WorldWideScience

Sample records for providing high-level qualitative

  1. Qualitative assessment of tongue drive system by people with high-level spinal cord injury.

    Science.gov (United States)

    Kim, Jeonghee; Park, Hangue; Bruce, Joy; Rowles, Diane; Holbrook, Jaimee; Nardone, Beatrice; West, Dennis P; Laumann, Anne E; Roth, Elliot; Veledar, Emir; Ghovanloo, Maysam

    2014-01-01

    The Tongue Drive System (TDS) is a minimally invasive, wireless, and wearable assistive technology (AT) that enables people with severe disabilities to control their environments using tongue motion. TDS translates specific tongue gestures into commands by sensing the magnetic field created by a small magnetic tracer applied to the user's tongue. We have previously quantitatively evaluated the TDS for accessing computers and powered wheelchairs, demonstrating its usability. In this study, we focused on its qualitative evaluation by people with high-level spinal cord injury who each received a magnetic tongue piercing and used the TDS for 6 wk. We used two questionnaires, an after-scenario and a poststudy, designed to evaluate the tongue-piercing experience and the TDS usability compared with that of the sip-and-puff and the users' current ATs. After study completion, 73% of the participants were positive about keeping the magnetic tongue-barbell in order to use the TDS. All were satisfied with the TDS performance and most said that they were able to do more things using TDS than their current ATs (4.22/5).

  2. a qualitative study of providers' perspectives

    African Journals Online (AJOL)

    Background: Glaucoma management is challenging to patients as well as to the eye care providers.The study is aimed at describing the challenges faced by providers using qualitative methods. Methods: In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres ...

  3. Scoring methods and results for qualitative evaluation of public health impacts from the Hanford high-level waste tanks. Integrated Risk Assessment Program

    Energy Technology Data Exchange (ETDEWEB)

    Buck, J.W.; Gelston, G.M.; Farris, W.T.

    1995-09-01

    The objective of this analysis is to qualitatively rank the Hanford Site high-level waste (HLW) tanks according to their potential public health impacts through various (groundwater, surface water, and atmospheric) exposure pathways. Data from all 149 single-shell tanks (SSTs) and 23 of the 28 double-shell tanks (DSTs) in the Tank Waste Remediation System (TWRS) Program were analyzed for chemical and radiological carcinogenic as well as chemical noncarcinogenic health impacts. The preliminary aggregate score (PAS) ranking system was used to generate information from various release scenarios. Results based on the PAS ranking values should be considered relative health impacts rather than absolute risk values.

  4. Effective factors in providing holistic care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2015-01-01

    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  5. How do providers prioritize prevention? A qualitative study.

    Science.gov (United States)

    Solomon, Jeffrey L; Gifford, Allen L; Asch, Steven M; Meuller, Nora; Thomas, Colin M; Stevens, John M; Bokhour, Barbara G

    2013-10-01

    Preventive care is an essential element of comprehensive primary care medicine, yet many providers do not address the full range of recommended preventive care services. There is little understanding of how, during time-constrained clinical encounters, providers prioritize preventive care services. To identify and compare how Department of Veterans Affairs (VA) primary care providers (PCPs) prioritized general preventive care services, including HIV testing. A semistructured, qualitative interview design. We conducted semistructured phone interviews with 31 PCPs across 2 urban VA facilities. Interviews entailed questions about the most common preventive care services in primary care, how decisions are made to address some preventive care services but not others, and the role of clinical reminders (CRs) in prioritizing care. Interviews were audio-recorded and transcribed verbatim. We conducted an iterative thematic analysis of interview transcripts, utilizing NVivo 8, a qualitative data management and coding software. Most PCPs indicated they did not utilize CRs as a primary means of prioritizing general preventive care. Instead, PCPs prioritized general preventive care by attending to patients' individual needs and/or keeping in mind influential clinical training experiences. Prioritizing HIV testing included 1 or a combination of the following strategies: being attuned to HIV risk factors prior to the appearance of the CR, being prompted by the CR, and having a positive attitude toward CR design. Prioritizing preventive care can be accomplished using various strategies, including CRs. Healthcare systems might benefit from encouraging PCPs to use a range of strategies.

  6. High-level verification

    CERN Document Server

    Lerner, Sorin; Kundu, Sudipta

    2011-01-01

    Given the growing size and heterogeneity of Systems on Chip (SOC), the design process from initial specification to chip fabrication has become increasingly complex. This growing complexity provides incentive for designers to use high-level languages such as C, SystemC, and SystemVerilog for system-level design. While a major goal of these high-level languages is to enable verification at a higher level of abstraction, allowing early exploration of system-level designs, the focus so far for validation purposes has been on traditional testing techniques such as random testing and scenario-based

  7. ALICE High Level Trigger

    CERN Multimedia

    Alt, T

    2013-01-01

    The ALICE High Level Trigger (HLT) is a computing farm designed and build for the real-time, online processing of the raw data produced by the ALICE detectors. Events are fully reconstructed from the raw data, analyzed and compressed. The analysis summary together with the compressed data and a trigger decision is sent to the DAQ. In addition the reconstruction of the events allows for on-line monitoring of physical observables and this information is provided to the Data Quality Monitor (DQM). The HLT can process event rates of up to 2 kHz for proton-proton and 200 Hz for Pb-Pb central collisions.

  8. Patient-provider conversations about sterilization: A qualitative analysis.

    Science.gov (United States)

    Kimport, Katrina; Dehlendorf, Christine; Borrero, Sonya

    2017-03-01

    Although female sterilization is the second most commonly used contraceptive method in the US, research suggests that providers may serve as barriers to desired sterilization. We conducted a modified grounded theory analysis of audio-recorded contraceptive counseling visits with 52 women who specified on a previsit survey that they wanted no future children and a supplemental analysis of visits with 14 women who wanted or were unsure about future children in which sterilization was mentioned. Sterilization was discussed in only 19 of the 52 visits, primarily with patients who were older women with children. Although some framed sterilization positively, many clinicians discouraged patients from pursuing sterilization, encouraging them instead to use long-acting reversible methods and framing the permanence of sterilization as undesirable. In the 33 remaining sessions, sterilization was not mentioned, and clinicians largely failed to solicit patients' future reproductive intentions. We found no clear patterns regarding discussion of sterilization in the 14 supplemental cases. Clinicians did not discuss sterilization with all patients for whom it might have been appropriate and thus missed opportunities to discuss sterilization as part of the full range of appropriate methods. When they did discuss sterilization, they only infrequently presented the method in positive ways and more commonly encouraged patients to choose a long-acting reversible method instead. Clinicians may want to reflect on their counseling practices around sterilization to ensure that counseling is centered on patient preferences, rather than driven by their own assumptions about the desirability of reversibility. Clinicians often fail to discuss sterilization as a contraceptive option with potentially appropriate candidates and, when they do, often discourage its selection. Clinicians should consider assessing reproductive intentions to ensure that potentially relevant methods are included in

  9. Emotional Aspects of Computer-based Provider Order Entry: A Qualitative Study

    OpenAIRE

    Sittig, Dean F; Krall, Michael; Kaalaas-Sittig, JoAnn; Ash, Joan S.

    2005-01-01

    Objectives: Computer-based provider order entry (CPOE) systems are implemented to increase both efficiency and accuracy in health care, but these systems often cause a myriad of emotions to arise. This qualitative research investigates the emotions surrounding CPOE implementation and use.

  10. Primary care provider approaches to preventive health delivery: a qualitative study.

    Science.gov (United States)

    Murugan, Hemalatha; Spigner, Clarence; McKinney, Christy M; Wong, Christopher J

    2018-01-08

    Aim The objective of this study was to seek decision-making insights on the provider level to gain understanding of the values that shape how providers deliver preventive health in the primary care setting. The primary care clinic is a core site for preventive health delivery. While many studies have identified barriers to preventive health, less is known regarding how primary care providers (PCPs) make preventive health decisions such as what services to provide, under what circumstances, and why they might choose one over another. Qualitative methods were chosen to deeply explore these issues. We conducted semi-structured, one-on-one interviews with 21 PCPs at clinics affiliated with an academic medical center. Interviews with providers were recorded and transcribed. We conducted a qualitative analysis to identify themes and develop a theoretical framework using Grounded Theory methods. Findings The following themes were revealed: longitudinal care with an established PCP-patient relationship is perceived as integral to preventive health; conflict and doubt accompany non-preventive visits; PCPs defer preventive health for pragmatic reasons; when preventive health is addressed, providers use multiple contextual factors to decide which interventions are discussed; and PCPs desired team-based preventive health delivery, but wish to maintain their role when shared decision-making is required. We present a conceptual framework called Pragmatic Deferral.

  11. PERCEPTIONS OF INDONESIAN PRACTICAL NURSES TOWARDS UPDATING CAPABILITY TO PROVIDE CARE: A QUALITATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Fitri Arofiati

    2017-02-01

    Full Text Available Background: Capability to provide care can be recognized as the combination of nursing knowledge, skills, and attitude of care which is dynamic. Objective: This study aims to explore the perceptions of practical nurses towards updating capability to provide care. Methods: A descriptive qualitative study was conducted to explore the deep understanding of practical nurses towards updating capability to provide care. Data were gathered using in-depth interview with 25 practical nurses from different areas of practices, three times focus group discussion (FGD and participant-observation. Qualitative content analysis model was applied to anaylze the data. Result: There were two themes emerged from data: 1 Internal perceptions of updating capacity to provide care, with three subthemes: Having great expectation, Being confidence as a professional nurse, and Developing Self-Initiation, 2 External contexts driving perception of practicing nurses, with two subthemes: Giving best care and Acquiring requirement. Conclusions: The findings indicated that updating capacity to provide care supports practical nurses to provide better nursing services to patients and meet the regulation of nursing professionalism.

  12. Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study.

    Science.gov (United States)

    Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Høyland, Sindre; Braut, Geir Sverre; Søreide, Eldar

    2017-02-01

    Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome. Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts. The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety. Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.

  13. Obstacles to the discussion of sexual problems in menopausal women: a qualitative study of healthcare providers.

    Science.gov (United States)

    Ghazanfarpour, Masoumeh; Khadivzadeh, Talat; Latifnejad Roudsari, Robab; Mehdi Hazavehei, Seyed Mohammad

    2017-07-01

    The aim of this study was to explore issues that challenge menopausal women in discussions of their sexual problems with a physician. This was done from the perspective of healthcare providers. In a descriptive exploratory qualitative study, using a semi-structured interview and purposive sampling, a sample set of 12 midwives and 13 general practitioners aged 25-70 years were selected in order to elicit meaning behind their experiences about the subject under study. Data analysis was carried out using qualitative content analysis. Results were used to identify a number of obstacles that hindered women from seeking help for sexual problems from GPs and midwives. These obstacles included the following: (1) traditional and cultural beliefs; (2) religious belief; (3) individuals' beliefs and (4) access to services. More research is needed to explore effective strategies to overcome these problems. Impact statement Current knowledge on the subject: In the literature, many reasons have been identified for the unwillingness of Iranian women to discuss their sexual problems with health providers. These include lack of time, feelings of shame and an expectation that a doctor cannot help. However, no qualitative study has addressed barriers held by menopausal women for seeking treatment for sexual problems. The contribution made by the results of this study: The results of this study add to the growing body of research on reasons that determine why most postmenopausal women rarely visit a doctor unless they were in tremendous physical or emotional pain. Also, menopausal women thought that an unmarried health provider would be less understanding about sexual and marital problems and they felt guilty about sharing such issues with them. Patients' opinions on the nature of menopause (a pathological vs. physiological process) affect the way in which the symptoms of menopause and sexual problems are handled by patient. The implications are of these findings for clinical

  14. Provider perspectives on barriers to family planning quality in Uganda: a qualitative study.

    Science.gov (United States)

    Mugisha, John Frank; Reynolds, Heidi

    2008-01-01

    Provider perspectives on the quality of family planning services have been overlooked in quality of care research and interventions. This qualitative study was carried out in four districts in Uganda, a country where lack of access to quality family planning services remains a challenge. Using four focus group discussions, 16 provider in-depth interviews and nine manager in-depth interviews, this study documented providers' perceptions of quality of care and of barriers to quality services at the organisational and societal levels. To guide study development, analysis and interpretation, the authors relied on an ecological framework where providers' abilities are shaped by the larger organisational and societal environments in which providers live and work. Providers felt that organisational factors, such as supply availability, workload and their own knowledge and skills, affected their abilities to offer quality care. At the same time, providers were challenged by societal factors such as male partner participation, financial constraints, misconceptions and leadership support. While making changes to the elements of quality care that clients experience is important, it is not sufficient in view of the organisational and social barriers. Across the different levels of the ecological framework, providers face barriers to providing quality family planning services that are synergistic. Solutions to improve quality of care must address also limitations at the organisational and societal levels since efforts to overcome a particular constraint are less likely to be successful if this interdependence is not taken into account.

  15. Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study.

    Science.gov (United States)

    Reese, Jennifer Barsky; Beach, Mary Catherine; Smith, Katherine Clegg; Bantug, Elissa T; Casale, Kristen E; Porter, Laura S; Bober, Sharon L; Tulsky, James A; Daly, Mary B; Lepore, Stephen J

    2017-04-27

    Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development. Patient data (n = 28) were derived from focus groups and interviews with partnered and unpartnered women treated for breast cancer reporting sexual concerns. Provider data (n = 11) came from interviews with breast cancer oncologists and nurse practitioners. Patient and provider data were analyzed separately using the framework method of qualitative analysis. Findings revealed individual and institutional barriers to effective communication about sexual concerns and highlighted key communication facilitators (e.g., a positive patient-provider relationship, patient communication as a driver of provider communication, and vice versa). Patients expressed preferences for open, collaborative communication; providers expressed preferences for focused intervention targets (identifying concerns, offering resources/referrals) and convenient format. A model of effective communication of sexual concerns was developed to inform communication interventions. Findings suggest that to improve patient-provider communication about sexual concerns, knowledge and skills-based interventions that activate patients and that equip providers for effective discussions about sexual concerns are needed, as are institutional changes that could incentivize such discussions.

  16. Improving Pediatric Education for Emergency Medical Services Providers: A Qualitative Study.

    Science.gov (United States)

    Brown, Seth A; Hayden, Theresa C; Randell, Kimberly A; Rappaport, Lara; Stevenson, Michelle D; Kim, In K

    2017-02-01

    Previous studies have illustrated pediatric knowledge deficits among Emergency Medical Services (EMS) providers. The purpose of this study was to identify perspectives of a diverse group of EMS providers regarding pediatric prehospital care educational deficits and proposed methods of training improvements. Purposive sampling was used to recruit EMS providers in diverse settings for study participation. Two separate focus groups of EMS providers (administrative and non-administrative personnel) were held in three locations (urban, suburban, and rural). A professional moderator facilitated focus group discussion using a guide developed by the study team. A grounded theory approach was used to analyze data. Forty-two participants provided data. Four major themes were identified: (1) suboptimal previous pediatric training and training gaps in continuing pediatric education; (2) opportunities for improved interactions with emergency department (ED) staff, including case-based feedback on patient care; (3) barriers to optimal pediatric prehospital care; and (4) proposed pediatric training improvements. Focus groups identified four themes surrounding preparation of EMS personnel for providing care to pediatric patients. These themes can guide future educational interventions for EMS to improve pediatric prehospital care. Brown SA , Hayden TC , Randell KA , Rappaport L , Stevenson MD , Kim IK . Improving pediatric education for Emergency Medical Services providers: a qualitative study. Prehosp Disaster Med. 2017;32(1):20-26.

  17. Emotional aspects of computer-based provider order entry: a qualitative study.

    Science.gov (United States)

    Sittig, Dean F; Krall, Michael; Kaalaas-Sittig, Joann; Ash, Joan S

    2005-01-01

    Computer-based provider order entry (CPOE) systems are implemented to increase both efficiency and accuracy in health care, but these systems often cause a myriad of emotions to arise. This qualitative research investigates the emotions surrounding CPOE implementation and use. We performed a secondary analysis of several previously collected qualitative data sets from interviews and observations of over 50 individuals. Three researchers worked in parallel to identify themes that expressed emotional responses to CPOE. We then reviewed and classified these quotes using a validated hierarchical taxonomy of semantically homogeneous terms associated with specific emotions. The implementation and use of CPOE systems provoked examples of positive, negative, and neutral emotions. Negative emotional responses were the most prevalent, by far, in all the observations. Designing and implementing CPOE systems is difficult. These systems and the implementation process itself often inspire intense emotions. If designers and implementers fail to recognize that various CPOE features and implementation strategies can increase clinicians' negative emotions, then the systems may fail to become a routine part of the clinical care delivery process. We might alleviate some of these problems by designing positive feedback mechanisms for both the systems and the organizations.

  18. Providing social services in a new immigrant settlement city: A qualitative inquiry.

    Science.gov (United States)

    Negi, Nalini Junko; Maskell, Erin; Goodman, Marci; Hooper, Jenia; Roberts, Jamie

    2018-01-01

    Nationally, a new trend in migration has included the settlement of Latina/o immigrants in cities without an established community of Latinas/os. Social services become even more salient in this context in the absence of informal social networks of support. This study, guided by social ecological theory, advances our limited understanding of social services in new immigrant settlement destinations by elucidating contextual and structural factors endemic to the social service delivery process in these new immigrant destinations. Twenty-nine social service providers who work with Latina/o immigrants in Baltimore were interviewed and Consensual Qualitative Research (CQR; Hill, Thompson, & Nutt Williams, 1997) methods were used to analyze data through consensus and the use of multiple data "auditors." Findings extend our understanding of the context of social services in a new immigrant settlement city by identifying qualitative factors related to the new immigrant settlement, organization and work, community, and client level that impact access and quality of services. A theoretically driven conceptual framework adapted from the Structural Environmental conceptual framework (Organista, 2007) is also proposed to explain the transactional interconnectedness among structural-, environmental-, and client-level factors in the social service delivery process. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  19. Healthcare providers' perceptions of a situational awareness display for emergency department resuscitation: a simulation qualitative study.

    Science.gov (United States)

    Calder, Lisa A; Bhandari, Abhi; Mastoras, George; Day, Kathleen; Momtahan, Kathryn; Falconer, Matthew; Weitzman, Brian; Sohmer, Benjamin; Cwinn, A Adam; Hamstra, Stanley J; Parush, Avi

    2017-11-29

    Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety. To determine resuscitation team members' perceptions of the Situational Awareness Display's utility. We conducted focus groups with healthcare providers during Situational Awareness Display development. After simulations assessing the display, we conducted debriefs with participants. Dual site tertiary care level 1 trauma centre in Ottawa, Canada. We recruited by email physicians, nurses and respiratory therapist. Situational Awareness Display, a visual cognitive aid that provides key clinical information to enhance resuscitation team communication and situational awareness. Themes emerging from focus groups and simulation debriefs. Three reviewers independently coded and analysed transcripts using content qualitative analysis. We recruited a total of 33 participants in two focus groups (n = 20) and six simulation debriefs with three 4-5 member teams (n = 13). Majority of participants (10/13) strongly endorsed the Situational Awareness Display's utility in simulation (very or extremely useful). Focus groups and debrief themes included improved perception of patient data, comprehension of context and ability to project to future decisions. Participants described potentially positive and negative impacts on patient safety and positive impacts on provider performance and team communication. Participants expressed a need for easy data entry incorporated into clinical workflow and training on how to use the display. Emergency resuscitation team participants felt the Situational Awareness Display has potential to improve provider performance, team communication and situational awareness, ultimately enhancing quality of care.

  20. Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study.

    Science.gov (United States)

    Maragh-Bass, Allysha C; Fields, Julie C; McWilliams, Junette; Knowlton, Amy R

    2017-04-01

    Introduction Research suggests Emergency Medical Services (EMS) over-use in urban cities is partly due to substance users with limited access to medical/social services. Recent efforts to deliver brief, motivational messages to encourage these individuals to enter treatment have not considered EMS providers. Problem Little research has been done with EMS providers who serve substance-using patients. The EMS providers were interviewed about participating in a pilot program where they would be trained to screen their patients for substance abuse and encourage them to enter drug treatment. Qualitative interviews were conducted with Baltimore City Fire Department (BCFD; Baltimore, Maryland USA) EMS providers (N=22). Topics included EMS misuse, work demands, and views on participating in the pilot program. Interviews were transcribed and analyzed using grounded theory and constant-comparison. Participants were mostly white (68.1%); male (68.2%); with Advanced Life Skills training (90.9%). Mean age was 37.5 years. Providers described the "frequent flyer problem" (eg, EMS over-use by a few repeat non-emergent cases). Providers expressed disappointment with local health delivery due to resource limitations and being excluded from decision making within their administration, leading to reduced team morale and burnout. Nonetheless, providers acknowledged they are well-positioned to intervene with substance-using patients because they are in direct contact and have built rapport with them. They noted patients might be most receptive to motivational messages immediately after overdose revival, which several called "hitting their bottom." Several stated that involvement with the proposed study would be facilitated by direct incorporation into EMS providers' current workflow. Many recommended that research team members accompany EMS providers while on-call to observe their day-to-day work. Barriers identified by the providers included time constraints to intervene, limited

  1. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians' views, a qualitative study.

    Science.gov (United States)

    Yoxall, Charles W; Ayers, Susan; Sawyer, Alexandra; Bertullies, Sophia; Thomas, Margaret; D Weeks, Andrew; Duley, Lelia

    2015-09-30

    The aims of this study were to assess clinicians' views and experiences of providing immediate neonatal care at birth beside the mother, and of using a mobile trolley designed to facilitate this bedside care. Qualitative interview study with semistructured interviews. The results were analysed using thematic analysis. A large UK maternity unit. Clinicians (n=20) from a range of disciplines who were present when the trolley was used to provide neonatal care at birth at the bedside. Five clinicians provided/observed advanced resuscitation by the bedside. Five themes were identified: (1) Parents' involvement, which included 'Contact and involvement', 'Positive emotions for parents' and 'Staff communication'; (2) Reservations about neonatal care at birth beside the mother, which included 'Impact on clinicians' and 'Impact on parents'; (3) Practical challenges in providing neonatal care at the bedside, which included 'Cord length' and 'Caesarean section'; (4) Comparison of the trolley with usual resuscitation equipment and (5) Training and integration of bedside care into clinical routine, which included 'Teething problems' and 'Training'. Overall, most clinicians were positive about providing immediate neonatal care at the maternal bedside, particularly in terms of the clinicians' perceptions of the parents' experience. Clinicians also perceived that their close proximity to parents improved communication. However, there was some concern about performing more intensive interventions in front of parents. Providing immediate neonatal care and resuscitation at the bedside requires staff training and support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians’ views, a qualitative study

    Science.gov (United States)

    Yoxall, Charles W; Ayers, Susan; Sawyer, Alexandra; Bertullies, Sophia; Thomas, Margaret; D Weeks, Andrew; Duley, Lelia

    2015-01-01

    Objectives The aims of this study were to assess clinicians’ views and experiences of providing immediate neonatal care at birth beside the mother, and of using a mobile trolley designed to facilitate this bedside care. Design Qualitative interview study with semistructured interviews. Results The results were analysed using thematic analysis. Setting A large UK maternity unit. Participants Clinicians (n=20) from a range of disciplines who were present when the trolley was used to provide neonatal care at birth at the bedside. Five clinicians provided/observed advanced resuscitation by the bedside. Results Five themes were identified: (1) Parents’ involvement, which included ‘Contact and involvement’, ‘Positive emotions for parents’ and ‘Staff communication’; (2) Reservations about neonatal care at birth beside the mother, which included ‘Impact on clinicians’ and ‘Impact on parents’; (3) Practical challenges in providing neonatal care at the bedside, which included ‘Cord length’ and ‘Caesarean section’; (4) Comparison of the trolley with usual resuscitation equipment and (5) Training and integration of bedside care into clinical routine, which included ‘Teething problems’ and ‘Training’. Conclusions Overall, most clinicians were positive about providing immediate neonatal care at the maternal bedside, particularly in terms of the clinicians’ perceptions of the parents’ experience. Clinicians also perceived that their close proximity to parents improved communication. However, there was some concern about performing more intensive interventions in front of parents. Providing immediate neonatal care and resuscitation at the bedside requires staff training and support. PMID:26423852

  3. Midwives' perception of their role in providing antenatal asthma management in Australia--a qualitative study.

    Science.gov (United States)

    McLaughlin, Karen; Kable, Ashley; Ebert, Lyn; Murphy, Vanessa

    2016-04-01

    International guidelines recommend a collaborative approach to the care of pregnant women with asthma. Midwives, as the primary health care provider for childbearing women should be viewed as collaborative partners in the provision of antenatal asthma management. However, the role of the midwife in providing antenatal asthma management has not been widely reported. Australian midwives' perceived role in antenatal asthma management was studied using a qualitative descriptive method. Semi-structured in-depth interviews were conducted with 13 midwives working in a regional tertiary hospital. Morse and Field's four-stage process was used to analyse the data. the perceived role of the midwife in antenatal asthma management varied among participants. Some midwives stated their role was to refer women on to other health professionals. Other midwives stated that they should provide education to the women regarding their asthma management during their pregnancy. participants were uncertain about their role and lacked confidence in antenatal asthma management. The midwifery context in which they worked and the resources available to them at this health care facility appeared to influence the perception of their role. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. The experience of providing end of life care at a children's hospice: a qualitative study.

    Science.gov (United States)

    McConnell, Tracey; Porter, Sam

    2017-02-13

    More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children's hospice. Qualitative research incorporating interviews and a focus group. Data were analysed using thematic analysis. Purposeful sampling led to a total of 15 care team staff recruited from a children's hospice offering palliative and specialist care to life-limited children and young people. The hospice setting provides a model of excellence in supporting staff and mitigating challenging aspects of their role, which includes peer/organisational support, and regular ongoing training in key aspects of children's palliative care. Key recommendations for improving their experience included advanced communication training and knowledge sharing with other children's palliative care specialists within the acute setting. Service and policy initiatives should encourage open, informal peer/organisational support among the wider children's palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children's hospices and hospital settings.

  5. CHALLENGES IN THE MANAGEMENT OF GLAUCOMA IN A DEVELOPING COUNTRY; A QUALITATIVE STUDY OF PROVIDERS' PERSPECTIVES.

    Science.gov (United States)

    Adekoya, B J; Adepoju, F G; Moshood, K F; Balarabe, A H

    2015-01-01

    Glaucoma management is challenging to patients as well as to the eye care providers. The study is aimed at describing the challenges faced by providers using qualitative methods. In-depth interviews were conducted with selected Ophthalmologists and resident doctors in ophthalmology at centres offering medical and surgical glaucoma services in Lagos state, Nigeria, according to established qualitative methods. This was done using semi-structured, open ended questions to explore the providers' perspective on glaucoma burden, challenges in the management, surgery for glaucoma, acceptance of glaucoma surgery by patients, and recommendations for improving glaucoma services. The discussions were recorded with the aid of a micro-cassette recorder. Familiarisation was done to identify key ideas in the data, then, the main themes and sub-themes were identified. Quotes that reflect the themes and sub-themes were then identified in the data. In-depth interviews were conducted with a total of 11 ophthalmologists and resident doctors in training. Majority were of the opinion that glaucoma is a significant burden constituting about 35% of outpatient visits. Identified patient related challenges include; late presentation, lack of glaucoma awareness, delay in referral from optometrists, and poor compliance with medications. Shortages in needed equipment were also identified. Availability, affordability and counterfeiting of drugs were the major challenges related to medical treatment. Majority of the participants agreed that surgery should be offered to the patients as soon as the diagnosis of glaucoma is made. However, continuous monitoring of the patient on medical treatment is another line of option for them in early cases; if they are convinced the patients will be compliant. Some respondents considered the current number of glaucoma surgeries as adequate, while some think otherwise. Reasons put forward for reluctance to offer glaucoma surgery include; late presentation, lack

  6. [Comprehensibility of patient education in orthopaedic rehabilitation: a qualitative study on patients and providers].

    Science.gov (United States)

    Nagl, M; Ullrich, A; Farin, E

    2013-02-01

    An important requirement for achieving postulated goals in the context of patient education is that patient education be conducted in a way that the patients can understand it. It is the objective of this explorative study to examine how patients and providers evaluate the comprehensibility and patients' comprehension of patient education under routine conditions during orthopaedic rehabilitation. Furthermore, we aim to explore the influencing factors that patients and providers describe as conducive and counterproductive to the comprehensibility of patient education, and the ideas or desires they have as to how patient education can be made more comprehensible. We conducted guided focus groups with 50 patients with chronic back pain or osteoarthritis aged between 22 and 71 years (M=50.4, SD=9.4) and 35 patient education providers aged between 26 and 61 years (M=44.9, SD=9.8) in a total of 9 orthopaedic rehabilitation centres. Qualitative analyses of the interview transcripts were conducted according to Mayring's content analytic approach using Atlas.ti software. Patients and providers evaluate patient education as generally comprehensible. The involvement of patients in patient education is reported by both patients and providers as the main conducive factor. Patients describe poor (e. g. superficial or contradictory) information as counterproductive regarding comprehensibility, while providers tend to mention patients' lack of motivation and of taking personal responsibility as hindering patients' comprehension. Patients' and providers' proposals and ideas can be organized in the topics patient education (e. g. stronger reference to patients' everyday life), providers (e. g. improving providers' tutoring skills), information (e. g. more information), patient involvement (e. g. stronger consideration of patients' interests), organization (e. g. smaller groups), and goal clarification (e. g. consideration of patients' expectations). Our results reveal that good

  7. Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers

    Directory of Open Access Journals (Sweden)

    Ingrid T. Katz

    2016-08-01

    Full Text Available Abstract Background Despite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates. Methods We conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24, their caregivers (n = 24, and nurses (n = 18, and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion. Results Themes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, “newer” vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections. Conclusions Optimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families’ concerns about vaccine safety and efficacy.

  8. Providing immediate neonatal care and resuscitation at birth beside the mother: parents' views, a qualitative study.

    Science.gov (United States)

    Sawyer, Alexandra; Ayers, Susan; Bertullies, Sophia; Thomas, Margaret; Weeks, Andrew D; Yoxall, Charles W; Duley, Lelia

    2015-09-18

    The aims of this study were to assess parents' views of immediate neonatal care and resuscitation at birth being provided beside the mother, and their experiences of a mobile trolley designed to facilitate this bedside care. Qualitative study with semistructured interviews. Results were analysed using thematic analysis. Large UK maternity hospital. Mothers whose baby received initial neonatal care in the first few minutes of life at the bedside, and their birth partners, were eligible. 30 participants were interviewed (19 mothers, 10 partners and 1 grandmother). 5 babies required advanced neonatal resuscitation. 5 themes were identified: (1) Reassurance, which included 'Baby is OK', 'Having baby close', 'Confidence in care', 'Knowing what's going on' and 'Dad as informant'; (2) Involvement of the family, which included 'Opportunity for contact', 'Family involvement' and 'Normality'; (3) Staff communication, which included 'Communication' and 'Experience'; (4) Reservations, which included 'Reservations about witnessing resuscitation', 'Negative emotions' and 'Worries about the impact on staff' and (5) Experiences of the trolley, which included 'Practical issues' and 'Comparisons with standard resuscitation equipment'. Families were positive about neonatal care being provided at the bedside, and felt it gave reassurance about their baby's health and care. They also reported feeling involved as a family. Some parents reported experiencing negative emotions as a result of witnessing resuscitation of their baby. Parents were positive about the trolley. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Harm reduction interventions in HIV care: a qualitative exploration of patient and provider perspectives

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    Suzanne Carlberg-Racich

    2016-04-01

    Full Text Available Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction—which removes judgment and operates at the patient’s stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38. A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen’s Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm

  10. The perspective of rural physicians providing abortion in Canada: qualitative findings of the BC Abortion Providers Survey (BCAPS).

    Science.gov (United States)

    Dressler, Jennifer; Maughn, Nanamma; Soon, Judith A; Norman, Wendy V

    2013-01-01

    An increasing proportion of Canadian induced abortions are performed in large urban areas. For unknown reasons the number of rural abortion providers in Canadian provinces, such as British Columbia (BC), has declined substantially. This study explored the experiences of BC rural and urban physicians providing abortion services. The mixed methods BC Abortion Providers Survey employed self-administered questionnaires, distributed to all known current and some past BC abortion providers in 2011. The optional semi-structured interviews are the focus of this analysis. Interview questions probed the experiences, facilitators and challenges faced by abortion providers, and their future intentions. Interviews were transcribed and analyzed using cross-case and thematic analysis. Twenty interviews were completed and transcribed, representing 13/27 (48.1%) rural abortion providers, and 7/19 (36.8%) of urban providers in BC. Emerging themes differed between urban and rural providers. Most urban providers worked within clinics and reported a supportive environment. Rural physicians, all providing surgical abortions within hospitals, reported challenging barriers to provision including operating room scheduling, anesthetist and nursing logistical issues, high demand for services, professional isolation, and scarcity of replacement abortion providers. Many rural providers identified a need to "fly under the radar" in their small community. This first study of experiences among rural and urban abortion providers in Canada identifies addressable challenges faced by rural physicians. Rural providers expressed a need for increased support from hospital administration and policy. Further challenges identified include a desire for continuing professional education opportunities, and for available replacement providers.

  11. The perspective of rural physicians providing abortion in Canada: qualitative findings of the BC Abortion Providers Survey (BCAPS.

    Directory of Open Access Journals (Sweden)

    Jennifer Dressler

    Full Text Available An increasing proportion of Canadian induced abortions are performed in large urban areas. For unknown reasons the number of rural abortion providers in Canadian provinces, such as British Columbia (BC, has declined substantially. This study explored the experiences of BC rural and urban physicians providing abortion services.The mixed methods BC Abortion Providers Survey employed self-administered questionnaires, distributed to all known current and some past BC abortion providers in 2011. The optional semi-structured interviews are the focus of this analysis. Interview questions probed the experiences, facilitators and challenges faced by abortion providers, and their future intentions. Interviews were transcribed and analyzed using cross-case and thematic analysis.Twenty interviews were completed and transcribed, representing 13/27 (48.1% rural abortion providers, and 7/19 (36.8% of urban providers in BC. Emerging themes differed between urban and rural providers. Most urban providers worked within clinics and reported a supportive environment. Rural physicians, all providing surgical abortions within hospitals, reported challenging barriers to provision including operating room scheduling, anesthetist and nursing logistical issues, high demand for services, professional isolation, and scarcity of replacement abortion providers. Many rural providers identified a need to "fly under the radar" in their small community.This first study of experiences among rural and urban abortion providers in Canada identifies addressable challenges faced by rural physicians. Rural providers expressed a need for increased support from hospital administration and policy. Further challenges identified include a desire for continuing professional education opportunities, and for available replacement providers.

  12. SIGWX Charts - High Level Significant Weather

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — High level significant weather (SIGWX) forecasts are provided for the en-route portion of international flights. NOAA's National Weather Service Aviation Center...

  13. Regrets associated with providing healthcare: qualitative study of experiences of hospital-based physicians and nurses.

    Directory of Open Access Journals (Sweden)

    Delphine S Courvoisier

    Full Text Available BACKGROUND: Regret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty. OBJECTIVE: To explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with. METHOD: Qualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysis RESULTS: All interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one's unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one's limits and of medicine's limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility. CONCLUSIONS: Since regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover.

  14. Patients' perspectives on providing a stool sample to their GP: a qualitative study.

    Science.gov (United States)

    Lecky, Donna M; Hawking, Meredith K D; McNulty, Cliodna A M

    2014-11-01

    Stool specimen collection is challenging and informal feedback has indicated that participants find the process difficult. Increasing stool specimen returns would improve the investigation of outbreaks of diarrhoeal and food-borne disease. To explore the barriers to stool sample collection and specimen return to ascertain which factors may help to improve the process. Qualitative patient interview study in Gloucester, UK. A two-stage purposive sampling process was used to identify patients who had either previous experience or no experience of collecting a stool sample. The interview schedule, based on the theory of planned behaviour, was used to facilitate interviews with 26 patients. Interview transcripts were analysed using a modified framework analysis. Barriers to collection included embarrassment, fear of results, concerns around hygiene and contamination, discretion and privacy, and lack of information. Personal gain was identified as the main incentive to collecting and returning a stool sample. The need for an information leaflet on stool collection was emphasised by most patients. GPs could make a number of small changes that could make a big difference for patients and potentially increase stool sample return. If they, rather than receptionists, distributed collection kits it may be easier for patients to ask any questions they had regarding collection. In addition, the provision of a stool-collection information leaflet could increase patients' confidence regarding collecting the sample, and providing drop-off boxes for specimens could help prevent patients' embarrassment regarding handing their stool over to a receptionist. © British Journal of General Practice 2014.

  15. Community and healthcare providers' perspectives on male circumcision: a multi-centric qualitative study in India.

    Directory of Open Access Journals (Sweden)

    Seema Sahay

    Full Text Available Although male circumcision (MC is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs about adult MC as an HIV prevention option in India.This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC/non-circumcising communities (NCC; including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision.Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for 'religious identity/privilege/sacrifice' or 'hygiene'; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting 'foreign' evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence.HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility

  16. Providing immediate neonatal care and resuscitation at birth beside the mother: parents’ views, a qualitative study

    Science.gov (United States)

    Sawyer, Alexandra; Ayers, Susan; Bertullies, Sophia; Thomas, Margaret; Weeks, Andrew D; Yoxall, Charles W; Duley, Lelia

    2015-01-01

    Objectives The aims of this study were to assess parents’ views of immediate neonatal care and resuscitation at birth being provided beside the mother, and their experiences of a mobile trolley designed to facilitate this bedside care. Design Qualitative study with semistructured interviews. Results were analysed using thematic analysis. Setting Large UK maternity hospital. Participants Mothers whose baby received initial neonatal care in the first few minutes of life at the bedside, and their birth partners, were eligible. 30 participants were interviewed (19 mothers, 10 partners and 1 grandmother). 5 babies required advanced neonatal resuscitation. Results 5 themes were identified: (1) Reassurance, which included ‘Baby is OK’, ‘Having baby close’, ‘Confidence in care’, ‘Knowing what's going on’ and ‘Dad as informant’; (2) Involvement of the family, which included ‘Opportunity for contact’, ‘Family involvement’ and ‘Normality’; (3) Staff communication, which included ‘Communication’ and ‘Experience’; (4) Reservations, which included ‘Reservations about witnessing resuscitation’, ‘Negative emotions’ and ‘Worries about the impact on staff’ and (5) Experiences of the trolley, which included ‘Practical issues’ and ‘Comparisons with standard resuscitation equipment’. Conclusions Families were positive about neonatal care being provided at the bedside, and felt it gave reassurance about their baby's health and care. They also reported feeling involved as a family. Some parents reported experiencing negative emotions as a result of witnessing resuscitation of their baby. Parents were positive about the trolley. PMID:26384723

  17. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

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    Sword Wendy

    2012-04-01

    Full Text Available Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of

  18. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study

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    Rashidian Arash

    2011-07-01

    Full Text Available Abstract Background The cesarean section rate has been steadily rising from 35% in 2000 to 40% in 2005 in Iran. The objective of this study was to identify barriers of reduce the cesarean section rate in Iran, as perceived by obstetricians and midwives as the main behavioral change target groups. Methods A qualitative study with purposive sampling was designed in which data were collected through in-depth interviews and document analyses. Hospitals were selected on the bases of being public and or private and their response to the ministry's C-section reduction interventions. The hospital director, obstetricians and midwives from each hospital were included in the study. The classification of barriers suggested by Grol and Wensing was used for the thematic analysis. Results After 26 in-depth interviews and document analyses, the barriers were identified as: financial, insurance and judicial problems at the economic and political context level; the type and ownership of hospitals, absence of an on call physician, absence of clear job-descriptions for obstetricians and midwives, too many interventions in the delivery process and shortage of human resources and facilities at the organizational context level; distrust and insufficient collaborations between obstetricians and midwives from macro to micro level at the social context level; attitudes toward complications of C-section, reduced capabilities of obstetricians, midwives and residents at the individual professional level; and finally, at the innovation level, vaginal delivery is time consuming, imposes high stress levels and is unpredictable. Conclusion Changing service providers' behavior is not possible through presentation of scientific evidence alone. A multi-level and multidisciplinary approach using behavior change theories is unavoidable. In future studies, the effect of the barriers should be determined to help policy makers recognize the most effective interventional package.

  19. Mental health service responses to human trafficking: a qualitative study of professionals' experiences of providing care.

    Science.gov (United States)

    Domoney, Jill; Howard, Louise M; Abas, Melanie; Broadbent, Matthew; Oram, Sian

    2015-11-17

    Human trafficking is a global crime and human rights violation. Although research has demonstrated a high prevalence of mental disorder among trafficked people and that trafficked people are in contact with mental health services, little is known about mental health professionals' experiences of identifying and providing care for trafficked people. This study aimed to understand how people are identified as trafficked within mental health services and the challenges professionals experience in responding to trafficked people's mental health needs. Qualitative study of electronic health records of trafficked people in contact with secondary mental health services in South East London, England. Comprehensive clinical electronic health records for over 200,000 patients in contact with secondary mental health services in South London were searched and retrieved to identify trafficked patients. Content analysis was used to establish how people were identified as trafficked, and thematic analysis was used to explore the challenges experienced in responding to mental health needs. The sample included 130 trafficked patients, 95 adults and 35 children. In 43 % (41/95) of adult cases and 63 % (22/35) child cases, mental health professionals were informed that their patient was a potential victim of trafficking by another service involved in their patient's care. Cases were also identified through patients disclosing their experiences of exploitation and abuse. Key challenges faced by staff included social and legal instability, difficulties ascertaining history, patients' lack of engagement, availability of services, and inter-agency working. Training to increase awareness, encourage helpful responses, and inform staff about the available support options would help to ensure the mental health needs of trafficked people are met. Further research is needed to establish if these challenges are similar in other health settings.

  20. A qualitative study on feedback provided by students in nurse education.

    Science.gov (United States)

    Chan, Zenobia C Y; Stanley, David John; Meadus, Robert J; Chien, Wai Tong

    2017-08-01

    This study aims to help nurse educators/academics understand the perspectives and expectations of students providing their feedback to educators about teaching performance and subject quality. The aim of this study is to reveal students' voices regarding their feedback in nurse education in order to shed light on how the current student feedback practice may be modified. A qualitative study using focus group inquiry. Convenience sampling was adopted and participants recruited from one school of nursing in Hong Kong. A total of 66 nursing students from two pre-registration programs were recruited for seven focus group interviews: one group of Year 1 students (n=21), two groups of Year 3 students (n=27), and four groups of Final Year students (n=18). The interviews were guided by a semi-structured interview guideline and the interview narratives were processed through content analysis. The trustworthiness of this study was guaranteed through peer checking, research meetings, and an audit trail. The participants' privacy was protected throughout the study. Four core themes were discerned based on the narratives of the focus group interviews: (1) "timing of collecting feedback at more than one time point"; (2) "modify the questions being asked in collecting student feedback"; (3) "are electronic means of collecting feedback good enough?; and (4) "what will be next for student feedback?". This study is significant in the following three domains: 1) it contributed to student feedback because it examined the issue from a student's perspective; 2) it explored the timing and channels for collecting feedback from the students' point of view; and 3) it showed the preferred uses of student feedback. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  1. Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities.

    Directory of Open Access Journals (Sweden)

    Barbara Navaza

    Full Text Available Provider-initiated HIV testing (PITC is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under researched. This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals' experiences offering HIV tests to migrants in Barcelona and Madrid.We conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American migrants and 21 health professionals. We imported verbatim transcripts and detailed field work notes into the qualitative software package Nvivo-10 and applied to all data a coding framework to examine systematically different HIV testing dimensions and modalities. The dimensions analysed were based on the World Health Organization "5 Cs" principles: Consent, Counselling, Connection to treatment, Correctness of results and Confidentiality.Health professionals reported that PITC was conceptually acceptable for them, although their perceived inability to adequately communicate HIV+ results and resulting bottle necks in the flow of care were recurrent concerns. Endorsement and adherence to the principles underpinning the rights-based response to HIV varied widely across health settings. The offer of an HIV test during routine consultations was generally appreciated by users as a way of avoiding the embarrassment of asking for it. Several participants deemed compulsory testing as acceptable on public health grounds. In spite of--and sometimes because of--partial endorsement of rights-based approaches, PITC was acceptable in a population with high levels of internalised stigma.PITC is a promising approach to reach sexual minority migrants who hold high levels of internalised stigma but explicit extra efforts are needed

  2. Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities.

    Science.gov (United States)

    Navaza, Barbara; Abarca, Bruno; Bisoffi, Federico; Pool, Robert; Roura, Maria

    2016-01-01

    Provider-initiated HIV testing (PITC) is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under researched. This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals' experiences offering HIV tests to migrants in Barcelona and Madrid. We conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American migrants and 21 health professionals. We imported verbatim transcripts and detailed field work notes into the qualitative software package Nvivo-10 and applied to all data a coding framework to examine systematically different HIV testing dimensions and modalities. The dimensions analysed were based on the World Health Organization "5 Cs" principles: Consent, Counselling, Connection to treatment, Correctness of results and Confidentiality. Health professionals reported that PITC was conceptually acceptable for them, although their perceived inability to adequately communicate HIV+ results and resulting bottle necks in the flow of care were recurrent concerns. Endorsement and adherence to the principles underpinning the rights-based response to HIV varied widely across health settings. The offer of an HIV test during routine consultations was generally appreciated by users as a way of avoiding the embarrassment of asking for it. Several participants deemed compulsory testing as acceptable on public health grounds. In spite of--and sometimes because of--partial endorsement of rights-based approaches, PITC was acceptable in a population with high levels of internalised stigma. PITC is a promising approach to reach sexual minority migrants who hold high levels of internalised stigma but explicit extra efforts are needed to safeguard the

  3. High level controls at RHIC

    Science.gov (United States)

    Peggs, S.; Saltmarsh, C.; Satogata, T.; Fryer, M.

    1994-12-01

    We report on the software tools and techniques in development to ensure that the commissioning and operations teams for RHIC have access to high level analysis, diagnosis, modelling and control functions early in the start up of the machine. The first tests will be for the sextant test in mid-1995.

  4. High-Level Radioactive Waste.

    Science.gov (United States)

    Hayden, Howard C.

    1995-01-01

    Presents a method to calculate the amount of high-level radioactive waste by taking into consideration the following factors: the fission process that yields the waste, identification of the waste, the energy required to run a 1-GWe plant for one year, and the uranium mass required to produce that energy. Briefly discusses waste disposal and…

  5. Análisis cualitativo de las implicaciones musculares de la escalada deportiva de alto nivel en competición. (Qualitative Study of high level sport climbing muscular involvement in competition.

    Directory of Open Access Journals (Sweden)

    Ana María de Benito

    2013-04-01

    Full Text Available El objetivo de esta investigación fue analizar las acciones musculares ejecutadas por los escaladores de alto nivel en competición. La muestra del estudio está compuesta por 72 varones (nivel técnico medio “a vista” 7C+/8A que participaron en las pruebas de Copa de España de Escalada de Dificultad de 2009 y 2010. Se registraron un total de 7.738 movimientos para su análisis. Se ha utilizado un método de observación validado previamente, siendo las variables de estudio: acción, posición corporal, extremidad ejecutante, tiempo empleado, zona temporal, inicio de movimiento, fin de movimiento y movimiento. Los resultados concluyen que los grupos musculares más importantes para los escaladores de alto nivel son, además de los músculos flexores del tronco, los extensores, aductores y extensores horizontales del hombro, los flexores y pronadores del codo, los extensores, aductores, abductores, rotadores internos y rotadores externos de la cadera y los extensores de rodilla. Ahora bien, el tipo de contracción muscular realizada por cada uno de ellos, dependerá del movimiento requerido. La información aquí presentada puede resultar de gran utilidad a la hora de planificar programas de entrenamiento más personalizados que mejoren el rendimiento del escalador.AbstractThe purpose of the current study was to analyse the muscular contractions carried out by the high level climbers in competition. The sample studied was made up of 72 male subjects (“on sight”-level 5.12c/5.13a who participated in the Spanish Climbing Cup of 2009 and 2010. 7738 movements were registered to analyse them. The observational model used was designed and validated through a previous study. Answer levels were: action, corporal position, limb, time, time zone, start of movement, end of movement and movement. The results obtained establish that the most important muscles for high level climbers are, apart from abdominal muscles, extensors, adductors and

  6. High-Level Application Framework for LCLS

    Energy Technology Data Exchange (ETDEWEB)

    Chu, P; Chevtsov, S.; Fairley, D.; Larrieu, C.; Rock, J.; Rogind, D.; White, G.; Zalazny, M.; /SLAC

    2008-04-22

    A framework for high level accelerator application software is being developed for the Linac Coherent Light Source (LCLS). The framework is based on plug-in technology developed by an open source project, Eclipse. Many existing functionalities provided by Eclipse are available to high-level applications written within this framework. The framework also contains static data storage configuration and dynamic data connectivity. Because the framework is Eclipse-based, it is highly compatible with any other Eclipse plug-ins. The entire infrastructure of the software framework will be presented. Planned applications and plug-ins based on the framework are also presented.

  7. High-level Petri Nets

    DEFF Research Database (Denmark)

    High-level Petri nets are now widely used in both theoretical analysis and practical modelling of concurrent systems. The main reason for the success of this class of net models is that they make it possible to obtain much more succinct and manageable descriptions than can be obtained by means...... of low-level Petri nets - while, on the other hand, they still offer a wide range of analysis methods and tools. The step from low-level nets to high-level nets can be compared to the step from assembly languages to modern programming languages with an elaborated type concept. In low-level nets...... there is only one kind of token and this means that the state of a place is described by an integer (and in many cases even by a boolean). In high-level nets each token can carry a complex information/data - which, e.g., may describe the entire state of a process or a data base. Today most practical...

  8. RPython high-level synthesis

    Science.gov (United States)

    Cieszewski, Radoslaw; Linczuk, Maciej

    2016-09-01

    The development of FPGA technology and the increasing complexity of applications in recent decades have forced compilers to move to higher abstraction levels. Compilers interprets an algorithmic description of a desired behavior written in High-Level Languages (HLLs) and translate it to Hardware Description Languages (HDLs). This paper presents a RPython based High-Level synthesis (HLS) compiler. The compiler get the configuration parameters and map RPython program to VHDL. Then, VHDL code can be used to program FPGA chips. In comparison of other technologies usage, FPGAs have the potential to achieve far greater performance than software as a result of omitting the fetch-decode-execute operations of General Purpose Processors (GPUs), and introduce more parallel computation. This can be exploited by utilizing many resources at the same time. Creating parallel algorithms computed with FPGAs in pure HDL is difficult and time consuming. Implementation time can be greatly reduced with High-Level Synthesis compiler. This article describes design methodologies and tools, implementation and first results of created VHDL backend for RPython compiler.

  9. EAP high-level product architecture

    DEFF Research Database (Denmark)

    Guðlaugsson, Tómas Vignir; Mortensen, Niels Henrik; Sarban, Rahimullah

    2013-01-01

    the function of the EAP transducers to be changed, by basing the EAP transducers on a different combination of organ alternatives. A model providing an overview of the high level product architecture has been developed to support daily development and cooperation across development teams. The platform approach...... of EAP technology products while keeping complexity under control. High level product architecture has been developed for the mechanical part of EAP transducers, as the foundation for platform development. A generic description of an EAP transducer forms the core of the high level product architecture....... This description breaks down the EAP transducer into organs that perform the functions that may be present in an EAP transducer. A physical instance of an EAP transducer contains a combination of the organs needed to fulfill the task of actuator, sensor, and generation. Alternative principles for each organ allow...

  10. Factors influencing practice variation in the management of nephrotic syndrome: a qualitative study of pediatric nephrology care providers.

    Science.gov (United States)

    Samuel, Susan M; Flynn, Rachel; Zappitelli, Michael; Dart, Allison; Parekh, Rulan; Pinsk, Maury; Mammen, Cherry; Wade, Andrew; Scott, Shannon D

    2017-06-07

    Treatment protocols for childhood nephrotic syndrome are highly variable between providers and care centres. We conducted a qualitative study to understand the complex multilevel processes that lead to practice variation and influence provider management of nephrotic syndrome. Focus groups with multidisciplinary pediatric nephrology care providers (n = 67) from 10 Canadian pediatric nephrology centres that had more than 1 pediatric nephrologist were conducted between September 2013 and April 2015. Focus group discussions were guided by the Ottawa Model for Research Use. We used a semistructured interview guide to elicit participants' perspectives regarding 1) the work setting and context of the clinical environment, 2) reasons for variation at the provider level and 3) clinical practice guidelines for nephrotic syndrome. Focus group discussions were transcribed and analyzed concurrently with the use of qualitative content analysis. Emerging themes were grouped into 2 categories: centre-level factors and provider-level factors. At the centre level, the type of care model used, clinic structures and resources, and lack of communication and collaboration within and between Canadian centres influenced care variation. At the provider level, use of experiential knowledge versus empirical knowledge and interpretation of patient characteristics influenced provider management of nephrotic syndrome. Centre- and provider-level factors play an important role in shaping practice differences in the management of childhood nephrotic syndrome. Further research is needed to determine whether variation in care is associated with disparities in outcomes. Copyright 2017, Joule Inc. or its licensors.

  11. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers.

    Science.gov (United States)

    Suurmond, J; Lieveld, A; van de Wetering, M; Schouten-van Meeteren, A Y N

    2017-03-28

    In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers. © 2017 John Wiley & Sons Ltd.

  12. Child Care Providers' Strategies for Supporting Healthy Eating: A Qualitative Approach

    Science.gov (United States)

    Lynch, Meghan; Batal, Malek

    2012-01-01

    Recent research has revealed child care settings and providers to be important influences on children's developing behaviors. Yet most research on children's nutritional development has focused on home settings and parents. Thus, through semistructured interviews with child care providers, this study aimed to develop a better understanding of the…

  13. Improving continence services for older people from the service-providers' perspective: a qualitative interview study.

    Science.gov (United States)

    Orrell, Alison; McKee, Kevin; Dahlberg, Lena; Gilhooly, Mary; Parker, Stuart

    2013-07-30

    To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. 3 acute and 13 primary care National Health Service Trusts in England. 16 continence service leads in England actively treating and managing older people with UI. In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

  14. Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

    Science.gov (United States)

    O'Malley, Ann S; Sarwar, Rumin; Keith, Rosalind; Balke, Patrick; Ma, Sai; McCall, Nancy

    2017-12-01

    Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. Semi-structured telephone interviews from January to April 2016 with 71 respondents. Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices

  15. Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).

    Science.gov (United States)

    Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

    2014-07-08

    To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design

  16. Personal Trainer Perceptions of Providing Nutrition Care to Clients: A Qualitative Exploration.

    Science.gov (United States)

    Barnes, Katelyn; Ball, Lauren; Desbrow, Ben

    2017-04-01

    Personal trainers are well placed to provide basic nutrition care in line with national dietary guidelines. However, many personal trainers provide nutrition care beyond their scope of practice and this has been identified as a major industry risk due to a perceived lack of competence in nutrition. This paper explores the context in which personal trainers provide nutrition care, by understanding personal trainers' perceptions of nutrition care in relation to their role and scope of practice. Semistructured telephone interviews were conducted with 15 personal trainers working within Australia. Thematic analysis was used to identify key themes. All personal trainers reported to provide nutrition care and reported that nutrition care was an important component of their role. Despite this, many were unaware or uncertain of the scope of practice for personal trainers. Some personal trainers reported a gap between the nutrition knowledge they received in their formal education, and the knowledge they needed to optimally support their clients to adopt healthy dietary behaviors. Overall, the personal training context is likely to be conducive to providing nutrition care. Despite concerns about competence personal trainers have not modified their nutrition care practices. To ensure personal trainers provide nutrition care in a safe and effective manner, greater enforcement of the scope of practice is required as well as clear nutrition competencies or standards to be developed during training.

  17. Abortion providers' experiences with Medicaid abortion coverage policies: a qualitative multistate study.

    Science.gov (United States)

    Dennis, Amanda; Blanchard, Kelly

    2013-02-01

    To evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers. From 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states. In-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment. Data were transcribed verbatim before being coded. In two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates. Poor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health. © Health Research and Educational Trust.

  18. Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers.

    Science.gov (United States)

    Kominiarek, Michelle A; Gay, Franklin; Peacock, Nadine

    2015-08-01

    To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥ 30 kg/m(2) and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Women frequently stated a GWG goal >20 lbs. Women described a body image not in line with clinical recommendations ("200 pounds is not that big."). They avoided the term "obese". They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of "exercise" varied. Family members could help, but generational differences posed challenges. Most had to "encourage myself" and "do this for me and the baby". Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

  19. Multiple sclerosis patients need and want information on exercise promotion from healthcare providers: a qualitative study.

    Science.gov (United States)

    Learmonth, Yvonne C; Adamson, Brynn C; Balto, Julia M; Chiu, Chung-Yi; Molina-Guzman, Isabel; Finlayson, Marcia; Riskin, Barry J; Motl, Robert W

    2017-08-01

    There is growing recognition of the benefits and safety of exercise and its importance in the comprehensive care of persons with multiple sclerosis (MS), yet uptake is low. We explored the needs and wants of patients with MS regarding exercise promotion through healthcare providers. Participants were adults with MS who had mild-or-moderate disability and a range of exercise levels. All participants lived in the Midwest of the United States. Fifty semi-structured interviews were conducted and analysed using thematic analysis. Two themes emerged, namely interactions between patients and healthcare providers and needs and wants of patients. Analysis of participant accounts illustrate that current exercise promotion by healthcare providers does not meet patient needs and wants. The identified needs and wants of persons with MS involved (i) information and knowledge on the benefits of exercise and exercise prescription, (ii) materials to allow home and community exercise and (iii) tools for initiating and maintaining exercise behaviour. Patients with MS frequently interact with healthcare providers and are generally unsatisfied with exercise promotion during interactions. Healthcare providers can address the low uptake of exercise among persons with MS by acting upon the identified unmet needs involving materials, knowledge and behaviour change strategies for exercise. © 2016 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  20. Abortion counselling according to healthcare providers: a qualitative study in the Lisbon metropolitan area, Portugal.

    Science.gov (United States)

    Beja, Vanda; Leal, Isabel

    2010-10-01

    To gain a deeper understanding of healthcare providers' perceptions on the abortion counselling they provide and its usefulness. We conducted in-depth interviews with 16 healthcare providers working in the Lisbon metropolitan area. The interviews were then subjected to content analysis. We identified the following themes on abortion counselling description: receiving the woman and understanding her request; providing information; supporting decision-making; managing emotional and psychological issues; addressing contraception; managing third-party involvement; offering psychological counselling; informing about the State's support and offering social counselling. All participants described counselling as useful but valued different aspects of it: information provision; addressing contraception to prevent future unplanned pregnancy/abortion; emotional support; decision-making support; addressing emotional issues beyond abortion; enticing women to seek healthcare in the future; preventing poor emotional post-abortion adjustment. Counselling was considered of no use to change the woman's abortion decision. The abortion counselling provided in Portugal is in tune with the latest literature on the subject, following a client-centred approach focused on the provision of information and emotional support. It can be improved, however, particularly in what concerns the staff's communication and counselling skills. Further research is needed to improve the provision of abortion care in Portugal.

  1. Hospital-community interface: a qualitative study on patients with cancer and health care providers' experiences.

    Science.gov (United States)

    Admi, Hanna; Muller, Ella; Ungar, Lea; Reis, Shmuel; Kaffman, Michael; Naveh, Nurit; Shadmi, Efrat

    2013-10-01

    Patients with cancer must deal with complex and fragmented healthcare systems in addition to coping with the burden of their illness. To improve oncology treatment along the care continuum, the barriers and facilitators for streamlined oncologic care need to be better understood. This study sought to gain insight into the hospital-community interface from the point of view of patients with cancer, their families, and health care providers on both sides of the interface i.e., the community and hospital settings. The sample comprised 37 cancer patients, their family members, and 40 multidisciplinary health care providers. Twelve participants were interviewed individually and 65 took part in 10 focus groups. Based on the grounded theory approach, theoretical sampling and constant comparative analyses were used. Two major concepts emerged: "ambivalence and confusion" and "overcoming healthcare system barriers." Ambiguity was expressed regarding the roles of health care providers in the community and in the hospital. We identified three main strategies by which these patients and their families overcame barriers within the system: patients and families became their own case managers; patients and health care providers used informal routes of communication; and nurse specialists played a significant role in managing care. The heavy reliance on informal routes of communication and integration by patients and providers emphasizes the urgent need for change in order to improve coordinating mechanisms for hospital-community oncologic care. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Family planning providers' perspectives on family planning service delivery in Ibadan and Kaduna, Nigeria: a qualitative study.

    Science.gov (United States)

    Hebert, Luciana Estelle; Schwandt, Hilary Megan; Boulay, Marc; Skinner, Joanna

    2013-01-01

    In Nigeria, fertility continues to be high and contraceptive prevalence remains low. This study was conducted in order to understand the perceptions of, experiences with and challenges of delivering family planning services in two urban areas of Nigeria from the perspectives of family planning service providers. A qualitative study using 59 in-depth interviews was conducted among family planning providers working in hospitals, primary health centres, clinics, pharmacies and patent medicine vendors in Ibadan and Kaduna, Nigeria. Providers support a mix of individuals and organisations involved in family planning provision, including the government of Nigeria. The Nigerian government's role can take a variety of forms, including providing promotional materials for family planning facilities as well as facilitating training and educational opportunities for providers, since many providers lack basic training in family planning provision. Providers often describe their motivation to provide in terms of the health benefits offered by family planning methods. Few providers engage in any marketing of their services and many providers exclude youth and unmarried individuals from their services. The family planning provider community supports a diverse network of providers, but needs further training and support in order to improve the quality of care and market their services. Adolescents, unmarried individuals and women seeking post-abortion care are vulnerable populations that providers need to be better educated about and trained in how to serve. The perspectives of providers should be considered when designing family planning interventions in urban areas of Nigeria.

  3. The patient-provider discordance in patients' needs assessment: a qualitative study in breast cancer patients receiving oral chemotherapy.

    Science.gov (United States)

    Wei, Chunlan; Nengliang, Yao; Yan, Wang; Qiong, Fang; Yuan, Changrong

    2017-01-01

    To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients. A descriptive qualitative design was used. A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information. Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication. Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy. Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of

  4. Service providers' experiences and needs in working with refugees in the Geelong region: a qualitative study.

    Science.gov (United States)

    Jewson, Ashlee; Lamaro, Greer; Crisp, Beth R; Hanna, Lisa; Taket, Ann

    2015-01-01

    Service providers in Geelong, one of the priority locations for the resettlement of refugees in regional Australia, were interviewed to explore their perceptions of the health and wellbeing needs of refugees, and the capacity of service providers in a regional area to meet these. In all, 22 interviews were conducted with health and human service professionals in a range of organisations offering refugee-specific services, culturally and linguistically diverse (CALD) services in general, and services to the wider community, including refugees. The findings revealed that a more coordinated approach would increase the effectiveness of existing services; however, the various needs of refugees were more than could be met by organisations in the region at current resource levels. More staff and interpreting services were required, as well as professional development for staff who have had limited experience in working with refugees. It should not be assumed that service needs for refugees resettled in regional Australia will be the same as those of refugees resettled in capital cities. Some services provided in Melbourne were not available in Geelong, and there were services not currently provided to refugees that may be critical in facilitating resettlement in regional and rural Australia.

  5. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research

    National Research Council Canada - National Science Library

    Luke Robertshaw; Surindar Dhesi; Laura L Jones

    2017-01-01

    Objectives To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries...

  6. General practitioners' knowledge, attitudes and views of providing preconception care: a qualitative investigation

    OpenAIRE

    Ojukwu, O; Patel, D.; Stephenson, J; Howden, B; Shawe, J

    2016-01-01

    Background: Preconception health and care aims to reduce parental risk factors before pregnancy through health promotion and intervention. Little is known about the preconception interventions that general practitioners (GPs) provide. The aim of this study was to examine GPs’ knowledge, attitudes, and views towards preconception health and care in the general practice setting. Methods: As part of a large mixed-methods study to explore preconception care in England, we surveyed 1,173 women...

  7. Midwives' Role in Providing Nutrition Advice during Pregnancy: Meeting the Challenges? A Qualitative Study

    OpenAIRE

    Arrish, Jamila; Yeatman, Heather; Williamson, Moira

    2017-01-01

    This study explored the Australian midwives' role in the provision of nutrition advice. Little is known about their perceptions of this role, the influence of the model of care, and the barriers and facilitators that may influence them providing quality nutrition advice to pregnant women. Semistructured telephone interviews were undertaken with a subsample (n = 16) of the members of the Australian College of Midwives who participated in an online survey about midwives' nutrition knowledge, at...

  8. Patients’ and nurses’ views on providing psychological support within cardiac rehabilitation programmes: a qualitative study

    Science.gov (United States)

    Turner, Katrina M; Winder, Rachel; Campbell, John L; Gandhi, Manish; Dickens, Chris M; Richards, Suzanne

    2017-01-01

    Objective To explore patients’ and nurses’ views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. Design In-depth interviews analysed thematically. Participants 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. Setting Cardiac services based in the South West of England and the East Midlands, UK. Results Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients’ accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual’s mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. Conclusions Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. Trial registration number ISCTRN34701576. PMID:28864707

  9. Mutual Expectations of Mothers of Hospitalized Children and Pediatric Nurses Who Provided Care: Qualitative Study.

    Science.gov (United States)

    Konuk Şener, Dilek; Karaca, Aysel

    This study attempted to identify the mutual expectations of mothers whose children were hospitalized in the pediatric department of a university hospital and nurses who provided care. A descriptive phenomenological design has been used in this study. Data were obtained through tape-recorded semi-structured interviews. This study was conducted at a pediatric clinic, at a university hospital in a small city in Turkey. Participants comprised five nurses working in the children's clinic and 24 mothers who accompanied their children to the hospital. The six major themes that emerged were mothers' feelings and thoughts about the hospital experience, mothers' expectations for attention and support during hospitalization, mothers' expectations for invasive procedures, issues regarding physical comfort and hospital infrastructure, nurses' feelings and thoughts about working in the pediatric clinic, and nurses' expectations of the mothers. Mothers expected nurses to provide physical support including medication administration, and installing/applying IV and nebulizer treatments; and emotional support in terms of having a friendly, rather than critical attitude, and being approachable and receptive of mothers' questions and anxieties. Nurses stated that they were aware of these expectations but needed mothers to be understanding and tolerant, considering their difficult working conditions. Children's hospitalization is a stressful experience for parents. Open and therapeutic communication and relationships between parents and nurses contribute to improving the quality of care provided to children and their families. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Patients' and nurses' views on providing psychological support within cardiac rehabilitation programmes: a qualitative study.

    Science.gov (United States)

    Turner, Katrina M; Winder, Rachel; Campbell, John L; Richards, David A; Gandhi, Manish; Dickens, Chris M; Richards, Suzanne

    2017-09-01

    To explore patients' and nurses' views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. In-depth interviews analysed thematically. 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. Cardiac services based in the South West of England and the East Midlands, UK. Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients' accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual's mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. ISCTRN34701576. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. The perspective of healthcare providers and patients on health literacy: a systematic review of the quantitative and qualitative studies.

    Science.gov (United States)

    Rajah, Retha; Ahmad Hassali, Mohamed Azmi; Jou, Lim Ching; Murugiah, Muthu Kumar

    2017-10-01

    Health literacy (HL) is a multifaceted concept, thus understanding the perspective of healthcare providers, patients, and the system is vital. This systematic review examines and synthesises the available studies on HL-related knowledge, attitude, practice, and perceived barriers. CINAHL and Medline (via EBSCOhost), Google Scholar, PubMed, ProQuest, Sage Journals, and Science Direct were searched. Both quantitative and/or qualitative studies in the English language were included. Intervention studies and studies focusing on HL assessment tools and prevalence of low HL were excluded. The risk of biasness reduced with the involvement of two reviewers independently assessing study eligibility and quality. A total of 30 studies were included, which consist of 19 quantitative, 9 qualitative, and 2 mixed-method studies. Out of 17 studies, 13 reported deficiency of HL-related knowledge among healthcare providers and 1 among patients. Three studies showed a positive attitude of healthcare providers towards learning about HL. Another three studies demonstrated patients feel shame exposing their literacy and undergoing HL assessment. Common HL communication techniques reported practiced by healthcare providers were the use of everyday language, teach-back method, and providing patients with reading materials and aids, while time constraint was the most reported HL perceived barriers by both healthcare providers and patients. Significant gaps exists in HL knowledge among healthcare providers and patients that needs immediate intervention. Such as, greater effort placed in creating a health system that provides an opportunity for healthcare providers to learn about HL and patients to access health information with taking consideration of their perceived barriers.

  12. The CMS High Level Trigger

    CERN Document Server

    Gori, Valentina

    2014-01-01

    The CMS experiment has been designed with a 2-level trigger system: the Level 1 Trigger, implemented on custom-designed electronics, and the High Level Trigger (HLT), a streamlined version of the CMS offline reconstruction software running on a computer farm. A software trigger system requires a tradeoff between the complexity of the algorithms running on the available computing power, the sustainable output rate, and the selection efficiency. Here we will present the performance of the main triggers used during the 2012 data taking, ranging from simpler single-object selections to more complex algorithms combining different objects, and applying analysis-level reconstruction and selection. We will discuss the optimisation of the triggers and the specific techniques to cope with the increasing LHC pile-up, reducing its impact on the physics performance.

  13. The CMS High Level Trigger

    CERN Document Server

    Trocino, Daniele

    2014-01-01

    The CMS experiment has been designed with a 2-level trigger system: the Level 1 Trigger, implemented in custom-designed electronics, and the High Level Trigger (HLT), a streamlined version of the CMS offline reconstruction software running on a computer farm. A software trigger system requires a tradeoff between the complexity of the algorithms running with the available computing power, the sustainable output rate, and the selection efficiency. We present the performance of the main triggers used during the 2012 data taking, ranging from simple single-object selections to more complex algorithms combining different objects, and applying analysis-level reconstruction and selection. We discuss the optimisation of the trigger and the specific techniques to cope with the increasing LHC pile-up, reducing its impact on the physics performance.

  14. Motivation and challenges for use of malaria rapid diagnostic tests among informal providers in Myanmar: a qualitative study.

    Science.gov (United States)

    Sudhinaraset, May; Briegleb, Christina; Aung, Moe; Khin, Hnin Su Su; Aung, Tin

    2015-02-06

    Rapid diagnostic tests (RDTs) for malaria enable proper diagnosis and have been shown to reduce overuse of artemisinin combination therapy. Few studies have evaluated the feasibility and use of RDTs in the private sector in Myanmar. The objectives of the study were to: 1) understand the acceptability of using RDTs in the informal sector in Myanmar; 2) examine motivations for use among informal providers; and, 3) highlight decision-making and knowledge of providers for diagnostic testing and treatment. Qualitative interviews were conducted with 30 informal providers. Purposeful sampling was used to enrol study participants in the Mon and Shan State in Myanmar. All interviews were conducted in Burmese, translated into English, and two researchers coded all interviews using Atlas ti. Major themes identified included: 1) informal provider and outlet characteristics, including demographic and background characteristics; 2) the benefits and challenges of using RDTs according to providers; 3) provider experiences with using RDTs, including motivations for using the RDT; 4) adherence to test results, either positive or negative; and, 5) recommendations from informal providers to promote increased use of RDTs in their communities. This study found that introducing RDTs to informal providers in Myanmar was feasible, resulting in improved provider empowerment and patient-provider relationships. Specific challenges included facility infrastructure to use and dispose RDTs and provider knowledge. This varied across the type of informal provider, with itinerant drug vendors more comfortable and knowledgeable about RDTs compared to general retail sellers and medical drug representatives. This study found informal providers in Myanmar found the introduction of RDTs to be highly acceptable. Providers discussed improvement in service quality including provider empowerment and patient-provider relationships. The study also highlighted a number of challenges that informal providers

  15. High-level radioactive wastes. Supplement 1

    Energy Technology Data Exchange (ETDEWEB)

    McLaren, L.H. (ed.)

    1984-09-01

    This bibliography contains information on high-level radioactive wastes included in the Department of Energy's Energy Data Base from August 1982 through December 1983. These citations are to research reports, journal articles, books, patents, theses, and conference papers from worldwide sources. Five indexes, each preceded by a brief description, are provided: Corporate Author, Personal Author, Subject, Contract Number, and Report Number. 1452 citations.

  16. Acute coronary syndrome critical pathway: chest PAIN caremap: a qualitative research study--provider-level intervention.

    Science.gov (United States)

    Saint-Jacques, Henock; Burroughs, Valentine J; Watkowska, Justyna; Valcarcel, Michelle; Moreno, Pedro; Maw, Myo

    2005-09-01

    Recently published data on healthcare performance continue to show a substantial gap between evidence-based guidelines and management of patients in real-world settings. This article describes an operational model that will be used to test whether a critical pathway applied in a secondary care-level institution may improve the process of care related to acute coronary syndromes (ACS). We have developed the pathway for management of all patients who present to our emergency department with a chief complaint of acute chest pain. Based on individual immediate ischemic event risk, patients are categorized according to a prespecified algorithm under the acronym of "PAIN" (P-Priority risk, A-Advanced risk, I-Intermediate risk, and N-Negative/low risk) as prespecified in an algorithm. Along with the algorithm come 2 detailed order sets, 1 for ST-elevation ACS and another for non ST-elevation ACS. The pathway, together with the 2 order sets, are color-coded with the "PAIN" acronym (P-red, A-yellow, I-yellow, N-green) that will guide patient management according to his or her risk stratification. These colors, similar to the road traffic light code, have been chosen as an easy reference for the provider about the sequential risk level of patients with ACS. This experimental model intends, with its unique structured approach, to increase awareness and improve adherence to the published American Heart Association/American College of Cardiology guidelines for the management of ACS.

  17. The Health Care Provider's Experience With Fathers of Overweight and Obese Children: A Qualitative Analysis.

    Science.gov (United States)

    Anti, Eliza; Laurent, Jennifer S; Tompkins, Connie

    2016-01-01

    The purpose of this study was to explore the experience of health care providers (HCPs) in the outpatient setting as they work with fathers of children who are overweight and obese. Interpretative phenomenological analysis was used for data collection and analysis. Seven HCPs were interviewed about their experiences. Two major themes emerged from the experiences of these HCPs: "dad in the back seat" and "paternal resistance." The theme of "dad in the back seat" captured the HCPs' experiences and perceptions of parental roles and related stereotypes with respect to fathers' lack of presence in the health-care setting, family roles that relegate fathers to the back seat in dealing with this issue, and the tendency of fathers to take a passive role and defer to mothers in the management of their child's weight. "Paternal resistance" reflected the perceived tendency of the father to resist the acceptance of his child's weight as a problem and to resist change and even undermine family efforts to make healthier choices. HCPs' experiences of fathers as having a minimal role in the management of their child's overweight and obesity may lead them to neglect fathers as agents of change with regard to this important issue. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  18. Barriers and facilitators for the management of vertigo: a qualitative study with primary care providers.

    Science.gov (United States)

    Stephan, Anna-Janina; Kovacs, Eva; Phillips, Amanda; Schelling, Jörg; Ulrich, Susanne Marlene; Grill, Eva

    2018-02-08

    Although the management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers' (PCPs) perspectives, needs, and attitudes regarding vertigo management. The objective of this study was to understand which challenges and barriers PCPs see when diagnosing and treating patients presenting with vertigo or dizziness. Specifically, we wanted to identify facilitators and barriers of successful guideline implementation in order to inform the development of targeted interventions. A theory-based interview structure was developed based on the implementation theory of capability, opportunity, and motivation for behaviour change (COM-B) using questions based on constructs from the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Transcripts of the semi-structured interviews were analysed using directed content analysis. The pathways through which guideline characteristics and supportive interventions affect the relationship between the PCPs' perceived capability, opportunity, and motivation as well as their practice of managing vertigo patients were graphically presented using the COM-B model structure. Twelve PCPs from Bavaria in Southern Germany participated in semi-structured interviews. Diagnostics posed the biggest challenge in vertigo management to the PCPs. Requirements for an acceptable guideline were stakeholder involvement in the development process, clarity of presentation, and high applicability. Guideline implementation might be effectively supported through educational meetings and sustained by organisational interventions. From the PCPs' perspective, both guideline characteristics and interventions supporting guideline implementation may help resolve challenges in vertigo management in primary care. These results should be used to guide future interventions in the primary care setting to ensure successful and

  19. Communicating about eating behaviors. A qualitative study of Chilean women and their health-care providers

    Science.gov (United States)

    Gálvez, Patricia; Valencia, Alejandra; Palomino, Ana M.; Cataldo, Marjorie; Schwingel, Andiara

    2015-01-01

    Good communication between health care providers (HCPs) and patients is critical in achieving positive health outcomes. The purpose of this article was to compare the perceptions of Chilean woman and their HCPs with respect to determinants of eating behaviors. Semi-structured interviews were conducted with women (n=15) visiting a public health care center in Chile and with their HCPs (n=8) who were in charge of promoting healthy eating behaviors among women. Data from the interviews indicated similarities and inconsistencies in determinants of eating behaviors between the groups. Both mentioned many important factors that influence women's eating behaviors, including food preferences, dietary knowledge, self-control and self-efficacy, family, food cost, and food availability. HCPs appeared to be less aware of the role that personality traits and past experiences play as potential determinants which women mentioned. In contrast, women were less aware of the influence of anxiety and low self-esteem on eating choices, which HCPs noted as key factors. Although it was encouraging to see agreement between women and their HCPs in some areas, it is important to work on increasing understanding among the groups with respect to the important role psychological factors play in influencing eating behavior. We suggest that HCPs should focus on the importance of women's personality traits and past eating behaviors, as well as work on improving women's self-esteem and helping to decrease their anxiety levels. HCPs should be encouraged to develop good communication with each person in order to help them understand the roles that external and internal factors play in eating behaviors. PMID:25661846

  20. Patient and Provider Perceptions of Weight Gain, Physical Activity, and Nutrition Counseling during Pregnancy: A Qualitative Study.

    Science.gov (United States)

    Whitaker, Kara M; Wilcox, Sara; Liu, Jihong; Blair, Steven N; Pate, Russell R

    2016-01-01

    This study investigated patient and provider perceptions of weight gain, physical activity, and nutrition counseling during prenatal care visits. Individual qualitative interviews were conducted with 30 pregnant women between 20 and 30 weeks gestation (15 African American, 15 White) and 11 prenatal care providers (5 attending physicians, 5 residents, 1 nurse practitioner) in 2014. The majority of patients and providers reported receiving or giving advice on weight gain (87% and 100%, respectively), physical activity (87% and 91%), and nutrition (100% and 91%) during a prenatal visit. Discussion of counseling content was largely consistent between patients and providers. However, counseling was limited and not fully consistent with current weight gain, physical activity, or dietary guidelines during pregnancy. Most patients viewed provider advice positively, but some wanted more detailed information. Providers discussed many barriers to lifestyle counseling, including lack of time, inadequate training, concern about the sensitivity of the topic, lower education or income level of the patient, cultural differences, and lack of patient interest. Providers discussed weight gain, physical activity, and nutrition during prenatal care visits and patients accurately recalled this advice. However, counseling was limited and not fully consistent with guidelines. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  1. Cancer and the LGBTQ Population: Quantitative and Qualitative Results from an Oncology Providers' Survey on Knowledge, Attitudes, and Practice Behaviors.

    Science.gov (United States)

    Tamargo, Christina L; Quinn, Gwendolyn P; Sanchez, Julian A; Schabath, Matthew B

    2017-10-07

    Despite growing social acceptance, the LGBTQ population continues to face barriers to healthcare including fear of stigmatization by healthcare providers, and providers' lack of knowledge about LGBTQ-specific health issues. This analysis focuses on the assessment of quantitative and qualitative responses from a subset of providers who identified as specialists that treat one or more of the seven cancers that may be disproportionate in LGBTQ patients. A 32-item web-based survey was emailed to 388 oncology providers at a single institution. The survey assessed: demographics, knowledge, attitudes, and practice behaviors. Oncology providers specializing in seven cancer types had poor knowledge of LGBTQ-specific health needs, with fewer than half of the surveyed providers (49.5%) correctly answering knowledge questions. Most providers had overall positive attitudes toward LGBTQ patients, with 91.7% agreeing they would be comfortable treating this population, and would support education and/or training on LGBTQ-related cancer health issues. Results suggest that despite generally positive attitudes toward the LGBTQ population, oncology providers who treat cancer types most prevalent among the population, lack knowledge of their unique health issues. Knowledge and practice behaviors may improve with enhanced education and training on this population's specific needs.

  2. Parental experiences of providing skin-to-skin care to their newborn infant—Part 1: A qualitative systematic review

    Directory of Open Access Journals (Sweden)

    Agneta Anderzén-Carlsson

    2014-10-01

    Full Text Available Aim: To describe parental experiences of providing skin-to-skin care (SSC to their newborn infants. Background: SSC care for newborn infants has been reported to have positive physiological and psychological benefits to the infants and their parents. No systematic review regarding parental experiences has been identified. Design: In this first part of a meta-study, the findings of a systematic literature review on parental experience of SSC care are presented. Data sources: Four databases were searched, without year or language limitations, up until December 2013. Manual searches were performed in reference lists and in a bibliography of the topic. Review methods: After a quality-appraisal process, data from the original articles were extracted and analysed using qualitative content analysis. Results: The systematic and manual searches led to the inclusion of 29 original qualitative papers from nine countries, reporting experiences from 401 mothers and 94 fathers. Two themes that characterized the provision of SSC emerged: a restoring experience and an energy-draining experience. Conclusion: This review has added scientific and systematic knowledge about parental experiences of providing SSC. Further research about fathers’ experiences is recommended.

  3. Electric heating provides a high level of home comfort - economically

    Energy Technology Data Exchange (ETDEWEB)

    Haapakoski, M.

    1997-11-01

    Research and development at IVO in the area of electric heating boasts a tradition going back almost thirty years. Research aimed at further progress is continuing. IVO and power companies launched the `Electrically heated houses of the century` project four years ago. The first results show that electric heating continues to be very competitive with other heating systems. It is an economical way of heating the home and it also increases the comfort of those living there

  4. Optimizing High Level Waste Disposal

    Energy Technology Data Exchange (ETDEWEB)

    Dirk Gombert

    2005-09-01

    If society is ever to reap the potential benefits of nuclear energy, technologists must close the fuel-cycle completely. A closed cycle equates to a continued supply of fuel and safe reactors, but also reliable and comprehensive closure of waste issues. High level waste (HLW) disposal in borosilicate glass (BSG) is based on 1970s era evaluations. This host matrix is very adaptable to sequestering a wide variety of radionuclides found in raffinates from spent fuel reprocessing. However, it is now known that the current system is far from optimal for disposal of the diverse HLW streams, and proven alternatives are available to reduce costs by billions of dollars. The basis for HLW disposal should be reassessed to consider extensive waste form and process technology research and development efforts, which have been conducted by the United States Department of Energy (USDOE), international agencies and the private sector. Matching the waste form to the waste chemistry and using currently available technology could increase the waste content in waste forms to 50% or more and double processing rates. Optimization of the HLW disposal system would accelerate HLW disposition and increase repository capacity. This does not necessarily require developing new waste forms, the emphasis should be on qualifying existing matrices to demonstrate protection equal to or better than the baseline glass performance. Also, this proposed effort does not necessarily require developing new technology concepts. The emphasis is on demonstrating existing technology that is clearly better (reliability, productivity, cost) than current technology, and justifying its use in future facilities or retrofitted facilities. Higher waste processing and disposal efficiency can be realized by performing the engineering analyses and trade-studies necessary to select the most efficient methods for processing the full spectrum of wastes across the nuclear complex. This paper will describe technologies being

  5. Experiences of health care providers with integrated HIV and reproductive health services in Kenya: a qualitative study.

    Science.gov (United States)

    Mutemwa, Richard; Mayhew, Susannah; Colombini, Manuela; Busza, Joanna; Kivunaga, Jackline; Ndwiga, Charity

    2013-01-11

    There is broad consensus on the value of integration of HIV services and reproductive health services in regions of the world with generalised HIV/AIDS epidemics and high reproductive morbidity. Integration is thought to increase access to and uptake of health services; and improves their efficiency and cost-effectiveness through better use of available resources. However, there is still very limited empirical literature on health service providers and how they experience and operationalize integration. This qualitative study was conducted among frontline health workers to explore provider experiences with integration in order to ascertain their significance to the performance of integrated health facilities. Semi-structured in-depth interviews were conducted with 32 frontline clinical officers, registered nurses, and enrolled nurses in Kitui district (Eastern province) and Thika and Nyeri districts (Central province) in Kenya. The study was conducted in health facilities providing integrated HIV and reproductive health services (post-natal care and family planning). All interviews were conducted in English, transcribed and analysed using Nvivo 8 qualitative data analysis software. Providers reported delivering services in provider-level and unit-level integration, as well as a combination of both. Provider experiences of actual integration were mixed. At personal level, providers valued skills enhancement, more variety and challenge in their work, better job satisfaction through increased client-satisfaction. However, they also felt that their salaries were poor, they faced increased occupational stress from: increased workload, treating very sick/poor clients, and less quality time with clients. At operational level, providers reported increased service uptake, increased willingness among clients to take an HIV test, and reduced loss of clients. But the majority also reported infrastructural and logistic deficiencies (insufficient physical room space, equipment

  6. Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory.

    Science.gov (United States)

    Thurston, Wilfreda E; Coupal, Stephanie; Jones, C Allyson; Crowshoe, Lynden F J; Marshall, Deborah A; Homik, Joanne; Barnabe, Cheryl

    2014-06-11

    Access to health services is a determinant of population health and is known to be reduced for a variety of specialist services for Indigenous populations in Canada. With arthritis being the most common chronic condition experienced by Indigenous populations and causing high levels of disability, it is critical to resolve access disparities through an understanding of barriers and facilitators to care. The objective of this study was to inform future health services reform by investigating health care access from the perspective of Aboriginal people with arthritis and health professionals. Using constructivist grounded theory methodology we investigated Indigenous peoples' experiences in accessing arthritis care through the reports of 16 patients and 15 healthcare providers in Alberta, Canada. Semi-structured interviews were conducted between July 2012 and February 2013 and transcribed verbatim. The patient and provider data were first analyzed separately by two team members then brought together to form a framework. The framework was refined through further analysis following the multidisciplinary research team's discussions. Once the framework was developed, reports on the patient and provider data were shared with each participant group independently and participants were interviewed to assess validity of the summary. In the resulting theoretical framework Indigenous participants framed their experience with arthritis as 'toughing it out' and spoke of racism encountered in the healthcare setting as a deterrent to pursuing care. Healthcare providers were frustrated by high disease severity and missed appointments, and framed Indigenous patients as lacking 'buy-in'. Constraints imposed by complex healthcare systems contributed to tensions between Indigenous peoples and providers. Low specialist care utilization rates among Indigenous people cannot be attributed to cultural and social preferences. Further, the assumptions made by providers lead to stereotyping and

  7. A qualitative assessment of factors influencing acceptance of a new rotavirus vaccine among health care providers and consumers

    Directory of Open Access Journals (Sweden)

    Herring Mark

    2007-10-01

    Full Text Available Abstract Background In 2006, a new rotavirus vaccine (RotaTeq was licensed in the US and recommended for routine immunization of all US infants. Because a previously licensed vaccine (Rotashield was withdrawn from the US for safety concerns, identifying barriers to uptake of RotaTeq will help develop strategies to broaden vaccine coverage. Methods We explored beliefs and attitudes of parents (n = 57 and providers (n = 10 towards rotavirus disease and vaccines through a qualitative assessment using focus groups and in-depth interviews. Results All physicians were familiar with safety concerns about rotavirus vaccines, but felt reassured by RotaTeq's safety profile. When asked about likelihood of using RotaTeq on a scale of one to seven (1 = "absolutely not;" 7 = "absolutely yes" the mean score was 5 (range = 3–6. Physicians expressed a high likelihood of adopting RotaTeq, particularly if recommended by their professional organizations and expressed specific interest in post-marketing safety data. Similarly, consumers found the RotaTeq safety profile to be favorable and would rely on their physician's recommendation for vaccination. However, when asked to rank likelihood of having their child vaccinated against rotavirus (1 = "definitely not get;" 7 = "definitely get", 29% ranked 1 or 2, 36% 3 or 4, and 35% 5 to 7. Conclusion Our qualitative assessment provides complementary data to recent quantitative surveys and suggests that physicians and parents are likely to adopt the newly licensed rotavirus vaccine. Increasing parental awareness of the rotavirus disease burden and providing physicians with timely post-marketing surveillance data will be integral to a successful vaccination program.

  8. Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People's democratic republic: a qualitative study.

    Science.gov (United States)

    Sychareun, Vanphanom; Phommachanh, Sysavanh; Soysouvanh, Soudavanh; Lee, Chaeun; Kang, Minah; Oh, Juhwan; Durham, Jo

    2013-12-27

    To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national 'Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services'. This paper reports on implementation constraints identified in three demonstration sites. The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al's health system constraint framework. In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women's position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up. The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the initiative. To achieve effective implementation

  9. Using Health Provider Insights to Inform Pediatric HIV Disclosure: A Qualitative Study and Practice Framework from Kenya

    Science.gov (United States)

    John-Stewart, Grace; Shah, Brandi; Wamalwa, Dalton; Maleche-Obimbo, Elizabeth; Kelley, Maureen

    2014-01-01

    Abstract Optimal pediatric HIV disclosure impacts illness and developmental experiences while improving access to timely treatment. However, disclosure rates in high HIV prevalence countries remain low and there are limited data on best practices. We conducted a qualitative study of disclosure practices and interviewed healthcare providers from five pediatric HIV clinics in Kenya. We identified themes central to disclosure practices, rationale for approaches, barriers to implementing disclosure, and creative strategies to overcome challenges. We used these insights to develop a practice-based framework for disclosure that is sensitive to practical challenges. Overall, providers had limited training but extensive experience in disclosure, endorsed individualized disclosure practices, invested substantial time on disclosure despite clinical burden, and noted adverse outcomes associated with unplanned or abrupt disclosure. Providers advocated for an approach to disclosure that is child-centered but respects caregiver fears and values. Caregiver support was provided to enable caregivers to be the person who ultimately disclosed HIV status to children. Unplanned or abrupt disclosure to children was reported to have severe and persistent adverse impact and was a stimulus to accelerate disclosure in scenarios when providers believed children may be suspecting their diagnosis. Based on these expert insights, the framework we developed incorporates concurrent evaluation of child and caregiver readiness, identifies cues to prompt disclosure discussions, includes caregiver education and support, and utilizes a gradual approach of unveiling HIV diagnosis to the child. PMID:25216105

  10. The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study.

    Science.gov (United States)

    Roberts, J; Sealy, D; Marshak, H Hopp; Manda-Taylor, L; Gleason, P; Mataya, R

    2015-12-01

    Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.

  11. Implementing and Using a Patient Portal: A qualitative exploration of patient and provider perspectives on engaging patients.

    Science.gov (United States)

    Ryan, Bridget L; Brown, Judith Belle; Terry, Amanda; Cejic, Sonny; Stewart, Moira; Thind, Amardeep

    2016-07-04

    The use of portals might be expected to rise; however, adoption has been slow. Development of portals has occurred with limited patient involvement. This paper fills a need for literature concerning perspectives regarding the value of portals, how best to organize and provide portals, and critically how to seek patient involvement in implementation.ObjectiveThe objective was to explore the feelings, ideas, and expectations of patients and primary care providers concerning the implementation and use of patient portals. The study employed a descriptive qualitative design interviewing seven patients and four providers from an interdisciplinary primary health care clinic in Ontario, Canada. Patients were older with at least one chronic condition. Interviews were analysed independently by three coders who then met to synthesize the findings. There was limited experience of portals and substantial convergence between patients and providers regarding concerns and potential benefits with an overall positive view. Four themes emerged: 1) the Context in which patient portal use takes place; 2) the Necessary conditions for use of a patient portal; 3) the Implementation of a patient portal; and 4) the Use of a patient portal for care. Findings highlight that it is not sufficient to engage patients in the use of a portal; it is critical that patients be engaged in the early stages of implementation. With many health and fitness electronic tools available (e.g. Fitbit©), this study remind us that tools are not enough. Patient engagement requires patient-centred partnerships between patients and health care providers.

  12. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers.

    Science.gov (United States)

    Hesselink, Gijs; Flink, Maria; Olsson, Mariann; Barach, Paul; Dudzik-Urbaniak, Ewa; Orrego, Carola; Toccafondi, Giulio; Kalkman, Cor; Johnson, Julie K; Schoonhoven, Lisette; Vernooij-Dassen, Myrra; Wollersheim, Hub

    2012-12-01

    Advocates for quality and safety have called for healthcare that is patient-centred and decision-making that involves patients. The aim of the paper is to explore the barriers and facilitators to patient-centred care in the hospital discharge process. A qualitative study using purposive sampling of 192 individual interviews and 26 focus group interviews was conducted in five European Union countries with patients and/or family members, hospital physicians and nurses, and community general practitioners and nurses. A modified Grounded Theory approach was used to analyse the data. The barriers and facilitators were classified into 15 categories from which four themes emerged: (1) healthcare providers do not sufficiently prioritise discharge consultations with patients and family members due to time restraints and competing care obligations; (2) discharge communication varied from instructing patients and family members to shared decision-making; (3) patients often feel unprepared for discharge, and postdischarge care is not tailored to individual patient needs and preferences; and (4) pressure on available hospital beds and community resources affect the discharge process. Our findings suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients' and families' capabilities, needs and preferences. Future interventions should be directed at healthcare providers' attitudes and their organisation's leadership, with a focus on improving communication among care providers, patients and families, and between hospital and community care providers.

  13. Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers.

    Science.gov (United States)

    Zhang, Jing; Chen, Yunan; Ashfaq, Shazia; Bell, Kristin; Calvitti, Alan; Farber, Neil J; Gabuzda, Mark T; Gray, Barbara; Liu, Lin; Rick, Steven; Street, Richard L; Zheng, Kai; Zuest, Danielle; Agha, Zia

    2016-01-01

    Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing "best" practices to improve patient-centered care in today's highly "wired" health environment. These findings also show that more user-centered EHR design is needed to improve system usability. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. "They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults: a multicenter qualitative study.

    Science.gov (United States)

    Johnson, Heather M; Warner, Ryan C; Bartels, Christie M; LaMantia, Jamie N

    2017-01-03

    Young adults (18-39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers' perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care. Primary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed. Primary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation. Tailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the "health identity" of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.

  15. High-level waste qualification: Managing uncertainty

    Energy Technology Data Exchange (ETDEWEB)

    Pulsipher, B.A.

    1993-09-01

    A vitrification facility is being developed by the U.S. Department of Energy (DOE) at the West Valley Demonstration Plant (WVDP) near Buffalo, New York, where approximately 300 canisters of high-level nuclear waste glass will be produced. To assure that the produced waste form is acceptable, uncertainty must be managed. Statistical issues arise due to sampling, waste variations, processing uncertainties, and analytical variations. This paper presents elements of a strategy to characterize and manage the uncertainties associated with demonstrating that an acceptable waste form product is achieved. Specific examples are provided within the context of statistical work performed by Pacific Northwest Laboratory (PNL).

  16. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers.

    Science.gov (United States)

    Bohren, Meghan A; Vogel, Joshua P; Tunçalp, Özge; Fawole, Bukola; Titiloye, Musibau A; Olutayo, Akinpelu Olanrewaju; Ogunlade, Modupe; Oyeniran, Agnes A; Osunsan, Olubunmi R; Metiboba, Loveth; Idris, Hadiza A; Alu, Francis E; Oladapo, Olufemi T; Gülmezoglu, A Metin; Hindin, Michelle J

    2017-01-17

    Global efforts have increased facility-based childbirth, but substantial barriers remain in some settings. In Nigeria, women report that poor provider attitudes influence their use of maternal health services. Evidence also suggests that women in Nigeria may experience mistreatment during childbirth; however, there is limited understanding of how and why mistreatment this occurs. This study uses qualitative methods to explore women and providers' experiences and perceptions of mistreatment during childbirth in two health facilities and catchment areas in Abuja, Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) were used with a purposive sample of women of reproductive age, midwives, doctors and facility administrators. Instruments were semi-structured discussion guides. Participants were asked about their experiences and perceptions of, and perceived factors influencing mistreatment during childbirth. Thematic analysis was used to synthesize findings into meaningful sub-themes, narrative text and illustrative quotations, which were interpreted within the context of this study and an existing typology of mistreatment during childbirth. Women and providers reported experiencing or witnessing physical abuse including slapping, physical restraint to a delivery bed, and detainment in the hospital and verbal abuse, such as shouting and threatening women with physical abuse. Women sometimes overcame tremendous barriers to reach a hospital, only to give birth on the floor, unattended by a provider. Participants identified three main factors contributing to mistreatment: poor provider attitudes, women's behavior, and health systems constraints. Moving forward, findings from this study must be communicated to key stakeholders at the study facilities. Measurement tools to assess how often mistreatment occurs and in what manner must be developed for monitoring and evaluation. Any intervention to prevent mistreatment will need to be multifaceted, and

  17. Public Expectations of Hospitals to Provide Resources and Services to the Uninjured During Disasters: A Qualitative Study.

    Science.gov (United States)

    Charney, Rachel L; Rebmann, Terri; Dalawari, Preeti; Endrizal, Amy

    Hospitals are perceived as stable sources of support and assistance for the community during disasters. Expectations may outstrip hospital plans or ability to provide for the public. The purpose of this project was to explore racial disparities found in prior research and general perceptions related to the public's expectations of hospitals during disasters. Qualitative interviews were conducted with members of the general public. Content analysis was used to analyze the data and identify themes that describe racial differences related to public expectations of hospitals. A total of 28 interviews were conducted. Half of the participants (n = 14) were black, 57% (n = 16) female, with a mean age of 49 years. No racial differences in terms of the general public's expectations of hospitals were identified. Participants believed that hospitals have a service role and responsibility during disaster response to provide both tangible and intangible supplies and resources to the uninjured public. Hospitals were perceived as able to provide these resources, in terms of having sufficient funds and supplies to share with the uninjured public. In addition, hospitals are perceived as being caring organizations that have compassion toward the public and thus as welcoming places to seek assistance following a disaster. Hospitals need to be prepared to manage the general public's expectations both before and during disasters.

  18. Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People’s democratic republic: a qualitative study

    Science.gov (United States)

    2013-01-01

    Background To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national ‘Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services’. This paper reports on implementation constraints identified in three demonstration sites. Methods The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al’s health system constraint framework. Results In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women’s position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up. Conclusion The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the

  19. Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines.

    Science.gov (United States)

    Lee, Kira; Devine, Alexandra; Marco, Ma Jesusa; Zayas, Jerome; Gill-Atkinson, Liz; Vaughan, Cathy

    2015-10-15

    The Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers' efforts to respond. This study aims to contribute to the available evidence by examining service providers' perceptions of disability and their experiences providing sexual and reproductive health services to women with disability. The study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants' discussion of service provision to women with disability. Analysis of service providers' accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse. Recent legislative change in the Philippines

  20. Qualitative study investigating the commissioning process for older people's services provided by third sector organisations: SOPRANO study protocol.

    Science.gov (United States)

    Sands, Gina; Chadborn, Neil; Craig, Chris; Gladman, John

    2016-05-18

    The commissioning of third sector services for older people may influence the quality, availability and coordination of services for older people. The SOPRANO study aims to understand the relationships between and processes of commissioning bodies and third sector organisations providing health and social care services for older people. This qualitative study will be based in the East Midlands region of England. An initial scoping survey of commissioners will give an overview of services to maintain the health and well-being of older people in the community that are commissioned. Following this, semistructured interviews will be conducted with 4 sample groups: health and social care commissioners, service provider managers, service provider case workers and older service users. A sample size of 10-15 participants in each of the 4 groups is expected to be sufficient to reach data saturation, resulting in a final expected sample size of 40-60 participants. Informed consent will be gained from all participants, and those unable to provide informed consent will be excluded. The interview data will be analysed by 2 researchers using framework content analysis. Approval for the study has been gained from the University of Nottingham School of Medicine ethical review board, and the relevant approvals have been gained from the National Health Service (NHS) research and development departments for interviewing NHS staff. Early engagement with a wide range of stakeholders will ensure that the research findings are extensively disseminated to relevant stakeholders (including commissioners and third sector providers) in an accessible format using the extensive communication networks available to the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care CLAHRCs (applied health research organisations covering all of England). The study will also be disseminated through academic routes such as conference presentations and

  1. An exploratory qualitative assessment of factors influencing childhood vaccine providers' intention to recommend immunization in the Netherlands.

    Science.gov (United States)

    Mollema, Liesbeth; Staal, Jojet M; van Steenbergen, Jim E; Paulussen, Theo Gwm; de Melker, Hester E

    2012-02-14

    Under the Dutch national immunization program (NIP), childhood vaccination is not mandatory, but its recommendation by childhood vaccine providers (CVP) is important for maintaining high vaccination coverage. We therefore examined factors related to providers' intentions to recommend vaccinations to parents of young children. We conducted four focus group discussions with nurses and physicians who provide vaccines to children 0-4 years old in diverse regions of the Netherlands. Three groups represented CVPs at child welfare centers (CWCs) serving the general population, with the fourth representing anthroposophical CWCs. Elements of the Theory of Planned Behaviour (TPB) were used to design the groups; thematic analysis was used to structure and analyze the dataset. Four main themes emerged, including 1) perceived responsibility: to promote vaccines and discuss pros and cons with parents (although this was usually not done if parents readily accepted the vaccination); 2) attitudes toward the NIP: mainly positive, but doubts as to NIP plans to vaccinate against diseases with a low perceived burden; 3) organizational factors: limited time and information can hamper discussions with parents; 4) relationship with parents: crucial and based mainly on communication to establish trust. Compared to CVPs at standard CWCs, the anthroposophical CWCs spent more time communicating and were more willing to adapt the NIP to individual cases. Our qualitative assessment provides an overview of beliefs associated with providers' intention to recommend vaccinations. They were motivated to support the NIP, but their intentions to recommend vaccinations were affected by the perceived relevance of the vaccines, practical issues like limited time and by certain types of resistant parents. These results will inform future studies to test the magnitude and relative impact of these factors.

  2. An exploratory qualitative assessment of factors influencing childhood vaccine providers' intention to recommend immunization in the Netherlands

    Directory of Open Access Journals (Sweden)

    Mollema Liesbeth

    2012-02-01

    Full Text Available Abstract Background Under the Dutch national immunization program (NIP, childhood vaccination is not mandatory, but its recommendation by childhood vaccine providers (CVP is important for maintaining high vaccination coverage. We therefore examined factors related to providers' intentions to recommend vaccinations to parents of young children. Methods We conducted four focus group discussions with nurses and physicians who provide vaccines to children 0-4 years old in diverse regions of the Netherlands. Three groups represented CVPs at child welfare centers (CWCs serving the general population, with the fourth representing anthroposophical CWCs. Elements of the Theory of Planned Behaviour (TPB were used to design the groups; thematic analysis was used to structure and analyze the dataset. Results Four main themes emerged, including 1 perceived responsibility: to promote vaccines and discuss pros and cons with parents (although this was usually not done if parents readily accepted the vaccination; 2 attitudes toward the NIP: mainly positive, but doubts as to NIP plans to vaccinate against diseases with a low perceived burden; 3 organizational factors: limited time and information can hamper discussions with parents; 4 relationship with parents: crucial and based mainly on communication to establish trust. Compared to CVPs at standard CWCs, the anthroposophical CWCs spent more time communicating and were more willing to adapt the NIP to individual cases. Conclusions Our qualitative assessment provides an overview of beliefs associated with providers' intention to recommend vaccinations. They were motivated to support the NIP, but their intentions to recommend vaccinations were affected by the perceived relevance of the vaccines, practical issues like limited time and by certain types of resistant parents. These results will inform future studies to test the magnitude and relative impact of these factors.

  3. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

    Science.gov (United States)

    Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

    2015-01-01

    To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Qualitative ethnographic study. A maternity hospital, Afghanistan. Doctors, midwives and care assistants. Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. The culture of care in an Afghan maternity hospital. A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment-fearing humiliation, blame and the loss of employment. Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. © 2014 Royal College of Obstetricians and Gynaecologists.

  4. High level white noise generator

    Science.gov (United States)

    Borkowski, Casimer J.; Blalock, Theron V.

    1979-01-01

    A wide band, stable, random noise source with a high and well-defined output power spectral density is provided which may be used for accurate calibration of Johnson Noise Power Thermometers (JNPT) and other applications requiring a stable, wide band, well-defined noise power spectral density. The noise source is based on the fact that the open-circuit thermal noise voltage of a feedback resistor, connecting the output to the input of a special inverting amplifier, is available at the amplifier output from an equivalent low output impedance caused by the feedback mechanism. The noise power spectral density level at the noise source output is equivalent to the density of the open-circuit thermal noise or a 100 ohm resistor at a temperature of approximately 64,000 Kelvins. The noise source has an output power spectral density that is flat to within 0.1% (0.0043 db) in the frequency range of from 1 KHz to 100 KHz which brackets typical passbands of the signal-processing channels of JNPT's. Two embodiments, one of higher accuracy that is suitable for use as a standards instrument and another that is particularly adapted for ambient temperature operation, are illustrated in this application.

  5. Integrated opioid substitution therapy and HIV care: a qualitative systematic review and synthesis of client and provider experiences.

    Science.gov (United States)

    Guise, Andy; Seguin, Maureen; Mburu, Gitau; McLean, Susie; Grenfell, Pippa; Islam, Zahed; Filippovych, Sergii; Assan, Happy; Low, Andrea; Vickerman, Peter; Rhodes, Tim

    2017-09-01

    People who use drugs in many contexts have limited access to opioid substitution therapy and HIV care. Service integration is one strategy identified to support increased access. We reviewed and synthesized literature exploring client and provider experiences of integrated opioid substitution therapy and HIV care to identify acceptable approaches to care delivery. We systematically reviewed qualitative literature. We searched nine bibliographic databases, supplemented by manual searches of reference lists of articles from the database search, relevant journals, conferences, key organizations and consultation with experts. Thematic synthesis was used to develop descriptive themes in client and provider experiences. The search yielded 11 articles for inclusion, along with 8 expert and policy reports. We identify five descriptive themes: the convenience and comprehensive nature of co-located care, contrasting care philosophies and their role in shaping integration, the limits to disclosure and communication between clients and providers, opioid substitution therapy enabling HIV care access and engagement, and health system challenges to delivering integrated services. The discussion explores how integrated opioid substitution therapy and HIV care needs to adapt to specific social conditions, rather than following universal approaches. We identify priorities for future research. Acceptable integrated opioid substitution therapy and HIV care for people who use drugs and providers is most likely through co-located care and relies upon attention to stigma, supportive relationships and client centred cultures of delivery. Further research is needed to understand experiences of integrated care, particularly delivery in low and middle income settings and models of care focused on community and non-clinic based delivery.

  6. Management of respiratory tract infections in young children-A qualitative study of primary care providers' perspectives.

    Science.gov (United States)

    Biezen, Ruby; Brijnath, Bianca; Grando, Danilla; Mazza, Danielle

    2017-03-07

    Respiratory tract infections in young children are the most common cause of general practice visits in Australia. Despite the availability of clinical practice guidelines, the treatment and management of respiratory tract infections in young children is inconsistent. The aim of the study was to explore the management of respiratory tract infections in young children from a multi-disciplinary perspective using across-sectional qualitative research design based on the theoretical domains framework and the Capability, Opportunity and Motivation-B model. In-depth interviews were conducted with 30 primary care providers to explore their knowledge, views and management of respiratory tract infections in young children. Interviews focused on symptomatic management, over-the-counter medications and antibiotic use, and data were thematically analysed. Our findings showed that factors such as primary care providers' time constraints, parental anxiety, general practitioners' perception of what parents want, perceived parental pressure, and fear of losing patients were some of the reasons why primary care providers did not always adhere to guideline recommendations. Primary care providers also provided conflicting advice to parents concerning over-the-counter medications and when children should resume normal activities. Overall, this study showed that complex interactions involving emotional and psychological factors influenced the decision making process of primary care providers' management of respiratory tract infections in young children. A team care approach with consistent advice, and improved communication between primary care providers and parents is vital to overcome some of these barriers and improve guideline adherence. The findings of this research will inform the development of interventions to better manage respiratory tract infections in young children. CLINICIANS SWAYED BY PARENTAL ANXIETY AND PRESSURE: The emotions and psychology of both parents and

  7. A qualitative exploration of how Canadian informal caregivers in medical tourism use experiential resources to cope with providing transnational care.

    Science.gov (United States)

    Whitmore, Rebecca; Crooks, Valorie A; Snyder, Jeremy

    2017-01-01

    Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences of informal caregivers in medical tourism to learn more about the lived experiences or 'experiential resources' they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers' well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants' perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism

  8. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark.

    Science.gov (United States)

    Jensen, Natasja Koitzsch; Norredam, Marie; Priebe, Stefan; Krasnik, Allan

    2013-01-28

    Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients' refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this

  9. A nationwide survey of public healthcare providers' impressions of family medicine specialists in Malaysia: a qualitative analysis of written comments.

    Science.gov (United States)

    Chew, Boon-How; Cheong, Ai-Theng; Ismail, Mastura; Hamzah, Zuhra; A-Rashid, Mohd-Radzniwan; Md-Yasin, Mazapuspavina; Ali, Norsiah; Mohd-Salleh, Noridah; Bashah, Baizury

    2016-01-07

    To examine impressions of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. Cross-sectional study. This study is part of a larger national study on the perception of Malaysian public healthcare professionals on FMSs (PERMFAMS). PHCPs from three categories of health facility: hospitals, health clinics and health offices. Qualitative analyses of written comments of respondents' general impression of FMSs. The participants' response rate was 58.0% (780/1345), with almost equal proportions from each public healthcare facility. A total of 23 categories for each of the 648 impression comments were identified. The six emerging themes were: (1) importance of FMSs; (2) roles of FMSs; (3) clinical performance of FMSs; (4) attributes of FMSs; (5) FMS practice challenges; (6) misconception of FMS roles. Overall, FMS practice was perceived to be safe and able to provide effective treatments in a challenging medical discipline that was in line with the current standards of medical care and ethical and professional values. The areas of concern were in clinical performance expressed by PHCPs from some hospitals and the lack of personal attributes and professionalism among FMSs mentioned by PHCPs from health clinics and offices. FMSs were perceived to be capable of providing effective treatment and were considered to be important primary care physicians. There were a few negative impressions in some areas of FMS practice, which demanded attention by the FMSs themselves and the relevant authorities in order to improve efficiency and safeguard the fraternity's reputation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Ecosystem Services Provided by Agroecosystems: A Qualitative and Quantitative Assessment of this Relationship in the Pampa Region, Argentina

    Science.gov (United States)

    Rositano, Florencia; Ferraro, Diego Omar

    2014-03-01

    The development of an analytical framework relating agricultural conditions and ecosystem services (ES) provision could be very useful for developing land-use systems which sustain natural resources for future use. According to this, a conceptual network was developed, based on literature review and expert knowledge, about the functional relationships between agricultural management and ES provision in the Pampa region (Argentina). We selected eight ES to develop this conceptual network: (1) carbon (C) balance, (2) nitrogen (N) balance, (3) groundwater contamination control, (4) soil water balance, (5) soil structural maintenance, (6) N2O emission control, (7) regulation of biotic adversities, and (8) biodiversity maintenance. This conceptual network revealed a high degree of interdependence among ES provided by Pampean agroecosystems, finding two trade-offs, and two synergies among them. Then, we analyzed the conceptual network structure, and found that both environmental and management variables influenced ES provision. Finally, we selected four ES to parameterize and quantify along 10 growing seasons (2000/2001-2009/2010) through a probabilistic methodology called Bayesian Networks. Only N balance was negatively impacted by agricultural management; while C balance, groundwater contamination control, and N2O emission control were not. Outcomes of our work emphasize the idea that qualitative and quantitative methodologies should be implemented together to assess ES provision in Pampean agroecosystems, as well as in other agricultural systems.

  11. The views and attitudes of health professionals providing antenatal care to women with a high BMI: a qualitative research study.

    Science.gov (United States)

    Knight-Agarwal, Catherine Ruth; Kaur, Manmeet; Williams, Lauren T; Davey, Rachel; Davis, Deborah

    2014-06-01

    The prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m(2) and over. A qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n=10), one with continuity of care midwives (n=18) and one with obstetricians (n=5). Data were analysed using Interpretative Phenomenological Analysis (IPA). Six dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women. Health professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals. Copyright © 2013. Published by Elsevier Ltd.

  12. Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers

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    Mar Miserachs

    2017-01-01

    Full Text Available With improved survival outcomes after pediatric liver transplantation (LT, health-related quality of life (HRQoL is an important outcome metric. Understanding the elements contributing to HRQoL after LT in children would enable more targeted strategies towards optimizing best outcomes. This qualitative study aimed to explore health care providers (HCP perceptions about HRQoL after pediatric LT. Thirteen experienced HCP participated in two focus group discussions. Data analysis via a thematic analysis approach revealed 4 major themes: “LT as a facilitator of better HRQoL,” “coping and adapting to LT,” “living with a transplanted liver,” and “the family context.” HCP identified elements that both enhance (improved physical health, peer relationship, and activities of daily living and challenge (need for immunosuppression, transplant follow-up, and restrictions the multidimensional domains of HRQoL. HCP perceived LT to be a stressful life-changing event for children and their families. Patients and their parents’ ability to cope and adjust positively to LT was perceived as a key contributor to better HRQoL. HCP perspective highlights the importance of promoting psychosocial support and a family-centered care delivery model towards the overarching goal of optimizing durable outcomes.

  13. Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study.

    Science.gov (United States)

    Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che

    2016-05-01

    Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  14. Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi

    Directory of Open Access Journals (Sweden)

    Peter MacPherson

    2012-12-01

    Full Text Available Introduction: Linkage from HIV testing and counselling (HTC to initiation of antiretroviral therapy (ART is suboptimal in many national programmes in sub-Saharan Africa, leading to delayed initiation of ART and increased risk of death. Reasons for failure of linkage are poorly understood. Methods: Semi-structured qualitative interviews were undertaken with health providers and HIV-positive primary care patients as part of a prospective cohort study at primary health centres in Blantyre, Malawi. Patients successful and unsuccessful in linking to ART were included. Results: Progression through the HIV care pathway was strongly influenced by socio-cultural norms, particularly around the perceived need to regain respect lost during a period of visibly declining health. Capacity to call upon the support of networks of families, friends and employers was a key determinant of successful progression. Over-busy clinics, non-functioning laboratories and unsuitable tools used for ART eligibility assessment (WHO clinical staging system and centralized CD4 count measurement were important health systems determinants of drop-out. Conclusions: Key interventions that could rapidly improve linkage include guarantee of same-day, same-clinic ART eligibility assessments; utilization of the support offered by peer-groups and community health workers; and integration of HTC and ART programmes.

  15. Perceived needs for support among care home staff providing end of life care for people with dementia: a qualitative study.

    Science.gov (United States)

    Vandrevala, T; Samsi, K; Rose, C; Adenrele, C; Barnes, C; Manthorpe, J

    2017-02-01

    The aim of the current exploratory study was to investigate the impact on care home staff when working with people with dementia at the end of life and to explore how they cope with this aspect of their work. With UK policy encouraging death in the place of residence, rather than hospital, more people with dementia are dying in care homes. A qualitative approach was employed; 20 care home staff working in five English care homes were interviewed. Thematic Analysis was used to analyse the data. Care home staff found the external demands on them and difficulties associated with interacting with people with dementia sometimes challenging, stressful and anxiety-provoking, particularly as residents approached end of life. Emotional aspects of caring for dying residents were sometimes heightened by close attachments with residents and their families. Staff were able to recognise these unmet needs and identified a need for further training and emotional support to manage these stressors. This study revealed rich and complex understandings of the practice dimensions of caring for people with dementia at the end of life and the impact these have on staff. There is a need to develop effective psychosocial interventions that focus on emotional support for care home staff. There will be challenges in providing this in employment settings that are generally low paid, low status, have high turnover and are reliant on temporary or migrant staff, where training is not rewarded, mandatory or culturally valued. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Using contraceptives to delay first birth: a qualitative study of individual, community and health provider perceptions in southern Tanzania

    Directory of Open Access Journals (Sweden)

    Yovitha Sedekia

    2017-10-01

    Full Text Available Abstract Background Young adolescents and unmarried women in low and middle income countries face challenges in accessing family planning services. One factor likely to limit contraceptive use is the attitude and opinion of local stakeholders such as community leaders and health workers. Much of the existing evidence on this topic focuses on women who have already started childbearing. Using primary qualitative data, we explored individual, community and health provider’s perceptions about using modern contraceptives to delay the first birth in a high fertility setting. Methods A descriptive qualitative study was conducted in Tandahimba district in southern Tanzania between December 2014 and March 2015. We conducted 8 focus group discussions with men and women and 25 in-depth interviews (18 with women, 4 with family planning service providers and 3 with district-level staff. Participants were purposively sampled. Data transcripts were managed and coded using Nvivo 11 software and we employed a thematic framework analysis. Results Three main themes emerged about using modern contraceptives to delay first birth: (1 the social and biological status of the woman (2 the type of contraceptive and (3 non-alignment among national policies for adolescents. Use of modern contraceptives to delay first birth was widely acceptable for women who were students, young, unmarried and women in unstable marriage. But long-acting reversible methods such as implants and intrauterine devices were perceived as inappropriate methods for delaying first birth, partly because of fears around delayed return to fecundity, discontinuation once woman’s marital status changes and permanently limiting future fertility. The support for use of modern contraceptives to delay a first pregnancy was not unanimous. A small number of participants from both rural and urban areas did not approve the use of contraceptive methods before the birth of a first baby at all, not even for

  17. A qualitative study of women's and health providers' attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea.

    Science.gov (United States)

    Balde, Mamadou Diouldé; Bangoura, Abou; Diallo, Boubacar Alpha; Sall, Oumar; Balde, Habibata; Niakate, Aïssatou Sona; Vogel, Joshua P; Bohren, Meghan A

    2017-01-13

    Reducing maternal morbidity and mortality remains a key health challenge in Guinea. Anecdotal evidence suggests that women in Guinea are subjected to mistreatment during childbirth in health facilities, but limited research exists on this topic. This study was conducted to better understand the social norms and the acceptability of four scenarios of mistreatment during childbirth, from the perspectives of women and service providers. This study used qualitative methods including in-depth interviews (IDIs) and focus group discussions (FGDs) with women of reproductive age, midwives, nurses and doctors. This study was conducted in one urban area (Mamou) and one peri-urban area (Pita) in Guinea. Participants were presented with four scenarios of mistreatment during childbirth, including a provider: (1) slapping a woman; (2) verbally abusing a woman; (3) refusing to help a woman; and (4) forcing a woman to give birth on the floor. Data were collected in local languages (Pular and Malinké) and French, and transcribed and analyzed in French. We used a thematic analysis approach and manually coded the data using a codebook developed for the project. A total of 40 IDIs and eight FGDs were conducted with women of reproductive age, 5 IDIs with doctors, and 13 IDIs with midwives. Most women were not accepting of any of the scenarios, unless the action was perceived to be used to save the life of the mother or child. However, they perceived a woman's disobedience and uncooperativeness to contribute to her poor treatment. Women reacted to this mistreatment by accepting poor treatment, refusal to use the same hospital, revenge against the provider or complaints to hospital management. Service providers were accepting of mistreatment when women were disobedient, uncooperative, or to save the life of the baby. This is the first known study on mistreatment of women during childbirth to be conducted in Guinea. Both women and service providers were accepting of mistreatment during

  18. Patients' reported reasons for non-use of an internet-based patient-provider communication service: qualitative interview study.

    Science.gov (United States)

    Varsi, Cecilie; Gammon, Deede; Wibe, Torunn; Ruland, Cornelia M

    2013-11-11

    The adoption of Internet-based patient-provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. The goal of our study was to investigate patients' views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW).

  19. Dying at home: a qualitative study of family carers' views of support provided by GPs community staff.

    Science.gov (United States)

    Seamark, David; Blake, Susan; Brearley, Sarah G; Milligan, Christine; Thomas, Carol; Turner, Mary; Wang, Xu; Payne, Sheila

    2014-12-01

    Dying at home is the preference of many patients with life-limiting illness. This is often not achieved and a key factor is the availability of willing and able family carers. To elicit family carers' views about the community support that made death at home possible. Qualitative study in East Devon, North Lancashire, and Cumbria. Participants were bereaved family carers who had provided care at the end of life for patients dying at home. Semi-structured interviews were conducted 6-24 months after the death. Fifty-nine bereaved family carers were interviewed (54% response rate; 69% female). Two-thirds of the patients died from cancer with median time of home care being 5 months and for non-cancer patients the median time for home care was 30 months. An overarching theme was of continuity of care that divided into personal, organisational, and informational continuity. Large numbers and changes in care staff diluted personal continuity and failure of the GPs to visit was viewed negatively. Family carers had low expectations of informational continuity, finding information often did not transfer between secondary and primary care and other care agencies. Organisational continuity when present provided comfort and reassurance, and a sense of control. The requirement for continuity in delivering complex end-of-life care has long been acknowledged. Family carers in this study suggested that minimising the number of carers involved in care, increasing or ensuring personal continuity, and maximising the informational and organisational aspects of care could lead to a more positive experience. © British Journal of General Practice 2014.

  20. A qualitative study: potential benefits and challenges of traditional healers in providing aspects of palliative care in rural South Africa.

    Science.gov (United States)

    Campbell, L M; Amin, N N

    2014-01-01

    This article draws on selected palliative care providers' views and experiences to reflect on the potential benefits and possible challenges of involving traditional healers in palliative care in rural areas of South Africa. There is increasing consensus that palliative care should be offered by a range of professional and non-professional healthcare givers. Including non-professionals such as traditional healers in a palliative care team may strengthen care provisioning as they have intimate knowledge of patients' local culture and spiritual beliefs. Employing the qualitative method of photo-elicitation, one-on-one discussions about the photographs taken by participants were conducted. The participants - 4 palliative care nurses and 17 home-based care workers - were purposively selected to provide in-depth information about their experiences as palliative caregivers in rural homes. Healthcare workers' experiences revealed that the patients they cared for valued traditional rituals connected to illness, dying, death and bereavement. Participants suggested that traditional healers should be included in palliative care training programs as they could offer appropriate psychological, cultural and spiritual care. A challenge identified by participants was the potential of traditional healers to foster a false sense of longevity in patients facing death. The importance of recognising the value of traditional practices in palliative care should not be underrated in rural South Africa. Traditional healers could enhance palliative care services as they have deep, insider knowledge of patients' spiritual needs and awareness of cultural practices relating to illness, death, dying and bereavement. Incorporating traditional healers into healthcare services where there are differences in the worldviews of healthcare providers and patients, and a sensitivity to mediate cultural differences between caregivers and patients, could have the benefit of providing appropriate care in

  1. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

    Directory of Open Access Journals (Sweden)

    Jensen Natasja Koitzsch

    2013-01-01

    Full Text Available Abstract Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE. Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy

  2. High-level language computer architecture

    CERN Document Server

    Chu, Yaohan

    1975-01-01

    High-Level Language Computer Architecture offers a tutorial on high-level language computer architecture, including von Neumann architecture and syntax-oriented architecture as well as direct and indirect execution architecture. Design concepts of Japanese-language data processing systems are discussed, along with the architecture of stack machines and the SYMBOL computer system. The conceptual design of a direct high-level language processor is also described.Comprised of seven chapters, this book first presents a classification of high-level language computer architecture according to the pr

  3. Patients’ Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study

    Science.gov (United States)

    Gammon, Deede; Wibe, Torunn; Ruland, Cornelia M

    2013-01-01

    Background The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. Objective The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. Methods This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Results Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Conclusions Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. Trial Registration ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW). PMID:24220233

  4. Non-dental primary care providers? views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

    OpenAIRE

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2015-01-01

    Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experie...

  5. Is patient education helpful in providing care for patients with rheumatoid arthritis? A qualitative study involving French nurses.

    Science.gov (United States)

    Fall, Estelle; Chakroun, Nadia; Dalle, Nathalie; Izaute, Marie

    2013-09-01

    This French study explored nurses' involvement in patient education for patients with rheumatoid arthritis. The study design was qualitative. Semistructured interviews were conducted with 16 hospital nurses. Data analysis was performed according to Giorgi's descriptive phenomenological method, and supported by specific qualitative analysis software (Sphinx). The results showed the important role of hospital nurses in rheumatoid arthritis care. Patient education is a core part of nurses' work, allowing them to give patients information and emotional support. The interviewees displayed skills in helping patients learn to care for themselves. However, patient education mostly concerned patients who are already committed to their health care. Non-adherent patients warrant special attention; their acceptance of their disease, perceptions about disease and treatment, motivation, and autonomy should be specifically addressed. French nurses could benefit from more training, and could be aided by psychologists. Ambulatory services could also be developed for patient education in France, based on examples from other countries. © 2013 Wiley Publishing Asia Pty Ltd.

  6. High-Level Dialogue on International Migration

    Directory of Open Access Journals (Sweden)

    UNHCR

    2006-08-01

    Full Text Available UNHCR wishes to bring the following observations andrecommendations to the attention of the High-LevelDialogue (HLD on International Migration and Development,to be held in New York, 14-15 September 2006:

  7. Overview of high level synthesis tools

    CERN Document Server

    Evans, J

    2011-01-01

    High Level Synthesis takes an abstract behavioural or algorithmic description of a digital system and creates a register transfer level structure that realises the described behaviour. Various methodologies have been developed to perform such synthesis tasks. This paper presents the different HLS concepts used in the current leading tools. It makes a comparison between the different approaches and highlights their advantages and limitations. We also present a high level synthesis example.

  8. Delivering Service Quality in Alcohol Treatment: A Qualitative Comparison of Public and Private Treatment Centres by Service Users and Service Providers

    Science.gov (United States)

    Resnick, Sheilagh M.; Griffiths, Mark D.

    2012-01-01

    In the UK, quality of care has now been placed at the centre of the National Health Service (NHS) modernisation programme. To date, there has been little research on the service quality delivery of alcohol treatment services from the perspective of both the service user and service provider. Therefore, this qualitative study explored the…

  9. Care provided by the father to the child with cancer under the influence of masculinities: qualitative meta-synthesis

    Directory of Open Access Journals (Sweden)

    Naiara Barros Polita

    Full Text Available ABSTRACT Objective: To synthesize and interpret findings and conclusions of qualitative research addressing the experience of the father in the care of the child with cancer. Method: Meta-synthesis of 16 qualitative studies from six databases, analyzed through taxonomic analysis. Results: Child and adolescent cancer have several repercussions on the daily life of the father, especially related to the stigma around the disease, the fear of the unknown and the social and family role. Faced with the illness and the need to care for the child, the father seeks to recover normality in the family and transitions between hegemonic masculine behaviors and practices culturally recognized as female. Final Considerations: The complex experience of the father, influenced by masculinities, was evidenced. The limitations regard the restricted understanding of the contextual specificities of the experiences, due to the limited characteristics of the parents and children described in the studies. The knowledge produced is useful to promote involvement of fathers in the care of the child, as well as to strengthen and assist him in this task.

  10. A qualitative study of provider perspectives on the barriers to contraceptive use in Kaliro and Iganga Districts, Eastern Central Uganda

    Directory of Open Access Journals (Sweden)

    Constance Sibongile Shumba

    2016-01-01

    Full Text Available Background: Family planning confers unique benefits including preventing unintended pregnancies, improving maternal and child health outcomes, and increasing women’s access to education and economic opportunities. However, Uganda has a low contraceptive prevalence rate of only 30%, and progress in improving maternal and child health outcomes is slow. Objective: This assessment explores community health workers’ and facility-based health workers’ qualitative perspectives on the use of contraceptives in the Iganga and Kaliro districts in Eastern Central Uganda. Methods: The baseline assessment used a qualitative approach with a focused sample of community- and facility-based health workers aged 20-60 years. Two focus group discussions with Community Health Workers and four key informant interviews with facility-based health workers were conducted. Thematic content analysis was done manually. Results: The main factors influencing contraceptive use in these communities were preference for large families, perceived inadequate knowledge of family planning and fear of side effects, inadequate spousal and family support, male domination and risk of violence, divorce and polygamy, inadequate human resource capacity and low motivation, and user fees. Conclusion: The study findings suggest that there is low use of contraceptives for family planning in the Kaliro and Iganga districts in Uganda. Recommendations include developing a strong focus in exploring policy options to build the capacities of trained health workers to offer long-term methods in order to increase the availability of family planning options. Family planning interventions should increase the availability of contraceptive methods using gender-sensitive strategies, including community mobilization.

  11. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

    Science.gov (United States)

    Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

    2016-01-15

    Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled

  12. PAIRWISE BLENDING OF HIGH LEVEL WASTE (HLW)

    Energy Technology Data Exchange (ETDEWEB)

    CERTA, P.J.

    2006-02-22

    The primary objective of this study is to demonstrate a mission scenario that uses pairwise and incidental blending of high level waste (HLW) to reduce the total mass of HLW glass. Secondary objectives include understanding how recent refinements to the tank waste inventory and solubility assumptions affect the mass of HLW glass and how logistical constraints may affect the efficacy of HLW blending.

  13. The Effects of High Level Infrasound

    Science.gov (United States)

    1980-02-01

    This paper will attempt to survey the current knowledge on the effects of relative high levels of infrasound on humans. While this conference is...8217Is hearing the main concern of infrasound and low frequency exposure, or is there a more sensitive mechanism?’. It would be comforting to know that

  14. A Qualitative Evaluation of Engagement and Attrition in a Nurse Home Visiting Program: From the Participant and Provider Perspective.

    Science.gov (United States)

    Beasley, Lana O; Ridings, Leigh E; Smith, Tyler J; Shields, Jennifer D; Silovsky, Jane F; Beasley, William; Bard, David

    2017-10-11

    Beginning parenting programs in the prenatal and early postnatal periods have a large potential for impact on later child and maternal outcomes. Home-based parenting programs, such as the Nurse Family Partnership (NFP), have been established to help address this need. Program reach and impact is dependent on successful engagement of expecting mothers with significant risks; however, NFP attrition rates remain high. The current study qualitatively examined engagement and attrition from the perspectives of NFP nurses and mothers in order to identify mechanisms that enhance service engagement. Semi-structured interviews were conducted in focus groups composed of either engaged (27 total mothers) or unengaged (15 total mothers) mothers from the NFP program. NFP nurses (25 total nurses) were recruited for individual semi-structured interviews. Results suggest that understanding engagement in the NFP program requires addressing both initial and sustained engagement. Themes associated with enhanced initial engagement include nurse characteristics (e.g., flexible, supportive, caring) and establishment of a solid nurse-family relationship founded on these characteristics. Factors impacting sustained engagement include nurse characteristics, provision of educational materials on child development, individualized services for families, and available family support. Identified barriers to completing services include competing demands and lack of support. Findings of this study have direct relevance for workforce planning, including hiring and training through integrating results regarding effective nurse characteristics. Additional program supports to enhance parent engagement may be implemented across home-based parenting programs in light of the current study's findings.

  15. Provider perspectives on the enabling environment required for skilled birth attendance: a qualitative study in western Nepal.

    Science.gov (United States)

    Morgan, Alison; Jimenez Soto, Eliana; Bhandari, Gajananda; Kermode, Michelle

    2014-12-01

    In Nepal, where difficult geography and an under-resourced health system contribute to poor health care access, the government has increased the number of trained skilled birth attendants (SBAs) and posted them in newly constructed birthing centres attached to peripheral health facilities that are available to women 24 h a day. This study describes their views on their enabling environment. Qualitative methods included semi-structured interviews with 22 SBAs within Palpa district, a hill district in the Western Region of Nepal; a focus group discussion with ten SBA trainees, and in-depth interviews with five key informants. Participants identified the essential components of an enabling environment as: relevant training; ongoing professional support; adequate infrastructure, equipment and drugs; and timely referral pathways. All SBAs who practised alone felt unable to manage obstetric complications because quality management of life-threatening complications requires the attention of more than one SBA. Maternal health guidelines should account for the provision of an enabling environment in addition to the deployment of SBAs. In Nepal, referral systems require strengthening, and the policy of posting SBAs alone, in remote clinics, needs to be reconsidered to achieve the goal of reducing maternal deaths through timely management of obstetric complications. © 2014 John Wiley & Sons Ltd.

  16. An exploratory qualitative assessment of factors influencing childhood vaccine providers' intention to recommend immunization in the Netherlands

    OpenAIRE

    Mollema Liesbeth; Staal Jojet M; van Steenbergen Jim E; Paulussen Theo GWM; de Melker Hester E

    2012-01-01

    Abstract Background Under the Dutch national immunization program (NIP), childhood vaccination is not mandatory, but its recommendation by childhood vaccine providers (CVP) is important for maintaining high vaccination coverage. We therefore examined factors related to providers' intentions to recommend vaccinations to parents of young children. Methods We conducted four focus group discussions with nurses and physicians who provide vaccines to children 0-4 years old in diverse regions of the...

  17. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research

    Science.gov (United States)

    Robertshaw, Luke; Dhesi, Surindar

    2017-01-01

    Objectives To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. Design Systematic review and qualitative thematic synthesis. Methods Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. Results Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. Conclusions A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group. PMID:28780549

  18. A Qualitative Study of Providers' Perception of Adherence of Women Living with HIV/AIDS in Puerto Rico

    Science.gov (United States)

    Rivero-Mendez, Marta; Dawson-Rose, Carol S.; Solis-Baez, Solymar S.

    2010-01-01

    This study examines healthcare providers' perceptions regarding experiences and factors that contribute to adherent and non-adherent behaviors to HIV treatment among women living with HIV infection in Puerto Rico and describes strategies implemented to improve adherence. Providers' accounts revealed that women with HIV infection are living…

  19. The influence of parents and the home environment on preschoolers' physical activity behaviours: a qualitative investigation of childcare providers' perspectives

    National Research Council Canada - National Science Library

    Tucker, Patricia; van Zandvoort, Melissa M; Burke, Shauna M; Irwin, Jennifer D

    2011-01-01

    .... This study sought to examine childcare providers' perspectives of the importance of parents and the home environment for supporting the physical activity behaviours of preschool-aged children (aged 2.5-5 years...

  20. High-Level Overview of Data Needs for RE Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, Anthony

    2016-12-22

    This presentation provides a high level overview of analysis topics and associated data needs. Types of renewable energy analysis are grouped into two buckets: First, analysis for renewable energy potential, and second, analysis for other goals. Data requirements are similar but and they build upon one another.

  1. High-Level waste process and product data annotated bibliography

    Energy Technology Data Exchange (ETDEWEB)

    Stegen, G.E.

    1996-02-13

    The objective of this document is to provide information on available issued documents that will assist interested parties in finding available data on high-level waste and transuranic waste feed compositions, properties, behavior in candidate processing operations, and behavior on candidate product glasses made from those wastes. This initial compilation is only a partial list of available references.

  2. High-Level Waste Melter Study Report

    Energy Technology Data Exchange (ETDEWEB)

    Perez Jr, Joseph M; Bickford, Dennis F; Day, Delbert E; Kim, Dong-Sang; Lambert, Steven L; Marra, Sharon L; Peeler, David K; Strachan, Denis M; Triplett, Mark B; Vienna, John D; Wittman, Richard S

    2001-07-13

    At the Hanford Site in Richland, Washington, the path to site cleanup involves vitrification of the majority of the wastes that currently reside in large underground tanks. A Joule-heated glass melter is the equipment of choice for vitrifying the high-level fraction of these wastes. Even though this technology has general national and international acceptance, opportunities may exist to improve or change the technology to reduce the enormous cost of accomplishing the mission of site cleanup. Consequently, the U.S. Department of Energy requested the staff of the Tanks Focus Area to review immobilization technologies, waste forms, and modifications to requirements for solidification of the high-level waste fraction at Hanford to determine what aspects could affect cost reductions with reasonable long-term risk. The results of this study are summarized in this report.

  3. High Level Waste (HLW) Feed Process Control Strategy

    Energy Technology Data Exchange (ETDEWEB)

    STAEHR, T.W.

    2000-06-14

    The primary purpose of this document is to describe the overall process control strategy for monitoring and controlling the functions associated with the Phase 1B high-level waste feed delivery. This document provides the basis for process monitoring and control functions and requirements needed throughput the double-shell tank system during Phase 1 high-level waste feed delivery. This document is intended to be used by (1) the developers of the future Process Control Plan and (2) the developers of the monitoring and control system.

  4. Coping and compromise: a qualitative study of how primary health care providers respond to health reform in China.

    Science.gov (United States)

    Zhang, Mingji; Wang, Wei; Millar, Ross; Li, Guohong; Yan, Fei

    2017-08-04

    Health reform in China since 2009 has emphasized basic public health services to enhance the function of Community Health Services as a primary health care facility. A variety of studies have documented these efforts, and the challenges these have faced, yet up to now the experience of primary health care (PHC) providers in terms of how they have coped with these changes remains underdeveloped. Despite the abundant literature on psychological coping processes and mechanisms, the application of coping research within the context of human resources for health remains yet to be explored. This research aims to understand how PHC providers coped with the new primary health care model and the job characteristics brought about by these changes. Semi-structured interviews with primary health care workers were conducted in Jinan city of Shandong province in China. A maximum variation sampling method selected 30 PHC providers from different specialties. Thematic analysis was used drawing on a synthesis of theories related to the Job Demands-Resources model, work adjustment, and the model of exit, voice, loyalty and neglect to understand PHC providers' coping strategies. Our interviews identified that the new model of primary health care significantly affected the nature of primary health work and triggered a range of PHC providers' coping processes. The results found that health workers perceived their job as less intensive than hospital medical work but often more trivial, characterized by heavy workload, blurred job description, unsatisfactory income, and a lack of professional development. However, close relationship with community and low work pressure were satisfactory. PHC providers' processing of job demands and resources displayed two ways of interaction: aggravation and alleviation. Processing of job demands and resources led to three coping strategies: exit, passive loyalty, and compromise with new roles and functions. Primary health care providers employed coping

  5. High-level Synthesis Integrated Verification

    Directory of Open Access Journals (Sweden)

    M. Dossis

    2015-10-01

    Full Text Available It is widely known in the engineering community that more than 60% of the IC design project time is spent on verification. For the very complex contemporary chips, this may prove prohibitive for the IC to arrive at the correct time in the market and therefore, valuable sales share may be lost by the developing industry. This problem is deteriorated by the fact that most of conventional verification flows are highly repetitive and a great proportion of the project time is spent on last-moment simulations. In this paper we present an integrated approach to rapid, high-level verification, exploiting the advantages of a formal High-level Synthesis tool, developed by the author. Verification in this work is supported at 3 levels: high-level program code, RTL simulation and rapid, generated C testbench execution. This paper is supported by strong experimental work with 3-4 popular design synthesis and verification that proves the principles of our methodology.

  6. What do Non-clergy Spiritual Care Providers Contribute to End of Life Care in Israel? A Qualitative Study.

    Science.gov (United States)

    Pagis, Michal; Tal, Orly; Cadge, Wendy

    2017-04-01

    Spiritual care is an increasingly important component of end of life care. As it emerges in Israel, it is intentionally built on a nonclerical model. Based on interviews with spiritual care providers in Israel, we find that they help patients and families talk about death and say goodbyes. They encourage the wrapping up of unfinished business, offer diverse cultural resources that can provide meaning, and use presence and touch to produce connection. As spiritual care emerges in Israel, providers are working with patients at the end of life in ways they see as quite distinct from rabbis. They offer broad frames of meaning to which patients from a range of religious traditions can connect.

  7. Key findings: a qualitative assessment of provider and patient perceptions of HIV/AIDS in South Africa.

    Science.gov (United States)

    Ransom, James; Johnson, Anton F

    2009-01-01

    In 1997, at the Davos International Economic Forum, Nelson Mandela stated that "the poor, the vulnerable, the unschooled, the socially marginalized, the women, and the children, those who bear the burden of colonial legacy-these are the sectors of society which bear the burden of AIDS" (Richter, 2001). Nearly a decade later, that statement still holds true, especially in Mr. Mandela's home country. South Africa continues to have one of the world's highest prevalence ratios of HIV infection (UNAIDS, 2002). This paper explores the significance of perceptions, knowledge, practices, and attitudes toward HIV/AIDS in two important groups in South Africa: health care providers based in public health clinics and their patients. This paper will assess the provider-patient interaction from the perspective of members of the South African HIV/AIDS treatment and prevention community. The analysis will examine the results of in-depth interviews and focus group discussions with providers and patients, respectively, in two of South Africa's nine provinces. Between December 2002 and April 2003 in Guateng and KwaZulu-Natal provinces, we conducted (1) in-depth interviews of a spectrum of health care providers at five local public health clinics and (2) focus groups of patients who patronize those clinics. The results show that there are gaps in the HIV/AIDS knowledge of some of the health care providers and that the participants' health beliefs and practices are embedded in the social conditions in which they live and work, which has a ripple effect on their risk behaviors and trumps any intervention messages from their health care providers and larger public health intervention messages.

  8. Latino family childcare providers' beliefs, attitudes, and practices related to promotion of healthy behaviors among preschool children: a qualitative study.

    Science.gov (United States)

    Lindsay, Ana C; Salkeld, Judith A; Greaney, Mary L; Sands, Faith D

    2015-01-01

    The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care. Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing children's early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity. Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providers (n = 44). Data was analyzed to identify recurrent themes. Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH. Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity.

  9. Strengthening diabetes retinopathy services in India: Qualitative insights into providers' perspectives: The India 11-city 9-state study

    Directory of Open Access Journals (Sweden)

    Nanda Kishore Kannuri

    2016-01-01

    Full Text Available Context: There is a lack of evidence on the subjective aspects of the provider perspective regarding diabetes and its complications in India. Objectives: The study was undertaken to understand the providers' perspective on the delivery of health services for diabetes and its complications, specifically the eye complications in India. Settings and Design: Hospitals providing diabetic services in government and private sectors were selected in 11 of the largest cities in India, based on geographical distribution and size. Methods: Fifty-nine semi-structured interviews conducted with physicians providing diabetes care were analyzed all interviews were recorded, transcribed, and translated. Nvivo 10 software was used to code the transcripts. Thematic analysis was conducted to analyze the data. Results: The results are presented as key themes: “Challenges in managing diabetes patients,” “Current patient management practices,” and “Strengthening diabetic retinopathy (DR services at the health systems level.” Diabetes affects people early across the social classes. Self-management was identified as an important prerequisite in controlling diabetes and its complications. Awareness level of hospital staff on DR was low. Advances in medical technology have an important role in effective management of DR. A team approach is required to provide comprehensive diabetic care. Conclusions: Sight-threatening DR is an impending public health challenge that needs a concerted effort to tackle it. A streamlined, multi-dimensional approach where all the stakeholders cooperate is important to strengthening services dealing with DR in the existing health care setup.

  10. Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: a qualitative study.

    Science.gov (United States)

    Spitz, Aerin; Moore, Alison A; Papaleontiou, Maria; Granieri, Evelyn; Turner, Barbara J; Reid, M Carrington

    2011-07-14

    The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions

  11. Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

    Directory of Open Access Journals (Sweden)

    Turner Barbara J

    2011-07-01

    Full Text Available Abstract Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results Most participants (96% employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Conclusions Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods

  12. A qualitative study of patient and provider perspectives on using web-based pain coping skills training to treat persistent cancer pain.

    Science.gov (United States)

    Rini, Christine; Vu, Maihan B; Lerner, Hannah; Bloom, Catherine; Carda-Auten, Jessica; Wood, William A; Basch, Ethan M; Voorhees, Peter M; Reeder-Hayes, Katherine E; Keefe, Francis J

    2017-03-07

    Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care. Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data. Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care. Web-based PCST was acceptable to patients and providers. Our findings suggest

  13. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

    OpenAIRE

    Jensen Natasja Koitzsch; Norredam Marie; Priebe Stefan; Krasnik Allan

    2013-01-01

    Abstract Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health prob...

  14. The influence of parents and the home environment on preschoolers' physical activity behaviours: A qualitative investigation of childcare providers' perspectives

    Directory of Open Access Journals (Sweden)

    Irwin Jennifer D

    2011-03-01

    Full Text Available Abstract Background Physical activity offers numerous physiological and psychological benefits for young children; however, many preschool-aged children are not engaging in sufficient activity. The home environment, inclusive of parent role modeling, has been identified as influencing preschoolers' physical activity. This study sought to examine childcare providers' perspectives of the importance of parents and the home environment for supporting the physical activity behaviours of preschool-aged children (aged 2.5-5 years attending childcare. Methods A heterogeneous sample of childcare providers (n = 84; response rate 39% working at childcare facilities in London, Ontario participated. Thirteen semi-structured focus groups were conducted in London centres between February 2009 and February 2010. Focus groups were audio recorded and transcribed verbatim and inductive content analysis was used to code and classify themes. A number of strategies were used to verify the trustworthiness of the data. Results Childcare providers acknowledged their reliance on parents/guardians to create a home environment that complements the positive physical activity messaging children may receive in childcare. Moreover, childcare staff highlighted the need for positive parent role modeling and parent support to encourage active healthy lifestyles among young children. Conclusion This study's findings highlight the need for increased parent-caregiver partnering in terms of communication and cooperation in service of promoting appropriate amounts of physical activity among London preschoolers.

  15. Use of Healthcare Services by Patients with Non-Communicable Diseases in Nepal: A Qualitative Study with Healthcare Providers.

    Science.gov (United States)

    Khanal, Saval; Veerman, Lennert; Nissen, Lisa; Hollingworth, Samantha

    2017-06-01

    The healthcare systems in many Low-and Middle-Income Countries (LMICs) like Nepal have long focused on preventing and treating infectious diseases. Little is known about their preparedness to address the increasing prevalence of Non-Communicable Diseases (NCDs). This study aimed to investigate the use of healthcare services by patients with NCDs in Nepal. Nine healthcare providers (including health assistants, pharmacy assistants, nurse, specialised nurse, practicing pharmacists, chief hospital pharmacist, doctors and specialised doctor) from Pokhara, Nepal, were recruited using purposive sampling. In depth interviews about the magnitude of NCDs, first point of care, screening and diagnosis, prevention and management, follow-up, and healthcare system responses to NCD burden were conducted. Data were thematically analysed with a deductive approach. Although the healthcare system in Nepal is still primarily focused on communicable infectious diseases, healthcare providers are aware of the increasing burden of NCDs and NCD risk factors. The first points of care for patients with NCDs are government primary healthcare facilities and private pharmacies. NCDs are often diagnosed late and opportunistically. NCD prevention and treatment is unaffordable for many people. There are no government sponsored NCD screening programs. There are problems associated with screening, diagnosis, treatment and follow-up of patients with NCDs in Nepal. Healthcare providers believe that the current healthcare system in Nepal is inadequate to address the growing problem of NCDs. The health system of Nepal will face challenges to incorporate programs to prevent and treat NCDs in addition to the pre-existing communicable diseases.

  16. A methodological approach for using high-level Petri Nets to model the immune system response.

    Science.gov (United States)

    Pennisi, Marzio; Cavalieri, Salvatore; Motta, Santo; Pappalardo, Francesco

    2016-12-22

    Mathematical and computational models showed to be a very important support tool for the comprehension of the immune system response against pathogens. Models and simulations allowed to study the immune system behavior, to test biological hypotheses about diseases and infection dynamics, and to improve and optimize novel and existing drugs and vaccines. Continuous models, mainly based on differential equations, usually allow to qualitatively study the system but lack in description; conversely discrete models, such as agent based models and cellular automata, permit to describe in detail entities properties at the cost of losing most qualitative analyses. Petri Nets (PN) are a graphical modeling tool developed to model concurrency and synchronization in distributed systems. Their use has become increasingly marked also thanks to the introduction in the years of many features and extensions which lead to the born of "high level" PN. We propose a novel methodological approach that is based on high level PN, and in particular on Colored Petri Nets (CPN), that can be used to model the immune system response at the cellular scale. To demonstrate the potentiality of the approach we provide a simple model of the humoral immune system response that is able of reproducing some of the most complex well-known features of the adaptive response like memory and specificity features. The methodology we present has advantages of both the two classical approaches based on continuous and discrete models, since it allows to gain good level of granularity in the description of cells behavior without losing the possibility of having a qualitative analysis. Furthermore, the presented methodology based on CPN allows the adoption of the same graphical modeling technique well known to life scientists that use PN for the modeling of signaling pathways. Finally, such an approach may open the floodgates to the realization of multi scale models that integrate both signaling pathways (intra

  17. Challenges in Providing Counselling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya

    Science.gov (United States)

    Taegtmeyer, Miriam; Davies, Alun; Mwangome, Mary; van der Elst, Elisabeth M.; Graham, Susan M.; Price, Matt A.; Sanders, Eduard J.

    2013-01-01

    The role of men who have sex with men (MSM) in the African HIV epidemic is gaining recognition yet capacity to address the HIV prevention needs of this group is limited. HIV testing and counselling is not only a critical entry point for biomedical HIV prevention interventions, such as pre-exposure prophylaxis, rectal microbicides and early treatment initiation, but is also an opportunity for focused risk reduction counselling that can support individuals living in difficult circumstances. For prevention efforts to succeed, however, MSM need to access services and they will only do so if these are non-judgmental, informative, focused on their needs, and of clear benefit. This study aimed to understand Kenyan providers' attitudes towards and experiences with counselling MSM in a research clinic targeting this group for HIV prevention. We used in-depth interviews to explore values, attitudes and cognitive and social constructs of 13 counsellors and 3 clinicians providing services to MSM at this clinic. Service providers felt that despite their growing experience, more targeted training would have been helpful to improve their effectiveness in MSM-specific risk reduction counselling. They wanted greater familiarity with MSM in Kenya to better understand the root causes of MSM risk-taking (e.g., poverty, sex work, substance abuse, misconceptions about transmission, stigma, and sexual desire) and felt frustrated at the perceived intractability of some of their clients' issues. In addition, they identified training needs on how to question men about specific risk behaviours, improved strategies for negotiating risk reduction with counselling clients, and improved support supervision from senior counsellors. This paper describes the themes arising from these interviews and makes practical recommendations on training and support supervision systems for nascent MSM HIV prevention programmes in Africa. PMID:23762241

  18. Medicine sellers' perspectives on their role in providing health care in North-West Cameroon: a qualitative study.

    Science.gov (United States)

    Hughes, R; Chandler, C R; Mangham-Jefferies, L J; Mbacham, W

    2013-09-01

    Increasing recognition of the importance of medicine sellers in low-resource settings has emerged alongside assumptions that their motives and capacities primarily relate to profit maximization. This article suggests a need to reframe thinking about the role of medicine sellers in developing country health systems. We used in-depth interviews to explore perceptions of medicine seller roles among a restricted random sample of 20 medicine sellers in North-West Cameroon. Interviews and analysis explored self-perception of their work/role, community perceptions, skills and knowledge, regulation, future plans, links with the formal health system and diversity among medicine sellers. Medicine sellers in our study were a varied, yet distinct group. They saw themselves as closely integrated in the social and medical landscapes of clients. Although some client interactions were described as simple sales, many respondents presented themselves as gatekeepers of medicines and knowledge, reflecting a conceptualization of the distinctness of medicines over other commodities. Acknowledgement of limits in knowledge and resources led to recognition of the need for formal healthcare providers and justified a restricted scope of practice and the need for referral. Motivation was derived from a desire for both financial and social capital combined with a proximity to medicines and repeated exposure to ill health. Legitimacy was perceived to be derived from: a historical mandate; informal and formal training and effective 'community regulation'. The distinct role that medicine sellers describe themselves as occupying in this study area can be characterized as provision of 'first aid', urgent, reactive and sometimes providing intermediate care prior to referral. Medicine sellers suggest that they do not aspire to be doctors and emphasize the complementary, rather than competitive, nature of their relationship with formal providers. We discuss the challenges and opportunities of

  19. Challenges in providing counselling to MSM in highly stigmatized contexts: results of a qualitative study from Kenya.

    Directory of Open Access Journals (Sweden)

    Miriam Taegtmeyer

    Full Text Available The role of men who have sex with men (MSM in the African HIV epidemic is gaining recognition yet capacity to address the HIV prevention needs of this group is limited. HIV testing and counselling is not only a critical entry point for biomedical HIV prevention interventions, such as pre-exposure prophylaxis, rectal microbicides and early treatment initiation, but is also an opportunity for focused risk reduction counselling that can support individuals living in difficult circumstances. For prevention efforts to succeed, however, MSM need to access services and they will only do so if these are non-judgmental, informative, focused on their needs, and of clear benefit. This study aimed to understand Kenyan providers' attitudes towards and experiences with counselling MSM in a research clinic targeting this group for HIV prevention. We used in-depth interviews to explore values, attitudes and cognitive and social constructs of 13 counsellors and 3 clinicians providing services to MSM at this clinic. Service providers felt that despite their growing experience, more targeted training would have been helpful to improve their effectiveness in MSM-specific risk reduction counselling. They wanted greater familiarity with MSM in Kenya to better understand the root causes of MSM risk-taking (e.g., poverty, sex work, substance abuse, misconceptions about transmission, stigma, and sexual desire and felt frustrated at the perceived intractability of some of their clients' issues. In addition, they identified training needs on how to question men about specific risk behaviours, improved strategies for negotiating risk reduction with counselling clients, and improved support supervision from senior counsellors. This paper describes the themes arising from these interviews and makes practical recommendations on training and support supervision systems for nascent MSM HIV prevention programmes in Africa.

  20. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

    Directory of Open Access Journals (Sweden)

    Moyer Cheryl A

    2012-06-01

    Full Text Available Abstract Background Knowledge, attitudes and practices of community members and healthcare providers in rural northern Ghana regarding clean delivery are not well understood. This study explores hand washing/use of gloves during delivery, delivering on a clean surface, sterile cord cutting, appropriate cord tying, proper cord care following delivery, and infant bathing and cleanliness. Methods In-depth interviews and focus group discussions were audiotaped, transcribed, and analyzed using NVivo 9.0. Results 253 respondents participated, including women with newborn infants, grandmothers, household and compound heads, community leaders, traditional birth attendants, and formally trained health care providers. There is widespread understanding of the need for clean delivery to reduce the risk of infection to both mothers and their babies during and shortly after delivery. Despite this understanding, the use of gloves during delivery and hand washing during and after delivery were mentioned infrequently. The need for a clean delivery surface was raised repeatedly, including explicit discussion of avoiding delivering in the dirt. Many activities to do with cord care involved non-sterile materials and practices: 1 Cord cutting was done with a variety of tools, and the most commonly used were razor blades or scissors; 2 Cord tying utilized a variety of materials, including string, rope, thread, twigs, and clamps; and 3 Cord care often involved applying traditional salves to the cord - including shea butter, ground shea nuts, local herbs, local oil, or “red earth sand.” Keeping babies and their surroundings clean was mentioned repeatedly as an important way to keep babies from falling ill. Conclusions This study suggests a widespread understanding in rural northern Ghana of the need for clean delivery. Nonetheless, many recommended clean delivery practices are ignored. Overarching themes emerging from this study included the increasing use of

  1. ARSH 6: Reproductive health needs assessment of adolescents and young people (15-24 y): a qualitative study on 'perceptions of program managers and health providers'.

    Science.gov (United States)

    Nair, M K C; Leena, M L; George, Babu; Thankachi, Yamini; Russell, Paul Swamidhas Sudhakar

    2013-11-01

    To understand the perceptions of program managers and service providers using in depth interview technique, a well-accepted qualitative research that can also offer semi quantitative input. Need assessment was done qualitatively using in-depth interviews, among program managers of health care system including District Medical Officers and RCH Officers and program service providers, both in rural and urban areas. In total 34 in-depth interviews were conducted. Nearly half (2+) of the program managers and service providers of adolescent programs opined that the important problems faced by adolescents were issues related to sexuality, psychosocial conflict, identity crisis, adjustment problems and scholastic problems. Approximately half of them thought that improper parenting, negative attitude of parents, separated parents, ignorance of parents, family background, nuclear family setup etc. are the most important factors, which influence adolescent problems and that friends and media are their major source of reproductive sexual health information. Nearly half of them pointed out that pain and psychological disturbances like anxiety, tension and anger were the important menstrual problems faced by adolescents. Again nearly half of them, felt that FLE (Family Life Education) should be given at school and ARSH services at PHCs, but there was little consensus on provision of contraceptive service and abortion services to adolescents. All the service providers and program managers are ready to cooperate but they had varied opinions about who should impart adolescent reproductive sexual health education and how the program should be done.

  2. The CMS High-Level Trigger

    CERN Document Server

    Covarelli, Roberto

    2009-01-01

    At the startup of the LHC, the CMS data acquisition is expected to be able to sustain an event readout rate of up to 100 kHz from the Level-1 trigger. These events will be read into a large processor farm which will run the "High-Level Trigger" (HLT) selection algorithms and will output a rate of about 150 Hz for permanent data storage. In this report HLT performances are shown for selections based on muons, electrons, photons, jets, missing transverse energy, tau leptons and b quarks: expected efficiencies, background rates and CPU time consumption are reported as well as relaxation criteria foreseen for a LHC startup instantaneous luminosity.

  3. Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives.

    Science.gov (United States)

    Gainer, Ryan A; Curran, Janet; Buth, Karen J; David, Jennie G; Légaré, Jean-Francois; Hirsch, Gregory M

    2017-07-01

    Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention

  4. Making a success of providing NHS Health Checks in community pharmacies across the Tees Valley: a qualitative study

    Directory of Open Access Journals (Sweden)

    Heywood Peter J

    2011-09-01

    Full Text Available Abstract Background In England and Wales, the Department of Health introduced a primary prevention programme, NHS Health Checks, to provide screening for cardiovascular risk amongst people aged 40-74. The aim of this programme is to offer treatment and advice to those identified with an increased risk of cardiovascular diseases (CVD. The North East of England has some of the highest rates of CVD in the UK and prevention is therefore a priority. NHS Tees funded this programme of work under the local branding of Healthy Heart Checks (HHC. These were initially implemented principally through GP practices from October 2008 but, in order to mitigate the possibility that some hard to reach communities would be reluctant to engage with some primary care settings, plans were also developed to deliver the programme through workplace settings and through community pharmacies. This paper reports specifically on the findings from the evaluation in respect of the setting up of HHCs in community pharmacies and aims to offer some lessons for other service settings where this option is seen as a way of providing low threshold services which will minimise inequalities in intervention uptake. Methods In assessing the community pharmacy component of HHCs, a selection of staff having direct involvement in the process was invited to take part in the evaluation. Interviews were carried out with representatives from community pharmacy, staff members from the commissioning Primary Care Trusts and with Local Pharmaceutical Committee members. Results Evaluation and analysis identified challenges which should be anticipated and addressed in initiating HHC in community pharmacies. These have been categorised into four main themes for discussion in this paper: (1 establishing and maintaining pharmacy Healthy Heart Checks, (2 overcoming IT barriers, (3 developing confident, competent staff and (4 ensuring volume and through flow in pharmacy. Conclusions Delivering NHS health

  5. Providing reviews of evidence to COPD patients: qualitative study of barriers and facilitating factors to patient-mediated practice change.

    Science.gov (United States)

    Harris, Melanie; Wildgoose, Deborah; Veale, Antony J; Smith, Brian J

    2010-01-01

    This study aimed to identify barriers and facilitating factors to people with COPD performing the following actions: (a) reading a manual that contained summaries of evidence on treatments used in chronic obstructive pulmonary disease (COPD) and (b) at a medical consultation, asking questions that were provided in the manual and were designed to prompt doctors to review current treatments in the light of evidence. The manual was developed using current best practice and was designed to facilitate reading and discussion with doctors. In-depth interviews were held with patients who had received the manual. Of 125 intervention participants from a controlled clinical trial of the manual, 16 were interviewed in their homes in and around Adelaide, South Australia. Plain language writing and a simple layout facilitated reading of the manual by participants. Where the content matched the interests of participants this also facilitated reading. On the other hand, some participants showed limited interest in the evidence summaries. Participant comments indicated that they did not see it as possible or acceptable for patients to master research evidence or initiate discussions of evidence with doctors. These appeared to be the main barriers to effectiveness of the manual. If evidence summaries for patients are to be used in disease management, they should be understandable and relevant to patients and provide a basis for discussion between patients and doctors. Work is now needed so that we can both present evidence summaries in a way that is relevant to patients and reduce the barriers to patient-initiated discussions of evidence.

  6. Providing experiential information on early medical abortion: a qualitative evaluation of an animated personal account, Lara's Story.

    Science.gov (United States)

    Sherman, Sarah; Harden, Jeni; Cattanach, Dawn; Cameron, Sharon T

    2017-10-01

    An animated film has been created to provide information to women requesting early medical abortion (EMA). The 9 min film, Lara's Story, was created using one woman's personal account of her experience. This study evaluated the views of women who had recently undergone EMA on the film and its potential usefulness in providing experiential information to women requesting EMA. Women who had undergone EMA within the past month were recruited. They were shown the film and interviewed in a semi-structured style. Interviews were recorded and transcribed verbatim. They were analysed using cross-sectional indexing and thematic analysis with an inductive approach. 13 women were interviewed. All reported that the film gave a realistic account of EMA and most agreed that they would have wanted to watch it before EMA had it been available. Some said that it might help women who were struggling with decision-making with regard to EMA and all said that there should be unrestricted access to the film from the website of the abortion service. The women commented that the animated style of the film allowed all groups of women to relate to the story. Some commented that Lara's experience of pain, bleeding and side effects such as nausea differed from their own and therefore felt that it would be useful to make more than one woman's account available. The availability of animated audiovisual films recounting women's experiences of EMA might be a valuable adjunct to clinical information for women seeking EMA. © Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research.

    Science.gov (United States)

    Robertshaw, Luke; Dhesi, Surindar; Jones, Laura L

    2017-08-04

    To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. Systematic review and qualitative thematic synthesis. Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

  8. Commissioning of the CMS High Level Trigger

    Energy Technology Data Exchange (ETDEWEB)

    Agostino, Lorenzo; et al.

    2009-08-01

    The CMS experiment will collect data from the proton-proton collisions delivered by the Large Hadron Collider (LHC) at a centre-of-mass energy up to 14 TeV. The CMS trigger system is designed to cope with unprecedented luminosities and LHC bunch-crossing rates up to 40 MHz. The unique CMS trigger architecture only employs two trigger levels. The Level-1 trigger is implemented using custom electronics, while the High Level Trigger (HLT) is based on software algorithms running on a large cluster of commercial processors, the Event Filter Farm. We present the major functionalities of the CMS High Level Trigger system as of the starting of LHC beams operations in September 2008. The validation of the HLT system in the online environment with Monte Carlo simulated data and its commissioning during cosmic rays data taking campaigns are discussed in detail. We conclude with the description of the HLT operations with the first circulating LHC beams before the incident occurred the 19th September 2008.

  9. Commissioning of the CMS High Level Trigger

    CERN Document Server

    Agostino, Lorenzo; Beccati, Barbara; Behrens, Ulf; Berryhil, Jeffrey; Biery, Kurt; Bose, Tulika; Brett, Angela; Branson, James; Cano, Eric; Cheung, Harry; Ciganek, Marek; Cittolin, Sergio; Coarasa, Jose Antonio; Dahmes, Bryan; Deldicque, Christian; Dusinberre, Elizabeth; Erhan, Samim; Gigi, Dominique; Glege, Frank; Gomez-Reino, Robert; Gutleber, Johannes; Hatton, Derek; Laurens, Jean-Francois; Loizides, Constantin; Ma, Frank; Meijers, Frans; Meschi, Emilio; Meyer, Andreas; Mommsen, Remigius K; Moser, Roland; O'Dell, Vivian; Oh, Alexander; Orsini, Luciano; Patras, Vaios; Paus, Christoph; Petrucci, Andrea; Pieri, Marco; Racz, Attila; Sakulin, Hannes; Sani, Matteo; Schieferdeckerd, Philipp; Schwick, Christoph; Serrano Margaleff, Josep Francesc; Shpakov, Dennis; Simon, Sean; Sumorok, Konstanty; Sungho Yoon, Andre; Wittich, Peter; Zanetti, Marco

    2009-01-01

    The CMS experiment will collect data from the proton-proton collisions delivered by the Large Hadron Collider (LHC) at a centre-of-mass energy up to 14 TeV. The CMS trigger system is designed to cope with unprecedented luminosities and LHC bunch-crossing rates up to 40 MHz. The unique CMS trigger architecture only employs two trigger levels. The Level-1 trigger is implemented using custom electronics, while the High Level Trigger (HLT) is based on software algorithms running on a large cluster of commercial processors, the Event Filter Farm. We present the major functionalities of the CMS High Level Trigger system as of the starting of LHC beams operations in September 2008. The validation of the HLT system in the online environment with Monte Carlo simulated data and its commissioning during cosmic rays data taking campaigns are discussed in detail. We conclude with the description of the HLT operations with the first circulating LHC beams before the incident occurred the 19th September 2008.

  10. Engineering neural systems for high-level problem solving.

    Science.gov (United States)

    Sylvester, Jared; Reggia, James

    2016-07-01

    There is a long-standing, sometimes contentious debate in AI concerning the relative merits of a symbolic, top-down approach vs. a neural, bottom-up approach to engineering intelligent machine behaviors. While neurocomputational methods excel at lower-level cognitive tasks (incremental learning for pattern classification, low-level sensorimotor control, fault tolerance and processing of noisy data, etc.), they are largely non-competitive with top-down symbolic methods for tasks involving high-level cognitive problem solving (goal-directed reasoning, metacognition, planning, etc.). Here we take a step towards addressing this limitation by developing a purely neural framework named galis. Our goal in this work is to integrate top-down (non-symbolic) control of a neural network system with more traditional bottom-up neural computations. galis is based on attractor networks that can be "programmed" with temporal sequences of hand-crafted instructions that control problem solving by gating the activity retention of, communication between, and learning done by other neural networks. We demonstrate the effectiveness of this approach by showing that it can be applied successfully to solve sequential card matching problems, using both human performance and a top-down symbolic algorithm as experimental controls. Solving this kind of problem makes use of top-down attention control and the binding together of visual features in ways that are easy for symbolic AI systems but not for neural networks to achieve. Our model can not only be instructed on how to solve card matching problems successfully, but its performance also qualitatively (and sometimes quantitatively) matches the performance of both human subjects that we had perform the same task and the top-down symbolic algorithm that we used as an experimental control. We conclude that the core principles underlying the galis framework provide a promising approach to engineering purely neurocomputational systems for problem

  11. Healthcare provider attitudes towards the problem list in an electronic health record: a mixed-methods qualitative study

    Science.gov (United States)

    2012-01-01

    Background The problem list is a key part of the electronic health record (EHR) that allows practitioners to see a patient’s diagnoses and health issues. Yet, as the content of the problem list largely represents the subjective decisions of those who edit it, patients’ problem lists are often unreliable when shared across practitioners. The lack of standards for how the problem list is compiled in the EHR limits its effectiveness in improving patient care, particularly as a resource for clinical decision support and population management tools. The purpose of this study is to discover practitioner opinions towards the problem list and the logic behind their decisions during clinical situations. Materials and methods An observational cross-sectional study was conducted at two major Boston teaching hospitals. Practitioners’ opinions about the problem list were collected through both in-person interviews and an online questionnaire. Questions were framed using vignettes of clinical scenarios asking practitioners about their preferred actions towards the problem list. Results These data confirmed prior research that practitioners differ in their opinions over managing the problem list, but in most responses to a questionnaire, there was a common approach among the relative majority of respondents. Further, basic demographic characteristics of providers (age, medical experience, etc.) did not appear to strongly affect attitudes towards the problem list. Conclusion The results supported the premise that policies and EHR tools are needed to bring about a common approach. Further, the findings helped identify what issues might benefit the most from a defined policy and the level of restriction a problem list policy should place on the addition of different types of information. PMID:23140312

  12. A Qualitative study of language barriers between South African health care providers and cross-border migrants.

    Science.gov (United States)

    Hunter-Adams, Jo; Rother, Hanna-Andrea

    2017-01-31

    Communication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation. As part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically. Zimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants' highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters. Although there are several factors impeding cross-border migrants' access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are

  13. Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study.

    Science.gov (United States)

    Samele, Chiara; Forrester, Andrew; Urquía, Norman; Hopkin, Gareth

    2016-04-01

    This study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services. A purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified. Twenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners. The prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.

  14. Mechanisms of change of a novel weight loss programme provided by a third sector organisation: a qualitative interview study.

    Science.gov (United States)

    McMahon, Naoimh E; Visram, Shelina; Connell, Louise A

    2016-05-10

    There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants. The programme, delivered by a third sector organisation, addressed both diet and physical activity. Over a 26 week period participants engaged in three weekly sessions (education and exercise in a large group, exercise in a small group and a one-to-one education and exercise session). Novel aspects included the intensity and duration of the programme, a competitive selection process, milestone physical challenges (e.g. working up to a 5 K and 10 K walk/run during the programme), alumni support (face-to-face and online) and family attendance at exercise sessions. Data were collected through interviews with programme providers (n = 2) and focus groups with participants (n = 12). Discussions were audio-recorded, transcribed and analysed using NVivo10. Published behaviour change frameworks and behaviour change technique taxonomies were used to guide the coding process. Clients' interactions with components of the weight loss programme brought about a change in their commitment, knowledge, beliefs about capabilities and social and environmental contexts. Intervention components that generated these changes included the competitive selection process, group and online support, family involvement and overcoming milestone challenges over the 26 week programme. The mechanisms by which these components triggered change differed between participants. There is an urgent need to establish robust interventions that can support people who are overweight and obese to achieve a healthy weight and maintain this change. Third

  15. Mechanisms of change of a novel weight loss programme provided by a third sector organisation: a qualitative interview study

    Directory of Open Access Journals (Sweden)

    Naoimh E. McMahon

    2016-05-01

    Full Text Available Abstract Background There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants. The programme, delivered by a third sector organisation, addressed both diet and physical activity. Over a 26 week period participants engaged in three weekly sessions (education and exercise in a large group, exercise in a small group and a one-to-one education and exercise session. Novel aspects included the intensity and duration of the programme, a competitive selection process, milestone physical challenges (e.g. working up to a 5 K and 10 K walk/run during the programme, alumni support (face-to-face and online and family attendance at exercise sessions. Methods Data were collected through interviews with programme providers (n = 2 and focus groups with participants (n = 12. Discussions were audio-recorded, transcribed and analysed using NVivo10. Published behaviour change frameworks and behaviour change technique taxonomies were used to guide the coding process. Results Clients’ interactions with components of the weight loss programme brought about a change in their commitment, knowledge, beliefs about capabilities and social and environmental contexts. Intervention components that generated these changes included the competitive selection process, group and online support, family involvement and overcoming milestone challenges over the 26 week programme. The mechanisms by which these components triggered change differed between participants. Conclusions There is an urgent need to establish robust interventions that can support people who are overweight and

  16. Tracking at High Level Trigger in CMS

    CERN Document Server

    Tosi, Mia

    2014-01-01

    A reduction of several orders of magnitude of the event rate is needed to reach values compatible with detector readout, offline storage and analysis capability. The CMS experiment has been designed with a two-level trigger system: the Level-1 Trigger (L1T), implemented on custom-designed electronics, and the High Level Trigger (HLT), a streamlined version of the CMS offline reconstruction software running on a computer farm. A software trigger system requires a trade-off between the complexity of the algorithms, the sustainable output rate, and the selection efficiency. With the computing power available during the 2012 data taking the maximum reconstruction time at HLT was about 200 ms per event, at the nominal L1T rate of 100 kHz. Track reconstruction algorithms are widely used in the HLT, for the reconstruction of the physics objects as well as in the identification of b-jets and lepton iso...

  17. The ARES High-level Intermediate Representation

    Energy Technology Data Exchange (ETDEWEB)

    Moss, Nicholas David [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-03-03

    The LLVM intermediate representation (IR) lacks semantic constructs for depicting common high-performance operations such as parallel and concurrent execution, communication and synchronization. Currently, representing such semantics in LLVM requires either extending the intermediate form (a signi cant undertaking) or the use of ad hoc indirect means such as encoding them as intrinsics and/or the use of metadata constructs. In this paper we discuss a work in progress to explore the design and implementation of a new compilation stage and associated high-level intermediate form that is placed between the abstract syntax tree and when it is lowered to LLVM's IR. This highlevel representation is a superset of LLVM IR and supports the direct representation of these common parallel computing constructs along with the infrastructure for supporting analysis and transformation passes on this representation.

  18. Intergenerational ethics of high level radioactive waste

    Energy Technology Data Exchange (ETDEWEB)

    Takeda, Kunihiko [Nagoya Univ., Graduate School of Engineering, Nagoya, Aichi (Japan); Nasu, Akiko; Maruyama, Yoshihiro [Shibaura Inst. of Tech., Tokyo (Japan)

    2003-03-01

    The validity of intergenerational ethics on the geological disposal of high level radioactive waste originating from nuclear power plants was studied. The result of the study on geological disposal technology showed that the current method of disposal can be judged to be scientifically reliable for several hundred years and the radioactivity level will be less than one tenth of the tolerable amount after 1,000 years or more. This implies that the consideration of intergenerational ethics of geological disposal is meaningless. Ethics developed in western society states that the consent of people in the future is necessary if the disposal has influence on them. Moreover, the ethics depends on generally accepted ideas in western society and preconceptions based on racism and sexism. The irrationality becomes clearer by comparing the dangers of the exhaustion of natural resources and pollution from harmful substances in a recycling society. (author)

  19. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies.

    Directory of Open Access Journals (Sweden)

    Rasha Khatib

    Full Text Available BACKGROUND: Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. METHODS: Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. FINDINGS: Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. CONCLUSIONS: This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi

  20. Non-dental primary care providers' views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study.

    Science.gov (United States)

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2015-10-29

    To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Qualitative study with semistructured interviews and thematic analysis. Four remote communities in outback Queensland, Australia. 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Parental experiences of providing skin-to-skin care to their newborn infant--part 2: a qualitative meta-synthesis.

    Science.gov (United States)

    Anderzén-Carlsson, Agneta; Lamy, Zeni C; Tingvall, Maria; Eriksson, Mats

    2014-01-01

    To synthesize and interpret qualitative research findings focusing on parental experiences of skin-to-skin care (SSC) for newborn infants. SSC induces many benefits for newborn infants and their parents. Three meta-analyses have been conducted on physiological outcomes, but no previous qualitative meta-synthesis on parental experiences of SSC has been identified. The present meta-synthesis was guided by the methodology described by Paterson and co-workers. Four databases were searched, without year or language limitations, up until December 2013. Manual searches were also performed. The searches and subsequent quality appraisal resulted in the inclusion of 29 original qualitative papers from 9 countries, reporting experiences from 401 mothers and 94 fathers. The meta-synthesis entails a meta-data analysis, analysis of meta-method, and meta-theory in the included primary studies. Based on the three analyses, the meta-synthesis represents a new interpretation of a phenomenon. The results of the meta-data analysis have been presented as a qualitative systematic review in a separate paper. When synthesizing and interpreting the findings from the included analyses, a theoretical model of Becoming a parent under unfamiliar circumstances emerged. Providing SSC seems to be a restorative as well as an energy-draining experience. A supportive environment has been described as facilitating the restorative experience, whereas obstacles in the environment seem to make the provision of SSC energy-draining for parents. When the process is experienced as positive, it facilitates the growth of parental self-esteem and makes the parents ready to assume full responsibility for their child. The results show that SSC can be interpreted not only as a family-including and important health care intervention but also in terms of actually becoming a parent. The process of becoming a parent in this specific situation is influenced by external factors in three different levels; family and

  2. Parental experiences of providing skin-to-skin care to their newborn infant—Part 2: A qualitative meta-synthesis

    Directory of Open Access Journals (Sweden)

    Agneta Anderzén-Carlsson

    2014-10-01

    Full Text Available Aim: To synthesize and interpret qualitative research findings focusing on parental experiences of skin-to-skin care (SSC for newborn infants. Background: SSC induces many benefits for newborn infants and their parents. Three meta-analyses have been conducted on physiological outcomes, but no previous qualitative meta-synthesis on parental experiences of SSC has been identified. Design: The present meta-synthesis was guided by the methodology described by Paterson and co-workers. Data sources: Four databases were searched, without year or language limitations, up until December 2013. Manual searches were also performed. The searches and subsequent quality appraisal resulted in the inclusion of 29 original qualitative papers from 9 countries, reporting experiences from 401 mothers and 94 fathers. Review methods: The meta-synthesis entails a meta-data analysis, analysis of meta-method, and meta-theory in the included primary studies. Based on the three analyses, the meta-synthesis represents a new interpretation of a phenomenon. The results of the meta-data analysis have been presented as a qualitative systematic review in a separate paper. Results: When synthesizing and interpreting the findings from the included analyses, a theoretical model of Becoming a parent under unfamiliar circumstances emerged. Providing SSC seems to be a restorative as well as an energy-draining experience. A supportive environment has been described as facilitating the restorative experience, whereas obstacles in the environment seem to make the provision of SSC energy-draining for parents. When the process is experienced as positive, it facilitates the growth of parental self-esteem and makes the parents ready to assume full responsibility for their child. Conclusion: The results show that SSC can be interpreted not only as a family-including and important health care intervention but also in terms of actually becoming a parent. The process of becoming a parent in this

  3. High-Level Development of Multiserver Online Games

    Directory of Open Access Journals (Sweden)

    Frank Glinka

    2008-01-01

    Full Text Available Multiplayer online games with support for high user numbers must provide mechanisms to support an increasing amount of players by using additional resources. This paper provides a comprehensive analysis of the practically proven multiserver distribution mechanisms, zoning, instancing, and replication, and the tasks for the game developer implied by them. We propose a novel, high-level development approach which integrates the three distribution mechanisms seamlessly in today's online games. As a possible base for this high-level approach, we describe the real-time framework (RTF middleware system which liberates the developer from low-level tasks and allows him to stay at high level of design abstraction. We explain how RTF supports the implementation of single-server online games and how RTF allows to incorporate the three multiserver distribution mechanisms during the development process. Finally, we describe briefly how RTF provides manageability and maintenance functionality for online games in a grid context with dynamic resource allocation scenarios.

  4. Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data.

    Science.gov (United States)

    Rehnström Loi, Ulrika; Gemzell-Danielsson, Kristina; Faxelid, Elisabeth; Klingberg-Allvin, Marie

    2015-02-12

    Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values

  5. Tracking at High Level Trigger in CMS

    CERN Document Server

    Tosi, Mia

    2016-01-01

    The trigger systems of the LHC detectors play a crucial role in determining the physics capabili- ties of the experiments. A reduction of several orders of magnitude of the event rate is needed to reach values compatible with detector readout, offline storage and analysis capability. The CMS experiment has been designed with a two-level trigger system: the Level-1 Trigger (L1T), implemented on custom-designed electronics, and the High Level Trigger (HLT), a stream- lined version of the CMS offline reconstruction software running on a computer farm. A software trigger system requires a trade-off between the complexity of the algorithms, the sustainable out- put rate, and the selection efficiency. With the computing power available during the 2012 data taking the maximum reconstruction time at HLT was about 200 ms per event, at the nominal L1T rate of 100 kHz. Track reconstruction algorithms are widely used in the HLT, for the reconstruction of the physics objects as well as in the identification of b-jets and ...

  6. The ATLAS high level trigger steering

    Science.gov (United States)

    Berger, N.; Bold, T.; Eifert, T.; Fischer, G.; George, S.; Haller, J.; Hoecker, A.; Masik, J.; Nedden, M. Z.; Reale, V. P.; Risler, C.; Schiavi, C.; Stelzer, J.; Wu, X.

    2008-07-01

    The High Level Trigger (HLT) of the ATLAS experiment at the Large Hadron Collider receives events which pass the LVL1 trigger at ~75 kHz and has to reduce the rate to ~200 Hz while retaining the most interesting physics. It is a software trigger and performs the reduction in two stages: the LVL2 trigger and the Event Filter (EF). At the heart of the HLT is the Steering software. To minimise processing time and data transfers it implements the novel event selection strategies of seeded, step-wise reconstruction and early rejection. The HLT is seeded by regions of interest identified at LVL1. These and the static configuration determine which algorithms are run to reconstruct event data and test the validity of trigger signatures. The decision to reject the event or continue is based on the valid signatures, taking into account pre-scale and pass-through. After the EF, event classification tags are assigned for streaming purposes. Several new features for commissioning and operation have been added: comprehensive monitoring is now built in to the framework; for validation and debugging, reconstructed data can be written out; the steering is integrated with the new configuration (presented separately), and topological and global triggers have been added. This paper will present details of the final design and its implementation, the principles behind it, and the requirements and constraints it is subject to. The experience gained from technical runs with realistic trigger menus will be described.

  7. Tracking at High Level Trigger in CMS

    Science.gov (United States)

    Tosi, M.

    2016-04-01

    The trigger systems of the LHC detectors play a crucial role in determining the physics capabilities of experiments. A reduction of several orders of magnitude of the event rate is needed to reach values compatible with detector readout, offline storage and analysis capability. The CMS experiment has been designed with a two-level trigger system: the Level-1 Trigger (L1T), implemented on custom-designed electronics, and the High Level Trigger (HLT), a streamlined version of the CMS offline reconstruction software running on a computer farm. A software trigger system requires a trade-off between the complexity of the algorithms, the sustainable output rate, and the selection efficiency. With the computing power available during the 2012 data taking the maximum reconstruction time at HLT was about 200 ms per event, at the nominal L1T rate of 100 kHz. Track reconstruction algorithms are widely used in the HLT, for the reconstruction of the physics objects as well as in the identification of b-jets and lepton isolation. Reconstructed tracks are also used to distinguish the primary vertex, which identifies the hard interaction process, from the pileup ones. This task is particularly important in the LHC environment given the large number of interactions per bunch crossing: on average 25 in 2012, and expected to be around 40 in Run II. We will present the performance of HLT tracking algorithms, discussing its impact on CMS physics program, as well as new developments done towards the next data taking in 2015.

  8. The ATLAS High Level Trigger Steering

    CERN Document Server

    Berger, N; Eifert, T; Fischer, G; George, S; Haller, J; Höcker, A; Masik, J; Zur Nedden, M; Pérez-Réale, V; Risler, C; Schiavi, C; Stelzer, J; Wu, X; International Conference on Computing in High Energy and Nuclear Physics

    2008-01-01

    The High Level Trigger (HLT) of the ATLAS experiment at the Large Hadron Collider receives events which pass the LVL1 trigger at ~75 kHz and has to reduce the rate to ~200 Hz while retaining the most interesting physics. It is a software trigger and performs the reduction in two stages: the LVL2 trigger and the Event Filter (EF). At the heart of the HLT is the Steering software. To minimise processing time and data transfers it implements the novel event selection strategies of seeded, step-wise reconstruction and early rejection. The HLT is seeded by regions of interest identified at LVL1. These and the static configuration determine which algorithms are run to reconstruct event data and test the validity of trigger signatures. The decision to reject the event or continue is based on the valid signatures, taking into account pre-scale and pass-through. After the EF, event classification tags are assigned for streaming purposes. Several powerful new features for commissioning and operation have been added: co...

  9. Consumer providers' experiences of recovery and concerns as members of a psychiatric multidisciplinary outreach team: A qualitative descriptive study from the Japan Outreach Model Project 2011-2014.

    Directory of Open Access Journals (Sweden)

    Yoshifumi Kido

    Full Text Available The objective of this study was to clarify consumer providers (CPs subjective experiences as members of a psychiatric multidisciplinary outreach team that provided services to individuals with a mental illness living in the community.A qualitative descriptive study was conducted through semi-structured interviews. Participants were clients hired as CPs in the Japanese Outreach Model Project from September 2011 until March 2014. Of the seventeen CPs, nine participated in this study. We looked at the CPs' subjective experiences of fulfillment and difficulty.In the process of providing services, CPs experienced both achievements and concerns. They had a sense of achievement by caring for their clients and they experienced that they themselves were recovering. They were also concerned about having inadequate knowledge and skills to provide psychiatric services to their clients. Further, there were concerns about their dual role on the multidisciplinary team and being support staff while they were still using mental health services themselves.The results show that the activities of CPs included fulfillment, recovery, and dilemmas. Clarifications will likely contribute to an increase in understanding and cooperation between CPs and other professionals with whom they work. Further studies are needed to investigate policies related to mental health consumers who are also providers of mental health services.

  10. Handbook of high-level radioactive waste transportation

    Energy Technology Data Exchange (ETDEWEB)

    Sattler, L.R.

    1992-10-01

    The High-Level Radioactive Waste Transportation Handbook serves as a reference to which state officials and members of the general public may turn for information on radioactive waste transportation and on the federal government`s system for transporting this waste under the Civilian Radioactive Waste Management Program. The Handbook condenses and updates information contained in the Midwestern High-Level Radioactive Waste Transportation Primer. It is intended primarily to assist legislators who, in the future, may be called upon to enact legislation pertaining to the transportation of radioactive waste through their jurisdictions. The Handbook is divided into two sections. The first section places the federal government`s program for transporting radioactive waste in context. It provides background information on nuclear waste production in the United States and traces the emergence of federal policy for disposing of radioactive waste. The second section covers the history of radioactive waste transportation; summarizes major pieces of legislation pertaining to the transportation of radioactive waste; and provides an overview of the radioactive waste transportation program developed by the US Department of Energy (DOE). To supplement this information, a summary of pertinent federal and state legislation and a glossary of terms are included as appendices, as is a list of publications produced by the Midwestern Office of The Council of State Governments (CSG-MW) as part of the Midwestern High-Level Radioactive Waste Transportation Project.

  11. QSPIN: A High Level Java API for Quantum Computing Experimentation

    Science.gov (United States)

    Barth, Tim

    2017-01-01

    QSPIN is a high level Java language API for experimentation in QC models used in the calculation of Ising spin glass ground states and related quadratic unconstrained binary optimization (QUBO) problems. The Java API is intended to facilitate research in advanced QC algorithms such as hybrid quantum-classical solvers, automatic selection of constraint and optimization parameters, and techniques for the correction and mitigation of model and solution errors. QSPIN includes high level solver objects tailored to the D-Wave quantum annealing architecture that implement hybrid quantum-classical algorithms [Booth et al.] for solving large problems on small quantum devices, elimination of variables via roof duality, and classical computing optimization methods such as GPU accelerated simulated annealing and tabu search for comparison. A test suite of documented NP-complete applications ranging from graph coloring, covering, and partitioning to integer programming and scheduling are provided to demonstrate current capabilities.

  12. RETENTION OF SULFATE IN HIGH LEVEL RADIOACTIVE WASTE GLASS

    Energy Technology Data Exchange (ETDEWEB)

    Fox, K.

    2010-09-07

    High level radioactive wastes are being vitrified at the Savannah River Site for long term disposal. Many of the wastes contain sulfate at concentrations that can be difficult to retain in borosilicate glass. This study involves efforts to optimize the composition of a glass frit for combination with the waste to improve sulfate retention while meeting other process and product performance constraints. The fabrication and characterization of several series of simulated waste glasses are described. The experiments are detailed chronologically, to provide insight into part of the engineering studies used in developing frit compositions for an operating high level waste vitrification facility. The results lead to the recommendation of a specific frit composition and a concentration limit for sulfate in the glass for the next batch of sludge to be processed at Savannah River.

  13. Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach.

    Science.gov (United States)

    Pendergrass, Kathy M; Nemeth, Lynne; Newman, Susan D; Jenkins, Carolyn M; Jones, Elaine G

    2017-06-01

    Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. Semistructured interviews in a qualitative design using a socio-ecological model (SEM). Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters. ©2017 American Association of Nurse Practitioners.

  14. HIV Care Providers' Attitudes regarding Mobile Phone Applications and Web-Based Dashboards to support Patient Self-Management and Care Coordination: Results from a Qualitative Feasibility Study.

    Science.gov (United States)

    Swendeman, Dallas; Farmer, Shu; Mindry, Deborah; Lee, Sung-Jae; Medich, Melissa

    2016-10-01

    In-depth qualitative interviews were conducted with healthcare providers (HCPs) from five HIV medical care coordination teams in a large Los Angeles County HIV clinic, including physicians, nurses, and psychosocial services providers. HCPs reported on the potential utility, acceptability, and barriers for patient self-monitoring and notifications via mobile phones, and web-based dashboards for HCPs. Potential benefits included: 1) enhancing patient engagement, motivation, adherence, and self-management; and 2) improving provider-patient relationships and HCP care coordination. Newly diagnosed and patients with co-morbidities were highest priorities for mobile application support. Facilitators included universal mobile phone ownership and use of smartphones or text messaging. Patient-level barriers included concerns about low motivation and financial instability for consistent use by some patients. Organizational barriers, cited primarily by physicians, included concerns about privacy protections, easy dashboard access, non-integrated electronic records, and competing burdens in limited appointment times. Psychosocial services providers were most supportive of the proposed mobile tools.

  15. Extending Java for High-Level Web Service Construction

    DEFF Research Database (Denmark)

    Christensen, Aske Simon; Møller, Anders; Schwartzbach, Michael Ignatieff

    2003-01-01

    We incorporate innovations from the project into the Java language to provide high-level features for Web service programming. The resulting language, JWIG, contains an advanced session model and a flexible mechanism for dynamic construction of XML documents, in particular XHTML. To support program...... development we provide a suite of program analyses that at compile time verify for a given program that no runtime errors can occur while building documents or receiving form input, and that all documents being shown are valid according to the document type definition for XHTML 1.0.We compare JWIG...

  16. 'To use or not to use': a qualitative study to evaluate experiences of healthcare providers and patients with the assessment of burden of COPD (ABC) tool.

    Science.gov (United States)

    Slok, Annerika H M; Twellaar, Mascha; Jutbo, Leslie; Kotz, Daniel; Chavannes, Niels H; Holverda, Sebastiaan; Salomé, Philippe L; Dekhuijzen, P N Richard; Rutten-van Mölken, Maureen P M H; Schuiten, Denise; In 't Veen, Johannes C C M; van Schayck, Onno C P

    2016-11-17

    In the management of chronic conditions, such as chronic obstructive pulmonary disease (COPD), there is a shift from doctor-driven care to patient-centred integrated care with active involvement of and self-management by the patient. A recently developed tool, the assessment of burden of COPD (ABC) tool, can be used in this transition to facilitate self-management support and shared decision-making. We performed a qualitative study, in which we collected and analysed the data using the methods of conventional content analyses. We performed in-depth interviews consisting of mainly open questions. Fifteen healthcare providers and 21 patients were interviewed who had worked with the ABC tool in daily care. In general, participants responded positively to the tool. Healthcare providers felt the visual representation provided was effective and comprehensible for patients and provided them with insight into their disease, a finding that patients confirmed. If patients were allowed to choose between a consultation with or without the ABC tool, the majority would prefer using the tool: it provides them with an overview and insight, which makes it easier to discuss all relevant topics related to COPD. The tool can provide structure in consultations, and is compatible with the concepts of 'motivational interviewing' and 'individualised care-planning'. Suggestions for improvement related to content and layout. So far, the tool has only been available as a stand-alone online program, that is not connected to the electronic medical record systems. It was therefore suggested that the tool be integrated into the systems to enhance its usability and its uptake by healthcare providers.

  17. Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone's Ebola epidemic.

    Science.gov (United States)

    McMahon, Shannon A; Ho, Lara S; Brown, Hannah; Miller, Laura; Ansumana, Rashid; Kennedy, Caitlin E

    2016-11-01

    Although research on the epidemiology and ecology of Ebola has expanded since the 2014-15 outbreak in West Africa, less attention has been paid to the mental health implications and the psychosocial context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone's Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola's destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or 'suffering with' patients. To mitigate psychiatric morbidities and maladaptive coping mechanisms-and to prevent the spread of Ebola-researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  18. “Completely out-at-sea” with “two-gender medicine”: A qualitative analysis of physician-side barriers to providing healthcare for transgender patients

    Directory of Open Access Journals (Sweden)

    Snelgrove John W

    2012-05-01

    Full Text Available Abstract Background Members of the transgender community have identified healthcare access barriers, yet a corresponding inquiry into healthcare provider perspectives has lagged. Our aim was to examine physician perceptions of barriers to healthcare provision for transgender patients. Methods This was a qualitative study with physician participants from Ontario, Canada. Semi-structured interviews were used to capture a progression of ideas related to barriers faced by physicians when caring for trans patients. Qualitative data were then transcribed verbatim and analysed with an emergent grounded theory approach. Results A total of thirteen (13 physician participants were interviewed. Analysis revealed healthcare barriers that grouped into five themes: Accessing resources, medical knowledge deficits, ethics of transition-related medical care, diagnosing vs. pathologising trans patients, and health system determinants. A centralising theme of “not knowing where to go or who to talk to” was also identified. Conclusions The findings of this study show that physicians perceive barriers to the care of trans patients, and that these barriers are multifactorial. Access barriers impede physicians when referring patients to specialists or searching for reliable treatment information. Clinical management of trans patients is complicated by a lack of knowledge, and by ethical considerations regarding treatments—which can be unfamiliar or challenging to physicians. The disciplinary division of responsibilities within medicine further complicates care; few practitioners identify trans healthcare as an interest area, and there is a tendency to overemphasise trans status in mental health evaluations. Failure to recognise and accommodate trans patients within sex-segregated healthcare systems leads to deficient health policy. The findings of this study suggest potential solutions to trans healthcare barriers at the informational level—with increased

  19. Meeting psychosocial needs for persons with dementia in home care services - a qualitative study of different perceptions and practices among health care providers.

    Science.gov (United States)

    Hansen, Anette; Hauge, Solveig; Bergland, Ådel

    2017-09-11

    The majority of persons with dementia are home-dwelling. To enable these persons to stay in their own homes as long as possible, a holistic, individual and flexible care is recommended. Despite a requirement for meeting psychological, social and physical needs, home care services seem to focus on patients' physical needs. Accordingly, the aim of this study was to explore how the psychosocial needs of home-dwelling, older persons with dementia were perceived, emphasized and met by home care services. A descriptive, qualitative approach was used. Data were collected through semi-structured focus group interviews with 24 health care providers in home care services from four municipalities. Data were analysed using systematic text condensation. This study showed major differences in how health care providers perceived the psychosocial needs of older home-dwelling persons with dementia and how they perceived their responsibilities for meeting those psychosocial needs. The differences in the health care providers' perceptions seemed to significantly influence the provided care. Three co-existing logics of care were identified: the physical need-oriented logic, the renouncement logic and the integrated logic. The differences in how health care providers perceived the psychosocial needs of persons with dementia and their responsibilities for meeting those needs, influenced how the psychosocial needs were met. These differences indicates a need for a clarification of how psychosocial needs should be conceptualized and who should be responsible for meeting these needs. Further, increased competence and increased consciousness of psychosocial needs and how those needs can be met, are essential for delivering high-quality holistic care that enables persons with dementia to live in their own home for as long as possible.

  20. Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study.

    Science.gov (United States)

    Cottrell, Michelle A; Hill, Anne J; O'Leary, Shaun P; Raymer, Maree E; Russell, Trevor G

    2017-12-01

    The Neurosurgical & Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC&MDS) originated as a complementary, non-surgical pathway for patients referred to public neurosurgical and orthopaedic specialist services. Patient access to the N/OPSC&MDS could potentially be improved with the implementation of telerehabilitation as an additional method of service delivery. To evaluate service provider's views on (1) current barriers to patients' accessing N/OPSC & MD services, and (2) the implementation of telerehabilitation within the N/OPSC&MDS. Qualitative descriptive study design. Healthcare providers (n = 26) were recruited from six N/OPSC&MD services located throughout Queensland, Australia. Semi-structured interviews were conducted to explore service providers' views with respect to existing barriers to patients accessing the N/OPSC&MDS, and if telerehabilitation could be feasibly adopted to address current barriers. Template analysis resulted in six themes: (1) barriers to some patients' accessing current N/OPSC&MD services are complex & multifaceted; (2) telerehabilitation could improve patient access to appropriate management for their musculoskeletal condition; (3) telerehabilitation may have limitations when compared to face-to-face healthcare; (4) the delivery of telerehabilitation needs to be flexible; (5) perceived barriers, and (6) facilitators to the successful implementation of telerehabilitation within the N/OPSC&MDS. This study represents a critical step in determining the readiness of service providers for the implementation of telerehabilitation within the N/OPSC&MDS. Although cautious, service providers are overall accepting of the implementation of telerehabilitation, acknowledging that it could eliminate several current barriers, subsequently achieving more equitable access to the service. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  1. Hyperloop Commercial Feasibility Analysis : High Level Overview

    Science.gov (United States)

    2016-07-01

    Hyperloop is a concept for very highspeed, fixedguideway, intercity surface transportation, using capsulelike vehicles that operate in sealed partialvacuum tubes. This report provide a highlevel evaluation of hyperloop in terms of its ...

  2. Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making.

    Science.gov (United States)

    McKenzie, Emily; Potestio, Melissa L; Boyd, Jamie M; Niven, Daniel J; Brundin-Mather, Rebecca; Bagshaw, Sean M; Stelfox, Henry T

    2017-12-01

    Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus. Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  3. Understanding Postpartum Healthcare Services and Exploring the Challenges and Motivations of Maternal Health Service Providers in the Philippines: a Qualitative Study.

    Science.gov (United States)

    Yamashita, Tadashi; Suplido, Sherri Ann; Llave, Cecilia; Tuliao, Maria Teresa R; Tanaka, Yuko; Matsuo, Hiroya

    2015-06-01

    Given the shortage of medical professionals in the Philippines, Barangay Health Workers (BHWs) may play a role in providing postpartum healthcare services. However, as there are no reports regarding BHW activities in postpartum healthcare, we conducted this study to understand postpartum healthcare services and to explore the challenges and motivations of maternal health service providers. Focus group interview (FGI) of 13 participants was conducted as qualitative research methodology at Muntinlupa City. The results were analyzed according to the interview guide. The proceedings of the FGI were transcribed verbatim, and researchers read and coded the transcripts. The codes were then used to construct categories. Four important activities were highlighted among 11 analysis codes. These activities were "Assessment of postpartum women's conditions," "Recommendation to visit a health facility," "Measurement of blood-pressure and vitamin intake," and "Providing postpartum health information." Among five analysis codes, we identified three challenges that BHWs face, which were "No current information regarding postpartum care," "Some postpartum women do not want to receive healthcare services from BHW," and "Too many assigned postpartum women." Among five analysis codes, we identified two reasons for continuing BHW activities, which were "Hospitality to help postpartum women and their family in the community" and "Performance of mission in providing BHW services." This study is the first to evaluate BHW activities in postpartum healthcare services. Our results indicate that BHWs play a potentially important role in evaluating postpartum women's physical and mental conditions through home-visiting services. However, several difficulties adversely affected their activities, and these must be addressed to maximize the contributions of BHWs to the postpartum healthcare system.

  4. Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers.

    Science.gov (United States)

    Balde, Mamadou Diouldé; Diallo, Boubacar Alpha; Bangoura, Abou; Sall, Oumar; Soumah, Anne Marie; Vogel, Joshua P; Bohren, Meghan A

    2017-01-11

    Every woman is entitled to respectful care during childbirth; so it is concerning to hear of informal reports of mistreatment during childbirth in Guinea. This study sought to explore the perceptions and experiences of mistreatment during childbirth, from the perspectives of women and service providers, and the analysis presents findings according to a typology of mistreatment during childbirth. This study used qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) and was conducted with four groups of participants: women of reproductive age, midwives, doctors, and administrators. The study took place in two sites in Guinea, an urban area (Mamou) and peri-urban (Pita). Data collection was conducted in two health facilities for providers and administrators, and in the health facility catchment area for women. Data were collected in local languages (Pular and Malinké), then transcribed and analyzed in French. We used a thematic analysis approach and coded transcripts manually. A total of 64 IDIs and eight FGDs were conducted and are included in this analysis, including 40 IDIs and eight FGDs with women of reproductive age, 5 IDIs with doctors, 13 IDIs with midwives, and 6 IDIs with administrators. Participants described their own personal experiences, experiences of women in their communities and perceptions regarding mistreatment during childbirth. Results were organized according to a typology of mistreatment during childbirth, and included instances of physical abuse, verbal abuse, abandonment and neglect. Women described being slapped by providers, yelled at for noncompliance with provider requests, giving birth on the floor and without skilled attendance in the health facility. Poor physical conditions of health facilities and health workforce constraints contributed to experiences of mistreatment. These results are important because they demonstrate that the mistreatment of women during childbirth exists in Guinea and occurs in

  5. Very-High Level Concurrent Programming.

    Science.gov (United States)

    1984-12-01

    physical device for storing a mail organized file. iv) Post office like facility (POST): A post file is a distributor of records to other (source) mailbox... Mlm : The module may produce or consume SAN files provided that they are not connected to other modules. ii) on rent g2xatlon: The module must operate

  6. Dilemmas in providing resilience-enhancing social services to long-term social assistance clients. A qualitative study of Swedish social workers

    Science.gov (United States)

    2012-01-01

    Background Long-term recipients of social assistance face barriers to social and economic inclusion, and have poorer health and more limited opportunities for improving their health than many other groups in the population. During recent decades there have been changes in Swedish social policy, with cutbacks in public benefits and a re-emphasis on means-tested policies. In this context, it is important to investigate the necessary conditions for social workers to offer social assistance and services, as well as the mediating role of social workers between public policies and their clients. Swedish social services aim to promote social inclusion by strengthening the individual´s own resources. We investigated the issues that arise when providing social services to long-term social assistance clients within the framework of resilience, which focuses on the processes leading to positive functioning in adverse conditions. Methods Interviews were conducted with 23 social workers in Stockholm and analysed by qualitative content analysis. Results The main theme to emerge from the interviews concerned the constraints that the social workers faced in providing social services to social assistance clients. The first subtheme focused on dilemmas in the interaction between social workers and clients resulting from the dual role of exercising authority and supporting and building trust with clients. Working conditions of social workers also played a crucial role. The second subtheme addressed the impact of the societal context, such as labour market opportunities and coordination between authorities. Conclusions Overall, we found that social workers to a great extent tried to find individual solutions to structural problems. To provide resilience-enhancing social services to long-term social assistance clients with varying obstacles and needs requires a constructive working environment, supportive societal structures and inter-sectoral cooperation between different authorities

  7. Regulating the for-profit private healthcare providers towards universal health coverage: A qualitative study of legal and organizational framework in Mongolia.

    Science.gov (United States)

    Tsevelvaanchig, Uranchimeg; Narula, Indermohan S; Gouda, Hebe; Hill, Peter S

    2017-05-29

    Regulating the behavior of private providers in the context of mixed health systems has become increasingly important and challenging in many developing countries moving towards universal health coverage including Mongolia. This study examines the current regulatory architecture for private healthcare in Mongolia exploring its role for improving accessibility, affordability, and quality of private care and identifies gaps in policy design and implementation. Qualitative research methods were used including documentary review, analysis, and in-depth interviews with 45 representatives of key actors involved in and affected by regulations in Mongolia's mixed health system, along with long-term participant observation. There has been extensive legal documentation developed regulating private healthcare, with specific organizations assigned to conduct health regulations and inspections. However, the regulatory architecture for healthcare in Mongolia is not optimally designed to improve affordability and quality of private care. This is not limited only to private care: important regulatory functions targeted to quality of care do not exist at the national level. The imprecise content and details of regulations in laws inviting increased political interference, governance issues, unclear roles, and responsibilities of different government regulatory bodies have contributed to failures in implementation of existing regulations. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Spent Fuel and High-Level Radioactive Waste Transportation Report

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    This publication is intended to provide its readers with an introduction to the issues surrounding the subject of transportation of spent nuclear fuel and high-level radioactive waste, especially as those issues impact the southern region of the United States. It was originally issued by SSEB in July 1987 as the Spent Nuclear Fuel and High-Level Radioactive Waste Transportation Primer, a document patterned on work performed by the Western Interstate Energy Board and designed as a ``comprehensive overview of the issues.`` This work differs from that earlier effort in that it is designed for the educated layman with little or no background in nuclear waste Issues. In addition. this document is not a comprehensive examination of nuclear waste issues but should instead serve as a general introduction to the subject. Owing to changes in the nuclear waste management system, program activities by the US Department of Energy and other federal agencies and developing technologies, much of this information is dated quickly. While this report uses the most recent data available, readers should keep in mind that some of the material is subject to rapid change. SSEB plans periodic updates in the future to account for changes in the program. Replacement pages will be supplied to all parties in receipt of this publication provided they remain on the SSEB mailing list.

  9. Mental health care providers' perceptions of the barriers to suicide prevention amongst people with substance use disorders in South Africa: a qualitative study.

    Science.gov (United States)

    Goldstone, Daniel; Bantjes, Jason

    2017-01-01

    Substance use is a well-established, and potentially modifiable, risk factor for suicide. Suicide prevention interventions are typically framed within the biomedical paradigm and focus on addressing individual risk factors, improving access to psychiatric care, and improving the skills of medical personnel to recognise at-risk individuals. Few studies have focused on contextual factors that hinder suicide prevention in people with substance use disorders, particularly in low-resource settings. The aim of this qualitative study was to explore mental health care providers' perceptions of barriers to suicide prevention in people with substance use disorders in South Africa. Semi-structured interviews were conducted with 18 mental health care providers who worked with suicidal people with substance use disorders in Cape Town, South Africa. Data were analysed using thematic analysis and Atlas.ti software was used to code the data inductively. Two superordinate themes were identified: structural issues in service provision and broad contextual issues that pose barriers to suicide prevention. Participants thought that inadequate resources and insufficient training hindered them from preventing suicide. Fragmented service provision was perceived to lead to patients not receiving the psychiatric, psychological, and social care that they needed. Contextual problems such as poverty and inequality, the breakdown of family, and stigma made participants think that preventing suicide in people with substance use disorders was almost impossible. These findings suggest that structural, social, and economic issues serve as barriers to suicide prevention. This challenges individual risk-factor models of suicide prevention and highlights the need to consider a broad range of contextual and socio-cultural factors when planning suicide prevention interventions. Findings suggest that the responsibility for suicide prevention may need to be distributed between multiple stakeholders

  10. What happens during early outpatient palliative care consultations for persons with newly diagnosed advanced cancer? A qualitative analysis of provider documentation.

    Science.gov (United States)

    Bagcivan, Gulcan; Dionne-Odom, J Nicholas; Frost, Jennifer; Plunkett, Margaret; Stephens, Lisa A; Bishop, Peggy; Taylor, Richard A; Li, Zhongze; Tucker, Rodney; Bakitas, Marie

    2018-01-01

    Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters. Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations. Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated. Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US. In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants. Outpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom

  11. Conceptualization of a hypothetical high-level nuclear waste repository site in unsaturated, fractured tuff

    Energy Technology Data Exchange (ETDEWEB)

    Parsons, A.M.; Olague, N.E.; Gallegos, D.P. [Sandia National Labs., Albuquerque, NM (USA)

    1991-01-01

    Under the sponsorship of the US Nuclear Regulatory Commission (NRC), Sandia National Laboratories (SNL) is developing a performance assessment methodology for the analysis of long-term disposal and isolation of high-level nuclear wastes (HLW) in alternative geologic media. As part of this exercise, SNL created a conceptualization of ground-water flow and radionuclide transport in the far field of a hypothetical HLW repository site located in unsaturated, fractured tuff formations. This study provides a foundation for the development of conceptual mathematical, and numerical models to be used in this performance assessment methodology. This conceptualization is site specific in terms of geometry, the regional ground-water flow system, stratigraphy, and structure in that these are based on information from Yucca Mountain located on the Nevada Test Site. However, in terms of processes in unsaturated, fractured, porous media, the model is generic. This report also provides a review and evaluation of previously proposed conceptual models of unsaturated and saturated flow and solute transport. This report provides a qualitative description of a hypothetical HLW repository site in fractured tuff. However, evaluation of the current knowledge of flow and transport at Yucca Mountain does not yield a single conceptual model. Instead, multiple conceptual models are possible given the existing information.

  12. Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities

    National Research Council Canada - National Science Library

    Navaza, B; Abarca, H; Bisoffi, F; Pool, R; Roura, M

    2016-01-01

    .... This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals...

  13. Progress in the High Level Trigger Integration

    CERN Multimedia

    Cristobal Padilla

    2007-01-01

    During the week from March 19th to March 23rd, the DAQ/HLT group performed another of its technical runs. On this occasion the focus was on integrating the Level 2 and Event Filter triggers, with a much fuller integration of HLT components than had been done previously. For the first time this included complete trigger slices, with a menu to run the selection algorithms for muons, electrons, jets and taus at the Level-2 and Event Filter levels. This Technical run again used the "Pre-Series" system (a vertical slice prototype of the DAQ/HLT system, see the ATLAS e-news January issue for details). Simulated events, provided by our colleagues working in the streaming tests, were pre-loaded into the ROS (Read Out System) nodes. These are the PC's where the data from the detector is stored after coming out of the front-end electronics, the "first part of the TDAQ system" and the interface to the detectors. These events used a realistic beam interaction mixture and had been subjected to a Level-1 selection. The...

  14. High-Level Synthesis: Productivity, Performance, and Software Constraints

    Directory of Open Access Journals (Sweden)

    Yun Liang

    2012-01-01

    Full Text Available FPGAs are an attractive platform for applications with high computation demand and low energy consumption requirements. However, design effort for FPGA implementations remains high—often an order of magnitude larger than design effort using high-level languages. Instead of this time-consuming process, high-level synthesis (HLS tools generate hardware implementations from algorithm descriptions in languages such as C/C++ and SystemC. Such tools reduce design effort: high-level descriptions are more compact and less error prone. HLS tools promise hardware development abstracted from software designer knowledge of the implementation platform. In this paper, we present an unbiased study of the performance, usability and productivity of HLS using AutoPilot (a state-of-the-art HLS tool. In particular, we first evaluate AutoPilot using the popular embedded benchmark kernels. Then, to evaluate the suitability of HLS on real-world applications, we perform a case study of stereo matching, an active area of computer vision research that uses techniques also common for image denoising, image retrieval, feature matching, and face recognition. Based on our study, we provide insights on current limitations of mapping general-purpose software to hardware using HLS and some future directions for HLS tool development. We also offer several guidelines for hardware-friendly software design. For popular embedded benchmark kernels, the designs produced by HLS achieve 4X to 126X speedup over the software version. The stereo matching algorithms achieve between 3.5X and 67.9X speedup over software (but still less than manual RTL design with a fivefold reduction in design effort versus manual RTL design.

  15. High-level waste management technology program plan

    Energy Technology Data Exchange (ETDEWEB)

    Harmon, H.D.

    1995-01-01

    The purpose of this plan is to document the integrated technology program plan for the Savannah River Site (SRS) High-Level Waste (HLW) Management System. The mission of the SRS HLW System is to receive and store SRS high-level wastes in a see and environmentally sound, and to convert these wastes into forms suitable for final disposal. These final disposal forms are borosilicate glass to be sent to the Federal Repository, Saltstone grout to be disposed of on site, and treated waste water to be released to the environment via a permitted outfall. Thus, the technology development activities described herein are those activities required to enable successful accomplishment of this mission. The technology program is based on specific needs of the SRS HLW System and organized following the systems engineering level 3 functions. Technology needs for each level 3 function are listed as reference, enhancements, and alternatives. Finally, FY-95 funding, deliverables, and schedules are s in Chapter IV with details on the specific tasks that are funded in FY-95 provided in Appendix A. The information in this report represents the vision of activities as defined at the beginning of the fiscal year. Depending on emergent issues, funding changes, and other factors, programs and milestones may be adjusted during the fiscal year. The FY-95 SRS HLW technology program strongly emphasizes startup support for the Defense Waste Processing Facility and In-Tank Precipitation. Closure of technical issues associated with these operations has been given highest priority. Consequently, efforts on longer term enhancements and alternatives are receiving minimal funding. However, High-Level Waste Management is committed to participation in the national Radioactive Waste Tank Remediation Technology Focus Area. 4 refs., 5 figs., 9 tabs.

  16. A high-level language for rule-based modelling.

    Science.gov (United States)

    Pedersen, Michael; Phillips, Andrew; Plotkin, Gordon D

    2015-01-01

    Rule-based languages such as Kappa excel in their support for handling the combinatorial complexities prevalent in many biological systems, including signalling pathways. But Kappa provides little structure for organising rules, and large models can therefore be hard to read and maintain. This paper introduces a high-level, modular extension of Kappa called LBS-κ. We demonstrate the constructs of the language through examples and three case studies: a chemotaxis switch ring, a MAPK cascade, and an insulin signalling pathway. We then provide a formal definition of LBS-κ through an abstract syntax and a translation to plain Kappa. The translation is implemented in a compiler tool which is available as a web application. We finally demonstrate how to increase the expressivity of LBS-κ through embedded scripts in a general-purpose programming language, a technique which we view as generally applicable to other domain specific languages.

  17. Mammut: High-level management of system knobs and sensors

    Science.gov (United States)

    De Sensi, Daniele; Torquati, Massimo; Danelutto, Marco

    Managing low-level architectural features for controlling performance and power consumption is a growing demand in the parallel computing community. Such features include, but are not limited to: energy profiling, platform topology analysis, CPU cores disabling and frequency scaling. However, these low-level mechanisms are usually managed by specific tools, without any interaction between each other, thus hampering their usability. More important, most existing tools can only be used through a command line interface and they do not provide any API. Moreover, in most cases, they only allow monitoring and managing the same machine on which the tools are used. MAMMUT provides and integrates architectural management utilities through a high-level and easy-to-use object-oriented interface. By using MAMMUT, is possible to link together different collected information and to exploit them on both local and remote systems, to build architecture-aware applications.

  18. 4.5 Meter high level waste canister study

    Energy Technology Data Exchange (ETDEWEB)

    Calmus, R. B.

    1997-10-01

    The Tank Waste Remediation System (TWRS) Storage and Disposal Project has established the Immobilized High-Level Waste (IBLW) Storage Sub-Project to provide the capability to store Phase I and II BLW products generated by private vendors. A design/construction project, Project W-464, was established under the Sub-Project to provide the Phase I capability. Project W-464 will retrofit the Hanford Site Canister Storage Building (CSB) to accommodate the Phase I I-ILW products. Project W-464 conceptual design is currently being performed to interim store 3.0 m-long BLW stainless steel canisters with a 0.61 in diameter, DOE is considering using a 4.5 in canister of the same diameter to reduce permanent disposal costs. This study was performed to assess the impact of replacing the 3.0 in canister with the 4.5 in canister. The summary cost and schedule impacts are described.

  19. FLUIDIZED BED STEAM REFORMING ENABLING ORGANIC HIGH LEVEL WASTE DISPOSAL

    Energy Technology Data Exchange (ETDEWEB)

    Williams, M

    2008-05-09

    Waste streams planned for generation by the Global Nuclear Energy Partnership (GNEP) and existing radioactive High Level Waste (HLW) streams containing organic compounds such as the Tank 48H waste stream at Savannah River Site have completed simulant and radioactive testing, respectfully, by Savannah River National Laboratory (SRNL). GNEP waste streams will include up to 53 wt% organic compounds and nitrates up to 56 wt%. Decomposition of high nitrate streams requires reducing conditions, e.g. provided by organic additives such as sugar or coal, to reduce NOX in the off-gas to N2 to meet Clean Air Act (CAA) standards during processing. Thus, organics will be present during the waste form stabilization process regardless of the GNEP processes utilized and exists in some of the high level radioactive waste tanks at Savannah River Site and Hanford Tank Farms, e.g. organics in the feed or organics used for nitrate destruction. Waste streams containing high organic concentrations cannot be stabilized with the existing HLW Best Developed Available Technology (BDAT) which is HLW vitrification (HLVIT) unless the organics are removed by pretreatment. The alternative waste stabilization pretreatment process of Fluidized Bed Steam Reforming (FBSR) operates at moderate temperatures (650-750 C) compared to vitrification (1150-1300 C). The FBSR process has been demonstrated on GNEP simulated waste and radioactive waste containing high organics from Tank 48H to convert organics to CAA compliant gases, create no secondary liquid waste streams and create a stable mineral waste form.

  20. Longstanding pain and social strain: patients' and health care providers' experiences with fracture management by skeletal traction; a qualitative study from Malawi.

    Science.gov (United States)

    Haug, Lise; Wazakili, Margaret; Young, Sven; Van den Bergh, Graziella

    2017-08-01

    The aim of the study is to contribute to a more holistic evidence based on lower limb fracture management in low-income settings, by exploring the perspectives of those actually experiencing and administering skeletal traction in Malawi. The study took place at Queen Elizabeth Central Hospital in Blantyre and Kamuzu Central Hospital in Lilongwe, the two largest public hospitals of Malawi. Qualitative data were collected by participant observation, individual interviews with eight patients, two orthopedic surgeons, one physiotherapist, and two focus group discussions with multidisciplinary teams. Patients experienced physical and psychological pain from the prolonged traction treatment in bed. Anxiety, indignity and emotional distress in the ward environment were commonly observed. Patients emphasized the negative impact on their families and the significant economic consequences due to prolonged hospitalization. Health care providers identified the major obstacles for quality treatment due to the lack of staff, equipment, specialized knowledge and skills. Rehabilitation services were nearly absent, thus little effort was made to maintain function and enhance recovery during and after long-term bed confinement. The use of long-term skeletal traction has a devastating impact on the patients and families, and causes major frustrations to health workers involved with fracture management in a low-resource setting. Implications for Rehabilitation As stated by various health care providers, there is a need to improve trauma care, strengthen rehabilitation services and educate more rehabilitation staff so they can take up the different roles and functions required in treatment and rehabilitation after injuries and other debilitating conditions. In the current situation, sufficient pain relief for patients is required. This should go hand in hand with the empowerment of patients so as to fulfill their rights to quality health services. For health care providers

  1. A nationwide survey on the expectation of public healthcare providers on family medicine specialists in Malaysia-a qualitative analysis of 623 written comments.

    Science.gov (United States)

    Chew, Boon-How; Cheong, Ai-Theng; Ismail, Mastura; Hamzah, Zuhra; A-Rashid, Mohd-Radzniwan; Md-Yasin, Mazapuspavina; Ali, Norsiah

    2014-06-11

    To examine the expectation of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. Cross-sectional study. This study is part of a larger national study on the perception of the Malaysian public healthcare professionals on FMSs. PHCPs from three categories of health facilities, namely hospitals, health clinics and health offices. Qualitative analysis of written comments of respondents' expectation of FMSs. The participants' response rate was 58% (780/1345) with an almost equal proportion from each public healthcare facility. We identified 21 subthemes for the 623 expectation comments. The six emerging themes are (1) need for more FMSs, (2) clinical roles and functions of FMSs, (3) administrative roles of FMSs, (4) contribution to community and public health, (5) attributes improvement and (6) research and audits. FMSs were expected to give attention to clinical duty. Delivering this responsibility with competence included having the latest medical knowledge in their own and others' medical disciplines, practising evidence-based medicine in prehospital and posthospital care, better supervision of staff and doctors under their care, fostering effective teamwork, communicating more often with hospital specialists and making appropriate referral. Expectations ranged from definite and strong for more FMSs at the health clinics to low expectation for FMSs' involvement in research; to mal-expectation on FMSs' involvement in community and public health programmes. There were some remarkable differences in expectations on FMSs from the three different PHCPs. These ranged from being clinically competent and administratively available for patients and staff at the health clinics, to mal-expectations on FMSs to engage in public health affairs. Relevant parties, including FMSs themselves, could take appropriate self-improvement initiatives to enhance public practice of family medicine and

  2. Tanzanian farmers' knowledge and attitudes to GM biotechnology and the potential use of GM crops to provide improved levels of food security. A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Herron Caroline M

    2010-07-01

    Full Text Available Abstract Background Genetically Modified (GM crops have been championed as one possible method to improve food security and individual nutritional status in sub Saharan Africa. Understanding and acceptability of GM crop technology to farmers and consumers have not been assessed. We developed a qualitative research study involving farmers as both producers and consumers to gauge the understanding of GM crop technology, its acceptability, and identifying issues of concern. Methods Nineteen individual interviews (10 male and 9 female and five mixed gender focus group discussions with local farmers were conducted in 3 regions in Tanzania. Analysis took place concurrently with data collection. Following initial interviews, subsequent questions were adjusted based on emerging themes. Results Understanding, awareness and knowledge of GM crop technology and terminology and its potential risks and benefits was very poor in all regions. Receptivity to the potential use of GM crops was, however, high. Respondents focused on the potential benefits of GM crops rather than any potential longer term health risks. A number of factors, most significantly field trial data, would influence farmers' decisions regarding the introduction of GM crop varieties into their farming practice. Understanding of the potential improved health provision possible by changes in agricultural practice and food-related decision making, and the health benefits of a diet containing essential vitamins, minerals and micronutrients is also poor in these communities. Conclusion This study forms a basis from which further research work can be undertaken. It is important to continue to assess opinions and attitudes of farmers and consumers in sub Saharan Africa towards potential use of GM technologies whilst highlighting the importance of the relationship between agriculture, health and development. This will allow people in the region to make accurate, informed decisions about whether they

  3. Tanzanian farmers' knowledge and attitudes to GM biotechnology and the potential use of GM crops to provide improved levels of food security. A Qualitative Study.

    Science.gov (United States)

    Lewis, Christopher P; Newell, James N; Herron, Caroline M; Nawabu, Haidari

    2010-07-12

    Genetically Modified (GM) crops have been championed as one possible method to improve food security and individual nutritional status in sub Saharan Africa. Understanding and acceptability of GM crop technology to farmers and consumers have not been assessed. We developed a qualitative research study involving farmers as both producers and consumers to gauge the understanding of GM crop technology, its acceptability, and identifying issues of concern. Nineteen individual interviews (10 male and 9 female) and five mixed gender focus group discussions with local farmers were conducted in 3 regions in Tanzania. Analysis took place concurrently with data collection. Following initial interviews, subsequent questions were adjusted based on emerging themes. Understanding, awareness and knowledge of GM crop technology and terminology and its potential risks and benefits was very poor in all regions. Receptivity to the potential use of GM crops was, however, high. Respondents focused on the potential benefits of GM crops rather than any potential longer term health risks. A number of factors, most significantly field trial data, would influence farmers' decisions regarding the introduction of GM crop varieties into their farming practice. Understanding of the potential improved health provision possible by changes in agricultural practice and food-related decision making, and the health benefits of a diet containing essential vitamins, minerals and micronutrients is also poor in these communities. This study forms a basis from which further research work can be undertaken. It is important to continue to assess opinions and attitudes of farmers and consumers in sub Saharan Africa towards potential use of GM technologies whilst highlighting the importance of the relationship between agriculture, health and development. This will allow people in the region to make accurate, informed decisions about whether they believe use of GM biotechnology is an appropriate way in which

  4. LabPush: a pilot study of providing remote clinics with laboratory results via short message service (SMS) in Swaziland, Africa - a qualitative study.

    Science.gov (United States)

    Hao, Wen-Rui; Hsu, Yi-Hsin; Chen, Kuan-Chen; Li, Hsien-Chang; Iqbal, Usman; Nguyen, Phung-Anh; Huang, Chih-Wei; Yang, Hsuan-Chia; Lee, Peisan; Li, Mei-Hsuan; Hlatshwayo, Sharoon Lungile; Li, Yu-Chuan Jack; Jian, Wen-Shan

    2015-01-01

    Developing countries are confronting a steady growth in the prevalence of the infectious diseases. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. Although labs usually able to accomplish the requested blood test and produce the results within two days after receiving the samples, but the time for the results to be delivered back to clinics is quite variable depending on how often the motorbike transport makes trips between the clinic and the lab. In this study, we seek to assess factors facilitating as well as factors hindering the adoption of mobile devices in the Swazi healthcare through evaluating the end-users of the LabPush system. A qualitative study with semi-structured and in-depth one on one interviews were conducted over two month period July-August 2012. Purposive sampling was used; participants were those operating and using the LabPush system at the remote clinics, at the national laboratory and the supervisors of users at Swaziland. Interview questions were focused on perceived of ease of use and usefulness of the system. All interviews were recorded and then transcribed. This study had aimed its primary focus on reducing TAT, prompt patient care, reducing bouncing of patients and defaulting of patients which were challenges that the clinicians have always had. Therefore, the results revealed several barriers and facilitators to the adoption of mobile device by healthcare providers in the Swaziland. The themes Shortens TAT, Technical support, Patient-centered care, Mindset, Improved communication, Missing Reports, Workload, Workflow, Security of smart phone, Human error and Ownership are sorted by facilitators to barriers. Thus the end-users perspective, prompt patient care, reduced bouncing of patients, technical support, better communication, willing participant and social influence were facilitators of the adoption m-health in the Swazi healthcare. Copyright

  5. A nationwide survey on the expectation of public healthcare providers on family medicine specialists in Malaysia—a qualitative analysis of 623 written comments

    Science.gov (United States)

    Chew, Boon-How; Cheong, Ai-Theng; Ismail, Mastura; Hamzah, Zuhra; A-Rashid, Mohd-Radzniwan; Md-Yasin, Mazapuspavina; Ali, Norsiah

    2014-01-01

    Objective To examine the expectation of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. Design Cross-sectional study. Setting This study is part of a larger national study on the perception of the Malaysian public healthcare professionals on FMSs. Participants PHCPs from three categories of health facilities, namely hospitals, health clinics and health offices. Main outcome measures Qualitative analysis of written comments of respondents’ expectation of FMSs. Results The participants’ response rate was 58% (780/1345) with an almost equal proportion from each public healthcare facility. We identified 21 subthemes for the 623 expectation comments. The six emerging themes are (1) need for more FMSs, (2) clinical roles and functions of FMSs, (3) administrative roles of FMSs, (4) contribution to community and public health, (5) attributes improvement and (6) research and audits. FMSs were expected to give attention to clinical duty. Delivering this responsibility with competence included having the latest medical knowledge in their own and others’ medical disciplines, practising evidence-based medicine in prehospital and posthospital care, better supervision of staff and doctors under their care, fostering effective teamwork, communicating more often with hospital specialists and making appropriate referral. Expectations ranged from definite and strong for more FMSs at the health clinics to low expectation for FMSs’ involvement in research; to mal-expectation on FMSs’ involvement in community and public health programmes. Conclusions There were some remarkable differences in expectations on FMSs from the three different PHCPs. These ranged from being clinically competent and administratively available for patients and staff at the health clinics, to mal-expectations on FMSs to engage in public health affairs. Relevant parties, including FMSs themselves, could take

  6. A qualitative study on knowledge, perceptions, and attitudes of mothers and health care providers toward pneumococcal conjugate vaccine in Bandung, West Java, Indonesia.

    Science.gov (United States)

    Harjaningrum, Agnes Tri; Kartasasmita, Cissy; Orne-Gliemann, Joanna; Jutand, Marthe-Aline; Goujon, Nicolas; Koeck, Jean-Louis

    2013-03-01

    Due to the high burden of pneumonia in Indonesia, the inclusion of pneumococcal conjugate vaccine (PCV) into Indonesia's National Immunization Program (NIP) is recommended by World Health Organization. Prior to the introduction of new vaccines, it is imperative to assess the perceptions of the public and medical community about the disease and the vaccine. The purpose of this qualitative study was to explore the knowledge, perceptions, and attitudes of mothers and health care providers (HCPs) toward PCV in Bandung, West Java, Indonesia. Fifty-five respondents (26 mothers and 29 HCPs) were interviewed at public and private health care facilities in Bandung using semi-structured interviews in May-June 2011. Data were analyzed manually according to pre-defined themes. Although most mothers had low knowledge about PCV, did not perceive themselves as susceptible to the disease, perceived that cost was the main barrier to PCV access, and obtained little information on PCV, they considered pneumonia as a severe disease and a priority health problem, perceived benefits of the vaccine, and were likely to adopt it. Similarly, knowledge about PCV among most HCPs was limited. Despite perceiving cost as the main barrier, most HCPs perceived benefits of the vaccine, susceptibility and severity of the disease, regarded pneumonia as a priority health problem, and were likely to suggest the new vaccination. Despite the poor knowledge of mothers and HCPs about PCV, they are aware of the high burden of pneumonia and the need for a vaccine in the NIP. Perceived severity and benefits among mothers, and, additionally, perceived susceptibility among HCPs were manifested in the willingness to accept PCV. The findings would contribute to better understanding the factors, which could support decision-making about vaccine introduction, and be utilized for developing suitable messages for mothers and HCPs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Qualitative study to explore the health and well-being impacts on adults providing informal support to female domestic violence survivors.

    Science.gov (United States)

    Gregory, Alison; Feder, Gene; Taket, Ann; Williamson, Emma

    2017-03-24

    Domestic violence (DV) is hazardous to survivors' health, from injuries sustained and from resultant chronic physical and mental health problems. Support from friends and relatives is significant in the lives of DV survivors; research shows associations between positive support and the health, well-being and safety of survivors. Little is known about how people close to survivors are impacted. The aim of this study was exploratory, with the following research question: what are the health and well-being impacts on adults who provide informal support to female DV survivors? A qualitative study using semistructured interviews conducted face to face, by telephone or using Skype. A thematic analysis of the narratives was carried out. Community-based, across the UK. People were eligible to take part if they had had a close relationship (either as friend, colleague or family member) with a woman who had experienced DV, and were aged 16 or over during the time they knew the survivor. Participants were recruited via posters in community venues, social media and radio advertisement. 23 participants were recruited and interviewed; the majority were women, most were white and ages ranged from mid-20s to 80. Generated themes included: negative impacts on psychological and emotional well-being of informal supporters, and related physical health impacts. Some psychological impacts were over a limited period; others were chronic and had the potential to be severe and enduring. The impacts described suggested that those providing informal support to survivors may be experiencing secondary traumatic stress as they journey alongside the survivor. Friends and relatives of DV survivors experience substantial impact on their own health and well-being. There are no direct services to support this group. These findings have practical and policy implications, so that the needs of informal supporters are legitimised and met. Published by the BMJ Publishing Group Limited. For permission to

  8. Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences.

    Science.gov (United States)

    Chimeddamba, Oyun; Peeters, Anna; Ayton, Darshini; Tumenjargal, Enkhjargal; Sodov, Sonin; Joyce, Catherine

    2015-08-11

    Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting. A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework. The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased

  9. Supervision of the ATLAS High Level Trigger System

    CERN Document Server

    Wheeler, S.; Meessen, C.; Qian, Z.; Touchard, F.; Negri, France A.; Zobernig, H.; CHEP 2003 Computing in High Energy Physics; Negri, France A.

    2003-01-01

    The ATLAS High Level Trigger (HLT) system provides software-based event selection after the initial LVL1 hardware trigger. It is composed of two stages, the LVL2 trigger and the Event Filter. The HLT is implemented as software tasks running on large processor farms. An essential part of the HLT is the supervision system, which is responsible for configuring, coordinating, controlling and monitoring the many hundreds of processes running in the HLT. A prototype implementation of the supervision system, using tools from the ATLAS Online Software system is presented. Results from scalability tests are also presented where the supervision system was shown to be capable of controlling over 1000 HLT processes running on 230 nodes.

  10. High-level power analysis and optimization techniques

    Science.gov (United States)

    Raghunathan, Anand

    1997-12-01

    This thesis combines two ubiquitous trends in the VLSI design world--the move towards designing at higher levels of design abstraction, and the increasing importance of power consumption as a design metric. Power estimation and optimization tools are becoming an increasingly important part of design flows, driven by a variety of requirements such as prolonging battery life in portable computing and communication devices, thermal considerations and system cooling and packaging costs, reliability issues (e.g. electromigration, ground bounce, and I-R drops in the power network), and environmental concerns. This thesis presents a suite of techniques to automatically perform power analysis and optimization for designs at the architecture or register-transfer, and behavior or algorithm levels of the design hierarchy. High-level synthesis refers to the process of synthesizing, from an abstract behavioral description, a register-transfer implementation that satisfies the desired constraints. High-level synthesis tools typically perform one or more of the following tasks: transformations, module selection, clock selection, scheduling, and resource allocation and assignment (also called resource sharing or hardware sharing). High-level synthesis techniques for minimizing the area, maximizing the performance, and enhancing the testability of the synthesized designs have been investigated. This thesis presents high-level synthesis techniques that minimize power consumption in the synthesized data paths. This thesis investigates the effects of resource sharing on the power consumption in the data path, provides techniques to efficiently estimate power consumption during resource sharing, and resource sharing algorithms to minimize power consumption. The RTL circuit that is obtained from the high-level synthesis process can be further optimized for power by applying power-reducing RTL transformations. This thesis presents macro-modeling and estimation techniques for switching

  11. Practical Use of High-level Petri Net

    DEFF Research Database (Denmark)

    The aim of the workshop is to bring together researchers and practitioners with interests in the use of high-level nets and their tools for practical applications. A typical paper is expected to report on a case study where high-level Petri nets and their tools have been used in practice. We also...... welcome papers describing a tool, a methodology, or other developments that have proved successful to make high-level Petri nets more applicable in practice....

  12. Hip Arthroscopy in High-Level Baseball Players.

    Science.gov (United States)

    Byrd, J W Thomas; Jones, Kay S

    2015-08-01

    To report the results of hip arthroscopy among high-level baseball players as recorded by outcome scores and return to baseball. All patients undergoing hip arthroscopy were prospectively assessed with the modified Harris Hip Score. On review of all procedures performed over a 12-year period, 44 hips were identified among 41 intercollegiate or professional baseball players who had achieved 2-year follow-up. Among the 41 players, follow-up averaged 45 months (range, 24 to 120 months), with a mean age of 23 years (range, 18 to 34 years). There were 23 collegiate (1 bilateral) and 18 professional (2 bilateral) baseball players, including 10 Major League Baseball players. Of the 8 Major League Baseball pitchers, 6 (75%) also underwent ulnar collateral ligament elbow surgery. Improvement in the modified Harris Hip Score averaged 13 points (from 81 points preoperatively to 94 points postoperatively); a paired-samples t test determined that this mean improvement of 13 points was statistically significant (P baseball after 42 of 44 procedures (95%) at a mean of 4.3 months (range, 3 to 8 months), with 90% regaining the ability to participate at their previous level of competition. There were no complications. Three players (1 bilateral) underwent repeat arthroscopy. This study supports the idea that arthroscopic treatment for a variety of hip pathologies in high-level baseball players provides a successful return to sport and improvement in functional outcome scores. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. 40 CFR 227.30 - High-level radioactive waste.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false High-level radioactive waste. 227.30...-level radioactive waste. High-level radioactive waste means the aqueous waste resulting from the operation of the first cycle solvent extraction system, or equivalent, and the concentrated waste from...

  14. Process for solidifying high-level nuclear waste

    Science.gov (United States)

    Ross, Wayne A.

    1978-01-01

    The addition of a small amount of reducing agent to a mixture of a high-level radioactive waste calcine and glass frit before the mixture is melted will produce a more homogeneous glass which is leach-resistant and suitable for long-term storage of high-level radioactive waste products.

  15. Qualitative Research Process

    OpenAIRE

    Dewan Mahboob HOSSAIN

    2011-01-01

    This article provides with an overview of the qualitative research methods. Over last few decades, qualitative research is getting very popular in the fields of business, sociology, psychology and others. This article, in its introduction, gives a general idea about the qualitative research. Then it discusses the main differences between qualitative and quantitative research methods. The article also discusses about the ethical issues important for qualitative research. Lastly it discusses ab...

  16. High-Level Multi-Threading in hProlog

    OpenAIRE

    Van Overveldt, Timon; Demoen, Bart

    2011-01-01

    A new high-level interface to multi-threading in Prolog, implemented in hProlog, is described. Modern CPUs often contain multiple cores and through high-level multi-threading a programmer can leverage this power without having to worry about low-level details. Two common types of high-level explicit parallelism are discussed: independent and-parallelism and competitive or-parallelism. A new type of explicit parallelism, pipeline parallelism, is proposed. This new type can be used in certain c...

  17. Reachability Trees for High-level Petri Nets

    DEFF Research Database (Denmark)

    Jensen, Kurt; Jensen, Arne M.; Jepsen, Leif Obel

    1986-01-01

    High-level Petri nets have been introduced as a powerful net type by which it is possible to handle rather complex systems in a succinct and manageable way. The success of high-level Petri nets is undebatable when we speak about description, but there is still much work to be done to establish...... the necessary analysis methods. In other papers it is shown how to generalize the concept of place- and transition invariants from place/transition nets to high-level Petri nets. Our present paper contributes to this with a generalization of reachability trees, which is one of the other important analysis...

  18. The ATLAS High Level Trigger Infrastructure, Performance and Future Developments

    CERN Document Server

    Winklmeier, F; The ATLAS collaboration

    2009-01-01

    The ATLAS High Level Trigger (HLT) is a distributed real-time software system that performs the final online selection of events produced during proton-proton collisions at the Large Hadron Collider (LHC). It is designed as a two-stage event filter running on a farm of commodity PC hardware. Currently the system consists of about 850 multi-core processing nodes that will be extended incrementally following the increasing luminosity of the LHC to about 2000 nodes depending on the evolution of the processor technology. Due to the complexity and similarity of the algorithms a large fraction of the software is shared between the online and offline event reconstruction. The HLT Infrastructure serves as the interface between the two domains and provides common services for the trigger algorithms. The consequences of this design choice will be discussed and experiences from the operation of the ATLAS HLT during cosmic ray data taking and first beam in 2008 will be presented. Since the event processing time at the HL...

  19. Vestibular contributions to high-level sensorimotor functions.

    Science.gov (United States)

    Medendorp, W Pieter; Selen, Luc J P

    2017-10-01

    The vestibular system, which detects motion and orientation of the head in space, is known to be important in controlling gaze to stabilize vision, to ensure postural stability and to provide our sense of self-motion. While the brain's computations underlying these functions are extensively studied, the role of the vestibular system in higher level sensorimotor functions is less clear. This review covers new research on the vestibular influence on perceptual judgments, motor decisions, and the ability to learn multiple motor actions. Guided by concepts such as optimization, inference, estimation and control, we focus on how the brain determines causal relationships between memorized and visual representations in the updating of visual space, and how vestibular, visual and efferent motor information are integrated in the estimation of body motion. We also discuss evidence that these computations involve multiple coordinate representations, some of which can be probed in parietal cortex using neuronal oscillations derived from EEG. In addition, we describe work on decision making during self-motion, showing a clear modulation of bottom-up acceleration signals on decisions in the saccadic system. Finally, we consider the importance of vestibular signals as contextual cues in motor learning and recall. Taken together, these results emphasize the impact of vestibular information on high-level sensorimotor functions, and identify future directions for theoretical, behavioral, and neurophysiological investigations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Peace-building and reconciliation dividends of integrated health services delivery in post-conflict Burundi: qualitative assessments of providers and community members.

    Science.gov (United States)

    Christensen, Cathryn; Edward, Anbrasi

    2015-01-01

    While demonstrating causality remains challenging, several 'health-peace' mechanisms have been proposed to describe how health systems contribute to peace-building and stability in post-conflict settings. A qualitative study was undertaken in southern Burundi to identify drivers of social tension and reconciliation in the catchment area of Village Health Works, a health services organisation. Key informant interviews and focus group discussions were conducted in early 2014 with a total of one hundred and twenty community members and staff representing a range of conflict and recovery experience. Themes emerging from these interviews indicated mechanisms at the individual, household, community, and regional levels through which health provision mitigates tensions and promotes social cohesion. This peace dividend was amplified by the clinic's integrated model, which facilitates further community interaction through economic, agricultural and education programmes. Land pressure and the marginalisation of repatriated refugees were cited as drivers of local tension.

  1. High-Level Waste System Process Interface Description

    Energy Technology Data Exchange (ETDEWEB)

    d' Entremont, P.D.

    1999-01-14

    The High-Level Waste System is a set of six different processes interconnected by pipelines. These processes function as one large treatment plant that receives, stores, and treats high-level wastes from various generators at SRS and converts them into forms suitable for final disposal. The three major forms are borosilicate glass, which will be eventually disposed of in a Federal Repository, Saltstone to be buried on site, and treated water effluent that is released to the environment.

  2. Health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia : a systematic literature review of qualitative and quantitative data.

    OpenAIRE

    Rehnstr?m Loi, Ulrika; Gemzell-Danielsson, Kristina; Faxelid, Elisabeth; Klingberg-Allvin, Marie

    2015-01-01

    Background Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim...

  3. Evaluation of high-level waste pretreatment processes with an approximate reasoning model

    Energy Technology Data Exchange (ETDEWEB)

    Bott, T.F.; Eisenhawer, S.W.; Agnew, S.F.

    1999-04-01

    The development of an approximate-reasoning (AR)-based model to analyze pretreatment options for high-level waste is presented. AR methods are used to emulate the processes used by experts in arriving at a judgment. In this paper, the authors first consider two specific issues in applying AR to the analysis of pretreatment options. They examine how to combine quantitative and qualitative evidence to infer the acceptability of a process result using the example of cesium content in low-level waste. They then demonstrate the use of simple physical models to structure expert elicitation and to produce inferences consistent with a problem involving waste particle size effects.

  4. Phase I high-level waste pretreatment and feed staging plan

    Energy Technology Data Exchange (ETDEWEB)

    Manuel, A.F.

    1996-02-05

    This document provides the preliminary planning basis for the U.S. Department of Energy (DOE) to provide a sufficient quantity of high-level waste feed to the privatization contractor during Phase I. By this analysis of candidate high-level waste feed sources, the initial quantity of high-level waste feed totals more than twice the minimum feed requirements. The flexibility of the current infrastructure within tank farms provides a variety of methods to transfer the feed to the privatization contractor`s site location. The amount and type of pretreatment (sludge washing) necessary for the Phase I processing can be tailored to support the demonstration goals without having a significant impact on glass volume (i.e., either inhibited water or caustic leaching can be used).

  5. Pain in patients with multiple sclerosis: a complex assessment including quantitative and qualitative measurements provides for a disease-related biopsychosocial pain model

    Directory of Open Access Journals (Sweden)

    Michalski D

    2011-08-01

    Full Text Available Dominik Michalski1,*, Stefanie Liebig1,*, Eva Thomae1,2, Andreas Hinz3, Florian Then Bergh1,21Department of Neurology, 2Translational Centre for Regenerative Medicine (TRM, 3Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany *These authors contributed equallyBackground: Pain of various causes is a common phenomenon in patients with Multiple Sclerosis (MS. A biopsychosocial perspective has proven a useful theoretical construct in other chronic pain conditions and was also started in MS. To support such an approach, we aimed to investigate pain in MS with special emphasis on separating quantitative and qualitative aspects, and its interrelation to behavioral and physical aspects.Materials and methods: Pain intensity (NRS and quality (SES were measured in 38 consecutive outpatients with MS (mean age, 42.0 ± 11.5 years, 82% women. Pain-related behavior (FSR, health care utilization, bodily complaints (GBB-24 and fatigue (WEIMuS were assessed by questionnaires, and MS-related neurological impairment by a standardized neurological examination (EDSS.Results: Mean pain intensity was 4.0 (range, 0–10 and mean EDSS 3.7 (range, 0–8 in the overall sample. Currently present pain was reported by 81.6% of all patients. Disease duration and EDSS did not differ between patients with and without pain and were not correlated to quality or intensity of pain. Patients with pain had significantly higher scores of musculoskeletal complaints, but equal scores of exhaustion, gastrointestinal and cardiovascular complaints. Pain intensity correlated only with physical aspects, whereas quality of pain was additionally associated with increased avoidance, resignation and cognitive fatigue.Conclusion: As in other conditions, pain in MS must be assessed in a multidimensional way. Further research should be devoted to adapt existing models to a MS-specific model of pain.Keywords: pain intensity, quality of pain, pain

  6. A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP in clinical settings to prevent HIV infection.

    Directory of Open Access Journals (Sweden)

    Emily A Arnold

    Full Text Available A recent clinical trial demonstrated that a daily dose tenofovir disoproxil fumarate and emtricitabrine (TDF-FTC can reduce HIV acquisition among men who have sex with men (MSM and transgender (TG women by 44%, and up to 90% if taken daily. We explored how medical and service providers understand research results and plan to develop clinical protocols to prescribe, support and monitor adherence for patients on PrEP in the United States.Using referrals from our community collaborators and snowball sampling, we recruited 22 healthcare providers in San Francisco, Oakland, and Los Angeles for in-depth interviews from May-December 2011. The providers included primary care physicians seeing high numbers of MSM and TG women, HIV specialists, community health clinic providers, and public health officials. We analyzed interviews thematically to produce recommendations for setting policy around implementing PrEP. Interview topics included: assessing clinician impressions of PrEP and CDC guidance, considerations of cost, office capacity, dosing schedules, and following patients over time.Little or no demand for PrEP from patients was reported at the time of the interviews. Providers did not agree on the most appropriate patients for PrEP and believed that current models of care, which do not involve routine frequent office visits, were not well suited for prescribing PrEP. Providers detailed the need to build capacity and were concerned about monitoring side effects and adherence. PrEP was seen as potentially having impact on the epidemic but providers also noted that community education campaigns needed to be tailored to effectively reach specific vulnerable populations.While PrEP may be a novel and clinically compelling prevention intervention for MSM and TG women, it raises a number of important implementation challenges that would need to be addressed. Nonetheless, most providers expressed optimism that they eventually could prescribe and monitor Pr

  7. Patients' and providers' perspectives of a polypill strategy to improve cardiovascular prevention in Australian primary health care: a qualitative study set within a pragmatic randomized, controlled trial.

    Science.gov (United States)

    Liu, Hueiming; Massi, Luciana; Laba, Tracey-Lea; Peiris, David; Usherwood, Tim; Patel, Anushka; Cass, Alan; Eades, Anne-Marie; Redfern, Julie; Hayman, Noel; Howard, Kirsten; Brien, Jo-anne; Jan, Stephen

    2015-05-01

    This study explores health provider and patient attitudes toward the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention. In-depth, semistructured interviews (n=94) were conducted with health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and indigenous patients thought the strategy acceptable and beneficial for indigenous patients given the high disease burden. Providers noted the inflexibility of the fixed dose regimen, with dosages sometimes inappropriate for patients with complex management considerations. Future polypill formulations with varied strengths and classes of medications may overcome this barrier. Many providers suggested the polypill strategy, in its current formulations, might be more suited to high-risk primary prevention patients. The polypill strategy was generally acceptable to patients and providers in cardiovascular prevention. Limitations to provider acceptability of this particular polypill were revealed, as was a perception it might be more suitable for high-risk primary prevention patients, though future combinations could facilitate its use in secondary prevention. Participants suggested a polypill-based strategy as particularly appropriate for lowering the high cardiovascular burden in indigenous populations. URL: http

  8. Leveraging the private sector for child health: a qualitative examination of caregiver and provider perspectives on private sector care for childhood pneumonia in Uttar Pradesh, India.

    Science.gov (United States)

    Brunie, Aurélie; Lenzi, Rachel; Lahiri, Anamika; Izadnegahdar, Rasa

    2017-02-22

    The private health sector is a primary source of curative care for childhood illnesses in many low- and middle-income countries. Therefore ensuring appropriate private sector care is an important step towards improving outcomes from illnesses like pneumonia, which is the leading infectious cause of childhood mortality worldwide. This study aimed to provide evidence on private sector care for childhood pneumonia in Uttar Pradesh, India, by simultaneously exploring providers' knowledge and practices and caregivers' experiences. We conducted in-depth interviews with a purposive sample of 36 practitioners and 34 caregivers in two districts. Practitioners included allopathic doctors, AYUSH providers, and drug sellers. Caregivers were mothers of children under the age of five with symptoms consistent with pneumonia who had seen one of those practitioners. Interview transcripts were analyzed thematically. Caregivers were generally prompt in seeking care outside the home, but many initially favored local informal providers based on access and cost. Drug sellers were not commonly consulted for treatment. Formal providers had imperfect, but reasonable, knowledge of pneumonia and followed appropriate steps for diagnosis, though some gaps were noticed that were primarily related to lack of (or failure to use) diagnostic tools. Most practitioners prescribed antibiotics and supportive symptomatic treatment. Relational and structural factors encouraged overuse of antibiotics and treatment interruption. Caregivers often had a limited understanding of treatment but wanted rapid symptomatic improvements, frequently leading to sequentially consulting multiple providers and interrupting treatment when symptoms improved. Providers were confronted with these expectations and care-seeking patterns. This study contributes in-depth evidence on private sector care for childhood pneumonia in UP. Achieving appropriate care requires an enriched perspective that simultaneously considers the

  9. Process Design Concepts for Stabilization of High Level Waste Calcine

    Energy Technology Data Exchange (ETDEWEB)

    T. R. Thomas; A. K. Herbst

    2005-06-01

    The current baseline assumption is that packaging ¡§as is¡¨ and direct disposal of high level waste (HLW) calcine in a Monitored Geologic Repository will be allowed. The fall back position is to develop a stabilized waste form for the HLW calcine, that will meet repository waste acceptance criteria currently in place, in case regulatory initiatives are unsuccessful. A decision between direct disposal or a stabilization alternative is anticipated by June 2006. The purposes of this Engineering Design File (EDF) are to provide a pre-conceptual design on three low temperature processes under development for stabilization of high level waste calcine (i.e., the grout, hydroceramic grout, and iron phosphate ceramic processes) and to support a down selection among the three candidates. The key assumptions for the pre-conceptual design assessment are that a) a waste treatment plant would operate over eight years for 200 days a year, b) a design processing rate of 3.67 m3/day or 4670 kg/day of HLW calcine would be needed, and c) the performance of waste form would remove the HLW calcine from the hazardous waste category, and d) the waste form loadings would range from about 21-25 wt% calcine. The conclusions of this EDF study are that: (a) To date, the grout formulation appears to be the best candidate stabilizer among the three being tested for HLW calcine and appears to be the easiest to mix, pour, and cure. (b) Only minor differences would exist between the process steps of the grout and hydroceramic grout stabilization processes. If temperature control of the mixer at about 80„aC is required, it would add a major level of complexity to the iron phosphate stabilization process. (c) It is too early in the development program to determine which stabilizer will produce the minimum amount of stabilized waste form for the entire HLW inventory, but the volume is assumed to be within the range of 12,250 to 14,470 m3. (d) The stacked vessel height of the hot process vessels

  10. Modeling pitting corrosion damage of high-level radioactive-waste containers, with emphasis on the stochastic approach

    Energy Technology Data Exchange (ETDEWEB)

    Henshall, G.A.; Halsey, W.G.; Clarke, W.L.; McCright, R.D.

    1993-01-01

    Recent efforts to identify methods of modeling pitting corrosion damage of high-level radioactive-waste containers are described. The need to develop models that can provide information useful to higher level system performance assessment models is emphasized, and examples of how this could be accomplished are described. Work to date has focused upon physically-based phenomenological stochastic models of pit initiation and growth. These models may provide a way to distill information from mechanistic theories in a way that provides the necessary information to the less detailed performance assessment models. Monte Carlo implementations of the stochastic theory have resulted in simulations that are, at least qualitatively, consistent with a wide variety of experimental data. The effects of environment on pitting corrosion have been included in the model using a set of simple phenomenological equations relating the parameters of the stochastic model to key environmental variables. The results suggest that stochastic models might be useful for extrapolating accelerated test data and for predicting the effects of changes in the environment on pit initiation and growth. Preliminary ideas for integrating pitting models with performance assessment models are discussed. These ideas include improving the concept of container ``failure``, and the use of ``rules-of-thumb`` to take information from the detailed process models and provide it to the higher level system and subsystem models. Finally, directions for future work are described, with emphasis on additional experimental work since it is an integral part of the modeling process.

  11. Effects of Feeding High Level of Cowpea Husk on the ...

    African Journals Online (AJOL)

    This study was conducted at Usmanu Danfodiyo University, Sokoto, to find out the effect of feeding high levels of cowpea husk on the haematological parameters and Blood urea nitrogen of Uda lambs. Fifteen (15) weeks feeding trial (including three (3) weeks digestibility trial) was conducted using sixteen (16) growing Uda ...

  12. Site suitability criteria for solidified high level waste repositories

    Energy Technology Data Exchange (ETDEWEB)

    Heckman, R.A.; Holdsworth, T.; Towse, D.F.

    1979-03-07

    Activities devoted to development of regulations, criteria, and standards for storage of solidified high-level radioactive wastes are reported. The work is summarized in sections on site suitability regulations, risk calculations, geological models, aquifer models, human usage model, climatology model, and repository characteristics. Proposed additional analytical work is also summarized. (JRD)

  13. Murine erythrocytes contain high levels of lysophospholipase activity

    NARCIS (Netherlands)

    Kamp, J.A.F. op den; Roelofsen, B.; Sanderink, G.; Middelkoop, E.; Hamer, R.

    1984-01-01

    Murine erythrocytes were found to be unique in the high levels of lysophospholipase activity in the cytosol of these cells. The specific activity of the enzyme in the cytosol of the murine cells is 10-times higher than in the cytosol of rabbit erythrocytes and approximately three orders of magnitude

  14. High Level Trigger Performance Plots for ICHEP2016

    CERN Document Server

    CMS Collaboration

    2016-01-01

    The performance of the High Level Trigger (HLT) with the first data collected in 2016 is presented. Preliminary results are shown on the performance of tau objects, b-tagging, SUSY and Exotics multijet triggers. Simulation on jet reconstruction at the HLT is also shown.

  15. High-level lipase production by Aspergillus candidus URM 5611 ...

    African Journals Online (AJOL)

    The current study evaluated lipase production by Aspergillus candidus URM 5611 through solid state fermentation (SSF) by using almond bran licuri as a new substrate. The microorganism produced high levels of the enzyme (395.105 U gds-1), thus surpassing those previously reported in the literature. The variable ...

  16. False high level in total bilirubin estimation in nonicteric serum

    African Journals Online (AJOL)

    reagents in next three days. Repeated estimations by Roche reagents showed falsely very high level of total bilirubin. However, estimation by DiaSys and Randox reagents showed acceptable normal levels as per visual estimation. There was interference, most probably due to paraprotein in the estimation of total bilirubin ...

  17. Incidence of high-level gentamicin resistance in enterococci at ...

    African Journals Online (AJOL)

    enterococcaJ isolates. Results. The incidence of HLGR was 26.5% of. Enterococcus faecaJis isolates and 20% of E. faecium isolates grown during the study period. Conclusions. High-level gentamicin resistance is common among enterococci isolated at Johannesburg. Hospital, and this observation must be considered in.

  18. Incidence of high-level gentamicin resistance in enterococci at ...

    African Journals Online (AJOL)

    The incidence of HLGR was 26.5% of Enterococcus faecaJis isolates and 20% of E. faecium isolates grown during the study period. Conclusions. High-level gentamicin resistance is common among enterococci isolated at Johannesburg Hospital, and this observation must be considered in defining strategies for the ...

  19. Cloning, high-level expression, purification and characterization of a ...

    African Journals Online (AJOL)

    The staphylokinase (Sak) is emerging as an important thrombolytic agent for the treatment of patients suffering from cardiovascular disease. Hence in this study, we reported the cloning, high-level expression, purification and characterization of the Sak variant SakøC from Staphylococcus aureus QT08 in Escherichia coli ...

  20. High level expression of human basic fibroblast growth factor in ...

    African Journals Online (AJOL)

    USER

    2010-04-19

    Apr 19, 2010 ... High-level expression of recombinant human basic fibroblast growth factor in Escherichia coli presents research opportunities such as analysis ... The general agreement from the published data on heterologous gene ..... for protein expression (Casimiro et al., 1997; Gold et al.,. 1981; Hamdan et al., 2002; ...

  1. Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania.

    Science.gov (United States)

    Prytherch, Helen; Kagoné, Moubassira; Aninanya, Gifty A; Williams, John E; Kakoko, Deodatus C V; Leshabari, Melkidezek T; Yé, Maurice; Marx, Michael; Sauerborn, Rainer

    2013-04-25

    In Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation. In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country. Across the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term 'motivation' was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams. Understandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in

  2. Provider-Initiated HIV Testing for Migrants in Spain : A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities

    NARCIS (Netherlands)

    Navaza, B.; Abarca, H.; Bisoffi, F.; Pool, R.; Roura, M.

    2016-01-01

    Introduction Provider-initiated HIV testing (PITC) is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under

  3. Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

    Directory of Open Access Journals (Sweden)

    Sharad Onta

    2014-08-01

    Full Text Available Background: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs, distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

  4. Qualitative research.

    Science.gov (United States)

    Maher, Lisa; Dertadian, George

    2017-08-07

    This narrative review aims to highlight key insights from qualitative research on drug use and drug users by profiling a selection of classic works. Consensus methods were used to identify and select four papers published in 1938, 1969, 1973 and 1984 considered to be classics. These landmark qualitative studies included the first account of addiction as a social process, demonstrating that people have meaningful responses to drug use that cannot be reduced to their pharmacological effects; the portrayal of inner-city heroin users as exacting, energetic and engaged social agents; identification of the interactive social learning processes involved in becoming a drug user; the application of the 'career' concept to understanding transitions and trajectories of drug use over time; and the articulation of a framework for understanding drug use that incorporates the interaction between pharmacology, psychology and social environments. These classic sociological and anthropological studies deployed qualitative research methods to show how drug use is shaped by complex sets of factors situated within social contexts, viewing drug users as agents engaged actively in social processes and worlds. Their findings have been used to challenge stereotypes about drug use and drug users, develop a deeper understanding of drug use among hidden, hard-to-research and under-studied populations, and provide the foundations for significant developments in scientific knowledge about the nature of drug use. They continue to retain their relevance, providing important correctives to biomedical and behaviourist paradigms, reminding us that drug use is a social process, and demonstrating how the inductive approach of qualitative research can strengthen the way we understand and respond to drug use and related harms. © 2017 Society for the Study of Addiction.

  5. Qualitative studies

    National Research Council Canada - National Science Library

    Qualitative Studies (QS) aims to become a central forum for discussions of qualitative research in psychology, education, communication, cultural studies, health sciences and social sciences in general...

  6. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers.

    Science.gov (United States)

    Ancker, Jessica S; Witteman, Holly O; Hafeez, Baria; Provencher, Thierry; Van de Graaf, Mary; Wei, Esther

    2015-06-04

    A critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. As part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information. Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. A total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients' perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4) Information management as invisible work

  7. Exploring Working Relationships in Mental Health Care via an E-Recovery Portal: Qualitative Study on the Experiences of Service Users and Health Providers.

    Science.gov (United States)

    Strand, Monica; Gammon, Deede; Eng, Lillian Sofie; Ruland, Cornelia

    2017-11-14

    The quality of working relationships between service users and health providers is fundamental in the processes of recovery in mental health. How Internet-based interventions will influence these relationships for persons with long-term care needs, and the measures that can be taken to maintain and enhance working relationships through Internet, is still not well understood. The aim of this study was to gain insights into how service users and health providers experience their working relationships when they are offered the option of supplementing ongoing collaboration with an e-recovery portal. In this exploratory and descriptive study, an e-recovery portal was used by service users and their health providers in 2 mental health communities in Norway for at least 6 months and at most 12 months (2015-2016). The portal consists of secure messaging, a peer support forum, and a toolbox of resources for working with life domains including status, goals and activities, network map, crisis plan, and exercises. The portal was owned and managed by the service user while health providers could remotely access parts of the service user-generated content. The participants could use the portal in whatever way they wished, to suit their collaboration. Data from 6 focus groups, 17 individual interviews, and an interview with 1 dyad about their experiences of use of the portal over the study period were inductively coded and thematically analyzed. The thematic analysis resulted in 2 main themes: (1) new relational avenues and (2) out of alignment, illustrated by 8 subthemes. The first main theme is about dyads who reported new and enriching ways of working together through the portal, particularly related to written communication and use of the goal module. Illustrative subthemes are ownership, common ground, goals and direction, and sense of presence and availability. The second main theme illuminates the difficulties that arose when service users' and health providers

  8. ?They?re younger? it?s harder.? Primary providers? perspectives on hypertension management in young adults: a multicenter qualitative study

    OpenAIRE

    Johnson, Heather M.; Warner, Ryan C.; Bartels, Christie M.; LaMantia, Jamie N.

    2017-01-01

    Background Young adults (18?39?year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers? perspectives on barriers to diagn...

  9. The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Oyun Chimeddamba

    2016-04-01

    Full Text Available (1 Background: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2 Methods: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3 Results: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4 Conclusions: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

  10. Cross-cultural perspectives on the patient-provider relationship: a qualitative study exploring reflections from Ghanaian medical students following a clinical rotation in the United States.

    Science.gov (United States)

    Abedini, Nauzley C; Danso-Bamfo, Sandra; Kolars, Joseph C; Danso, Kwabena A; Donkor, Peter; Johnson, Timothy R B; Moyer, Cheryl A

    2015-09-28

    In international health experiences, learners are exposed to different culturally-based patient care models. Little is known about student perceptions of patient-provider interactions when they travel from low-to high-resource settings. The purpose of this study was to explore these reflections among a subset of Ghanaian medical students who participated in clinical rotations at the University of Michigan Medical School (UMMS). In-depth, semi-structured interviews lasting 60-90 min were conducted with 15 individuals who had participated in 3-to 4-week clinical rotations at UMMS between January 2008 and December 2011. Interviews were conducted from March to August 2012 and transcribed verbatim, then independently coded by three investigators. Investigators compared open codes and reached a consensus regarding major themes. Participating Ghanaian medical students reported that their perspectives of the patient-provider relationship were significantly affected by participation in a UMMS rotation. Major thematic areas included: (1) observations of patient care during the UMMS rotation, including patient comfort and privacy, physician behavior toward patients, and patient behavior; (2) reflections on the role of humanism and respect within patient care; (3) barriers to respectful care; and (4) transformation of student behaviors and attitudes. Students also reported integrating more patient-centered care into their own medical practice upon return to Ghana Participation in a US-based clinical rotation has the potential to introduce medical students from resource-limited settings to a different paradigm of patient-provider interactions, which may impact their future behavior and perspectives regarding patient care in their home countries. Students from under-resourced settings can derive tremendous value from participation in clinical electives in more affluent settings, namely through exposure to a different type of medical care.

  11. Patient–Provider Communication and Counseling about Gestational Weight Gain and Physical Activity: A Qualitative Study of the Perceptions and Experiences of Latinas Pregnant with their First Child

    Directory of Open Access Journals (Sweden)

    Ana Cristina Lindsay

    2017-11-01

    Full Text Available Latina women in the United States (U.S. are disproportionately affected by obesity and are more likely to begin pregnancy overweight and gain excessive weight during pregnancy. The prenatal care period represents a window of opportunity for women to access the healthcare system and receive preventive services, education, nutritional support, and other social services to improve pregnancy outcomes. Excessive gestational weight gain (GWG has numerous negative short- and long-term consequences for both the mother and newborn. We explored nulliparous Latina women’s perceptions about their experiences communicating with their primary healthcare provider about GWG and physical activity (PA to identify possible intervention targets using in-depth, semi-structured interviews. Bilingual, trained research staff conducted 23 interviews with first-time pregnant Latinas between 22 and 36 weeks of gestation. Interviews were transcribed verbatim and analyzed using content analysis. Salient text passages were extracted, shortened, coded, and grouped into categories. Women, including those who self-identified as being overweight or obese prior to pregnancy, reported receiving limited or no advice from their healthcare providers about GWG or PA. Additionally, analysis revealed that although participants value information received from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program counselors, they would like to receive more information from their primary healthcare providers about adequate GWG. Furthermore, study findings indicate that some participants received conflicting information regarding PA during pregnancy. Study findings suggest the need for increased integration of communication and counseling about GWG and PA into prenatal care services to promote healthy weight gain and PA among low-income Latina women.

  12. How does the pharmaceutical industry influence prescription? A qualitative study of provider payment incentives and drug remunerations in hospitals in Shanghai.

    Science.gov (United States)

    Yang, Wei

    2016-10-01

    Over-prescription has become one major problem in China's health care sector. Incorporating interview data from hospitals in Shanghai, this paper provided empirical evidence on how the process of over-prescription was carried out in day-to-day clinical settings, and demonstrates various mechanisms that allow over-prescription to continue vigorously in the context of the Chinese health care system. In particular, this study identified four levels of incentives that over-prescription was carried out: hospital, medical department, doctors and pharmaceutical companies. Due to the insufficient funding from the government and rising operational costs, hospitals had to rely on the sales of drugs and provision of medical services to survive. This funding pressure then transferred to specific revenue targets for medical departments. A combination of incentives, including drug remunerations, bonus system, low pay and high workloads motivated over-prescription at doctor level. At pharmaceutical company level, high profits of pharmaceuticals products as well as lack of emphasis on efficacy of drugs led to under-table payments and illicit drug remunerations. The study argued that the way that the Chinese health care system operates was based on the profit-seeking principle rather than on fulfilling its social functions, and called for a systematic reform of provider incentives to eradicating the problem of over-prescription.

  13. Experiences of Kenyan healthcare workers providing services to men who have sex with men: qualitative findings from a sensitivity training programme

    Directory of Open Access Journals (Sweden)

    Elise M van der Elst

    2013-12-01

    Full Text Available Introduction: Men who have sex with men (MSM in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs about the health issues and needs of MSM patients. Methods: Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in serving MSM patients and impacts of programme participation on HCWs’ personal attitudes and professional capacities. Results: Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions: Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology.

  14. Visual high-level regions respond to high-level stimulus content in the absence of low-level confounds.

    Science.gov (United States)

    Schindler, Andreas; Bartels, Andreas

    2016-05-15

    High-level regions of the ventral stream exhibit strong category selectivity to stimuli such as faces, houses, or objects. However, recent studies suggest that at least part of this selectivity stems from low-level differences inherent to images of the different categories. For example, visual outdoor and indoor scenes as well as houses differ in spatial frequency, rectilinearity and obliqueness when compared to face or object images. Correspondingly, scene responsive para-hippocampal place area (PPA) showed strong preference to low-level properties of visual scenes also in the absence of high-level scene content. This raises the question whether all high-level responses in PPA, the fusiform face area (FFA), or the object-responsive lateral occipital compex (LOC) may actually be explained by systematic differences in low-level features. In the present study we contrasted two classes of simple stimuli consisting of ten rectangles each. While both were matched in visual low-level features only one class of rectangle arrangements gave rise to a percept compatible with a high-level 3D layout such as a scene or an object. We found that areas PPA, transverse occipital sulcus (TOS, also referred to as occipital place area, OPA), as well as FFA and LOC showed robust responses to the visual scene class compared to the low-level matched control. Our results suggest that visual category responsive regions are not purely driven by low-level visual features but also by the high-level perceptual stimulus interpretation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Insect cell transformation vectors that support high level expression and promoter assessment in insect cell culture

    Science.gov (United States)

    A somatic transformation vector, pDP9, was constructed that provides a simplified means of producing permanently transformed cultured insect cells that support high levels of protein expression of foreign genes. The pDP9 plasmid vector incorporates DNA sequences from the Junonia coenia densovirus th...

  16. Belle-II High Level Trigger at SuperKEKB

    Science.gov (United States)

    Lee, S.; Itoh, R.; Higuchi, T.; Nakao, M.; Suzuki, S. Y.; Won, E.

    2012-12-01

    A next generation B-factory experiment, Belle II, is now being constructed at KEK in Japan. The upgraded accelerator SuperKEKB is designed to have the maximum luminosity of 8 × 1035 cm-2s-1 that is a factor 40 higher than the current world record. As a consequence, the Belle II detector yields a data stream of the event size ~1 MB at a Level 1 rate of 30 kHz. The Belle II High Level Trigger (HLT) is designed to reduce the Level 1 rate to 1/5 by performing the real time full event reconstruction and by applying the physics level event selection as the software trigger. In this paper, the development of the high level trigger system for Belle II and its performance is discussed.

  17. Storage of High Level Nuclear Waste in Germany

    Directory of Open Access Journals (Sweden)

    Dietmar P. F. Möller

    2007-01-01

    Full Text Available Nuclear energy is very often used to generate electricity. But first the energy must be released from atoms what can be done in two ways: nuclear fusion and nuclear fission. Nuclear power plants use nuclear fission to produce electrical energy. The electrical energy generated in nuclear power plants does not produce polluting combustion gases but a renewable energy, an important fact that could play a key role helping to reduce global greenhouse gas emissions and tackling global warming especially as the electricity energy demand rises in the years ahead. This could be assumed as an ideal win-win situation, but the reverse site of the medal is that the production of high-level nuclear waste outweighs this advantage. Hence the paper attempt to highlight the possible state-of-art concepts for the safe and sustaining storage of high-level nuclear waste in Germany.

  18. SymexTRON: Symbolic Execution of High-Level Transformation Languages

    DEFF Research Database (Denmark)

    Al-Sibahi, Ahmad Salim; Dimovski, Aleksandar; Wasowski, Andrzej

    2016-01-01

    Transformations form an important part of developing domain specific languages, where they are used to provide semantics for typing and evaluation. Yet, few solutions exist for verifying transformations written in expressive high-level transformation languages. We take a step towards that goal......, by developing a general symbolic execution technique that handles programs written in these high-level transformation languages. We use logical constraints to describe structured symbolic values, including containment, acyclicity, simple unordered collections (sets) and to handle deep type-based querying...

  19. Adapting high-level language programs for parallel processing using data flow

    Science.gov (United States)

    Standley, Hilda M.

    1988-01-01

    EASY-FLOW, a very high-level data flow language, is introduced for the purpose of adapting programs written in a conventional high-level language to a parallel environment. The level of parallelism provided is of the large-grained variety in which parallel activities take place between subprograms or processes. A program written in EASY-FLOW is a set of subprogram calls as units, structured by iteration, branching, and distribution constructs. A data flow graph may be deduced from an EASY-FLOW program.

  20. High-level Component Interfaces for Collaborative Development: A Proposal

    Directory of Open Access Journals (Sweden)

    Thomas Marlowe

    2009-12-01

    Full Text Available Software development has rapidly moved toward collaborative development models where multiple partners collaborate in creating and evolving software intensive systems or components of sophisticated ubiquitous socio-technical-ecosystems. In this paper we extend the concept of software interface to a flexible high-level interface as means for accommodating change and localizing, controlling and managing the exchange of knowledge and functional, behavioral, quality, project and business related information between the partners and between the developed components.

  1. VHDL Specification Methodology from High-level Specification

    OpenAIRE

    Benmohammed, M.; S. Merniz

    2005-01-01

    Design complexity has been increasing exponentially this last decade. In order to cope with such an increase and to keep up designers' productivity, higher level specifications were required. Moreover new synthesis systems, starting with a high level specification, have been developed in order to automate and speed up processor design. This study presents a VHDL specification methodology aimed to extend structured design methodologies to the behavioral level. The goal is t...

  2. Reprogrammable Controller Design From High-Level Specification

    OpenAIRE

    Benmohammed, M.; M. Bourahla; S. Merniz

    2003-01-01

    Existing techniques in high-level synthesis mostly assume a simple controller architecture model in the form of a single FSM. However, in reality more complex controller architectures are often used. On the other hand, in the case of programmable processors, the controller architecture is largely defined by the available control-flow instructions in the instruction set. With the wider acceptance of behavioral synthesis, the application of these methods for the design of programmable contr...

  3. Mixing Processes in High-Level Waste Tanks - Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, P.F.

    1999-05-24

    The mixing processes in large, complex enclosures using one-dimensional differential equations, with transport in free and wall jets is modeled using standard integral techniques. With this goal in mind, we have constructed a simple, computationally efficient numerical tool, the Berkeley Mechanistic Mixing Model, which can be used to predict the transient evolution of fuel and oxygen concentrations in DOE high-level waste tanks following loss of ventilation, and validate the model against a series of experiments.

  4. The epistemological chain in high-level adventure sports coaches

    OpenAIRE

    Collins, L.; Collins, D; Grecic, D.,

    2015-01-01

    This paper considers the personal epistemology of adventure sports coaches, the existence of the epistemological chain and its impact on professional judgment and decision-making. The epistemological chain’s role and operationalization in other fields is considered, offering clues to how it may manifest itself in the adventure sports coach context. High-level adventure sports coaches were interviewed and an interpretive phenomenological analysis approach was adopted for the interview transcri...

  5. Femoroacetabular impingement in former high-level youth soccer players.

    Science.gov (United States)

    Johnson, Adam C; Shaman, Mark A; Ryan, Thomas G

    2012-06-01

    Femoroacetabular impingement (FAI) can be a source of hip pain in young adults. Repetitive kicking associated with youth soccer may lead to morphologic changes of the proximal femur that predispose a person to the development of FAI. Young adults who participated in high-level soccer competition as youths are more likely to demonstrate radiographic changes consistent with FAI and to have increased alpha angles as compared with controls. Cross-sectional study; Level of evidence, 3. Pelvic radiographs (anteroposterior and frog-lateral) were obtained on 50 individuals who participated in high-level soccer during skeletal immaturity and 50 controls who did not participate in high-level soccer. There were 25 men and 25 women in each group. All subjects were between 18 and 30 years of age, had a body mass index of less than 30, and had not sought or received treatment for hip disorders. Radiographs were analyzed independently for the presence of FAI, and alpha angles were measured. Hips with alpha angles that measured greater than or equal to 55° were deemed to have cam deformity. Fifteen of the 25 male subjects had evidence of cam deformity, compared with 14 male controls. Nine of the 25 female subjects had evidence of cam deformity, compared with 8 female controls. Neither of these differences was statistically significant. There was a significantly higher prevalence of cam deformity in men as compared with women (29 vs 17, P = .016). Participation in high-level soccer during skeletal immaturity is not associated with a higher risk of development of cam deformity in the young adult years. There is a high prevalence of cam deformity in the young adult population. Males demonstrate a higher prevalence of cam deformity than do females.

  6. Developing a gender-based approach to chronic conditions and women's health: a qualitative investigation of community-dwelling women and service provider perspectives.

    Science.gov (United States)

    DiGiacomo, Michelle; Green, Anna; Rodrigues, Emma; Mulligan, Kathryn; Davidson, Patricia M

    2015-11-21

    Chronic conditions contribute to over 70 % of Australia's total disease burden, and this is set to increase to 80 % by 2020. Women's greater longevity means that they are more likely than men to live with disability and have unique health concerns related to their gender based roles in society. Cultural and social issues can impact on women's health and are important to consider in health services planning and research. In this study, we aimed to identify barriers and facilitators to providing a gender-based approach to chronic conditions and women's health in an eastern metropolitan region of Australia. Focus groups were used to engage both community-dwelling women who had chronic conditions and relevant professional stakeholders in the target area. Recorded proceedings underwent thematic analysis. Five focus groups were conducted with professional stakeholders and women community members in February and March 2014. Resultant themes included: women's disempowerment through interactions with health systems; social and economic constraints and caregiving roles act to exclude women from participating in self-care and society; and empowerment can be achieved through integrated models of care that facilitate voice and enable communication and engagement. This study underscores the importance of including perspectives of sex and gender in health care services planning. Tailoring services to socio-demographic and cultural groups is critical in promoting access to health care services. Unique epidemiological trends, particularly the ageing of women and new migrant groups, require particular attention.

  7. Using peer advocates to improve access to services among hard-to-reach populations with hepatitis C: a qualitative study of client and provider relationships.

    Science.gov (United States)

    MacLellan, Jennifer; Surey, Julian; Abubakar, Ibrahim; Stagg, Helen R; Mannell, Jenevieve

    2017-11-28

    Peer support programmes use individuals with specific experiences to improve engagement and outcomes among new clients. However, the skills and techniques used to achieve this engagement have not been mapped. This potentially restricts the development and replication of successful peer advocate models of care. This study explored how a group of peer advocates with experience of homelessness, alcohol and drug misuse made and sustained relationships with their client group. For the purposes of this project, the client group were located among a hepatitis C-positive cohort of people who have a history of injecting drug use and homelessness. Five self-selecting advocates gave a narrative interview lasting 40-90 min. These interviews were double transcribed using both thematic analysis and narrative analysis in order to triangulate the data and provide a robust set of findings about the unique skills of peer advocates in creating and sustaining relationships with clients from hard-to-reach populations. Peer advocates build rapport with clients through disclosing personal details about their lives. While this runs counter to assumptions about the need to maintain distance in client-patient relationships, the therapeutic benefits appear to outweigh the potential costs of this engagement. We conclude the therapeutic benefits of self-disclosure between peer advocates and their clients offer a moral grounding for self-disclosure as a means of building relationships with key hard-to-reach populations.

  8. Advanced High-Level Waste Glass Research and Development Plan

    Energy Technology Data Exchange (ETDEWEB)

    Peeler, David K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Vienna, John D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Schweiger, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Fox, Kevin M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2015-07-01

    The U.S. Department of Energy Office of River Protection (ORP) has implemented an integrated program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product quality requirements. The integrated ORP program is focused on providing a technical, science-based foundation from which key decisions can be made regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities. The fundamental data stemming from this program will support development of advanced glass formulations, key process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste (HLW) vitrification facilities with an appreciation toward reducing overall mission life. The purpose of this advanced HLW glass research and development plan is to identify the near-, mid-, and longer-term research and development activities required to develop and validate advanced HLW glasses and their associated models to support facility operations at WTP, including both direct feed and full pretreatment flowsheets. This plan also integrates technical support of facility operations and waste qualification activities to show the interdependence of these activities with the advanced waste glass (AWG) program to support the full WTP mission. Figure ES-1 shows these key ORP programmatic activities and their interfaces with both WTP facility operations and qualification needs. The plan is a living document that will be updated to reflect key advancements and mission strategy changes. The research outlined here is motivated by the potential for substantial economic benefits (e.g., significant increases in waste throughput and reductions in glass volumes) that will be realized when advancements in glass formulation continue and models supporting facility operations are implemented. Developing and applying advanced

  9. Patients' perspectives of accessibility and digital delivery of factual content provided by official medical and surgical specialty society websites: a qualitative assessment.

    Science.gov (United States)

    Ow, Darren; Wetherell, David; Papa, Nathan; Bolton, Damien; Lawrentschuk, Nathan

    2015-03-27

    Health care websites provide a valuable resource of health information to online consumers, especially patients. Official surgical and medical society websites should be a reliable first point of contact. The primary aim of this study was to quantitatively assess medical and surgical society websites for content and highlight the essential features required for a high-quality, user-friendly society website. Twenty specialty association websites from each of the regions, Australia, UK, Canada, Europe, and the USA were selected for a total of 100 websites. Medical and surgical specialities were consistent across each region. Each website was systematically and critically analysed for content and usability. The average points scored per website was 3.2 out of 10. Of the total (N=100) websites, 12 scored at least 7 out of 10 points and 2 scored 9 out of 10. As well, 35% (35.0/100) of the websites had an information tab for patients on their respective homepages while 38% (38.0/100) had download access to patient information. A minority of the websites included different forms of multimedia such as pictures and diagrams (24.0/100, 24%) and videos (18.0/100, 18%). We found that most society websites did not meet an adequate standard for delivery of information. Half of the websites were not patient accessible, with the primary focus being for health professionals. As well, most required logins for information access. Specialty health care societies should create patient-friendly websites that would be beneficial to all online consumers.

  10. High Level Competence: A Tool for Coping with Organizational Change

    Science.gov (United States)

    Heilmann, Pia

    2007-01-01

    Purpose: The purpose of this paper is to find out and understand the different competence development needs of managers and their ways of learning. The examined managers work in middle management in Finnish information and communication technology sector (ICT) and paper business sector. Design/methodology/approach: The research was qualitative by…

  11. Criticality Safety Evaluation of Hanford Site High Level Waste Storage Tanks

    Energy Technology Data Exchange (ETDEWEB)

    ROGERS, C.A.

    2000-02-17

    This criticality safety evaluation covers operations for waste in underground storage tanks at the high-level waste tank farms on the Hanford site. This evaluation provides the bases for criticality safety limits and controls to govern receipt, transfer, and long-term storage of tank waste. Justification is provided that a nuclear criticality accident cannot occur for tank farms operations, based on current fissile material and operating conditions.

  12. Market Designs for High Levels of Variable Generation: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Milligan, M.; Holttinen, H.; Kiviluoma, J.; Orths, A.; Lynch, M.; Soder, L.

    2014-10-01

    Variable renewable generation is increasing in penetration in modern power systems, leading to higher variability in the supply and price of electricity as well as lower average spot prices. This raises new challenges, particularly in ensuring sufficient capacity and flexibility from conventional technologies. Because the fixed costs and lifetimes of electricity generation investments are significant, designing markets and regulations that ensure the efficient integration of renewable generation is a significant challenge. This papers reviews the state of play of market designs for high levels of variable generation in the United States and Europe and considers new developments in both regions.

  13. ATLAS High Level Trigger Infrastructure, ROI Collection and Event Building

    CERN Document Server

    Kordas, K; Baines, J T M; Beck, H P; Bee, C; Bogaerts, A; Bold, T; Bosman, M; Comune, G; Cranfield, R; Crone, G; Di Mattia, A; Dos Anjos, A; Ellis, Nick; Ertorer, E; Falciano, S; Ferrari, R; Ferrer, M L; Gadomski, S; Gameiro, S; Garitaonandia, H; George, S; Gesualdi-Mello, A; Gorini, B; Green, B; Haeberli, C; Haller, J; Hauser, R; Joos, M; Kieft, G; Klous, S; Kugel, A; Lankford, A; Liu, W; Maeno, T; Masik, J; Meessen, C; Misiejuk, A; Morettini, P; Müller, M; Nagasaka, Y; Negri, A; Padilla, C; Pasqualucci, E; Pauly, T; Perera, V J O; Petersen, J; Portes de Albuquerque, M; Schiavi, C; Schlereth, J L; Segura, E; Seixas, M; Spiwoks, R; Stamen, R; Strong, J; Sushkov, S; Tapprogge, S; Teixeira-Dias, P; Torres, R; Touchard, F; Tremblet, L; Ünel, G; Vandelli, W; Van Wasen, J; Vermeulen, J; Werner, P; Wheeler, S; Wickens, F; Wiedenmann, W; Wu, X; Yasu, Y; Yu, M; Zobernig, H

    2006-01-01

    We describe the base-line design and implementation of the Data Flow and High Level Trigger (HLT) part of the ATLAS Trigger and Data Acquisition (TDAQ) system. We then discuss improvements and generalization of the system design to allow the handling of events in parallel data streams and we present the possibility for event duplication, partial Event Building and data stripping. We then present tests on the deployment and integration of the TDAQ infrastructure and algorithms at the TDAQ â€?pre-series” cluster (~10% of full ATLAS TDAQ). Finally, we tackle two HLT performance issues.

  14. Corrosion and failure processes in high-level waste tanks

    Energy Technology Data Exchange (ETDEWEB)

    Mahidhara, R.K.; Elleman, T.S.; Murty, K.L. [North Carolina State Univ., Raleigh, NC (United States)

    1992-11-01

    A large amount of radioactive waste has been stored safely at the Savannah River and Hanford sites over the past 46 years. The aim of this report is to review the experimental corrosion studies at Savannah River and Hanford with the intention of identifying the types and rates of corrosion encountered and indicate how these data contribute to tank failure predictions. The compositions of the High-Level Wastes, mild steels used in the construction of the waste tanks and degradation-modes particularly stress corrosion cracking and pitting are discussed. Current concerns at the Hanford Site are highlighted.

  15. Deployment of the ATLAS High-Level Triggers

    CERN Document Server

    Anjos, A; Baines, J T M; Beck, H P; Bee, C P; Biglietti, M; Bogaerts, J A C; Bosman, M; Burckhart, Doris; Caprini, M; Caron, B; Casado, M P; Cataldi, G; Cavalli, D; Ciobotaru, M; Comune, G; Conde, P; Corso-Radu, A; Crone, G; Damazio, D; De Santo, A; Díaz-Gómez, M; Di Mattia, A; Dobson, M; Ellis, Nick; Emeliyanov, D; Epp, B; Falciano, S; Ferrari, R; Francis, D; Gadomski, S; Gameiro, S; Garitaonandia, H; George, S; Ghete, V; Goncalo, R; Gorini, B; Gruwé, M; Haeberli, C; Haller, J; Joos, M; Kabana, S; Kazarov, A; Khomich, A; Kilvington, G; Kirk, J; Kolos, S; Konstantinidis, N P; Kootz, A; Lankford, A; Lehmann, G; Lowe, A; Luminari, L; Maeno, T; Masik, J; Meirosu, C; Meessen, C; Mello, A G; Moore, R; Morettini, P; Negri, A; Nikitin, N; Nisati, A; Osuna, C; Padilla, C; Panikashvili, N; Parodi, F; Pasqualucci, E; Pérez-Réale, V; Petersen, J; Pinfold, J L; Pinto, P; Qian, Z; Resconi, S; Rosati, S; Sánchez, C; Santamarina-Rios, C; Scannicchio, D A; Schiavi, C; Segura, E; Seixas, J M; Sivoklokov, S Yu; Sloper, J; Sobreira, A; Soloviev, I; Soluk, R A; Stancu, S; Stefanidis, E; Sushkov, S; Sutton, M; Tapprogge, S; Tarem, S; Thomas, E; Touchard, F; Tremblet, L; Ünel, G; Usai, G; Vandelli, Wainer R; Venda-Pinto, B; Ventura, A; Vercesi, V; Wengler, T; Werner, P; Wheeler, S J; Wickens, F J; Wiedenmann, W; Wielers, M; Wiesmann, M; Yasu, Y; Zobernig, G; 14th IEEE - NPSS Real Time Conference 2005 Nuclear Plasma Sciences Society

    2005-01-01

    The ATLAS combined test beam in the second half of 2004 saw the first deployment of the ATLAS High-Level Triggers (HLT). The next steps are deployment on the pre-series farms in the experimental area during 2005, commissioning and cosmics tests in 2006 and collisions in 2007. This paper reviews the experience gained in the test beam, describes the current status and discusses the further enhancements to be made. We address issues related to the dataflow, selection algorithms, testing, software distribution, installation and improvements.

  16. Health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research.

    Science.gov (United States)

    Flemming, Kate; Graham, Hilary; McCaughan, Dorothy; Angus, Kathryn; Sinclair, Lesley; Bauld, Linda

    2016-03-31

    Reducing smoking in pregnancy is a policy priority in many countries and as a result there has been a rise in the development of services to help pregnant women to quit. A wide range of professionals are involved in providing these services, with midwives playing a particularly pivotal role. Understanding professionals' experiences of providing smoking cessation support in pregnancy can help to inform the design of interventions as well as to improve routine care. A synthesis of qualitative research of health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and the post-partum period was conducted using meta-ethnography. Searches were undertaken from 1990 to January 2015 using terms for maternity health professionals and smoking cessation advisors, pregnancy, post-partum, smoking, and qualitative in seven electronic databases. The review was reported in accordance with the 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) statement. Eight studies reported in nine papers were included, reporting on the views of 190 health professionals/key informants, including 85 midwives and health visitors. The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers or facilitators to an individual's ability to provide smoking cessation support to pregnant or post-partum women. Underpinning these factors was an acknowledgment that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessation The review identifies a role for professional education, both pre-qualification and in continuing professional development that will enable individuals to provide smoking cessation support to pregnant women. Key to the success of this education is recognising the centrality of the professional-client/patient relationship

  17. Health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research

    Directory of Open Access Journals (Sweden)

    Kate Flemming

    2016-03-01

    Full Text Available Abstract Background Reducing smoking in pregnancy is a policy priority in many countries and as a result there has been a rise in the development of services to help pregnant women to quit. A wide range of professionals are involved in providing these services, with midwives playing a particularly pivotal role. Understanding professionals’ experiences of providing smoking cessation support in pregnancy can help to inform the design of interventions as well as to improve routine care. Methods A synthesis of qualitative research of health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and the post-partum period was conducted using meta-ethnography. Searches were undertaken from 1990 to January 2015 using terms for maternity health professionals and smoking cessation advisors, pregnancy, post-partum, smoking, and qualitative in seven electronic databases. The review was reported in accordance with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ (ENTREQ statement. Results Eight studies reported in nine papers were included, reporting on the views of 190 health professionals/key informants, including 85 midwives and health visitors. The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers or facilitators to an individual’s ability to provide smoking cessation support to pregnant or post-partum women. Underpinning these factors was an acknowledgment that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessation Conclusions The review identifies a role for professional education, both pre-qualification and in continuing professional development that will enable individuals to provide smoking cessation support to pregnant women. Key to the success of this education

  18. BEAM SCRAPING FOR LHC INJECTION: HIGH LEVEL APPLICATION DEVELOPMENT

    CERN Document Server

    LETNES, P A

    2008-01-01

    The Large Hadron Collider (LHC) at CERN (European Organization for Nuclear Research) will be the world's most powerful accelerator when it is commissioned during 2008. To operate the LHC, injection of very high intensity beams from the Super Proton Synchrotron (SPS) pre-accelerator is required. With intensities of more than 3 _ 1013 p=cycle, it is essential that there is virtually no beam halo present. Such particles can hit the LHC beam pipe, and may cause magnet quenches due to heating. Fast scrapers have been installed in the SPS to measure and remove any halo before the beam is extracted towards the LHC. Fast scrapers have been chosen because there is too little time available for beam cleaning with large collimators. The scraper hardware has been in place in the SPS ring for several years. A low level computer for controlling the scrapers is also in place. A high level control application was, however, not written at the time. The development of the missing high level control application is the subject o...

  19. Executive functions in kindergarteners with high levels of disruptive behaviours.

    Science.gov (United States)

    Monette, Sébastien; Bigras, Marc; Guay, Marie-Claude

    2015-11-01

    Executive function (EF) deficits have yet to be demonstrated convincingly in children with disruptive behaviour disorders (DBD), as only a few studies have reported these. The presence of EF weaknesses in children with DBD has often been contested on account of the high comorbidity between DBD and attention-deficit/hyperactivity disorder (ADHD) and of methodological shortcomings regarding EF measures. Against this background, the link between EF and disruptive behaviours in kindergarteners was investigated using a carefully selected battery of EF measures. Three groups of kindergarteners were compared: (1) a group combining high levels of disruptive behaviours and ADHD symptoms (COMB); (2) a group presenting high levels of disruptive/aggressive behaviours and low levels of ADHD symptoms (AGG); and (3) a normative group (NOR). Children in the COMB and AGG groups presented weaker inhibition capacities compared with normative peers. Also, only the COMB group showed weaker working memory capacities compared with the NOR group. Results support the idea that preschool children with DBD have weaker inhibition capacities and that this weakness could be common to both ADHD and DBD. © 2015 The British Psychological Society.

  20. Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

    Science.gov (United States)

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2015-01-01

    Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. PMID:26515687

  1. High Level Waste System Impacts from Acid Dissolution of Sludge

    Energy Technology Data Exchange (ETDEWEB)

    KETUSKY, EDWARD

    2006-04-20

    This research evaluates the ability of OLI{copyright} equilibrium based software to forecast Savannah River Site High Level Waste system impacts from oxalic acid dissolution of Tank 1-15 sludge heels. Without further laboratory and field testing, only the use of oxalic acid can be considered plausible to support sludge heel dissolution on multiple tanks. Using OLI{copyright} and available test results, a dissolution model is constructed and validated. Material and energy balances, coupled with the model, identify potential safety concerns. Overpressurization and overheating are shown to be unlikely. Corrosion induced hydrogen could, however, overwhelm the tank ventilation. While pH adjustment can restore the minimal hydrogen generation, resultant precipitates will notably increase the sludge volume. OLI{copyright} is used to develop a flowsheet such that additional sludge vitrification canisters and other negative system impacts are minimized. Sensitivity analyses are used to assess the processability impacts from variations in the sludge/quantities of acids.

  2. High-Level Language Production in Parkinson's Disease: A Review

    Directory of Open Access Journals (Sweden)

    Lori J. P. Altmann

    2011-01-01

    Full Text Available This paper discusses impairments of high-level, complex language production in Parkinson's disease (PD, defined as sentence and discourse production, and situates these impairments within the framework of current psycholinguistic theories of language production. The paper comprises three major sections, an overview of the effects of PD on the brain and cognition, a review of the literature on language production in PD, and a discussion of the stages of the language production process that are impaired in PD. Overall, the literature converges on a few common characteristics of language production in PD: reduced information content, impaired grammaticality, disrupted fluency, and reduced syntactic complexity. Many studies also document the strong impact of differences in cognitive ability on language production. Based on the data, PD affects all stages of language production including conceptualization and functional and positional processing. Furthermore, impairments at all stages appear to be exacerbated by impairments in cognitive abilities.

  3. The High Level Trigger of the CMS experiment

    CERN Document Server

    Gao, Xuyang

    2016-01-01

    The CMS experiment has been designed with a 2-level trigger system the Level 1 Trigger, implemented on custom-designed electronics, and the High Level Trigger, a streamlined version of the CMS offline reconstruction software running on a computer farm. In this poster we will present the performance with the specific algorithms developed to cope with the increasing LHC pile-up and bunch crossing rate using 13 TeV data during 2015, and prospects for improvements brought to both L1T and HLT strategies to meet the new challenges for 2016 scenarios with a peak instantaneous luminosity of $1.2 \\times 10^{34} $cm$^{-2}$s$^{-1}$ and 30 pileup events.

  4. SIMULANT DEVELOPMENT FOR SAVANNAH RIVER SITE HIGH LEVEL WASTE

    Energy Technology Data Exchange (ETDEWEB)

    Stone, M; Russell Eibling, R; David Koopman, D; Dan Lambert, D; Paul Burket, P

    2007-09-04

    The Defense Waste Processing Facility (DWPF) at the Savannah River Site vitrifies High Level Waste (HLW) for repository internment. The process consists of three major steps: waste pretreatment, vitrification, and canister decontamination/sealing. The HLW consists of insoluble metal hydroxides (primarily iron, aluminum, magnesium, manganese, and uranium) and soluble sodium salts (carbonate, hydroxide, nitrite, nitrate, and sulfate). The HLW is processed in large batches through DWPF; DWPF has recently completed processing Sludge Batch 3 (SB3) and is currently processing Sludge Batch 4 (SB4). The composition of metal species in SB4 is shown in Table 1 as a function of the ratio of a metal to iron. Simulants remove radioactive species and renormalize the remaining species. Supernate composition is shown in Table 2.

  5. Reprogrammable Controller Design From High-Level Specification

    Directory of Open Access Journals (Sweden)

    M. Benmohammed

    2003-10-01

    Full Text Available Existing techniques in high-level synthesis mostly assume a simple controller architecture model in the form of a single FSM. However, in reality more complex controller architectures are often used. On the other hand, in the case of programmable processors, the controller architecture is largely defined by the available control-flow instructions in the instruction set. With the wider acceptance of behavioral synthesis, the application of these methods for the design of programmable controllers is of fundamental importance in embedded system technology. This paper describes an important extension of an existing architectural synthesis system targeting the generation of ASIP reprogrammable architectures. The designer can then generate both style of architecture, hardwired and programmable, using the same synthesis system and can quickly evaluate the trade-offs of hardware decisions.

  6. Simulation Modeling of Space Missions Using the High Level Architecture

    Directory of Open Access Journals (Sweden)

    Luis Rabelo

    2013-01-01

    Full Text Available This paper discusses an environment being developed to model a mission of the Space Launch System (SLS and the Multipurpose Crew Vehicle (MPCV being launched from Kennedy Space Center (KSC to the International Space Station (ISS. Several models representing different phases of the mission such as the ground operations processes, engineered systems, and range components such as failure tree, blast, gas dispersion, and debris modeling are explained. These models are built using different simulation paradigms such as continuous, system dynamics, discrete-event, and agent-based simulation modeling. The High Level Architecture (HLA is the backbone of this distributed simulation. The different design decisions and the information fusion scheme of this unique environment are explained in detail for decision-making. This can also help in the development of exploration missions beyond the International Space Station.

  7. Transmutation of high-level radioactive waste - Perspectives

    CERN Document Server

    Junghans, Arnd; Grosse, Eckart; Hannaske, Roland; Kögler, Toni; Massarczyk, Ralf; Schwengner, Ronald; Wagner, Andreas

    2014-01-01

    In a fast neutron spectrum essentially all long-lived actinides (e.g. Plutonium) undergo fission and thus can be transmuted into generally short lived fission products. Innovative nuclear reactor concepts e.g. accelerator driven systems (ADS) are currently in development that foresee a closed fuel cycle. The majority of the fissile nuclides (uranium, plutonium) shall be used for power generation and only fission products will be put into final disposal that needs to last for a historical time scale of only 1000 years. For the transmutation of high-level radioactive waste a lot of research and development is still required. One aspect is the precise knowledge of nuclear data for reactions with fast neutrons. Nuclear reactions relevant for transmutation are being investigated in the framework of the european project ERINDA. First results from the new neutron time-of-flight facility nELBE at Helmholtz-Zentrum Dresden-Rossendorf will be presented.

  8. High Level Control Applications for SOLEIL Commissioning and Operation

    CERN Document Server

    Nadolski, Laurent S; Ho, Katy; Leclercq, Nicolas; Ounsy, Majid; Petit, Sylvain

    2005-01-01

    The SOLEIL control system, namely TANGO developed in collaboration with ESRF, is now mature and stable. TANGO has also been chosen now by several other laboratories. High-level control applications implemented in the control room for the storage ring, the two transfer lines, and the booster will be described in this paper. Three kinds of tools for commissioning are used. First the generic TANGO tools (alarms, simple graphical control applications), which allow us to control in a simple way any TANGO Device Server. Secondly a Matlab Middle Layer (adapted from ALS and SPEAR3): Matlab is fully interconnected with TANGO; it is used primarily for writing Physics control applications. Finally Globalscreen, a commercial SCADA software devoted for building operation applications has been selected (panels for controlling or displaying setpoint, readback values, status of equipments). In addition an overview of the historical and short-term databases for the accelerators will be given. They have been developed in house...

  9. High-level waste tank farm set point document

    Energy Technology Data Exchange (ETDEWEB)

    Anthony, J.A. III

    1995-01-15

    Setpoints for nuclear safety-related instrumentation are required for actions determined by the design authorization basis. Minimum requirements need to be established for assuring that setpoints are established and held within specified limits. This document establishes the controlling methodology for changing setpoints of all classifications. The instrumentation under consideration involve the transfer, storage, and volume reduction of radioactive liquid waste in the F- and H-Area High-Level Radioactive Waste Tank Farms. The setpoint document will encompass the PROCESS AREA listed in the Safety Analysis Report (SAR) (DPSTSA-200-10 Sup 18) which includes the diversion box HDB-8 facility. In addition to the PROCESS AREAS listed in the SAR, Building 299-H and the Effluent Transfer Facility (ETF) are also included in the scope.

  10. Review of High Level Waste Tanks Ultrasonic Inspection Data

    Energy Technology Data Exchange (ETDEWEB)

    Wiersma, B

    2006-03-09

    A review of the data collected during ultrasonic inspection of the Type I high level waste tanks has been completed. The data was analyzed for relevance to the possibility of vapor space corrosion and liquid/air interface corrosion. The review of the Type I tank UT inspection data has confirmed that the vapor space general corrosion is not an unusually aggressive phenomena and correlates well with predicted corrosion rates for steel exposed to bulk solution. The corrosion rates are seen to decrease with time as expected. The review of the temperature data did not reveal any obvious correlations between high temperatures and the occurrences of leaks. The complex nature of temperature-humidity interaction, particularly with respect to vapor corrosion requires further understanding to infer any correlation. The review of the waste level data also did not reveal any obvious correlations.

  11. The ALICE High Level Trigger: status and plans

    CERN Document Server

    Krzewicki, Mikolaj; Gorbunov, Sergey; Breitner, Timo; Lehrbach, Johannes; Lindenstruth, Volker; Berzano, Dario

    2015-01-01

    The ALICE High Level Trigger (HLT) is an online reconstruction, triggering and data compression system used in the ALICE experiment at CERN. Unique among the LHC experiments, it extensively uses modern coprocessor technologies like general purpose graphic processing units (GPGPU) and field programmable gate arrays (FPGA) in the data flow. Realtime data compression is performed using a cluster finder algorithm implemented on FPGA boards. These data, instead of raw clusters, are used in the subsequent processing and storage, resulting in a compression factor of around 4. Track finding is performed using a cellular automaton and a Kalman filter algorithm on GPGPU hardware, where both CUDA and OpenCL technologies can be used interchangeably. The ALICE upgrade requires further development of online concepts to include detector calibration and stronger data compression. The current HLT farm will be used as a test bed for online calibration and both synchronous and asynchronous processing frameworks already before t...

  12. High level of burnout in intensivists: prevalence and associated factors.

    Science.gov (United States)

    Embriaco, Nathalie; Azoulay, Elie; Barrau, Karine; Kentish, Nancy; Pochard, Frédéric; Loundou, Anderson; Papazian, Laurent

    2007-04-01

    Professional burnout is a psychological syndrome arising in response to chronic interpersonal stressors on the job. There is the perception that intensivists are particularly exposed to stress because lives are literally in their hands. To evaluate the prevalence and associated factors (patients or organization) of burnout among physicians working in intensive care units (ICUs) (including interns, residents, fellows, and attending physicians). A 1-day national survey was conducted in adult ICUs in French public hospitals. The level of burnout was evaluated on the basis of the Maslach Burnout Inventory (MBI). A total of 189 ICUs participated and 978 surveys were returned (82.3% response rate). A high level of burnout was identified in 46.5% of the respondents. Ordinal logistic regression showed that female sex (odds ratio, 1.58; 95% confidence interval, 1.09 to 2.30) was independently associated with a higher MBI score. Whereas no factor related to the severity of illness of patients was retained by the model, organizational factors were strongly associated with a higher MBI score. Workload (the number of night shifts per month, a long period of time from the last nonworking week, night shift the day before the survey) and impaired relationships (such as conflict with another colleague intensivist, and/or with a nurse) were the variables independently associated with a higher MBI score. In contrast, the quality of the relationships with chief nurses and nurses was associated with a lower MBI score. Approximately one-half of the intensivists presented a high level of burnout. Organizational factors, but not factors related to the patients, appeared to be associated with burnout.

  13. Influence of High Level Features of HVS on Performance of FSIM

    Directory of Open Access Journals (Sweden)

    P. Dostal

    2013-12-01

    Full Text Available In this paper the influence of information about high level features of Human Visual System (HVS on objective quality assessment is studied. This was done by extending the existing full-reference objective image quality metric – FSIM – where the different importance of certain areas of image is considered using Phase Congruency (PC algorithm. Here, the estimation of Region of Interest (ROI based on this algorithm is complemented by Fixation Density Maps (FDM containing the information about high level features of HVS. Use of another low level features based algorithm (Phase Spectrum of Fourier Transform was also considered and compared to the PC algorithm. The performance was evaluated qualitatively on images reconstructed according to ROI and quantitatively on images from LIVE database. The correlation between subjective and objective tests was calculated using Pearson’s Correlation Coefficient and Spearman’s Rank Order Coefficient. The statistical significance of the difference between correlation coefficients was assessed by Fisher r-to-z transformation. The performance of the metric was also compared to other state-of-the-art image quality metrics (SSIM, MS-SSIM, and FSIM.

  14. High Level Environmental Screening Study for Offshore Wind Farm Developments – Marine Habitats and Species Project

    OpenAIRE

    Hiscock, K; Tyler-Walters, H.; Jones, H.

    2002-01-01

    High level environmental screening study for offshore wind farm developments – marine habitats and species \\ud This report provides an awareness of the environmental issues related to marine habitats and species for developers and regulators of offshore wind farms. \\ud The information is also relevant to other offshore renewable energy developments. \\ud The marine habitats and species considered are those associated with the seabed, seabirds, and sea mammals. The report concludes that the fol...

  15. Development of site suitability criteria for the high level waste repository for Lawrence Livermore Laboratories

    Energy Technology Data Exchange (ETDEWEB)

    1977-06-01

    Results of our mining, geological and geotechnical studies provided in support of the development of site suitability criteria for the high level waste repository are presented. The primary purpose of the work was the identification and development of appropriate geotechnical descriptors and coefficients required for the Site Suitability Repository Model. This model was developed by The Analytic Sciences Corporation (TASC) of Reading, Massachusetts and is not described in this report.

  16. Inhibition of Cardiomyogenesis in Embryocarcinoma Cells Induced by Long-Term High Level of Glucose

    Directory of Open Access Journals (Sweden)

    Wen-Juan Li

    2016-05-01

    Full Text Available Background/Aims: Cardiac myocytes constitute the first differentiated cell type during mammalian heart formation with the ability to beat spontaneously and rhythmically. Hyperglycemia is a primary risk factor for cardiovascular disease in pre-gestational diabetes mellitus (PGDM. However, the impact that hyperglycemia has on cardiac progenitors or on precursors differentiation remains poorly understood. The aim of the present study is to investigate whether hyperglycemia affects cardiomyogenesis of embryocarcinoma cells. Methods: P19CL6 cells differentiation induced by 1% DMSO was evaluated under either normal glucose (5.6 mmol/L or high level of glucose concentrations (20 mmol/L or 40 mmol/L. To investigate the effect of long-term high level of glucose on cardiomyocytes differentiation, sarcomeric α-actinin, peroxisome proliferator-activated receptor coactivator-1 (PGC-1α, transcription factor GATA4 and Nkx2.5 were assessed by qRT-PCR analysis, western blot and immunofluorescence. Results: We observed that long-term high level of glucose markedly reduced P19CL6 cells differentiation into cardiomyocytes. The change in PGC-1α expression was consistent with changes in cardiac muscle myosin expression after exposure to 20 mmol/L or 40 mmol/L of glucose. On the other hand, the high level of glucose concentration profoundly decreased both GATA4 and Nkx2-5 expressions from day 6 to day 12 after differentiation, which was induced by 1% DMSO. Conclusion: Our results elucidate that the effect resulting from the long-term exposure of cardiac progenitors to high level of glucose is associated with decreased expression of GATA4 and Nkx2.5, providing a novel mechanism by which high glucose is able to affect cell differentiation.

  17. A qualitative systematic review of service user and service provider perspectives on the acceptability, relative benefits, and potential harms of art therapy for people with non-psychotic mental health disorders.

    Science.gov (United States)

    Scope, Alison; Uttley, Lesley; Sutton, Anthea

    2017-03-01

    This systematic review aimed to synthesize qualitative evidence relating to user and service provider perspective on the acceptability and relative benefits and potential harms of art therapy for people with non-psychotic mental disorders. A comprehensive literature search was conducted in 13 major bibliographic databases from May to July 2013. A qualitative evidence synthesis was conducted using thematic framework synthesis. The searches identified 10,270 citations from which 12 studies were included. Ten studies included data from 183 service users, and two studies included data from 16 service providers. The evidence demonstrated that art therapy was an acceptable treatment. The benefits associated with art therapy included the following: the development of relationships with the therapist and other group members; understanding the self/own illness/the future; gaining perspective; distraction; personal achievement; expression; relaxation; and empowerment. Small numbers of patients reported varying reasons for not wanting to take part, and some highlighted potentially negative effects of art therapy which included the evoking of feelings which could not be resolved. The findings suggest that for the majority of respondents art therapy was an acceptable intervention, although this was not the case for all respondents. Therefore, attention should be focussed on both identifying those who are most likely to benefit from art therapy and ensuring any potential harms are minimized. The findings provide evidence to commissioners and providers of mental health services about the value of future art therapy services. Art therapy was reported to be an acceptable treatment for the majority of respondents. Art therapy may not be a preferred treatment option for a small number of patients, emphasizing the importance of considering patient preference in choice of treatment, and selection of the most suitable patients for art therapy. Consideration should be made of adjustments

  18. Interventions for Individuals With High Levels of Needle Fear

    Science.gov (United States)

    Noel, Melanie; Taddio, Anna; Antony, Martin M.; Asmundson, Gordon J.G.; Riddell, Rebecca Pillai; Chambers, Christine T.; Shah, Vibhuti

    2015-01-01

    Background: This systematic review evaluated the effectiveness of exposure-based psychological and physical interventions for the management of high levels of needle fear and/or phobia and fainting in children and adults. Design/Methods: A systematic review identified relevant randomized and quasi-randomized controlled trials of children, adults, or both with high levels of needle fear, including phobia (if not available, then populations with other specific phobias were included). Critically important outcomes were self-reported fear specific to the feared situation and stimulus (psychological interventions) or fainting (applied muscle tension). Data were pooled using standardized mean difference (SMD) or relative risk with 95% confidence intervals. Results: The systematic review included 11 trials. In vivo exposure-based therapy for children 7 years and above showed benefit on specific fear (n=234; SMD: −1.71 [95% CI: −2.72, −0.7]). In vivo exposure-based therapy with adults reduced fear of needles posttreatment (n=20; SMD: −1.09 [−2.04, −0.14]) but not at 1-year follow-up (n=20; SMD: −0.28 [−1.16, 0.6]). Compared with single session, a benefit was observed for multiple sessions of exposure-based therapy posttreatment (n=93; SMD: −0.66 [−1.08, −0.24]) but not after 1 year (n=83; SMD: −0.37 [−0.87, 0.13]). Non in vivo e.g., imaginal exposure-based therapy in children reduced specific fear posttreatment (n=41; SMD: −0.88 [−1.7, −0.05]) and at 3 months (n=24; SMD: −0.89 [−1.73, −0.04]). Non in vivo exposure-based therapy for adults showed benefit on specific fear (n=68; SMD: −0.62 [−1.11, −0.14]) but not procedural fear (n=17; SMD: 0.18 [−0.87, 1.23]). Applied tension showed benefit on fainting posttreatment (n=20; SMD: −1.16 [−2.12, −0.19]) and after 1 year (n=20; SMD: −0.97 [−1.91, −0.03]) compared with exposure alone. Conclusions: Exposure-based psychological interventions and applied muscle tension show

  19. CEMENTITIOUS GROUT FOR CLOSING SRS HIGH LEVEL WASTE TANKS - #12315

    Energy Technology Data Exchange (ETDEWEB)

    Langton, C.; Burns, H.; Stefanko, D.

    2012-01-10

    In 1997, the first two United States Department of Energy (US DOE) high level waste tanks (Tanks 17-F and 20-F: Type IV, single shell tanks) were taken out of service (permanently closed) at the Savannah River Site (SRS). In 2012, the DOE plans to remove from service two additional Savannah River Site (SRS) Type IV high-level waste tanks, Tanks 18-F and 19-F. These tanks were constructed in the late 1950's and received low-heat waste and do not contain cooling coils. Operational closure of Tanks 18-F and 19-F is intended to be consistent with the applicable requirements of the Resource Conservation and Recovery Act (RCRA) and the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and will be performed in accordance with South Carolina Department of Health and Environmental Control (SCDHEC). The closure will physically stabilize two 4.92E+04 cubic meter (1.3 E+06 gallon) carbon steel tanks and isolate and stabilize any residual contaminants left in the tanks. The closure will also fill, physically stabilize and isolate ancillary equipment abandoned in the tanks. A Performance Assessment (PA) has been developed to assess the long-term fate and transport of residual contamination in the environment resulting from the operational closure of the F-Area Tank Farm (FTF) waste tanks. Next generation flowable, zero-bleed cementitious grouts were designed, tested, and specified for closing Tanks 18-F and 19-F and for filling the abandoned equipment. Fill requirements were developed for both the tank and equipment grouts. All grout formulations were required to be alkaline with a pH of 12.4 and chemically reduction potential (Eh) of -200 to -400 to stabilize selected potential contaminants of concern. This was achieved by including Portland cement and Grade 100 slag in the mixes, respectively. Ingredients and proportions of cementitious reagents were selected and adjusted, respectively, to support the mass placement strategy developed by

  20. The CMS High Level Trigger System: Experience and Future Development

    CERN Document Server

    Bauer, Gerry; Bowen, Matthew; Branson, James G; Bukowiec, Sebastian; Cittolin, Sergio; Coarasa, J A; Deldicque, Christian; Dobson, Marc; Dupont, Aymeric; Erhan, Samim; Flossdorf, Alexander; Gigi, Dominique; Glege, Frank; Gomez-Reino, R; Hartl, Christian; Hegeman, Jeroen; Holzner, André; Y L Hwong; Masetti, Lorenzo; Meijers, Frans; Meschi, Emilio; Mommsen, R K; O'Dell, Vivian; Orsini, Luciano; Paus, Christoph; Petrucci, Andrea; Pieri, Marco; Polese, Giovanni; Racz, Attila; Raginel, Olivier; Sakulin, Hannes; Sani, Matteo; Schwick, Christoph; Shpakov, Dennis; Simon, M; Spataru, A C; Sumorok, Konstanty

    2012-01-01

    The CMS experiment at the LHC features a two-level trigger system. Events accepted by the first level trigger, at a maximum rate of 100 kHz, are read out by the Data Acquisition system (DAQ), and subsequently assembled in memory in a farm of computers running a software high-level trigger (HLT), which selects interesting events for offline storage and analysis at a rate of order few hundred Hz. The HLT algorithms consist of sequences of offline-style reconstruction and filtering modules, executed on a farm of 0(10000) CPU cores built from commodity hardware. Experience from the operation of the HLT system in the collider run 2010/2011 is reported. The current architecture of the CMS HLT, its integration with the CMS reconstruction framework and the CMS DAQ, are discussed in the light of future development. The possible short- and medium-term evolution of the HLT software infrastructure to support extensions of the HLT computing power, and to address remaining performance and maintenance issues, are discussed.

  1. Muons in the CMS High Level Trigger System

    CERN Document Server

    AUTHOR|(CDS)2072218

    2016-01-01

    The trigger systems of LHC detectors play a fundamental role in defining the physics capabilities of the experiments. A reduction of several orders of magnitude in the rate of collected events, with respect to the proton-proton bunch crossing rate generated by the LHC, is mandatory to cope with the limits imposed by the readout and storage system. An accurate and efficient online selection mechanism is thus required to fulfill the task keeping maximal the acceptance to physics signals. The CMS experiment operates using a two-level trigger system. Firstly a Level-1 Trigger (L1T) system, implemented using custom-designed electronics, is designed to reduce the event rate to a limit compatible to the CMS Data Acquisition (DAQ) capabilities. A High Level Trigger System (HLT) follows, aimed at further reducing the rate of collected events finally stored for analysis purposes. The latter consists of a streamlined version of the CMS offline reconstruction software and operates on a computer farm. It runs algorithms o...

  2. THE HIGH LEVEL ACCESSION DIALOGUE FOR MACEDONIA: ADVANTAGES AND DISADVANTAGES

    Directory of Open Access Journals (Sweden)

    Mladen Karadjoski

    2015-04-01

    Full Text Available One of the strategic goals for the Republic of Macedonia is membership in the European Union. At the end of 2011, the Commission launched a so-called High Level Accession Dialogue for Macedonia, with a possibility to start the negotiations after the fulfillment of the Dialogue goals and benchmarks. For these reasons, the main goal of this paper will be to give an answer of the dilemma whether the Accession Dialogue for Macedonia is an accelerator of the entrance in the European Union, or is just a sophisticated tool for delay of the start of the negotiations for final accession. The expected results will correspond with the future EU plans for Macedonia, but also for the other Western Balkan countries, i.e. we will try to examine whether these countries have a realistic perspective for entrance in the European Union, or they are just a “declarative décor” for the vocabulary of the Brussels diplomats and member countries representatives. That will help to determine i.e. to try to predict the next steps of these countries, connected with the European integration, regardless of the actual constellation in the European Union concerning the Enlargement policy. The descriptive method, content analyses method, comparative method, but also the inductive and deductive methods will be used in this paper.

  3. B-tagging at High Level Trigger in CMS

    CERN Document Server

    Chabert, Eric Christian

    2014-01-01

    The CMS experiment has been designed with a 2-level trigger system. The Level 1 Trigger is implemented on custom-designed electronics. The High Level Trigger (HLT) is a streamlined version of the CMS offline reconstruction software running on a computer farm. Using b-tagging at trigger level will play a crucial role during the Run II data taking to ensure the Top quark, beyond the Standard Model and Higgs boson physics programme of the experiment. It will help to significantly reduce the trigger output rate which will increase due to the higher instantaneous luminosity and higher cross sections at 13 TeV. B-tagging algorithms based on the identification of tracks displaced from the primary proton-proton collision or on the reconstruction of secondary vertices have been successfully used during Run I. We will present their design and performance with an emphasis on the dedicated aspects of track and primary vertex reconstruction, as well as the improvements foreseen to meet the challenges of the Run II data ta...

  4. Studies of ATM for ATLAS high level triggers

    CERN Document Server

    Bystrický, J; Huet, M; Le Dû, P; Mandjavidze, I D

    2001-01-01

    This paper presents some of the conclusions of our studies on ATM and Fast Ethernet in the ATLAS level-2 trigger Pilot project. We describe the general concept and principles of our data collection and event building scheme that could be transposed to various experiments in high energy and nuclear physics. To validate the approach in view of ATLAS High Level Triggers, we assembled a testbed composed of up to 48 computers linked by a 7.5 Gbit/s ATM switch. This modular switch is used as a single entity or is split into several smaller interconnected switches. This allows studying how to construct a large network from smaller units. Alternatively, the ATM network can be replaced by Fast Ethernet. We detail the operation of the system and present series of performance measurements made with event building traffic pattern. We extrapolate these results to show how today's commercial networking components could be used to build a 1000-port network adequate for ATLAS needs. Finally, we list the benefits and the limi...

  5. Multi-threading in the ATLAS High-Level Trigger

    CERN Document Server

    Barton, Adam Edward; The ATLAS collaboration

    2018-01-01

    Over the next decade of LHC data-taking the instantaneous luminosity will reach up 7.5 times the design value with over 200 interactions per bunch-crossing and will pose unprecedented challenges for the ATLAS trigger system. With the evolution of the CPU market to many-core systems, both the ATLAS offline reconstruction and High-Level Trigger (HLT) software will have to transition from a multi-process to a multithreaded processing paradigm in order not to exhaust the available physical memory of a typical compute node. The new multithreaded ATLAS software framework, AthenaMT, has been designed from the ground up to support both the offline and online use-cases with the aim to further harmonize the offline and trigger algorithms. The latter is crucial both in terms of maintenance effort and to guarantee the high trigger efficiency and rejection factors needed for the next two decades of data-taking. We report on an HLT prototype in which the need for HLT­specific components has been reduced to a minimum while...

  6. Psychological stress in high level sailors during competition

    Directory of Open Access Journals (Sweden)

    L. Segato

    2010-01-01

    Full Text Available The purpose of this work was to investigate the psychological stress present in elite sailors in a competition. Based on a descriptive field research, 31 elite sailors volunteered to participate. They answered the Perceived Stress Scale (Cohen & Williamson, 1988 and also specific questions on self-control, sources and strategies of coping. Data were analyzed by using descriptive and inferential (Student t test and Pearson's correlation statistics. These athletes revealed low and moderate scores (M = 20.00, DP = 6.83 of stress originated from both intrinsic (ship troubles, team disorders and extrinsic (study, working and training, family and financial problems sources. The group reported good stress control during competition through the use of cognitive (avoidance and somatic (listening music, resting/sleeping, talk to friends strategies. It is important that sailors are able to control and cope with high levels of psychological stress and to understand how to proceed when under unstable and unexpected situations that arise during competition.

  7. The CMS High Level Trigger System: Experience and future development

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, G.; et al.

    2012-01-01

    The CMS experiment at the LHC features a two-level trigger system. Events accepted by the first level trigger, at a maximum rate of 100 kHz, are read out by the Data Acquisition system (DAQ), and subsequently assembled in memory in a farm of computers running a software high-level trigger (HLT), which selects interesting events for offline storage and analysis at a rate of order few hundred Hz. The HLT algorithms consist of sequences of offline-style reconstruction and filtering modules, executed on a farm of 0(10000) CPU cores built from commodity hardware. Experience from the operation of the HLT system in the collider run 2010/2011 is reported. The current architecture of the CMS HLT, its integration with the CMS reconstruction framework and the CMS DAQ, are discussed in the light of future development. The possible short- and medium-term evolution of the HLT software infrastructure to support extensions of the HLT computing power, and to address remaining performance and maintenance issues, are discussed.

  8. Multiple Word-Length High-Level Synthesis

    Directory of Open Access Journals (Sweden)

    Dominique Heller

    2008-09-01

    Full Text Available Digital signal processing (DSP applications are nowadays widely used and their complexity is ever growing. The design of dedicated hardware accelerators is thus still needed in system-on-chip and embedded systems. Realistic hardware implementation requires first to convert the floating-point data of the initial specification into arbitrary length data (finite-precision while keeping an acceptable computation accuracy. Next, an optimized hardware architecture has to be designed. Considering uniform bit-width specification allows to use traditional automated design flow. However, it leads to oversized design. On the other hand, considering non uniform bit-width specification allows to get a smaller circuit but requires complex design tasks. In this paper, we propose an approach that inputs a C/C++ specification. The design flow, based on high-level synthesis (HLS techniques, automatically generates a potentially pipeline RTL architecture described in VHDL. Both bitaccurate integer and fixed-point data types can be used in the input specification. The generated architecture uses components (operator, register, etc. that have different widths. The design constraints are the clock period and the throughput of the application. The proposed approach considers data word-length information in all the synthesis steps by using dedicated algorithms. We show in this paper the effectiveness of the proposed approach through several design experiments in the DSP domain.

  9. Multiple Word-Length High-Level Synthesis

    Directory of Open Access Journals (Sweden)

    Coussy Philippe

    2008-01-01

    Full Text Available Abstract Digital signal processing (DSP applications are nowadays widely used and their complexity is ever growing. The design of dedicated hardware accelerators is thus still needed in system-on-chip and embedded systems. Realistic hardware implementation requires first to convert the floating-point data of the initial specification into arbitrary length data (finite-precision while keeping an acceptable computation accuracy. Next, an optimized hardware architecture has to be designed. Considering uniform bit-width specification allows to use traditional automated design flow. However, it leads to oversized design. On the other hand, considering non uniform bit-width specification allows to get a smaller circuit but requires complex design tasks. In this paper, we propose an approach that inputs a C/C++ specification. The design flow, based on high-level synthesis (HLS techniques, automatically generates a potentially pipeline RTL architecture described in VHDL. Both bitaccurate integer and fixed-point data types can be used in the input specification. The generated architecture uses components (operator, register, etc. that have different widths. The design constraints are the clock period and the throughput of the application. The proposed approach considers data word-length information in all the synthesis steps by using dedicated algorithms. We show in this paper the effectiveness of the proposed approach through several design experiments in the DSP domain.

  10. Evaluation of the bone status in high-level cyclists.

    Science.gov (United States)

    Guillaume, Gérard; Chappard, Daniel; Audran, Maurice

    2012-01-01

    The purpose of this study was to evaluate the bone status in highly trained professional cyclists subjected to regular training and tough competitions. Bone mineral density (BMD) was measured at different regions of interest by dual-energy X-ray absorptiometry, and main biological parameters related to bone metabolism were obtained in 29 cyclists. Lumbar BMD was 0.94 ± 0.01g/cm(2) (Z-score=-1.28 ± 0.07), and 1 cyclist out of 4 had an abnormally low value (Z-score cyclists (15%) had Z-scores cyclists had low 25-hydroxyvitamin D levels. Blood testosterone and thyroid stimulating hormone were in the normal range. Insulin-like growth factor 1 levels were in the normal range; however, a significant inverse correlation was found with lumbar BMD (r=0.495; p=0.003). We confirm that cycling has no positive effect on BMD, BMD being often lower than in normal controls at the lumbar site; femoral BMD is less concerned. The absence of beneficial changes at the spine can be explained by biomechanical conditions related to the cyclists' position, reducing loading strains. It is necessary to pay greater attention to the bone status of high-level athletes to prevent an increased risk of fractures. Copyright © 2012 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  11. Studies of ATM for ATLAS high-level triggers

    CERN Document Server

    Bystrický, J; Huet, M; Le Dû, P; Mandjavidze, I D

    2001-01-01

    This paper presents some of the conclusions of our studies on asynchronous transfer mode (ATM) and fast Ethernet in the ATLAS level-2 trigger pilot project. We describe the general concept and principles of our data-collection and event-building scheme that could be transposed to various experiments in high-energy and nuclear physics. To validate the approach in view of ATLAS high-level triggers, we assembled a testbed composed of up to 48 computers linked by a 7.5-Gbit/s ATM switch. This modular switch is used as a single entity or is split into several smaller interconnected switches. This allows study of how to construct a large network from smaller units. Alternatively, the ATM network can be replaced by fast Ethernet. We detail the operation of the system and present series of performance measurements made with event-building traffic pattern. We extrapolate these results to show how today's commercial networking components could be used to build a 1000-port network adequate for ATLAS needs. Lastly, we li...

  12. A readout buffer prototype for ATLAS high-level triggers

    CERN Document Server

    Calvet, D; Huet, M; Le Dû, P; Mandjavidze, I D; Mur, M

    2001-01-01

    Readout buffers are critical components in the dataflow chain of the ATLAS trigger/data-acquisition system. At up to 75 kHz, after each Level-1 trigger accept signal, these devices receive and store digitized data from groups of front-end electronic channels. Several readout buffers are grouped to form a readout buffer complex that acts as a data server for the high-level trigger selection algorithms and for the final data-collection system. This paper describes a functional prototype of a readout buffer based on a custom-made PCI mezzanine card that is designed to accept input data at up to 160 MB /s, to store up to 8 MB of data, and to distribute data chunks at the desired request rate. We describe the hardware of the card that is based on an Intel 1960 processor and complex programmable logic devices. We present the integration of several of these cards in a readout buffer complex. We measure various performance figures and discuss to which extent these can fulfil ATLAS needs. (5 refs).

  13. Identification of areas with high levels of untreated dental caries.

    Science.gov (United States)

    Ellwood, R P; O'Mullane, D M

    1996-02-01

    In order to examine the geographical variation of dental health within 10 county districts in North Wales, 3538 children were examined. The associations between three demographic indicators, based on the 1981 OPCS census, and dental health outcomes were assessed for electoral wards within the county districts. The Townsend and Jarman indices were the first two indicators employed and the third was based on a mathematical model representing the variation in the mean number of untreated decayed surfaces per person for the wards. This model was developed using the children examined in the five most westerly county districts. Using the data derived from the five most easterly county districts, the three indicators were assessed. All three showed strong correlations (r > or = 0.88) with dental health. These results indicate that measures of dental health based on large administrative units may obscure variation within them. It is concluded that geographical methods of this type may be useful for targeting dental resources at small areas with high levels of need.

  14. High-level fluorescence labeling of gram-positive pathogens.

    Directory of Open Access Journals (Sweden)

    Simone Aymanns

    Full Text Available Fluorescence labeling of bacterial pathogens has a broad range of interesting applications including the observation of living bacteria within host cells. We constructed a novel vector based on the E. coli streptococcal shuttle plasmid pAT28 that can propagate in numerous bacterial species from different genera. The plasmid harbors a promoterless copy of the green fluorescent variant gene egfp under the control of the CAMP-factor gene (cfb promoter of Streptococcus agalactiae and was designated pBSU101. Upon transfer of the plasmid into streptococci, the bacteria show a distinct and easily detectable fluorescence using a standard fluorescence microscope and quantification by FACS-analysis demonstrated values that were 10-50 times increased over the respective controls. To assess the suitability of the construct for high efficiency fluorescence labeling in different gram-positive pathogens, numerous species were transformed. We successfully labeled Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus dysgalactiae subsp. equisimilis, Enterococcus faecalis, Enterococcus faecium, Streptococcus mutans, Streptococcus anginosus and Staphylococcus aureus strains utilizing the EGFP reporter plasmid pBSU101. In all of these species the presence of the cfb promoter construct resulted in high-level EGFP expression that could be further increased by growing the streptococcal and enterococcal cultures under high oxygen conditions through continuous aeration.

  15. The Software Architecture of the LHCb High Level Trigger

    CERN Multimedia

    CERN. Geneva

    2012-01-01

    The LHCb experiment is a spectrometer dedicated to the study of heavy flavor at the LHC. The rate of proton-proton collisions at the LHC is 15 MHz, but disk space limitations mean that only 3 kHz can be written to tape for offline processing. For this reason the LHCb data acquisition system -- trigger -- plays a key role in selecting signal events and rejecting background. In contrast to previous experiments at hadron colliders like for example CDF or D0, the bulk of the LHCb trigger is implemented in software and deployed on a farm of 20k parallel processing nodes. This system, called the High Level Trigger (HLT) is responsible for reducing the rate from the maximum at which the detector can be read out, 1.1 MHz, to the 3 kHz which can be processed offline,and has 20 ms in which to process and accept/reject each event. In order to minimize systematic uncertainties, the HLT was designed from the outset to reuse the offline reconstruction and selection code, and is based around multiple independent and redunda...

  16. Defense High-Level Waste Leaching Mechanisms Program. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Mendel, J.E. (compiler)

    1984-08-01

    The Defense High-Level Waste Leaching Mechanisms Program brought six major US laboratories together for three years of cooperative research. The participants reached a consensus that solubility of the leached glass species, particularly solubility in the altered surface layer, is the dominant factor controlling the leaching behavior of defense waste glass in a system in which the flow of leachant is constrained, as it will be in a deep geologic repository. Also, once the surface of waste glass is contacted by ground water, the kinetics of establishing solubility control are relatively rapid. The concentrations of leached species reach saturation, or steady-state concentrations, within a few months to a year at 70 to 90/sup 0/C. Thus, reaction kinetics, which were the main subject of earlier leaching mechanisms studies, are now shown to assume much less importance. The dominance of solubility means that the leach rate is, in fact, directly proportional to ground water flow rate. Doubling the flow rate doubles the effective leach rate. This relationship is expected to obtain in most, if not all, repository situations.

  17. Control of high-level radioactive waste-glass melters

    Energy Technology Data Exchange (ETDEWEB)

    Bickford, D.F.; Coleman, C.J.

    1990-01-01

    The Defense Waste Processing Facility (DWPF) will immobilize Savannah River Site High Level Waste as a durable borosilicate glass for permanent disposal in a repository. The DWPF will be controlled based on glass composition. The following discussion is a preliminary analysis of the capability of the laboratory methods that can be used to control the glass composition, and the relationships between glass durability and glass properties important to glass melting. The glass durability and processing properties will be controlled by controlling the chemical composition of the glass. The glass composition will be controlled by control of the melter feed transferred from the Slurry Mix Evaporator (SME) to the Melter Feed Tank (MFT). During cold runs, tests will be conducted to demonstrate the chemical equivalence of glass sampled from the pour stream and glass removed from cooled canisters. In similar tests, the compositions of glass produced from slurries sampled from the SME and MFT will be compared to final product glass to determine the statistical relationships between melter feed and glass product. The total error is the combination of those associated with homogeneity in the SME or MFT, sampling, preparation of samples for analysis, instrument calibration, analysis, and the composition/property model. This study investigated the sensitivity of estimation of property data to the combination of variations from sampling through analysis. In this or a similar manner, the need for routine glass product sampling will be minimized, and glass product characteristics will be assured before the melter feed is committed to the melter.

  18. Psychological stress in high level sailors during competition

    Directory of Open Access Journals (Sweden)

    Luciana Segato

    2010-09-01

    Full Text Available The purpose of this work was to investigate the psychological stress present in elite sailors in a competition. Based on a descriptive field research, 31 elite sailors volunteered to participate. They answered the Perceived Stress Scale (Cohen & Williamson, 1988 and also specific questions on self-control, sources and strategies of coping. Data were analyzed by using descriptive and inferential (Student t test and Pearson's correlation statistics. These athletes revealed low and moderate scores (M = 20.00, DP = 6.83 of stress originated from both intrinsic (ship troubles, team disorders and extrinsic (study, working and training, family and financial problems sources. The group reported good stress control during competition through the use of cognitive (avoidance and somatic (listening music, resting/sleeping, talk to friends strategies. It is important that sailors are able to control and cope with high levels of psychological stress and to understand how to proceed when under unstable and unexpected situations that arise during competition.

  19. Validity in Qualitative Evaluation

    Directory of Open Access Journals (Sweden)

    Vasco Lub

    2015-12-01

    Full Text Available This article provides a discussion on the question of validity in qualitative evaluation. Although validity in qualitative inquiry has been widely reflected upon in the methodological literature (and is still often subject of debate, the link with evaluation research is underexplored. Elaborating on epistemological and theoretical conceptualizations by Guba and Lincoln and Creswell and Miller, the article explores aspects of validity of qualitative research with the explicit objective of connecting them with aspects of evaluation in social policy. It argues that different purposes of qualitative evaluations can be linked with different scientific paradigms and perspectives, thus transcending unproductive paradigmatic divisions as well as providing a flexible yet rigorous validity framework for researchers and reviewers of qualitative evaluations.

  20. Demonstrating Reliable High Level Waste Slurry Sampling Techniques to Support Hanford Waste Processing

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, Steven E.

    2013-11-11

    The Hanford Tank Operations Contractor (TOC) and the Hanford Waste Treatment and Immobilization Plant (WTP) contractor are both engaged in demonstrating mixing, sampling, and transfer system capability using simulated Hanford High-Level Waste (HL W) formulations. This work represents one of the remaining technical issues with the high-level waste treatment mission at Hanford. The TOC must demonstrate the ability to adequately mix and sample high-level waste feed to meet the WTP Waste Acceptance Criteria and Data Quality Objectives. The sampling method employed must support both TOC and WTP requirements. To facilitate information transfer between the two facilities the mixing and sampling demonstrations are led by the One System Integrated Project Team. The One System team, Waste Feed Delivery Mixing and Sampling Program, has developed a full scale sampling loop to demonstrate sampler capability. This paper discusses the full scale sampling loops ability to meet precision and accuracy requirements, including lessons learned during testing. Results of the testing showed that the Isolok(R) sampler chosen for implementation provides precise, repeatable results. The Isolok(R) sampler accuracy as tested did not meet test success criteria. Review of test data and the test platform following testing by a sampling expert identified several issues regarding the sampler used to provide reference material used to judge the Isolok's accuracy. Recommendations were made to obtain new data to evaluate the sampler's accuracy utilizing a reference sampler that follows good sampling protocol.

  1. Southern routes for high-level radioactive waste: Agencies, contacts, and designations

    Energy Technology Data Exchange (ETDEWEB)

    1991-05-01

    The Southern Routes for High-Level Radioactive Waste: Agencies, Contacts and Designations is a compendium of sixteen southern states' routing programs for the transportation of high-level radioactive materials. The report identifies the state-designated routing agencies as defined under 49 Code of Federal Regulations (CFR) Part 171 and provides a reference to the source and scope of the agencies' rulemaking authority. Additionally, the state agency and contact designated by the state's governor to receive advance notification and shipment routing information under 10 CFR Parts 71 and 73 are also listed. This report also examines alternative route designations made by southern states and the lessons that were learned from the designation process.

  2. Southern routes for high-level radioactive waste: Agencies, contacts, and designations

    Energy Technology Data Exchange (ETDEWEB)

    1991-05-01

    The Southern Routes for High-Level Radioactive Waste: Agencies, Contacts and Designations is a compendium of sixteen southern states` routing programs for the transportation of high-level radioactive materials. The report identifies the state-designated routing agencies as defined under 49 Code of Federal Regulations (CFR) Part 171 and provides a reference to the source and scope of the agencies` rulemaking authority. Additionally, the state agency and contact designated by the state`s governor to receive advance notification and shipment routing information under 10 CFR Parts 71 and 73 are also listed. This report also examines alternative route designations made by southern states and the lessons that were learned from the designation process.

  3. The ATLAS online High Level Trigger framework experience reusing offline software components in the ATLAS trigger

    CERN Document Server

    Wiedenmann, W

    2009-01-01

    Event selection in the Atlas High Level Trigger is accomplished to a large extent by reusing software components and event selection algorithms developed and tested in an offline environment. Many of these offline software modules are not specifically designed to run in a heavily multi-threaded online data flow environment. The Atlas High Level Trigger (HLT) framework based on the Gaudi and Atlas Athena frameworks, forms the interface layer, which allows the execution of the HLT selection and monitoring code within the online run control and data flow software. While such an approach provides a unified environment for trigger event selection across all of Atlas, it also poses strict requirements on the reused software components in terms of performance, memory usage and stability. Experience of running the HLT selection software in the different environments and especially on large multi-node trigger farms has been gained in several commissioning periods using preloaded Monte Carlo events, in data taking peri...

  4. Automatic Generation of Web Applications from Visual High-Level Functional Web Components

    Directory of Open Access Journals (Sweden)

    Quan Liang Chen

    2009-01-01

    Full Text Available This paper presents high-level functional Web components such as frames, framesets, and pivot tables, which conventional development environments for Web applications have not yet supported. Frameset Web components provide several editing facilities such as adding, deleting, changing, and nesting of framesets to make it easier to develop Web applications that use frame facilities. Pivot table Web components sum up various kinds of data in two dimensions. They reduce the amount of code to be written by developers greatly. The paper also describes the system that implements these high-level functional components as visual Web components. This system assists designers in the development of Web applications based on the page-transition framework that models a Web application as a set of Web page transitions, and by using visual Web components, makes it easier to write processes to be executed when a Web page transfers to another.

  5. "Be kind to young people so they feel at home": a qualitative study of adolescents' and service providers' perceptions of youth-friendly sexual and reproductive health services in Vanuatu.

    Science.gov (United States)

    Kennedy, Elissa C; Bulu, Siula; Harris, Jennifer; Humphreys, David; Malverus, Jayline; Gray, Natalie J

    2013-10-31

    Sexual activity during adolescence is common in Vanuatu, however many adolescents lack access to sexual and reproductive health (SRH) services and subsequently suffer a disproportionate burden of poor SRH. There is limited peer-reviewed research describing adolescents' SRH service delivery preferences in Vanuatu to inform policy and programs. The aim of this qualitative study was to explore the barriers preventing adolescents from accessing SRH services in Vanuatu and the features of a youth-friendly health service as defined by adolescents. Sixty-six focus group discussions were conducted with 341 male and female adolescents aged 15-19 years in rural and urban communities. Additionally, 12 semi-structured interviews were undertaken with policymakers and service providers. Data were analysed using thematic analysis. Socio-cultural norms and taboos regarding adolescent sexual behaviour were the most significant factors preventing adolescents from accessing services. These contributed to adolescents' own fear and shame, judgmental attitudes of service providers, and disapproval from parents and community gate-keepers. Lack of confidentiality and privacy, costs, and adolescents' lack of SRH knowledge were also important barriers. Adolescents and service providers identified opportunities to make existing services more youth-friendly. The most important feature of a youth-friendly health service described by adolescents was a friendly service provider. Free or affordable services, reliable commodity supply, confidentiality and privacy were also key features. The need to address socio-cultural norms and community knowledge and attitudes was also highlighted. There are significant demand and supply-side barriers contributing to low utilisation of SRH services by adolescents in Vanuatu. However, there are many opportunities to make existing SRH services more youth-friendly, such as improving service provider training. Investment is also required in strategies that aim to

  6. PLUTONIUM/HIGH-LEVEL VITRIFIED WASTE BDBE DOSE CALCULATION

    Energy Technology Data Exchange (ETDEWEB)

    D.C. Richardson

    2003-03-19

    In accordance with the Nuclear Waste Policy Amendments Act of 1987, Yucca Mountain was designated as the site to be investigated as a potential repository for the disposal of high-level radioactive waste. The Yucca Mountain site is an undeveloped area located on the southwestern edge of the Nevada Test Site (NTS), about 100 miles northwest of Las Vegas. The site currently lacks rail service or an existing right-of-way. If the Yucca Mountain site is found suitable for the repository, rail service is desirable to the Office of Civilian Waste Management (OCRWM) Program because of the potential of rail transportation to reduce costs and to reduce the number of shipments relative to highway transportation. A Preliminary Rail Access Study evaluated 13 potential rail spur options. Alternative routes within the major options were also developed. Each of these options was then evaluated for potential land use conflicts and access to regional rail carriers. Three potential routes having few land use conflicts and having access to regional carriers were recommended for further investigation. Figure 1-1 shows these three routes. The Jean route is estimated to be about 120 miles long, the Carlin route to be about 365 miles long, and Caliente route to be about 365 miles long. The remaining ten routes continue to be monitored and should any of the present conflicts change, a re-evaluation of that route will be made. Complete details of the evaluation of the 13 routes can be found in the previous study. The DOE has not identified any preferred route and recognizes that the transportation issues need a full and open treatment under the National Environmental Policy Act. The issue of transportation will be included in public hearings to support development of the Environmental Impact Statement (EIS) proceedings for either the Monitored Retrievable Storage Facility or the Yucca Mountain Project or both.

  7. High level secretion of cellobiohydrolases by Saccharomyces cerevisiae

    Directory of Open Access Journals (Sweden)

    Ahlgren Simon

    2011-09-01

    Full Text Available Abstract Background The main technological impediment to widespread utilization of lignocellulose for the production of fuels and chemicals is the lack of low-cost technologies to overcome its recalcitrance. Organisms that hydrolyze lignocellulose and produce a valuable product such as ethanol at a high rate and titer could significantly reduce the costs of biomass conversion technologies, and will allow separate conversion steps to be combined in a consolidated bioprocess (CBP. Development of Saccharomyces cerevisiae for CBP requires the high level secretion of cellulases, particularly cellobiohydrolases. Results We expressed various cellobiohydrolases to identify enzymes that were efficiently secreted by S. cerevisiae. For enhanced cellulose hydrolysis, we engineered bimodular derivatives of a well secreted enzyme that naturally lacks the carbohydrate-binding module, and constructed strains expressing combinations of cbh1 and cbh2 genes. Though there was significant variability in the enzyme levels produced, up to approximately 0.3 g/L CBH1 and approximately 1 g/L CBH2 could be produced in high cell density fermentations. Furthermore, we could show activation of the unfolded protein response as a result of cellobiohydrolase production. Finally, we report fermentation of microcrystalline cellulose (Avicel™ to ethanol by CBH-producing S. cerevisiae strains with the addition of beta-glucosidase. Conclusions Gene or protein specific features and compatibility with the host are important for efficient cellobiohydrolase secretion in yeast. The present work demonstrated that production of both CBH1 and CBH2 could be improved to levels where the barrier to CBH sufficiency in the hydrolysis of cellulose was overcome.

  8. Muons in the CMS High Level Trigger System

    Science.gov (United States)

    Verwilligen, Piet; CMS Collaboration

    2016-04-01

    The trigger systems of LHC detectors play a fundamental role in defining the physics capabilities of the experiments. A reduction of several orders of magnitude in the rate of collected events, with respect to the proton-proton bunch crossing rate generated by the LHC, is mandatory to cope with the limits imposed by the readout and storage system. An accurate and efficient online selection mechanism is thus required to fulfill the task keeping maximal the acceptance to physics signals. The CMS experiment operates using a two-level trigger system. Firstly a Level-1 Trigger (L1T) system, implemented using custom-designed electronics, is designed to reduce the event rate to a limit compatible to the CMS Data Acquisition (DAQ) capabilities. A High Level Trigger System (HLT) follows, aimed at further reducing the rate of collected events finally stored for analysis purposes. The latter consists of a streamlined version of the CMS offline reconstruction software and operates on a computer farm. It runs algorithms optimized to make a trade-off between computational complexity, rate reduction and high selection efficiency. With the computing power available in 2012 the maximum reconstruction time at HLT was about 200 ms per event, at the nominal L1T rate of 100 kHz. An efficient selection of muons at HLT, as well as an accurate measurement of their properties, such as transverse momentum and isolation, is fundamental for the CMS physics programme. The performance of the muon HLT for single and double muon triggers achieved in Run I will be presented. Results from new developments, aimed at improving the performance of the algorithms for the harsher scenarios of collisions per event (pile-up) and luminosity expected for Run II will also be discussed.

  9. High levels of serum hyaluronic acid in adults with dermatomyositis

    Directory of Open Access Journals (Sweden)

    Alana Ausciutti Victorino

    2015-04-01

    Full Text Available Background / objectives. Hyaluronic acid (HA is rarely described in dermatomyositis (DM. Thus, we determined any clinical association of serum levels of hyaluronic acid (HA in patients with dermatomyositis (DM. Materials and Methods. This cross-sectional single-center analysis 75 DM and 75 healthy individuals, during the period from January 2012 to July 2013. An anti-HA antibody assay was performed using specific ELISA/EIA kits, according to the manufacturer’s protocol. Results. The patients with DM and control subjects had comparable demographic distributions (p>0.05. The median time duration between disease diagnosis and initial symptoms was 6.0 [3.0-12.0] months, with a median DM disease duration of 4.0 [1.0-7.0] years. The median level of serum HA was significantly increased in patients with DM compared to the control group [329.0 (80.0-958.0 vs. 133.0 (30.0-262.0 ng/mL, respectively; p0.05. Serum HA also did not correlate with gender, ethnicity, auto-antibodies or drug use (p>0.05, but did correlate with cutaneous features, such as photosensitivity (p=0.001, “shawl” sign (p=0.018, “V-neck” sign (p=0.005 and cuticular hypertrophy (p=0.014. Conclusions. A high level of serum AH was observed in DM compared to healthy individuals. In DM, HA did not correlate to demographic, auto-antibodies and therapy parameters. However, HA correlated specifically with some cutaneous features, suggesting that this glycosaminoglycan could be involved in modulating cutaneous inflammation in this population. More studies are necessary to understand the correlation between AH and patients with DM.

  10. Deep borehole disposal of high-level radioactive waste.

    Energy Technology Data Exchange (ETDEWEB)

    Stein, Joshua S.; Freeze, Geoffrey A.; Brady, Patrick Vane; Swift, Peter N.; Rechard, Robert Paul; Arnold, Bill Walter; Kanney, Joseph F.; Bauer, Stephen J.

    2009-07-01

    Preliminary evaluation of deep borehole disposal of high-level radioactive waste and spent nuclear fuel indicates the potential for excellent long-term safety performance at costs competitive with mined repositories. Significant fluid flow through basement rock is prevented, in part, by low permeabilities, poorly connected transport pathways, and overburden self-sealing. Deep fluids also resist vertical movement because they are density stratified. Thermal hydrologic calculations estimate the thermal pulse from emplaced waste to be small (less than 20 C at 10 meters from the borehole, for less than a few hundred years), and to result in maximum total vertical fluid movement of {approx}100 m. Reducing conditions will sharply limit solubilities of most dose-critical radionuclides at depth, and high ionic strengths of deep fluids will prevent colloidal transport. For the bounding analysis of this report, waste is envisioned to be emplaced as fuel assemblies stacked inside drill casing that are lowered, and emplaced using off-the-shelf oilfield and geothermal drilling techniques, into the lower 1-2 km portion of a vertical borehole {approx}45 cm in diameter and 3-5 km deep, followed by borehole sealing. Deep borehole disposal of radioactive waste in the United States would require modifications to the Nuclear Waste Policy Act and to applicable regulatory standards for long-term performance set by the US Environmental Protection Agency (40 CFR part 191) and US Nuclear Regulatory Commission (10 CFR part 60). The performance analysis described here is based on the assumption that long-term standards for deep borehole disposal would be identical in the key regards to those prescribed for existing repositories (40 CFR part 197 and 10 CFR part 63).

  11. Lumbar disc herniation at high levels : MRI and clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Paek, Chung Ho; Kwon, Soon Tae; Lee, Jun Kyu; Ahn, Jae Sung; Lee, Hwan Do; Chung, Yon Su; Jeong, Ki Ho; Cho, Jun Sik [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1999-04-01

    To assess the frequency, location, associated MR findings, and clinical symptoms of the high level lumbar disc herniation(HLDH). A total of 1076 patients with lunbar disc herniation were retrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms of frequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. The prevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in 14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to 72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated disc herniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variable involvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14 patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6 patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) with HLDH(n=41), there was a previous history of trauma. Patients with HLDH showed a relatively high incidence of associated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl's node, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history of trauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relatively nonspecific and their incidence was low.

  12. Stability of High-Level Radioactive Waste Forms

    Energy Technology Data Exchange (ETDEWEB)

    Besmann, T.M.

    2001-06-22

    High-level waste (HLW) glass compositions, processing schemes, limits on waste content, and corrosion/dissolution release models are dependent on an accurate knowledge of melting temperatures and thermochemical values. Unfortunately, existing models for predicting these temperatures are empirically-based, depending on extrapolations of experimental information. In addition, present models of leaching behavior of glass waste forms use simplistic assumptions or experimentally measured values obtained under non-realistic conditions. There is thus a critical need for both more accurate and more widely applicable models for HLW glass behavior, which this project addressed. Significant progress was made in this project on modeling HLW glass. Borosilicate glass was accurately represented along with the additional important components that contain iron, lithium, potassium, magnesium, and calcium. The formation of crystalline inclusions in the glass, an issue in Hanford HLW formulations, was modeled and shown to be predictive. Thus the results of this work have already demonstrated practical benefits with the ability to map compositional regions where crystalline material forms, and therefore avoid that detrimental effect. With regard to a fundamental understanding, added insights on the behavior of the components of glass have been obtained, including the potential formation of molecular clusters. The EMSP project had very significant effects beyond the confines of Environmental Management. The models developed for glass have been used to solve a very costly problem in the corrosion of refractories for glass production. The effort resulted in another laboratory, Sandia National Laboratories-Livermore, to become conversant in the techniques and to apply those through a DOE Office of Industrial Technologies project joint with PPG Industries. The glass industry as a whole is now cognizant of these capabilities, and there is a Glass Manufacturer's Research Institute

  13. “I Am Ready and Willing to Provide the Service … Though My Religion Frowns on Abortion”—Ghanaian Midwives’ Mixed Attitudes to Abortion Services: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Prince Oppong-Darko

    2017-12-01

    Full Text Available Background: Unsafe abortion is a major preventable public health problem and contributes to high mortality among women. Ghana has ratified international conventions to prevent unwanted pregnancies and provide safe abortion services, legally authorizing midwives to provide induced abortion services in certain circumstances. Objective: The aim of the study was to understand midwives’ readiness to be involved in legal induced abortions, should the law become less restricted in Ghana. Methods: A qualitative study design, with a topic guide for individual in-depth interviews of selected midwives, was adopted. The interviews were tape-recorded and analyzed using content analysis. Results: Participants emphasized their willingness to reduce maternal mortalities, their experiences of maternal deaths, and their passion for the health of pregnant women. Knowledge of Ghana’s abortion law was generally low. Different views were expressed regarding readiness to engage in abortion services. Some expressed it as being sinful and against their religion to assist in abortion care, whilst others felt it was good to save the lives of women. Conclusion: The midwives made it clear that unsafe abortions are common, stigmatizing and contributing to maternal mortality, issues that must be addressed. They made various suggestions to reduce this preventable tragedy.

  14. Yucca Mountain, Nevada - A Proposed Geologic Repository for High-Level Radioactive Waste (Volume 1) Introduction

    Energy Technology Data Exchange (ETDEWEB)

    R.A. Levich; J.S. Stuckless

    2006-09-25

    Yucca Mountain in Nevada represents the proposed solution to what has been a lengthy national effort to dispose of high-level radioactive waste, waste which must be isolated from the biosphere for tens of thousands of years. This chapter reviews the background of that national effort and includes some discussion of international work in order to provide a more complete framework for the problem of waste disposal. Other chapters provide the regional geologic setting, the geology of the Yucca Mountain site, the tectonics, and climate (past, present, and future). These last two chapters are integral to prediction of long-term waste isolation.

  15. Knowledge of the self-control benefits of high-level versus low-level construal.

    Science.gov (United States)

    MacGregor, Karen E; Carnevale, Jessica J; Dusthimer, Nicole E; Fujita, Kentaro

    2017-04-01

    Research indicates that inducing high-level construal (processing that highlights invariant, essential features) relative to low-level construal (processing that highlights idiosyncratic, peripheral features) promotes self-control (Fujita & Carnevale, 2012). In the present work, we investigate to what extent people recognize the self-control benefits of high-level construal, and explore the consequences of this knowledge. Studies 1 and 2 provide initial evidence that individuals are aware that high-level relative to low-level construal promotes self-control in the dieting domain. Studies 3 and 4 find that individual differences in this knowledge predict self-control success outcomes (i.e., body mass index) among those who are motivated by dieting goals. Examining academics as a domain of self-control, Study 5 demonstrates that those with higher knowledge of construal level's impact on self-control earned higher end-of-semester grades to the extent that they were motivated to do well academically. Theoretical and practical implications of these findings are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  16. Specifying the Concept of Future Generations for Addressing Issues Related to High-Level Radioactive Waste.

    Science.gov (United States)

    Kermisch, Celine

    2016-12-01

    The nuclear community frequently refers to the concept of "future generations" when discussing the management of high-level radioactive waste. However, this notion is generally not defined. In this context, we have to assume a wide definition of the concept of future generations, conceived as people who will live after the contemporary people are dead. This definition embraces thus each generation following ours, without any restriction in time. The aim of this paper is to show that, in the debate about nuclear waste, this broad notion should be further specified and to clarify the related implications for nuclear waste management policies. Therefore, we provide an ethical analysis of different management strategies for high-level waste in the light of two principles, protection of future generations-based on safety and security-and respect for their choice. This analysis shows that high-level waste management options have different ethical impacts across future generations, depending on whether the memory of the waste and its location is lost, or not. We suggest taking this distinction into account by introducing the notions of "close future generations" and "remote future generations", which has important implications on nuclear waste management policies insofar as it stresses that a retrievable disposal has fewer benefits than usually assumed.

  17. EEG oscillations entrain their phase to high-level features of speech sound.

    Science.gov (United States)

    Zoefel, Benedikt; VanRullen, Rufin

    2016-01-01

    Phase entrainment of neural oscillations, the brain's adjustment to rhythmic stimulation, is a central component in recent theories of speech comprehension: the alignment between brain oscillations and speech sound improves speech intelligibility. However, phase entrainment to everyday speech sound could also be explained by oscillations passively following the low-level periodicities (e.g., in sound amplitude and spectral content) of auditory stimulation-and not by an adjustment to the speech rhythm per se. Recently, using novel speech/noise mixture stimuli, we have shown that behavioral performance can entrain to speech sound even when high-level features (including phonetic information) are not accompanied by fluctuations in sound amplitude and spectral content. In the present study, we report that neural phase entrainment might underlie our behavioral findings. We observed phase-locking between electroencephalogram (EEG) and speech sound in response not only to original (unprocessed) speech but also to our constructed "high-level" speech/noise mixture stimuli. Phase entrainment to original speech and speech/noise sound did not differ in the degree of entrainment, but rather in the actual phase difference between EEG signal and sound. Phase entrainment was not abolished when speech/noise stimuli were presented in reverse (which disrupts semantic processing), indicating that acoustic (rather than linguistic) high-level features play a major role in the observed neural entrainment. Our results provide further evidence for phase entrainment as a potential mechanism underlying speech processing and segmentation, and for the involvement of high-level processes in the adjustment to the rhythm of speech. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Multi-Threaded Algorithms for GPGPU in the ATLAS High Level Trigger

    Science.gov (United States)

    Conde Muíño, P.; ATLAS Collaboration

    2017-10-01

    General purpose Graphics Processor Units (GPGPU) are being evaluated for possible future inclusion in an upgraded ATLAS High Level Trigger farm. We have developed a demonstrator including GPGPU implementations of Inner Detector and Muon tracking and Calorimeter clustering within the ATLAS software framework. ATLAS is a general purpose particle physics experiment located on the LHC collider at CERN. The ATLAS Trigger system consists of two levels, with Level-1 implemented in hardware and the High Level Trigger implemented in software running on a farm of commodity CPU. The High Level Trigger reduces the trigger rate from the 100 kHz Level-1 acceptance rate to 1.5 kHz for recording, requiring an average per-event processing time of ∼ 250 ms for this task. The selection in the high level trigger is based on reconstructing tracks in the Inner Detector and Muon Spectrometer and clusters of energy deposited in the Calorimeter. Performing this reconstruction within the available farm resources presents a significant challenge that will increase significantly with future LHC upgrades. During the LHC data taking period starting in 2021, luminosity will reach up to three times the original design value. Luminosity will increase further to 7.5 times the design value in 2026 following LHC and ATLAS upgrades. Corresponding improvements in the speed of the reconstruction code will be needed to provide the required trigger selection power within affordable computing resources. Key factors determining the potential benefit of including GPGPU as part of the HLT processor farm are: the relative speed of the CPU and GPGPU algorithm implementations; the relative execution times of the GPGPU algorithms and serial code remaining on the CPU; the number of GPGPU required, and the relative financial cost of the selected GPGPU. We give a brief overview of the algorithms implemented and present new measurements that compare the performance of various configurations exploiting GPGPU cards.

  19. ProFET: Feature engineering captures high-level protein functions.

    Science.gov (United States)

    Ofer, Dan; Linial, Michal

    2015-11-01

    The amount of sequenced genomes and proteins is growing at an unprecedented pace. Unfortunately, manual curation and functional knowledge lag behind. Homologous inference often fails at labeling proteins with diverse functions and broad classes. Thus, identifying high-level protein functionality remains challenging. We hypothesize that a universal feature engineering approach can yield classification of high-level functions and unified properties when combined with machine learning approaches, without requiring external databases or alignment. In this study, we present a novel bioinformatics toolkit called ProFET (Protein Feature Engineering Toolkit). ProFET extracts hundreds of features covering the elementary biophysical and sequence derived attributes. Most features capture statistically informative patterns. In addition, different representations of sequences and the amino acids alphabet provide a compact, compressed set of features. The results from ProFET were incorporated in data analysis pipelines, implemented in python and adapted for multi-genome scale analysis. ProFET was applied on 17 established and novel protein benchmark datasets involving classification for a variety of binary and multi-class tasks. The results show state of the art performance. The extracted features' show excellent biological interpretability. The success of ProFET applies to a wide range of high-level functions such as subcellular localization, structural classes and proteins with unique functional properties (e.g. neuropeptide precursors, thermophilic and nucleic acid binding). ProFET allows easy, universal discovery of new target proteins, as well as understanding the features underlying different high-level protein functions. ProFET source code and the datasets used are freely available at https://github.com/ddofer/ProFET. michall@cc.huji.ac.il Supplementary data are available at Bioinformatics online. © The Author 2015. Published by Oxford University Press. All rights

  20. Pseudomonas aeruginosa develops Ciprofloxacin resistance from low to high level with distinctive proteome changes.

    Science.gov (United States)

    Peng, Jianhe; Cao, Jing; Ng, Fui Mee; Hill, Jeffrey

    2017-01-30

    Pseudomonas aeruginosa infection is difficult to treat because of its drug resistance, but how it develops drug resistance remains largely unknown. In this study we investigated Ciprofloxacin resistance development in P. aeruginosa. Different Ciprofloxacin concentrations selected different low level resistant mutants, and high level resistant mutants emerged from low level resistant mutants if stressed further by Ciprofloxacin. A deep quantitative proteomic study of the Ciprofloxacin resistant mutants uncovered the cellular pathways that supported such resistances. The two low level resistant mutants had different molecular mechanisms. One was mainly due to switching to anaerobic respiration and overexpression of catalase and peroxidase, and the other was probably due to iron and polyamine uptake and DNA repair. High level of resistance involved the mexCD-oprJ efflux pump and the downregulation of PQS quorum sensing. Other pathways might also have contributed to high level resistance, like the arginine deiminase pathway, catalase, peroxidase, protein degradation and DNA repair. The intracellular Ciprofloxacin concentration assay indicated that only the mexCD-oprJ overexpressed mutants had low drug accumulation. This study provided a comprehensive overview of the proteomic landscape in the evolution of Ciprofloxacin resistance in P. aeruginosa, and might have implications in diagnosis and treatment of Ciprofloxacin resistant P. aeruginosa. Data are available via ProteomeXchange with identifier PXD004560. Pseudomonas aeruginosa infection is difficult to treat because of its drug resistance, but how it develops drug resistance remains largely unknown. In this study we investigated Ciprofloxacin resistance development in P. aeruginosa. We found that Ciprofloxacin resistance developed from low to high level. Two different low levels resistant molecular mechanisms were discovered from different mutants selected by different Ciprofloxacin concentrations, one was mainly

  1. High-Level Vision and Planning Workshop Proceedings

    Science.gov (United States)

    1989-08-01

    Correspondence in Line Drawings of Multiple View-. In Proc. of 8th Intern. Joint Conf. on Artificial intellignece . 1983. [63] Tomiyasu, K. Tutorial...joint U.S.-Israeli workshop on artificial intelligence are provided in this Institute for Defense Analyses document. This document is based on a broad...participants is provided along with applicable references for individual papers. 14. SUBJECT TERMS 15. NUMBER OF PAGES Artificial Intelligence; Machine Vision

  2. The role of high level play as a predictor social functioning in autism.

    Science.gov (United States)

    Manning, Margaret M; Wainwright, Laurel D

    2010-05-01

    Play and social abilities of a group of children diagnosed with high functioning autism were compared to a second group diagnosed with a variety of developmental language disorders (DLD). The children with autism engaged in fewer acts of high level play. The children with autism also had significantly lower social functioning than the DLD group early in the play session; however, these differences were no longer apparent by the end of the play session. In addition, a significant association existed between play and social functioning regardless of diagnosis. This suggests that play may act as a current indicator of social ability while providing an arena for social skills practice.

  3. Vestibular contributions to high-level sensorimotor functions

    NARCIS (Netherlands)

    Medendorp, W.P.; Selen, L.P.J.

    2017-01-01

    The vestibular system, which detects motion and orientation of the head in space, is known to be important in controlling gaze to stabilize vision, to ensure postural stability and to provide our sense of self-motion. While the brain's computations underlying these functions are extensively studied,

  4. Ethical challenges related to elder care. High level decision-makers' experiences

    Directory of Open Access Journals (Sweden)

    Kihlgren Mona

    2007-04-01

    Full Text Available Abstract Background Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. Methods A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Results Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Conclusion Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to

  5. Automatic compilation from high-level biologically-oriented programming language to genetic regulatory networks.

    Science.gov (United States)

    Beal, Jacob; Lu, Ting; Weiss, Ron

    2011-01-01

    The field of synthetic biology promises to revolutionize our ability to engineer biological systems, providing important benefits for a variety of applications. Recent advances in DNA synthesis and automated DNA assembly technologies suggest that it is now possible to construct synthetic systems of significant complexity. However, while a variety of novel genetic devices and small engineered gene networks have been successfully demonstrated, the regulatory complexity of synthetic systems that have been reported recently has somewhat plateaued due to a variety of factors, including the complexity of biology itself and the lag in our ability to design and optimize sophisticated biological circuitry. To address the gap between DNA synthesis and circuit design capabilities, we present a platform that enables synthetic biologists to express desired behavior using a convenient high-level biologically-oriented programming language, Proto. The high level specification is compiled, using a regulatory motif based mechanism, to a gene network, optimized, and then converted to a computational simulation for numerical verification. Through several example programs we illustrate the automated process of biological system design with our platform, and show that our compiler optimizations can yield significant reductions in the number of genes (~ 50%) and latency of the optimized engineered gene networks. Our platform provides a convenient and accessible tool for the automated design of sophisticated synthetic biological systems, bridging an important gap between DNA synthesis and circuit design capabilities. Our platform is user-friendly and features biologically relevant compiler optimizations, providing an important foundation for the development of sophisticated biological systems.

  6. Qualitative Methods Overview

    OpenAIRE

    Moriarty, Joanna

    2011-01-01

    The social care evidence base reveals a distinct preference for qualitative methods covering a broad range of social care topics. This review provides an introduction to the different ways in which qualitative research has been used in social care and some of the reasons why it has been successful in identifying under-researched areas, in documenting the experiences of people using services, carers, and practitioners, and in evaluating new types of service or intervention. Examples of complet...

  7. High Level Architecture (HLA) federation with Umbra and OPNET federates.

    Energy Technology Data Exchange (ETDEWEB)

    Oppel, Fred John III; Hart, Brian; Van Leeuwen, Brian P.

    2004-03-01

    Network-centric systems that depend on mobile wireless ad hoc networks for their information exchange require detailed analysis to support their development. In many cases, this critical analysis is best provided with high-fidelity system simulations that include the effects of network architectures and protocols. In this research, we developed a high-fidelity system simulation capability using an HLA federation. The HLA federation, consisting of the Umbra system simulator and OPNET Modeler network simulator, provides a means for the system simulator to both affect, and be affected by, events in the network simulator. Advances are also made in increasing the fidelity of the wireless communication channel and reducing simulation run-time with a dead reckoning capability. A simulation experiment is included to demonstrate the developed modeling and simulation capability.

  8. Phylogeographic reconstruction of a bacterial species with high levels of lateral gene transfer

    Directory of Open Access Journals (Sweden)

    Kaul Rajinder

    2009-11-01

    Full Text Available Abstract Background Phylogeographic reconstruction of some bacterial populations is hindered by low diversity coupled with high levels of lateral gene transfer. A comparison of recombination levels and diversity at seven housekeeping genes for eleven bacterial species, most of which are commonly cited as having high levels of lateral gene transfer shows that the relative contributions of homologous recombination versus mutation for Burkholderia pseudomallei is over two times higher than for Streptococcus pneumoniae and is thus the highest value yet reported in bacteria. Despite the potential for homologous recombination to increase diversity, B. pseudomallei exhibits a relative lack of diversity at these loci. In these situations, whole genome genotyping of orthologous shared single nucleotide polymorphism loci, discovered using next generation sequencing technologies, can provide very large data sets capable of estimating core phylogenetic relationships. We compared and searched 43 whole genome sequences of B. pseudomallei and its closest relatives for single nucleotide polymorphisms in orthologous shared regions to use in phylogenetic reconstruction. Results Bayesian phylogenetic analyses of >14,000 single nucleotide polymorphisms yielded completely resolved trees for these 43 strains with high levels of statistical support. These results enable a better understanding of a separate analysis of population differentiation among >1,700 B. pseudomallei isolates as defined by sequence data from seven housekeeping genes. We analyzed this larger data set for population structure and allele sharing that can be attributed to lateral gene transfer. Our results suggest that despite an almost panmictic population, we can detect two distinct populations of B. pseudomallei that conform to biogeographic patterns found in many plant and animal species. That is, separation along Wallace's Line, a biogeographic boundary between Southeast Asia and Australia

  9. Phylogeographic reconstruction of a bacterial species with high levels of lateral gene transfer

    Science.gov (United States)

    Pearson, T.; Giffard, P.; Beckstrom-Sternberg, S.; Auerbach, R.; Hornstra, H.; Tuanyok, A.; Price, E.P.; Glass, M.B.; Leadem, B.; Beckstrom-Sternberg, J. S.; Allan, G.J.; Foster, J.T.; Wagner, D.M.; Okinaka, R.T.; Sim, S.H.; Pearson, O.; Wu, Z.; Chang, J.; Kaul, R.; Hoffmaster, A.R.; Brettin, T.S.; Robison, R.A.; Mayo, M.; Gee, J.E.; Tan, P.; Currie, B.J.; Keim, P.

    2009-01-01

    Background: Phylogeographic reconstruction of some bacterial populations is hindered by low diversity coupled with high levels of lateral gene transfer. A comparison of recombination levels and diversity at seven housekeeping genes for eleven bacterial species, most of which are commonly cited as having high levels of lateral gene transfer shows that the relative contributions of homologous recombination versus mutation for Burkholderia pseudomallei is over two times higher than for Streptococcus pneumoniae and is thus the highest value yet reported in bacteria. Despite the potential for homologous recombination to increase diversity, B. pseudomallei exhibits a relative lack of diversity at these loci. In these situations, whole genome genotyping of orthologous shared single nucleotide polymorphism loci, discovered using next generation sequencing technologies, can provide very large data sets capable of estimating core phylogenetic relationships. We compared and searched 43 whole genome sequences of B. pseudomallei and its closest relatives for single nucleotide polymorphisms in orthologous shared regions to use in phylogenetic reconstruction. Results: Bayesian phylogenetic analyses of >14,000 single nucleotide polymorphisms yielded completely resolved trees for these 43 strains with high levels of statistical support. These results enable a better understanding of a separate analysis of population differentiation among >1,700 B. pseudomallei isolates as defined by sequence data from seven housekeeping genes. We analyzed this larger data set for population structure and allele sharing that can be attributed to lateral gene transfer. Our results suggest that despite an almost panmictic population, we can detect two distinct populations of B. pseudomallei that conform to biogeographic patterns found in many plant and animal species. That is, separation along Wallace's Line, a biogeographic boundary between Southeast Asia and Australia. Conclusion: We describe an

  10. An approximate-reasoning-based method for screening high-level waste tanks for flammable gas

    Energy Technology Data Exchange (ETDEWEB)

    Eisenhawer, S.W.; Bott, T.F.; Smith, R.E.

    1998-07-01

    The in situ retention of flammable gas produced by radiolysis and thermal decomposition in high-level waste can pose a safety problem if the gases are released episodically into the dome space of a storage tank. Screening efforts at Hanford have been directed at identifying tanks in which this situation could exist. Problems encountered in screening motivated an effort to develop an improved screening methodology. Approximate reasoning (AR) is a formalism designed to emulate the kinds of complex judgments made by subject matter experts. It uses inductive logic structures to build a sequence of forward-chaining inferences about a subject. AR models incorporate natural language expressions known as linguistic variables to represent evidence. The use of fuzzy sets to represent these variables mathematically makes it practical to evaluate quantitative and qualitative information consistently. The authors performed a pilot study to investigate the utility of AR for flammable gas screening. They found that the effort to implement such a model was acceptable and that computational requirements were reasonable. The preliminary results showed that important judgments about the validity of observational data and the predictive power of models could be made. These results give new insights into the problems observed in previous screening efforts.

  11. FADO 2.0: A high level tagging language

    Science.gov (United States)

    Werner, C. M. L.; Pimenta, M.; Varela, J.; Souza, J.

    1989-12-01

    FADO 2.0 is a high language, developed in the context of the 4th level trigger of the DELPHI data acquisition project at CERN, that provides a simple and consice way to define physics criteria for event tagging. Its syntax is based on mathematical logic and set theory, as it was found the most appropriate framework to describe the properties of single HEP events. The language is one of the components of the FADO tagging system. The system also implements implicity a mechanism to selectively reconstruct the event data that are needed to fulfil the physics criteria, following the speed requirements of the online data-acquisition system. A complete programming environment is now under development, which will include a syntax directed editor, and incremental compiler, a debugger and a configurer. This last tool can be used to transport the system into the context of other HEP applications, namely offline event selection and filtering.

  12. Sandia National Laboratories' new high level acoustic test facility

    Energy Technology Data Exchange (ETDEWEB)

    Rogers, J. D.; Hendrick, D. M.

    1989-01-01

    A high intensity acoustic test facility has been designed and is under construction at Sandia National Laboratories in Albuquerque, NM. The chamber is designed to provide an acoustic environment of 154dB (re 20 {mu}Pa) overall sound pressure level over the bandwidth of 50 Hz to 10,000 Hz. The chamber has a volume of 16,000 cubic feet with interior dimensions of 21.6 ft {times} 24.6 ft {times} 30 ft. The construction of the chamber should be complete by the summer of 1990. This paper discusses the design goals and constraints of the facility. The construction characteristics are discussed in detail, as are the acoustic performance design characteristics. The authors hope that this work will help others in designing acoustic chambers. 12 refs., 6 figs.

  13. Intermittent Testing and Training for High-Level Football Players

    DEFF Research Database (Denmark)

    Ingebrigtsen, Jørgen

    on the Yo-Yo IR2 test and other field- and laboratory tests of intermittent interval training performed as anaerobic speed-endurance production training is very limited for football players. Hence, this latter question is examined in Study IV.In Study I we find no differences in anthropometric...... times, RSA, or jump performances. Hence, our results indicate that short-term anaerobic production training is effective for improving acceleration and intermittent exercise performance among well-trained junior elite players.In conclusion, the present thesis provides evidence that the traditional...... on four articles that focus on physical testing and training for elite and sub-elite football players.The first article (Study I) aims to identify and establish aerobic capacities and anthropometric characteristics of elite female football players with the use of laboratory tests, and to examine whether...

  14. Spray Calciner/In-Can Melter high-level waste solidification technical manual

    Energy Technology Data Exchange (ETDEWEB)

    Larson, D.E. (ed.)

    1980-09-01

    This technical manual summarizes process and equipment technology developed at Pacific Northwest Laboratory over the last 20 years for vitrification of high-level liquid waste by the Spray Calciner/In-Can Melter process. Pacific Northwest Laboratory experience includes process development and demonstration in laboratory-, pilot-, and full-scale equipment using nonradioactive synthetic wastes. Also, laboratory- and pilot-scale process demonstrations have been conducted using actual high-level radioactive wastes. In the course of process development, more than 26 tonnes of borosilicate glass have been produced in 75 canisters. Four of these canisters contained radioactive waste glass. The associated process and glass chemistry is discussed. Technology areas described include calciner feed treatment and techniques, calcination, vitrification, off-gas treatment, glass containment (the canister), and waste glass chemistry. Areas of optimization and site-specific development that would be needed to adapt this base technology for specific plant application are indicated. A conceptual Spray Calciner/In-Can Melter system design and analyses are provided in the manual to assist prospective users in evaluating the process for plant application, to provide equipment design information, and to supply information for safety analyses and environmental reports. The base (generic) technology for the Spray Calciner/In-Can Melter process has been developed to a point at which it is ready for plant application.

  15. High-level waste borosilicate glass: A compendium of corrosion characteristics. Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    Cunnane, J.C. [comp.; Bates, J.K.; Bradley, C.R. [Argonne National Lab., IL (United States)] [and others

    1994-03-01

    The objective of this document is to summarize scientific information pertinent to evaluating the extent to which high-level waste borosilicate glass corrosion and the associated radionuclide release processes are understood for the range of environmental conditions to which waste glass may be exposed in service. Alteration processes occurring within the bulk of the glass (e.g., devitrification and radiation-induced changes) are discussed insofar as they affect glass corrosion.This document is organized into three volumes. Volumes I and II represent a tiered set of information intended for somewhat different audiences. Volume I is intended to provide an overview of waste glass corrosion, and Volume 11 is intended to provide additional experimental details on experimental factors that influence waste glass corrosion. Volume III contains a bibliography of glass corrosion studies, including studies that are not cited in Volumes I and II. Volume I is intended for managers, decision makers, and modelers, the combined set of Volumes I, II, and III is intended for scientists and engineers working in the field of high-level waste.

  16. High-level managers' considerations for RFID adoption in hospitals: an empirical study in Taiwan.

    Science.gov (United States)

    Lai, Hui-Min; Lin, I-Chun; Tseng, Ling-Tzu

    2014-02-01

    Prior researches have indicated that an appropriate adoption of information technology (IT) can help hospitals significantly improve services and operations. Radio Frequency Identification (RFID) is believed to be the next generation innovation technology for automatic data collection and asset/people tracking. Based on the Technology-Organization-Environment (TOE) framework, this study investigated high-level managers' considerations for RFID adoption in hospitals. This research reviewed literature related IT adoption in business and followed the results of a preliminary survey with 37 practical experts in hospitals to theorize a model for the RFID adoption in hospitals. Through a field survey of 102 hospitals and hypotheses testing, this research identified key factors influencing RFID adoption. Follow-up in-depth interviews with three high-level managers of IS department from three case hospitals respectively also presented an insight into the decision of RFID's adoption. Based on the research findings, cost, ubiquity, compatibility, security and privacy risk, top management support, hospital scale, financial readiness and government policy were concluded to be the key factors influencing RFID adoption in hospitals. For practitioners, this study provided a comprehensive overview of government policies able to promote the technology, while helping the RFID solution providers understand how to reduce the IT barriers in order to enhance hospitals' willingness to adopt RFID.

  17. LANL High-Level Model (HLM) database development letter report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-10-01

    Traditional methods of evaluating munitions have been able to successfully compare like munition`s capabilities. On the modern battlefield, however, many different types of munitions compete for the same set of targets. Assessing the overall stockpile capability and proper mix of these weapons is not a simple task, as their use depends upon the specific geographic region of the world, the threat capabilities, the tactics and operational strategy used by both the US and Threat commanders, and of course the type and quantity of munitions available to the CINC. To sort out these types of issues, a hierarchical set of dynamic, two-sided combat simulations are generally used. The DoD has numerous suitable models for this purpose, but rarely are the models focused on munitions expenditures. Rather, they are designed to perform overall platform assessments and force mix evaluations. However, in some cases, the models could be easily adapted to provide this information, since it is resident in the model`s database. Unfortunately, these simulations` complexity (their greatest strength) precludes quick turnaround assessments of the type and scope required by senior decision-makers.

  18. High levels of vicarious exposure bias pain judgments.

    Science.gov (United States)

    Prkachin, Kenneth M; Rocha, Elizabete M

    2010-09-01

    The present study evaluated the effects of exposure to facial expression of pain, on observers' perceptions of pain expression. Participants were undergraduates shown brief video clips of the facial expressions of shoulder-pain patients displaying no pain or moderate pain. Participants were randomly allocated to either a high preexposure condition in which each clip was preceded by 10 other clips showing strong pain or a no-exposure control. On each test trial, participants indicated whether they thought the person they saw was in pain or not. Data were analyzed using signal detection theory methods. High prior exposure to pain was unrelated to sensitivity to pain expression, but did significantly diminish the likelihood of judging the other to be in pain. Results are discussed in terms of their implications for pain judgments of health-care professionals, adaptation-level theory, and the psychophysical method of selective adaptation. This paper provides an experimental demonstration that, when people have large amounts of exposure to others' expressions of pain, their estimation of others' pain is reduced. The findings offer 1 explanation for the widely observed underestimation bias in pain judgments and may suggest ways of changing it. Copyright 2010. Published by Elsevier Inc.

  19. Survey of degradation modes of candidate materials for high-level radioactive-waste disposal containers

    Energy Technology Data Exchange (ETDEWEB)

    Gdowski, G.E.; Bullen, D.B. (Science and Engineering Associates, Inc., Pleasanton, CA (USA))

    1988-08-01

    Three copper-based alloys and three iron- to nickel-based austenitic alloys are being considered as possible materials for fabrication of containers for disposal of high-level radioactive waste. This waste will include spent fuel assemblies from reactors as well as high-level waste in borosilicate glass and will be sent to the prospective site at Yucca Mountain, Nevada, for disposal. The containers must maintain substantially complete containment for at least 300 yr and perhaps as long as 1000 yr. During the first 50 yr after emplacement, they must be retrievable from the disposal site. Shortly after the containers are emplaced in the repository, they will be exposed to high temperatures and high gamma radiation fields from the decay of the high-level waste. This volume surveys the available data on oxidation and corrosion of the iron- to nickel-based austenitic materials (Types 304L and 316L stainless steels and Alloy 825) and the copper-based alloy materials (CDA 102 (oxygen-free copper), CDA 613 (Cu-7Al), and CDA 715 (Cu-30Ni)), which are the present candidates for fabrication of the containers. Studies that provided a large amount of data are highlighted, and those areas in which little data exists are identified. Examples of successful applications of these materials are given. On the basis of resistance to oxidation and general corrosion, the austenitic materials are ranked as follows: Alloy 825 (best), Type 316L stainless steel, and then Type 304L stainless steel (worst). For the copper-based materials, the ranking is as follows: CDA 715 and CDA 613 (both best), and CDA 102 (worst). 110 refs., 30 figs., 13 tabs.

  20. Application of new technologies for characterization of Hanford Site high-level waste

    Energy Technology Data Exchange (ETDEWEB)

    Winters, W.I.

    1998-02-03

    To support remediation of Hanford Site high-level radioactive waste tanks, new chemical and physical measurement technologies must be developed and deployed. This is a major task of the Chemistry Analysis Technology Support (CATS) group of the Hanford Corporation. New measurement methods are required for efficient and economical resolution of tank waste safety, waste retrieval, and disposal issues. These development and deployment activities are performed in cooperation with Waste Management Federal Services of Hanford, Inc. This paper provides an overview of current analytical technologies in progress. The high-level waste at the Hanford Site is chemically complex because of the numerous processes used in past nuclear fuel reprocessing there, and a variety of technologies is required for effective characterization. Programmatic and laboratory operational needs drive the selection of new technologies for characterizing Hanford Site high-level waste, and these technologies are developed for deployment in laboratories, hot cells or in the field. New physical methods, such as the propagating reactive systems screening tool (PRSST) to measure the potential for self-propagating reactions in stored wastes, are being implemented. Technology for sampling and measuring gases trapped within the waste matrix is being used to evaluate flammability hazards associated with gas releases from stored wastes. Application of new inductively coupled plasma and laser ablation mass spectrometry systems at the Hanford Site`s 222-S Laboratory will be described. A Raman spectroscopy probe mounted in a cone penetrometer to measure oxyanions in wastes or soils will be described. The Hanford Site has used large volumes of organic complexants and acids in processing waste, and capillary zone electrophoresis (CZE) methods have been developed for determining several of the major organic components in complex waste tank matrices. The principles involved, system installation, and results from

  1. Reference design and operations for deep borehole disposal of high-level radioactive waste.

    Energy Technology Data Exchange (ETDEWEB)

    Herrick, Courtney Grant; Brady, Patrick Vane; Pye, Steven; Arnold, Bill Walter; Finger, John Travis; Bauer, Stephen J.

    2011-10-01

    A reference design and operational procedures for the disposal of high-level radioactive waste in deep boreholes have been developed and documented. The design and operations are feasible with currently available technology and meet existing safety and anticipated regulatory requirements. Objectives of the reference design include providing a baseline for more detailed technical analyses of system performance and serving as a basis for comparing design alternatives. Numerous factors suggest that deep borehole disposal of high-level radioactive waste is inherently safe. Several lines of evidence indicate that groundwater at depths of several kilometers in continental crystalline basement rocks has long residence times and low velocity. High salinity fluids have limited potential for vertical flow because of density stratification and prevent colloidal transport of radionuclides. Geochemically reducing conditions in the deep subsurface limit the solubility and enhance the retardation of key radionuclides. A non-technical advantage that the deep borehole concept may offer over a repository concept is that of facilitating incremental construction and loading at multiple perhaps regional locations. The disposal borehole would be drilled to a depth of 5,000 m using a telescoping design and would be logged and tested prior to waste emplacement. Waste canisters would be constructed of carbon steel, sealed by welds, and connected into canister strings with high-strength connections. Waste canister strings of about 200 m length would be emplaced in the lower 2,000 m of the fully cased borehole and be separated by bridge and cement plugs. Sealing of the upper part of the borehole would be done with a series of compacted bentonite seals, cement plugs, cement seals, cement plus crushed rock backfill, and bridge plugs. Elements of the reference design meet technical requirements defined in the study. Testing and operational safety assurance requirements are also defined. Overall

  2. THE OCCURRENCE OF HIGH-LEVELS OF ACUTE BEHAVIORAL DISTRESS IN CHILDREN AND ADOLESCENTS UNDERGOING ROUTINE VENIPUNCTURES

    NARCIS (Netherlands)

    HUMPHREY, GB; BOON, CMJ; VANDENHEUVELL, GFECV; VANDEWIEL, HBM

    While there is no question that children dislike needles, there are very little data available on the occurrence of high levels of distress experienced by children undergoing routine venipunctures. To provide some insight into this problem, trained observers evaluated distress in 223 different

  3. Foreign programs for the storage of spent nuclear power plant fuels, high-level waste canisters and transuranic wastes

    Energy Technology Data Exchange (ETDEWEB)

    Harmon, K.M.; Johnson, A.B. Jr.

    1984-04-01

    The various national programs for developing and applying technology for the interim storage of spent fuel, high-level radioactive waste, and TRU wastes are summarized. Primary emphasis of the report is on dry storage techniques for uranium dioxide fuels, but data are also provided concerning pool storage.

  4. Can Sisyphus succeed? Getting U.S. high-level nuclear waste into a geological repository.

    Science.gov (United States)

    North, D Warner

    2013-01-01

    The U.S. government has the obligation of managing the high-level radioactive waste from its defense activities and also, under existing law, from civilian nuclear power generation. This obligation is not being met. The January 2012 Final Report from the Blue Ribbon Commission on America's Nuclear Future provides commendable guidance but little that is new. The author, who served on the federal Nuclear Waste Technical Review Board from 1989 to 1994 and subsequently on the Board on Radioactive Waste Management of the National Research Council from 1994 to 1999, provides a perspective both on the Commission's recommendations and a potential path toward progress in meeting the federal obligation. By analogy to Sisyphus of Greek mythology, our nation needs to find a way to roll the rock to the top of the hill and have it stay there, rather than continuing to roll back down again. © 2012 Society for Risk Analysis.

  5. Strontium and Actinide Separations from High Level Nuclear Waste Solutions using Monosodium Titanate - Actual Waste Testing

    Energy Technology Data Exchange (ETDEWEB)

    Peters, T.B.; Barnes, M.J.; Hobbs,D.T.; Walker, D.D.; Fondeur, F.F.; Norato, M.A.; Pulmano, R.L.; Fink, S.D.

    2005-11-01

    Pretreatment processes at the Savannah River Site will separate {sup 90}Sr, alpha-emitting and radionuclides (i.e., actinides) and {sup 137}Cs prior to disposal of the high-level nuclear waste. Separation of {sup 90}Sr and alpha-emitting radionuclides occurs by ion exchange/adsorption using an inorganic material, monosodium titanate (MST). Previously reported testing with simulants indicates that the MST exhibits high selectivity for strontium and actinides in high ionic strength and strongly alkaline salt solutions. This paper provides a summary of data acquired to measure the performance of MST to remove strontium and actinides from actual waste solutions. These tests evaluated the effects of ionic strength, mixing, elevated alpha activities, and multiple contacts of the waste with MST. Tests also provided confirmation that MST performs well at much larger laboratory scales (300-700 times larger) and exhibits little affinity for desorption of strontium and plutonium during washing.

  6. Comparing Self-Regulation-Associated Event Related Potentials in Preschool Children with and without High Levels of Disruptive Behavior.

    Science.gov (United States)

    Grabell, Adam S; Olson, Sheryl L; Tardif, Twila; Thompson, Meaghan C; Gehring, William J

    2017-08-01

    Deficient self-regulation plays a key role in the etiology of early onset disruptive behavior disorders and signals risk for chronic psychopathology. However, to date, there has been no research comparing preschool children with and without high levels of disruptive behavior using Event Related Potentials (ERPs) associated with specific self-regulation sub-processes. We examined 15 preschool children with high levels of disruptive behavior (35 % female) and 20 peers with low disruptive behavior (50 % female) who completed a Go/No-go task that provided emotionally valenced feedback. We tested whether 4 ERP components: the Error Related Negativity, the Error Positivity, the Feedback Related Negativity, and the No-go N2, differed in preschool children with and without high levels of disruptive behavior. Preschoolers with high levels of disruptive behavior showed less differentiation between the Error Positivity and corresponding waveforms following correct responses at posterior sites. Preschoolers with high and low disruptive behavior also showed differences in Go/No-go N2 waveform amplitudes across electrodes. These findings suggest that preschool children with high levels of disruptive behavior may show abnormal brain activity during certain self-regulation sub-processes, informing potential advances in conceptualizing and treating early disruptive behavior.

  7. Hanford High-Level Waste Vitrification Program at the Pacific Northwest National Laboratory: technology development - annotated bibliography

    Energy Technology Data Exchange (ETDEWEB)

    Larson, D.E.

    1996-09-01

    This report provides a collection of annotated bibliographies for documents prepared under the Hanford High-Level Waste Vitrification (Plant) Program. The bibliographies are for documents from Fiscal Year 1983 through Fiscal Year 1995, and include work conducted at or under the direction of the Pacific Northwest National Laboratory. The bibliographies included focus on the technology developed over the specified time period for vitrifying Hanford pretreated high-level waste. The following subject areas are included: General Documentation; Program Documentation; High-Level Waste Characterization; Glass Formulation and Characterization; Feed Preparation; Radioactive Feed Preparation and Glass Properties Testing; Full-Scale Feed Preparation Testing; Equipment Materials Testing; Melter Performance Assessment and Evaluations; Liquid-Fed Ceramic Melter; Cold Crucible Melter; Stirred Melter; High-Temperature Melter; Melter Off-Gas Treatment; Vitrification Waste Treatment; Process, Product Control and Modeling; Analytical; and Canister Closure, Decontamination, and Handling

  8. Commentary: Writing and evaluating qualitative research reports

    Science.gov (United States)

    An overview of qualitative methods is provided, particularly for reviewers and authors who may be less familiar with qualitative research. A question and answer format is used to address considerations for writing and evaluating qualitative research. When producing qualitative research, individuals ...

  9. Impaired global, and compensatory local, biological motion processing in people with high levels of autistic traits

    Directory of Open Access Journals (Sweden)

    Jeroen J A Van Boxtel

    2013-04-01

    Full Text Available People with Autism Spectrum Disorder (ASD are hypothesized to have poor high-level processing but superior low-level processing, causing impaired social recognition, and a focus on non-social stimulus contingencies. Biological motion perception provides an ideal domain to investigate exactly how ASD modulates the interaction between low and high-level processing, because it involves multiple processing stages, and carries many important social cues. We investigated individual differences among typically developing observers in biological motion processing, and whether such individual differences associate with the number of autistic traits. In Experiment 1, we found that individuals with fewer autistic traits were automatically and involuntarily attracted to global biological motion information, whereas individuals with more autistic traits did not show this pre-attentional distraction. We employed an action adaptation paradigm in the second study to show that individuals with more autistic traits were able to compensate for deficits in global processing with an increased involvement in local processing. Our findings can be interpreted within a predictive coding framework, which characterizes the functional relationship between local and global processing stages, and explains how these stages contribute to the perceptual difficulties associated with ASD.

  10. Automatic Generation of Optimized and Synthesizable Hardware Implementation from High-Level Dataflow Programs

    Directory of Open Access Journals (Sweden)

    Khaled Jerbi

    2012-01-01

    Full Text Available In this paper, we introduce the Reconfigurable Video Coding (RVC standard based on the idea that video processing algorithms can be defined as a library of components that can be updated and standardized separately. MPEG RVC framework aims at providing a unified high-level specification of current MPEG coding technologies using a dataflow language called Cal Actor Language (CAL. CAL is associated with a set of tools to design dataflow applications and to generate hardware and software implementations. Before this work, the existing CAL hardware compilers did not support high-level features of the CAL. After presenting the main notions of the RVC standard, this paper introduces an automatic transformation process that analyses the non-compliant features and makes the required changes in the intermediate representation of the compiler while keeping the same behavior. Finally, the implementation results of the transformation on video and still image decoders are summarized. We show that the obtained results can largely satisfy the real time constraints for an embedded design on FPGA as we obtain a throughput of 73 FPS for MPEG 4 decoder and 34 FPS for coding and decoding process of the LAR coder using a video of CIF image size. This work resolves the main limitation of hardware generation from CAL designs.

  11. Automatic Compilation from High-Level Biologically-Oriented Programming Language to Genetic Regulatory Networks

    Science.gov (United States)

    Beal, Jacob; Lu, Ting; Weiss, Ron

    2011-01-01

    Background The field of synthetic biology promises to revolutionize our ability to engineer biological systems, providing important benefits for a variety of applications. Recent advances in DNA synthesis and automated DNA assembly technologies suggest that it is now possible to construct synthetic systems of significant complexity. However, while a variety of novel genetic devices and small engineered gene networks have been successfully demonstrated, the regulatory complexity of synthetic systems that have been reported recently has somewhat plateaued due to a variety of factors, including the complexity of biology itself and the lag in our ability to design and optimize sophisticated biological circuitry. Methodology/Principal Findings To address the gap between DNA synthesis and circuit design capabilities, we present a platform that enables synthetic biologists to express desired behavior using a convenient high-level biologically-oriented programming language, Proto. The high level specification is compiled, using a regulatory motif based mechanism, to a gene network, optimized, and then converted to a computational simulation for numerical verification. Through several example programs we illustrate the automated process of biological system design with our platform, and show that our compiler optimizations can yield significant reductions in the number of genes () and latency of the optimized engineered gene networks. Conclusions/Significance Our platform provides a convenient and accessible tool for the automated design of sophisticated synthetic biological systems, bridging an important gap between DNA synthesis and circuit design capabilities. Our platform is user-friendly and features biologically relevant compiler optimizations, providing an important foundation for the development of sophisticated biological systems. PMID:21850228

  12. Automatic compilation from high-level biologically-oriented programming language to genetic regulatory networks.

    Directory of Open Access Journals (Sweden)

    Jacob Beal

    Full Text Available The field of synthetic biology promises to revolutionize our ability to engineer biological systems, providing important benefits for a variety of applications. Recent advances in DNA synthesis and automated DNA assembly technologies suggest that it is now possible to construct synthetic systems of significant complexity. However, while a variety of novel genetic devices and small engineered gene networks have been successfully demonstrated, the regulatory complexity of synthetic systems that have been reported recently has somewhat plateaued due to a variety of factors, including the complexity of biology itself and the lag in our ability to design and optimize sophisticated biological circuitry.To address the gap between DNA synthesis and circuit design capabilities, we present a platform that enables synthetic biologists to express desired behavior using a convenient high-level biologically-oriented programming language, Proto. The high level specification is compiled, using a regulatory motif based mechanism, to a gene network, optimized, and then converted to a computational simulation for numerical verification. Through several example programs we illustrate the automated process of biological system design with our platform, and show that our compiler optimizations can yield significant reductions in the number of genes (~ 50% and latency of the optimized engineered gene networks.Our platform provides a convenient and accessible tool for the automated design of sophisticated synthetic biological systems, bridging an important gap between DNA synthesis and circuit design capabilities. Our platform is user-friendly and features biologically relevant compiler optimizations, providing an important foundation for the development of sophisticated biological systems.

  13. Independent Assessment of the Savannah River Site High-Level Waste Salt Disposition Alternatives Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    J. T. Case (DOE-ID); M. L. Renfro (INEEL)

    1998-12-01

    This report presents the results of the Independent Project Evaluation (IPE) Team assessment of the Westinghouse Savannah River Company High-Level Waste Salt Disposition Systems Engineering (SE) Team's deliberations, evaluations, and selections. The Westinghouse Savannah River Company concluded in early 1998 that production goals and safety requirements for processing SRS HLW salt to remove Cs-137 could not be met in the existing In-Tank Precipitation Facility as currently configured for precipitation of cesium tetraphenylborate. The SE Team was chartered to evaluate and recommend an alternative(s) for processing the existing HLW salt to remove Cs-137. To replace the In-Tank Precipitation process, the Savannah River Site HLW Salt Disposition SE Team downselected (October 1998) 140 candidate separation technologies to two alternatives: Small-Tank Tetraphenylborate (TPB) Precipitation (primary alternative) and Crystalline Silicotitanate (CST) Nonelutable Ion Exchange (backup alternative). The IPE Team, commissioned by the Department of Energy, concurs that both alternatives are technically feasible and should meet all salt disposition requirements. But the IPE Team judges that the SE Team's qualitative criteria and judgments used in their downselection to a primary and a backup alternative do not clearly discriminate between the two alternatives. To properly choose between Small-Tank TPB and CST Ion Exchange for the primary alternative, the IPE Team suggests the following path forward: Complete all essential R and D activities for both alternatives and formulate an appropriate set of quantitative decision criteria that will be rigorously applied at the end of the R and D activities. Concurrent conceptual design activities should be limited to common elements of the alternatives.

  14. Commissioning of the CMS High-Level Trigger with Cosmic Rays

    CERN Document Server

    Chatrchyan, S; Sirunyan, A M; Adam, W; Arnold, B; Bergauer, H; Bergauer, T; Dragicevic, M; Eichberger, M; Erö, J; Friedl, M; Frühwirth, R; Ghete, V M; Hammer, J; Hänsel, S; Hoch, M; Hörmann, N; Hrubec, J; Jeitler, M; Kasieczka, G; Kastner, K; Krammer, M; Liko, D; Magrans de Abril, I; Mikulec, I; Mittermayr, F; Neuherz, B; Oberegger, M; Padrta, M; Pernicka, M; Rohringer, H; Schmid, S; Schöfbeck, R; Schreiner, T; Stark, R; Steininger, H; Strauss, J; Taurok, A; Teischinger, F; Themel, T; Uhl, D; Wagner, P; Waltenberger, W; Walzel, G; Widl, E; Wulz, C E; Chekhovsky, V; Dvornikov, O; Emeliantchik, I; Litomin, A; Makarenko, V; Marfin, I; Mossolov, V; Shumeiko, N; Solin, A; Stefanovitch, R; Suarez Gonzalez, J; Tikhonov, A; Fedorov, A; Karneyeu, A; Korzhik, M; Panov, V; Zuyeuski, R; Kuchinsky, P; Beaumont, W; Benucci, L; Cardaci, M; De Wolf, E A; Delmeire, E; Druzhkin, D; Hashemi, M; Janssen, X; Maes, T; Mucibello, L; Ochesanu, S; Rougny, R; Selvaggi, M; Van Haevermaet, H; Van Mechelen, P; Van Remortel, N; Adler, V; Beauceron, S; Blyweert, S; D'Hondt, J; De Weirdt, S; Devroede, O; Heyninck, J; Kalogeropoulos, A; Maes, J; Maes, M; Mozer, M U; Tavernier, S; Van Doninck, W; Van Mulders, P; Villella, I; Bouhali, O; Chabert, E C; Charaf, O; Clerbaux, B; De Lentdecker, G; Dero, V; Elgammal, S; Gay, A P R; Hammad, G H; Marage, P E; Rugovac, S; Vander Velde, C; Vanlaer, P; Wickens, J; Grunewald, M; Klein, B; Marinov, A; Ryckbosch, D; Thyssen, F; Tytgat, M; Vanelderen, L; Verwilligen, P; Basegmez, S; Bruno, G; Caudron, J; Delaere, C; Demin, P; Favart, D; Giammanco, A; Grégoire, G; Lemaitre, V; Militaru, O; Ovyn, S; Piotrzkowski, K; Quertenmont, L; Schul, N; Beliy, N; Daubie, E; Alves, G A; Pol, M E; Souza, M H G; Carvalho, W; De Jesus Damiao, D; De Oliveira Martins, C; Fonseca De Souza, S; Mundim, L; Oguri, V; Santoro, A; Silva Do Amaral, S M; Sznajder, A; Fernandez Perez Tomei, T R; Ferreira Dias, M A; Gregores, E M; Novaes, S F; Abadjiev, K; Anguelov, T; Damgov, J; Darmenov, N; Dimitrov, L; Genchev, V; Iaydjiev, P; Piperov, S; Stoykova, S; Sultanov, G; Trayanov, R; Vankov, I; Dimitrov, A; Dyulendarova, M; Kozhuharov, V; Litov, L; Marinova, E; Mateev, M; Pavlov, B; Petkov, P; Toteva, Z; Chen, G M; Chen, H S; Guan, W; Jiang, C H; Liang, D; Liu, B; Meng, X; Tao, J; Wang, J; Wang, Z; Xue, Z; Zhang, Z; Ban, Y; Cai, J; Ge, Y; Guo, S; Hu, Z; Mao, Y; Qian, S J; Teng, H; Zhu, B; Avila, C; Baquero Ruiz, M; Carrillo Montoya, C A; Gomez, A; Gomez Moreno, B; Ocampo Rios, A A; Osorio Oliveros, A F; Reyes Romero, D; Sanabria, J C; Godinovic, N; Lelas, K; Plestina, R; Polic, D; Puljak, I; Antunovic, Z; Dzelalija, M; Brigljevic, V; Duric, S; Kadija, K; Morovic, S; Fereos, R; Galanti, M; Mousa, J; Papadakis, A; Ptochos, F; Razis, P A; Tsiakkouri, D; Zinonos, Z; Hektor, A; Kadastik, M; Kannike, K; Müntel, M; Raidal, M; Rebane, L; Anttila, E; Czellar, S; Härkönen, J; Heikkinen, A; Karimäki, V; Kinnunen, R; Klem, J; Kortelainen, M J; Lampén, T; Lassila-Perini, K; Lehti, S; Lindén, T; Luukka, P; Mäenpää, T; Nysten, J; Tuominen, E; Tuominiemi, J; Ungaro, D; Wendland, L; Banzuzi, K; Korpela, A; Tuuva, T; Nedelec, P; Sillou, D; Besancon, M; Chipaux, R; Dejardin, M; Denegri, D; Descamps, J; Fabbro, B; Faure, J L; Ferri, F; Ganjour, S; Gentit, F X; Givernaud, A; Gras, P; Hamel de Monchenault, G; Jarry, P; Lemaire, M C; Locci, E; Malcles, J; Marionneau, M; Millischer, L; Rander, J; Rosowsky, A; Rousseau, D; Titov, M; Verrecchia, P; Baffioni, S; Bianchini, L; Bluj, M; Busson, P; Charlot, C; Dobrzynski, L; Granier de Cassagnac, R; Haguenauer, M; Miné, P; Paganini, P; Sirois, Y; Thiebaux, C; Zabi, A; Agram, J L; Besson, A; Bloch, D; Bodin, D; Brom, J M; Conte, E; Drouhin, F; Fontaine, J C; Gelé, D; Goerlach, U; Gross, L; Juillot, P; Le Bihan, A C; Patois, Y; Speck, J; Van Hove, P; Baty, C; Bedjidian, M; Blaha, J; Boudoul, G; Brun, H; Chanon, N; Chierici, R; Contardo, D; Depasse, P; Dupasquier, T; El Mamouni, H; Fassi, F; Fay, J; Gascon, S; Ille, B; Kurca, T; Le Grand, T; Lethuillier, M; Lumb, N; Mirabito, L; Perries, S; Vander Donckt, M; Verdier, P; Djaoshvili, N; Roinishvili, N; Roinishvili, V; Amaglobeli, N; Adolphi, R; Anagnostou, G; Brauer, R; Braunschweig, W; Edelhoff, M; Esser, H; Feld, L; Karpinski, W; Khomich, A; Klein, K; Mohr, N; Ostaptchouk, A; Pandoulas, D; Pierschel, G; Raupach, F; Schael, S; Schultz von Dratzig, A; Schwering, G; Sprenger, D; Thomas, M; Weber, M; Wittmer, B; Wlochal, M; Actis, O; Altenhöfer, G; Bender, W; Biallass, P; Erdmann, M; Fetchenhauer, G; Frangenheim, J; Hebbeker, T; Hilgers, G; Hinzmann, A; Hoepfner, K; Hof, C; Kirsch, M; Klimkovich, T; Kreuzer, P; Lanske, D; Merschmeyer, M; Meyer, A; Philipps, B; Pieta, H; Reithler, H; Schmitz, S A; Sonnenschein, L; Sowa, M; Steggemann, J; Szczesny, H; Teyssier, D; Zeidler, C; Bontenackels, M; Davids, M; Duda, M; Flügge, G; Geenen, H; Giffels, M; Haj Ahmad, W; Hermanns, T; Heydhausen, D; Kalinin, S; Kress, T; Linn, A; Nowack, A; Perchalla, L; Poettgens, M; Pooth, O; Sauerland, P; Stahl, A; Tornier, D; Zoeller, M H; Aldaya Martin, M; Behrens, U; Borras, K; Campbell, A; Castro, E; Dammann, D; Eckerlin, G; Flossdorf, A; Flucke, G; Geiser, A; Hatton, D; Hauk, J; Jung, H; Kasemann, M; Katkov, I; Kleinwort, C; Kluge, H; Knutsson, A; Kuznetsova, E; Lange, W; Lohmann, W; Mankel, R; Marienfeld, M; Meyer, A B; Miglioranzi, S; Mnich, J; Ohlerich, M; Olzem, J; Parenti, A; Rosemann, C; Schmidt, R; Schoerner-Sadenius, T; Volyanskyy, D; Wissing, C; Zeuner, W D; Autermann, C; Bechtel, F; Draeger, J; Eckstein, D; Gebbert, U; Kaschube, K; Kaussen, G; Klanner, R; Mura, B; Naumann-Emme, S; Nowak, F; Pein, U; Sander, C; Schleper, P; Schum, T; Stadie, H; Steinbrück, G; Thomsen, J; Wolf, R; Bauer, J; Blüm, P; Buege, V; Cakir, A; Chwalek, T; De Boer, W; Dierlamm, A; Dirkes, G; Feindt, M; Felzmann, U; Frey, M; Furgeri, A; Gruschke, J; Hackstein, C; Hartmann, F; Heier, S; Heinrich, M; Held, H; Hirschbuehl, D; Hoffmann, K H; Honc, S; Jung, C; Kuhr, T; Liamsuwan, T; Martschei, D; Mueller, S; Müller, Th; Neuland, M B; 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Ignatenko, M; Jarvis, C; Mumford, J; Plager, C; Rakness, G; Schlein, P; Tucker, J; Valuev, V; Wallny, R; Yang, X; Babb, J; Bose, M; Chandra, A; Clare, R; Ellison, J A; Gary, J W; Hanson, G; Jeng, G Y; Kao, S C; Liu, F; Liu, H; Luthra, A; Nguyen, H; Pasztor, G; Satpathy, A; Shen, B C; Stringer, R; Sturdy, J; Sytnik, V; Wilken, R; Wimpenny, S; Branson, J G; Dusinberre, E; Evans, D; Golf, F; Kelley, R; Lebourgeois, M; Letts, J; Lipeles, E; Mangano, B; Muelmenstaedt, J; Norman, M; Padhi, S; Petrucci, A; Pi, H; Pieri, M; Ranieri, R; Sani, M; Sharma, V; Simon, S; Würthwein, F; Yagil, A; Campagnari, C; D'Alfonso, M; Danielson, T; Garberson, J; Incandela, J; Justus, C; Kalavase, P; Koay, S A; Kovalskyi, D; Krutelyov, V; Lamb, J; Lowette, S; Pavlunin, V; Rebassoo, F; Ribnik, J; Richman, J; Rossin, R; Stuart, D; To, W; Vlimant, J R; Witherell, M; Apresyan, A; Bornheim, A; Bunn, J; Chiorboli, M; Gataullin, M; Kcira, D; Litvine, V; Ma, Y; Newman, H B; Rogan, C; Timciuc, V; Veverka, J; Wilkinson, R; Yang, Y; Zhang, L; Zhu, K; Zhu, R Y; Akgun, B; Carroll, R; Ferguson, T; Jang, D W; Jun, S Y; Paulini, M; Russ, J; Terentyev, N; Vogel, H; Vorobiev, I; Cumalat, J P; Dinardo, M E; Drell, B R; Ford, W T; Heyburn, B; Luiggi Lopez, E; Nauenberg, U; Stenson, K; Ulmer, K; Wagner, S R; Zang, S L; Agostino, L; Alexander, J; Blekman, F; Cassel, D; Chatterjee, A; Das, S; Gibbons, L K; Heltsley, B; Hopkins, W; Khukhunaishvili, A; Kreis, B; Kuznetsov, V; Patterson, J R; Puigh, D; Ryd, A; Shi, X; Stroiney, S; Sun, W; Teo, W D; Thom, J; Vaughan, J; Weng, Y; Wittich, P; Beetz, C P; Cirino, G; Sanzeni, C; Winn, D; Abdullin, S; Afaq, M A; Albrow, M; Ananthan, B; Apollinari, G; Atac, M; Badgett, W; Bagby, L; Bakken, J A; Baldin, B; Banerjee, S; Banicz, K; Bauerdick, L A T; Beretvas, A; Berryhill, J; Bhat, P C; Biery, K; Binkley, M; Bloch, I; Borcherding, F; Brett, A M; Burkett, K; Butler, J N; Chetluru, V; Cheung, H W K; Chlebana, F; Churin, I; Cihangir, S; Crawford, M; Dagenhart, W; Demarteau, M; Derylo, G; Dykstra, D; Eartly, D P; Elias, J E; Elvira, V D; Evans, D; Feng, L; Fischler, M; Fisk, I; Foulkes, S; Freeman, J; Gartung, P; Gottschalk, E; Grassi, T; Green, D; Guo, Y; Gutsche, O; Hahn, A; Hanlon, J; Harris, R M; Holzman, B; Howell, J; Hufnagel, D; James, E; Jensen, H; Johnson, M; Jones, C D; Joshi, U; Juska, E; Kaiser, J; Klima, B; Kossiakov, S; Kousouris, K; Kwan, S; Lei, C M; Limon, P; Lopez Perez, J A; Los, S; Lueking, L; Lukhanin, G; Lusin, S; Lykken, J; Maeshima, K; Marraffino, J M; Mason, D; McBride, P; Miao, T; Mishra, K; Moccia, S; Mommsen, R; Mrenna, S; Muhammad, A S; Newman-Holmes, C; Noeding, C; O'Dell, V; Prokofyev, O; Rivera, R; Rivetta, C H; Ronzhin, A; Rossman, P; Ryu, S; Sekhri, V; Sexton-Kennedy, E; Sfiligoi, I; Sharma, S; Shaw, T M; Shpakov, D; Skup, E; Smith, R P; Soha, A; Spalding, W J; Spiegel, L; Suzuki, I; Tan, P; Tanenbaum, W; Tkaczyk, S; Trentadue, R; Uplegger, L; Vaandering, E W; Vidal, R; Whitmore, J; Wicklund, E; Wu, W; Yarba, J; Yumiceva, F; Yun, J C; Acosta, D; Avery, P; Barashko, V; Bourilkov, D; Chen, M; Di Giovanni, G P; Dobur, D; Drozdetskiy, A; Field, R D; Fu, Y; Furic, I K; Gartner, J; Holmes, D; Kim, B; Klimenko, S; Konigsberg, J; Korytov, A; Kotov, K; Kropivnitskaya, A; Kypreos, T; Madorsky, A; Matchev, K; Mitselmakher, G; Pakhotin, Y; Piedra Gomez, J; Prescott, C; Rapsevicius, V; Remington, R; Schmitt, M; Scurlock, B; Wang, D; Yelton, J; Ceron, C; Gaultney, V; Kramer, L; Lebolo, L M; Linn, S; Markowitz, P; Martinez, G; Rodriguez, J L; Adams, T; Askew, A; Baer, H; Bertoldi, M; Chen, J; Dharmaratna, W G D; Gleyzer, S V; Haas, J; Hagopian, S; Hagopian, V; Jenkins, M; Johnson, K F; Prettner, E; Prosper, H; Sekmen, S; Baarmand, M M; Guragain, S; Hohlmann, M; Kalakhety, H; Mermerkaya, H; Ralich, R; Vodopiyanov, I; Abelev, B; Adams, M R; Anghel, I M; Apanasevich, L; Bazterra, V E; Betts, R R; Callner, J; Castro, M A; Cavanaugh, R; Dragoiu, C; Garcia-Solis, E J; Gerber, C E; Hofman, D J; Khalatian, S; Mironov, C; Shabalina, E; Smoron, A; Varelas, N; Akgun, U; Albayrak, E A; Ayan, A S; Bilki, B; Briggs, R; Cankocak, K; Chung, K; Clarida, W; Debbins, P; Duru, F; Ingram, F D; Lae, C K; McCliment, E; Merlo, J P; Mestvirishvili, A; Miller, M J; Moeller, A; Nachtman, J; Newsom, C R; Norbeck, E; Olson, J; Onel, Y; Ozok, F; Parsons, J; Schmidt, I; Sen, S; Wetzel, J; Yetkin, T; Yi, K; Barnett, B A; Blumenfeld, B; Bonato, A; Chien, C Y; Fehling, D; Giurgiu, G; Gritsan, A V; Guo, Z J; Maksimovic, P; Rappoccio, S; Swartz, M; Tran, N V; Zhang, Y; Baringer, P; Bean, A; Grachov, O; Murray, M; Radicci, V; Sanders, S; Wood, J S; Zhukova, V; Bandurin, D; Bolton, T; Kaadze, K; Liu, A; Maravin, Y; Onoprienko, D; Svintradze, I; Wan, Z; Gronberg, J; Hollar, J; Lange, D; Wright, D; Baden, D; Bard, R; Boutemeur, M; Eno, S C; Ferencek, D; Hadley, N J; Kellogg, R G; Kirn, M; Kunori, S; Rossato, K; Rumerio, P; Santanastasio, F; Skuja, A; Temple, J; Tonjes, M B; Tonwar, S C; Toole, T; Twedt, E; Alver, B; Bauer, G; Bendavid, J; Busza, W; Butz, E; Cali, I A; Chan, M; D'Enterria, D; Everaerts, P; Gomez Ceballos, G; Hahn, K A; Harris, P; Jaditz, S; Kim, Y; Klute, M; Lee, Y J; Li, W; Loizides, C; Ma, T; Miller, M; Nahn, S; Paus, C; Roland, C; Roland, G; Rudolph, M; Stephans, G; Sumorok, K; Sung, K; Vaurynovich, S; Wenger, E A; Wyslouch, B; Xie, S; Yilmaz, Y; Yoon, A S; Bailleux, D; Cooper, S I; Cushman, P; Dahmes, B; De Benedetti, A; Dolgopolov, A; Dudero, P R; Egeland, R; Franzoni, G; Haupt, J; Inyakin, A; Klapoetke, K; Kubota, Y; Mans, J; Mirman, N; Petyt, D; Rekovic, V; Rusack, R; Schroeder, M; Singovsky, A; Zhang, J; Cremaldi, L M; Godang, R; Kroeger, R; Perera, L; Rahmat, R; Sanders, D A; Sonnek, P; Summers, D; Bloom, K; Bockelman, B; Bose, S; Butt, J; Claes, D R; Dominguez, A; Eads, M; Keller, J; Kelly, T; Kravchenko, I; Lazo-Flores, J; Lundstedt, C; Malbouisson, H; Malik, S; Snow, G R; Baur, U; Iashvili, I; Kharchilava, A; Kumar, A; Smith, K; Strang, M; Alverson, G; Barberis, E; Boeriu, O; Eulisse, G; Govi, G; McCauley, T; Musienko, Y; Muzaffar, S; Osborne, I; Paul, T; Reucroft, S; Swain, J; Taylor, L; Tuura, L; Anastassov, A; Gobbi, B; Kubik, A; Ofierzynski, R A; Pozdnyakov, A; Schmitt, M; Stoynev, S; Velasco, M; Won, S; Antonelli, L; Berry, D; Hildreth, M; Jessop, C; Karmgard, D J; Kolberg, T; Lannon, K; Lynch, S; Marinelli, N; Morse, D M; Ruchti, R; Slaunwhite, J; Warchol, J; Wayne, M; Bylsma, B; Durkin, L S; Gilmore, J; Gu, J; Killewald, P; Ling, T Y; Williams, G; Adam, N; Berry, E; Elmer, P; Garmash, A; Gerbaudo, D; Halyo, V; Hunt, A; Jones, J; Laird, E; Marlow, D; Medvedeva, T; Mooney, M; Olsen, J; Piroué, P; Stickland, D; Tully, C; Werner, J S; Wildish, T; Xie, Z; Zuranski, A; Acosta, J G; Bonnett Del Alamo, M; Huang, X T; Lopez, A; Mendez, H; Oliveros, S; Ramirez Vargas, J E; Santacruz, N; Zatzerklyany, A; Alagoz, E; Antillon, E; Barnes, V E; Bolla, G; Bortoletto, D; Everett, A; Garfinkel, A F; Gecse, Z; Gutay, L; Ippolito, N; Jones, M; Koybasi, O; Laasanen, A T; Leonardo, N; Liu, C; Maroussov, V; Merkel, P; Miller, D H; Neumeister, N; Sedov, A; Shipsey, I; Yoo, H D; Zheng, Y; Jindal, P; Parashar, N; Cuplov, V; Ecklund, K M; Geurts, F J M; Liu, J H; Maronde, D; Matveev, M; Padley, B P; Redjimi, R; Roberts, J; Sabbatini, L; Tumanov, A; Betchart, B; Bodek, A; Budd, H; Chung, Y S; de Barbaro, P; Demina, R; Flacher, H; Gotra, Y; Harel, A; Korjenevski, S; Miner, D C; Orbaker, D; Petrillo, G; Vishnevskiy, D; Zielinski, M; Bhatti, A; Demortier, L; Goulianos, K; Hatakeyama, K; Lungu, G; Mesropian, C; Yan, M; Atramentov, O; Bartz, E; Gershtein, Y; Halkiadakis, E; Hits, D; Lath, A; Rose, K; Schnetzer, S; Somalwar, S; Stone, R; Thomas, S; Watts, T L; Cerizza, G; Hollingsworth, M; Spanier, S; Yang, Z C; York, A; Asaadi, J; Aurisano, A; Eusebi, R; Golyash, A; Gurrola, A; Kamon, T; Nguyen, C N; Pivarski, J; Safonov, A; Sengupta, S; Toback, D; Weinberger, M; Akchurin, N; Berntzon, L; Gumus, K; Jeong, C; Kim, H; Lee, S W; Popescu, S; Roh, Y; Sill, A; Volobouev, I; Washington, E; Wigmans, R; Yazgan, E; Engh, D; Florez, C; Johns, W; Pathak, S; Sheldon, P; Andelin, D; Arenton, M W; Balazs, M; Boutle, S; Buehler, M; Conetti, S; Cox, B; Hirosky, R; Ledovskoy, A; Neu, C; Phillips II, D; Ronquest, M; Yohay, R; Gollapinni, S; Gunthoti, K; Harr, R; Karchin, P E; Mattson, M; Sakharov, A; Anderson, M; Bachtis, M; Bellinger, J N; Carlsmith, D; Crotty, I; Dasu, S; Dutta, S; Efron, J; Feyzi, F; Flood, K; Gray, L; Grogg, K S; Grothe, M; Hall-Wilton, R; Jaworski, M; Klabbers, P; Klukas, J; Lanaro, A; Lazaridis, C; Leonard, J; Loveless, R; Magrans de Abril, M; Mohapatra, A; Ott, G; Polese, G; Reeder, D; Savin, A; Smith, W H; Sourkov, A; Swanson, J; Weinberg, M; Wenman, D; Wensveen, M; White, A

    2010-01-01

    The CMS High-Level Trigger (HLT) is responsible for ensuring that data samples with potentially interesting events are recorded with high efficiency and good quality. This paper gives an overview of the HLT and focuses on its commissioning using cosmic rays. The selection of triggers that were deployed is presented and the online grouping of triggered events into streams and primary datasets is discussed. Tools for online and offline data quality monitoring for the HLT are described, and the operational performance of the muon HLT algorithms is reviewed. The average time taken for the HLT selection and its dependence on detector and operating conditions are presented. The HLT performed reliably and helped provide a large dataset. This dataset has proven to be invaluable for understanding the performance of the trigger and the CMS experiment as a whole.

  15. Psilocybin impairs high-level but not low-level motion perception.

    Science.gov (United States)

    Carter, Olivia L; Pettigrew, John D; Burr, David C; Alais, David; Hasler, Felix; Vollenweider, Franz X

    2004-08-26

    The hallucinogenic serotonin(1A&2A) agonist psilocybin is known for its ability to induce illusions of motion in otherwise stationary objects or textured surfaces. This study investigated the effect of psilocybin on local and global motion processing in nine human volunteers. Using a forced choice direction of motion discrimination task we show that psilocybin selectively impairs coherence sensitivity for random dot patterns, likely mediated by high-level global motion detectors, but not contrast sensitivity for drifting gratings, believed to be mediated by low-level detectors. These results are in line with those observed within schizophrenic populations and are discussed in respect to the proposition that psilocybin may provide a model to investigate clinical psychosis and the pharmacological underpinnings of visual perception in normal populations.

  16. The C Object System: Using C as a High-Level Object-Oriented Language

    CERN Document Server

    Deniau, Laurent

    2010-01-01

    The C Object System (Cos) is a small C library which implements high-level concepts available in Clos, Objc and other object-oriented programming languages: uniform object model (class, meta-class and property-metaclass), generic functions, multi-methods, delegation, properties, exceptions, contracts and closures. Cos relies on the programmable capabilities of the C programming language to extend its syntax and to implement the aforementioned concepts as first-class objects. Cos aims at satisfying several general principles like simplicity, extensibility, reusability, efficiency and portability which are rarely met in a single programming language. Its design is tuned to provide efficient and portable implementation of message multi-dispatch and message multi-forwarding which are the heart of code extensibility and reusability. With COS features in hand, software should become as flexible and extensible as with scripting languages and as efficient and portable as expected with C programming. Likewise, Cos con...

  17. Development of a thermal transient calculational tool for High Level Waste tanks

    Energy Technology Data Exchange (ETDEWEB)

    Kielpinski, A.L.

    1994-06-01

    Thermal design constraints exist on the processing operations in the High Level Waste (HLW) tanks of the Savannah River Site (SRS). A FORTRAN computer code was developed to provide a simple, fast, and reasonably accurate analysis tool for plant operation design. The code computes a lumped transient temperature for the liquid contents of a waste tank by modeling the liquid (slurry), the vapor space above it, the tank wall, and the cooling air outside of the tank. Results for a typical processing cycle of several months` duration can be obtained in 2--4 minutes CPU time on a VAX computer. This paper discusses the code`s mathematical models, presents model results for a typical HLW process schedule, and compares the code predictions with operations data.

  18. RADIOACTIVE HIGH LEVEL WASTE TANK PITTING PREDICTIONS: AN INVESTIGATION INTO CRITICAL SOLUTION CONCENTRATIONS

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, E.

    2012-11-08

    A series of cyclic potentiodynamic polarization tests was performed on samples of ASTM A537 carbon steel in support of a probability-based approach to evaluate the effect of chloride and sulfate on corrosion the steel's susceptibility to pitting corrosion. Testing solutions were chosen to systemically evaluate the influence of the secondary aggressive species, chloride, and sulfate, in the nitrate based, high-level wastes. The results suggest that evaluating the combined effect of all aggressive species, nitrate, chloride, and sulfate, provides a consistent response for determining corrosion susceptibility. The results of this work emphasize the importance for not only nitrate concentration limits, but also chloride and sulfate concentration limits.

  19. Next Generation Extractants for Cesium Separation from High-Level Waste

    Energy Technology Data Exchange (ETDEWEB)

    Moyer, Bruce A [ORNL; Bazelaire, Eve [ORNL; Bonnesen, Peter V [ORNL; Custelcean, Radu [ORNL; Delmau, Laetitia Helene [ORNL; Ditto, Mary E [ORNL; Engle, Nancy L [ORNL; Gorbunova, Maryna [ORNL; Haverlock, Tamara [ORNL; Levitskaia, Tatiana G. [Pacific Northwest National Laboratory (PNNL); Bartsch, Richard A. [Texas Tech University, Lubbock; Surowiec, Malgorzata A. [Texas Tech University, Lubbock; Marquez, Manuel [University of Texas; Zhou, Hui [Texas Tech University, Lubbock

    2006-01-01

    This project seeks a fundamental understanding and major improvement in cesium separation from high-level waste by cesium-selective calixcrown extractants. Systems of particular interest involve novel solvent-extraction systems containing specific members of the calix[4]arene-crown-6 family, alcohol solvating agents, and alkylamines. Questions being addressed bear upon cesium binding strength, extraction selectivity, cesium stripping, and extractant solubility. Enhanced properties in this regard will specifically benefit applied projects funded by the USDOE Office of Environmental Management to clean up sites such as the Savannah River Site (SRS), Hanford, and the Idaho National Environmental and Engineering Laboratory. The most direct beneficiary will be the SRS Salt Processing Project, which has recently identified the Caustic-Side Solvent Extraction (CSSX) process employing a calixcrown as its preferred technology for cesium removal from SRS high-level tank waste. Disposal of high-level waste is horrendously expensive, in large part because the actual radioactive matter in underground waste tanks at various USDOE sites has been diluted over 1000-fold by ordinary inorganic chemicals. To vitrify the entire mass of the high-level waste would be prohibitively expensive. Accordingly, an urgent need has arisen for technologies to remove radionuclides such as {sup 137}Cs from the high-level waste so that the bulk of it may be diverted to cheaper low-level waste forms and cheaper storage. To address this need in part, chemical research at Oak Ridge National Laboratory (ORNL) has focused on calixcrown extractants, molecules that combine a crown ether with a calixarene. This hybrid possesses a cavity that is highly complementary for the Cs{sup +} ion vs. the Na+ ion, making it possible to cleanly separate cesium from wastes that contain 10,000- to 1,000,000-fold higher concentrations of sodium. Previous EMSP results in Project 55087 elucidated the underlying extraction

  20. Polarity-specific high-level information propagation in neural networks.

    Science.gov (United States)

    Lin, Yen-Nan; Chang, Po-Yen; Hsiao, Pao-Yueh; Lo, Chung-Chuan

    2014-01-01

    Analyzing the connectome of a nervous system provides valuable information about the functions of its subsystems. Although much has been learned about the architectures of neural networks in various organisms by applying analytical tools developed for general networks, two distinct and functionally important properties of neural networks are often overlooked. First, neural networks are endowed with polarity at the circuit level: Information enters a neural network at input neurons, propagates through interneurons, and leaves via output neurons. Second, many functions of nervous systems are implemented by signal propagation through high-level pathways involving multiple and often recurrent connections rather than by the shortest paths between nodes. In the present study, we analyzed two neural networks: the somatic nervous system of Caenorhabditis elegans (C. elegans) and the partial central complex network of Drosophila, in light of these properties. Specifically, we quantified high-level propagation in the vertical and horizontal directions: the former characterizes how signals propagate from specific input nodes to specific output nodes and the latter characterizes how a signal from a specific input node is shared by all output nodes. We found that the two neural networks are characterized by very efficient vertical and horizontal propagation. In comparison, classic small-world networks show a trade-off between vertical and horizontal propagation; increasing the rewiring probability improves the efficiency of horizontal propagation but worsens the efficiency of vertical propagation. Our result provides insights into how the complex functions of natural neural networks may arise from a design that allows them to efficiently transform and combine input signals.

  1. Multilayer Protective Coatings for High-Level Nuclear Waste Storage Containers

    Science.gov (United States)

    Fusco, Michael

    Corrosion-based failures of high-level nuclear waste (HLW) storage containers are potentially hazardous due to a possible release of radionuclides through cracks in the canister due to corrosion, especially for above-ground storage (i.e. dry casks). Protective coatings have been proposed to combat these premature failures, which include stress-corrosion cracking and hydrogen-diffusion cracking, among others. The coatings are to be deposited in multiple thin layers as thin films on the outer surface of the stainless steel waste basket canister. Coating materials include: TiN, ZrO2, TiO2, Al 2O3, and MoS2, which together may provide increased resistances to corrosion and mechanical wear, as well as act as a barrier to hydrogen diffusion. The focus of this research is on the corrosion resistance and characterization of single layer coatings to determine the possible benefit from the use of the proposed coating materials. Experimental methods involve electrochemical polarization, both DC and AC techniques, and corrosion in circulating salt brines of varying pH. DC polarization allows for estimation of corrosion rates, passivation behavior, and a qualitative survey of localized corrosion, whereas AC electrochemistry has the benefit of revealing information about kinetics and interfacial reactions that is not obtainable using DC techniques. Circulation in salt brines for nearly 150 days revealed sustained adhesion of the coatings and minimal weight change of the steel samples. One-inch diameter steel coupons composed of stainless steel types 304 and 316 and A36 low alloy carbon steel were coated with single layers using magnetron sputtering with compound targets in an inert argon atmosphere. This resulted in very thin films for the metal-oxides based on low sputter rates. DC polarization showed that corrosion rates were very similar between bare and coated stainless steel samples, whereas a statistically significant decrease in uniform corrosion was measured on coated

  2. Low Power Design with High-Level Power Estimation and Power-Aware Synthesis

    CERN Document Server

    Ahuja, Sumit; Shukla, Sandeep Kumar

    2012-01-01

    Low-power ASIC/FPGA based designs are important due to the need for extended battery life, reduced form factor, and lower packaging and cooling costs for electronic devices. These products require fast turnaround time because of the increasing demand for handheld electronic devices such as cell-phones, PDAs and high performance machines for data centers. To achieve short time to market, design flows must facilitate a much shortened time-to-product requirement. High-level modeling, architectural exploration and direct synthesis of design from high level description enable this design process. This book presents novel research techniques, algorithms,methodologies and experimental results for high level power estimation and power aware high-level synthesis. Readers will learn to apply such techniques to enable design flows resulting in shorter time to market and successful low power ASIC/FPGA design. Integrates power estimation and reduction for high level synthesis, with low-power, high-level design; Shows spec...

  3. Principles for Language Extensions to VHDL to Support High-Level Modeling

    OpenAIRE

    Ashenden, Peter J.; Philip A. Wilsey

    1999-01-01

    This paper reviews proposals for extensions to VHDL to support high-level modeling and places them within a taxonomy that describes the modeling requirements they address. Many of the proposals focus on object-oriented extensions, whereas this paper argues that extension of VHDL to support high-level modeling requires a broader review. The paper presents a detailed discussion of issues to be considered in adding high-level modeling extensions to VHDL, including concurrency and ...

  4. Randomized Comparison of 3 High-Level Disinfection and Sterilization Procedures for Duodenoscopes.

    Science.gov (United States)

    Snyder, Graham M; Wright, Sharon B; Smithey, Anne; Mizrahi, Meir; Sheppard, Michelle; Hirsch, Elizabeth B; Chuttani, Ram; Heroux, Riley; Yassa, David S; Olafsdottir, Lovisa B; Davis, Roger B; Anastasiou, Jiannis; Bapat, Vijay; Bidari, Kiran; Pleskow, Douglas K; Leffler, Daniel; Lane, Benjamin; Chen, Alice; Gold, Howard S; Bartley, Anthony; King, Aleah D; Sawhney, Mandeep S

    2017-10-01

    Duodenoscopes have been implicated in the transmission of multidrug-resistant organisms (MDRO). We compared the frequency of duodenoscope contamination with MDRO or any other bacteria after disinfection or sterilization by 3 different methods. We performed a single-center prospective randomized study in which duodenoscopes were randomly reprocessed by standard high-level disinfection (sHLD), double high-level disinfection (dHLD), or standard high-level disinfection followed by ethylene oxide gas sterilization (HLD/ETO). Samples were collected from the elevator mechanism and working channel of each duodenoscope and cultured before use. The primary outcome was the proportion of duodenoscopes with an elevator mechanism or working channel culture showing 1 or more MDRO; secondary outcomes included the frequency of duodenoscope contamination with more than 0 and 10 or more colony-forming units (CFU) of aerobic bacterial growth on either sampling location. After 3 months of enrollment, the study was closed because of the futility; we did not observe sufficient events to evaluate the primary outcome. Among 541 duodenoscope culture events, 516 were included in the final analysis. No duodenoscope culture in any group was positive for MDRO. Bacterial growth of more than 0 CFU was noted in 16.1% duodenoscopes in the sHLD group, 16.0% in the dHLD group, and 22.5% in the HLD/ETO group (P = .21). Bacterial growth or 10 or more CFU was noted in 2.3% of duodenoscopes in the sHLD group, 4.1% in the dHLD group, and 4.2% in the HLD/ETO group (P = .36). MRDOs were cultured from 3.2% of pre-procedure rectal swabs and 2.5% of duodenal aspirates. In a comparison of duodenoscopes reprocessed by sHLD, dHLD, or HLD/ETO, we found no significant differences between groups for MDRO or bacteria contamination. Enhanced disinfection methods (dHLD or HLD/ETO) did not provide additional protection against contamination. However, insufficient events occurred to assess our primary study end

  5. ITP. FOR: A code to calculate thermal transients in High Level Waste Tanks

    Energy Technology Data Exchange (ETDEWEB)

    Kielpinski, A.L.

    1992-10-01

    A variety of processing operations for high level radioactive waste occur in the High Level Waste Tanks in the H-Area of the Savannah River Site. Thermal design constraints exist on these processes, principally to limit the amount of corrosion inhibitor which must be added to protect the tank and cooling coil materials. The required amount of corrosion inhibitor, which must subsequently be removed prior to trapping the waste in borosilicate glass, increases exponentially with temperature over a fairly narrow range (some tens of degrees Celsius). For this reason, there is a need to model the thermal-hydraulic processes occurring in the waste tanks. A FORTRAN computer code, called ITP.FOR, was written to provide a simple but reasonably accurate analysis tool for plant operation design. The code was specifically written to model Tank 48, in which the In-Tank Precipitation (ITP) process of precipitating radioactive cesium will be initiated. Although the ITP.FOR code was written as personal-use software for scoping design calculations for Tank 48, the current intent is to extend the code's applicability to other H-Area waste tanks, and to certify the code in accordance with the NRTSC Quality Assurance requirements for critical-use software (1Q-34, 1991). Since the code's capabilities have generated some interest to date, the present report is presented as interim documentation of the code's mathematical models. This documentation will eventually be supplanted by the formal documentation of the expanded and benchmarked code.

  6. ITP.FOR: A code to calculate thermal transients in High Level Waste Tanks

    Energy Technology Data Exchange (ETDEWEB)

    Kielpinski, A.L.

    1992-10-01

    A variety of processing operations for high level radioactive waste occur in the High Level Waste Tanks in the H-Area of the Savannah River Site. Thermal design constraints exist on these processes, principally to limit the amount of corrosion inhibitor which must be added to protect the tank and cooling coil materials. The required amount of corrosion inhibitor, which must subsequently be removed prior to trapping the waste in borosilicate glass, increases exponentially with temperature over a fairly narrow range (some tens of degrees Celsius). For this reason, there is a need to model the thermal-hydraulic processes occurring in the waste tanks. A FORTRAN computer code, called ITP.FOR, was written to provide a simple but reasonably accurate analysis tool for plant operation design. The code was specifically written to model Tank 48, in which the In-Tank Precipitation (ITP) process of precipitating radioactive cesium will be initiated. Although the ITP.FOR code was written as personal-use software for scoping design calculations for Tank 48, the current intent is to extend the code`s applicability to other H-Area waste tanks, and to certify the code in accordance with the NRTSC Quality Assurance requirements for critical-use software (1Q-34, 1991). Since the code`s capabilities have generated some interest to date, the present report is presented as interim documentation of the code`s mathematical models. This documentation will eventually be supplanted by the formal documentation of the expanded and benchmarked code.

  7. Vapor Corrosion Response of Low Carbon Steel Exposed to Simulated High Level Radioactive Waste

    Energy Technology Data Exchange (ETDEWEB)

    Wiersma, B

    2006-01-26

    A program to resolve the issues associated with potential vapor space corrosion and liquid/air interface corrosion in the Type III high level waste tanks is in place. The objective of the program is to develop understanding of vapor space (VSC) and liquid/air interface (LAIC) corrosion to ensure a defensible technical basis to provide accurate corrosion evaluations with regard to vapor space and liquid/air interface corrosion. The results of the FY05 experiments are presented here. The experiments are an extension of the previous research on the corrosion of tank steel exposed to simple solutions to corrosion of the steel when exposed to complex high level waste simulants. The testing suggested that decanting and the consequent residual species on the tank wall is the predominant source of surface chemistry on the tank wall. The laboratory testing has shown that at the boundary conditions of the chemistry control program for solutions greater than 1M NaNO{sub 3}{sup -}. Minor and isolated pitting is possible within crevices in the vapor space of the tanks that contain stagnant dilute solution for an extended period of time, specifically when residues are left on the tank wall during decanting. Liquid/air interfacial corrosion is possible in dilute stagnant solutions, particularly with high concentrations of chloride. The experimental results indicate that Tank 50 would be most susceptible to the potential for liquid/air interfacial corrosion or vapor space corrosion, with Tank 49 and 41 following, since these tanks are nearest to the chemistry control boundary conditions. The testing continues to show that the combination of well-inhibited solutions and mill-scale sufficiently protect against pitting in the Type III tanks.

  8. Training Load and Player Monitoring in High-Level Football: Current Practice and Perceptions.

    Science.gov (United States)

    Akenhead, Richard; Nassis, George P

    2016-07-01

    Training load (TL) is monitored with the aim of making evidence-based decisions on appropriate loading schemes to reduce injuries and enhance team performance. However, little is known in detail about the variables of load and methods of analysis used in high-level football. Therefore, the aim of this study was to provide information on the practices and practitioners' perceptions of monitoring in professional clubs. Eighty-two high-level football clubs from Europe, the United States, and Australia were invited to answer questions relating to how TL is quantified, how players' responses are monitored, and their perceptions of the effectiveness of monitoring. Forty-one responses were received. All teams used GPS and heart-rate monitors during all training sessions, and 28 used rating of perceived exertion. The top-5-ranking TL variables were acceleration (various thresholds), total distance, distance covered above 5.5 m/s, estimated metabolic power, and heart-rate exertion. Players' responses to training are monitored using questionnaires (68% of clubs) and submaximal exercise protocols (41%). Differences in expected vs actual effectiveness of monitoring were 23% and 20% for injury prevention and performance enhancement, respectively (P < .001 d = 1.0-1.4). Of the perceived barriers to effectiveness, limited human resources scored highest, followed by coach buy-in. The discrepancy between expected and actual effectiveness appears to be due to suboptimal integration with coaches, insufficient human resources, and concerns over the reliability of assessment tools. Future approaches should critically evaluate the usefulness of current monitoring tools and explore methods of reducing the identified barriers to effectiveness.

  9. Anticipated Degradation Modes of Metallic Engineered Barriers for High-Level Nuclear Waste Repositories

    Science.gov (United States)

    Rodríguez, Martín A.

    2014-03-01

    Metallic engineered barriers must provide a period of absolute containment to high-level radioactive waste in geological repositories. Candidate materials include copper alloys, carbon steels, stainless steels, nickel alloys, and titanium alloys. The national programs of nuclear waste management have to identify and assess the anticipated degradation modes of the selected materials in the corresponding repository environment, which evolves in time. Commonly assessed degradation modes include general corrosion, localized corrosion, stress-corrosion cracking, hydrogen-assisted cracking, and microbiologically influenced corrosion. Laboratory testing and modeling in metallurgical and environmental conditions of similar and higher aggressiveness than those expected in service conditions are used to evaluate the corrosion resistance of the materials. This review focuses on the anticipated degradation modes of the selected or reference materials as corrosion-resistant barriers in nuclear repositories. These degradation modes depend not only on the selected alloy but also on the near-field environment. The evolution of the near-field environment varies for saturated and unsaturated repositories considering backfilled and unbackfilled conditions. In saturated repositories, localized corrosion and stress-corrosion cracking may occur in the initial aerobic stage, while general corrosion and hydrogen-assisted cracking are the main degradation modes in the anaerobic stage. Unsaturated repositories would provide an oxidizing environment during the entire repository lifetime. Microbiologically influenced corrosion may be avoided or minimized by selecting an appropriate backfill material. Radiation effects are negligible provided that a thick-walled container or an inner shielding container is used.

  10. Hi-LAB: A New Measure of Aptitude for High-Level Language Proficiency

    Science.gov (United States)

    Linck, Jared A.; Hughes, Meredith M.; Campbell, Susan G.; Silbert, Noah H.; Tare, Medha; Jackson, Scott R.; Smith, Benjamin K.; Bunting, Michael F.; Doughty, Catherine J.

    2013-01-01

    Few adult second language (L2) learners successfully attain high-level proficiency. Although decades of research on beginning to intermediate stages of L2 learning have identified a number of predictors of the rate of acquisition, little research has examined factors relevant to predicting very high levels of L2 proficiency. The current study,…

  11. Requirements for high level models supporting design space exploration in model-based systems engineering

    NARCIS (Netherlands)

    Haveman, Steven; Bonnema, Gerrit Maarten

    2013-01-01

    Most formal models are used in detailed design and focus on a single domain. Few effective approaches exist that can effectively tie these lower level models to a high level system model during design space exploration. This complicates the validation of high level system requirements during

  12. Medicare Provider Data - Hospice Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

  13. High level of microsynteny and purifying selection affect the evolution of WRKY family in Gramineae.

    Science.gov (United States)

    Jin, Jing; Kong, Jingjing; Qiu, Jianle; Zhu, Huasheng; Peng, Yuancheng; Jiang, Haiyang

    2016-01-01

    The WRKY gene family, which encodes proteins in the regulation processes of diverse developmental stages, is one of the largest families of transcription factors in higher plants. In this study, by searching for interspecies gene colinearity (microsynteny) and dating the age distributions of duplicated genes, we found 35 chromosomal segments of subgroup I genes of WRKY family (WRKY I) in four Gramineae species (Brachypodium, rice, sorghum, and maize) formed eight orthologous groups. After a stepwise gene-by-gene reciprocal comparison of all the protein sequences in the WRKY I gene flanking areas, highly conserved regions of microsynteny were found in the four Gramineae species. Most gene pairs showed conserved orientation within syntenic genome regions. Furthermore, tandem duplication events played the leading role in gene expansion. Eventually, environmental selection pressure analysis indicated strong purifying selection for the WRKY I genes in Gramineae, which may have been followed by gene loss and rearrangement. The results presented in this study provide basic information of Gramineae WRKY I genes and form the foundation for future functional studies of these genes. High level of microsynteny in the four grass species provides further evidence that a large-scale genome duplication event predated speciation.

  14. Convolutional Oriented Boundaries: From Image Segmentation to High-Level Tasks.

    Science.gov (United States)

    Maninis, Kevis-Kokitsi; Pont-Tuset, Jordi; Arbelaez, Pablo; Van Gool, Luc

    2017-05-02

    We present Convolutional Oriented Boundaries (COB), which produces multiscale oriented contours and region hierarchies starting from generic image classification Convolutional Neural Networks (CNNs). COB is computationally efficient, because it requires a single CNN forward pass for multi-scale contour detection and it uses a novel sparse boundary representation for hierarchical segmentation; it gives a significant leap in performance over the state-of-the-art, and it generalizes very well to unseen categories and datasets. Particularly, we show that learning to estimate not only contour strength but also orientation provides more accurate results. We perform extensive experiments for low-level applications on BSDS, PASCAL Context, PASCAL Segmentation, and NYUD to evaluate boundary detection performance, showing that COB provides state-of-the-art contours and region hierarchies in all datasets. We also evaluate COB on high-level tasks when coupled with multiple pipelines for object proposals, semantic contours, semantic segmentation, and object detection on MS-COCO, SBD, and PASCAL; showing that COB also improves the results for all tasks.

  15. An Overview of the ATLAS High Level Trigger Dataflow and Supervision

    CERN Document Server

    Wheeler, S; Baines, J T M; Bee, C P; Biglietti, M; Bogaerts, A; Boisvert, V; Bosman, M; Brandt, S; Caron, B; Casado, M P; Cataldi, G; Cavalli, D; Cervetto, M; Comune, G; Corso-Radu, A; Di Mattia, A; Díaz-Gómez, M; Dos Anjos, A; Drohan, J; Ellis, Nick; Elsing, M; Epp, B; Etienne, F; Falciano, S; Farilla, A; George, S; Ghete, V M; González, S; Grothe, M; Kaczmarska, A; Karr, K M; Khomich, A; Konstantinidis, N P; Krasny, W; Li, W; Lowe, A; Luminari, L; Meessen, C; Mello, A G; Merino, G; Morettini, P; Moyse, E; Nairz, A; Negri, A; Nikitin, N V; Nisati, A; Padilla, C; Parodi, F; Pérez-Réale, V; Pinfold, J L; Pinto, P; Polesello, G; Qian, Z; Resconi, S; Rosati, S; Scannicchio, D A; Schiavi, C; Schörner-Sadenius, T; Segura, E; De Seixas, J M; Shears, T G; Sivoklokov, S Yu; Smizanska, M; Soluk, R A; Stanescu, C; Tapprogge, Stefan; Touchard, F; Vercesi, V; Watson, A; Wengler, T; Werner, P; Wickens, F J; Wiedenmann, W; Wielers, M; Zobernig, G; RT 2003 13th IEEE-NPSS Real Time Conference

    2004-01-01

    The ATLAS High Level Trigger (HLT) system provides software-based event selection after the initial LVL1 hardware trigger. It is composed of two stages, the LVL2 trigger and the Event Filter (EF). The LVL2 trigger performs event selection with optimized algorithms using selected data guided by Region of Interest pointers provided by the LVL1 trigger. Those events selected by LVL2, are built into complete events, which are passed to the EF for a further stage of event selection and classification using off-line algorithms. Events surviving the EF selection are passed for off-line storage. The two stages of HLT are implemented on processor farms. The concept of distributing the selection process between LVL2 and EF is a key element in the architecture, which allows it to be flexible to changes (luminosity, detector knowledge, background conditions etc.) Although there are some differences in the requirements between these sub-systems there are many commonalities. An overview of the dataflow (event selection) an...

  16. High-level mobility outcomes following acquired brain injury: a preliminary evaluation.

    Science.gov (United States)

    Williams, Gavin P; Morris, Meg E

    2009-04-01

    To evaluate the efficacy of a high-level mobility programme for people with acquired brain injury (ABI). A cohort study which evaluated the efficacy of a high-level mobility programme for people with ABI. A major rehabilitation hospital. Twenty-eight people with acquired brain injury. A 3 month high-level mobility programme conducted twice weekly consisting of strengthening exercises, pre-running and running drills and agility exercises supplemented with a gym or home exercise programme. The primary outcome measure was the high-level mobility assessment tool (HiMAT). Participants were predominantly male and young (average age 33.2 years, range 16-72 years) with chronic ABI. HiMAT scores for the 28 participants who returned at the 3 month follow-up initially ranged from 6-44 points (mean 20.3). The 3 month follow-up scores ranged from 12-51 points (mean 29.2). The mean HiMAT score change ranged from 2-20 points (mean 8.9). Significant recovery in high-level mobility was achieved during a 3 month running programme. People with chronic ABI may also expect to benefit from retraining high-level mobility. Clinical trials are needed to assess the effectiveness of training programmes for high-level mobility.

  17. PyMCT: A Very High Level Language Coupling Tool For Climate System Models

    Science.gov (United States)

    Tobis, M.; Pierrehumbert, R. T.; Steder, M.; Jacob, R. L.

    2006-12-01

    At the Climate Systems Center of the University of Chicago, we have been examining strategies for applying agile programming techniques to complex high-performance modeling experiments. While the "agile" development methodology differs from a conventional requirements process and its associated milestones, the process remain a formal one. It is distinguished by continuous improvement in functionality, large numbers of small releases, extensive and ongoing testing strategies, and a strong reliance on very high level languages (VHLL). Here we report on PyMCT, which we intend as a core element in a model ensemble control superstructure. PyMCT is a set of Python bindings for MCT, the Fortran-90 based Model Coupling Toolkit, which forms the infrastructure for the inter-component communication in the Community Climate System Model (CCSM). MCT provides a scalable model communication infrastructure. In order to take maximum advantage of agile software development methodologies, we exposed MCT functionality to Python, a prominent VHLL. We describe how the scalable architecture of MCT allows us to overcome the relatively weak runtime performance of Python, so that the performance of the combined system is not severely impacted. To demonstrate these advantages, we reimplemented the CCSM coupler in Python. While this alone offers no new functionality, it does provide a rigorous test of PyMCT functionality and performance. We reimplemented the CPL6 library, presenting an interesting case study of the comparison between conventional Fortran-90 programming and the higher abstraction level provided by a VHLL. The powerful abstractions provided by Python will allow much more complex experimental paradigms. In particular, we hope to build on the scriptability of our coupling strategy to enable systematic sensitivity tests. Our most ambitious objective is to combine our efforts with Bayesian inverse modeling techniques toward objective tuning at the highest level, across model

  18. Demonstration of Caustic-Side Solvent Extraction with Savannah River Site High Level Waste

    Energy Technology Data Exchange (ETDEWEB)

    Walker, D.D.

    2001-08-27

    Researchers successfully demonstrated the chemistry and process equipment of the Caustic-Side Solvent Extraction (CSSX) flowsheet for the decontamination of high level waste using a 33-stage, 2-cm centrifugal contactor apparatus at the Savannah River Technology Center. This represents the first CSSX process demonstration using Savannah River Site (SRS) high level waste. Three tests lasting 6, 12, and 48 hours processed simulated average SRS waste, simulated Tank 37H/44F composite waste, and Tank 37H/44F high level waste, respectively.

  19. A framework for the definition of variants of high-level Petri nets

    DEFF Research Database (Denmark)

    Kindler, Ekkart; Petrucci, Laure

    2009-01-01

    with data-type specific issues, which often blocks the view for the really relevant parts. Even worse, supposedly simpler versions of high-level nets often are more difficult to define than high-level nets in general. This paper introduces the concepts and the mathematical tools to ease the definition...... analysis algorithms for symmetric nets. During the standardisation of high-level nets and some of their variations, it turned out that defining the legal data types and the operations on them is the most difficult part. In particular, these definitions become lengthy and mix Petri net specific issues...

  20. Qualitative Economics

    DEFF Research Database (Denmark)

    Fast, Michael; Clark II, Woodrow W

                         This book is about science -- specifically, the science of economics. Or lack thereof is more accurate. The building of any science, let alone economics, is grounded in the understanding of what is beneath the "surface" of economics. Science, and hence economics, should...... be concerned with formulating ideas that express theories which produce descriptions of how to understand phenomenon and real world experiences.                       Economics must become a science, because the essence of economics in terms of human actions, group interactions and communities are in need...... of scientific inquiry. Academics and scholars need a scientific perspective that can hypothesize, theorize document, understand and analyze human dynamics from the individual to more societal interactions. And that is what qualitative economics does; it can make economics into becoming a science. The economic...

  1. Qualitative Value Profiling

    DEFF Research Database (Denmark)

    Duus, Henrik Johannsen; Bjerre, Mogens

    2015-01-01

    Qualitative value profiling (QVP) is a relatively unknown method of strategic analysis for companies in international business-to-business settings. The purpose of QVP is to reduce the information complexity that is faced by international companies in dealing with business partners. The QVP method...... and consequently, for the advancement of international development. Further use of QVP is recommended and suggestions for future research are provided....

  2. Potential Application Of Radionuclide Scaling Factors To High Level Waste Characterization

    Energy Technology Data Exchange (ETDEWEB)

    Reboul, S. H. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2013-09-30

    Production sources, radiological properties, relative solubilities in waste, and laboratory analysis techniques for the forty-five radionuclides identified in Hanford's Waste Treatment and Immobilization Plant (WTP) Feed Acceptance Data Quality Objectives (DQO) document are addressed in this report. Based on Savannah River Site (SRS) experience and waste characteristics, thirteen of the radionuclides are judged to be candidates for potential scaling in High Level Waste (HLW) based on the concentrations of other radionuclides as determined through laboratory measurements. The thirteen radionuclides conducive to potential scaling are: Ni-59, Zr-93, Nb-93m, Cd-113m, Sn-121m, Sn-126, Cs-135, Sm-151, Ra-226, Ra-228, Ac-227, Pa-231, and Th-229. The ability to scale radionuclides is useful from two primary perspectives: 1) it provides a means of checking the radionuclide concentrations that have been determined by laboratory analysis; and 2) it provides a means of estimating radionuclide concentrations in the absence of a laboratory analysis technique or when a complex laboratory analysis technique fails. Along with the rationale for identifying and applying the potential scaling factors, this report also provides examples of using the scaling factors to estimate concentrations of radionuclides in current SRS waste and into the future. Also included in the report are examples of independent laboratory analysis techniques that can be used to check results of key radionuclide analyses. Effective utilization of radionuclide scaling factors requires understanding of the applicable production sources and the chemistry of the waste. As such, the potential scaling approaches identified in this report should be assessed from the perspective of the Hanford waste before reaching a decision regarding WTP applicability.

  3. Design Automation Using Script Languages. High-Level CAD Templates in Non-Parametric Programs

    Science.gov (United States)

    Moreno, R.; Bazán, A. M.

    2017-10-01

    The main purpose of this work is to study the advantages offered by the application of traditional techniques of technical drawing in processes for automation of the design, with non-parametric CAD programs, provided with scripting languages. Given that an example drawing can be solved with traditional step-by-step detailed procedures, is possible to do the same with CAD applications and to generalize it later, incorporating references. In today’s modern CAD applications, there are striking absences of solutions for building engineering: oblique projections (military and cavalier), 3D modelling of complex stairs, roofs, furniture, and so on. The use of geometric references (using variables in script languages) and their incorporation into high-level CAD templates allows the automation of processes. Instead of repeatedly creating similar designs or modifying their data, users should be able to use these templates to generate future variations of the same design. This paper presents the automation process of several complex drawing examples based on CAD script files aided with parametric geometry calculation tools. The proposed method allows us to solve complex geometry designs not currently incorporated in the current CAD applications and to subsequently create other new derivatives without user intervention. Automation in the generation of complex designs not only saves time but also increases the quality of the presentations and reduces the possibility of human errors.

  4. High-level waste borosilicate glass a compendium of corrosion characteristics. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Cunnane, J.C. [comp.; Bates, J.K.; Bradley, C.R. [Argonne National Lab., IL (United States)

    1994-03-01

    Current plans call for the United States Department of Energy (DOE) to start up facilities for vitrification of high-level radioactive waste (HLW) stored in tanks at the Savannah River Site, Aiken, South Carolina, in 1995; West Valley Demonstration Project, West Valley, New York, in 1996; and at the Hanford Site, Richland, Washington, after the year 2000. The product from these facilities will be canistered HLW borosilicate glass, which will be stored, transported, and eventually disposed of in a geologic repository. The behavior of this glass waste product, under the range of likely service conditions, is the subject of considerable scientific and public interest. Over the past few decades, a large body of scientific information on borosilicate waste glass has been generated worldwide. The intent of this document is to consolidate information pertaining to our current understanding of waste glass corrosion behavior and radionuclide release. The objective, scope, and organization of the document are discussed in Section 1.1, and an overview of borosilicate glass corrosion is provided in Section 1.2. The history of glass as a waste form and the international experience with waste glass are summarized in Sections 1.3 and 1.4, respectively.

  5. Risk perception on management of nuclear high-level and transuranic waste storage

    Energy Technology Data Exchange (ETDEWEB)

    Dees, Lawrence A. [Colorado Christian Univ., Lakewood, CO (United States)

    1994-08-15

    The Department of Energy`s program for disposing of nuclear High-Level Waste (HLW) and transuranic (TRU) waste has been impeded by overwhelming political opposition fueled by public perceptions of actual risk. Analysis of these perceptions shows them to be deeply rooted in images of fear and dread that have been present since the discovery of radioactivity. The development and use of nuclear weapons linked these images to reality and the mishandling of radioactive waste from the nations military weapons facilities has contributed toward creating a state of distrust that cannot be erased quickly or easily. In addition, the analysis indicates that even the highly educated technical community is not well informed on the latest technology involved with nuclear HLW and TRU waste disposal. It is not surprising then, that the general public feels uncomfortable with DOE`s management plans for with nuclear HLW and TRU waste disposal. Postponing the permanent geologic repository and use of Monitored Retrievable Storage (MRS) would provide the time necessary for difficult social and political issues to be resolved. It would also allow time for the public to become better educated if DOE chooses to become proactive.

  6. Commissioning of the ATLAS high-level trigger with single beam and cosmic rays

    Science.gov (United States)

    Erkcan Özcan, V.

    2010-11-01

    ATLAS is one of the two general-purpose detectors at the Large Hadron Collider (LHC). Using fast reconstruction algorithms, its trigger system needs to efficiently reject a huge rate of background events and still select potentially interesting ones with good efficiency. After a first processing level using custom electronics, the trigger selection is made by software running on two processor farms, designed to have a total of around two thousand multi-core machines. This system is known as the High Level Trigger (HLT). To reduce the network data traffic and the processing time to manageable levels, the HLT uses seeded, step-wise reconstruction, aiming at the earliest possible rejection of background events. The recent LHC startup and short single-beam run provided a "stress test" of the trigger. Following this period, ATLAS continued to collect cosmic-ray events for detector alignment and calibration purposes. These running periods allowed strict tests of the HLT reconstruction and selection algorithms as well as of its configuration and monitoring systems. This facilitated the commissioning of several tracking, muon-finding, and calorimetry algorithms under different running conditions. After an overview of the trigger design, this paper focuses on the experience gained in running the trigger in the fast-changing environment of the detector commissioning. It will emphasize the commissioning of the HLT algorithms, monitoring and configuration.

  7. Commissioning of the ATLAS High Level Trigger with single beam and cosmic rays

    Science.gov (United States)

    Di Mattia, A.; ATLAS Collaboration

    2010-04-01

    ATLAS is one of the two general-purpose detectors at the Large Hadron Collider (LHC). The trigger system is responsible for making the online selection of interesting collision events. At the LHC design luminosity of 1034 cm-2s-1 it will need to achieve a rejection factor of the order of 10-7 against random proton-proton interactions, while selecting with high efficiency events that are needed for physics analyses. After a first processing level using custom electronics based on FPGAs and ASICs, the trigger selection is made by software running on two processor farms, containing a total of around two thousand multi-core machines. This system is known as the High Level Trigger (HLT). To reduce the network data traffic and the processing time to manageable levels, the HLT uses seeded, step-wise reconstruction, aiming at the earliest possible rejection of background events. The recent LHC startup and short single-beam run provided a "stress test" of the system and some initial calibration data. Following this period, ATLAS continued to collect cosmic-ray events for detector alignment and calibration purposes. After giving an overview of the trigger design and its innovative features, this paper focuses on the experience gained from operating the ATLAS trigger with single LHC beams and cosmic-rays.

  8. Better economy in field running than on the treadmill: evidence from high-level distance runners

    Directory of Open Access Journals (Sweden)

    M Mooses

    2015-05-01

    Full Text Available Given the ongoing interest in ways to improve the specificity of testing elite athletes in their natural environment, portable metabolic systems provide an opportunity to assess metabolic demand of exercise in sport-specific settings. Running economy (RE and maximal oxygen uptake ( ·VO 2 max were compared between track and treadmill (1% inclination conditions in competitive level European distance runners who were fully habituated to treadmill running (n = 13. All runners performed an exercise test on running track and on treadmill. While ·VO 2 max was similar on the track and on the treadmill (68.5 ± 5.3 vs. 71.4 ± 6.4 ml∙kg -1 ∙min -1 , p = 0.105, respectively, superior RE was found on the track compared to the treadmill (215.4 ± 12.4 vs. 236.8 ± 18.0 O2 ml∙kg -1 ∙km -1 , p < 0.001. RE on the track was strongly correlated with RE on the treadmill (r = 0.719, p = 0.006. The present findings indicate that high-level distance runners have significantly better RE but not ·VO2max on the track compared to treadmill. This difference may be due to biomechanical adjustments. As RE is strongly correlated between the two conditions, it would be reasonable to assume that interventions affecting RE on the treadmill will also affect RE on the track.

  9. Astonishing Judo, first contact tactics: A Biomechanical evaluation of tactics at start of high level competitions

    CERN Document Server

    Sacripanti, Attilio

    2014-01-01

    This paper is focalized on the limit application of judo throws, by tactics at first contact time, with some astonishing information at a first seeing, but biomechanically grounded, not often applied or because against the sound common sense or out the old oral judo tradition. To do so we provide an appraisal of the grips concept and his consequences in the Olympic sport judo from a biomechanics perspective, we will try to deeper both the concept and the function of grips and define the potential application of some throws without grips. Broadening this situation we try to underline some specific throwing situation in which grips are or not at all applied or applied in non conventional way. We describe at first the problem from the theoretical point of view. And as second point we try to find practical application, original or already developed in high level competitions. The provocative words Judo without grips or throw without grips are connected to the limit application of some biomechanical tricks, ground...

  10. Quality assurance plan for the High Level Controller for the CBMS Block II

    Energy Technology Data Exchange (ETDEWEB)

    Reid, R.W.; Robbins, I.F.; Stewart, K.A.; Terry, C.L.; Whitaker, R.A.; Wolf, D.A.; Zager, J.C.

    1997-09-01

    This document establishes the software Quality Assurance Plan (QAP) for the High Level Controller for the Chemical and Biological Mass Spectrometer Block II (HLC/CBMS-II) project activities under the Computing, Robotics, and Education (CRE) Directorate management. It defines the requirements and assigns responsibilities for ensuring, with a high degree of confidence, that project objectives will be achieved as planned. The CBMS Program was awarded to ORNL by the US Army Chemical and Biological Defense command, Aberdeen Proving Ground, Maryland, to design the next version (Block II) mass spectrometer for the detection and identification of chemical and biological warfare agents, to fabricate four engineering prototypes, and to construct eight preproduction units. Section 1 of this document provides an introduction to the HLC/CBMS-II project QAP. Sections 2 and 3 describe the specific aspects of quality assurance as applicable to the project. Section 4 reviews the project approach to risk management. The Risk Management Matrix given in Appendix A is a tool to assess, prioritize, and prevent problems before they occur; therefore, the matrix will be reviewed and revised on a periodic basis. Appendix B shows the quality assurance criteria of the DOE Order 5700.6C and their applicability to this project.

  11. The High-Level Interface Definitions in the ASTRI/CTA Mini Array Software System (MASS)

    Science.gov (United States)

    Conforti, V.; Tosti, G.; Schwarz, J.; Bruno, P.; Cefal‘A, M.; Paola, A. D.; Gianotti, F.; Grillo, A.; Russo, F.; Tanci, C.; Testa, V.; Antonelli, L. A.; Canestrari, R.; Catalano, O.; Fiorini, M.; Gallozzi, S.; Giro, E.; Palombara, N. L.; Leto, G.; Maccarone, M. C.; Pareschi, G.; Stringhetti, L.; Trifoglio, M.; Vercellone, S.; Astri Collaboration; Cta Consortium

    2015-09-01

    ASTRI (Astrofisica con Specchi a Tecnologia Replicante Italiana) is a Flagship Project funded by the Italian Ministry of Education, University and Research, and led by INAF, the Italian National Institute of Astrophysics. Within this framework, INAF is currently developing an end-to-end prototype, named ASTRI SST-2M, of a Small Size Dual-Mirror Telescope for the Cherenkov Telescope Array, CTA. A second goal of the project is the realization of the ASTRI/CTA mini-array, which will be composed of seven SST-2M telescopes placed at the CTA Southern Site. The ASTRI Mini Array Software System (MASS) is designed to support the ASTRI/CTA mini-array operations. MASS is being built on top of the ALMA Common Software (ACS) framework, which provides support for the implementation of distributed data acquisition and control systems, and functionality for log and alarm management, message driven communication and hardware devices management. The first version of the MASS system, which will comply with the CTA requirements and guidelines, will be tested on the ASTRI SST-2M prototype. In this contribution we present the interface definitions of the MASS high level components in charge of the ASTRI SST-2M observation scheduling, telescope control and monitoring, and data taking. Particular emphasis is given to their potential reuse for the ASTRI/CTA mini-array.

  12. Unique Flap Conformation in an HIV-1 Protease with High-level Darunavir Resistance

    Directory of Open Access Journals (Sweden)

    Masaaki eNakashima

    2016-02-01

    Full Text Available Darunavir (DRV is one of the most powerful protease inhibitors for treating human immunodeficiency virus type-1 (HIV-1 infection and presents a high genetic barrier to the generation of resistant viruses. However, DRV-resistant HIV-1 infrequently emerges from viruses exhibiting resistance to other protease inhibitors. To address this resistance, researchers have gathered genetic information on DRV resistance. In contrast, few structural insights into the mechanism underlying DRV resistance are available. To elucidate this mechanism, we determined the crystal structure of the ligand-free state of a protease with high-level DRV resistance and six DRV resistance-associated mutations (including I47V and I50V, which we generated by in vitro selection. This crystal structure showed a unique curling conformation at the flap regions that was not found in the previously reported ligand-free protease structures. Molecular dynamics simulations indicated that the curled flap conformation altered the flap dynamics. These results suggest that the preference for a unique flap conformation influences DRV binding. These results provide new structural insights into elucidating the molecular mechanism of DRV resistance and aid to develop PIs effective against DRV-resistant viruses.

  13. Extracellular DNA amplicon sequencing reveals high levels of benthic eukaryotic diversity in the central Red Sea

    KAUST Repository

    Pearman, John K.

    2015-11-01

    The present study aims to characterize the benthic eukaryotic biodiversity patterns at a coarse taxonomic level in three areas of the central Red Sea (a lagoon, an offshore area in Thuwal and a shallow coastal area near Jeddah) based on extracellular DNA. High-throughput amplicon sequencing targeting the V9 region of the 18S rRNA gene was undertaken for 32 sediment samples. High levels of alpha-diversity were detected with 16,089 operational taxonomic units (OTUs) being identified. The majority of the OTUs were assigned to Metazoa (29.2%), Alveolata (22.4%) and Stramenopiles (17.8%). Stramenopiles (Diatomea) and Alveolata (Ciliophora) were frequent in a lagoon and in shallower coastal stations, whereas metazoans (Arthropoda: Maxillopoda) were dominant in deeper offshore stations. Only 24.6% of total OTUs were shared among all areas. Beta-diversity was generally lower between the lagoon and Jeddah (nearshore) than between either of those and the offshore area, suggesting a nearshore–offshore biodiversity gradient. The current approach allowed for a broad-range of benthic eukaryotic biodiversity to be analysed with significantly less labour than would be required by other traditional taxonomic approaches. Our findings suggest that next generation sequencing techniques have the potential to provide a fast and standardised screening of benthic biodiversity at large spatial and temporal scales.

  14. Analysis of crack initiation and growth in the high level vibration test at Tadotsu

    Energy Technology Data Exchange (ETDEWEB)

    Kassir, M.K.; Park, Y.J.; Hofmayer, C.H.; Bandyopadhyay, K.K.; Shteyngart, S. [Brookhaven National Lab., Upton, NY (United States)

    1993-08-01

    The High Level Vibration Test data are used to assess the accuracy and usefulness of current engineering methodologies for predicting crack initiation and growth in a cast stainless steel pipe elbow under complex, large amplitude loading. The data were obtained by testing at room temperature a large scale modified model of one loop of a PWR primary coolant system at the Tadotsu Engineering Laboratory in Japan. Fatigue crack initiation time is reasonably predicted by applying a modified local strain approach (Coffin-Mason-Goodman equation) in conjunction with Miner`s rule of cumulative damage. Three fracture mechanics methodologies are applied to investigate the crack growth behavior observed in the hot leg of the model. These are: the {Delta}K methodology (Paris law), {Delta}J concepts and a recently developed limit load stress-range criterion. The report includes a discussion on the pros and cons of the analysis involved in each of the methods, the role played by the key parameters influencing the formulation and a comparison of the results with the actual crack growth behavior observed in the vibration test program. Some conclusions and recommendations for improvement of the methodologies are also provided.

  15. Analysis of the lack of scientific and technological talents of high-level women in China

    Science.gov (United States)

    Lin, Wang

    2017-08-01

    The growth and development of high-level female scientific and technological talents has become a global problem, facing severe challenges. The lack of high-level women in science and technology has become a global problem. How to recruit and help female scientists and technological talents grow raises awareness from the industry. To find out the main reasons for the lack of high-level female scientific and technological talent. This paper analyses the impact of gender discrimination on the lack of high-level female scientific and technological talents, the impact of disciplinary differences on female roles. The main reasons are: women’s natural disadvantage of mathematical thinking; female birth, the traditional culture on the role of women and the impact of values.

  16. Advanced Distributed Simulation Technology II (ADST II) High Level Architecture Support Experiments

    National Research Council Canada - National Science Library

    1998-01-01

    The purpose of the High Level Architecture (HLA) Support Experiments (HSE) project was to perform experimentation and research in HLA technology to support the evolution and further implementation of the HLA specifications...

  17. Demonstration of Small Tank Tetraphenylborate Precipitation Process Using Savannah River Site High Level Waste

    Energy Technology Data Exchange (ETDEWEB)

    Peters, T.B.

    2001-09-10

    This report details the experimental effort to demonstrate the continuous precipitation of cesium from Savannah River Site High Level Waste using sodium tetraphenylborate. In addition, the experiments examined the removal of strontium and various actinides through addition of monosodium titanate.

  18. Frameworks to monitor and predict rates and resource usage in the ATLAS High Level Trigger

    Science.gov (United States)

    Martin, Tim; ATLAS Collaboration

    2017-10-01

    The ATLAS High Level Trigger Farm consists of around 40,000 CPU cores which filter events at an input rate of up to 100 kHz. A costing framework is built into the high level trigger thus enabling detailed monitoring of the system and allowing for data-driven predictions to be made utilising specialist datasets. An overview is presented in to how ATLAS collects in-situ monitoring data on CPU usage during the trigger execution, and how these data are processed to yield both low level monitoring of individual selection-algorithms and high level data on the overall performance of the farm. For development and prediction purposes, ATLAS uses a special ‘Enhanced Bias’ event selection. This mechanism is explained along with how it is used to profile expected resource usage and output event rate of new physics selections, before they are executed on the actual high level trigger farm.

  19. Frameworks to monitor and predict rates and resource usage in the ATLAS High Level Trigger

    CERN Document Server

    AUTHOR|(INSPIRE)INSPIRE-00219969; The ATLAS collaboration

    2016-01-01

    The ATLAS High Level Trigger Farm consists of around 40,000 CPU cores which filter events at an input rate of up to 100 kHz. A costing framework is built into the high level trigger thus enabling detailed monitoring of the system and allowing for data-driven predictions to be made utilising specialist datasets. An overview is presented in to how ATLAS collects in-situ monitoring data on CPU usage during the trigger execution, and how these data are processed to yield both low level monitoring of individual selection-algorithms and high level data on the overall performance of the farm. For development and prediction purposes, ATLAS uses a special ‘Enhanced Bias’ event selection. This mechanism is explained along with how it is used to profile expected resource usage and output event rate of new physics selections, before they are executed on the actual high level trigger farm.

  20. Virological profile of pregnant HIV positive women with high levels of ...

    African Journals Online (AJOL)

    Virological profile of pregnant HIV positive women with high levels of CD4 count in low income settings: Can viral load help as eligibility criteria for maternal triple ARV prophylaxis (WHO 2010 option B)?

  1. OCCURRENCE OF HIGH-LEVEL AMINOGLYCOSIDE RESISTANCE IN ENVIRONMENTAL ISOLATES OF ENTEROCOCCI

    Science.gov (United States)

    High-level resistance fo aminoglycosides was observed in environmental isolates of enterococci. Various aquatic habitats, including agricultural runoff, creeks, rivers, wastewater, and wells, were analyzed. Strains of Enterococcus faecalis, e.faecium, E. gallinarum, and other Ent...

  2. Anthropometric and fitness profile of high-level basketball, handball and volleyball players

    Directory of Open Access Journals (Sweden)

    J. Peña

    2018-01-01

    Conclusions: There is evidence of anthropometric and physiological differences among the high-level team sports analyzed. Its assessment seems capital for the improvement of training strategies and accurate talent identification processes.

  3. Factors related to high-level mobility in male servicemembers with traumatic lower-limb loss

    OpenAIRE

    Ignacio A. Gaunaurd, PhD, MSPT; Kathryn E. Roach, PhD, PT; Michele A. Raya, PhD, PT, SCS, ATC; COL (Ret) Rebecca Hooper, PhD, PT; Alison A. Linberg, DPT, ATC; Justin Z. Laferrier, PhD, MSPT, OCS, SCS, ATP, CSCS; MAJ (Ret) Stuart M. Campbell, MPT; COL (Ret) Charles Scoville, PT, DPT; Robert S. Gailey, PhD, PT

    2013-01-01

    The purpose of this study was to examine the possible relationship between factors modifiable by rehabilitation interventions (rehabilitation factors), other factors related to lower-limb loss (other factors), and high-level mobility as measured by the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in servicemembers (SMs) with traumatic lower-limb loss. One-hundred eighteen male SMs with either unilateral transtibial amputation (TTA), unilateral transfemoral amputation (TFA), or...

  4. Research and development on geological disposal of high-level radioactive waste; First progress report

    OpenAIRE

    1992-01-01

    The "first progress report of research and development ongeological disposal of high level radioactive waste", h3 in short, isintended for the japanese authorities. In accordance with the "overallprogram for high level radioactive waste management" set forth byatomic energy commission, h3 is designed to clarify the current status ofthe research and development work performed by power reactor and nuclearfuel development corporation(pnc) up to the year 1991. H3 presents the updated knowledge on...

  5. H-3 Summary report research and development on geolgical disposal of high-level radioactive waste

    OpenAIRE

    1992-01-01

    The "First progress report of research and development ongeological disposal of high level radioactive waste",H3 in short,is intended for the Japanese authorities. In accordance with the "Overall program for high level radioactive waste management" set forth by atomic energy commission, H3 is designed to clarify the current status of the research and development work performed by power reactor and nuclear fuel development corporation (PNC) up to the year 1991. H3 presents the updated knowledg...

  6. Quantifying Qualitative Data Using Cognitive Maps

    Science.gov (United States)

    Scherp, Hans-Ake

    2013-01-01

    The aim of the article is to show how substantial qualitative material consisting of graphic cognitive maps can be analysed by using digital CmapTools, Excel and SPSS. Evidence is provided of how qualitative and quantitative methods can be combined in educational research by transforming qualitative data into quantitative data to facilitate…

  7. Normative data for critical speed and D' for high-level male rugby players.

    Science.gov (United States)

    Kramer, Mark; Clark, Ida E; Jamnick, Nick; Strom, Cody; Pettitt, Robert W

    2017-03-08

    The critical speed (CS) concept helps characterize the aerobic and anaerobic fitness of an athlete. Rugby players should hypothetically have modest CS values but extremely high curvature constant (D') values, yet, normative data are currently unavailable. To develop normative data of CS and D' for high-level male rugby players, a total of 30 male rugby players, were recruited from the Eastern Cape of South Africa. All subjects performed the running 3-min all-out exercise test (3 MT) using global positioning system (GPS) technology to determine CS and D'. The GPS data were used to determine the total distance and velocities performed, and to examine for pacing affects. Summary statistics of mean ± SD are provided. High total running speeds for the initial 150 s (S150s = 5.79 ± 0.59 m/s) and total distance (3 MT distance = 871.5 ± 71.9 m) were observed. A total of 13 of 30 subjects surpassed the 300 m D' value (mean D' = 288.2 ± 49.1 m). The CS of the total group was 3.87 ± 0.55 m/s. All 3MT-derived data was categorized using stanine tables that allowed for the generation of normative data to which future performances, performances across similar sporting domains and more accurate contrasts across the literature can be compared. Skewing of CS and D' was observed between forwards and backs, therefore between-group differences in neither CS nor D' were observed (p > 0.05). Comparisons with previous literature indicate male rugby players have higher CS values than female rugby players. When compared with Olympic distance runners, male rugby players have markedly higher D' values and markedly lower CS values. The 3 MT provides a useful procedure for assessing and prescribing high-intensity interval training for rugby athletes.

  8. FPGA based data processing in the ALICE High Level Trigger in LHC Run 2

    Science.gov (United States)

    Engel, Heiko; Alt, Torsten; Kebschull, Udo; ALICE Collaboration

    2017-10-01

    The ALICE High Level Trigger (HLT) is a computing cluster dedicated to the online compression, reconstruction and calibration of experimental data. The HLT receives detector data via serial optical links into FPGA based readout boards that process the data on a per-link level already inside the FPGA and provide it to the host machines connected with a data transport framework. FPGA based data pre-processing is enabled for the biggest detector of ALICE, the Time Projection Chamber (TPC), with a hardware cluster finding algorithm. This algorithm was ported to the Common Read-Out Receiver Card (C-RORC) as used in the HLT for RUN 2. It was improved to handle double the input bandwidth and adjusted to the upgraded TPC Readout Control Unit (RCU2). A flexible firmware implementation in the HLT handles both the old and the new TPC data format and link rates transparently. Extended protocol and data error detection, error handling and the enhanced RCU2 data ordering scheme provide an improved physics performance of the cluster finder. The performance of the cluster finder was verified against large sets of reference data both in terms of throughput and algorithmic correctness. Comparisons with a software reference implementation confirm significant savings on CPU processing power using the hardware implementation. The C-RORC hardware with the cluster finder for RCU1 data is in use in the HLT since the start of RUN 2. The extended hardware cluster finder implementation for the RCU2 with doubled throughput is active since the upgrade of the TPC readout electronics in early 2016.

  9. Benefits of Qualitative Simulation for Managing Fluctuating Staffing Needs

    Energy Technology Data Exchange (ETDEWEB)

    T. T. Nichols

    2001-07-02

    Management of the High Level Waste Program Office at the Idaho National Environmental and Engineering Laboratory has projected oscillating future employment levels. A simple computer model was created to help convince management that qualitative modeling of ''soft'' variables can provide appreciable insight into the consequences and performance of alternative staffing policies. Advocacy of the model underlying the simulation or a particular strategy did not motivate the study, but rather a desire to instill enthusiasm and elicit new and improved conceptual models from management. Six qualitative and three quantitative generic insights to managing staffing levels are gained from the simulations. These insights in their generic form should be familiar to those knowledgeable of system dynamics or computer/instrument process control. Their potential usefulness to developing staffing strategies is stressed. The two primary overarching assertions that flow from the simulation results are: (1) the presence of multiple feedbacks, time delays, and continuous flows introduce instability into a personnel system that complicates the management of staffing levels. Many times ''soft'' variables, such as morale, productivity, and efficiency are the sources of such influences; and (2) such influences can be successfully modeled. In the case of the simple model used in these simulations, for example, the qualitative impact of a strategy using hiring and laying off as the sole managerial interventions is assessed.

  10. Benefits of Qualitative Simulation for Managing Fluctuating Staffing Needs

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, Todd Travis

    2001-07-01

    Management of the High Level Waste Program Office at the Idaho National Environmental and Engineering Laboratory has projected oscillating future employment levels. A simple computer model was created to help convince management that qualitative modeling of "soft" variables can provide appreciable insight into the consequences and performance of alternative staffing policies. Advocacy of the model underlying the simulation or a particular strategy did not motivate the study, but rather a desire to instill enthusiasm and elicit new and improved conceptual models from management. Six qualitative and three quantitative generic insights to managing staffing levels are gained from the simulations. These insights in their generic form should be familiar to those knowledgeable of system dynamics or computer/instrument process control. Their potential usefulness to developing staffing strategies is stressed. The two primary overarching assertions that flow from the simulation results are: 1) the presence of multiple feedbacks, time delays, and continuous flows introduce instability into a personnel system that complicates the management of staffing levels. Many times "soft" variables, such as morale, productivity, and efficiency are the sources of such influences; and 2) such influences can be successfully modeled. In the case of the simple model used in these simulations, for example, the qualitative impact of a strategy using hiring and laying off as the sole managerial interventions is assessed.

  11. Shale disposal of U.S. high-level radioactive waste.

    Energy Technology Data Exchange (ETDEWEB)

    Sassani, David Carl; Stone, Charles Michael; Hansen, Francis D.; Hardin, Ernest L.; Dewers, Thomas A.; Martinez, Mario J.; Rechard, Robert Paul; Sobolik, Steven Ronald; Freeze, Geoffrey A.; Cygan, Randall Timothy; Gaither, Katherine N.; Holland, John Francis; Brady, Patrick Vane

    2010-05-01

    This report evaluates the feasibility of high-level radioactive waste disposal in shale within the United States. The U.S. has many possible clay/shale/argillite basins with positive attributes for permanent disposal. Similar geologic formations have been extensively studied by international programs with largely positive results, over significant ranges of the most important material characteristics including permeability, rheology, and sorptive potential. This report is enabled by the advanced work of the international community to establish functional and operational requirements for disposal of a range of waste forms in shale media. We develop scoping performance analyses, based on the applicable features, events, and processes identified by international investigators, to support a generic conclusion regarding post-closure safety. Requisite assumptions for these analyses include waste characteristics, disposal concepts, and important properties of the geologic formation. We then apply lessons learned from Sandia experience on the Waste Isolation Pilot Project and the Yucca Mountain Project to develop a disposal strategy should a shale repository be considered as an alternative disposal pathway in the U.S. Disposal of high-level radioactive waste in suitable shale formations is attractive because the material is essentially impermeable and self-sealing, conditions are chemically reducing, and sorption tends to prevent radionuclide transport. Vertically and laterally extensive shale and clay formations exist in multiple locations in the contiguous 48 states. Thermal-hydrologic-mechanical calculations indicate that temperatures near emplaced waste packages can be maintained below boiling and will decay to within a few degrees of the ambient temperature within a few decades (or longer depending on the waste form). Construction effects, ventilation, and the thermal pulse will lead to clay dehydration and deformation, confined to an excavation disturbed zone within

  12. Qualitative tools and experimental philosophy

    Science.gov (United States)

    Andow, James

    2016-01-01

    Abstract Experimental philosophy brings empirical methods to philosophy. These methods are used to probe how people think about philosophically interesting things such as knowledge, morality, and freedom. This paper explores the contribution that qualitative methods have to make in this enterprise. I argue that qualitative methods have the potential to make a much greater contribution than they have so far. Along the way, I acknowledge a few types of resistance that proponents of qualitative methods in experimental philosophy might encounter, and provide reasons to think they are ill-founded. PMID:28392629

  13. Development of a test system for high level liquid waste partitioning

    Directory of Open Access Journals (Sweden)

    Duan Wu H.

    2015-01-01

    Full Text Available The partitioning and transmutation strategy has increasingly attracted interest for the safe treatment and disposal of high level liquid waste, in which the partitioning of high level liquid waste is one of the critical technical issues. An improved total partitioning process, including a tri-alkylphosphine oxide process for the removal of actinides, a crown ether strontium extraction process for the removal of strontium, and a calixcrown ether cesium extraction process for the removal of cesium, has been developed to treat Chinese high level liquid waste. A test system containing 72-stage 10-mm-diam annular centrifugal contactors, a remote sampling system, a rotor speed acquisition-monitoring system, a feeding system, and a video camera-surveillance system was successfully developed to carry out the hot test for verifying the improved total partitioning process. The test system has been successfully used in a 160 hour hot test using genuine high level liquid waste. During the hot test, the test system was stable, which demonstrated it was reliable for the hot test of the high level liquid waste partitioning.

  14. Factors related to high-level mobility in male servicemembers with traumatic lower-limb loss.

    Science.gov (United States)

    Gaunaurd, Ignacio A; Roach, Kathryn E; Raya, Michele A; Hooper, Rebecca; Linberg, Alison A; Laferrier, Justin Z; Campbell, Stuart M; Scoville, Charles; Gailey, Robert S

    2013-01-01

    The purpose of this study was to examine the possible relationship between factors modifiable by rehabilitation interventions (rehabilitation factors), other factors related to lower-limb loss (other factors), and high-level mobility as measured by the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in servicemembers (SMs) with traumatic lower-limb loss. One-hundred eighteen male SMs with either unilateral transtibial amputation (TTA), unilateral transfemoral amputation (TFA), or bilateral lower-limb amputation (BLLA) participated. Stepwise regression analysis was used to develop separate regression models of factors predicting CHAMP score. Regression models containing both rehabilitation factors and other factors explained 81% (TTA), 36% (TFA), and 91% (BLLA) of the variance in CHAMP score. Rehabilitation factors such as lower-limb strength and dynamic balance were found to be significantly related to CHAMP score and can be enhanced with the appropriate intervention. Further, the findings support the importance of salvaging the knee joint and its effect on high-level mobility capabilities. Lastly, the J-shaped energy storage and return feet were found to improve high-level mobility for SMs with TTA. These results could help guide rehabilitation and aid in developing appropriate interventions to assist in maximizing high-level mobility capabilities for SMs with traumatic lower-limb loss.

  15. Mixing processes in high-level waste tanks. Progress report, September 15, 1996--September 14, 1997

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, P.F.

    1997-01-01

    'U.C. Berkeley has made excellent progress in the last year in building and running experiments and performing analysis to study mixing processes that can affect the distribution of fuel and oxygen in the air space of DOE high-level waste tanks, and the potential to create flammable concentrations at isolated locations, achieving all of the milestones outlined in the proposal. The DOE support has allowed the acquisition of key experimental equipment, and has funded the full-time efforts of one doctoral student and one postdoctoral researcher working on the project. In addition, one masters student and one other doctoral student, funded by external sources, have also contributed to the research effort. Flammable gases can be generated in DOE high-level waste tanks, including radiolytic hydrogen, and during cesium precipitation from salt solutions, benzene. Under normal operating conditions the potential for deflagration or detonation from these gases is precluded by purging and ventilation systems, which remove the flammable gases and maintain a well-mixed condition in the tanks. Upon failure of the ventilation system, due to seismic or other events, however, it has proven more difficult to make strong arguments for well-mixed conditions, due to the potential for density-induced stratification which can potentially sequester fuel or oxidizer at concentrations significantly higher than average. This has complicated the task of defining the safety basis for tank operation. The author is currently developing numerical tools for modeling the transient evolution of fuel and oxygen concentrations in waste tanks following loss of ventilation. When used with reasonable grid resolutions, standard multi-dimensional fluid dynamics codes suffer from excessive numerical diffusion effects, which strongly over predict mixing and provide nonconservative estimates, particularly after stratification occurs. The National Institute of Standards and Technology (NIST) has developed

  16. Doing qualitative research in dentistry and dental education.

    Science.gov (United States)

    Edmunds, S; Brown, G