WorldWideScience

Sample records for primary facility type

  1. Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

    Directory of Open Access Journals (Sweden)

    Nithra Kitreerawutiwong

    Full Text Available Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district health promotion hospitals (THPHs were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2.A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district health promotion hospitals (THPHs led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses.THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30, followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06. THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22.Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

  2. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility

    Directory of Open Access Journals (Sweden)

    Archana Jain

    2013-01-01

    Full Text Available In 2011 census, 5.3% of the Indian population was > 65 years of age. This number has steadily grown over past few years and is steeply growing. Healthcare burden of elderly diabetics is immense and proper diagnosis and treatment alone can prevent further complications. According to the most recent surveillance data in U.S., the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria used. In CSIR-NEERI, India, we have healthcare system wherein a fixed and limited number of patients are treated for their lifetime by qualified practitioners with negligible financial burden of the treatment costs. The patients have regular monthly follow up and hence we diagnose Diabetes and evaluate the control and diagnose micro vascular and macro vascular complications in all patients. We did retrospective analysis of all elderly patients following up in NEERI Hospital to find the exact prevalence of T2DM in elderly. It was observed that from total 585 elderly people, 178 had T2DM (30.42%- Prevalence.The sex ratio of Diabetic males to females was almost equal (1:0.97.Obesity was present in 114 people (64%.High prevalence of hypertension was found in Diabetic elderly population (80%. Comparing our prevalence rates with few other studies, it was found that our prevalence rates are quite high. The contributing factors may be urban living, with high prevalence of central obesity and Asian ethnicity, over and above, data of all patients undergoing treatment is available. We treated all diabetics with persistent values of Systolic BP > 130 mm of Hg and Diastolic values of BP > 80mm of Hg as Hypertensives, in order to achieve reduction in cardiovascular mortality and morbidity. This paper is for awareness of disease burden, in real primary care setup. It is not cross-sectional study but study with 100% inclusion of beneficiaries′. This is real world urban diabetes prevalence, also associated hypertension

  3. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility.

    Science.gov (United States)

    Jain, Archana; Paranjape, Shilpa

    2013-10-01

    In 2011 census, 5.3% of the Indian population was > 65 years of age. This number has steadily grown over past few years and is steeply growing. Healthcare burden of elderly diabetics is immense and proper diagnosis and treatment alone can prevent further complications. According to the most recent surveillance data in U.S., the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria used. In CSIR-NEERI, India, we have healthcare system wherein a fixed and limited number of patients are treated for their lifetime by qualified practitioners with negligible financial burden of the treatment costs. The patients have regular monthly follow up and hence we diagnose Diabetes and evaluate the control and diagnose micro vascular and macro vascular complications in all patients. We did retrospective analysis of all elderly patients following up in NEERI Hospital to find the exact prevalence of T2DM in elderly. It was observed that from total 585 elderly people, 178 had T2DM (30.42%- Prevalence). The sex ratio of Diabetic males to females was almost equal (1:0.97). Obesity was present in 114 people (64%). High prevalence of hypertension was found in Diabetic elderly population (80%). Comparing our prevalence rates with few other studies, it was found that our prevalence rates are quite high. The contributing factors may be urban living, with high prevalence of central obesity and Asian ethnicity, over and above, data of all patients undergoing treatment is available. We treated all diabetics with persistent values of Systolic BP > 130 mm of Hg and Diastolic values of BP > 80mm of Hg as Hypertensives, in order to achieve reduction in cardiovascular mortality and morbidity. This paper is for awareness of disease burden, in real primary care setup. It is not cross-sectional study but study with 100% inclusion of beneficiaries'. This is real world urban diabetes prevalence, also associated hypertension and central

  4. WWER type reactor primary loop imitation on large test loop facility in MARIA reactor

    International Nuclear Information System (INIS)

    Moldysh, A.; Strupchevski, A.; Kmetek, Eh.; Spasskov, V.P.; Shumskij, A.M.

    1982-01-01

    At present in Poland in cooperation with USSR a nuclear water loop test facility (WL) in 'MARIA' reactor in Sverke is under construction. The program objective is to investigate processes occuring in WWER reactor under emergency conditions, first of all after the break of the mainprimary loop circulation pipe-line. WL with the power of about 600 kW consists of three major parts: 1) an active loop, imitating the undamaged loops of the WWER reactor; 2) a passive loop assignedfor modelling the broken loop of the WWER reactor; 3) the emergency core cooling system imitating the corresponding full-scale system. The fuel rod bundle consists of 18 1 m long rods. They were fabricated according to the standard WWER fuel technology. In the report some general principles of WWERbehaviour imitation under emergency conditions are given. They are based on the operation experience obtained from 'SEMISCALE' and 'LOFT' test facilities in the USA. A description of separate modelling factors and criteria effects on the development of 'LOCA'-type accident is presented (the break cross-section to the primary loop volume ratio, the pressure differential between inlet and outlet reactor chambers, the pressure drop rate in the loop, the coolant flow rate throuh the core etc.). As an example a comparison of calculated flow rate variations for the WWER-1000 reactor and the model during the loss-of-coolant accident with the main pipe-line break at the core inlet is given. Calculations have been carried out with the use of TECH'-M code [ru

  5. ITER primary cryopump test facility

    International Nuclear Information System (INIS)

    Petersohn, N.; Mack, A.; Boissin, J.C.; Murdoc, D.

    1998-01-01

    A cryopump as ITER primary vacuum pump is being developed at FZK under the European fusion technology programme. The ITER vacuum system comprises of 16 cryopumps operating in a cyclic mode which fulfills the vacuum requirements in all ITER operation modes. Prior to the construction of a prototype cryopump, the concept is tested on a reduced scale model pump. To test the model pump, the TIMO facility is being built at FZK in which the model pump operation under ITER environmental conditions, except for tritium exposure, neutron irradiation and magnetic fields, can be simulated. The TIMO facility mainly consists of a test vessel for ITER divertor duct simulation, a 600 W refrigerator system supplying helium in the 5 K stage and a 30 kW helium supply system for the 80 K stage. The model pump test programme will be performed with regard to the pumping performance and cryogenic operation of the pump. The results of the model pump testing will lead to the design of the full scale ITER cryopump. (orig.)

  6. Diabetic retinopathy and its risk factors in patients with type 2 diabetes attending rural primary healthcare facilities in Tamil Nadu.

    Science.gov (United States)

    Fredrick, Tony; Kaur, Prabhdeep; Murhekar, Manoj V; Jayaraman, Yuvaraj; Kolandaswamy, K; Rao, Sudha Ramachandra; David, Joseph K

    2016-01-01

    India has a high burden of diabetic retinopathy ranging from 12.2% to 20.4% among patients with type 2 diabetes mellitus (T2DM). A T2DM management programme was initiated in the public sector in Tamil Nadu. We estimated the prevalence of diabetic retinopathy and its associated risk factors. We did a cross-sectional survey among patients with T2DM attending two primary health centres for treatment and follow-up in Kancheepuram, Tamil Nadu in January- March 2013. We did a questionnaire-based survey, and measured blood pressure and biochemical parameters (serum creatinine, plasma glucose, etc.) of the patients. We examined their eyes by direct and indirect ophthalmoscopy and defined diabetic retinopathy using a modified classification by Klein et al. We calculated the proportion and 95% CI for the prevalence and adjusted odds ratio (AOR) for risk factors associated with diabetic retinopathy. Among the 270 patients, the mean (SD) age was 54.5 (10) years. The median duration of T2DM was 48 months. The prevalence of diabetic retinopathy was 29.6%. Overall, 65.9% of patients had hypertension, 14.4% had nephropathy (eGFR 5 years (AOR 6.5, 95% CI 3.6-11.7), poor glycaemic control (AOR 2.4, 95% CI 1.4-4.4), and nephropathy (AOR 2.3, 95% CI 1.1-4.6). There was a high burden of undetected retinopathy and other comorbid conditions among patients with T2DM. Early detection of comorbid conditions and glycaemic control can be improved by training care-providers and educating patients.

  7. Fast Flux Test Facility primary sodium valves

    International Nuclear Information System (INIS)

    Rabe, G.B.; Ezra, B.C.

    1977-01-01

    The design and development of the valves used in the primary sodium coolant loop of the Fast Flux Test Facility is described. One tilting-disk check valve is used in the cold leg of the coolant loop. It is designed to limit flow reversal in the loop while maintaining a low pressure drop during forward flow. Two isolation valves are used in each coolant loop--one in the cold leg and one in the hot leg. They are of the motor-operated swinging-gate type. The design, analysis, and testing programs undertaken to develop and qualify these valves are described

  8. Effectiveness of counseling at primary health facilities: Level of ...

    African Journals Online (AJOL)

    Effectiveness of counseling at primary health facilities: Level of knowledge of antenatal attendee and their ... Objectives: To determine the effectiveness of counseling on HIV done in primary health facilities ... AJOL African Journals Online.

  9. Natural circulation under variable primary mass inventories at BETHSY facility

    International Nuclear Information System (INIS)

    Bazin, P.; Clement, P.; Deruaz, R.

    1989-01-01

    BETHSY is a high pressure integral test facility which models a 3 loop Framatome PWR with the intent of studying PWR accidents. The BETHSY programme includes both accident transients and tests under successive steady state conditions. So far, tests of the latter type have been especially devoted to situations where natural circulation takes place in the primary coolant system (PCS). Tests 4.1a and 4.1a TC, the results of which are introduced, deal with PCS natural circulation patterns and related heat transport mechanisms under two different core power levels (2 and 5% of nominal power), variable primary mass inventory (100% to 30-40% according to core power) and at two different steam generator liquid levels (standard value and 1 meter). (orig.)

  10. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    ... Research Council ae Currently from Cape Peninsula University of Technology ... Keywords: primary health care facilities; nutritional status; children; caregivers' rural; South Africa ... underlying causes of malnutrition in children, while poor food quality, .... Information on PHC facility infrastructure and services was obtained.

  11. Logic model needs for diverse facility types

    International Nuclear Information System (INIS)

    Wilson, J.R.

    1995-01-01

    This paper compares the characteristics of fault trees (where initiators are developed within the fault tree) vs. event trees (where the nodes are developed by fault trees). This comparison requires some additional discussion on the subtlety of initiators. Difficulties when analyzing various reactor-type and processing facilities are discussed to illustrate the particular characteristics of each type of logic. The intent is to allow probabilistic risk assessment (PRA) analysts to be open-quotes bi-logical,close quotes or equally comfortable with event-tree or fault-tree logic, knowing when to apply each

  12. Lining facility for FBR type reactor

    International Nuclear Information System (INIS)

    Shimano, Kunio.

    1991-01-01

    In a lining facility for protecting structural material concretes for concrete buildings in an FBR type power plant, sodium-resistant and heat-resistant first and second coating layers are lined at the surface of concretes, and steam releasing materials are disposed between the first and the second coating layers for releasing water contents evaporated from the concretes to the outside. With such a constitution, since there is no structures for welding steel plates to each other as in the prior art, the fabrication is made easy. Further, since cracks of coating materials can be suppressed, reactor safety is improved. (T.M.)

  13. Fast flux test facility primary sodium check valve

    International Nuclear Information System (INIS)

    Rabe, G.B.; Nash, C.F.

    1975-01-01

    The design and development of a tilting-disc check valve for the primary sodium coolant loop of the Fast Flux Test Facility is described. The demanding design requirements specified for this system dictated a design with unique features. These features, along with the structural design and analysis requirements and the testing program used to develop and justify the design, are described

  14. [Quality Indicators of Primary Health Care Facilities in Austria].

    Science.gov (United States)

    Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

    2017-07-11

    Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Primary coolant circuits in FBR type reactors

    International Nuclear Information System (INIS)

    Kutani, Masushiro.

    1985-01-01

    Purpose: To eliminate the requirement of a pump for the forcive circulation of primary coolants and avoid the manufacturing difficulty of equipments. Constitution: In primary coolant circuits of an LMFBR type reactor having a recycling path forming a closed loop between a reactor core and a heat exchanger, coolants recycled through the recycling path are made of a magnetic fluid comprising liquid sodium incorporated with fine magnetic powder, and an electromagnet is disposed to the downstream of the heat exchanger. In the above-mentioned structure, since the magnetic fluid as the primary coolants losses its magnetic property when heated in the reactor core but recovers the property at a lower temperature after the completion of the heat exchange, the magnetic fluid can forcively be flown through the recycling path under the effect of the electromagnet disposed to the down stream of the heat exchanger to thereby forcively recycle the primary coolants. (Kawakami, Y.)

  16. Fast Flux Test Facility replacement of a primary sodium pump

    International Nuclear Information System (INIS)

    Krieg, S.A.; Thomson, J.D.

    1985-01-01

    The Fast Flux Test Facility is a 400 MW Thermal Sodium Cooled Fast Reactor operated by Westinghouse Hanford Company for the US Department of Energy. During startup testing in 1979, the sodium level in one of the primary sodium pumps was inadvertently raised above the normal height. This resulted in distortion of the pump shaft. Pump replacement was carried out using special maintenance equipment. Nuclear radiation and contamination were not significant problems since replacement operations were carried out shortly after startup of the Fast Flux Test Facility

  17. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    OpenAIRE

    Alam, Khurshid; Ahmed, Shakil

    2010-01-01

    Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Give...

  18. Simulation of natural circulation on an integral type experimental facility, MASLWR

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Youngjong; Lim, Sungwon; Ha, Jaejoo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2013-05-15

    The OSU MASLWR test facility was reconfigured to eliminate a recurring grounding problem and improve facility reliability in anticipation of conducting an IAEA International Collaborative Standard Problem (ICSP). The purpose of ICSP is to provide experimental data on flow instability phenomena under natural circulation conditions and coupled containment/reactor vessel behavior in integral-type reactors, and to evaluate system code capabilities to predict natural circulation phenomena for integral type PWR, by simulating an integrated experiment. A natural circulation in the primary side during various core powers is analyzed using TASS/SMR code for the integral type experimental facility. The calculation results show higher steady state primary flow than experiment. If it matches the initial flow with experiment, it shows lower primary flow than experiment according to the increase of power. The code predictions may be improved by applying a Reynolds number dependent form loss coefficient to accurately account for unrecoverable pressure losses.

  19. Energy efficiency in California laboratory-type facilities

    Energy Technology Data Exchange (ETDEWEB)

    Mills, E.; Bell, G.; Sartor, D. [and others

    1996-07-31

    The central aim of this project is to provide knowledge and tools for increasing the energy efficiency and performance of new and existing laboratory-type facilities in California. We approach the task along three avenues: (1) identification of current energy use and savings potential, (2) development of a {ital Design guide for energy- Efficient Research Laboratories}, and (3) development of a research agenda for focused technology development and improving out understanding of the market. Laboratory-type facilities use a considerable amount of energy resources. They are also important to the local and state economy, and energy costs are a factor in the overall competitiveness of industries utilizing laboratory-type facilities. Although the potential for energy savings is considerable, improving energy efficiency in laboratory-type facilities is no easy task, and there are many formidable barriers to improving energy efficiency in these specialized facilities. Insufficient motivation for individual stake holders to invest in improving energy efficiency using existing technologies as well as conducting related R&D is indicative of the ``public goods`` nature of the opportunity to achieve energy savings in this sector. Due to demanding environmental control requirements and specialized processes, laboratory-type facilities epitomize the important intersection between energy demands in the buildings sector and the industrial sector. Moreover, given the high importance and value of the activities conducted in laboratory-type facilities, they represent one of the most powerful contexts in which energy efficiency improvements stand to yield abundant non-energy benefits if properly applied.

  20. Optimization of the National Ignition Facility primary shield design

    International Nuclear Information System (INIS)

    Annese, C.E.; Watkins, E.F.; Greenspan, E.; Miller, W.F.

    1993-10-01

    Minimum cost design concepts of the primary shield for the National Ignition laser fusion experimental Facility (NIF) are searched with the help of the optimization code SWAN. The computational method developed for this search involves incorporating the time dependence of the delayed photon field within effective delayed photon production cross sections. This method enables one to address the time-dependent problem using relatively simple, time-independent transport calculations, thus significantly simplifying the design process. A novel approach was used for the identification of the optimal combination of constituents that will minimize the shield cost; it involves the generation, with SWAN, of effectiveness functions for replacing materials on an equal cost basis. The minimum cost shield design concept was found to consist of a mixture of polyethylene and low cost, low activation materials such as SiC, with boron added near the shield boundaries

  1. Optimizing the Primary Prevention of Type-2 Diabetes in Primary Health Care

    Science.gov (United States)

    2017-08-18

    Interprofessional Relations; Primary Health Care/Organization & Administration; Diabetes Mellitus, Type 2/Prevention & Control; Primary Prevention/Methods; Risk Reduction Behavior; Randomized Controlled Trial; Life Style

  2. Emission Facilities - Erosion & Sediment Control Facilities

    Data.gov (United States)

    NSGIC Education | GIS Inventory — An Erosion and Sediment Control Facility is a DEP primary facility type related to the Water Pollution Control program. The following sub-facility types related to...

  3. Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

    Science.gov (United States)

    Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

    2013-01-01

    Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

  4. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

    Science.gov (United States)

    Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

    2013-01-01

    Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

  5. Primary Criteria for Near Surface Disposal Facility in Egypt Proposal approach

    International Nuclear Information System (INIS)

    Abdellatif, M.M.

    2013-01-01

    The objective of radioactive waste disposal is to isolate waste from the surrounding media to protect human health and environment from the harmful effect of the ionizing radiation. The required degree of isolation can be obtained by implementing various disposal methods, of which near surface disposal represents an option commonly used and demonstrated in several countries. Near surface disposal has been practiced for some decades, with a wide variation in sites, types and amounts of wastes, and facility designs employed. Experience has shown that the effective and safe isolation of waste depends on the performance of the overall disposal system, which is formed by three major components or barriers: the site, the disposal facility and the waste form. The site selection process for low-level and intermediate level radioactive waste disposal facility addressed a wide range of public health, safety, environmental, social and economic factors. The primary goal of the sitting process is to identify a site that is capable of protecting public health, safety and the environment. This paper is concerning a proposal approach for the primary criteria for near surface disposal facility that could be applicable in Egypt.

  6. The status of school sanitation facilities in some selected primary ...

    African Journals Online (AJOL)

    admin

    The access to drinking water facilities. (water taps) ... in access by male and female pupils (latrine to students' ratio) is very .... utilization of WASH facilities and attaining clean school ... productive cooperation in rendering valuable information.

  7. Physics and detector simulation facility Type O workstation specifications

    International Nuclear Information System (INIS)

    Chartrand, G.; Cormell, L.R.; Hahn, R.; Jacobson, D.; Johnstad, H.; Leibold, P.; Marquez, M.; Ramsey, B.; Roberts, L.; Scipioni, B.; Yost, G.P.

    1990-11-01

    This document specifies the requirements for the front-end network of workstations of a distributed computing facility. This facility will be needed to perform the physics and detector simulations for the design of Superconducting Super Collider (SSC) detectors, and other computations in support of physics and detector needs. A detailed description of the computer simulation facility is given in the overall system specification document. This document provides revised subsystem specifications for the network of monitor-less Type 0 workstations. The requirements specified in this document supersede the requirements given. In Section 2 a brief functional description of the facility and its use are provided. The list of detailed specifications (vendor requirements) is given in Section 3 and the qualifying requirements (benchmarks) are described in Section 4

  8. A model for plasma evolution in Filipov type plasma focus facilities

    International Nuclear Information System (INIS)

    Siahpoush, V.; Sobhanian, S.; Tafreshi, M. A.; Lamehi, M.

    2003-01-01

    A model is presented in this paper for the evolution of plasma in Filipov type plasma focus facilities. With the help of this model, one can predict some of the main parameters of the produced plasma and obtain the optimized geometrical an physical properties (anode radius and length, gas pressure, capacitance, bank energy etc) for the primary design purposes. The results obtained by this model will be compared with the experimental data obtained from the 90 kJ plasma focus facility D ena

  9. Primary cooling system for BWR type reactor

    International Nuclear Information System (INIS)

    Ibe, Eishi; Takahashi, Masanori; Aoki, Yasuko

    1993-01-01

    The present invention effectively uses information from a plurality of sensors in order to suppress corrosion circumstance of a nuclear reactor. That is, a predetermined general water quality factor at a predetermined position is determined as a standard index. A concentration of a water quality improver is controlled such that the index is within an aimed range. For this purpose, the entire sensor groups disposed in a primary coolant system of a nuclear reactor are divided into a plural systems of sensor groups each disposed on every different positions. Then, a predetermined sensor group (standard sensor group) is connected to a computing device and a data base so that it is always monitored for calculating and estimating the standard index. Only oxidative ingredient in water at the measuring point is noted, and a concentration distribution which agrees with an actually measured value of oxidative ingredients is extracted from data base and used as a correct concentration distribution. With such procedures, reactor water quality can be estimated accurately while compensating erroneous factors of individual sensors. Even when a new sensor is used, it is not necessary to greatly change control logic. (I.S.)

  10. Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia.

    Science.gov (United States)

    Leelavathi, M; Azimah, M N; Kharuddin, N F; Tzar, M N

    2013-05-01

    Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.

  11. Identification of Human Intrusion Types into Radwaste Disposal Facility

    International Nuclear Information System (INIS)

    Budi Setiawan

    2007-01-01

    Human intrusion has long been recognized as a potentially important post-closure safety issue for rad waste disposal facility. It is due to the difficulties in predicting future human activities. For the preliminary study of human intrusion, identification of human intrusion types need to be recognized and investigated also the approaching of problem solving must be known to predict the prevention act and accepted risk. (author)

  12. The status of school sanitation facilities in some selected primary ...

    African Journals Online (AJOL)

    Background: There is a growing demand on school hygiene and sanitation facilities given the growing number of school enrolment in Ethiopia. A safe school environment plays a key role in facilitating education and enduring pupils with improved life skills. Although there is much attention given for the expansion of schools ...

  13. Primary coolant system of BWR type reactor

    International Nuclear Information System (INIS)

    Ibe, Hidefumi; Takahashi, Masanori; Aoki, Yasuko

    1997-01-01

    The present invention provides a water quality control system for preventing corrosion and for extending working life of structural materials of a BWR-type reactor. Namely, a sensor group 1 and a sensor group 2 are disposed at different positions such as in a feedwater system, a recycling system, main steam pipes, and a pressure vessel, respectively. Each sensor group can record and generate alarms independently. The sensor group 1 for usual monitoring is connected to a calculation device by way of a switch to confirm that the monitored values are within a proper range by the injection of a water quality moderating agent. The sensor group 2 is caused to stand alone or connected with the calculation device by way of a switch optionally. When abnormality should occur in the sensor group 1, the sensor group 2 determines the limit for the increase/decrease of controlling amount of the moderating agent at a portion where the conditions are changed to the most severe direction by using data base. The moderating agent is injected and controlled based on the controlling amount. The system of the present invention can optionally cope with a new sensor and determination for new water quality standards. Then the evaluation/control accuracy of the entire system can be improved while covering up the errors of each sensor. (I.S.)

  14. Examining physicians’ preparedness for tobacco cessation services in India: Findings from primary care public health facilities in two Indian states

    Directory of Open Access Journals (Sweden)

    Rajmohan Panda

    2013-03-01

    Full Text Available BackgroundA total of 275 million tobacco users live throughout India and are in need of tobacco cessation services. However, the preparation of physicians to deliver this service at primary care health facilities remains unknown.AimsThe study aimed to examine the primary care physicians’ preparedness to deliver tobacco cessation services in two Indian states.MethodResearchers surveyed physicians working in primary care public health facilities, primarily in rural areas using a semistructured interview schedule. Physicians’ preparedness was defined in the study as those possessing knowledge of tobacco cessation methods and exhibiting a positive attitude towards the benefits of tobacco cessation counselling as well as being willing to be part of tobacco prevention or cessation program.ResultsOverall only 17% of physicians demonstrated adequate preparation to provide tobacco cessation services at primary care health facilities in both the States. The findings revealed minimal tobacco cessation training during formal medical education (21.3% and on-the-job training (18.9%. Factors, like sex and age of service provider, type of health facility, location of health facility and number of patients attended by the service provider, failed to show significance during bivariate and regression analysis. Preparedness was significantly predicted by state health system.ConclusionThe study highlights a lack of preparedness of primary care physicians to deliver tobacco cessation services. Both the curriculum in medical school and on-the-job training require an addition of a learning component on tobacco cessation. The addition of this component will enable existing primary care facilities to deliver tobacco cessation services.

  15. Investigation of primary-to-secondary leakage accident on the PSB-VVER integral test facility

    International Nuclear Information System (INIS)

    Lipatov, I.A.; Dremin, G.I.; Galtchanskaya, S.A.; Chmal, I.I.; Moloshnikov, A.S.; Gorbunov, Y.S.; Antonova, A.I.; Elkin, I.V.

    2001-01-01

    The full text follows. The paper presents the main results from the test on primary-to-secondary leakage of 100 mm in equivalent diameter. The test was performed on the PSB-VVER integral test facility. PSB-VVER is a 4-loops scaled down model of primary system of NPP with VVER-1000 Russian type reactor. Volume - power scale is about 1/300 while elevation scale is 1/1. All components of the primary system of the reference NPP are modeled on PSB-VVER. Both passive (accumulators) and active (high and low pressure) ECCSs, pressurizer spray and relief circuits, feed water system and atmospheric dumping system (ADS) as well as the primary circuit gas remove emergency system are also simulated. The primary-to-secondary leakage was simulated using an external break line which connects the upper part of the hot header to SG water volume. The break line included a break nozzle (a cylindrical channel d = 5.8 mm, l/d = 10 with sharp inlet edge), quick-acting valve and two-phase mass flow rate measurement system. In addition loss of off-site power at the moment when a scram-signal is generated was assumed in the experiment. Thus the accident is to be considered as a beyond-design-basic one. The loss of off-site power results in the following: -main circulation pump shutdown; -pressurizer heaters switching off; -HPIS water cooling flow rate and number of points of water injection are reduced The study focuses on the adequacy of the associated accident management (AM) procedure developed by EDO ''GIDROPRESS'' as a General Designer of VVER-type reactors. The AM-procedure was adopted to the PSB-VVER test facility conditions using CATHARE (France) and DINAMIKA (Russia) codes analysis. The AM-procedure in PSB-VVER is as follows: after about 30 min of the onset of the accident, when the accident type and the localization of the SG affected become evident for the operator, he closes all the main steam isolation valves, inhibits the ADS actuation in the affected SG and begins to remove

  16. Investigation of primary-to-secondary leakage accident on the PSB-VVER integral test facility

    Energy Technology Data Exchange (ETDEWEB)

    Lipatov, I.A.; Dremin, G.I.; Galtchanskaya, S.A.; Chmal, I.I.; Moloshnikov, A.S.; Gorbunov, Y.S.; Antonova, A.I. [Electrogorsk Research and Engineering Center, EREC, Moscow (Russian Federation); Elkin, I.V. [RRC ' ' Kurchatov Institute, Moscow (Russian Federation)

    2001-07-01

    The full text follows. The paper presents the main results from the test on primary-to-secondary leakage of 100 mm in equivalent diameter. The test was performed on the PSB-VVER integral test facility. PSB-VVER is a 4-loops scaled down model of primary system of NPP with VVER-1000 Russian type reactor. Volume - power scale is about 1/300 while elevation scale is 1/1. All components of the primary system of the reference NPP are modeled on PSB-VVER. Both passive (accumulators) and active (high and low pressure) ECCSs, pressurizer spray and relief circuits, feed water system and atmospheric dumping system (ADS) as well as the primary circuit gas remove emergency system are also simulated. The primary-to-secondary leakage was simulated using an external break line which connects the upper part of the hot header to SG water volume. The break line included a break nozzle (a cylindrical channel d = 5.8 mm, l/d = 10 with sharp inlet edge), quick-acting valve and two-phase mass flow rate measurement system. In addition loss of off-site power at the moment when a scram-signal is generated was assumed in the experiment. Thus the accident is to be considered as a beyond-design-basic one. The loss of off-site power results in the following: -main circulation pump shutdown; -pressurizer heaters switching off; -HPIS water cooling flow rate and number of points of water injection are reduced The study focuses on the adequacy of the associated accident management (AM) procedure developed by EDO ''GIDROPRESS'' as a General Designer of VVER-type reactors. The AM-procedure was adopted to the PSB-VVER test facility conditions using CATHARE (France) and DINAMIKA (Russia) codes analysis. The AM-procedure in PSB-VVER is as follows: after about 30 min of the onset of the accident, when the accident type and the localization of the SG affected become evident for the operator, he closes all the main steam isolation valves, inhibits the ADS actuation in the affected SG

  17. Emission Facilities - Air Emission Plants

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Represents the Primary Facility type Air Emission Plant (AEP) point features. Air Emissions Plant is a DEP primary facility type related to the Air Quality Program....

  18. Aqueous Boric acid injection facility of PWR type reactor

    International Nuclear Information System (INIS)

    Matsuoka, Tsuyoshi; Iwami, Masao.

    1996-01-01

    If a rupture should be caused in a secondary system of a PWR type reactor, pressure of a primary coolant recycling system is lowered, and a back flow check valve is opened in response to the lowering of the pressure. Then, low temperature aqueous boric acid in the lower portion of a pressurized tank is flown into the primary coolant recycling system based on the pressure difference, and the aqueous boric acid reaches the reactor core together with coolants to suppress reactivity. If the injection is continued, high temperature aqueous boric acid in the upper portion boils under a reduced pressure, further urges the low temperature aqueous boric acid in the lower portion by the steam pressure and injects the same to the primary system. The aqueous boric acid stream from the pressurized tank flowing by self evaporation of the high temperature aqueous boric acid itself is rectified by a rectifying device to prevent occurrence of vortex flow, and the steam is injected in a state of uniform stream. When the pressure in the pressurized tank is lowered, a bypass valve is opened to introduce the high pressure fluid of primary system into the pressurized tank to keep the pressure to a predetermined value. When the pressure in the pressurized tank is elevated to higher than the pressure of the primary system, a back flow check valve is opened, and high pressure aqueous boric acid is flown out of the pressurized tank to keep the pressure to a predetermined value. (N.H.)

  19. Spectrum of abdominal organ injury in a primary blast type

    Directory of Open Access Journals (Sweden)

    Amin Abid

    2009-12-01

    Full Text Available Abstract Introduction Abdominal organ injury in a primary blast type is always challenging for diagnosis. Air containing abdominal viscera is most vulnerable to effects of primary blast injury. In any patient exposed to a primary blast wave who presents with an acute abdomen, an abdominal organ injury is to be kept in a clinical suspicion. Aim Study various abdominal organ injuries occurring in a primary type of blast injury. Material and methods: All those who had exploratory laparotomy for abdominal organ injuries after a primary blast injury for a period of 10 years from January 1998 - January 2008 were included in this retrospective study. Results Total 154 patients had laparotomy for abdominal organ injuries with a primary blast type of injury. Small intestine was damaged in 48 patients (31.1% followed by spleen in 22.7% cases. 54 patients (35.06% had more than one organ injured. Liver laceration was present in 30 patients (19.48%. Multiple small gut perforations were present in 37 patients (77.08%. Negative laparotomy was found in 5 patients (3.24% whereas 3 (1.94% had re-exploration. Mortality was present in 6 patients (3.89%. Conclusions Primary blast injury causes varied abdominal organ injuries. Single or multiple organ damage can be there. Small intestine is commonest viscera injured. Laparotomy gives final diagnosis.

  20. A study on hazard types occurring in hydrogen facilities

    International Nuclear Information System (INIS)

    Cho, Nam Chul; Jae, Moo Sung; Eon, Yang Joon

    2004-01-01

    Hydrogen has ideal characteristics as an energy carrier. Hydrogen can be used as a clean fuel in a variety of energy end-use sectors including the conversion to electricity. After combustion, it produces only water. Therefore, the concept of hydrogen energy system has attracted much interest worldwide. But hydrogen has a defect that the explosion risk is high to an inflammable gas of a colorless, tasteless and odorless. Therefore, to use the hydrogen to the source of energy, hydrogen accident sequences and causes analysis must be needed. For this, hazard types occurring in hydrogen facilities have been considered through the case of domestic and foreign hydrogen accident in this study and hazard types to be considered are ignition, leaks, hydrogen dispersion, fire an explosion, storage vessel failure, vent and exhaust system, purging, condensation of air, hydrogen embrittlement, physiological hazard, and collisions during transportation

  1. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

    Science.gov (United States)

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

  2. Intelligent type sodium level gauge and its graduation calibration facility

    International Nuclear Information System (INIS)

    Chen Daolong; Wang Xuan; Li Xinying; Sun Huiqing; Zhu Jie

    1998-04-01

    The component construction and their performances of the intelligent type sodium level gauge newly-developed and its graduation calibration facility are presented. They can be operated in the temperature limit 100∼550 degree C. Its graduation characteristic calibration test is described. The temperature effect is analyzed. The graduation characteristic equation using the medium temperature as the parameter is given. The calibration errors are analyzed. The measurement system using this sodium level gauge is presented. The tests show that the intelligent type sodium level gauge possesses good linearity. The accurate sodium level measurement data can be obtained by means of its on-line compensation function of the temperature effect. Moreover, it possesses the self-inspection, the electric shutoff protection, the setting of full-scale, the thermocouple breaking alarm, the two upper limits and two lower limits alarms, the standard analog output signal and the digital output signal. Therefore, it is applicable particularly to the instrument, control and protection systems of LMFBR. The basic error of this intelligent type sodium level gauge is +-1.9% of measuring range

  3. Primary Hyperparathyroidism in Patients with Multiple Endocrine Neoplasia Type 1

    Directory of Open Access Journals (Sweden)

    Grzegorz Piecha

    2010-01-01

    Full Text Available Primary hyperparathyroidism may occur as a part of an inherited syndrome in a combination with pancreatic endocrine tumours and/or pituitary adenoma, which is classified as Multiple Endocrine Neoplasia type 1 (MEN-1. This syndrome is caused by a germline mutation in MEN-1 gene encoding a tumour-suppressor protein, menin. Primary hyperparathyroidism is the most frequent clinical presentation of MEN-1, which usually appears in the second decade of life as an asymptomatic hypercalcemia and progresses through the next decades. The most frequent clinical presentation of MEN-1-associated primary hyperparathyroidism is bone demineralisation and recurrent kidney stones rarely followed by chronic kidney disease. The aim of this paper is to present the pathomechanism, screening procedures, diagnosis, and management of primary hyperparathyroidism in the MEN-1 syndrome. It also summarises the recent advances in the pharmacological therapy with a new group of drugs—calcimimetics.

  4. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Alam Khurshid

    2010-06-01

    Full Text Available Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC, a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG targets the financial sustainability of such facilities is crucial. Methods The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value. Sensitivity analysis was done using 3% discount rate. Results The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient. Conclusion The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase

  5. Primary School Teachers' Perceptions of Adequacy and Quality of Physical Facilities in Public Primary Schools under Free Primary Education

    Science.gov (United States)

    Muthima, Ndirangu Wahome; Udoto, Maurice O.; Anditi, Zephania O.

    2016-01-01

    The Free Primary Education (FPE) programme was commissioned in Kenya in January 2003 to provide basic education to all children of school going age and to ease the burden of cost sharing from the parents. However, even though the public primary school class teachers were to shoulder the greatest responsibility in the implementation of this…

  6. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    OpenAIRE

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

  7. Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

    Science.gov (United States)

    Novignon, Jacob; Nonvignon, Justice

    2017-06-12

    Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private

  8. Differences in Construction, Facilities, Equipment and Academic Achievement Among Ugandan Primary Schools

    Science.gov (United States)

    Heyneman, S. P.

    1977-01-01

    This study sets out to clarify two questions within the context of a non-industrial society's educational system: (1) In what areas would there be measurable variation in physical facilities between primary schools? (2) Is any of this variation statistically related to the academic performance of children on the national selection examination…

  9. PRELIMINARY STUDY TO PRIMARY EDUCATION FACILITIES (A Comparison Study between Indonesia and Developed Countries

    Directory of Open Access Journals (Sweden)

    Lucy Yosita

    2006-01-01

    Full Text Available This writing is a preliminary study to condition of primary education facilities in Indonesia, and then comparing these with theories as well as various relevant cases aimed to know the problem more obviously. Basically, there is difference between primary education facilities in Indonesia with those in developed countries. Meanwhile on the other hand, the condition as well as the completion of education facility is actually as the main factor contributes to address the purpose of learning process. If building design, interior and also site plan were dynamic in form, space, colour and tools, those would be probably more stimulate activity and influence into the growth of students. However, lastly, it is still required further analysis, as an example analysis to student's behaviour in spaces of learning environment, more detail and within enough time, not only at indoor but also at outdoor.

  10. Survival after bone metastasis by primary cancer type

    DEFF Research Database (Denmark)

    Svensson, Elisabeth; Christiansen, Christian F; Ulrichsen, Sinna P

    2017-01-01

    %, 11% to 14%). The risk of mortality was increased for the majority of cancer types among patients with bone and synchronous metastases compared with bone only (adjusted relative risk 1.29-1.57), except for cervix, ovarian and bladder cancer. CONCLUSIONS: While patients with bone metastases after most......OBJECTIVE: In the 10 most common primary types with bone metastases, we aimed to examine survival, further stratifying on bone metastases only or with additional synchronous metastases. METHODS: We included all patients aged 18 years and older with incident hospital diagnosis of solid cancer...... between 1994 and 2010, subsequently diagnosed with BM until 2012. We followed patients from date of bone metastasis diagnosis until death, emigration or 31 December 2012, whichever came first. We computed 1-year, 3-year and 5-year survival (%) and the corresponding 95% CIs stratified on primary cancer...

  11. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    Science.gov (United States)

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

  12. Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates.

    Science.gov (United States)

    Goldzweig, Caroline Lubick; Parkerton, Patricia H; Washington, Donna L; Lanto, Andrew B; Yano, Elizabeth M

    2004-04-01

    Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates. To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates. Cross-sectional study of screening rates among 144 Department of Veterans Affairs (VA) medical centers and for a national sample of women. We linked practice structure and quality improvement characteristics of individual VA medical centers from 2 national surveys (1 to primary care directors and 1 to a stratified random sample of employees) to breast and cervical cancer screening rates determined from a review of random medical records. We conducted bivariate analyses and multivariate logistic regression of primary care practice and facility features on cancer screening rates, above and below the median. While the national screening rates were high for breast (87%) and cervical cancer (90%), higher screening rates were more likely when primary care providers were consistently notified of specialty visits and when staff perceived a greater organizational commitment to quality and anticipated rewards and recognition for better performance. Organization and quality orientation of the primary care practice and its facility can enhance breast and cervical cancer screening rates. Internal recognition of quality performance and an overall commitment to quality improvement may foster improved prevention performance, with impact varying by clinical service.

  13. Alignment between chronic disease policy and practice: case study at a primary care facility.

    Science.gov (United States)

    Draper, Claire A; Draper, Catherine E; Bresick, Graham F

    2014-01-01

    Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar

  14. Cost of delivering health care services at primary health facilities in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    2017-11-01

    Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

  15. Plain radiologic findings of primary lung cancer by histologic types

    International Nuclear Information System (INIS)

    Lee, Young Seok; Park, Jae Hyung; Choi, Byung In; Yeon, Kyung Mo; Kim, Chu Wan

    1983-01-01

    Plain chest films are the most useful modality in diagnosis of primary lung cancer, but it is difficult to interpret the radiologic findings by histological types. Authors reviewed chest films of 324 cases of histologically confirmed primary lung cancer from January 1974 to April 1982 at Seoul National University. The results are as follows; 1. Incidence was most common in the 6th decade as 34.4%. Male to female sex radio was 3.8 : 1 and there was no sex difference in Adenocarcinoma. 2. Distribution of histologic types of primary lung cancers as follows; Squamous cell carcinoma 50.6%, Small cell carcinoma 22.5%, Large cell carcinoma 9.3%, Bronchogenic adeno carcinoma 10.5%, Bronchioloalveolar cell carcinoma 1.9%, Adenosquamous carcinoma 0.6%, Carcinoid tumor 0.3%, Adenoid cystic carcinoma 0.3%. 3. Radiologic findings by histologic types are follows; a) Squamous cell carcinoma commonly present as collapse (51.8%), peripheral mass (40.8%), pneumonitis (37.2%), hilar involvement (34.8%), and in single abnormality, peripheral mass (44.4%). b) Small cell carcinoma commonly present as hilar involvement (78.1%), mediastinal widening or mass (53.4%) and in single abnormality, hilar involvement (58.3%). c) Large cell carcinoma commonly present as hilar involvement (50%), pneumonia (46.7%), collapse (40%), peripheral mass (36.7%) and in single abnormality, large peripheral mass (33.3%). d) Bronchogenic adenocarcinoma commonly present as peripheral mass (44.1%), collapse (41.2%), pleural effusion (35.2%) and in single abnormality, peripheral mass (50%). e) Solitary peripheral mass commonly present as lobulation (48%) and spiculated margin (51%), but no specific findings by histologic types. Cavitary formation was most common in Squamous cell carcinoma

  16. Primary ureteral carcinoma: MRI diagnosis and comparison with other diagnostic imaging facilities

    International Nuclear Information System (INIS)

    An Ningyu; Jiang Bo; Cai Youquan; Liang Yan

    2004-01-01

    Objective: To investigate MRI examination methods and imaging manifestations of primary ureteral carcinoma, and to evaluate its clinical values when comparing with other diagnostic imaging facilities. Methods: Eighty-seven cases of primary ureteral carcinoma who were operated within recent 8 years came into the study, among which, 35 cases had MRI examinations. For MRI examination, coronal heavy T 2 WI (water imaging) was performed to show the dilated ureter, then axial T 2 WI and T 1 WI were scanned at the obstruction level. 11 cases underwent additional Gd-DTPA dynamic contrast enhanced scans. The original pre-operative diagnostic reports of various imaging facilities were analyzed comparing with the results of operation and pathology. Results: MRI showed ureteral dilatation in 33 of 35 cases, no abnormal appearance in 1 case, and only primary kidney atrophy post renal transplantation in 1 case. Among the 33 cases with ureteral obstruction, soft mass at the obstruction level was detected on axial scans in 32 cases. The lesions showed gradual and homogeneous mild to moderate enhancement on contrast MRI. The overall employment rate of imaging facilities was as follows: ultrasound (94.3%), IVU (59.8%), CT (52.9%), MRI (40.2%), and RUP (35.6%). The accurate diagnostic rate was as follows :MRI (91.4%), RUP (80.6%), CT (63.0%), ultrasound (47.6%), and IVU (11.5%). Conclusion: Combination of MR water imaging and conventional sequences can demonstrate most primary ureteral carcinoma lesions and has a highest diagnostic accuracy among the current diagnostic imaging facilities. It should be taken as the first diagnostic imaging method of choice when primary ureteral carcinoma is suspected after ultrasound screening

  17. PMK-2 the Hungarian integral type test facility. Documentations, publications and archivations of experiments

    International Nuclear Information System (INIS)

    Perneczky, L.; Guba, A.; Ezsoel, G.; Toth, I.; Szabados, L.

    2002-01-01

    The PMK-2 experimental facility at the KFKI-AEKI, Budapest, is a full pressure, scaled down model of the primary and partly the secondary circuit of the Paks NPP, which is equipped with four VVER-440/213-type reactors. Since the start-up of the facility altogether 48 experiments have been performed for groups of transients as follows: one- and two-phase natural circulation, loss of coolant accidents, special plant transients and experiments in support of accident management procedures. The results have been used for the validation of thermal-hydraulic system codes for VVER applications. Following the experiments a detailed documentation and archiving activity - using an optimised data storage - was required to preserve the essential information and to assure these for a widely utilisation for the international nuclear community. In the publication list related to the facility and the experiments for the moment altogether 280 items - documents, articles in periodicals, papers in proceedings and research reports - in six languages were collected. The paper gives an overview on this activity including the participation in the EU CERTA-TN programme, where AEKI introduced representative databases of two PMK-2 tests in the STRESA Network.(author)

  18. Survival after bone metastasis by primary cancer type

    DEFF Research Database (Denmark)

    Svensson, Elisabeth; Christiansen, Christian F; Ulrichsen, Sinna P

    2017-01-01

    OBJECTIVE: In the 10 most common primary types with bone metastases, we aimed to examine survival, further stratifying on bone metastases only or with additional synchronous metastases. METHODS: We included all patients aged 18 years and older with incident hospital diagnosis of solid cancer...... between 1994 and 2010, subsequently diagnosed with BM until 2012. We followed patients from date of bone metastasis diagnosis until death, emigration or 31 December 2012, whichever came first. We computed 1-year, 3-year and 5-year survival (%) and the corresponding 95% CIs stratified on primary cancer...... prostate (34%), breast (22%) and lung (20%). One-year survival after bone metastasis diagnosis was lowest in patients with lung cancer (10%, 95% CI 9% to 11%) and highest in patients with breast cancer (51%, 50% to 53%). At 5 years of follow-up, only patients with breast cancer had over 10% survival (13...

  19. Type D (distressed) personality in primary care patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Nefs, Giesje; Pouwer, Francois; Pop, Victor J M

    2012-01-01

    D Scale-14 (DS14) in type 2 diabetes patients. METHODS: 1553 primary care patients with type 2 diabetes were assessed for demographic, clinical, lifestyle and psychological characteristics in 2007. A subgroup (n=1012) completed the DS14 again 1 year later. RESULTS: The two-factor model of the Type D...... or physiological risk factors, but Type D women had a more sedentary lifestyle (p=.003). Type D patients experienced less social support and more stressful life events, loneliness, and more depressed mood, anhedonia and anxiety (p0......OBJECTIVE: In cardiovascular research, Type D personality (high negative affectivity and social inhibition) has been associated with a more than 3-fold increased risk of adverse health outcomes. This study examined the validity and clinical correlates of the Type D construct as assessed by the Type...

  20. Process cost and facility considerations in the selection of primary cell culture clarification technology.

    Science.gov (United States)

    Felo, Michael; Christensen, Brandon; Higgins, John

    2013-01-01

    The bioreactor volume delineating the selection of primary clarification technology is not always easily defined. Development of a commercial scale process for the manufacture of therapeutic proteins requires scale-up from a few liters to thousands of liters. While the separation techniques used for protein purification are largely conserved across scales, the separation techniques for primary cell culture clarification vary with scale. Process models were developed to compare monoclonal antibody production costs using two cell culture clarification technologies. One process model was created for cell culture clarification by disc stack centrifugation with depth filtration. A second process model was created for clarification by multi-stage depth filtration. Analyses were performed to examine the influence of bioreactor volume, product titer, depth filter capacity, and facility utilization on overall operating costs. At bioreactor volumes 5,000 L, clarification using centrifugation followed by depth filtration offers significant cost savings. For bioreactor volumes of ∼ 2,000 L, clarification costs are similar between depth filtration and centrifugation. At this scale, factors including facility utilization, available capital, ease of process development, implementation timelines, and process performance characterization play an important role in clarification technology selection. In the case study presented, a multi-product facility selected multi-stage depth filtration for cell culture clarification at the 500 and 2,000 L scales of operation. Facility implementation timelines, process development activities, equipment commissioning and validation, scale-up effects, and process robustness are examined. © 2013 American Institute of Chemical Engineers.

  1. 15 years of The Hungarian integral type test facility: horizontal SG related PMK-2 experiments

    International Nuclear Information System (INIS)

    Perneczky, L.; Ezsoel, G.; Guba, A.; Szabados, L.

    2001-01-01

    The PMK-2 experimental facility at the KFKI-AEKI, Budapest, is a full pressure, scaled down model of the primary and partly the secondary circuit of the Paks Nuclear Power Plant. This NPP is equipped with four VVER-440/213-type reactors. Such plants are slightly different from PWRs of usual design and have a number of special features as 6-loop primary circuit, horizontal steam generators, loop seal in hot and cold legs, setpoint pressure of passive safety injection tanks (SIT) higher than secondary pressure, etc. The PMK-2 was primarily designed for investigating operational and off-normal transient processes, as well as small-break loss of coolant accidents of Paks NPP. The volume and power scaling ratios are 1:2070. Due to the importance of gravitational forces in both single- and two-phase flow the elevation ratio is 1:1 except for the lower plenum and pressuriser. The six loops of the plant are modelled by a single active loop. Transients can be started from nominal operating conditions. The pressuriser (PRZ) is connected to the lower part of the hot leg as in the reference system. The core model consists of 19 electrically heated rods. The main circulating pump of the PMK-2 serves to produce the nominal operating conditions and to simulate the flow coast-down following pump trip. The horizontal design of the VVER-440 steam generator is modelled by horizontal heat transfer tubes between hot and cold vertical collectors in the primary side. The emergency core cooling systems including the SITs. High and low pressure injection systems of the Paks NPP are also modelled. The first design of the PMK-NVH facility only modelled the primary circuit of plant. This version was used until 1990. The PMK-2 facility is an upgraded version (first of all by addition of a controlled secondary heat removal system) extending the capability of the test loop to modelling transient processes evoked by initiating events in the secondary circuit or including accident sequences in

  2. Polyglandular Autoimmune Syndrome Type III with Primary Hypoparathyroidism

    Directory of Open Access Journals (Sweden)

    Sang Jin Kim

    2013-09-01

    Full Text Available Polyglandular autoimmune syndrome is defined as multiple endocrine gland insufficiencies accompanied by autoimmune diseases of the endocrine and nonendocrine system. After Schmidt introduced a case of nontuberculosis adrenal gland dysfunction with thyroiditis in 1926, Neufeld defined polyglandular autoimmune syndrome by I, II, and III subtypes in 1980 by their presentation of occurrence age, heredity methods, relationship with human leukocyte antigen, and accompanying diseases. We report a case of a 32-year-old female with polyglandular autoimmune syndrome III accompanied by type 1 diabetes mellitus that was treated with insulin (36 units per day for 11 years. She had insulin deficiency and Hashimoto thyroiditis as an autoimmune disorder. In addition, she had several features similar to Albright's hereditary osteodystrophy including short stature, truncal obesity, round face, short neck, low intelligence (full IQ 84, and decreased memory. Although Albright's hereditary osteodystrophy is morphological evidence of pseudohypoparathyroidism or pseudopseudohypoparathyroidism, she had primary hypoparathyroidism on laboratory results. Here, we report a case of polyglandular autoimmune syndrome III with type 1 diabetes mellitus, autoimmune thyroiditis, and primary hypoparathyroidism, accompanied by clinical features similar to Albright's hereditary osteodystrophy.

  3. Corrosion product behaviour in the primary circuit of the KNK nuclear reactor facility

    International Nuclear Information System (INIS)

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

    1976-01-01

    During nuclear operation of the KNK facility from 1972 until September 1974 the composition and behaviour of radionuclides occuring in the primary circuit were investigated. Besides traces of 140 Ba/ 140 La, no fission product activity was detectable in the KNK primary circuit. The fuel element purification from sodium deposits (prior to transport to the reprocessing plant) did not yield any indication of a fuel element failure during KNK-I operation. The activity inventory of the primary loop was exclusively made up of activated corrosion products and 22 Na. The main activity was due to 65 Zn, followed by 54 Mn, 22 Na, sup(110m)Ag, 182 Ta, 60 Co and 124 Sb. It was found that the sorption of 65 Zn and 54 Mn on crucibles made from nickel was condiserably higher than on vessels made from other materials. This observation was confirmed both in tests with material samples from the primary circuit and for disks of gate valves of the primary circuit. sup(110m)Ag did hardly exhibit any sorption effects and had been dissolved largely homogeneously in the hot primary coolant. In the first primary cold trap which was removed from the circuit after some 20,000 hours of operation, only 65 Zn and 54 Mn were detected in addition to traces of 60 Co and 182 Ta. (author)

  4. Pre-test analysis of protected loss of primary pump transients in CIRCE-HERO facility

    Science.gov (United States)

    Narcisi, V.; Giannetti, F.; Del Nevo, A.; Tarantino, M.; Caruso, G.

    2017-11-01

    In the frame of LEADER project (Lead-cooled European Advanced Demonstration Reactor), a new configuration of the steam generator for ALFRED (Advanced Lead Fast Reactor European Demonstrator) was proposed. The new concept is a super-heated steam generator, double wall bayonet tube type with leakage monitoring [1]. In order to support the new steam generator concept, in the framework of Horizon 2020 SESAME project (thermal hydraulics Simulations and Experiments for the Safety Assessment of MEtal cooled reactors), the ENEA CIRCE pool facility will be refurbished to host the HERO (Heavy liquid mEtal pRessurized water cOoled tubes) test section to investigate a bundle of seven full scale bayonet tubes in ALFRED-like thermal hydraulics conditions. The aim of this work is to verify thermo-fluid dynamic performance of HERO during the transition from nominal to natural circulation condition. The simulations have been performed with RELAP5-3D© by using the validated geometrical model of the previous CIRCE-ICE test section [2], in which the preceding heat exchanger has been replaced by the new bayonet bundle model. Several calculations have been carried out to identify thermal hydraulics performance in different steady state conditions. The previous calculations represent the starting points of transient tests aimed at investigating the operation in natural circulation. The transient tests consist of the protected loss of primary pump, obtained by reducing feed-water mass flow to simulate the activation of DHR (Decay Heat Removal) system, and of the loss of DHR function in hot conditions, where feed-water mass flow rate is absent. According to simulations, in nominal conditions, HERO bayonet bundle offers excellent thermal hydraulic behavior and, moreover, it allows the operation in natural circulation.

  5. Primary functions of the first Japanese large-scale facility for exposing small animals to radon

    International Nuclear Information System (INIS)

    Ishimori, Yuu; Tanaka, Hiroshi; Mitsunobu, Fumihiro; Yamaoka, Kiyonori; Kataoka, Takahiro; Sakoda, Akihiro

    2010-01-01

    The Japan Atomic Energy Agency (JAEA) and Okayama University have carried out the experimental animal study and its related studies since 2007 in order to examine the physiological effects of radon in detail. Thus, a radon test facility for small animals was developed in order to increase the statistical certainty of our animal tests. This paper illustrates the performances of that facility, the first large-scale facility of its types in Japan. The facility has a potential of approximately 150 mouse-scale tests at the same time. The apparatus for exposing small animals to radon has six animal chamber groups each of which consists of five independent cages. Different radon concentrations in each animal chamber group are available. The major functions of the facility controlling radon and avoiding thoron were shown theoretically and experimentally. The relative standard deviation of radon concentration at the highest concentration group was about 5%, although the lower concentration groups seemed to be affected by variations in background radon. (author)

  6. CATHARE-2 prediction of large primary to secondary leakage (PRISE) at PSB-VVER experimental facility

    Energy Technology Data Exchange (ETDEWEB)

    Sabotinov, L.; Chevrier, P. [Institut de Radioprotection et de Surete Nucleaire, 92 - Fontenay aux Roses (France)

    2007-07-01

    The large primary to secondary leakage (PRISE) is a specific loss-of-coolant accident in VVER reactors, related to the break of the steam generator collector cover, leading to loss of primary mass inventory and possible direct radioactive release to atmosphere. The best estimate thermal-hydraulic computer code CATHARE-2 Version 2.5-1 was used for post-test analysis of a PRISE experiment, conducted at the large scale test facility PSB-VVER in Russia. The PSB rig is 1:300 scaled model of VVER-1000 NPP. The accident is calculated with a 1.4% break size, which corresponds to 100 mm leak from primary to secondary side in the real NPP. A computer model has been developed for CATHARE-2 V2.5-1, taking into account all important components of the PSB facility: reactor model (lower plenum, core, bypass, upper plenum, downcomer), 4 separate loops, pressurizer, horizontal multi-tube steam generators, break section. The secondary side is presented by recirculation model. A large number of sensitivity calculations has been performed regarding break modeling, reactor pressure vessel modeling, counter current flow modeling, hydraulic losses, heat losses, steam generator level regulation. Comparison between calculated and experimental results shows good prediction of the basic thermal-hydraulic phenomena and parameters such as primary and secondary pressures, temperatures, loop flows, etc. Some discrepancies were observed in the calculations of primary mass inventory and loop seal clearance. Nevertheless the final core heat up, which is one of the most important safety criteria, was correctly predicted. (authors)

  7. The replacement of an electromagnetic primary sodium sampling pump in the Fast Flux Test Facility

    International Nuclear Information System (INIS)

    Grygiel, M.L.; McCargar, C.G.

    1985-01-01

    On November 16, 1984 a leak was discovered in one of the Fast Flux Test Facility (FFTF) Primary Sodium Sampling System electromagnetic pumps. The leak was discovered in the course of routine cell entry to investigate a shorted trace heat element. The purpose of this paper is to describe the circumstances surrounding the occurrence of the leak, the actions taken to replace the damaged pump and the additional steps which were necessary to return the plant to power. In addition, the processes involved in producing the leak are described briefly. The relative ease of recovery from this incident is indicative of the overall feasibility of the Liquid Metal Reactor (LMR) operational concept

  8. Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana.

    Directory of Open Access Journals (Sweden)

    Robert Kaba Alhassan

    Full Text Available Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed.This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities.A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities.Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05 and staff competencies (Coef. = 7.1, p<0.05. Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period

  9. Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis.

    Science.gov (United States)

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

    2017-02-01

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

  10. Environmental Monitoring, Water Quality - Water Pollution Control Facilities

    Data.gov (United States)

    NSGIC Education | GIS Inventory — A Water Pollution Control Facility is a DEP primary facility type related to the Water Pollution Control Program. The sub-facility types related to Water Pollution...

  11. Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

    Directory of Open Access Journals (Sweden)

    Sayed Masoom Shah

    2016-08-01

    Full Text Available Background: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC infrastructure, Pakistan’s health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. Methods: An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Results: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs

  12. Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan.

    Science.gov (United States)

    Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

    2016-04-09

    Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Inadequate remuneration, unreasonable

  13. Protection of WWER type primary loops against extreme effects

    International Nuclear Information System (INIS)

    Podrouzek, J.; Rejent, B.

    1985-01-01

    Dynamic analyses of the WWER-440 primary loops for the Mochovce nuclear power plant showed that the unprotected primary loop is very soft with a first eigenfrequency of 0.38 Hz. Protection with amortisseurs and viscous shock absorbers was compared and the viscous shock absorber in all cases proved to be more suitable. GERB viscous absorbers will be installed at the Mochovce nuclear power plant. First calculations of the dynamic resistance of the WWER-1000 primary loops for the Temelin nuclear power plant to extreme events were also made. It was shown that the unprotected primary loop is rather soft with a first eigenfrequency of 0.9 Hz, or 0.6 Hz at the pressurizer branch. It will therefore be necessary to protect the primary loops with viscous shock absorbers. (Z.M.)

  14. Investigation on proper materials of a liner system for trench type disposal facilities of radioactive wastes from research, industrial and medical facilities

    International Nuclear Information System (INIS)

    Nakata, Hisakazu; Amazawa, Hiroya; Sakai, Akihiro; Arikawa, Masanobu; Sakamoto, Yoshiaki

    2011-08-01

    The Low-level Radioactive Waste Disposal Project Center of Japan Atomic Energy Agency will settle on near surface disposal facilities with and without engineered barriers for radioactive wastes from research, industrial and medical facilities. Both of them are so called 'concrete pit type' and 'trench type', respectively. The technical standard of constructing and operating a disposal facility based on 'Law for the Regulations of Nuclear Source Material, Nuclear Fuel Material and Reactors' have been regulated partly by referring to that of 'Waste Management and Public Cleansing Law'. This means that the concrete pit type and the trench type disposal facility resemble an isolated type for specified industrial wastes and a non leachate controlled type final disposal site for stable industrial wastes, respectively. On the other, We plan to design a disposal facility with a liner system corresponding to a leachate controlled type final disposal site on a crucial assumption that radioactive wastes other than stable industrial wastes to be disposed into the trench type disposal facility is generated. By current nuclear related regulations in Japan, There are no technical standard of constructing the disposal facility with the liner system referring to that of 'Waste Management and Public Cleansing Law'. We investigate the function of the liner system in order to design a proper liner system for the trench type disposal facility. In this report, We investigated liner materials currently in use by actual leachate controlled type final disposal sites in Japan. Thereby important items such as tensile strength, durability from a view point of selecting proper liner materials were studied. The items were classified into three categories according to importance. We ranked proper liner materials for the trench type disposal facility by evaluating the important items per material. As a result, high density polyethylene(HDPE) of high elasticity type polymetric sheet was selected

  15. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

    DEFF Research Database (Denmark)

    Ahiabu, Mary-Anne; Tersbøl, Britt Pinkowski; Biritwum, Richard

    2016-01-01

    with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support......Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality...... assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern...

  16. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Adeloye A. Adeniji

    2016-06-01

    Full Text Available Background: In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. Aim: This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting: Gugulethu Community Health Centre, Cape Town. Methods: A purposive sample consisted of five women (one coded green, three orange, one yellow and four men (one coded green and three yellow. A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. Results: All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Conclusion: Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened. Keywords: emergency care; primary care; triage; patient satisfaction

  17. Environmental consequences of hydroelectric development: the role of facility size and type

    International Nuclear Information System (INIS)

    Gleick, P.H.

    1992-01-01

    The development of hydroelectric power throughout the world is receiving renewed attention as the economic, political, and environmental costs of conventional energy production rise. There is currently a perception that hydroelectricity has environmental and economic advantages over electricity produced by conventional energy technologies, but there is a paucity of information about the environmental impacts of hydroelectric facilities as a function of size and type. We characterize the environmental impacts of hydroelectric developments and quantify these impacts as a function of the size and type of project. Several unexpected conclusions arise from our analysis. For most hydroelectric facilities, size, as measured by installed capacity, is not necessarily a good indicator or the severity of environmental costs. For impacts such as land flooded and evaporative water lost, smaller facilities cause greater environmental disruptions per unit of energy produced than do larger facilities. (Author)

  18. Household Consumption of Food-Away-From-Home: Total Expenditure and by Type of Food Facility

    OpenAIRE

    Vicki A. McCracken; Jon A. Brandt

    1987-01-01

    Consistent with prior expectations based on household production theory, household income, time value, size and composition, and the environment in which production and consumption occurred were all important determinants of total household expenditures on food-away-from-home. However, the importance of these factors varied by type of food facility: conventional restaurants, fast-food facilities, and other commercial establishments. Decomposition of the tobit elasticities indicated the differ...

  19. Assessing the Primary Data Hosted by the Spanish Node of the Global Biodiversity Information Facility (GBIF)

    Science.gov (United States)

    Otegui, Javier; Ariño, Arturo H.; Encinas, María A.; Pando, Francisco

    2013-01-01

    In order to effectively understand and cope with the current ‘biodiversity crisis’, having large-enough sets of qualified data is necessary. Information facilitators such as the Global Biodiversity Information Facility (GBIF) are ensuring increasing availability of primary biodiversity records by linking data collections spread over several institutions that have agreed to publish their data in a common access schema. We have assessed the primary records that one such publisher, the Spanish node of GBIF (GBIF.ES), hosts on behalf of a number of institutions, considered to be a highly representative sample of the total mass of available data for a country in order to know the quantity and quality of the information made available. Our results may provide an indication of the overall fitness-for-use in these data. We have found a number of patterns in the availability and accrual of data that seem to arise naturally from the digitization processes. Knowing these patterns and features may help deciding when and how these data can be used. Broadly, the error level seems low. The available data may be of capital importance for the development of biodiversity research, both locally and globally. However, wide swaths of records lack data elements such as georeferencing or taxonomical levels. Although the remaining information is ample and fit for many uses, improving the completeness of the records would likely increase the usability span for these data. PMID:23372828

  20. Physicians' professionalism at primary care facilities from patients' perspective: The importance of doctors' communication skills.

    Science.gov (United States)

    Sari, Merry Indah; Prabandari, Yayi Suryo; Claramita, Mora

    2016-01-01

    Professionalism is the core duty of a doctor to be responsible to the society. Doctors' professionalism depicts an internalization of values and mastery of professionals' standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors' professionalism may influence patients' satisfaction, and therefore, it is important to know from the patients' perspectives what was expected of medical doctors' professionalism. This study was conducted to determine the attributes of physician professionalism from the patient's perspective. This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Communication skills were considered as the top priority of medical doctors' attributes of professionalism in the perspectives of the patients. This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

  1. Physicians′ professionalism at primary care facilities from patients′ perspective: The importance of doctors′ communication skills

    Directory of Open Access Journals (Sweden)

    Merry Indah Sari

    2016-01-01

    Full Text Available Background: Professionalism is the core duty of a doctor to be responsible to the society. Doctors′ professionalism depicts an internalization of values and mastery of professionals′ standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors′ professionalism may influence patients′ satisfaction, and therefore, it is important to know from the patients′ perspectives what was expected of medical doctors′ professionalism. Objective: This study was conducted to determine the attributes of physician professionalism from the patient′s perspective. Materials and Methods: This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Results: Communication skills were considered as the top priority of medical doctors′ attributes of professionalism in the perspectives of the patients. Conclusion: This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

  2. RADON-type disposal facility safety case for the co-ordinated research project on improvement of safety assessment methodologies for near surface radioactive waste disposal facilities (ISAM)

    International Nuclear Information System (INIS)

    Guskov, A.; Batanjieva, B.; Kozak, M.W.; Torres-Vidal, C.

    2002-01-01

    The ISAM safety assessment methodology was applied to RADON-type facilities. The assessments conducted through the ISAM project were among the first conducted for these kinds of facilities. These assessments are anticipated to lead to significantly improved levels of safety in countries with such facilities. Experience gained though this RADON-type Safety Case was already used in Russia while developing national regulatory documents. (author)

  3. Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

    Science.gov (United States)

    Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

    2015-05-01

    Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

  4. A study on the primary requirement for the safety of the Wolsong tritium removal facility

    International Nuclear Information System (INIS)

    Hwang, K. H.; Lee, K. J.; Jeong, C. W.

    2001-01-01

    Owing to the using a heavy water as a moderator and a coolant in Heavy water reactor, A large mount of tritium is produced due to a reaction of deuterium with neutron in the reactor and some of tritium is released to the environment. In Wolsong, 4 units (CANDU-600 type) Heavy water reactor is in operation. And the generated amount of tritium is increased with the increase of operational year of the Wolsong nuclear reactor. Decommissioning of the Wolsong unit 1 is expected to start at 2013. Before 2013, to reduce the workers internal radiation doses and environmental release of tritium, Tritium Removal Facility (TRF) is required and should be operated. Wolsong TRF (WTRF) is under developing stage by Korea Electric Power Corporation(KEPCO)and scheduled to start operation about 2006. Once the facility begins operation it can be contributed to the greatly reduction of tritium release to the environment and worker's expose. In this situation, study about the safety assessment method and regulatory requirement is essential for safety insurance of WTRF. And this helps the safety acquirement, successful operation and reliance of WTRF

  5. Police Stations, City of Wichita Police Department substation locations. Cover is derived from Emergency Facilities (scEfac) cover. Used for Public Safety map rolls. Primary attributes include station number, address, mailing city, type, and name., Published in 2008, 1:1200 (1in=100ft) scale, Sedgwick County Government.

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Police Stations dataset current as of 2008. City of Wichita Police Department substation locations. Cover is derived from Emergency Facilities (scEfac) cover. Used...

  6. THE RELATIONSHIP BETWEEN DIABETES MELLITUS AND BODY MASS INDEX: PRIMARY CARE FACILITY IN PUERTO RICO.

    Science.gov (United States)

    Chavier-Roper, Rolance G; Alick-Ortiz, Sharlene; Davila-Plaza, Geraldine; Morales-Quiñones, Aixa G

    2014-01-01

    Obesity is a major risk factor in the development of Diabetes Mellitus (DM). Body Mass Index (BMI), an estimation based on the persons weight and height, helps identify patients at risk to develop DM. We report the relationship between DM and BMI using data from a primary care facility in Puerto Rico. Patients were chosen at random with the only requirement to be included in this study was age over 50. A population of 200 patients was obtained and each participant was categorized by gender, weight, height, BMI and their status as a known diabetic or not. In respect to the diabetic population identified, which totaled 67 patients, 1 out of 67 (1%) were underweight, 14 out of 67 (20%) were normal, 28 out of 67 (42%) were overweight, and 24 out of 67 (36%) obese. 78% of the diabetic population fell in the categories of either overweight or obese. BMI increases the incidence of Diabetes Mellitus in patients older than 50 years of age.

  7. Shield design of concrete wall between decay tank room and primary pump room in TRIGA facility

    International Nuclear Information System (INIS)

    Khan, M. J. H.; Rahman, M.; Haque, A.; Zulquarnain, A.; Ahmed, F. U.; Bhuiyan, S. I.

    2007-01-01

    The objective of this study is to recommend the radiation protection design parameters from the shielding point of view for concrete wall between the decay tank room and the primary pump room in TRIGA Mark-II research reactor facility. The shield design for this concrete wall has been performed with the help of Point-kernel Shielding Code Micro-Shield 5.05 and this design was also validated based on the measured dose rate values with Radiation Survey Meter (G-M Counter) considering the ICRP-60 (1990) recommendations for occupational dose rate limit (10 μSv/hr). The recommended shield design parameters are: (i) thickness of 114.3 cm Ilmenite-Magnetite Concrete (IMC) or 129.54 cm Ordinary Reinforced Concrete (ORC) for concrete wall A (ii) thickness of 66.04 cm Ilmenite-Magnetite Concrete (IMC) or 78.74 cm Ordinary Reinforced Concrete (ORC) for concrete wall B and (iii) door thickness of 3.175 cm Mild Steel (MS) on the entrance of decay tank room. In shielding efficiency analysis, the use of I-M concrete in the design of this concrete wall shows that it reduced the dose rate by a factor of at least 3.52 times approximately compared to ordinary reinforced concrete

  8. Three formulations of the multi-type capacitated facility location problem

    DEFF Research Database (Denmark)

    Klose, Andreas

    The "multi-type" or "modular" capacitated facility location problem is a discrete location model that addresses non-convex piecewise linear production costs as, for instance, staircase cost functions. The literature basically distinguishes three different ways to formulate non-convex piecewise...

  9. Cavity-Type BPMs For The TESLA Test Facility Free Electron Laser

    CERN Document Server

    Waldmann, H

    2003-01-01

    For measurements of the beam position at the undulator section of the TESLA Test Facility (TTF) at DESY cavity-type beam position monitors were developed, installed and brought into operation. Besides of some theoretical aspects results of in-beam measurements at the TTF are presented and pros and cons of this monitor concept are discussed.

  10. Efficient monitoring of type 2 diabetes in primary care

    NARCIS (Netherlands)

    Wermeling, P.R.

    2013-01-01

    Guidelines for treatment of patients with type 2 diabetes mellitus advise to monitor patients every three months, but this advice is not evidence-based. In this study we investigated whether the monitoring frequency in well-controlled diabetes patients (not using insulin, HbA1c ≤58 mmol/mol,

  11. Educational Facility Evaluations of Primary Schools in Rural Honduras: Departments of Cortes and Meambar.

    Science.gov (United States)

    Council of Educational Facility Planners, International, Scottsdale, AZ.

    A team of 11 educational facility planners and architects from the United States and Canada conducted a facility evaluation of schools in the rural areas of Meambar and Cortes, Honduras. Team members were all part of the Council of Educational Facility Planners, International and traveled to Honduras under the auspices of a Christian mission…

  12. Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue.

    Science.gov (United States)

    Opwora, Antony; Waweru, Evelyn; Toda, Mitsuru; Noor, Abdisalan; Edwards, Tansy; Fegan, Greg; Molyneux, Sassy; Goodman, Catherine

    2015-05-01

    With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect. In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups. We present data on user fee implementation, revenue and expenditure from a nationally representative survey of Kenyan primary health facilities. Data were collected from 248 randomly selected public health centres and dispensaries in 2010, comprising an interview with the health worker in charge, exit interviews with curative outpatients, and a financial record review. Adherence to user fee policy was assessed for eight tracer conditions based on health worker reports, and patients were asked about actual amounts paid. No facilities adhered fully to the user fee policy across all eight tracers, with adherence ranging from 62.2% for an adult with tuberculosis to 4.2% for an adult with malaria. Three quarters of exit interviewees had paid some fees, with a median payment of US dollars (USD) 0.39, and a quarter of interviewees were required to purchase additional medical supplies at a later stage from a private drug retailer. No consistent pattern of association was identified between facility characteristics and policy adherence. User fee revenues accounted for almost all facility cash income, with average revenue of USD 683 per facility per year. Fee revenue was mainly used to cover support staff, non-drug supplies and travel allowances. Adherence to user fee policy was very low, leading to concerns about the impact on access and the financial burden on households. However, the potential to ensure adherence was constrained by the facilities' need for revenue to cover basic operating costs, highlighting the need for alternative funding strategies for peripheral health facilities. Published by Oxford University Press in association with

  13. 41 CFR 102-72.45 - What are the different types of delegations related to facility management?

    Science.gov (United States)

    2010-07-01

    ... different types of delegations related to facility management? The principal types of delegations involved... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are the different types of delegations related to facility management? 102-72.45 Section 102-72.45 Public Contracts and...

  14. Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan.

    Science.gov (United States)

    Tappis, Hannah; Koblinsky, Marge; Doocy, Shannon; Warren, Nicole; Peters, David H

    2016-01-01

    The objective of this study was to assess the association between health facility characteristics and other individual/household factors with a woman's likelihood of skilled birth attendance in north-central Afghanistan. Data from a 2010 household survey of 6879 households in 9 provinces of Afghanistan were linked to routine facility data. Hierarchical logistic regression models were used to assess determinants of skilled birth attendance. Women who reported having at least one antenatal visit with a skilled provider were 5.6 times more likely to give birth with a skilled attendant than those who did not. The odds of skilled birth attendance were 84% higher for literate women than those without literacy skills and 79% higher among women in the upper 2 wealth quintiles than women in the poorest quintile. This study did not show any direct linkages between facility characteristics and skilled birth attendance but provided insights into why studies assuming that women seek care at the nearest primary care facility may lead to misinterpretation of care-seeking patterns. Findings reveal a 36 percentage point gap between women who receive skilled antenatal care and those who received skilled birth care. Nearly 60% of women with a skilled attendant at their most recent birth bypassed the nearest primary care facility to give birth at a more distant primary care facility, hospital, or private clinic. Distance and transport barriers were reported as the most common reasons for home birth. Assumptions that women who give birth with a skilled attendant do so at the closest health facility may mask the importance of supply-side determinants of skilled birth attendance. More research based on actual utilization patterns, not assumed catchment areas, is needed to truly understand the factors influencing care-seeking decisions in both emergency and nonemergency situations and to adapt strategies to reduce preventable mortality and morbidity in Afghanistan. © 2016 by the American

  15. E-SCAPE: A scale facility for liquid-metal, pool-type reactor thermal hydraulic investigations

    Energy Technology Data Exchange (ETDEWEB)

    Van Tichelen, Katrien, E-mail: kvtichel@sckcen.be [SCK-CEN, Boeretang 200, 2400 Mol (Belgium); Mirelli, Fabio, E-mail: fmirelli@sckcen.be [SCK-CEN, Boeretang 200, 2400 Mol (Belgium); Greco, Matteo, E-mail: mgreco@sckcen.be [SCK-CEN, Boeretang 200, 2400 Mol (Belgium); Viviani, Giorgia, E-mail: giorgiaviviani@gmail.com [University of Pisa, Lungarno Pacinotti 43, 56126 Pisa (Italy)

    2015-08-15

    Highlights: • The E-SCAPE facility is a thermal hydraulic scale model of the MYRRHA fast reactor. • The focus is on mixing and stratification in liquid-metal pool-type reactors. • Forced convection, natural convection and the transition are investigated. • Extensive instrumentation allows validation of computational models. • System thermal hydraulic and CFD models have been used for facility design. - Abstract: MYRRHA (Multi-purpose hYbrid Research Reactor for High-tech Applications) is a flexible fast-spectrum research reactor under design at SCK·CEN. MYRRHA is a pool-type reactor with lead bismuth eutectic (LBE) as primary coolant. The proper understanding of the thermal hydraulic phenomena occurring in the reactor pool is an important issue in the design and licensing of the MYRRHA system and liquid-metal cooled reactors by extension. Model experiments are necessary for understanding the physics, for validating experimental tools and to qualify the design for the licensing. The E-SCAPE (European SCAled Pool Experiment) facility at SCK·CEN is a thermal hydraulic 1/6-scale model of the MYRRHA reactor, with an electrical core simulator, cooled by LBE. It provides experimental feedback to the designers on the forced and natural circulation flow patterns. Moreover, it enables to validate the computational methods for their use with LBE. The paper will elaborate on the design of the E-SCAPE facility and its main parameters. Also the experimental matrix and the pre-test analysis using computational fluid dynamics (CFD) and system thermal hydraulics codes will be described.

  16. a System Dynamics Model to Study the Importance of Infrastructure Facilities on Quality of Primary Education System in Developing Countries

    Science.gov (United States)

    Pedamallu, Chandra Sekhar; Ozdamar, Linet; Weber, Gerhard-Wilhelm; Kropat, Erik

    2010-06-01

    The system dynamics approach is a holistic way of solving problems in real-time scenarios. This is a powerful methodology and computer simulation modeling technique for framing, analyzing, and discussing complex issues and problems. System dynamics modeling and simulation is often the background of a systemic thinking approach and has become a management and organizational development paradigm. This paper proposes a system dynamics approach for study the importance of infrastructure facilities on quality of primary education system in developing nations. The model is proposed to be built using the Cross Impact Analysis (CIA) method of relating entities and attributes relevant to the primary education system in any given community. We offer a survey to build the cross-impact correlation matrix and, hence, to better understand the primary education system and importance of infrastructural facilities on quality of primary education. The resulting model enables us to predict the effects of infrastructural facilities on the access of primary education by the community. This may support policy makers to take more effective actions in campaigns.

  17. Filtering device for primary coolant circuits in BWR type reactors

    International Nuclear Information System (INIS)

    Tajima, Fumio; Yamamoto, Tetsuo.

    1985-01-01

    Purpose: To obtain a filtering device with a large filtering area and requiring less space. Constitution: A condensate inlet for introducing condensates to be filtered of primary coolant circuits, a filtrate exit, a backwash water exit and a bent tube are disposed to a container, and a plurality of hollow thread membrane modules are suspended in the container. The condensates are caused to flow through the condensate inlet, filtered through the hollow thread membrane and then discharged from the filtrate exit. When the filtering treatment is proceeded to some extent, since solid contents captured in the hollow thread membranes are accumulated, a differential pressure is produced between the condensate inlet and the filtrate exit. When the differential pressure reaches a predetermined value, the backwash is conducted to discharge the liquid cleaning wastes through the backwash exit. The bent tube disposed to the container body is used for water and air draining. The hollow thread membranes are formed with porous resin such as of polyethylene. (Kawakami, Y.)

  18. Primary coolant recycling device for FBR type reactor

    International Nuclear Information System (INIS)

    Kanbe, Mitsuru; Tokiwai, Moriyasu

    1998-01-01

    A primary coolants (liquid sodium) recycling device comprises a plurality of recycling pumps. The recycling pumps are operated while using, as a power source, electric power generated by a thermoelectric power generation system by utilizing heat stored in the coolants. The thermoelectric power generation system comprises a thermo-electric conversion module, heat collecting heat pipes as a high temperature side heat conduction means and heat dissipating pipes as a low temperature side heat conduction means. The heat of coolants is transferred to the surface of the high temperature side of each thermo-electric conversion elements of the thermal power generation system by the heat collecting heat pipes. The heat on the low temperature side of each of the thermo-electric conversion elements is removed by the heat dissipating pipes. Accordingly, temperature difference is caused between both surfaces of the thermo-electric conversion elements. Even upon loss of a main power source due to stoppage of electricity, electric power is generated by utilizing heat of coolants, so that the recycling pumps circulate coolants to cool a reactor core continuously. (I.N.)

  19. Analyzing the equity of public primary care provision in Kenya: variation in facility characteristics by local poverty level

    Directory of Open Access Journals (Sweden)

    Toda Mitsuru

    2012-12-01

    Full Text Available Abstract Introduction Equitable access to health care is a key health systems goal, and is a particular concern in low-income countries. In Kenya, public facilities are an important resource for the poor, but little is known on the equity of service provision. This paper assesses whether poorer areas have poorer health services by investigating associations between public facility characteristics and the poverty level of the area in which the facility is located. Methods Data on facility characteristics were collected from a nationally representative sample of public health centers and dispensaries across all 8 provinces in Kenya. A two-stage cluster randomized sampling process was used to select facilities. Univariate associations between facility characteristics and socioeconomic status (SES of the area in which the facility was located were assessed using chi-squared tests, equity ratios and concentration indices. Indirectly standardized concentration indices were used to assess the influence of SES on facility inputs and service availability while controlling for facility type, province, and remoteness. Results For most indicators, we found no indication of variation by SES. The clear exceptions were electricity and laboratory services which showed evidence of pro-rich inequalities, with equity ratios of 3.16 and 3.43, concentration indices of 0.09 (p Conclusions The paper shows how local area poverty data can be combined with national health facility surveys, providing a tool for policy makers to assess the equity of input and service availability. There was little evidence of inequalities for most inputs and services, with the clear exceptions of electricity and laboratory services. However, efforts are required to improve the availability of key inputs and services across public facilities in all areas, regardless of SES.

  20. [Design of a supervision model for administration of the Child Development Evaluation Test at primary care facilities in Mexico].

    Science.gov (United States)

    Villasís-Keever, Miguel Ángel; Rizzoli-Córdoba, Antonio; Delgado-Ginebra, Ismael; Mares-Serratos, Blanca Berenice; Martell-Valdez, Liliana; Sánchez-Velázquez, Olivia; Reyes-Morales, Hortensia; O'Shea-Cuevas, Gabriel; Aceves-Villagrán, Daniel; Carrasco-Mendoza, Joaquín; Antillón-Ocampo, Fátima Adriana; Villagrán-Muñoz, Víctor Manuel; Halley-Castillo, Elizabeth; Baqueiro-Hernández, César Iván; Pizarro-Castellanos, Mariel; Martain-Pérez, Itzamara Jacqueline; Palma-Tavera, Josuha Alexander; Vargas-López, Guillermo; Muñoz-Hernández, Onofre

    The Child Development Evaluation (CDE) test designed and validated in Mexico has been used as a screening tool for developmental problems in primary care facilities across Mexico. Heterogeneous results were found among those states where these were applied, despite using the same standardized training model for application. The objective was to evaluate a supervision model for quality of application of the CDE test at primary care facilities. A study was carried out in primary care facilities from three Mexican states to evaluate concordance of the results between supervisor and primary care personnel who administered the test using two different methods: direct observation (shadow study) or reapplication of the CDE test (consistency study). There were 380 shadow studies applied to 51 psychologists. General concordance of the shadow study was 86.1% according to the supervisor: green 94.5%, yellow 73.2% and red 80.0%. There were 302 re-test evaluations with a concordance of 88.1% (n=266): green 96.8%, yellow 71.7% and red 81.8%. There were no differences between CDE test subgroups by age. Both shadow and re-test study were adequate for the evaluation of the quality of the administration of the CDE Test and may be useful as a model of supervision in primary care facilities. The decision of which test to use relies on the availability of supervisors. Copyright © 2015 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  1. The progress and results of a demonstration test of a cavern-type disposal facility

    International Nuclear Information System (INIS)

    Akiyama, Yoshihiro; Terada, Kenji; Oda, Nobuaki; Yada, Tsutomu; Nakajima, Takahiro

    2011-01-01

    The cavern-type disposal facilities for low-level waste (LLW) with relatively high radioactivity levels mainly generated from power reactor decommissioning and for part of transuranic (TRU) waste mainly from spent fuel reprocessing are designed to be constructed in a cavern 50 to 100 meters below ground, and to employ an engineered barrier system (EBS) of a combination of bentonite and cement materials in Japan. In order to advance the feasibility study for these disposal, a government-commissioned research project named Demonstration Test of Cavern-Type Disposal Facility started in fiscal 2005, and since fiscal 2007 a full-scale mock-up test facility has been constructed under actual subsurface environment. The main objective of the test is to establish construction methodology and procedures which ensure the required quality of the EBS on-site. By fiscal 2009 some parts of the facility have been constructed, and the test has demonstrated both practicability of the construction and achievement of the quality. They are respectively taken as low-permeability of less than 5x10 13 m/s and low-diffusivity of less than 1x10 -12 m 2 /s at the time of completion of construction. This paper covers the project outline and the test results obtained by the construction of some parts of a bentonite and cement materials. (author)

  2. Current status of the Demonstration Test of Underground Cavern-Type Disposal Facilities

    International Nuclear Information System (INIS)

    Akiyama, Yoshihiro; Terada, Kenji; Oda, Nobuaki; Yada, Tsutomu; Nakajima, Takahiro

    2011-01-01

    In Japan, the underground cavern-type disposal facilities for low-level waste (LLW) with relatively high radioactivity, mainly generated from power reactor decommissioning, and for certain transuranic (TRU) waste, mainly from spent fuel reprocessing, are designed to be constructed in a cavern 50-100 m underground and to employ an engineered barrier system (EBS) made of bentonite and cement materials. To advance a disposal feasibility study, the Japanese government commissioned the Demonstration Test of Underground Cavern-Type Disposal Facilities in fiscal year (FY) 2005. Construction of a full-scale mock-up test facility in an actual subsurface environment started in FY 2007. The main test objective is to establish the construction methodology and procedures that ensure the required quality of the EBS on-site. A portion of the facility was constructed by 2010, and the test has demonstrated both the practicability of the construction and the achievement of quality standards: low permeability of less than 5x10 -13 m/s and low-diffusion of less than 1x10 -12 m 2 /s at the completion of construction. This paper covers the test results from the construction of certain parts using bentonite and cement materials. (author)

  3. Design Methodology of Process Layout considering Various Equipment Types for Large scale Pyro processing Facility

    International Nuclear Information System (INIS)

    Yu, Seung Nam; Lee, Jong Kwang; Lee, Hyo Jik

    2016-01-01

    At present, each item of process equipment required for integrated processing is being examined, based on experience acquired during the Pyropocess Integrated Inactive Demonstration Facility (PRIDE) project, and considering the requirements and desired performance enhancement of KAPF as a new facility beyond PRIDE. Essentially, KAPF will be required to handle hazardous materials such as spent nuclear fuel, which must be processed in an isolated and shielded area separate from the operator location. Moreover, an inert-gas atmosphere must be maintained, because of the radiation and deliquescence of the materials. KAPF must also achieve the goal of significantly increased yearly production beyond that of the previous facility; therefore, several parts of the production line must be automated. This article presents the method considered for the conceptual design of both the production line and the overall layout of the KAPF process equipment. This study has proposed a design methodology that can be utilized as a preliminary step for the design of a hot-cell-type, large-scale facility, in which the various types of processing equipment operated by the remote handling system are integrated. The proposed methodology applies to part of the overall design procedure and contains various weaknesses. However, if the designer is required to maximize the efficiency of the installed material-handling system while considering operation restrictions and maintenance conditions, this kind of design process can accommodate the essential components that must be employed simultaneously in a general hot-cell system

  4. First lasings at IR-and FIR range using hybrid type undulator (FEL facility 4) and Halbach type undulator

    International Nuclear Information System (INIS)

    Takii, T.; Oshita, E.; Okuma, S.; Wakita, K.; Koga, A.; Tomimasu, T.; Ohasi, K.

    1997-01-01

    First lasing at 18μm was achieved by using a 2.7-m long hybrid type undulator (undulator 4) for far-infrared FELs and a 6.72-m long optical cavity installed at the 33-MeV beam line of the downstream of the FEL facility 1 (FEL-1). We are challenged at two-color FEL oscillation in mid-infrared range using the undulator 1 (λ u=3.4mm) and in far-infrared range using the undulator 4 (λ u=9mm). At first, a 30-MeV, 60-A beam passed through the undulator 1 without lasing is transported using a QFQDBQFQDBQFQDQF system and is used for lasing at the undulator 4. However, six pairs of steering coils had to be attached on the beam duct to reduce the deviation of the electron beam trajectory due to the vertical field distribution induced by the built-in electromagnets. The minimum gap of the undulator 4 was designed to be 35mm. However, the steering coils attached on the beam duct increased the gap up to 52mm. Therefore, the hybrid type undulator was replaced by a new Halbach type one (λ u=8mm, N=30) after the first lasing at 18μm on October 24, '96. The New FEL facility 4 was installed in the middle of December and first lasing at 18.6μm was achieved on December 26, within 10 hours operation. (author)

  5. Absolute measurement of the DT primary neutron yield on the National Ignition Facility

    Directory of Open Access Journals (Sweden)

    Leeper R.J.

    2013-11-01

    Full Text Available The measurement of the absolute neutron yield produced in inertial confinement fusion target experiments conducted on the National Ignition Facility (NIF is essential in benchmarking progress towards the goal of achieving ignition on this facility. This paper describes three independent diagnostic techniques that have been developed to make accurate and precise DT neutron yield measurements on the NIF.

  6. Vulnerability Analysis for Physical Protection System at Hypothetical Facility of a Different Type Reactor

    International Nuclear Information System (INIS)

    Jung, Won-Moog; Kim, Jung-Soo; Kim, Jae-Kwang; Yoo, Ho-Sik; Kwak, Sung-Ho; Jang, Sung-Soon

    2007-01-01

    Since the 9/11 event in the U.S.A, International terror possibilities has been increased for nuclear facilities including nuclear power plants(NPPs). It is necessary to evaluate the performance of an existing physical protection system(PPS) at nuclear facilities based on such malevolent acts. Detection, delay, and response elements are all important to PPS. They are used for the analysis and evaluation of a PPS and its effectiveness. Methods are available to analyze a PPS and evaluate its effectiveness. Sandia National Laboratory(SNL) in the U.S.A developed a System Analysis of Vulnerability to Intrusion (SAVI) computer code for evaluating the effectiveness of PPS against outsider threats. This study presents the vulnerability analysis of the PPS at hypothetical facility of a different type using SAVI code that the basic input parameters are from PPS of a different type. For analysis, first, the site-specific Adversary Sequence Diagrams(ASDs) of the PPS is designed. It helps to understand the functions of the existing PPS composed of physical areas and Protection Elements(PEs). Then, the most vulnerable path of an ASD as a measure of effectiveness is determined. The results in the analysis can compare with the most vulnerable paths at a different type

  7. Experimental Study on the Natural Circulation Characteristics in the Primary Loop of the SMART Reactor by using the VISTA Facility

    International Nuclear Information System (INIS)

    Park, Hyun-Sik; Choi, Ki-Yong; Cho, Seok; Yi, Sung-Jae; Park, Choon-Kyung; Chung, Moon-Ki

    2007-01-01

    The SMART uses a two-phase natural circulation in the PRHRS loop to remove the heat from the steam generators to the PRHRS heat exchangers, while a single phase natural circulation occurs in the primary loop to transfer the decay heat from the core to the steam generator. Natural circulation operation with a power range of 20 ∼ 25% was considered for SMART and nowadays the possibility of increasing the power level during the natural circulation operation is being investigated. Previously Park et al. performed several experiments by using the VISTA facility on the thermal-hydraulic characteristics of the PRHRS for the SMART-P, which includes a single-phase natural circulation in the primary loop. From the analysis with the TASS-SMR code it was shown that the reference temperature for the primary steam generator inlet temperature should be increased in order to compensate for the decreased core flow. To investigate the possibility of an increase of the power and reference temperature, it is necessary to get experimental data to characterize the natural circulation phenomena in the primary loop of the SMART. In this paper, the characteristics of natural circulation in the primary loop are experimentally investigated during various operational conditions by using the VISTA facility

  8. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Directory of Open Access Journals (Sweden)

    Kunimitsu Ayano

    2009-04-01

    Full Text Available Abstract Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics, which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96. Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07, illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15, the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22, and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06. Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and

  9. Test-retest reproducibility of accommodative facility measures in primary school children.

    Science.gov (United States)

    Adler, Paul; Scally, Andrew J; Barrett, Brendan T

    2018-05-08

    To determine the test-retest reproducibility of accommodative facility (AF) measures in an unselected sample of UK primary school children. Using ±2.00 DS flippers and a viewing distance of 40 cm, AF was measured in 136 children (range 4-12 years, average 8.1 ± 2.1) by five testers on three occasions (average interval between successive tests: eight days, range 1-21 days). On each occasion, AF was measured monocularly and binocularly, for two minutes. Full datasets were obtained in 111 children (81.6 per cent). Intra-individual variation in AF was large (standard deviation [SD] = 3.8 cycles per minute [cpm]) and there was variation due to the identity of the tester (SD = 1.6 cpm). On average, AF was greater: (i) in monocular compared to binocular testing (by 1.4 cpm, p cpm, p cpm lower than in children ≥ 10 years old, p = 0.009); and (iv) on subsequent testing occasions (for example, visit-2 AF was 2.0 cpm higher than visit-1 AF, p cpm monocularly and ≥ 8 cpm binocularly), but this rose to 83.8 per cent after the third test. Using less stringent pass criteria (≥ 6 cpm monocularly and ≥ 3 cpm binocularly), the equivalent figures were 82.9 and 96.4 per cent, respectively. Reduced AF did not co-exist with abnormal near point of accommodation or reduced visual acuity. The results reveal considerable intra-individual variability in raw AF measures in children. When the results are considered as pass/fail, children who initially exhibit normal AF continued to do so on repeat testing. Conversely, the vast majority of children with initially reduced AF exhibit normal performance on repeat testing. Using established pass/fail criteria, the prevalence of persistently reduced AF in this sample is 3.6 per cent. © 2018 Optometry Australia.

  10. Design and construction of a cryogenic facility providing absolute measurements of radon 222 activity for developing a primary standard

    International Nuclear Information System (INIS)

    Picolo, Jean-Louis

    1995-06-01

    Radon 222 metrology is required to obtain higher accuracy in assessing human health risks from exposure to natural radiation. This paper describes the development of a cryogenic facility that allows absolute measurements of radon 222 in order to obtain a primary standard. The method selected is the condensation of a radon 222 sample on a geometrically defined cold surface with a constant, well known and adjustable temperature and facing an alpha particles detector. Counting of the alpha particles reaching the detector and the precisely known detection geometry provide an absolute measurement of the source activity. After describing the cryogenic facility, the measurement accuracy and precision are discussed and a comparison made with other measurement systems. The relative uncertainty is below 1 pc (1 σ). The facility can also be used to improve our knowledge of the nuclear properties of radon 222 and to produce secondary standards. (author) [fr

  11. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

    Directory of Open Access Journals (Sweden)

    Muhammad Ashraf Majrooh

    Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. RESULTS: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. CONCLUSION: The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and

  12. Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states.

    Science.gov (United States)

    Mbachu, Chinyere; Onwujekwe, Obinna; Ezumah, Nkoli; Ajayi, Olayinka; Sanwo, Olusola; Uzochukwu, Benjamin

    2016-09-01

    Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players' capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players' support largely depends on how well the reform aligns with political structures and current institutional practices.

  13. Challenges with implementing malaria rapid diagnostic tests at primary care facilities in a Ghanaian district: a qualitative study.

    Science.gov (United States)

    Boadu, Nana Yaa; Amuasi, John; Ansong, Daniel; Einsiedel, Edna; Menon, Devidas; Yanow, Stephanie K

    2016-02-27

    Rapid diagnostic Tests (RDTs) for malaria enable diagnostic testing at primary care facilities in resource-limited settings, where weak infrastructure limits the use of microscopy. In 2010, Ghana adopted a test-before-treat guideline for malaria, with RDT use promoted to facilitate diagnosis. Yet healthcare practitioners still treat febrile patients without testing, or despite negative malaria test results. Few studies have explored RDT implementation beyond the notions of provider or patient acceptability. The aim of this study was to identify the factors directly influencing malaria RDT implementation at primary care facilities in a Ghanaian district. Qualitative interviews, focus groups and direct observations were conducted with 50 providers at six purposively selected primary care facilities in the Atwima-Nwabiagya district. Data were analysed thematically. RDT implementation was hampered by: (1) healthcare delivery constraints (weak supply chain, limited quality assurance and control, inadequate guideline emphasis, staffing limitations); (2) provider perceptions (entrenched case-management paradigms, limited preparedness for change); (3) social dynamics of care delivery (expected norms of provider-patient interaction, test affordability); and (4) limited provider engagement in policy processes leading to fragmented implementation of health sector reform. Limited health system capacity, socio-economic, political, and historical factors hampered malaria RDT implementation at primary care facilities in the study district. For effective RDT implementation providers must be: (1) adequately enabled through efficient allocation and management of essential healthcare commodities; (2) appropriately empowered with the requisite knowledge and skill through ongoing, effective professional development; and (3) actively engaged in policy dialogue to demystify socio-political misconceptions that hinder health sector reform policies from improving care delivery. Clear

  14. Thermal-hydraulic model of the primary coolant circuits for the full-scale training facility with WWER-1000

    International Nuclear Information System (INIS)

    Kroshilin, A.E.; Zhukavin, A.P.; Pryakhin, V.N.

    1992-01-01

    The mathematical model realized in the full-scale educational facility for NPP operator training is described. The RETACT computational complex providing real time process simulation for all regimes including the maximum credible accident is used for calculation of thermohydraulic parameters of the primary coolant circuits and steam generator under stationary and transient conditions. The two-velocity two-temperature model of one-dimensional steam-water flow containing uncondensed gases is realized in the program

  15. Test facility of the VVER-440 condensation-type pressure suppression system

    International Nuclear Information System (INIS)

    Wolff, H.; Arndt, S.

    2004-01-01

    Since the early nineties, GRS has supported regulatory authorities in Central and Eastern Europe in performing safety assessments of nuclear power plants. Especially studies of the condensation-type pressure suppression system of VVER-440/V-213-type plants have been important in this respect. Major steps in demonstrating complete functioning of the condensation-type pressure suppression system under accident conditions by experiments run in the Russian large scale test facility, BC V-213, have been completed in the past two years within the framework of various international experimental programs. The test results were used to validate specifically for power plants with VVER-400/V-213 reactors the COCOSYS GRS computer code, which is used in the safety assessments. The results of recalculations of the C02 EREC test, which simulates a break of a main steam pipe, demonstrate the present state of validation of COCOSYS for VVER condensation-type pressure suppression systems. (orig.) [de

  16. Strategies for energy benchmarking in cleanrooms and laboratory-type facilities

    International Nuclear Information System (INIS)

    Sartor, Dale; Piette, Mary Ann; Tschudi, William; Fok, Stephen

    2000-01-01

    Buildings with cleanrooms and laboratories are growing in terms of total floor area and energy intensity. This building type is common in institutions such as universities and in many industries such as microelectronics and biotechnology. These buildings, with high ventilation rates and special environmental considerations, consume from 4 to 100 times more energy per square foot than conventional commercial buildings. Owners and operators of such facilities know they are expensive to operate, but have little way of knowing if their facilities are efficient or inefficient. A simple comparison of energy consumption per square foot is of little value. A growing interest in benchmarking is also fueled by: A new U.S. Executive Order removing the exemption of federal laboratories from energy efficiency goals, setting a 25% savings target, and calling for baseline guidance to measure progress; A new U.S. EPA and U.S. DOE initiative, Laboratories for the 21st Century, establishing voluntary performance goals and criteria for recognition; and A new PG and E market transformation program to improve energy efficiency in high tech facilities, including a cleanroom energy use benchmarking project. This paper identifies the unique issues associated with benchmarking energy use in high-tech facilities. Specific options discussed include statistical comparisons, point-based rating systems, model-based techniques, and hierarchical end-use and performance-metrics evaluations

  17. Comparison and discussion of two types of threat (Hazard) categorization method for nuclear facilities

    International Nuclear Information System (INIS)

    Tang, Rongyao; Xu, Xiaoxiao; Zhang, Jiangang; Zhao, Bin

    2008-01-01

    The emergency threat categorization method suggested by international atomic energy agency (IAEA) and hazard categorization standard by the Department of Energy of United States (USDOE) for nuclear facilities are compared and discussed in this paper. The research shows the two types of categorization method for nuclear facility are similar, though each has its own speciality. The categorization method suggested by IAEA is quite completed and sound in scientific basis. The thresholds of radioactive material are connected with the quantity of dangerous source, and the latest radiobiological effect research results are taken in setting the thresholds. While the main purpose is put on emergency management, some of the categorization criteria do not fit for safety surveillance of nuclear facilities. The categorization method of DOE is advanced in its operability, and it fits for safety surveillance. The disadvantage is that the thresholds of radioactive material need to be updated because the parameters used in calculation is outdated, and also the threshold of category 3 is somewhat disputable for many reasons. We should take advantage of both methods and adjust the standards according to the application purpose while establishing the categorization standard of nuclear facilities in China. (author)

  18. Engaging Communities in Commodity Stock Monitoring Using Telecommunication Technology in Primary Health Care Facilities in Rural Nigeria

    Directory of Open Access Journals (Sweden)

    Ugo Okoli

    2015-10-01

    Full Text Available Background: With several efforts being made by key stakeholders to bridge the gap between beneficiaries and their having full access to free supplies, frequent stock-out, pilfering, collection of user fees for health commodities, and poor community engagement continue to plague the delivery of health services at the primary health care (PHC level in rural Nigeria. Objective: To assess the potential in the use of telecommunication technology as an effective way to engage members of the community in commodity stock monitoring, increase utilization of services, as well as promote accountability and community ownership. Methods: The pilot done in 8 PHCs from 4 locations within Nigeria utilized telecommunication technologies to exchange information on stock monitoring. A triangulated technique of data validation through cross verification from 3 subsets of respondents was used: 160 ward development committee (WDC members, 8 officers-in-charge (OICs of PHCs, and 383 beneficiaries (health facility users participated. Data collection made through a call center over a period of 3 months from July to September 2014 focused on WDC participation in inventory of commodities and type and cost of maternal, neonatal, and child health services accessed by each beneficiary. Results: Results showed that all WDCs involved in the pilot study became very active, and there was a strong cooperation between the OICs and the WDCs in monitoring commodity stock levels as the OICs participated in the monthly WDC meetings 96% of the time. A sharp decline in the collection of user fees was observed, and there was a 10% rise in overall access to free health care services by beneficiaries. Conclusion: This study reveals the effectiveness of mobile phones and indicates that telecommunication technologies can play an important role in engaging communities to monitor PHC stock levels as well as reduce the incidence of user fees collection and pilfering of commodities (PHC level in

  19. Concurrent primary hyperparathyroidism and pheochromocytoma in a Chinese lady with neurofibromatosis type 1

    Directory of Open Access Journals (Sweden)

    Cheuk-Lik Wong

    2018-04-01

    Full Text Available We report a case of elderly Chinese lady with neurofibromatosis type-1 presenting with longstanding palpitation, paroxysmal hypertension and osteoporosis. Biochemical testing showed mild hypercalcaemia with non-suppressed parathyroid hormone level suggestive of primary hyperparathyroidism, and mildly elevated urinary fractionated normetanephrine and plasma-free normetanephrine pointing to a catecholamine-secreting pheochromocytoma/paraganglioma. Further scintigraphic investigation revealed evidence of a solitary parathyroid adenoma causing primary hyperparathyroidism and a left pheochromocytoma. Resection of the parathyroid adenoma and pheochromocytoma resulted in normalization of biochemical abnormalities and hypertension. The rare concurrence of primary hyperparathyroidism and pheochromocytoma in neurofibromatosis type-1 is discussed.

  20. Yield of opportunistic targeted screening for type 2 diabetes in primary care: the diabscreen study.

    NARCIS (Netherlands)

    Klein Woolthuis, E.P.; Grauw, W.J.C. de; Gerwen, W.H.E.M. van; Hoogen, H.J.M. van den; Lisdonk, E.H. van de; Metsemakers, J.F.M.; Weel, C. van

    2009-01-01

    PURPOSE: In screening for type 2 diabetes, guidelines recommend targeting high-risk individuals. Our objectives were to assess the yield of opportunistic targeted screening for type 2 diabetes in primary care and to assess the diagnostic value of various risk factors. METHODS: In 11 family practices

  1. Study protocol for the SMART2D adaptive implementation trial: a cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden.

    Science.gov (United States)

    Guwatudde, David; Absetz, Pilvikki; Delobelle, Peter; Östenson, Claes-Göran; Olmen Van, Josefien; Alvesson, Helle Molsted; Mayega, Roy William; Ekirapa Kiracho, Elizabeth; Kiguli, Juliet; Sundberg, Carl Johan; Sanders, David; Tomson, Göran; Puoane, Thandi; Peterson, Stefan; Daivadanam, Meena

    2018-03-17

    Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes. An adaptive implementation cluster randomised trial is being implemented in two rural districts in Uganda with three clusters per study arm, in an urban township in South Africa with one cluster per study arm, and in socially disadvantaged suburbs in Stockholm, Sweden with one cluster per study arm. Clusters are communities within the catchment areas of participating primary healthcare facilities. There are two study arms comprising a facility plus community interventions arm and a facility-only interventions arm. Uganda has a third arm comprising usual care. Intervention strategies focus on organisation of care, linkage between health facility and the community, and strengthening patient role in self-management, community mobilisation and a supportive environment. Among T2D participants, the primary outcome is controlled plasma glucose; whereas among prediabetes participants the primary outcome is reduction in plasma glucose. The study has received approval in Uganda from the Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and from the Uganda National Council for Science and Technology; in South Africa from the Biomedical Science Research Ethics Committee of the University of the Western Cape; and in Sweden from the Regional Ethical Board in Stockholm. Findings will be disseminated through peer-reviewed publications and scientific meetings. ISRCTN11913581; Pre-results. © Article author(s) (or their

  2. Draft of diagnostic techniques for primary coolant circuit facilities using control computer

    International Nuclear Information System (INIS)

    Suchy, R.; Procka, V.; Murin, V.; Rybarova, D.

    A method is proposed of in-service on-line diagnostics of primary circuit selected parts by means of a control computer. Computer processing will involve the measurements of neutron flux, pressure difference in pumps and in the core, and the vibrations of primary circuit mechanical parts. (H.S.)

  3. Access to water and sanitation facilities in primary schools: A neglected educational crisis in Ngamiland district in Botswana

    Science.gov (United States)

    Ngwenya, B. N.; Thakadu, O. T.; Phaladze, N. A.; Bolaane, B.

    2018-06-01

    In developing countries, the sanitation and hygiene provision often receives limited resources compared to the water supply. However, water supply benefits tend to diminish if improved sanitation and hygiene are neglected. This paper presents findings of a situational analysis of water supply, sanitation and hygiene infrastructure and their utilization in three primary schools in north-western Botswana. The overall objective of the paper is to determine access and functionality of water supply, sanitation and hygiene infrastructure in three primary schools. The specific objectives are: a) Learners' perspective of their water and sanitation facilities and b) gendered utilization of sanitation and hygiene facilities. Data were collected through a face-to-face administered social survey tool to 286 learners selected through proportionate stratified random sampling from three purposively selected villages in the middle and lower Okavango Delta. Findings indicate that standpipes provide 96% of potable water supply. However, the majority (65% of leaners) indicated that they 'sometimes' experienced water shortage due to dry/nonfunctioning taps/pumps and leaks/wastage. Overall, schools have relatively sufficient sanitation facilities consisting of both water borne toilets and VIP latrines. The major sanitation gap identified was that 80% flush toilets hardly work, while 77% of VIP toilets were in disrepair. Furthermore, poor water supply compromised hand washing with 65.7% learners "always" washing their hands if school standpipes had water, while the majority did not wash hands if standpipes were dry. The study concluded that availability of sanitation infrastructure does not necessarily translate into utilization in the study area due to multiple problems, such as lack of personal hygiene supplies (regular toilet paper and hand washing detergents), privacy issues and recurring water problems. The chronicity of inadequate water, sanitation and hygiene infrastructure in

  4. Facile synthesis of birnessite-type manganese oxide nanoparticles as supercapacitor electrode materials.

    Science.gov (United States)

    Liu, Lihu; Luo, Yao; Tan, Wenfeng; Zhang, Yashan; Liu, Fan; Qiu, Guohong

    2016-11-15

    Manganese oxides are environmentally benign supercapacitor electrode materials and, in particular, birnessite-type structure shows very promising electrochemical performance. In this work, nanostructured birnessite was facilely prepared by adding dropwise NH2OH·HCl to KMnO4 solution under ambient temperature and pressure. In order to fully exploit the potential of birnessite-type manganese oxide electrode materials, the effects of specific surface area, pore size, content of K(+), and manganese average oxidation state (Mn AOS) on their electrochemical performance were studied. The results showed that with the increase of NH2OH·HCl, the Mn AOS decreased and the corresponding pore sizes and specific surface area of birnessite increased. The synthesized nanostructured birnessite showed the highest specific capacitance of 245Fg(-1) at a current density of 0.1Ag(-1) within a potential range of 0-0.9V, and excellent cycle stability with a capacitance retention rate of 92% after 3000 cycles at a current density of 1.0Ag(-1). The present work implies that specific capacitance is mainly affected by specific surface area and pore volume, and provides a new method for the facile preparation of birnessite-type manganese oxide with excellent capacitive performance. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Results of 15 years experiments in the PMK-2 integral-type facility for VVERs

    Energy Technology Data Exchange (ETDEWEB)

    Szabados, L.; Ezsoel, G.; Perneczky, L. [KFKI Atomic Energy Research Institute, Budapest (Hungary)

    2001-07-01

    Due to the specific features of the VVER-440/213-type reactors the transient behaviour of such a reactor system is different from the usual PWR system behaviour. To provide an experimental database for the transient behaviour of VVER systems the PMK integral-type facility, the scaled down model of the Paks NPP was designed and constructed in the early 1980's. Since the start-up of the facility 48 experiments have been performed. It was confirmed through the experiments that the facility is a suitable tool for the computer code validation experiments and to the identification of basic thermal-hydraulic phenomena occurring during plant accidents. High international interest was shown by the four Standard Problem Exercises of the IAEA and by the projects financed by the EU-PHARE. A wide range of small- and medium-size LOCA sequences have been studied to know the performance and effectiveness of ECC systems and to evaluate the thermal-hydraulic safety of the core. Extensive studies have been performed to investigate the one- and two-phase natural circulation, the effect of disturbances coming from the secondary circuit and to validate the effectiveness of accident management measures like bleed and feed. The VVER-specific case, the opening of the SG collector cover was also extensively investigated. Examples given in the report show a few results of experiments and the results of calculation analyses performed for validation purposes of codes like RELAP5, ATHLET and CATHARE. There are some other white spots in Cross Reference Matrices for VVER reactors and, therefore, further experiments are planned to perform tests primarily in further support of accident management measures at low power states of plants to facilitate the improved safety management of VVER-440-type reactors. (authors)

  6. Results of 15 years experiments in the PMK-2 integral-type facility for VVERs

    International Nuclear Information System (INIS)

    Szabados, L.; Ezsoel, G.; Perneczky, L.

    2001-01-01

    Due to the specific features of the VVER-440/213-type reactors the transient behaviour of such a reactor system is different from the usual PWR system behaviour. To provide an experimental database for the transient behaviour of VVER systems the PMK integral-type facility, the scaled down model of the Paks NPP was designed and constructed in the early 1980's. Since the start-up of the facility 48 experiments have been performed. It was confirmed through the experiments that the facility is a suitable tool for the computer code validation experiments and to the identification of basic thermal-hydraulic phenomena occurring during plant accidents. High international interest was shown by the four Standard Problem Exercises of the IAEA and by the projects financed by the EU-PHARE. A wide range of small- and medium-size LOCA sequences have been studied to know the performance and effectiveness of ECC systems and to evaluate the thermal-hydraulic safety of the core. Extensive studies have been performed to investigate the one- and two-phase natural circulation, the effect of disturbances coming from the secondary circuit and to validate the effectiveness of accident management measures like bleed and feed. The VVER-specific case, the opening of the SG collector cover was also extensively investigated. Examples given in the report show a few results of experiments and the results of calculation analyses performed for validation purposes of codes like RELAP5, ATHLET and CATHARE. There are some other white spots in Cross Reference Matrices for VVER reactors and, therefore, further experiments are planned to perform tests primarily in further support of accident management measures at low power states of plants to facilitate the improved safety management of VVER-440-type reactors. (authors)

  7. Type B investigation report of curium-244 exposure at the ORNL TRU Facility, January 15, 1986

    International Nuclear Information System (INIS)

    Love, G.L.; Butler, H.M.; Duncan, D.T.; Oakes, T.W.

    1986-04-01

    This Type B Investigative Report provides an evaluation of relevant events and activities that led to, were a part of, or resulted from the release of curium-244 in the Building 7920 facility at ORNL in January 1986. Impacts have been evaluated with respect to employee exposures and the costs and loss of productivity resulting from increased bioassay analyses and activities of investigative committees. Management systems evaluated include (1) training of employees performing lab analyses, (2) adherence to procedures, and (3) response to unusual circumstances

  8. 43 CFR 404.9 - What types of infrastructure and facilities may be included in an eligible rural water supply...

    Science.gov (United States)

    2010-10-01

    ... facilities may be included in an eligible rural water supply project? 404.9 Section 404.9 Public Lands... RURAL WATER SUPPLY PROGRAM Overview § 404.9 What types of infrastructure and facilities may be included in an eligible rural water supply project? A rural water supply project may include, but is not...

  9. System seismic analysis of an innovative primary system for a large pool type LMFBR plant

    International Nuclear Information System (INIS)

    Pan, Y.C.; Wu, T.S.; Cha, B.K.; Burelbach, J.; Seidensticker, R.

    1984-01-01

    The system seismic analysis of an innovative primary system for a large pool type liquid metal fast breeder reactor (LMFBR) plant is presented. In this primary system, the reactor core is supported in a way which differs significantly from that used in previous designs. The analytical model developed for this study is a three-dimensional finite element model including one-half of the primary system cut along the plane of symmetry. The model includes the deck and deck mounted components,the reactor vessel, the core support structure, the core barrel, the radial neutron shield, the redan, and the conical support skirt. The sodium contained in the primary system is treated as a lumped mass appropriately distributed among various components. The significant seismic behavior as well as the advantages of this primary system design are discussed in detail

  10. Developing Livestock Facility Type Information from USDA Agricultural Census Data for Use in Epidemiological and Economic Models

    Energy Technology Data Exchange (ETDEWEB)

    Melius, C; Robertson, A; Hullinger, P

    2006-10-24

    The epidemiological and economic modeling of livestock diseases requires knowing the size, location, and operational type of each livestock facility within the US. At the present time, the only national database of livestock facilities that is available to the general public is the USDA's 2002 Agricultural Census data, published by the National Agricultural Statistics Service, herein referred to as the 'NASS data.' The NASS data provides facility data at the county level for various livestock types (i.e., beef cows, milk cows, cattle on feed, other cattle, total hogs and pigs, sheep and lambs, milk goats, and angora goats). However, the number and sizes of facilities for the various livestock types are not independent since some facilities have more than one type of livestock, and some livestock are of more than one type (e.g., 'other cattle' that are being fed for slaughter are also 'cattle on feed'). In addition, any data tabulated by NASS that could identify numbers of animals or other data reported by an individual respondent is suppressed by NASS and coded with a 'D.'. To be useful for epidemiological and economic modeling, the NASS data must be converted into a unique set of facility types (farms having similar operational characteristics). The unique set must not double count facilities or animals. At the same time, it must account for all the animals, including those for which the data has been suppressed. Therefore, several data processing steps are required to work back from the published NASS data to obtain a consistent database for individual livestock operations. This technical report documents data processing steps that were used to convert the NASS data into a national livestock facility database with twenty-eight facility types. The process involves two major steps. The first step defines the rules used to estimate the data that is suppressed within the NASS database. The second step converts the NASS

  11. Pathways to high and low performance: factors differentiating primary care facilities under performance-based financing in Nigeria

    Science.gov (United States)

    Mabuchi, Shunsuke; Sesan, Temilade; Bennett, Sara C

    2018-01-01

    Abstract The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed to understand which factors differentiated primary health care centres (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. We used a multiple case study where we compared two high-performing PHCCs and two low-performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. We also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health centre management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health centre management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health centre managers, provide long-term coaching in managerial skills, and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central

  12. Primary study for boron neutron capture therapy uses the RSG-GAS beam tube facility

    International Nuclear Information System (INIS)

    Suroso

    2000-01-01

    The minimum epithermal neutron flux as one of the prerequisite of Boron Neutron Capture Therapy (BNCT) is 1.0 x 10 9 n/(cm 2 s) RSG-GAS have 6 beam tube facilities for neutron source, which is one of the beam tube S-2 has a possibility to utilization for BNCT facility. The totally flux neutron measurement in the front of S-2 beam tube is 1.8 x 10 7 n/(cm 2 s). The neutron flux measurement was less than for BNCT minimum prerequisite. Concerning to the flux neutron production in the reactor, which is reach to 2.5 x 10 14 n/(cm 2 s), there for the S-2 beam tube could be used beside collimator modification

  13. The development of a generic design for primary healthcare facilities in South Africa

    CSIR Research Space (South Africa)

    Van Wyk, Llewellyn V

    2016-05-01

    Full Text Available the patients’ details, blood pressure and possibly their weight. Patients required to give a urine sample for testing will use the universally accessible ablution facility adjacent to the sample room. Having been attended to by the nurse, patients... stable service provision especially with regard to water, sanitation, electricity and the proper storage of drugs. Innovative infrastructure service technologies are technologies that can be implemented to provide alternative methods for securing a...

  14. STUDENTS’ PERCEPTION ABOUT CLINICAL LEARNING ENVIRONMENT IN THE PRIMARY, SECONDARY AND TERTIARY MEDICAL FACILITIES

    OpenAIRE

    Dewi, Dian Puspita; Rahayu, Gandes Retno; Kristina, Tri Nur

    2018-01-01

    Background: Learning environment is an important factor in learning process and can affect students' competence and work-readiness. Learning environment is not only about physical facilities but also social and psychological condition. The complexity of clinical learning environments pose challenges and problems that may affect students learning process so it is necessary to monitoring and evaluating students learning environments. This study aims to assess students' perception of their learn...

  15. Analysis of computed tomographic manifestations of primary lung cancer by histologic types

    International Nuclear Information System (INIS)

    Kim, Kyo Yeoun; Choe, Kyu Ok

    1988-01-01

    It is well known that primary lung cancer is one of the most common malignancies in Korea. With respect to the histologic type, primary lung carcinoma manifests itself in a number of different ways. The authors analyzed the computed tomographic (C-T) findings of 183 cases of pathologically confirmed primary lung cancer from 1983 to Aug. 1987 without prior information of histologic types. The results are as follows. 1. The distribution of histologic types of primary lung cancer was as follows: epidermoid carcinoma, 96 cases (52.5%); adenocarcinoma, 43 cases (23.5%); undifferentiated large cell carcinoma, 17 cases (9.2%) and undifferentiated small cell carcinoma, 27 cases (14.8%). 2. The male to female ratio was 3.9:1, the highest ratio occurring in undifferentiated small cell carcinoma 12.5:1 and the lowest ratio in adenocarcinoma 1.1:1 where there was no significant difference in the male to female ratio. 3. Chest computed tomographic findings by histologic type were as follows: (a) Epidermoid carcinoma (96 cases): The central type was the most prevalent (52 cases) with an incidence of 54%. Major air way obstruction was most frequently encountered in this type and was complete in 60% of the cases and partial in 25%. The incidence of cavitating malignancy was 10%, more common than other histologica types. (b) Adenocarcinoma (43 cases): The peripheral type was the most prevalent (28 cases) with an incidence of 63%. Lung to lung metastasis was 23%, more common than other histologic types. (c) Undifferentiated large cell carcinoma (17 cases): The highest incidence occurred in the peripheral type, 9 cases (53%). Chest wall involvement was 12%, more common than other histologic types. (d) Undifferentiated small cell carcinoma (27 cases): The central type (19 cases) presented the highest incidence (70%). Major air way obstruction was noted less severe than epidermoid carcinoma: complete 33%, partial 63%. The incidence of pericardial effusion and/or thickening was 18

  16. Validation of ammonia diffusive and active samplers in a controlled atmosphere test facility using traceable Primary Standard Gas Mixtures

    Science.gov (United States)

    Martin, Nicholas A.; Ferracci, Valerio; Cassidy, Nathan; Hook, Josh; Battersby, Ross M.; Tang, Yuk S.; Stevens, Amy C. M.; Jones, Matthew R.; Braban, Christine F.; Gates, Linda; Hangartner, Markus; Stoll, Jean-Marc; Sacco, Paolo; Pagani, Diego; Hoffnagle, John A.

    2017-04-01

    Intensive animal farming, the increased use of fertilizers, and certain industrial processes are believed to be responsible for the observed increases in the amount fraction of ammonia (NH3) found in Europe. NH3 contributes to eutrophication and acidification of land and freshwater, potentially leading to a loss of biodiversity and undesirable changes to the ecosystem. It also contributes to the formation of secondary particulate matter (PM) formation, which is associated with poor air quality and adverse health outcomes. Measurements of ambient ammonia are principally carried out with low-cost diffusive samplers or by active sampling with denuders, with each method delivering time-integrated values over the monitoring period. However, such techniques have not yet been extensively validated. The goal of this work was to provide improvements in the metrological traceability through the determination of NH3 diffusive sampling rates. Five different designs of commercial diffusive samplers (FSM Radiello radial sampler, Gradko diffusion tube, Gradko DIFRAM-400, Passam ammonia sampler, and CEH ALPHA sampler) were employed, together with a pumped denuder sampler (CEH DELTA denuder) for comparison. All devices were simultaneously exposed for either 28 days or 14 days (dependent on sampler type) in a controlled atmosphere test facility (CATFAC) containing traceable amount fractions of humidified ammonia using new stable ammonia Primary Standard Gas Mixtures developed by gravimetry at NPL, under a wide range of conditions that are relevant to ambient monitoring. Online continuous monitoring of the ammonia test atmospheres was carried out by extractive sampling, employing a calibrated cavity ring-down spectrometer, which had been modified to account for cross interference by water vapour. Each manufacturer extracted the captured ammonia on the exposed samplers in the form of ammonium (NH4+) using their own accredited traceable wet chemical techniques, and then reported data

  17. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa

    NARCIS (Netherlands)

    Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

    2013-01-01

    Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB

  18. Restraint effect of water infiltration by soil cover types of LLW disposal facility

    International Nuclear Information System (INIS)

    Park, S. M.; Lee, E. Y.; Lee, C. K.; Kim, C. L.

    2002-01-01

    Since soil cover for LLW disposal vault shows quite different restraint effect of water infiltration depending on its type, four different types of soil cover were studied and simulated using HELP code. Simulation result showed that Profile B1 is the most effective type in restraint of water infiltration to the disposal vault. Profile B1 is totally 6m thick and composed of silt, gravelly sand, pea gravel, sand and clayey soil mixed with bentonite 20%. Profile B1 also includes artificial layers, such as asphalt and geomembrane layers. This profile is designed conceptually by NETEC for the soil cover of the near surface disposal facility of the low-level radioactive waste. For comparison, 3 types of different profile were tested. One profile includes bentonite mixed layer only as water barrier layer, or one as same as profile B1 but without geomembrane layer or one without asphalt layer respectively. The simulation using HELP code showed that the water balance in profile B1 was effectively controlled

  19. Management of obesity in patients with type 2 diabetes mellitus in primary care.

    Science.gov (United States)

    Mohammad, Shoaib; Ahmad, Jamal

    2016-01-01

    Obesity and being overweight is the most powerful risk factor accounting for 80-90% of patients with type 2 diabetes mellitus (T2DM). The epidemic of obesity is driving the diabetes epidemic to alarming levels and primary care is becoming an important setting for obesity management in T2DM in India. Yet many primary care providers feel ill-equipped or inadequately supported to address obesity in patients with diabetes. This article reviews the most recent and strongest evidence-based strategies that may aid physicians in management of obesity in patients with T2DM in primary care. A systematic literature search of MEDLINE using the search terms Obesity, Obesity in T2DM, weight loss and Primary Care was conducted. The American Diabetes Association, National Institute for Health, National Institute of Health and Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization websites were also searched. Most studies in this area are observational in design with few randomized controlled trials (RCTs). Articles and studies involving meta-analysis or RCTs were preferred over other types. Effective weight management treatment in T2DM patient can be implemented in the primary care setting. Evidence based individualized lifestyle and pharmacologic measures supported by behavioral intervention and counseling with appropriate and informed surgical referrals has the potential to improve the success of weight management within primary care. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  20. Identification and treatment of lithium as the primary toxicant in a groundwater treatment facility effluent

    International Nuclear Information System (INIS)

    Kszos, L.A.; Crow, K.R.

    1996-01-01

    6 Li is used in manufacturing nuclear weapons, shielding, and reactor control rods. Li compounds have been used at DOE facilities and Li-contaminated waste has historically been land disposed. Seep water from burial grounds near Y-12 contain small amounts of chlorinated hydrocarbons, traces of PCBs, and 10-19 mg/L Li. Seep treatment consists of oil-water separation, filtration, air stripping, and carbon adsorption. Routine biomonitoring tests using fathead minnows and Ceriodaphniadubia are conducted. Evaluation of suspected contaminants revealed that toxicity was most likely due to Li. Laboratory tests showed that 1 mg Li/L reduced the survival of both species; 0.5 mg Li/L reduced Ceriodaphnia reproduction and minnow growth. However, the toxicity was greatly reduced in presence of sodium (up to 4 mg Li/L, Na can fully negate the toxic effect of Li). Because of the low Na level discharged from the treatment facility, Li removal from the ground water was desired. SuperLig reg-sign columns were used (Li-selective organic macrocycle bonded to silica gel). Bench-scale tests showed that the material was very effective for removing Li from the effluent, reducing the toxicity

  1. Analysis of histological type and CT features on patients with haemoptysis in primary lung cancer

    International Nuclear Information System (INIS)

    Zhang Yixing; Huang Jinhuo

    2008-01-01

    Objective: To explore the CT features and histological types of haemoptysis patients with primary lung cancer. Methods: 50 haemoptysis patients (group A) with primary lung cancer confirmed by bronchoendoscopic examination or operation were analyzed. 50 cases of primary lung cancer without haemoptysis were studied as the contrast group (group B). The tumor size, shape, cavity, as well as location and pathological type were compared. Results: The proportions of adenocarcinoma and squamous cell carcinoma were 48%, 26% in Group A and 23%, 31% in Group B respectively. The occurrent rate of adenocarcinoma showed significant difference between Group A and B (P>0.05). The proportion of central lung cancer and peripheral lung cancer were 54%, 50% and 46%, 50% in Group A and B respectively. No significant difference occurred in both two types of cancer between two groups (P>0.05). The average size of cancer mass were 30±2.54 mm in Group A and 32±1.93mm in group B. The occurrence rate of lung cavity was 18% and 15% respectively in Group A and B. No significant difference existed in size and the occurrence rate of lung cancer mass between Group A and B (P>0.05). Conclusion: Haemoptysis in patients of primary lung cancer was correlated with pathology type, instead of location, size and cavities. (authors)

  2. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    NARCIS (Netherlands)

    Lodders, J.N.; Parmar, S.; Stienen, N.-L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

    2015-01-01

    Background: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods: Desired data was retrieved

  3. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    NARCIS (Netherlands)

    Lodders, J.N.; Parmar, S.; Stienen, N.L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

    2015-01-01

    BACKGROUND: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. MATERIAL AND METHODS: Desired data was retrieved

  4. Developing Poultry Facility Type Information from USDA Agricultural Census Data for Use in Epidemiological and Economic Models

    Energy Technology Data Exchange (ETDEWEB)

    Melius, C

    2007-12-05

    The epidemiological and economic modeling of poultry diseases requires knowing the size, location, and operational type of each poultry type operation within the US. At the present time, the only national database of poultry operations that is available to the general public is the USDA's 2002 Agricultural Census data, published by the National Agricultural Statistics Service, herein referred to as the 'NASS data'. The NASS data provides census data at the county level on poultry operations for various operation types (i.e., layers, broilers, turkeys, ducks, geese). However, the number of farms and sizes of farms for the various types are not independent since some facilities have more than one type of operation. Furthermore, some data on the number of birds represents the number sold, which does not represent the number of birds present at any given time. In addition, any data tabulated by NASS that could identify numbers of birds or other data reported by an individual respondent is suppressed by NASS and coded with a 'D'. To be useful for epidemiological and economic modeling, the NASS data must be converted into a unique set of facility types (farms having similar operational characteristics). The unique set must not double count facilities or birds. At the same time, it must account for all the birds, including those for which the data has been suppressed. Therefore, several data processing steps are required to work back from the published NASS data to obtain a consistent database for individual poultry operations. This technical report documents data processing steps that were used to convert the NASS data into a national poultry facility database with twenty-six facility types (7 egg-laying, 6 broiler, 1 backyard, 3 turkey, and 9 others, representing ducks, geese, ostriches, emus, pigeons, pheasants, quail, game fowl breeders and 'other'). The process involves two major steps. The first step defines the rules used to

  5. Buffer Construction Methodology in Demonstration Test For Cavern Type Disposal Facility

    International Nuclear Information System (INIS)

    Yoshihiro, Akiyama; Takahiro, Nakajima; Katsuhide, Matsumura; Kenji, Terada; Takao, Tsuboya; Kazuhiro, Onuma; Tadafumi, Fujiwara

    2009-01-01

    A number of studies concerning a cavern type disposal facility have been carried out for disposal of low level radioactive waste mainly generated by power plant decommissioning in Japan. The disposal facility is composed of an engineered barrier system with concrete pit and bentonite buffer, and planed to be constructed in sub-surface 50 - 100 meters depth. Though the previous studies have mainly used laboratory and mock-up tests, we conducted a demonstration test in a full-size cavern. The main objectives of the test were to study the construction methodology and to confirm the quality of the engineered barrier system. The demonstration test was planned as the construction of full scale mock-up. It was focused on a buffer construction test to evaluate the construction methodology and quality control in this paper. Bentonite material was compacted to 1.6 Mg/m 3 in-site by large vibrating roller in this test. Through the construction of the buffer part, a 1.6 Mg/m 3 of the density was accomplished, and the data of workability and quality is collected. (authors)

  6. Macrodactylini (Coleoptera, Scarabaeidae, Melolonthinae: primary types of type species and taxonomic changes to the generic classification

    Directory of Open Access Journals (Sweden)

    Juares Fuhrmann

    2017-09-01

    Full Text Available Type series for 35 type species of Macrodactylini (Coleoptera: Scarabaeidae: Melolonthinae are studied and taxonomic changes are proposed. The following 35 lectotypes are designated: Agaocnemis pruina Moser, 1918; Amphicrania ursina Burmeister, 1855; Anomalochilus singularis Blanchard, 1850; Anomalonyx uruguayensis Moser, 1921; Aulanota sulcipennis Moser, 1924; Barybas nanus Blanchard, 1850; Barybas volvulus Burmeister, 1855; Calodactylus tibialis Blanchard, 1850; Ceraspis pruinosa LePeletier de Saint-Fargeau & Audinet-Serville, 1828; Ceratolontha venezuelae Arrow, 1948; Chariodactylus chacoensis Moser, 1919; Clavipalpus dejeani Laporte, 1832; Corminus canescens Burmeister, 1855; Ctenotis obesa Burmeister, 1855; Ctilocephala pellucens Burmeister, 1855; Demodema fallax Blanchard, 1850; Euryaspis gaudichaudii Blanchard, 1851; Faula cornuta Blanchard, 1850; Gama grandicornis Blanchard, 1850; Gastrohoplus mirabilis Moser, 1921; Mallotarsus spadiceus Blanchard, 1850; Manodactylus gaujoni Moser, 1919; Manopus biguttatus Conte de Castelnau, 1840; Melolontha rufipennis Fabricius, 1801; Oedichira pachydactyla Burmeister, 1855; Pachycerus castaneipennis Guérin-Méneville, 1831; Pachylotoma viridis Blanchard, 1850; Pectinosoma elongata Arrow, 1913; Philochlaenia virescens Blanchard, 1842; Plectris tomentosa LePeletier de Saint-Fargeau & Audinet-Serville, 1828; Pseudohercitis viridiaenea Moser, 1921; Rhinaspoides aeneofusca Moser, 1919; Schizochelus flavescens Blanchard, 1850; Serica marmorea Guérin-Méneville, 1831; and Ulomenes hypocrita Blanchard, 1850. The following six genera are revalidated: Byrasba Harold, 1869 (formerly a synonym of Rhinaspis Perty, 1833; Euryaspis Blanchard, 1851 (formerly a synonym of Plectris LePeletier de Saint-Fargeau & Audinet-Serville, 1828; Junkia Dalla Torre, 1913 (formerly a synonym of Plectris; Faula Blanchard, 1850 (formerly a synonym of Ceraspis LePeletier de Saint-Fargeau & Audinet-Serville, 1828; Paulosawaya

  7. Declassification of radioactive water from a pool type reactor after nuclear facility dismantling

    Science.gov (United States)

    Arnal, J. M.; Sancho, M.; García-Fayos, B.; Verdú, G.; Serrano, C.; Ruiz-Martínez, J. T.

    2017-09-01

    This work is aimed to the treatment of the radioactive water from a dismantled nuclear facility with an experimental pool type reactor. The main objective of the treatment is to declassify the maximum volume of water and thus decrease the volume of radioactive liquid waste to be managed. In a preliminary stage, simulation of treatment by the combination of reverse osmosis (RO) and evaporation have been performed. Predicted results showed that the combination of membrane and evaporation technologies would result in a volume reduction factor higher than 600. The estimated time to complete the treatment was around 650 h (25-30 days). For different economical and organizational reasons which are explained in this paper, the final treatment of the real waste had to be reduced and only evaporation was applied. The volume reduction factor achieved in the real treatment was around 170, and the time spent for treatment was 194 days.

  8. Evaluation on construction quality of pit filler material of cavern type radioactive waste disposal facility

    International Nuclear Information System (INIS)

    Takechi, Shin-ichi; Yokozeki, Kosuke; Shimbo, Hiroshi; Terada, Kenji; Akiyama, Yoshihiro; Yada, Tsutomu; Tsuji, Yukikazu

    2014-01-01

    The pit filler material of the underground cavern-type radioactive waste disposal facility, which is poured directly around the radioactive waste packages where high temperature environment is assumed by their decay heat, is concerned to be adversely affected on the filling behavior and its hardened properties. There also are specific issues that required quality of construction must be achieved by unmanned construction with remote operation, because the pit filler construction shall be done under radiation environment. In this paper, the mix proportion of filler material is deliberated with filling experiments simulating high temperature environment, and also the effect of temperature on hardened properties are confirmed with high temperature curing test. Subsequently, the feasibility of unmanned construction method of filler material by pumping, and by movable bucket, are comparatively discussed through a real size demonstration. (author)

  9. 2 MeV, 60 kW dual-beam type electron accelerator irradiation facility

    International Nuclear Information System (INIS)

    Yotsumoto, Keiichi; Kanazawa, Takao; Haruyama, Yasuyuki; Agematsu, Takashi; Mizuhashi, Kiyoshi; Sunaga, Hiromi; Washino, Masamitsu; Tamura, Naoyuki

    1984-02-01

    The specification of new irradiation facility which has been constructed from 1978 through 1981 as the replacement of 1st Accelerator of JAERI, TRCRE are described. The accelerator is the Cockcroft-Walton type and both vertical and horizontal accelerating tubes are arranged on a single high voltage generator. Transferring of the high voltage to the horizontal accelerating tube is performed with the high voltage changing system in the pressure vessel. The output ratings of the accelerator are 2 MV of acceleration voltage and 30 mA of beam current. By providing the dual beam system, two irradiation rooms, one for vertical and the other for horizontal beam, are independently operationable. Persons can enter the horizontal irradiation room for experimental setting even when the vertical irradiation room is in operation. The specification of the buildings, the exhaust air treatment system, the irradiation conveyor and the safety observation system are also described. (author)

  10. The relationship of radiological findings and pathological types of primary lung cancer

    International Nuclear Information System (INIS)

    Kang, Hye Jung; Baik, Dae Il; Han, Chang Yul; Park, Soo Sung

    1982-01-01

    The present study was intended to define the relationship of radiological findings and pathological types of primary lung cancer. The 85 cases was selected after confirmation of the cell types by bronchoscopic biopsy, cervical lymph node or thoracotomy biopsy and lung resection. Results of the study were presented below. 1. Primary lung cancer is frequently developed after 4th decade and males were affected more frequently than females with ratio of 2 to 1. 2. The frequencies of pathologic cell types of lung cancer were presented as follows. Squamous cell carcinoma 40% Adenocarcinoma 25% Undifferential cell carcinoma 30% Alveolar cell carcinoma 5% 3. The findings of plain chest radiography were presented as follows. In squamous cell carcinoma. hilar enlargement or hilar mass is the most frequent findings (53%) with atelectasis (26%) or obstructive pneumonitis (26%). In adenocarcinoma, pleural effusion is accompanied about half of cases (53%). In undifferential cell carcinoma, hilar mass with mediastinal widening and pleural effusion is frequent finding

  11. Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Nefs, Giesje; Pouwer, François; Denollet, Johan

    2010-01-01

    tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460) and the 2007 (M1; N = 2,225) and 2008 (M2; N = 2,032) follow-up assessments. DISCUSSION: The DiaDDZoB Study is expected......BACKGROUND: Depression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk....... METHODS/DESIGN: This prospective cohort study will examine: (1) the course of depressive symptoms in primary care patients with type 2 diabetes; (2) whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk...

  12. The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.

    Science.gov (United States)

    Alcalde-Rabanal, Jacqueline Elizabeth; Nigenda, Gustavo; Bärnighausen, Till; Velasco-Mondragón, Héctor Eduardo; Darney, Blair Grant

    2017-08-03

    The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources. The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P human resources in primary health facilities.

  13. Demonstration test of underground cavern-type disposal facilities, fiscal 2010 status - 59180

    International Nuclear Information System (INIS)

    Akiyama, Yoshihiro; Terada, Kenji; Oda, Nobuaki; Yada, Tsutomu; Nakajima, Takahiro

    2012-01-01

    A test to demonstrate practical construction technology for underground cavern-type disposal facilities is currently underway. Cavern-type disposal facilities are a radioactive waste repository excavated to a depth of 50 to 100 m below ground and constructed with an engineered barrier system (EBS) that is a combination of low-permeable bentonite material and low-diffusive cementitious material. The disposed materials are low-level radioactive waste with relatively high radioactivity, mainly generated from power reactor decommissioning, and certain transuranic wastes that are mainly generated from spent fuel reprocessing. The project started in fiscal 2005*, and since fiscal 2007 a full-scale mock-up of a disposal facility has been constructed in an actual sub-surface environment. The main objective of the demonstration test is to establish construction procedures and methods which ensure the required quality of an EBS on-site. Certain component parts of the facility had been constructed in an underground cavern by fiscal 2010, and tests so far have demonstrated both the practicability of the construction and the achievement of the required quality. This paper covers the project outline and the test results obtained by the construction of certain EBS components. The following results were obtained from the construction test of EBS in the test cavern: 1) The dry density of bentonite buffer at the lower layer constructed by vibratory compaction shows that 95% of core samples have densities within the target range. 2) The specified mix for the low-diffusion layer has uniform density and crack-control properties, and meets the requirements for diffusion performance. 3) The specified mix of the concrete pit has sufficient passing ability through congested reinforcement and meets the requirements of strength performance. 4) The dry density of the bentonite buffer at the lateral layer constructed by the spraying method shows that 65% of the core samples are within the

  14. THE PRIMARY TARGET FACILITY FOR A NEUTRINO FACTORY BASED ON MUON BEAMS

    International Nuclear Information System (INIS)

    HASSENEIN, A.; KAHN, S.A.; KING, B.J.; KIRK, H.G.; LUDEWIG, H.; PALMER, R.B.; PEARSON, C.E.; SAMULYAK, R.; SIMOS, N.; STUMER, I.; THIEBERGER, P.; WEGGEL, R.J.

    2001-01-01

    Neutrino beams from the decay of muons in a storage ring offer the prospect of very high flux, well-understood spectra, and equal numbers of electron and muon neutrinos, as desirable for detailed exploration of neutrino oscillations via long baseline detectors [1]. Such beams require. large numbers of muons, and hence a high performance target station at which a 1-4 MW proton beam of 16-24 GeV impinges on a compact target, all inside a high field solenoid channel to capture as much of the phase volume of soft pions as possible. A first concept was based on a carbon target, as reported in 2000 the Neutrino Factory Study-I [2]. A higher performance option based on a free mercury jet has been studied in 2001 as part of the Neutrino Factory Feasibility Study-II [3,4]. An overview of a mercury jet target facility is presented here, including requirements, design concept and summaries of simulated performance. Further details are presented in related papers at this conference

  15. Identification of the chemical inventory of different paint types applied in nuclear facilities

    International Nuclear Information System (INIS)

    Sabrina Tietze; Foreman, M.R.St.J.; Ekberg, CH.H.; Chalmers University of Technology, Chemical and Biological Engineering, Goeteborg; Dongen van, B.E.

    2013-01-01

    The floors, concrete walls and many of the metal surfaces in nuclear power plant containments are coated with zinc primers or paint films to preserve the metal surfaces and simplify decontamination in the containment after the occurrence of a severe nuclear incident or accident. A chemical examination of paint films from different nuclear installations out of operation, as well as current operating ones, reveals that different types of paints are used whose composition can vary significantly. Results obtained for one type of paint at a certain nuclear site are in most cases unlikely to be comparable with sites painted with another type of paint. During normal operation and particularly during nuclear accidents, the paints will degrade under the high temperature, steam and irradiation influence. As paint and its degradation products can act as sources and depots for volatile iodine compounds, the type and aging conditions of the paint films will have a significant impact on the source term of the volatile fission product iodine. Thus, great care should be taken when extrapolating any results obtained for the interaction of radioactive iodine with one paint product to a different paint product. The main focus of the study is a comparison of the chemical profile of paint films applied in Swedish nuclear power plants. Teknopox Aqua V A, an epoxy paint recently used at Ringhals 2, and an emulsion paint used in the scrubber buildings of Ringhals 1-4 are compared with a paint film from Barsebaeck nuclear power plant unit 1 that had been aged under real reactor conditions for 20 years. In addition, two paint films, an emulsion and a gloss paint, used in an international nuclear fuel reprocessing facility, are compared with the paints from the Swedish nuclear power plants. (author)

  16. EXPLICIT AND IMPLICIT TYPES OF CORRECTIVE FEEDBACK IN TURKISH PRIMARY EDUCATION

    Directory of Open Access Journals (Sweden)

    M. Pınar BABANOĞLU

    2015-08-01

    Full Text Available Corrective feedback (CF has become a significant notion in EFL learning as it is seen as a facilitator to enhance L2 learning. CF is basically refer to any feedback provided to learner containing evidence of learner error of language form (Russel & Spada, 2006, or an immediate response by teacher to learner utterances containing error explained which is also theoretically a complex phenomenon with several functions (Lyster, et.al., 2012. A distinction can be drawn whether CF types are being implicit or explicit that there is not a clear indication of error in implicit CF whereas there is in explicit CF types. This study investigates the explicit and implicit CF types used by teachers in EFL classrooms in primary levels aiming at to see whether there are quantitative differences in the preference of CF types being explicit/implicit. Data of the study gathered from EFL classroom teachers’ course session observations at various levels of primary school. Methodology depends on frequency analysis of CF types employed by teachers during EFL course sessions. Results favored explicit CF types by teachers during EFL sessions.

  17. Huff-type competitive facility location model with foresight in a discrete space

    OpenAIRE

    Milad Gorji Ashtiani; Ahmad Makui; Reza Ramezanian

    2011-01-01

    Consider a chain as leader that wants to open p new facilities in a linear market, like metro. In this market, there is a competitor, called follower. The leader and the follower have established some facilities in advance. When the leader opens p new facilities, its competitor, follower, reacts the leader’s action and opens r new facilities. The optimal locations for leader and follower are chosen among predefined potential locations. Demand is considered as demand points and is assumed inel...

  18. Image quality of mammography in Croatian nationwide screening program: Comparison between various types of facilities

    International Nuclear Information System (INIS)

    Brnić, Zoran; Blašković, Darko; Klasić, Branimir; Ramač, Jelena Popić; Flegarić-Bradić, Mirjana; Štimac, Damir; Lubina, Ivan Zvonimir; Brnić, Vedran; Faj, Dario

    2012-01-01

    Purpose: The study was aimed to provide objective evidence about the mammographic image quality in Croatia, to compare it between different types of MG facilities and to identify the most common deficiencies and possible reasons as well as the steps needed to improve image quality. Materials and methods: A total of 420 mammographic examinations collected from 84 mammographic units participating in the Croatian nationwide breast cancer screening program were reviewed in terms of four image quality categories: identification of patient and examination, breast positioning and compression, exposure and contrast, and artifacts. Those were rated using image evaluating system based on American College of Radiology and European Commission proposals. The results were compared among different types of mammographic units, and common image quality deficiencies were identified. Results: Total image quality scores of 12.8, 16.1, 13.0 and 13.7 were found for general hospitals, university hospitals, private clinics and public healthcare centres, respectively. Average score for all mammographic units was 13.5 (out of 25 points). University hospitals were significantly better than all other mammography units in overall image quality, which was mostly contributed by better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts. Conclusions: Serious deficiencies in identification and breast positioning, which might compromise breast cancer screening outcome, were detected in our material. They occur mainly due to subjective reasons and could be corrected through additional staff training and improvement of working discipline.

  19. Cherenkov-type diagnostics of fast electrons beams escaping from MCF facilities

    Energy Technology Data Exchange (ETDEWEB)

    Jakubowski, L.; Malinowski, K.; Mirowski, R.; Rabinski, M.; Sadowski, M.J.; Zebrowski, J. [Institute for Nuclear Studies - IPJ, 05-400 Otwock-Swierk (Poland)

    2011-07-01

    The paper presents the feasibility study, the measuring system and the first experimental results of a new method developed for direct detection of high-energy (super-thermal, ripple-born and runaway) electrons generated in magnetic confinement fusion (MCF) facilities. The technique in question is based on registration of the Cherenkov radiation, emitted by energetic electrons, moving through a transparent medium (radiator) with a velocity higher than the velocity of light in this material. The main aim of our studies was to develop a diagnostic technique applicable for measurements of fast electron beams within MCF devices. The IPJ team proposed Cherenkov-type probes because of their high spatial- and temporal-resolutions. The most important results of applications of the presented Cherenkov-type diagnostics have proved that the one- and four-channel versions of the detecting head are useful for studies of the fast (ripple-born and runaway) electrons in different MCF experiments. Experience collected during the described studies allows to introduce some changes in the radiator configuration and to modify the Cherenkov probe design. This document is composed of a paper followed by a poster

  20. The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda

    Science.gov (United States)

    Dhillon, Ranu S.; Bonds, Matthew H.; Fraden, Max; Ndahiro, Donald; Ruxin, Josh

    2011-01-01

    This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five ‘imidugudu’ or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights. PMID:21732708

  1. Spontaneous regression of primary diffuse large B-cell lymphoma, leg type.

    Science.gov (United States)

    Alcántara-González, J; González-García, C; Fernández-Guarino, M; Jaén-Olasolo, P

    2014-01-01

    Primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL LT) accounts for approximately 20% of all primary cutaneous B-cell lymphomas and tends to present as infiltrated nodules, tumors, and plaques on the legs in the elderly. Unlike other primary cutaneous large B-cell lymphomas, it has a poor prognosis and tends to require treatment with systemic chemotherapy. We present the case of an 82-year-old patient with a 1-year history of nodules and plaques on her right leg. Biopsy led to a diagnosis of PCLBCL LT and the lesions resolved without treatment within 1 month of the first visit. This is an atypical course of PCLBCL LT and we believe that it is the first such case to be reported in the literature. Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.

  2. Effectiveness of counseling at primary health facilities: level of knowledge of antenatal attendee and their attitude on Prevention of Mother to Child Transmission of HIV in primary health facilities in Dar es Salaam, Tanzania.

    Science.gov (United States)

    Wangwe, P J T; Nyasinde, M; Charles, D S K

    2014-03-01

    Children living with HIV worldwide majority are infected through mother to child transmission of HIV (MTCT) acquired during pregnancy. Knowledge, attitude and behavioral changes are pivot tools towards success of any interventions. To determine the effectiveness of counseling on HIV done in primary health facilities (PHF), level of knowledge gained and attitude changes towards PMTCT. A cross sectional study assessing pregnant women's knowledge and their attitude towards PMTCT was conducted in Temeke district from October 2010 to Jan 2011 using a structured questionnaire. A total of 383 antenatal attendees were referred to Temeke district for management after counselled and tested for HIV in PHFs. Majority (86.9%) had primary education and good knowledge on MTCT. Correct timing of ARVs prophylaxis (15.7%) as preventive measures for MTCT was poor. Education and employment were associated with good knowledge on MTCT of HIV. Women had positive attitudes towards HIV counseling and testing, but stigma was a barrier to disclosure of one's serostatus. There is knowledge gap in routine PMTCT counseling among antenatal attendees in our PHFs. Effective counseling on PMTCT in the PHFs will bridge the identified knowledge gap and help in reduction of pediatric HIV.

  3. Type of primary education is associated with condom use at sexual debut among Chilean adolescents.

    Science.gov (United States)

    Huneeus, Andrea; Deardorff, Julianna; Lahiff, Maureen; Guendelman, Sylvia

    2014-05-01

    Although condom use in adolescence is related to higher lifetime educational attainment, the association between primary education (from kindergarten to eighth grade) and adolescent sexual behavior is not well understood. This study examined the association between type of school in which primary education was completed-public, charter, or private-and condom use at sexual debut among Chilean adolescents. Drawing on the 2009 Chilean National Youth Survey, a population-based sample of general community youth aged 15 to 29 years, we conducted a study of the 4217 participants who reported onset of sexual activity during adolescence. Bivariate and multple logistic regression was used to examine the relationship between type of primary school attended (60.1% public, 30.3% charter, and 9.6% private) and condom use at sexual debut while controlling for sociodemographic characteristics and sexual behavior. Compared with students who completed their primary education in private or charter schools, students who completed their primary education in public schools had 1.85 (95% confidence interval, 1.12-3.04) and 1.67 (95% confidence interval, 1.26-2.23) higher odds, respectively, of not using condoms at sexual debut. Odds were similar for students living in urban settings, whereas there were too few students attending private schools in rural areas to allow meaningful estimates. Independent of household income, primary schooling is associated with sexual health behaviors among Chilean adolescents living in urban areas and can serve as a target for public health interventions designed to prevent sexually transmitted infections in adolescence.

  4. Maximum dose angle for oblique incidence on primary beam protective barriers in the design of medical radiation therapy facilities

    International Nuclear Information System (INIS)

    Fondevila, Damian; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Monica; Dosoretz, Bernardo

    2008-01-01

    Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle (α max ) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining α max , which is a function of the thickness of the barrier (t E ) and the equilibrium tenth-value layer (TVL e ) of the shielding material for the nominal energy of the beam. It can be seen that α max increases for increasing TVL e (hence, beam energy) and decreases for increasing t E , with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation

  5. Maximum dose angle for oblique incidence on primary beam protective barriers in the design of medical radiation therapy facilities.

    Science.gov (United States)

    Fondevila, Damián; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Mónica; Dosoretz, Bernardo

    2008-05-01

    Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle (alpha(max)) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining alpha(max), which is a function of the thickness of the barrier (t(E)) and the equilibrium tenth-value layer (TVL(e)) of the shielding material for the nominal energy of the beam. It can be seen that alpha(max) increases for increasing TVL(e) (hence, beam energy) and decreases for increasing t(E), with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation.

  6. Laboratory testing improves diagnosis and treatment outcomes in primary health care facilities

    Directory of Open Access Journals (Sweden)

    Jane Y. Carter

    2012-10-01

    Setting: Six rural health centres in Kenya. Design: Cross-sectional study to observe change in diagnosis and treatment made by clinical officers after laboratory testing in outpatients attending six rural health centres in Kenya. Subject: The diagnosis and treatment of 1134 patients attending outpatient services in six rural health centres were compared before and after basic laboratory testing. Essential clinical diagnostic equipment and laboratory tests were established at each health centre. Clinical officers and laboratory technicians received on-site refresher training in good diagnostic practices and laboratory procedures before the study began. Results: Laboratory tests were ordered on 704 (62.1% patients. Diagnosis and treatment were changed in 45% of tested patients who returned with laboratory results (21% of all patients attending the clinics. 166 (23.5% patients did not return to the clinician for a final diagnosis and management decision after laboratory testing. Blood slide examination for malaria parasites, wet preparations, urine microscopy and stool microscopy resulted in most changes to diagnosis. There was no significant change in drug costs after laboratory testing. The greatest changes in numbers of recorded diseases following laboratory testing was for intestinal worms (53% and malaria (21%. Conclusion: Effective use of basic laboratory tests at primary health care level significantly improves diagnosis and patient treatment. Use of laboratory testing can be readily incorporated into routine clinical practice. On-site refresher training is an effective means of improving the quality of patient care and communication between clinical and laboratory staff.

  7. Primary hyperoxaluria type 1: clinical manifestations in infancy and prenatal diagnosis

    DEFF Research Database (Denmark)

    Illum, N; Lavard, L; Danpure, C J

    1992-01-01

    biopsy demonstrated complete absence of alanine: glyoxylate aminotransferase catalytic activity and immunoreactive protein compatible with a diagnosis of primary hyperoxaluria type 1. He died at the age of 11 months, just before liver transplantation was made possible. Fetal liver biopsy in the mother......A 9-month-old Pakistani boy of consanguineous parents presented with uraemia preceded by pyuria from 5 weeks of age. He had no history of renal calculi or macroscopic haematuria. Renal biopsy revealed severe calcium oxalate deposition in the tubuli and fibrosis of the interstitial tissue. Liver......'s subsequent pregnancy showed normal enzymatic activity. Early detection and early replacement of the missing enzyme by liver transplantation are considered to be crucial for the survival of severely affected infants with the acute neonatal form of primary hyperoxaluria type 1. Persistent pyuria could...

  8. Clinical coaching in primary care: Capable of improving control in patients with type 2 diabetes mellitus?

    Science.gov (United States)

    González-Guajardo, Eduardo Enrique; Salinas-Martínez, Ana María; Botello-García, Antonio; Mathiew-Quiros, Álvaro

    2016-06-01

    Few clinical coaching studies are both endorsed by real cases and focused on reducing suboptimal diabetes control. We evaluated the effectiveness of coaching on improving type 2 diabetes goals after 3 years of implementation in primary care. A cross-sectional study with follow up was conducted during 2008-2011. Coaching consisted of guiding family doctors to improve their clinical abilities, and it was conducted by a medical doctor trained in skill building, experiential learning, and goal setting. Effectiveness was assessed by means of fasting plasma glucose and glycosylated hemoglobin outcomes. The main analysis consisted of 1×3 and 2×3 repeated measures ANOVAs. A significant coaching×time interaction was observed, indicating that the difference in glucose between primary care units with and without coaching increased over time (Wilks' lambda multivariate test, PCoaching increased 1.4 times (95%CI 1.3, 1.5) the possibility of reaching the fasting glucose goal after controlling for baseline values. There was also a significant improvement in glycosylated hemoglobin (Bonferroni-corrected p-value for pairwise comparisons, Pcoaching was found to be worth the effort to improve type 2 diabetes control in primary care. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  9. Ownership type and team climate in elderly care facilities: the moderating effect of stress factors.

    Science.gov (United States)

    Heponiemi, Tarja; Elovainio, Marko; Kouvonen, Anne; Noro, Anja; Finne-Soveri, Harriet; Sinervo, Timo

    2012-03-01

    This paper is a report of a study examining the association between ownership type and perceived team climate among older people care staff. In addition, we examined whether work stress factors (time pressure, resident-related stress, role conflicts and role ambiguity) mediated or moderated the above mentioned association. There has been a trend towards contracting out in older people care facilities in Finland and the number of private for-profit firms has increased. Studies suggest that there may be differences in employee well-being and quality of care according to the ownership type of older people care. Cross-sectional survey data was collected during the autumn of 2007 from 1084 Finnish female older people care staff aged 18-69 years were used. Team Climate Inventory was used to measure team climate. Ownership type was divided into four categories: for-profit sheltered homes, not-for-profit sheltered homes, public sheltered homes and not-for-profit nursing homes. Analyses of covariance were used to examine the associations. Team climate dimensions participative safety, vision and support for innovation were higher in not-for-profit organizations (both sheltered homes and nursing homes) compared to for-profit sheltered homes and public sheltered homes. Stress factors did not account for these associations but acted as moderators in a way that in terms of task orientation and participative safety employees working in for-profit organizations seemed to be slightly more sensitive to work-related stress than others. Our results suggest that for-profit organizations and public organizations may have difficulties in maintaining their team climate. In consequence, these organizations should focus more effort on improving their team climate. © 2011 Blackwell Publishing Ltd.

  10. Experiments for simulating a great leak in the primary coolant circuit of a PWR type reactor

    International Nuclear Information System (INIS)

    Liebig, E.

    1977-01-01

    A loss of coolant accident is to be simulated on a high pressure test rig. The accident is initiated by an externally induced rupture of a pair of rupture-disks installed in a coolant ejection device. Several problems of simulating leaks in the primary coolant circuit of PWR type reactors are dealt with. The selection of appropriate rupture-disks for such experiments is described

  11. Role of NSO compounds during primary cracking of a Type II kerogen and a Type III lignite

    Science.gov (United States)

    Behar, F.; Lorant, F.; Lewan, M.

    2008-01-01

    The aim of this work is to follow the generation of NSO compounds during the artificial maturation of an immature Type II kerogen and a Type III lignite in order to determine the different sources of the petroleum potential during primary cracking. Experiments were carried out in closed system pyrolysis in the temperature range from 225 to 350 ??C. Two types of NSOs were recovered: one is soluble in n-pentane and the second in dichloromethane. A kinetic scheme was optimised including both kerogen and NSO cracking. It was validated by complementary experiments carried out on isolated asphaltenes generated from the Type II kerogen and on the total n-pentane and DCM extracts generated from the Type III lignite. Results show that kerogen and lignite first decompose into DCM NSOs with minor generation of hydrocarbons. Then, the main source of petroleum potential originates from secondary cracking of both DCM and n-pentane NSOs through successive decomposition reactions. These results confirm the model proposed by Tissot [Tissot, B., 1969. Premie??res donne??es sur les me??canismes et la cine??tique de la formation du pe??trole dans les bassins se??dimentaires. Simulation d'un sche??ma re??actionnel sur ordinateur. Oil and Gas Science and Technology 24, 470-501] in which the main source of hydrocarbons is not the insoluble organic matter, but the NSO fraction. As secondary cracking of the NSOs largely overlaps that of the kerogen, it was demonstrated that bulk kinetics in open system is a result of both kerogen and NSO cracking. Thus, another kinetic scheme for primary cracking in open system was built as a combination of kerogen and NSO cracking. This new kinetic scheme accounts for both the rate and amounts of hydrocarbons generated in a closed pyrolysis system. Thus, the concept of successive steps for hydrocarbon generation is valid for the two types of pyrolysis system and, for the first time, a common kinetic scheme is available for extrapolating results to natural

  12. Safety assessment in primary Mycobacterium tuberculosis smear microscopy centres in Blantyre Malawi: a facility based cross sectional survey.

    Science.gov (United States)

    Majamanda, J; Ndhlovu, P; Shawa, I T

    2013-12-01

    Tuberculosis (TB) is caused by Mycobacterium tuberculosis and is transmitted mainly through aerosolization of infected sputum which puts laboratory workers at risk in spite of the laboratory workers' risk of infection being at 3 to 9 times higher than the general public. Laboratory safety should therefore be prioritized and optimized to provide sufficient safety to laboratory workers. To assess the safety for the laboratory workers in TB primary microscopy centres in Blantyre urban. TB primary microscopy centers in Blantyre urban were assessed in aspects of equipment availability, facility layout, and work practice, using a standardized WHO/AFRO ISO 15189 checklist for the developing countries which sets the minimum safety score at ≥80%. Each center was graded according to the score it earned upon assessment. Only one (1) microscopy center out nine (9) reached the minimum safety requirement. Four (4) centers were awarded 1 star level, four (4) centers were awarded 2 star level and only one (1) center was awarded 3 star level. In Blantyre urban, 89% of the Tuberculosis microscopy centers are failing to provide the minimum safety to the laboratory workers. Government and other stake holders should be committed in addressing the safety challenges of TB microscopy centres in the country to ensure safety for the laboratory workers. It is recommended that the study be conducted at the regional or national level for both public and private laboratories in order to have a general picture of safety in Tb microscopy centres possibly across the country.

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

    Science.gov (United States)

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

    2018-01-01

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

  14. Community governance in primary health care: towards an international Ideal Type.

    Science.gov (United States)

    Meads, Geoffrey; Russell, Grant; Lees, Amanda

    2017-10-01

    Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non

  15. Availability of herbal medicines and medicinal plants in the primary health facilities of the state of São Paulo, Southeast Brazil: results from the National Program for Access and Quality Improvement in Primary Care.

    Science.gov (United States)

    Caccia-Bava, Maria do Carmo Gullaci Guimarães; Bertoni, Bianca Waléria; Pereira, Ana Maria Soares; Martinez, Edson Zangiacomi

    2017-05-01

    This study aims to describe the availability of herbal medicines and medicinal plants in the primary care facilities in the state of São Paulo, Southeast Brazil, from the results of the first cycle of the National Program for Access and Quality Improvement in Primary Care (PMAQ). The PMAQ uses a national cross-sectional multicenter design, with data from 4,249 health facilities distributed among 645 municipalities of the state of São Paulo. Of these facilities, 467 (11%) had herbal medicines and/or medicinal plants. Among the 645 municipalities, 104 (16.1%) had at least one health facility that provided these drugs. We observed that the availability of herbal medicines is greater in larger cities with better social and economic conditions. Furthermore, we found that use of industrialized herbal medicines prevailed over that of vegetal drugs or compounded herbal medicines.

  16. Workers' exposure to bioaerosols from three different types of composting facilities.

    Science.gov (United States)

    Bonifait, Laetitia; Marchand, Geneviève; Veillette, Marc; M'Bareche, Hamza; Dubuis, Marie-Eve; Pépin, Carole; Cloutier, Yves; Bernard, Yves; Duchaine, Caroline

    2017-10-01

    Composting is a natural dynamic biological process used to valorise putrescible organic matter. The composting process can involve vigorous movements of waste material piles, which release high concentrations of bioaerosols into the surrounding environment. There is a lack of knowledge concerning the dispersal of airborne microorganisms emitted by composting plants (CP) as well as the potential occupational exposure of composting workers. The aim of this study was to investigate the workers exposure to bioaerosols during working activities in three different types of composting facilities (domestic, manure, carcass) using two different quantification methods (cultivation and qPCR) for bacteria and moulds concentrations. As expected, even if there are differences between all CP frameworks, independently of the type of the raw compost used, the production of bioaerosols increases significantly during handling activities. Important concentrations of mesophilic moulds and mesophilic bacteria were noted in the working areas with a respective maximal concentration of 2.3 × 10 5 CFU/m 3 and 1.6 × 10 5 CFU/m 3 . A. fumigatus and thermophilic Actinomycetes were also detected in all working areas for the 3 CP. This study emphases the risks for workers to being in contact with aerosolized pathogens such as Mycobacterium and Legionella and more specifically, L. pneumophila. The presence of high concentration of these bacteria in CP suggests a potential occupational health risk. This study may lead to recommendations for the creation of limits for occupational exposure. There is a need for identifying the standards exposure limits to bioaerosols in CP and efficient recommendation for a better protection of workers' health.

  17. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South AfricaExperiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-07-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans.Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  18. Pre elementary design of primary reformer for hydrogen plant coupled with HTGR type NPP

    International Nuclear Information System (INIS)

    Dedy Priambodo; Erlan Dewita; Sudi Ariyanto

    2012-01-01

    Hydrogen has a high potent for new energy, because of it availability. Steam reforming is a fully developed commercial technology and is the most economical method for production of hydrogen. Steam reforming uses an external source of hot gas to heat tubes in which a catalytic reaction takes place that converts steam and lighter hydrocarbons such as natural gas (methane) or refinery feedstock into hydrogen and carbon monoxide (syngas) at high temperature on primary reformer (800-900°C). Utilization of helium from HTGR as heating medium for primary reformer has consequence to type and shape of its reactor. The main goal of this paper is to determine type/shape and pre elementary design of chemical reactor for the cogeneration system of Hydrogen Plant and HTGR The primary reformer for this system is Fixed Bed Multitube reactor with specification tube: NPS 3,5 Sch 40 ST 40S, 0.281 in thickness, number of tube 849 pieces and ASTM HH 30 for tube material. Tube arrangement is 'triangular pitch' on shell Split-Ring Floating Head from Steel Alloy SA 301 Grade B equipted with 8 baffles. (author)

  19. Feedback control of primary circulation pump of PIUS-Type reactor

    International Nuclear Information System (INIS)

    Fujii, Mikiya; Anoda, Yoshinari; Murata, Hideo; Yonomoto, Taisuke; Kukita, Yutaka; Tasaka, Kanji.

    1991-05-01

    In operating the PIUS-Type reactor, it is required to keep stationary density interfaces between the primary loop hot water and the poison tank cold, borated water by maintaining pressure balance between the primary-loop and the poison-tank. The authors have developed a primary circulation pump speed control system and tested it in small-scale experiments. This control system regulates the pump speed based on measurements of the density lock differential pressure which is proportional to the elevation of the interface in the density lock. This pump speed control facilitated the normal plant operation which included core power changes. However, the elevation of the density interface indicated oscillatory behavior when the pump speed was regulated as a linear function of the density lock differential pressure. The mechanism responsible for such oscillatory behavior was found to be manometric oscillations that could be eliminated by adding a damping term to compensate for the mechanical delay of the primary pump speed. The passive shutdown function of the reactor was retained by setting an upper limit to the pump speed. This was confirmed in a loss-of-feedwater abnormal transient test. (author)

  20. Experiments in LEENA facility with modified wire type leak detector layout in large sodium pipelines

    International Nuclear Information System (INIS)

    Vijayakumar, G.; Chandramouli, S.; Nashine, B.K.; Selvaraj, P.; Rajan, K.K.

    2017-01-01

    Highlights: • FBR large horizontal secondary pipeline were simulated and five sodium leak experiments were conducted by providing modified wire type leak detector layout at 550 °C. • Early detection of sodium leak is needed for minimizing the sodium leaked out and consequent damages. • PFBR leak detector layout on large horizontal pipelines can detect a leak rate of 200 g/h within 6 h. • By reducing the distance between leak point and detector to half, detection time was reduced to 1/6th and found that a leak rate of 200 g/h can be detected in one hour. • A relationship between leak rate and detection time was established based on experimental results. - Abstract: Sodium cooled Fast Breeder Reactors (SFRs) are envisaged in the second phase of Indian nuclear power programme. Liquid sodium is used as the coolant in the SFRs due to its favourable nuclear properties and excellent heat transfer properties. Leaks in sodium systems have the potential of being exceptionally hazardous due to the reaction of liquid sodium with oxygen and water vapour in the air. When a sodium leak occurs, the sodium leak rate, the total quantity of sodium leaked and leak detector layout governs the detection time. Other factors to be considered are insulation material packing condition, distance between the leak point and detector, heater layout, pipe geometry, temperature etc. Potential regions of leakage in Fast Breeder Reactor (FBR) sodium circuits are near welds, high stress areas and regions subjected to thermal striping. Early detection of leak is needed for minimizing the quantity of sodium leaked to outside and consequent damages. Three wire type leak detectors (WLDs positioned at 90°, 180° and 270°) working on conductivity principle are used for detecting sodium leak in the large horizontal secondary sodium pipelines of Prototype Fast Breeder Reactor (PFBR). It was found from the upper boundary curve based on LEENA (LEak Experiments in NAtrium) facility experimental

  1. Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour

    NARCIS (Netherlands)

    Tenneij, N.H.; Koot, H.M.

    2008-01-01

    Background: Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types

  2. Bose-type distribution and primary cosmic ray nucleon spectrum from sea-level muon spectrum

    CERN Document Server

    Bhattacharya, D P; Roychowdhury, R K

    1976-01-01

    The recent CERN Intersecting Storage Ring cross section data on the p +p to pi /sup +or-/+X inclusive reactions have been analysed using the Bose-type distribution of the form E(d/sup 3/ sigma )/(d/sup 3/p)=(Axs /sup 1/2/)/(exp( epsilon ( lambda )/T)-1) proposed by Hoang (1973). This formula has been used to derive the cosmic ray primary nucleon spectrum from the sea-level muon spectrum. It is found that the primary spectrum obeys the following relation: N(E/sub p/)dE/sub p /=2.06E/sub p//sup -2.64/dE/sub p/. The result has been compared with the recent experimental data and theoretical predictions given by different authors. (11 refs).

  3. Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache.

    Science.gov (United States)

    Jay, Gary W; Barkin, Robert L

    2017-12-01

    In Part 2 of Primary Headache disorders, we discuss the fourth Primary Headache Disorder, Tension-Type Headache (TTHA). We are again using the ICHD-III (Beta) definitions of such headaches, taking into consideration episodic and chronic TTHA, as well as the presence or absence of pericranial muscle tenderness. We discuss the pathophysiology and pharmacotherapeutic treatment of TTHA, and the aspects of the Myofascial Pain Syndrome that enhance and help the development of TTHA. We then discuss Medication Overuse Headache (MOH), itself a Secondary headache disorder, but one that is extremely important as it assists with the chronification of both migraine and TTHA. Finally we discuss how to manage and treat those patients with MOH. Chronic migraine, which is TTHA, Migraine as well as, in many patients, MOH, is discussed along with the treatment of this multifaceted disorder. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Comorbidity and glycemia control among patients with type 2 diabetes in primary care

    Directory of Open Access Journals (Sweden)

    Catherine Hudon

    2008-11-01

    Full Text Available Catherine Hudon1,3, Martin Fortin1,3, Marie-France Dubois2, José Almirall31Department of Family Medicine, 2Department of Community Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada; 3Centre de Santé et de Services Sociaux de Chicoutimi, Quebec, CanadaAbstract: Reports on the relationship between comorbidity and glycemia control in diabetic patients are conflicting and the method of measuring comorbidity varies widely among studies. The aim of the present study was to evaluate the relationship between diabetes control and comorbidity, taking into account all comorbidities and their severity, in a primary care setting. We performed a retrospective descriptive study based on chart review of 96 randomly selected type 2 diabetic patients. Comorbidity was measured with the cumulative illness rating scale (CIRS, an exhaustive comorbidity index. Diabetes was considered as controlled if the mean value of two measurements of glycosylated hemoglobin A (HbA1c was less than 7%. Taking diabetes control as the dependent variable, its relationship with the CIRS score, age, sex, diabetes duration, and diabetes-related complications was explored. Diabetes control was not significantly related with the CIRS score, age, sex or diabetes severity. Diabetes duration was the only variable significantly related to diabetes control. Our study suggests that comorbidity measured with the CIRS in patients with type 2 diabetes is not a factor that prevents the achievement of a good glycemia control.Keywords: glycemia control, type 2 diabetes mellitus, comorbidity, primary care

  5. Laboratory results gained from cold worked type 316Ti under simulated PWR primary environment

    International Nuclear Information System (INIS)

    Devrient, B.; Kilian, R.; Koenig, G.; Widera, M.; Wermelinger, T.

    2015-01-01

    Beginning in 2005, intergranular stress corrosion cracking (IGSCC) of barrel bolts made from cold worked type 316Ti (German Material No. 1.4571 K) was observed in several S/KWU type PWRs. This mechanism was so far less understood for PWR primary conditions. Therefore an extended joint research program was launched by AREVA GmbH and VGB e.V. to clarify the specific conditions which contributed to the observed findings on barrel bolts. In the frame of this research program beneath the evaluation of the operational experience also laboratory tests on the general cracking behavior of cold worked type 316Ti material, which followed the same production line as for barrel bolt manufacturing in the eighties, with different cold work levels covering up to 30 % were performed to determine whether there is a specific susceptibility of cold worked austenitic stainless steel specimens to suffer IGSCC under simulated PWR primary conditions. All these slow strain rate tests on tapered specimens and component specimens came to the results that first, much higher cold work levels than used for the existing barrel bolts are needed for IGSCC initiation. Secondly, additional high active plastic deformation is needed to generate and propagate intergranular cracking. And thirdly, all specimens finally showed ductile fracture at the applied strain rates. (authors)

  6. Psoriasis risk in patients with type 2 diabetes in German primary care practices.

    Science.gov (United States)

    Jacob, Louis; Kostev, Karel

    2017-02-01

    To analyze psoriasis risk in type 2 diabetes mellitus (T2DM) patients treated in German primary care practices. The study included 87,964 T2DM patients aged 40 years or over who received their initial diabetes diagnosis between 2004 and 2013. Patients were excluded if they had been diagnosed with psoriasis prior to diabetes diagnosis or if the observation period prior to the index date was less than 365 days. After applying these exclusion criteria, 72,148 T2DM patients were included. A total of 72,148 non-diabetic controls were matched (1:1) to T2DM cases based on age, gender, type of health insurance (private or statutory), number of medical visits, and index date. The primary outcome was the diagnosis of psoriasis. Skin infections, dermatitis/eczema, hyperlipidemia, and medications associated with psoriasis (beta blockers, angiotensin-converting enzyme (ACE) inhibitors, lithium, antimalarials, nonsteroidal anti-inflammatory drugs, and benzodiazepines) were included as potential confounders. The mean age was 68.7 years (SD=12.7 years) and 48.6% of subjects were men. Hyperlipidemia, dermatitis/eczema, and skin infections were more frequent in T2DM patients than in controls. Beta blockers, ACE inhibitors, and nonsteroidal anti-inflammatory drugs were also more commonly used in people with T2DM than in controls. A total of 3.4% of T2DM patients and 2.8% of matched controls developed psoriasis within ten years of follow-up (p-value risk of developing psoriasis than controls (HR=1.18, 95% CI: 1.08-1.29). T2DM was positively associated with psoriasis in patients treated in German primary care practices. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  7. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa.

    Science.gov (United States)

    Sokhela, Dudu G; Makhanya, Nonhlanhla J; Sibiya, Nokuthula M; Nokes, Kathleen M

    2013-07-05

    Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service. A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Effective health communication strategies contribute to positive

  8. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-07-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service. Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  9. [Prevalence of renal involvement in a population of type Ii diabetics followed up in primary care].

    Science.gov (United States)

    Marín, R; Coca, A; Tranche, S; Rodríguez Mañas, L; Abellán, J; Moyá, A

    2002-01-01

    Patients with type 2 diabetes use to be managed in their primary care settings during the early stages of the disease. The main objective of the study was to determine renal impairment prevalence, and to assess its significance, within type 2 diabetics controlled by their family physicians. Transverse observation of patients with type 2 diabetes who were the first 20 unselected cases seen by 183 family physicians from 16 of the 17 Autonomic Communities of our country. The following variables were determined: serum creatinine, glucose, and HbA1c concentrations, proteinuria (dipstick test in a first-voided morning urine sample), blood pressure levels, and associated cardiovascular disease. Data from 3,583 type 2 diabetic subjects were evaluated. Mean age was 64 +/- 10 years and 45% were male. A serum creatinine > or = 1.2 mg/dl was observed in 523 (15.5%) patients. Proteinuria was present in 794 (23.5%) cases, being > or = 2 + in 215 (6.5%) subjects. Patients with a serum creatinine > or = 1.2 mg/dl were older, shower higher blood pressure levels, and suffered from more cardiovascular disease (32.0 vs 19.5%) than those with a serum creatinine or = 2 + proteinuria (p or = 140/90 mmHg in 69% of the cases, being < 130/85 mmHg in only 8% of the subjects. There is a high prevalence of renal impairment, approximately of 25% within type 2 diabetic patients seen at the primary care level. Optimal blood pressure level seems to be extremely infrequent bearing in mind the diagnosis of diabetes and the associated cardiovascular disease.

  10. Accumulation of type VI collagen in the primary osteon of the rat femur during postnatal development.

    Science.gov (United States)

    Kohara, Yukihiro; Soeta, Satoshi; Izu, Yayoi; Amasaki, Hajime

    2015-05-01

    In rodents, the long bone diaphysis is expanded by forming primary osteons at the periosteal surface of the cortical bone. This ossification process is thought to be regulated by the microenvironment in the periosteum. Type VI collagen (Col VI), a component of the extracellular matrix (ECM) in the periosteum, is involved in osteoblast differentiation at early stages. In several cell types, Col VI interacts with NG2 on the cytoplasmic membrane to promote cell proliferation, spreading and motility. However, the detailed functions of Col VI and NG2 in the ossification process in the periosteum are still under investigation. In this study, to clarify the relationship between localization of Col VI and formation of the primary osteon, we examined the distribution of Col VI and osteoblast lineages expressing NG2 in the periosteum of rat femoral diaphysis during postnatal growing periods by immunohistochemistry. Primary osteons enclosing the osteonal cavity were clearly identified in the cortical bone from 2 weeks old. The size of the osteonal cavities decreased from the outer to the inner region of the cortical bone. In addition, the osteonal cavities of newly formed primary osteons at the outermost region started to decrease in size after rats reached the age of 4 weeks. Immunohistochemistry revealed concentrated localization of Col VI in the ECM in the osteonal cavity. Col VI-immunoreactive areas were reduced and they disappeared as the osteonal cavities became smaller from the outer to the inner region. In the osteonal cavities of the outer cortical regions, Runx2-immunoreactive spindle-shaped cells and mature osteoblasts were detected in Col VI-immunoreactive areas. The numbers of Runx2-immunoreactive cells were significantly higher in the osteonal cavities than in the osteogenic layers from 2 to 4 weeks. Most of these Runx2-immunoreactive cells showed NG2-immunoreactivity. Furthermore, PCNA-immunoreactivity was detected in the Runx2-immunoreactive spindle

  11. Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh.

    Directory of Open Access Journals (Sweden)

    Sk Masum Billah

    Full Text Available In 2011, the Bangladesh Government introduced the National Nutrition Services (NNS by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC and management of sick children younger than five years.Service delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 541 mothers/caregivers of sick children.Structural readiness to provide nutrition services was higher for ANC compared to management of sick children; 73% of ANC rooms had >5 of the 13 essential items while only 13% of the designated areas for management of sick children had >5 of the 13 essential items. One in five (19% healthcare providers had received nutrition training through the NNS. Delivery of the nutrition services was poor: <30% of women received all four key antenatal nutrition services, 25% of sick children had their weight checked against a growth-chart and <1% had their height measured. Nevertheless, most mothers/caregivers rated their satisfaction of the service above average.Strengthening the provision of equipment and increasing the coverage of training are imperative to improve nutrition services. Inherent barriers to implementing nutrition services in primary health care, especially high caseloads during the management of sick under-five children, should

  12. Perceptions on evaluative and formative functions of external supervision of Rwandan primary healthcare facilities: A qualitative study.

    Science.gov (United States)

    Schriver, Michael; Cubaka, Vincent Kalumire; Itangishaka, Sylvere; Nyirazinyoye, Laetitia; Kallestrup, Per

    2018-01-01

    External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. Qualitative, exploratory study. Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.

  13. Huff-type competitive facility location model with foresight in a discrete space

    Directory of Open Access Journals (Sweden)

    Milad Gorji Ashtiani

    2011-01-01

    Full Text Available Consider a chain as leader that wants to open p new facilities in a linear market, like metro. In this market, there is a competitor, called follower. The leader and the follower have established some facilities in advance. When the leader opens p new facilities, its competitor, follower, reacts the leader’s action and opens r new facilities. The optimal locations for leader and follower are chosen among predefined potential locations. Demand is considered as demand points and is assumed inelastic. Considering huff model, demand points are probabilistically absorbed by all facilities. The leader’s objective is maximization of its market share after opening follower’s new facilities. For solving leader problem, first the follower’s problem is solved for all leader’s potential locations and the best location for leader is obtained and then, a heuristic model is proposed for leader problem when the leader and the follower want to open one new facility. Computational results show that the proposed method is efficient for large scale problems.

  14. An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

    Science.gov (United States)

    Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

    2017-07-11

    There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately

  15. A study of visual double stars with early type primaries. IV. Astrophysical data

    International Nuclear Information System (INIS)

    Lindroos, K.P.

    1985-01-01

    Astrophysical parameters (MK class, colour excess, absolute magnitude, distance, effective temperature mass and age) are derived from calibrations of the uvbyβ indices for the members of 253 double stars with O or B type primaries and faint secondaries. The photometric spectral classification is compared to the MK classes and the agreement is very good. The derived data together with spectroscopic and JHKL data are used for deciding which pairs are likely to be physical and which are optical and it is shown that 98 (34%) of the secondaries are likely to be members of physical systems. For 90% of the physical pairs the projected separations between the components is less than 25000 AU. A majority of the physical secondaries are late type stars and 50% of them are contracting towards the zero-age main-sequence. Also presented are new uvbyβ data for 43 secondaries and a computer programme for determining astrophysical parameters from uvbyβ data

  16. Primary photoluminescence in as-neutron (electron) -irradiated n-type 6H-SiC

    International Nuclear Information System (INIS)

    Zhong, Z.Q.; Wu, D.X.; Gong, M.; Wang, O.; Shi, S.L.; Xu, S.J.; Chen, X.D.; Ling, C.C.; Fung, S.; Beling, C.D.; Brauer, G.; Anwand, W.; Skorupa, W.

    2006-01-01

    Low-temperature photoluminescence spectroscopy has revealed a series of features labeled S 1 , S 2 , S 3 in n-type 6H-SiC after neutron and electron irradiation. Thermal annealing studies showed that the defects S 1 , S 2 , S 3 disappeared at 500 deg. C. However, the well-known D 1 center was only detected for annealing temperatures over 700 deg. C. This experimental observation not only indicated that the defects S 1 , S 2 , S 3 were a set of primary defects and the D 1 center was a kind of secondary defect, but also showed that the D 1 center and the E 1 , E 2 observed using deep level transient spectroscopy might not be the same type of defects arising from the same physical origin

  17. Primary NK/T cell lymphoma nasal type of the colon

    Directory of Open Access Journals (Sweden)

    Ana María Chirife

    2013-02-01

    Full Text Available Since nasal NK/T-cell lymphoma and NK/T-cell lymphoma nasal type are rare diseases, colonic involvement has seldom been seen. We report a case of a patient with a primary NK/T-cell lymphoma nasal type of the colon. The patient had no history of malignant diseases and was diagnosed after exhaustive study in the context of fever of unknown origin. The first therapeutic approach followed the DAEPOCH-protocol: etoposide, prednisone, doxor-rubicin, vincristine and cyclophosphamide. The persistence of constitutional symptoms after the first treatment course motivated the switch to a second line following the SMILE-protocol: dexamethasone, metotrexate, ifosfamide, E.coli L-asparaginase, and etoposide. Despite intensive chemotherapy, the patient died 2 months after the diagnose of an extranodal NK/T-cell lymphoma of the colon and 4 months after the first symptomatic appearance of disease.

  18. A Study on the Ion Beam Extraction using Duo-PiGatron Ion source for Vertical Type Ion Beam Facility

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bom Sok; Lee, Chan young; Lee, Jae Sang [KAERI, Daejeon (Korea, Republic of)

    2015-05-15

    In Korea Multipurpose Accelerator Complex (KOMAC), we have started ion beam service in the new beam utilization building since March this year. For various ion beam irradiation services, we are developed implanters such as metal (150keV/1mA), gaseous (200keV/5mA) and high current ion beam facility (20keV/150mA). One of the new one is a vertical type ion beam facility without acceleration tube (60keV/20mA) which is easy to install the sample. After the installation is complete, it is where you are studying the optimal ion beam extraction process. Detailed experimental results will be presented. Vertical Type Ion Beam Facility without acceleration tube of 60keV 20mA class was installed. We successfully extracted 60keV 20mA using Duo- PiGatron Ion source for Vertical Type Ion Beam Facility. Use the BPM and Faraday-cup, is being studied the optimum conditions of ion beam extraction.

  19. Application of an experimental irradiation facility type K-120 for the radiation treatment of agricultural products in large quantity

    International Nuclear Information System (INIS)

    Stenger, V.; Foeldiak, G.; Horvath, I.; Hargittai, P.; Bartfai, Cs.

    1979-01-01

    During experimental and pilot irradiation carried out by the 60 Co irradiation facility type K-120 of the Institute of Isotopes of the Hungarian Academy of Sciences an irradiation technology for the treatment of agricultural and food products of considerable density has been developed. Applying transport containers of commercial size the intermittent radiation treatment of great quantity products was made possible with homogeneous dose distribution. The radiation technical characteristics, the utilization coefficient and the capacity of the facility for every agricultural product were calculated. (author)

  20. Audit of HIV counselling and testing services among primary healthcare facilities in Cameroon: a protocol for a multicentre national cross-sectional study.

    Science.gov (United States)

    Tianyi, Frank-Leonel; Tochie, Joel Noutakdie; Agbor, Valirie Ndip; Kadia, Benjamin Momo

    2018-03-01

    HIV testing is an invaluable entry point to prevention, care and treatment services for people living with HIV and AIDS. Poor adherence to recommended protocols and guidelines reduces the performance of rapid diagnostic tests, leading to misdiagnosis and poor estimation of HIV seroprevalence. This study seeks to evaluate the adherence of primary healthcare facilities in Cameroon to recommended HIV counselling and testing (HCT) procedures and the impact this may have on the reliability of HIV test results. This will be an analytical cross-sectional study involving primary healthcare facilities from all the 10 regions of Cameroon, selected by a multistaged random sampling of primary care facilities in each region. The study will last for 9 months. A structured questionnaire will be used to collect general information concerning the health facility, laboratory and other departments involved in the HCT process. The investigators will directly observe at least 10 HIV testing processes in each facility and fill out the checklist accordingly. Clearance has been obtained from the National Ethical Committee to carry out the study. Informed consent will be sought from the patients to observe the HIV testing process. The final study will be published in a peer-reviewed journal and the findings presented to health policy-makers and the general public. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. School Playground Facilities as a Determinant of Children's Daily Activity: A Cross-Sectional Study of Danish Primary School Children

    DEFF Research Database (Denmark)

    Nielsen, Glen; Bugge, Anna; El-Naaman, Bianca

    2012-01-01

    This study investigates the influence of school playground facilities on children's daily physical activity.......This study investigates the influence of school playground facilities on children's daily physical activity....

  2. PWR type reactor equipped with a primary circuit loop water level gauge

    International Nuclear Information System (INIS)

    Suzuki, Mitsuhiro.

    1990-01-01

    The time of lowering a water level to less than the position of high temperature side pipeway nozzle has been rather delayed because of the swelling of mixed water level due to heat generation of the reactor core. Further, there has been a certain restriction for the installation, maintenance and adjustment of a water level gauge since it is at a position under high radiation exposure. Then, a differential pressure type water level gauge with temperature compensation is disposed at a portion below a water level gauge of a pressurizer and between the steam generator exit plenum and the lower end of the loop seal. Further, a similar water level system is disposed to all of the loops of the primary circulation circuits. In a case that the amount of water contained in a reactor container should decreased upon occurrence of loss of coolant accidents caused by small rupture and stoppage of primary circuit pumps, lowering of the water level preceding to the lowering of the water level in the reactor core is detected to ensure the amount of water. Since they are disposed to all of the loops and ensure the excess margin, reliability for the detection of the amount of contained water can be improved by averaging time for the data of the water level and averaging the entire systems, even when there are vibrations in the fluid or pressure in the primary circuit. (N.H.)

  3. Protein Homeostasis Defects of Alanine-Glyoxylate Aminotransferase: New Therapeutic Strategies in Primary Hyperoxaluria Type I

    Directory of Open Access Journals (Sweden)

    Angel L. Pey

    2013-01-01

    Full Text Available Alanine-glyoxylate aminotransferase catalyzes the transamination between L-alanine and glyoxylate to produce pyruvate and glycine using pyridoxal 5′-phosphate (PLP as cofactor. Human alanine-glyoxylate aminotransferase is a peroxisomal enzyme expressed in the hepatocytes, the main site of glyoxylate detoxification. Its deficit causes primary hyperoxaluria type I, a rare but severe inborn error of metabolism. Single amino acid changes are the main type of mutation causing this disease, and considerable effort has been dedicated to the understanding of the molecular consequences of such missense mutations. In this review, we summarize the role of protein homeostasis in the basic mechanisms of primary hyperoxaluria. Intrinsic physicochemical properties of polypeptide chains such as thermodynamic stability, folding, unfolding, and misfolding rates as well as the interaction of different folding states with protein homeostasis networks are essential to understand this disease. The view presented has important implications for the development of new therapeutic strategies based on targeting specific elements of alanine-glyoxylate aminotransferase homeostasis.

  4. Prognostic implication of human papillomavirus types and species in cervical cancer patients undergoing primary treatment.

    Directory of Open Access Journals (Sweden)

    Yat Ming Lau

    Full Text Available High-risk human papillomavirus (HPV types are associated with cervical cancer. It is well established that individual HPV types vary in oncogenicity, but current data on their prognostic implication remain controversial. We examined the association between HPV types/species and the survival of 236 Chinese women aged 26-87 (mean 54.4 years after receiving primary treatment for cervical cancer. Overall, 45.8% were of FIGO stage I, 41.9% stage II, and 12.3% stage III. The four most prevalent types found were HPV-16 (60.2%, HPV-18 (21.6%, HPV-52 (11.9%, and HPV-58 (9.3%. Overall, 19.5% of patients had multiple-type infections, 78.4% harboured one or more alpha-9 species, and 28.8% harboured one or more alpha-7 species. After a median follow-up of 8.0 years, 156 (66.1% patients survived. The 3-year overall survival rate was 75.5%. Factors independently associated with a poorer 3-year overall survival were age >60 years, tumour size >4 cm, lymph node involvement and treatment with radiotherapy+/-chemotherapy. Univariate analysis showed HPV-16 single-type infection was associated with a marginally poorer disease-specific survival (71.6% vs. 87.0%, HR: 1.71, 95% CI = 1.01-2.90, whereas non-HPV-16 alpha-9 species was associated with a better disease-specific survival (90.0% vs. 76.2%, HR: 0.36, 95% CI = 0.16-0.79. However, on multivariate analysis, HPV infection status irrespective of different grouping methods, including individual types, species, single-type or co-infection, did not carry any significant prognostic significance. In conclusion, we did not observe any association between infection with a particular HPV type/species and survival. An HPV type-based stratification in treatment and follow-up plan could not be recommended.

  5. Fracture resistance of 3 types of primary esthetic stainless steel crowns.

    Science.gov (United States)

    Beattie, Sean; Taskonak, Burak; Jones, James; Chin, Judith; Sanders, Brian; Tomlin, Angela; Weddell, James

    2011-01-01

    Demand is increasing for esthetic restorations in pediatric dentistry. When full coverage is indicated, one option is to use esthetic stainless steel crowns (SSCs). However, this type of crown is prone to fracture. The purpose of this study was to evaluate the fracture resistance of 3 types of esthetic SSCs. Esthetic SSCs for first primary mandibular molars were cemented to idealized epoxy dies with glass ionomer cement. The die-crown units were fractured on a universal testing machine. The force was delivered by a stainless steel ball fixture, set in a uniaxial lever to replicate a cusp contact, with a crosshead speed of 1 mm/min. The differences among the 3 types of crown, in terms of force required to fracture, were compared statistically by 1-way analysis of variance. Pairwise comparisons were performed with Fisher's protected least significant difference test, at an overall significance level of 5%. The force required to fracture, expressed as average ± standard error, did not differ significantly among the 3 brands of esthetic SSCs: 1730 N ± 50 N, 1826 N ± 62 N and 1671 N ± 68 N, respectively (p = 0.19), well below the maximum bite force of pediatric patients determined in a previous study. Esthetic SSCs should be able to resist occlusal forces over short clinical periods. However, long-term occlusal loading and fatigue failures should be taken into account when evaluating the success of this type of crown.

  6. Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review

    Science.gov (United States)

    Rushforth, Bruno; McCrorie, Carolyn; Glidewell, Liz; Midgley, Eleanor; Foy, Robbie

    2016-01-01

    Background Despite the availability of evidence-based guidance, many patients with type 2 diabetes do not achieve treatment goals. Aim To guide quality improvement strategies for type 2 diabetes by synthesising qualitative evidence on primary care physicians’ and nurses’ perceived influences on care. Design and setting Systematic review of qualitative studies with findings organised using the Theoretical Domains Framework. Method Databases searched were MEDLINE, Embase, CINAHL, PsycInfo, and ASSIA from 1980 until March 2014. Studies included were English-language qualitative studies in primary care of physicians’ or nurses’ perceived influences on treatment goals for type 2 diabetes. Results A total of 32 studies were included: 17 address general diabetes care, 11 glycaemic control, three blood pressure, and one cholesterol control. Clinicians struggle to meet evolving treatment targets within limited time and resources, and are frustrated with resulting compromises. They lack confidence in knowledge of guidelines and skills, notably initiating insulin and facilitating patient behaviour change. Changing professional boundaries have resulted in uncertainty about where clinical responsibility resides. Accounts are often couched in emotional terms, especially frustrations over patient compliance and anxieties about treatment intensification. Conclusion Although resources are important, many barriers to improving care are amenable to behaviour change strategies. Improvement strategies need to account for differences between clinical targets and consider tailored rather than ‘one size fits all’ approaches. Training targeting knowledge is necessary but insufficient to bring about major change; approaches to improve diabetes care need to delineate roles and responsibilities, and address clinicians’ skills and emotions around treatment intensification and facilitation of patient behaviour change. PMID:26823263

  7. Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

    Science.gov (United States)

    Wanyonyi, Kristina L; Radford, David R; Gallagher, Jennifer E

    2017-01-01

    This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England. Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008-2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients' individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments. Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (care in the form of 'instruction and advice', compared with 46% of working age adults (18-64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): 'partial dentures' (7%); 'scale and polish' (3.7%); 'tooth extraction' (3%; p = 0.001), and 'instruction and advice' (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive 'instruction and advice' than non-smokers (OR 4.124; 95% CI: 3.088-5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely

  8. Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

    Directory of Open Access Journals (Sweden)

    Kristina L Wanyonyi

    Full Text Available This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England.Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008-2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients' individual characteristics (demography, smoking, payment status and contextual experience (deprivation based on area of residence, with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments.Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years and older adults (≥65 years received preventive care in the form of 'instruction and advice', compared with 46% of working age adults (18-64 years; p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001: 'partial dentures' (7%; 'scale and polish' (3.7%; 'tooth extraction' (3%; p = 0.001, and 'instruction and advice' (3%; p = 0.001. Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive 'instruction and advice' than non-smokers (OR 4.124; 95% CI: 3.088-5.508; p = 0.01. A further new finding from the multilevel models was a significant difference in treatment related to area

  9. Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

    Science.gov (United States)

    Bintabara, Deogratius; Mpondo, Bonaventura C T

    2018-01-01

    Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania. This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension. The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary

  10. Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

    Directory of Open Access Journals (Sweden)

    Deogratius Bintabara

    Full Text Available Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania.This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50% of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value < 0.2 were fitted into the multiple logistic regression models using a 5% significance level.Out of 725 health facilities involved in the current study, about 68% were public facilities and 73% located in rural settings. Only 28% of the assessed facilities were considered prepared for the outpatient primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension.The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership

  11. [Intimate partner violence. Types and risk in primary care health users in Cancun, Quintana Roo, Mexico].

    Science.gov (United States)

    Sandoval-Jurado, Luis; Jiménez-Báez, María Valeria; Rovira Alcocer, Gloria; Vital Hernandez, Omar; Pat Espadas, Fany Guadalupe

    2017-10-01

    To identify the prevalence and type of intimate partner violence in women assigned at primary care health and estimates the risks for violence. Case (incident cases)-control. Primary health care unit in Cancun, Quintana Roo, Mexico. Women over 18years old living in couple at last 12months. Validated violence scale for Mexican population was evaluated: total partner violence, physical, psychological and sexual violence. History of violence and sociodemographic variables. Chi square for categorical variables and odds ratio (OR) for risk estimate was determined. The total intimate partner violence was 15.05%, psychological violence in 37.3%. Overall violence, age differences, socioeconomic status, marital status, history of violence and alcohol intake by the partner (P<.05) were observed. The risk increased in over 40 years old (OR: 2.09; 95%CI: 1.07 to 4.11), history of violence (OR: 5.9; 95%CI: 2.8 to 12.44) and alcohol intake by partner (OR=12.38; 95%CI: 2.15 to 29.59). Low socioeconomic status (OR: 0.384; 95%CI: 0.19 to 0.74) and free union (OR: 0.507; 95%CI: 0.27 to 0.95) were relation factors to lower intimate violence partner. Sexual violence predominated among users of primary health care and the risk that present this behavior increases with the consumption of alcoholic beverages in the couple and a history of violence, but the free union and socioeconomic status were possibility protected for violence. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  12. [Compliance with process indicators in people with type 2 diabetes and linking incentives in Primary Care].

    Science.gov (United States)

    Pascual de la Pisa, Beatriz; Márquez Calzada, Cristina; Cuberos Sánchez, Carla; Cruces Jiménez, José Miguel; Fernández Gamaza, Manuel; Martínez Martínez, María Isabel

    2015-03-01

    Pay-for-performance programs to improve the quality of health care are extending gradually, particularly en Primary Health Care. Our aim was to explore the relationship between the degree of compliance with the process indicators (PrI) of type 2 diabetes (T2DM) in Primary Care and linkage to incentives. Cross-sectional, descriptive, observational study. Six Primary Health Care centers in Seville Aljarafe District randomly selected and stratified by population size. From 3.647 adults included in Integrated Healthcare Process of T2DM during 2008, 366 patients were included according sample size calculation by stratified random sampling. PrI: eye and feet examination, glycated hemoglobin, lipid profile, microalbuminuria and electrocardiogram. Confounding: Age, gender, characteristics town for patients and professional variables. The mean age was 66.36 years (standard deviation [DE]: 11,56); 48.9% were women. PrI with better compliance were feet examination, glycated hemoglobin and lipid profile (59.6%, 44.3% and 44%, respectively). 2.7% of patients had simultaneous compliance of the six PrI and 11.74% of patients three PrI linkage to incentives. Statistical association was observed in the compliance of the PrI incentives linked or not (P=.001). The degree of compliance with the PrI for screening chronic complications of T2DM is mostly low but this was higher on indicators linked to incentives. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  13. A Rare Case of Continuous Type Splenogonadal Fusion in a Young Male with Primary Infertility

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2014-01-01

    Full Text Available Splenogonadal fusion is a rare developmental anomaly in which an abnormal connection between splenic tissue and gonads or mesonephric derivatives is present. Here we present a case of young man with the complaint of primary infertility for 3 years. On evaluation (USG and MRI abdomen and pelvis, his right scrotal testis was atrophied and left intra-abdominal undescended testis. On laparoscopic assessment, a mass was seen on the left side due to continuous type of splenogonadal fusion for which excision and left orchidectomy were done. Postoperative period was uneventful and he was discharged under satisfactory condition. Splenogonadal fusion is a rare entity and it is commonly mistaken for testicular tumour. It should be considered in the differential diagnosis of testicular masses especially when there are associated congenital anomalies and preoperative laparoscopic assessment, should be done to avoid unnecessary radical surgery.

  14. Distinct types of primary cutaneous large B-cell lymphoma identified by gene expression profiling.

    Science.gov (United States)

    Hoefnagel, Juliette J; Dijkman, Remco; Basso, Katia; Jansen, Patty M; Hallermann, Christian; Willemze, Rein; Tensen, Cornelis P; Vermeer, Maarten H

    2005-05-01

    In the European Organization for Research and Treatment of Cancer (EORTC) classification 2 types of primary cutaneous large B-cell lymphoma (PCLBCL) are distinguished: primary cutaneous follicle center cell lymphomas (PCFCCL) and PCLBCL of the leg (PCLBCL-leg). Distinction between both groups is considered important because of differences in prognosis (5-year survival > 95% and 52%, respectively) and the first choice of treatment (radiotherapy or systemic chemotherapy, respectively), but is not generally accepted. To establish a molecular basis for this subdivision in the EORTC classification, we investigated the gene expression profiles of 21 PCLBCLs by oligonucleotide microarray analysis. Hierarchical clustering based on a B-cell signature (7450 genes) classified PCLBCL into 2 distinct subgroups consisting of, respectively, 8 PCFCCLs and 13 PCLBCLsleg. PCLBCLs-leg showed increased expression of genes associated with cell proliferation; the proto-oncogenes Pim-1, Pim-2, and c-Myc; and the transcription factors Mum1/IRF4 and Oct-2. In the group of PCFCCL high expression of SPINK2 was observed. Further analysis suggested that PCFCCLs and PCLBCLs-leg have expression profiles similar to that of germinal center B-cell-like and activated B-cell-like diffuse large B-cell lymphoma, respectively. The results of this study suggest that different pathogenetic mechanisms are involved in the development of PCFCCLs and PCLBCLs-leg and provide molecular support for the subdivision used in the EORTC classification.

  15. Glycemic control among patients with type 2 diabetes at a primary health care center in Oman.

    Science.gov (United States)

    Al Balushi, Khalid A; Al-Haddabi, Mahmod; Al-Zakwani, Ibrahim; Al Za'abi, Mohammed

    2014-10-01

    To determine the status of blood sugar control by using fasting blood sugar (FBS) of ≤6.1 mmol/l and glycosyted hemoglobin A1c (HbAc1) of Oman. The overall mean age of the cohort was 53±12 years (range: 24-91) with females representing 60% (n=106) of the study sample. The study found that only 9.6% (n=17) and 35% (n=62) of the patients attained optimal FBS and HbAc1 levels, respectively. Higher HbA1c was significantly associated with higher diastolic BP (84 versus 80 mm Hg; p=0.006), higher total cholesterol (5.2 versus 4.7 mmol/l; p=0.002) and higher low-density lipoprotein cholesterol (3.8 versus 3.0 mmol/l; p=0.034). The results demonstrated poor glycemic control in Oman type 2 diabetic patients comparable to local and global studies especially in those hypertensive and dyslipidemic patients. Implementation of early and aggressive management of diabetes mellitus at the primary care setting is warranted. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  16. The Inter Facility Testing of a Standard Oscillating Water Column (OWC) Type Wave Energy Converter (WEC)

    DEFF Research Database (Denmark)

    Andersen, Morten Thøtt; Thomsen, Jonas Bjerg

    This report describes the behavior and preliminary performance of a simplified standard oscillating water column (OWC) wave energy converter (WEC). The same tests will be conducted at different scales at 6 different test facilities and the results obtained will be used for comparison. This project...

  17. HCMV Displays a Unique Transcriptome of Immunomodulatory Genes in Primary Monocyte-Derived Cell Types.

    Directory of Open Access Journals (Sweden)

    Ellen Van Damme

    Full Text Available Human cytomegalovirus (HCMV is a betaherpesvirus which rarely presents problems in healthy individuals, yet may result in severe morbidity in immunocompromised patients and in immune-naïve neonates. HCMV has a large 235 kb genome with a coding capacity of at least 165 open reading frames (ORFs. This large genome allows complex gene regulation resulting in different sets of transcripts during lytic and latent infection. While latent virus mainly resides within monocytes and CD34+ progenitor cells, reactivation to lytic infection is driven by differentiation towards terminally differentiated myeloid dendritic cells and macrophages. Consequently, it has been suggested that macrophages and dendritic cells contribute to viral spread in vivo. Thus far only limited knowledge is available on the expression of HCMV genes in terminally differentiated myeloid primary cells and whether or not the virus exhibits a different set of lytic genes in primary cells compared with lytic infection in NHDF fibroblasts. To address these questions, we used Illumina next generation sequencing to determine the HCMV transcriptome in macrophages and dendritic cells during lytic infection and compared it to the transcriptome in NHDF fibroblasts. Here, we demonstrate unique expression profiles in macrophages and dendritic cells which significantly differ from the transcriptome in fibroblasts mainly by modulating the expression of viral transcripts involved in immune modulation, cell tropism and viral spread. In a head to head comparison between macrophages and dendritic cells, we observed that factors involved in viral spread and virion composition are differentially regulated suggesting that the plasticity of the virion facilitates the infection of surrounding cells. Taken together, this study provides the full transcript expression analysis of lytic HCMV genes in monocyte-derived type 1 and type 2 macrophages as well as in monocyte-derived dendritic cells. Thereby

  18. Primary isolation strain determines both phage type and receptors recognised by Campylobacter jejuni bacteriophages.

    Directory of Open Access Journals (Sweden)

    Martine C Holst Sørensen

    Full Text Available In this study we isolated novel bacteriophages, infecting the zoonotic bacterium Campylobacter jejuni. These phages may be used in phage therapy of C. jejuni colonized poultry to prevent spreading of the bacteria to meat products causing disease in humans. Many C. jejuni phages have been isolated using NCTC12662 as the indicator strain, which may have biased the selection of phages. A large group of C. jejuni phages rely on the highly diverse capsular polysaccharide (CPS for infection and recent work identified the O-methyl phosphoramidate modification (MeOPN of CPS as a phage receptor. We therefore chose seven C. jejuni strains each expressing different CPS structures as indicator strains in a large screening for phages in samples collected from free-range poultry farms. Forty-three phages were isolated using C. jejuni NCTC12658, NCTC12662 and RM1221 as host strains and 20 distinct phages were identified based on host range analysis and genome restriction profiles. Most phages were isolated using C. jejuni strains NCTC12662 and RM1221 and interestingly phage genome size (140 kb vs. 190 kb, host range and morphological appearance correlated with the isolation strain. Thus, according to C. jejuni phage grouping, NCTC12662 and NCTC12658 selected for CP81-type phages, while RM1221 selected for CP220-type phages. Furthermore, using acapsular ∆kpsM mutants we demonstrated that phages isolated on NCTC12658 and NCTC12662 were dependent on the capsule for infection. In contrast, CP220-type phages isolated on RM1221 were unable to infect non-motile ∆motA mutants, hence requiring motility for successful infection. Hence, the primary phage isolation strain determines both phage type (CP81 or CP220 as well as receptors (CPS or flagella recognised by the isolated phages.

  19. Advanced nutrient root feeding system for conveyer-type cylindrical plant growth facilities developed for microgravity

    Science.gov (United States)

    Berkovich, Yuliy A.; Smolyanina, Svetlana O.; Krivobok, Anna; Krivobok, Nikolay

    A new brand of cylindrical conveyer-type space plant growth facilities (PGF) has been created to improve of cosmonauts’ diet in the microgravity conditions. Up to date several ground prototypes of the space PGF have been made and tested: “Phytocycle”, “Vitacycle”, “Phytocycle-LED”, “Phytoconveyer”; now the space PGF “Vitacycle-T” for the Russian segment of the ISS is under developing. In the PGFs the ion-exchange salt-saturated fibrous artificial soil (AS) is used as a root medium. We have proposed the system for enrichment of irrigation water by nutrients to decrease of the AS store required for PGF working during the long space mission. The system includes root modules filled in fibrous ion-exchange AS, the enrichment column with crumble salt-saturation ion-exchange resin and the cassette with slow releasing fertilizer (SRF). Both substrates (ion-exchange resin and SRF) are necessary because of the SRF contains mostly N, P and K but another three essential elements S, Ca, Mg are provided by the ion-exchange resin. In the system water goes throw the enrichment column with ion-exchange resin fertilizing by the nutrients and comes into the mixer cell fertilize equipped with the electrical conductivity sensor. When the signal of the conductivity sensor is coming to the controller it turns on the pump directed the water flow throw the cassette with SRF until the electric conductivity of the solution in the mixer cell will reach the setpoint. The nutrient root feeding system was tested during 88 days when Chinese cabbage grew in PGF “Phytocycle-LED”. The crop has been continuously illuminated by red and blue LEDs in the PPF ratio 7 to 1; an integral PPF level has been (240 ± 10) µmol/(m2×s). There was no renewal of the used fibrous AS during the experiment. The PGF total electric power consumption was of 0,45 kW. The average fresh biomass productivity of the PGF during steady state working mode was equal 135×g/day per m2 of the illuminated

  20. Primary NK/T cell lymphoma nasal type of the stomach with skin involvement: a case report

    Directory of Open Access Journals (Sweden)

    Sebastian Kobold

    2009-12-01

    Full Text Available Since nasal NK/T cell lymphoma and NK/T cell lymphoma nasal type are rare diseases, gastric involvement has seldom been seen. We report a unique case of a patient with a primary NK/T cell lymphoma nasal type of the stomach with skin involvement. The patient had no history of malignant diseases and was diagnosed with hematemesis and intense bleeding from his gastric primary site. Shortly after this event, exanthemic skin lesions appeared with concordant histology to the primary site. Despite chemotherapy, the patient died one month after the first symptomatic appearance of disease.

  1. Experimental facility of innovative types as the laboratory analog of research reactor experimental device

    International Nuclear Information System (INIS)

    Androsenko, A.A.; Androsenko, P.A.; Zabud'ko, A.N.; Kremenetskij, A.K.; Nikolaev, A.N.; Trykov, L.A.

    1991-01-01

    The paper analyses capability of creating laboratory analogs of complex experimental facilities at research reactors utilizing power radionuclide neutron sources fabricated in industrial conditions. Some experimental and calculational investigations of neutron-physical characteristics are presented, which have been attained at the RIZ research reactor laboratory analog. Experimental results are supplemented by calculational investigations, fulfilled by means of the BRAND three-dimensional computational complex and the ROZ-6 one-dimensional program. 4 refs.; 3 figs

  2. Psychometric properties of the exercise self-efficacy scale in Dutch primary care patients with type 2 diabetes mellitus

    NARCIS (Netherlands)

    van der Heijden, M.M.P.; Pouwer, F.; Pop, V.J.M.

    2014-01-01

    Background Excercise self-efficacy is believed to influence physical activity bahavior. Purpose The purpose of this study is to assess the psychometric aspects of the Exercise Self-efficacy Scale (ESS) in a type 2 diabetes Dutch Primary care sample. Method Type 2 diabetes patients (n = 322; <80

  3. Primary enteric-type adenocarcinomas of the urinary bladder are histogenetically analogous to colorectal carcinomas: Immunohistochemical evaluation of 109 cases

    Directory of Open Access Journals (Sweden)

    Saad S. Eissa

    2010-04-01

    In conclusion, primary non-urachal enteric-type adenocarcinoma of the urinary bladder is morphologically and immunophenotypically similar – if not identical – to colonic adenocarcinoma. The frequent association of enteric carcinomas of the urinary bladder with intestinal metaplasia and/or colonic-type adenomas with dysplasia suggests possible carcinogenetic pathways similar to that observed in colorectal carcinomas.

  4. Risk factors for development of impaired renal function in Type 2 diabetes mellitus patients in primary care.

    NARCIS (Netherlands)

    Naushahi, M.J.; Grauw, W.J.C. de; Avery, A.J.; Gerwen, W.H.E.M. van; Lisdonk, E.H. van de; Weel, C. van

    2004-01-01

    AIMS: To evaluate risk factors for the development of an impaired renal function, defined as a glomerular filtration rate (GFR) by Cockcroft-Gault formula < 50.5 ml/min, in primary care patients with Type 2 diabetes mellitus. METHODS: A case-control study of Type 2 diabetes mellitus patients with

  5. Integration of traditional birth attendants into prevention of mother-to-child transmission at primary health facilities in Kaduna, North-West Nigeria

    Directory of Open Access Journals (Sweden)

    Reward O. Nsirim

    2016-05-01

    Full Text Available One of the fundamental challenges to implementing successful prevention of mother-tochild transmission (PMTCT programs in Nigeria is the uptake of PMTCT services at health facilities. Several issues usually discourage many pregnant women from receiving antenatal care services at designated health facilities within their communities. The CRS Nigeria PMTCT Project funded by the Global Fund in its Round 9 Phase 1 in Nigeria, sought to increase demand for HIV counseling and testing services for pregnant women at 25 supported primary health centers (PHCs in Kaduna State, North-West Nigeria by integrating traditional birth attendants (TBAs across the communities where the PHCs were located into the project. Community dialogues were held with the TBAs, community leaders and women groups. These dialogues focused on modes of mother to child transmission of HIV and the need for TBAs to refer their clients to PHCs for testing. Subsequently, data on number of pregnant women who were counseled, tested and received results was collected on a monthly basis from the 25 facilities using the national HIV/AIDS tools. Prior to this integration, the average number of pregnant women that were counseled, tested and received results was 200 pregnant women across all the 25 health facilities monthly. After the integration of TBAs into the program, the number of pregnant women that were counseled, tested and received results kept increasing month after month up to an average of 1500 pregnant women per month across the 25 health facilities. TBAs can thus play a key role in improving service uptake and utilization for pregnant women at primary health centers in the community – especially in the context of HIV/AIDS. They thus need to be integrated, rather than alienated, from primary healthcare service delivery.

  6. Integration of Traditional Birth Attendants into Prevention of Mother-to-Child Transmission at Primary Health Facilities in Kaduna, North-West Nigeria.

    Science.gov (United States)

    Nsirim, Reward O; Iyongo, Joseph A; Adekugbe, Olayinka; Ugochuku, Maureen

    2015-03-31

    One of the fundamental challenges to implementing successful prevention of mother-to-child transmission (PMTCT) programs in Nigeria is the uptake of PMTCT services at health facilities. Several issues usually discourage many pregnant women from receiving antenatal care services at designated health facilities within their communities. The CRS Nigeria PMTCT Project funded by the Global Fund in its Round 9 Phase 1 in Nigeria, sought to increase demand for HIV counseling and testing services for pregnant women at 25 supported primary health centers (PHCs) in Kaduna State, North-West Nigeria by integrating traditional birth attendants (TBAs) across the communities where the PHCs were located into the project. Community dialogues were held with the TBAs, community leaders and women groups. These dialogues focused on modes of mother to child transmission of HIV and the need for TBAs to refer their clients to PHCs for testing. Subsequently, data on number of pregnant women who were counseled, tested and received results was collected on a monthly basis from the 25 facilities using the national HIV/AIDS tools. Prior to this integration, the average number of pregnant women that were counseled, tested and received results was 200 pregnant women across all the 25 health facilities monthly. After the integration of TBAs into the program, the number of pregnant women that were counseled, tested and received results kept increasing month after month up to an average of 1500 pregnant women per month across the 25 health facilities. TBAs can thus play a key role in improving service uptake and utilization for pregnant women at primary health centers in the community - especially in the context of HIV/AIDS. They thus need to be integrated, rather than alienated, from primary healthcare service delivery.

  7. Extreme intrafamilial variability of Saudi brothers with primary hyperoxaluria type 1

    Directory of Open Access Journals (Sweden)

    Alfadhel M

    2012-08-01

    Full Text Available Majid Alfadhel,1 Khalid A Alhasan,2 Mohammed Alotaibi,3 Khalid Al Fakeeh41Division of Genetics, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2Division of Nephrology Department of Pediatrics, King Saud University King Khalid University Hospital, Riyadh, Saudi Arabia; 3Department of Radiology, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 4Division of Nephrology, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi ArabiaBackground: Primary hyperoxaluria type 1 (PH1 is characterized by progressive renal insufficiency culminating in end-stage renal disease, and a wide range of clinical features related to systemic oxalosis in different organs. It is caused by autosomal recessive deficiency of alanine:glyoxylate aminotransferase due to a defect in AGXT gene.Case report: Two brothers (one 6 months old; the other 2 years old presented with acute renal failure and urinary tract infection respectively. PH1 was confirmed by high urinary oxalate level, demonstration of oxalate crystals in bone biopsy, and pathogenic homozygous known AGXT gene mutation. Despite the same genetic background, same sex, and shared environment, the outcome of the two siblings differs widely. While one of them died earlier with end-stage renal disease and multiorgan failure caused by systemic oxalosis, the older brother is pyridoxine responsive with normal development and renal function.Conclusion: Clinicians should be aware of extreme intrafamilial variability of PH1 and international registries are needed to characterize the genotype-phenotype correlation in such disorder.Keywords: primary hyperoxaluria, oxalosis, PH1, intrafamilial variability

  8. Theoretical and experimental studies on bellows type expansion joints behaviour of Chinon 3 primary coolant system

    International Nuclear Information System (INIS)

    Vrillon, B.; Jeanpierre, F.; Copin, A.; Gregoire, J.P.

    1975-01-01

    The vibration study of the bellows was performed in two stages. A series of vibration tests was performed on a real bellow joint. By comparing the experimental results with calculations using the finite elements method for revolution shells it was possible to qualify the representation of the waves and reinforcement rings. The resonant frequencies and modes were calculated for the various joints under reactor conditions. According to the excitation sources considered, the amplitude of the displacements and stresses can be determined from these characteristic modes. The corrugations are protected internally from the aerodynamic effects of the gas flow by an inner sleeve welded to the primary piping upstream and free downstream. The annular space between this sleeve and the corrugations forms a resonant volume liable to be excited by flow-induced pressure fluctuations. It was possible to calculate the characteristic resonance frequencies and modes of this gas column (air at normal temperature and pressure). A full-scale mock-up test under conditions corresponding to the calculation hypotheses gave experimental proof of the calculation results. Owing to the good correlation between the results of these two studies an attempt was made to calculate the acoustical behaviour of these cavities for nominal running conditions (temperature and pressure) as a function of the known excitation sources. The results obtained from all these tests show that the use of bellows type expansion joints on a primary reactor circuit offers the same guarantees of reliability and resistance as any other circuit component under pressure, as long as the strains they undergo remain within the limits specified by the regulations and nuclear codifications

  9. Effects of increased nurses’ workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province

    OpenAIRE

    Rhulani C. Shihundla; Rachel T. Lebese; Maria S. Maputle

    2016-01-01

    Background: Recording of information on multiple documents increases professional nurses’ responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC) facilities in which a patient’s information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT) regis...

  10. Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China.

    Science.gov (United States)

    Yao, Qiang; Liu, Chaojie; Ferrier, J Adamm; Liu, Zhiyong; Sun, Ju

    2015-07-30

    To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%). NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

  11. Assessment of quality of prescribing in patients of hypertension at primary and secondary health care facilities using the Prescription Quality Index (PQI) tool.

    Science.gov (United States)

    Suthar, Jalpa Vashishth; Patel, Varsha J

    2014-01-01

    To determine the quality of prescribing in hypertension in primary and secondary health care settings using the Prescription Quality Index (PQI) tool and to assess the reliability of this tool. An observational cross-sectional study was carried out for 6 months in order to assess quality of prescribing of antihypertensive drugs using Prescription Quality Index (PQI) at four primary (PHC) and two secondary (SHC) health care facilities. Patients attending these facilities for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor (score of ≤31), medium (score 32-33) and high quality (score 34-43) based on PQI total score. Psychometric analysis using factor analysis was carried out to assess reliability and validity. Total 73 hypertensive patients were included. Mean age was 61.2 ± 11 years with 35 (48%) patients above 65 years of age. Total PQI score was 26 ± 11. There was a significant difference in PQI score between PHC and SHC (P hypertensive patients was poor, somewhat better in primary as compared to secondary health care facility. PQI is reliable for measuring prescribing quality in hypertension in Indian set up.

  12. Safety assessment of a borehole type disposal facility using the ISAM methodology

    International Nuclear Information System (INIS)

    Blerk, J.J. van; Yucel, V.; Kozak, M.W.; Moore, B.A.

    2002-01-01

    As part of the IAEA's Co-ordinated Research Project (CRP) on Improving Long-term of Safety Assessment Methodologies for Near Surface Waste Disposal Facilities (ISAM), three example cases were developed. The aim was to test the ISAM safety assessment methodology using as realistic as possible data. One of the Test Cases, the Borehole Test Case (BTC), related to a proposed future disposal option for disused sealed radioactive sources. This paper uses the various steps of the ISAM safety assessment methodology to describe the work undertaken by ISAM participants in developing the BTC and provides some general conclusions that can be drawn from the findings of their work. (author)

  13. Effect of conservative treatment on the renal outcome of children with primary hyperoxaluria type 1.

    Science.gov (United States)

    Fargue, Sonia; Harambat, Jérôme; Gagnadoux, Marie-France; Tsimaratos, Michel; Janssen, Françoise; Llanas, Brigitte; Berthélémé, Jean-Pierre; Boudailliez, Bernard; Champion, Gérard; Guyot, Claude; Macher, Marie-Alice; Nivet, Hubert; Ranchin, Bruno; Salomon, Rémi; Taque, Sophie; Rolland, Marie-Odile; Cochat, Pierre

    2009-10-01

    Primary hyperoxaluria type 1 results from alanine:glyoxylate aminotransferase deficiency. Due to genotype/phenotype heterogeneity in this autosomal recessive disorder, the renal outcome is difficult to predict in these patients and the long-term impact of conservative management in children is unknown. We report here a multicenter retrospective study on the renal outcome in 27 affected children whose biological diagnosis was based on either decreased enzyme activity or identification of mutations in the patient or his siblings. The median age at first symptoms was 2.4 years while that at initiation of conservative treatment was 4.1 years; 6 children were diagnosed upon family screening. The median follow-up was 8.7 years. At diagnosis, 15 patients had an estimated glomerular filtration rate (eGFR) below 90, and 7 children already had stage 2-3 chronic kidney disease. The median baseline eGFR was 74, which rose to 114 with management in the 22 patients who did not require renal replacement therapy. Overall, 20 patients had a stable eGFR, however, 7 exhibited a decline in eGFR of over 20 during the study period. In a Cox regression model, the only variable significantly associated with deterioration of renal function was therapeutic delay with a relative risk of 1.7 per year. Our study strongly suggests that early and aggressive conservative management may preserve renal function of compliant children with this disorder, thereby avoiding dialysis and postponing transplantation.

  14. Development of one body α-γ type manipulator for hot cell facility

    International Nuclear Information System (INIS)

    Jung, S. K.; Lee, S. B.; Lee, E. P.

    2004-01-01

    To handle the high level radioactive materials in a sealed type hot cell, our company has developed the one body alpha-gamma type manipulator and this is an improved model compared with the previously developed beta-gamma and separated alpha-gamma type manipulators. The successful development of one body alpha-gamma type manipulator means our company has a whole capacity to design and fabricate all kinds of manipulators using in hot cells. Until now most of the manipulators in Korea were imported from other countries. The development of Korean manipulators gives us the easier maintenance and lower price compared to the foreign products. It is also possible to export the Korean manipulators to overseas

  15. Correlates of physical activity and sitting time in adults with type 2 diabetes attending primary health care in Oman.

    Science.gov (United States)

    Alghafri, Thamra S; Alharthi, Saud M; Al-Farsi, Yahya; Bannerman, Elaine; Craigie, Angela M; Anderson, Annie S

    2017-08-01

    Despite evidence of the benefits of physical activity in the management of type 2 diabetes, it is poorly addressed in diabetes care. This study aimed to identify the prevalence and correlates of meeting ≥600MET-min/wk. (150 min/wk) of physical activity and sitting time in adults with type 2 diabetes in Oman. Approaches to encourage physical activity in diabetes care were explored. A cross-sectional study using the Global Physical Activity Questionnaire was conducted in 17 randomly selected primary health centres in Muscat. Clinical data including co-morbidities were extracted from the health information system. Questions on physical activity preferences and approaches were included. Patients were approached if they were ≥18 years, and had been registered in the diabetes clinic for >2 years. The questionnaire was completed by 305 people (females 57% and males 43%). Mean age (SD) was 57 (10.8) years and mean BMI (SD) was 31.0 (6.0) kg/m 2 . Duration of diabetes ranged from 2 to 25 (mean 7.6) years. Hypertension (71%) and dyslipidaemia (62%) were common comorbidities. Most (58.4%) had an HbA1c ≥7% indicating poor glycaemic control (55% in males vs 61% in females). Physical activity recommendations were met by 21.6% of the participants, mainly through leisure activities. Odds of meeting the recommendations were significantly higher in males (OR 4.8, 95% CI 2.5-9.1), individuals ≤57 years (OR 3.0, 95% CI 1.6-5.9), those at active self-reported stages of change for physical activity (OR 2.2, 95% CI 1.2-4.1) and those reporting no barriers to performing physical activity (OR 2.7, 95% CI 1.4-4.9). Median (25th, 75th percentiles) sitting time was 705 (600, 780) min/d. Older age (>57 years) was associated with longer sitting time (>705 min/d) (OR 2.8, 95% CI 1.7-4.6). Preferred methods to support physical activity in routine diabetes care were consultations (38%), structured physical activity sessions (13.4%) and referrals to physical activity facilities (5

  16. Neuron Types in the Presumptive Primary Somatosensory Cortex of the Florida Manatee (Trichechus manatus latirostris).

    Science.gov (United States)

    Reyes, Laura D; Stimpson, Cheryl D; Gupta, Kanika; Raghanti, Mary Ann; Hof, Patrick R; Reep, Roger L; Sherwood, Chet C

    2015-01-01

    Within afrotherians, sirenians are unusual due to their aquatic lifestyle, large body size and relatively large lissencephalic brain. However, little is known about the neuron type distributions of the cerebral cortex in sirenians within the context of other afrotherians and aquatic mammals. The present study investigated two cortical regions, dorsolateral cortex area 1 (DL1) and cluster cortex area 2 (CL2), in the presumptive primary somatosensory cortex (S1) in Florida manatees (Trichechus manatus latirostris) to characterize cyto- and chemoarchitecture. The mean neuron density for both cortical regions was 35,617 neurons/mm(3) and fell within the 95% prediction intervals relative to brain mass based on a reference group of afrotherians and xenarthrans. Densities of inhibitory interneuron subtypes labeled against calcium-binding proteins and neuropeptide Y were relatively low compared to afrotherians and xenarthrans and also formed a small percentage of the overall population of inhibitory interneurons as revealed by GAD67 immunoreactivity. Nonphosphorylated neurofilament protein-immunoreactive (NPNFP-ir) neurons comprised a mean of 60% of neurons in layer V across DL1 and CL2. DL1 contained a higher percentage of NPNFP-ir neurons than CL2, although CL2 had a higher variety of morphological types. The mean percentage of NPNFP-ir neurons in the two regions of the presumptive S1 were low compared to other afrotherians and xenarthrans but were within the 95% prediction intervals relative to brain mass, and their morphologies were comparable to those found in other afrotherians and xenarthrans. Although this specific pattern of neuron types and densities sets the manatee apart from other afrotherians and xenarthrans, the manatee isocortex does not appear to be explicitly adapted for an aquatic habitat. Many of the features that are shared between manatees and cetaceans are also shared with a diverse array of terrestrial mammals and likely represent highly conserved

  17. Tests of the space gamma spectrometer prototype at the JINR experimental facility with different types of neutron generators

    Science.gov (United States)

    Litvak, M. L.; Vostrukhin, A. A.; Golovin, D. V.; Dubasov, P. V.; Zontikov, A. O.; Kozyrev, A. S.; Krylov, A. R.; Krylov, V. A.; Mitrofanov, I. G.; Mokrousov, M. I.; Repkin, A. N.; Timoshenko, G. N.; Udovichenko, K. V.; Shvetsov, V. N.

    2017-07-01

    The results of the tests of the HPGe gamma spectrometer performed with a planetary soil model and different types of pulse neutron generators are presented. All measurements have been performed at the experimental nuclear planetary science facility (Joint Institute for Nuclear Research) for the physical calibration of active gamma and neutron spectrometers. The aim of the study is to model a space experiment on determining the elemental composition of Martian planetary matter by neutron-induced gamma spectroscopy. The advantages and disadvantages of a gas-filled neutron generator in comparison with a vacuum-tube neutron generator are examined.

  18. Better antiretroviral therapy outcomes at primary healthcare facilities: an evaluation of three tiers of ART services in four South African provinces.

    Science.gov (United States)

    Fatti, Geoffrey; Grimwood, Ashraf; Bock, Peter

    2010-09-21

    There are conflicting reports of antiretroviral therapy (ART) effectiveness comparisons between primary healthcare (PHC) facilities and hospitals in low-income settings. This comparison has not been evaluated on a broad scale in South Africa. A retrospective cohort study was conducted including ART-naïve adults from 59 facilities in four provinces in South Africa, enrolled between 2004 and 2007. Kaplan-Meier estimates, competing-risks Cox regression, generalised estimating equation population-averaged models and logistic regression were used to compare death, loss to follow-up (LTFU) and virological suppression (VS) between PHC, district and regional hospitals. 29 203 adults from 47 PHC facilities, nine district hospitals and three regional hospitals were included. Patients at PHC facilities had more advanced WHO stage disease when starting ART. Retention in care was 80.1% (95% CI: 79.3%-80.8%), 71.5% (95% CI: 69.1%-73.8%) and 68.7% (95% CI: 67.0%-69.7%) at PHC, district and regional hospitals respectively, after 24 months of treatment (Phospitals (aHR 2.19; 95% CI: 1.94-2.47) and mortality was independently elevated at district hospitals (aHR 1.60; 95% CI: 1.30-1.99) compared to PHC facilities after 12 months of ART. District and regional hospital patients had independently reduced probabilities of VS, aOR 0.76 (95% CI: 0.59-0.97) and 0.64 (95% CI: 0.56-0.75) respectively compared to PHC facilities over 24 months of treatment. ART outcomes were superior at PHC facilities, despite PHC patients having more advanced clinical stage disease when starting ART, suggesting that ART can be adequately provided at this level and supporting the South African government's call for rapid up-scaling of ART at the primary level of care. Further prospective research is required to determine the degree to which outcome differences are attributable to either facility level characteristics or patient co-morbidity at hospital level.

  19. Better antiretroviral therapy outcomes at primary healthcare facilities: an evaluation of three tiers of ART services in four South African provinces.

    Directory of Open Access Journals (Sweden)

    Geoffrey Fatti

    Full Text Available BACKGROUND: There are conflicting reports of antiretroviral therapy (ART effectiveness comparisons between primary healthcare (PHC facilities and hospitals in low-income settings. This comparison has not been evaluated on a broad scale in South Africa. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cohort study was conducted including ART-naïve adults from 59 facilities in four provinces in South Africa, enrolled between 2004 and 2007. Kaplan-Meier estimates, competing-risks Cox regression, generalised estimating equation population-averaged models and logistic regression were used to compare death, loss to follow-up (LTFU and virological suppression (VS between PHC, district and regional hospitals. 29 203 adults from 47 PHC facilities, nine district hospitals and three regional hospitals were included. Patients at PHC facilities had more advanced WHO stage disease when starting ART. Retention in care was 80.1% (95% CI: 79.3%-80.8%, 71.5% (95% CI: 69.1%-73.8% and 68.7% (95% CI: 67.0%-69.7% at PHC, district and regional hospitals respectively, after 24 months of treatment (P<0.0001. In adjusted regression analyses, LTFU was independently increased at regional hospitals (aHR 2.19; 95% CI: 1.94-2.47 and mortality was independently elevated at district hospitals (aHR 1.60; 95% CI: 1.30-1.99 compared to PHC facilities after 12 months of ART. District and regional hospital patients had independently reduced probabilities of VS, aOR 0.76 (95% CI: 0.59-0.97 and 0.64 (95% CI: 0.56-0.75 respectively compared to PHC facilities over 24 months of treatment. CONCLUSIONS/SIGNIFICANCE: ART outcomes were superior at PHC facilities, despite PHC patients having more advanced clinical stage disease when starting ART, suggesting that ART can be adequately provided at this level and supporting the South African government's call for rapid up-scaling of ART at the primary level of care. Further prospective research is required to determine the degree to which

  20. Radiation shielding at interim storage facility for CANDU-type nuclear spent fuel

    International Nuclear Information System (INIS)

    Mateescu, S.; Radu, M. Pantazi D.; Stanciu, M.

    1997-01-01

    Technical measures in radiological protection are taken in the interim storage facility design to ensure that, during normal operation, exposures of workers and members of public to ionizing radiation are limited to levels lower than regulatory limits. The spent fuel storage design provides for radiation exposure to be as low as reasonable achievable (ALARA principles). The evaluation of radiation shields includes the most conservative provisions: - all locations which may contain spent fuel are full; - the spent fuel has reached the maximum burnup; - the post irradiation cooling period should be the minimum reasonable; - equipment for handling contains the maximum amount of spent fuel. Radiation shields should ensure that external radiation fields do not exceed limits accepted by the Regulatory Body Module. The evaluation has been performed with two computer codes, QAD-5K and MICROSHIELD-4. (authors)

  1. Automatic stair-climbing algorithm of the planetary wheel type mobile robot in nuclear facilities

    International Nuclear Information System (INIS)

    Kim, Byung Soo; Kim, Seung Ho; Lee, Jong Min

    1995-01-01

    A mobile robot, named KAEROT, has been developed for inspection and maintenance operations in nuclear facilities. The main feature of locomotion system is the planetary wheel assembly with small wheels. This mechanism has been designed to be able to go over the stairs and obstacles with stability. This paper presents the inverse kinematic solution that is to be operated by remote control. The automatic stair climbing algorithm is also proposed. The proposed algorithms the moving paths of small wheels and calculates the angular velocity of 3 actuation wheels. The results of simulations and experiments are given for KAEROT performed on the irregular stairs in laboratory. It is shown that the proposed algorithm provides the lower inclination angle of the robot body and increases its stability during navigation. 14 figs., 16 refs. (Author)

  2. Automatic stair-climbing algorithm of the planetary wheel type mobile robot in nuclear facilities

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byung Soo; Kim, Seung Ho; Lee, Jong Min [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    1995-10-01

    A mobile robot, named KAEROT, has been developed for inspection and maintenance operations in nuclear facilities. The main feature of locomotion system is the planetary wheel assembly with small wheels. This mechanism has been designed to be able to go over the stairs and obstacles with stability. This paper presents the inverse kinematic solution that is to be operated by remote control. The automatic stair climbing algorithm is also proposed. The proposed algorithms the moving paths of small wheels and calculates the angular velocity of 3 actuation wheels. The results of simulations and experiments are given for KAEROT performed on the irregular stairs in laboratory. It is shown that the proposed algorithm provides the lower inclination angle of the robot body and increases its stability during navigation. 14 figs., 16 refs. (Author).

  3. Divergence in Forest-Type Response to Climate and Weather: Evidence for Regional Links Between Forest-Type Evenness and Net Primary Productivity

    Science.gov (United States)

    Bradford, J.B.

    2011-01-01

    Climate change is altering long-term climatic conditions and increasing the magnitude of weather fluctuations. Assessing the consequences of these changes for terrestrial ecosystems requires understanding how different vegetation types respond to climate and weather. This study examined 20 years of regional-scale remotely sensed net primary productivity (NPP) in forests of the northern Lake States to identify how the relationship between NPP and climate or weather differ among forest types, and if NPP patterns are influenced by landscape-scale evenness of forest-type abundance. These results underscore the positive relationship between temperature and NPP. Importantly, these results indicate significant differences among broadly defined forest types in response to both climate and weather. Essentially all weather variables that were strongly related to annual NPP displayed significant differences among forest types, suggesting complementarity in response to environmental fluctuations. In addition, this study found that forest-type evenness (within 8 ?? 8 km2 areas) is positively related to long-term NPP mean and negatively related to NPP variability, suggesting that NPP in pixels with greater forest-type evenness is both higher and more stable through time. This is landscape- to subcontinental-scale evidence of a relationship between primary productivity and one measure of biological diversity. These results imply that anthropogenic or natural processes that influence the proportional abundance of forest types within landscapes may influence long-term productivity patterns. ?? 2011 Springer Science+Business Media, LLC (outside the USA).

  4. Design of a system for examinations of the history of operation of selected WWER primary circuit facilities. Stage I: requirements

    International Nuclear Information System (INIS)

    Brumovsky, M.; Kraus, V.; Ruscak, M.; Vejvoda, S.

    1994-01-01

    A survey is presented of data required for the evaluation and control of nuclear power plant aging and service life, and a data acquisition and record-keeping system is proposed. The data fall in 3 classes: (i) information on the initial status, including design data and status data at the beginning of the operational lifetime of the facilities; (ii) data on the history of operation, including operating conditions at the level of the corresponding system and facility, as well as operating test and failure data; and (iii) data on the history of maintenance, including data on the monitoring of the facility condition and on maintenance. Basic information requirements for the evaluation of the service life of the pressure vessel, steam generator, pressurizer, and main circulation pipe are given; the way of processing this information is outlined. (J.B.). 2 figs

  5. Commissioning dosimetry for the laboratory irradiation facility type PX-γ-30

    International Nuclear Information System (INIS)

    Prieto Miranda, E.F.; Cuesta Fuente, G.I.; Chavez Ardanza, A.; Sainz Vidal, D.

    1997-01-01

    In the present paper at the laboratory irradiation type PX-y-30 was carried out the commissioning dosimetry, which belongs to Radiological Department of the CEADEN. It was determined the dose distribution as well as principal dosimetric parameters of the irradiation process. Besides, an irradiation position was found for the calibration or intercomparison of dosimetry systems

  6. Novel multiple endocrine neoplasia type 1 variations in patients with sporadic primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    S Birla

    2016-01-01

    Full Text Available Background and Objectives: Primary hyperparathyroidism (PHPT can occur either as a sporadic case or in association with syndromes such as multiple endocrine neoplasia. Multiple endocrine neoplasia type 1 (MEN1 is a rare autosomal-dominant disease resulting from mutations in MEN1 gene encoding a 621 amino acid long tumor suppressor protein “menin.” We report here the results of MEN1 screening in 31 patients diagnosed with sporadic PHPT. Materials and Methods: Diagnosis of sporadic PHPT was made when blood urea and serum creatinine were normal, serum parathyroid hormone was high, and parathyroid enlargement could be localized on ultrasound and/or parathyroid scan. A total of 31 patients and 50 healthy volunteers were recruited for molecular analysis after taking informed consent. Results: Major symptoms at presentation were bone pain, fatigue, muscle weakness, and renal stones. Molecular genetic analysis revealed the presence of two novel intronic variations, c. 913-79T>A and c. 784-129T>A which by human splicing finder are predicted to cause potential alteration of splicing by either activating an intronic cryptic acceptor site or converting a conserved exonic splicing silencer sequence to an exonic splicing enhancer site. Apart from these, two reported polymorphisms rs144677807 and rs669976 were seen only in patients and none of the controls. Other reported polymorphisms rs2071313 and rs654440 were identified both in controls and patients. Conclusions: This is the first study of MEN1 gene screening in sporadic PHPT in India reporting on the clinical and genetic findings, wherein two novel intronic variations c. 913-79T>A and c. 784-129T>A were identified showing their possible role in disease causation.

  7. Type 2 diabetes management in Hong Kong ethnic minorities: what primary care physicians need to know.

    Science.gov (United States)

    Chen, Catherine X R; Chan, K H

    2014-06-01

    To identify the demographics and compare diabetes control in ethnic minority group diabetes patients with Chinese diabetes patients who are managed in primary care settings and to explore strategies to improve their care. Retrospective case series. General Outpatient Clinic of a Hong Kong Hospital Authority hospital. Chinese type 2 diabetes patients and ethnic minority groups who had been regularly followed up with annual assessments carried out between 1 March 2012 to 28 February 2013 were recruited. Their serum levels of fasting glucose, creatinine, estimated glomerular filtration rate, haemoglobin A1c levels, lipid profile, blood pressure, and co-morbidities were retrieved from the Clinical Management System. Student's t test and analysis of variance were used to evaluate continuous variables and the Chi squared test for categorical data. All statistical tests were two-sided, and a P value of minority groups. Compared with Chinese diabetes patients, the latter were much younger and more obese (both Pminority groups than in the controls (78 ± 11 mm Hg vs 73 ± 11 mm Hg; Pminority groups than their Chinese counterparts (1.19 ± 0.33 mmol/L vs 1.28 ± 0.36 mmol/L; P=0.001). Among the five major ethnic minority groups with diabetes, Pakistani patients had particularly poor glycaemic control and the Nepalese had the poorest diastolic blood pressure control. Ethnic minority groups are an integral part of the Hong Kong population. Compared with Chinese diabetes patients, those from the ethnic minorities were much younger and more obese. Deficiencies exist in the comprehensive management of diabetes in these ethnic minorities, particularly with respect to glycaemic control. Culturally tailored health care interventions are therefore warranted to promote patient education and clinical effectiveness and to improve their long-term health status.

  8. Clinical and Genetic Analysis of Multiple Endocrine Neoplasia Type 1-Related Primary Hyperparathyroidism in Chinese.

    Directory of Open Access Journals (Sweden)

    Jing Kong

    Full Text Available Multiple endocrine neoplasia type 1-related primary hyperparathyroidism (MHPT differs in many aspects from sporadic PHPT (SHPT. The aims of this study were to summarize the clinical features and genetic background of Chinese MHPT patients and compare the severity of the disease with those of SHPT.A total of 40 MHPT (27 sporadic, 7 families and 169 SHPT cases of Chinese descent were retrospectively analyzed. X-rays and ultrasound were used to assess the bone and urinary system. Dual energy x-ray absorptiometry (DXA were performed to measure bone mineral density (BMD. Besides direct sequencing of the MEN1 and CDKN1B genes, multiplex ligation-dependent probe amplification (MLPA was used to screen gross deletion for the MEN1 gene.Compared with SHPT patients, MHPT patients showed lower prevalence of typical X-ray changes related to PHPT (26.3% vs. 55.7%, P = 0.001 but higher prevalence of urolithiasis/renal calcification (40.2% vs. 60.0%, P = 0.024. MHPT patients showed higher phosphate level (0.84 vs. 0.73mmol/L, P<0.05 but lower ALP (103.0 vs. 174.0U/L, P<0.001 and PTH (4.0 vs. 9.8×upper limit, P<0.001 levels than SHPT patients. There were no significant differences in BMD Z-scores at the lumbar spine and femoral neck between the two groups. Mutations in the MEN1 gene were detected in 27 MHPT cases. Among the nine novel mutations were novel, one of them involved the deletion of exon 5 and 6.MHPT patients experienced more common kidney complications but less skeletal issues, and a milder biochemical manifestation compared with SHPT patients. MEN1 mutation detection rate was 79.4% and 9 of the identified mutations were novel.

  9. Tuberculosis knowledge, attitudes and practices of patients at primary health care facilities in a South African metropolitan: research towards improved health education.

    Science.gov (United States)

    Kigozi, N Gladys; Heunis, J Christo; Engelbrecht, Michelle C; Janse van Rensburg, André P; van Rensburg, H C J Dingie

    2017-10-10

    Health education is important to empower patients and encourage their contribution towards tuberculosis (TB) control. In South Africa, health education activities are integrated into services provided at the primary health care (PHC) level. This study was conducted in a high TB burden metropolitan area in South Africa. The objective was to assess TB-related knowledge, attitudes and infection control practices of patients attending PHC facilities. In September and October 2015, a cross-sectional survey using fieldworker-administered questionnaires was conducted among patients older than 17 years attending 40 PHC facilities in the Mangaung Metropolitan. Convenience sampling was used to select patients. Participation in the study was voluntary. Descriptive, inferential and multivariate logistic regression analyses were performed. Statistical significance was considered at alpha data were included in the analysis. Most of the patients knew that TB transmission is facilitated by crowded conditions (84.6%) and that pulmonary TB is contagious (73.0%). Surprisingly, the majority of patients also believed that one can get TB from sharing toothbrushes (85.0%) or kissing (65.0%). An overwhelming majority of patients perceived TB to be serious (89.7%), and concurred that taking treatment (97.2%) and opening windows to prevent transmission in PHC facilities (97.0%) are important. Being employed (AOR: 11.5; CI: 4.8-27.6), having received TB infection control information from a PHC facility (AOR: 2.2; CI: 1.5-3.4), and being a TB patient (AOR: 1.6; CI: 1.02-2.46) increased the likelihood of adopting good infection control practices. These findings highlight the need for health education efforts to strengthen accurate information dissemination to promote sound TB knowledge and attitudes among patients attending PHC facilities. Health education efforts should also capitalise on the positive finding of this study that information dissemination at PHC facilities increases good

  10. Feasibility Study of SSTO Base Heating Simulation in Pulsed-Type Facilities

    Science.gov (United States)

    Park, Chung Sik; Sharma, Surendra; Edwards, Thomas A. (Technical Monitor)

    1995-01-01

    A laboratory simulation of the base heating environment of the proposed reusable Single-Stage-To-Orbit vehicle during its ascent flight was proposed. The rocket engine produces CO2 and H2, which are the main combustible components of the exhaust effluent. The burning of these species, known as afterburning, enhances the base region gas temperature as well as the base heating. To determine the heat flux on the SSTO vehicle, current simulation focuses on the thermochemistry of the afterburning, thermophysical properties of the base region gas, and ensuing radiation from the gas. By extrapolating from the Saturn flight data, the Damkohler number for the afterburning of SSTO vehicle is estimated to be of the order of 10. The limitations on the material strengths limit the laboratory simulation of the flight Damkohler number as well as other flow parameters. A plan is presented in impulse facilities using miniature rocket engines which generate the simulated rocket plume by electric ally-heating a H2/CO2 mixture.

  11. Facile synthesis of cyclopentenone B1- and L1-type Phytoprostanes

    Directory of Open Access Journals (Sweden)

    Alexandre eGuy

    2015-07-01

    Full Text Available Phytoprostanes (PhytoPs represent non-enzymatic metabolites of α-linolenic acid (ALA, the essential omega-3 polyunsaturated fatty acid (PUFA derived from plants. PhytoPs are present in the plant kingdom and represent endogenous mediators capable of protecting cells from oxidative stress damages in plants. Recently, it was found that such metabolites are present in cooking oil in high quantities, and also that B1-PhytoPs protect immature neurons from oxidant injury and promote differentiation of oligodendrocyte progenitors through PPAR-γ activation. We report a novel and facile synthesis of natural 2,3-substituted cyclopentenone PhytoPs, 16-B1-PhytoP and 9-L1-PhytoP. Our strategy is based on reductive alkylation at the 2-position of 1,3-cyclopentanedione using a recent protocol developed by Ramachary et al., and on a cross-coupling metathesis to access conjugate dienone system. In conclusion, this strategy permitted access to B1- and L1-PhytoPs in a relative short sequence process, and afford the possibility to easily develop analogs of PhytoPs.

  12. Production of exotic, short lived carbon isotopes in ISOL-type facilities

    CERN Document Server

    Franberg, Hanna; Köster, Ulli; Ammann, Markus

    2008-01-01

    The beam intensities of short-lived carbon isotopes at Isotope Separation On-Line (ISOL) facilities have been limited in the past for technical reasons. The production of radioactive ion beams of carbon isotopes is currently of high interest for fundamental nuclear physics research. To produce radioactive ions a target station consisting of a target in a container connected to an ion source via a transfer line is commonly used. The target is heated to vaporize the product for transport. Carbon in elementary form is a very reactive element and react strongly with hot metal surfaces. Due to the strong chemisorption interaction, in the target and ion source unit, the atoms undergo significant retention on their way from the target to the ion source. Due to this the short lived isotopes decays and are lost leading to low ion yields. A first approach to tackle these limitations consists of incorporating the carbon atoms into less reactive molecules and to use materials for the target housing and the transfer line ...

  13. Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities.

    Science.gov (United States)

    Gupta, Varun; Parikh, Rikesh; Nguyen, Lyly; Afshari, Ashkan; Shack, R Bruce; Grotting, James C; Higdon, K Kye

    2017-02-01

    There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned. This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals. A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed. Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  14. Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana

    NARCIS (Netherlands)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Ogink, Alice; van Ostenberg, Paul; Rinke de Wit, Tobias F.

    2015-01-01

    Background Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is

  15. Creatinine plasma at uncontrolled type 2 diabetes mellitus and controlled type 2 diabetes mellitus patients at primary health care in Binjai city, Indonesia

    Science.gov (United States)

    Rusdiana; Savira, M.; Syahputra, M.; Santoso, A.

    2018-03-01

    The aim of the study knowing the comparison creatinine plasma levels at uncontrolled type 2 diabetes mellitus and controlled type 2 diabetes mellitus patients at Primary Health Care in Binjai city of North Sumatera in Indonesia. This cross-sectional study was conductedon 40 type 2 Diabetes Mellitus patients who attended Primary Health Care in Binjai. Patients with age > 40 years old, (both sexes) were included in the study. We recorded different demographic parameter as age, Body Mass Index, Blood Pressure, and personal history status. And we examined the biochemicalparameters including Hba1c, Fasting Blood Sugar Levels (FBL) and creatinine serum. We separated into two groups base on HbA1c test, controlled type 2 diabetes mellitus and uncontrolled type 2 diabetes mellitus. We measured FBL by using the portable measuring instrument, and Thamrin clinical laboratory measured Hba1c, andwe measured creatinine plasmaby spectrophotometry in Biochemistry laboratory. With statistical analysis using T-test found that there was asignificant differencein creatinine plasma levels between uncontrolled type 2 diabetes mellitus with controlled type 2 diabetes mellitus (p<0.005).

  16. Primary cilium - antenna-like structure on the surface of most mammalian cell types

    International Nuclear Information System (INIS)

    Dvorak, J; Kasaova, L; Filip, S; Petera, J; Sitorova, V; Nikolov, D Hadzi; Ryska, A; Mokry, J; Richter, I

    2011-01-01

    The primary cilium is a sensory solitary non-motile microtubule-based organelle protruding in the quiescent phase of the cell cycle from the surface of the majority of human cells, including embryonic cells, stem cells and stromal cells of malignant tumors. The presence of a primary cilium on the surface of a cell is transient, limited to the quiescent G 1 (G 0 ) phase and the beginning of the S phase of the cell cycle. The primary cilium is formed from the mother centriole. Primary cilia are key coordinators of signaling pathways during development and tissue homeostasis and, when deffective, they are a major cause of human diseases and developmental disorders, now commonly referred to as ciliopathies. Most cancer cells do not possess a primary cilium. The loss of the primary cilium is a regular feature of neoplastic transformation in the majority of solid tumors. The primary cilium could serve as a tumor suppressor organelle. The aim of this paper was to provide a review of the current knowledge of the primary cilium.

  17. Primary cilium - antenna-like structure on the surface of most mammalian cell types

    Science.gov (United States)

    Dvorak, J.; Sitorova, V.; Hadzi Nikolov, D.; Mokry, J.; Richter, I.; Kasaova, L.; Filip, S.; Ryska, A.; Petera, J.

    2011-12-01

    The primary cilium is a sensory solitary non-motile microtubule-based organelle protruding in the quiescent phase of the cell cycle from the surface of the majority of human cells, including embryonic cells, stem cells and stromal cells of malignant tumors. The presence of a primary cilium on the surface of a cell is transient, limited to the quiescent G1(G0) phase and the beginning of the S phase of the cell cycle. The primary cilium is formed from the mother centriole. Primary cilia are key coordinators of signaling pathways during development and tissue homeostasis and, when deffective, they are a major cause of human diseases and developmental disorders, now commonly referred to as ciliopathies. Most cancer cells do not possess a primary cilium. The loss of the primary cilium is a regular feature of neoplastic transformation in the majority of solid tumors. The primary cilium could serve as a tumor suppressor organelle. The aim of this paper was to provide a review of the current knowledge of the primary cilium.

  18. WHO/INRUD patient care and facility-specific drug use indicators at primary health care centres in Eastern province, Saudi Arabia.

    Science.gov (United States)

    El Mahalli, A A; Akl, O A M; Al-Dawood, S F; Al-Nehab, A A; Al-Kubaish, H A; Al-Saeed, S; Elkahky, A A A; Salem, A M A A

    2012-11-01

    This study aimed to measure the performance of primary health care centres in Eastern province, Saudi Arabia, using the WHO/International Network of Rational Use of Drugs patient care and facility-specific drug use indicators. In a cross-sectional study, 10 health centres were selected using systematic random sampling. A total of 300 patients were interviewed while visiting the centre from January to March 2011 and 10 pharmacists from the same centres were interviewed. Average consultation time was 7.3 min (optimal > or = 30 min), percentage of drugs adequately labelled was 10% (optimal 100%) and patient's knowledge of correct dosage was 79.3% (optimal 100%). The percentage of key drugs in stock was only 59.2% (optimal 100%). An overall index of rational facility-specific drug use was calculated and applied to rank the health centres for benchmarking.

  19. Outcome of surgery for primary and recurrent desmoid-type fibromatosis. A retrospective case series of 174 patients

    Directory of Open Access Journals (Sweden)

    Panagiotis Tsagozis, BSc, MD, PhD

    2017-05-01

    Conclusions: A complete primary excision is the best window of opportunity to achieve local control of desmoid-type fibromatosis. Once the disease relapses, surgical intervention is accompanied with a high risk of failure, irrespective of the quality of the margins and adjuvant treatment given.

  20. Characteristics of primary infection of a European human immunodeficiency virus type 1 clade B isolate in chimpanzees

    NARCIS (Netherlands)

    Bogers, W. M.; Koornstra, W. H.; Dubbes, R. H.; ten Haaft, P. J.; Verstrepen, B. E.; Jhagjhoorsingh, S. S.; Haaksma, A. G.; Niphuis, H.; Laman, J. D.; Norley, S.; Schuitemaker, H.; Goudsmit, J.; Hunsmann, G.; Heeney, J. L.; Wigzell, H.

    1998-01-01

    The aim of the study was to select, from a panel of candidate European human immunodeficiency virus type 1 (HIV-1) clade B primary virus isolates, one isolate based on replication properties in chimpanzee peripheral blood mononuclear cells (PBMC). Secondly, to evaluate the in vivo kinetics of

  1. Patient characteristics do not predict poor glycaemic control in type 2 diabetes patients treated in primary care

    NARCIS (Netherlands)

    Goudswaard, AN; Stolk, RP; Zuithoff, P; Rutten, GEHM

    Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA(1c) greater than or equal to7%). Data were collected from the medical

  2. A facility for the testing and repair of primary collectors of steam generators at WWER nuclear power plants

    International Nuclear Information System (INIS)

    Herman, M.; Kuna, M.

    1990-01-01

    A facility labelled ZOKPG-1 has been developed for in-service inspection and repair of steam generator collectors in WWER-440 nuclear power plants. The facility makes possible visual, capillary, luminescence and ultrasonic inspection and eddy current testing of the internal surface, base material and welded joints of the collector. The repair modules of the ZOKPG-1 manipulator enable electroerosive elimination of surface defects of the material and local electrochemical decontamination of the internal surfaces. The manipulator can be operated at temperatures up to 40 degC, humidity up to 100%, and in conditions of radiation load up to 15 mGy/h and of surface contamination on the order of 100 Bq/cm 2 . (Z.M.). 16 figs

  3. Feasibility and effectiveness of the implementation of a primary prevention programme for type 2 diabetes in routine primary care practice: a phase IV cluster randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Sanchez Alvaro

    2012-11-01

    Full Text Available Abstract Background The objective of this study is to perform an independent evaluation of the feasibility and effectiveness of an educational programme for the primary prevention of type 2 diabetes (DM2 in high risk populations in primary care settings, implanted within the Basque Health Service - Osakidetza. Methods/design This is a prospective phase IV cluster clinical trial conducted under routine conditions in 14 primary health care centres of Osakidetza, randomly assigned to an intervention or control group. We will recruit a total sample of 1089 individuals, aged between 45 and 70 years old, without diabetes but at high risk of developing the condition (Finnish Diabetes Risk Score, FINDRISC ≥ 14 and follow them up for 2 years. Primary health care nursing teams of the intervention centres will implement DE-PLAN, a structured educational intervention program focused on changing healthy lifestyles (diet and physical activity; while the patients in the control centres will receive the usual care for the prevention and treatment of DM2 currently provided in Osakidetza. The effectiveness attributable to the programme will be assessed by comparing the changes observed in patients exposed to the intervention and those in the control group, with respect to the risk of developing DM2 and lifestyle habits. In terms of feasibility, we will assess indicators of population coverage and programme implementation. Discussion The aim of this study is to provide the scientific basis for disseminate the programme to the remaining primary health centres in Osakidetza, as a novel way of addressing prevention of DM2. The study design will enable us to gather information on the effectiveness of the intervention as well as the feasibility of implementing it in routine practice. Trial registration ClinicalTrials.gov NCT01365013

  4. Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care.

    Science.gov (United States)

    Mata-Cases, Manel; Benito-Badorrey, Belén; Roura-Olmeda, Pilar; Franch-Nadal, Josep; Pepió-Vilaubí, Josep Maria; Saez, Marc; Coll-de-Tuero, Gabriel

    2013-11-01

    To assess clinical inertia, defined as failure to intensify antidiabetic treatment of patients who have not achieved the HbA1c therapeutic goal (≤7%). Multicenter cross-sectional study. Clinical inertia was assessed in a random sample of type 2 diabetes mellitus (T2DM) patients seen in primary care centers. A total of 2783 patients (51.3% males; mean age: 68 [±11.5] years; diabetes duration: 7.1 [±5.6] years; mean HbA1c: 6.8 [±1.5]) were analyzed. Of those, 997 (35.8%) had HbA1c >7%. Treatment was intensified in 66.8% and consisted of: dose increase (40.5%); addition of oral antidiabetic (45.8%); or insulin treatment initiation (3.7%). Mean HbA1c values in patients for whom treatment was intensified vs. non-intensified were 8.4% (±1.2) vs. 8.2% (±1.2), p inertia was detected in 33.2% of patients and diminished along with treatment complexity: lifestyle changes only (38.8%), oral monotherapy (40.3%), combined oral antidiabetics (34.5%), insulin monotherapy (26.1%) and combination of insulin and oral antidiabetics (21.4%). Clinical inertia decreased as HbA1c increased: 37.3% for HbA1c values ranging between 7.1%-8%; 29.4% for the 8.1%-9% HbA1c range and 27.1% for HbA1c ≥9%. Multivariate analysis confirmed that diabetes duration, step of treatment and HbA1c were related to inertia. For each unit of HbA1c increase clinical inertia decreased 47% (OR: 0.53). The retrospective design of the study precluded an accurate investigation about reasons for lack of intensification that could actually be justified by some patient conditions, especially patients' lack of adherence. Clinical inertia affected one third of T2DM patients with poor glycemic control and was greater in patients treated with only lifestyle changes or oral monotherapy. Treatment changes were performed when mean HbA1c values were 1.4 points above therapeutic goals.

  5. Functioning glucagonoma associated with primary hyperparathyroidism: multiple endocrine neoplasia type 1 or incidental association?

    International Nuclear Information System (INIS)

    Erdas, Enrico; Mariotti, Stefano; Pomata, Mariano; Aste, Nicola; Pilloni, Luca; Nicolosi, Angelo; Licheri, Sergio; Cappai, Antonello; Mastinu, Marco; Cetani, Filomena; Pardi, Elena

    2012-01-01

    Diagnosis of multiple endocrine neoplasia type 1 (MEN1) is commonly based on clinical criteria, and confirmed by genetic testing. In patients without known MEN1-related germline mutations, the possibility of a casual association between two or more endocrine tumors cannot be excluded and subsequent management may be difficult to plan. We describe a very uncommon case of functioning glucagonoma associated with primary hyperparathyroidism (pHPT) in which genetic testing failed to detect germline mutations of MEN-1 and other known genes responsible for MEN1. The patient, a 65-year old woman, had been suffering for more than 1 year from weakness, progressive weight loss, angular cheilitis, glossitis and, more recently, skin rashes on the perineum, perioral skin and groin folds. After multidisciplinary investigations, functioning glucagonoma and asymptomatic pHPT were diagnosed and, since family history was negative, sporadic MEN1 was suspected. However, genetic testing revealed neither MEN-1 nor other gene mutations responsible for rarer cases of MEN1 (CDKN1B/p27 and other cyclin-dependent kinase inhibitor genes CDKN1A/p15, CDKN2C/p18, CDKN2B/p21). The patient underwent distal splenopancreatectomy and at the 4-month follow-up she showed complete remission of symptoms. Six months later, a thyroid nodule, suspected to be a malignant neoplasia, and two hyperfunctioning parathyroid glands were detected respectively by ultrasound with fine needle aspiration cytology and 99m Tc-sestamibi scan with SPECT acquisition. Total thyroidectomy was performed, whereas selective parathyroidectomy was preferred to a more extensive procedure because the diagnosis of MEN1 was not supported by genetic analysis and intraoperative intact parathyroid hormone had revealed “adenoma-like” kinetics after the second parathyroid resection. Thirty-nine and 25 months after respectively the first and the second operation, the patient is well and shows no signs or symptoms of recurrence. Despite

  6. Functioning glucagonoma associated with primary hyperparathyroidism: multiple endocrine neoplasia type 1 or incidental association?

    Directory of Open Access Journals (Sweden)

    Erdas Enrico

    2012-12-01

    Full Text Available Abstract Background Diagnosis of multiple endocrine neoplasia type 1 (MEN1 is commonly based on clinical criteria, and confirmed by genetic testing. In patients without known MEN1-related germline mutations, the possibility of a casual association between two or more endocrine tumors cannot be excluded and subsequent management may be difficult to plan. We describe a very uncommon case of functioning glucagonoma associated with primary hyperparathyroidism (pHPT in which genetic testing failed to detect germline mutations of MEN-1 and other known genes responsible for MEN1. Case presentation The patient, a 65-year old woman, had been suffering for more than 1 year from weakness, progressive weight loss, angular cheilitis, glossitis and, more recently, skin rashes on the perineum, perioral skin and groin folds. After multidisciplinary investigations, functioning glucagonoma and asymptomatic pHPT were diagnosed and, since family history was negative, sporadic MEN1 was suspected. However, genetic testing revealed neither MEN-1 nor other gene mutations responsible for rarer cases of MEN1 (CDKN1B/p27 and other cyclin-dependent kinase inhibitor genes CDKN1A/p15, CDKN2C/p18, CDKN2B/p21. The patient underwent distal splenopancreatectomy and at the 4-month follow-up she showed complete remission of symptoms. Six months later, a thyroid nodule, suspected to be a malignant neoplasia, and two hyperfunctioning parathyroid glands were detected respectively by ultrasound with fine needle aspiration cytology and 99mTc-sestamibi scan with SPECT acquisition. Total thyroidectomy was performed, whereas selective parathyroidectomy was preferred to a more extensive procedure because the diagnosis of MEN1 was not supported by genetic analysis and intraoperative intact parathyroid hormone had revealed “adenoma-like” kinetics after the second parathyroid resection. Thirty-nine and 25 months after respectively the first and the second operation, the patient is well

  7. Characteristics Associated with Uncontrolled Blood Pressure Among Portuguese Primary Care Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Inês Rosendo

    2017-03-01

    Conclusion: The sub-group of people with diabetes identified to have worse tensional control should have a different and more intensive approach in primary care. We recommend further longitudinal and population based confirmatory research.

  8. Scaled Facility Design Approach for Pool-Type Lead-Bismuth Eutectic Cooled Small Modular Reactor Utilizing Natural Circulation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sangrok; Shin, Yong-Hoon; Lee, Jueun; Hwang, Il Soon [Seoul National University, Seoul (Korea, Republic of)

    2015-10-15

    In low carbon era, nuclear energy is the most prominent energy source of electricity. For steady ecofriendly nuclear energy supply, Generation IV reactors which are future nuclear reactor require safety, sustainability, economics and non-proliferation as four criteria. Lead cooled fast reactor (LFR) is one of these reactor type and Generation IV international forum (GIF) adapted three reference LFR systems which are a small and movable systems with long life without refueling, intermediate size and huge electricity generation system for power grid. NUTRECK (Nuclear Transmutation Energy Center of Korea) has been designed reactor called URANUS (Ubiquitous, Rugged, Accident-forgiving, Non-proliferating, and Ultra-lasting Sustainer) which is small modular reactor and using lead-bismuth eutectic coolant. To prove natural circulation capability of URANUS and analyze design based accidents, scaling mock-up experiment facility will be constructed. In this paper, simple specifications of URANUS will be presented. Then based on this feature, scaling law and scaled facility design results are presented. To validate safety feature and thermodynamics characteristic of URANUS, scaled mockup facility of URANUS is designed based on the scaling law. This mockup adapts two area scale factors, core and lower parts of mock-up are scaled for 3D flow experiment. Upper parts are scaled different size to reduce electricity power and LBE tonnage. This hybrid scaling method could distort some thermal-hydraulic parameters, however, key parameters for experiment will be matched for up-scaling. Detailed design of mock-up will be determined through iteration for design optimization.

  9. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

    Science.gov (United States)

    Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F

    2015-01-01

    Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, pquality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the need to intensify client education and balanced

  10. Comparison of mass balance, energy consumption and cost of composting facilities for different types of organic waste

    International Nuclear Information System (INIS)

    Zhang Huijun; Matsuto, Toshihiko

    2011-01-01

    Mass balance, energy consumption and cost are basic pieces of information necessary for selecting a waste management technology. In this study, composting facilities that treat different types of organic waste were studied by questionnaire survey and via a chemical analysis of material collected at the facilities. The mass balance was calculated on a dry weight basis because the moisture content of organic waste was very high. Even though the ratio of bulking material to total input varied in the range 0-65% on a dry basis, the carbon and ash content, carbon/nitrogen ratio, heavy metal content and inorganic nutrients in the compost were clearly influenced by the different characteristics of the input waste. The use of bulking material was not correlated with ash or elemental content in the compost. The operating costs were categorised into two groups. There was some economy of scale for wages and maintenance cost, but the costs for electricity and fuel were proportional to the amount of waste. Differences in operating costs can be explained by differences in the process characteristics.

  11. Assessment of oral hygiene and periodontal health around posterior primary molars after their restoration with various crown types.

    Science.gov (United States)

    Beldüz Kara, Nihal; Yilmaz, Yucel

    2014-07-01

    To compare the time-dependent changes in oral hygiene and periodontal health after restoring primary posterior molars with a traditional stainless steel crown (SSC) or an aesthetic crown using various measures of periodontal health and oral hygiene. This investigation was a randomized, non-blinded prospective controlled clinical trial in which 264 crowns of different types were fitted onto the first and/or second primary molars of 76 children. The oral hygiene and the gingival health of the restored teeth and the antagonistic teeth were evaluated clinically and radiographically at 3- and 6-month intervals for 18 months after fitting the crowns. The periodontal health of the control teeth was better than that of the remaining 215 restored teeth. The oral hygiene, as measured by the simplified oral hygiene index, and gingival health, as measured by the gingival index and the volume of gingival crevicular fluid, of the restored teeth, irrespective of crown type, progressively increased during the 18-month study period. Oral hygiene and gingival health around a restored primary tooth deteriorate with time. Our results suggest that SSC, an open-faced SSC, or a NuSmile(®) pediatric crown should be the preferred crown type for restoring posterior primary teeth. © 2013 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. A nuclear desalination complex with a VK-300 boiling type reactor facility

    International Nuclear Information System (INIS)

    Kuznetzov, Y.N.; Mishanina, Y.A.; Romenkov, A.A.

    2004-01-01

    RDIPE has developed a detailed design of an enhanced safety nuclear steam supply system (NSSS) with a VK-300 boiling water reactor for combined heat and power generation. The thermal power of the reactor is 750 MW. The maximum electrical power in the condensation mode is 250 MWe. The maximum heat generation capacity of 400 Gcal/h is reached at 150 MWe. This report describes, in brief, the basic technical concepts for the VK-300 NSSS and the power unit, with an emphasis on enhanced safety and good economic performance. With relatively small power, good technical and economic performance of the VK-300 reactor that is a base for the desalination complex is attained through: reduced capital costs of the nuclear plant construction thanks to technical approaches ensuring maximum simplicity of the reactor design and the NSSS layout; a single-circuit power unit configuration (reactor-turbine) excluding expensive equipment with a lot of metal, less pipelines and valves; reduced construction costs of the basic buildings thanks to reduced construction volumes due to rational arrangement concepts; higher reliability of equipment and reduced maintenance and repair costs; longer reactor design service life of up to 60 years; selection of the best reactor and desalination equipment interface pattern. The report considers the potential application of the VK-300 reactor as a source of energy for distillation desalination units. The heat from the reactor is transferred to the desalination unit via an intermediate circuit. Comparison is made between variants of the reactor integration with desalination units of the following types: multi-stage flash (MSF technology); multi-effect distillation horizontal-tube film units of the DOU GTPA type (MED technology). The NDC capacity with the VK-300 reactor, in terms of distillate, will be more than 200,000 m 3 /day, with the simultaneous output of electric power from the turbine generator buses of around 150 MWe. The variants of the

  13. Facile synthesis of nanorod-type graphitic carbon nitride/Fe2O3 composite with enhanced photocatalytic performance

    International Nuclear Information System (INIS)

    Wang, Jiangpeng; Li, Changqing; Cong, Jingkun; Liu, Ziwei; Zhang, Hanzhuo; Liang, Mei; Gao, Junkuo; Wang, Shunli; Yao, Juming

    2016-01-01

    Here we report a facile synthesis of nanorod-type graphitic carbon nitride/Fe 2 O 3 composite (Fe 2 O 3 -g-C 3 N 4 ) by using Fe-melamine supramolecular framework as precursor. The chemical and optical properties of the nanocomposites are well-characterized. The Fe 2 O 3 -g-C 3 N 4 nanocomposite demonstrated excellent photocatalytic activities under visible light due to the efficient utilization of sunlight and the construction of Z-scheme electron transfer pathway. The results indicated that it could be a promising approach for the preparation of efficient g-C 3 N 4 nanocomposites photocatalysts by using metal-melamine supramolecular framework as precursors. - Graphical abstract: Nanorod-type graphitic carbon nitride/Fe 2 O 3 composite (Fe 2 O 3 -g-C 3 N 4 ) was synthesized by using Fe-melamine supramolecular framework as precursor. The Fe 2 O 3 -g-C 3 N 4 nanocomposite demonstrated excellent photocatalytic activities under visible light. Display Omitted - Highlights: • Nanorod-type graphitic carbon nitride/Fe 2 O 3 composite (Fe 2 O 3 -g-C 3 N 4 ) was synthesized. • Fe 2 O 3 -g-C 3 N 4 showed strong optical absorption in the visible-light region. • The Fe 2 O 3 -g-C 3 N 4 nanocomposite demonstrated excellent photocatalytic activities.

  14. Qualification testing facility for type A, B and C packages to be used for transport and storage of radioactive materials

    International Nuclear Information System (INIS)

    Vieru, G.; Nistor, V.; Vasile, A.; Cojocaru, V.

    2009-01-01

    In accordance with the Economic Commission for Europe-Committee on inland transport (ADR- European Agreement-concerning the international carriage of dangerous goods by road, 2007 Edition) the Safety and Security of the dangerous goods class No. 7 - Radioactive Materials during transport in all different modes - by road, by rail, by sea, by inland rivers or by air - have to be ensured at a very high level. The radioactive materials (RAM) packaging have to comply to all transport conditions, routine or in accident conditions, possibly to occur during transportation operations. It is well known that the safety in the transport of RAM is dependent on packaging appropriate for the contents being shipped rather than on operational and/or administrative actions required for the package. The quality of these packages - type A, B or C has to be proved by performing qualification tests in accordance with the Romanian nuclear regulation conditions provided by CNCAN Order no. 357/22.12.2005- N orms for a Safe Transport of Radioactive Material , the IAEA Vienna Recommendation (1, 2) stipulated in the Safety standard TS-R-1- Regulation for the Safe Transport of Radioactive Material, 2005 Edition, and other applicable international recommendations. The paper will describe the components of the designed testing facilities, and the qualification testing to be performed for all type A, B and C packages subjected to the testing Quality assurance and quality controls measures taken in order to meet technical specification provided by the design are also presented and commented. The paper concludes that the new Romanian Testing Facilities for RAM packages will comply with the national safe standards as well as with the IAEA applicable recommendation provided by the TS-R-1 safety standard. (authors)

  15. Facile synthesis of B-type carbonated nanoapatite with tailored microstructure

    Energy Technology Data Exchange (ETDEWEB)

    Gualtieri, Magdalena Lassinantti, E-mail: magdalena.gualtieri@unimore.it [Dipartimento Ingegneria “Enzo Ferrari”, Università degli studi di Modena e Reggio Emilia, I-41125 Modena (Italy); Romagnoli, Marcello, E-mail: marcello.romagnoli@unimore.it [Dipartimento Ingegneria “Enzo Ferrari”, Università degli studi di Modena e Reggio Emilia, I-41125 Modena (Italy); Hanuskova, Miriam, E-mail: Miriam.hanuskova@unimore.it [Dipartimento Ingegneria “Enzo Ferrari”, Università degli studi di Modena e Reggio Emilia, I-41125 Modena (Italy); Fabbri, Elena, E-mail: Elena.fabbri@unimore.it [Dipartimento Ingegneria “Enzo Ferrari”, Università degli studi di Modena e Reggio Emilia, I-41125 Modena (Italy); Gualtieri, Alessandro F., E-mail: Alessandro.gualtieri@unimore.it [Dipartimento di Scienze Chimiche e Geologiche, Università degli studi di Modena e Reggio Emilia, I-41121 Modena (Italy)

    2014-12-15

    Nanolime and a phosphate-based chelating agent were used to synthesize B-type carbonated apatite. Developed Rietveld refinement strategies allowed one to determine process yield, product crystallinity as well as structural (unit cell) and microstructural (size, strain) parameters. The effect of synthesis temperature (20–60 °C) as well as Ca/P ratio (1.5–2.5) and solid content (10–30 wt%) of the starting batch on these properties were investigated. FTIR, TEM and gas adsorption data provided supporting evidence. The process yield was 42–60 wt% and found to be governed by the Ca/P ratio. The purified products had high specific surface area (107–186 m{sup 2}/g) and crystallinity (76–97%). The unit cell parameters, correlated to the degree of structural carbonate, were sensitive to the Ca/P ratio. Instead, temperature governed the microstructural parameters. Less strained and larger crystals were obtained at higher temperatures. Long-term aging up to 6 months at 20 °C compensated for higher crystal growth kinetics at higher temperature. - Graphical abstract: Controlled synthesis of carbonated apatite at moderate temperatures using nanolime and sodiumhexametaphosphate as starting reagent. - Highlights: • Chemical synthesis of nano-sized apatite with tailored microstructure was performed. • Colloidal Ca(OH){sub 2} and a phosphorus-based chelating agents were used as reagents. • The method is simple and reproducible which facilitate industrial process scale-up. • Rietveld refinement strategies for product characterization were developed. • Rietveld analyses provided yield, microstructural and structure information.

  16. Facile synthesis of B-type carbonated nanoapatite with tailored microstructure

    International Nuclear Information System (INIS)

    Gualtieri, Magdalena Lassinantti; Romagnoli, Marcello; Hanuskova, Miriam; Fabbri, Elena; Gualtieri, Alessandro F.

    2014-01-01

    Nanolime and a phosphate-based chelating agent were used to synthesize B-type carbonated apatite. Developed Rietveld refinement strategies allowed one to determine process yield, product crystallinity as well as structural (unit cell) and microstructural (size, strain) parameters. The effect of synthesis temperature (20–60 °C) as well as Ca/P ratio (1.5–2.5) and solid content (10–30 wt%) of the starting batch on these properties were investigated. FTIR, TEM and gas adsorption data provided supporting evidence. The process yield was 42–60 wt% and found to be governed by the Ca/P ratio. The purified products had high specific surface area (107–186 m 2 /g) and crystallinity (76–97%). The unit cell parameters, correlated to the degree of structural carbonate, were sensitive to the Ca/P ratio. Instead, temperature governed the microstructural parameters. Less strained and larger crystals were obtained at higher temperatures. Long-term aging up to 6 months at 20 °C compensated for higher crystal growth kinetics at higher temperature. - Graphical abstract: Controlled synthesis of carbonated apatite at moderate temperatures using nanolime and sodiumhexametaphosphate as starting reagent. - Highlights: • Chemical synthesis of nano-sized apatite with tailored microstructure was performed. • Colloidal Ca(OH) 2 and a phosphorus-based chelating agents were used as reagents. • The method is simple and reproducible which facilitate industrial process scale-up. • Rietveld refinement strategies for product characterization were developed. • Rietveld analyses provided yield, microstructural and structure information

  17. Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China.

    Directory of Open Access Journals (Sweden)

    Jiazhi Zeng

    Full Text Available China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants' experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool--Adult Short Version (PCAT-AS, representing 10 primary care domains was used to collect information on migrants' quality of primary care experiences. These domains include first contact (utilization, first contact (accessibility, ongoing care, coordination (referrals, coordination (information systems, comprehensiveness (services available, comprehensiveness (services provided, family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients' perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49 reported the highest PCAT total scores, followed by municipal hospitals (25.02, community health centers/community health stations (24.24, and township health centers/rural health stations (24.18. Tertiary hospital users reported significantly better performance in first contact (utilization, first contact (accessibility, coordination (information system, comprehensiveness (service available, and cultural competence

  18. Prevention of mother-to-child transmission of HIV guidelines: Nurses’ views at four primary healthcare facilities in the Limpopo Province

    Directory of Open Access Journals (Sweden)

    Barbara A. Hanrahan

    2017-06-01

    Full Text Available Background: When new guidelines for existing programmes are introduced, it is often the clinicians tasked with the execution of the guidelines who bear the brunt of the changes. Frequently their opinions are not sought. In this study, the researcher interviewed registered nurses working in the field of the prevention of mother-to-child transmission (PMTCT of human immunodeficiency virus (HIV to gain an understanding of their perspectives on the changes introduced to the guidelines. The guideline changes in 2014 were to move from the World Health Organization (WHO Option B to Option B + which prescribes lifelong antiretroviral therapy (ART for all HIV-positive pregnant women regardless of CD4 cell count. Objective: To determine what the registered nurses’ perspectives are on the PMTCT programme as implemented at four PHC facilities in the Limpopo Province. Method: For this qualitative investigation, a descriptive research design was implemented. The data were collected during semi-structured interviews with nurses from four primary healthcare facilities in the Limpopo Province of South Africa. Data were analysed using thematic analysis. Results: Challenges preventing effective implementation (e.g. increased workloads, viz. staff shortages; poor planning of training; equipment and medication shortages and long lead times; poor patient education were identified. Conclusion: In spite of the successes of the PMTCT programme, considerable challenges still prevail; lack of patient education, poor facilities management and staff shortages could potentially influence the implementation of the PMTCT guidelines negatively.

  19. Evaluation of the Cable Types for Safety Requirements during Fire Conditions in Nuclear Facility

    International Nuclear Information System (INIS)

    Al-kattan, W.A.

    2015-01-01

    In Nuclear Power Plants (NPPs), the fire in cables causes many dangerous events in electrical or mechanical operations causing a nuclear reactor melt down. Main Control Room (MCR) in nuclear power plants have therefore, special concern in the fire protection systems. The Nuclear International Atomic Energy Agency (IAEA) has promoted the use of risk-informed and performance based methods for fire protection. These methods affirm the relevant needs to develop realistic methods to quantify the risk of fire to NPPs safety. The recent electrical cable testing has been carried out to provide empirical data on the failure modes and likelihood of fire-induced damage. In this thesis, will use fire modeling to develop fire probabilistic safety assessment to estimate the likelihood of fire induced cable damage given a specified fire profile. The objective of this work is to provide a comprehensive evaluation of the most recent fire-induced circuit failure due to different cables type that used inside the NPPs by simulation using fire modeling. One of this work scope is to suggest a suitable cable insulation material especially in case of the thermal failure thresholds, for developing the electrical cable thermal fragility distributions and evaluate parameters that influence fire-induced circuit failure modes. The main control room is implementing using the CFAST (fire simulation package). The simulation results represent the full development fire temperature and heat flux as well as the output gases. The results can be used as the basic parameters of the cables comparison and then evaluation.The importance of these results are not only for evaluating the cables but one can efficiently use them to improve the whole NPPs safety levels. The gases results of the fire simulation inside the room are oxygen, carbon monoxide, carbon dioxide, and hydrogen chloride. These gases are being used lot achieving the healthy protection of NPPs. Finally, one can measure the healthy environment

  20. Comparison of decay heat exchangers placing in the primary circuit of pool type fast reactor

    International Nuclear Information System (INIS)

    Birbraer, P.N.; Gorbunov, V.S.; Zotov, V.G.; Kuzavkov, N.G.; Pykhonin, V.A.; Sobolev, V.A.; Ryzhov, V.A.

    1993-01-01

    Description of two alternative arrangements of decay beat exchangers (DHXs) in the fast reactor tank is presented: in 'hot' cavity and in 'cold' cavity. The results of calculation for the two alternative arrangements as regards static and dynamic parameters in the primary circuit on 1-D program are given. (author)

  1. Cancer recording in patients with type 2 diabetes in primary care and hospital admission data

    Directory of Open Access Journals (Sweden)

    Rachael Williams

    2017-04-01

    A good level of concordance and low level of misclassification of cancer exist between CPRD primary care data and HES. The value of linking these data for establishing cancer outcomes lies more in the complimentary variables held than in reducing misclassification.

  2. Vaginal type-II mucosa is an inductive site for primary CD8+ T-cell mucosal immunity

    Science.gov (United States)

    Wang, Yichuan; Sui, Yongjun; Kato, Shingo; Hogg, Alison E.; Steel, Jason C.; Morris, John C.; Berzofsky, Jay A.

    2014-01-01

    The structured lymphoid tissues are considered the only inductive sites where primary T cell immune responses occur. The naïve T cells in structured lymphoid tissues, once being primed by antigen -bearing dendritic cells, differentiate into memory T cells and traffic back to the mucosal sites through the bloodstream. Contrary to this belief, here we show that the vaginal type-II mucosa itself, despite lack of structured lymphoid tissues, can act as an inductive site during primary CD8+ T cell immune responses. We provide evidence that the vaginal mucosa supports both the local immune priming of naïve CD8+ T cells and the local expansion of antigen-specific CD8+ T cells, thereby demonstrating a different paradigm for primary mucosal T cell immune induction. PMID:25600442

  3. Effects of increased nurses’ workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province

    Directory of Open Access Journals (Sweden)

    Rhulani C. Shihundla

    2016-05-01

    Full Text Available Background: Recording of information on multiple documents increases professional nurses’ responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC facilities in which a patient’s information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT register; consent form for HIV and AIDS testing; HIV Counselling and Testing (HCT register (if tested positive for HIV and AIDS then this must be recorded in the Antiretroviral Therapy (ART wellness register; ART file with an accompanying single file, completion of which is time-consuming; tuberculosis (TB suspects register; blood specimen register; maternity case record book and Basic Antenatal Care (BANC checklist. Nurses forget to record information in some documents which leads to the omission of important data. Omitting information might lead to mismanagement of patients. Some of the documents have incomplete and inaccurate information. As PHC facilities in Vhembe District render twenty four hour services through a call system, the same nurses are expected to resume duty at 07:00 the following morning. They are expected to work effectively and when tired a nurse may record illegible information which may cause problems when the document is retrieved by the next person for continuity of care. Objectives: The objective of this study was to investigate and describe the effects of increased nurses’ workload on quality documentation of patient information at PHC facilities in Vhembe District, Limpopo Province. Methods: The study was conducted in Vhembe District, Limpopo Province, where the effects of increased nurses’ workload on quality documentation of information is currently experienced. The research design was explorative, descriptive and contextual in

  4. Effects of increased nurses' workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province.

    Science.gov (United States)

    Shihundla, Rhulani C; Lebese, Rachel T; Maputle, Maria S

    2016-05-13

    Recording of information on multiple documents increases professional nurses' responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC) facilities in which a patient's information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT) register; consent form for HIV and AIDS testing; HIV Counselling and Testing (HCT) register (if tested positive for HIV and AIDS then this must be recorded in the Antiretroviral Therapy (ART) wellness register); ART file with an accompanying single file, completion of which is time-consuming; tuberculosis (TB) suspects register; blood specimen register; maternity case record book and Basic Antenatal Care (BANC) checklist. Nurses forget to record information in some documents which leads to the omission of important data. Omitting information might lead to mismanagement of patients. Some of the documents have incomplete and inaccurate information. As PHC facilities in Vhembe District render twenty four hour services through a call system, the same nurses are expected to resume duty at 07:00 the following morning. They are expected to work effectively and when tired a nurse may record illegible information which may cause problems when the document is retrieved by the next person for continuity of care. The objective of this study was to investigate and describe the effects of increased nurses' workload on quality documentation of patient information at PHC facilities in Vhembe District, Limpopo Province. The study was conducted in Vhembe District, Limpopo Province, where the effects of increased nurses' workload on quality documentation of information is currently experienced. The research design was explorative, descriptive and contextual in nature. The population consisted of all nurses who

  5. Primary Adenocarcinoma of Intestinal Type Arising From a Vaginal Mass: A Case Report.

    Science.gov (United States)

    Morrell, Lindsay H; Matthews, Kirk J; Chafe, Weldon E

    2015-07-01

    A patient with a history of a severe vaginal laceration during vaginal birth, unknown degree, presented with recurrent vaginal discharge and was found to have a vaginal mass. Pathologic analysis showed squamous mucosa transitioning into colonic type of mucosa with adenocarcinoma developed from colonic type of mucosa, reminiscent of anorectal junction.

  6. Spontaneous regression of primary cutaneous diffuse large B-cell lymphoma, leg type with significant T-cell immune response

    Directory of Open Access Journals (Sweden)

    Paul M. Graham, DO

    2018-05-01

    Full Text Available We report a case of histologically confirmed primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT that subsequently underwent spontaneous regression in the absence of systemic treatment. The case showed an atypical lymphoid infiltrate that was CD20+ and MUM-1+ and CD10–. A subsequent biopsy of the spontaneously regressed lesion showed fibrosis associated with a lymphocytic infiltrate comprising reactive T cells. PCDLBCL-LT is a cutaneous B-cell lymphoma with a poor prognosis, which is usually treated with chemotherapy. We describe a case of clinical and histologic spontaneous regression in a patient with PCDLBCL-LT who had a negative systemic workup but a recurrence over a year after his initial presentation. Key words: B cell, lymphoma, primary cutaneous diffuse large B-cell lymphoma, leg type, regression

  7. Radiological protection issues during primary filter housing replacement in a high alpha, beta-gamma shielded facility at Dounreay

    International Nuclear Information System (INIS)

    Mowat, D.; Watkin, T.

    2006-01-01

    Dounreay, on the north coast of Scotland, was home to the United Kingdom Fast Breeder Reactor (F.B.R.) development programme. F.B.R. use excess, non-moderated ('fast') neutrons to convert (breed) uranium, in elements positioned at the outer edges of the reactor core, into plutonium which can then be used as fuel.Site construction began in 1955 and three reactors were built and operated; the Dounreay Materials Test Reactor (D.M.T.R.) 1958-1969, the Dounreay Fast Reactor (D.F.R.) 1959-1977 and the Prototype Fast Reactor (P.F.R.) 1974-1994. The D.F.R. was conventionally fuelled by highly enriched uranium whereas the P.F.R. used a ceramic form of plutonium oxide (PuO 2 ) as its fuel. Dounreay was almost entirely self-sufficient in that a fuel cycle (chemical reprocessing) area was constructed complete with recovery plants, laboratories, waste storage and other support services buildings. Liquid plutonium nitrate product was sent to Sellafield, in Cumbria, to convert for future use, and the fuel elements were then fabricated at Springfields. Eventually, recovered P.F.R. plutonium was loaded back into the reactor, closing the fuel cycle. As a matter of interest for this paper, a Post Irradiation Examination (P.I.E.) facility, D2001, was built in the early 1960' s. The Plant was equipped with a suite of ten north and south side cells built to a high level of containment within which irradiated P.F.R. fuel could be remotely disassembled and examined. This work supported the continuing development of F.B.R. design and technology and the Plant has operated very successfully throughout its lifetime. A programme of improvement was implemented to enhance reliability, productivity and to modernize the facility to meet current nuclear and engineering standards. The experience of this work is detailed in this paper. (N.C.)

  8. Evaluation on applicability of construction methods and construction quality of low-diffusion layer of cavern type radioactive waste disposal facility

    International Nuclear Information System (INIS)

    Takechi, Shin-ichi; Yokozeki, Kosuke; Terada, Kenji; Akiyama, Yoshihiro; Yada, Tsutomu; Tsuji, Yukikazu

    2014-01-01

    A performance verification experiment of cavern type radioactive waste disposal facility with a real scale construction is being conducted to evaluate the applicability of proposed construction methods and construction quality of the facility. In this paper, we confirmed that the low-diffusion layer, which is one of the cementitious materials based members, could be filled with mortar from end to end of the member; cracks of low-diffusion layer would not affect the long-term safety evaluation of the facility. And also we figured out the relationship between the material strength and the accumulated temperature, relationship between diffusion coefficient and porosity of low-diffusion layer. (author)

  9. Assessing the ability of MODIS EVI to estimate terrestrial ecosystem gross primary production of multiple land cover types

    Czech Academy of Sciences Publication Activity Database

    Shi, H.; Li, L.; Eamus, D.; Huete, A.; Cleverly, J.; Tian, X.; Yu, Q.; Wang, S.; Montagnani, L.; Magliulo, V.; Rotenberg, E.; Pavelka, Marian; Carrara, A.

    2017-01-01

    Roč. 72, Jan (2017), s. 153-164 ISSN 1470-160X R&D Projects: GA MŠk(CZ) LM2015061 Institutional support: RVO:67179843 Keywords : Enhanced vegetation index * Gross primary production * Land cover types * Leaf area index * MODIS * Remote sensing Subject RIV: EH - Ecology, Behaviour OBOR OECD: Environmental sciences (social aspects to be 5.7) Impact factor: 3.898, year: 2016

  10. Comparison of the microhardness of primary and permanent teeth after immersion in two types of carbonated beverages.

    Science.gov (United States)

    Haghgou, Hamid R; Haghgoo, Roza; Asdollah, Fatemah Molla

    2016-01-01

    The consumption of carbonated beverages is one of the etiological factors that cause dental erosion. The purpose of this research was to compare changes in the microhardness of permanent and primary teeth after immersion in two types of carbonated beverages. This investigation was done on 30 healthy permanent molars and 30 healthy primary canines. Each group of primary and permanent teeth was subdivided into three groups of 10 teeth. The teeth was immersed in 40 ml of each of the three beverages for 5 min. One subgroup was immersed in water (as a control). The next was immersed in Lemon Delster and the last subgroup was immersed in Coca-Cola. The microhardness of enamel was measured using the Vickers method before and after immersion. Finally, the data was analyzed by paired t-test, one-way analysis of variance, and t-test. Microhardness reduction in the primary teeth was significant in both the Lemon Delster and Coca-Cola groups (P Coca-Cola and Lemon Delster caused a significant reduction of microhardness in tooth enamel. This reduction was greater in primary teeth than in permanent teeth, and was also greater after immersion in Coca-Cola than after immersion in Lemon Delster.

  11. Fiscal 1997 survey report. Basic survey on trends of waste use type production facilities and waste fuel production facilities; 1997 nendo chosa hokokusho. Haikibutsu riyogata seizo shisetsu oyobi haikibutsu nenryo seizo shisetsu doko kiso chosa hokokusho

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    This survey was made to obtain the basic data for future spread and promotion of No.6 type (waste use type production facilities) and No.7 type (waste fuel production facilities) which were added to the objects having been subsidized since fiscal 1997 under `the environmental harmony type energy community project.` In the former, the kiln in the cement industry and the blast furnace in the steel industry can be extremely large places to receive waste plastic since the facilities are distributed in every area and the treatment capacity is large. However, the effective collection, transportation and sorting of large quantity of waste plastic, especially the problem of removal of vinyl chloride, is a big bottleneck. As to the use of waste plastic using gasification technology, there are no actual results on the commercial basis. That is, however, appropriate for treatment of the waste difficult in treatment, and can be expected of the usage in the chemical industry. In the latter, in the facilities using industrial waste raw materials as fuel, solidification and liquefaction are both operated on a commercial basis. In relation to the solidification and use as fuel of general waste, the treatment of combustion ash is preventing the expansion of use of waste in the industrial field because of a large quantity of chlorine included in the products. 92 refs., 54 figs., 35 tabs.

  12. Modeling in fast dynamics of accidents in the primary circuit of PWR type reactors

    International Nuclear Information System (INIS)

    Robbe, M.F.

    2003-12-01

    Two kinds of accidents, liable to occur in the primary circuit of a Pressurized Water Reactor and involving fast dynamic phenomena, are analyzed. The Loss Of Coolant Accident (LOCA) is the accident used to define the current PWR. It consists in a large-size break located in a pipe of the primary circuit. A blowdown wave propagates through the circuit. The pressure differences between the different zones of the reactor induce high stresses in the structures of the lower head and may degrade the reactor core. The primary circuit starts emptying from the break opening. Pressure decreases very quickly, involving a large steaming. Two thermal-hydraulic simulations of the blowdown phase of a LOCA are computed with the Europlexus code. The primary circuit is represented by a pipe-model including the hydraulic peculiarities of the circuit. The main differences between both computations concern the kind of reactor, the break location and model, and the initialization of the accidental operation. Steam explosion is a hypothetical severe accident liable to happen after a core melting. The molten part of the core (called corium) falls in the lower part of the reactor. The interaction between the hot corium and the cold water remaining at the bottom of the vessel induces a massive and violent vaporization of water, similar to an explosive phenomenon. A shock wave propagates in the vessel. what can damage seriously the neighbouring structures or drill the vessel. This work presents a synthesis of in-vessel parametrical studies carried out with the Europlexus code, the linkage of the thermal-hydraulic code Mc3d dedicated to the pre-mixing phase with the Europlexus code dealing with the explosion, and finally a benchmark between the Cigalon and Europlexus codes relative to the Vulcano mock-up. (author)

  13. Analytical and sampling problems in primary coolant circuits of PWR-type reactors

    International Nuclear Information System (INIS)

    Illy, H.

    1980-10-01

    Details of recent analytical methods on the analysis and sampling of a PWR primary coolant are given in the order as follows: sampling and preparation; analysis of the gases dissolved in the water; monitoring of radiating substances; checking of boric acid concentration which controls the reactivity. The bibliography of this work and directions for its use are published in a separate report: KFKI-80-48 (1980). (author)

  14. Anemia in pregnancy and its associated factors among primary care clients in Sagamu, Southwest, Nigeria: A facility-based study

    Directory of Open Access Journals (Sweden)

    Oluwafolahan Olugbenga Sholeye

    2017-01-01

    Full Text Available Introduction: In Nigeria, anemia in pregnancy is one of the leading causes of poor pregnancy outcomes. This study, therefore, determined the prevalence of anemia and its associated factors, among pregnant primary care clients in Sagamu, Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out among 400 pregnant, primary care clients in Sagamu, selected through multi-stage sampling. Data were collected with the aid of an interviewer-administered, semi-structured questionnaire, a stadiometer, measuring tape, and a hemoglobinometer. Data were analyzed using SPSS version 17.00. Relevant descriptive and inferential statistics were calculated. Participation was fully voluntary. Results: The mean age of respondents was 25.4 ± 4.2 years. Most respondents (51.8% were traders. About a third (32.5% of respondents were anemic; of these, 72.1% were mildly anemic, while 27.1% were moderately anemic. Anemia was associated with household food security (P = 0.044 and level of food insecurity (P = 0.001 but not with age, occupation, educational status, household size, number of previous pregnancies, body mass index, mid-upper arm circumference, snacking, vegetable intake, and food avoidance (P > 0.05. Conclusion: Anemia in pregnancy is still high among respondents and associated with household food insecurity. Interventions targeted at improving household food security, dietary intake, and socioeconomic conditions will significantly reduce the prevalence and severity of anemia in pregnancy.

  15. [Frequency of the metabolic syndrome among overweight and obese patients in a primary health care facility in northern Mexico].

    Science.gov (United States)

    Zonana-Nacach, Abraham; Castillón-Chapa, Mario Arturo

    2006-01-01

    Assess the frequency of the metabolic syndrome (MS) among overweight and obese subjects attending a primary health care clinic in Tijuana, Baja California, Mexico. Male and female patients over 20 years of age attending a primary health care setting during April-Sept 2004 were selected to participate in the study. Metabolic syndrome was defined using the Adult Treatment Panel III criteria (NCEP III). Three-hundred twenty one patients with a mean age 47.9 years were assessed. The MS frequency was 44% for those patients without previous history of diabetes mellitus or hypertension (n = 281). The MS was present in 30% and 53% of overweight and obese patients respectively. Being an older male who had not been born in Baja California State were significantly associated with the presence of MS. The frequency of MS in a selected group of patients was common and higher than the national prevalence. The high frequency of MS in our study could be associated with a high prevalence of diabetes and obesity in the northwest population of Mexico.

  16. Primary system thermal-hydraulic simulation of a experimental pool type research fast reactor

    International Nuclear Information System (INIS)

    Borges, E.M.; Braz Filho, F.A.

    1993-01-01

    The first step of the Fast Reactor Program (REARA) is the design of an experimental reactor. To this end a 5 MW t pool type reactor was adapted. The objective of this work is to evaluate the reactor behaviour at the on set protected accidents. The program NALAP was used in this study and the results showed the outstanding safety margins that this reactor type presents inherently. (author)

  17. Primary tumor location predicts poor clinical outcome with cetuximab in RAS wild-type metastatic colorectal cancer.

    Science.gov (United States)

    Kim, Dalyong; Kim, Sun Young; Lee, Ji Sung; Hong, Yong Sang; Kim, Jeong Eun; Kim, Kyu-Pyo; Kim, Jihun; Jang, Se Jin; Yoon, Young-Kwang; Kim, Tae Won

    2017-11-23

    In metastatic colorectal cancer, the location of the primary tumor has been suggested to have biological significance. In this study, we investigated whether primary tumor location affects cetuximab efficacy in patients with RAS wild-type metastatic colorectal cancer. Genotyping by the SequenomMassARRAY technology platform (OncoMap) targeting KRAS, NRAS, PIK3CA, and BRAF was performed in tumors from 307 patients who had been given cetuximab as salvage treatment. Tumors with mutated RAS (KRAS or NRAS; n = 127) and those with multiple primary location (n = 10) were excluded. Right colon cancer was defined as a tumor located in the proximal part to splenic flexure. A total of 170 patients were included in the study (right versus left, 23 and 147, respectively). Patients with right colon cancer showed more mutated BRAF (39.1% vs. 5.4%), mutated PIK3CA (13% vs. 1.4%), poorly differentiated tumor (17.4% vs. 3.4%), and peritoneal involvement (26.1% vs. 8.8%) than those with left colon and rectal cancer. Right colon cancer showed poorer progression-free survival (2.0 vs.5.0 months, P = 0.002) and overall survival (4.1 months and 13.0 months, P < 0.001) than the left colon and rectal cancer. By multivariable analysis, BRAF mutation, right colon primary, poorly differentiated histology, and peritoneal involvement were associated with risk of death. In RAS wild-type colon cancer treated with cetuximab as salvage treatment, right colon primary was associated with poorer survival outcomes than left colon and rectal cancer.

  18. Physical violence between intimate partners during pregnancy and postpartum: a prediction model for use in primary health care facilities.

    Science.gov (United States)

    Moraes, Claudia L; Tavares da Silva, Tatiana de S; Reichenheim, Michael E; Azevedo, Gustavo L; Dias Oliveira, Alessandra S; Braga, José U

    2011-09-01

    This article offers a simple predictive model of physical intimate partner violence (PIPV) to be used by primary health care (PHC) professionals. The sample comprised 811 mothers of children economic, demographic and life style variables were considered as potential predictors. Maternal age education of 2 children under 5, tobacco smoking, alcohol misuse and illicit drug use by the mother and/or partner, and perception of baby's ill-health were identified as predictors of PIPV. The model-projected prevalence of PIPV for pregnancy and/or postpartum was just 10.1% in the absence of these characteristics, whereas this increased to 96.4% when all the seven characteristics were present. Child, maternal and family characteristics greatly increase the likelihood of PIPV and could be used together as screening indicators. © 2011 Blackwell Publishing Ltd.

  19. Facile and Efficient Acetylation of Primary Alcohols and Phenols with Acetic Anhydride Catalyzed by Dried Sodium Bicarbonate

    Directory of Open Access Journals (Sweden)

    Fulgentius Nelson Lugemwa

    2013-12-01

    Full Text Available A variety of primary alcohols and phenols were reacted with acetic anhydride at room temperature in the presence of sodium bicarbonate to produce corresponding esters in good to excellent yields. The acetylation of 4-nitrobenzyl alcohol was also carried out using other bicarbonates and carbonates. The reaction in the presence of cesium bicarbonate and lithium carbonate gave 4-nitrobenzyl acetate in excellent yield, while in the presence of Na2CO3, K2CO3, Cs2CO3, or KHCO3 the yield was in the range of 80%–95%. Calcium carbonate and cobaltous carbonate did not promote the acetylation of 4-ntirobenzyl alcohol using acetic anhydride. The acetylation of 4-nitrobenzyl alcohol was carried out using ethyl acetate, THF, toluene, diethyl ether, dichloromethane and acetonitrile, and gave good yields ranging from 75%–99%. Toluene was the best solvent for the reaction, while diethyl ether was the poorest.

  20. Bond strength of resin modified glass ionomer cement to primary dentin after cutting with different bur types and dentin conditioning

    Directory of Open Access Journals (Sweden)

    Rebeca Di Nicoló

    2007-10-01

    Full Text Available The aim of this in vitro study was to evaluate the effect of different bur types and acid etching protocols on the shear bond strength (SBS of a resin modified glass ionomer cement (RM-GIC to primary dentin. Forty-eight clinically sound human primary molars were selected and randomly assigned to four groups (n=12. In G1, the lingual surface of the teeth was cut with a carbide bur until a 2.0-mm-diameter dentin area was exposed, followed by the application of RM-GIC (Vitremer - 3M/ESPE prepared according to the manufacturer's instructions. The specimens of G2, received the same treatment of G1, however the dentin was conditioned with phosphoric acid. In groups G3 and G4 the same procedures of G1 and G2 were conducted respectively, nevertheless dentin cutting was made with a diamond bur. The specimens were stored in distilled water at 37ºC for 24h, and then tested in a universal testing machine. SBS. data were submitted to 2-way ANOVA (= 5% and indicated that SBS values of RM-GIC bonded to primary dentin cut with different burs were not statistically different, but the specimens that were conditioned with phosphoric acid presented SBS values significantly higher that those without conditioning. To observe micromorphologic characteristics of the effects of dentin surface cut by diamond or carbide rotary instruments and conditioners treatment, some specimens were examined by scanning electron microscopy. Smear layer was present in all specimens regardless of the type of rotary instrument used for dentin cutting, and specimens etched with phosphoric acid presented more effective removal of smear layer. It was concluded that SBS of a RM-GIC to primary dentin was affected by the acid conditioning but the bur type had no influence.

  1. Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial.

    Directory of Open Access Journals (Sweden)

    Robert Kaba Alhassan

    Full Text Available Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps.To evaluate the effect of SCE interventions on health worker motivation and experiences with clients.The study is a cluster randomized trial involving health workers in private (n = 38 and public (n = 26 primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72% were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation.Intrinsic (non-financial work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were

  2. Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial.

    Science.gov (United States)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F

    2016-01-01

    Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps. To evaluate the effect of SCE interventions on health worker motivation and experiences with clients. The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation. Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked

  3. Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial

    Science.gov (United States)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Rinke de Wit, Tobias F.

    2016-01-01

    Background Health worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps. Purpose To evaluate the effect of SCE interventions on health worker motivation and experiences with clients. Methods The study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation. Results Intrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while

  4. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

    Directory of Open Access Journals (Sweden)

    Robert Kaba Alhassan

    Full Text Available Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge.To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS in Ghana are also discussed.This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare.Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001. Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in

  5. Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees.

    Science.gov (United States)

    Lodenstein, Elsbet; Mafuta, Eric; Kpatchavi, Adolphe C; Servais, Jean; Dieleman, Marjolein; Broerse, Jacqueline E W; Barry, Alpha Amadou Bano; Mambu, Thérèse M N; Toonen, Jurrien

    2017-06-13

    Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health services. This article explores the social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo. The paper is based on a cross-case comparison of 11 HFCs across the three countries. The HFCs were purposefully selected based on the (past) presence of community participation support programs. The cases were derived from qualitative research involving document analysis as well as interviews and focus group discussions with health workers, citizens, committee members, and local authorities. Most HFCs facilitate social accountability by engaging with health providers in person or through meetings to discuss service failures, leading to changes in the quality of services, such as improved health worker presence, the availability of night shifts, the display of drug prices and replacement of poorly functioning health workers. Social accountability practices are however often individualised and not systematic, and their success depends on HFC leadership and synergy with other community structures. The absence of remuneration for HFC members does not seem to affect HFC engagement in social accountability. Most HFCs in this study offer a social accountability forum, but the informal and non-systematic character and limited community consultation leave opportunities for the exclusion of voices of marginalised groups. More inclusive, coherent and authoritative social accountability practices can be developed by making explicit the mandate of HFC in the planning, monitoring, and supervision of health services; providing instruments for organising local accountability processes; strengthening opportunities for community input and feedback; and

  6. Lack of facilities rather than sociocultural factors as the primary barrier to physical activity among female Saudi university students.

    Science.gov (United States)

    Samara, Anastasia; Nistrup, Anne; Al-Rammah, Tamader Y; Aro, Arja R

    2015-01-01

    The Kingdom of Saudi Arabia is experiencing a dramatic increase in physical inactivity, with women having higher levels of inactivity than men among all age groups. It is assumed that factors such as dress codes, restrictions on going outdoors, and conservative norms are the main reasons for women's low physical activity. Our aim was to explore the different parameters related to physical activity, including self-efficacy, as well as the perceived barriers to and benefits of physical activity in young Saudi females. Ninety-four first-year female Saudi university students in Riyadh, Kingdom of Saudi Arabia, participated in the present study in 2014. The students were from eight bachelor's programs in health and well-being, and each completed a questionnaire with questions divided into five parts as follows: 1) socioeconomic status, 2) physical activity, 3) self-efficacy 4) social factors, and 5) barriers and facilitators related to physical activity. The students exercised at home and alone, and there was low self-efficacy for physical activity (mean score =42±14). Among social factors, attending university was the only factor that hindered physical activity (32%). Physical activity was positively perceived overall (mean score =131±10). Students showed awareness of the benefits of physical activity for health and well-being. The most important barrier was the lack of designated areas available for physical activity. Students disagreed that family or the Islamic community were barriers to physical activity. The lack of facilities and lack of encouragement from the university, but not a lack of knowledge (a high level of knowledge is to be expected given their health and well-being studies backgrounds) and/or restrictions from families and society, seem to hinder female students' physical activity, at least young Saudi students.

  7. Impact of an intensive multifactorial intervention in patients with type 2 diabetes at Primary Health Care

    Directory of Open Access Journals (Sweden)

    Mª Carmen Serrano Cepas

    2013-11-01

    Full Text Available Diabetes is one of the diseases with a higher social and sanitary impact and therefore, it is one of the priorities in the service we provide. The success of the interventions with people suffering from diabetes lies in the efficacy of the pharmacological treatments as well as in the change of lifestyles and the different confrontations how these patients face their process. Health workers feel quite frustrated as a result of the slight success of our actions to achieve them to follow an adequate diet, make physical exercise or improve their self-sufficiency and self control when dealing with the different situations that should be faced because of diabetes. For such reason, the primary care professionals from Guadalhorce valley Sanitary District applied several different interventions from those generally used for many years. These intensive interventions will consist on eight group sessions of diabetological education, planning and accompaniment at the physical exercises and patients will also receive personalized diet advice; the intervention will be developed during three months, and afterward the level of glycosylated haemoglobin will be measured in order to see if it has improved. Therefore, we are going to evaluate in an objective way the effectiveness of this intensive intervention comparing it to the habitual intervention followed in Primary Health Care.

  8. High temperature filtration of radioactivable corrosion products in the primary circuit of PWR type reactors

    International Nuclear Information System (INIS)

    Dolle, L.

    1976-01-01

    A effective limitation to the deposition of radioactive corrosion products in the core of a reactor at power operation, is to be obtained by filtering the water of the primary circuit at a flow rate upper than 1% of the coolant flow rate. However, in view of accounting for more important release of corrosion products during the reactor start-up and also for some possible variations in the efficiency of the system, it is better that the flow rate to be treated by the cleaning circuit is stated at 5%. Filtration must be effected at the temperature of the primary circuit and preferably on each loop. To this end, the feasibility of electromagnetic filtration or filtration through a deep bed of granulated graphite has been studied. The on-loop tests effected on each filter gave efficiencies and yields respectively upper than 90% and 99% for magnetite and ferrite particles in suspension in water at 250 deg C. Such results confirm the interest lying in high temperature filtration and lead to envisage its application to reactors [fr

  9. Depressive symptoms are associated with physical inactivity in patients with type 2 diabetes. The DIAZOB Primary Care Diabetes study

    DEFF Research Database (Denmark)

    Koopmans, Berber; Pouwer, Francois; de Bie, Robert A

    2009-01-01

    through decreased physical activity. OBJECTIVE: To test whether type 2 diabetes patients with elevated depression scores are more often physically inactive. METHODS: Demographic features, clinical factors, level of physical inactivity and depressive symptoms were assessed in 2646 primary care patients...... with type 2 diabetes. Sequential multiple logistic regression analyses [odds ratio, 95% confidence interval (CI)] were performed to test the association between depressive symptoms and physical inactivity. RESULTS: About 48% of the respondents were physically inactive. Elevated depressive symptoms were...... found in 14% of the respondents. After adjustment for potential confounders, the odds for being physically inactive were almost doubled in depressed patients with type 2 diabetes 1.74 (95% CI 1.32-2.31). CONCLUSIONS: Presence of depressive symptoms almost doubles the likelihood of physical inactivity...

  10. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.

    Science.gov (United States)

    Cully, Jeffrey A; Armento, Maria E A; Mott, Juliette; Nadorff, Michael R; Naik, Aanand D; Stanley, Melinda A; Sorocco, Kristen H; Kunik, Mark E; Petersen, Nancy J; Kauth, Michael R

    2012-07-11

    Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews

  11. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design

    Directory of Open Access Journals (Sweden)

    Cully Jeffrey A

    2012-07-01

    Full Text Available Abstract Background Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. Methods This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1 to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases primary care patients and (2 to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200 or usual care (n = 120. Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points and

  12. 14 CFR 21.24 - Issuance of type certificate: primary category aircraft.

    Science.gov (United States)

    2010-01-01

    ... flight manual required by § 21.5(b), including any information required to be furnished by the applicable... all necessary drawings and documents used to define the type design; and lists all the engineering... completed the engineering analysis necessary to demonstrate compliance with the applicable airworthiness...

  13. Primary defects in lipolysis and insulin action in skeletal muscle cells from type 2 diabetic individuals

    DEFF Research Database (Denmark)

    Kase, E. T.; Feng, Y. Z.; Badin, P. M.

    2015-01-01

    A decrease in skeletal muscle lipolysis and hormone sensitive-lipase (HSL) expression has been linked to insulin resistance in obesity. The purpose of this study was to identify potential intrinsic defects in lipid turnover and lipolysis in myotubes established from obese and type 2 diabetic...

  14. Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health-care facilities: study design of a cluster randomized controlled trial in Pakistan

    Directory of Open Access Journals (Sweden)

    Muhammad Amir Khan

    2015-11-01

    Full Text Available Background: Respiratory diseases, namely asthma and chronic obstructive pulmonary disease (COPD, account for one-fourth of the patients at the primary health-care (PHC facilities in Pakistan. Standard care practices to manage these diseases are necessary to reduce the morbidity and mortality rate associated with non-communicable diseases in developing countries. Objective: To develop and measure the effectiveness of operational guidelines and implementation materials, with sound scientific evidence, for expanding lung health care, especially asthma and COPD through PHC facilities already strengthened for tuberculosis (TB care in Pakistan. Design: A cluster randomized controlled trial with two arms (intervention and control, with qualitative and costing study components, is being conducted in 34 clusters; 17 clusters per arm (428 asthma and 306 COPD patients, in three districts in Pakistan from October 2014 to December 2016. The intervention consists of enhanced case management of asthma and COPD patients through strengthening of PHC facilities. The main outcomes to be measured are asthma and COPD control among the registered cases at 6 months. Cluster- and individual-level analyses will be done according to intention to treat. Residual confounding will be addressed by multivariable logistic and linear regression models for asthma and COPD control, respectively. The trial is registered with ISRCTN registry (ISRCTN 17409338. Conclusions: Currently, only about 20% of the estimated prevalent asthma and COPD cases are being identified and reported through the respective PHC network. Lung health care and prevention has not been effectively integrated into the core PHC package, although a very well-functioning TB program exists at the PHC level. Inclusion of these diseases in the already existent TB program is expected to increase detection rates and care for asthma and COPD.

  15. Cooling effects of artificial water facilities by using a moving type turbulence promoter; Kudo ranryu sokushintai ni yoru suireikyaku jikkenho

    Energy Technology Data Exchange (ETDEWEB)

    Miyake, K; Nomura, T; Nishimura, N; Iyota, H [Osaka City University, Osaka (Japan)

    1996-10-27

    Artificial water facilities present an effective means to alleviate trying micrometeorological phenomena such as warming of the urban space. For the reproduction of such an alleviating means by use of a model in a wind tunnel, a moving disturbance promoter (moving spire) was developed so as to render disturbances in a wind tunnel current similar in scale to ones in the real atmosphere, and an air current cooling experiment was conducted using a model fountain. The effort was intended for a small-size wind tunnel without a space large enough for disturbance promoter installation, and a moving type spire was developed for promoting disturbance effectively. The new spire is driven by a driving unit consisting of a motor and cam and can change its angle relative to the main current by 140{degree} at a rotation cycle of 1.7Hz., and this changes the flow direction of the main current periodically. As compared with the generally used combination of a roughness block and stationery spire, this new spire produced a disturbance intensity two times greater and a disturbance scale three times larger. When the disturbance intensity and scale were increased, the cooling characteristics of the air current changed in response to changes in the state of flow. 8 refs., 7 figs., 1 tab.

  16. Lack of facilities rather than sociocultural factors as the primary barrier to physical activity among female Saudi university students

    Directory of Open Access Journals (Sweden)

    Samara A

    2015-03-01

    Full Text Available Anastasia Samara,1 Anne Nistrup,1 Tamader Y AL-Rammah,2 Arja R Aro11Unit for Health Promotion and Research, University of Southern Denmark, Esbjerg, Denmark; 2Faculty of Rehabilitation and Health Sciences, Princess Nora Bint Abdul Rahman University, Riyadh, Kingdom of Saudi ArabiaPurpose: The Kingdom of Saudi Arabia is experiencing a dramatic increase in physical inactivity, with women having higher levels of inactivity than men among all age groups. It is assumed that factors such as dress codes, restrictions on going outdoors, and conservative norms are the main reasons for women’s low physical activity. Our aim was to explore the different parameters related to physical activity, including self-efficacy, as well as the perceived barriers to and benefits of physical activity in young Saudi females.Patients and methods: Ninety-four first-year female Saudi university students in Riyadh, Kingdom of Saudi Arabia, participated in the present study in 2014. The students were from eight bachelor’s programs in health and well-being, and each completed a questionnaire with questions divided into five parts as follows: 1 socioeconomic status, 2 physical activity, 3 self-efficacy 4 social factors, and 5 barriers and facilitators related to physical activity.Results: The students exercised at home and alone, and there was low self-efficacy for physical activity (mean score =42±14. Among social factors, attending university was the only factor that hindered physical activity (32%. Physical activity was positively perceived overall (mean score =131±10. Students showed awareness of the benefits of physical activity for health and well-being. The most important barrier was the lack of designated areas available for physical activity. Students disagreed that family or the Islamic community were barriers to physical activity.Conclusion: The lack of facilities and lack of encouragement from the university, but not a lack of knowledge (a high level of

  17. Stress corrosion cracking of steam generator tube and primary pipe in PWR type nuclear power plants

    International Nuclear Information System (INIS)

    Zhang Weiguo; Gao Fengqin; Zhou Hongyi

    1992-03-01

    The behavior of stress corrosion cracking (SCC) was studied by slow strain rate test (SSRT), constant load test (CLT) and low frequency cyclic loading test (LFCLT). The purpose of these tests is to get the test data for evaluating the integrity of pressurized boundary of pipes in Qinshan and Guangdong nuclear power plants (NPPs). Tested materials are 316 nuclear grade stainless steel (SS) for primary pipes in welded heat affected zone (WHAZ) and tubes of heat transfer, such as Incoloy-800, Inconel-600 and 321 SS which are used for steam generator in PWR NPPs. The effects of material metallurgy, shot peening treatment, tensile load, strain rate, cyclic load and water chemistry on the behavior of SCC were considered

  18. Stress corrosion cracking of steam generator tube and primary pipe in PWR type nuclear power plants

    International Nuclear Information System (INIS)

    Zhang Weiguo; Gao Fengqin; Zhou Hongyi

    1993-01-01

    The behavior of stress corrosion cracking (SCC) is studied by slow strain rate test (SSRT), constant load test (CLT) and low frequency cyclic loading test (LFCLT). The purpose of these tests is to get the test data for evaluating the integrity of pressurized boundary of pipes in Qinshan and Guangdong nuclear power plants. Tested materials are 316 nuclear grade stainless steel (SS) for primary pipes in welded heat affected zone (WHAZ) and steam generator tubes, such as Incoloy-800, Inconel-600, Inconel-690 and 321 SS which are used for steam generator in PWR. The effects of material metallurgy, shot-peening treatment, tensile load, strain rate, cyclic load and water chemistry on the behavior of SCC are investigated

  19. Feedback control of primary pump using midplane temperature of lower density lock for a PIUS-type reactor

    International Nuclear Information System (INIS)

    Tasaka, Kanji; Haga, Katsuhiro; Tamaki, Masayoshi

    1993-01-01

    A new automatic pump speed control system, using a measurement of the temperature distribution in the lower density lock, is proposed for the PIUS-type reactor. This control system maintains the fluid temperature at the axial center of the lower density lock at the average of the fluid temperatures below and above the lower density lock in order to prevent the poison water from penetrating into the core during normal operation. In a startup test, the effectiveness of this control system to bring the system quickly to the stable state from a very small initial temperature difference between top and bottom of the lower density lock has been confirmed. The effectiveness of the primary pump trip at the limit speed in the control system to shutdown the core power safely in an accident such as a loss-of-feedwater accident with and without the primary loop isolation has also been proved

  20. An algorithm for identification and classification of individuals with type 1 and type 2 diabetes mellitus in a large primary care database

    Directory of Open Access Journals (Sweden)

    Sharma M

    2016-10-01

    Full Text Available Manuj Sharma,1 Irene Petersen,1,2 Irwin Nazareth,1 Sonia J Coton,1 1Department of Primary Care and Population Health, University College London, London, UK; 2Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark Background: Research into diabetes mellitus (DM often requires a reproducible method for identifying and distinguishing individuals with type 1 DM (T1DM and type 2 DM (T2DM.  Objectives: To develop a method to identify individuals with T1DM and T2DM using UK primary care electronic health records.  Methods: Using data from The Health Improvement Network primary care database, we developed a two-step algorithm. The first algorithm step identified individuals with potential T1DM or T2DM based on diagnostic records, treatment, and clinical test results. We excluded individuals with records for rarer DM subtypes only. For individuals to be considered diabetic, they needed to have at least two records indicative of DM; one of which was required to be a diagnostic record. We then classified individuals with T1DM and T2DM using the second algorithm step. A combination of diagnostic codes, medication prescribed, age at diagnosis, and whether the case was incident or prevalent were used in this process. We internally validated this classification algorithm through comparison against an independent clinical examination of The Health Improvement Network electronic health records for a random sample of 500 DM individuals.  Results: Out of 9,161,866 individuals aged 0–99 years from 2000 to 2014, we classified 37,693 individuals with T1DM and 418,433 with T2DM, while 1,792 individuals remained unclassified. A small proportion were classified with some uncertainty (1,155 [3.1%] of all individuals with T1DM and 6,139 [1.5%] with T2DM due to unclear health records. During validation, manual assignment of DM type based on clinical assessment of the entire electronic record and algorithmic assignment led to equivalent classification

  1. Seasonal Shifts in Primary Water Source Type: A Comparison of Largely Pastoral Communities in Uganda and Tanzania

    Directory of Open Access Journals (Sweden)

    Amber L. Pearson

    2016-01-01

    Full Text Available Many water-related illnesses show an increase during the wet season. This is often due to fecal contamination from runoff, yet, it is unknown whether seasonal changes in water availability may also play a role in increased illness via changes in the type of primary water source used by households. Very little is known about the dynamic aspects of access to water and changes in source type across seasons, particularly in semi-arid regions with annual water scarcity. The research questions in this study were: (1 To what degree do households in Uganda (UG and Tanzania (TZ change primary water source type between wet and dry seasons?; and (2 How might seasonal changes relate to water quality and health? Using spatial survey data from 92 households each in UG and TZ this study found that, from wet to dry season, 26% (UG and 9% (TZ of households switched from a source with higher risk of contamination to a source with lower risk. By comparison, only 20% (UG and 0% (TZ of households switched from a source with lower risk of contamination to a source with higher risk of contamination. This research suggests that one pathway through which water-related disease prevalence may differ across seasons is the use of water sources with higher risk contamination, and that households with access to sources with lower risks of contamination sometimes choose to use more contaminated sources.

  2. Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider.

    Science.gov (United States)

    Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna

    2014-01-01

    Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

  3. Facile synthesis of pyrite-type binary nickel iron diselenides as efficient electrocatalyst for oxygen evolution reaction

    Energy Technology Data Exchange (ETDEWEB)

    Chi, Jing-Qi; Shang, Xiao [State Key Laboratory of Heavy Oil Processing, China University of Petroleum (East China), Qingdao 266580 (China); Liang, Fei [State Key Laboratory of Heavy Oil Processing, China University of Petroleum (East China), Qingdao 266580 (China); College of Science, China University of Petroleum (East China), Qingdao 266580 (China); Dong, Bin, E-mail: dongbin@upc.edu.cn [State Key Laboratory of Heavy Oil Processing, China University of Petroleum (East China), Qingdao 266580 (China); College of Science, China University of Petroleum (East China), Qingdao 266580 (China); Li, Xiao; Liu, Yan-Ru; Yan, Kai-Li [State Key Laboratory of Heavy Oil Processing, China University of Petroleum (East China), Qingdao 266580 (China); Gao, Wen-Kun [State Key Laboratory of Heavy Oil Processing, China University of Petroleum (East China), Qingdao 266580 (China); College of Science, China University of Petroleum (East China), Qingdao 266580 (China); Chai, Yong-Ming [State Key Laboratory of Heavy Oil Processing, China University of Petroleum (East China), Qingdao 266580 (China); Liu, Chen-Guang, E-mail: cgliu@upc.edu.cn [State Key Laboratory of Heavy Oil Processing, China University of Petroleum (East China), Qingdao 266580 (China)

    2017-04-15

    Highlights: • Binary pyrite-type Ni{sub 0.5}Fe{sub 0.5}Se{sub 2}/CFC was prepared by a facile two-step process. • The effect of Ni/Fe (Ni{sub x}Fe{sub 1-x}Se{sub 2} x = 0, 0.2, 0.5, 0.8, 1) on OER was investigated. • Ni{sub 0.5}Fe{sub 0.5}Se{sub 2}/CFC (x = 0.5) possesses the better electrocatalytic activity for OER. • The enhanced activity may be attributed to binary Ni{sub 0.5}Fe{sub 0.5}Se{sub 2} and CFC support. - Abstract: Pyrite-type binary nickel iron diselenides (Ni{sub 0.5}Fe{sub 0.5}Se{sub 2}) supported on carbon fiber cloth (CFC) as electrocatalysts for oxygen evolution reaction (OER) have been prepared by a facile two-step process. Firstly, binary Ni{sub 0.5}Fe{sub 0.5} hydroxide nanosheets have been electrodeposited on CFC. Secondly, a solvothermal selenization process has been used to convert Ni{sub 0.5}Fe{sub 0.5}/CFC into Ni{sub 0.5}Fe{sub 0.5}Se{sub 2}/CFC. XRD shows that Ni{sub 0.5}Fe{sub 0.5}Se{sub 2} on CFC has the typically octahedral crystalline. XPS proves the existence and valence of Ni, Fe and Se. SEM images show that Ni{sub 0.5}Fe{sub 0.5}Se{sub 2} has novel pyrite-type octahedral morphology with uniform size and good dispersion on the surface of CFC. SEM elemental mapping images confirm the good distribution of Ni, Fe, Se element on CFC. TEM and SAED provide the clear diffraction rings of octahedral Ni{sub 0.5}Fe{sub 0.5}Se{sub 2}, which is consistent with the results of XRD. Furtherly, the effect of different ratio of Ni/Fe (Ni{sub x}Fe{sub 1-x}Se{sub 2} x = 0, 0.2, 0.5, 0.8, 1) on OER performances has been systematically investigated. The electrochemical measurements results show that Ni{sub 0.5}Fe{sub 0.5}Se{sub 2}/CFC (x = 0.5) possesses the better electrocatalytic activity with the lower overpotential, Tafel slope and long-term stability than other samples. The enhanced activity of Ni{sub 0.5}Fe{sub 0.5}Se{sub 2}/CFC may be attributed to the intrinsic activity of binary Ni{sub 0.5}Fe{sub 0.5}Se{sub 2} and faster electron

  4. Primary and secondary battery consumption trends in Sweden 1996–2013: Method development and detailed accounting by battery type

    International Nuclear Information System (INIS)

    Patrício, João; Kalmykova, Yuliya; Berg, Per E.O.; Rosado, Leonardo; Åberg, Helena

    2015-01-01

    Highlights: • Developed MFA method was validated by the national statistics. • Exponential increase of EEE sales leads to increase in integrated battery consumption. • Digital convergence is likely to be a cause for primary batteries consumption decline. • Factors for estimation of integrated batteries in EE are provided. • Sweden reached the collection rates defined by European Union. - Abstract: In this article, a new method based on Material Flow Accounting is proposed to study detailed material flows in battery consumption that can be replicated for other countries. The method uses regularly available statistics on import, industrial production and export of batteries and battery-containing electric and electronic equipment (EEE). To promote method use by other scholars with no access to such data, several empirically results and their trends over time, for different types of batteries occurrence among the EEE types are provided. The information provided by the method can be used to: identify drivers of battery consumption; study the dynamic behavior of battery flows – due to technology development, policies, consumers behavior and infrastructures. The method is exemplified by the study of battery flows in Sweden for years 1996–2013. The batteries were accounted, both in units and weight, as primary and secondary batteries; loose and integrated; by electrochemical composition and share of battery use between different types of EEE. Results show that, despite a fivefold increase in the consumption of rechargeable batteries, they account for only about 14% of total use of portable batteries. Recent increase in digital convergence has resulted in a sharp decline in the consumption of primary batteries, which has now stabilized at a fairly low level. Conversely, the consumption of integrated batteries has increased sharply. In 2013, 61% of the total weight of batteries sold in Sweden was collected, and for the particular case of alkaline manganese

  5. Primary and secondary battery consumption trends in Sweden 1996–2013: Method development and detailed accounting by battery type

    Energy Technology Data Exchange (ETDEWEB)

    Patrício, João, E-mail: joao.patricio@chalmers.se [Department of Civil and Environmental Engineering, Chalmers University of Technology, 412 96 Gothenburg (Sweden); Kalmykova, Yuliya; Berg, Per E.O.; Rosado, Leonardo [Department of Civil and Environmental Engineering, Chalmers University of Technology, 412 96 Gothenburg (Sweden); Åberg, Helena [The Faculty of Education, University of Gothenburg, 40530 Gothenburg (Sweden)

    2015-05-15

    Highlights: • Developed MFA method was validated by the national statistics. • Exponential increase of EEE sales leads to increase in integrated battery consumption. • Digital convergence is likely to be a cause for primary batteries consumption decline. • Factors for estimation of integrated batteries in EE are provided. • Sweden reached the collection rates defined by European Union. - Abstract: In this article, a new method based on Material Flow Accounting is proposed to study detailed material flows in battery consumption that can be replicated for other countries. The method uses regularly available statistics on import, industrial production and export of batteries and battery-containing electric and electronic equipment (EEE). To promote method use by other scholars with no access to such data, several empirically results and their trends over time, for different types of batteries occurrence among the EEE types are provided. The information provided by the method can be used to: identify drivers of battery consumption; study the dynamic behavior of battery flows – due to technology development, policies, consumers behavior and infrastructures. The method is exemplified by the study of battery flows in Sweden for years 1996–2013. The batteries were accounted, both in units and weight, as primary and secondary batteries; loose and integrated; by electrochemical composition and share of battery use between different types of EEE. Results show that, despite a fivefold increase in the consumption of rechargeable batteries, they account for only about 14% of total use of portable batteries. Recent increase in digital convergence has resulted in a sharp decline in the consumption of primary batteries, which has now stabilized at a fairly low level. Conversely, the consumption of integrated batteries has increased sharply. In 2013, 61% of the total weight of batteries sold in Sweden was collected, and for the particular case of alkaline manganese

  6. Diffuse Type Primary Mycobacterium Tuberculosis of the Breast: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun A; Kang, Bong Joo; Kim, Sung Hun; Kim, Hnana; Lee, Ah Won [Seoul St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

    2011-12-15

    Tuberculous mastitis is a rare manifestation of mycobacterium tuberculosis infection. It mimics inflammatory breast cancer or other pyogenic inflammations. In most of the tuberculous mastitis reports, coexisting or prior tuberculosis infection and secondary infection of the breast by direct spread via axillary or cervical lymphadenopathy, or hematogenous spread have been noted. We describe the mammographic and ultrasonographic findings of a case of diffuse type mycobacterium tuberculosis of the breast showing diffuse edema which was confirmed as tuberculosis through biopsy and had no evidence of old or concurrent pulmonary tuberculosis on chest computed tomography

  7. Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study.

    Science.gov (United States)

    Aninanya, Gifty Apiung; Howard, Natasha; Williams, John E; Apam, Benjamin; Prytherch, Helen; Loukanova, Svetla; Kamara, Eunice Karanja; Otupiri, Easmon

    2016-01-01

    maternal health workers in primary care facilities in northern Ghana. PBIs appeared to improve motivation, but not dramatically, and the long-term and unintended effects of their introduction require additional study.

  8. Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Gifty Apiung Aninanya

    2016-10-01

    evidence on the effects of PBIs on motivational constructs among maternal health workers in primary care facilities in northern Ghana. PBIs appeared to improve motivation, but not dramatically, and the long-term and unintended effects of their introduction require additional study.

  9. Quality of primary health care and autonomous motivation for effective diabetes self-management among patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Anne M Koponen

    2017-05-01

    Full Text Available This study showed, in line with self-determination theory, that of the six central quality dimensions of primary health care (access to care, continuity of care, diabetes counseling, autonomy support from one’s physician, trust, patient-centered care, autonomy support from one’s physician was most strongly associated with autonomous motivation (self-regulation for effective diabetes self-management among patients with type 2 diabetes ( n  = 2866. However, overall support for diabetes care received from friends, family members, other patients with diabetes, and health care professionals may even play a greater role.

  10. Serious clopidogrel associated renal hematoma in a type 2 diabetic patient with primary hyperparathyroidism after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Bahceci, Mithat; Tuzcu, Alpaslan; Agil, Cuneyt; Akay, Ferruh; Akay, Hatice

    2005-01-01

    Renal hematoma after extracorporeal shock wave lithotripsy SWL is a rare complication. We report a case of a large renal hematoma following SWL that resulted in nephrectomy in a type 2 diabetic patient with primary hyperparathyroidism using clopidogrel due to coronary heart disease CHD. Although it was claimed that preoperative use of clopidogrel was not associated with increased bleeding, all patients who are scheduled for SWL should be interrogated in terms of using of platelet aggregation inhibitors such as clopidogrel, and these drugs should be interrupted appropriately before undergoing SWL. (author)

  11. A divergent [5+2] cascade approach to bicyclo[3.2.1]octanes: facile synthesis of ent-kaurene and cedrene-type skeletons.

    Science.gov (United States)

    He, Chi; Bai, Zengbing; Hu, Jialei; Wang, Bingnan; Xie, Hujun; Yu, Lei; Ding, Hanfeng

    2017-07-25

    A solvent-dependent oxidative dearomatization-induced divergent [5+2] cascade approach to bicyclo[3.2.1]octanes was described. This novel protocol enables a facile synthesis of a series of diversely functionalized ent-kaurene and cedrene-type skeletons in good yields and excellent diastereoselectivities.

  12. Hypermineralization and High Osteocyte Lacunar Density in Osteogenesis Imperfecta Type V Bone Indicate Exuberant Primary Bone Formation.

    Science.gov (United States)

    Blouin, Stéphane; Fratzl-Zelman, Nadja; Glorieux, Francis H; Roschger, Paul; Klaushofer, Klaus; Marini, Joan C; Rauch, Frank

    2017-09-01

    In contrast to "classical" forms of osteogenesis imperfecta (OI) types I to IV, caused by a mutation in COL1A1/A2, OI type V is due to a gain-of-function mutation in the IFITM5 gene, encoding the interferon-induced transmembrane protein 5, or bone-restricted interferon-inducible transmembrane (IFITM)-like protein (BRIL). Its phenotype distinctly differs from OI types I to IV by absence of blue sclerae and dentinogenesis imperfecta, by the occurrence of ossification disorders such as hyperplastic callus and forearm interosseous membrane ossification. Little is known about the impact of the mutation on bone tissue/material level in untreated and bisphosphonate-treated patients. Therefore, investigations of transiliac bone biopsy samples from a cohort of OI type V children (n = 15, 8.7 ± 4 years old) untreated at baseline and a subset (n = 8) after pamidronate treatment (2.6 years in average) were performed. Quantitative backscattered electron imaging (qBEI) was used to determine bone mineralization density distribution (BMDD) as well as osteocyte lacunar density. The BMDD of type V OI bone was distinctly shifted toward a higher degree of mineralization. The most frequently occurring calcium concentration (CaPeak) in cortical (Ct) and cancellous (Cn) bone was markedly increased (+11.5%, +10.4%, respectively, p < 0.0001) compared to healthy reference values. Treatment with pamidronate resulted in only a slight enhancement of mineralization. The osteocyte lacunar density derived from sectioned bone area was elevated in OI type V Ct and Cn bone (+171%, p < 0.0001; +183.3%, p < 0.01; respectively) versus controls. The high osteocyte density was associated with an overall immature primary bone structure ("mesh-like") as visualized by polarized light microscopy. In summary, the bone material from OI type V patients is hypermineralized, similar to other forms of OI. The elevated osteocyte lacunar density in connection with lack of regular bone

  13. Protein synthesis by isolated type II pneumocytes in suspension and in primary culture

    International Nuclear Information System (INIS)

    Brandes, M.E.; Finkelstein, J.N.

    1987-01-01

    Protein synthesis in rabbit type II pneumocytes immediately after isolation or during the first 7 days in culture was examined by incorporation of [ 3 H] leucine or [ 35 S]methionine. After a 1h incubation with label, total cellular protein was analyzed by 1 or 2-D PAGE and fluorography. Following isolation, incorporation was limited to a small number of proteins of apparent molecular weight 70kD, 55-60kD, 25kD and 20+22kD which appear to lack cognates in cultured cells. At 3h, these isolation proteins (IPs) account for ∼ 50% of the labeled protein. Pretreatment with actinomycin D abolished synthesis of the IPs suggesting a requirement for active mRNA production. These proteins are actively synthesized during the first 10h following cell isolation. Loss of active synthesis is accompanied by a gradual enhancement in synthesis of other proteins. Actin synthesis, 125 I-EGF binding to cultured type II cells indicate changing receptor number and binding affinity with time in culture

  14. Parathyroidectomy Ameliorates Glucose and Blood Pressure Control in a Patient with Primary Hyperparathyroidism, Type 2 Diabetes, and Hypertension

    Directory of Open Access Journals (Sweden)

    Alok Kumar

    2015-01-01

    Full Text Available Effect of parathyroidectomy on glucose control and hypertension is controversial. Here, we report a case of a patient with primary hyperparathyroidism, type 2 diabetes mellitus, and hypertension in whom parathyroidectomy ameliorated both glucose control and blood pressure. Once high serum calcium levels were noticed, ultrasonography of neck confirmed a well-defined oval hypoechoic mass posterior to the right lobe of the thyroid, confirmed by scintiscan. Parathyroidectomy resulted in improvement of blood pressure and blood glucose. We could stop insulin and antihypertensive medications. We conclude that in patients with type 2 diabetes with vague complaints like fatigue, body ache, and refractory hypertension, as a part of the diagnostic workup, clinicians should also check serum calcium levels and parathyroid hormone to rule out hyperparathyroidism. Correction of hyperparathyroidism may result in improvement of hypertension and glucose control.

  15. Shared care management of patients with type 2 diabetes across the primary and secondary healthcare sectors

    DEFF Research Database (Denmark)

    Munch, Lene; Bennich, Birgitte; Arreskov, Anne B

    2016-01-01

    Assessment Measure III. The experiences of the patients and families when participating in the shared care program will be explored by collecting dyadic interviews. DISCUSSION: This study will evaluate the quality of a shared care programme for patients with T2D, and provide evidence about advantages......BACKGROUND: The prevalence of type 2 diabetes (T2D) is growing globally and hospital-based outpatient clinics are burdened with increasing numbers of patients. To ensure high quality treatment and care, it is necessary to structurally reorganise the management of patients with T2D. The objective...... of this study is to test if T2D patients (who are at intermediate risk of or are already having incipient diabetic complications) jointly managed by a hospital-based outpatient clinic and general practitioners (shared care programme) have a non-inferior outcome compared to an established programme...

  16. Perceptions of primary healthcare professionals towards their role in type 2 diabetes mellitus patient education in Brazil

    Directory of Open Access Journals (Sweden)

    Bodstein Regina CA

    2010-09-01

    Full Text Available Abstract Background The aim of the current study was to analyze the perceptions, knowledge, and practices of primary healthcare professionals in providing patient education to people with type 2 diabetes mellitus. Methods A total of 23 health professionals working in primary healthcare units in Belo Horizonte, Minas Gerais State, Brazil, participated in a focus group in order to discuss their patient education practices and the challenges for effective patient education in diabetes self-management. Results The results were categorized as follows: 1 lack of preparation and technical knowledge among the health professionals on some aspects of diabetes mellitus and the health professionals' patient education practices; 2 work conditions and organization; 3 issues related or attributed to the clientele themselves; and 4 diabetes care model. Conclusions This study highlights the importance of reorienting the patient education practices, health professionals' skills and work goals, and evaluation of the educational interventions, in order to establish strategies for health promotion and prevention and control of the disease. Descriptors Health Education; Prevention of Diabetes Mellitus; Primary Healthcare

  17. Cardiovascular risk management of different ethnic groups with type 2 diabetes in primary care in New Zealand.

    Science.gov (United States)

    Elley, C Raina; Kenealy, Tim; Robinson, Elizabeth; Bramley, Dale; Selak, Vanessa; Drury, Paul L; Kerse, Ngaire; Pearson, Janet; Lay-Yee, Roy; Arroll, Bruce

    2008-03-01

    To examine cardiovascular preventive and renal protective treatment for different ethnic groups with diabetes in primary care. The study population included patients with type 2 diabetes attending an annual review in New Zealand primary care during 2004. Primary care data were linked to hospital admission data to identify previous cardiovascular disease (CVD). For those without previous CVD, 5-year cardiovascular risk was calculated. Proportions on, and predictors of appropriate treatment according to guidelines were investigated. Data were available on 29,179 patients. Maori and Pacific participants had high rates of obesity, poor glycaemic control and albuminuria. Two thirds of all participants with previous CVD (68% of Maori and 70% of Pacific) and 44% with high CVD risk received appropriate CVD treatment; 73% of Maori, 62% of Pacific and 65% of European patients with albuminuria received ACE-inhibitors. Those with high CVD risk were more likely, and those that were young were less likely, to receive anti-hypertensive and lipid-lowering treatment after controlling for other factors. Maori and Pacific people were receiving similar high rates of appropriate CVD and renal preventive drug therapy to Europeans, but their prevalence of smoking, obesity, raised HbA1c and albuminuria were substantially higher. Non-drug components of preventive care also need to be addressed to reduce major ethnic disparities in diabetes-related morbidity and mortality in New Zealand.

  18. Can widely used cell type markers predict the suitability of immortalized or primary mammary epithelial cell models?

    Directory of Open Access Journals (Sweden)

    Edgar Corneille Ontsouka

    Full Text Available BACKGROUND: Mammary cell cultures are convenient tools for in vitro studies of mammary gland biology. However, the heterogeneity of mammary cell types, e.g., glandular milk secretory epithelial or myoepithelial cells, often complicates the interpretation of cell-based data. The present study was undertaken to determine the relevance of bovine primary mammary epithelial cells isolated from American Holstein (bMEC US or Swiss Holstein-Friesian (bMEC CH cows, and of primary bovine mammary alveolar epithelial cells stably transfected with simian virus-40 (SV-40 large T-antigen (MAC-T for in vitro analyses. This was evaluated by testing their expression pattern of cytokeratin (CK 7, 18, 19, vimentin, and α-smooth muscle actin (α-SMA. RESULTS: The expression of the listed markers was assessed using real-time quantitative PCR, flow cytometry and immunofluorescence microscopy. Characteristic markers of the mesenchymal (vimentin, myoepithelial (α-SMA and glandular secretory cells (CKs showed differential expression among the studied cell cultures, partly depending on the analytical method used. The relative mRNA expression of vimentin, CK7 and CK19, respectively, was lower (P < 0.05 in immortalized than in primary mammary cell cultures. The stain index (based on flow cytometry of CK7 and CK19 protein was lower (P < 0.05 in MAC-T than in bMECs, while the expression of α-SMA and CK18 showed an inverse pattern. Immunofluorescence microscopy analysis mostly confirmed the mRNA data, while partly disagreed with flow cytometry data (e.g., vimentin level in MAC-T. The differential expression of CK7 and CK19 allowed discriminating between immortal and primary mammary cultures. CONCLUSIONS: The expression of the selected widely used cell type markers in primary and immortalized MEC cells did not allow a clear preference between these two cell models for in vitro analyses studying aspects of milk composition. All tested cell models exhibited to a variable

  19. Feasibility analysis of the Primary Loop of Pool-Type Natural Circulating Nuclear Reactor Dedicated to Seawater Desalination

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Woonho; Jeong, Yong Hoon [KAIST, Daejeon (Korea, Republic of)

    2016-05-15

    In this study, the feasibility of natural circulation was evaluated for the reference plant AHR400 (Advanced Heating Reactor 400MWth). AHR400 is a pool-type desalination-dedicated nuclear reactor. As a consequence, AHR400 has low operating pressure and temperature which provides large safety margin. Removal of the reactor coolant pump from the AHR400 will enforce integrity of the reactor vessel and passive safety feature. Therefore, the study also tried to find out optimized primary loop design to achieve total natural circulation of the coolant. Natural circulation capacity of the primary loop of the desalination dedicated nuclear reactor AHR400 was evaluated. It was concluded that to remove RCP from the AHR400 and operates the reactor only by natural circulation of the coolant is impossible. Decreased core power as half make removal of RCP possible with 15m central height difference between the core and IHXs. Furthermore, validation and modification of pressure loss coefficients by small-scaled natural circulation experiment at a pool-type reactor would provide more accurate results.

  20. Type I primary neuropathic amyloidosis (Andrade, Portuguese: a clinical and laboratory study of 21 cases

    Directory of Open Access Journals (Sweden)

    Eduardo M. Azevedo

    1975-06-01

    Full Text Available The authors present a review of 21 cases with the diagnosis of type I amyloid neuropathy based on epidemiological data, clinical evolution and histopathological findings. They call attention to the possibility of cranial nerves involvement (hyposmia, diplopia, masseterian hypotrophy, peripheral facial paralysis, hypoacusis, dysphonia, laryngeal paralysis, dysphagia, and trapezium muscle hypotrophy, to the severeness of the digestive symptoms, to the precocity of the autonomic disorders, and to the rather high incidence (6 cases of heart involvement. The electromyography showed anterior horn involvement in 3 cases. The electrocardiography showed repolarization disorders in 11 cases, left ventricular overload in 6 cases and atrioventricular block in 5 cases. The serum proteins electrophoresis showed frequent abnormalities, but no typical curve could be obtained. The barium-contrasted X-rays of the gastrointestinal tract showed no anatomical lesions, but functional abnormalities (hypo or hypermotility were found in 14 examinations. The Schilling test showed impairment of vitamin B12 absorption in 50% of the cases. However, with the concomitant administration of intrinsic factor (3 cases there was improvement of its absorption. This proves that the gastric mucosa plays an important role in the disease malabsorption. The test with labeled-triolein showed slow absorption in 2 cases and steatorrhea in 3 (6 tests. For the confirmation of the amyloid deposits, the best histopathological procedure was nerve biopsy. In men, when the nerve biopsy was negative, testicular biopsy has shown to be a good option.

  1. Pore pressure measurement plan of near field rock used on three dimensional groundwater flow analysis in demonstration test of cavern type disposal facility

    International Nuclear Information System (INIS)

    Onuma, Kazuhiro; Terada, Kenji; Matsumura, Katsuhide; Koyama, Toshihiro; Yajima, Kazuaki

    2008-01-01

    Demonstration test of underground cavern type disposal facilities is planed though carrying out construction of full scale engineering barrier system which simulated in the underground space in full scale and under actual environment. This test consists of three part, these are construction test, performance test and measurement test. Behavior of near field rock mass is measured about hydrological behavior under and after construction to evaluate effect at test facility. To make plan of pore pressure measurement, three dimensional groundwater flow analysis has been carried out. Based on comparison of analysis before and after test, detail plan has been studied. (author)

  2. Productive vegetation: relationships between net primary productivity, vegetation types and climate change in the Wet Tropics bioregion

    International Nuclear Information System (INIS)

    Ramirez, Vanessa Valdez; Williams, Stephen E.; VanDerWal, Jeremy

    2007-01-01

    Full text: Full text: There is now ample evidence demonstrating the impacts of climate change on biodiversity and human society (Walther ef a/. 2002). Numerous studies have shown climate change is one of the most significant threats to tropical forests, such as the Wet Tropics Heritage Area, due to their high biodiversity and endemism (Pounds ef al. 1999; Hughes 2000; Parmesan and Yohe 2003). Williams ef al. (2003) suggested that small shifts in net primary productivity (NPP) as a result of climate change could lead to potentially massive follow-on effects for the extremely diverse and vulnerable rainforest flora and fauna. It is therefore crucial to explore the relationships between NPP and local biodiversity, especially to create models for different climate change scenarios. Nevertheless, NPP in the Wet Tropics has yet to be estimated. This is the first study to provide a general NPP estimate for the Wet Tropics bioregion using climate surrogates (Schuur 2003). This technique estimates NPP in an accurate, repeatable, and cost-effective way. NPP values were linked to vegetation types and examined under various climatic and environmental conditions. Results show a significant difference in productivity according to vegetation types and climatic variables, with temperature and rainfall seasonality as the most important determining variables. Additionally, lowland and upland vegetations showed a significant difference in productivity patterns throughout the year. Vegetation types located above 1000 metres in altitude had the lowest values of mean annual productivity due to their high rainfall and low temperatures; vegetation types located below 600 metres showed increased productivity values during the wet season (December-March). Net primary productivity will certainly be impacted by changes in temperature and rainfall, due to climate change. Although an increase in NPP values can be predicted for upland areas, the more widely distributed lowlands will drastically

  3. Primary osteopathy of vertebrae in a neurofibromatosis type 1 murine model.

    Science.gov (United States)

    Zhang, Wei; Rhodes, Steven D; Zhao, Liming; He, Yongzheng; Zhang, Yingze; Shen, Yong; Yang, Dalong; Wu, Xiaohua; Li, Xiaohong; Yang, Xianlin; Park, Su-Jung; Chen, Shi; Turner, Charles; Yang, Feng-Chun

    2011-06-01

    Neurofibromatosis type 1 (NF1) is a common autosomal dominant genetic disorder caused by mutation of the NF1 tumor suppressor gene. Spinal deformities are common skeletal manifestations in patients with NF1. To date, the mechanism of vertebral abnormalities remains unclear because of the lack of appropriate animal models for the skeletal manifestations of NF1. In the present study, we report a novel murine NF1 model, Nf1(flox/-);Col2.3Cre(+) mice. These mice display short vertebral segments. In addition, a significant reduction in cortical and trabecular bone mass of the vertebrae was observed in Nf1(flox/-);Col2.3Cre(+) mice as measured by dual-energy X-ray absorptiometry (DEXA) and peripheral quantitative computed tomography (pQCT). Peak stress and peak load were also significantly reduced in Nf1(flox/-);Col2.3Cre(+) mice as compared to controls. Furthermore, the lumbar vertebrae showed enlargement of the inter-vertebral canal, a characteristic feature of lumbar vertebrae in NF1 patients. Finally, histologic analysis demonstrated increased numbers of osteoclasts and decreased numbers of osteoblasts in the vertebrae of Nf1(flox/-);Col2.3Cre(+) mice in comparison to controls. In summary, Nf1(flox/-);Col2.3Cre(+) mice demonstrate multiple structural and functional abnormalities in the lumbar vertebrae which recapitulate the dystrophic vertebral changes in NF1 patients. This novel murine model provides a platform to understand the cellular and molecular mechanisms underlying the pathogenesis of spinal deficits in NF1 patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Perception of quality of maternal healthcare services among women utilising antenatal services in selected primary health facilities in Anambra State, Southeast Nigeria

    Science.gov (United States)

    Emelumadu, Obiageli F.; Onyeonoro, Ugochukwu Uchenna; Ukegbu, Andrew Ugwunna; Ezeama, Nkiru N.; Ifeadike, Chigozie Ozoemena; Okezie, Obasi Kanu

    2014-01-01

    Background: This is a cross-sectional descriptive study aimed at assessing antenatal care service attendees’ perception of quality of maternal healthcare (MHC) services in Anambra State, southeast Nigeria. Materials and Methods: A total of 310 pregnant women utilising antenatal care (ANC) services in three purposively selected primary health centres (PHCs) in rural communities in Anambra State were studied. Reponses were elicited from the participants selected consecutively over a 4-month period, using a pre-tested, semi-structured interviewer-administered questionnaire on socio-demographic characteristics, utilisation and perception of MHC services. Data collected were analysed using SPSS version 17. Results: Findings showed that utilisation of facility for both antenatal (97.0%; 95% CI, 94.4–98.4%) and natal services (92.7%; 95% CI 89.2–95.2%) were quite high. Generally, most of the women were satisfied with MHC services (89.7%). Most of them were satisfied with the staff attitude (85.1%), waiting time (84.1%) and cost of services (79.5%). Being ≥30 years (X2 = 4.61, P = 0.032), married (X2 = 9.70, P = 0.008) and multiparous (X2 = 9.14, P = 0.028), as well as utilisation of formal health facility for antenatal (X2 = 26.94, P = 0.000) and natal (X2 = 33.42, P = 0.000) services were associated with satisfaction with maternal health services. Conclusions: The study showed high level of satisfaction with quality of maternal health services among antenatal attendees and highlights the need to strengthen interventions that increase uptake of formal MHC services. PMID:24791050

  5. Primary fibromyalgia

    DEFF Research Database (Denmark)

    Jacobsen, S; Jensen, L T; Foldager, M

    1990-01-01

    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....

  6. Primary and secondary battery consumption trends in Sweden 1996-2013: method development and detailed accounting by battery type.

    Science.gov (United States)

    Patrício, João; Kalmykova, Yuliya; Berg, Per E O; Rosado, Leonardo; Åberg, Helena

    2015-05-01

    In this article, a new method based on Material Flow Accounting is proposed to study detailed material flows in battery consumption that can be replicated for other countries. The method uses regularly available statistics on import, industrial production and export of batteries and battery-containing electric and electronic equipment (EEE). To promote method use by other scholars with no access to such data, several empirically results and their trends over time, for different types of batteries occurrence among the EEE types are provided. The information provided by the method can be used to: identify drivers of battery consumption; study the dynamic behavior of battery flows - due to technology development, policies, consumers behavior and infrastructures. The method is exemplified by the study of battery flows in Sweden for years 1996-2013. The batteries were accounted, both in units and weight, as primary and secondary batteries; loose and integrated; by electrochemical composition and share of battery use between different types of EEE. Results show that, despite a fivefold increase in the consumption of rechargeable batteries, they account for only about 14% of total use of portable batteries. Recent increase in digital convergence has resulted in a sharp decline in the consumption of primary batteries, which has now stabilized at a fairly low level. Conversely, the consumption of integrated batteries has increased sharply. In 2013, 61% of the total weight of batteries sold in Sweden was collected, and for the particular case of alkaline manganese dioxide batteries, the value achieved 74%. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Promising adoption of an electronic clinical decision support system for antenatal and intrapartum care in rural primary healthcare facilities in sub-Saharan Africa: The QUALMAT experience.

    Science.gov (United States)

    Sukums, Felix; Mensah, Nathan; Mpembeni, Rose; Massawe, Siriel; Duysburgh, Els; Williams, Afua; Kaltschmidt, Jens; Loukanova, Svetla; Haefeli, Walter E; Blank, Antje

    2015-09-01

    The QUALMAT project has successfully implemented an electronic clinical decision support system (eCDSS) for antenatal and intrapartum care in two sub-Saharan African countries. The system was introduced to facilitate adherence to clinical practice guidelines and to support decision making during client encounter to bridge the know-do gap of health workers. This study aimed to describe health workers' acceptance and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system. This longitudinal study was conducted in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013 employing mixed methods. The study population included healthcare workers who were involved in the provision of maternal care in six rural PHC facilities from one district in each country where the eCDSS was implemented. All eCDSS users participated in the study with 61 and 56 participants at the midterm and final assessment, respectively. After several rounds of user training and support the eCDSS has been successfully adopted and constantly used during patient care in antenatal clinics and maternity wards. The eCDSS was used in 71% (2703/3798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1185/1427) and 67% (1435/2144) of all deliveries in Tanzania and in Ghana, respectively. Several barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and organization attributes. Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was successful and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our

  8. FAR FROM THE CITY LIGHTS: ENGLISH READING PERFORMANCE OF ESL LEARNERS IN DIFFERENT TYPES OF RURAL PRIMARY SCHOOL

    Directory of Open Access Journals (Sweden)

    Tintswalo Manyike

    2012-09-01

    Full Text Available In this paper, the findings of a research study, in which the English reading performances of Grade 7 English Second Language (ESL learners in four different types of rural primary school which use English as the language of learning and teaching (LoLT were observed, are examined and how poor scores can be partly explained by the social context of learners and schools is explored. Although the Language in Education Policy in South Africa seeks to distribute and maintain the linguistic capital of the official languages through its support of multilingualism, the predominant preference for English as the LoLT in schooling disadvantages most ESL learners and perpetuates inequality in learner outcomes. This situation is exacerbated in certain school contexts such as those in rural settings. Bourdieu’s theory of linguistic capital and Coleman’s distinction between school social capital and home social capital are used as theoretical frameworks to the empirical inquiry undertaken in this study. The findings indicate a difference in the grammar and comprehension scores of learners in the respective participating schools as well as a sharp difference in the performance of learners in the different types of school involved. This suggests the current use of English as the LoLT does not mean that linguistic capital is equally distributed throughout schools. School type can thus act as an agent of cultural reproduction which influences learner outcomes.

  9. Relationship between self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting.

    OpenAIRE

    Tharek, Zahirah; Ramli, Anis Safura; Whitford, David L; Ismail, Zaliha; Mohd Zulkifli, Maryam; Ahmad Sharoni, Siti Khuzaimah; Shafie, Asrul A; Jayaraman, Thevaraajan

    2018-01-01

    BACKGROUND: Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self...

  10. Knowledge of hypertension and its management among hypertensive patients on chronic medicines at primary health care public sector facilities in South Africa; findings and implications.

    Science.gov (United States)

    Rampamba, Enos M; Meyer, Johanna C; Helberg, Elvera; Godman, Brian

    2017-08-01

    There are high growing prevalence rates of hypertension in South Africa. Consequently, there is a need to assess knowledge and management among hypertensive patients receiving chronic medication from primary health care (PHC) facilities in South Africa as a basis for improving future management. This is important as South Africa seeks to improve its management of chronic diseases. Descriptive, quantitative study amongst chronic hypertensive patients in the chronic disease programme. Patients were interviewed face-to-face by trained pharmacists using a structured questionnaire. Data analysis included descriptive and inferential statistics. Half (53.7%) of the patients had uncontrolled blood pressure (BP). Less than a third of patients (27.7%) knew what hypertension is, the meaning of recorded BP numbers (4.5%), and what normal BP should be (19.9%). All patients who knew the meaning of BP numbers had formal education (p = 0.047). Only 15.6% of the 56.0% patients, who received hypertension information, received it on antihypertensive medicines specifically. The majority of the patients lacked hypertension specific knowledge and only half had controlled BP. Interventions to improve the control of high BP should be targeted at closing knowledge gaps as part of the current chronic treatment initiatives in South Africa to ensure the benefits of increased access to care are realized.

  11. Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review.

    Science.gov (United States)

    Noten, Suzie; Meeus, Mira; Stassijns, Gaetane; Van Glabbeek, Francis; Verborgt, Olivier; Struyf, Filip

    2016-05-01

    To systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder. PubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists. All English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included. Two reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials. The efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (n=2), Cyriax approach (n=1), and Maitland technique (n=6) showed improvement in pain score and ROM. With respect to translational mobilizations (n=1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (n=1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (n=1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (n=1) were found on both pain and ROM. Overall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment. Copyright © 2016

  12. Acknowledging and allocating responsibility for clinical inertia in the management of Type 2 diabetes in primary care: a qualitative study.

    Science.gov (United States)

    Zafar, A; Stone, M A; Davies, M J; Khunti, K

    2015-03-01

    Failure to intensify treatment in patients with Type 2 diabetes with suboptimal blood glucose control has been termed clinical inertia and has been shown to contribute to poorer patient outcomes. We aimed to identify and explore perceptions about clinical inertia from the perspective of primary healthcare providers. A qualitative study was conducted in Leicestershire and Northamptonshire, UK. Purposive sampling was based on healthcare providers working in primary care settings with 'higher' and 'lower' target achievement based on routine data. Twenty semi-structured interviews were conducted, face-to-face or by telephone. Thematic analysis was informed by the constant comparative approach. An important broad theme that emerged during the analysis was related to attribution and explanation of responsibility for clinical inertia. This included general willingness to accept a degree of responsibility for clinical inertia. In some cases, however, participants had inaccurate perceptions about levels of target achievement in their primary care centres, as indicated by routine data. Participants sought to lessen their own sense of accountability by highlighting patient-level barriers such as comorbidities and human fallibility, and also system-level barriers, particularly time constraints. Perceptions about ways of addressing the problem of clinical inertia were not seen as straightforward, further emphasizing a complex and cumulative pattern of barriers. In order to understand and address the problem of clinical inertia, provider, patient- and system-level barriers should be considered together rather than as separate issues. Acknowledgement of responsibility should be regarded positively as a motivator for change. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  13. Development of ANC-type empirical two-phase pump model for full size CANDU primary heat transport pump

    International Nuclear Information System (INIS)

    Chan, A.M.C.; Huynh, H.M.

    2004-01-01

    The development of an ANC-type empirical two-phase pump model for CANDU (Canadian Deuterium) reactor primary heat transport pumps is described in the present paper. The model was developed based on Ontario Hydro Technologies' full scale Darlington pump first quadrant test data. The functional form of the ANC model which is widely used was chosen to facilitate the implementation of the model into existing computer codes. The work is part of a bigger test program with the aims: (1) to produce high quality pump performance data under off-normal operating conditions using both full-size and model scale pumps; (2) to advance our basic understanding of the dominant mechanisms affecting pump performance based on more detailed local measurements; and (3) to develop a 'best-estimate' or improved pump model for use in reactor licensing and safety analyses. (author)

  14. Weak cation magnetic separation technology and MALDI-TOF-MS in screening serum protein markers in primary type I osteoporosis.

    Science.gov (United States)

    Shi, X L; Li, C W; Liang, B C; He, K H; Li, X Y

    2015-11-30

    We investigated weak cation magnetic separation technology and matrix-assisted laser desorption ionization-time of flight-mass spectrometry (MALDI-TOF-MS) in screening serum protein markers of primary type I osteoporosis. We selected 16 postmenopausal women with osteoporosis and nine postmenopausal women as controls to find a new method for screening biomarkers and establishing a diagnostic model for primary type I osteoporosis. Serum samples were obtained from controls and patients. Serum protein was extracted with the WCX protein chip system; protein fingerprints were examined using MALDI-TOF-MS. The preprocessed and model construction data were handled by the ProteinChip system. The diagnostic models were established using a genetic arithmetic model combined with a support vector machine (SVM). The SVM model with the highest Youden index was selected. Combinations with the highest accuracy in distinguishing different groups of data were selected as potential biomarkers. From the two groups of serum proteins, 123 cumulative MS protein peaks were selected. Significant intensity differences in the protein peaks of 16 postmenopausal women with osteoporosis were screened. The difference in Youden index between the four groups of protein peaks showed that the highest peaks had mass-to-charge ratios of 8909.047, 8690.658, 13745.48, and 15114.52. A diagnosis model was established with these four markers as the candidates, and the model specificity and sensitivity were found to be 100%. Two groups of specimens in the SVM results on the scatterplot were distinguishable. We established a diagnosis model, and provided a new serological method for screening and diagnosis of osteoporosis with high sensitivity and specificity.

  15. Understanding type 2 diabetes mellitus screening practices among primary care physicians: a qualitative chart-stimulated recall study.

    Science.gov (United States)

    Hafez, Dina; Nelson, Daniel B; Martin, Evan G; Cohen, Alicia J; Northway, Rebecca; Kullgren, Jeffrey T

    2017-04-04

    Early diagnosis and treatment of prediabetes and type 2 diabetes mellitus (T2DM) can prevent future health problems, yet many individuals with these conditions are undiagnosed. This could be due, in part, to primary care physicians' (PCP) screening practices, about which little is known. The objectives of this study were to identify factors that influence PCPs' decisions to screen patients for T2DM and to characterize their interpretation and communication of screening test results to patients. We conducted semi-structured chart-stimulated recall interviews with 20 University of Michigan Health System (UMHS) primary care physicians. PCPs were asked about their recent decisions to screen or not screen 134 purposively sampled non-diabetic patients who met American Diabetes Association criteria for screening for T2DM. Interviews were audio-recorded, transcribed, and analyzed using qualitative directed content analysis. Data on patient demographic characteristics and comorbidities were abstracted from the electronic health record. The most common reasons PCPs gave for not screening 63 patients for T2DM were knowledge of a previously normal screening test (49%) and a visit for reasons other than a health maintenance examination (48%). The most common reasons PCPs gave for screening 71 patients for T2DM were knowledge of a previously abnormal screening test (49%), and patients' weight (42%) and age (38%). PCPs correctly interpreted 89% of screening test results and communicated 95% of test results to patients. Among 24 patients found to have prediabetes, PCPs usually (58%) recommended weight loss and increased physical activity but never recommended participation in a Diabetes Prevention Program or use of metformin. Previous screening test results, visit types, and patients' weight and age influenced PCPs' decisions to screen for T2DM. When patients were screened, test results were generally correctly interpreted and consistently communicated. Recommendations to patients

  16. ATLAS Facility Description Report

    International Nuclear Information System (INIS)

    Kang, Kyoung Ho; Moon, Sang Ki; Park, Hyun Sik; Cho, Seok; Choi, Ki Yong

    2009-04-01

    A thermal-hydraulic integral effect test facility, ATLAS (Advanced Thermal-hydraulic Test Loop for Accident Simulation), has been constructed at KAERI (Korea Atomic Energy Research Institute). The ATLAS has the same two-loop features as the APR1400 and is designed according to the well-known scaling method suggested by Ishii and Kataoka to simulate the various test scenarios as realistically as possible. It is a half-height and 1/288-volume scaled test facility with respect to the APR1400. The fluid system of the ATLAS consists of a primary system, a secondary system, a safety injection system, a break simulating system, a containment simulating system, and auxiliary systems. The primary system includes a reactor vessel, two hot legs, four cold legs, a pressurizer, four reactor coolant pumps, and two steam generators. The secondary system of the ATLAS is simplified to be of a circulating loop-type. Most of the safety injection features of the APR1400 and the OPR1000 are incorporated into the safety injection system of the ATLAS. In the ATLAS test facility, about 1300 instrumentations are installed to precisely investigate the thermal-hydraulic behavior in simulation of the various test scenarios. This report describes the scaling methodology, the geometric data of the individual component, and the specification and the location of the instrumentations in detail

  17. Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study

    Directory of Open Access Journals (Sweden)

    Teshome W

    2015-05-01

    , age, facility type, and educational status were independently associated with LTFU. Moreover, baseline tuberculous disease, poor functional status, and follow-up at a health center were associated with an elevated probability of death. Conclusion: We observed a higher death rate and a lower LTFU rate in health centers than in hospitals. Most of the associated variables were also previously documented. Higher LTFU was noticed for patients with a smaller gap between testing and initiation of treatment. Keywords: antiretroviral therapy, primary care, loss to follow-up, death rates, Ethiopia

  18. High Nrf2 expression in alveolar type I pneumocytes is associated with low recurrences in primary spontaneous pneumothorax.

    Science.gov (United States)

    Chen, Yu-Wen; Chiu, Wen-Chin; Chou, Shah-Hwa; Su, Yu-Han; Huang, Ying-Fong; Lee, Yen-Lung; Yuan, Shyng-Shiou F; Lee, Yi-Chen

    2017-10-01

    Recurrent primary spontaneous pneumothorax (PSP) is a troublesome problem and a major concern for the patients. This study examined whether nuclear factor erythroid 2-related factor 2 (Nrf2) expression in alveolar type I pneumocytes was associated with the clinical manifestations of PSP patients including disease recurrence. Eighty-eight PSP patients who were managed with needlescopic video-assisted thoracoscopic surgery (NVATS) were included in this study. Immunohistochemistry (IHC) was assessed to determine Nrf2 expression in resected lung tissues and the results were correlated with clinicopathological characteristics by the chi-square or the Fisher's exact test. The prognostic value of Nrf2 for overall recurrence was evaluated by univariate and multivariable Cox regression model. The expression of Nrf2 was observed in type I pneumocytes of lung tissues from PSP patients by IHC. We found that low Nrf2 expression in PSP patients, especially in young (age ≤ 20, p = 0.033) and body mass index (BMI) ≥18 kg/m 2 (p = 0.019) groups, was significantly correlated with PSP recurrence. In the univariate and multivariate analyses, high Nrf2 expression was a significant protective factor for overall recurrence in PSP patients (univariate: p = 0.026; multivariate: p = 0.004). The expression level of Nrf2 in alveolar type I pneumocytes was a potential factor involved in PSP recurrence. Our findings suggest that elevated Nrf2 expression in PSP patients may be a promising way for reducing PSP recurrence. Copyright © 2017. Published by Elsevier Taiwan.

  19. Group Patient Education: Effectiveness of a Brief Intervention in People with Type 2 Diabetes Mellitus in Primary Health Care in Greece: A Clinically Controlled Trial

    Science.gov (United States)

    Merakou, K.; Knithaki, A.; Karageorgos, G.; Theodoridis, D.; Barbouni, A.

    2015-01-01

    This study aims to assess the impact of a brief patient group education intervention in people with type 2 diabetes mellitus. The sample, 193 people with type 2 diabetes mellitus who were patients at the diabetic clinic of a primary health care setting in Attica, was assigned to two groups, intervention (138 individuals) and control group (55…

  20. The effect of comorbidity on glycemic control and systolic blood pressure in type 2 diabetes: a cohort study with 5 year follow-up in primary care.

    NARCIS (Netherlands)

    Luijks, H.; Biermans, M.; Bor, H.; Weel, C. van; Lagro-Janssen, T.; Grauw, W. de; Schermer, T.

    2017-01-01

    Aims: To explore the longitudinal effect of chronic comorbid diseases on glycemic control (HbA1C) and systolic blood pressure (SBP) in type 2 diabetes patients. Methods: In a representative primary care cohort of patients with newly diagnosed type 2 diabetes in The Netherlands (n = 610), we tested

  1. Academic Achievement in Primary School in Offspring Born to Mothers With Type 1 Diabetes (the EPICOM Study): A Register-Based Prospective Cohort Study

    DEFF Research Database (Denmark)

    Knorr, Sine; Clausen, Tine D; Vlachová, Zuzana

    2015-01-01

    OBJECTIVE: This study examined the effect of maternal pregestational type 1 diabetes on offspring primary school performance. RESEARCH DESIGN AND METHODS: We performed a prospective combined clinical and register-based cohort study comparing primary school performance in offspring (n = 707......) of women with pregestational type 1 diabetes with matched control offspring (n = 60,341). We also examined the association between HbA1c levels during pregnancy and later school performance among offspring born to women with pregestational type 1 diabetes. RESULTS: Offspring of mothers with pregestational...

  2. PATTERNS OF DOMINANCE OF LANGUAGE VITALITIES AMONG MALAYSIAN STUDENTS IN PRIMARY NATIONAL-TYPE AND SECONDARY SCHOOLS

    Directory of Open Access Journals (Sweden)

    Soo Ying How

    2017-01-01

    Full Text Available Multilingualism is embedded in the Malaysian Education Blueprint (2015-2025 as a stated goal towards nation building. The education system provides opportunity to learn Malay which is the national language, the mother tongue (Mandarin or Tamil and the English language as part of formal schooling. In fact, Malaysian primary schools are classified into two major divisions. Students can opt to study in national schools in which the medium of instruction is Malay with the provision for the learning of English and a mother tongue. The other option allows students to enrol in national-type schools of which the medium of instruction is either Mandarin or Tamil, with English and Malay taught as academic subjects. At secondary level, the medium of instruction in national schools is Malay and students are provided the opportunity to learn their mother tongue and English. Other than in school, other social milieus also allow the use and practice of these languages. Given this linguistic environment, there exists a myriad of language experiences within and outside formal learning which together would influence the totality of language vitality. This paper investigates language vitality featured in this multilingual environment. It focuses on the vitality of the English language among students that appears to co-exist with the learning and use of other languages as they progress through the primary and secondary levels. The vitality is measured by the following indicators: language preference, choice, dominance, use, attitude and motivation and proficiency which were used to develop a questionnaire to obtain data on strength evaluation of these languages. The methodology encompasses random and convenient sampling to obtain representative responses from students with different levels of education and language experiences. The study reveals relative vitalities of languages used and highlights values attached to languages at different points of language

  3. Guide to research facilities

    Energy Technology Data Exchange (ETDEWEB)

    1993-06-01

    This Guide provides information on facilities at US Department of Energy (DOE) and other government laboratories that focus on research and development of energy efficiency and renewable energy technologies. These laboratories have opened these facilities to outside users within the scientific community to encourage cooperation between the laboratories and the private sector. The Guide features two types of facilities: designated user facilities and other research facilities. Designated user facilities are one-of-a-kind DOE facilities that are staffed by personnel with unparalleled expertise and that contain sophisticated equipment. Other research facilities are facilities at DOE and other government laboratories that provide sophisticated equipment, testing areas, or processes that may not be available at private facilities. Each facility listing includes the name and phone number of someone you can call for more information.

  4. Type B Drum packages

    International Nuclear Information System (INIS)

    Edwards, W.S.

    1995-11-01

    The Type B Drum package is a container in which a single drum containing Type B quantities of radioactive material will be packaged for shipment. The Type B Drum containers are being developed to fill a void in the packaging and transportation capabilities of the US Department of Energy (DOE), as no double containment packaging for single drums of Type B radioactive material is currently available. Several multiple-drum containers and shielded casks presently exist. However, the size and weight of these containers present multiple operational challenges for single-drum shipments. The Type B Drum containers will offer one unshielded version and, if needed, two shielded versions, and will provide for the option of either single or double containment. The primary users of the Type B Drum container will be any organization with a need to ship single drums of Type B radioactive material. Those users include laboratories, waste retrieval facilities, emergency response teams, and small facilities

  5. Facile fabrication of wire-type indium gallium zinc oxide thin-film transistors applicable to ultrasensitive flexible sensors.

    Science.gov (United States)

    Kim, Yeong-Gyu; Tak, Young Jun; Kim, Hee Jun; Kim, Won-Gi; Yoo, Hyukjoon; Kim, Hyun Jae

    2018-04-03

    We fabricated wire-type indium gallium zinc oxide (IGZO) thin-film transistors (TFTs) using a self-formed cracked template based on a lift-off process. The electrical characteristics of wire-type IGZO TFTs could be controlled by changing the width and density of IGZO wires through varying the coating conditions of template solution or multi-stacking additional layers. The fabricated wire-type devices were applied to sensors after functionalizing the surface. The wire-type pH sensor showed a sensitivity of 45.4 mV/pH, and this value was an improved sensitivity compared with that of the film-type device (27.6 mV/pH). Similarly, when the wire-type device was used as a glucose sensor, it showed more variation in electrical characteristics than the film-type device. The improved sensing properties resulted from the large surface area of the wire-type device compared with that of the film-type device. In addition, we fabricated wire-type IGZO TFTs on flexible substrates and confirmed that such structures were very resistant to mechanical stresses at a bending radius of 10 mm.

  6. Treatment of Type 2 Diabetes Mellitus in a Primary Care Setting in Taiwan: Comparison with Secondary/Tertiary Care

    Directory of Open Access Journals (Sweden)

    Tong-Yuan Tai

    2006-01-01

    Conclusion: Diabetes control was poorer in primary care than in secondary/tertiary care patients, but control of blood pressure was better in primary care patients. The shorter duration of diabetes and better control of blood pressure in primary care patients and in patients aged < 65 years compared with their elderly counterparts might be related to a lower prevalence of complications.

  7. Prevalence, correlates, attitude and treatment seeking of erectile dysfunction among type 2 diabetic Chinese men attending primary care outpatient clinics

    Directory of Open Access Journals (Sweden)

    Wai Hon Lo

    2014-10-01

    Full Text Available To investigate the prevalence, correlates, attitude and treatment seeking behavior of erectile dysfunction (ED in type 2 diabetes mellitus (T2DM patients in the primary care setting, a multi-center cross-sectional survey using a structured anonymous self-administered questionnaire was performed in 10 general outpatient clinics. Of the 603 subjects (91% response rate, the prevalence of ED men, as defined by the International Index of Erectile Function, was 79.1%. Most subjects had mild ED (28.9%, followed by mild-to-moderate ED (27.9%, then moderate ED (13.4% and severe ED (9%. Nearly 55% of those with ED did not consider themselves as having ED. Less than 10% of them had ever sought medical treatment, although 76.1% of them wished to receive management from doctor(s should they be diagnosed with ED. They considered the most important management from doctors to be clinical assessment (41.7%, followed by management of potential underlying cause (37.8%, referral to specialist (27.5%, education (23.9%, prescription of phosphodiesterase type 5 inhibitors (16.9% and referral to counseling service (6.7%. The prevalence of ED was strongly associated with subjects who thought they had ED (odds ratio (OR = 90.49 (20.00-409.48, P< 0.001 and were from the older age group (OR = 1.043 (1.011-1.076, P= 0.008. In conclusion, ED is highly prevalent among T2DM men. The majority of them wanted management from doctors should they have ED, but only a minority would actually voice out the request. Screening of ED among T2DM men using structural questionnaire allowed the diagnosis of more than half of the ED cases, which otherwise would have gone undiagnosed.

  8. Global Transcriptome Analysis of Primary Cerebrocortical Cells: Identification of Genes Regulated by Triiodothyronine in Specific Cell Types.

    Science.gov (United States)

    Gil-Ibañez, Pilar; García-García, Francisco; Dopazo, Joaquín; Bernal, Juan; Morte, Beatriz

    2017-01-01

    Thyroid hormones, thyroxine, and triiodothyronine (T3) are crucial for cerebral cortex development acting through regulation of gene expression. To define the transcriptional program under T3 regulation, we have performed RNA-Seq of T3-treated and untreated primary mouse cerebrocortical cells. The expression of 1145 genes or 7.7% of expressed genes was changed upon T3 addition, of which 371 responded to T3 in the presence of cycloheximide indicating direct transcriptional regulation. The results were compared with available transcriptomic datasets of defined cellular types. In this way, we could identify targets of T3 within genes enriched in astrocytes and neurons, in specific layers including the subplate, and in specific neurons such as prepronociceptin, cholecystokinin, or cortistatin neurons. The subplate and the prepronociceptin neurons appear as potentially major targets of T3 action. T3 upregulates mostly genes related to cell membrane events, such as G-protein signaling, neurotransmission, and ion transport and downregulates genes involved in nuclear events associated with the M phase of cell cycle, such as chromosome organization and segregation. Remarkably, the transcriptomic changes induced by T3 sustain the transition from fetal to adult patterns of gene expression. The results allow defining in molecular terms the elusive role of thyroid hormones on neocortical development. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  9. Liver peroxisomal alanine:glyoxylate aminotransferase and the effects of mutations associated with Primary Hyperoxaluria Type I: An overview.

    Science.gov (United States)

    Oppici, Elisa; Montioli, Riccardo; Cellini, Barbara

    2015-09-01

    Liver peroxisomal alanine:glyoxylate aminotransferase (AGT) (EC 2.6.1.44) catalyses the conversion of l-alanine and glyoxylate to pyruvate and glycine, a reaction that allows glyoxylate detoxification. Inherited mutations on the AGXT gene encoding AGT lead to Primary Hyperoxaluria Type I (PH1), a rare disorder characterized by the deposition of calcium oxalate crystals primarily in the urinary tract. Here we describe the results obtained on the biochemical features of AGT as well as on the molecular and cellular effects of polymorphic and pathogenic mutations. A complex scenario on the molecular pathogenesis of PH1 emerges in which the co-inheritance of polymorphic changes and the condition of homozygosis or compound heterozygosis are two important factors that determine the enzymatic phenotype of PH1 patients. All the reported data represent relevant steps toward the understanding of genotype/phenotype correlations, the prediction of the response of the patients to the available therapies, and the development of new therapeutic approaches. This article is part of a Special Issue entitled: Cofactor-dependent proteins: evolution, chemical diversity and bio-applications. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. A two-plasmid strategy for engineering a dengue virus type 3 infectious clone from primary Brazilian isolate.

    Science.gov (United States)

    Santos, Jefferson J S; Cordeiro, Marli T; Bertani, Giovani R; Marques, Ernesto T A; Gil, Laura H V G

    2014-12-01

    Dengue infections represent one of the most prevalent arthropod-borne diseases worldwide, causing a wide spectrum of clinical outcomes. Engineered infectious clone is an important tool to study Dengue virus (DENV) biology. Functional full-length cDNA clones have been constructed for many positive-strand RNA viruses and have provided valuable tools for studying the molecular mechanisms involved in viral genome replication, virion assembly, virus pathogenesis and vaccine development. We report herein the successful development of an infectious clone from a primary Brazilian isolate of dengue virus 3 (DENV3) of the genotype III. Using a two-plasmid strategy, DENV3 genome was divided in two parts and cloned separately into a yeast-bacteria shuttle vector. All plasmids were assembled in yeast by homologous recombination technique and a full-length template for transcription was obtained by in vitro ligation of the two parts of the genome. Transcript-derived DENV3 is infectious upon transfection into BHK-21 cells and in vitro characterization confirmed its identity. Growth kinetics of transcript-derived DENV3 was indistinguishable from wild type DENV3. This system is a powerful tool that will help shed light on molecular features of DENV biology, as the relationship of specific mutations and DENV pathogenesis.

  11. A new AMS facility based on a Cockcroft-Walton type 1 MV tandetron at IFIN-HH Magurele, Romania

    Science.gov (United States)

    Stan-Sion, C.; Enachescu, M.; Ghita, D. G.; Calinescu, C. I.; Petre, A.; Mosu, D. V.; Klein, M.

    2014-01-01

    A 1 MV AMS machine was recently installed in the National Institute for Physics and Nuclear Engineering IFIN-HH, Bucharest Romania. It is the second AMS facility at IFIN-HH having the goal not only to continue but mainly to enlarge the research area of this highly sensitive analyzing method. The multi-element AMS was developed by HVEE to measure 14C, 10Be, and 26Al, and 129I. The results of an acceptance test are presented and demonstrate that this machine is capable of routine 14C age dating and of measurements of other radioisotopes in terms of accuracy and precision as well as a low background level.

  12. National Solar Thermal Test Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The National Solar Thermal Test Facility (NSTTF) is the only test facility in the United States of its type. This unique facility provides experimental engineering...

  13. Severe fuel damage experiments performed in the QUENCH facility with 21-rod bundles of LWR-type

    International Nuclear Information System (INIS)

    Sepold, L.; Hering, W.; Schanz, G.; Scholtyssek, W.; Steinbrueck, M.; Stuckert, J.

    2006-01-01

    The objective of the QUENCH experimental program at the Karlsruhe Research Center is to investigate core degradation and the hydrogen source term that results from quenching/flooding an uncovered core, to examine the physical/chemical behavior of overheated fuel elements under different flooding conditions, and to create a data base for model development and improvement of severe fuel damage (SFD) code systems. The large-scale 21-rod bundle experiments conducted in the QUENCH out-of-pile facility are supported by an extensive separate-effects test program, by modeling activities as well as application and improvement of SFD code systems. International cooperations exist with institutions mainly within the European Union but e.g. also with the Russian Academy of Science (IBRAE, Moscow) and the CSARP program of the USNRC. So far, eleven experiments have been performed, two of them with B 4 C absorber material. Experimental parameters were: the temperature at initiation of reflood, the degree of peroxidation, the quench medium, i.e. water or steam, and its injection rate, the influence of a B 4 C absorber rod, the effect of steam-starved conditions before quench, the influence of air oxidation before quench, and boil-off behavior of a water-filled bundle with subsequent quenching. The paper gives an overview of the QUENCH program with its organizational structure, describes the test facility and the test matrix with selected experimental results. (author)

  14. Health Systems Readiness to Manage the Hypertension Epidemic in Primary Health Care Facilities in the Western Cape, South Africa: A Study Protocol.

    Science.gov (United States)

    Deuboué Tchialeu, Rodrigue Innocent; Yaya, Sanni; Labonté, Ronald

    2016-02-29

    (IDRC). The study is currently in the data analysis phase and results are expected during the first half of 2016. This investigation will highlight the detailed processes in place for the care of hypertensive patients in primary health care facilities, and thus also identify the challenges. It will also describe the drug supply chain management systems in place and identify their strengths and weaknesses. The findings, along with the estimates from modeling and simulation, will inform the health system minimum requirements to scale-up interventions to manage and control the hypertension epidemic in the Western Cape province of South Africa.

  15. The elimination rates of intact GIP as well as its primary metabolite, GIP 3-42, are similar in type 2 diabetic patients and healthy subjects

    DEFF Research Database (Denmark)

    Vilsbøll, Tina; Agersø, Henrik; Lauritsen, Torsten

    2006-01-01

    in the two groups and ranged from 8 to 21 l per subject. The primary metabolite, GIP 3-42, generated through the action of dipeptidyl peptidase IV (DPP-IV), was eliminated with a mean half-life of 17.5 and 20.5 min in patients and healthy subjects (NS). CONCLUSION: Elimination of GIP is similar in obese type...... 2 diabetic patients and matched healthy subjects. Differences in elimination of GIP and its primary metabolite, therefore, do not seem to contribute to the defective insulinotropic effect of GIP in type 2 diabetes....

  16. I. Do chronic pain patients' perceptions about their preinjury jobs determine their intent to return to the same type of job post-pain facility treatment?

    Science.gov (United States)

    Fishbain, D A; Rosomoff, H L; Cutler, R B; Steele-Rosomoff, R

    1995-12-01

    To demonstrate that chronic pain patients' (CPPs') perceptions about their preinjury jobs determine their intent to return to the same type of job post pain facility treatment. A total of 225 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relating to intent to return to the same type of preinjury job post-pain facility treatment. The CPPs were broken down into subgroups (males, females, college males, noncollege males, college females, noncollege females), and within each subgroup those not intending to return to the same type of pre-injury job were compared to those intending to return on the preinjury job perception questions. In addition for the whole group, stepwise discriminant analysis was used to predict who planned to return to the preinjury job utilizing the job perceptions questions. Multidisciplinary Pain Center. Consecutive chronic pain patients. For the whole group, CPPs not intending to return were more likely to complain of job excessive physical demands, job satisfaction, and job dislike. Job perception complaints that were significantly different between the intending and not intending to return groups differed between the subgroups. For example, noncollege males not intending to return were more likely to complain of excessive physical demands only versus satisfaction and liking as significant items for college males who did not intend to return. Within the discriminant analysis, the combination of job satisfaction, excessive physical demands, employee conflicts, job liking, job dangerousness, supervisory conflicts, job stress, and age classified 73.46% of the CPPs correctly as to intent to return to the same type of preinjury job. There appears to be a relationship between preinjury job perceptions and intent to return to the same type of job post pain treatment. However, subgroups of CPPs will differ by which job perceptions are important towards making that decision.

  17. Sensitivity to Nuclear Data and Neutron Source Type in Calculations of Transmutation Capabilities of the Energy Amplifier Demonstration Facility

    International Nuclear Information System (INIS)

    Dahlfors, Marcus

    2003-05-01

    This text is a summary of two studies the author has performed within the field of 3-D Monte Carlo calculations of Accelerator Driven Systems (ADS) for transmutation of nuclear waste. The simulations were carried out with the state-of-the-art computer code package EA-MC, developed by C. Rubbia and his group at CERN. The concept studied is ANSALDOs 80 MWth Energy Amplifier Demonstration Facility based on classical MOX-fuel technology and on molten Lead-Bismuth Eutectic cooling. A review of neutron cross section sensitivity in numerical calculations of an ADS and a comparative assessment relevant to the transmutation efficiency of plutonium and minor actinides in fusion/fission hybrids and ADS are presented

  18. Sensitivity to Nuclear Data and Neutron Source Type in Calculations of Transmutation Capabilities of the Energy Amplifier Demonstration Facility

    Energy Technology Data Exchange (ETDEWEB)

    Dahlfors, Marcus

    2003-05-01

    This text is a summary of two studies the author has performed within the field of 3-D Monte Carlo calculations of Accelerator Driven Systems (ADS) for transmutation of nuclear waste. The simulations were carried out with the state-of-the-art computer code package EA-MC, developed by C. Rubbia and his group at CERN. The concept studied is ANSALDOs 80 MWth Energy Amplifier Demonstration Facility based on classical MOX-fuel technology and on molten Lead-Bismuth Eutectic cooling. A review of neutron cross section sensitivity in numerical calculations of an ADS and a comparative assessment relevant to the transmutation efficiency of plutonium and minor actinides in fusion/fission hybrids and ADS are presented.

  19. Molecular Mechanisms of Disease Progression in Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type during Ibrutinib Therapy

    Directory of Open Access Journals (Sweden)

    Lucy C. Fox

    2018-06-01

    Full Text Available Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT is one of the well-recognized extranodal lymphomas commonly addicted to the B-cell receptor-MYD88 superpathway. We aimed to describe the genomic changes in a patient who progressed through treatment with ibrutinib, a Bruton’s tyrosine kinase (BTK inhibitor. An 80-year-old woman presented with multiply relapsed PCDLBCL-LT after multiple lines of chemoimmunotherapy and radiotherapy. Pre-treatment testing of the localized cutaneous tumor lesion on a lymphoid amplicon panel demonstrated an MYD88 p.L265P mutation. Ibrutinib therapy was subsequently commenced, resulting in complete resolution of the skin disease. Despite an ongoing skin response, the patient developed progressive nodal disease at two months. Genomic analysis of the cutaneous tumor sample at baseline was compared to that of the inguinal lymph node upon progression, and revealed the acquisition of multiple genomic changes. These included several aberrations expected to bypass BTK inhibition, including two CARD11-activating mutations, and a deleterious mutation in the nuclear factor kappa B (NF-κB negative regulator, NFKBIE. In addition, an IgH-IRF8 translocation was detected (which brings the IRF8 transcription factor under control of the immunoglobulin heavy chain locus, representing a third plausible mechanism contributing to ibrutinib resistance. Several copy-number changes occurred in both samples, including an amplification of 18q, which encodes the anti-apoptotic protein BCL2. We describe the first case of novel genomic changes of PCDLBCL-LT that occurred while on ibrutinib, providing important mechanistic insights into both pathogenesis and drug resistance.

  20. Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Jessie Nallely Zurita-Cruz

    Full Text Available Abstract Objectives: In prepubertal type 1 diabetic patients (DM1, the availability of an informal primary caregiver (ICP is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire, family functionality (family APGAR, support of another person in patient care, stress (Perceived Stress Scale, and socioeconomic status (Bronfman questionnaire. Multivariate logistic and linear regression analyses were performed. Results: The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p = 0.001. While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238-1.743, p = 0.011 and stress (β 1.918, 95% CI 1.10-2.736, p = 0.001 in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336-2.177, p = 0.008 were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.

  1. An online photographic catalog of primary types of Platygastroidea (Hymenoptera in the National Museum of Natural History, Smithsonian Institution

    Directory of Open Access Journals (Sweden)

    Elijah J. Talamas

    2017-06-01

    Full Text Available A photographic catalog of primary types of Platygastroidea housed in the National Insect Collection, National Museum of Natural History, is here made available online at the image database at The Ohio State University (specimage.osu.edu. Following examination of this collection we enact the following taxonomic changes: Leptacis piniella MacGown syn. n. is treated as a junior synonym of Leptacis pinicola MacGown; Sacespalus indicus Mani is transferred to Platygaster Latreille; Platygaster indica Mukerjee is given the replacement name Platygaster chaos Talamas, n. n.; Synopeas rugiceps (Ashmead, comb. n. is transferred from Leptacis Förster; Axea atriclava (Kieffer, comb. n. is transferred from Psilanteris Kieffer; Chakra pachmarhica (Sharma, comb. n. is transferred from Paridris Kieffer; Paridris dubeyi Sharma, syn. n. is treated as a junior synonym of Chakra pachmarhica; Holoteleia indica (Mani is transferred to Opisthacantha Ashmead and given a replacement name, Opisthacantha nomados Talamas, n. n.; Psilanteris nigriclavata (Ashmead, comb. n. is transferred from Anteris Förster; Probaryconus grenadensis (Ashmead, comb. n. is transferred from Monoteleia Kieffer; Monoteleia syn.n. is treated as a junior synonym of Probaryconus Kieffer; Paridris karnatakensis Sharma, syn. n is treated as a junior synonym of Probaryconus cauverycus Saraswat; Probaryconus punctatus (Ashmead, comb. n. is transferred from Oxyteleia Kieffer; Triteleia bengalensis (Saraswat, comb. n. is transferred from Alloteleia Kieffer; Trimorus varius Fouts, syn. n. and Trimorus pulchricornis Fouts, syn. n. are treated as junior synonyms of Trimorus annulicornis (Ashmead; Neotypes are designated for Gryon leptocorisae (Howard, Idris seminiger (Ashmead, Telenomus graptae Howard, Telenomus persimilis Ashmead, and Telenomus rileyi Howard; lectotypes are designated for Cremastobaeus bicolor Ashmead, Oethecoctonus insularis (Ashmead, Oethecoctonus laticinctus (Ashmead and Probaryconus

  2. DJ-1 Modulates Nuclear Erythroid 2-Related Factor-2-Mediated Protection in Human Primary Alveolar Type II Cells in Smokers.

    Science.gov (United States)

    Bahmed, Karim; Messier, Elise M; Zhou, Wenbo; Tuder, Rubin M; Freed, Curt R; Chu, Hong Wei; Kelsen, Steven G; Bowler, Russell P; Mason, Robert J; Kosmider, Beata

    2016-09-01

    Cigarette smoke (CS) is a main source of oxidative stress and a key risk factor for emphysema, which consists of alveolar wall destruction. Alveolar type (AT) II cells are in the gas exchange regions of the lung. We isolated primary ATII cells from deidentified organ donors whose lungs were not suitable for transplantation. We analyzed the cell injury obtained from nonsmokers, moderate smokers, and heavy smokers. DJ-1 protects cells from oxidative stress and induces nuclear erythroid 2-related factor-2 (Nrf2) expression, which activates the antioxidant defense system. In ATII cells isolated from moderate smokers, we found DJ-1 expression by RT-PCR, and Nrf2 and heme oxygenase (HO)-1 translocation by Western blotting and immunocytofluorescence. In ATII cells isolated from heavy smokers, we detected Nrf2 and HO-1 cytoplasmic localization. Moreover, we found high oxidative stress, as detected by 4-hydroxynonenal (4-HNE) (immunoblotting), inflammation by IL-8 and IL-6 levels by ELISA, and apoptosis by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay in ATII cells obtained from heavy smokers. Furthermore, we detected early DJ-1 and late Nrf2 expression after ATII cell treatment with CS extract. We also overexpressed DJ-1 by adenovirus construct and found that this restored Nrf2 and HO-1 expression and induced nuclear translocation in heavy smokers. Moreover, DJ-1 overexpression also decreased ATII cell apoptosis caused by CS extract in vitro. Our results indicate that DJ-1 activates the Nrf2-mediated antioxidant defense system. Furthermore, DJ-1 overexpression can restore the impaired Nrf2 pathway, leading to ATII cell protection in heavy smokers. This suggests a potential therapeutic strategy for targeting DJ-1 in CS-related lung diseases.

  3. Facile synthesis of bismuth oxyhalide nanosheet films with distinct conduction type and photo-induced charge carrier behavior

    Science.gov (United States)

    Jia, Huimin; He, Weiwei; Zhang, Beibei; Yao, Lei; Yang, Xiaokai; Zheng, Zhi

    2018-05-01

    A modified successive ionic layer adsorption and reaction (SILAR) method was developed to fabricate 2D ordered BiOX (X = CI, Br, I) nanosheet array films on FTO substrates at room temperature. The formation of BiOX films were characterized by X-ray powder diffraction (XRD), scanning electron microscopy (SEM), high resolution transmission electron microscopy (HRTEM), UV-vis absorption spectroscopy, and X-ray photoelectron spectroscopy (XPS). The semiconductor surface states determine the type of semiconductor. Although BiOCI, BiOBr and BiOI belong to the bismuth oxyhalide semiconductor family and possess similar crystal and electronic structures, they show different conductivity types due to their respective surface states. Mott-Schottky curve results demonstrate that the BiOCl and BiOI nanosheet arrays display n-type semiconductor properties, while the BiOBr films exhibit p-type semiconductor properties. Assisted by surface photovoltage (SPV) and transient photovoltage (TPV) techniques, the photoinduced charge transfer dynamics on the surface/interface of the BiOX/FTO nanosheet films were systematically and comparatively investigated. As revealed by the results, both the separation and transfer dynamics of the photo-induced carrier are influenced by film thickness.

  4. Facile preparation of hierarchically porous diatomite/MFI-type zeolite composites and their performance of benzene adsorption: the effects of NaOH etching pretreatment.

    Science.gov (United States)

    Yu, Wenbin; Yuan, Peng; Liu, Dong; Deng, Liangliang; Yuan, Weiwei; Tao, Bo; Cheng, Hefa; Chen, Fanrong

    2015-03-21

    Hierarchically porous diatomite/MFI-type zeolite (Dt/Z) composites with excellent benzene adsorption performance were prepared. The hierarchical porosity was generated from the microporous zeolite coated at the surface of diatom frustules and from the macroporous diatomite support. A facile NaOH etching method was employed for the first time to treat the frustule support, followed by hydrothermal growth of MFI-type zeolite at the surface of frustules previously seeded with nanocrystalline silicalite-1 (Sil-1). NaOH etching enlarged the pores on diatom frustules and further increased the coated zeolite contents (W(z)). The central macropore size of the diatom frustules increased from approximately 200-500 nm to 400-1000 nm after NaOH etching. The W(z) could reach 61.2%, while the macroporosity of the composites was largely preserved due to more voids for zeolite coating being formed by NaOH etching. The Dt/Z composites exhibited higher benzene adsorption capacity per unit mass of zeolite and less mass transfer resistance than Sil-1, evaluated via a method of breakthrough curves. These results demonstrate that etching of a diatomite support is a facile but crucial process for the preparation of Dt/Z composites, enabling the resulting composites to become promising candidates for uses in volatile organic compounds emission control. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Spread of CTX-M-type ESßLs in isolates of E. coli from long-term care and rehabilitation facilities in Northern Italy

    Directory of Open Access Journals (Sweden)

    Elisabetta Nucleo

    2008-09-01

    Full Text Available During the period March 2003 – May 2004 at the Laboratory of Clinical Microbiology “Redaelli” LTCRF in Milan, Italy, a total of 529 E. coli, obtained from inpatients of 3 different Long Term Care Rehabilitation Facilities (LTCRFs in Northern Italy, were processed and 77 ESßLs producers (14.5% were identified by Vitek System. The results were confirmed by double-disk synergy test with tazobactam (TZP. 61/77 isolates were characterized by higher levels of resistance to cefotaxime (CTX than to ceftazidime (CAZ. (ß-lactamase production was investigated by analytical isoelectric focusing (IEF coupled with a bioassay and showed multiple (ß-lactamase bands including one enzyme with pI 8.4 that, in a bioassay, was more active on CTX,ATM than on CAZ. The presence of (ß-lactamase genes was investigated by colony blot hybridization and by PCR amplification of blaTEM, blaSHV and blaCTX-M alleles. 43/61 isolates produced both TEM-1 and CTX-M-type enzymes, 14/61 expressed only CTX-M-type while in 4 cases were found blaCTX-M, blaTEM and blaSHV genes.The remainders (16/77, characterized by high levels of resistance to both CTX and CAZ, produced TEM-1 and SHV-5 enzymes (1/16 and TEM type ESßLs (15/16. Conjugation experiments, performed in liquid medium, confermed that the ESßLs determinants were transferable. Pulsed-field gel electrophoresis profiles of genomic DNA, digested with NotI, were analysed and revealed clonal heterogeneity. Our work confirms the emergence of CTX-M-type enzymes and their spread in Northern Italy also in longterm care and rehabilitation facilities that may be an important reservoir of ES?L producing E. coli.

  6. Combined human papillomavirus typing and TP53 mutation analysis in distinguishing second primary tumors from lung metastases in patients with head and neck squamous cell carcinoma.

    Science.gov (United States)

    Daher, Tamas; Tur, Mehmet Kemal; Brobeil, Alexander; Etschmann, Benjamin; Witte, Biruta; Engenhart-Cabillic, Rita; Krombach, Gabriele; Blau, Wolfgang; Grimminger, Friedrich; Seeger, Werner; Klussmann, Jens Peter; Bräuninger, Andreas; Gattenlöhner, Stefan

    2018-06-01

    In head and neck squamous cell carcinoma (HNSCC), the occurrence of concurrent lung malignancies poses a significant diagnostic challenge because metastatic HNSCC is difficult to discern from second primary lung squamous cell carcinoma (SCC). However, this differentiation is crucial because the recommended treatments for metastatic HNSCC and second primary lung SCC differ profoundly. We analyzed the origin of lung tumors in 32 patients with HNSCC using human papillomavirus (HPV) typing and targeted next generation sequencing of all coding exons of tumor protein 53 (TP53). Lung tumors were clearly identified as HNSCC metastases or second primary tumors in 29 patients, thus revealing that 16 patients had received incorrect diagnoses based on clinical and morphological data alone. The HPV typing and mutation analysis of all TP53 coding exons is a valuable diagnostic tool in patients with HNSCC and concurrent lung SCC, which can help to ensure that patients receive the most suitable treatment. © 2018 Wiley Periodicals, Inc.

  7. Changes in feedwater organic matter concentrations based on intake type and pretreatment processes at SWRO facilities, Red Sea, Saudi Arabia

    KAUST Repository

    Dehwah, Abdullah

    2015-03-01

    Transparent exopolymer particles (TEP), natural organic matter, and bacterial concentrations in feedwater are important factors that can lead to membrane biofouling in seawater reverse osmosis (SWRO) systems. Two methods for controlling these concentrations in the feedwater prior to pretreatment have been suggested; use of subsurface intake systems or placement of the intake at a greater depth in the sea. These proposed solutions were tested at two SWRO facilities located along the Red Sea of Saudi Arabia. A shallow well intake system was very effective in reducing the algae and bacterial concentrations and somewhat effective in reducing TEP concentrations. An intake placed at a depth of 9. m below the surface was found to have limited impact on improving water quality compared to a surface intake. The algae and bacteria concentration in the feedwater (deep) was lower compared to the surface seawater, but the overall TEP concentration was higher. Bacteria and TEP measurements made in the pretreatment process train in the plant and after the cartridge filters suggest that regrowth of bacteria is occurring within the cartridge filters.

  8. Changes in feedwater organic matter concentrations based on intake type and pretreatment processes at SWRO facilities, Red Sea, Saudi Arabia

    KAUST Repository

    Dehwah, Abdullah; Li, Sheng; Almashharawi, Samir; Winters, Harvey; Missimer, Thomas M.

    2015-01-01

    Transparent exopolymer particles (TEP), natural organic matter, and bacterial concentrations in feedwater are important factors that can lead to membrane biofouling in seawater reverse osmosis (SWRO) systems. Two methods for controlling these concentrations in the feedwater prior to pretreatment have been suggested; use of subsurface intake systems or placement of the intake at a greater depth in the sea. These proposed solutions were tested at two SWRO facilities located along the Red Sea of Saudi Arabia. A shallow well intake system was very effective in reducing the algae and bacterial concentrations and somewhat effective in reducing TEP concentrations. An intake placed at a depth of 9. m below the surface was found to have limited impact on improving water quality compared to a surface intake. The algae and bacteria concentration in the feedwater (deep) was lower compared to the surface seawater, but the overall TEP concentration was higher. Bacteria and TEP measurements made in the pretreatment process train in the plant and after the cartridge filters suggest that regrowth of bacteria is occurring within the cartridge filters.

  9. Transcriptomic and anatomical complexity of primary, seminal, and crown roots highlight root type-specific functional diversity in maize (Zea mays L.).

    Science.gov (United States)

    Tai, Huanhuan; Lu, Xin; Opitz, Nina; Marcon, Caroline; Paschold, Anja; Lithio, Andrew; Nettleton, Dan; Hochholdinger, Frank

    2016-02-01

    Maize develops a complex root system composed of embryonic and post-embryonic roots. Spatio-temporal differences in the formation of these root types imply specific functions during maize development. A comparative transcriptomic study of embryonic primary and seminal, and post-embryonic crown roots of the maize inbred line B73 by RNA sequencing along with anatomical studies were conducted early in development. Seminal roots displayed unique anatomical features, whereas the organization of primary and crown roots was similar. For instance, seminal roots displayed fewer cortical cell files and their stele contained more meta-xylem vessels. Global expression profiling revealed diverse patterns of gene activity across all root types and highlighted the unique transcriptome of seminal roots. While functions in cell remodeling and cell wall formation were prominent in primary and crown roots, stress-related genes and transcriptional regulators were over-represented in seminal roots, suggesting functional specialization of the different root types. Dynamic expression of lignin biosynthesis genes and histochemical staining suggested diversification of cell wall lignification among the three root types. Our findings highlight a cost-efficient anatomical structure and a unique expression profile of seminal roots of the maize inbred line B73 different from primary and crown roots. © The Author 2015. Published by Oxford University Press on behalf of the Society for Experimental Biology.

  10. Human antibodies that neutralize primary human immunodeficiency virus type 1 in vitro do not provide protection in an in vivo model.

    NARCIS (Netherlands)

    M. Schutten (Martin); K. Tenner-Racz; P. Racz; D.W. van Bekkum (Dirk); A.D.M.E. Osterhaus (Albert)

    1996-01-01

    textabstractRecently, conflicting data have been published about the ability of antibodies which efficiently neutralize T cell-adapted human immunodeficiency virus type 1 (HIV-1) strains to neutralize primary HIV-1 strains in vitro and in vivo. Here we present data indicating that such antibodies

  11. Psychological Types of Female Primary School Teachers in Anglican State-Maintained Schools in England and Wales: Implications for Continuing Professional Development

    Science.gov (United States)

    Francis, Leslie J.; Lankshear, David W.; Robbins, Mandy

    2011-01-01

    A sample of 221 female primary school teachers in Anglican state-maintained schools in England and Wales completed the Francis Psychological Type Scales (FPTS). The data demonstrated clear preferences for Extraversion (E) over Introversion (I), for Sensing (S) over Intuition (N), for Feeling (F) over Thinking (T) and for Judging (J) over…

  12. List of the primary types of social wasps (Hymenoptera: Vespidae) deposited in the Nationaal Natuurhistorisch Museum, Leiden, and the Zoölogisch Museum, Amsterdam

    NARCIS (Netherlands)

    Kojima, J.; Achterberg, van C.

    1997-01-01

    The primary types of social wasp subfamilies Vespinae, Polistinae and Stenogastrinae housed in the Nationaal Natuurhistorisch Museum in Leiden and the Zoölogisch Museum in Amsterdam are listed. Their complete label data are given unless they are available elsewhere. Lectotypes of Polistes snelleni

  13. Is albuminuria screening and treatment optimal in patients with type 2 diabetes in primary care? Observational data of the GIANTT cohort

    NARCIS (Netherlands)

    Hellemons, M.E.; Denig, P.; Voorham, J.; Heerspink, H.J.L.; de Zeeuw, Dick

    Failure of diagnosing and treatment of albuminuria play a role in morbidity and mortality in type 2 diabetes (T2DM). We evaluated guideline adherence and factors associated with albuminuria screening and treatment in T2DM patients in primary care. Guidelines recommend annual measurement of

  14. Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings.

    LENUS (Irish Health Repository)

    Murphy, Mark E

    2017-08-04

    Poorly controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of healthcare interventions, specifically targeting patients with poorly controlled T2DM, which seek to improve glycaemic control and cardiovascular risk in primary care settings.

  15. Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care: Who do we reach?

    NARCIS (Netherlands)

    Stoop, C.H.; Nefs, G.M.; Pop, V.J.M.; Pouwer, F.

    2017-01-01

    AIMS: This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms. METHODS: People with

  16. Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care : Who do we reach?

    NARCIS (Netherlands)

    Stoop, C.H.; Nefs, G.M.; Pop, V.J.M.; Pouwer, François

    2017-01-01

    Aims: This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms. Methods: People with

  17. Development of a standardized ELISA for the determination of autoantibodies against human M-type phospholipase A2 receptor in primary membranous nephropathy

    NARCIS (Netherlands)

    Dahnrich, C.; Komorowski, L.; Probst, C.; Seitz-Polski, B.; Esnault, V.; Wetzels, J.F.M.; Hofstra, J.M.; Hoxha, E.; Stahl, R.A.K.; Lambeau, G.; Stocker, W.; Schlumberger, W.

    2013-01-01

    BACKGROUND: Autoantibodies against the M-type phospholipase A2 receptor (PLA2R1) are specific markers for primary membranous nephropathy (pMN) and anti-PLA2R1 serum levels may be useful to monitor disease activity. So far, a recombinant cell-based indirect immunofluorescence assay (RC-IFA) using

  18. Uptake and Effects of the e-Vita Personal Health Record with Self-Management Support and Coaching, for Type 2 Diabetes Patients Treated in Primary Care

    NARCIS (Netherlands)

    van Vugt, M.; de Wit, M.; Sieverink, Floor; Roelofsen, Y.; Hendriks, S.H.; Bilo, H.J.G.; Snoek, F.J.

    2016-01-01

    We studied the use, uptake, and effects of e-Vita, a personal health record, with self-management support and personalized asynchronized coaching, for type 2 diabetes patients treated in primary care. Patients were invited by their practice nurse to join the study aimed at testing use and effects of

  19. Distribution patterns of the metastases of the lung carcinoma in relation to histological type of the primary tumor: An autopsy study

    Directory of Open Access Journals (Sweden)

    Ivana Savic Milovanovic

    2017-01-01

    Conclusions: While, overall, the most frequent hematogenous metastases occur in the liver and adrenal glands, various histological types of lung cancer show specific dissemination patterns. Knowing distribution of metastases is essential for making algorithms of treatment, as well as for improving clinical assessment of the patients with unclear clinical findings and suspicion on occult primary lung cancer.

  20. Relationships between net primary productivity and stand age for several forest types and their influence on China's carbon balance.

    Science.gov (United States)

    Wang, Shaoqiang; Zhou, Lei; Chen, Jingming; Ju, Weimin; Feng, Xianfeng; Wu, Weixing

    2011-06-01

    Affected by natural and anthropogenic disturbances such as forest fires, insect-induced mortality and harvesting, forest stand age plays an important role in determining the distribution of carbon pools and fluxes in a variety of forest ecosystems. An improved understanding of the relationship between net primary productivity (NPP) and stand age (i.e., age-related increase and decline in forest productivity) is essential for the simulation and prediction of the global carbon cycle at annual, decadal, centurial, or even longer temporal scales. In this paper, we developed functions describing the relationship between national mean NPP and stand age using stand age information derived from forest inventory data and NPP simulated by the BEPS (Boreal Ecosystem Productivity Simulator) model in 2001. Due to differences in ecobiophysical characteristics of different forest types, NPP-age equations were developed for five typical forest ecosystems in China (deciduous needleleaf forest (DNF), evergreen needleleaf forest in tropic and subtropical zones (ENF-S), deciduous broadleaf forest (DBF), evergreen broadleaf forest (EBF), and mixed broadleaf forest (MBF)). For DNF, ENF-S, EBF, and MBF, changes in NPP with age were well fitted with a common non-linear function, with R(2) values equal to 0.90, 0.75, 0.66, and 0.67, respectively. In contrast, a second order polynomial was best suitable for simulating the change of NPP for DBF, with an R(2) value of 0.79. The timing and magnitude of the maximum NPP varied with forest types. DNF, EBF, and MBF reached the peak NPP at the age of 54, 40, and 32 years, respectively, while the NPP of ENF-S maximizes at the age of 13 years. The highest NPP of DBF appeared at 122 years. NPP was generally lower in older stands with the exception of DBF, and this particular finding runs counter to the paradigm of age-related decline in forest growth. Evaluation based on measurements of NPP and stand age at the plot-level demonstrates the reliability

  1. Primary Hyperparathyroidism

    Science.gov (United States)

    ... 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 ...

  2. Technical support for GEIS: radioactive waste isolation in geologic formations. Volume 18. Facility construction feasibility and costs by rock type

    International Nuclear Information System (INIS)

    1978-04-01

    The results of a study that compared the general engineering feasibility and unit costs associated with sinking shafts and mining storage rooms in the four rock types (salt, granite, shale, basalt) are presented in this volume. The report includes a discussion of the general effects of rock characteristics on shaft and mine design, the application of these design considerations to the specific designs developed for the Draft GEIS, shaft and mine construction techniques, and the unit cost comparison. The repository designs upon which this comparison was based are presented in other volumes of this series

  3. Primary intestinal lymphangiectasia as a component of autoimmune polyglandular syndrome type I: a report of 2 cases.

    Science.gov (United States)

    Makharia, Govind K; Tandon, Nikhil; Stephen, Neil de Jesus Rangel; Gupta, Siddhartha Datta; Tandon, Rakesh K

    2007-01-01

    Chronic diarrhea and steatorrhea occur frequently in patients with autoimmune polyglandular syndrome (APS) type I. Intestinal lymphangiectasia has been reported earlier as a cause of steatorrhea in a young girl with APS Type I. We describe 2 patients with APS Type I who were found to have intestinal lymphangiectasia, one of whom had symptomatic protein-losing enteropathy.

  4. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

    NARCIS (Netherlands)

    Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; Van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.P.; Rinke de Wit, T.F.

    2015-01-01

    Background: Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

  5. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

    NARCIS (Netherlands)

    Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F.

    2015-01-01

    Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

  6. Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

    NARCIS (Netherlands)

    Alhassan, R.K.; Duku, S.O.; Janssens, W.; Nketiah-Amponsah, E.; Spieker, N.; van Ostenberg, P.; Arhinful, D.K.; Pradhan, M.; Rinke de Wit, T.F.

    2015-01-01

    Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will

  7. Rat primary embryo fibroblast cells suppress transformation by the E6 and E7 genes of human papillomavirus type 16 in somatic hybrid cells.

    OpenAIRE

    Miyasaka, M; Takami, Y; Inoue, H; Hakura, A

    1991-01-01

    The E6 and E7 genes of human papillomavirus type 16 (HPV-16) transform established lines of rat cells but not rat cells in primary culture irrespective of the expression of the two genes. The reason for this difference between the susceptibilities of cell lines and primary cells was examined by using hybrid cells obtained by somatic cell fusion of rat cell lines transformed by the E6 and E7 genes of HPV-16 and freshly isolated rat embryo fibroblast cells. In these hybrid cells, transformed ph...

  8. Alkylated selenophene-based ladder-type monomers via a facile route for high performance thin-film transistor applications

    KAUST Repository

    Fei, Zhuping

    2017-05-26

    We report the synthesis of two new selenophene containing ladder-type monomers, cyclopentadiselenophene (CDS) and indacenodiselenophene (IDSe), via a twofold and fourfold Pd catalyzed coupling with a 1,1-diborylmethane derivative. Co-polymers with benzothiadiazole (BT) were prepared in high yield by Suzuki polymerization to afford co-polymers which exhibited excellent solubility in a range of non-chlorinated solvents. The CDS co-polymer exhibited a band gap of just 1.18 eV, which is amongst the lowest reported for donor-acceptor polymers. Thin-film transistors were fabricated using environmentally benign, non-chlorinated solvents with the CDS and IDSe co-polymers exhibiting hole mobility up to 0.15 and 6.4 cm2 /Vs, respectively. This high performance was achieved without the undesirable peak in mobility often observed at low gate voltages due to parasitic contact resistance.

  9. Alkylated selenophene-based ladder-type monomers via a facile route for high performance thin-film transistor applications

    KAUST Repository

    Fei, Zhuping; Han, Yang; Gann, Eliot; Hodsden, Thomas; Chesman, Anthony; McNeill, Christopher R.; Anthopoulos, Thomas D.; Heeney, Martin

    2017-01-01

    We report the synthesis of two new selenophene containing ladder-type monomers, cyclopentadiselenophene (CDS) and indacenodiselenophene (IDSe), via a twofold and fourfold Pd catalyzed coupling with a 1,1-diborylmethane derivative. Co-polymers with benzothiadiazole (BT) were prepared in high yield by Suzuki polymerization to afford co-polymers which exhibited excellent solubility in a range of non-chlorinated solvents. The CDS co-polymer exhibited a band gap of just 1.18 eV, which is amongst the lowest reported for donor-acceptor polymers. Thin-film transistors were fabricated using environmentally benign, non-chlorinated solvents with the CDS and IDSe co-polymers exhibiting hole mobility up to 0.15 and 6.4 cm2 /Vs, respectively. This high performance was achieved without the undesirable peak in mobility often observed at low gate voltages due to parasitic contact resistance.

  10. Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes: rationale and design of the DiaDDZoB Study

    Directory of Open Access Journals (Sweden)

    Pop Victor JM

    2010-07-01

    Full Text Available Abstract Background Depression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk for macrovascular disease, its association with microvascular complications remains understudied. The predictive role of other psychological risk factors such as Type D (distressed personality and the mechanisms that possibly link depression and Type D personality with poor vascular outcomes are also still unclear. Methods/Design This prospective cohort study will examine: (1 the course of depressive symptoms in primary care patients with type 2 diabetes; (2 whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk of all-cause or vascular mortality; and (3 the behavioral and physiological mechanisms that may mediate these associations. The DiaDDZoB Study is embedded within the larger DIAZOB Primary Care Diabetes study, which covers a comprehensive cohort of type 2 diabetes patients treated by over 200 primary care physicians in South-East Brabant, The Netherlands. These patients will be followed during their lifetime and are assessed annually for demographic, clinical, lifestyle and psychosocial factors. Measurements include an interviewer-administered and self-report questionnaire, regular care laboratory tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460 and the 2007 (M1; N = 2,225 and 2008 (M2; N = 2,032 follow-up assessments. Discussion The DiaDDZoB Study is expected to contribute to the current understanding of the course of depression in primary care patients with type 2 diabetes and will also test whether depressed

  11. Application of SAFRAN Tool for the Knowledge Management at the Stage of Radioactive Waste Retrieval from Historical Radon-type Storage Facility

    International Nuclear Information System (INIS)

    Smetnik, A.; Murlis, D.

    2016-01-01

    Our task was to assess waste retrieval operations from a typical RADON-type historical waste storage facility during decommissioning. Challenges: “Historical radioactive waste” is generated without a complete traceable characterization programme or quality management system in place. Key characteristics of historical waste are: — may be conditioned, partially treated, or raw; — poor or no information/traceability; — cannot conclusively identify originating process/location; — waste streams may be mixed. Conclusions: • SAFRAN uses methodologies agreed upon at the international level, namely, by IAEA standards; • Several experts can work more effectively when performing the same safety assessment. SAFRAN makes it easier to exchange experience through sharing projects and data bases; • It is helpful for systematic and structured safety assessment as per safety standards; • It manages information and data in the same software environment. • SAFRAN can play a significant role in managing records and knowledge on radioactive waste, nuclear facility site, characteristics of geological environment and safety barriers. • It can provide reliable long-term storage and effective management of safety related records for the purposes of safety reassessments, review and supervision.

  12. Development of evaluation method for heat removal design of dry storage facilities. Pt. 4. Numerical analysis on vault storage system of cross flow type

    International Nuclear Information System (INIS)

    Sakamoto, Kazuaki; Hattori, Yasuo; Koga, Tomonari; Wataru, Masumi

    1999-01-01

    On the basis of the result of the heat removal test on vault storage system of cross flow type using the 1/5 scale model, an evaluation method for the heat removal design was established. It was composed of the numerical analysis for the convection phenomena of air flow inside the whole facility and that for the natural convection and the detailed turbulent mechanism near the surface of the storage tube. In the former analysis, air temperature distribution in the storage area obtained by the calculation gave good agreement within ±3degC with the test result. And fine turbulence models were introduced in the latter analysis to predict the separation flow in the boundary layer near the surface of the storage tube and the buoyant flow generated by the heat from the storage tube. Furthermore, the properties of removing the heat in a designed full-scale storage facility, such as flow pattern in the storage area, temperature and heat transfer rate of the storage tubes, were evaluated by using each of three methods, which were the established numerical analysis method, the experimental formula demonstrated in the heat removal test and the conventional evaluation method applied to the past heat removal design. As a result, the safety margin and issues included in the methods were grasped, and the measures to make a design more rational were proposed. (author)

  13. Relationship between self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting.

    Science.gov (United States)

    Tharek, Zahirah; Ramli, Anis Safura; Whitford, David Leonard; Ismail, Zaliha; Mohd Zulkifli, Maryam; Ahmad Sharoni, Siti Khuzaimah; Shafie, Asrul Akmal; Jayaraman, Thevaraajan

    2018-03-09

    Self-efficacy has been shown to be positively correlated with self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus. However, such evidence is lacking in the Malaysian primary care setting. The objectives of this study were to i) determine the levels of self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting ii) determine the relationship between self-efficacy, self-care behaviour and glycaemic control iii) determine the factors associated with glycaemic control. This was a cross-sectional study involving patients with type 2 diabetes mellitus from two public primary care clinics in Malaysia. Self-efficacy and self-care behaviour levels were measured using previously translated and validated DMSES and SDSCA questionnaires in Malay versions, respectively. Glycaemic control was measured using HbA 1c. RESULTS: A total of 340 patients with type 2 diabetes mellitus were recruited. The total mean (±SD) of self-efficacy and self-care behaviour scores were 7.33 (±2.25) and 3.76 (±1.87), respectively. A positive relationship was found between self-efficacy and self-care behaviour (r 0.538, P self-efficacy score was shown to be correlated with lower HbA 1c (r - 0.41, P self-efficacy scores (b - 0.398; 95% CI: -0.024, - 0.014; P diabetes (b 0.177; 95% CI: 0.002, 0.007; P self-efficacy was correlated with improved self-care behaviour and better glycaemic control. Findings of this study suggest the importance of including routine use of self-efficacy measures in the management of type 2 diabetes mellitus in primary care.

  14. Thermal Response of Whipox-Type All-Oxide Ceramic Matrix Composites during Reentry Simulation in the Dlr-Lbk Arc-Heated Facility

    Science.gov (United States)

    Mechnich, P.; Braue, W.; Schneider, H.; Koch, U.; Esser, B.; Gülhan, A.

    2005-02-01

    All-oxide ceramic matrix composites (CMCs) such as WHIPOXTM (wound highly porous oxide) exhibit excellent damage tolerance and thermal stability up to 1400°C. Due to their low density and thermal conductivity these new ceramic materials are considered promising candidates for thermal protection systems (TPS) of spacecrafts. The performance of WHIPOX-type CMCs was evaluated during reentry simulations in the L2K leg of the arc-heated LBK facility of DLR, Cologne. The application of reaction-bonded alumina (RBAO) coatings provides significant CMC surface protection and decreased gas permeability, which are key issues for reentry applications. Since emittance and catalycity of the RBAO-coatings limit the performance of CMCs in a reentry environment, binary SiC/RBAO coatings providing higher emittance and/or lower catalycity proved to be a promising approach.

  15. Development of the radiation models of a BWR type reactor and it facility in the SUN-RAH

    International Nuclear Information System (INIS)

    Barron A, I.

    2005-01-01

    This work about generation models, transport in processes and radioactive contamination of areas of a BWR central, is an amplification to the project developed in the UNAM to have a support tool in subjects or electric generation courses. It is planned about the implementation of models of radiation generation in a BWR type reactor for complement the functions developed in the University Simulator of Nucleo electric- Boiling water reactor (SUN-RAH) which it has been implemented in Simulink of MatLab and it has a model for the dynamics of one nucleo electric central that presents the main characteristics of the reactor vessel, the recirculation system, steam lines, turbines, generator, condensers and feeding water, defined by the main processes that intervene in the generation of energy of these plants. By this way the radiation monitoring systems for area and process, operate simultaneously with the processes of energy generation, with that is possible to observe the changes that present with respect to the operation conditions of the plant, and likewise to appreciate the radiation transport process through the components of the reactor, steam lines and turbines, for different operation conditions and possible faults that they could be presented during the reactor operation. (Author)

  16. [Supply and demand of medical specialists in the health facilities of the Ministry of Health: national, regional and by type of specialty gaps].

    Science.gov (United States)

    Zevallos, Leslie; Pastor, Reyna; Moscoso, Betsy

    2011-06-01

    To characterize the supply, demand and the gap of medical specialists in facilities of the Ministry of Health of Peru (MINSA) at the national, regional and specialty type levels. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

  17. Indigenous Sky Stories: Reframing How We Introduce Primary School Students to Astronomy--A Type II Case Study of Implementation

    Science.gov (United States)

    Ruddell, Nicholas; Danaia, Lena; McKinnon, David

    2016-01-01

    The Indigenous Sky Stories Program may have the potential to deliver significant and long-lasting changes to the way science is taught to Year 5 and 6 primary school students. The context for this article is informed by research that shows that educational outcomes can be strengthened when Indigenous knowledge is given the space to co-exist with…

  18. Influence of Soap Characteristics and Food Service Facility Type on the Degree of Bacterial Contamination of Open, Refillable Bulk Soaps.

    Science.gov (United States)

    Schaffner, Donald W; Jensen, Dane; Gerba, Charles P; Shumaker, David; Arbogast, James W

    2018-02-01

    Concern has been raised regarding the public health risks from refillable bulk-soap dispensers because they provide an environment for potentially pathogenic bacteria to grow. This study surveyed the microbial quality of open refillable bulk soap in four different food establishment types in three states. Two hundred ninety-six samples of bulk soap were collected from food service establishments in Arizona, New Jersey, and Ohio. Samples were tested for total heterotrophic viable bacteria, Pseudomonas, coliforms and Escherichia coli, and Salmonella. Bacteria were screened for antibiotic resistance. The pH, solids content, and water activity of all soap samples were measured. Samples were assayed for the presence of the common antibacterial agents triclosan and parachlorometaxylenol. More than 85% of the soap samples tested contained no detectable microorganisms, but when a sample contained any detectable microorganisms, it was most likely contaminated at a very high level (∼7 log CFU/mL). Microorganisms detected in contaminated soap included Klebsiella oxytoca, Serratia liquefaciens, Shigella sonnei, Enterobacter gergoviae, Serratia odorifera, and Enterobacter cloacae. Twenty-three samples contained antibiotic-resistant organisms, some of which were resistant to two or more antibiotics. Every sample containing less than 4% solids had some detectable level of bacteria, whereas no samples with greater than 14% solids had detectable bacteria. This finding suggests the use of dilution and/or low-cost formulations as a cause of bacterial growth. There was a statistically significant difference ( P = 0.0035) between the fraction of bacteria-positive samples with no detected antimicrobial agent (17%) and those containing an antimicrobial agent (7%). Fast food operations and grocery stores were more likely to have detectable bacteria in bulk-soap samples compared with convenience stores ( P food service establishments.

  19. Pre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility.

    Science.gov (United States)

    Lupi, Alessandro; Schaffer, Alon; Lazzero, Maurizio; Tessitori, Massimo; De Martino, Leonardo; Rognoni, Andrea; Bongo, Angelo S; Porto, Italo

    2016-12-01

    Pre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion. We retrospectively compared 143 patients, pre-treated in spoke centers or ambulance with ticagrelor at least 1.5h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted from RENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials.gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint. The primary endpoint, baseline TIMI flow grade, was significantly higher in Pre-treatment Group (0.88±1.14 vs 0.53±0.86, P=0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups. In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Jessie Nallely Zurita-Cruz

    2017-03-01

    Full Text Available Objectives: In prepubertal type 1 diabetic patients (DM1, the availability of an informal primary caregiver (ICP is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire, family functionality (family APGAR, support of another person in patient care, stress (Perceived Stress Scale, and socioeconomic status (Bronfman questionnaire. Multivariate logistic and linear regression analyses were performed. Results: The patients’ median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06–151.9, p = 0.001. While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238–1.743, p = 0.011 and stress (β 1.918, 95% CI 1.10–2.736, p = 0.001 in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336–2.177, p = 0.008 were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients. Resumo: Objetivos: Em pacientes pré-púberes com diabetes tipo 1 (DM1, a disponibilidade de um cuidador familiar principal (CFP é fundamental para tomar decisões de administração; neste estudo, foram identificados os fatores de risco relacionados a CFPs associados ao controle glicêmico. Pacientes

  1. What is the impact of primary care model type on specialist referral rates? A cross-sectional study.

    Science.gov (United States)

    Liddy, Clare; Singh, Jatinderpreet; Kelly, Ryan; Dahrouge, Simone; Taljaard, Monica; Younger, Jamie

    2014-02-03

    Several new primary care models have been implemented in Ontario, Canada over the past two decades. These practice models differ in team structure, physician remuneration, and group size. Few studies have examined the impact of these models on specialist referrals. We compared specialist referral rates amongst three primary care models: 1) Enhanced Fee-for-service, 2) Capitation- Non-Interdisciplinary (CAP-NI), 3) Capitation - Interdisciplinary (CAP-I). We conducted a cross-sectional study using health administrative data from primary care practices in Ontario from April 1st, 2008 to March 31st, 2010. The analysis included all family physicians providing comprehensive care in one of the three models, had at least 100 patients, and did not have a prolonged absence (eight consecutive weeks). The primary outcome was referral rate (# of referrals to all medical specialties/1000 patients/year). A multivariable clustered Poisson regression analysis was used to compare referral rates between models while adjusting for provider (sex, years since graduation, foreign trained, time in current model) and patient (age, sex, income, rurality, health status) characteristics. Fee-for-service had a significantly lower adjusted referral rate (676, 95% CI: 666-687) than the CAP-NI (719, 95% confidence interval (CI): 705-734) and CAP-I (694, 95% CI: 681-707) models and the interdisciplinary CAP-I group had a 3.5% lower referral rate than the CAP-NI group (RR = 0.965, 95% CI: 0.943-0.987, p = 0.002). Female and Canadian-trained physicians referred more often, while female, older, sicker and urban patients were more likely to be referred. Primary care model is significantly associated with referral rate. On a study population level, these differences equate to 111,059 and 37,391 fewer referrals by fee-for-service versus CAP-NI and CAP-I, respectively - a difference of $22.3 million in initial referral appointment costs. Whether a lower rate of referral is more appropriate or not is not

  2. Improving Ebola infection prevention and control in primary healthcare facilities in Sierra Leone: a single-group pretest post-test, mixed-methods study.

    Science.gov (United States)

    Ratnayake, Ruwan; Ho, Lara S; Ansumana, Rashid; Brown, Hannah; Borchert, Matthias; Miller, Laura; Kratz, Thomas; McMahon, Shannon A; Sahr, Foday

    2016-01-01

    Accomplishing infection prevention and control (IPC) in health facilities in Sub-Saharan Africa is challenging. Owing to poor IPC, healthcare workers (HCWs) were frequently infected during Sierra Leone's Ebola epidemic. In late 2014, IPC was rapidly and nationally scaled up. We carried out workshops in sampled facilities to further improve adherence to IPC. We investigated HCW experiences and observed practice gaps, before and after the workshops. We conducted an uncontrolled, before and after, mixed-methods study in eight health facilities in Bo and Kenema Districts during December 2014 and January 2015. Quantitative methods administered to HCWs at baseline and follow-up included a survey on attitudes and self-efficacy towards IPC, and structured observations of behaviours. The intervention involved a workshop for HCWs to develop improvement plans for their facility. We analysed the changes between rounds in survey responses and behaviours. We used interviews to explore attitudes and self-efficacy throughout the study period. HCWs described IPC as 'life-saving' and personal protective equipment (PPE) as uncomfortable for providers and frightening for patients. At baseline, self-efficacy was high (median=4/strongly agree). Responses reflecting unfavourable attitudes were low for glove use (median=1/strongly disagree, IQR, 1-2) and PPE use with ill family members (median=1, IQR, 1-2), and mixed for PPE use with ill HCWs (median=2/disagree, IQR, 1-4). Observations demonstrated consistent glove reuse and poor HCW handwashing. The maintenance of distance (RR 1.09, 95% CI 1.02 to 1.16) and patient handwashing (RR 1.19, 95% CI 1.3 to 1.25) improved to >90%. We found favourable attitudes towards IPC and gaps in practice. Risk perceptions of HCWs and tendencies to ration PPE where chronic supply chain issues normally lead to PPE stock-outs may affect practice. As Sierra Leone's Ebola Recovery Strategy aims to make all facilities IPC compliant, socio

  3. The experimental definition of the acoustic standing wave series shapes, formed in the coolant of the primary circuit of VVER-440 type reactor

    International Nuclear Information System (INIS)

    Bulavin, V.V.; Pavelko, V.I.

    1995-01-01

    On the basis of pressure fluctuation measurements in some primary circuit loops at 2 nd Unit of Kola NPP with VVER-440 type reactors, the shapes of acoustic standing waves (ASW) were determined at frequencies corresponding to four minimal oscillation eigenfrequencies in the primary circuit coolant. On identification of the ASW modes and properties, experimental results based on six circulating loops in symmetric arrangement allowed determination of the three-dimensional space structure of the wave nodes and antinodes inside and outside of the reactor vessel (RV). As part of this analysis, the geometric features of the primary circuit that caused the formation of these standing waves were identified. Differences in each ASW shape were shown to cause different individual effects on the neutron field in the reactor core and on fuel assembly vibration. This has been partially confirmed by ex-core neutron ionization chamber noise analysis. One type of ASW, possessing an antinode inside the RV, can be used for measurement of the pressure coefficient of reactivity. However, this must be done with care to avoid the potential for incorrect results in some cases. The results presented in this paper can be readily extended to other VVER type reactors with both odd and even number of loops. (author)

  4. Neuro-Compatible Metabolic Glycan Labeling of Primary Hippocampal Neurons in Noncontact, Sandwich-Type Neuron-Astrocyte Coculture.

    Science.gov (United States)

    Choi, Ji Yu; Park, Matthew; Cho, Hyeoncheol; Kim, Mi-Hee; Kang, Kyungtae; Choi, Insung S

    2017-12-20

    Glycans are intimately involved in several facets of neuronal development and neuropathology. However, the metabolic labeling of surface glycans in primary neurons is a difficult task because of the neurotoxicity of unnatural monosaccharides that are used as a metabolic precursor, hindering the progress of metabolic engineering in neuron-related fields. Therefore, in this paper, we report a neurosupportive, neuron-astrocyte coculture system that neutralizes the neurotoxic effects of unnatural monosaccharides, allowing for the long-term observation and characterization of glycans in primary neurons in vitro. Polysialic acids in neurons are selectively imaged, via the metabolic labeling of sialoglycans with peracetylated N-azidoacetyl-d-mannosamine (Ac 4 ManNAz), for up to 21 DIV. Two-color labeling shows that neuronal activities, such as neurite outgrowth and recycling of membrane components, are highly dynamic and change over time during development. In addition, the insertion sites of membrane components are suggested to not be random, but be predominantly localized in developing neurites. This work provides a new research platform and also suggests advanced 3D systems for metabolic-labeling studies of glycans in primary neurons.

  5. Behavior change in a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention content

    NARCIS (Netherlands)

    Vermunt, P.W.A.; Milder, I.E.J.; Wielaard, F.; Baan, C.A.; Schelfhout, J.D.M.; Westert, G.P.; van Oers, J.A.M.

    2013-01-01

    Background Despite the favorable effects of behavior change interventions on diabetes risk, lifestyle modification is a complicated process. In this study we therefore investigated opportunities for refining a lifestyle intervention for type 2 diabetes prevention, based on participant perceptions of

  6. Eccentric Coil Test Facility (ECTF)

    International Nuclear Information System (INIS)

    Burn, P.B.; Walstrom, P.L.; Anderson, W.C.; Marguerat, E.F.

    1975-01-01

    The conceptual design of a facility for testing superconducting coils under some conditions peculiar to tokamak systems is given. A primary element of the proposed facility is a large 25 MJ background solenoid. Discussions of the mechanical structure, the stress distribution and the thermal stability for this coil are included. The systems for controlling the facility and diagnosing test coil behavior are also described

  7. Development of evaluation method for heat removal design of dry storage facilities. pt. 1. Heat removal test on vault storage system of cross flow type

    International Nuclear Information System (INIS)

    Sakamoto, Kazuaki; Koga, Tomonari; Wataru, Masumi; Hattori, Yasuo

    1997-01-01

    The report describes the result of heat removal test of passive cooling vault storage system of cross flow type using 1/5 scale model. Based on a prospect of steady increase in the amount of spent fuel, it is needed to establish large capacity dry storage technologies for spent fuel. Air flow patterns, distributions of air temperature and velocity were measured, by which heat removal characteristics of the system were made clear. Air flow patterns in the storage module depended on the ratio of the buoyant force to the inertial force; the former generated by the difference of air temperatures and the height of the storage module, the latter by the difference of air densities between the outlet of the storage module and ambience and the height of the chimney of the storage facility. A simple method to estimate air flow patterns in the storage module was suggested, where Ri(Richardson) number was applied to represent the ratio. Moreover, heat transfer coefficient from a model of storage tube to cooling air was evaluated, and it was concluded that the generalized expression of heat transfer coefficient for common heat exchangers could be applied to the vault storage system of cross flow type, in which dozens of storage tubes were placed in a storage module. (author)

  8. Health-Related Quality of Life in Primary Care: Which Aspects Matter in Multimorbid Patients with Type 2 Diabetes Mellitus in a Community Setting?

    Directory of Open Access Journals (Sweden)

    Martina Kamradt

    Full Text Available Knowledge about predictors of health-related quality of life for multimorbid patients with type 2 diabetes mellitus in primary care could help to improve quality and patient-centeredness of care in this specific group of patients. Thus, the aim of this study was to investigate the impact of several patient characteristics on health-related quality of life of multimorbid patients with type 2 diabetes mellitus in a community setting.A cross-sectional study with 32 primary care practice teams in Mannheim, Germany, and randomly selected multimorbid patients with type 2 diabetes mellitus (N = 495 was conducted. In order to analyze associations of various patient characteristics with health-related quality of life (EQ-5D index a multilevel analysis was applied.After excluding patients with missing data, the cohort consisted of 404 eligible patients. The final multilevel model highlighted six out of 14 explanatory patient variables which were significantly associated with health-related quality of life: female gender (r = -0.0494; p = .0261, school education of nine years or less (r = -0.0609; p = .0006, (physical mobility restrictions (r = -0.1074; p = .0003, presence of chronic pain (r = -0.0916; p = .0004, diabetes-related distress (r = -0.0133; p < .0001, and BMI (r = -0.0047; p = .0045.The findings of this study suggest that increased diabetes-related distress, chronic pain, restrictions in (physical mobility, female gender, as well as lower education and, increased BMI have a noteworthy impact on health-related quality of life in multimorbid patients with type 2 diabetes mellitus seen in primary care practices in a community setting. The highlighted aspects should gain much more attention when treating multimorbid patients with type 2 diabetes mellitus.

  9. Health-Related Quality of Life in Primary Care: Which Aspects Matter in Multimorbid Patients with Type 2 Diabetes Mellitus in a Community Setting?

    Science.gov (United States)

    Kamradt, Martina; Krisam, Johannes; Kiel, Marion; Qreini, Markus; Besier, Werner; Szecsenyi, Joachim; Ose, Dominik

    2017-01-01

    Knowledge about predictors of health-related quality of life for multimorbid patients with type 2 diabetes mellitus in primary care could help to improve quality and patient-centeredness of care in this specific group of patients. Thus, the aim of this study was to investigate the impact of several patient characteristics on health-related quality of life of multimorbid patients with type 2 diabetes mellitus in a community setting. A cross-sectional study with 32 primary care practice teams in Mannheim, Germany, and randomly selected multimorbid patients with type 2 diabetes mellitus (N = 495) was conducted. In order to analyze associations of various patient characteristics with health-related quality of life (EQ-5D index) a multilevel analysis was applied. After excluding patients with missing data, the cohort consisted of 404 eligible patients. The final multilevel model highlighted six out of 14 explanatory patient variables which were significantly associated with health-related quality of life: female gender (r = -0.0494; p = .0261), school education of nine years or less (r = -0.0609; p = .0006), (physical) mobility restrictions (r = -0.1074; p = .0003), presence of chronic pain (r = -0.0916; p = .0004), diabetes-related distress (r = -0.0133; p diabetes-related distress, chronic pain, restrictions in (physical) mobility, female gender, as well as lower education and, increased BMI have a noteworthy impact on health-related quality of life in multimorbid patients with type 2 diabetes mellitus seen in primary care practices in a community setting. The highlighted aspects should gain much more attention when treating multimorbid patients with type 2 diabetes mellitus.

  10. Facilities & Leadership

    Data.gov (United States)

    Department of Veterans Affairs — The facilities web service provides VA facility information. The VA facilities locator is a feature that is available across the enterprise, on any webpage, for the...

  11. Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

    Directory of Open Access Journals (Sweden)

    Kyokunzire C

    2018-03-01

    Full Text Available Catherine Kyokunzire,1 Nicholas Matovu2,3 1Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Community Health, Division of Noncommunicable Diseases, Ministry of Health – Uganda, Kampala, Uganda; 3Global Health Corps Fellowship Program 2017/2018, New York, NY, USA Purpose: The purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda.Research design and methods: A facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs at the 95% confidence interval (CI were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0.Results: The overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78, being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71, being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14 and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27, taking three or less tests of blood glucose per day (APRR: 0

  12. Comment on “An algorithm for identification and classification of individuals with type 1 and type 2 diabetes mellitus in a large primary care database”, written by Sharma et al

    Directory of Open Access Journals (Sweden)

    Bocquet V

    2017-01-01

    Full Text Available Valéry Bocquet Competence Center for Methodology and Statistics, Luxembourg Institute of Health, LuxembourgDiabetes is a disease whose global prevalence has been rising year after year, and by 2014 more than 400 million individuals were diagnosed with diabetes.1 As a consequence, screening of patients with type 1 or type 2 diabetes has become important, both to estimate the prevalence of diabetes and to treat affected individuals. For that purpose, a two-step algorithm suggested by Sharma et al2 was recently published, whose aims were to identify type 1 or type 2 individuals from a primary care database. The first step of the algorithm was based on the diagnostic records, treatment given, and results obtained from clinical tests. The second part was based on the combination of diagnostic codes, prescribed medications, age at the time of diagnosis, and finally whether the case was prevalent or incident.View original paper by Sharma et al

  13. Pro–A-Type Natriuretic Peptide, Proadrenomedullin, and N-Terminal Pro–B-Type Natriuretic Peptide Used in a Multimarker Strategy in Primary Health Care in Risk Assessment of Patients With Symptoms of Heart Failure

    DEFF Research Database (Denmark)

    Alehagen, Urban; Dahlström, Ulf; Rehfeld, Jens F

    2013-01-01

    Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-A-type...... natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM), individually or combined, gives prognostic information regarding cardiovascular and all-cause mortality that could motivate use in elderly patients presenting with symptoms suggestive of heart failure in primary health care....

  14. Stress corrosion cracking of iron-nickel-chromium alloys in primary circuit environment of PWR-type reactors

    International Nuclear Information System (INIS)

    Boursier, Jean-Marie

    1993-01-01

    Stress corrosion cracking of Alloy 600 steam generator tubing is a great concern for pressurized water reactors. The mechanism that controls intergranular stress corrosion cracking of Alloy 600 in primary water (lithiated-borated water) has yet to be clearly identified. A study of stress corrosion cracking behaviour, which can identify the main parameters that control the cracking phenomenon, was so necessary to understand the stress corrosion cracking process. Constant extension rate tests, and constant load tests have evidenced that Alloy 600 stress corrosion cracking involves firstly an initiation period, then a slow propagation stage with crack less than 50 to 80 micrometers, and finally a rapid propagation stage leading to failure. The influence of mechanical parameters have shown the next points: - superficial strain hardening and cold work have a strong effect of stress corrosion cracking resistance (decrease of initiation time and increase of crack growth rate), - strain rate was the most suitable parameter for describing the different stage of propagation. The creep behaviour of alloy 600 has shown an increase of creep rate in primary water compared to air, which implies a local interaction plasticity/corrosion. An assessment of the durations of the initiation and the propagation stages was attempted for the whole uniaxial tensile tests, using the macroscopic strain rate: - the initiation time is less than 100 hours and seems to be an electrochemical process, - the durations of the propagation stage are strongly dependent on the strain rate. The behaviour in high primary water temperature of Alloys 690 and 800, which replace Alloy 600, was studied to appraise their margin, and validate their choice. Then the last chapter has to objective to evaluate the crack tip strain rate, in order to better describe the evolution of the different stages of cracking. (author) [fr

  15. Accelerator development for a radioactive beam facility based on ATLAS

    International Nuclear Information System (INIS)

    Shepard, K. W.

    1998-01-01

    The existing superconducting linac ATLAS is in many respects an ideal secondary beam accelerator for an ISOL (Isotope separator on-line) type radioactive beam facility. Such a facility would require the addition of two major accelerator elements: a low charge state injector for the existing heavy ion linac, and a primary beam accelerator providing 220 MV of acceleration for protons and light ions. Development work for both of these elements, including the option of superconducting cavities for the primary beam accelerator is discussed

  16. Accelerator development for a radioactive beam facility based on ATLAS.

    Energy Technology Data Exchange (ETDEWEB)

    Shepard, K. W.

    1998-01-08

    The existing superconducting linac ATLAS is in many respects an ideal secondary beam accelerator for an ISOL (Isotope separator on-line) type radioactive beam facility. Such a facility would require the addition of two major accelerator elements: a low charge state injector for the existing heavy ion linac, and a primary beam accelerator providing 220 MV of acceleration for protons and light ions. Development work for both of these elements, including the option of superconducting cavities for the primary beam accelerator is discussed.

  17. Biochemistry Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Biochemistry Facility provides expert services and consultation in biochemical enzyme assays and protein purification. The facility currently features 1) Liquid...

  18. Allegheny County Primary Care Access

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The data on health care facilities includes the name and location of all the hospitals and primary care facilities in Allegheny County. The current listing of...

  19. Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decision-making: experience from Cape Town, South Africa.

    Science.gov (United States)

    Scott, Vera; Gilson, Lucy

    2017-09-15

    Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Central governance shaped what information and knowledge was valued - and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential

  20. 1325-N Liquid Waste Disposal Facility Supplemental Information to the Hanford Facility Contingency Plan (DOE/RL-93-75)

    International Nuclear Information System (INIS)

    Edens, V.G.

    1998-03-01

    The 1325-N Liquid Waste Disposal Facility located at the 100-N Area of the Hanford Site started receiving part of the N Reactor liquid radioactive effluent flow in 1983. In September 1985, the 1325-N Facility became the primary liquid waste disposal system for the N Reactor. The facility is located approximately 60 feet above and 2000 feet east of the shore of the Columbia River. Waste stream discharges were ceased in April 1991.Specific information on types of waste discharged to 1325-N are contained within the Part A, Form 3, Permit application of this unit

  1. Solid Waste Management Facilities with Permits by the Iowa DNR

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — All types of facilities that handle solid waste, including: sanitary landfills, appliance demanufacturing facilities, transfer stations, land application sites,...

  2. Primary study on synthesis and characterization of the new type EB curable resins. Pt.2: Alkyd resins modified by LFA

    International Nuclear Information System (INIS)

    Yi Min; Wei Jinshan; Li Jun; Wang Ruiyu; Ha Hongfei

    1995-01-01

    The authors have synthesized a new type of EB curable resin by using oil fatty acid. The preparation method of coating and the performance of EB curing coating film were described. The synthesis process has been simplified and the price of the raw materials was lower

  3. Therapeutic inertia in the management of hyperlipidaemia in type 2 diabetic patients: a cross-sectional study in the primary care setting.

    Science.gov (United States)

    Man, F Y; Chen, C Xr; Lau, Y Y; Chan, K

    2016-08-01

    To study the prevalence of therapeutic inertia in lipid management among type 2 diabetic patients in the primary care setting and to explore associated factors. This was a cross-sectional study involving type 2 diabetic patients with suboptimal lipid control followed up in all general out-patient clinics of Kowloon Central Cluster in Hong Kong from 1 October 2011 to 30 September 2013. Main outcome measures included prevalence of therapeutic inertia in low-density lipoprotein management among type 2 diabetic patients and its association with patient and physician characteristics. Based on an agreed standard, lipid control was suboptimal in 49.1% (n=9647) of type 2 diabetic patients who attended for a regular annual check-up (n=19 662). Among the sampled 369 type 2 diabetic patients with suboptimal lipid control, therapeutic inertia was found to be present in 244 cases, with a prevalence rate of 66.1%. When the attending doctors' profiles were compared, the mean duration of clinical practice was significantly longer in the therapeutic inertia group than the non-therapeutic inertia group. Doctors without prior training in family medicine were also found to have a higher rate of therapeutic inertia. Patients in the therapeutic inertia group had longer disease duration, a higher co-morbidity rate of cardiovascular disease, and a closer-to-normal low-density lipoprotein level. Logistic regression analysis revealed that lack of family medicine training among doctors was positively associated with the presence of therapeutic inertia whereas patient's low-density lipoprotein level was inversely associated. Therapeutic inertia was common in the lipid management of patients with type 2 diabetes in a primary care setting. Lack of family medicine training among doctors and patient's low-density lipoprotein level were associated with the presence of therapeutic inertia. Further study of the barriers and strategies to overcome therapeutic inertia is needed to improve patient

  4. Sequential immunization with V3 peptides from primary human immunodeficiency virus type 1 produces cross-neutralizing antibodies against primary isolates with a matching narrow-neutralization sequence motif.

    Science.gov (United States)

    Eda, Yasuyuki; Takizawa, Mari; Murakami, Toshio; Maeda, Hiroaki; Kimachi, Kazuhiko; Yonemura, Hiroshi; Koyanagi, Satoshi; Shiosaki, Kouichi; Higuchi, Hirofumi; Makizumi, Keiichi; Nakashima, Toshihiro; Osatomi, Kiyoshi; Tokiyoshi, Sachio; Matsushita, Shuzo; Yamamoto, Naoki; Honda, Mitsuo

    2006-06-01

    An antibody response capable of neutralizing not only homologous but also heterologous forms of the CXCR4-tropic human immunodeficiency virus type 1 (HIV-1) MNp and CCR5-tropic primary isolate HIV-1 JR-CSF was achieved through sequential immunization with a combination of synthetic peptides representing HIV-1 Env V3 sequences from field and laboratory HIV-1 clade B isolates. In contrast, repeated immunization with a single V3 peptide generated antibodies that neutralized only type-specific laboratory-adapted homologous viruses. To determine whether the cross-neutralization response could be attributed to a cross-reactive antibody in the immunized animals, we isolated a monoclonal antibody, C25, which neutralized the heterologous primary viruses of HIV-1 clade B. Furthermore, we generated a humanized monoclonal antibody, KD-247, by transferring the genes of the complementary determining region of C25 into genes of the human V region of the antibody. KD-247 bound with high affinity to the "PGR" motif within the HIV-1 Env V3 tip region, and, among the established reference antibodies, it most effectively neutralized primary HIV-1 field isolates possessing the matching neutralization sequence motif, suggesting its promise for clinical applications involving passive immunizations. These results demonstrate that sequential immunization with B-cell epitope peptides may contribute to a humoral immune-based HIV vaccine strategy. Indeed, they help lay the groundwork for the development of HIV-1 vaccine strategies that use sequential immunization with biologically relevant peptides to overcome difficulties associated with otherwise poorly immunogenic epitopes.

  5. Effect of oral booster vaccination of rainbow trout against Yersinia ruckeri depends on type of primary immunization

    DEFF Research Database (Denmark)

    Jaafar, Rzgar M.; Al-Jubury, Azmi; Dalsgaard, Inger

    2017-01-01

    provided as dip (most effective), bath (less effective) or orally (least effective). Oral immunization may be used as booster after dip but applied as a single oral application it induced merely a slight and statistically non-significant response. It is noteworthy that primary oral immunization followed...... already primed by one of these vaccination methods. Oral vaccination of trout (administering vaccine in feed) is an even more convenient way of presenting antigen to the fish but the effect of an oral booster has not previously been described in detail. The present work describes to what extent protection...... by an oral booster vaccination showed a trend for an even weaker response. It should be investigated if continued exposure to a low antigen concentration - as performed by two oral immunizations - may induce tolerance to the pathogen and thereby leave the fish more vulnerable....

  6. Temporal discrimination thresholds in adult-onset primary torsion dystonia: an analysis by task type and by dystonia phenotype.

    LENUS (Irish Health Repository)

    Bradley, D

    2012-01-01

    Adult-onset primary torsion dystonia (AOPTD) is an autosomal dominant disorder with markedly reduced penetrance. Sensory abnormalities are present in AOPTD and also in unaffected relatives, possibly indicating non-manifesting gene carriage (acting as an endophenotype). The temporal discrimination threshold (TDT) is the shortest time interval at which two stimuli are detected to be asynchronous. We aimed to compare the sensitivity and specificity of three different TDT tasks (visual, tactile and mixed\\/visual-tactile). We also aimed to examine the sensitivity of TDTs in different AOPTD phenotypes. To examine tasks, we tested TDT in 41 patients and 51 controls using visual (2 lights), tactile (non-painful electrical stimulation) and mixed (1 light, 1 electrical) stimuli. To investigate phenotypes, we examined 71 AOPTD patients (37 cervical dystonia, 14 writer\\'s cramp, 9 blepharospasm, 11 spasmodic dysphonia) and 8 musician\\'s dystonia patients. The upper limit of normal was defined as control mean +2.5 SD. In dystonia patients, the visual task detected abnormalities in 35\\/41 (85%), the tactile task in 35\\/41 (85%) and the mixed task in 26\\/41 (63%); the mixed task was less sensitive than the other two (p = 0.04). Specificity was 100% for the visual and tactile tasks. Abnormal TDTs were found in 36 of 37 (97.3%) cervical dystonia, 12 of 14 (85.7%) writer\\'s cramp, 8 of 9 (88.8%) blepharospasm, 10 of 11 (90.1%) spasmodic dysphonia patients and 5 of 8 (62.5%) musicians. The visual and tactile tasks were found to be more sensitive than the mixed task. Temporal discrimination threshold results were comparable across common adult-onset primary torsion dystonia phenotypes, with lower sensitivity in the musicians.

  7. The European EUCCLID pilot study on care and complications in an unselected sample of people with type 2 diabetes in primary care

    DEFF Research Database (Denmark)

    Gorter, K.J.; Wens, J.; Khunti, K.

    2010-01-01

    indicators, UKPDS-risk engine, psychological and general well-being. RESULTS: We included 103 participants from 22 GPs in 11 countries. Central data and laboratory samples were successfully collected. Of the participants 54% were female, mean age was 66 years and mean duration of diabetes was 9.6 years......BACKGROUND: European studies on quality of diabetes care in an unselected primary care diabetes population are scarce. RESEARCH QUESTION: To test the feasibility of the set-up and logistics of a cross-sectional EUropean study on Care and Complications in patients with type 2 diabetes (T2DM......) in Primary Care (EUCCLID) in 12 European countries. METHOD: One rural and one urban practice from each country participated. The central coordinating centre randomly selected five patients from each practice. Patient characteristics were assessed including medical history, anthropometric measures, quality...

  8. Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Madsbad, Sten; Kehlet, Henrik

    2015-01-01

    when adjusting for covariates (odds ratio: 1.19 [0.93-1.54]; P = 0.172). Correspondingly, the NNH was 78 but ranged between 31 and infinity. Type 2 diabetes was not associated with 30- (1.02 [0.75-1.39]; P = 0.897) or 90-day readmissions (1.22 [0.87-1.71]; P = 0.254), and with an NNH of 957 (59...

  9. Enhanced self-monitoring blood glucose in non-insulin requiring Type 2 diabetes: A qualitative study in primary care.

    Science.gov (United States)

    Brackney, Dana Elisabeth

    2018-03-31

    To contribute to both theoretical and practical understanding of the role of self-monitoring blood glucose for self-management by describing the experience of people with non-insulin requiring Type 2 diabetes in an enhanced structured self-monitoring blood glucose intervention. The complex context of self-monitoring blood glucose in Type 2 diabetes requires a deeper understanding of the clients' illness experience with structured self-monitoring of blood glucose. Clients' numeracy skills contribute to their response to blood glucose readings. Nurses' use of motivational interviewing to increase clients' regulatory self-efficacy is important to the theoretical perspective of the study. A qualitative descriptive study. A purposive sample of eleven adults recently (diabetes who had experienced a structured self-monitoring blood glucose intervention participated in this study. Audio recordings of semi-structured interviews and photos of logbooks were analyzed for themes using constant comparison and member checking. The illness experience states of Type 2 diabetes include 'Diagnosis', 'Behavior change', and 'Routine checking'. People check blood glucose to confirm their Type 2 diabetes diagnosis, to console their diabetes related fears, to create personal explanations of health behavior's impact on blood glucose, to activate behavior change and to congratulate their diabetes self-management efforts. These findings support the Transtheoretical model's stages of change and change processes. Blood glucose checking strengthens the relationships between theoretical concepts found in Diabetes Self-management Education-Support including: engagement, information sharing, and behavioral support. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. Dance Facilities.

    Science.gov (United States)

    Ashton, Dudley, Ed.; Irey, Charlotte, Ed.

    This booklet represents an effort to assist teachers and administrators in the professional planning of dance facilities and equipment. Three chapters present the history of dance facilities, provide recommended dance facilities and equipment, and offer some adaptations of dance facilities and equipment, for elementary, secondary and college level…

  11. Possible pressurized thermal shock events during large primary to secondary leakage. The Hungarian AGNES project and PRISE accident scenarios in VVER-440/V213 type reactor

    Energy Technology Data Exchange (ETDEWEB)

    Perneczky, L. [KFKI Atomic Energy Research Inst., Budabest (Hungary)

    1997-12-31

    Nuclear power plants of WWER-440/213-type have several special features. Consequently, the transient behaviour of such a reactor system should be different from the behaviour of the PWRs of western design. The opening of the steam generator (SG) collector cover, as a specific primary to secondary circuit leakage (PRISE) occurring in WWER-type reactors happened first time in Rovno NPP Unit I on January 22, 1982. Similar accident was studied in the framework of IAEA project RER/9/004 in 1987-88 using the RELAP4/mod6 code. The Hungarian AGNES (Advanced General and New Evaluation of Safety) project was performed in the period 1991-94 with the aim to reassess the safety of the Paks NPP using state-of-the-art techniques. The project comprised three type of analyses for the primary to secondary circuit leakages: Design Basis Accident (DBA) analyses, Pressurized Thermal Shock (PTS) study and deterministic analyses for Probabilistic Safety Analysis (PSA). Major part of the thermohydraulic analyses has been performed by the RELAP5/mod2.5/V251 code version with two input models. 32 refs.

  12. Possible pressurized thermal shock events during large primary to secondary leakage. The Hungarian AGNES project and PRISE accident scenarios in VVER-440/V213 type reactor

    Energy Technology Data Exchange (ETDEWEB)

    Perneczky, L [KFKI Atomic Energy Research Inst., Budabest (Hungary)

    1998-12-31

    Nuclear power plants of WWER-440/213-type have several special features. Consequently, the transient behaviour of such a reactor system should be different from the behaviour of the PWRs of western design. The opening of the steam generator (SG) collector cover, as a specific primary to secondary circuit leakage (PRISE) occurring in WWER-type reactors happened first time in Rovno NPP Unit I on January 22, 1982. Similar accident was studied in the framework of IAEA project RER/9/004 in 1987-88 using the RELAP4/mod6 code. The Hungarian AGNES (Advanced General and New Evaluation of Safety) project was performed in the period 1991-94 with the aim to reassess the safety of the Paks NPP using state-of-the-art techniques. The project comprised three type of analyses for the primary to secondary circuit leakages: Design Basis Accident (DBA) analyses, Pressurized Thermal Shock (PTS) study and deterministic analyses for Probabilistic Safety Analysis (PSA). Major part of the thermohydraulic analyses has been performed by the RELAP5/mod2.5/V251 code version with two input models. 32 refs.

  13. Identification of Cell Type-Specific Differences in Erythropoietin Receptor Signaling in Primary Erythroid and Lung Cancer Cells.

    Directory of Open Access Journals (Sweden)

    Ruth Merkle

    2016-08-01

    Full Text Available Lung cancer, with its most prevalent form non-small-cell lung carcinoma (NSCLC, is one of the leading causes of cancer-related deaths worldwide, and is commonly treated with chemotherapeutic drugs such as cisplatin. Lung cancer patients frequently suffer from chemotherapy-induced anemia, which can be treated with erythropoietin (EPO. However, studies have indicated that EPO not only promotes erythropoiesis in hematopoietic cells, but may also enhance survival of NSCLC cells. Here, we verified that the NSCLC cell line H838 expresses functional erythropoietin receptors (EPOR and that treatment with EPO reduces cisplatin-induced apoptosis. To pinpoint differences in EPO-induced survival signaling in erythroid progenitor cells (CFU-E, colony forming unit-erythroid and H838 cells, we combined mathematical modeling with a method for feature selection, the L1 regularization. Utilizing an example model and simulated data, we demonstrated that this approach enables the accurate identification and quantification of cell type-specific parameters. We applied our strategy to quantitative time-resolved data of EPO-induced JAK/STAT signaling generated by quantitative immunoblotting, mass spectrometry and quantitative real-time PCR (qRT-PCR in CFU-E and H838 cells as well as H838 cells overexpressing human EPOR (H838-HA-hEPOR. The established parsimonious mathematical model was able to simultaneously describe the data sets of CFU-E, H838 and H838-HA-hEPOR cells. Seven cell type-specific parameters were identified that included for example parameters for nuclear translocation of STAT5 and target gene induction. Cell type-specific differences in target gene induction were experimentally validated by qRT-PCR experiments. The systematic identification of pathway differences and sensitivities of EPOR signaling in CFU-E and H838 cells revealed potential targets for intervention to selectively inhibit EPO-induced signaling in the tumor cells but leave the responses in

  14. Oral bacteria influenced by the functional status of the elderly people and the type and quality of facilities for the bedridden.

    Science.gov (United States)

    Tada, A; Watanabe, T; Yokoe, H; Hanada, N; Tanzawa, H

    2002-01-01

    To analyse the relationship between oral bacteria and the health and functional status of the elderly. The bacteria species in the oral cavity of the elderly were examined. It was found that the bedridden subjects staying at two hospitals for long-term (HOBR) showed significantly lower detection rates of commensal bacteria species and significantly higher detection rates of Pseudomonas aeruginosa, of methicillin-resistant Staphylococcus aureus (MRSA) and of coagulase(-) Staph. aureus than those living independently (the independent). In addition, the detection rate of Haemophilus parainfluenzae in NUBR was discovered to be higher than that found in the independent. In HOBR, the detection rate of Ps. aeruginosa was significantly higher among in-patients who required continual care than those in need of partial care, while the detection rate of MRSA was significantly higher among in-patients with low serum albumin than those with normal serum albumin. Oral bacteria examination analysis proved that the risks of infection of some pathogenic bacteria species were correlated with functional status, physical function and nutritional state. Our study suggests that the oral bacteria, especially pathogenic bacteria were influenced by the functional status of the elderly and the type and quality of the facilities for the bedridden, physical function and nutritional state.

  15. Epidemiology and Characteristics of Escherichia coli Sequence Type 131 (ST131) from Long-Term Care Facility Residents Colonized Intestinally with Fluoroquinolone-Resistant Escherichia coli

    Science.gov (United States)

    Han, Jennifer H.; Garrigan, Charles; Johnston, Brian; Nachamkin, Irving; Clabots, Connie; Bilker, Warren B.; Santana, Evelyn; Tolomeo, Pam; Maslow, Joel; Myers, Janice; Carson, Lesley; Lautenbach, Ebbing; Johnson, James R.

    2016-01-01

    The objective of this study was to evaluate molecular and epidemiologic factors associated with Escherichia coli sequence type 131 (ST131) among long-term care facility (LTCF) residents who acquired gastrointestinal tract colonization with fluoroquinolone-resistant E. coli (FQREC). Colonizing isolates from 37 residents who newly developed FQREC colonization at three LTCFs from 2006–2008 were evaluated. Twenty-nine (78%) of 37 total FQREC colonizing isolates were ST131. Most ST131 isolates had a distinctive combination of gyrA and parC replacement mutations. The ST131 and non-ST131 isolates differed significantly for the prevalence of many individual virulence factors but not for the proportion that qualified molecularly as extraintestinal pathogenic E. coli (ExPEC) or aggregate virulence factor scores. E. coli ST131 was highly prevalent among LTCF residents with FQREC colonization. Future studies should determine the risk factors for infection among ST131-colonized residents, and assess the potential for increased transmissibility of ST131 in the long-term care setting. PMID:27939288

  16. Evaluating the sensitivity of EQ-5D in a sample of patients with type 2 diabetes mellitus in two tertiary health care facilities in Nigeria.

    Science.gov (United States)

    Ekwunife, Obinna Ikechukwu; Ezenduka, Charles C; Uzoma, Bede Emeka

    2016-01-12

    The EQ-5D instrument is arguably the most well-known and commonly used generic measure of health status internationally. Although the instrument has been employed in outcomes studies of diabetes mellitus in many countries, it has not yet been used in Nigeria. This study was carried out to assess the sensitivity of the EQ-5D instrument in a sample of Nigerian patients with type 2 diabetes mellitus (T2DM). A cross-sectional study was conducted using the EQ-5D instrument to assess the self-reported quality of life of patients with T2DM attending two tertiary healthcare facilities in south eastern Nigeria consenting patients completed the questionnaire while waiting to see a doctor. A priori hypotheses were examined using multiple regression analysis to model the relationship between the dependent variables (EQ VAS and EQ-5D Index) and hypothesized independent variables. A total of 226 patients with T2DM participated in the study. The average age of participants was 57 years (standard deviation 10 years) and 61.1% were male. The EQ VAS score and EQ-5D index averaged 66.19 (standard deviation 15.42) and 0.78 (standard deviation 0.21) respectively. Number of diabetic complications, number of co-morbidities, patient's age and being educated predicted EQ VAS score by -6.76, -6.15, -0.22, and 4.51 respectively. Also, number of diabetic complications, number of co-morbidities, patient's age and being educated predicted EQ-5D index by -0.12, -0.07, -0.003, and 0.06 respectively.. Our findings indicate that the EQ-5D could adequately capture the burden of type 2 diabetes and related complications among Nigerian patients.

  17. Sci—Fri PM: Topics — 07: Monte Carlo Simulation of Primary Dose and PET Isotope Production for the TRIUMF Proton Therapy Facility

    Energy Technology Data Exchange (ETDEWEB)

    Lindsay, C; Jirasek, A [University of Victoria (Australia); Blackmore, E; Hoehr, C; Schaffer, P; Trinczek, M [TRIUMF (Canada); Sossi, V [University of British Columbia (Canada)

    2014-08-15

    Uveal melanoma is a rare and deadly tumour of the eye with primary metastases in the liver resulting in an 8% 2-year survival rate upon detection. Large growths, or those in close proximity to the optic nerve, pose a particular challenge to the commonly employed eye-sparing technique of eye-plaque brachytherapy. In these cases external beam charged particle therapy offers improved odds in avoiding catastrophic side effects such as neuropathy or blindness. Since 1995, the British Columbia Cancer Agency in partnership with the TRIUMF national laboratory have offered proton therapy in the treatment of difficult ocular tumors. Having seen 175 patients, yielding 80% globe preservation and 82% metastasis free survival as of 2010, this modality has proven to be highly effective. Despite this success, there have been few studies into the use of the world's largest cyclotron in patient care. Here we describe first efforts of modeling the TRIUMF dose delivery system using the FLUKA Monte Carlo package. Details on geometry, estimating beam parameters, measurement of primary dose and simulation of PET isotope production are discussed. Proton depth dose in both modulated and pristine beams is successfully simulated to sub-millimeter precision in range (within limits of measurement) and 2% agreement to measurement within in a treatment volume. With the goal of using PET signals for in vivo dosimetry (alignment), a first look at PET isotope depth distribution is presented — comparing favourably to a naive method of approximating simulated PET slice activity in a Lucite phantom.

  18. [3H]GABA uptake as a marker for cell type in primary cultures of cerebellum and olfactory bulb

    International Nuclear Information System (INIS)

    Currie, D.N.; Dutton, G.R.

    1980-01-01

    Uptake of [ 3 H]GABA into cell cultures of rat cerebellum and olfactory bulb was studied by autoradiography, using β-alanine and aminocyclohexane carboxylic acid to distinguish neuronal-specific and glial-specific uptake. Neurons and astrocytes were also labelled by tetanus toxin and anti-GFAP respectively. This combination of markers allowed identification and quantification of several cell types. Cerebellar cultures were found to contain 77% granule neurons, 7.5% inhibitory neurons (probably stellate and basket cells) and 15% astrocytes. Olfactory bulb cultures were over 50% in small neurons which accumulated GABA, the olfactory bulb granule neuron being GABAergic in vivo. (Auth.)

  19. Correlation between cognitive impairment and depressive mood of Thai elderly with type 2 diabetes in a primary care setting

    Directory of Open Access Journals (Sweden)

    Supaporn Trongsakul

    2015-07-01

    Full Text Available The prevalence of type 2 diabetes increases with age.1 More than 80% of people with diabetes live in low-and middle-income countries.2 Diabetes care is important in lowering blood glucose level and maintaining a good metabolic control in order to help prevent complication of diabetes. For successful diabetes self-management, individuals must commit to lifelong daily self-care tasks such as adhering to diet, exercise, medication regimens and checking blood glucose level. The coordination of these tasks often requires complex cognitive functioning.3

  20. Primary defect transformations in high-resistivity p-type silicon irradiated with electrons at cryogenic temperatures

    CERN Document Server

    Makarenko, L F; Korshunov, F P; Murin, L I; Moll, M

    2009-01-01

    It has been revealed that self-interstitials formed under low intensity electron irradiationin high resistivity p-type silicon can be retained frozen up to room temperature. Low thermal mobility of the self-interstitials suggests that Frenkelpair sinsilicon can be stable at temperatures of about or higher than 100K. A broad DLTS peak with activation energy of 0.14–0.17eV can be identified as related to Frenkel pairs. This peak anneals out at temperatures of 120 140K. Experimental evidences are presented that be coming more mobile under forwardcurrent injection the self-interstitials change their charge state to a less positive one.

  1. Structural Test Facility

    Data.gov (United States)

    Federal Laboratory Consortium — Provides a wide variety of testing equipment, fixtures and facilities to perform both unique aviation component testing as well as common types of materials testing...

  2. Clinico-Radiologic Findings in Primary Cutaneous Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Mimicking Cellulitis of the Left Arm

    International Nuclear Information System (INIS)

    Kim, Soo Hyun; Seon, Hyun Ju; Choi, Yoo Duk; Yun, Sook Jung

    2015-01-01

    Extranodal natural killer (NK)/T-cell lymphoma is a very rare and aggressive disease characterized histopathologically by an Epstein-Barr virus (EBV)-positive atypical lymphoid cytotoxic infiltrate, extensive vascular destruction, and prominent tissue necrosis. It commonly shows cutaneous lesions that primarily or secondarily mimic cellulitis at the primary site. We report on a very rare case of extranodal NK/T-cell lymphoma, nasal type of skin/soft tissue, in a 64-year-old man, and describe the radiological findings. The condition was misdiagnosed as cellulitis of the left arm based on initial noninvasive clinical and radiologic work-up

  3. Immunoglobulin G Avidities in Infants in Mexico after Primary Immunization with Three Doses of Polyribosylribitol Phosphate-Tetanus Toxoid Haemophilus influenzae Type b Vaccine▿ †

    Science.gov (United States)

    Gómez-de-León, Patricia; Díaz-García, F. Javier; Villaseñor-Sierra, Alberto; Segura, Jorge; Carranza, Martha I.; Arredondo-Garcia, José Luis; Santos, José Ignacio

    2008-01-01

    Serum immunoglobulin G concentrations and avidities specific to Haemophilus influenzae type b (Hib) were measured in 208 children living in Guadalajara and Mexico City. Protective concentrations were found in 98.9% and 100.0% of participants, respectively. Geometric mean concentrations differed between both populations and/or among age groups. Mean avidities differed only among the 7- to 12-month-old children. Diphtheria-tetanus-whole-cell pertussis-hepatitis B-Hib primary vaccination seems to induce protection in Mexican children. PMID:18417667

  4. Immunoglobulin G avidities in infants in Mexico after primary immunization with three doses of polyribosylribitol phosphate-tetanus toxoid Haemophilus influenzae type b vaccine.

    Science.gov (United States)

    Gómez-de-León, Patricia; Díaz-García, F Javier; Villaseñor-Sierra, Alberto; Segura, Jorge; Carranza, Martha I; Arredondo-Garcia, José Luis; Santos, José Ignacio

    2008-06-01

    Serum immunoglobulin G concentrations and avidities specific to Haemophilus influenzae type b (Hib) were measured in 208 children living in Guadalajara and Mexico City. Protective concentrations were found in 98.9% and 100.0% of participants, respectively. Geometric mean concentrations differed between both populations and/or among age groups. Mean avidities differed only among the 7- to 12-month-old children. Diphtheria-tetanus-whole-cell pertussis-hepatitis B-Hib primary vaccination seems to induce protection in Mexican children.

  5. In Vitro Retentive Effect of Groove, Sandblasting, and Cement Type on Stainless Steel Crowns in Primary Molars.

    Science.gov (United States)

    Pathak, Sidhant; Shashibhushan, K K; Bharath, K P; Poornima, P; Reddy, V V Subba

    2015-01-01

    The purpose of this study was to evaluate and compare the effect of placing vertical grooves, sandblasting, and luting cements on the retention of stainless steel crowns (SSCs). Eighty extracted primary molars were mounted in acrylic blocks. Specimens were divided into Group 1 (RelyX U200) and Group 2 (Smart Cem2). Teeth in each group were further subdivided into Subgroup A (no vertical grooves and no sandblasting), Subgroup B (vertical grooves), Subgroup C (sandblasting of crowns), and Subgroup D (vertical grooves and sandblasting of crowns). After cementation, SSCs were pulled off using a universal testing machine. One-way analysis of variance was used for statistical analyses. In Groups 1 and 2, the highest retentive strengths were found in Subgroup D (1,124 and 783 kPa, respectively), followed by Subgroup C (1,066 and 748 kPa, respectively), Subgroup A (762 and 356 kPa, respectively), and Subgroup B (743 and 314 kPa, respectively). Retentive strength in Group one was significantly higher than in Group two; Subgroups A and B were significantly lower than C and D. RelyX U200 showed higher retentive strength than Smart Cem2. Sandblasting increased the retention strength, whereas a vertical groove had no significant effect on retention.

  6. Enhanced primary treatment of concentrated black water and kitchen residues within DESAR concept using two types of anaerobic digesters.

    Science.gov (United States)

    Kujawa-Roeleveld, K; Elmitwalli, T; Zeeman, G

    2006-01-01

    Anaerobic digestion of concentrated domestic wastewater streams--black or brown water, and solid fraction of kitchen waste is considered as a core technology in a source separation based sanitation concept (DESAR--decentralised sanitation and reuse). A simple anaerobic digester can be implemented for an enhanced primary treatment or, in some situations, as a main treatment. Two reactor configurations were extensively studied; accumulation system (AC) and UASB septic tank at 15, 20 and 25 degrees C. Due to long retention times in an AC reactor, far stabilisation of treated medium can be accomplished with methanisation up to 60%. The AC systems are the most suitable to apply when the volume of waste to be treated is minimal and when a direct reuse of a treated medium in agriculture is possible. Digested effluent contains both liquid and solids. In a UASB septic tank, efficient separation of solids and liquid is accomplished. The total COD removal was above 80% at 25 degrees C. The effluent contains COD and nutrients, mainly in a soluble form. The frequency of excess sludge removal is low and sludge is well stabilised due to a long accumulation time.

  7. Isotope distributions in primary heat transport and containment systems during a severe accident in CANDU type reactor

    International Nuclear Information System (INIS)

    Constantin, M.

    2005-01-01

    The paper is intended to analyse the distribution of the fission products (FPs) in CANDU Primary Heat Transport (PHT) and CANDU Containment Systems by using the ASTEC code. The complexity of the data required by ASTEC and the complexity both of CANDU PHT and Containment System were strong motivation to begin with a simplified model. The data related to the nodes' definitions, temperatures and pressure conditions were chosen as possible as real data from CANDU loss of coolant accident sequence (CATHENA code results). The source term of FPs introduced into the PHT was estimated by ORIGEN code. The FPs distribution in the nodes of the circuit and the FPs mass transfer per isotope and chemical species were obtained by using SOPHAEROS module. The distributions within the containment are obtained by the CPA module (thermalhydraulic calculations in the containment and FPs aerosol transport). The results consist of mass distributions in the nodes of the circuit and the transferred mass to the containment through the break for different species (FPs and chemical species) and mass distributions in the different parts of the containment and different hosts. (authors)

  8. A systematic review of the cost-effectiveness of lifestyle modification as primary prevention intervention for type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Katrin Radl

    2013-06-01

    Full Text Available Background: diabetes is one of the leading causes of death, and has a huge economic impact on the burden of society. Lifestyle interventions such as diet, physical activity and weight reducing are proven to be effective in the prevention of diabetes. To encourage policy actions, data on the costeffectiveness of such strategies of prevention programmes are needed.Methods: a systematic review of the literature on the cost-effectiveness of prevention strategies focusing on lifestyle interventions for diabetes type 2 patients. A weighted version of Drummond checklist was used to further assess the quality of the included studies.Results: six studies met the inclusion criteria and were therefore considered in this paper. Intensive lifestyle intervention to prevent diabetes type 2 is cost-effective in comparison to other interventions. All studies were judged of medium-to-high quality.Conclusions: policy makers should consider the adoption of a prevention strategy focusing on intensive lifestyle changes because they are proven to be either cost-saving or cost-effective.

  9. Anxiety and depressive symptoms in primary caregivers of patients with severe depression. A snapshot from a military mental health care facility

    International Nuclear Information System (INIS)

    Javed, M.; Ayaz, S.B.; Ullah, A.; Matee, S.

    2015-01-01

    This study aimed at determining the frequency and severity of anxiety and depressive symptoms in primary caregivers of severely depressed patients and evaluate the impact of demographic factors. Methodology: It was a cross-sectional study conducted in the out-patient as well as the in-patient setting of Armed Forces institute of Mental Health, Rawalpindi, from September 2009 to May 2012. Through non-probability purposive sampling, primary caregivers of patients diagnosed with severe depression by consultant psychiatrists were included and scored by resident psychiatrists on Revised Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). Results: Of 316 caregivers (mean age: 37.75 ± 12.26 years), majority (52.8%) were females, married (70.6%), employed (58.5%), earned < Rs. 5,000 per month (40.5%) and literate from grade 1-5 (21.8%). Most of them were mothers (25.3%) of the patients and were the caregivers for less than one year (43.4%). The mean total BDI-II score was 17.29 ± 13.94.It was significantly high in subjects belonging to age group of < 44 years. The mean total BAI score was 14.44 ± 11.56 and it was not significantly related to any demographic factor. Conclusion: Caregivers of severely depressed patients suffered considerable levels of anxiety and depressive symptoms. Younger caregivers were at higher risk of developing depressive symptoms but the age did not significantly affect development of anxiety. Gender, marital status, employment status, monthly income, relationship with the patient, ethnicity based on provinces, educational level and duration of care giving did not appear to be significantly related to the development of anxiety or depressive symptoms in our sample. (author)

  10. Identification and Molecular Typing of Naegleria fowleri from a Patient of Primary Amebic Meningoencephalitis (PAM) in China.

    Science.gov (United States)

    Zhang, Ling-Ling; Wu, Mao; Hu, Bang-Chuan; Chen, Hua-Liang; Pan, Jin-Ren; Ruan, Wei; Yao, Li-Nong

    2018-05-08

    Naegleria fowleri (N. fowleri) is the only Naegleria spp. known to cause an acute, fulminant, and rapidly fatal central nervous system infection called primary amebic meningoencephalitis (PAM) in human. In 2016, a suspected PAM patient was found in Zhejiang Province of China. The pathogen was identified by microscopic examination and PCR. The positive PCR products were sequenced and the sequences were aligned using NCBI BLAST programme. The homologous and phylogenetic analysis was conducted using the MEGA 6 programme. Under the microscopy, the motile cells with pseudopodia were observed in the direct smear, the motion characteristics of pseudopodia as well as the cell morphology suggested that the pathogen were amoeba trophozoites. The smears stained with Wright-Giemsa showed amoeba trophozoites with various sharps, which were measured of 10-25μm and characterized by the prominent, centrally placed nucleolus and the vacuolated cytoplasm. The PCR showed negative for E. histolytica and E. dispar, while positive for Naegleria spp.and N. fowleri. The nucleotide sequences acquired from this study were submitted to the Genbank with accession numbers of KX909928 and KX909927, respectively. The Blast analysis revealed that the sequences of KX909928 and KX909927 have 100% similarity with the sequence of N. fowleri gene (KT375442.1). Sequence alignment and phylogenetic tree reavealed that N. fowleri collected from this study was classified as genotype 2 and had a closest relative with N. lovaniensis. This study confirms N. fowleri as the agent responsible for this patient, however, PAM normally progresses fast and universally fatal within a week, so the patient still died at two weeks after the onset of symptoms. Copyright © 2018. Published by Elsevier Ltd.

  11. Appendiceal goblet cell carcinoids and adenocarcinomas ex-goblet cell carcinoid are genetically distinct from primary colorectal-type adenocarcinoma of the appendix

    DEFF Research Database (Denmark)

    Jesinghaus, Moritz; Konukiewitz, Björn; Foersch, Sebastian

    2018-01-01

    The appendix gives rise to goblet cell carcinoids, which represent special carcinomas with distinct biological and histological features. Their genetic background and molecular relationship to colorectal adenocarcinoma is largely unknown. We therefore performed a next-generation sequencing analysis...... a morphomolecular entity, histologically and genetically distinct from appendiceal colorectal-type adenocarcinomas and its colorectal counterparts. Altered Wnt-signaling associated genes, apart from APC, may act as potential drivers of these neoplasms. The absence of KRAS/NRAS mutations might render some....../adenocarcinoma ex-goblet cell carcinoid (n=2, respectively). Mutations in colorectal cancer-related genes (eg, TP53, KRAS, APC) were rare to absent in both, goblet cell carcinoids and adenocarcinomas ex-goblet cell carcinoid, but frequent in primary colorectal-type adenocarcinomas of the appendix. Additional large...

  12. Patients with type 2 diabetes benefit from primary care-based disease management: a propensity score matched survival time analysis.

    Science.gov (United States)

    Drabik, Anna; Büscher, Guido; Thomas, Karsten; Graf, Christian; Müller, Dirk; Stock, Stephanie

    2012-08-01

    This study aimed to assess the impact of a nationwide German diabetes mellitus disease management program (DMP) on survival time and costs in comparison to routine care. The authors conducted a retrospective observational cohort study using routine administration data from Germany's largest sickness fund to identify insured suffering from diabetes in 2002. A total of 95,443 insured with type 2 diabetes mellitus who were born before January 1, 1962 met the defined inclusion criteria, resulting in 19,888 pairs of DMP participants and nonparticipants matched for socioeconomic and health status using propensity score matching methods. This is the first time propensity score matching has been used to evaluate a survival benefit of DMPs. In the time frame analyzed (3 years), mean survival time for the DMP group was 1045 days vs. 985 days for the routine care group (Ptime. They also incurred lower costs compared to propensity score matched insured in routine care.

  13. Feedback control of a primary pump for safe and stable operation of a PIUS-type reactor

    International Nuclear Information System (INIS)

    Tasaka, K.; Imai, S.; Masaoka, H.; Tamaki, M.; Kukita, Y.

    1993-01-01

    A new automatic pump speed control system by using a measurement of the temperature distribution in the lower density lock is proposed for the PIUS-type reactor. This control system maintains the fluid temperature at the axial center of the lower density lock at the average of the fluid temperatures below and above the density lock in order to prevent the poison water from penetrating into the core during normal operation. The effectiveness of this control system was successfully confirmed by a series of experiments such as start-up and power ramping tests for the stable normal operation and a loss-of-feedwater test for the safe shutdown in an accident condition, using a small scale atmospheric pressure test loop which simulated the PIUS principle. (orig.)

  14. Cancer recording in patients with and without type 2 diabetes in the Clinical Practice Research Datalink primary care data and linked hospital admission data: a cohort study.

    Science.gov (United States)

    Williams, Rachael; van Staa, Tjeerd-Pieter; Gallagher, Arlene M; Hammad, Tarek; Leufkens, Hubert G M; de Vries, Frank

    2018-05-26

    Conflicting results from studies using electronic health records to evaluate the associations between type 2 diabetes and cancer fuel concerns regarding potential biases. This study aimed to describe completeness of cancer recording in UK primary care data linked to hospital admissions records. Patients aged 40+ years with insulin or oral antidiabetic prescriptions in Clinical Practice Research Datalink (CPRD) primary care without type 1 diabetes were matched by age, sex and general practitioner practice to non-diabetics. Those eligible for linkage to Hospital Episode Statistics Admitted Patient Care (HES APC), and with follow-up during April 1997-December 2006 were included. Cancer recording and date of first record of cancer were compared. Characteristics of patients with cancer most likely to have the diagnosis recorded only in a single data source were assessed. Relative rates of cancer estimated from the two datasets were compared. 53 585 patients with type 2 diabetes matched to 47 435 patients without diabetes were included. Of all cancers (excluding non-melanoma skin cancer) recorded in CPRD, 83% were recorded in HES APC. 94% of cases in HES APC were recorded in CPRD. Concordance was lower when restricted to same-site cancer records, and was negatively associated with increasing age. Relative rates for cancer were similar in both datasets. Good concordance in cancer recording was found between CPRD and HES APC among type 2 diabetics and matched controls. Linked data may reduce misclassification and increase case ascertainment when analysis focuses on site-specific cancers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. The completeness of electronic medical record data for patients with Type 2 Diabetes in primary care and its implications for computer modelling of predicted clinical outcomes.

    Science.gov (United States)

    Staff, Michael; Roberts, Christopher; March, Lyn

    2016-10-01

    To describe the completeness of routinely collected primary care data that could be used by computer models to predict clinical outcomes among patients with Type 2 Diabetes (T2D). Data on blood pressure, weight, total cholesterol, HDL-cholesterol and glycated haemoglobin levels for regular patients were electronically extracted from the medical record software of 12 primary care practices in Australia for the period 2000-2012. The data was analysed for temporal trends and for associations between patient characteristics and completeness. General practitioners were surveyed to identify barriers to recording data and strategies to improve its completeness. Over the study period data completeness improved up to around 80% complete although the recording of weight remained poorer at 55%. T2D patients with Ischaemic Heart Disease were more likely to have their blood pressure recorded (OR 1.6, p=0.02). Practitioners reported not experiencing any major barriers to using their computer medical record system but did agree with some suggested strategies to improve record completeness. The completeness of routinely collected data suitable for input into computerised predictive models is improving although other dimensions of data quality need to be addressed. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  16. Study protocol for “MOVEdiabetes”: a trial to promote physical activity for adults with type 2 diabetes in primary health care in Oman

    Directory of Open Access Journals (Sweden)

    Thamra S. Alghafri

    2017-01-01

    Full Text Available Abstract Background Benefits of physical activity in the management of diabetes are well documented. However, evidence on the effectiveness of interventions integrating physical activity in diabetes care is sparse especially in the countries of the Gulf Cooperation Council. The results from this study will increase our understanding of the use of multi-component interventions aimed at increasing physical activity levels in inactive adults with type 2 diabetes in primary health care in Oman. Methods/design The study is a one year 1:1 cluster randomized controlled trial of the MOVEdiabetes programme (intervention versus usual care in eight primary health care centres in Oman. The MOVEdiabetes programme utilizes face to face physical activity consultations promoting 150 min of moderate to vigorous physical activity per week (≥600MET-mins/week, pedometers to self-monitor step counts and monthly telephone WhatsApp messages for follow up support. Inactive adults with type 2 diabetes and no contraindication to physical activity will be recruited over a two months period, and followed up for 12 months. To demonstrate a 50% between group difference in physical activity levels (MET-mins/week over 12 months, (at a power of 80%, and significance level of 5%, 128 participants would be required to complete the study (64 in each arm. Based on a drop-out rate of 20%, 154 participants would require to be recruited (77 in each arm. Assuming a recruitment rate of 70%, 220 potential eligible participants would need to be approached. The primary outcome is change in levels of physical activity measured by the Global Physical Activity Questionnaire. In addition, accelerometers will be used in a sub group to objectively assess physical activity. Secondary outcomes include changes in metabolic and cardiovascular biomarkers, change in self-reported health, social support, self-efficacy for physical activity, and perceived acceptability of the program. All

  17. Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study

    Directory of Open Access Journals (Sweden)

    Vernby Åsa

    2006-12-01

    Full Text Available Abstract Background A good patient-physician interaction is particularly important in chronic diseases like diabetes. There are so far no published data regarding the interaction between the primary health-care providers and patients with type 2 diabetes in Oman, where diabetes is a major and growing health problem. This study aimed at exploring how health-care providers interact with patients with type 2 diabetes at primary health-care level in Muscat, Oman, focusing on the consultation environment, and some aspects of care and information. Methods Direct observations of 90 consultations between 23 doctors and 13 diabetes nurses concerned with diabetes management during their consultations with type 2 diabetes patients in six primary health-care centres in the Muscat region, using checklists developed from the National Diabetes Guidelines. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled and sub-optimal if less than 50% were fulfilled. Results Overall 52% of the doctors' consultations were not optimal. Some important aspects for a positive consultation environment were fulfilled in only about half of the doctors' consultations: ensuring privacy of consultation (49%, eye contact (49%, good attention (52%, encouraging asking questions (47%, and emphasizing on the patients' understanding of the provided information (52%. The doctors enquired about adverse effects of anti-diabetes drugs in less than 10% of consultations. The quality of the nurses' consultations was sub-optimal in about 75% of 85 consultations regarding aspects of consultation environment, care and information. Conclusion The performance of the primary health-care doctors and diabetes nurses needs to be improved. The role of the diabetes nurses and the teamwork should be enhanced. We suggest a multidisciplinary team approach, training and education to the providers to upgrade their skills regarding communication and care. Barriers to

  18. The correlation of deceleration capacity of rate with the cardiac function and micro-inflammatory state in patients with both primary hypertension and type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Qing-Rong Zhou

    2017-05-01

    Full Text Available Objective: To study the correlation of deceleration capacity of rate with the cardiac function and micro-inflammatory state in patients with both primary hypertension and type 2 diabetes mellitus. Methods: A total of 60 patients with both primary hypertension and type 2 diabetes mellitus who were treated in our hospital between May 2012 and February 2016 were collected as the observation group, and 50 patients with primary hypertension who were treated in our hospital during the same period were selected as the control group. According to the median of deceleration capacity of rate (DC, the observation group of patients were further divided into high DC group and low DC group (n=30. The 24 h dynamic electrocardiogram of the included patients were obtained to calculate the DC value; color Doppler diasonograph was used to measure the echocardiogram of the two groups, and obtain the left cardiac function indexes and strain rate indexes; enzyme-linked immunosorbent assay (ELISA was used to detect the contents of serum pro-inflammatory factors and anti-inflammatory factors. Results: The DC value of observation group was lower than that of control group; left cardiac function indexes IVSTd, LVIDd and LVIDs levels of low DC group and high DC group were higher than those of control group, strain rate indexes SRs, SRe and Sra levels were lower than those of control group, and serum pro-inflammatory factors CRP, IL-6, IL-18 and PCT contents were higher than those of control group while anti-inflammatory factors IL-10 and IL-13 contents were lower than those of control group; IVSTd, LVIDd and LVIDs levels of low DC group were higher than those of high DC group, SRs, SRe and Sra levels were lower than those of high DC group, and serum CRP, IL-6, IL-18 and PCT contents were higher than those of high DC group while IL-10 and IL-13 contents were lower than those of high DC group. Conclusion: DC value is lower in patients with both primary hypertension and type

  19. Important points for primary cleft palate repair for speech derived from speech outcome after three different types of palatoplasty.

    Science.gov (United States)

    Funayama, Emi; Yamamoto, Yuhei; Nishizawa, Noriko; Mikoya, Tadashi; Okamoto, Toru; Imai, Satoko; Murao, Naoki; Furukawa, Hiroshi; Hayashi, Toshihiko; Oyama, Akihiko

    2014-12-01

    This study was performed to investigate speech outcomes after three different types of palatoplasty for the same cleft type. The objective of this study was to investigate the surgical techniques that are essential for normal speech on the basis of each surgical characteristic. Thirty-eight consecutive nonsyndromic patients with unilateral complete cleft of the lip, alveolus, and palate were enrolled in this study. Speech outcomes, i.e., nasal emission, velopharyngeal insufficiency, and malarticulation after one-stage pushback (PB), one-stage modified Furlow (MF), or conventional two-stage MF palatoplasty, were evaluated at 4 (before intensive speech therapy) and 8 (after closure of oronasal fistula/unclosed hard palate) years of age. Velopharyngeal insufficiency at 4 (and 8) years of age was present in 5.9% (0.0%), 0.0% (0.0%), and 10.0% (10.0%) of patients who underwent one-stage PB, one-stage MF, or two-stage MF palatoplasty, respectively. No significant differences in velopharyngeal function were found among these three groups at 4 and 8 years of age. Malarticulation at 4 years of age was found in 35.3%, 10.0%, and 63.6% of patients who underwent one-stage PB, one-stage MF, and two-stage MF palatoplasty, respectively. Malarticulation at 4 years of age was significantly related to the presence of a fistula/unclosed hard palate (P<0.01). One-stage MF palatoplasty that was not associated with postoperative oronasal fistula (ONF) showed significantly better results than two-stage MF (P<0.01). Although the incidences of malarticulation at 8 years of age were decreased in each group compared to at 4 years of age, the incidence was still high in patients treated with two-stage MF (45.5%). On the whole, there was a significant correlation between ONF/unclosed hard palate at 4 years of age and malarticulation at 8 years of age (P<0.05). Appropriate muscle sling formation can compensate for a lack of retropositioning of the palate for adequate velopharyngeal closure

  20. 'Working with the team': an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care.

    Science.gov (United States)

    Hepworth, Julie; Askew, Deborah; Jackson, Claire; Russell, Anthony

    2013-01-01

    This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants' responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.