
Pallesen, Trine; Holm Jacobsen, Peter
aggregators and reconfigures existing market actors. In this paper, we study a case, EcoGrid 2.0 on the Danish island Bornholm, as a case of a ‘marketized’ solution to the infrastructural concerns emerging from the large share of fluctuating wind power in the system. The market design involves transforming...
Feezel, Jerry D.; Myers, Scott A.
Finds that graduate teaching assistants (GTAs) experience eight interrelated types of communication concern (self, task, impact, role conflict, teaching, area knowledge, procedural knowledge, and time management). Shows that GTA variables of expected duties, prior teaching experience, newness to area, foreign or domestic birth, and age are likely…
Harrison, Therese W.
With threats of being labeled abnormal or facing rejection, homosexual adolescents are pressured to hide their sexual identities. To provide optimal anticipatory guidance and support, professionals must understand the natural development of sexual attraction and the disclosure concerns and risks for developing homosexual adolescents (e.g., risk…
EDF and GDF, the French government owned electric power and gas utilities have jointly decided to improve their employment and employee situation with the hiring of 11000 to 15000 young people for a 3-year period and the reduction of the working hours. A european disagreement is to be judged concerning electric power and gas import and export monopolies in several european countries
Yadav, Monika; Das, Ajay; Sharma, Sushama; Tiwari, Ashwini
This study examined the concerns of regular elementary school teachers in Gurgaon, India, in order to work with students with disabilities in inclusive education settings. A total of 175 teachers responded to a two-part questionnaire. Data were analyzed using descriptive and inferential statistics. The data indicated that the teachers in Gurgaon,…
A major concern to anyone involved in the alcoholism field is the basic understanding of alcoholism as a disease that Hispanics have not yet completely accepted. Hispanics have usually labeled the use of alcoholic beverages as being embedded into Hispanic culture and have viewed alcoholism as an individual weakness to be endured in silence. (NQ)
Problems and principles of domestic sanitary legislation, concerning population radiation protection, are considered. The legislation envisages preventive measures, directed to contamination preventation of the main environmental objects, it regulates their content in the objects, their human intake and ionizing radiation doses, which might affect population. Existing domestic hygienic guides and safety standards for personnel and population are enumerated and characterized
Ryan, Joseph B.; Katsiyannis, Antonis; Counts, Jennifer M.; Shelnut, Jill C.
There have been an increasing number of incidents in which school resource officers (SRO) have been used to manage student disciplinary issues with disastrous results. Court cases brought by parents and advocacy groups claim SROs have traumatized and injured students. This article addresses several critical issues concerning SROs being used to…
Mary M. Rowland; Lowell H. Suring; Matthias Leu; Steven T. Knick; Michael J. Wisdom
Selection of species of concern is a critical early step in conducting broad-scale ecological assessments for conservation planning and management. Many criteria can be used to guide this selection, such as conservation status, existing knowledge base, and association with plant communities of interest. In conducting the Wyoming Basins Ecoregional Assessment (WBEA), we...
Full Text Available The main purpose of our study is to provide evidence the practically consideration of auditor judgement on going concern opinion. By using quasi experimental, we found strong evidence that auditors' judgement is affected by financial indicators, evidence, and disclosure. We have another finding that consensus among auditors' judgement and the interaction effects between the three independent variables is significant.
Lago, Patricia; Avgeriou, Paris; Hilliard, Rich
As noted earlier, some stakeholder concerns are well-served today by available architecture viewpoints, frameworks, or ADLs, while others aren't expressible with available, off-the-shelf approaches. Hence the theme of this special issue: exploring the space of architecting in the face of multiple
Szakonyi, Gergely; Zelkó, Romána
The present paper summarizes the commonly applied types of drug uptake and the pharmacists' advice concerning a certain dosage form. The manuscript also deals with the modified release dosage forms and their abbreviations in the name of the marketing authorized products.
This podcast discusses the special concerns many older adults face during a disaster. It is primarily targeted to public health and aging services professionals. Created: 1/26/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) and Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER). Date Released: 1/26/2009.
Full Text Available WLANs have become the network of choice over the years due to its many benefits however due to this very reason many threats have become associated to it and is the focus of this paper. The paper also highlights mitigation techniques to tackle the listed threats along with some best practices.
Full Text Available Autoerotic death is a very rare case in forensic medicine. It is usually caused by asphyxia, but other reasons are also possible. Herein we present a case of autoerotic death due to electrocution caused by a self-made electrical device. The device was constructed to increase sexual feelings through stimulation of the scrotal area.
Escareno J, E.; Vega C, H. R.
The dose due to 40 K has been estimated. Potassium is one of the most abundant elements in nature, being approximately 2% of the Earth's crust. Potassium has three isotopes 39 K, 40 K and 41 K, two are stable while 40 K is radioactive with a half life of 1.2x10 9 years; there is 0.0117% 40 K-to-K ratio. Potassium plays an important role in plants, animals and humans growth and reproduction. Due to the fact that K is an essential element for humans, 40 K is the most abundant radioisotope in human body. In order to keep good health conditions K must be intake at daily basis trough food and beverages, however when K in ingested above the requirements produce adverse health effects in persons with renal, cardiac and hypertension problems or suffering diabetes. In 89.3% 40 K decays to 40 C through β-decay, in 10.3% decays through electronic capture and emitting 1.46 MeV γ-ray. K is abundant in soil, construction materials, sand thus γ-rays produced during 40 K decay contribute to external dose. For K in the body practically all 40 K decaying energy is absorbed by the body; thus 40 K contributes to total dose in humans and it is important to evaluate its contribution. In this work a set of 40 K sources were prepared using different amounts of KCl salt, a γ-ray spectrometer with a NaI(Tl) was characterized to standardized the sources in order to evaluate the dose due to 40 K. Using thermoluminescent dosemeters the dose due to 40 K was measured and related to the amount of 40 K γ-ray activity. (Author)
Boyle, Breidge; Addor, Marie-Claude; Arriola, Larraitz
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....
To, Kelvin K W; Tsang, Alan K L; Chan, Jasper F W; Cheng, Vincent C C; Chen, Honglin; Yuen, Kwok-Yung
In December 2013, China reported the first human case of avian influenza A(H10N8). A 73-year-old female with chronic diseases who had visited a live poultry market succumbed with community-acquired pneumonia. While human infections with avian influenza viruses are usually associated with subtypes prevalent in poultries, A(H10N8) isolates were mostly found in migratory birds and only recently in poultries. Although not possible to predict whether this single intrusion by A(H10N8) is an accident or the start of another epidemic like the preceding A(H7N9) and A(H5N1), several features suggest that A(H10N8) is a potential threat to humans. Recombinant H10 could attach to human respiratory epithelium, and A(H10N4) virus could cause severe infections in minks and chickens. A(H10N8) viruses contain genetic markers for mammalian adaptation and virulence in the haemagglutinin (A135T, S138A[H3 numbering]), M1(N30D, T215A), NS1(P42S) and PB2(E627K) protein. Studies on this human A(H10N8) isolate will reveal its adaptability to humans. Clinicians should alert the laboratory to test for A(H5,6,7,9,10) viruses in patients with epidemiological exposure in endemic geographical areas especially when human influenza A(H1,3) and B are negative. Vigilant virological and serological surveillance for A(H10N8) in human, poultry and wild bird is important for following the trajectory of this emerging influenza virus. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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.
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.
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.
Chocron, M.; Fabbri, S.; Mizrahi, R.; Savino, E.J.; Versaci, R.A.
One of the main activities to be undertaken by CNEA will be to provide technological assistance to NASA in problems concerning NPP operation. Works on life extensions of NPP are included in these activities. To fulfill these requirements the Atomic Energy National Commission (CNEA) has constituted a technical committee for Nuclear Power Plants Support (CAPCEN). CAPCEN should be the knowledge reservoir of those issues concerning the performance, safety and life extension of Nuclear Power Plants. One of CAPCEN's most important activities is to promote research work connected with such issues. The main technical areas are: Pressure Vessel and Piping, Heat Exchanges and Fuel Channels and Reactor Inner Components. Efforts are focused on the identification of the main components susceptible of ageing, the study of their ageing mechanisms, the follow-up of their behaviour during operation, and the measures taken to extend their life. (author)
This paper reports that environmental concerns have leapt to the forefront of industry's concerns in operating in Latin America. The United Nations Conference on Environment and Development in Rio de Janeiro June 3-14 focused a strong world spotlight on the region's environmental and commercial resources. Protection of the region's rain forests, which accounts for a huge share of the world's total, is emerging as an especially contentious issue. Ecuador's Oriente region may well prove the litmus test of how or whether oil and gas companies are able to operate in Latin American rain forests. Controversy over industry operations in the Oriente have heated to the point that environmentalist and native groups have routinely picketed company offices in Quito and used mass fundraiser mailings in North America
Full Text Available The objectives of the present research are related to the approaches concerning the “performance audit” concept in the specialized literature and practice as well as the clear delimitation of this concept of financial audit and internal audit. For a clear emphasis of the objectives and principles of the performance audit, I highlighted the similarities and differences among the three types of audit by means of several criteria such as: audit standards, audited subjects, nature of the audit evidence, manners of assessment. Within this basically predominant research, I used several research methods and techniques such as: the critical analysis of the bibliographic sources concerning the performance audit, the documentation related to the international audit standards, comparative studies.
Background: The increasing number of children defined as overweight or obeseis causing concern among politicians and health advocates; several countries havelaunched policies addressing the issue.Method: The paper presents an analysis of how the childhood obesity is defined,explained and suggested...... policies to address the problem from the WHO, the EU,Canada, England and New Zealand.Results: Considering the dramatic language used when describing childhood obe-sity, the proposed interventions are modest. Either the politicians do not considerthe problem that great after all, or other concerns...... by evidence, and the evidence cited is sometimesmisinterpreted or disregarded.Conclusion: There is a discrepancy between how the problem of childhood obe-sity is presented as alarming and the modest measures suggested....
Chicken pox is a common viral infection presenting with fever and discrete vesicular lesions. This infection can be widely detected in developing countries, especially for those tropical countries. The pregnant can get chicken pox, and this becomes an important obstetrical concern. In this specific paper, the author hereby details and discusses on chicken pox in pregnancy. Clinical presentation, diagnosis, treatment, and prevention are briefly summarized. In addition, the effects of chicken pox on pregnancy as well as the vertical transmission are also documented.
A pandemic is a human medical problem but must be understood at multiple levels. Analysis of social and commercial forces is vital, and, more comprehensively, an ecological framework is necessary for an inclusive picture. Ecological health webworked with political and social determinants surrounds issues of human health. In this constellation of both natural and social factors, ethical concerns will arise at these multiple levels, from human health to the conservation and health of wild nature.
The objectives of the present research are related to the approaches concerning the “performance audit” concept in the specialized literature and practice as well as the clear delimitation of this concept of financial audit and internal audit. For a clear emphasis of the objectives and principles of the performance audit, I highlighted the similarities and differences among the three types of audit by means of several criteria such as: audit standards, audited subjects, nature of the audit ev...
Tae G. Ryu; Chul-Young Roh
In this study, we expand on several previous studies related to the materiality judgments and the auditor's propensity to issue a going-concern opinion to financially troubled but non-bankrupt companies. We test the auditor's materiality thresholds by investigating whether there is any significant difference in accuracy among audit firms, especially between Big Six (Five) and non-Big Six (Five) audit firms. Binary logit regression is used to analyze 1,332 firms that were non-bankrupt but fina...
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.
von Rohr, Claudia Rudolf; Koski, Sonja E; Burkart, Judith M; Caws, Clare; Fraser, Orlaith N; Ziltener, Angela; van Schaik, Carel P
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.
Asensio-Sánchez, V M; Gonzalez-Buendia, L; Marcos-Fernández, M
A case of maculopathy due to "poppers" is described. Poppers is a drug composed of various forms of alkyl nitrite. A 39 year-old man, who had been using poppers for years, was seen in the clinic with phosphenes, reduced visual acuity and central scotoma. The SD-OCT in the right eye showed disruption at the level of the IS/OS junction line. The SD-OCT scan in the left eye showed an outer rectangular retinal hole and an outer retinal cyst. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.
Bruner, Heather C.
Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.
Bruner, Heather C; Bruner, David I
Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.
Gomez-Lazaro, Emilio; Munoz-Benavente, Irene; Hansen, Anca Daniela
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...
The US Nuclear Regulatory Commission published a policy statement last summer on ''below regulatory concern'' (BRC), which exempted small quantities of radioactive material from regulatory control and would allow the deregulated disposal of some low level waste. The policy drew opposition from several groups. NRC is not planning to revise its BRC policy statement, but wants to develop a concensus on how to implement the policy. Although the Commission's publication of a long needed policy framework for guiding exemption decisions should be welcomed by those of us who have been concerned with making such decisions, there is an urgent need for further consensus building. The policy statement offers only broad guidelines, some of which could be confusing and seem contradictory. The policy statement by itself could further erode public confidence in the NRC's commitment to specific limits of risk, and the ability of its staff to independently evaluate the risks. Another reason why it is appropriate and urgent to embark upon consensus building involving all parties and the public, is that the risks of low level radioactive waste disposal as practiced and proposed in the United States have long been exaggerated in biased reports that receive most media attention. A consensus process needs to be established so that the public can have confidence that its concerns have been properly addressed. (author)
Gao, Xuexian; Zheng, Haidong
Environmental regulators often use environmental policy to induce green investment by firms. However, if an environmental policy fails to exert a long-run effect on regulating the economic agents' behavior, it may be more reasonable to think of the firm as the leader in the game, since the investment in green technology is usually a strategic decision. In this paper, we consider a three-stage Stackelberg game to address the interaction between a profit-maximizing firm (Stackelberg leader) facing emission-dependent demand, and the environmental regulator (Stackelberg follower). The firm decides on the green technology level in the first stage of the game based on its understanding of the regulator's profits function, especially an environmental concern that is introduced as an exogenous variable. In the current research, we show that high levels of the regulator's environmental concerns do not necessarily lead to the choice of green technology by the firm, and green investment level depends on the combined effects of the market and operational factors for a given level of the regulator's environmental concerns. The result also shows that increasing environmental awareness amongst the consumers is an effective way to drive the firm's green investment.
Full Text Available Environmental regulators often use environmental policy to induce green investment by firms. However, if an environmental policy fails to exert a long-run effect on regulating the economic agents’ behavior, it may be more reasonable to think of the firm as the leader in the game, since the investment in green technology is usually a strategic decision. In this paper, we consider a three-stage Stackelberg game to address the interaction between a profit-maximizing firm (Stackelberg leader facing emission-dependent demand, and the environmental regulator (Stackelberg follower. The firm decides on the green technology level in the first stage of the game based on its understanding of the regulator’s profits function, especially an environmental concern that is introduced as an exogenous variable. In the current research, we show that high levels of the regulator’s environmental concerns do not necessarily lead to the choice of green technology by the firm, and green investment level depends on the combined effects of the market and operational factors for a given level of the regulator’s environmental concerns. The result also shows that increasing environmental awareness amongst the consumers is an effective way to drive the firm’s green investment.
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.
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)
Berlin, M.; Cauvin, M.
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
Znamirovschi, V.; Mastan, I.; Cozar, O.
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)
Couvreur, V.; Carminati, A.; Rothfuss, Y.; Meunier, F.; Vanderborght, J.; Javaux, M.
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.
Girling, Jane E; Hawthorne, Samuel Cj; Marino, Jennifer L; Nur Azurah, Abdul G; Grover, Sonia R; Jayasinghe, Yasmin L
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.
Wright, R Eric; Reed, Nia; Carnes, Neal; Kooreman, Harold E
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
Snyder, Barbara K; Burack, Gail D; Petrova, Anna
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.
Philips, H; Rotthier, P; Meyvis, L; Remmen, R
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.
Cos Welsh, J; Espinosa de los Monteros, A; de la Luz Ajuria, M; Morillo Almao, E
Three sisters of 27 7/12, 13 8/12 and 9 1/12 years of age, respectively, with proportionate dwarfism, high pitched voice and lack of sexual development are described. All the patients had very low serum levels of immunoreactive growth hormone (GH), as well as of LH and FSH. Hypoglycemia induced by insulin and arginine infusion failed to increase GH levels, and the administration of the hypothalamic LH-FSH releasing hormone (LH-RH) did not elicit any response in the secretion of gonadotropins. The oldest sister developed hypothyroidism in recent years, since the I131 thyroid uptake was normal ten years before; her serum TSH was low and did not change with TRH stimulation. In addition, a low pituitary ACTH reserve was demonstrated by the hypoglycemia and metirapone tests. Case 2 showed partial pituitary TSH and ACTH reserve, whereas the youngest child only had low TSH pituitary reserve. These patients had all the clinical and laboratory characteristics of familial panhypopituitarism, with normal sella turcica. Genetic transmission in this cases is consistent with the autosomal recessive form, which is the most frequent type of inheritance of this entity. Consanguinity can not be ruled out. The results of the hypothalamic-pituitary functional tests apparently suggest that the primary defect could be located at the pituitary level. It is also possible that the pathological process may have a progressive evolution.
DeCarle, Donald W.
In dystocia caused by abnormal conditions of the soft parts, the etiologic changes may be either in the genital tissues or in adjacent soft structures. Broadly, the conditions causing the difficulty may be grouped as follows: (1) anomalies or congenital modifications; (2) tumors; (3) modifications due to age, accident or surgical operations; (4) modification of the expulsive forces; (5) abnormalities of the products of conception. Often in such circumstances cesarean section is necessary. Sometimes when tumor is present it can be removed before it interferes with delivery, but decision to excise the growth must be guided by such factors as the location of the lesion and the stage of gestation. This would determine to what extent the maintenance of pregnancy would be jeopardized by surgical intervention before term. PMID:13190430
Hales, T; Seligman, P J; Newman, S C; Timbrook, C L
Each year in the United States, an estimated 800 to 1,400 people are murdered at work, and an unknown number of nonfatal injuries due to workplace violence occur. Based on Ohio's workers' compensation claims from 1983 through 1985, police officers, gasoline service station employees, employees of the real estate industry, and hotel/motel employees were found to be at the highest risk for occupational violent crime (OVC) injury and death. Grocery store employees, specifically those working in convenience food stores, and employees of the real estate industry had the most reported rapes. Four previously unidentified industries at increased risk of employee victimization were described. Identification of industries and occupations at high risk for crime victimization provides the opportunity to focus preventive strategies to promote employee safety and security in the workplace.
Full Text Available Background. Invagination of the vermiform appendix is a very rare occurrence. We summarize epidemiologic and etiologic factors, types of classification, symtomatology, diagnostic features and treatment.Patients and treatment. The authors present 49-years old female with long-standing abdominal pains, who came in our hospital due to acute exacerbation with sever abdominal pain. Because of progressive symptoms and sensitivity in the right-lower abdominal quadrant a diagnostic laparoscopy was performed. An anomaly of cecum and the absence of appendix vermiformis have forced us to proceed with laparotomy in McBurnay point. After cecotomy an invaginated gangrenous appendix was found. The histological examination revealed endometriosis.Conclusions. By presenting this extremely rare pathology we also want to emphasize the important role of diagnostic laparoscopy in front of acute abdomen.
The trend in flying at higher altitudes and latitudes results in increased exposure to cosmic radiation. The biological incidence of highest energy particles and heavy ions is not well documented. Crew members flying transpolar routes are already exposed to levels of about 6 mSv.y -1 , and are expected to exceed this level in a number of cases. Epidemiological studies are important in risk assessment. Organisation of monitoring campaigns, aircrew information, solar flares and related high levels of exposures, pregnancy related issues, medical control, recognition of occupational exposure during illness, including cancer cases, and social protection, are also major concerns. (author)
In this presentation I would like to share with you the way in which the Australian Communications Authority (ACA) goes about 'managing' community issues relating to the RF spectrum. In particular, I would like to refer to community issues associated with concerns about health. I will refer only briefly to the siting of mobile phone base stations as that will be covered elsewhere. Before getting into the community issues, I would like to provide some context about the ACA and the arrangements it has for regulating radiofrequency electromagnetic radiation (RF EMR). Copyright (2001) Australasian Radiation Protection Society Inc
Cancino, Juliana; Marangoni, Valeria S.; Zucolotto, Valtencir
The recent advances in the development of nanomaterials have opened new and exciting opportunities for their applications in medicine. These applications include molecular imaging, drug-delivery, and photothermal therapy. Despite the progress in medicinal applications of nanomaterials, several key problems remain unaddressed. Recent advances in this area include the enhancement of sensitivity in early diagnosis and therapy, in addition to investigations into the possible toxicity of nanomaterials. However, since little is known about the toxicity of nanomaterials, the regulation of these materials is a slow and complex process. This paper reviews the current scenario in the applications of nanomaterials in medicine as well as the main concerns and regulatory questions. (author)
Leth, Peter Mygind
Post mortem examination report concerning Nadim Nuwawara, 17-years old, who was killed may 15 2014 in Beitunia near Rahmallah, Palestine. The examination was performed by an international team consisting of dr. Saber Al-Aloul, director of the Medico Legal Institute at Quds University, dr. Marc A....... Krouse, Deputy Chief Medical Examiner, Office of Chief Medical Examiner, Fort Worth, Texas, USA, dr. Chen Kugel, Chief Forensic Pathologist, Abu Kabir Institute of Forensic Medicine, Tel Aviv, dr. Ricardo Pablo Nachman, forensic expert at Abu Kabir Institute of Forensic Medicine, Tel Aviv and dr. Peter...
Separation of concerns by explicit aspectualization is but one tool in a more complex toolbox. In particular, integration of separately expressed aspects must also be considered, and this integration may be so tight that the aspects cannot be expressed fully independently in the rst place......, uncovering a tree of dimensions which may be used to characterize various approaches. However, this analysis does not go into the nature of integration, and hence an example of a tight integration of aspects and types is covered in more detail....
Victor Raj, D.; Livingstone, Roshan Samuel
Interventional radiological procedures are on the increase by virtue of the fact that these procedures replace highly invasive surgical and other procedures. Radiation dose to patients and hospital workers are of significance since these procedures tend to impart large dose to them. Moreover, long term risk from radiation absorbed by patients is of concern since the life expectancy of major fraction of patients is long after undergoing the procedure. This study intends to measure radiation dose imparted to patients as well as personnel- radiologists, technologists, nurses, etc. and estimate the risk factor involved
Lee, Peter A; Reiter, Edward O
Long before adolescence, males hear insinuations about adequacy of penis size. This concern may heighten during teen years and persist to varying degrees into adulthood. Men tend to underestimate their own penis size. This chapter provides objective information about anatomy and growth of the penis, including data about normal sizes. Published data indicate that, although full growth may be reached at different ages during adolescence, size is similar for most adult males. Hopefully, this information will provide the basis for teenaged males to develop a healthy perspective and to avoid intimidation by unfounded claims about sexual enhancement or size enlargement techniques.
Choi, Eun Kyung; Cho, Moon June; Ha, Sung Whan; Park, Charn Il; Bang, Young Ju; Kim, Noe Kyung
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
... which cause different symptoms. Semantic variant primary progressive aphasia Symptoms include these difficulties: Comprehending spoken or written ... word meanings Naming objects Logopenic variant primary progressive aphasia Symptoms include: Having difficulty retrieving words Frequently pausing ...
... Vestibular schwannoma (acoustic neuroma) - adults; Meningioma - adults; Cancer - brain tumor (adults) ... Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, ...
Full Text Available Background. Primary ovarian malignant melanoma is extremely rare. It usually appears in the wall of a dermoid cyst or is associated with another teratomatous component. Metastatic primary malignant melanoma to ovary from a primary melanoma elsewhere is well known and has been often reported especially in autopsy studies. Case report. We presented a case of primary ovarian malignant melanoma in a 45- year old woman, with no evidence of extraovarian primary melanoma nor teratomatous component. The tumor was unilateral, macroscopically on section presented as solid mass, dark brown to black color. Microscopically, tumor cells showed positive immunohistochemical reaction for HMB-45, melan-A and S-100 protein, and negative immunoreactivity for estrogen and progesteron receptors. Conclusion. Differentiate metastatic melanoma from rare primary ovarian malignant melanoma, in some of cases may be a histopathological diagnostic problem. Histopathological diagnosis of primary ovarian malignant melanoma should be confirmed by immunohistochemical analyses and detailed clinical search for an occult primary tumor.
Harrison, Therese W
Development of sexual identity in middle childhood and early adolescence is a natural process. However, it is more stressful for homosexual adolescents. Society continues to stigmatize and marginalize homosexuality. To avoid rejection and hostility, homosexual adolescents are pressured to hide their sexual identities. This fact compounds the anticipated normal developmental concerns of adolescence, and can create unique problems for the homosexual adolescents. Homosexuality can place them at risk for social stigmatization, isolation, depression, suicide, abuse, and rejection by their families and friends. During this exceptionally stressful time, both adolescent students and their families need anticipatory guidance and support. In providing anticipatory guidance, this article discusses critical roles played by professionals who work with adolescents in community or school settings. Included are insights into development of this normal variant of sexual attraction and orientation, risks that homosexual adolescent students may face as well as their disclosure concerns, and possible reactions families may have following disclosure. Supporting homosexual adolescents and their families is emphasized with regard to sensitively providing information, disclosure decisions, coping with stigmatization, and resiliency factors.
This Law aims at determining the basic system concerning indemnification for nuclear damage caused by the operation of reactors, fabrication, reprocessing and use of nuclear fuel materials as well as the transportation, storing or disposal of such materials or those contaminated by such materials (including fission products) accompanying these operations in view of protecting the sufferers and contributing to the wholesome development of atomic energy enterprises. The ''nuclear damage'' referred to in this Law is the damages caused by the action during the process of fission of nuclear fuel materials or the action of radiation or the poisonous action of said nuclear fuel materials or matters contaminated by said materials (those causing poisoning or deuteropathy in human bodies by taking in or inhaling such materials). Upon giving nuclear damage by the operation of reactors and others, the atomic energy entrepreneurs concerned are responsible for indemnifying the damage. Atomic energy entrepreneurs should not operate reactors without first taking the measures for indemnifying nuclear damages. Said measures are conclusion of nuclear damage indemnification responsibility insurance contract and nuclear damage indemnification contract or deposit, by which 6,000 million yen may be earmarked for such indemnification per factory, place of business or nuclear ship
European Union (E.U.) produces only half its needs concerning energy. It is expected that by 2030, the energy balance will be 86% for fossil energies, 8% for renewable energies and 6% for nuclear energy. Different scenario show that the dependence of E.U will worsen and reach 70% unless a common strategy is launched to curb the tendency. E.U is elaborating a common policy concerning energy, this policy rests on 4 axis: 1) monitoring the increase of the energy consumption by promoting energy savings in housing and transport, 2) directing the energy demand towards less polluting energy by using taxes, public funding and European regulations as incentive tools, 3) sustaining a constant dialogues with energy exporting countries in order to get a more stable energy market and have a benefiting influence on prices, and 4) developing new routes of importation of energy by for instance contributing to the construction of new oil or gas pipeline networks. (A.C.)
Dandolo, A; Prajs, N; Lizop, M
Hemorrhagic fever with renal syndrome (HFRS) is due to an infection by the virus of the Hantavirus genus. Rodent hosts of Hantavirus are present in restricted areas in France; consequently, there are ecological niches and microepidemics of human Hantavirus infections. A HFRS case was diagnosed in the Paris region. The 11-year-old child had an acute debut fever-persistent despite antipyretic medication-asthenia, headache, abdominal pain, myalgia, thrombocytopenia, as well as renal failure with proteinuria. The diagnosis was made with a relevant clinical history and the specific serology of Puumala hantavirus. Therefore, a kidney biopsy was not necessary. What was interesting was the diagnostic approach because of the difference between the place and time of contamination and where the child became ill and developed the symptoms. The child was infected by Puumala hantavirus in Les Ardennes, a high-risk area, but became ill in the Paris region, an area with no prevalence. We review Hantavirus infections in France and its differential diagnosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Full Text Available The infantile form of primary hyperoxaluria type-1 (PH-1 is characterized by a rapid progression to the end-stage renal disease (ESRD due to both increased oxalate load and reduced glomerular filtration rate. In the literature, data on this form are limited. The purpose of this study is to analyze retrospectively the clinical, biological, and radiological features of children who were diagnosed with PH-1 during the 1styear of life. We reviewed the records of all children with PH-1 diagnosed and followed-up at our department between January 1995 and December 2013. Among them, only infants younger than 12 months of age were retrospectively enrolled in the study. Fourteen infants with the median age of two months were enrolled in the study. At diagnosis, 11 patients had ESRD. All patients had nephrocalcinosis and two of them had calculi. The diagnosis was established in nine patients on the basis of the positive family history of PH-1, bilateral nephrocalcinosis, and quantitative crystalluria. In four patients, the diagnosis was made with molecular analysis of DNA. Kidney biopsy contributed to the diagnosis in one patient. During follow-up, two patients were pyridoxine sensitive and preserved renal function. Seven among 11 patients who had ESRD died, four patients are currently undergoing peritoneal dialysis. Children with infantile PH and ESRD are at high risk of early death. Peritoneal dialysis is not a treatment of choice. Combined liver-kidney transplantation is mandatory.
Al-Herz, Waleed; Aldhekri, Hasan; Barbouche, Mohamed-Ridha; Rezaei, Nima
Primary immunodeficiencies (PIDs) are a heterogeneous group of genetic disorders caused by defects in the immune system that predispose patients to infections, autoimmune diseases, lymphoproliferation and malignancies. Most PIDs are inherited in an autosomal recessive pattern; therefore, they are more common in areas with high rates of consanguineous marriage. Reports about PIDs from these areas have demonstrated a peculiar prevalence of more severe forms of diseases compared to other regions, and patients born to consanguineous parents have increased rates of morbidity and mortality compared to other patients. Individuals at high risk of having a child with a PID who wish to have a healthy child have limited options, these include prenatal diagnosis and pre-implantation genetic diagnosis. However, these options require a collaborative team of specialists and may not always be implemented due to geographic, religious, financial or social factors. The recent introduction of newborn-screening programs for a number of T and B lymphocyte deficiencies will facilitate early diagnosis and therapeutic interventions, which may include hematopoietic stem cell transplantation and intravenous immunoglobulin treatment. There is a need for the implementation of strategies to increase public awareness of the health risks associated with consanguineous marriage. It should be stressed that genetic counseling should be an important component of the care of patients with PIDs as well as their families. © 2014 S. Karger AG, Basel.
Livio Dei Cas
Full Text Available The first human deaths due to air pollution were recorded in the mid-20th century. There were 6,000 cases of illness recorded in Donora, Pennsylvania, in 1948 and 20,000 in London in 1952; 15 and 4,000 cases of death, respectively, were allegedly ascribed to air pollution. Since then, many countries have adopted standards of air quality in order to protect environmental and human health, although the quality of the air in some industrialized countries remains worrying. Emerging countries in the Far East and South America are also cause for concern because of the growth in the population, industrialization and transport. The WHO World Health Report 2002 estimated that air pollutants, particularly PM10, are associated with a mortality rate of 5% for cancer of the respiratory system, 2% for cardiovascular diseases and about 1% for respiratory tract infections. These estimates consider the mortality but not the morbidity rate, which would increase proportionally the number of cases of these pathologies, despite the difficulty in evaluation.
Archer, Joanne; Hanlon, Ann M.; Levine, Jennie A.
Primary source research requires students to acquire specialized research skills. This paper presents results from a user study testing the effectiveness of a Web guide designed to convey the concepts behind "primary source literacy". The study also evaluated students' strengths and weaknesses when conducting primary source research. (Contains 3…
...-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...
Since researchers of teacher concerns agree that unless these concerns are deter ... lysis techniques appropriate for identifying the subjects/areas which are concerns of ... opportunities to practice their classroom management skills especially ...
Bansal, Mohit; Gupta, Nidhi; Gupta, Preety; Arora, Vikram; Thakar, Sahil
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.
Larsen, B.; Schibbye, K.; Andersson, Johan; Norrby, S.; Timm, T.; Haegg, C.; Johansson, Gunnar
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
Duncombe, Rebecca; Cale, Lorraine; Harris, Jo
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.…
Full Text Available Primary hyperparathyroidism is a common condition that affects 0.3% of the general population. Primary and tertiary care specialists can encounter patients with primary hyperparathyroidism, and prompt recognition and treatment can greatly reduce morbidity and mortality from this disease. In this paper we will review the basic physiology of calcium homeostasis and then consider genetic associations as well as common etiologies and presentations of primary hyperparathyroidism. We will consider emerging trends in detection and measurement of parathyroid hormone as well as available imaging modalities for the parathyroid glands. Surgical indications and approach will be reviewed as well as medical management of primary hyperparathyroidism with bisphosphonates and calcimimetics.
Cusano, Natalie E.; Silverberg, Shonni J.; Bilezikian, John P.
Primary hyperparathyroidism, a common endocrine disorder, is traditionally defined by hypercalcemia and elevated levels of parathyroid hormone (PTH). A newer presentation of primary hyperparathyroidism has been described over the past decade, in which PTH is elevated but serum calcium is consistently normal, in the absence of secondary causes of hyperparathyroidism, such as renal disease or vitamin D deficiency. Recognition of this phenotype of primary hyperparathyroidism, normocalcemic primary hyperparathyroidism, supports a biphasic chronological time course in some individuals in which PTH levels are first elevated but serum calcium is normal, followed by the development of frank hypercalcemia. This review focuses on the available literature regarding this newly described phenotype of primary hyperparathyroidism. PMID:23374739
K. Rob. V. Wikman
Full Text Available Linnæus' Nemesis divina has been interpreted in different ways. Crucial is its central problem: the ideas of fate and retribution, but these are, in turn, dependent on Linnæus' conception of God and nature and not least on his opinions concerning the unity and coherence of the natural and ethical order of the world. From whatever sources Linnæus may have derived his religious ideas and whatever changes they may have undergone, his religious attitude in face of the works of nature remained unshaken. But Linnæus' religion, as we find it fragmentarily in these literary sources, was entirely undogmatic, untheological and, from a Christian point of view, even heterodox. Partly, this was in accord with his belief in the necessary immanent coherence in the processes of nature and the concomitant idea of the righteous divine order of the world.
After placing the development work on reactivity accidents in the various actions decided upon further to the Chernobyl accident, this note describes the first results obtained and the further developments. As a general rule, the Chernobyl accident has not provided, from a strictly technical viewpoint, any fundamentally new material which had previouly been unknown. Analysis have made it possible to more clearly establish the safety importance of certain operating rules, in particular concerning handling whithin coolant system pumps. They have not show the need to modify the design of the french PWR.s. This development work must be continued to gain a fuller understanding of the behaviour of fuel, specially after irradiation and power cycling
Swayze, G.A.; Clark, R.N.; Higgins, C.T.; Kokaly, R.F.; Livo, K. Eric; Hoefen, T.M.; Ong, C.; Kruse, F.A.
Imaging spectroscopy has been successfully used to aid researchers in characterizing potential environmental impacts posed by acid-rock drainage, ore-processing dust on mangroves, and asbestos in serpentine mineral deposits and urban dust. Many of these applications synergistically combine field spectroscopy with remote sensing data, thus allowing more-precise data calibration, spectral analysis of the data, and verification of mapping. The increased accuracy makes these environmental evaluation tools efficient because they can be used to focus field work on those areas most critical to the research effort. The use of spectroscopy to evaluate minerals of environmental concern pushes current imaging spectrometer technology to its limits; we present laboratory results that indicate the direction for future designs of imaging spectrometers.
Wavelets is the outcome of the synthesis of ideas that have emerged in different branches of science and technology, mainly in the last decade. The concept of wavelet packets, which are superpositions of wavelets, has been introduced a couple of years ago. They form bases which retain many properties of wavelets like orthogonality, smoothness and localization. The Walsh orthornomal system is a special case of wavelet packet. The wavelet packets provide at our disposal a library of orthonormal bases, each of which can be used to analyze a given signal of finite energy. The optimal choice is decided by the entropy criterion. In the present paper we discuss results concerning convergence, coefficients, and approximation of wavelet packets series in general and wavelets series in particular. Wavelet packet techniques for solutions of differential equations are also mentioned. (author). 117 refs
Full Text Available A survey on the challenges and concerns invovled with digitizing natural history specimens was circulated to curators, collections managers, and administrators in the natural history community in the Spring of 2009, with over 200 responses received. The overwhelming barrier to digitizing collections was a lack of funding, based on a limited number of sources, leaving institutions mostly responsible for providing the necessary support. The uneven digitization landscape leads to a patchy accumulation of records at varying qualities, and based on different priorities, ulitimately influencing the data's fitness for use. The survey also found that although the kind of specimens found in collections and their storage can be quite varible, there are many similar challenges when digitizing including imaging, automated text scanning and parsing, geo-referencing, etc. Thus, better communication between domains could foster knowledge on digitization leading to efficiencies that could be disseminated through documentation of best practices and training.
Carstensøe-Seidenfaden, Pernille; Teilmann, Grete Katrine; Kensing, Finn
often experience deteriorating glycaemic control and distress. Parents are important in adolescents' ability to self-manage type 1 diabetes, but they report anxiety and frustrations. A better understanding of the challenges adolescents and parents face, in relation to the daily self-management of type 1...... diabetes, is important to improve clinical practice. DESIGN: A qualitative explorative study using visual storytelling as part of individual interviews. METHODS: A purposive sample of nine adolescents and their parents (seven mothers, six fathers) took photographs illustrating their experiences living...... and challenges unsolved. CONCLUSIONS: The concerns and challenges adolescents and their parents face in the transition from child- to adulthood are still present despite new treatment modalities. Parents are fundamental in supporting the adolescents' self-management-work; however, the parties have unspoken...
Rodríguez, Pilar; Yagüe, Agustín; Alarcón, Pedro P.; Garbajosa, Juan
Agile methods have appeared as an attractive alternative to conventional methodologies. These methods try to reduce the time to market and, indirectly, the cost of the product through flexible development and deep customer involvement. The processes related to requirements have been extensively studied in literature, in most cases in the frame of conventional methods. However, conclusions of conventional methodologies could not be necessarily valid for Agile; in some issues, conventional and Agile processes are radically different. As recent surveys report, inadequate project requirements is one of the most conflictive issues in agile approaches and better understanding about this is needed. This paper describes some findings concerning requirements activities in a project developed under an agile methodology. The project intended to evolve an existing product and, therefore, some background information was available. The major difficulties encountered were related to non-functional needs and management of requirements dependencies.
Judgment of the State Administrative Court of Baden Wuerttemberg in head notes including: The authority of the Minister-President to give general guidelines includes the right to issue single directives; in matters of prime political significance he can take measures to realize such aims. - It is no extraneous consideration for the supervisory board under atomic energy law to point out in an order concerning a nuclear reactor shutdown that the disallowed operation of a nuclear plant conflicts with the obligation of the state to provide protection and constitutes a penal offence. Further a discourse on the assignment of discretionary powers under Paragraph 19 Section 3 Clause 2 No. 3 of the Atomic Energy Law. (HSCH) [de
Siddiqi, A H
Wavelets is the outcome of the synthesis of ideas that have emerged in different branches of science and technology, mainly in the last decade. The concept of wavelet packets, which are superpositions of wavelets, has been introduced a couple of years ago. They form bases which retain many properties of wavelets like orthogonality, smoothness and localization. The Walsh orthornomal system is a special case of wavelet packet. The wavelet packets provide at our disposal a library of orthonormal bases, each of which can be used to analyze a given signal of finite energy. The optimal choice is decided by the entropy criterion. In the present paper we discuss results concerning convergence, coefficients, and approximation of wavelet packets series in general and wavelets series in particular. Wavelet packet techniques for solutions of differential equations are also mentioned. (author). 117 refs.
This paper is made up of 3 parts. The first part briefly presents the missions of IRSN (French research institute on nuclear safety), the second part reviews the research works currently led by IRSN in the following fields : -) the assessment of safety computer codes, -) thermohydraulics, -) reactor ageing, -) reactivity accidents, -) loss of coolant, -) reactor pool dewatering, -) core meltdown, -) vapor explosion, and -) fission product release. In the third part, IRSN is shown to give a major importance to experimental programs led on research or test reactors for collecting valid data because of the complexity of the physical processes that are involved. IRSN plans to develop a research program concerning the safety of high or very high temperature reactors. (A.C.)
Kikkenborg Berg, Selina; Elleman-Jensen, Line; Zwisler, Ann-Dorthe
given about sexual activity, (b) the areas of patient concerns related to sexual function and the ICD, and (c) changes in sexual behavior.Methods:A randomized controlled trial including 196 patients (1:1) was designed, including 12 weeks of exercise training and 1 year of psycho-educational follow......Background:Studies show that patients with implantable cardioverter defibrillators (ICD) frequently experience sexual dysfunction. These experiences are often linked to exercise intolerance, side-effects of medication, and psychological problems.Objective:To describe (a) the level of information......-up focusing on modifiable factors associated with poor outcomes, including sexual functioning. The Sex After ICD Survey was administered 6 months after the randomization as part of the planned explorative outcomes. 141 patients responded.Results:The analyses showed that 37 of the 69 (55.2%) patients...
O'Keeffe, Gwenn Schurgin
This article explores the impact of social media on child development and family health. Why do we allow our children to use social media sites before their privacy policies allow? Why do we let them lie about their ages to use these sites? What is it about technology that lets us bend these rules in a way we would never do in the unplugged world? Gaining insight into the answers to these questions and what is positive and negative about social media and the digital world allows us to talk to families about this world, allay their concerns, and keep children of all age safe when using social media. Copyright © 2016 Elsevier Inc. All rights reserved.
Explained is the title subject with international and Japanese official argument or publications and actions, where the security is defined as protection of sealed and unsealed radioisotopes (RI) from malicious acts. IAEA worked out the Code of Conduct on the Safety and Security of Radioactive Sources in 2004 based on its preceding argument and with the turning point of the terrorism 3.11 (2001), and Nuclear Security Recommendations on radioactive material and associated facilities (2011), for whose prerequisite, Security of radioactive sources: implementing guide (2009) and Security in the transport of radioactive material (2008) had been drawn up. The Code of Conduct indicates the security system to regulate the sealed sources that each nation has to build up through legislation, setup of regulatory agency, registration of the sources, provision of concerned facilities with radiation protection, etc. For attaining this purpose, IAEA defined Guidance on the Import and Export of Radioactive Sources (2005, 2012), Categorization of radioactive sources (2005) and Dangerous quantities of radioactive material (D-VALUES) (2006). For updating the related matters, IAEA holds international conferences somewhere in the world every year. The Nuclear Security Recommendations indicate the nation's responsibility of building up and maintaining the security system above with well-balanced measures between the safe and secure use of RI without the invalid inhibition of their usage. Japan government worked out the concept essential for ensuring the nuclear security in Sep. 2011, in which for RI, defined were the risk and benefit in use and security, and securing role of the present legal systems concerning the safety handling and objective RI involved in their registration system. Securing measures of RI in such usage as medical and industrial aids must be of advanced usefulness and safety in harmony with activities of other countries. (T.T)
Esposito, V.J.; Gutierrez, J.E.
One of the goals of the nuclear industry is to achieve economic performance such that nuclear power plants are competitive in a de-regulated market. The manner in which nuclear fuel is designed and operated lies at the heart of economic viability. In this sense reliability, operating flexibility and low costs are the three major requirements of the NPP today. The translation of these three requirements to the design is part of our work. The challenge today is to produce a fuel design which will operate with long operating cycles, high discharge burnup, power up-rating and while still maintaining all design and safety margins. European Fuel Group (EFG) understands that to achieve the required performance high duty/energy fuel designs are needed. The concerns for high duty design includes, among other items, core design methods, advanced Safety Analysis methodologies, performance models, advanced material and operational strategies. The operational aspects require the trade-off and evaluation of various parameters including coolant chemistry control, material corrosion, boiling duty, boron level impacts, etc. In this environment MAEF is the design that EFG is now offering based on ZIRLO alloy and a robust skeleton. This new design is able to achieve 70 GWd/tU and Lead Test Programs are being executed to demonstrate this capability. A number of performance issues which have been a concern with current designs have been resolved such as cladding corrosion and incomplete RCCA insertion (IRI). As the core duty becomes more aggressive other new issues need to be addressed such as Axial Offset Anomaly. These new issues are being addressed by combination of the new design in concert with advanced methodologies to meet the demanding needs of NPP. The ability and strategy to meet high duty core requirements, flexibility of operation and maintain acceptable balance of all technical issues is the discussion in this paper. (authors)
Renault, Luc; Perrot, Emmanuel; Pradat, Eric; Bartoli, Christophe; Greillier, Laurent; Remacle-Bonnet, Anne; Telmon, Norbert; Mazières, Julien; Molinier, Laurent; Couraud, Sébastien
Few studies have looked at lung cancer in prisoners, despite this population is possibly at increased risk of malignancy. In a previous study, we found an early onset of lung cancer in prisoners. Thus, the present CARCAN study was aimed at assessing the epidemiological characteristics, management, prognosis, and incidence of lung cancer in prisoners compared to a sample of non-prisoner patients. We performed a multi-center observational case-control study. Cases were prisoners diagnosed with lung cancer from 2005 to 2013. Controls were non-prisoner lung cancer patients selected from hospital databases and randomly matched to cases (targeted case-control ratio: 1:3). Incidence rates in both groups were calculated using national statistics. Seventy-two cases and 170 controls met inclusion criteria. Cases were mainly men (99%). Mean age at diagnosis was 52.9 (± 11.0) in cases and 64.3 (± 10.1) in controls (p < 0.0001). More case patients were current smokers compared to control patients (83% vs 53%; p < 0.0001). We found no significant differences between the two groups as concerns histologic types, TNM stages at diagnosis, initially-employed treatments, times to management or survival. Incidence rates (2008-2012) in male prisoners were higher than those in the general population in all concerned age groups. There is a shift of lung cancer toward young people in prisons. However, the presentation, management, and prognosis of lung cancer are similar between prisoners and non-prisoners. These finding could justify a specific screening policy for the incarcerated populations.
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
Exposure to ionizing radiation occurs in many occupations. Workers can be exposed to both natural and artificial sources of radiation. Any exposure to ionizing radiation incurs some risk, either to the individual or to the individual's progeny. This dissertation investigated the radiation risk due to occupational exposure in industrial radiography. Analysis of the reported risk estimates to occupational exposure contained in the UNSCEAR report of 2008 in industrial radiography practice was done. The causes of accidents in industrial radiography include: Lack of or inadequate regulatory control, inadequate training, failure to follow operational procedures, human error, equipment malfunction or defect, inadequate maintenance and wilful violation have been identified as primary causes of accidents. To minimise radiation risks in industrial radiography exposure devices and facilities should be designed such that there is intrinsic safety and operational safety ensured by establishing a quality assurance programme, safety culture fostered and maintained among all workers, industrial radiography is performed in compliance with approved local rules, workers engaged have appropriate qualifications and training, available safe operational procedures are followed, a means is provided for detecting incidents and accidents and an analysis of the causes and lessons learned. (author)
Takahashi, Kenzo; Kanda, Hideyuki; Mizushima, Shunsaku
In 2012, several kinds of electronic books (e-books) became available in Japan. Since several major book retailers launched e-book businesses, it is expected that e-books will become a popular source of information in the country. However, we are concerned that e-books may also be a source of misinformation. In examining 24 available materials published by anti-vaccinists, "atopy businesses", and "wellness maintenance" authors, each was found to contain inaccuracies or misinformation. Thus far, such information is only available in printed books. If these books are scanned and circulated, or published in e-book format, this misinformation may circulate rapidly as e-book devices are becoming popular, and, consequently, harm people's health. We think that it is important for the government to formulate ethical guidelines for the publishing e-books with due consideration to freedom of expression.
Zhu, Hui; Huang, Cheng; Lu, Rongxing; Li, Hui
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.
Negoescu Gheorghe; Radu Riana Iren
In full times of crisis, money has become increasingly more important. We put the issue to analyze whether money can be considered a form of energy. The article is taking into consideration the conservation of energy and for money is due to kinetic energy during the boom and to potential energy during the crisis. In the article is also made an illustration of the energetic content of money at a company’s level.
Full Text Available Commercial discounts accounting presents a particular importance because, on the one hand, of their widely spread on a large scale in the commercial activity and on the second hand, due to the influence of the accounting and reporting method over the value added tax. The paper theoretically addresses commercial reductions and also their reflection in the accounting according with the latest regulations in force.
van Aalderen-Smeets, Sandra I.; Walma van der Molen, Juliette H.; Asma, Lieke J. F.
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…
Problems of the regional energy supply industry touching directly the energy supply utilities (e.g. territorial reform, power prices) are discussed. In a survey on the overall energy situation in the FRG as seen by energy supply utilities, the following conclusions are drawn: 1) The electricity supply industry is in the favourite position to make the required structural changes by utilizing primary energy for generating electric power. It offers - via electric energy - an effective opportunity for substituting oil. 2) The electricity supply industry alone will be in a position to use nuclear energy during the next few decades. A decision in favour of nuclear energy must not be at disposal to make oneself momentarily politically popular. This indispensable decision results exclusively from our responsibility for the future of our national economy and thus our society. (orig./HP) [de
Cheraghi, Mohammad Ali; Rezasoltani, Parvaneh; Vedadhir, AbouAli; Taghizadeh, Ziba; Samadanifard, Seyyed Hossein
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
Vedadhir, AbouAli; Taghizadeh, Ziba; Samadanifard, Seyyed Hossein
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
Pulzer, A; Burger-Stritt, S; Hahner, S
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.
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.
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
Kramer, Sharon; Previsic, Mirko; Nelson, Peter; Woo, Sheri
To accelerate the adoption of these emerging marine hydrokinetic technologies, navigational and environmental issues and concerns must be identified and addressed. As hydrokinetic projects move forward, various stakeholders will need to be engaged; one of the key issues that project proponents face as they engage stakeholders is that many conflicting uses and environmental issues are not well-understood. Much of this lack of understanding comes from a limited understanding of the technologies themselves. To address this issue, in September 2008, RE Vision consulting, LLC, was selected by the Department of Energy, under their market acceleration program, to apply a scenario-based assessment approach to the emerging hydrokinetic technology sector. The goal was to improve understanding of potential environmental and navigation impacts of these technologies and focus stakeholders on the critical issues. To meet this goal, the study established baseline scenarios for wave and tidal power conversion at potential future deployment sites. The scenarios captured variations in technical approaches and deployment scales and thus grounded the analysis in realistic constraints. The work conducted under this award provides an important foundation to other market acceleration activities carried out by the DOE and other stakeholders in this sector. The scenarios were then evaluated using a framework developed by H.T. Harvey & Associates to identify and characterize key environmental concerns and uncertainties. In collaboration with PCCI and the U.S. Coast Guard, navigation issues were assessed and guidelines developed to assure the safe operation of these systems. Finally, the work highlights “next steps” to take to continue development and adoption of marine hydrokinetic energy. Throughout the project, close collaboration with device developers, project developers and regulatory stakeholders was pursued to ensure that assumptions and constraints are realistic. Results concur
Milazzo, Maria Francesca; Ancione, Giuseppa; Lisi, Roberto
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.
Korczynski, R E
The Workplace Safety and Health Branch initiated a proactive study in the welding industry in Manitoba. Eight welding companies participated in this study. Health concerns raised by welders were welders' flash, sore/red/teary eyes, headaches, nosebleeds, and a black mucous discharge from their nasal membrane. Most welders expressed concern regarding excessive smoke levels in the workplace and inadequate ventilation. Types of welding identified were MIG mild steel, MIG stainless steel, and TIG aluminum. Monitoring involved an assessment of noise levels, fume composition, and carbon monoxide and ozone concentrations. Metal analyses were according to National Institute for Occupational Safety and Health (NIOSH) Method 7300. Noise dosimeters used were the Quest model 100 and Micro 14 & 15. Carbon monoxide was monitored using the Gastech Model 4700 and ozone using the AID Portable Ozone Meter Model 560. In Manitoba, a hearing conservation program is required when the equivalent sound exposure level (normalized Lex 8-hr) exceeds 80 dBA-weighted. The American Conference of Governmental Industrial Hygienists' threshold limit value-time weighted average (ACGIH TLV-TWA) for iron is 5.0 mg/m3, manganese is 0.2 mg/m3, carbon monoxide is 25 ppm, and ozone is 0.05 ppm (heavy work), 0.08 ppm (moderate work), and 0.1 ppm (light work). Welders' personal exposures to manganese ranged from 0.01-4.93 mg/m3 (N = 42; AM = 0.5; GM = 0.2; SD +/- 0.9; GSD +/- 3.2) and to iron ranged from 0.04-16.29 mg/m3 (N = 42; AM = 3.0; GM = 1.4; SD +/- 3.5; GSD +/- 2.5). Noise exposures ranged from 79-98 dBA (N = 44; AM = 88.9; GM = 88.8; SD +/- 4.2; GSD +/- 1.0). Carbon monoxide levels were less than 5.0 ppm (at source) and ozone levels varied from 0.4-0.6 ppm (at source). Ventilation upgrades in the workplace were required in most welding shops. Only 7 percent of the welders wore respiratory protection. A hearing conservation program and hearing protection were required at all monitored workplaces.
VanDerSluys, W.A.; Emanuelson, R.H.
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
Cronenberg, A.W.; Behling, S.R.; Broughton, J.M.
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
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.…
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.
Opeyemi C Banjo
Full Text Available The ethical dimensions of pharmacological cognitive enhancement have been widely discussed in academic circles and the popular media, but missing from the conversation have been the perspectives of physicians - key decision makers in the adoption of new technologies into medical practice. We queried primary care physicians in major urban centers in Canada and the United States with the aim of understanding their attitudes towards cognitive enhancement. Our primary hypothesis was that physicians would be more comfortable prescribing cognitive enhancers to older patients than to young adults. Physicians were presented with a hypothetical pharmaceutical cognitive enhancer that had been approved by the regulatory authorities for use in healthy adults, and was characterized as being safe, effective, and without significant adverse side effects. Respondents overwhelmingly reported increasing comfort with prescribing cognitive enhancers as the patient age increased from 25 to 65. When asked about their comfort with prescribing extant drugs that might be considered enhancements (sildenafil, modafinil, and methylphenidate or our hypothetical cognitive enhancer to a normal, healthy 40 year old, physicians were more comfortable prescribing sildenafil than any of the other three agents. When queried as to the reasons they answered as they did, the most prominent concerns physicians expressed were issues of safety that were not offset by the benefit afforded the individual, even in the face of explicit safety claims. Moreover, many physicians indicated that they viewed safety claims with considerable skepticism. It has become routine for safety to be raised and summarily dismissed as an issue in the debate over pharmacological cognitive enhancement; the observation that physicians were so skeptical in the face of explicit safety claims suggests that such a conclusion may be premature. Thus, physician attitudes suggest that greater weight be placed upon the
Metzler, Theodore A; Barnes, Susan J
The three dialogues in this contribution concern 21st century application of life-like robots in the care of older adults. They depict conversations set in the near future, involving a philosopher (Dr Phonius) and a nurse (Dr Myloss) who manages care at a large facility for assisted living. In their first dialogue, the speakers discover that their quite different attitudes towards human-robot interaction parallel fundamental differences separating their respective concepts of consciousness. The second dialogue similarly uncovers deeply contrasting notions of personhood that appear to be associated with respective communities of nursing and robotics. The additional key awareness that arises in their final dialogue links applications of life-like robots in the care of older adults with potential transformations in our understandings of ourselves - indeed, in our understandings of the nature of our own humanity. This series of dialogues, therefore, appears to address a topic in nursing philosophy that merits our careful attention. © 2013 John Wiley & Sons Ltd.
Full Text Available The preference for a son continues to be a prevalent norm in the traditional Indian household. This is evident from the declining sex ratio which has dropped to alarming levels, especially in the northern states according to Census 2001 reports. The proliferation and abuse of advanced technologies coupled with social factors contributing to the low status of women such as dowry, concerns with family name and looking up to the son as a breadwinner has made the evil practice of female feticide to become common in the middle and higher socioeconomic households, especially in the northern states. Despite the existence of the Prenatal Diagnostic Techniques Act, there is a dire need to strengthen this law since the number of convictions is despairingly low as compared to the burden posed by this crime. Moreover, it is necessary to gear efforts against the cultural, economic and religious roots of this social malady by woman empowerment and intensive Information, Education and Communication campaigns. The medical colleges and professional bodies have a vital role to play by sensitizing medical students who are the doctors of tomorrow.
This subject plays at present in particular a role in the course of judicial examinations of immediately enforceable orders for the partial construction licences of nuclear power plants. The author distinguishes beween three kinds of forecast decisions: 1. Appraising forecast decisions with standards of judgment taken mainly from the fields of the art, culture, morality, religion are, according to the author, only legally verifyable to a limited extent. 2. With regard to forecast decisions not arguable, e.g. where the future behaviour of persons is concerned, the same should be applied basically. 3. In contrast to this, the following is applicable for programmatic, proceedingslike, or creative forecast decisions, in particular in economics: 'An administrative estimation privilege in a prognostic sense with the consequence that the court has to accept the forecast decision which lies within the forecast margins and which cannot be disproved, and that the court may not replace this forecast decision by its own probability judgment. In these cases, administration has the right to create its own forecast standards.' Judicial control in these cases was limited to certain substantive and procedural mistakes made by the administration in the course of forecast decision finding. (orig./HP) [de
Nierhaus, M [Koeln Univ. (Germany, F.R.)
This subject plays at present in particular a role in the course of judicial examinations of immediately enforceable orders for the partial construction licences of nuclear power plants. The author distinguishes beween three kinds of forecast decisions: 1. Appraising forecast decisions with standards of judgment taken mainly from the fields of the art, culture, morality, religion are, according to the author, only legally verifyable to a limited extent. 2. With regard to forecast decisions not arguable, e.g. where the future behaviour of persons is concerned, the same should be applied basically. 3. In contrast to this, the following is applicable for programmatic, proceedingslike, or creative forecast decisions, in particular in economics: 'An administrative estimation privilege in a prognostic sense with the consequence that the court has to accept the forecast decision which lies within the forecast margins and which cannot be disproved, and that the court may not replace this forecast decision by its own probability judgment. In these cases, administration has the right to create its own forecast standards.' Judicial control in these cases was limited to certain substantive and procedural mistakes made by the administration in the course of forecast decision finding.
Full Text Available The hourly values of the geomagnetic field from 1911 to 1931 derived from measurements made at Eskdalemuir observatory in the UK, and available online from the World Data Centre for Geomagnetism at http://www.wdc.bgs.ac.uk/, have now been corrected. Previously they were 2-point averaged and transformed from the original north, east and vertical down values in the tables in the observatory yearbooks. This paper documents the course of events from discovering the post-processing done to the data to the final resolution of the problem. As it was through the development of a new index, the Inter-Hour Variability index, that this post-processing came to light, we provide a revised series of this index for Eskdalemuir and compare it with that from another European observatory. Conclusions of studies concerning long-term magnetic field variability and inferred solar variability, whilst not necessarily consistent with one another, are not obviously invalidated by the incorrect hourly values from Eskdalemuir. This series of events illustrates the challenges that lie ahead in removing any remaining errors and inconsistencies in the data holdings of different World Data Centres.
Furer, P; Walker, J R; Chartier, M J; Stein, M B
To clarify the relationship between panic disorder and the symptoms of hypochondriasis and somatization, we evaluated these symptoms and diagnoses in patients attending an Anxiety Disorders Clinic. Structured clinical interviews, self-report measures, and symptom diaries were used to assess 21 patients with panic disorder, 23 patients with social phobia, and 22 control subjects with no psychiatric disorders. Ten of the patients with panic disorder (48%) also met DSM-IV criteria for hypochondriasis, whereas only one of the patients with social phobia and none of the healthy control subjects met the criteria for this diagnosis. None of the participants met DSM-IV criteria for somatization disorder, even though both anxiety groups reported high levels of somatic symptoms. The panic disorder group reported higher levels of fear about illness and disease conviction and endorsed more somatic symptoms than did the other groups. A higher proportion of panic disorder patients reported previously diagnosed medical conditions (48%) as compared with patients with social phobia (17%) or healthy control subjects (14%). The panic disorder patients with DSM-IV hypochondriasis obtained higher scores on measures of hypochondriacal concerns, somatization, blood-injury phobia, and general anxiety and distress than did the panic disorder patients without hypochondriasis. The results suggest a strong association between panic disorder and hypochondriasis.
Nikawa, H; Hamada, T; Yamamoto, T
This paper critically reviews the history of denture plaque and identifies some concerns with the presence of Candida in the mouth. This review covers literature sources related to Candida albicans and its relationship to denture plaque. The articles selected for this review are from referred journals and describe C. albicans and its relationship to oral, gastrointestinal and pleuropulmonary infections. The relationship to caries, root caries and periodontal disease is also covered. Denture plaque containing Candida could cause not only oral candidiasis, like oral thrush or denture-induced stomatitis, but also caries, root caries and periodontitis of abutment teeth. However, there is only limited experimental evidence or information available on the cariogenicity of Candida. The continuous swallowing or aspiration of micro-organisms from denture plaque exposes patients, particularly the immunocompromised host or medicated elderly, to the risks of unexpected infections. The term, 'denture plaque' has been used throughout the review. However, the term 'plaque on denture' should be used because the microbial flora and its pathogenicity of denture plaque resembles those of plaque formed on the tooth surface, so called dental plaque. In addition, the term 'denture related stomatitis' would be preferable to 'denture induced stomatitis', since the inflammation of (palatal) mucosa is not induced by the denture, but by wearing the denture or by plaque on the denture.
IMPORTANT REMINDER If you have just come back from one of the regions identified by the WHO as being infected with SARS, it is essential to monitor your state of health for ten days after your return. The syndrome manifests itself in the rapid onset of a high fever combined with respiratory problems (coughing, breathlessness, breathing difficulty). Should these signs appear, you must contact the CERN Medical Service as quickly as possible on number 73802 or 73186 during normal working hours, and the fire brigade at all other times on number 74444, indicating that you have just returned from one of the WHO-identified areas with recent local transmission.China: Beijing, Hong Kong (Special Administrative Region), Guangdong Province, Inner Mongolia, Shanxi Province, Tianjin ProvinceTaiwan:TaipeiMoreover, until further notice the CERN Management requests that all trips to these various regions of the world be reduced to a strict minimum and then only with the consent of the Division Leader concerned. Anyone comin...
Full Text Available Marketing is a major factor to boost the competitiveness of the firm in an environment which is more and more turbulent. It centers the company’s management as being the ideal satisfaction of the current and potential consumer. This is why, in our conception, the marketing’s management represents a subsystem of the company’s’ general management by which shall be administered to specific activities, and also designed to contour the company’s’ activity object. In this article, the intent is to highlight the fact that the benchmarketing has come loose from cultivating the traditional process to the innovative organizational culture product. In this paper, the authors consider benchmarketing as a process of qualitative organizational culture adaptation to market requirements, depending on the context, so as to ensure the improvement of the economic criteria of appreciation of the business lucrative activities. Based on direct observations concerning small firms, followed by analysis, comparison and synthesis, the authors suggest taking into consideration the theoretical and practical benchmarketings’ approach, as being the current strategy of acquiring and cultivating excellence, as initiation philosophy and business development.
Asmatulu, Eylem; Alonayni, Abdullah; Alamir, Mohammed
Because of the superior properties, composites have been used in many industrial applications, including aerospace, wind turbines, ships, cars, fishing rods, storage tanks, swimming pool panels, and baseball bats. Each application may require different combinations of reinforcements and matrices, which make the manufacturing safety even more challenging while working on these substances. In this study, safety issues in composite manufacturing and machining were investigated in detail, and latest developments were provided for workers. The materials most frequently used in composite manufacturing, such as matrix (polyester, vinylester, phenolic, epoxies, methyl ethyl ketone peroxide, benzoil peroxide, hardeners, and solvents), and reinforcement materials (carbon, glass and Kevlar fibers, honeycomb and foams) can be highly toxic to human body. These materials can also be very toxic to the environment when dumped out uncontrollably, creating major future health and environmental concerns. Throughout the manufacturing process, workers inhale vapors of the liquid matrix, hardeners and solvents / thinners, as well as reinforcement materials (chopped fibers and particles) in airborne. Milling, cutting and machining of the composites can further increase the toxic inhalations of airborne composite particles, resulting in major rashes, irritation, skin disorders, coughing, severe eye and lung injury and other serious illnesses. The major portions of these hazardous materials can be controlled using appropriate personal protective equipment for the chemicals and materials used in composite manufacturing and machining. This study provides best possible safety practices utilized in composite manufacturing facilities for workers, engineers and other participants.
Shimazaki, Kei-Ichi; Kawai, Kazuhiro
Lactoferrin is a multifunctional, iron-binding glycoprotein found in milk and other exocrine secretions. Lactoferrin in milk plays vital roles in the healthy development of newborn mammals, and is also an innate resistance factor involved in the prevention of mammary gland infection by microorganisms. Inflammation of the udder because of bacterial infection is referred to as mastitis. There have been many investigations into the relationships between lactoferrin and mastitis, which fall into several categories. The main categories are fluctuations in the lactoferrin concentration of milk, lactoferrin activity against mastitis pathogens, elucidation of the processes underlying the onset of mastitis, participation of lactoferrin in the immune system, and utilization of lactoferrin in mastitis treatment and prevention. This minireview describes lactoferrin research concerning bovine mastitis. In the 1970s, many researchers reported that the lactoferrin concentration fluctuates in milk from cows with mastitis. From the late 1980s, many studies clarified the infection-defense mechanism in the udder and the contribution of lactoferrin to the immune system. After the year 2000, the processes underlying the onset of mastitis were elucidated in vivo and in vitro, and lactoferrin was applied for the treatment and prevention of mastitis.
The dilemma of cyber communications insecurity has existed all the times since the beginning of the network communications. The problems and concerns of unauthorized access and hacking has existed form the time of introduction of world wide web communication and Internet's expansion for popular use in 1990s, and has remained till present time as one of the most important issues. The wireless network security is no exception. Serious and continuous efforts of investigation, research and development has been going on for the last several decades to achieve the goal of provision of 100 percent or full proof security for all the protocols of networking architectures including the wireless networking. Some very reliable and robust strategies have been developed and deployed which has made network communications more and more secure. However, the most desired goal of complete security has yet to see the light of the day. The latest Cyber War scenario, reported in the media of intrusion and hacking of each other's defense and secret agencies between the two super powers USA and China has further aggravated the situation. This sort of intrusion by hackers between other countries such as India and Pakistan, Israel and Middle East countries has also been going on and reported in the media frequently. The paper reviews and critically examines the strategies already in place, for wired network. Wireless Network Security and also suggests some directions and strategies for more robust aspects to be researched and deployed.
The author gathers in this document several papers he has already published in order to shed light on different aspects concerning ion-crystal interactions. This document is divided into 3 chapters. In the first chapter the author presents results obtained from experiments dedicated to charge exchanges and energy released by heavy ions in channeling conditions. Different processes involved in ion-electron interactions are considered: The tri-electronic recombination, the electron capture through nuclear excitation (NEEC), resonant transfer and excitation (RTE), resonant transfer and double excitation (RTDE) and electron impact ionization (EII). The second chapter deals with the measurement of nuclear fission times through crystal blocking experiments. The crystal blocking technique allows the measurement in a model-independent way of the recoil distance covered by the excited nucleus during the whole fission process (starting from the initial collision and ending at the scission point). The last chapter is dedicated to the photon impact ionization through the conversion of a high-energy photon into an electron-positron pair
The confirmation of the courts of justice is required for the permission of power stations. This proposition is not in the laws in FRG, but in view of the recent judicatory regulation, it seems to be the norm established experimentally. From the character of German nation, more than 40 specialists and the committees independent of administration take part in the procedure of administrative permission, but considering the temporary procedure, the processes of five classes of courts join in these. Based on the background of such situation, the author outlined the traditional practice in the legislation and administration in the field of nuclear power generation, then investigated into the decisions of Freiburg and Wuerzburg courts of administrative litigation in 1977 and the decision of the federal constitutional court in 1978. Confronting the same technology of light water reactors, the Freiburg court said that the device protecting from the burst of a pressure vessel is necessary, but the Wuerzburg court did not demand it. The confrontations similar to it were seen in the requirements for the utilization of radioactive substances and the final storage of them. The recent decision of the federal constitutional court is concerned with FBRs, and the court discussed the problem of ''residual risks''. The studies on the German decisions are useful for Japan. (Kako, I.)
Craddock, Nadia; Dlova, Ncoza; Diedrichs, Phillippa C
Colourism, a form of prejudice and discrimination based solely upon skin colour, stands to jeopardize the physical health, wellbeing and life chances of adolescents of colour, globally. Research shows that adolescents can experience colourism at school and college, in the criminal justice system, at work and in the media they consume. It is therefore unsurprising that adolescents of colour often express a desire for lighter skin tones and/or are dissatisfied with their skin tone. Although research is scarce, some studies include older adolescents in their samples of skin-lightening product users. This is significant as the evidence is clear that the unmonitored use of skin-lightening products can be harmful to physical and psychological health, with evidence linking skin-lightening use to skin damage, kidney failure and depression. Although it is evident that colourism is central to the lives of adolescents of colour, more research is needed concerning the use of skin-lightening products among adolescents. Media literacy and critical race theory offer avenues in helping attenuate the harmful impact of colourism for adolescents of colour.
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
Kawamichi, Hiroaki; Yoshihara, Kazufumi; Sugawara, Sho K; Matsunaga, Masahiro; Makita, Kai; Hamano, Yuki H; Tanabe, Hiroki C; Sadato, Norihiro
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.
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.)
Sebastian, Shibu Thomas; Siddanna, Sunitha
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.
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.''