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Sample records for proving peripartum care

  1. Peripartum cardiomyopathy

    Science.gov (United States)

    ... exercise to help keep your heart strong. Avoid cigarettes and alcohol. Your provider may advise you to avoid getting pregnant again if you have had heart failure during a previous pregnancy. Alternative Names Cardiomyopathy - peripartum; Cardiomyopathy - pregnancy Images Heart, section ...

  2. [Peripartum cardiomyopathy].

    Science.gov (United States)

    Antohe, Ileana

    2003-01-01

    Peripartum cardiomyopathy (CMP) represents an intriguing and incompletely characterised cause of heart failure arising in women without previously known heart disease during last trimester of pregnancy or first 20 weeks after birth. Fundamental clinical and basic research is lacking regarding this rare but potentially devastating disorder. The article reviews present accepted definition of CMP, epidemiological data, possible etiologic factors and pathogenic mechanisms proposed in CMP. It describes identified risk factors for CMP, clinical symptoms and signs, diagnostic assessment and treatment. Prognosis, follow up criteria and education for patients with previous CMP concerning subsequent pregnancies are also described.

  3. Peripartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Rodolfo Citro

    2011-07-01

    Full Text Available Peripartum cardiomyopathy is an uncommon form of congestive heart failure associated with systolic dysfunction of left ventricle. The onset is characterised by symptoms of heart failure occurring between the last month of pregnancy and 5-6 months postpartum. The early diagnosis and the institution of medical treatment for this disease are essential because the inadequate management may affect the patient’s long-term prognosis and can lead to severe complications, including death.Currently its aetiology is not completely understood. Many aetiopathogenetic hypotheses have been formulated: inflammation, viral agents, autoimmune processes. In the last years, evidences aroused for a role of prolactin and its 16 kDa metabolite in reducing cardiomyocite metabolic activity and contraction. In this article we have reviewed the current literature with special emphasis on the role of prolactin and the related current treatment strategies. In particular, bromocriptine appears promising, even if women need to be informed that the drug stops the production of breastmilk. Further researchers, such as large multicenter trials, are needed to decide the best treatment for the women suffering of this disease.

  4. [Peripartum cardiomyopathy--a case report].

    Science.gov (United States)

    Banaczek, Zbigniew; Rak, Grzegorz; Gołyska-Rączkiewicz, Danuta

    2015-01-01

    Peripartum cardiomyopathy, a type of dilated cardiomyopathy of unknown origin, occurs in previously healthy women in the final month of pregnancy and up to 5 months after delivery. Although the incidence is low--less than 0.1% of pregnancies--morbidity and mortality rates are high at 5% to 32%. The etiology of left ventricular dysfunction is unknown. Diagnosis of peripartum cardiomyopathy requires heightened awareness among multidisciplinary patient care teams and a high degree of suspicion. Confirmation involves the echocardiography reveals severe left ventricular failure. The outcome of peripartum cardiomyopathy is also highly variable. For some women, the clinical and echocardiographic status improves and sometimes returns to normal, whereas for others, the disease progresses to severe cardiac failure and even sudden cardiac death. Management of peripartum cardiomyopathy should aim first at improving heart-failure symptoms through conventional therapies, and then at administering targeted therapies.The prognosis is best when peripartum cardiomyopathy is diagnosed and treated early. Fortunately, despite a high risk of recurrence in subsequent pregnancies, many patients with peripartum cardiomyopathy recover within 3 to 6 months of disease onset. Future pregnancy is not recommended especially in patients with persistent left ventricular dysfunction because of the risk of dangerous complications.

  5. Peripartum cardiomyopathy: a review.

    Science.gov (United States)

    Bhattacharyya, Anirban; Basra, Sukhdeep Singh; Sen, Priyanka; Kar, Biswajit

    2012-01-01

    Peripartum cardiomyopathy is idiopathic heart failure occurring in the absence of any determinable heart disease during the last month of pregnancy or the first 5 months postpartum. The incidence varies worldwide but is high in developing nations; the cause of the disease might be a combination of environmental and genetic factors. Diagnostic echocardiographic criteria include left ventricular ejection fraction 2.7 cm/m(2). Electrocardiography, magnetic resonance imaging, endomyocardial biopsy, and cardiac catheterization aid in the diagnosis and management of peripartum cardiomyopathy. Cardiac protein assays can also be useful, as suggested by reports of high levels of NT-proBNP, cardiac troponin, tumor necrosis factor-α, interleukin-6, interferon-γ, and C-reactive protein in peripartum cardiomyopathy. The prevalence of mutations associated with familial dilated-cardiomyopathy genes in patients with peripartum cardiomyopathy suggests an overlap in the clinical spectrum of these 2 diseases.Treatment for peripartum cardiomyopathy includes conventional pharmacologic heart-failure therapies-principally diuretics, angiotensin-converting enzyme inhibitors, vasodilators, digoxin, β-blockers, anticoagulants, and peripartum cardiomyopathy-targeted therapies. Therapeutic decisions are influenced by drug-safety profiles during pregnancy and lactation. Mechanical support and transplantation might be necessary in severe cases. Targeted therapies (such as intravenous immunoglobulin, pentoxifylline, and bromocriptine) have shown promise in small trials but require further evaluation. Fortunately, despite a mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, many patients with peripartum cardiomyopathy recover within 3 to 6 months of disease onset.

  6. [Neuroradiological pattern of peripartum cerebro vascular disease medicating transfer to determine care unit].

    Science.gov (United States)

    Lakhdar, Rim; Baffoun, Nader; Hammami, Nadia; Nagi, Sonia; Baccar, Kamel; Drissi, Syrine; Kaddour, Chokri

    2012-03-01

    Pregnancy and puerperium are considered a period of a high risk of stroke responsible in a part of the morbidity and mortality in women. Imaging is the pivotal tool to diagnostics and care. To investigate the clinical and imaging features cerebrovascular complications during pregnancy and in post partum period. We report a retrospective analysis of forty four patients (November 2002 - October 2010) admitted in the intensive car department of the national institute of neurology for cerebro-vascular complications during pregnancy and in post partum period. Cerebro-vascular imaging modalities included cerebral computed tomography (CCT) with and without contrast in 94% of cases, magnetic resonance imaging (MRI) in 30.6% of cases completed by venous angiography MRI in 27.2% of cases and angiography MRI of Willis polygon in 11.3% of cases and by cerebral angiography in 13.6% of cases. Posterior reversible encephalopathy syndrome (PRES) is diagnosed in 61.4 % of cases followed by meningo-cerebral haemorrhage (MCH) in 29.5% and finally cerebral venous thrombosis (CVT) and arterial ischemia in 4.5% of cases each one. The cerebro-vascular complications are revelled in 86.3 % of the cases during the postpartum and were associated with the eclampsia or preeclampsia in 90.9 % of the cases (n=40). CCT showed typical lesions of PRES in 23 patients. It confirms the presence of hematoma in the 13 patients with MCH and find hypodense lesion in one case with ischemic stroke. CCT show direct (delta sign) and indirect signs of CVT. MRI confirms the diagnostic of PRES, when done (11 of 12 cases) and show cortical sub cortical hyper signal on T2 and FLAIR and hypo signal on T1 sequences. MRI was normal in one case. It shows hemorrhagic lesion in the 2 cases of MCH, thrombosis in the cases of CVT and ischemic lesion in the cases of ischemic stroke. CCT and MRI done within 48 hours from admission were decisive for early diagnostic and for fast and adequate care. Early recognition of stroke

  7. Emergency peripartum hysterectomy

    DEFF Research Database (Denmark)

    Jakobsson, Maija; Tapper, Anna Maija; Colmorn, Lotte Berdiin

    2015-01-01

    .7%), uterine rupture (n = 31, 14.7%), other bleeding disorders (n = 12, 5.7%), and other indications (n = 8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post-term birth increased the risk for emergency peripartum...... 7 days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period. MAIN OUTCOME MEASURES: Emergency peripartum hysterectomy rate. RESULTS: The total number of emergency...... peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10 000 (95% confidence interval 3.0-4.0) births. Finland had the highest prevalence (5.1) and Norway the lowest (2.9). Primary indications included an abnormally invasive placenta (n = 91, 43.1%), atonic bleeding (n = 69, 32...

  8. Symptoms in women with Peripartum Cardiomyopathy: A mixed method study.

    Science.gov (United States)

    Patel, Harshida; Berg, Marie; Barasa, Anders; Begley, Cecily; Schaufelberger, Maria

    2016-01-01

    Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women's experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and describe women's experiences of symptoms in Peripartum Cardiomyopathy. A triangulation of methods with individual interviews and data from medical records. Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project. 19 women were interviewed and medical records were reviewed by authors. All interview transcripts were analysed using qualitative inductive content analysis to identify key themes. The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in two post partum and time from symptoms to diagnosis varied between three and 190 days (median 40). The physical symptoms were:shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotional symptoms were: fear, anxiety, feelings of panic, and thoughts of impending death. Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and

  9. Peripartum management of diabetes

    Directory of Open Access Journals (Sweden)

    Pramila Kalra

    2013-01-01

    Full Text Available The peripartum control of diabetes is very important for the well-being of the newborn as higher incidence of neonatal hypoglycemia is seen if maternal hyperglycemia happens during this period. Type of diabetes (type 1, type 2 or gestational diabetes also has an effect on the glucose concentration during intrapartum period. During the latent phase of labor, the metabolic demands are stable but during active labor there is increased metabolic demand and decreased insulin requirement. After delivery once the placenta is extracted, insulin resistance rapidly comes down and in patients with pre-gestational diabetes there will be a sudden drop in insulin requirement and the insulin may not be required in women with gestational diabetes, but they just need close monitoring. During breast-feeding blood glucose levels fall because of high metabolic demand and women need to take extra calories to maintain the levels and more vigilance especially in type 1 and type 2 diabetic mothers is required. The protocols used for the management of peripartum management of diabetes mostly rely on glucose and insulin infusion to maintain maternal blood sugars between 70 and 110 mg/dl. The data is mostly from retrospective studies and few randomized control trials done mainly in type 1 diabetes patients. The review summarizes guidelines, which are used for peripartum management of blood glucose.

  10. TREATMENT OF PERIPARTUM CARDIOMYOPATHY (REVIEW)

    OpenAIRE

    N. T. Vatutin; G. G. Taradin; L. G. Popelnukhina; Y. P. Gritzenko; I. A. Sidorenko

    2017-01-01

    The presented review concerns discussion about current insights into treatment of peripartum cardiomyopathy. The definition of peripartum cardiomyopathy and general issues about diagnosis and pathogenesis of the disorder are provided at the head of the review. Particularly, the role of the system «prolactin — cathepsin D — prolactin 16 kDa» in cardiomyopathy development is disclosed. The general approaches to management of the patients are highlighted. The review provides detailed data about ...

  11. Current management of peripartum cardiomyopathy: A review ...

    African Journals Online (AJOL)

    Electrocardiogram, magnetic resonance imaging, endomyocardial biopsy and cardiac catheterization aid in the diagnosis and management of peripartum cardiomyopathy. Treatment includes both conventional pharcomological heart failure and peripartum cardiomyopathy targeted therapies.Therapeutic decisions are ...

  12. Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-year ...

    African Journals Online (AJOL)

    The mean duration of hospital stay was 9.8 ± 2.4 days. Conclusion: The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention ...

  13. Peripartum kardiomyopati hos overvaegtig gravid

    DEFF Research Database (Denmark)

    Kielgast, Urd Lynge; Schierbeck, Louise; Dümcke, Christine

    2009-01-01

    Peripartum cardiomyopathy (PPCM) is a rare, but life-threatening cardiac disorder which complicates pregnancy. However, the classical symptoms of heart failure can be masked - especially in obese women. Here, we present a case report of PPCM complicated with vitamin-D deficiency in a severely obese...

  14. Potentially avoidable peripartum hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  15. TREATMENT OF PERIPARTUM CARDIOMYOPATHY (REVIEW

    Directory of Open Access Journals (Sweden)

    N. T. Vatutin

    2017-01-01

    Full Text Available The presented review concerns discussion about current insights into treatment of peripartum cardiomyopathy. The definition of peripartum cardiomyopathy and general issues about diagnosis and pathogenesis of the disorder are provided at the head of the review. Particularly, the role of the system «prolactin — cathepsin D — prolactin 16 kDa» in cardiomyopathy development is disclosed. The general approaches to management of the patients are highlighted. The review provides detailed data about indications, adverse effects and derived clinical experience concerning the main pharmacological drugs which had been used in peripartum cardiomyopathy treatment given their possible unfavorable influence on fetus maturation and maternal lactation. The detailed description is provided on diuretics including loop, thiazide and potassium-sparing drugs. It was noted relative safety and efficiency of nitrates and hydralazine in conditions of limited choice from vasodilator group and, particularly, angiotensinconverting-enzyme inhibitors and angiotensin-II receptor blockers which are contraindicated in pregnancy. A special attention is paid to the group of inotropic drugs: levosimendan, milrinone, and cardiac glycosides. The role of β-blockers and ivabradine is disclosed in heart failure treatment of peripartum cardiomyopathy. Anticoagulants were presented in details given that these drugs are justified in severe cardiac chambers dilation, decrease in ejection fraction, and in presence of intracardiac thrombosis. The place of antiarrhythmic drugs administrating in various cardiac rhythm disorders is discussed in the review. The data is given with account of potential influence on fetus in antenatal peripartum cardiomyopathy in which lidocaine and sotalol are the most preferable drugs; adenosine, quinidine, and flecainide are useful with caution, but amiodarone and dronedarone are absolutely contraindicated. Taking into account proposed pathogenic

  16. Peripartum bacteremia in the era of group B streptococcus prophylaxis.

    Science.gov (United States)

    Cape, Alison; Tuomala, Ruth E; Taylor, Chirisse; Puopolo, Karen M

    2013-04-01

    To define the microbial epidemiology and clinical risk factors associated with peripartum bacteremia in the era of group B streptococcus prophylaxis. We identified all cases of maternal bacteremia occurring during the peripartum time period (defined as from 7 days before delivery until 30 days after delivery) in a large maternity center from 2000 to 2008. Chart review was performed to determine the clinical factors associated with bacteremia. During the study period, blood cultures were obtained from 1,295 febrile peripartum women (1.6% of all parturients); 172 of 1,295 febrile peripartum women (13.3%) had bacteremia (2.2 cases per 1,000 deliveries) with 194 microbial isolates and 1 yeast. The most frequent bacterial isolates were Escherichia coli (35.9%), enterococci (23.6%), and anaerobic species (9.2%); group B streptococcus was isolated in only eight cases (4.1%). Clinical diagnoses among infected women included endometritis (56%), chorioamnionitis (21%), and urosepsis (8%). Among women with endometritis, 77% underwent cesarean delivery (compared with vaginal delivery; relative risk [RR] 10.85, 95% confidence interval [CI] 6.75-17.45) and 39% delivered at less than 37 weeks of gestation (compared with 37 weeks or more; RR 3.21, 95% CI 2.42-4.25). Severe maternal complications of bacteremia were noted; six women required intensive care unit admission, five women had development of ileus, and one death occurred because of urosepsis. In the era of group B streptococcus prophylaxis, E coli and enterococci are the most frequent bacteria isolated in peripartum bacteremia. Group B streptococcus accounted for only 4% of cases. III.

  17. Peripartum hysterectomy: an evolving picture.

    LENUS (Irish Health Repository)

    Turner, Michael J

    2012-02-01

    Peripartum hysterectomy (PH) is one of the obstetric catastrophes. Evidence is emerging that the role of PH in modern obstetrics is evolving. Improving management of postpartum hemorrhage and newer surgical techniques should decrease PH for uterine atony. Rising levels of repeat elective cesarean deliveries should decrease PH following uterine scar rupture in labor. Increasing cesarean rates, however, have led to an increase in the number of PHs for morbidly adherent placenta. In the case of uterine atony or rupture where PH is required, a subtotal PH is often sufficient. In the case of pathological placental localization involving the cervix, however, a total hysterectomy is required. Furthermore, the involvement of other pelvic structures may prospectively make the diagnosis difficult and the surgery challenging. If resources permit, PH for pathological placental localization merits a multidisciplinary approach. Despite advances in clinical practice, it is likely that peripartum hysterectomy will be more challenging for obstetricians in the future.

  18. Taking health care to factory floor proves smart move for growing Ontario company.

    Science.gov (United States)

    Mason, R B

    1997-11-15

    A fully equipped, state-of-the-art wellness centre that employs physicians and other health care providers to meet the health needs of more than 1200 employees is being credited with giving a Canadian company a leg up on the competition.

  19. Peripartum Cardiomyopathy: Euro Observational Research Program

    NARCIS (Netherlands)

    M.F. Hoes; I.M. van Hagen (Iris); F. Russo; D.J. van Veldhuisen (Dirk); M.P. van den Berg (Maarten); J.W. Roos-Hesselink (Jolien); K.Y. van Spaendonck-Zwarts (Karin); P. van der Meer (Peter)

    2014-01-01

    textabstractPeripartum cardiomyopathy is a rare but potentially life-threatening form of heart failure affecting women late in pregnancy or in the first months after delivery. Peripartum cardiomyopathy is difficult to diagnose and its onset and progression are variable between individuals. The

  20. Peripartum cardiomyopathy: Euro Observational Research Program

    NARCIS (Netherlands)

    Hoes, M. F.; van Hagen, I.; Russo, F.; van Veldhuisen, D. J.; van den Berg, M. P.; Roos-Hesselink, J.; van Spaendonck-Zwarts, K. Y.; van der Meer, P.

    2014-01-01

    Peripartum cardiomyopathy is a rare but potentially life-threatening form of heart failure affecting women late in pregnancy or in the first months after delivery. Peripartum cardiomyopathy is difficult to diagnose and its onset and progression are variable between individuals. The pathophysiology

  1. Peripartum cardiomyopathy : Euro Observational Research Program

    NARCIS (Netherlands)

    Hoes, M. F.; van Hagen, I.; Russo, F.; Van Veldhuisen, D. J.; Van den Berg, M. P.; Roos-Hesselink, J.; van Spaendonck-Zwarts, K. Y.; van der Meer, P.

    Peripartum cardiomyopathy is a rare but potentially life-threatening form of heart failure affecting women late in pregnancy or in the first months after delivery. Peripartum cardiomyopathy is difficult to diagnose and its onset and progression are variable between individuals. The pathophysiology

  2. Peripartum Cardiomyopathy: A Current Review

    Directory of Open Access Journals (Sweden)

    Katie M. Twomley

    2010-01-01

    Full Text Available Peripartum cardiomyopathy (PPCM is a rare but potentially lethal complication of pregnancy occurring in approximately 1 : 3,000 live births in the United States although some series report a much higher incidence. African-American women are particularly at risk. Diagnosis requires symptoms of heart failure in the last month of pregnancy or within five months of delivery in the absence of recognized cardiac disease prior to pregnancy as well as objective evidence of left ventricular systolic dysfunction. This paper provides an updated, comprehensive review of PPCM, including emerging insights into the etiology of this disorder as well as current treatment options.

  3. Peripartum hysterectomy in Denmark 1995-2004

    DEFF Research Database (Denmark)

    Sakse, Abelone Elisabeth; Weber, Tom; Nickelsen, Carsten Nahne Amtoft

    2007-01-01

    BACKGROUND: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery. METHODS...

  4. Sepsis: Primary indication for peripartum hysterectomies in a South ...

    African Journals Online (AJOL)

    Background. Peripartum hysterectomies are lifesaving procedures but definitions vary. Indications are variable and dependant on resources and geographical factors. Objectives. To evaluate the incidence, aetiology and complications associated with peripartum hysterectomies in a tertiary hospital in South Africa. Methods.

  5. Anaesthetic management of patients with peripartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Rashmi Ramachandran

    2011-01-01

    Full Text Available Peripartum cardiomyopathy (PPCM is a disease affecting the parturient during late pregnancy or immediately after delivery. This unique disorder not just endangers the life of mother and progeny but is also a financial burden to the health system due to its potential to cause prolonged and persistent cardiac function insufficiency in the mother. The hallmark of the disease is onset of decreased cardiac ejection fraction either in the late pregnancy or early puerperium. Over the last few decades, the disease has been extensively researched and investigated to formulate diagnostic guidelines and therapeutic approaches. Many theories regarding its pathophysiology have also been proposed. The clinical presentation and the basic and intensive interventional strategies of the disease are more or less similar to that of dilated cardiomyopathy due to any other cause; however, at all points of time the pregnant or lactating state of mother and the subsequent effect of the medication and therapeutic interventions on the fetus or neonate needs to be considered. Apart from intensive care management, these patients may also require anaesthetic intervention for management of painless labor and/or either vaginal or operative delivery. Favorable maternal and fetal outcome require that the basic hemodynamic goals be always kept in mind while choosing the techniques and drugs to provide anaesthesia to the patients with PPCM. Literature search of the anaesthetic management of patients with diagnosis of PPCM undergoing operative delivery reveals both general and regional anaesthesia being used with comparable outcomes.

  6. Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study.

    Science.gov (United States)

    Sayama, S; Takeda, N; Iriyama, T; Inuzuka, R; Maemura, S; Fujita, D; Yamauchi, H; Nawata, K; Bougaki, M; Hyodo, H; Shitara, R; Nakayama, T; Komatsu, A; Nagamatsu, T; Osuga, Y; Fujii, T

    2017-03-11

    To investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR). Retrospective case series study. Tertiary perinatal care centre at a university hospital. Pregnant women fulfilling the revised Ghent nosology (2010) criteria for MFS who were managed at our institute. The pregnancy outcomes of all patients with MFS managed at our institute between 1982 and September 2016 were reviewed retrospectively based on medical records. Obstetrical management and complication including the incidence of AD throughout the peripartum period. Among 22 patients (28 pregnancies) who had been managed as potential MFS or related disorders, 14 (17 pregnancies) fulfilled the revised Ghent nosology (2010) criteria for MFS and were enrolled in this study. Five patients (five pregnancies) had received ARR before conception: three (60%) developed type B aortic dissection [AD(B)] during the peripartum period, compared with only one of 10 patients (12 pregnancies) without ARR (P MFS patients after prophylactic ARR are still at high risk of AD(B) during the peripartum period. Careful pre-pregnancy counselling and multidisciplinary care throughout the peripartum period are essential for the management of MFS, even after surgical repair of an ascending aortic aneurysm. MFS patients after prophylactic ARR are still at high risk of type B aortic dissection during the peripartum period. © 2017 Royal College of Obstetricians and Gynaecologists.

  7. Anaesthetic challenges in emergency peripartum hysterectomy in ...

    African Journals Online (AJOL)

    Conclusion: Emergency peripartum hysterectomies challenge the anaesthetist and the obstetrician who have to maintain haemodynamic stability in patients who may have lost volumes of blood, in a setting where blood and colloid availability is often limited. The maternal mortality was higher than that of most of the studies ...

  8. Mental Illness in the Peripartum Period

    Science.gov (United States)

    Ostler, Teresa

    2009-01-01

    Women are particularly vulnerable in the peripartum period for either developing a mental illness or suffering symptom exacerbation. These illnesses are often experienced covertly, however, and women may not seek out professional help, even though their symptoms may be seriously affecting their well-being and parenting. This article provides an…

  9. [Assessment, delivery and peripartum care in the case of a uterine rupture during labor of a woman with a previous C-section].

    Science.gov (United States)

    Parrilla-Fernández, Alberto; Manrique-Tejedor, Javier; Figuerol-Calderó, M Inmaculada; García-Romero, Verónica

    Uterine rupture is a rare but severe complication in obstetrics. A previous C-section is the most important risk factor. Its incidence during labor in women with a previous C-section is of approximately 0.3-0.47%, being potentially severe. We present the case of a pregnant women with a previous C-section who suffered uterine rupture during labor. The rapid assessment and action of the midwife and obstetric team was essential to obtain a successful obstetric outcome, avoiding maternal and fetal mortality; and nursing care given to the mother and the newborn after birth contributed to achieving a normal postpartum. It is necessary to have specific knowledge about this condition that, despite rare, can present insidiously with a potential risk for the mother and the fetus. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  10. Peripartum hysterectomy: an economic analysis of direct healthcare costs using routinely collected data.

    Science.gov (United States)

    Achana, F A; Fleming, K M; Tata, L J; Sultan, A A; Petrou, S

    2017-10-03

    To estimate resource use and costs associated with peripartum hysterectomy for the English National Health Service. Analysis of linked Clinical Practice Research Datalink and Hospital Episodes Statistics (CPRD-HES) data. Women undergoing peripartum hysterectomy between 1997 and 2013 and matched controls. Inverse probability weighted generalised estimating equations were used to model the non-linear trend in healthcare service use and costs over time, accounting for missing data, adjusting for maternal age, body mass index, delivery year, smoking and socio-economic indicators. Primary care, hospital outpatient and inpatient attendances and costs (UK 2015 prices). The study sample included 1362 women (192 cases and 1170 controls) who gave birth between 1997 and 2013; 1088 (153 cases and 935 controls) of these were deliveries between 2003 and 2013 when all categories of hospital resource use were available. Based on the 2003-2013 delivery cohort, peripartum hysterectomy was associated with a mean adjusted additional total cost of £5380 (95% CI £4436-6687) and a cost ratio of 1.76 (95% CI 1.61-1.98) over 5 years of follow up compared with controls. Inpatient costs, mostly incurred during the first year following surgery, accounted for 78% excluding or 92% including delivery-related costs. Peripartum hysterectomy is associated with increased healthcare costs driven largely by increased post-surgery hospitalisation rates. To reduce healthcare costs and improve outcomes for women who undergo hysterectomy, interventions that reduce avoidable repeat hospitalisations following surgery such as providing active follow up, treatment and support in the community should be considered. A large amount of NHS data on peripartum hysterectomy suggests active community follow up could reduce costs, #HealthEconomics. © 2017 Royal College of Obstetricians and Gynaecologists.

  11. A case of peripartum heart failure

    Directory of Open Access Journals (Sweden)

    Annalisa Vinci

    2008-03-01

    Full Text Available A 32-year-old woman was admitted in congestive heart failure (CHF 3 days after delivery. She had no history of cardiovascular disease and impaired left ventricular Ejection Fraction (EF 35%. She underwent complete heart catheterisation, selective coronary angiography and right ventricular endomyocardial biopsy (EMB.Coronary arteries were normal and EMB revealed active virus negative myocarditis. Serum was positive for anti-heart autoantibodies (AHA. Thus myocarditis was classified as autoimmune and the patient was treated with immunosuppressive therapy, with clinical and hemodynamic improvement. At 27 months follow-up EMB showed healed myocarditis. Peripartum cardiomyopathy (PPCM is a rare disorder in which left ventricular dysfunction and heart failure occur in the peripartum period in previously healthy women. The etiology is still unknown but a sizable proportion of patients may have an underlying organ-specific autoimmune myocarditis.

  12. Personal commentary: monitoring subsequent pregnancy in recovered peripartum cardiomyopathy mothers.

    Science.gov (United States)

    Fett, James D

    2009-12-01

    Peripartum cardiomyopathy (PPCM) is defined as the first appearance of systolic heart failure in a previously healthy woman during the last month of pregnancy or up to 6 months postpartum. Both planned and unplanned pregnancies may occur in recovered and non-recovered PPCM mothers, requiring careful counseling and management strategies. Previous studies indicate that relapse of heart failure in post-PPCM pregnancies is always a possibility, even in recovered PPCM mothers. The risk of relapse is high when the left ventricular ejection fraction is less than 0.50, and should be considered a relative contraindication to subsequent pregnancy. There are not yet established protocols for monitoring subsequent pregnancies in those who once had PPCM, and few medical articles with guidelines. This personal commentary contains parameters that have been found useful to contribute to safer monitoring with improved outcomes.

  13. Understanding peripartum pelvic pain: Implications of a patient survey

    NARCIS (Netherlands)

    J.M.A. Mens (Jan); A. Vleeming (Andry); R. Stoeckart (Rob); H.J. Stam (Henk); C.J. Snijders (Chris)

    1996-01-01

    textabstractStudy Design. An analysis was made of the self-reported medical histories of patients with peripartum pelvic pain. Objectives. To compile an inventory of the disabilities of patients with peripartum pelvic pain, analyze factors associated with the risk for development of the disease, and

  14. Emergency laparotomy for peripartum haemorrhage in Bida North ...

    African Journals Online (AJOL)

    Subject: All patients with peripartum haemorrhage (ruptured gravid uterus and uncontrollable post partum haemorrhage) that needed emergency laparotomy between 1 June, 2000 31 May, 2004. Methods: A detailed history including biosocial and possible predisposing factors to peripartum haemorrhage at presentation ...

  15. An obstetric emergency called peripartum cardiomyopathy!

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Peripartum cardiomyopathy (PPCM is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. The etiology of PPCM is still not known. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. The only way to prevent PPCM is to avoid further pregnancies.

  16. Peripartum cardiomyopathy: A puzzle closer to solution

    Science.gov (United States)

    Fett, James D

    2014-01-01

    Peripartum cardiomyopathy (PPCM) represents new heart failure in a previously heart-healthy peripartum patient. It is necessary to rule out all other known causes of heart failure before accepting a diagnosis of PPCM. The modern era for PPCM in the United States and beyond began with the report of the National Institutes of Health PPCM Workshop in 2000, clarifying all then-currently known aspects of the disease. Since then, hundreds of publications have appeared, an indication of how devastating this disease can be to young mothers and their families and the urgent desire to find solutions for its cause and better treatment. The purpose of this review is to highlight the important advances that have brought us nearer to the solution of this puzzle, focusing on what we have learned about PPCM since 2000; and what still remains unanswered. Despite many improvements in outcome, we still do not know the actual triggers that initiate the pathological process; but realize that cardiac angiogenic imbalances resulting from complex pregnancy-related immune system and hormonal changes play a key role. PMID:24669290

  17. A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography.

    Science.gov (United States)

    Hibbard, J U; Lindheimer, M; Lang, R M

    1999-08-01

    The diagnosis of peripartum cardiomyopathy is one of exclusion, made after careful search for an underlying cause. Research in this area is compromised by the reliance of some on clinical criteria alone without strict echocardiographic criteria. This article argues for uniform criteria that define peripartum cardiomyopathy, similar to the criteria for idiopathic dilated cardiomyopathy set forth by a National Heart, Lung, and Blood Institute-sponsored workshop and proposes that the new definition include heart failure within the last month of pregnancy or 5 months postpartum; absence of preexisting heart disease; no determinable etiology, the traditional definition; and strict echocardiographic criteria of left ventricular dysfunction: ejection fraction less than 45%, or M-mode fractional shortening less than 30%, or both, and end-diastolic dimension more than 2.7 cm/m2. Mortality from peripartum cardiomyopathy remains high, 25-50%, and a recent review related long-term prognosis to echocardiographic measures of left ventricular chamber dimension and function at diagnosis and recovery. We describe a modified pharmacologic echocardiographic stress test that might be useful in determining left ventricular contractile reserve in women believed to be recovered by routine echocardiographic studies. The test reproduces hemodynamic stress akin to pregnancy, and the data might be useful when counseling women on future childbearing. Women who respond with reduced cardiac reserve might be advised to avoid pregnancy.

  18. Clinical characteristics and risk factors for peripartum cardiomyopathy

    African Journals Online (AJOL)

    Clinical characteristics and risk factors for peripartum cardiomyopathy. ... African Health Sciences ... If you would like more information about how to print, save, and work with PDFs, Highwire Press provides a helpful Frequently Asked ...

  19. Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-year ...

    African Journals Online (AJOL)

    : This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south–east Nigeria. Materials and Methods: A retrospective study of the case files of patients requiring an ...

  20. Peripartum cardiomyopathy: challenges in diagnosis and management.

    Science.gov (United States)

    Fett, James D

    2016-09-01

    Peripartum cardiomyopathy (PPCM) is one of the leading causes of maternal mortality all over the world. Fortunately, some of the most important answers to the "PPCM puzzle" are emerging: This is an update that includes current and recent research results. These developments hold promise to importantly decrease mortality from PPCM and increase recovery rates. Expert commentary: Increasing risks for the development and severity of PPCM include a genetic predisposition and the presence of any form of hypertension in pregnancy. Earlier recognition/diagnosis of PPCM confers greater opportunity for full recovery. Important biomarkers have the potential to help to recognize PPCM earlier and to provide better treatment. "Follow the Guidelines" is good advice for the best opportunity to achieve full recovery. These include the use of diuretics, BB, ACEI/ARB in tolerable dosages. Phasing out specific treatments appears to be safe for some; but the process must be individualized.

  1. Peripartum Depression, Traditional Culture, and Israeli Society.

    Science.gov (United States)

    Dekel, Sharon; Stanger, Varda; Georgakopoulos, Emily R; Stuebe, Caren M; Dishy, Gabriella A

    2016-08-01

    Although it is known that culture affects psychopathology, the nature of the relationship between culture and peripartum depression (PPD) is not fully understood. Here we report on 2 cases of Israeli women who are affiliated with traditional cultural groups that emphasize reproduction but developed PPD after childbirth. The first woman is an ultra-Orthodox Israeli Jew and the second is an Israeli Arab. The 2 cases illustrate the effect of cultural beliefs and rituals on the conceptualization, treatment, and trajectory of PPD. The cases suggest a complex relationship between traditional cultures and PPD, including the possibility that cultural factors may have both adaptive and maladaptive consequences. Future qualitative and quantitative studies are needed to further clarify this relationship. © 2016 Wiley Periodicals, Inc.

  2. Emergency peripartum hysterectomy in Isfahan; maternal mortality and morbidity rates among the women who underwent peripartum hysterectomy

    Directory of Open Access Journals (Sweden)

    Fatemeh Mostajeran Gurtani

    2013-01-01

    Conclusion : This study indicated the high rate of mortality among patients underwent peripartum hysterectomy. Evaluation of management during referring the patients and designing more studies to evaluate the mortality and morbidities are warranted.

  3. On Mathematical Proving

    Science.gov (United States)

    Stefaneas, Petros; Vandoulakis, Ioannis M.

    2015-12-01

    This paper outlines a logical representation of certain aspects of the process of mathematical proving that are important from the point of view of Artificial Intelligence. Our starting-point is the concept of proof-event or proving, introduced by Goguen, instead of the traditional concept of mathematical proof. The reason behind this choice is that in contrast to the traditional static concept of mathematical proof, proof-events are understood as processes, which enables their use in Artificial Intelligence in such contexts, in which problem-solving procedures and strategies are studied. We represent proof-events as problem-centered spatio-temporal processes by means of the language of the calculus of events, which captures adequately certain temporal aspects of proof-events (i.e. that they have history and form sequences of proof-events evolving in time). Further, we suggest a "loose" semantics for the proof-events, by means of Kolmogorov's calculus of problems. Finally, we expose the intented interpretations for our logical model from the fields of automated theorem-proving and Web-based collective proving.

  4. Cardiomiopatía periparto Peripartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Jorge E Velásquez V

    2008-02-01

    Full Text Available La cardiomiopatía periparto es una entidad clínica con una frecuencia variable de acuerdo con la zona en estudio. Se caracteriza por disfunción sistólica del ventrículo izquierdo y posterior aparición de síntomas de falla cardiaca, los cuales ocurren durante el último mes de gestación y los primeros meses post- parto. Su etiología aún no es clara, pero se plantean diferentes teorías, las cuales se basan en fenómenos inflamatorios, infecciosos y auto-inmunes. Recientemente, se describieron alteraciones relacionadas con el estrés oxidativo, que podrían explicar en gran medida esta patología. Su presentación clínica guarda gran similitud con las demás causas de falla cardíaca, aunque se han descrito presentaciones atípicas. Su diagnóstico requiere alto nivel de sospecha y debe considerarse en toda mujer con síntomas de falla cardíaca durante el periparto. El tratamiento convencional de la falla cardiaca crónica que incluye beta-bloqueadores, inhibidores de la enzima convertidora de angiotensina y diuréticos, además de los adelantos en el diagnóstico y manejo de la falla cardiaca aguda, permitió cambiar la historia de la enfermedad al disminuir la mortalidad y recuperar la función sistólica del ventrículo izquierdo. Las gestaciones posteriores al desarrollo de esta entidad, dependerán de la recuperación completa de la función cardíaca, sin disminuir el riesgo de recurrencia. Todavía existen múltiples preguntas por responder en áreas como etiología, factores de riesgo, tratamiento y marcadores pronósticos que permitan prevenir y manejar en forma oportuna y segura tanto a la madre como a su hijo.Peripartum cardiomyopathy is a clinical entity with a variable frequency according to the zone of the study. It is characterized by a systolic dysfunction of the left ventricle and posterior appearance of heart failure symptoms that occur during the last month of pregnancy and the first post-partum months. Its etiology

  5. Peripartum cardiomyopathy: a systematic literature review.

    Science.gov (United States)

    Ersbøll, Anne S; Damm, Peter; Gustafsson, Finn; Vejlstrup, Niels G; Johansen, Marianne

    2016-11-01

    Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease defined by heart failure towards the end of pregnancy or in the months following delivery. We aim to raise awareness of the condition and give the clinician an overview of current knowledge on the mechanisms of pathophysiology, diagnostics and clinical management. Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data. Guidelines and reviews that provided comprehensive overviews were included, too. New research on the pathophysiological mechanisms of PPCM points towards a two-hit multifactorial cause involving genetic factors and an antiangiogenic hormonal environment of late gestation with high levels of prolactin and sFlt-1. The prevalence of concomitant preeclampsia is high (often 30-45%) and symptoms can be similar, posing diagnostic difficulties. Most women (71-98%) present postpartum. Echocardiography is essential for diagnosis, and cardiac magnetic resonance imaging may provide new insights to pathophysiology and prognosis. Management is multidisciplinary and involves advanced heart failure therapy. Treatment, timing and mode of delivery in pregnant women depend on disease severity. The risk of relapse in subsequent pregnancies is >20%, and women are often advised against a new pregnancy. PPCM has a huge impact on cardiovascular health and reproductive life perspective. New insights into genetics, molecular pathophysiological mechanisms and clinical studies have resulted in potential disease-specific therapies, but many questions remain unanswered. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis, and management.

    Science.gov (United States)

    Garg, Jalaj; Palaniswamy, Chandrasekar; Lanier, Gregg M

    2015-01-01

    Peripartum cardiomyopathy (PPCM) is a serious pregnancy-associated disorder of unknown etiology. The precise cellular and molecular mechanisms underlying PPCM are unclear. A heightened awareness among health care providers can result in early diagnosis of heart failure in late pregnancy and the early postpartum period. Though the symptoms of dyspnea and fatigue can result from normal physiologic changes during pregnancy, an electrocardiogram and brain natriuretic peptide level should be obtained in these patients, in addition to baseline laboratory tests such as a complete blood count, and basic metabolic and hepatic function panels. If the electrocardiogram and brain natriuretic peptide level are abnormal, an echocardiogram should be obtained. The role of endomyocardial biopsy for the diagnosis of PPCM is controversial. Patients should be started on diuretics if volume overloaded, and beta-blockers (preferably metoprolol) if no contraindications exist; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy or lactation. There are no standard, universally accepted guidelines for the management of PPCM. Although experimental therapies like bromocriptine, pentoxifylline and immunoglobulins have shown promising results, large double-blind randomized trials are essential to confirm the results of smaller studies. In patients with persistent severe left ventricular (LV) dysfunction, advanced therapies like mechanical circulatory support and heart transplantation should be considered. Owing to recent data demonstrating deterioration of LV systolic function after initial recovery, it is essential to maintain long-term follow up of these patients regardless of initial recovery of LV function. We present a comprehensive review of the literature etiopathogenesis, diagnosis, and management of PPCM.

  7. Peripartum Cardiomyopathy | Okeke | Annals of Medical and Health ...

    African Journals Online (AJOL)

    Peripartum cardiomyopathy (PPCM) is a rare form of unexplained cardiac failure of unknown origin, unique to the pregnant woman with highly variable outcome associated with high morbidity and mortality. PPCM is fraught with controversies in its definition, epidemiology, pathophysiology, diagnosis and management.

  8. Clinical characteristics and risk factors for peripartum cardiomyopathy

    African Journals Online (AJOL)

    Background: Peripartum cardiomyopathy (PPCM) is a potentially fatal form of heart failure and the recognition of its risk factors is important for prevention and treatment. Objective: To explore the clinical characteristics and the risk factors for PPCM. Methods: Echocardiographic was used to examine the left ventricular ...

  9. Rates and determinants of peripartum and puerperal anemia in ...

    African Journals Online (AJOL)

    2015-12-11

    Dec 11, 2015 ... Abstract. Background: Anemia in the peripartum or postpartum period could pose a significant risk for maternal morbidity and ... Aims: To determine the rates of anemia at term and in the puerperium and describe the determinants of puerperal ..... Figure 1: Classification of 48‑h postpartum hemoglobin levels.

  10. Emotion and mood adaptations in the peripartum female:complementary contributions of GABA and oxytocin.

    Science.gov (United States)

    Lonstein, J S; Maguire, J; Meinlschmidt, G; Neumann, I D

    2014-10-01

    Peripartum hormones and sensory cues from young modify the maternal brain in ways that can render females either at risk for, or resilient to, elevated anxiety and depression. The neurochemical systems underlying these aspects of maternal emotional and mood states include the inhibitory neurotransmitter GABA and the neuropeptide oxytocin (OXT). Data from laboratory rodents indicate that increased activity at the GABA(A) receptor contributes to the postpartum suppression of anxiety-related behaviour that is mediated by physical contact with offspring, whereas dysregulation in GABAergic signalling results in deficits in maternal care, as well as anxiety- and depression-like behaviours during the postpartum period. Similarly, activation of the brain OXT system accompanied by increased OXT release within numerous brain sites in response to reproductive stimuli also reduces postpartum anxiety- and depression-like behaviours. Studies of peripartum women are consistent with these findings in rodents. Given the similar consequences of elevated central GABA and OXT activity on maternal anxiety and depression, balanced and partly reciprocal interactions between these two systems may be essential for their effects on maternal emotional and mood states, in addition to other aspects of postpartum behaviour and physiology. © 2014 British Society for Neuroendocrinology.

  11. Severe Staphylococcus aureus Endocarditis Presenting as Peripartum Thrombotic Thrombocytopenic Purpura.

    Science.gov (United States)

    Quinn, Kieran L; Osmond, Mark; Badiwala, Mitesh; Sermer, Mathew; Lapinsky, Stephen E

    2016-11-01

    Thrombotic thrombocytopenic purpura (TTP) is a life-threatening illness that occurs in both pregnant and non-pregnant women. Several other conditions can mimic the disease, which makes the diagnosis challenging. We describe a case of severe Staphylococcus aureus endocarditis that initially presented as peripartum TTP in a 39-year-old woman at 29+6 weeks' gestation. We give an overview of the diagnostic considerations and management of thrombocytopenia in pregnancy and review the literature related to TTP and peripartum infective endocarditis. Given the significant differences in definitive therapies for the spectrum of thrombocytopenic conditions that occur in pregnancy, timely and accurate diagnosis of TTP is critical for optimal management. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  12. Interactive Theorem Proving and Verification

    Indian Academy of Sciences (India)

    Research in the area of automated reasoning is largely concentrated around two major themes – Automated Theorem Proving and Interactive Theorem Proving. The goal of Auto- mated Theorem Proving, as the name suggests, is to try to prove a wide range of mathematical theorems using a computer in an automatic ...

  13. Anaesthetic challenges in emergency peripartum hysterectomy

    African Journals Online (AJOL)

    2009-09-17

    Sep 17, 2009 ... anaesthetic and obstetric records, foeto-maternal outcomes and the need for critical care management. Results: There ... ICU were also noted. In our ..... 17. Kuliya-Gwarzo A, Kwaru AH. Pattern of blood donation in. Aminu Kano Teaching Hospital. Journal of Medicine and. Rehabilitation. 2007;1:35–8. 18.

  14. Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mouquet, Frederic; Groote, Pascal de; Bouabdallaoui, Nadia; Dagorn, Joel; Lamblin, Nicolas; Bauters, Christophe [Pole de Cardiologie et Maladies Vasculaires, CHRU Lille et Universite Lille 2, Lille Cedex (France); Lions, Christophe; Willoteaux, Serge; Beregi, Jean Paul [Radiologie et Imagerie Cardiovasculaire, CHRU Lille et Universite Lille 2, Lille Cedex (France); Deruelle, Philippe [Gynecologie-Maternite, CHRU Lille et Universite Lille 2, Lille Cedex (France)

    2008-12-15

    Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure. Only half of the patients recover normal cardiac function. We assessed the usefulness of magnetic resonance imaging (MRI) and late enhancement imaging to detect myocardial fibrosis in order to predict cardiac function recovery in patients with peripartum cardiomyopathy. Among a consecutive series of 1,037 patients referred for heart failure treatment or prognostic evaluation between 1999 and 2006, eight women had confirmed PPCM. They all underwent echocardiography and cardiac MRI for assessment of left ventricular anatomy, systolic function and detection of myocardial fibrosis through late enhancement imaging. Mean ({+-} SD) baseline left ventricular ejection fraction (LVEF) was 28 {+-} 4%. After a follow-up of 50 {+-} 9 months, half the patients recovered normal cardiac function (LVEF = 58 {+-} 4%) and four did not (LVEF = 35 {+-} 6%). None of the eight patients exhibited abnormal myocardial late enhancement. No difference in MRI characteristics was observed between the two groups. Patients with PPCM do not exhibit a specific cardiac MRI pattern and particularly no myocardial late enhancement. It suggests that myocardial fibrosis does not play a major role in the limitation of cardiac function recovery after PPCM. (orig.)

  15. Molecular mechanisms of peripartum cardiomyopathy: A vascular/hormonal hypothesis.

    Science.gov (United States)

    Bello, Natalie A; Arany, Zoltan

    2015-08-01

    Peripartum cardiomyopathy (PPCM) is characterized by the development of systolic heart failure in the last month of pregnancy or within the first 5 months postpartum. The disease affects between 1:300 and 1:3000 births worldwide. Heart failure can resolve spontaneously but often does not. Mortality rates, like incidence, vary widely based on location, ranging from 0% to 25%. The consequences of PPCM are thus often devastating for an otherwise healthy young woman and her newborn. The cause of PPCM remains elusive. Numerous hypotheses have been proposed, with mixed supporting evidence. Recent work has suggested that PPCM is a vascular disease, triggered by the profound hormonal changes of late gestation. We focus here on these new mechanistic findings, and their potential implication for understanding and treating PPCM. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Geometric inequalities methods of proving

    CERN Document Server

    Sedrakyan, Hayk

    2017-01-01

    This unique collection of new and classical problems provides full coverage of geometric inequalities. Many of the 1,000 exercises are presented with detailed author-prepared-solutions, developing creativity and an arsenal of new approaches for solving mathematical problems. This book can serve teachers, high-school students, and mathematical competitors. It may also be used as supplemental reading, providing readers with new and classical methods for proving geometric inequalities. .

  17. Changing trends in peripartum hysterectomy over the last 4 decades.

    LENUS (Irish Health Repository)

    Flood, Karen M

    2012-02-01

    OBJECTIVE: The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years. STUDY DESIGN: A retrospective cohort study was performed from 1966-2005 of patients who had PH in any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained from the combined patient databases of each hospital. RESULTS: There were 872,379 deliveries during the study period, among which 358 women underwent PH (0.4\\/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005, PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the overall cesarean delivery rate has increased from 6-19% during these 2 decades, the percentage of PH that occurs in the setting of a previous cesarean delivery has increased from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with "uterine rupture" as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5% (P < .00001). CONCLUSION: PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery rate, there has been a marked increase in the incidence of placenta accreta.

  18. Serum Selenium and Ceruloplasmin in Nigerians with Peripartum Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Kamilu M. Karaye

    2015-04-01

    Full Text Available The study aimed to determine if selenium deficiency, serum ceruloplasmin and traditional birth practices are risk factors for peripartum cardiomyopathy (PPCM, in Kano, Nigeria. This is a case-control study carried out in three hospitals, and PPCM patients were followed up for six months. Critically low serum selenium concentration was defined as <70 µg/L. A total of 39 PPCM patients and 50 controls were consecutively recruited after satisfying the inclusion criteria. Mean serum selenium in patients (61.7 ± 14.9 µg/L was significantly lower than in controls (118.4 ± 45.6 µg/L (p < 0.001. The prevalence of serum selenium <70 µg/L was significantly higher among patients (76.9% than controls (22.0% (p < 0.001. The mean ceruloplasmin and prevalence of socio-economic indices, multiparity, pregnancy-induced hypertension, obesity and twin pregnancy were not different between the groups (p > 0.05. Logistic regression showed that rural residency significantly increased the odds for serum selenium <70 µg/L by 2.773-fold (p = 0.037. Baseline serum levels of selenium and ceruloplasmin were not associated with six-month mortality. This study has shown that selenium deficiency is a risk factor for PPCM in Kano, Nigeria, and is related to rural residency. However, serum ceruloplasmin, customary birth practices and some other characteristics were not associated with PPCM in the study area.

  19. Gestational Weight Gain and Peripartum Cardiomyopathy in a Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Hiroko Matsumiya

    2015-01-01

    Full Text Available Preeclamptic twin pregnancy with larger gestational weight gain (GWG is suggested to have a higher risk of peripartum cardiomyopathy (PPCM. This was true in a 5-year experience at a single center. A primiparous woman with twins and prepregnancy weight of 51.0 kg exhibited hypertension at gestational week (GW 32−6/7 and GWG of 18.3 kg (6.0 kg and 2.9 kg during the last four weeks and one week of gestation, resp. concomitant with generalized edema, gave birth at GW 34−4/7, developed proteinuria, cough, and dyspnea postpartum, and was diagnosed with preeclampsia and PPCM showing left ventricular ejection fraction of 34% and plasma BNP level of 1530 pg/mL. This was the only case of PPCM among 101 (12 with preeclampsia and 3266 women with twin and singleton pregnancies, respectively. Thus, PPCM occurred significantly more often in women with preeclamptic twin pregnancies than in women with singleton pregnancies (8.3% [1/12] versus 0.0% [0/3266], P=0.0355. This patient showed the greatest weight gain of 6.0 kg during the last four weeks of gestation and the greatest weight loss of 19.2 kg during one month postpartum among 90 women with twin deliveries at GW ≥ 32.

  20. [Severe pulmonary embolism and acute lower limb ischemia complicating peripartum cardiomyopathy successfully treated by streptokinase].

    Science.gov (United States)

    Yaméogo, N V; Kaboré, E; Seghda, A; Kagambèga, L J; Kaboré, H P; Millogo, G R C; Kologo, K J; Kambiré, Y; Bama, A; Toguyeni, B J Y; Samadoulougou, A K; Zabsonré, P

    2016-02-01

    Peripartum cardiomyopathy is a cardiac disease at high thromboembolism potential. The authors report a case of peripartum cardiomyopathy admitted for congestive heart failure. Echocardiography found a dilated cardiomyopathy with severely impaired left ventricular systolic function and biventricular thrombi. During hospitalization his condition was complicated by severe bilateral pulmonary embolism and left lower limb arterial acute thrombosis. The treatment consisted of thrombolysis with streptokinase associated with dobutamine (in addition to the conventional treatment of heart failure and bromocriptine). The outcome was favorable, marked by pulmonary and lower limb arterial unblocking. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  1. Depression and health behaviors in women with Peripartum Cardiomyopathy.

    Science.gov (United States)

    Rosman, Lindsey; Salmoirago-Blotcher, Elena; Cahill, John; Wuensch, Karl L; Sears, Samuel F

    Depression and health behavior engagement are a critical issue for recovery and secondary prevention in heart failure patients. No prior studies have examined these important clinical outcomes in young women diagnosed with Peripartum Cardiomyopathy (PPCM). We sought to characterize the prevalence of depression and health behaviors in PPCM patients and examine whether depression is associated with reduced engagement in health behaviors. A nation-wide, cohort of 177 PPCM patients (mean age of 34.8 ± 5.7 years; median time since diagnosis of 3.0 ± 4.3 years) from a web-based quality of life registry completed questionnaires about depression (Patient Health Questionnaire; a cutoff score ≥10 was used for depression screening) and health behaviors. T-tests, chi-square and linear regression were used to compare clinical characteristics and health behaviors among depressed and non-depressed women. The prevalence of clinical depression at enrollment was 32.3% and was associated with use of antihypertensive medications, disability insurance status, higher BMI, history of arrhythmia and current or past use of psychotropic medication. Health behavior engagement for diet, physical activity, and tobacco cessation were low in the overall sample and depressed PPCM patients were significantly less likely to attend medical appointments than non-depressed women. Nearly 1 in 3 PPCM survivors reported symptoms of clinical depression which was associated with worse attendance at medical follow-up visits. Further research is needed to develop risk stratification models and patient-centered interventions to improve clinical outcomes for PPCM survivors. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Contraception and reproductive counseling in women with peripartum cardiomyopathy.

    Science.gov (United States)

    Rosman, Lindsey; Salmoirago-Blotcher, Elena; Wuensch, Karl L; Cahill, John; Sears, Samuel F

    2017-07-01

    Pregnancies following a diagnosis of peripartum cardiomyopathy (PPCM) are associated with increased risk for maternal morbidity and mortality. Yet patterns of contraceptive use and reproductive counseling have received little attention. This nationwide registry-based study sought to evaluate patterns and clinical characteristics associated with contraceptive use, and examine the prevalence of contraceptive counseling in women with PPCM. From December 2015 to June 2016, 177 PPCM patients (mean age of 34.8±5.7years, median time since diagnosis of 3.0±4.3years) completed questionnaires about contraceptive use and counseling at registry enrollment. T Tests, chi-square and logistic regression were used to compare demographic and clinical characteristics among women who reported contraceptive use vs. nonuse. Tubal ligation (24.3%), condoms (22.0%) and intrauterine devices (IUDs; 16.4%) were the most common forms of contraception. Among sexually active women, 28.9% reported contraceptive nonuse. Contraceptive users had a lower body mass index higher education, and were less likely to be in a dating relationship, have hypertension, wear an external cardioverter-defibrillator, and use antihypertensive medications compared with nonusers (all p<0.05). Two-thirds of women received counseling about risks of subsequent pregnancies and contraceptive strategies. This preliminary study indicates that 1 in 4 PPCM patients are sexually active and are not using contraception to prevent PPCM reoccurrence. Although a majority of women did receive reproductive counseling, as many as 25% of patients reported no discussion of contraceptive strategies to prevent unintended pregnancy and heart failure relapse. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Natural course of subsequent pregnancy after peripartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Francisco Manes Albanesi Fº

    1999-07-01

    Full Text Available OBJECTIVE: To assess the effect of subsequent pregnancy after peripartum cardiomyopathy (PPCM on maternal and fetal outcome. METHODS: Prospective study of 34 patients with the diagnosis of PPCM (mean age= 26years. At the time of first diagnosis 5 were in NYHA functional class (FC II for heart failure, one in FC III and 28 in FC IV. After clinical treatment, patients were advised to avoid new pregnancies and a follow-up was obtained. RESULTS: There were 12 (35.3% subsequent pregnancies in patients (pt aged 19 to 44 years (mean 32, divided into two groups: GI: 6 pts who had normalized their heart size and GII: 6 pts with persistent cardiomegaly. GI had initially mild clinical manifestations ( 3 were in FC II, 1 in FC II and 2 in FC IV and complete recovery of cardiac function (FC I. A new pregnancy was well-tolerated in 5 (83.3%; 1 pt presented with preeclampsia, and progressed to FC II. Presently, 5 pt are in FC I and 1 in FC II. GII pts had more severe heart failure at the onset of PPCM (1 pt in FC II and 5 in FC IV; during follow-up, 4 pt were in FC I and 2 in FC II. A new pregnancy was well tolerated in all of them, but the eldest, who had had 2 pregnancies and had a progressive worsening of clinical status, dying 8 years after the last pregnancy and 13 years after the diagnosis of PPCM. The remaining 5 pt are still alive, 3 in FC I and 2 in FC II, with worsening of FC in 1. Subsequent pregnancies occurred 3-7 years after clinical treatment of PPCM and no fetal distress was observed. CONCLUSION: Subsequent pregnancies are well-tolerated after PPCM, but not devoid of risk. No fetal distress was observed. A minimum interval of 3 years after the recovery of function seems to be safe for subsequent pregnancies.

  4. Aetiology and risk factors of peripartum cardiomyopathy: a systematic review.

    Science.gov (United States)

    Ntusi, Ntobeko B A; Mayosi, Bongani M

    2009-01-09

    Peripartum cardiomyopathy (PPCM) is a disorder of unknown aetiology in which heart failure due to left ventricular dysfunction occurs between the last month of pregnancy and first five months post-partum. Theories abound concerning the specific cause and risk factors for PPCM, but none have been accepted universally. The primary objective of this review was to summarize the state of knowledge on the pathogenesis of PPCM, especially in light of recent studies. We searched MEDLINE (January 1966-September 2007), OVID, and reference lists of articles for studies containing information on the aetiology and risk factors for PPCM, and published in English. The literature reveals a wealth of articles proposing various mechanisms for aetiology and risk factors of PPCM. There is conflicting evidence on the pathogenetic role of viral myocarditis, abnormal immune response to pregnancy, abnormal response to the haemodynamic stress of pregnancy, accelerated myocyte apoptosis, cytokine-induced inflammation, malnutrition, genetic factors, excessive prolactin production, abnormal hormonal function, increased adrenergic tone, and myocardial ischaemia. A number of factors are postulated to increase the risk of the development of PPCM. These include non-Caucasian ethnicity, advanced maternal age, multiparity, poor socioeconomic status, multiple pregnancy and prolonged tocolytic use. The authors call for a strict definition of PPCM that excludes known causes of heart failure, such as the pregnancy-induced hypertensive spectrum of disorders. The aetiology and risk factors for PPCM are poorly defined. There is a need for large-scale multi-centre epidemiological studies and registries to delineate the aetiology and pathogenesis of PPCM.

  5. Peripartum back fat thickness of multiparous Holstein-Friesian cows with displacement of the abomasum or ketosis.

    Science.gov (United States)

    Yamakawa, Kazuhiro; Aoki, Takahiro; Matsui, Motozumi; Yamada, Kazutaka; Ishii, Mitsuo

    2012-05-01

    To establish a method to predict postpartum diseases using prepartum back fat thickness (BFT), the peripartum BFTs of 54 healthy multiparous cows before calving, which were diagnosed with postpartum displacement of the abomasum (DA), clinical ketosis or subclinical ketosis were compared with those of healthy cows from 8 weeks before the expected calving date to 8 weeks after calving. The peripartum BFTs of the cows with DA or clinical ketosis were significantly higher than those of healthy cows. The peripartum BFTs of the cows with subclinical ketosis were not significantly higher than those of the healthy cows.

  6. Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage.

    LENUS (Irish Health Repository)

    O'Brien, D

    2010-12-01

    The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD).

  7. Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy

    NARCIS (Netherlands)

    van Spaendonck-Zwarts, Karin Y.; Posafalvi, Anna; van den Berg, Maarten P.; Hilfiker-Kleiner, Denise; Bollen, Ilse A. E.; Sliwa, Karen; Alders, Marielle; AlMomani, Rowida; van Langen, Irene M.; van der Meer, Peter; Sinke, Richard J.; van der Velden, Jolanda; Van Veldhuisen, Dirk J.; van Tintelen, J. Peter; Jongbloed, Jan D. H.

    2014-01-01

    Aim Peripartum cardiomyopathy (PPCM) can be an initial manifestation of familial dilated cardiomyopathy (DCM). We aimed to identify mutations in families that could underlie their PPCM and DCM. Methods and results We collected 18 families with PPCM and DCM cases from various countries. We studied

  8. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM)

    NARCIS (Netherlands)

    Sliwa, Karen; Mebazaa, Alexandre; Hilfiker-Kleiner, Denise; Petrie, Mark C.; Maggioni, Aldo P.; Laroche, Cecile; Regitz-Zagrosek, Vera; Schaufelberger, Maria; Tavazzi, Luigi; van der Meer, Peter; Roos-Hesselink, JolienW.; Seferovic, Petar; van Spandonck-Zwarts, Karin; Mbakwem, Amam; Boehm, Michael; Mouquet, Frederic; Pieske, Burkert; Hall, Roger; Ponikowski, Piotre; Bauersachs, Johann

    Aims: The purpose of this study is to describe disease presentation, co-morbidities, diagnosis and initial therapeutic management of patients with peripartum cardiomyopathy (PPCM) living in countries belonging to the European Society of Cardiology (ESC) vs. non-ESC countries. Methods and results:

  9. Peri-partum cardiomyopathy in a pregnant woman at term revealed ...

    African Journals Online (AJOL)

    Peripartum Cardiomyopathy is insufficient congestive heart occurring in the last month of pregnancy and 5 months after delivery, in the absence of preexisting heart disease and identified etiology. This heart disease is associated with echocardiography systolic dysfunction and left ventricular dilatation. Its incidence ranges ...

  10. Rapid left ventricular recovery after cabergoline treatment in a patient with peripartum cardiomyopathy

    NARCIS (Netherlands)

    de Jong, Jonas S. S. G.; Rietveld, Kirsten; van Lochem, Laura T.; Bouma, Berto J.

    2009-01-01

    The aetiology of peripartum cardiomyopathy (PPCM) is still largely unknown. Recent evidence suggests that the breakdown products from prolactin can induce cardiomyopathy. Prolactin secretion can be reduced with bromocriptine which had beneficial effects in a small study. We present a case of a

  11. Terson Syndrome from a Significant Cerebral Infarct Occurring During the Peripartum Period.

    Science.gov (United States)

    Chu, Edward Rickie L; Sandinha, Teresa; Lake, Stewart; Pater, John

    2009-11-02

    This case report describes a 23-day-old infant with significant infarct in the right middle cerebral artery territory associated with intraparenchymal hemorrhage within the infarct, subdural hygroma, and bilateral intraocular hemorrhage. The features, severity, and timing of the pathology are suggestive of Terson syndrome that has occurred during the peripartum period. Copyright 2009, SLACK Incorporated.

  12. Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy

    NARCIS (Netherlands)

    van Spaendonck-Zwarts, Karin Y.; Posafalvi, Anna; van den Berg, Maarten P.; Hilfiker-Kleiner, Denise; Bollen, Ilse A. E.; Sliwa, Karen; Alders, Mariëlle; Almomani, Rowida; van Langen, Irene M.; van der Meer, Peter; Sinke, Richard J.; van der Velden, Jolanda; van Veldhuisen, Dirk J.; van Tintelen, J. Peter; Jongbloed, Jan D. H.

    2014-01-01

    Peripartum cardiomyopathy (PPCM) can be an initial manifestation of familial dilated cardiomyopathy (DCM). We aimed to identify mutations in families that could underlie their PPCM and DCM. We collected 18 families with PPCM and DCM cases from various countries. We studied the clinical

  13. Contraception, pregnancy, and peripartum experiences among women with epilepsy in Bhutan.

    Science.gov (United States)

    Halani, Sheliza; Tshering, Lhab; Bui, Esther; Clark, Sarah J; Grundy, Sara J; Pem, Tandin; Lhamo, Sonam; Dema, Ugyen; Nirola, Damber K; Dorji, Chencho; Mateen, Farrah J

    2017-12-01

    Reports on the reproductive health of women with epilepsy (WWE) in low- and middle-income countries (LMICs) are limited. Bhutan is a lower income country with a high estimated prevalence of epilepsy and no out-of-pocket payment requirements for health visits or medications. We developed a 10-category survey to interview WWE ages 20-59 years in the Kingdom of Bhutan to understand their contraceptive use and peripartum experiences. WWE were recruited from 2016-2017 from an existing epilepsy cohort and their reproductive health data were merged with epilepsy and socioeconomic data obtained from initial clinical evaluations performed between 2014 and 2016. Of the 134 WWE eligible for the study, 94 were reachable and there was 1 refusal to participate (response rate 99% among reachable WWE; 69% of all WWE in the cohort). Of the 93 WWE (median age 27 years, range 20-52), 50 (54%) reported prior pregnancies. Of the entire cohort, 55 women responded on contraception: 26 (47%) WWE had never used contraception in their lifetime. Of the 29 WWE who had ever used contraception, the most commonly reported form was male condoms (14/29, 48%), followed by depot medroxyprogesterone acetate injections (13/29, 45%), and intrauterine devices (5/29, 17%). Sixty-three percent of WWE recalled receiving information on family planning (31 of 49). Of the 50 WWE with prior pregnancies, 37 of 46 (80%) used folic acid; 6 WWE reported commencing it in the first trimester while 29 WWE began supplementation in the second trimester. Primary school education or higher was associated with folic acid supplementation during pregnancy (26/29 vs. 11/17, p=0.040). Epilepsy affected at least one of the pregnancies in 38 of the cases (76%) with an average of 2.3 pregnancies per woman). There was a total of 86 pregnancies and an average inter-pregnancy interval of 3.5 years. Ninety-five percent of women attended prenatal care (36/38), 22% had at least one miscarriage (8/37), 14% had at least one pre

  14. Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy.

    Science.gov (United States)

    Deffieux, Xavier; Vinchant, Marie; Wigniolle, Ingrid; Goffinet, François; Sentilhes, Loïc

    2017-01-01

    Intra-abdominal packing is a possible option for persistent bleeding following hysterectomy for postpartum hemorrhage. However, to date, only very limited data about maternal outcome after intra-abdominal packing for surgically uncontrolled hemorrhage following hysterectomy are available. The objective of the current study was to estimate maternal outcome after intra-abdominal packing following unsuccessful peripartum hysterectomy for postpartum hemorrhage. A questionnaire was mailed to all maternity units performing more than 850 deliveries per year. Inclusion criteria were: all cases of abdominal packing performed following unsuccessful peripartum hysterectomy for postpartum hemorrhage between 2003 and 2013. The primary outcome was success of intra-abdominal packing, defined as the arrest of hemorrhage with no need of additional procedure. The total number of deliveries during the study period that occurred in the 51 participating centers was 1,430,142. The centers reported a total of 718 (1 per 2000 deliveries) peripartum hysterectomies for PPH and 53 abdominal packings performed after unsuccessful peripartum hysterectomy (about 1 per 14 hysterectomies). A median of 5 [IQR 3-7] pads were used for packing. Abdominal packing was removed after a median of 39.5 hours [IQR 24-48]. The success rate of abdominal packing was 62% (33/53). Among the 20 (38%) women in whom bleeding did not stop following the use of abdominal packing, 6 required a second surgical intervention, 6 a pelvic artery embolization and the 8 other women had "only" further intensive resuscitation and pharmacological treatments. Finally, mortality rate was 24% (13/53). Our results suggest that abdominal packing, used for duration of 24 to 48 hours, seems to be an option as an ultimate procedure to control persistent life-threatening postpartum hemorrhage following peripartum hysterectomy.

  15. The development of peripartum depressive symptoms is associated with gene polymorphisms of MAOA, 5-HTT and COMT

    NARCIS (Netherlands)

    Doornbos, Bennard; Dijck-Brouwer, D. A. Janneke; Kema, Ido P.; Tanke, Marit A. C.; van Goor, Saskia A.; Muskiet, Frits A. J.; Korf, Jakob

    2009-01-01

    Background: Polymorphisms of monoamine-related genes have been associated with depression following life events. The peripartum is a physiologically and psychologically challenging period, characterized by fluctuations in depressive symptoms, therefore facilitating prospective investigations in this

  16. Proving allelopathy in crop-weed interactions

    Science.gov (United States)

    Allelopathy (plant/plant chemical warfare) is difficult to prove, especially when competition for resources is the dominant component of plant/plant interference (interference = allelopathy +competition). This paper describes experimental approaches for proving allelopathy and points out common pit...

  17. Acute Onset Peripartum Cardiomyopathy in a Woman with Severe Pre-eclamptia: A Diagnostic Dilemma

    OpenAIRE

    Basak, Sonela; Rudra, Pallab

    2013-01-01

    Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that can present as acute life-threatening pulmonary oedema in late pregnancy or early puerperium, its diagnosis is mainly by exclusion of other causes. Morbidity is high due to the reduced physiological reserve in pregnancy. PPCM and severe pre-eclampsia can co-exist and their clinical presentation may overlap, making the diagnosis more difficult and often delayed, with potentially devastating consequences. Here, we would l...

  18. Analysis of the risk factors relating to cows' resistance to Rhipicephalus microplus ticks during the peripartum.

    Science.gov (United States)

    da Silva, Jenevaldo Barbosa; Rangel, Charles Passos; de Azevedo Baêta, Bruna; da Fonseca, Adivaldo Henrique

    2014-08-01

    This study aimed to evaluate season, breed, number of lactations and milk production as risk factors relating to Rhipicephalus microplus infestation in dairy cows during the peripartum. Eighty-four animals were randomly selected through proportional stratified sampling. All engorged and partially engorged female R. microplus specimens measuring 4.5-8.0 mm were counted during the 5 weeks before calving, calving week and 5 weeks after calving. The peripartum had a significant effect [calving (p tick count was higher during the rainy season than during the dry season, there was no significant difference (p = 0.055; PR = 0.63). The average R. microplus count was significantly higher (p < 0.05; PR = 2.10) in Bos taurus animals, followed by F1 (p < 0.05; PR = 1.64) and Girolando (p < 0.05; PR = 1.39). The average R. microplus count was significantly higher (p < 0.05; PR = 0.97) in first-lactation animals, followed by those at the second, third and, fourth or subsequent lactation. Milk production showed a negative correlation with R. microplus count, such that high-production animals were significantly (p = 0.003; PR = 2.04) more vulnerable to infestation than were low-production animals. First-lactation and high-production B. taurus animals had greatest vulnerability to R. microplus infestation over the peripartum period, and constituted the at-risk group in the dairy herd.

  19. Symbolic logic and mechanical theorem proving

    CERN Document Server

    Chang, Chin-Liang

    1969-01-01

    This book contains an introduction to symbolic logic and a thorough discussion of mechanical theorem proving and its applications. The book consists of three major parts. Chapters 2 and 3 constitute an introduction to symbolic logic. Chapters 4-9 introduce several techniques in mechanical theorem proving, and Chapters 10 an 11 show how theorem proving can be applied to various areas such as question answering, problem solving, program analysis, and program synthesis.

  20. Valutazione economica dello studio PROVE-IT

    Directory of Open Access Journals (Sweden)

    Lorenzo G. Mantovani

    2007-10-01

    Full Text Available Introduction: the PROVE-IT (“Intensive versus moderate lipid lowering with statins after acute coronary syndromes” was a comparison of pravastatin 40 mg/die versus atorvastatin 80 mg/die in patients with an acute coronary syndrome (ACS. Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs usual-dose of pravastatin in Italian patients with a history of acute coronary syndrome. Methods: the analysis is conducted on the basis of clinical outcomes of the PROVE-IT study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die versus usual-dose of pravastatin (40 mg/die in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006. Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations. We considered an observation period of 24 months. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis. Results: the cost of pravastatin or atorvastatin therapy over the 2 years period amounted to approximately 1.3 millions euro and 870,000 euro per 1,000 patients respectively. Atorvastatin was more efficacious compared to pravastatin and the overall cost of care per 1,000 patients over 24 months of follow-up was estimated at 3.2 millions euro in the pravastatin and 2.5 millions euro in the atorvastatin group, resulting into a cost saving of about 700,000 euro that is 27% of total costs occurred in the pravastatin group. Discussion: this study demonstrates that high does atorvastatin treatment leads to a reduction of direct costs for the National Health System

  1. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy.

    Science.gov (United States)

    Sliwa, Karen; Hilfiker-Kleiner, Denise; Petrie, Mark C; Mebazaa, Alexandre; Pieske, Burkert; Buchmann, Eckhart; Regitz-Zagrosek, Vera; Schaufelberger, Maria; Tavazzi, Luigi; van Veldhuisen, Dirk J; Watkins, Hugh; Shah, Ajay J; Seferovic, Petar M; Elkayam, Uri; Pankuweit, Sabine; Papp, Zoltan; Mouquet, Frederic; McMurray, John J V

    2010-08-01

    Peripartum cardiomyopathy (PPCM) is a cause of pregnancy-associated heart failure. It typically develops during the last month of, and up to 6 months after, pregnancy in women without known cardiovascular disease. The present position statement offers a state-of-the-art summary of what is known about risk factors for potential pathophysiological mechanisms, clinical presentation of, and diagnosis and management of PPCM. A high index of suspicion is required for the diagnosis, as shortness of breath and ankle swelling are common in the peripartum period. Peripartum cardiomyopathy is a distinct form of cardiomyopathy, associated with a high morbidity and mortality, but also with the possibility of full recovery. Oxidative stress and the generation of a cardiotoxic subfragment of prolactin may play key roles in the pathophysiology of PPCM. In this regard, pharmacological blockade of prolactin offers the possibility of a disease-specific therapy.

  2. TOTAL PLACENTA PREVIA AND PERIPARTUM HYSTERECTOMY – CASE REPORT

    Directory of Open Access Journals (Sweden)

    Vladimir Weber

    2018-02-01

    Full Text Available Background. Postpartum haemorrhage usually occurs due to uterus atonia, adherent placenta, placenta accreta, coagulopathy or uterus rupture. In total placenta previa haemorrhage occurs more often and usually is more severe. Case report. We presented the example of severe postpartum haemorrhage with parturient woman after scheduled Caesarean section, due to total placenta previa, which was ended by performing hysterectomy. Conclusions. In postpartum haemorrhage, the treatment is conservative and if there is no improvement timely surgery is required. Abdominal hysterectomy is the final option and in case of severe haemorrhage it proved to be life saving for parturient woman.

  3. APTE: An Algorithm for Proving Trace Equivalence

    OpenAIRE

    Cheval, Vincent

    2014-01-01

    This paper presents APTE, a new tool for automatically proving the security of cryptographic protocols. It focuses on proving trace equivalence between processes, which is crucial for specifying privacy type properties such as anonymity and unlinkability.\\ud \\ud The tool can handle protocols expressed in a calculus similar to the applied-pi calculus, which allows us to capture most existing protocols that rely on classical cryptographic primitives. In particular, APTE handles private channels...

  4. Metabolic and oxidative status of Saanen goats of different parity during the peripartum period.

    Science.gov (United States)

    Radin, Lada; Šimpraga, Miljenko; Vince, Silvijo; Kostelić, Antun; Milinković-Tur, Suzana

    2015-11-01

    The aim of this study was to research changes in metabolic and antioxidative status of Saanen goats of different parity occurring during the peripartum period. Blood samples were taken on 10-7 and 3-1 d prepartally and 1-3, 14 and 28 d postpartally from goats allocated in three groups according to their parity: primiparous (PRIM), goats that kidded the 2nd or 3rd time (MID), and goats that kidded 4 or more times (MULTI)). Metabolic profile parameters (non-esterified fatty acids (NEFA), β-hydroxybutyrate (BHB), glucose, triglycerides, albumin and urea) and indicators of oxidative stress ((superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA)) were determined. Intense metabolic changes associated with late pregnancy and onset of lactation were pronounced the most in MULTI goats that also had the biggest litter per goat. Significant differences were found in metabolic parameters NEFA, BHB, glucose, triglycerides within groups during peripartum period, as well as between them (the effect of parity). MDA concentrations were indicative of increased lipid peroxidation around parturition, especially pronounced in MULTI group 1-3 d prepartally, when the highest GSH-Px/SOD ratio was also found. Postpartally, antioxidant enzymes ratio in MID and MULTI group decreased while MDA concentrations remained high, suggesting antioxidant system inefficiency. Significant time × group interaction was observed for most of the parameters. The obtained results show that the goats of higher parity display higher levels of metabolism intensity and consequently, varying levels of oxidative stress during the peripartum period. Further studies should determine applicability of NEFA and BHB in periparturient metabolic profiling in dairy goats as well as establish normal ranges and cut-off levels for these biomarkers.

  5. NUTRITIVE VALUE OF DIETS WITH INACTIVE DRY YEAST FOR SAANEN GOATS IN THE PERIPARTUM PERIOD

    OpenAIRE

    BRUNA SUSAN DE LABIO MOLINA; LARISSA RIBAS DE LIMA; LUDMILA COUTO GOMES; LUCIANO SOARES DE LIMA; CLAUDETE REGINA ALCALDE

    2016-01-01

    The aim was to evaluate the replacement of soybean meal by inactive dry yeast ( Saccharomyces cerevisiae ) from sugar cane on nutritive value of diets for Saanen goats in the peripartum. Twenty - four Saanen goats (nine primiparous, 55.35 ± 4.55 kg and fifteen multiparous, 73.12 ± 8.51 kg) in prepartum and postpartum periods were distributed in a completely randomized design with a 3 × 2 (diet × parturition order) factorial arrangement. Diets were composed of soybean meal...

  6. NUTRITIVE VALUE OF DIETS WITH INACTIVE DRY YEAST FOR SAANEN GOATS IN THE PERIPARTUM PERIOD

    OpenAIRE

    Molina, Bruna Susan de Labio; Lima, Larissa Ribas de; Gomes,Ludmila Couto; Lima, Luciano Soares de; Alcalde,Claudete Regina

    2016-01-01

    ABSTRACT: The aim was to evaluate the replacement of soybean meal by inactive dry yeast (Saccharomyces cerevisiae) from sugar cane on nutritive value of diets for Saanen goats in the peripartum. Twenty-four Saanen goats (nine primiparous, 55.35 ± 4.55 kg and fifteen multiparous, 73.12 ± 8.51 kg) in prepartum and postpartum periods were distributed in a completely randomized design with a 3 × 2 (diet × parturition order) factorial arrangement. Diets were composed of soybean meal, soybean meal ...

  7. Serelaxin treatment promotes adaptive hypertrophy but does not prevent heart failure in experimental peripartum cardiomyopathy.

    Science.gov (United States)

    Nonhoff, Justus; Ricke-Hoch, Melanie; Mueller, Mirco; Stapel, Britta; Pfeffer, Tobias; Kasten, Martina; Scherr, Michaela; von Kaisenberg, Constantin; Bauersachs, Johann; Haghikia, Arash; Hilfiker-Kleiner, Denise

    2017-05-01

    Peripartum cardiomyopathy (PPCM) is a systolic left ventricular dysfunction developing in the peripartum phase in previously healthy women. Relaxin-2 is a pregnancy hormone with potential beneficial effects in heart failure patients. We evaluated Relaxin-2 as a potential diagnostic marker and/or a therapeutic agent in PPCM. In healthy peripartum women, serum Relaxin-2 levels (measured by ELISA in the second half of pregnancy) were elevated showing a decreasing trend in the first postpartum week and returned to non-pregnant levels thereafter. In PPCM patients diagnosed in the first postpartum week, serum Relaxin-2 levels were lower compared to healthy postpartum stage-matched controls. In PPCM patients diagnosed later (0.5-10 months postpartum) Relaxin-2 levels were in the range of non-pregnant controls and not different from healthy postpartum stage-matched controls. In mice, serum Relaxin-1 (functional equivalent of human Relaxin-2) was increased late in pregnancy and rapidly cleared in the first postpartum week. In mice with PPCM due to a cardiomyocyte-specific knockout of STAT3 (CKO) neither low nor high dose of recombinant Relaxin-2 (serelaxin, sRlx-LD: 30 µg/kg/day; sRlx-HD: 300 µg/kg/day) affected cardiac fibrosis, inflammation and heart failure but sRlx-HD increased capillary/cardiomyocyte ratio. sRlx-HD significantly increased heart/body weight ratio and cardiomyocyte cross-sectional area in postpartum CKO and wild-type mice without changing the foetal gene expression program (ANP or β-MHC). sRlx-HD augmented plasma Prolactin levels in both genotypes, which induced cardiac activation of STAT5. In vitro analyses showed that Prolactin induces cardiomyocyte hypertrophy via activation of STAT5. Although Relaxin-2 levels seemed lower in PPCM patients diagnosed early postpartum, we observed a high pregnancy-related variance of serum Relaxin-2 levels peripartum making it unsuitable as a biomarker for this condition. Supplementation with sRlx may contribute to

  8. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy : a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy

    NARCIS (Netherlands)

    Sliwa, Karen; Hilfiker-Kleiner, Denise; Petrie, Mark C.; Mebazaa, Alexandre; Pieske, Burkert; Buchmann, Eckhart; Regitz-Zagrosek, Vera; Schaufelberger, Maria; Tavazzi, Luigi; van Veldhuisen, Dirk J.; Watkins, Hugh; Shah, Ajay J.; Seferovic, Petar M.; Elkayam, Uri; Pankuweit, Sabine; Papp, Zoltan; Mouquet, Frederic; McMurray, John J. V.

    Peripartum cardiomyopathy (PPCM) is a cause of pregnancy-associated heart failure. It typically develops during the last month of, and up to 6 months after, pregnancy in women without known cardiovascular disease. The present position statement offers a state-of-the-art summary of what is known

  9. Proving program inclusion using Hoare's logic

    NARCIS (Netherlands)

    Bergstra, J.A.; Klop, J.W.

    1984-01-01

    We explore conservative refinements of specifications. These form a quite appropriate framework for a proof theory for program inclusion based on a proof theory for program correctness. We propose two formalized proof methods for program inclusion and prove these to be sound. Both methods are

  10. Affect, Behavioural Schemas and the Proving Process

    Science.gov (United States)

    Selden, Annie; McKee, Kerry; Selden, John

    2010-01-01

    In this largely theoretical article, we discuss the relation between a kind of affect, behavioural schemas and aspects of the proving process. We begin with affect as described in the mathematics education literature, but soon narrow our focus to a particular kind of affect--nonemotional cognitive feelings. We then mention the position of feelings…

  11. Proving a Result in Combinatorics using Equations

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 9; Issue 2. Proving a Result in Combinatorics using Equations. V Rajesh. Classroom Volume 9 Issue 2 February 2004 pp 85-87. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/009/02/0085-0087. Keywords.

  12. Peripartum cardiomyopathy is associated with increased uric acid concentrations: A population based study.

    Science.gov (United States)

    Sagy, Iftach; Salman, Amjad Abu; Kezerle, Louise; Erez, Offer; Yoel, Idan; Barski, Leonid

    Peri-partum cardiomyopathy (PPCM) is a clinical heart failure that usually develops during the final stage of pregnancy or the first months following delivery. High maternal serum uric acid concentrations have been previous associated with heart failure and preeclampsia. 1) To explored the clinical characteristics of PPCM patients; and 2) to determine the association between maternal serum uric acid concentrations and PPCM. This is a retrospective population based case control study. Cases and controls were matched 1:4 (for gestational age, medical history of cardiac conditions and creatinine); conditional logistic regression was used to identify clinical parameters that were associated with PPCM. The prevalence of peripartum cardiomyopathy at our institution was 1-3832 deliveries (42/160,964). In a matched multivariate analysis high maternal serum uric acid concentrations were associated with PPCM (O.R 1.336, 95% C.I 1.003-1.778). Uric acid concentrations were higher within the Non-Jewish patients and mothers of male infant with PPCM in compare to those without PPCM (p value 0.003 and 0.01 respectively). PPCM patients had increased maternal serum uric acid concentrations. This observation aligns with previous report regarding the increased uric acid concentration in women with preeclampsia and congestive heart failure, suggestive of a common underlying mechanism that mediates the myocardial damage. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Metabolic profile of santa inês ewes whith low body condition score during peripartum

    Directory of Open Access Journals (Sweden)

    Nayara Resende Nasciutti

    2012-02-01

    Full Text Available The objective of this study was to analyse the variations in the metabolic profile of protein, energy enzyme and mineral of Santa Inês ewes with low body condition score (BCS during peripartum. Blood samples were collected from 12 animals by jugular venipuncture to determine the serum biochemical profiles of protein, energy, mineral and enzyme metabolisms. Samples were collected on the following days: days 28, 21, 14, and 7 before lambing, at birth and, at days 2, 4, 7, 14, 21, and 28 postpartum (dpp. The samples were centrifuged and the serum analysed by Automated-Analyser. There was no alteration of the BCS during the 28 dpp, between 0.6 and 2.1 ± 2.4 ± 0.5, and was considered, as lean. The values of the total serum protein, globulin, albumin, and albumin/globulin ratio were reduced effective from the period before birth until 28dpp. The values of beta-hydroxybutyrate, calcium, phosphorus and magnesium remained below those of reference values. The concentrations of alanin aminotransferase (ALT were decreased particularly during the weeks before delivery. It was concluded that Santa Inês sheep with low body condition score demonstrated a reduction in the metabolism of proteins, energy, mineral and enzyme during peripartum.

  14. [Clinical pathological analysis of peripartum maternal mortality (author's transl)].

    Science.gov (United States)

    Pickel, H; Lahousen, M; Becker, H; Leinzinger, P

    1981-05-29

    All maternal deaths which occurred in relation to labour at the Department of Obstetrics and Gynaecology, University Hospital, Graz, between 1963 and 1978 were reviewed and analysed. 24 mothers died over this 15-year period. The maternal death rate was 0.34 per thousand. In all cases a post mortem examination was performed. The youngest woman was 19, the oldest 42 years old. Most of the decreased mothers were primiparae. The main cause of maternal death was post-partum haemorrhage, followed by infection of the uterus especially after Caesarean section. Three mothers died of liver distrophy. The remaining causes were eclampsia (2 cases); pulmonary artery embolism after Caesarean section (2 cases); irreversible shock from amniotic fluid and air embolism (one case each); uraemia due to glomerulo- or pyelonephritis (one case each); malignant melanoma (one case). It is demonstrated that special risk factors are advanced maternal age, low social status and lack of antenatal care.

  15. On proving syntactic properties of CPS programs

    DEFF Research Database (Denmark)

    Danvy, Olivier; Dzafic, Belmina; Pfenning, Frank

    1999-01-01

    Higher-order program transformations raise new challenges for proving properties of their output, since they resist traditional, first-order proof techniques. In this work, we consider (1) the “one-pass” continuation-passing style (CPS) transformation, which is second-order, and (2) the occurrences...... of parameters of continuations in its output. To this end, we specify the one-pass CPS transformation relationally and we use the proof technique of logical relations....

  16. Automated theorem proving theory and practice

    CERN Document Server

    Newborn, Monty

    2001-01-01

    As the 21st century begins, the power of our magical new tool and partner, the computer, is increasing at an astonishing rate. Computers that perform billions of operations per second are now commonplace. Multiprocessors with thousands of little computers - relatively little! -can now carry out parallel computations and solve problems in seconds that only a few years ago took days or months. Chess-playing programs are on an even footing with the world's best players. IBM's Deep Blue defeated world champion Garry Kasparov in a match several years ago. Increasingly computers are expected to be more intelligent, to reason, to be able to draw conclusions from given facts, or abstractly, to prove theorems-the subject of this book. Specifically, this book is about two theorem-proving programs, THEO and HERBY. The first four chapters contain introductory material about automated theorem proving and the two programs. This includes material on the language used to express theorems, predicate calculus, and the rules of...

  17. Theorem Proving In Higher Order Logics

    Science.gov (United States)

    Carreno, Victor A. (Editor); Munoz, Cesar A.; Tahar, Sofiene

    2002-01-01

    The TPHOLs International Conference serves as a venue for the presentation of work in theorem proving in higher-order logics and related areas in deduction, formal specification, software and hardware verification, and other applications. Fourteen papers were submitted to Track B (Work in Progress), which are included in this volume. Authors of Track B papers gave short introductory talks that were followed by an open poster session. The FCM 2002 Workshop aimed to bring together researchers working on the formalisation of continuous mathematics in theorem proving systems with those needing such libraries for their applications. Many of the major higher order theorem proving systems now have a formalisation of the real numbers and various levels of real analysis support. This work is of interest in a number of application areas, such as formal methods development for hardware and software application and computer supported mathematics. The FCM 2002 consisted of three papers, presented by their authors at the workshop venue, and one invited talk.

  18. Interval logic. Proof theory and theorem proving

    DEFF Research Database (Denmark)

    Rasmussen, Thomas Marthedal

    2002-01-01

    of a direction of an interval, and present a sound and complete Hilbert proof system for it. Because of its generality, SIL can conveniently act as a general formalism in which other interval logics can be encoded. We develop proof theory for SIL including both a sequent calculus system and a labelled natural...... deduction system. We conduct theoretical investigations of the systems with respect to subformula properties, proof search, etc. The generic theorem proving system Isabelle is used as a framework for encoding both proof theoretical systems. We consider a number of examples/small case-studies and discuss...

  19. Isolated Right Superior Vena Cava Drainage into the Left Atrium Diagnosed Noninvasively in the Peripartum Period

    Science.gov (United States)

    Baggett, Charles; Skeen, Shawn J.; Gantt, D. Scott; Trotter, Bradley R.; Birkemeier, Krista L.

    2009-01-01

    Isolated right superior vena cava drainage into the left atrium is an extremely rare cardiac anomaly, especially in the absence of other cardiac abnormalities. Only 28 of 5,127 reported consecutive congenital cardiac cases involved superior vena cava drainage into the left atrium, and all were associated with other cardiac anomalies. Of 19 reported cases of right superior vena cava drainage into the left atrium, most patients have been children who were experiencing mild hypoxemia and cyanosis. Herein, we describe the case of a 34-year-old woman who presented with asymptomatic hypoxemia in the peripartum period. She was diagnosed to have isolated drainage of the right superior vena cava into the left atrium. To the best of our knowledge, this is the 1st reported instance of such diagnosis by use of noninvasive imaging only, without cardiac catheterization. We also review the medical literature that pertains to our patient's anomaly. PMID:20069093

  20. Rapid left ventricular recovery after cabergoline treatment in a patient with peripartum cardiomyopathy

    Science.gov (United States)

    de Jong, Jonas S.S.G.; Rietveld, Kirsten; van Lochem, Laura T.; Bouma, Berto J.

    2009-01-01

    The aetiology of peripartum cardiomyopathy (PPCM) is still largely unknown. Recent evidence suggests that the breakdown products from prolactin can induce cardiomyopathy. Prolactin secretion can be reduced with bromocriptine which had beneficial effects in a small study. We present a case of a patient with PPCM who received cabergoline, a strong and long lasting antagonist of prolactin secretion. Following treatment, her prolactin levels dropped swiftly. N-terminal pro-BNP levels, which had remained high up to that point, dropped within 1 day (7006 to 4408 pg/mL). Echocardiographic left ventricular ejection fraction recovered from 26% on Day 4 postpartum to 32% and later 47% on Days 2 and 5 after cabergoline treatment. To our knowledge, this is the first description of a case of PPCM in which cabergoline was administered. PMID:19168522

  1. Research Gaps in Neonatal HIV-Related Care | Davies | Southern ...

    African Journals Online (AJOL)

    However, both in South Africa and across sub-Saharan African, lack of boosted peri-partum prophylaxis for high-risk vertical transmission, loss to followup, and failure to initiate HIV-infected infants on antiretroviral therapy (ART) before disease progression are key remaining gaps in neonatal HIV-related care. In this issue of ...

  2. Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy.

    Science.gov (United States)

    Schelbert, Erik B; Elkayam, Uri; Cooper, Leslie T; Givertz, Michael M; Alexis, Jeffrey D; Briller, Joan; Felker, G Michael; Chaparro, Sandra; Kealey, Angela; Pisarcik, Jessica; Fett, James D; McNamara, Dennis M

    2017-04-03

    In peripartum cardiomyopathy, the prevalence of focal myocardial damage detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is important to elucidate mechanisms of myocardial injury and cardiac dysfunction. LGE equates irreversible myocardial injury, but LGE prevalence in peripartum cardiomyopathy is uncertain. Among 100 women enrolled within the Investigations of Pregnancy Associated Cardiomyopathy cohort, we recruited 40 women at 13 centers to undergo LGE cardiovascular magnetic resonance, enrolled within the first 13 weeks postpartum. Follow-up scans occurred at 6 months postpartum, and death/transplant rates at 12 months. Baseline characteristics did not differ significantly in the parent cohort according to cardiovascular magnetic resonance enrollment except for mechanical circulatory support. LGE was noted only in 2 women (5%) at baseline. While left ventricular dysfunction with enlargement was prevalent at baseline cardiovascular magnetic resonance scans (eg, ejection fraction 38% [Q1-Q3 31-50%], end diastolic volume index=108 mL/m2 [Q1-Q3 83-134 mL/m2]), most women demonstrated significant improvements at 6 months, consistent with a low prevalence of LGE. LGE was not related to baseline clinical variables, ejection fraction, New York Heart Association heart failure class, or mortality. Neither of the 2 women who died exhibited LGE. LGE was inversely associated with persistent left ventricular ejection fraction at 6 months (P=0.006). Factors other than focal myocardial damage detectable by LGE explain the initial transient depressions in baseline left ventricular ejection fraction, yet focal myocardial damage may contribute to persistent myocardial dysfunction and hinder recovery in a small minority. Most women exhibit favorable changes in ventricular function over 6 months. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01085955. © 2017 The Authors. Published on behalf of the American Heart Association, Inc

  3. Prenatal and Postpartum Evening Salivary Cortisol Levels in Association with Peripartum Depressive Symptoms.

    Directory of Open Access Journals (Sweden)

    Stavros I Iliadis

    Full Text Available The biology of peripartum depression remains unclear, with altered stress and the Hypothalamus-Pituitary-Adrenal axis response having been implicated in its pathophysiology.The current study was undertaken as a part of the BASIC project (Biology, Affect, Stress, Imaging, Cognition, a population-based longitudinal study of psychological wellbeing during pregnancy and the postpartum period in Uppsala County, Sweden, in order to assess the association between evening salivary cortisol levels and depressive symptoms in the peripartum period. Three hundred and sixty-five pregnant women from the BASIC cohort were recruited at pregnancy week 18 and instructed to complete a Swedish validated version of the Edinburgh Postnatal Depression Scale at the 36th week of pregnancy as well as the sixth week after delivery. At both times, they were also asked to provide evening salivary samples for cortisol analysis. A comprehensive review of the relevant literature is also provided.Women with postpartum EPDS score ≥ 10 had higher salivary evening cortisol at six weeks postpartum compared to healthy controls (median cortisol 1.19 vs 0.89 nmol/L. A logistic regression model showed a positive association between cortisol levels and depressive symptoms postpartum (OR = 4.1; 95% CI 1.7-9.7. This association remained significant even after controlling for history of depression, use of tobacco, partner support, breastfeeding, stressful life events, and sleep problems, as possible confounders (aOR = 4.5; 95% CI 1.5-14.1. Additionally, women with postpartum depressive symptoms had higher postpartum cortisol levels compared to both women with depressive symptoms antenatally and controls (p = 0.019 and p = 0.004, respectively.Women with depressive symptoms postpartum had higher postpartum cortisol levels, indicating an altered response of the HPA-axis in postpartum depression.

  4. Resolution methods in proving the program correctness

    Directory of Open Access Journals (Sweden)

    Markoski Branko

    2007-01-01

    Full Text Available Program testing determines whether its behavior matches the specification, and also how it behaves in different exploitation conditions. Proving of program correctness is reduced to finding a proof for assertion that given sequence of formulas represents derivation within a formal theory of special predicted calculus. A well-known variant of this conception is described: correctness based on programming logic rules. It is shown that programming logic rules may be used in automatic resolution procedure. Illustrative examples are given, realized in prolog-like LP-language (with no restrictions to Horn's clauses and without the final failure. Basic information on LP-language are also given. It has been shown how a Pascal-program is being executed in LP-system proffer.

  5. Theorem Proving in Intel Hardware Design

    Science.gov (United States)

    O'Leary, John

    2009-01-01

    For the past decade, a framework combining model checking (symbolic trajectory evaluation) and higher-order logic theorem proving has been in production use at Intel. Our tools and methodology have been used to formally verify execution cluster functionality (including floating-point operations) for a number of Intel products, including the Pentium(Registered TradeMark)4 and Core(TradeMark)i7 processors. Hardware verification in 2009 is much more challenging than it was in 1999 - today s CPU chip designs contain many processor cores and significant firmware content. This talk will attempt to distill the lessons learned over the past ten years, discuss how they apply to today s problems, outline some future directions.

  6. Peripartum Cardiomyopathy

    Science.gov (United States)

    ... with a multidisciplinary team, including specialists from cardiology, obstetrics, anesthesia, and pediat- rics. Early delivery is not ... More recent research 4,5 sug- gests that outcomes of PPCM have improved, with survival rates as ...

  7. Peripartum Cardiomyopathy

    African Journals Online (AJOL)

    pregnancy. However, after delivery, women lose the increased immunity, and if fetal cells reside on cardiac tissue when the fetus is delivered, a pathological autoimmune response can occur, leading to PPCM in the mother after birth. Abnormal hemodynamic response. Physiological changes in the cardiovascular system in.

  8. Peripartum cardiomyopathy

    DEFF Research Database (Denmark)

    Ersboll, Anne S.; Damm, Peter; Gustafsson, Finn

    2016-01-01

    of pathophysiology, diagnostics and clinical management. MATERIAL AND METHODS: Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data. Guidelines and reviews....... The prevalence of concomitant preeclampsia is high (often 30-45%) and symptoms can be similar, posing diagnostic difficulties. Most women (71-98%) present postpartum. Echocardiography is essential for diagnosis, and cardiac magnetic resonance imaging may provide new insights to pathophysiology and prognosis....... Management is multidisciplinary and involves advanced heart failure therapy. Treatment, timing and mode of delivery in pregnant women depend on disease severity. The risk of relapse in subsequent pregnancies is >20%, and women are often advised against a new pregnancy. CONCLUSIONS: PPCM has a huge impact...

  9. a Test to Prove Cloud Whitening THEORY!

    Science.gov (United States)

    Buttram, J. W.

    2011-12-01

    Climate science researchers believe our planet can possibly tolerate twice the present carbon dioxide levels with no upwards temperature change, IF we could increase the amount of energy reflected back out into space by about 2.0%. (c)Cloudtec basically alters a blend of seawater and applies heat derived from magma to it at a temperature exceeding 2,000 degrees F. The interaction of seawater and magma displaces the oxygen, causing the volume of water to vaporize and expand over 4,000 times - transforming billions of tons of seawater into thousands of cubic miles of white, maritime, stratocumulus clouds to reflect the incident Sun's rays back out into space. A 6 month test to prove Cloud Whitening Theory will cost 6 million dollars. (No profit added.) This study will enable everyone on the planet with a computer the transparency to use satellite imagery and check out for themselves - if and when Cloud Whitening is occurring. If Cloud Whitening Theory is validated, (c)Cloudtec's innovation can strategically create the clouds we need to reflect the Sun's rays back out into space and help neutralize the projected 3.6 degrees F rise in temperature. Based on reasonable calculations of anthropogenic global warming: this one move alone would be comparable to slashing global carbon dioxide emissions by over 60% over the next 40 years.

  10. ANESTHETIC MANAGEMENT OF ATONIC POST - PARTUM HEMORRHAGE WITH HEMORRHAGIC SHOCK AND IMPENDING CARDIAC ARREST FOR EMERGENCY PERIPARTUM HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Ravishankar

    2015-07-01

    Full Text Available Post - partum hemorrhagic complication is a critical situation for an anesthesiologist, which requires timely and skillful anesthetic management. A massive post - partum bleeding leading to severe hypovolemic shock may result in life threatening cardio - pulmonary arrest. Here is a case report of 25 year old with atonic post - partum hemorrhage resulting in hypovolemic shock & impending cardiac arrest and successful anesthetic management for emergency peripartum hysterectomy to save the life of the patient.

  11. L’Inquisizione, gli indizi, le prove

    Directory of Open Access Journals (Sweden)

    Guido Dall’Olio

    2012-11-01

    Full Text Available This essay focuses on some characteristics of the inquisitorial trial, comparing it with the accusatory procedure. The inquisitorial trial, which resulted in almost inevitable torture of the accused, is certainly in our eyes an injustice and a violation of the legal rights that are essential for us in a proper procedure. However, the care with which the evidence was produced and examined by the institutions that adopted the inquisitorial procedure deserves to be emphasized, especially for the consequences it had in certain types of imaginary crime such as witchcraft.

  12. Prevalence and characteristics of dysfunction of right ventricle in peripartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Aw F

    2017-11-01

    Full Text Available Fatou Aw,1 Mouhamadou Bamba Ndiaye,1 Simon Antoine Sarr,1 Malick Bodian,1 Aliou Alassane Ngaide,2 Alassane Mbaye,2,3 Adama Kane,1 Abdoul Kane,4 Maboury Diao,1 Serigne Abdou Ba1 1Department of Cardiology, Aristide Le Dantec Teaching Hospital, 2Department of Cardiology, General Hospital of Grand Yoff, 3Department of Cardiology, Teaching Hospital of Fann, 4Cheikh Anta Diop University of Dakar, Dakar, Senegal Background: The study of the right ventricle (RV is of particular interest as it is believed to be involved in several heart diseases. Peripartum cardiomyopathy (PPCM is characterized by left ventricular systolic dysfunction occurring between the last month of pregnancy and the fifth month postpartum. It is often combined with RV dysfunction, but this has rarely been described in the literature. The main aim of this study was to assess the prevalence of RV dysfunction in a PPCM population.Methods: We conducted a prospective and investigative study at the Cardiac Clinic of the Aristide Le Dantec Teaching Hospital in Dakar, Senegal, between March and June 2013. All patients hospitalized during the study period and meeting the diagnostic criteria for PPCM were included.Results: During the study period, 326 patients were hospitalized in the cardiology department; 19 were diagnosed with PPCM corresponding to a hospital prevalence of 5.8%. All patients had left ventricular dysfunction, with an average ejection fraction of 23.01%±9.73% at the Simpson biplane. Based on the tricuspid annular plane systolic excursion (TAPSE, 11 out of the 19 patients (57.9% had RV systolic dysfunction. Ten patients (52.6% had an Sa tricuspid wave (speed of the systolic wave to the tricuspid ring in tissue Doppler below the standard. The average RV area shortening was 23.73%±14.16%, with extremes of 7.8% and 53.7%. Fifteen patients (78.9% had a rate of shortening fraction of the surface area of RV below the standard. When the other parameters were taken into account, 15

  13. NUTRITIVE VALUE OF DIETS WITH INACTIVE DRY YEAST FOR SAANEN GOATS IN THE PERIPARTUM PERIOD

    Directory of Open Access Journals (Sweden)

    BRUNA SUSAN DE LABIO MOLINA

    2016-01-01

    Full Text Available The aim was to evaluate the replacement of soybean meal by inactive dry yeast ( Saccharomyces cerevisiae from sugar cane on nutritive value of diets for Saanen goats in the peripartum. Twenty - four Saanen goats (nine primiparous, 55.35 ± 4.55 kg and fifteen multiparous, 73.12 ± 8.51 kg in prepartum and postpartum periods were distributed in a completely randomized design with a 3 × 2 (diet × parturition order factorial arrangement. Diets were composed of soybean meal, soybean meal plus dry yeast or dry yeast as protein source, and other ingredients: ground corn, mineral supplement and limestone. The roughage source used was the whole plant corn silage (40% of the total diet. Diets were evaluated as dry matter intake and digestibility of nutrients. The diet with total dry yeast inclusion promoted a reduction on the ether extract intake (postpartum and ether extract digestibility (prepartum and postpartum, due its lower ether extract content when compared to the other diets. Multiparous goats presented higher intakes for dry matter, nutrients and total digestible nutrients in both evaluated periods due their higher intake capacity. Primiparous goats in postpartum had better coefficients of digestibility for dry matter, organic matter, crude protein and total carbohydrates, and so a higher energetic value, attributed to total digestible nutrients compared to multiparous ones. Dry yeast can replace soybean meal with no changes on nutritive value of diets for Saanen goats.

  14. Peripartum hysterectomy in the first decade of the 21st century.

    LENUS (Irish Health Repository)

    Tadesse, W

    2012-02-01

    We reviewed the role of peripartum hysterectomy (PH) in the first decade of the 21st century. The study was confined to women who delivered a baby weighing 500 g or more between 2000 and 2009, and who required a hysterectomy within 72 h of delivery for obstetric reasons. Individual case records were reviewed. There were 19 cases of PH in 78,961 deliveries giving an incidence of 1 in 4,156 (0.02%). Of the 19 cases, 95% were delivered by caesarean section and 89% had one or more prior sections. The indications were placental bed pathology (79%), uterine atony (16%) and uterine trauma (5%). Of the 19 hysterectomies, 16 (84%) were total and a gynaecological oncologist was involved in nine (56%) of these cases. There were no maternal or fetal deaths, but a mother required an average blood transfusion of 10 units. The overall rate of PH was remarkably low compared with other studies but it is likely to increase in the future because of the strong association between increasing caesarean section rates and placental bed pathology. The potential involvement of the cervix and other pelvic structures by placental pathology means that PH in the future will be more challenging, and the hysterectomy will need to be total rather than subtotal.

  15. The Medical Treatment of New-Onset Peripartum Cardiomyopathy: A Systematic Review of Prospective Studies.

    Science.gov (United States)

    Desplantie, Olivier; Tremblay-Gravel, Maxime; Avram, Robert; Marquis-Gravel, Guillaume; Ducharme, Anique; Jolicoeur, E Marc

    2015-12-01

    Peripartum cardiomyopathy (PPCM) is a rare disorder with potentially fatal consequences, which occurs mainly in previously healthy women. The aetiology of PPCM remains unknown and various pathologic mechanisms have been proposed, including immune-mediated injuries and impaired response to oxidative stress and inflammatory cytokines. Several therapies have been studied, but few have been validated in a well-designed randomized controlled trial. In the present study we sought to review the medical treatment intended for acute PPCM. To this end, we performed a systematic review of the literature of randomized and nonrandomized prospective clinical studies. We identified 2 randomized controlled trials that evaluated the dopamine agonist bromocriptine and the inotrope levosimendan, respectively, and 1 nonrandomized study that evaluated the nonselective phosphodiesterase inhibitor pentoxifylline. We reviewed the pathophysiological, pharmacological, and clinical properties for each treatment option identified. Bromocriptine and pentoxifylline both improved left ventricular systolic function and patient-oriented clinical end points and levosimendan did not improve mortality or echocardiographic findings of PPCM. In this review we identified bromocriptine and pentoxifylline, but not levosimendan, as potentially useful agents to improve left ventricle function and outcomes in PPCM. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  16. Safety of contraceptive use among women with peripartum cardiomyopathy: a systematic review.

    Science.gov (United States)

    Tepper, Naomi K; Paulen, Melissa E; Marchbanks, Polly A; Curtis, Kathryn M

    2010-07-01

    Women with peripartum cardiomyopathy (PPCM) have significant health risks during subsequent pregnancies and therefore have a critical need for safe and effective contraception. This systematic review examines evidence regarding the safety of contraceptive use among women with PPCM. We searched the PubMed database for all primary research articles published through February 2009 that addressed the safety of any contraceptive method among women with PPCM or other cardiomyopathy of any type. Of 110 articles that addressed contraceptive safety among women with cardiac disease, three met our inclusion criteria. In these three studies, which included a total of five women with cardiomyopathy, though not specifically PPCM, cases of hypertension, transient ischemic attack (TIA), thromboembolism or heart failure were found among women with cardiac disease who used hormonal methods of contraception including combined oral contraceptives, progestin-only pills and depot medroxyprogesterone acetate. None of the studies reported any cases of cardiovascular complications or infective endocarditis among women with cardiac disease who used intrauterine devices (IUDs). We found no data concerning the safety of contraceptive use among women with PPCM, though we did find limited evidence of hypertension, TIA, thromboembolism and heart failure among women with cardiac disease who used hormonal methods of contraception. None of the studies reported any cases of cardiovascular complications or infective endocarditis among women with cardiac disease who used IUDs. Published by Elsevier Inc.

  17. A Case Report of Recurrent Severe Peripartum Cardiomyopathy Complicated by Factor V Leiden and Multiple Endocrine Neoplasia Type 1: A Management Conundrum.

    Science.gov (United States)

    Kleiman, Amanda M; Sheeran, Jessica L; Tiouririne, Mohamed

    2017-10-26

    Cardiovascular disease is the leading cause of peripartum death in the United States during pregnancy. The presence of concomitant diagnoses may complicate or conflict with the management of the primary cardiovascular diagnosis and further complicate pregnancy and delivery. We describe the management of a 29-year-old, gravida 5, para 1 woman with severe peripartum cardiomyopathy during this and a previous pregnancy complicated by multiple endocrine neoplasia type and factor V Leiden thrombophilia, limiting therapeutic options and contributing to considerable perioperative management challenges.

  18. Clinical features and peripartum outcomes in pregnant women with cardiac disease: a nationwide retrospective cohort study in Japan.

    Science.gov (United States)

    Isogai, Toshiaki; Matsui, Hiroki; Tanaka, Hiroyuki; Kohyama, Akira; Fushimi, Kiyohide; Yasunaga, Hideo

    2018-02-17

    Although the number of pregnancies in women with cardiac disease is increasing worldwide, there are few data concerning their clinical characteristics and peripartum outcomes. Using the Diagnosis Procedure Combination database between 2008 and 2014 in Japan, we retrospectively identified pregnant women who underwent high-risk delivery due to obstetric or non-obstetric comorbidities. We classified eligible women into those with pre-existing cardiac disease (cardiac disease group) and those with non-cardiac comorbidities (non-cardiac disease group) and compared their characteristics and peripartum outcomes. Of 94,364 women undergoing high-risk delivery at 556 hospitals, 857 (0.91%) had pre-existing cardiac disease (302, congenital heart disease; 190, arrhythmia; 176, valvular heart disease; 120, ischemic heart disease; 65, cardiomyopathy; 4, pericardial disease). Women in the cardiac disease group were more likely to be treated at university hospitals (51.1 versus 28.6%; p women with congenital heart disease (12.3%), valvular heart disease (12.5%), or cardiomyopathy (12.3%) than in women with arrhythmia (6.3%) or ischemic heart disease (5.8%). Multivariable logistic regression analysis showed a significant positive association between pre-existing cardiac disease and risk of heart failure (adjusted odds ratio, 24.7; 95% confidence interval, 17.6-34.6; p woman in the cardiac disease group died, whereas 18 women (0.02%) in the non-cardiac disease group did (p = 1.000). These findings suggest that pregnant women with pre-existing cardiac disease are at a higher risk of heart failure during the peripartum period than those with non-cardiac comorbidities.

  19. The development of peripartum depressive symptoms is associated with gene polymorphisms of MAOA, 5-HTT and COMT.

    Science.gov (United States)

    Doornbos, Bennard; Dijck-Brouwer, D A Janneke; Kema, Ido P; Tanke, Marit A C; van Goor, Saskia A; Muskiet, Frits A J; Korf, Jakob

    2009-10-01

    Polymorphisms of monoamine-related genes have been associated with depression following life events. The peripartum is a physiologically and psychologically challenging period, characterized by fluctuations in depressive symptoms, therefore facilitating prospective investigations in this gene x environment (G x E) interaction. Eighty nine pregnant women filled in two Edinburgh Postpartum Depression Scale (EPDS) questionnaires during pregnancy and two in the postpartum period. MAOA, COMT and 5-HTT polymorphisms were analyzed. We found a significant interaction between the development of depressive symptoms in the course of pregnancy and polymorphisms in 5-HTT (p=0.019); MAOA (p=0.044) and COMT (p=0.026), and MAOA x COMT (p<0.001). Particularly, women carrying the combination of low activity variants of MAOA and COMT showed increased EPDS scores at week 36 of pregnancy and 6 weeks postpartum, but not during early pregnancy or 12 weeks postpartum. We found that MAOA in combination with COMT appears to regulate not only the stress response in laboratory experiments, but also seems to influence the stress-evoked onset of mood during normal, mild, stressful events, such as experienced in the peripartum period. These findings support the GxE concept for depression, but they underline the complexity of this concept, as the cumulating effects of these polymorphic genes (i.e. MAOA+COMT) might be needed and the effects of these polymorphic genes becomes apparent in special environmental or physiological conditions (i.e. the peripartum period). We therefore suggest that G x E interactions become especially noticeable from longitudinal study designs in specific physiological or social challenging periods.

  20. Clinical Profi le and Predictors of Outcomes of Patients with Peripartum Cardiomyopathy: The Philippine Heart Center Experience.

    Science.gov (United States)

    Cuenza, Lucky R; Manapat, Normita; Jalique, Jundelle Romulo K

    2016-10-01

    Peripartum cardiomyopathy is a rare form of dilated cardiomyopathy characterized by heart failure and left ventricular dysfunction associated with pregnancy. While clinical characteristics of these patients have been previously described in literature, there is limited data regarding the natural history and predictors of outcomes of these patients in Asia, most specifi cally in Filipino patients. Clinical and echocardiographic data of 39 patients diagnosed with peripartum cardiomyopathy were analyzed. Patients were followed up for the occurrence of death and major adverse events (MAE) and outcomes were correlated with patient variables. The mean age of the patients was 28.4 ± 6.9 and the mean ejection fraction (EF) was 27.8 ± 8.4%. Heart failure was the most common symptom (98%) while arrhythmia was the initial presentation in 5 patients (12.8%). 14 patients had recovery of ejection fraction in 6 months (39%) with a mean EF of 55.5 ± 6.3. 16 patients had an initial EF of 25% had a 90% likelihood of survival for 8 years with a higher trend of mortality for patients whose EF did not recover in 6 months. Peripartum cardiomyopathy is associated with signifi cant morbidity and mortality. The degree of left ventricular dysfunction on presentation as well as improvement of EF within 6 months were predictive for the occurrence of death and major adverse events. This study emphasizes the need for aggressive treatment as well as clinical and echocardiographic follow up early in the course of disease in order to improve outcomes.

  1. Emergency peripartum hysterectomy, physical and mental consequences: a 6-year study

    Directory of Open Access Journals (Sweden)

    Denisa-Oana Bălălău

    2016-04-01

    Full Text Available Emergency peripartum hysterectomy (EPH is performed for massive postpartum hemorrhage following a cesarean delivery or vaginal delivery, in order to save the patient’s life. The current study was performed on a sample of 13.162 patients, which underwent cesarean or vaginal delivery during a period of 6 years, from 2010 to 2015, in Bucur Maternity Hospital. There were two subsequential groups consisting in: 6593 patients with cesarean operations and 6569 patients with vaginal delivery. In 12 cases occurred one or more of the risk factors that lead to EPH, divided equally across the two groups above. The main two types of surgery are a more frequent subtotal hysterectomy, which is the preferred type of EPH as it takes less time and is associated with fewer complications, and a total hysterectomy. The majority of procedures were performed at patients over 35 years old (9 of 12, with a median age of 31,16 (ranging from 21 to 44 years old. The most important risk factor present across the lot was multiparity (11 from 12, with cicatricial uterus being the second one (4 of 12. ICU median time was 4,5 days (ranging from 3 to 15 days, with a median blood transfusion necessity of around 2,4 I.U per patient. There were no mother or newborn reported deaths, neither PTSD following EPH.EPH is a procedure performed as last-resort, life-saving surgery, leaving no time for mental preparation of the patients. This may predispose to negative psychological outcomes, especially because they are not part of decision-making process due to the emergency character of hysterectomy.

  2. Decreased expression of programmed death 1 on peripheral blood lymphocytes disrupts immune homeostasis in peripartum cardiomyopathy.

    Science.gov (United States)

    Xia, Guozhi; Sun, Xin; Zheng, Xiaopu; Wang, Junkui

    2016-11-15

    Peripartum cardiomyopathy (PPCM) is a disease of unknown pathogenesis. Programmed death 1 (PD1) has been postulated to modulate immune response through potential mechanisms that remain elusive. This study aimed to elaborate the expression and function of PD1 on peripheral blood lymphocytes (PBLs) in the development of PPCM. Specimens of PBLs were performed to determine the expression of PD1 mRNA using fluorescence quantitative RT-PCR, and Th cytokines by ELISA. Immune homeostasis was evaluated with T lymphocyte phenotypes and immunoglobulin (Ig) isotypes as well as complement factors (C). Morphology of lymphocytes was observed using transmission electronic microscope. Significantly elevated levels of interferon (IFN)-γ, percentages of CD3(+), CD4(+), CD8(+) T lymphocytes, and pro-brain natriuretic peptide (BNP), but reduced levels of interleukin (IL)-4, IgG, IgM, IgA, C3, C4, and left ventricular ejection fraction (LVEF) were detected, which were associated with significantly lower of PD1 mRNA expression in PPCM relative to control. Furthermore, PD1 mRNA expression showed significant negative correlation with IFN-γ and CD3(+), CD4(+), CD8(+) T lymphocytes, and proBNP as well as positive correlation with IL-4, IgG, IgM, IgA, C3, C4, and LVEF. The morphologic features of cells indicated that the PBLs in PPCM were in the state of activation. Therefore, decreased expression of PD1 mRNA led to LV dysfunction and functional dysregulation of negative costimulation on cellular immunity. This study provided the first findings that PD1 expression was decreased, which might disrupt immune homeostasis that enhanced cellular immunity was predominant over attenuated humoral immunity that may work in the etiopathogenesis of PPCM. Copyright © 2016. Published by Elsevier Ireland Ltd.

  3. The Relationship Between Preeclampsia and Peripartum Cardiomyopathy: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Bello, Natalie; Hurtado Rendon, Iliana S.; Arany, Zoltan

    2014-01-01

    Objectives The goal of this study was to systematically review the peripartum cardiomyopathy (PPCM) literature and determine the prevalence of preeclampsia (PE) in women with PPCM. Secondary analyses included evaluation of the prevalence of hypertensive disorders, multiple gestations, and multiparity. Background PPCM is a significant cause of maternal and infant morbidity and mortality worldwide, yet its etiology remains unknown. PE is often cited as a risk factor for the development of PPCM, and recent research suggests that PE and PPCM share mechanisms that contribute to their pathobiology. No comprehensive evaluation of the relationship between PE and PPCM exists. Methods A systematic predetermined search strategy was performed in multiple databases to identify studies describing ≥3 women with PPCM. Prevalence rates of PE, hypertension, multiple gestations, and multiparity were pooled. Results Data from 22 studies (979 patients) were included in this analysis. The pooled prevalence of 22% (95% confidence interval [CI] 16 to 28) was more than quadruple the 5% average worldwide background rate of PE in pregnancy (p < 0.001). There were no geographic or racial differences detected in the prevalence of PE in women with PPCM. The rates of hypertension during pregnancy (37% [95% CI 29 to 45) and multiple gestations (9% [95% CI 7 to 11]) were also elevated. Conclusions The prevalence of PE, hypertensive disorders, and multiple gestations in women with PPCM is markedly higher than that in the general population. These findings support the concept of a shared pathogenesis between PE and PPCM and highlight the need for awareness of the overlap between these 2 diseases. PMID:24013055

  4. Impact of Preeclampsia on Clinical and Functional Outcomes in Women With Peripartum Cardiomyopathy.

    Science.gov (United States)

    Lindley, Kathryn J; Conner, Shayna N; Cahill, Alison G; Novak, Eric; Mann, Douglas L

    2017-06-01

    Preeclampsia is a risk factor for the development of peripartum cardiomyopathy (PPCM), but it is unknown whether preeclampsia impacts clinical or left ventricular (LV) functional outcomes. This study sought to assess clinical and functional outcomes in women with PPCM complicated by preeclampsia. This retrospective cohort study included women diagnosed with PPCM delivering at Barnes-Jewish Hospital between 2004 to 2014. The primary outcome was one-year event-free survival rate for the combined end point of death and hospital readmission. The secondary outcome was recovery of LV ejection fraction. Seventeen of 39 women (44%) with PPCM had preeclampsia. The groups had similar mean LV ejection fraction at diagnosis (29.6 with versus 27.3 without preeclampsia; P =0.5). Women with preeclampsia had smaller mean LV end-diastolic diameters (5.2 versus 6.0 cm; P =0.001), greater relative wall thickness (0.41 versus 0.35 mm Hg; P =0.009), and lower incidence of eccentric remodeling (12% versus 48%; P =0.03). Clinical follow-up was available for 32 women; 5 died of cardiovascular complications within 1 year of diagnosis (4/15 with versus 1/17 without preeclampsia; P =0.16). In time to event analysis, patients with preeclampsia had worse event-free survival during 1-year follow-up ( P =0.047). Echocardiographic follow-up was available in 10 survivors with and 16 without preeclampsia. LV ejection fraction recovered in 80% of survivors with versus 25% without preeclampsia ( P =0.014). PPCM with concomitant preeclampsia is associated with increased morbidity and mortality and different patterns of LV remodeling and recovery of LV function when compared with patients with PPCM that is not complicated by preeclampsia. © 2017 American Heart Association, Inc.

  5. Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: A retrospective survey

    NARCIS (Netherlands)

    S.C.M. Stoof (Carina); van Steenbergen, H.W. (H. W.); Zwagemaker, A. (A.); Y.V. Sanders (Yvonne); S.C. Cannegieter (Suzanne); Duvekot, J.J. (J. J.); F.W.G. Leebeek (Frank); M. Peters; M.J.H.A. Kruip (Marieke); J.C.J. Eikenboom (Jeroen)

    2015-01-01

    textabstractPregnant women with bleeding disorders require specialised peripartum care to prevent postpartum haemorrhage (PPH). If third trimester coagulation factor levels are <0.50 IU mL-1, prophylactic treatment is indicated and administered according to international guidelines.

  6. Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey

    NARCIS (Netherlands)

    Stoof, S. C. M.; van Steenbergen, H. W.; Zwagemaker, A.; Sanders, Y. V.; Cannegieter, S. C.; Duvekot, J. J.; Leebeek, F. W. G.; Peters, M.; Kruip, M. J. H. A.; Eikenboom, J.

    2015-01-01

    Pregnant women with bleeding disorders require specialised peripartum care to prevent postpartum haemorrhage (PPH). If third trimester coagulation factor levels are <0.50 IU mL(-1) , prophylactic treatment is indicated and administered according to international guidelines. However, optimal dose and

  7. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review.

    Science.gov (United States)

    Pearson, G D; Veille, J C; Rahimtoola, S; Hsia, J; Oakley, C M; Hosenpud, J D; Ansari, A; Baughman, K L

    2000-03-01

    Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women. In April 1997, the National Heart, Lung, and Blood Institute (NHLBI) and the Office of Rare Diseases of the National Institutes of Health (NIH) convened a Workshop on Peripartum Cardiomyopathy to foster a systematic review of information and to develop recommendations for research and education. Fourteen workshop participants were selected by NHLBI staff and represented cardiovascular medicine, obstetrics, immunology, and pathology. A representative subgroup of 8 participants and NHLBI staff formed the writing group for this article and updated the literature on which the conclusions were based. The workshop was an open meeting, consistent with NIH policy. Data presented at the workshop were augmented by a MEDLINE search for English-language articles published from 1966 to July 1999, using the terms peripartum cardiomyopathy, cardiomyopathy, and pregnancy. Articles on the epidemiology, pathogenesis, pathophysiology, diagnosis, treatment, and prognosis of PPCM were included. RECOMMENDATION PROCESS: After discussion of data presented, workshop participants agreed on a standardized definition of PPCM, a general clinical approach, and the need for a registry to provide an infrastructure for future research. Peripartum cardiomyopathy is a rare lethal disease about which little is known. Diagnosis is confined to a narrow period and requires echocardiographic evidence of left ventricular systolic dysfunction. Symptomatic patients should receive standard therapy for heart failure, managed by a multidisciplinary team. If subsequent pregnancies occur, they should be managed in collaboration with a high-risk perinatal center. Systematic data collection is required to answer important questions about incidence, treatment, and prognosis.

  8. 25 CFR 11.702 - Proving and admitting will.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Proving and admitting will. 11.702 Section 11.702 Indians... ORDER CODE Probate Proceedings § 11.702 Proving and admitting will. (a) Upon initiating the probate of an estate, the will of the decedent shall be filed with the court. Such will may be proven and...

  9. Reasoning and Proving Opportunities in Textbooks: A Comparative Analysis

    Science.gov (United States)

    Hong, Dae S.; Choi, Kyong Mi

    2018-01-01

    In this study, we analyzed and compared reasoning and proving opportunities in geometry lessons from American standard-based textbooks and Korean textbooks to understand how these textbooks provide student opportunities to engage in reasoning and proving activities. Overall, around 40% of exercise problems in Core Plus Mathematics Project (CPMP)…

  10. The Earth is Flat, and I Can Prove It!

    Science.gov (United States)

    Klinger, Art

    1998-01-01

    Describes an educational program that asks students to attempt to prove that the earth is spherical and that it rotates. Presents tips to pique student interest and charts related to sensing the spin, nonrotation notions, flat earth fallacies, evidence that the earth is spherical and rotates, and the role of watersheds in proving that the earth…

  11. 20 CFR 219.23 - Evidence to prove death.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Evidence to prove death. 219.23 Section 219... EVIDENCE REQUIRED FOR PAYMENT Evidence of Age and Death § 219.23 Evidence to prove death. (a) Preferred evidence of death. The best evidence of a person's death is— (1) A certified copy of or extract from the...

  12. Long-term impact of puerperal metritis on the profiles of peripheral blood leukocytes in peripartum dairy cows.

    Science.gov (United States)

    Magata, Fumie; Kitaoka, Ryuji; Morino, Ikumi; Teramura, Makoto; Kawashima, Chiho; Haneda, Shingo; Shimizu, Takashi

    2016-01-01

    To determine the effects of puerperal metritis on the immune response, changes in the differential peripheral blood leukocyte counts were analyzed during the peripartum period in cows with or without metritis. Multiparous Holstein cows were examined for uterine health disorders and classified into two groups: healthy (n = 11) or metritis (n = 5) cows. The lymphocyte and monocyte counts and the proportion of CD8(+) lymphocytes were higher in cows with metritis compared to healthy cows. Moreover, the effects of puerperal metritis on the lymphocyte counts and CD4(+)/CD8(+) ratio persisted weeks after the uterine inflammation had self-resolved. Taken together, the findings of the present study indicate the possible long-term alterations of systemic immune responses in cows with puerperal uterine inflammation. © 2015 Japanese Society of Animal Science.

  13. Effect of peripartum nutritional management on plasma profile of steroid hormones, metabolites, and postpartum fertility in buffaloes.

    Science.gov (United States)

    Kalasariya, R M; Dhami, A J; Hadiya, K K; Borkhatariya, D N; Patel, J A

    2017-03-01

    The aim of this study was to evaluate the influence of peripartum protein and minerals supplementation on plasma profile of steroid hormones, metabolites, and fertility in rural buffaloes. A total of 85 advanced pregnant (~8 months) pluriparous buffaloes selected at farmers' doorstep in three tribal villages of Middle Gujarat were randomly divided into two groups, viz., control (n=45) and nutrients treatment (40). The buffaloes of treatment group (n=40), in addition to farmers feeding schedule/control, received daily 1.5 kg compound concentrate mixture (22% CP) and 50 g of chelated ASMM for 2 months each pre- and post-partum. Further, 15 buffaloes, each of control and treatment group, were injected parentrally (deep i/m) with 5 ml of micro-minerals (each ml containing Se, Zn, Cu and Mn at 5, 40, 15 and 10 mg, respectively), twice 2 months before and on the day of calving, keeping rest of the animals (control, n=30 and treatment, n=25) as controls. Blood sampling was done on days -60, -30, -15, 0, 15, 30, 45, and 60 peripartum for estimation of plasma progesterone and estradiol by standard RIA techniques and other metabolites using assay kits on biochemistry analyzer. The puerperal events and postpartum fertility were monitored through history and by fortnightly palpation per rectum till day 45 and then again at 120 days postpartum for both the groups and subgroups. The mean plasma progesterone concentrations in all groups declined significantly (psteroid hormones, blood glucose, or plasma protein. The mean plasma total cholesterol was significantly lower (p0.05). The micro-minerals injection appreciably reduced the incidence of RFMs and significantly (psteroid hormones and blood metabolites though it significantly improved the postpartum reproductive performance in buffaloes under field conditions.

  14. Characterization of peripartum rumination and activity of cows diagnosed with metabolic and uterine diseases.

    Science.gov (United States)

    Liboreiro, Daniela N; Machado, Karine S; Silva, Paula R B; Maturana, Milton M; Nishimura, Thiago K; Brandão, Alice P; Endres, Márcia I; Chebel, Ricardo C

    2015-10-01

    The objectives of the current experiment were to characterize the correlation among total serum Ca, nonesterified fatty acids (NEFA), β-hydroxybutyrate (BHBA), and haptoglobin concentrations and daily rumination time (DRT) and activity of periparturient cows and to determine the association between periparturient events and peripartum DRT and activity. Holstein animals (nulliparous = 77, parous = 219) were enrolled in the experiment approximately 21 d before expected calving date. Cows were fitted with individual Heat Rumination Long Distance collars (HRLD, SCR Engineers Ltd., Netanya, Israel) from enrollment until approximately 21 ± 3 d postpartum. Blood samples collected weekly from enrollment to 21 d postpartum were used to determine concentrations of NEFA, BHBA, and haptoglobin. Blood samples collected within 72 h after calving were used to determine total serum Ca concentration. Subclinical ketosis was characterized by BHBA > 1,000 µmol/L in any sample, and subclinical hypocalcemia was characterized by Ca < 8.55 ng/dL within 72 h after calving. Cows were examined 1, 7 ± 3, and 14 ± 3 d postpartum for diagnosis of retained fetal membrane and metritis. Total Ca (r = 0.15), NEFA (r = -0.27), and haptoglobin (r = -0.18) concentrations were weakly correlated with DRT. Concentration of BHBA (r = -0.14) was weakly correlated with activity. Postpartum DRT was reduced among cows that delivered twins compared with cows that delivered singletons (437.9 ± 4.8 vs. 385.9 ± 17.1 min/d). Prepartum (465.8 ± 4.1 vs 430.8 ± 14.9 arbitrary units) and postpartum (536.5 ± 5.5 vs. 480.3 ± 19.4 arbitrary units) activity were reduced among cows that delivered twins compared with cows that delivered singletons. Delivery of stillborn calves was associated with reduced DRT prepartum (478.0 ± 5.9 vs. 417.0 ± 23.4 min/d) and postpartum (437.2 ± 4.8 vs. 386.5 ± 19.3 min/d). On the other hand, cows delivering stillborn calves had increased activity prepartum compared with cows

  15. Effects of dietary energy levels using calcium salts of fatty acids on nutritive value of diets and milk quality in peripartum dairy goats

    Directory of Open Access Journals (Sweden)

    Rodrigo de Souza

    2014-06-01

    Full Text Available Peripartum is a critical period for dairy goats, as dry matter intake (DMI is not enough to supply the energy requirement for foetal growth and subsequent lactation. The objective of this study was to evaluate the use of calcium salts of fatty acids (CSFA to increase dietary energy level of peripartum dairy goats and its effects on nutritive value of diets and milk quality. Twenty multiparous Saanen goats (body weight 63.5±10.3 kg were distributed in a completely randomised design in four treatments at the following dietary energy levels: 2.6 Mcal of metabolisable energy per kg of dry matter (Mcal ME/kg DM - control diet; and 2.7, 2.8, and 2.9 Mcal/kg DM - with added CSFA. Goats were housed in individual stalls and evaluated in the peripartum period, by measuring body weight (BW, DMI, dry matter and nutrient digestibility of diets, blood composition, and milk quality and yield. Increasing dietary energy level to 2.9 Mcal ME/kg DM had no effect on BW and did not limit DMI. CSFA supplementation increased intake of total digestible nutrients and did not affect fibre digestion. Blood triglycerides and cholesterol concentration increased with CSFA addition. The treatments had no effect on milk yield and composition; however, CSFA supplementation changed the fatty acid concentration of milk fat, increasing levels of polyunsaturated and essential fatty acids. In conclusion, peripartum dairy goats supplemented with CSFA to increase dietary energy level up to 2.9 Mcal ME/kg DM had a greater supply of total digestible nutrients and showed altered fatty acid concentration of milk fat.

  16. Lodox Statscan proves to be invaluable in forensic medicine ...

    African Journals Online (AJOL)

    Lodox Statscan proves to be invaluable in forensic medicine: forensic files. GJ Knobel, G Flash, GF Bowie. Abstract. No Abstract. South African Medical Journal Vol. 96(7) 2006: 593-594. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals ...

  17. Conditional and preferential logics proof methods and theorem proving

    CERN Document Server

    Pozzato, GL

    2010-01-01

    Contains a version of the author's PhD dissertation and focuses on proof methods and theorem proving for conditional and preferential logics. This book introduces proof methods (sequent and tableau calculi) for conditional and preferential logics, as well as theorem provers obtained by implementing the proposed calculi.

  18. Proving the correctness of client/server software

    Indian Academy of Sciences (India)

    , formal specification and verification of RPC mechanisms is a prerequisite for the verification of any such software. In this paper, we present a mathematical specification of an RPC mechanism and we outline how to prove the correctness of an ...

  19. Overcoming the Obstacle of Poor Knowledge in Proving Geometry Tasks

    Directory of Open Access Journals (Sweden)

    Zlatan Magajna

    2013-12-01

    Full Text Available Proving in school geometry is not just about validating the truth of a claim. In the school setting, the main function of the proof is to convince someone that a claim is true by providing an explanation. Students consider proving to be difficult; in fact, they find the very concept of proof demanding. Proving a claim in planar geometry involves several processes, the most salient being visual observation and deductive argumentation. These two processes are interwoven, but often poor observation hinders deductive argumentation. In the present article, we consider the possibility of overcoming the obstacle of a student’s poor observation by making use of computer-aided observation with appropriate software. We present the results of two small-scale research projects, both of which indicate that students are able to work out considerably more deductions if computer-aided observation is used. Not all students use computer-aided observation effectively in proving tasks: some find an exhaustive computer-provided list of properties confusing and are not able to choose the properties that are relevant to the task.

  20. Engaging Students in Proving: A Double Bind on the Teacher.

    Science.gov (United States)

    Herbst, Patricio G.

    2002-01-01

    Explores what is involved in the teacher's work of engaging students in producing a proof. Analyzes what teachers do to create a task in which students can produce a proof and what teachers do to get students to prove a proposition. Indicates that traditional, formal, two-column proofs place contradictory demands on teachers regarding how ideas…

  1. Proof phenomenon as a function of the phenomenology of proving.

    Science.gov (United States)

    Hipólito, Inês

    2015-12-01

    Kurt Gödel wrote (1964, p. 272), after he had read Husserl, that the notion of objectivity raises a question: "the question of the objective existence of the objects of mathematical intuition (which, incidentally, is an exact replica of the question of the objective existence of the outer world)". This "exact replica" brings to mind the close analogy Husserl saw between our intuition of essences in Wesensschau and of physical objects in perception. What is it like to experience a mathematical proving process? What is the ontological status of a mathematical proof? Can computer assisted provers output a proof? Taking a naturalized world account, I will assess the relationship between mathematics, the physical world and consciousness by introducing a significant conceptual distinction between proving and proof. I will propose that proving is a phenomenological conscious experience. This experience involves a combination of what Kurt Gödel called intuition, and what Husserl called intentionality. In contrast, proof is a function of that process - the mathematical phenomenon - that objectively self-presents a property in the world, and that results from a spatiotemporal unity being subject to the exact laws of nature. In this essay, I apply phenomenology to mathematical proving as a performance of consciousness, that is, a lived experience expressed and formalized in language, in which there is the possibility of formulating intersubjectively shareable meanings. Copyright © 2015. Published by Elsevier Ltd.

  2. Feedback theory extended for proving generation of contraction semigroups

    NARCIS (Netherlands)

    Kurula, Mikael; Zwart, Hans

    2016-01-01

    Recently, the following novel method for proving the existence of solutions for certain linear time-invariant PDEs was introduced: The operator associated with a given PDE is represented by a (larger) operator with an internal loop. If the larger operator (without the internal loop) generates a

  3. Prove It! Putting Together the Evidence-Based Practice Puzzle

    Science.gov (United States)

    Little, Hannah Byrd

    2015-01-01

    Why is it important to prove that school libraries add value to the school program? The National Center for Education Statistics reports that 20 percent of U.S. public schools lack a full or part-time certified librarian (NCES 2013). In California the ratio of certified school librarians to students is 1:7,374 (California Department of Education…

  4. Pengembangan Perangkat Pembelajaran Geometri Ruang dengan Model Proving Theorem

    Directory of Open Access Journals (Sweden)

    Bambang Eko Susilo

    2016-03-01

    Full Text Available Kemampuan berpikir kritis dan kreatif mahasiswa masih lemah. Hal ini ditemukan pada mahasiswa yang mengambil mata kuliah Geometri Ruang yaitu dalam membuktikan soal-soal pembuktian (problem to proof. Mahasiswa masih menyelesaikan secara algoritmik atau prosedural sehingga diperlukan pengembangan perangkat pembelajaran Geometri Ruang berbasis kompetensi dan konservasi dengan model Proving Theorem. Dalam penelitian ini perangkat perkuliahan yang dikembangkan yaitu Silabus, Satuan Acara Perkuliahan (SAP, Kontrak Perkuliahan, Media Pembelajaran, Bahan Ajar, Tes UTS dan UAS serta Angket Karakter Konservasi telah dilaksanakan dengan baik dengan kriteria (1 validasi perangkat pembelajaran mata kuliah Geometri ruang berbasis kompetensi dan konservasi dengan model proving theorem berkategori baik dan layak digunakan dan (2 keterlaksanaan RPP pada pembelajaran yang dikembangkan secara keseluruhan berkategori baik.Critical and creative thinking abilities of students still weak. It is found in students who take Space Geometry subjects that is in solving problems to to prove. Students still finish in algorithmic or procedural so that the required the development of Space Geometry learning tools based on competency and conservation with Proving Theorem models. This is a research development which refers to the 4-D models that have been modified for the Space Geometry learning tools, second semester academic year 2014/2015. Instruments used include validation sheet, learning tools and character assessment questionnaire. In this research, the learning tools are developed, namely Syllabus, Lesson Plan, Lecture Contract, Learning Media, Teaching Material, Tests, and Character Conservation Questionnaire had been properly implemented with the criteria (1 validation of Space Geometry learning tools based on competency and conservation with Proving Theorem models categorized good and feasible to use, and (2 the implementation of Lesson Plan on learning categorized

  5. Unexploded ordnance issues at Aberdeen Proving Ground: Background information

    Energy Technology Data Exchange (ETDEWEB)

    Rosenblatt, D.H.

    1996-11-01

    This document summarizes currently available information about the presence and significance of unexploded ordnance (UXO) in the two main areas of Aberdeen Proving Ground: Aberdeen Area and Edgewood Area. Known UXO in the land ranges of the Aberdeen Area consists entirely of conventional munitions. The Edgewood Area contains, in addition to conventional munitions, a significant quantity of chemical-munition UXO, which is reflected in the presence of chemical agent decomposition products in Edgewood Area ground-water samples. It may be concluded from current information that the UXO at Aberdeen Proving Ground has not adversely affected the environment through release of toxic substances to the public domain, especially not by water pathways, and is not likely to do so in the near future. Nevertheless, modest but periodic monitoring of groundwater and nearby surface waters would be a prudent policy.

  6. Unicorns do exist: a tutorial on "proving" the null hypothesis.

    Science.gov (United States)

    Streiner, David L

    2003-12-01

    Introductory statistics classes teach us that we can never prove the null hypothesis; all we can do is reject or fail to reject it. However, there are times when it is necessary to try to prove the nonexistence of a difference between groups. This most often happens within the context of comparing a new treatment against an established one and showing that the new intervention is not inferior to the standard. This article first outlines the logic of "noninferiority" testing by differentiating between the null hypothesis (that which we are trying to nullify) and the "nill" hypothesis (there is no difference), reversing the role of the null and alternate hypotheses, and defining an interval within which groups are said to be equivalent. We then work through an example and show how to calculate sample sizes for noninferiority studies.

  7. Renewable Energy Opportunties at Dugway Proving Ground, Utah

    Energy Technology Data Exchange (ETDEWEB)

    Orrell, Alice C.; Kora, Angela R.; Russo, Bryan J.; Horner, Jacob A.; Williamson, Jennifer L.; Weimar, Mark R.; Gorrissen, Willy J.; Nesse, Ronald J.; Dixon, Douglas R.

    2010-05-31

    This document provides an overview of renewable resource potential at Dugway Proving Ground, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and ground source heat pumps (GSHPs). The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment.

  8. Programming and Proving Correctness of the Scanning Algorithm with Backtrack,

    Science.gov (United States)

    1980-09-19

    components A, . A2,...An of the Cartesian product and that all eie- ments of the set A are generated sequentially from them. It is simplest to program how n...the gradual refine- ment of the program and proving its correctness and we do not work towards a meaningful program which will solve a given problem and...Privara, I..- " Teoria a aplikacia formalnej semantiky programovacich jazykov" LThe Theory and Application of ?ormal Semantics in Program- .m~ng

  9. Logic for computer science foundations of automatic theorem proving

    CERN Document Server

    Gallier, Jean H

    2015-01-01

    This advanced text for undergraduate and graduate students introduces mathematical logic with an emphasis on proof theory and procedures for algorithmic construction of formal proofs. The self-contained treatment is also useful for computer scientists and mathematically inclined readers interested in the formalization of proofs and basics of automatic theorem proving. Topics include propositional logic and its resolution, first-order logic, Gentzen's cut elimination theorem and applications, and Gentzen's sharpened Hauptsatz and Herbrand's theorem. Additional subjects include resolution in fir

  10. Changes in white blood pictures and some biochemical parameters of dairy cows in peripartum period and early lactation

    Directory of Open Access Journals (Sweden)

    Mirjana Joksimović Todorović

    2012-06-01

    Full Text Available The objective of this research was to determine the changes in the number of cells of white blood line and some biochemical parameters: concentration of glucose, concentration of non-esterified fatty acids (NEFA, activity of enzymes of aspartat aminotransferase (AST, alanin aminotransferase (ALT and gamma glutamyltranferase (GGT, in 17 Holstein-Friesian breed dairy cows in peripartum period and early lactation (on d 15 prepartum, on the day of parturition and on d 15, 30, and 45 postpartum. The highest values of total leukocytes count, neutrophiles, monocytes and basophiles count were recorded on the day of parturition, and then decreased, so that the minimum value established on d 45 of lactation. The lymphocytes count was the lowest on the day of parturation, while the eosinophils and basophiles counts were significantly different in observed time intervals. The concentration of glucose ranged from 3.07 mmol/L on d 15 prepartum to 2.71 mmol/L on d 15 postpartum. A high concentration of non-esterified fatty acids (NEFA in the postpartum period is a consequence of changes in energy balance and more intensive process of lypolisis in fat tissue, due to energy disbalance at the beginning of lactation. Established activity of enzymes AST, ALT and GGT was approximately the same in studied time intervals and was within physiological limits. The results of hematological and biochemical analysis in this paper do not indicate the development of postpartum ailments, because the investigated parameters were within physiological limits.

  11. Preparing for Mars: The Evolvable Mars Campaign 'Proving Ground' Approach

    Science.gov (United States)

    Bobskill, Marianne R.; Lupisella, Mark L.; Mueller, Rob P.; Sibille, Laurent; Vangen, Scott; Williams-Byrd, Julie

    2015-01-01

    As the National Aeronautics and Space Administration (NASA) prepares to extend human presence beyond Low Earth Orbit, we are in the early stages of planning missions within the framework of an Evolvable Mars Campaign. Initial missions would be conducted in near-Earth cis-lunar space and would eventually culminate in extended duration crewed missions on the surface of Mars. To enable such exploration missions, critical technologies and capabilities must be identified, developed, and tested. NASA has followed a principled approach to identify critical capabilities and a "Proving Ground" approach is emerging to address testing needs. The Proving Ground is a period subsequent to current International Space Station activities wherein exploration-enabling capabilities and technologies are developed and the foundation is laid for sustained human presence in space. The Proving Ground domain essentially includes missions beyond Low Earth Orbit that will provide increasing mission capability while reducing technical risks. Proving Ground missions also provide valuable experience with deep space operations and support the transition from "Earth-dependence" to "Earth-independence" required for sustainable space exploration. A Technology Development Assessment Team identified a suite of critical technologies needed to support the cadence of exploration missions. Discussions among mission planners, vehicle developers, subject-matter-experts, and technologists were used to identify a minimum but sufficient set of required technologies and capabilities. Within System Maturation Teams, known challenges were identified and expressed as specific performance gaps in critical capabilities, which were then refined and activities required to close these critical gaps were identified. Analysis was performed to identify test and demonstration opportunities for critical technical capabilities across the Proving Ground spectrum of missions. This suite of critical capabilities is expected to

  12. Proving Causation With Epidemiological Evidence in Tobacco Lawsuits

    Directory of Open Access Journals (Sweden)

    Sun Goo Lee

    2016-03-01

    Full Text Available Recently, a series of lawsuits were filed in Korea claiming tort liability against tobacco companies. The Supreme Court has already issued decisions in some cases, while others are still pending. The primary issue in these cases is whether the epidemiological evidence submitted by the plaintiffs clearly proves the causal relationship between smoking and disease as required by civil law. Proving causation is difficult in tobacco lawsuits because factors other than smoking are involved in the development of a disease, and also because of the lapse of time between smoking and the manifestation of the disease. The Supreme Court (Supreme Court Decision, 2011Da22092, April 10, 2014 has imposed some limitations on using epidemiological evidence to prove causation in tobacco lawsuits filed by smokers and their family members, but these limitations should be reconsidered. First, the Court stated that a disease can be categorized as specific or non-specific, and for each disease type, causation can be proven by different types of evidence. However, the concept of specific diseases is not compatible with multifactor theory, which is generally accepted in the field of public health. Second, when the epidemiological association between the disease and the risk factor is proven to be significant, imposing additional burdens of proof on the plaintiff may considerably limit the plaintiff’s right to recovery, but the Court required the plaintiffs to provide additional information such as health condition and lifestyle. Third, the Supreme Court is not giving greater weight to the evidential value of epidemiological study results because the Court focuses on the fact that these studies were group-level, not individual-level. However, group-level studies could still offer valuable information about individual members of the group, e.g., probability of causation.

  13. On proving confluence modulo equivalence for Constraint Handling Rules

    DEFF Research Database (Denmark)

    Christiansen, Henning; Kirkeby, Maja Hanne

    2017-01-01

    Previous results on proving confluence for Constraint Handling Rules are extended in two ways in order to allow a larger and more realistic class of CHR programs to be considered confluent. Firstly, we introduce the relaxed notion of confluence modulo equivalence into the context of CHR: while...... with meta-level restrictions that reflect the non-logical and incomplete predicates. This language represents subproofs as diagrams, which facilitates a systematic enumeration of proof cases, pointing forward to a mechanical support for such proofs. The Project is supported by The Danish...

  14. Effect of peripartum nutritional management on plasma profile of steroid hormones, metabolites, and postpartum fertility in buffaloes

    Directory of Open Access Journals (Sweden)

    R. M. Kalasariya

    2017-03-01

    Full Text Available Aim: The aim of this study was to evaluate the influence of peripartum protein and minerals supplementation on plasma profile of steroid hormones, metabolites, and fertility in rural buffaloes. Material and Methods: A total of 85 advanced pregnant (~8 months pluriparous buffaloes selected at farmers’ doorstep in three tribal villages of Middle Gujarat were randomly divided into two groups, viz., control (n=45 and nutrients treatment (40. The buffaloes of treatment group (n=40, in addition to farmers feeding schedule/control, received daily 1.5 kg compound concentrate mixture (22% CP and 50 g of chelated ASMM for 2 months each pre- and post-partum. Further, 15 buffaloes, each of control and treatment group, were injected parentrally (deep i/m with 5 ml of micro-minerals (each ml containing Se, Zn, Cu and Mn at 5, 40, 15 and 10 mg, respectively, twice 2 months before and on the day of calving, keeping rest of the animals (control, n=30 and treatment, n=25 as controls. Blood sampling was done on days −60, −30, −15, 0, 15, 30, 45, and 60 peripartum for estimation of plasma progesterone and estradiol by standard RIA techniques and other metabolites using assay kits on biochemistry analyzer. The puerperal events and postpartum fertility were monitored through history and by fortnightly palpation per rectum till day 45 and then again at 120 days postpartum for both the groups and subgroups. Results: The mean plasma progesterone concentrations in all groups declined significantly (p0.05. The micro-minerals injection appreciably reduced the incidence of RFMs and significantly (p<0.05 reduced the placental expulsion time over non-injected controls. In treatment group, the period for involution of uterus was significantly shorter (29.39±0.50 vs. 32.12±0.82 days, p<0.05, with early onset of first postpartum estrus (67.65±1.67 vs. 79.43±3.06 days, p<0.01, shorter service period (90.89±4.41 vs. 105.09±4.76 days, p<0.05 and higher conception rate

  15. Model Checking Failed Conjectures in Theorem Proving: A Case Study

    Science.gov (United States)

    Pike, Lee; Miner, Paul; Torres-Pomales, Wilfredo

    2004-01-01

    Interactive mechanical theorem proving can provide high assurance of correct design, but it can also be a slow iterative process. Much time is spent determining why a proof of a conjecture is not forthcoming. In some cases, the conjecture is false and in others, the attempted proof is insufficient. In this case study, we use the SAL family of model checkers to generate a concrete counterexample to an unproven conjecture specified in the mechanical theorem prover, PVS. The focus of our case study is the ROBUS Interactive Consistency Protocol. We combine the use of a mechanical theorem prover and a model checker to expose a subtle flaw in the protocol that occurs under a particular scenario of faults and processor states. Uncovering the flaw allows us to mend the protocol and complete its general verification in PVS.

  16. Formal Analysis of Soft Errors using Theorem Proving

    Directory of Open Access Journals (Sweden)

    Sofiène Tahar

    2013-07-01

    Full Text Available Modeling and analysis of soft errors in electronic circuits has traditionally been done using computer simulations. Computer simulations cannot guarantee correctness of analysis because they utilize approximate real number representations and pseudo random numbers in the analysis and thus are not well suited for analyzing safety-critical applications. In this paper, we present a higher-order logic theorem proving based method for modeling and analysis of soft errors in electronic circuits. Our developed infrastructure includes formalized continuous random variable pairs, their Cumulative Distribution Function (CDF properties and independent standard uniform and Gaussian random variables. We illustrate the usefulness of our approach by modeling and analyzing soft errors in commonly used dynamic random access memory sense amplifier circuits.

  17. A Hybrid Approach to Proving Memory Reference Monotonicity

    KAUST Repository

    Oancea, Cosmin E.

    2013-01-01

    Array references indexed by non-linear expressions or subscript arrays represent a major obstacle to compiler analysis and to automatic parallelization. Most previous proposed solutions either enhance the static analysis repertoire to recognize more patterns, to infer array-value properties, and to refine the mathematical support, or apply expensive run time analysis of memory reference traces to disambiguate these accesses. This paper presents an automated solution based on static construction of access summaries, in which the reference non-linearity problem can be solved for a large number of reference patterns by extracting arbitrarily-shaped predicates that can (in)validate the reference monotonicity property and thus (dis)prove loop independence. Experiments on six benchmarks show that our general technique for dynamic validation of the monotonicity property can cover a large class of codes, incurs minimal run-time overhead and obtains good speedups. © 2013 Springer-Verlag.

  18. Evaluation of depleted uranium in the environment at Aberdeen Proving Grounds, Maryland and Yuma Proving Grounds, Arizona. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Kennedy, P.L.; Clements, W.H.; Myers, O.B.; Bestgen, H.T.; Jenkins, D.G. [Colorado State Univ., Fort Collins, CO (United States). Dept. of Fishery and Wildlife Biology

    1995-01-01

    This report represents an evaluation of depleted uranium (DU) introduced into the environment at the Aberdeen Proving Grounds (APG), Maryland and Yuma Proving Grounds (YPG) Arizona. This was a cooperative project between the Environmental Sciences and Statistical Analyses Groups at LANL and with the Department of Fishery and Wildlife Biology at Colorado State University. The project represents a unique approach to assessing the environmental impact of DU in two dissimilar ecosystems. Ecological exposure models were created for each ecosystem and sensitivity/uncertainty analyses were conducted to identify exposure pathways which were most influential in the fate and transport of DU in the environment. Research included field sampling, field exposure experiment, and laboratory experiments. The first section addresses DU at the APG site. Chapter topics include bioenergetics-based food web model; field exposure experiments; bioconcentration by phytoplankton and the toxicity of U to zooplankton; physical processes governing the desorption of uranium from sediment to water; transfer of uranium from sediment to benthic invertebrates; spead of adsorpion by benthic invertebrates; uptake of uranium by fish. The final section of the report addresses DU at the YPG site. Chapters include the following information: Du transport processes and pathway model; field studies of performance of exposure model; uptake and elimination rates for kangaroo rates; chemical toxicity in kangaroo rat kidneys.

  19. Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study.

    Science.gov (United States)

    Chang, Ying-Jen; Ho, Chung-Han; Chen, Jen-Yin; Wu, Ming-Ping; Yu, Chia-Hung; Wang, Jhi-Joung; Chen, Chia-Ming; Chu, Chin-Chen

    2017-09-12

    During pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular disorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with a high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum CHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF. In this retrospective cohort study, PCHF patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwan's National Health Insurance Research Database. Risk factors and obstetric outcomes were compared in women with and without PCHF. From 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24.20/10 5 ). More women with than without PCHF were older (≥ 35, 18.16% vs. 9.62%), and had more multifetal gestations (7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%). After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29-83.22), pulmonary diseases (aOR: 13.12; 95% CI: 10.28-16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94-18.28), thyroid disease (aOR: 9.53; 95% CI: 5.27-17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89-6.85). PCHF patients also had a higher rate of cesarean sections (66.41% vs. 34.46%; p outcomes, including maternal death. Our findings should benefit healthcare providers, and government and health insurance policy makers.

  20. Association Between Diabetes During Pregnancy and Peripartum Cardiomyopathy: A Population-Level Analysis of 309,825 Women.

    Science.gov (United States)

    Dhesi, Sumandeep; Savu, Anamaria; Ezekowitz, Justin A; Kaul, Padma

    2017-07-01

    Peripartum cardiomyopathy (PPCM) is a form of heart failure associated with pregnancy. The objectives of our study were to determine the incidence and outcomes (maternal and neonatal) of PPCM and its association with diabetes mellitus (DM) in a contemporary population-based cohort. The cohort consisted of 309,825 women with a birth of at least 1 live newborn between January 01, 2005 and September 30, 2014, resulting in 469,150 birth events and 477,089 live newborns. A modified PPCM definition was used, allowing from 32 weeks' gestation and up to 6 months postpartum. Women were categorized according to DM status. A total of 194 PPCM birth events were identified, for an incidence rate of 1/2418 births. Women with PPCM were older, often primiparous, and more likely to have multiple gestations, pre-existing DM, and hypertensive disorders of pregnancy. Although the overall numbers were low, the incidence of PPCM was higher in pregnancies in women with pre-existing DM (1/613 birth events) and gestational DM (1/1751 birth events) vs those with neither (1/2550 birth events). Over a mean follow-up of 3.9 years, the mortality rate was higher in women affected by PPCM than in those who were not, with few deaths overall. Neonatal death was uncommon in the entire cohort but was numerically greater in the PPCM group. The incidence of PPCM in Alberta, Canada was approximately 1/2400 births and was modulated by the presence of DM in pregnancy. The relationship between DM status and PPCM may be confounded by other vascular risk factors, including hypertensive disorders of pregnancy. There were few maternal or neonatal deaths in the overall cohort, but they were numerically higher in the PPCM group. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Low STAT3 expression sensitizes to toxic effects of β-adrenergic receptor stimulation in peripartum cardiomyopathy.

    Science.gov (United States)

    Stapel, Britta; Kohlhaas, Michael; Ricke-Hoch, Melanie; Haghikia, Arash; Erschow, Sergej; Knuuti, Juhani; Silvola, Johanna M U; Roivainen, Anne; Saraste, Antti; Nickel, Alexander G; Saar, Jasmin A; Sieve, Irina; Pietzsch, Stefan; Müller, Mirco; Bogeski, Ivan; Kappl, Reinhard; Jauhiainen, Matti; Thackeray, James T; Scherr, Michaela; Bengel, Frank M; Hagl, Christian; Tudorache, Igor; Bauersachs, Johann; Maack, Christoph; Hilfiker-Kleiner, Denise

    2017-02-01

    The benefit of the β1-adrenergic receptor (β1-AR) agonist dobutamine for treatment of acute heart failure in peripartum cardiomyopathy (PPCM) is controversial. Cardiac STAT3 expression is reduced in PPCM patients. Mice carrying a cardiomyocyte-restricted deletion of STAT3 (CKO) develop PPCM. We hypothesized that STAT3-dependent signalling networks may influence the response to β-AR agonist treatment in PPCM patients and analysed this hypothesis in CKO mice. Follow-up analyses in 27 patients with severe PPCM (left ventricular ejection fraction ≤25%) revealed that 19 of 20 patients not obtaining dobutamine improved cardiac function. All seven patients obtaining dobutamine received heart transplantation (n = 4) or left ventricular assist devices (n = 3). They displayed diminished myocardial triglyceride, pyruvate, and lactate content compared with non-failing controls. The β-AR agonist isoproterenol (Iso) induced heart failure with high mortality in postpartum female, in non-pregnant female and in male CKO, but not in wild-type mice. Iso induced heart failure and high mortality in CKO mice by impairing fatty acid and glucose uptake, thereby generating a metabolic deficit. The latter was governed by disturbed STAT3-dependent signalling networks, microRNA-199a-5p, microRNA-7a-5p, insulin/glucose transporter-4, and neuregulin/ErbB signalling. The resulting cardiac energy depletion and oxidative stress promoted dysfunction and cardiomyocyte loss inducing irreversible heart failure, which could be attenuated by the β1-AR blocker metoprolol or glucose-uptake-promoting drugs perhexiline and etomoxir. Iso impairs glucose uptake, induces energy depletion, oxidative stress, dysfunction, and death in STAT3-deficient cardiomyocytes mainly via β1-AR stimulation. These cellular alterations may underlie the dobutamine-induced irreversible heart failure progression in PPCM patients who frequently display reduced cardiac STAT3 expression.

  2. Low STAT3 expression sensitizes to toxic effects of β-adrenergic receptor stimulation in peripartum cardiomyopathy

    Science.gov (United States)

    Stapel, Britta; Kohlhaas, Michael; Ricke-Hoch, Melanie; Haghikia, Arash; Erschow, Sergej; Knuuti, Juhani; Silvola, Johanna M. U.; Roivainen, Anne; Saraste, Antti; Nickel, Alexander G.; Saar, Jasmin A.; Sieve, Irina; Pietzsch, Stefan; Müller, Mirco; Bogeski, Ivan; Kappl, Reinhard; Jauhiainen, Matti; Thackeray, James T.; Scherr, Michaela; Bengel, Frank M.; Hagl, Christian; Tudorache, Igor; Bauersachs, Johann

    2017-01-01

    Abstract Aims The benefit of the β1-adrenergic receptor (β1-AR) agonist dobutamine for treatment of acute heart failure in peripartum cardiomyopathy (PPCM) is controversial. Cardiac STAT3 expression is reduced in PPCM patients. Mice carrying a cardiomyocyte-restricted deletion of STAT3 (CKO) develop PPCM. We hypothesized that STAT3-dependent signalling networks may influence the response to β-AR agonist treatment in PPCM patients and analysed this hypothesis in CKO mice. Methods and results Follow-up analyses in 27 patients with severe PPCM (left ventricular ejection fraction ≤25%) revealed that 19 of 20 patients not obtaining dobutamine improved cardiac function. All seven patients obtaining dobutamine received heart transplantation (n = 4) or left ventricular assist devices (n = 3). They displayed diminished myocardial triglyceride, pyruvate, and lactate content compared with non-failing controls. The β-AR agonist isoproterenol (Iso) induced heart failure with high mortality in postpartum female, in non-pregnant female and in male CKO, but not in wild-type mice. Iso induced heart failure and high mortality in CKO mice by impairing fatty acid and glucose uptake, thereby generating a metabolic deficit. The latter was governed by disturbed STAT3-dependent signalling networks, microRNA-199a-5p, microRNA-7a-5p, insulin/glucose transporter-4, and neuregulin/ErbB signalling. The resulting cardiac energy depletion and oxidative stress promoted dysfunction and cardiomyocyte loss inducing irreversible heart failure, which could be attenuated by the β1-AR blocker metoprolol or glucose-uptake-promoting drugs perhexiline and etomoxir. Conclusions Iso impairs glucose uptake, induces energy depletion, oxidative stress, dysfunction, and death in STAT3-deficient cardiomyocytes mainly via β1-AR stimulation. These cellular alterations may underlie the dobutamine-induced irreversible heart failure progression in PPCM patients who frequently display reduced cardiac STAT3

  3. NASA SPoRT GOES-R Proving Ground Activities

    Science.gov (United States)

    Stano, Geoffrey T.; Fuell, Kevin K.; Jedloec, Gary J.

    2010-01-01

    The NASA Short-term Prediction Research and Transition (SPoRT) program is a partner with the GOES-R Proving Ground (PG) helping prepare forecasters understand the unique products to come from the GOES-R instrument suite. SPoRT is working collaboratively with other members of the GOES-R PG team and Algorithm Working Group (AWG) scientists to develop and disseminate a suite of proxy products that address specific forecast problems for the WFOs, Regional and National Support Centers, and other NOAA users. These products draw on SPoRT s expertise with the transition and evaluation of products into operations from the MODIS instrument and the North Alabama Lightning Mapping Array (NALMA). The MODIS instrument serves as an excellent proxy for the Advanced Baseline Imager (ABI) that will be aboard GOES-R. SPoRT has transitioned and evaluated several multi-channel MODIS products. The true and false color products are being used in natural hazard detection by several SPoRT partners to provide better observation of land features, such as fires, smoke plumes, and snow cover. Additionally, many of SPoRT s partners are coastal offices and already benefit from the MODIS sea surface temperature composite. This, along with other surface feature observations will be developed into ABI proxy products for diagnostic use in the forecast process as well as assimilation into forecast models. In addition to the MODIS instrument, the NALMA has proven very valuable to WFOs with access to these total lightning data. These data provide situational awareness and enhanced warning decision making to improve lead times for severe thunderstorm and tornado warnings. One effort by SPoRT scientists includes a lightning threat product to create short-term model forecasts of lightning activity. Additionally, SPoRT is working with the AWG to create GLM proxy data from several of the ground based total lightning networks, such as the NALMA. The evaluation will focus on the vastly improved spatial

  4. The GOES-R Proving Ground: 2012 Update

    Science.gov (United States)

    Gurka, J.; Goodman, S. J.; Schmit, T.; Demaria, M.; Mostek, A.; Siewert, C.; Reed, B.

    2011-12-01

    The Geostationary Operational Environmental Satellite (GOES)-R will provide a great leap forward in observing capabilities, but will also offer a significant challenge to ensure that users are ready to exploit the vast improvements in spatial, spectral, and temporal resolutions. To ensure user readiness, forecasters and other users must have access to prototype advanced products well before launch, and have the opportunity to provide feedback to product developers and computing and communications managers. The operational assessment is critical to ensure that the end products and NOAA's computing and communications systems truly meet their needs in a rapidly evolving environment. The GOES-R Proving Ground (PG) engages the National Weather Service (NWS) forecast, watch and warning community and other agency users in pre-operational demonstrations of select products with GOES-R attributes (enhanced spectral, spatial, and temporal resolution). In the PG, developers and forecasters test and apply algorithms for new GOES-R satellite data and products using proxy and simulated data sets, including observations from current and future satellite instruments (MODIS, AIRS, IASI, SEVIRI, NAST-I, NPP/VIIRS/CrIS, LIS), lightning networks, and computer simulated products. The complete list of products to be evaluated in 2012 will be determined after evaluating results from experiments in 2011 at the NWS' Storm Prediction Center, National Hurricane Center, Aviation Weather Center, Ocean Prediction Center, Hydrometeorological Prediction Center, and from the six NWS regions. In 2012 and beyond, the PG will test and validate data processing and distribution systems and the applications of these products in operational settings. Additionally developers and forecasters will test and apply display techniques and decision aid tools in operational environments. The PG is both a recipient and a source of training. Training materials are developed using various distance training tools in

  5. Impact of metritis on the generation of reactive oxygen species by circulating phagocytes and plasma lipopolysaccharide concentration in peripartum dairy cows.

    Science.gov (United States)

    Magata, Fumie; Morino, Ikumi; Teramura, Makoto; Tsunoda, Ei; Kawashima, Chiho; Haneda, Shingo; Miyamoto, Akio; Kida, Katsuya; Shimizu, Takashi

    2017-02-01

    This study examined the relationship between postpartum metritis, reactive oxygen species (ROS) generation, and plasma lipopolysaccharide (LPS) concentration in peripartum dairy cows. Blood was collected twice weekly from 2 weeks prepartum through 6 weeks postpartum. Whole blood chemiluminescence (WBCL) was measured using the luminol-enhanced zymosan-stimulated chemiluminescence assay. Cows were examined for uterine health disorders and classified into two groups, healthy (n = 11) and metritis (n = 5). Metritis had a significant effect on WBCL, with cows with metritis having a higher WBCL. Plasma LPS concentrations in cows with metritis were significantly higher than in healthy cows. To examine the effect of LPS on WBCL, blood was sampled in healthy peripartum cows (1 to 2 weeks prepartum, n = 8; 0 to 3 weeks postpartum, n = 11; and 4 to 8 weeks postpartum, n = 8) and incubated with LPS. At 1 endotoxin units/mL of LPS, similar to the plasma LPS concentration in cows with metritis, the WBCL increased in cows at 0 to 3 weeks postpartum. Results indicate that the increase in ROS generation and plasma LPS concentration are associated with metritis, and LPS may be responsible for enhanced ROS generation in early postpartum dairy cows. © 2016 Japanese Society of Animal Science.

  6. Pacific Proving Grounds radioisotope imprint in the Philippine Sea sediments.

    Science.gov (United States)

    Pittauer, Daniela; Roos, Per; Qiao, Jixin; Geibert, Walter; Elvert, Marcus; Fischer, Helmut W

    2018-06-01

    Radionuclide concentrations were studied in sediment cores taken at the continental slope of the Philippine Sea off Mindanao Island in the equatorial Western Pacific. High resolution deposition records of anthropogenic radionuclides were collected at this site. Excess 210 Pb together with excess 228 Th and anthropogenic radionuclides provided information about accumulation rates. Concentrations of Am and Pu isotopes were detected by gamma spectrometry, alpha spectrometry and ICP-MS. The Pu ratios indicate a high portion (minimum of 60%) of Pu from the Pacific Proving Grounds (PPG). This implies that the transport of PPG derived plutonium with the Mindanao Current southward is similarly effective as the previously known transport towards the north with the Kuroshio Current. The record is compared to other studies from northwest Pacific marginal seas and Lombok basin in the Indonesian Archipelago. The sediment core top was found to contain a 6 cm thick layer dominated by terrestrial organic matter, which was interpreted as a result of the 2012 Typhoon Pablo-related fast deposition. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Environmental geophysics, offshore Bush River Peninsula, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Miller, S.F.; Kuecher, G.J.; Davies, B.E. [and others

    1995-11-01

    Geophysical studies in shallow waters adjacent to the Bush River Peninsula, Edgewood Area of Aberdeen Proving Ground, Maryland, have delineated the extent of waste disposal sites and established a hydrogeologic framework, which may control contaminant transport offshore. These studies indicate that during the Pleistocene Epoch, alternating stands of high and low sea levels resulted in a complex pattern of shallow channel-fill deposits around the Bush River Peninsula. Ground-penetrating radar studies reveal paleochannels greater than 50 ft deep. Some of the paleochannels are also imaged with marine seismic reflection. Conductivity highs measured with the EM-31 are also indicative of paleochannels. This paleochannel depositional system is environmentally significant because it may control the shallow groundwater flow regime beneath the peninsula. Magnetic, conductivity, and side-scan sonar anomalies outline anthropogenic anomalies in the study area. On the basis of geophysical data, underwater anthropogenic materials do exist in some isolated areas, but large-scale offshore dumping has not occurred in the area studied.

  8. Why prove it again? alternative proofs in mathematical practice

    CERN Document Server

    Dawson, Jr , John W

    2015-01-01

    This monograph considers several well-known mathematical theorems and asks the question, “Why prove it again?” while examining alternative proofs.   It  explores the different rationales mathematicians may have for pursuing and presenting new proofs of previously established results, as well as how they judge whether two proofs of a given result are different.  While a number of books have examined alternative proofs of individual theorems, this is the first that presents comparative case studies of other methods for a variety of different theorems. The author begins by laying out the criteria for distinguishing among proofs and enumerates reasons why new proofs have, for so long, played a prominent role in mathematical practice.  He then outlines various purposes that alternative proofs may serve.  Each chapter that follows provides a detailed case study of alternative proofs for particular theorems, including the Pythagorean Theorem, the Fundamental Theorem of Arithmetic, Desargues’ Theorem, the...

  9. Vertical Transmission of Dengue Virus in the Peripartum Period and Viral Kinetics in Newborns and Breast Milk: New Data.

    Science.gov (United States)

    Arragain, Lucille; Dupont-Rouzeyrol, Myrielle; O'Connor, Olivia; Sigur, Nathalie; Grangeon, Jean-Paul; Huguon, Emilie; Dechanet, Clothilde; Cazorla, Cécile; Gourinat, Ann-Claire; Descloux, Elodie

    2016-10-19

    We investigated 10 mother-newborn pairs and found a 90% rate of dengue virus (DENV) transmission during the perinatal period. Here, we describe DENV kinetics in the sera of newborns before the onset of disease. Of the breast-milk samples analyzed, 75% tested positive for DENV. Dengue is the most common mosquito-borne viral disease in humans. With this study, we aimed to investigate the risk of vertical (DENV) transmission during the peripartum period and to describe its viral kinetics in serum and breast milk. We carried out a prospective study during the 2012-2013 dengue epidemic in New Caledonia, its most severe on record. All mothers hospitalized at the Centre Hospitalier Territorial in Nouméa, New Caledonia, with symptoms of dengue infection between 7 days before and 2 days after delivery and/or whose infant was infected during breastfeeding were investigated. DENV was detected and quantified by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) in sera and breast milk (mothers), sera and gastric fluid (newborns), cord blood, and placentas. DENV kinetics and sequences in sera and breast milk were studied. Clinical presentation and biological evolution in mother-newborn pairs were analyzed. Ten mother-newborn pairs were investigated over an 11-month period. One premature birth, 3 hemorrhagic complications, and 1 maternal death occurred. Nine newborns were infected and symptomatic. One case of deep thrombocytopenia and 1 case of anoxic encephalopathy occurred. DENV was detected in breast milk samples from 9 (75%) of 12 infected breastfeeding mothers. Original DENV kinetics in sera and breast milk were described. The occurrence of vertical DENV transmission was high (90%) in viremic mothers at delivery, and these mothers and their infants were at major risk for obstetric and neonatal complications. The modes of viral transmission are difficult to clarify. The risk of DENV transmission through breast milk seems plausible. Close follow-up of

  10. Peripartum dynamics of Coxiella burnetii infections in intensively managed dairy goats associated with a Q fever outbreak in Australia.

    Science.gov (United States)

    Muleme, Michael; Stenos, John; Vincent, Gemma; Wilks, Colin R; Devlin, Joanne M; Campbell, Angus; Cameron, Alexander; Stevenson, Mark A; Graves, Stephen; Firestone, Simon M

    2017-04-01

    Coxiella burnetii may cause reproduction disorders in pregnant animals but subclinical infection in other animals. Unrecognised disease may delay implementation of control interventions, resulting in transmission of infection to other livestock and to humans. Seroreactivity to C. burnetii phase-specific antigens, is routinely used to interpret the course of human Q fever. This approach could be similarly useful in identifying new and existing infections in livestock herds to help describe risk factors or production losses associated with the infections and the implementation of disease-control interventions. This study aimed to elucidate the dynamics of C. burnetii infections using seroreactivity to phase-specific antigens and to examine the impact of infection on milk yield in goats in an endemically-infected farm that was associated with a Q fever outbreak in Australia. Seroreactivity pre- and post-partum and milk yield were studied in 164 goats (86 nulliparous and 78 parous). Post-partum, the seroprevalence of antibodies to C. burnetti increased from 4.7% to 31.4% throughout goats' first kiddings and from 47.4% to 55.1% in goats kidding for the second or greater time. Of 123 goats that were seronegative pre-partum, 26.8% seroconverted over the three-month peri-partum period, highlighting the importance of controlling infection throughout this time. The risk of seroconversion was comparable in first or later kidders, suggesting constant risk irrespective of parity. No loss in milk production associated with seroconversion to phase 2 was observed within the first nine weeks of lactation. However, seroconversion to only phase 1 was associated with extra 0.276L of milk per day (95% Confidence Interval: 0.010, 0.543; P=0.042), which warrants further investigation to ascertain whether or not the association is causal. Further studies on seroreactivity and milk production over longer periods are required, as milk production loss caused by C. burnetti may be an

  11. Depleted uranium human health risk assessment, Jefferson Proving Ground, Indiana

    Energy Technology Data Exchange (ETDEWEB)

    Ebinger, M.H.; Hansen, W.R.

    1994-04-29

    The risk to human health from fragments of depleted uranium (DU) at Jefferson Proving Ground (JPG) was estimated using two types of ecosystem pathway models. A steady-state, model of the JPG area was developed to examine the effects of DU in soils, water, and vegetation on deer that were hunted and consumed by humans. The RESRAD code was also used to estimate the effects of farming the impact area and consuming the products derived from the farm. The steady-state model showed that minimal doses to humans are expected from consumption of deer that inhabit the impact area. Median values for doses to humans range from about 1 mrem ({plus_minus}2.4) to 0.04 mrem ({plus_minus}0.13) and translate to less than 1 {times} 10{sup {minus}6} detriments (excess cancers) in the population. Monte Carlo simulation of the steady-state model was used to derive the probability distributions from which the median values were drawn. Sensitivity analyses of the steady-state model showed that the amount of DU in airborne dust and, therefore, the amount of DU on the vegetation surface, controlled the amount of DU ingested by deer and by humans. Human doses from the RESRAD estimates ranged from less than 1 mrem/y to about 6.5 mrem/y in a hunting scenario and subsistence fanning scenario, respectively. The human doses exceeded the 100 mrem/y dose limit when drinking water for the farming scenario was obtained from the on-site aquifer that was presumably contaminated with DU. The two farming scenarios were unrealistic land uses because the additional risk to humans due to unexploded ordnance in the impact area was not figured into the risk estimate. The doses estimated with RESRAD translated to less than 1 {times} 10{sup {minus}6} detriments to about 1 {times} 10{sup {minus}3} detriments. The higher risks were associated only with the farming scenario in which drinking water was obtained on-site.

  12. NASA'S Space Launch System: Progress Toward the Proving Ground

    Science.gov (United States)

    Jackman, Angie; Johnson, Les

    2017-01-01

    With significant and substantial progress being accomplished toward readying the Space Launch System (SLS) rocket for its first test flight, work is already also underway on preparations for the second flight – using an upgraded version of the vehicle – and beyond. Designed to support human missions into deep space, Space Launch System (SLS), is the most powerful human-rated launch vehicle the United States has ever undertaken, and together with the Orion spacecraft will support human exploration missions into the proving ground of cislunar space and ultimately to Mars. For its first flight, SLS will deliver a near-term heavy-lift capability for the nation with its 70-metric-ton Block 1 configuration. Each element of the vehicle now has flight hardware in production in support of the initial flight of the SLS, which will propel Orion around the moon and back. For its second flight, SLS will be upgraded to the more-capable Block 1B configuration. While the Block 1 configuration is capable of delivering more than 70 metric tons to low Earth orbit, the Block 1B vehicle will increase that capability to 105 metric tons. For that flight, the new configuration introduces two major new elements to the vehicle – an Exploration Upper Stage (EUS) that will be used for both ascent and in-space propulsion, and a Universal Stage Adapter (USA) that serves as a “payload bay” for the rocket, allowing the launch of large exploration systems along with the Orion spacecraft. Already, flight hardware is being prepared for the Block 1B vehicle. Beyond the second flight, additional upgrades will be made to the vehicle. The Block 1B vehicle will also be able to launch 8.4-meter-diameter payload fairings, larger than any previously flown, and the Spacecraft Payload Integration and Evolution (SPIE) Element will oversee development and production of those fairings. Ultimately, SLS will be evolved to a Block 2 configuration, which will replace the solid rocket boosters on the Block

  13. Primary prevention of cardiovascular diseases in primary care: prove principles and persistent practice

    NARCIS (Netherlands)

    Scheltens, T.

    2009-01-01

    Prevention of cardiovascular diseases in clinical practice includes identification of persons at high risk, assessing the well known risk factors, proper estimation and optimal communication of CVD risk and appropriate allocation of therapies, all with the aim to ultimately improve outcomes for

  14. Dynamic changes in high and low mammographic density human breast tissues maintained in murine tissue engineering chambers during various murine peripartum states and over time.

    Science.gov (United States)

    Chew, G L; Huang, D; Huo, C W; Blick, T; Hill, P; Cawson, J; Frazer, H; Southey, M D; Hopper, J L; Henderson, M A; Haviv, I; Thompson, E W

    2013-07-01

    Mammographic density (MD) is a strong heritable risk factor for breast cancer, and may decrease with increasing parity. However, the biomolecular basis for MD-associated breast cancer remains unclear, and systemic hormonal effects on MD-associated risk is poorly understood. This study assessed the effect of murine peripartum states on high and low MD tissue maintained in a xenograft model of human MD. Method High and low MD human breast tissues were precisely sampled under radiographic guidance from prophylactic mastectomy specimens of women. The high and low MD tissues were maintained in separate vascularised biochambers in nulliparous or pregnant SCID mice for 4 weeks, or mice undergoing postpartum involution or lactation for three additional weeks. High and low MD biochamber material was harvested for histologic and radiographic comparisons during various murine peripartum states. High and low MD biochamber tissues in nulliparous mice were harvested at different timepoints for histologic and radiographic comparisons. Results High MD biochamber tissues had decreased stromal (p = 0.0027), increased adipose (p = 0.0003) and a trend to increased glandular tissue areas (p = 0.076) after murine postpartum involution. Stromal areas decreased (p = 0.042), while glandular (p = 0.001) and adipose areas (p = 0.009) increased in high MD biochamber tissues during lactation. A difference in radiographic density was observed in high (p = 0.0021) or low MD biochamber tissues (p = 0.004) between nulliparous, pregnant and involution groups. No differences in tissue composition were observed in high or low MD biochamber tissues maintained for different durations, although radiographic density increased over time. Conclusion High MD biochamber tissues had measurable histologic changes after postpartum involution or lactation. Alterations in radiographic density occurred in biochamber tissues between different peripartum states and over time. These findings

  15. Bronchoscopic diagnostic procedures and microbiological examinations in proving endobronchial tuberculosis.

    Science.gov (United States)

    Şimşek, Abdullah; Yapıcı, İlhami; Babalık, Mesiha; Şimşek, Zekiye; Kolsuz, Mustafa

    2016-01-01

    To determine the proportional distribution of endobronchial tuberculosis (EBTB) subtypes and to evaluate the types of bronchoscopic diagnostic procedures that can prove granulomatous inflammation. This was a retrospective study of 18 HIV-negative patients with biopsy-proven EBTB treated between 2010 and 2014. The most common EBTB subtypes, as classified by the bronchoscopic features, were tumorous and granular (in 22.2% for both). Sputum smear microscopy was performed in 11 patients and was positive for AFB in 4 (36.3%). Sputum culture was also performed in 11 patients and was positive for Mycobacterium tuberculosis in 10 (90.9%). Smear microscopy of BAL fluid (BALF) was performed in 16 patients and was positive for AFB in 10 (62.5%). Culture of BALF was also performed in 16 patients and was positive for M. tuberculosis in 15 (93.7%). Culture of BALF was positive for M. tuberculosis in 93.7% of the 16 patients tested. Among the 18 patients with EBTB, granulomatous inflammation was proven by the following bronchoscopic diagnostic procedures: bronchial mucosal biopsy, in 8 (44.4%); bronchial brushing, in 7 (38.8%); fine-needle aspiration biopsy, in 2 (11.1%); and BAL, in 2 (11.1%). Bronchial anthracofibrosis was observed in 5 (27.7%) of the 18 cases evaluated. In our sample of EBTB patients, the most common subtypes were the tumorous and granular subtypes. We recommend that sputum samples and BALF samples be evaluated by smear microscopy for AFB and by culture for M. tuberculosis, which could increase the rates of early diagnosis of EBTB. We also recommend that bronchial brushing be employed together with other bronchoscopic diagnostic procedures in patients suspected of having EBTB. Determinar a distribuição proporcional dos subtipos de tuberculose endobrônquica (TBEB) e avaliar os tipos de procedimentos diagnósticos broncoscópicos que podem revelar inflamação granulomatosa. Este foi um estudo retrospectivo com 18 pacientes HIV negativos com TBEB comprovada

  16. Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Ntobeko B A Ntusi

    Full Text Available There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM, as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP (i.e., peripartum cardiac failure associated with any form of hypertension and PPCM have similar or different clinical features and outcome.We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years and PPCM (n = 30; age 31.5 ± 7.5 years. The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001. PPCM was more significantly associated with the following features than HHFP (p<0.05: twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05 to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05. There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005 during follow-up.There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.

  17. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM.

    Science.gov (United States)

    Sliwa, Karen; Hilfiker-Kleiner, Denise; Mebazaa, Alexandre; Petrie, Mark C; Maggioni, Aldo P; Regitz-Zagrosek, Vera; Schaufelberger, Maria; Tavazzi, Luigi; van Veldhuisen, Dirk J; Roos-Hesslink, Jolien W; Shah, Ajay J; Seferovic, Petar M; Elkayam, Uri; van Spaendonck-Zwarts, Karin; Bachelier-Walenta, Katrin; Mouquet, Frederic; Kraigher-Krainer, Elisabeth; Hall, Roger; Ponikowski, Piotr; McMurray, John J V; Pieske, Burkert

    2014-05-01

    The EURObservational Research Programme is a rolling programme of cardiovascular registries and surveys of the European Society of Cardiology (ESC). These registries will provide information on the nature of cardiovascular disease and its management. This manuscript provides an update on new literature on peripartum cardiomyopathy (PPCM), published since the 2010 Position Statement from the Heart Failure Association of the European Society of Cardiology Working Group on PPCM, and describes a new registry on this under-recognized condition. Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of the pregnancy, or in the months following delivery, where no other cause for heart failure is found. The PPCM Registry aims to describe disease presentation, comorbidities, diagnostic and therapeutic management of patients with PPCM, as well as information on their offspring. Centres not only from ESC and ESC-affiliated countries, but from around the world, are encouraged to participate. A prospective registry on patients presenting with PPCM. At the time of writing, approximately 100 patients have been enrolled from 20 countries. All data entry is online via secure passwords and is supported by well-trained information technology personnel. The EURObservational Research Programme will allow a comparison of women from around the world, from different ethnic backgrounds, presenting with PPCM and will report on their 6 month and 12 month outcomes. The study aims to include 1000 patients and follow them for 1 year. New centres volunteering to participate in the study will be welcomed. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

  18. emergency peripartum hysterectomy

    African Journals Online (AJOL)

    2001-02-02

    Feb 2, 2001 ... time she had repeated packed cells and platelet transfusions. She died of multiorgan failure; (b) the second ... patients required transfusion of blood products. Six patients required more than ten units of ... monitoring is not available, then “one to one” nursing is imperative as it is not only high risk patients.

  19. Peripartum cardiomyopathy in Denmark

    DEFF Research Database (Denmark)

    Ersbøll, Anne S; Johansen, Marianne; Damm, Peter

    2017-01-01

    and searched for cardiomyopathy and heart failure ICD-10 diagnoses in a period of nine months before to 12 months after a delivery from 1 January 2005 through 31 December 2014. Diagnoses were validated and additional data were extracted from patient charts. A total of 61 women met the inclusion criteria...... equalling 1 in 10 149 deliveries. The majority recovered left ventricular systolic function within one year, but 14.8% suffered a major adverse event with 3.3% mortality, 8.2% mechanical circulatory support requirement and/or heart transplantation and 4.9% persistent severe heart failure. Half of the women...... had a concomitant hypertensive disorder of pregnancy, and this subgroup had a milder course of the disease. Baseline left ventricular ejection fraction (LVEF) was the only significant predictor of LVEF 10-14 months after diagnosis, and cabergoline therapy to inhibit lactation predicted the dichotomous...

  20. emergency peripartum hysterectomy

    African Journals Online (AJOL)

    2001-02-02

    Feb 2, 2001 ... patients both had hysterectomy because of fulminant sepsis. One of a 26 year old para 2 who delivered at home, and subsequently presented to hospital with puerperal sepsis. Hysterectomy was done on third day after delivery for progressive deterioration in condition. She tested positive to HIV antibodies.

  1. 78 FR 60238 - Proposed Modification and Establishment of Restricted Areas; Aberdeen Proving Ground, MD

    Science.gov (United States)

    2013-10-01

    ...; Aberdeen Proving Ground, MD AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of proposed..., within the existing restricted areas R-4001A and R- 4001B, at the U.S. Army's Aberdeen Proving Ground in... nonparticipating aircraft from a hazard to navigation in the Aberdeen Proving Ground airspace. DATES: Comments must...

  2. Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: a German multi-centre analysis.

    Science.gov (United States)

    Duncker, David; Westenfeld, Ralf; Konrad, Torsten; Pfeffer, Tobias; Correia de Freitas, Carlos A; Pfister, Roman; Thomas, Dierk; Fürnkranz, Alexander; Andrié, René P; Napp, Andreas; Schmitt, Jörn; Karolyi, Laszlo; Wakili, Reza; Hilfiker-Kleiner, Denise; Bauersachs, Johann; Veltmann, Christian

    2017-08-01

    Peripartum cardiomyopathy (PPCM) is a rare cardiomyopathy characterized by an acute reduction in left ventricular ejection fraction (LVEF). Sudden deaths during the course of PPCM are reported to be elevated, the underlying mechanisms remains unknown. The aim of the present multi-centre study was to evaluate the arrhythmia burden in a multi-centre approach in patients with PPCM using a wearable cardioverter/defibrillator (WCD). Forty-nine patients from 16 German centres with newly diagnosed PPCM and LVEF ≤35% receiving a WCD were included in this retrospective analysis. Mean follow-up was 15 ± 10 months. At diagnosis, mean age was 33 ± 5 years, parity was 2.1 ± 1.6, LVEF was 21 ± 7%, NYHA functional class was 3.4 ± 0.7. Mean wear time was 120 ± 106 days, mean wear time per day was 21.4 ± 3.3 h. Six (12%) patients presented eight ventricular tachyarrhythmias during WCD period: five episodes of VF, two sustained ventricular tachycardia (VT) and one non-sustained VT occurred. This multicentre study underpins the elevated risk for ventricular tachyarrhythmias in patients with newly diagnosed PPCM and reduced LVEF. A WCD should be considered for 3-6 months in these patients to prevent sudden cardiac death from ventricular tachyarrhythmias.

  3. Emotional changes occurring in women in pregnancy, parturition and lying-in period according to factors exerting an effect on a woman during the peripartum period.

    Science.gov (United States)

    Pięta, Beata; Jurczyk, Mieczysława Urszula; Wszołek, Katarzyna; Opala, Tomasz

    2014-01-01

    Pregnancy, parturition and childcare, which are important moments in a woman's life, are connected with many emotional states of a future mother, a pregnant woman and a lying-in woman. The perinatal period is the time when the risk of psychological disorders in a pregnant woman may increase by even several times. Objective. The objective of the study was recognition of the main emotional and psychological changes in pregnant women, those in labour and lying-in, according to the factors occurring during the peripartum period. The study was conducted in the form of a survey and covered a group of 108 mothers who were hospitalized in gynaecological-obstetric and obstetric wards in the Karol Marcinkowski Gynaecological-Obstetric University Hospital in Poznań. There are a number of factors which may exert a negative effect on the emotions of women in pregnancy, parturition, and during lying-in. The study showed that there is a close relationship between the occurrence of these factors and emotional states of the mothers after giving birth. Special attention should be given to women in whom already during pregnancy factors arise which may have a negative impact on their mental state. Emotions during pregnancy, parturition and lying-in are often quite extreme, and achieve a high intensity, as well being very variable within a short period of time.

  4. Emotional changes occurring in women in pregnancy, parturition and lying-in period according to factors exerting an effect on a woman during the peripartum period

    Directory of Open Access Journals (Sweden)

    Beata Pięta

    2014-09-01

    Full Text Available [b]Introduction[/b]. Pregnancy, parturition and childcare, which are important moments in a woman’s life, are connected with many emotional states of a future mother, a pregnant woman and a lying-in woman. The perinatal period is the time when the risk of psychological disorders in a pregnant woman may increase by even several times. [b]Objective.[/b] The objective of the study was recognition of the main emotional and psychological changes in pregnant women, those in labour and lying-in, according to the factors occurring during the peripartum period. [b]Material and method[/b]. The study was conducted in the form of a survey and covered a group of 108 mothers who were hospitalized in gynaecological-obstetric and obstetric wards in the Karol Marcinkowski Gynaecological-Obstetric University Hospital in Poznań. [b]Results[/b]. There are a number of factors which may exert a negative effect on the emotions of women in pregnancy, parturition, and during lying-in. The study showed that there is a close relationship between the occurrence of these factors and emotional states of the mothers after giving birth. [b]Conclusion[/b]. Special attention should be given to women in whom already during pregnancy factors arise which may have a negative impact on their mental state. Emotions during pregnancy, parturition and lying-in are often quite extreme, and achieve a high intensity, as well being very variable within a short period of time.

  5. Peripartum changes in social support among women with and without anxiety and depressive disorders prior to pregnancy: a prospective-longitudinal study.

    Science.gov (United States)

    Asselmann, E; Wittchen, H-U; Erler, L; Martini, J

    2016-12-01

    This study aims to prospectively examine peripartum changes in social support in women with and without anxiety and depressive disorders prior to pregnancy. Data come from the Maternal Anxiety in Relation to Infant Development (MARI) Study, a prospective-longitudinal investigation among n = 306 expectant mothers. DSM-IV anxiety and depressive disorders were assessed in early pregnancy using the Composite International Diagnostic Interview for Women (CIDI-V). Social support was assessed with the Social Support Questionnaire during pregnancy as well as 4 and 16 months postpartum. Perceived social support in the total sample declined from prepartum to postpartum. Levels of prepartum and postpartum social support were lower in women with comorbid anxiety and depressive disorders compared to those with pure depressive disorder(s), pure anxiety disorder(s), or comorbid anxiety and depressive disorders prior to pregnancy. Moreover, social support more strongly declined from prepartum to postpartum in women with comorbid anxiety and depressive disorders compared to those without anxiety and depressive disorder prior to pregnancy. Findings suggest that women with a previous history of comorbid anxiety and depressive disorders are at particular risk for deficient social support during pregnancy and after delivery and might thus profit from targeted early interventions.

  6. Page 1 238 S Kesavan 5. Conclusion It has been proved that non ...

    Indian Academy of Sciences (India)

    which has been used only to prove the existence of a solution via a priori estimates. Indeed this condition can be removed and replaced by any other which guarantees the existence of a non-singular solution of the homogenized problem alone. Then the method of this paper can be used to prove (without new hypotheses) ...

  7. Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function-value of the wearable cardioverter/defibrillator.

    Science.gov (United States)

    Duncker, David; Haghikia, Arash; König, Thorben; Hohmann, Stephan; Gutleben, Klaus-Jürgen; Westenfeld, Ralf; Oswald, Hanno; Klein, Helmut; Bauersachs, Johann; Hilfiker-Kleiner, Denise; Veltmann, Christian

    2014-12-01

    The true incidence of life-threatening ventricular tachyarrhythmic events and the risk of sudden cardiac death in the early stage of peripartum cardiomyopathy (PPCM) are still unknown. We aimed to assess the usefulness of the wearable cardioverter/defibrillator (WCD) to bridge a potential risk for life-threatening arrhythmic events in patients with early PPCM, severely reduced left ventricular ejection fraction (LVEF) and symptoms of heart failure. Twelve consecutively admitted women with PPCM were included in this single-centre, prospective observational study between September 2012 and September 2013. Patients with LVEF ≤35% were considered to use the WCD for 3 months or even 6 months when considered necessary for LVEF recovery. Nine of the 12 women had a severely reduced LVEF (mean 18.3%) at the time of study enrollment; seven women received a WCD, while two patients refused to wear a WCD. During a median WCD follow-up of 81 days (range 25-345 days), we observed a total of four events of ventricular fibrillation with appropriate and successful WCD shocks in three of the seven women receiving a WCD. No syncope or sudden arrhythmic deaths occurred in women not using the WCD during a median follow-up of 12 months (range 5-15 months). All women showed impressive improvement of LVEF during follow-up. PPCM patients with severely reduced LVEF have an elevated risk for ventricular tachyarrhythmias early after diagnosis. Therefore, use of the WCD should be considered in all women with early-stage PPCM and severely reduced LVEF during the first 6 months after initiation of heart failure therapy. © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology.

  8. Classificació de proves no paramètriques. Com aplicar-les en SPSS

    Directory of Open Access Journals (Sweden)

    Vanesa Berlanga-Silvente

    2012-07-01

    Full Text Available Les proves no paramètriques engloben una sèrie de proves estadístiques, que tenen com a denominador comú l'absència de assumpcions sobre la llei de probabilitat que segueix la població de la qual ha estat extreta la mostra. Per aquesta raó és comú referir-s'hi com a proves de distribució lliure. A l'article es descriuen i treballen les proves no paramètriques ressaltant el seu fonament i les indicacions per al seu ús quan es tracta d'una sola mostra (Chi-quadrat, de dues mostres amb dades independents (U de Mann-Whitney, de dues mostres amb dades relacionades (T de Wilcoxon, de diverses mostres amb dades independents (H de Kruskal-Wallis i de diverses mostres amb dades relacionades (Friedman.

  9. PROVE GOES-8 Images of Jornada Experimental Range, New Mexico, 1997

    Data.gov (United States)

    National Aeronautics and Space Administration — As part of the Prototype Validation Experiment (PROVE) at the Jornada Experimental Range, GOES-8 images were collected every 30 minutes for 15 days overlapping the...

  10. 33 CFR 334.140 - Chesapeake Bay; U.S. Army Proving Ground Reservation, Aberdeen, Md.

    Science.gov (United States)

    2010-07-01

    ... Island to Locust Point; thence along straight line from Locust Point to Turkey Point for a distance of... right to land nor to cut or procure pound net poles or stakes on the Aberdeen Proving Ground Reservation...

  11. PROVE Land Cover and Leaf Area of Jornada Experimental Range, New Mexico, 1997

    Data.gov (United States)

    National Aeronautics and Space Administration — Field measurement of shrubland ecological properties is important for both site monitoring and validation of remote-sensing information. During the PROVE exercise on...

  12. Research gaps in neonatal HIV-related care

    Directory of Open Access Journals (Sweden)

    Mary-Ann Davies

    2015-05-01

    Full Text Available The South African prevention of mother to child transmission programme has made excellentprogress in reducing vertical HIV transmission, and paediatric antiretroviral therapyprogrammes have demonstrated good outcomes with increasing treatment initiation inyounger children and infants. However, both in South Africa and across sub-Saharan African,lack of boosted peri-partum prophylaxis for high-risk vertical transmission, loss to followup,and failure to initiate HIV-infected infants on antiretroviral therapy (ART before diseaseprogression are key remaining gaps in neonatal HIV-related care. In this issue of the Southern African Journal of HIV Medicine, experts provide valuable recommendations for addressingthese gaps. The present article highlights a number of areas where evidence is lacking toinform guidelines and programme development for optimal neonatal HIV-related care.

  13. Research gaps in neonatal HIV-related care

    Directory of Open Access Journals (Sweden)

    Mary-Ann Davies

    2015-04-01

    Full Text Available The South African prevention of mother to child transmission programme has made excellentprogress in reducing vertical HIV transmission, and paediatric antiretroviral therapyprogrammes have demonstrated good outcomes with increasing treatment initiation inyounger children and infants. However, both in South Africa and across sub-Saharan African,lack of boosted peri-partum prophylaxis for high-risk vertical transmission, loss to followup,and failure to initiate HIV-infected infants on antiretroviral therapy (ART before diseaseprogression are key remaining gaps in neonatal HIV-related care. In this issue of the Southern African Journal of HIV Medicine, experts provide valuable recommendations for addressingthese gaps. The present article highlights a number of areas where evidence is lacking toinform guidelines and programme development for optimal neonatal HIV-related care.

  14. The Development of the Proving Process Within a Dynamic Geometry Environment

    Directory of Open Access Journals (Sweden)

    Danh Nam Nguyen

    2012-10-01

    Full Text Available In this paper we classify student’s proving level and design an interactive help system (IHS corresponding with these levels in order to investigate the development of the proving process within a dynamic geometry environment. This help system was also used to provide tertiary students with a strategy for proving and to improve their proving levels. The open-ended questions and explorative tasks in the IHS make a contribution to support students’ learning of proving, especially during the processes of realizing invariants, formulating conjectures, producing arguments, and writing proofs. This research wants to react on the well-known students’ difficulties in writing a formal proof. The hypothesis of this work is that these difficulties are based on the lack of students’ understanding the relationship between argumentation and proof. Therefore, we used Toulmin model to analyze student’s argumentation structure and examine the role of abduction in writing a deductive proof. Furthermore, this paper also provides mathematics teachers with three basic conditions for understanding the development of the proving process and teaching strategies for assisting their students in constructing formal proofs.

  15. Formalizing and proving a typing result for security protocols in Isabelle/HOL

    DEFF Research Database (Denmark)

    Hess, Andreas Viktor; Modersheim, Sebastian

    2017-01-01

    or the positive output of a verification tool. However several of these works have used a typed model, where the intruder is restricted to "well-typed" attacks. There also have been several works that show that this is actually not a restriction for a large class of protocols, but all these results so far...... are again pen-and-paper proofs. In this work we present a formalization of such a typing result in Isabelle/HOL. We formalize a constraint-based approach that is used in the proof argument of such typing results, and prove its soundness, completeness and termination. We then formalize and prove the typing...... result itself in Isabelle. Finally, to illustrate the real-world feasibility, we prove that the standard Transport Layer Security (TLS) handshake satisfies the main condition of the typing result....

  16. Events occurring during the previous lactation, the dry period, and peripartum as risk factors for early lactation mastitis in cows receiving 2 different intramammary dry cow therapies.

    Science.gov (United States)

    Pinedo, P J; Fleming, C; Risco, C A

    2012-12-01

    The objective of this study was to investigate the association between mastitis events occurring during the previous lactation, the dry period, and the peripartum period on the incidence of early lactation mastitis in cows receiving ceftiofur hydrochloride or penicillin dihydrostreptomycin as intramammary dry cow antibiotic therapy. Cows (n=402) from 2 large dairy farms in Central Florida were enrolled in the study at the time of dry-off processing and were randomly assigned to 1 of 2 dry cow therapies: ceftiofur hydrochloride or penicillin dihydrostreptomycin. Composite milk samples were collected at dry-off and after calving for bacteriological examination and somatic cell count. Peripartal health disorders were monitored during the first 30 d of lactation and included calving difficulty, metritis, ketosis, and left displaced abomasum. Milk production and individual somatic cell scores (SCS) were recorded monthly by the Dairy Herd Improvement Association. The main outcome variables were the risk of clinical mastitis during the first 30 and 60 d of lactation, and the risk of subclinical mastitis at the first 2 monthly Dairy Herd Improvement Association tests after calving (up to 70 d in milk). Additionally, the SCS and the presence of mastitis pathogens in milk at dry-off and at calving were analyzed. Explanatory variables consisted of events occurring during the previous lactation, at dry-off and during the dry period, at calving, and within the first 30 d after calving. Multiple events occurring during the previous lactation had a significant effect on the incidence of mastitis in the subsequent lactation. These events included low milk yield, intermediate lactation length, clinical mastitis, and lactation SCS average. Similarly, intramammary infections with environmental bacteria at dry-off increased the chances of clinical mastitis the first month after calving. Dry-off therapy had a significant effect on mastitis incidence; cows treated with ceftiofur

  17. Effect of peripartum dietary energy supplementation on thyroid hormones, insulin-like growth factor-i and its binding proteins in early lactation dairy cows

    Directory of Open Access Journals (Sweden)

    Kirovski Danijela

    2012-01-01

    three examined postpartum periods, but the difference was significant only on day 60 after parturition (p<0.01, respectively. Concentrations of total protein and albumin were significantly higher in GLY compared to the control group in all three examined periods after parturition. Based on these results it can be concluded that peripartum dietary energy supplementation prevent cows' exposure to severe negative energy balance, preserves synthetic activity of hepatocytes and consequently has a positive impact on milk production and reproductive performances in dairy cows.

  18. Artocarpus altilis proving its worth in toxic metal removal from the ...

    African Journals Online (AJOL)

    Artocarpus altilis proving its worth in toxic metal removal from the environment. PO Okolo, EEI Irabor, TP Abugu. Abstract. Nuts of breadfruit tree (Artocarpus altilis) obtained from Ugbowo Campus of University of Benin, Benin City, were dehusked and the husk thoroughly washed with distilled water, air-dried, pulverized and ...

  19. Using eternity variables to specify and prove a serializable database interface

    NARCIS (Netherlands)

    Hesselink, Wim H.

    Eternity variables are introduced to specify and verify serializability of transactions of a distributed database. Eternity variables are a new kind of auxiliary variables. They do not occur in the implementation but are used in specification and verification. Elsewhere it has been proved that

  20. The Secret Prover : Proving Possession of Arbitrary Files While not Giving Them Away

    NARCIS (Netherlands)

    Teepe, Wouter

    2005-01-01

    The Secret Prover is a Java application which allows a user (A) to prove to another user (B), that A possesses a file. If B also possesses this file B will get convinced, and if B does not possess this file B will gain no information on (the contents of) this file. This is the first implementation

  1. Mathematical Understanding and Proving Abilities: Experiment with Undergraduate Student by Using Modified Moore Learning Approach

    Science.gov (United States)

    Maya, Rippi; Sumarmo, Utari

    2011-01-01

    This paper reports findings of a post test experimental control group design conducted to investigate the role of modified Moore learning approach on improving students' mathematical understanding and proving abilities. Subjects of study were 56 undergraduate students of one state university in Bandung, who took advanced abstract algebra course.…

  2. Wind tunnel experiments to prove a hydraulic passive torque control concept for variable speed wind turbines

    NARCIS (Netherlands)

    Diepeveen, N.F.B.; Jarquin-Laguna, A.

    2014-01-01

    In this paper the results are presented of experiments to prove an innovative concept for passive torque control of variable speed wind turbines using fluid power technology. It is demonstrated that by correctly configuring the hydraulic drive train, the wind turbine rotor operates at or near

  3. Searching for fixed point combinators by using automated theorem proving: A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Wos, L.; McCune, W.

    1988-09-01

    In this report, we establish that the use of an automated theorem- proving program to study deep questions from mathematics and logic is indeed an excellent move. Among such problems, we focus mainly on that concerning the construction of fixed point combinators---a problem considered by logicians to be significant and difficult to solve, and often computationally intensive and arduous. To be a fixed point combinator, THETA must satisfy the equation THETAx = x(THETAx) for all combinators x. The specific questions on which we focus most heavily ask, for each chosen set of combinators, whether a fixed point combinator can be constructed from the members of that set. For answering questions of this type, we present a new, sound, and efficient method, called the kernel method, which can be applied quite easily by hand and very easily by an automated theorem-proving program. For the application of the kernel method by a theorem-proving program, we illustrate the vital role that is played by both paramodulation and demodulation---two of the powerful features frequently offered by an automated theorem-proving program for treating equality as if it is ''understood.'' We also state a conjecture that, if proved, establishes the completeness of the kernel method. From what we can ascertain, this method---which relies on the introduced concepts of kernel and superkernel---offers the first systematic approach for searching for fixed point combinators. We successfully apply the new kernel method to various sets of combinators and, for the set consisting of the combinators B and W, construct an infinite set of fixed point combinators such that no two of the combinators are equal even in the presence of extensionality---a law that asserts that two combinators are equal if they behave the same. 18 refs.

  4. Mathematical Understanding and Proving Abilities: Experiment With Undergraduate Student By Using Modified Moore Learning Approach

    Directory of Open Access Journals (Sweden)

    Rippi Maya

    2011-07-01

    Full Text Available This paper reports findings of  a  post test experimental control group design conducted to investigate the role of modified Moore learning approach  on improving students’ mathematical understanding and proving abilities. Subject of study were 56 undergradute students of one state university in Bandung, who took advanced abstract algebra course. Instrument of study were a set test of mathematical understanding ability, a set test of mathematical proving ability, and a set of students’ opinion scale on modified Moore learning approach. Data were analyzed by using two path ANOVA. The study found that proof construction process was more difficult than mathematical understanding  task  for all students, and students still posed some difficulties on constructing mathematical proof task.  The study also found there were not differences  between students’  abilities on mathematical understanding and on proving abilities of  the both classes, and both abilities were classified as mediocre. However, in modified Moore learning approach class there were more students who got above average grades on mathematical understanding than those of conventional class. Moreover, students performed positive  opinion toward  modified Moore learning approach. They  were  active in questioning and solving problems, and in explaining their works in front of class as well, while students of conventional teaching prefered to listen to lecturer’s explanation. The study also found that there was no interaction between learning approach and students’ prior mathematics ability on mathematical understanding and proving abilities,  but  there were  quite strong  association between students’ mathematical understanding and proving abilities.Keywords:  modified Moore learning approach, mathematical understanding ability, mathematical proving ability. DOI: http://dx.doi.org/10.22342/jme.2.2.751.231-250

  5. Remedial investigation report for J-Field, Aberdeen Proving Ground, Maryland. Volume 3: Ecological risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Hlohowskyj, I.; Hayse, J.; Kuperman, R.; Van Lonkhuyzen, R.

    2000-02-25

    The Environmental Management Division of the U.S. Army Aberdeen Proving Ground (APG), Maryland, is conducting a remedial investigation (RI) and feasibility study (FS) of the J-Field area at APG, pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended. As part of that activity, Argonne National Laboratory (ANL) conducted an ecological risk assessment (ERA) of the J-Field site. This report presents the results of that assessment.

  6. Proving and Improving Wave Models in the Arctic Ocean and its MIZ

    Science.gov (United States)

    2015-09-30

    scale, the Greenland Sea Odden which is important for deep convection. The increased open water area present in the autumn Arctic Ocean , particularly...263(5144), 218–221, doi:10.1126/science.263.5144.218. Hunkins, K. (1966), Ekman drift currents in the Arctic Ocean , Deep Sea Res., 13(4), 607–620...1 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. Proving and Improving Wave Models in the Arctic Ocean

  7. Concept of Operations for a Prospective "Proving Ground" in the Lunar Vicinity

    Science.gov (United States)

    Love, Stanley G.; Hill, James J.

    2016-01-01

    NASA is studying a "Proving Ground" near the Moon to conduct human space exploration missions in preparation for future flights to Mars. This paper describes a concept of operations ("conops") for activities in the Proving Ground, focusing on the construction and use of a mobile Cislunar Transit Habitat capable of months-long excursions within and beyond the Earth-Moon system. Key elements in the conops include the Orion spacecraft (with mission kits for docking and other specialized operations) and the Space Launch System heavy-lift rocket. Potential additions include commercial launch vehicles and logistics carriers, solar electric propulsion stages to move elements between different orbits and eventually take them on excursions to deep space, a node module with multiple docking ports, habitation and life support blocks, and international robotic and piloted lunar landers. The landers might include reusable ascent modules which could remain docked to in-space elements between lunar sorties. The architecture will include infrastructure for launch preparation, communication, mission control, and range safety. The conops describes "case studies" of notional missions chosen to guide the design of the architecture and its elements. One such mission is the delivery of a 10-ton pressurized element, co-manifested with an Orion on a Block 1B Space Launch System rocket, to the Proving Ground. With a large solar electric propulsion stage, the architecture could enable a year-long mission to land humans on a near-Earth asteroid. In the last case, after returning to near-lunar space, two of the asteroid explorers could join two crewmembers freshly arrived from Earth for a Moon landing, helping to safely quantify the risk of landing deconditioned crews on Mars. The conops also discusses aborts and contingency operations. Early return to Earth may be difficult, especially during later Proving Ground missions. While adding risk, limited-abort conditions provide needed practice

  8. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM.

    Science.gov (United States)

    Sliwa, Karen; Mebazaa, Alexandre; Hilfiker-Kleiner, Denise; Petrie, Mark C; Maggioni, Aldo P; Laroche, Cecile; Regitz-Zagrosek, Vera; Schaufelberger, Maria; Tavazzi, Luigi; van der Meer, Peter; Roos-Hesselink, Jolien W; Seferovic, Petar; van Spandonck-Zwarts, Karin; Mbakwem, Amam; Böhm, Michael; Mouquet, Frederic; Pieske, Burkert; Hall, Roger; Ponikowski, Piotre; Bauersachs, Johann

    2017-09-01

    The purpose of this study is to describe disease presentation, co-morbidities, diagnosis and initial therapeutic management of patients with peripartum cardiomyopathy (PPCM) living in countries belonging to the European Society of Cardiology (ESC) vs. non-ESC countries. Out of 500 patients with PPCM entered by 31 March 2016, we report on data of the first 411 patients with completed case record forms (from 43 countries) entered into this ongoing registry. There were marked differences in socio-demographic parameters such as Human Development Index, GINI index on inequality, and Health Expenditure in PPCM patients from ESC vs. non-ESC countries (P heart failure after 1 month (92.3% vs. 81.3%, P heart failure were common within 1 month post-diagnosis and required intensive, multidisciplinary management. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  9. SPoRT's Participation in the GOES-R Proving Ground Activity

    Science.gov (United States)

    Jedlovec, Gary; Fuell, Kevin; Smith, Matthew; Stano, Geoffrey; Molthan, Andrew

    2011-01-01

    The next generation geostationary satellite, GOES-R, will carry two new instruments with unique atmospheric and surface observing capabilities, the Advanced Baseline Imager (ABI) and the Geostationary Lightning Mapper (GLM), to study short-term weather processes. The ABI will bring enhanced multispectral observing capabilities with frequent refresh rates for regional and full disk coverage to geostationary orbit to address many existing and new forecast challenges. The GLM will, for the first time, provide the continuous monitoring of total lightning flashes over a hemispherical region from space. NOAA established the GOES-R Proving Ground activity several years ago to demonstrate the new capabilities of these instruments and to prepare forecasters for their day one use. Proving Ground partners work closely with algorithm developers and the end user community to develop and transition proxy data sets representing GOES-R observing capabilities. This close collaboration helps to maximize refine algorithms leading to the delivery of a product that effectively address a forecast challenge. The NASA Short-term Prediction Research and Transition (SPoRT) program has been a participant in the NOAA GOES-R Proving Ground activity by developing and disseminating selected GOES-R proxy products to collaborating WFOs and National Centers. Established in 2002 to demonstrate the weather and forecasting application of real-time EOS measurements, the SPoRT program has grown to be an end-to-end research to operations activity focused on the use of advanced NASA modeling and data assimilation approaches, nowcasting techniques, and unique high-resolution multispectral data from EOS satellites to improve short-term weather forecasts on a regional and local scale. Participation in the Proving Ground activities extends SPoRT s activities and taps its experience and expertise in diagnostic weather analysis, short-term weather forecasting, and the transition of research and experimental

  10. SPoRT's Participation in the GOES-R Proving Ground Activity

    Science.gov (United States)

    Jedlovec, G.; Fuell, K.; Smith, M. R.; Stano, G. T.; Molthan, A.

    2011-12-01

    The next generation geostationary satellite, GOES-R, will carry two new instruments with unique atmospheric and surface observing capabilities, the Advanced Baseline Imager (ABI) and the Geostationary Lightning Mapper (GLM), to study short-term weather processes. The ABI will bring enhanced multispectral observing capabilities with frequent refresh rates for regional and full disk coverage to geostationary orbit to address many existing and new forecast challenges. The GLM will, for the first time, provide the continuous monitoring of total lightning flashes over a hemispherical region from space. NOAA established the GOES-R Proving Ground activity several years ago to demonstrate the new capabilities of these instruments and to prepare forecasters for their day one use. Proving Ground partners work closely with algorithm developers and the end user community to develop and transition proxy data sets representing GOES-R observing capabilities. This close collaboration helps to maximize refine algorithms leading to the delivery of a product that effectively address a forecast challenge. The NASA Short-term Prediction Research and Transition (SPoRT) program has been a participant in the NOAA GOES-R Proving Ground activity by developing and disseminating selected GOES-R proxy products to collaborating WFOs and National Centers. Established in 2002 to demonstrate the weather and forecasting application of real-time EOS measurements, the SPoRT program has grown to be an end-to-end research to operations activity focused on the use of advanced NASA modeling and data assimilation approaches, nowcasting techniques, and unique high-resolution multispectral data from EOS satellites to improve short-term weather forecasts on a regional and local scale. Participation in the Proving Ground activities extends SPoRT's activities and taps its experience and expertise in diagnostic weather analysis, short-term weather forecasting, and the transition of research and experimental

  11. Effects of prepartum dietary cation-anion difference on aspects of peripartum mineral and energy metabolism and performance of multiparous Holstein cows.

    Science.gov (United States)

    Leno, B M; Ryan, C M; Stokol, T; Kirk, D; Zanzalari, K P; Chapman, J D; Overton, T R

    2017-06-01

    The objectives of this study were to determine the effect of decreasing dietary cation-anion difference [DCAD; (Na+ + K+) - (Cl- + S2-)] of the prepartum diet on aspects of mineral metabolism, energy metabolism, and performance of peripartum dairy cows. Multiparous Holstein cows (n = 89) were enrolled between 38 and 31 d before expected parturition and randomized to treatments in a completely randomized design (restricted to balance for previous 305-d mature equivalent milk production, parity, and body condition score) at 24 d before expected parturition. Treatments consisted of a low-K ration without anion supplementation [CON; n = 30, DCAD = +18.3 mEq/100 g of dry matter (DM)]; partial anion supplementation to a low-K ration (MED; n = 30, DCAD = +5.9 mEq/100 g of DM); and anion supplementation to a low-K ration to reach a targeted average urine pH between 5.5 and 6.0 (LOW; n = 29, DCAD = -7.4 mEq/100 g of DM). Cows were fed a common postpartum diet and data collected through 63 d in milk. Urine pH (CON = 8.22, MED = 7.89, and LOW = 5.96) was affected quadratically by decreasing prepartum DCAD. A linear relationship between urine pH and urine Ca:creatinine ratio was observed (r = -0.81). Plasma Ca concentrations in the postpartum period (d 0 to 14; CON = 2.16, MED = 2.19, and LOW = 2.27 mmol/L) were increased linearly with decreasing prepartum DCAD. A treatment by parity (second vs. third and greater) interaction for postpartum plasma Ca concentration suggested that older cows had the greatest response to the low DCAD diet and older cows fed LOW had decreased prevalence of hypocalcemia after calving. A quadratic effect of decreasing DCAD on prepartum DMI was observed (CON = 13.6, MED = 14.0, and LOW = 13.2 kg/d). Milk production in the first 3 wk postpartum was increased linearly with decreasing DCAD (CON = 40.8, MED = 42.4, and LOW = 43.9 kg/d) and DMI in this period also tended to linearly increase (CON = 20.2, MED = 20.9, and LOW = 21.3 kg/d). Overall, effects

  12. Research Objectives for Human Missions in the Proving Ground of Cis-Lunar Space

    Science.gov (United States)

    Spann, James; Niles, Paul; Eppler, Dean; Kennedy, Kriss; Lewis, Ruthan; Sullivan, Thomas

    2016-07-01

    Introduction: This talk will introduce the preliminary findings in support of NASA's Future Capabilities Team. In support of the ongoing studies conducted by NASA's Future Capabilities Team, we are tasked with collecting re-search objectives for the Proving Ground activities. The objectives could include but are certainly not limited to: demonstrating crew well being and performance over long duration missions, characterizing lunar volatiles, Earth monitoring, near Earth object search and identification, support of a far-side radio telescope, and measuring impact of deep space environment on biological systems. Beginning in as early as 2023, crewed missions beyond low Earth orbit will be enabled by the new capabilities of the SLS and Orion vehicles. This will initiate the "Proving Ground" phase of human exploration with Mars as an ultimate destination. The primary goal of the Proving Ground is to demonstrate the capability of suitably long dura-tion spaceflight without need of continuous support from Earth, i.e. become Earth Independent. A major component of the Proving Ground phase is to conduct research activities aimed at accomplishing major objectives selected from a wide variety of disciplines including but not limited to: Astronomy, Heliophysics, Fun-damental Physics, Planetary Science, Earth Science, Human Systems, Fundamental Space Biology, Microgravity, and In Situ Resource Utilization. Mapping and prioritizing the most important objectives from these disciplines will provide a strong foundation for establishing the architecture to be utilized in the Proving Ground. Possible Architectures: Activities and objectives will be accomplished during the Proving Ground phase using a deep space habitat. This habitat will potentially be accompanied by a power/propulsion bus capable of moving the habitat to accomplish different objectives within cis-lunar space. This architecture can also potentially support stag-ing of robotic and tele-robotic assets as well as

  13. Satellite Proving Ground for the GOES-R Geostationary Lightning Mapper (GLM)

    Science.gov (United States)

    Goodman, Steven J.; Gurka, James; Bruning, E. C.; Blakeslee, J. R.; Rabin, Robert; Buechler, D.

    2009-01-01

    The key mission of the Satellite Proving Ground is to demonstrate new satellite observing data, products and capabilities in the operational environment to be ready on Day 1 to use the GOES-R suite of measurements. Algorithms, tools, and techniques must be tested, validated, and assessed by end users for their utility before they are finalized and incorporated into forecast operations. The GOES-R Proving Ground for the Geostationary Lightning Mapper (GLM) focuses on evaluating how the infusion of the new technology, algorithms, decision aids, or tailored products integrate with other available tools (weather radar and ground strike networks; nowcasting systems, mesoscale analysis, and numerical weather prediction models) in the hands of the forecaster responsible for issuing forecasts and warning products. Additionally, the testing concept fosters operation and development staff interactions which will improve training materials and support documentation development. Real-time proxy total lightning data from regional VHF lightning mapping arrays (LMA) in Northern Alabama, Central Oklahoma, Cape Canaveral Florida, and the Washington, DC Greater Metropolitan Area are the cornerstone for the GLM Proving Ground. The proxy data will simulate the 8 km Event, Group and Flash data that will be generated by GLM. Tailored products such as total flash density at 1-2 minute intervals will be provided for display in AWIPS-2 to select NWS forecast offices and national centers such as the Storm Prediction Center. Additional temporal / spatial combinations are being investigated in coordination with operational needs and case-study proxy data and prototype visualizations may also be generated from the NASA heritage Lightning Imaging Sensor and Optical Transient Detector data. End users will provide feedback on the utility of products in their operational environment, identify use cases and spatial/temporal scales of interest, and provide feedback to the developers for adjusted or

  14. How cytogenetical methods help victims prove radiation exposure and claim right for social support: NCERM experience

    Energy Technology Data Exchange (ETDEWEB)

    Aleksanin, S., E-mail: Aleksanin@arcerm.spb.ru [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation); Slozina, N., E-mail: NataliaSlozina@peterlink.ru [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation); Neronova, E.; Smoliakov, E. [Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia, (NRCERM) ul. Akademika Lebedeva 4/2, 194044 St. Petersburg (Russian Federation)

    2011-09-15

    Russian citizens who were irradiated because of radiation disasters, nuclear weapons testing and some other sources have a right to some social support and financial compensation. In order to get this compensation people have to prove that they were irradiated. As it is, not all victims for a variety of reasons have formal documents. Thus they apply for cytogenetic investigation to prove irradiation months, years and even decades after irradiation. Since 1992 the cytogenetic investigations related to radiation exposure were performed in NRCERM for more than 700 people. At the beginning of this investigation FISH method was not certified as a biodosimenty test in Russia. Only dicentric analysis was approved as a proof of irradiation. It is known that the rate of dicentrics decrease in time, but the residual level of cytogenetical markers could be revealed a long time after a radiation accident. Thus the dicentric analysis was performed for the people who applied for biological indication of radiation exposure at that time. Rates of dicentrics exceeding control levels were revealed in half the people who applied for radiation conformation. Now FISH method is certified in Russia and both cytogenetic tests of biodosimetry (dicentrics and FISH) are available for all comers. Increased levels of translocations were found in 8 cases (the dose rate from 0.16 to 0.64 Gy). On the basis of the results of cytogenetic tests official documents were supplied to these people and they were entitled to apply for radiation exposure compensation. Thus cytogenetic tests are very effective and in some cases the only possible way for the victims to prove irradiation exposure and to apply for radiation exposure compensation a long time after an accident.

  15. Proving Unlawful Discrimination in Capital Cases: In Quest of an Adequate Standard of Proof

    Directory of Open Access Journals (Sweden)

    Gregor Maučec

    2017-08-01

    Full Text Available In spite of some early judicial, political and scholarly discussions, as well as more recent scientific explorations of the topic, problems and concerns with proving discrimination in individual capital cases continue to be among the most debatable issues in human rights and criminal justice. In general, domestic courts (in particular US courts seem to remain relatively perfunctory and hostile to individual discrimination challenges in capital trials. They normally require capital defendants alleging discrimination to prove something which is virtually impossible to prove. On the other hand, numerous capital defence attorneys, legal commentators and even some of the trial judges themselves lay strictures on the existing judicial approach which almost routinely rejects discrimination claims in capital cases. They contend that appropriate modifications in current legislative arrangements and mechanical adjudication policy and practice are urgent and indispensable for more equitable resolutions and for a truly even-handed criminal justice system. In particular, there are concerns regarding the adequate distribution of the burden of proof between the litigants. Moreover, no clear or uniform approach to this conundrum can be identified in the international jurisprudence. This article seeks to provide some definite answers to open and conceptual questions posed in an attempt to legally define ‘the minimum core content’ of the evidentiary standard – as implicitly contained in the relevant international human rights treaties’ provisions – to be applied in capital sentencing discrimination cases. Additionally, part of this same standard of proof can also qualify as a general principle of international law, particularly in relation to impartial, unbiased and non-discriminatory approaches and decision-making by the judges and jurors involved in complex capital cases.

  16. A Simple Application of Lightweight Fusion to Proving the Equivalence of Abstract Machines

    DEFF Research Database (Denmark)

    Danvy, Olivier; Millikin, Kevin

    2007-01-01

    We show how Ohori and Sasano's recent lightweight fusion by fixed-point promotion provides a simple way to prove the equivalence of the two standard styles of specification of abstract machines: (1) as a transition function together with a `driver loop' implementing the iteration of this transition...... function; and (2) as a function directly iterating upon a configuration until reaching a final state, if ever. The equivalence hinges on the fact that the latter style of specification is a fused version of the former one. The need for such a simple proof is motivated by our recent work on syntactic...... correspondences between reduction semantics and abstract machines, using refocusing...

  17. Operation UPSHOT-KNOTHOLE. Operational Summary, Nevada Proving Grounds, 1 March - 9 June 1953

    Science.gov (United States)

    1982-08-01

    projaing stabi±izing agents were tested including sand-cementt sodium silicateg and lignin , The sand-cemnt test panels showed no damage to the effects of... Lignin proved its valua ana mohan.tc1a stabilizing agent in regions where the peak overpressure was less than 20 psi. Evaluation of these materials from a...selected officer volunp towns trained in culoulating the offscts of atomic wespona,, wase pomi~ tionod in trenches at 2W0 and AM0 Ids fr pom sex (a

  18. Respirometry applied to kinetic characterization of activated sludge; Caratterizzazione cinetica di fanghi attivi mediante prove respirometriche

    Energy Technology Data Exchange (ETDEWEB)

    Ricco, G. [Consiglio Nazionale delle Ricerche, Bari (Italy). Istituto Nazionale di Ricerca sulle Acque; Tomei, M.C. [Consiglio Nazionale delle Ricerche, Rome (Italy). Istituto Nazionale di Ricerca sulle Acque

    1999-10-01

    In this paper an experimental procedure to evaluate the biomass characterization parameters by utilizing respirometric tests is presented. Beside, a procedure for data analysis based on the kinetic, stoichiometric and mass balance equations describing the system in the various operating conditions required for the evaluation of the different parameters is proposed. Finally, the results of a first example of application to the sludge characterization of a civil waste water treatment plant are reported. [Italian] Viene presentato un primo esempio applicativo relativo alla caratterizzazione di un fango attivo proveniente da un impianto di trattamento di reflui civili utilizzando il modello cinetico di Monod con l'impiego di prove respirometriche.

  19. Proving the correctness of unfold/fold program transformations using bisimulation

    DEFF Research Database (Denmark)

    Hamilton, Geoff W.; Jones, Neil

    2011-01-01

    proofs show the original and transformed programs are contextually equivalent, i.e., have the same termination behaviour in all closed contexts. Contextual equivalence can, however, be difficult to establish directly. Gordon and Howe use an alternative approach: to represent a program's behaviour...... to describe contextually, due to use of non-local information. We show that weak bisimulation on labelled transition systems gives an elegant framework to prove contextual equivalence of original and transformed programs. One reason is that folds can be seen in the context of corresponding unfolds....

  20. Hydrogeologic data for the Canal Creek area, Aberdeen Proving Ground, Maryland, April 1986-March 1988

    Science.gov (United States)

    Oliveros, J.P.; Gernhardt, Patrice

    1989-01-01

    This report is a compilation of hydrologic and geologic data collected for the period April 1986 through March 1988 for the Canal Creek area of Aberdeen Proving Ground, Maryland. Geologic data include lithologic logs for 73 sites and geophysical logs for 71 sites. Hydrologic data consist of hydrographs and synoptic water level measurements. The hydrographs were taken from eight wells that were equipped with continuous water level recorders, and the synoptic water-level measurements were made four times during the study. Well-construction data also are included for 149 observation wells. (USGS)

  1. Initial building investigations at Aberdeen Proving Ground, Maryland: Objectives and methodology

    Energy Technology Data Exchange (ETDEWEB)

    Brubaker, K.L.; Dougherty, J.M.; McGinnis, L.D.

    1994-12-01

    As part of an environmental-contamination source-definition program at Aberdeen Proving Ground, detailed internal and external inspections of 23 potentially contaminated buildings are being conducted to describe and characterize the state of each building as it currently exists and to identify areas potentially contaminated with toxic or other hazardous substances. In addition, a detailed geophysical investigation is being conducted in the vicinity of each target building to locate and identify subsurface structures, associated with former building operations, that are potential sources of contamination. This report describes the objectives of the initial building inspections, including the geophysical investigations, and discusses the methodology that has been developed to achieve these objectives.

  2. How to prove the validity of a complex ballot encryption to the voter and the public

    OpenAIRE

    Joaquim, Rui

    2014-01-01

    One crucial aspect of any verifiable electronic voting system that uses encryption is the proof that the vote encryption is well-formed, i.e. the proof that the vote encryption encrypts a valid vote accordingly to the race specification. It makes no sense accepting an encrypted vote if, at the end of the election, the vote cannot be included in the tally because it is badly formed. Proving the validity of a complex vote encryption, without revealing the vote, is a hard problem. This paper...

  3. Seismic proving test of ultimate piping strength (current status of preliminary tests)

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, K.; Namita, Y.; Abe, H.; Ichihashi, I. [Seismic Engineering Center, NUPEC, Tokyo (Japan); Suzuki, K. [Tokyo Metropolitan Universtity, Hachioji (Japan); Ishiwata, M. [Hitachi, Ltd., Hitachi (Japan); Fujiwaka, T. [Ishikawajima-Harima Heavy Industries Co., Ltd., Yokohama (Japan); Yokota, H. [Mitsubishi Heavy Industries Ltd., Kobe (Japan)

    2001-07-01

    In 1998 Fiscal Year, the 6 year program of piping tests was initiated with the following objectives: i) to clarify the elasto-plastic response and ultimate strength of nuclear piping, ii) to ascertain the seismic safety margin of the current seismic design code for piping, and iii) to assess new allowable stress rules. In order to resolve extensive technical issues before proceeding on to the seismic proving test of a large-scale piping system, a series of preliminary tests of materials, piping components and simplified piping systems is intended. In this paper, the current status of the material tests and the piping component tests is reported. (author)

  4. Ecological survey of M-Field, Edgewood Area Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Downs, J.L.; Eberhardt, L.E.; Fitzner, R.E.; Rogers, L.E.

    1991-12-01

    An ecological survey was conducted on M-Field, at the Edgewood Area, Aberdeen Proving Ground, Maryland. M-Field is used routinely to test army smokes and obscurants, including brass flakes, carbon fibers, and fog oils. The field has been used for testing purposes for the past 40 years, but little documented history is available. Under current environmental regulations, the test field must be assessed periodically to document the presence or potential use of the area by threatened and endangered species. The M-Field area is approximately 370 acres and is part of the US Army`s Edgewood Area at Aberdeen Proving Ground in Harford County, Maryland. The grass-covered field is primarily lowlands with elevations from about 1.0 to 8 m above sea level, and several buildings and structures are present on the field. The ecological assessment of M-Field was conducted in three stages, beginning with a preliminary site visit in May to assess sampling requirements. Two field site visits were made June 3--7, and August 12--15, 1991, to identify the biota existing on the site. Data were gathered on vegetation, small mammals, invertebrates, birds, large mammals, amphibians, and reptiles.

  5. Ecological survey of M-Field, Edgewood Area Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Downs, J.L.; Eberhardt, L.E.; Fitzner, R.E.; Rogers, L.E.

    1991-12-01

    An ecological survey was conducted on M-Field, at the Edgewood Area, Aberdeen Proving Ground, Maryland. M-Field is used routinely to test army smokes and obscurants, including brass flakes, carbon fibers, and fog oils. The field has been used for testing purposes for the past 40 years, but little documented history is available. Under current environmental regulations, the test field must be assessed periodically to document the presence or potential use of the area by threatened and endangered species. The M-Field area is approximately 370 acres and is part of the US Army's Edgewood Area at Aberdeen Proving Ground in Harford County, Maryland. The grass-covered field is primarily lowlands with elevations from about 1.0 to 8 m above sea level, and several buildings and structures are present on the field. The ecological assessment of M-Field was conducted in three stages, beginning with a preliminary site visit in May to assess sampling requirements. Two field site visits were made June 3--7, and August 12--15, 1991, to identify the biota existing on the site. Data were gathered on vegetation, small mammals, invertebrates, birds, large mammals, amphibians, and reptiles.

  6. Proving the infringement of digital intellectual property rights: Overview of the Anglo-saxon legal system

    Directory of Open Access Journals (Sweden)

    Spasić Vidoje

    2015-01-01

    Full Text Available The multifaceted process of identifying and proving the infringement of intellectual property rights is further complicated and aggravated in the so-called analogue environment. The development of Information Technologies has given rise to a new set of problems. The digital technology has facilitated the infringement of intellectual property rights and additionally aggravated the process of proving these infringements. Hence, it is the duty of digital forensics to identify relevant (valid evidence and present it in the court of law, which is not an easy task. In that course, the problems are twofold: legal and technical. First of all, the legislation in many countries is not adjusted to resolving the issues constantly emerging in the digital environment and there are apparent differences in the manner of regulating these issues. On the other hand, there is no standardized and unified technology which would provide for a uniform qualification and comprehensive treatment of these issues. Moreover, the place of commission of these criminal offences as a rule does not coincide with the place of occurring legal consequences. Yet, in spite of all these difficulties, there are technological methods and tools which facilitate the detection of cybercrime and provide evidence for securing relevant punishment. In the time to come, the developments in this area are expected to be aimed at strengthening the protection of legitimate interests of holders of intellectual property rights.

  7. Ehrlichia chaffeensis (Rickettsiales: Ehrlichieae) infection in Amblyomma americanum (Acari: Ixodidae) at Aberdeen Proving Ground, Maryland.

    Science.gov (United States)

    Stromdahl, E Y; Randolph, M P; O'Brien, J J; Gutierrez, A G

    2000-05-01

    Human monocytic ehrlichiosis (HME) is a sometimes fatal, emerging tick-borne disease caused by the bacterium Ehrlichia chaffeensis. It is frequently misdiagnosed because its symptoms mimic those of the flu. Current evidence indicates that Amblyomma americanum (L.), the lone star tick, is the major vector of HME. To determine if E. chaffeensis is present in ticks at Aberdeen Proving Ground, MD, questing A. americanum ticks were collected from 33 sites. Nucleic acid was extracted from 34 adult and 81 nymphal pools. Sequences diagnostic for E. chaffeensis from three different loci (16S rRNA, 120-kDa protein, and a variable-length polymerase chain reaction [PCR] target, or VLPT) were targeted for amplification by the PCR. Fifty-two percent of the collection sites yielded pools infected with E. chaffeensis, confirming the presence and widespread distribution of E. chaffeensis at Aberdeen Proving Ground. Analysis with the both the 120-kDa protein primers and the VLPT primers showed that genetic variance exists. A novel combination of variance for the two loci was detected in two tick pools. The pathogenic implications of genetic variation in E. chaffeensis are as yet unknown.

  8. A theorem proving framework for the formal verification of Web Services Composition

    Directory of Open Access Journals (Sweden)

    Petros Papapanagiotou

    2011-08-01

    Full Text Available We present a rigorous framework for the composition of Web Services within a higher order logic theorem prover. Our approach is based on the proofs-as-processes paradigm that enables inference rules of Classical Linear Logic (CLL to be translated into pi-calculus processes. In this setting, composition is achieved by representing available web services as CLL sentences, proving the requested composite service as a conjecture, and then extracting the constructed pi-calculus term from the proof. Our framework, implemented in HOL Light, not only uses an expressive logic that allows us to incorporate multiple Web Services properties in the composition process, but also provides guarantees of soundness and correctness for the composition.

  9. Myoid hamartoma of the breast that proved difficult to diagnose: a case report

    Directory of Open Access Journals (Sweden)

    Mizuta Naruhiko

    2012-01-01

    Full Text Available Abstract Myoid hamartomas of the breast are extremely rare breast lesions, with a poorly understood pathogenesis. We describe the case of a 38-year-old premenopausal woman who presenting with a mass in the left breast. Mammography revealed an oval mass that was partly indistinct, and ultrasonography showed a hypoechoic mass with a slightly irregular margin. Bilateral breast dynamic magnetic resonance imaging was performed for a more detailed evaluation. The images showed rapid initial enhancement and a microlobulated margin. Because the suspicion of malignancy was strong at that time, core needle biopsy was performed. Histologically, the tumor was identified as fibroadenoma. A case of myoid hamartoma of the breast that proved difficult to diagnose is reported, and discussed with reference to the literature.

  10. An Overview of NASA SPoRT GOES-R JPSS Proving Ground Testbed Activities

    Science.gov (United States)

    Berndt, Emily; Stano, Geoffrey; Fuell, Kevin; Leroy, Anita; Mcgrath, Kevin; Molthan, Andrew; Schultz, Lori; Smith, Matthew; White, Kris; Schultz, Christopher; hide

    2017-01-01

    The Short-term Prediction Research and Transition (SPoRT) Center is funded by NASA's Earth Science Division and NOAA's JPSS and GOES-R Proving Grounds to transition satellite products and capabilities to the NWS to improve short term (0-48 hr) forecasts on a regional and local scale. SPoRT currently collaborates with 30+ NWS WFOs (at least one in each NWS region) and 5 National Centers/Testbeds. SPoRT matches user-identified forecast challenges to specific products, providing access to these data in AWIPS through new plug-in development, and generating applications-based training to use the products for their needs (R20). Upon transition, SPoRT collaborates with the user to assess the product impact in a real-world environment for feedback to product developers (O2R) and to benefit their peers.

  11. Calculus using proximities: a mathematical approach in which students can actually prove theorems

    Directory of Open Access Journals (Sweden)

    O’Donovan Richard

    2017-02-01

    Full Text Available Teaching and learning calculus are notoriously difficult and the didactic solutions may involve resorting to intuitive but vague definitions or informal gestures offered as proofs. The teaching literature is rife with examples of metaphors, adverb manipulations and descriptions of what happens “just before” the limit. It is then difficult to leave the domain of the mental image, thus losing the training in rigour. The author (with Karel Hrbacek and Olivier Lessmann has endeavoured a radically different approach with the objective of training students to prove theorems while preserving both intuition and mathematical rigour. Hence we change the mathematical setting rather than the didactic setting. The result (which is a by-product of nonstandard analysis has been used in several high schools in Geneva – Switzerland – for over ten years.

  12. NOAA's Joint Polar Satellite System's Proving Ground and Risk Reduction Program - Bringing New Capabilities to Operations!

    Science.gov (United States)

    Sjoberg, B.

    2015-12-01

    This presentation will focus on the NOAA Joint Polar Satellite System (JPSS) Program's Proving Ground and Risk Reduction (PGRR) initiative and how it has prepared NOAA users to effectively utilize new polar-orbiting capabilities. The PGRR Program was established in 2012, following the launch of the Suomi National Polar Partnership (SNPP) satellite. Two sets of PGRR Projects have been established grouped together in thirteen different initiatives. Details about how these projects have been continually tailored through the years to meet user requirements, will be highlighted. The presenter will focus on how the success of the first set of PGRR projects have been used to evaluate a follow-on set of projects and focus on exactly what the JPSS user community needs to meet their mission requirements. Details on the Dec 2014 PGRR Call-for-Proposals and the projects selected for funding will be discussed.

  13. An Abstract Model for Proving Safety of Multi-lane Traffic Manoeuvres

    DEFF Research Database (Denmark)

    Hilscher, Martin; Linker, Sven; Olderog, Ernst-Rüdiger

    2011-01-01

    We present an approach to prove safety (collision freedom) of multi-lane motorway traffic with lane-change manoeuvres. This is ultimately a hybrid verification problem due to the continuous dynamics of the cars. We abstract from the dynamics by introducing a new spatial interval logic based...... on the view of each car. To guarantee safety, we present two variants of a lane-change controller, one with perfect knowledge of the safety envelopes of neighbouring cars and one which takes only the size of the neighbouring cars into account. Based on these controllers we provide a local safety proof...... for unboundedly many cars by showing that at any moment the reserved space of each car is disjoint from the reserved space of any other car....

  14. Fractal geometry as a new approach for proving nanosimilarity: a reflection note.

    Science.gov (United States)

    Demetzos, Costas; Pippa, Natassa

    2015-04-10

    Nanosimilars are considered as new medicinal outcomes combining the generic drugs and the nanocarrier as an innovative excipient, in order to evaluate them as final products. They belong to the grey area - concerning the evaluation process - between generic drugs and biosimilar medicinal products. Generic drugs are well documented and a huge number of them are in market, replacing effectively the off-patent drugs. The scientific approach for releasing them to the market is based on bioequivalence studies, which are well documented and accepted by the regulatory agencies. On the other hand, the structural complexity of biological/biotechnology-derived products demands a new approach for the approval process taking into consideration that bioequivalence studies are not considered as sufficient as in generic drugs, and new clinical trials are needed to support their approval process of the product to the market. In proportion, due to technological complexity of nanomedicines, the approaches for proving the statistical identity or the similarity for generic and biosimilar products, respectively, with those of prototypes, are not considered as effective for nanosimilar products. The aim of this note is to propose a complementary approach which can provide realistic evidences concerning the nanosimilarity, based on fractal analysis. This approach is well fit with the structural complexity of nanomedicines and smooths the difficulties for proving the similarity between off-patent and nanosimilar products. Fractal analysis could be considered as the approach that completely characterizes the physicochemical/morphological characteristics of nanosimilar products and could be proposed as a start point for a deep discussion on nanosimilarity. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Fake News: A Technological Approach to Proving the Origins of Content, Using Blockchains.

    Science.gov (United States)

    Huckle, Steve; White, Martin

    2017-12-01

    In this article, we introduce a prototype of an innovative technology for proving the origins of captured digital media. In an era of fake news, when someone shows us a video or picture of some event, how can we trust its authenticity? It seems that the public no longer believe that traditional media is a reliable reference of fact, perhaps due, in part, to the onset of many diverse sources of conflicting information, via social media. Indeed, the issue of "fake" reached a crescendo during the 2016 U.S. Presidential Election, when the winner, Donald Trump, claimed that The New York Times was trying to discredit him by pushing disinformation. Current research into overcoming the problem of fake news does not focus on establishing the ownership of media resources used in such stories-the blockchain-based application introduced in this article is technology that is capable of indicating the authenticity of digital media. Put simply, using the trust mechanisms of blockchain technology, the tool can show, beyond doubt, the provenance of any source of digital media, including images used out of context in attempts to mislead. Although the application is an early prototype and its capability to find fake resources is somewhat limited, we outline future improvements that would overcome such limitations. Furthermore, we believe that our application (and its use of blockchain technology and standardized metadata) introduces a novel approach to overcoming falsities in news reporting and the provenance of media resources used therein. However, while our application has the potential to be able to verify the originality of media resources, we believe that technology is only capable of providing a partial solution to fake news. That is because it is incapable of proving the authenticity of a news story as a whole. We believe that takes human skills.

  16. 76 FR 50771 - Submission for Review: RI 25-37, Evidence To Prove Dependency of a Child, 3206-0206

    Science.gov (United States)

    2011-08-16

    ... MANAGEMENT Submission for Review: RI 25-37, Evidence To Prove Dependency of a Child, 3206-0206 AGENCY: U.S... Dependency of a Child. As required by the Paperwork Reduction Act of 1995 (Pub. L. 104-13, 44 U.S.C. chapter.... SUPPLEMENTARY INFORMATION: Evidence to Prove Dependency of a Child is designed to collect sufficient information...

  17. Outperforming whom? A multilevel study of performance-prove goal orientation, performance, and the moderating role of shared team identification.

    Science.gov (United States)

    Dietz, Bart; van Knippenberg, Daan; Hirst, Giles; Restubog, Simon Lloyd D

    2015-11-01

    Performance-prove goal orientation affects performance because it drives people to try to outperform others. A proper understanding of the performance-motivating potential of performance-prove goal orientation requires, however, that we consider the question of whom people desire to outperform. In a multilevel analysis of this issue, we propose that the shared team identification of a team plays an important moderating role here, directing the performance-motivating influence of performance-prove goal orientation to either the team level or the individual level of performance. A multilevel study of salespeople nested in teams supports this proposition, showing that performance-prove goal orientation motivates team performance more with higher shared team identification, whereas performance-prove goal orientation motivates individual performance more with lower shared team identification. Establishing the robustness of these findings, a second study replicates them with individual and team performance in an educational context. (c) 2015 APA, all rights reserved).

  18. Air monitoring for volatile organic compounds at the Pilot Plant Complex, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, J.F.; O`Neill, H.J.; Raphaelian, L.A.; Tomczyk, N.A.; Sytsma, L.F.; Cohut, V.J.; Cobo, H.A.; O`Reilly, D.P.; Zimmerman, R.E.

    1995-03-01

    The US Army`s Aberdeen Proving Ground has been a test site for a variety of munitions, including chemical warfare agents (CWA). The Pilot Plant Complex (PPC) at Aberdeen was the site of development, manufacture, storage, and disposal of CWA. Deterioration of the buildings and violations of environmental laws led to closure of the complex in 1986. Since that time, all equipment, piping, and conduit in the buildings have been removed. The buildings have been declared free of surface CWA contamination as a result of air sampling using the military system. However, no air sampling has been done to determine if other hazardous volatile organic compounds are present in the PPC, although a wide range of toxic and/or hazardous materials other than CWA was used in the PPC. The assumption has been that the air in the PPC is not hazardous. The purpose of this air-monitoring study was to screen the indoor air in the PPC to confirm the assumption that the air does not contain volatile organic contaminants at levels that would endanger persons in the buildings. A secondary purpose was to identify any potential sources of volatile organic contaminants that need to be monitored in subsequent sampling efforts.

  19. A Tool Use Task Proves Enriching for a Captive Sea Otter (Enhydra lutris

    Directory of Open Access Journals (Sweden)

    Pepper R. Hanna

    2016-05-01

    Full Text Available Environmental enrichment is used to improve an animal’s physical and psychological well-being while housed in a captive environment. Alligood and Leighty (2015 suggested that enrichment that emulates the natural and preferred behaviors of the species may be optimal for improving welfare. Cognitive tasks that mirror challenges in an animal’s natural environment may prove especially beneficial (Washburn, 2015. The present study was designed to determine whether two sea otters (Enhydra lutis, Emma and Buck, were capable of learning to use a novel tool in a novel context. The otters’ time spent engaged with the apparatus was also examined to determine if such a task would be enriching to these animals. Although the sea otters were not successful in solving the tool use task, interaction with the apparatus appeared enriching to Emma. She spent on average 55.4% of each trial at the apparatus, whereas Buck spent only 6.2%. Only Emma’s interaction with the apparatus suggests that this device was very interesting and consequently enriching for her. Cognitive challenges, then, may be enriching even when animals fail to solve the intended problem.

  20. A Mechanically Proved and an Incremental Development of the Session Initiation Protocol INVITE Transaction

    Directory of Open Access Journals (Sweden)

    Rajaa Filali

    2014-01-01

    Full Text Available The Session Initiation Protocol (SIP is an application layer signaling protocol used to create, manage, and terminate sessions in an IP based network. SIP is considered as a transactional protocol. There are two main SIP transactions, the INVITE transaction and the non-INVITE transaction. The SIP INVITE transaction specification is described in an informal way in Request for Comments (RFC 3261 and modified in RFC 6026. In this paper we focus on the INVITE transaction of SIP, over reliable and unreliable transport mediums, which is used to initiate a session. In order to ensure the correctness of SIP, the INVITE transaction is modeled and verified using event-B method and its Rodin platform. The Event-B refinement concept allows an incremental development by defining the studied system at different levels of abstraction, and Rodin discharges almost all proof obligations at each level. This interaction between modeling and proving reduces the complexity and helps in assuring that the INVITE transaction SIP specification is correct, unambiguous, and easy to understand.

  1. An Evaluation of Activated Bismuth Isotopes in Environmental Samples From the Former Western Pacific Proving Grounds

    Energy Technology Data Exchange (ETDEWEB)

    Robison, W.L.; Brunk, J.A.; Jokela, T.A.

    2000-03-21

    {sup 207}Bi (t{sub 1/2}=32.2 y) was generated by activation of weapons material during a few ''clean'' nuclear tests at the U.S. Western Pacific Proving Grounds of Enewetak and Bikini Atolls. The radionuclides first appeared in the Enewetak environment during 1958 and in the environment of Bikini during 1956. Crater sediments from Bikini with high levels of {sup 207}Bi were analyzed by gamma spectrometry in an attempt to determine the relative concentrations of {sup 208}Bi (t{sup 1/2} = 3.68 x 10{sup 5} y). The bismuth isotopes were probably generated during the ''clean'', 9.3 Mt Poplar test held on 7/12/58. The atom ratio of {sup 208}Bi to {sup 207}Bi (R value) ranges from {approx}12 to over 200 in sections of core sediments from the largest nuclear crater at Bikini atoll. The presence of bismuth in the device is suggested to account for R values in excess of 10.

  2. Hydrogeologic and chemical data for the O-Field area, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Nemoff, P.R.; Vroblesky, D.A.

    1989-01-01

    O-Field, located at the Edgewood area of Aberdeen Proving Ground , Maryland, was periodically used for disposal of munitions, waste chemicals, and chemical-warfare agents from World War II through the 1950' s. This report includes various physical, geologic, chemical, and hydrologic data obtained from well-core, groundwater, surface water, and bottom-sediment sampling sites at and near the O-Field disposal area. The data are presented in tables and hydrographs. Three site-location maps are also included. Well-core data include lithologic logs for 11 well- cluster sites, grain-size distributions, various chemical characteristics, and confining unit characteristics. Groundwater data include groundwater chemistry, method blanks for volatile organic carbon, available data on volatile and base/neutral organics, and compilation of corresponding method blanks, chemical-warfare agents, explosive-related products, radionuclides, herbicides, and groundwater levels. Surface-water data include field-measured characteristics; concentrations of various inorganic constituents including arsenic; selected organic constituents with method blanks; detection limits of organics; and a compilation of information on corresponding acids, volatiles, and semivolatiles. Bottom- sediment data include inorganic properties and constituents; organic chemistry; detection limits for organic chemicals; a compilation of information on acids, volatiles, and semivolatiles; and method blanks corresponding to acids, volatiles, and semivolatiles. A set of 15 water- level hydrographs for the period March 1986 through September 1987 also is included in the report. (USGS)

  3. Natural attenuation of chlorinated volatile organic compounds in a freshwater tidal wetland, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Lorah, Michelle M.; Olsen, Lisa D.; Smith, Barrett L.; Johnson, Mark A.; Fleck, William B.

    1997-01-01

    Ground-water contaminant plumes that are flowing toward or currently discharging to wetland areas present unique remediation problems because of the hydrologic connections between ground water and surface water and the sensitive habitats in wetlands. Because wetlands typically have a large diversity of microorganisms and redox conditions that could enhance biodegradation, they are ideal environments for natural attenuation of organic contaminants, which is a treatment method that would leave the ecosystem largely undisturbed and be cost effective. During 1992-97, the U.S. Geological Survey investigated the natural attenuation of chlorinated volatile organic compounds (VOC's) in a contaminant plume that discharges from a sand aquifer to a freshwater tidal wetland along the West Branch Canal Creek at Aberdeen Proving Ground, Maryland. Characterization of the hydrogeology and geochemistry along flowpaths in the wetland area and determination of the occurrence and rates of biodegradation and sorption show that natural attenuation could be a feasible remediation method for the contaminant plume that extends along the West Branch Canal Creek.

  4. Hydrogeology and soil gas at J-Field, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Hughes, W.B.

    1993-01-01

    Disposal of chemical warfare agents, munitions, and industrial chemicals in J-Field, Aberdeen Proving Ground, Maryland, has contaminated soil, groundwater and surface water. Seven exploratory borings and 38 observation wells were drilled to define the hydrogeologic framework at J-Field and to determine the type, extent, and movement of contaminants. The geologic units beneath J-Field consist of Coastal Plain sediments of the Cretaceous Patapsco Formation and Pleistocene Talbot Formation. The Patapsco Formation contains several laterally discontinuous aquifers and confining units. The Pleistocene deposits were divided into 3 hydrogeologic units--a surficial aquifer, a confining unit, and a confined aquifer. Water in the surficial aquifer flows laterally from topographically high areas to discharge areas in marshes and streams, and vertically to the underlying confined aquifer. In offshore areas, water flows from the deeper confined aquifers upward toward discharge areas in the Gunpowder River and Chesapeake Bay. Analyses of soil-gas samples showed high relative-flux values of chlorinated solvents, phthalates, and hydrocarbons at the toxic-materials disposal area, white-phosphorus disposal area, and riot-control-agent disposal area. The highest flux values were located downgradient of the toxic materials and white phosphorus disposal areas, indicating that groundwater contaminants are moving from source areas beneath the disposal pits toward discharge points in the marshes and estuaries. Elevated relative-flux values were measured upgradient and downgradient of the riot-control agent disposal area, and possibly result from soil and (or) groundwater contamination.

  5. Atrial overdriving is beneficial in patients with atrial arrhythmias: first results of the PROVE Study.

    Science.gov (United States)

    Funck, R C; Adamec, R; Lurje, L; Capucci, A; Ritter, P; Shekan, D; Slegers, L C; Tavernier, R; Ishikawa, T

    2000-11-01

    The AF Prevention by Overdriving (PROVE) trial is an ongoing prospective study of the effectiveness of atrial overdrive pacing combined with an Automatic Rest Rate function in the prevention of atrial arrhythmias. All patients who have received a Talent DR 213 pacemaker are eligible for enrollment into the study. After a 1-month monitoring period, the patients are divided into two groups. Group I includes patients with > or = 2 appropriate mode-switch (MS) episodes, or 1 MS episode of > or = 10 minutes, and/or > 300 atrial runs of > 5 beats/month. Group II includes all other patients. The number and duration of atrial arrhythmias are measured the pacemaker's Automatic Interpretation and Data Analysis software (AIDA). Patients' quality-of-life is measured by a validated functional status questionnaire. After having been grouped, the patients are randomly assigned, in a crossover design, to standard DDDR or overdrive pacing + Rest Rate, each programmed for a 3-month period. Preliminary results in 78 patients show a 34% reduction in the mean number of MS, and a mean 48% shortening of the overall duration of the episodes by overdrive pacing + Rest Rate, achieved by a mean 84% prevalence of atrial pacing. Overdrive pacing + Rest Rate was well tolerated and associated with a slight improvement in quality-of-life.

  6. The written mathematical communication profile of prospective math teacher in mathematical proving

    Science.gov (United States)

    Pantaleon, K. V.; Juniati, D.; Lukito, A.; Mandur, K.

    2018-01-01

    Written mathematical communication is the process of expressing mathematical ideas and understanding in writing. It is one of the important aspects that must be mastered by the prospective math teacher as tool of knowledge transfer. This research was a qualitative research that aimed to describe the mathematical communication profile of the prospective mathematics teacher in mathematical proving. This research involved 48 students of Mathematics Education Study Program; one of them with moderate math skills was chosen as the main subject. Data were collected through tests, assignments, and task-based interviews. The results of this study point out that in the proof of geometry, the subject explains what is understood, presents the idea in the form of drawing and symbols, and explains the content/meaning of a representation accurately and clearly, but the subject can not convey the argument systematically and logically. Whereas in the proof of algebra, the subject describes what is understood, explains the method used, and describes the content/meaning of a symbolic representation accurately, systematically, logically, but the argument presented is not clear because it is insufficient detailed and complete.

  7. Search for diagnostic proteins to prove authenticity of organic wheat grains (Triticum aestivum L.).

    Science.gov (United States)

    Zörb, Christian; Betsche, Thomas; Langenkämper, Georg

    2009-04-08

    Research comparing the biochemical composition of wheat grains from organic or conventional agriculture has used the targeted analytical approach. To obtain a more comprehensive record of the food's composition, we employed protein profiling techniques. Levels of 1049 proteins were recorded in wheat grains (Triticum aestivum L., cv. Titlis) of two growing seasons from a rigorously controlled field trial in Switzerland, containing organic and conventional plots. Levels of 25 proteins were different between organic and conventional wheat in both years. Storage proteins, enzymes of carbohydrate metabolism, a peroxidase, and proteins of unknown function were affected by the agricultural regime. Total protein content was lower in organic wheat. We consider these differences negligible with regard to nutrition in an average diet and propose that food quality of conventional and organic wheat grown in the field trial was equal. Applying various filters and calculations, one of which takes seasonal influences into account, 16 of the 25 proteins with different levels in organic and conventional wheat were retained. These 16 "diagnostic" proteins have the potential to afford a signature to prove authenticity of organic wheat.

  8. Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

    Directory of Open Access Journals (Sweden)

    Ihsan M. Ajeena

    2013-01-01

    Full Text Available Introduction. Carpal tunnel syndrome (CTS is the most commonly diagnosed entrapment neuropathy of the upper extremity. The objective of this study was to diagnose CTS and to assess its severity using high resolution ultrasound (HRUS depending on the results of nerve conduction study (NCS. Methods. A prospective cross-sectional study, in which HRUS was performed at 63 wrists of 35 female patients with different severity of CTS (as proved by NCS. Furthermore, 40 healthy volunteers (80 wrists underwent the same tests as the patients and have been chosen to match the patients in gender, age, and body mass index (BMI. The cross section area (CSA of the median nerve (MN was obtained using HRUS at the carpal tunnel inlet by direct tracing method. Results. There was a significant difference in the CSA of the MN at the tunnel inlet in CTS patients when compared with the control group. In fact, the CSA of the control group showed a significant difference from each of patients subgroups. Furthermore, a significant difference in the CSA was seen in between these subgroups. In conclusion, the US examination of the MN seems to be a promising method in diagnosing and grading of carpal tunnel syndrome.

  9. Contamination source review for Building E2370, Edgewood Area, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    O`Reilly, D.P.; Glennon, M.A.; Draugelis, A.K.; Rueda, J.; Zimmerman, R.E.

    1995-09-01

    The US Army Aberdeen Proving Ground (APG) commissioned Argonne National Laboratory (ANL) to conduct a contamination source review to identify and define areas of toxic or hazardous contaminants and to assess the physical condition and accessibility of APG buildings. The information obtained from this review may be used to assist the US Army in planning for the future use or disposition of the buildings. The contamination source review consisted of the following tasks: historical records search, physical inspection, photographic documentation, and geophysical investigation. This report provides the results of the contamination source review for Building E2370. Many of the APG facilities constructed between 1917 and the 1960s are no longer used because of obsolescence and their poor state of repair. Because many of these buildings were used for research, development, testing, and/or pilot-scale production of chemical warfare agents and other military substances, the potential exists for portions of the buildings to be contaminated with these substances, their degradation products, and other laboratory or industrial chemicals. These buildings and associated structures or appurtenances may contribute to environmental concerns at APG.

  10. Contamination source review for Building E1489, Edgewood Area, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Billmark, K.A.; Hayes, D.C.; Draugelis, A.K. [and others

    1995-09-01

    This report was prepared by Argonne National Laboratory (ANL) to document the results of a contamination source review of Building E1489 at the Aberdeen Proving Ground (APG) in Maryland. This report may be used to assist the U.S. Army-in planning for the future use or disposition of this building. The review included a historical records search, physical inspection, photographic documentation, and geophysical investigation. The field investigations were performed in 1994-1995. Building E1489 located in J-Field on the Gunpowder Peninsula in APG`s Edgewood Area housed a power generator that supplied electricity to a nearby observation tower. Building E1489 and the generator were abandoned in 1974, demolished by APG personnel and removed from real estate records. A physical inspection and photographic documentation of Building E1489 were completed by ANL staff during November 1994. In 1994, ANL staff conducted geophysical surveys in the immediate vicinity of Building E1489 by using several nonintrusive methods. Survey results suggest the presence of some underground objects near Building E1489, but they do not provide conclusive evidence of the source of geophysical anomalies observed during the survey. No air monitoring was conducted at the site, and no information on underground storage tanks associated with Building E1489 was available.

  11. Contamination source review for Building E3180, Edgewood Area, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Zellmer, S.D.; Smits, M.P.; Rueda, J.; Zimmerman, R.E.

    1995-09-01

    This report was prepared by Argonne National Laboratory (ANL) to document the results of a contamination source review of Building E3180 at the Aberdeen Proving Ground (APG) in Maryland. The report may be used to assist the US Army in planning for the future use or disposition of this building. The review included a historical records search, physical inspection, photographic documentation, geophysical investigation, collection of air samples, and review of available records regarding underground storage tanks associated with Building E3180. The field investigations were performed by ANL during 1994. Building,E3180 (current APG designation) is located near the eastern end of Kings Creek Road, north of Kings Creek, and about 0.5 miles east of the airstrip within APG`s Edgewood Area. The building was constructed in 1944 as a facsimile of a Japanese pillbox and used for the development of flame weapons systems until 1957 (EAI Corporation 1989). The building was not used from 1957 until 1965, when it was converted and used as a flame and incendiary laboratory. During the 1970s, the building was converted to a machine (metal) shop and used for that purpose until 1988.

  12. Contamination source review for Building E6891, Edgewood Area, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Zellmer, S.D.; Draugelis, A.K.; Rueda, J.; Zimmerman, R.E.

    1995-09-01

    The US Army Aberdeen Proving Ground (APG) commissioned Argonne National Laboratory (ANL) to conduct a contamination source review to identify and define areas of toxic or hazardous contaminants and to assess the physical condition and accessibility of various APG buildings. This report provides the results of the contamination source review for Building E6891. The information obtained from this review may be used to assist the US Army in planning for the future use or disposition of the buildings. The contamination source review consisted of the following tasks: historical records search, physical inspection, photographic documentation, geophysical investigation, and collection of air samples. This building is part of the Lauderick Creek Concrete Slab Test Site, located in the Lauderick Creek Area in the Edgewood Area. Many of the APG facilities constructed between 1917 and the 1960s are no longer used because of obsolescence and their poor state of repair. Because many of these buildings were used for research, development, testing, and/or pilot-scale production of chemical warfare agents and other military substances the potential exists` for portions of the buildings to be contaminated with these substances, their degradation products, and other laboratory or industrial chemicals. These buildings and associated structures or appurtenances may contribute to environmental concerns at APG.

  13. Contamination source review for Building E3162, Edgewood Area, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.A.; Draugelis, A.K.; Rueda, J.; Zimmerman, R.E.

    1995-09-01

    This report was prepared by Argonne National Laboratory (ANL) to document the results of a contamination source review for Building E3162 at the Aberdeen Proving Ground (APG) in Maryland. The report may be used to assist the US Army in planning for the future use or disposition of this building. The review included a historical records search, physical inspection, photographic documentation, geophysical investigation, and collection of air samples. The field investigations were performed by ANL during 1994 and 1995. Building E3162 (APG designation) is part of the Medical Research Laboratories Building E3160 Complex. This research laboratory complex is located west of Kings Creek, east of the airfield and Ricketts Point Road, and south of Kings Creek Road in the Edgewood Area of APG. The original structures in the E3160 Complex were constructed during World War 2. The complex was originally used as a medical research laboratory. Much of the research involved wound assessment involving chemical warfare agents. Building E3162 was used as a holding and study area for animals involved in non-agent burns. The building was constructed in 1952, placed on inactive status in 1983, and remains unoccupied. Analytical results from these air samples revealed no distinguishable difference in hydrocarbon and chlorinated solvent levels between the two background samples and the sample taken inside Building E3162.

  14. Review of analytical results from the proposed agent disposal facility site, Aberdeen Proving Ground

    Energy Technology Data Exchange (ETDEWEB)

    Brubaker, K.L.; Reed, L.L.; Myers, S.W.; Shepard, L.T.; Sydelko, T.G.

    1997-09-01

    Argonne National Laboratory reviewed the analytical results from 57 composite soil samples collected in the Bush River area of Aberdeen Proving Ground, Maryland. A suite of 16 analytical tests involving 11 different SW-846 methods was used to detect a wide range of organic and inorganic contaminants. One method (BTEX) was considered redundant, and two {open_quotes}single-number{close_quotes} methods (TPH and TOX) were found to lack the required specificity to yield unambiguous results, especially in a preliminary investigation. Volatile analytes detected at the site include 1, 1,2,2-tetrachloroethane, trichloroethylene, and tetrachloroethylene, all of which probably represent residual site contamination from past activities. Other volatile analytes detected include toluene, tridecane, methylene chloride, and trichlorofluoromethane. These compounds are probably not associated with site contamination but likely represent cross-contamination or, in the case of tridecane, a naturally occurring material. Semivolatile analytes detected include three different phthalates and low part-per-billion amounts of the pesticide DDT and its degradation product DDE. The pesticide could represent residual site contamination from past activities, and the phthalates are likely due, in part, to cross-contamination during sample handling. A number of high-molecular-weight hydrocarbons and hydrocarbon derivatives were detected and were probably naturally occurring compounds. 4 refs., 1 fig., 8 tabs.

  15. Prefixation Ability Index and Verbal Grammar Correlation Index prove the reality of Buyeo group

    Directory of Open Access Journals (Sweden)

    Alexander AKULOV

    2016-06-01

    Full Text Available All suggestions about reality of Buyeo group were based on the representation of a language as a heap of lexemes: such method allows different scholars to make different conclusions and doesn't suppose verification. Language is first of all structure/grammar, but not a heap of lexemes, so methods of comparative linguistics should be based on comparison of grammars. Prefixation Ability Index (PAI and Verbal Grammar Correlation Index (VGCI are typology based tools of comparative linguistics. PAI allows us to see whether languages are potentially related: if values of PAI differ more than fourfold, it's a sign of unrelatedness, if PAI values differ less than fourfold, there is a possibility for some further search to find proves of relatedness. VGCI completely answers questions about relatedness/unrelatedness: if VGCI value is 0.4 and more then languages are related, if VGCI is 0.3 and less then  languages are unrelated. PAI of Japanese is 0.13, PAI of Korean is 0.13; it means they can be related. VGCI of Japanese and Korean is 0.57, it's almost the same as VGCI of English and Afrikaans that is 0.56, so it means that Japanese and Korean belong to the same group, but not just to the same family.

  16. Remedial investigation report for J-Field, Aberdeen Proving Ground, Maryland. Volume 1: Remedial investigation results

    Energy Technology Data Exchange (ETDEWEB)

    Yuen, C. R.; Martino, L. E.; Biang, R. P.; Chang, Y. S.; Dolak, D.; Van Lonkhuyzen, R. A.; Patton, T. L.; Prasad, S.; Quinn, J.; Rosenblatt, D. H.; Vercellone, J.; Wang, Y. Y.

    2000-03-14

    This report presents the results of the remedial investigation (RI) conducted at J-Field in the Edgewood Area of Aberdeen Proving Ground (APG), a U.S. Army installation located in Harford County, Maryland. Since 1917, activities in the Edgewood Area have included the development, manufacture, and testing of chemical agents and munitions and the subsequent destruction of these materials at J-Field by open burning and open detonation. These activities have raised concerns about environmental contamination at J-Field. This RI was conducted by the Environmental Conservation and Restoration Division, Directorate of Safety, Health and Environmental Division of APG, pursuant to requirements outlined under the Comprehensive Environmental Response, Compensation, and Liability Act, as amended (CERCLA). The RI was accomplished according to the procedures developed by the U.S. Environmental Protection Agency (EPA 1988). The RI provides a comprehensive evaluation of the site conditions, nature of contaminants present, extent of contamination, potential release mechanisms and migration pathways, affected populations, and risks to human health and the environment. This information will be used as the basis for the design and implementation of remedial actions to be performed during the remedial action phase, which will follow the feasibility study (FS) for J-Field.

  17. Research of Pre-Service Elementary Mathematics Teachers’ Beliefs in Proof, Proving Processes and Proof Evaluation Processes

    Directory of Open Access Journals (Sweden)

    Candaş Uygan

    2014-08-01

    Full Text Available The purpose of this study is to research pre-service elementary mathematics teachers’ beliefs on meaning and features of mathematical proof, their proving processes and their reasoning process while evaluating validities of proof examples. This study is a qualitative research. Participants of the study are three pre-service elementary mathematics teachers who continue to study in a state university from Central Anatolia Region. Participants’ beliefs on proof were researched with semi-structured interview whilst proving processes and evaluation processes of proof examples were researched with clinical interviews. Interviews were recorded with video camera and data were analyzed according to qualitative methods. When beliefs on proof were analyzed, it was indicated that participants see mathematical proofs as problem solving process and exploration of source of mathematical knowledge, and believe that proofs have to be deductive, apprehensible and have to include generalizable results. Also according to opinions of all three participants, they believe that their proving abilities are insufficient. Analyze results related to proving processes indicated that pre-service teachers considered conclusions of theorems as if they are conditions of theorems and also used proving strategies uncomprehendingly in proving process. Finally, analyze results related to proof evaluation process indicated that participants assessed computer based experimental verifications as valid mathematical proofs and had mistakes when they evaluated warrants used in verifications that break axiomatical structure of proofs.Key Words:    Beliefs in the context of proof, proving, proof evaluation, teacher education

  18. Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture (PROVE): study protocol for a randomised controlled trial

    Science.gov (United States)

    2014-01-01

    Background Osteoporosis and vertebral fracture can have a considerable impact on an individual’s quality of life. There is increasing evidence that physiotherapy including manual techniques and exercise interventions may have an important treatment role. This pragmatic randomised controlled trial will investigate the clinical and cost-effectiveness of two different physiotherapy approaches for people with osteoporosis and vertebral fracture, in comparison to usual care. Methods/Design Six hundred people with osteoporosis and a clinically diagnosed vertebral fracture will be recruited and randomly allocated to one of three management strategies, usual care (control - A), an exercise-based physiotherapy intervention (B) or a manual therapy-based physiotherapy intervention (C). Those in the usual care arm will receive a single session of education and advice, those in the active treatment arms (B + C) will be offered seven individual physiotherapy sessions over 12 weeks. The trial is designed as a prospective, adaptive single-blinded randomised controlled trial. An interim analysis will be completed and if one intervention is clearly superior the trial will be adapted at this point to continue with just one intervention and the control. The primary outcomes are quality of life measured by the disease specific QUALLEFO 41 and the Timed Loaded Standing test measured at 1 year. Discussion There are a variety of different physiotherapy packages used to treat patients with osteoporotic vertebral fracture. At present, the indication for each different therapy is not well defined, and the effectiveness of different modalities is unknown. Trial registration Reference number ISRCTN49117867. PMID:24422876

  19. Work plan for conducting an ecological risk assessment at J-Field, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Hlohowskyj, I.; Hayse, J.; Kuperman, R. [Argonne National Lab., IL (United States). Environmental Assessment Div.] [and others

    1995-03-01

    The Environmental Management Division of Aberdeen Proving Ground (APG), Maryland, is conducting a remedial investigation and feasibility study (RI/FS) of the J-Field area at APG pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), as amended. J-Field is within the Edgewood Area of APG in Harford County, Maryland, and activities at the Edgewood Area since World War II have included the development, manufacture, testing, and destruction of chemical agents and munitions. The J-Field site was used to destroy chemical agents and munitions by open burning and open detonation. This work plan presents the approach proposed to conduct an ecological risk assessment (ERA) as part of the RI/FS program at J-Field. This work plan identifies the locations and types of field studies proposed for each area of concern (AOC), the laboratory studies proposed to evaluate toxicity of media, and the methodology to be used in estimating doses to ecological receptors and discusses the approach that will be used to estimate and evaluate ecological risks at J-Field. Eight AOCs have been identified at J-Field, and the proposed ERA is designed to evaluate the potential for adverse impacts to ecological receptors from contaminated media at each AOC, as well as over the entire J-Field site. The proposed ERA approach consists of three major phases, incorporating field and laboratory studies as well as modeling. Phase 1 includes biotic surveys of the aquatic and terrestrial habitats, biological tissue sampling and analysis, and media toxicity testing at each AOC and appropriate reference locations. Phase 2 includes definitive toxicity testing of media from areas of known or suspected contamination or of media for which the Phase 1 results indicate toxicity or adverse ecological effects. In Phase 3, the uptake models initially developed in Phase 2 will be finalized, and contaminant dose to each receptor from all complete pathways will be estimated.

  20. A Prochlorococcus proving ground for constraint-based metabolic modeling and multi-`omics data integration

    Science.gov (United States)

    Casey, J.; Ji, B.; Shaoie, S.; Mardinoglu, A.; Sarathi Sen, P.; Jahn, O.; Reda, K.; Leigh, J.; Follows, M. J.; Nielsen, J.; Karl, D. M.

    2016-02-01

    Representatives of the oligotrophic marine cyanobacterium Prochlorococcus marinus are the smallest free-living photosynthetic organisms, both in terms of physical size and genome size, yet are the most abundant photoautotrophic microbes in the oceans and profoundly influence global biogeochemical cycles. Physiological and regulatory control of nutrient and light stress has been observed in MED4 in culture and in its closely related `ecotype' eMED4 in the field, however its metabolism has not been investigated in detail. We present a genome-scale metabolic network reconstruction of the high-light adapted axenic strain MED4ax ("iJCMED4") for the quantitative analysis of a range of its metabolic phenotypes. The resulting structure is a proving ground for the incorporation of enzyme kinetics, biochemical and elemental compositional data, transcriptomic, proteomic, metabolomic, and fluxomic datasets which can be implemented within a constraint-based metabolic modeling environment. The iJCMED4 stoichiometric model consists of 523 metabolic genes encoding 787 reactions with 673 unique metabolites distributed in 5 sub-cellular compartments and is mass, charge, and thermodynamically balanced. Several variants of flux balance analysis were used to simulate growth and metabolic fluxes over the diel cycle, under various stress conditions (e.g., nitrogen, phosphorus, light), and within the framework of a global biogeochemical model (DARWIN). Model simulations accurately predicted growth rates in culture under a variety of defined medium compositions and there was close agreement of photosynthetic performance, biomass and energy yields and efficiencies, and transporter fluxes for iJCMED4 and culture experiments. In addition to a nearly optimal photosynthetic quotient and central carbon metabolism efficiency, MED4 has made dramatic alterations to redox and phosphorus metabolism across biosynthetic and intermediate pathways. We propose that reductions in phosphate reaction

  1. Benefit of Intensive Statin Therapy in Women: Results from PROVE IT-TIMI 22

    Science.gov (United States)

    Truong, Quynh A.; Murphy, Sabina A; McCabe, Carolyn H.; Armani, Annemarie; Cannon, Christopher P.

    2011-01-01

    Background Despite the known benefit of intensive statin therapy for reducing future cardiovascular events, its effectiveness in women has been questioned by some. Methods and Results In the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) trial, 911 (21.9%) women and 3251 (78.1%) men were randomized to intensive statin (atorvastatin 80 mg) versus standard therapy (pravastatin 40 mg) for a median duration of 2.1 years. The primary endpoint was death, myocardial infarction (MI), unstable angina (UA), revascularization (occurring after 30 days) or stroke. Safety endpoints included elevations in liver function tests, creatine kinase and myalgias/myositis. Women had a reduction in LDL of 42.8% from baseline at 30 days (to a median of 60 mg/dL) in the intensive therapy arm with 88.8% reaching LDL goal of <100 mg/dL and 65.0% with <70 mg/dL as compared with a 16.8% reduction in LDL (to a median of 88 mg/dL) in the standard therapy. Women on intensive statin therapy had a significant 25% relative reduction over standard-dose (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.57-0.99; p=0.04) for primary composite endpoint, compared with a 14% reduction for men (HR 0.86; 95% CI 0.75-0.99; p=0.04), p-interaction=0.38. No differences were observed between genders for safety (all p-interaction ≥0.11). Conclusions This trial provides evidence that both women and men derived benefit from intensive statin therapy following ACS and thus gender should not be a factor in determining who should be treated with intensive statin therapy. PMID:21487089

  2. A theorem proving approach for automatically synthesizing visualizations of flow cytometry data.

    Science.gov (United States)

    Raj, Sunny; Hussain, Faraz; Husein, Zubir; Torosdagli, Neslisah; Turgut, Damla; Deo, Narsingh; Pattanaik, Sumanta; Chang, Chung-Che Jeff; Jha, Sumit Kumar

    2017-06-07

    Polychromatic flow cytometry is a popular technique that has wide usage in the medical sciences, especially for studying phenotypic properties of cells. The high-dimensionality of data generated by flow cytometry usually makes it difficult to visualize. The naive solution of simply plotting two-dimensional graphs for every combination of observables becomes impractical as the number of dimensions increases. A natural solution is to project the data from the original high dimensional space to a lower dimensional space while approximately preserving the overall relationship between the data points. The expert can then easily visualize and analyze this low-dimensional embedding of the original dataset. This paper describes a new method, SANJAY, for visualizing high-dimensional flow cytometry datasets. This technique uses a decision procedure to automatically synthesize two-dimensional and three-dimensional projections of the original high-dimensional data while trying to minimize distortion. We compare SANJAY to the popular multidimensional scaling (MDS) approach for visualization of small data sets drawn from a representative set of benchmarks, and our experiments show that SANJAY produces distortions that are 1.44 to 4.15 times smaller than those caused due to MDS. Our experimental results show that SANJAY also outperforms the Random Projections technique in terms of the distortions in the projections. We describe a new algorithmic technique that uses a symbolic decision procedure to automatically synthesize low-dimensional projections of flow cytometry data that typically have a high number of dimensions. Our algorithm is the first application, to our knowledge, of using automated theorem proving for automatically generating highly-accurate, low-dimensional visualizations of high-dimensional data.

  3. Potential health impacts from range fires at Aberdeen Proving Ground, Maryland.

    Energy Technology Data Exchange (ETDEWEB)

    Willians, G.P.; Hermes, A.M.; Policastro, A.J.; Hartmann, H.M.; Tomasko, D.

    1998-03-01

    This study uses atmospheric dispersion computer models to evaluate the potential for human health impacts from exposure to contaminants that could be dispersed by fires on the testing ranges at Aberdeen Proving Ground, Maryland. It was designed as a screening study and does not estimate actual human health risks. Considered are five contaminants possibly present in the soil and vegetation from past human activities at APG--lead, arsenic, trichloroethylene (TCE), depleted uranium (DU), and dichlorodiphenyltrichloroethane (DDT); and two chemical warfare agents that could be released from unexploded ordnance rounds heated in a range fire--mustard and phosgene. For comparison, dispersion of two naturally occurring compounds that could be released by burning of uncontaminated vegetation--vinyl acetate and 2-furaldehyde--is also examined. Data from previous studies on soil contamination at APG are used in conjunction with conservative estimates about plant uptake of contaminants, atmospheric conditions, and size and frequency of range fires at APG to estimate dispersion and possible human exposure. The results are compared with US Environmental Protection Agency action levels. The comparisons indicate that for all of the anthropogenic contaminants except arsenic and mustard, exposure levels would be at least an order of magnitude lower than the corresponding action levels. Because of the compoundingly conservative nature of the assumptions made, they conclude that the potential for significant human health risks from range fires is low. The authors recommend that future efforts be directed at fire management and control, rather than at conducting additional studies to more accurately estimate actual human health risk from range fires.

  4. The Caring School Leadership Questionnaire (CSLQ) | van der ...

    African Journals Online (AJOL)

    The Caring School Leadership Questionnaire (CSLQ) ... emerged from the factor analysis proved to be the same as those theoretically identified as the three main determinants of care. Cronbach's ... Keywords: caring, caring school leadership, determinants of care, management, measuring instrument for caring school

  5. Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE study: findings at 3 months

    Directory of Open Access Journals (Sweden)

    Reddy RK

    2013-09-01

    Full Text Available Rahul K Reddy,1 Maziar Lalezary,1 Stephen J Kim,1 Jeffrey A Kammer,1 Rachel W Kuchtey,1 Edward F Cherney,1 Franco M Recchia,2 Karen M Joos,1 Anita Agarwal,1 Janice C Law11Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN, USA; 2Tennessee Retina, PC, Nashville, TN, USABackground: The purpose of this paper is to report the 3-month findings of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE study.Methods: Eighty eyes of 40 participants undergoing vitrectomy were enrolled. Participants underwent baseline evaluation of the study (surgical and fellow (control eye that included: intraocular pressure, central corneal thickness, gonioscopy, cup-to-disc ratio measurement, color fundus and optic disc photography, automated perimetry, and optical coherence tomography of the macula and optic nerve. Evaluation was repeated at 3 months. Main outcome measures were changes in macula and retinal nerve fiber layer (RNFL thickness and intraocular pressure.Results: All participants completed follow-up. Mean cup-to-disc ratio of study and fellow eyes at baseline was 0.43 ± 0.2 and 0.46 ± 0.2, respectively, and 13% of participants had undiagnosed narrow angles. There was no significant change in intraocular pressure, cup-to-disc ratio, or pattern standard deviation in study eyes compared with baseline or fellow eyes at 3 months. Vision improved in all study eyes at 3 months compared with baseline (P = 0.013, but remained significantly worse than fellow eyes (P < 0.001. Central subfield and temporal peripapillary RNFL thickness were significantly greater in eyes with epiretinal membrane (P < 0.05, and resolution after surgery correlated with visual improvement (P < 0.05.Conclusion: The 3-month results do not indicate any increased risk for open-angle glaucoma but suggest that a relatively high percentage of eyes may be at risk of angle closure glaucoma. Temporal RNFL thickness and central subfield were increased

  6. An Analysis of the Extratropical Transition of Hurricane Arthur (2014) from a JPSS Proving Ground Perspective

    Science.gov (United States)

    Folmer, M. J.; Berndt, E.; Halverson, J. B.; Dunion, J. P.; Goldberg, M.

    2015-12-01

    As part of the GOES-R and JPSS Satellite Proving Grounds, multiple proxy and operational products were available to analyze and forecast the complex evolution of Hurricane Arthur (2014). The National Hurricane Center, Ocean Prediction Center, Weather Prediction Center, and NESDIS Satellite Analysis Branch were able to monitor the tropical and extratropical transition of Arthur using various convective and red, green, blue (RGB) products that have been introduced in recent years. During the extratropical transition, the Air Mass RGB (AM RGB) product and AIRS/CrIS ozone products were available as a compliment to water vapor imagery to identify the upper-level low with associated stratospheric drying that absorbed much of Arthur's energy. The AM RGB product provides forecasters with an enhanced view of various air masses that are combined into a single image and can help differentiate between possible stratospheric/tropospheric interactions, moist tropical air masses, and cool, continental/maritime air masses. Even though this product provides a wealth of qualitative information about the horizontal distribution of synoptic features, forecasters are also interested in more quantitative information such as the vertical distribution of temperature, moisture, and ozone which impact the coloring of the resulting AM RGB. Currently, NOAA Unique CrIS/ATMS Processing System (NUCAPS) temperature and moisture soundings are available in AWIPS-II as a point-based display. Traditionally, soundings are used to anticipate and forecast severe convection, however unique and valuable information can be gained from soundings for other forecasting applications, such as extratropical transition, especially in data sparse regions. Additional research has been conducted to look at how NUCAPS soundings might help forecasters identify the pre-extratropical transition environment, leading to earlier diagnosis and better public advisories. NUCAPS soundings, AIRS soundings, NOAA G-IV GPS

  7. GOES-R Proving Ground Activities at the NASA Short-Term Prediction Research and Transition (SPoRT) Center

    Science.gov (United States)

    Molthan, Andrew

    2011-01-01

    SPoRT is actively involved in GOES-R Proving Ground activities in a number of ways: (1) Applying the paradigm of product development, user training, and interaction to foster interaction with end users at NOAA forecast offices national centers. (2) Providing unique capabilities in collaboration with other GOES-R Proving Ground partners (a) Hybrid GOES-MODIS imagery (b) Pseudo-GLM via regional lightning mapping arrays (c) Developing new RGB imagery from EUMETSAT guidelines

  8. An agromedicine initiative for first-year medical students, 1998-2004: biochemistry seminar proves feasible.

    Science.gov (United States)

    Simpson, William M; Shepard, B Merle; Rushing, James W; Schuman, Stanley H

    2006-01-01

    This report describes a 20 class-hour, 10-session seminar on agromedicine-oriented topics, delivered as part of a basic science course for medical students (biochemistry) at the Medical University of South Carolina. The course was initiated in 1998 and continued through 2004. The preceptors are family medicine and agricultural research professors. Concepts from primary care, epidemiology, entomology, toxicology, and food science appeal strongly to the first-year medical student group (limited to 10 students). The agromedicine/environmental medicine seminar series is one of 16 research seminars available for in-depth study. As part of the course in biochemistry, this seminar has earned positive evaluations from medical students who expect to widen their perspective on global health and the environment. Seminar topics include food safety, farm trauma, nutraceuticals, crop protection, insect-borne disease, occupational health and safety, diet and cancer, birth defects, and bioengineering. Seventy medical students have participated in the interdisciplinary seminar. They perceive environmental science as affecting the health of their patients and as an essential part of their preparation for curative and preventive medicine. Readers may find medical school curriculum committees more receptive to accepting and continuing an agromedicine offering if it can be incorporated in a basic science course such as biochemistry or pharmacology.

  9. Users manual on database of the Piping Reliability Proving Tests at the Japan Atomic Energy Research Institute

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-09-01

    Japan Atomic Energy Research Institute(JAERI) conducted Piping Reliability Proving Tests from 1975 to 1992 based upon the contracts between JAERI and Science and Technology Agency of Japan under the auspices of the special account law for electric power development promotion. The purposes of those tests are to prove the structural reliability of the primary cooling piping constituting a part of the pressure boundary in the water reactor power plants. The tests with large experimental facilities had ended already in 1990. After that piping reliability analysis by the probabilistic method followed until 1992. This report describes the users manual on databases about the test results using the large experimental facilities. Objectives of the piping reliability proving tests are to prove that the primary piping of the water reactor (1) be reliable throughout the service period, (2) have no possibility of rupture, (3) bring no detrimental influence on the surrounding instrumentations or equipments near the break location. The research activities using large scale piping test facilities are described. The present report does the database about the test results pairing the former report. With these two reports, all the feature of Piping Reliability Proving Tests is made clear. Briefings of the tests are described also written in Japanese or English. (author)

  10. E-squared nine do-it-yourself energy experiments that prove your thoughts create your reality

    CERN Document Server

    Grout, Pam

    2013-01-01

    E-Squared is a lab manual with simple experiments to prove once and for all that there really is a good, loving, totally hip force in the universe. Rather than take it on faith, you are invited to conduct ten 48-hour experiments to prove each of the principles in this book. Yes, you read that right. It says prove. The experiments, each of which can be conducted with absolutely no money and very little time expenditure, demonstrate that spiritual principles are as dependable as gravity, as consistent as Newton's 2nd law of motion. For years, you've been hoping and praying that spiritual principles are true. Now, you can know.

  11. Peripartum management of patient with a rare combination of two bleeding diatheses: Recognizing active role of anesthesiologists during preparatory preemptive prepartum multi-disciplinary conference

    Directory of Open Access Journals (Sweden)

    Jeffrey Kangas

    2015-01-01

    Full Text Available To provide optimal medical care to our patients, it is crucial that all members of operating room team have clear understanding of patients′ medical needs and the risks associated with their upcoming surgeries. Multi-disciplinary meetings to establish the best treatment options regarding patient care are not new to medicine. We hereby present a case in which an obstetric patient with a rare combination of two bleeding diathesis was managed using a similar multi-disciplinary approach. A 21-year-old pregnant patient with known von Willebrand′s disease type I and platelet storage pool disorder (dense granule deficiency type: Decreased number of granules per platelet presented to her hematologist for counseling regarding her current pregnancy. Decision was made to convene a multi-disciplinary conference with the panel inclusive of personnel from anesthesiology, adult hematology, pediatric hematology, pediatrics, maternal fetal medicine, obstetrics, pathology and blood bank services along with the patient and her family. The primary concerns of anesthesiologists were whether the patient with rare bleeding diathesis combination can have neuraxial analgesia-anesthesia and how likely the patient may have severe bleeding complications requiring massive blood transfusion protocol. As patient′s von Willebrand factor activity was normal (>150% secondary to pregnancy but platelet function was impaired, the hematologist′s recommendations were that patient should receive transfusion of 5 units random donor platelets prior to labor epidural catheter insertion and 5 units random donor platelets prior to removal of epidural catheter left-in-situ for 24 h postdelivery. Anesthesiologists as perioperative physicians are in a unique position to actively participate in multi-disciplinary approach to perioperative patient care. Complex patient scenarios wherein multiple clinicians are concurrently managing these patients can benefit the most from this approach.

  12. Proving Refinement Using Transduction

    DEFF Research Database (Denmark)

    Jonsson, Bengt; Pnueli, Amir; Rump, Camilla Østerberg

    1999-01-01

    We present a verification method, in which refinement between two systems is proven by constructing a transducer that inputs a computation of a concrete system and outputs a matching computation of the abstract system.......We present a verification method, in which refinement between two systems is proven by constructing a transducer that inputs a computation of a concrete system and outputs a matching computation of the abstract system....

  13. 'God' particle proves elusive

    CERN Document Server

    Radford, T

    2001-01-01

    For more than a decade, scientists at CERN have been hoping that a key theoretical particle called the Higgs boson, would turn up in a subatomic collision. Some of them are now though beginning to wonder if it has ever existed.

  14. A new lower bound for the total domination number in graphs proving a Graffiti.pc Conjecture

    DEFF Research Database (Denmark)

    Henning, Michael A.; Yeo, Anders

    2014-01-01

    the maximum distance in G of a vertex outside B to a vertex of B. The following conjecture is known as Graffiti.pc Conjecture #233 (http://cms.dt.uh.edu/ faculty/delavinae/research/wowII): if G is a connected graph of order at least two, then γt(G)≥2(ecc(B)+1)/3. We prove this conjecture. In fact...

  15. Seismic test facilities at the ENEA Casaccia Research Center; Prove sismiche con le tavole vibranti al centro ricerche Enea Casaccia

    Energy Technology Data Exchange (ETDEWEB)

    De Canio, G. [ENEA, Divisione Servizi Tecnologici, Centro Ricerche Casaccia, Rome (Italy)

    2000-07-01

    The main experimental facilities for seismic tests at the ENEA C.R. Casaccia laboratories consist of two high performance shake table for three axial seismic tests of structures up to 10 ton mass and 3g acceleration applied at the Center of Gravity at 1m from the base table. The activities are principally devoted to the dynamic characterization and vibration tests for mechanical and aero spatial structures, and the experimental analysis of innovative systems for the seismic isolation and retrofitting of civil, industrial, and historical buildings; together with the seismic tests of sub-structures and scaled mock-ups, in order to evaluate the isolation/dissipation performance of the anti-seismic devices, and the failure modes of the structural parts of the building. [Italian] Le principali attrezzature per le prove sismiche presso i laboratori del C.R. Casaccia consistono di due tavole vibranti triassali per prove su strutture fino a 10t di peso con una accelerazione di 3g applicata al centro di gravita' posto ad 1 m di altezza dal piano della tavola. Le principali attivita' riguardano: (a) test di caratterizzazione dinamica e prove di vibrazioni per strutture meccaniche ed aerospaziali; (b) l'analisi sperimentale di sistemi innovativi per l'isolamento sismico ed il consolidamento di strutture civili, industriali e storico monumentali, e le prove sismiche di elementi strutturali e di modelli in scala per la valutazione della capacita' di dissipazione dei dispositivi antisismici e le modalita' di formazione delle fratture.

  16. Legal frame for proving the safety of rail energy supply; Rechtlicher Rahmen fuer den Sicherheitsnachweis bei der Bahnenergieversorgung

    Energy Technology Data Exchange (ETDEWEB)

    Leitzke, C. [Deutsche Bahn AG, Berlin (Germany)

    2008-07-01

    The legal frame for proving the safety of rail energy supply is, as usual in technical and scientific matters, characterized by comparatively abstract expressions in the law and besides by reference to technical standards. Often only a view in the technical standards makes it possible to understand, what must be done to comply with the law and which behaviour must be judged as negligent under the law. For that reason ruling committees for technical standards bear a high responsibility. (orig.)

  17. Finding and proving the exact ground state of a generalized Ising model by convex optimization and MAX-SAT

    Science.gov (United States)

    Huang, Wenxuan; Kitchaev, Daniil A.; Dacek, Stephen T.; Rong, Ziqin; Urban, Alexander; Cao, Shan; Luo, Chuan; Ceder, Gerbrand

    2016-10-01

    Lattice models, also known as generalized Ising models or cluster expansions, are widely used in many areas of science and are routinely applied to the study of alloy thermodynamics, solid-solid phase transitions, magnetic and thermal properties of solids, fluid mechanics, and others. However, the problem of finding and proving the global ground state of a lattice model, which is essential for all of the aforementioned applications, has remained unresolved for relatively complex practical systems, with only a limited number of results for highly simplified systems known. In this paper, we present a practical and general algorithm that provides a provable periodically constrained ground state of a complex lattice model up to a given unit cell size and in many cases is able to prove global optimality over all other choices of unit cell. We transform the infinite-discrete-optimization problem into a pair of combinatorial optimization (MAX-SAT) and nonsmooth convex optimization (MAX-MIN) problems, which provide upper and lower bounds on the ground state energy, respectively. By systematically converging these bounds to each other, we may find and prove the exact ground state of realistic Hamiltonians whose exact solutions are difficult, if not impossible, to obtain via traditional methods. Considering that currently such practical Hamiltonians are solved using simulated annealing and genetic algorithms that are often unable to find the true global energy minimum and inherently cannot prove the optimality of their result, our paper opens the door to resolving longstanding uncertainties in lattice models of physical phenomena. An implementation of the algorithm is available at https://github.com/dkitch/maxsat-ising.

  18. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine.

    Science.gov (United States)

    Sawyer, Taylor; White, Marjorie; Zaveri, Pavan; Chang, Todd; Ades, Anne; French, Heather; Anderson, JoDee; Auerbach, Marc; Johnston, Lindsay; Kessler, David

    2015-08-01

    Acquisition of competency in procedural skills is a fundamental goal of medical training. In this Perspective, the authors propose an evidence-based pedagogical framework for procedural skill training. The framework was developed based on a review of the literature using a critical synthesis approach and builds on earlier models of procedural skill training in medicine. The authors begin by describing the fundamentals of procedural skill development. Then, a six-step pedagogical framework for procedural skills training is presented: Learn, See, Practice, Prove, Do, and Maintain. In this framework, procedural skill training begins with the learner acquiring requisite cognitive knowledge through didactic education (Learn) and observation of the procedure (See). The learner then progresses to the stage of psychomotor skill acquisition and is allowed to deliberately practice the procedure on a simulator (Practice). Simulation-based mastery learning is employed to allow the trainee to prove competency prior to performing the procedure on a patient (Prove). Once competency is demonstrated on a simulator, the trainee is allowed to perform the procedure on patients with direct supervision, until he or she can be entrusted to perform the procedure independently (Do). Maintenance of the skill is ensured through continued clinical practice, supplemented by simulation-based training as needed (Maintain). Evidence in support of each component of the framework is presented. Implementation of the proposed framework presents a paradigm shift in procedural skill training. However, the authors believe that adoption of the framework will improve procedural skill training and patient safety.

  19. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

    Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

  20. The effect of herbal formula PROVE 1 and Stevia levels in diets on diet utilization of growing pigs

    Directory of Open Access Journals (Sweden)

    Kooprasert, S.

    2007-05-01

    Full Text Available The objective of this experiment was to study the effect of 0.2% antibiotic (ascomix-s®, one kilogram of which contains lincomycin hydrochloride 44 g and sulfamethazine 110 g or 0.25% herbal formulaPROVE 1, combined with five levels of Stevia supplementation in the diets on digestibility of pigs. Two factors; 1 type of drug (0.2% antibiotic and 0.25% herbal formula PROVE 1 and 2 five Stevia levels (0,0.2, 0.4, 0.6 and 0.8% were investigated and 10 dietary treatments were used in this study. Ten related growing crossbred (Large White x Landrace barrow pigs (30±1.5 kg body weight were raised in individualmetabolism cages for three collecting periods (30, 40 and 50 kg body weight, each pig was fed one experimental diet throughout the collecting period.The results showed that pigs fed diet with either 0.2% antibiotic or 0.25% herbal formula PROVE 1 had similar digestibility of diet, crude protein (CP, fiber, ash and nitrogen free extract (NFE (89.01 vs 87.83,94.96 vs 94.23, 60.73 vs 59.03, 61.22 vs 60.44 and 93.28 vs 92.03%, respectively. Negligible differences were observed between 0 and 0.4% Stevia supplementation in diet, but levels showed better digestibility than the other levels of Stevia supplementation, and the diet with 0.4% Stevia supplementation had the highestdigestibility of diet, CP, fiber, ash and NFE (91.04, 96.43, 69.48, 70.47 and 94.07%, respectively. The diet with antibiotic combined with 0.4% Stevia had digestibility of diet, CP, fat and fiber better than the otherlevels of Stevia supplementation, especially digestibility of ash, which was significantly higher than that of diet with 0.2% Stevia, but not significantly different from the other levels of Stevia supplementation. A partof herbal formula PROVE1 combined with 0% Stevia had the highest digestibility of ash (72.90%, significantly higher than the other levels of Stevia supplementation, except the diet with herbal formula PROVE 1combined with 0.4% Stevia supplementation

  1. Prepartum Dönemde Sütçü İnek Rasyonlarına Anyonik Tuz İlavesinin Metabolik Profil, Peripartum Hastalıklar ve Gebelik Oranı Üzerine Etkisi

    Directory of Open Access Journals (Sweden)

    Mahmut Çinar

    2015-09-01

    Full Text Available Bu çalışma, prepartum dönemde sütçü inek rasyonlarına anyonik tuz (MgCl2 veya MgSO4 ilavesinin metabolik profil, peripartum hastalıklar ve gebelik oranı üzerine etkilerini belirlemek amacıyla yürütülmüştür. Kırk beş baş Holstein ırkı inek gebeliğin son 3 haftasından başlayarak vücut kondüsyon skorları benzer olan 3 gruba ayrılmıştır. Prepartum dönemde 21 gün süreyle, kontrol grubuna anyonik tuz içermeyen toplam karışım rasyon (TMR yedirilirken, muamele gruplarından birine 30 g/gün/inek MgCl2, diğerine ise 30 g/gün/inek MgSO4 ilave edilen TMR verilmiştir. Postpartum dönemde tüm gruplar tek bir toplam karışım rasyonla beslenmiştir. Postpartum 30. günden sonra gruplardaki ineklere Presynch-Ovsynch senkronizasyon protokolü uygulanmış ve sabit zamanlı tohumlama yapılmıştır. Çalışma postpartum 8. haftada sonlandırılmıştır. Toplam karışım rasyon içerisine MgCl2 ilave edilen grupta, MgSO4 ilave edilen ve kontrol grubuna nazaran süt verimi artmıştır. Anyonik tuz ilavelerinin serum AST ve ALT konsantrasyonlarını azalttığı, serum glukoz, HDL, IgG, Ca ve Mg konsantrasyonlarını arttırdığı belirlenmiştir. Grupların sağlık ve üreme performanslarının benzer olduğu saptanmıştır. Sonuç olarak, prepartum dönemde TMR içerisine anyonik tuz ilave edilmesinin süt verimi ve kan biyokimyasında değişimlere yol açabileceği söylenebilir.

  2. Investigation of soil contamination at the Riot Control Burning Pit area in J-Field, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ying-Ya; Yuen, C.R.; Martino, L.

    1996-05-01

    A remedial investigation was conducted to identify soil contamination in the Riot Control Burning Pit area in J-field, Aberdeen Proving Ground, Maryland. The investigation included geophysical surveys to delineate the filled section of the pit, soil-gas surveys to locate the organic contamination area, field X-ray fluorescence measurements along the burning pit to identify the major metal contamination, and surface and subsurface soil analyses to investigate the nature and extent of contamination. This paper presents the results of this investigation

  3. Feasibility of using damage to body armour as evidence to prove the degree of intent of wounding

    OpenAIRE

    Watson, Celia H.; Parker, Fiona; Horsfall, Ian; Fenne, Paul

    2008-01-01

    It has become standard practice for Police Authorities to issue stab resistant body armour to all officers who are placed at risk of knife assault. Subsequently if the officer is subjected to a knife attack it has been difficult to prove the degree of intent of wounding by a suspect. Arguments that no real harm could be intended, as the officer was protected by armour, are presented in court to mitigate any sentence of intent to wound. Several Police Forces have requested that damaged armour ...

  4. Hydrogeologic, soil, and water-quality data for j-field, Aberdeen Proving Ground, Maryland, 1989-94

    Science.gov (United States)

    Phelan, D.J.

    1996-01-01

    Disposal of chemical-warfare agents, munitions, and industrial chemicals in J-Field, Aberdeen Proving Ground, Maryland, has resulted in ground-water, surface-water, and soil contamination. This report presents data collected by the U.S. Geological Survey from Novembr 1989 through September 1994 as part of a remedial investigation of J-Field in response to the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). Hydrogeologic data, soil-gas and soil-quality data, and water-qualtiy data are included.

  5. Mean of the top ten percent of NDVI values in the Yuma Proving Ground during monsoon season, 1986-2011

    Science.gov (United States)

    Birtwistle, Amy N; Laituri, Melinda J.; Bledsoe, Brian P.; Friedman, Jonathan M.

    2016-01-01

    This study uses growth in vegetation during the monsoon season measured from LANDSAT imagery as a proxy for measured rainfall. NDVI values from 26 years of pre- and post-monsoon season Landsat imagery were derived across Yuma Proving Ground (YPG) in southwestern Arizona, USA. The LANDSAT imagery (1986-2011) was downloaded from USGS’s GlobeVis website (http://glovis.usgs.gov/). Change in NDVI was calculated within a set of 2,843 Riparian Area Polygons (RAPs) up to 1 km in length defined in ESRI ArcMap 10.2.

  6. An exception that proves the rule: recurrence free survival five years after extrapleural pneumonectomy for malignant pleural mesothelioma.

    Science.gov (United States)

    Treasure, Tom; Macbeth, Fergus

    2014-11-18

    Are case reports at all relevant and useful? A case report of an unusual case of mesothelioma prompts a discussion and concludes that they do have a role but that their observations and conclusions need to be treated with care.

  7. Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study.

    Science.gov (United States)

    Grobman, William A; Bailit, Jennifer L; Rice, Madeline Murguia; Wapner, Ronald J; Varner, Michael W; Thorp, John M; Leveno, Kenneth J; Caritis, Steve N; Iams, Jay D; Tita, Alan T; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Tolosa, Jorge E; Van Dorsten, J Peter

    2014-08-01

    The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care. The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided. The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained. Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided. Copyright © 2014 Mosby, Inc. All rights reserved.

  8. Finding and proving the exact ground state of a generalized Ising model by convex optimization and MAX-SAT

    CERN Document Server

    Huang, Wenxuan; Dacek, Stephen; Rong, Ziqin; Urban, Alexander; Cao, Shan; Luo, Chuan; Ceder, Gerbrand

    2016-01-01

    Lattice models, also known as generalized Ising models or cluster expansions, are widely used in many areas of science and are routinely applied to alloy thermodynamics, solid-solid phase transitions, magnetic and thermal properties of solids, and fluid mechanics, among others. However, the problem of finding the true global ground state of a lattice model, which is essential for all of the aforementioned applications, has remained unresolved, with only a limited number of results for highly simplified systems known. In this article, we present the first general algorithm to find the exact ground states of complex lattice models and to prove their global optimality, resolving this fundamental problem in condensed matter and materials theory. We transform the infinite-discrete-optimization problem into a pair of combinatorial optimization (MAX-SAT) and non-smooth convex optimization (MAX-MIN) problems, which provide upper and lower bounds on the ground state energy respectively. By systematically converging th...

  9. Historical wildlife dynamics on Dugway Proving Ground: population and disease trends in jack rabbits over two decades. [Lepus californicus

    Energy Technology Data Exchange (ETDEWEB)

    Eberhardt, L.E.; Van Voris, P.

    1986-08-01

    In an effort to determine whether US Army activities on the Dugway Proving Ground (DPG) have had an impact on resident wildlife, intensive studies have been conducted on the biology and ecology of the black-tailed jack rabbit (Lepus californicus) since 1965. in addition, the incidence of endemic diseases in several species of resident wildlife on the DPG have been studied from the late 1950s through the mid-1970s. The objectives of this report are to: (1) compile and summarize the jack rabbit data and some of the disease information that is presently contained only in annual reports; (2) compare the DPG jack rabbit data to data available on other jack rabbit populations; and (3) analyze the data for unusual or unexplained fluctuations in population densities or in incidence of disease.

  10. Toxicity of sediments surrounding the Gunpowder Neck Superfund Site at Aberdeen Proving Ground, Maryland. Final report, August 1992-December 1993

    Energy Technology Data Exchange (ETDEWEB)

    Haley, M.V.; Anthony, J.S.; Chester, N.A.; Kurnas, C.W.

    1995-07-01

    From the late 1940s through the 1960s, the standard practice for disposing of toxic chemicals at Aberdeen Proving Ground, MD, was open burning. This disposal site has since been placed on the National Priority List (NPt) by U.S. Environmental Protection Agency. In the spring 1992, sediment samples were taken from waterways that surround that disposal area. Chemical analysis and sediment toxicity assays (Ampelisca abdita) were conducted. Toxicity comparison, with sediment leachate from an Adapted Toxicity Characteristic teaching Procedure (ATCLP), were made using Daphnia magna and a fluorescent bacterium Photobacterium phosphoreum in MICROTOX assays. Amphipods showed a wide range of mortality in mud as well as coarser sediments indicating substrate preference is not critical to the outcome of the assay. Toxicity results from the leachates showed the sediments were not toxic to daphnia and MICROTOX assays.

  11. THE OLKHON GEODYNAMIC PROVING GROUND (LAKE BAIKAL: HIGH RESOLUTION SATELLITE DATA AND GEOLOGICAL MAPS OF NEW GENERATION

    Directory of Open Access Journals (Sweden)

    Valentin S. Fedorovsky

    2015-09-01

    Full Text Available The Olkhon region of the Western Pribaikalie is highly attractive for geologists due to the presence of diverse metamorphic complexes and highly complicated combinations of folded structures in this region. The Olkhon region is located within the area of the Pribaikalsky National Park of Russia. At abundant outcrops in the subject area, various geological aspects resulting from the Early Palaeozoic collision system can be studied in detail. By its parameters, the subject area can be considered a «geodynamic proving ground». In recent years, abundant aerospace materials on the area have been accumulated, and long-term field studies resulted in many discoveries and findings which encourage critical revision of the initial conceptions. The material available allows compilation of a new package of geological maps in hard and electronic versions.

  12. JPSS Proving Ground Activities with NASA's Short-term Prediction Research and Transition (SPoRT) Center

    Science.gov (United States)

    Schultz, L. A.; Smith, M. R.; Fuell, K.; Stano, G. T.; LeRoy, A.; Berndt, E.

    2015-12-01

    Instruments aboard the Joint Polar Satellite System (JPSS) series of satellites will provide imagery and other data sets relevant to operational weather forecasts. To prepare current and future weather forecasters in application of these data sets, Proving Ground activities have been established that demonstrate future JPSS capabilities through use of similar sensors aboard NASA's Terra and Aqua satellites, and the S-NPP mission. As part of these efforts, NASA's Short-term Prediction Research and Transition (SPoRT) Center in Huntsville, Alabama partners with near real-time providers of S-NPP products (e.g., NASA, UW/CIMSS, UAF/GINA, etc.) to demonstrate future capabilities of JPSS. This includes training materials and product distribution of multi-spectral false color composites of the visible, near-infrared, and infrared bands of MODIS and VIIRS. These are designed to highlight phenomena of interest to help forecasters digest the multispectral data provided by the VIIRS sensor. In addition, forecasters have been trained on the use of the VIIRS day-night band, which provides imagery of moonlit clouds, surface, and lights emitted by human activities. Hyperspectral information from the S-NPP/CrIS instrument provides thermodynamic profiles that aid in the detection of extremely cold air aloft, helping to map specific aviation hazards at high latitudes. Hyperspectral data also support the estimation of ozone concentration, which can highlight the presence of much drier stratospheric air, and map its interaction with mid-latitude or tropical cyclones to improve predictions of their strengthening or decay. Proving Ground activities are reviewed, including training materials and methods that have been provided to forecasters, and forecaster feedback on these products that has been acquired through formal, detailed assessment of their applicability to a given forecast threat or task. Future opportunities for collaborations around the delivery of training are proposed

  13. Demonstration of the Military Ecological Risk Assessment Framework (MERAF): Apache Longbow - Hell Missile Test at Yuma Proving Ground

    Energy Technology Data Exchange (ETDEWEB)

    Efroymson, R.A.

    2002-05-09

    This ecological risk assessment for a testing program at Yuma Proving Ground, Arizona, is a demonstration of the Military Ecological Risk Assessment Framework (MERAF; Suter et al. 2001). The demonstration is intended to illustrate how risk assessment guidance concerning-generic military training and testing activities and guidance concerning a specific type of activity (e.g., low-altitude aircraft overflights) may be implemented at a military installation. MERAF was developed with funding from the Strategic Research and Development Program (SERDP) of the Department of Defense. Novel aspects of MERAF include: (1) the assessment of risks from physical stressors using an ecological risk assessment framework, (2) the consideration of contingent or indirect effects of stressors (e.g., population-level effects that are derived from habitat or hydrological changes), (3) the integration of risks associated with different component activities or stressors, (4) the emphasis on quantitative risk estimates and estimates of uncertainty, and (5) the modularity of design, permitting components of the framework to be used in various military risk assessments that include similar activities. The particular subject of this report is the assessment of ecological risks associated with a testing program at Cibola Range of Yuma Proving Ground, Arizona. The program involves an Apache Longbow helicopter firing Hellfire missiles at moving targets, i.e., M60-A1 tanks. Thus, the three component activities of the Apache-Hellfire test were: (1) helicopter overflight, (2) missile firing, and (3) tracked vehicle movement. The demonstration was limited, to two ecological endpoint entities (i.e., potentially susceptible and valued populations or communities): woody desert wash communities and mule deer populations. The core assessment area is composed of about 126 km{sup 2} between the Chocolate and Middle Mountains. The core time of the program is a three-week period, including fourteen days of

  14. Long-term fate of depleted uranium at Aberdeen and Yuma Proving Grounds: Human health and ecological risk assessments

    Energy Technology Data Exchange (ETDEWEB)

    Ebinger, M.H.; Beckman, R.J.; Myers, O.B. [Los Alamos National Lab., NM (United States); Kennedy, P.L.; Clements, W.; Bestgen, H.T. [Colorado State Univ., Ft. Collins, CO (United States). Dept. of Fishery and Wildlife Biology

    1996-09-01

    The purpose of this study was to evaluate the immediate and long-term consequences of depleted uranium (DU) in the environment at Aberdeen Proving Ground (APG) and Yuma Proving Ground (YPG) for the Test and Evaluation Command (TECOM) of the US Army. Specifically, we examined the potential for adverse radiological and toxicological effects to humans and ecosystems caused by exposure to DU at both installations. We developed contaminant transport models of aquatic and terrestrial ecosystems at APG and terrestrial ecosystems at YPG to assess potential adverse effects from DU exposure. Sensitivity and uncertainty analyses of the initial models showed the portions of the models that most influenced predicted DU concentrations, and the results of the sensitivity analyses were fundamental tools in designing field sampling campaigns at both installations. Results of uranium (U) isotope analyses of field samples provided data to evaluate the source of U in the environment and the toxicological and radiological doses to different ecosystem components and to humans. Probabilistic doses were estimated from the field data, and DU was identified in several components of the food chain at APG and YPG. Dose estimates from APG data indicated that U or DU uptake was insufficient to cause adverse toxicological or radiological effects. Dose estimates from YPG data indicated that U or DU uptake is insufficient to cause radiological effects in ecosystem components or in humans, but toxicological effects in small mammals (e.g., kangaroo rats and pocket mice) may occur from U or DU ingestion. The results of this study were used to modify environmental radiation monitoring plans at APG and YPG to ensure collection of adequate data for ongoing ecological and human health risk assessments.

  15. Children discharged from neonatal intensive care: implications for the social care networks

    Directory of Open Access Journals (Sweden)

    Maria Licele do Nascimento

    2016-01-01

    Full Text Available Objective: tounderstand the social care networks of children discharged from Neonatal Intensive Care Unit. Methods: qualitative study conducted in the home of six families of seven children. In data collection, authors used the triangulation of techniques with thematic content analysis. Results: family composition is nuclear, social networks are formed by the support of family, leisure and spiritual ties, by school and hospital institutions. The families reported the challenges of caring for a premature baby, and the main care demands were respiratory, motor and cognitive. The non-effective communication between professionals and family showed negative impact on hospitalization and home care. Conclusion:social care networks for children discharged from the Neonatal Intensive Care unit proved to be disjointed and health care for children and family proved to be fragmented.

  16. Durability and service life design of concrete structures. Experiences and the way to prove in The Netherlands

    NARCIS (Netherlands)

    Siemes, A.J.M.; Vrouwenvelder, A.C.W.M.

    2002-01-01

    After the introduction of reinforced concrete it was believed that the material was extremely durable. Soon it was found however, that reinforced concrete could have serious durability problems and that special care should be taken to avoid them. Durability became an issue.

  17. Communication-related allegations against physicians caring for premature infants.

    Science.gov (United States)

    Nguyen, J; Muniraman, H; Cascione, M; Ramanathan, R

    2017-10-01

    Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

  18. 33 CFR 334.730 - Waters of Santa Rosa Sound and Gulf of Mexico adjacent to Santa Rosa Island, Air Force Proving...

    Science.gov (United States)

    2010-07-01

    ... Gulf of Mexico adjacent to Santa Rosa Island, Air Force Proving Ground Command, Eglin Air Force Base... Sound and Gulf of Mexico adjacent to Santa Rosa Island, Air Force Proving Ground Command, Eglin Air... regulations. (1) Experimental test operations will be conducted by the U.S. Air Force within the prohibited...

  19. Seeing a Colleague Encourage a Student to Make an Assumption while Proving: What Teachers Put in Play when Casting an Episode of Instruction

    Science.gov (United States)

    Nachlieli, Talli; Herbst, Patricio

    2009-01-01

    This article reports on an investigation of how teachers of geometry perceived an episode of instruction presented to them as a case of engaging students in proving. Confirming what was hypothesized, participants found it remarkable that a teacher would allow a student to make an assumption while proving. But they perceived this episode in various…

  20. 20 CFR 1002.33 - Does the employee have to prove that the employer discriminated against him or her in order to be...

    Science.gov (United States)

    2010-04-01

    ... employer discriminated against him or her in order to be eligible for reemployment? 1002.33 Section 1002.33... have to prove that the employer discriminated against him or her in order to be eligible for reemployment? No. The employee is not required to prove that the employer discriminated against him or her...

  1. Peripartum pain management in opioid dependent women

    OpenAIRE

    Höflich, Anna S.; Langer, Martin; Jagsch, Reinhold; Bäwert, Andjela; Winklbaur, Bernadette; Fischer, Gabriele; Unger, Annemarie

    2012-01-01

    Increased pain sensitivity and the development of opioid tolerance complicate the treatment of pain experienced by opioid maintained pregnant women during delivery and the perinatal period. The aim of the present study was to investigate differences in pain management of opioid maintained compared to non-dependent pregnant women during delivery and the postpartum period. 40 deliveries of 37 opioid dependent women enrolled in a double-blind, double-dummy randomized controlled trial (RCT) exami...

  2. Peripartum pain management in opioid dependent women.

    Science.gov (United States)

    Höflich, A S; Langer, M; Jagsch, R; Bäwert, A; Winklbaur, B; Fischer, G; Unger, A

    2012-04-01

    Increased pain sensitivity and the development of opioid tolerance complicate the treatment of pain experiencedby opioid maintained pregnantwomenduring delivery and the perinatal period. Theaim of the present study was to investigate differences in pain management of opioid maintained compared to nondependent pregnant women during delivery and the postpartum period. 40 deliveries of 37 opioid dependent women enrolled in a double-blind, double-dummy randomized controlled trial (RCT) examining the safety and efficacy of methadone (mean dose at the time of delivery = 63.89 mg) and buprenorphine (mean dose at the time of delivery = 14.05 mg) during pregnancy were analyzed and participants were matched to a non-dependent comparison group of 80 pregnant women. Differences in pain management (opioid and non-opioid analgesic medication) during delivery and perinatal period were analyzed. Following cesarean delivery opioid maintained women received significantly less opioid analgesics (day of delivery p = 0.038; day 1: p = 0.02), NSAIDs were administered more frequently to opioid dependent patients than to the comparison group during cesarean section and on the third day postpartum. Significantly higher nicotine consumption in the group of opioid dependentwomenhad a strong influence onthe retrieved results, and might be considered as an independent factor of altered pain experience. Differences in pain treatment became evident when comparing opioid maintained women to healthy controls. These differences might be based on psychosocial consequences of opioid addiction along with the lack of an interdisciplinary consensus on pain treatment protocols for opioid dependent patients. © 2011 European Federation of International Association for the Study of Pain Chapters.

  3. Peri-partum and pelvic floor dysfunction.

    Science.gov (United States)

    McClurg, Doreen

    2014-01-01

    Pelvic floor muscles (PFM) are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. Weakened PFM mean the internal organs are not fully supported and can lead to difficulties controlling the release of urine, faeces or flatus. Pregnancy and vaginal birth are a recognised cause of PFM weakness; however it has been shown that PFM exercises, if carried out correctly and routinely, can reduce the severity of symptoms. Midwives need to be pro-active in teaching PFM exercises and identifying women who may need to be referred on for more specialist treatment.

  4. Combining Theorem Proving and Model Checking in the Safety-Critical Software Development through Translating Event-B to SMV

    Directory of Open Access Journals (Sweden)

    Sen Liang

    2017-01-01

    Full Text Available Model checking and theorem proving are two key vertification techniques in the formal method, but each has its advantages and disadvantages. In this paper, we first try to present the general model transformation rules from Event-B to SMV in order to realize complementary advantages, and then design the model converter of Event-B to SMV according to the rules. ProB is the only tool to implement Event-B model checking, but it lacks the real-time property verification, while nuXmv is able to verify temporal logic formulas with the real-time property for SMV models. After completing the model transformation, we use ProB and nuXmv to make the verification of LTL and CTL formulas for two equivalent models respectively. Compared to the experimental results, in solving the same problem, nuXmv has more advantages over memory consumption, time efficiency and so on than ProB, especially when the formula to be verified is very complex. Therefore, if complex verifications of system models need to be performed, it is necessary to implement the model transformation between Event-B and SMV by using our translation rules, which is of great significance for the development, design and verification of safety-critical system softwares.

  5. The “incredible” difficulty of proving “incredibility” – Example of fire-induced multiple spurious operations

    Energy Technology Data Exchange (ETDEWEB)

    Gallucci, Raymond H.V., E-mail: Ray.Gallucci@nrc.gov

    2016-11-15

    “Risk-informed” regulation is often an alternative to “deterministically-based” regulation that offers relaxation in criteria for acceptability while possibly requiring greater analytical effort. “Risk-informed determinism” is an attempt to meld the best of both worlds by using risk information to set deterministic acceptance criteria a priori. A recent joint effort by the US Nuclear Regulatory Commission’s Office of Nuclear Regulatory Research (RES) and Electric Power Research Institute (EPRI) originally endeavored to do this for several examples involving fire-induced multiple spurious operations (MSOs) in electrical circuits at nuclear power plants. While a noble effort, this did not consider the actual distributions involved in the events, originally limiting the analysis to mean values and, in some cases, qualitative considerations. A much more comprehensive and defensible approach is performed here where the probabilistic distributions for all the factors are considered via simulation to meet quantitative acceptance criteria related to the concept of “incredibility” that is often the figure of merit that must be met in a deterministic world. The effort demonstrates that it can be “incredibly” difficult to prove “incredibility” in this context.

  6. Ground-water flow and the potential effects of remediation at Graces Quarters, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Tenbus, F.J.; Fleck, W.B.

    1996-01-01

    Ground water in the east-central part of Graces Quarters, a former open-air chemical-agent test facility at Aberdeen Proving Ground, Maryland, is contaminated with chlorinated volatile organic compounds. The U.S. Geological Survey's finite- difference model was used to help understand ground-water flow and simulate the effects of alternative remedial actions to clean up the ground water. Scenarios to simulate unstressed conditions and three extraction well con- figurations were used to compare alternative remedial actions on the contaminant plume. The scenarios indicate that contaminants could migrate from their present location to wetland areas within 10 years under unstressed conditions. Pumping 7 gal/min (gallons per minute) from one well upgradient of the plume will not result in containment or removal of the highest contaminant concentrations. Pumping 7 gal/min from three wells along the central axis of the plume should result in containment and removal of dissolved contami- nants, as should pumping 7 gal/min from three wells at the leading edge of the plume while injecting 7 gal/min back into an upgradient well.

  7. Temporal and vertical variation of hydraulic head in aquifers in the Edgewood area, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Donnelly, Colleen A.; Tenbus, Fredrick J.

    1998-01-01

    Water-level data and interpretations from previous hydrogeological studies conducted by the U.S. Geological Survey in the Edgewood Area of Aberdeen Proving Ground (APG), Maryland, were compared to determine similarities and differences among the aquifers. Because the sediments that comprise the shallow aquifers are discontinuous, the shallow ground-water-flow systems are local rather than extensive across the Edgewood Area. Hydrogeologic cross sections, hydrographs of water levels, and vertical gradients calculated from previous studies in the Canal Creek area, Graces Quarters, the O-Field area, Carroll Island, and the J-Field area, over periods of record ranging from 1 to 10 years during 1986-97, were used to determine recharge and discharge areas, connections between aquifers, and hydrologic responses of aquifers to natural and anthropogenic stress. Each of the aquifers in the study areas exhibited variation of hydraulic head that was attributed to seasonal changes in recharge. Upward hydraulic gradients and seasonal reversals of vertical hydraulic gradients between aquifers indicate the potential for local ground-water discharge from most of the aquifers that were studied in the Edgewood Area. Hydraulic head in individual aquifers in Graces Quarters and Carroll Island responded to offsite pumping during part of the period of record. Hydraulic head in most of the confined aquifers responded to tidal loading effects from nearby estuaries.

  8. Nonwoven-based gelatin/polycaprolactone membrane proves suitability in a preclinical assessment for treatment of soft tissue defects.

    Science.gov (United States)

    Schulz, Simon; Angarano, Marco; Fabritius, Martin; Mülhaupt, Rolf; Dard, Michel; Obrecht, Marcel; Tomakidi, Pascal; Steinberg, Thorsten

    2014-07-01

    Standard preclinical assessments in vitro often have limitations regarding their transferability to human beings, mainly evoked by their nonhuman and tissue-different/nontissue-specific source. Here, we aimed at employing tissue-authentic simple and complex interactive fibroblast-epithelial cell systems and their in vivo-relevant biomarkers for preclinical in vitro assessment of nonwoven-based gelatin/polycaprolactone membranes (NBMs) for treatment of soft tissue defects. NBMs were composed of electrospun gelatin and polycaprolactone nanofiber nonwovens. Scanning electron microscopy in conjunction with actin/focal contact integrin fluorescence revealed successful adhesion and proper morphogenesis of keratinocytes and fibroblasts, along with cells' derived extracellular matrix deposits. The "feel-good factor" of cells under study on the NBM was substantiated by forming a confluent connective tissue entity, which was concomitant with a stratified epithelial equivalent. Immunohistochemistry proved tissue authenticity over time by abundance of the biomarker vimentin in the connective tissue entity, and chronological increase of keratins KRT1/10 and involucrin expression in epithelial equivalents. Suitability of the novel NBM as wound dressing was evidenced by an almost completion of epithelial wound closure in a pilot mini-pig study, after a surgical intervention-caused gingival dehiscence. In summary, preclinical assessment by tissue-authentic cell systems and the animal pilot study revealed the NBM as an encouraging therapeutic medical device for prospective clinical applications.

  9. Environmental geophysics of the Pilot Plant on the west branch of Canal Creek, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    McGinnis, L.D.; Miller, S.F.; Daudt, C.R.; Thompson, M.D.; Borden, H.; Benson, M. [Argonne National Lab., IL (United States). Reclamation Engineering and Geosciences Section; Wrobel, J. [Directorate of Safety, Health, and Environment, Aberdeen Proving Ground, MD (United States)

    1994-05-01

    Plans to demolish and remediate the Pilot Plant complex in the Edgewood Area of Aberdeen Proving Ground have served to initiate a series of nonintrusive, environmental-geophysical studies. The studies are assisting in the location and identification of pipes, tanks, trenches, and liquid waste in the subsurface. Multiple databases have been integrated to provide support for detection of underground utilities and to determine the stratigraphy and lithology of the subsurface. The studies were conducted within the double security fence and exterior to the double fence, down gradient toward the west branch of Canal Creek. To determine if contaminants found in the creek were associated with the Pilot Plant, both the east and west banks were included in the study area. Magnetic, conductivity, inductive emf, and ground-penetrating-radar anomalies outline buried pipes, trenches, and various pieces of hardware associated with building activities. Ground-penetrating-radar imagery also defines a paleovalley cut 30 ft into Potomac Group sediments of Cretaceous age. The paleovalley crosses the site between Building E5654 and the Pilot Plant fence. The valley is environmentally significant because it may control the pathways of contaminants. The Pilot Plant complex was used to manufacture CC2 Impregnite and incapacitating agents; it also served as a production facility for nerve agents.

  10. Nonwoven-Based Gelatin/Polycaprolactone Membrane Proves Suitability in a Preclinical Assessment for Treatment of Soft Tissue Defects

    Science.gov (United States)

    Schulz, Simon; Angarano, Marco; Fabritius, Martin; Mülhaupt, Rolf; Dard, Michel; Obrecht, Marcel; Tomakidi, Pascal

    2014-01-01

    Standard preclinical assessments in vitro often have limitations regarding their transferability to human beings, mainly evoked by their nonhuman and tissue-different/nontissue-specific source. Here, we aimed at employing tissue-authentic simple and complex interactive fibroblast-epithelial cell systems and their in vivo-relevant biomarkers for preclinical in vitro assessment of nonwoven-based gelatin/polycaprolactone membranes (NBMs) for treatment of soft tissue defects. NBMs were composed of electrospun gelatin and polycaprolactone nanofiber nonwovens. Scanning electron microscopy in conjunction with actin/focal contact integrin fluorescence revealed successful adhesion and proper morphogenesis of keratinocytes and fibroblasts, along with cells' derived extracellular matrix deposits. The “feel-good factor” of cells under study on the NBM was substantiated by forming a confluent connective tissue entity, which was concomitant with a stratified epithelial equivalent. Immunohistochemistry proved tissue authenticity over time by abundance of the biomarker vimentin in the connective tissue entity, and chronological increase of keratins KRT1/10 and involucrin expression in epithelial equivalents. Suitability of the novel NBM as wound dressing was evidenced by an almost completion of epithelial wound closure in a pilot mini-pig study, after a surgical intervention-caused gingival dehiscence. In summary, preclinical assessment by tissue-authentic cell systems and the animal pilot study revealed the NBM as an encouraging therapeutic medical device for prospective clinical applications. PMID:24494668

  11. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Mokkink, H.G.A.; Weel, C. van; Bosch, W.J.H.M. van den

    2012-01-01

    Background: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. Aim: To further examine the validity, discriminative ability, and

  12. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Mokkink, H.G.A.; Weel, C. van; Bosch, W.J.H.M. van den

    2012-01-01

    BACKGROUND: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. AIM: To further examine the validity, discriminative ability, and

  13. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing ... care at the end of life, always includes palliative care. But you may receive palliative care at any ...

  14. Tracheostomy care

    Science.gov (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  15. Caratterizzazione microstrutturale e prove di resilienza su giunti Friction Stir Welding e Linear Friction Welding di compositi a matrice metallica

    Directory of Open Access Journals (Sweden)

    M. Merlin

    2010-04-01

    Full Text Available In questo studio sono stati caratterizzati giunti Friction Stir Welding e Linear Friction Welding su compositi a matrice in lega di alluminio e rinforzo particellare ceramico. Il processo FSW è stato applicato a due compositi ottenuti con processo fusorio, quindi estrusi e trattati termicamente T6: AA6061/20%vol.Al2O3p e AA7005/10%vol.Al2O3p. I giunti LFW sono stati invece realizzati su un composito con matrice in lega di alluminio e rinforzo particellare in carburo di silicio, ottenuto mediante metallurgia delle polveri, quindi forgiato e trattato termicamente T4: AA2124/25%vol.SiCp. Sono stati esaminati gli effetti della saldatura sullecaratteristiche microstrutturali dei giunti, avvalendosi di tecniche di microscopia ottica con analisi di immagine e di microscopia elettronica in scansione (SEM con microsonda a dispersione di energia (EDS. Sono state quindi condotte prove di resilienza con pendolo strumentato Charpy. Lo studio dei meccanismi di danneggiamento è stato effettuato mediante analisi al SEM delle superfici di frattura. Entrambi i processi di saldatura hanno portato a giunti sostanzialmente esenti da difetti. La microstruttura dei cordoni è risultata dipendente sia dalle caratteristiche microstrutturali iniziali dei compositi considerati, sia dalla tipologia di processo di saldatura. Nel caso dei compositi AA6061/20%Al2O3p e AA7005/10%Al2O3p saldati FSW si è osservato un sostanziale incremento di resilienza, rispetto al materiale base, in conseguenza dell’affinamento dei grani della matrice, della riduzione della dimensione media delle particelle di rinforzo e della loro spigolosità, indotte dal processo di saldatura. Il composito AA2124/25%SiCp saldato LFW ha presentato valori di resilienza confrontabili con quelli del materiale base, in conseguenza, soprattutto, dei limitati effetti della saldatura su dimensione e distribuzione delle particelle di rinforzo.

  16. Assessment of volatile organic compounds in surface water at West Branch Canal Creek, Aberdeen Proving Ground, Maryland, 1999

    Science.gov (United States)

    Olsen, Lisa D.; Spencer, Tracey A.

    2000-01-01

    The U.S. Geological Survey (USGS) collected 13 surface-water samples and 3 replicates from 5 sites in the West Branch Canal Creek area at Aberdeen Proving Ground from February through August 1999, as a part of an investigation of ground-water contamination and natural attenuation processes. The samples were analyzed for volatile organic compounds, including trichloroethylene, 1,1,2,2-tetrachloroethane, carbon tetrachloride, and chloroform, which are the four major contaminants that were detected in ground water in the Canal Creek area in earlier USGS studies. Field blanks were collected during the sampling period to assess sample bias. Field replicates were used to assess sample variability, which was expressed as relative percent difference. The mean variability of the surface-water replicate analyses was larger (35.4 percent) than the mean variability of ground-water replicate analyses (14.6 percent) determined for West Branch Canal Creek from 1995 through 1996. The higher variability in surface-water analyses is probably due to heterogeneities in the composition of the surface water rather than differences in sampling or analytical procedures. The most frequently detected volatile organic compound was 1,1,2,2- tetrachloroethane, which was detected in every sample and in two of the replicates. The surface-water contamination is likely the result of cross-media transfer of contaminants from the ground water and sediments along the West Branch Canal Creek. The full extent of surface-water contamination in West Branch Canal Creek and the locations of probable contaminant sources cannot be determined from this limited set of data. Tidal mixing, creek flow patterns, and potential effects of a drought that occurred during the sampling period also complicate the evaluation of surface-water contamination.

  17. Hydrogeologic setting, hydraulic properties, and ground-water flow at the O-Field area of Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Banks, W.S.; Smith, B.S.; Donnelly, C.A.

    1996-01-01

    The U.S. Army disposed chemical agents, laboratory materials, and unexploded ordnance at O-Field in the Edgewood area of Aberdeen Proving Ground, Maryland, from before World War II until at least the 1950's. Soil, ground water, surface water,and wetland sediments in the O-Field area were contaminated from the disposal activity. A ground-water-flow model of the O-Field area was constructed by the U.S. Geological Survey (USGS) in 1989 to simulate flow in the central and southern part of the Gunpowder Neck. The USGS began an additional study of the contamination in the O-Field area in cooperation with the U.S. Army in 1990 to (1) further define the hydrogeologic framework of the O-Field area, (2) characterize the hydraulic properties of the aquifers and confining units, and (3) define ground-water flow paths at O-Field based on the current data and simulations of ground-water flow. A water-table aquifer, an upper confining unit, and an upper confined aquifer comprise the shallow ground-water aquifer system of the O-Field area. A lower confining unit, through which ground-water movement is negligible, is considered a lower boundary to the shallow aquifer system. These units are all part of the Pleistocene Talbot Formation. The model developed in the previous study was redesigned using the data collected during this study and emphasized New O-Field. The current steady-state model was calibrated to water levels of June 1993. The rate of ground-water flow calculated by the model was approximately 0.48 feet per day (ft/d) and the rate determined from chlorofluorocarbon dates was approximately 0.39 ft/d.

  18. Ground-water flow and the possible effects of remedial actions at J-Field, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Hughes, W.B.

    1995-01-01

    J-Field, located in the Edgewood Area of Aberdeen Proving Ground, Md, has been used since World War II to test and dispose of explosives, chemical warfare agents, and industrial chemicals resulting in ground-water, surface-water, and soil contami- nation. The U.S. Geological Survey finite-difference model was used to better understand ground-water flow at the site and to simulate the effects of remedial actions. A surficial aquifer and a confined aquifer were simulated with the model. A confining unit separates these units and is represented by leakance between the layers. The area modeled is 3.65 mi2; the model was constructed with a variably spaced 40 X 38 grid. The horizontal and lower boundaries of the model are all no-flow boundaries. Steady-state conditions were used. Ground water at the areas under investigation flows from disposal pit areas toward discharge areas in adjacent estuaries or wetlands. Simulations indicate that capping disposal areas with an impermeable cover effectively slows advective ground water flow by 0.7 to 0.5 times. Barriers to lateral ground-water flow were simulated and effectively prevented the movement of ground water toward discharge areas. Extraction wells were simulated as a way to contain ground-water contamination and to extract ground water for treatment. Two wells pumping 5 gallons per minute each at the toxic-materials disposal area and a single well pumping 2.5 gallons per minute at the riot-control-agent disposal area effectively contained contamination at these sites. A combi- nation of barriers to horizontal flow east and south of the toxic-materials disposal area, and a single extraction well pumping at 5 gallons per minute can extract contaminated ground water and prevent pumpage of marsh water.

  19. Ex Vivo and In Vivo Mice Models to Study Blastocystis spp. Adhesion, Colonization and Pathology: Closer to Proving Koch's Postulates.

    Directory of Open Access Journals (Sweden)

    Sitara S R Ajjampur

    Full Text Available Blastocystis spp. are widely prevalent extra cellular, non-motile anerobic protists that inhabit the gastrointestinal tract. Although Blastocystis spp. have been associated with gastrointestinal symptoms, irritable bowel syndrome and urticaria, their clinical significance has remained controversial. We established an ex vivo mouse explant model to characterize adhesion in the context of tissue architecture and presence of the mucin layer. Using confocal microscopy with tissue whole mounts and two axenic isolates of Blastocystis spp., subtype 7 with notable differences in adhesion to intestinal epithelial cells (IEC, isolate B (ST7-B and isolate H (more adhesive, ST7-H, we showed that adhesion is both isolate dependent and tissue trophic. The more adhesive isolate, ST7-H was found to bind preferentially to the colon tissue than caecum and terminal ileum. Both isolates were also found to have mucinolytic effects. We then adapted a DSS colitis mouse model as a susceptible model to study colonization and acute infection by intra-caecal inoculation of trophic Blastocystis spp.cells. We found that the more adhesive isolate ST7-H was also a better colonizer with more mice shedding parasites and for a longer duration than ST7-B. Adhesion and colonization was also associated with increased virulence as ST7-H infected mice showed greater tissue damage than ST7-B. Both the ex vivo and in vivo models used in this study showed that Blastocystis spp. remain luminal and predominantly associated with mucin. This was further confirmed using colonic loop experiments. We were also successfully able to re-infect a second batch of mice with ST7-H isolates obtained from fecal cultures and demonstrated similar histopathological findings and tissue damage thereby coming closer to proving Koch's postulates for this parasite.

  20. Ex Vivo and In Vivo Mice Models to Study Blastocystis spp. Adhesion, Colonization and Pathology: Closer to Proving Koch's Postulates.

    Science.gov (United States)

    Ajjampur, Sitara S R; Png, Chin Wen; Chia, Wan Ni; Zhang, Yongliang; Tan, Kevin S W

    2016-01-01

    Blastocystis spp. are widely prevalent extra cellular, non-motile anerobic protists that inhabit the gastrointestinal tract. Although Blastocystis spp. have been associated with gastrointestinal symptoms, irritable bowel syndrome and urticaria, their clinical significance has remained controversial. We established an ex vivo mouse explant model to characterize adhesion in the context of tissue architecture and presence of the mucin layer. Using confocal microscopy with tissue whole mounts and two axenic isolates of Blastocystis spp., subtype 7 with notable differences in adhesion to intestinal epithelial cells (IEC), isolate B (ST7-B) and isolate H (more adhesive, ST7-H), we showed that adhesion is both isolate dependent and tissue trophic. The more adhesive isolate, ST7-H was found to bind preferentially to the colon tissue than caecum and terminal ileum. Both isolates were also found to have mucinolytic effects. We then adapted a DSS colitis mouse model as a susceptible model to study colonization and acute infection by intra-caecal inoculation of trophic Blastocystis spp.cells. We found that the more adhesive isolate ST7-H was also a better colonizer with more mice shedding parasites and for a longer duration than ST7-B. Adhesion and colonization was also associated with increased virulence as ST7-H infected mice showed greater tissue damage than ST7-B. Both the ex vivo and in vivo models used in this study showed that Blastocystis spp. remain luminal and predominantly associated with mucin. This was further confirmed using colonic loop experiments. We were also successfully able to re-infect a second batch of mice with ST7-H isolates obtained from fecal cultures and demonstrated similar histopathological findings and tissue damage thereby coming closer to proving Koch's postulates for this parasite.

  1. Constrained Parameterization of the Multichannel Analysis of Surface Waves Approach with Application at Yuma Proving Ground, Arizona

    Science.gov (United States)

    Schwenk, Jacob Tyler

    Field data from Yuma Proving Ground, Arizona was used to test the feasibility of merging common multichannel analysis of surface waves (MASW) processing routines with mode-consistent shear-wave refraction traveltime tomography and synthetic modeling to optimize and constrain inversion results. Shear-wave first-arrival refraction tomography was used to enhance layer-model resolution and refine the MASW layer model with independent body-wave information. Shear-wave tomograms suggested a high-velocity layer, not found in initial 'smooth' MASW velocity sections that were used as initial models for tomographic inversion. Increasing the stratification of the MASW layer model, to generally match tomogram structure, resulted in a higher-resolution MASW model constrained through joint analysis. This mutual analysis of shear-wave velocity (Vs) provided multiplicity to the structural interpretation of the site. Constrained-parameterization MASW results, compressional-wave tomography (Vp:Vs ratio), and density well logs populated a 2D model for numerical modeling, which was manually updated over several iterations to converge upon the site's first-arrival and dispersion characteristics. Further evaluation of the synthetic seismograms gave insight into the relationship between acquisition geometry (offset selection) and the associated dispersion-image character. Furthermore, modeling gave a secondary measurement on depth to half-space, velocity structure, and relative Vp:Vs ratios, which formulated a final MASW profile. The gradual change of the earth model, given an evolving hierarchy of constraint, is seen as the main finding of this thesis. The calculated movement towards a higher-resolution inversion based on joint geophysical measurements, analysis, and interpretation, engenders a constrained-parameterization solution with highest confidence.

  2. Optimization of ground-water withdrawal at the old O-Field area, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Banks, William S.L.; Dillow, Jonathan J.A.

    2001-01-01

    The U.S. Army disposed of chemical agents, laboratory materials, and unexploded ordnance at the Old O-Field landfill at Aberdeen Proving Ground, Maryland, beginning prior to World War II and continuing until at least the 1950?s. Soil, ground water, surface water, and wetland sediments in the Old O-Field area were contaminated by the disposal of these materials. The site is in the Atlantic Coastal Plain, and is characterized by a complex series of Pleistocene and Holocene sediments formed in various fluvial, estuarine, and marine-marginal hydrogeologic environments. A previously constructed transient finite-difference ground-water-flow model was used to simulate ground-water flow and the effects of a pump-and-treat remediation system designed to prevent contaminated ground water from flowing into Watson Creek (a tidal estuary and a tributary to the Gunpowder River). The remediation system consists of 14 extraction wells located between the Old O-Field landfill and Watson Creek.Linear programming techniques were applied to the results of the flow-model simulations to identify optimal pumping strategies for the remediation system. The optimal management objective is to minimize total withdrawal from the water-table aquifer, while adhering to the following constraints: (1) ground-water flow from the landfill should be prevented from reaching Watson Creek, (2) no extraction pump should be operated at a rate that exceeds its capacity, and (3) no extraction pump should be operated at a rate below its minimum capacity, the minimum rate at which an Old O-Field pump can function. Water withdrawal is minimized by varying the rate and frequency of pumping at each of the 14 extraction wells over time. This minimizes the costs of both pumping and water treatment, thus providing the least-cost remediation alternative while simultaneously meeting all operating constraints.The optimal strategy identified using this objective and constraint set involved operating 13 of the 14

  3. Ground-water and surface-water quality data for the West Branch Canal Creek area, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Spencer, Tracey A.; Phelan, Daniel J.; Olsen, Lisa D.; Lorah, Michelle M.

    2001-01-01

    This report presents ground-water and surface-water quality data from samples collected by the U.S. Geological Survey from November 1999 through May 2001 at West Branch Canal Creek, Aberdeen Proving Ground, Maryland. The report also provides a description of the sampling and analytical methods that were used to collect and analyze the samples, and includes an evaluation of the quality-assurance data. The ground-water sampling network included two 4-inch wells, two 2-inch wells, sixteen 1-inch piezometers, one hundred thirteen 0.75-inch piezometers, two 0.25-inch flexible-tubing piezo-meters, twenty-seven 0.25-inch piezometers, and forty-two multi-level monitoring system depths at six sites. Ground-water profiler samples were collected from nine sites at 34 depths. In addition, passive-diffusion-bag samplers were deployed at four sites, and porous-membrane sampling devices were installed in the upper sediment at five sites. Surface-water samples were collected from 20 sites. Samples were collected from wells and 0.75-inch piezometers for measurement of field parameters and reduction-oxidation constituents, and analysis of inorganic and organic constituents, during three sampling events in March?April and June?August 2000, and May 2001. Surface-water samples were collected from November 1999 through September 2000 during five sampling events for analysis of organic constituents. Ground-water profiler samples were collected in April?May 2000, and analyzed for field measure-ments, reduction-oxidation constituents, and inorganic constituents and organic constituents. Passive-diffusion-bag samplers were installed in September 2000, and samples were analyzed for organic constituents. Multi-level monitoring system samples were collected and analyzed for field measurements and reduction-oxidation con-stituents, inorganic constituents, and organic con-stituents in March?April and June?August 2000. Field measurements and organic constituents were collected from 0.25-inch

  4. Assessment of volatile organic compounds in surface water at Canal Creek, Aberdeen Proving Ground, Maryland, November 1999-September 2000

    Science.gov (United States)

    Phelan, Daniel J.; Olsen, Lisa D.; Senus, Michael P.; Spencer, Tracey A.

    2001-01-01

    The purpose of this report is to describe the occurrence and distribution of volatile organic compounds in surface-water samples collected by the U.S. Geological Survey in the Canal Creek area of Aberdeen Proving Ground, Maryland, from November 1999 through September 2000. The report describes the differences between years with below normal and normal precipitation, the effects of seasons, tide stages, and location on volatile organic compound concentrations in surface water, and provides estimates of volatile organic concentration loads to the tidal Gunpowder River. Eighty-four environmental samples from 20 surface-water sites were analyzed. As many as 13 different volatile organic compounds were detected in the samples. Concentrations of volatile organic compounds in surface-water samples ranged from below the reporting limit of 0.5 micrograms per liter to a maximum of 50.2 micrograms per liter for chloroform. Chloroform was detected most frequently, and was found in 55 percent of the environmental samples that were analyzed for volatile organic compounds (46 of 84 samples). Carbon tetrachloride was detected in 56 percent of the surface-water samples in the tidal part of the creek (34 of 61 samples), but was only detected in 3 of 23 samples in the nontidal part of the creek. 1,1,2,2-Tetrachloroethane was detected in 43 percent of the tidal samples (26 of 61 samples), but was detected at only two nontidal sites and only during November 1999. Three samples were collected from the tidal Gunpowder River about 300 feet from the mouth of Canal Creek in May 2000, and none of the samples contained volatile organic compound concentrations above detection levels. Volatile organic compound concentrations in surface water were highest in the reaches of the creek adjacent to the areas with the highest known levels of ground-water contamination. The load of total volatile organic compounds from Canal Creek to the Gunpowder River is approximately 1.85 pounds per day (0

  5. Simulation of ground-water flow and transport of chlorinated hydrocarbons at Graces Quarters, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Tenbus, Frederick J.; Fleck, William B.

    2001-01-01

    Military activity at Graces Quarters, a former open-air chemical-agent facility at Aberdeen Proving Ground, Maryland, has resulted in ground-water contamination by chlorinated hydrocarbons. As part of a ground-water remediation feasibility study, a three-dimensional model was constructed to simulate transport of four chlorinated hydrocarbons (1,1,2,2-tetrachloroethane, trichloroethene, carbon tetrachloride, and chloroform) that are components of a contaminant plume in the surficial and middle aquifers underlying the east-central part of Graces Quarters. The model was calibrated to steady-state hydraulic head at 58 observation wells and to the concentration of 1,1,2,2-tetrachloroethane in 58 observation wells and 101direct-push probe samples from the mid-1990s. Simulations using the same basic model with minor adjustments were then run for each of the other plume constituents. The error statistics between the simulated and measured concentrations of each of the constituents compared favorably to the error statisticst,1,2,2-tetrachloroethane calibration. Model simulations were used in conjunction with contaminant concentration data to examine the sources and degradation of the plume constituents. It was determined from this that mixed contaminant sources with no ambient degradation was the best approach for simulating multi-species solute transport at the site. Forward simulations were run to show potential solute transport 30 years and 100 years into the future with and without source removal. Although forward simulations are subject to uncertainty, they can be useful for illustrating various aspects of the conceptual model and its implementation. The forward simulation with no source removal indicates that contaminants would spread throughout various parts of the surficial and middle aquifers, with the100-year simulation showing potential discharge areas in either the marshes at the end of the Graces Quarters peninsula or just offshore in the estuaries. The

  6. Inorganic and organic ground-water chemistry in the Canal Creek area of Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Lorah, M.M.; Vroblesky, D.A.

    1989-01-01

    Groundwater chemical data were collected from November 1986 through April 1987 in the first phase of a 5-year study to assess the possibility of groundwater contamination in the Canal Creek area of Aberdeen Proving Ground, Maryland. Water samples were collected from 87 observation wells screened in Coastal Plain sediments; 59 samples were collected from the Canal Creek aquifer, 18 from the overlying surficial aquifer, and 10 from the lower confined aquifer. Dissolved solids, chloride, iron, manganese, fluoride, mercury, and chromium are present in concentrations that exceed the Federal maximum contaminant levels for drinking water. Elevated chloride and dissolved-solids concentrations appear to be related from contaminant plumes but also could result from brackish-water intrusion. Excessive concentrations of iron and manganese were the most extensive water quality problems found among the inorganic constituents and are derived from natural dissolution of minerals and oxide coatings in the aquifer sediments. Volatile organic compounds are present in the Canal Creek and surficial aquifers, but samples from the lower confined aquifer do not show any evidence of contamination by inorganic or organic chemicals. The volatile organic contaminants detected in the groundwater and their maximum concentrations (in micrograms/L) include 1,1,2,2- tetrachloroethane (9,000); carbon tetrachloride (480); chloroform (460); 1,1,2-trichloroethane (80); 1,2-dichloroethane (990); 1,1-dichloroethane (3.1); tetrachloroethylene (100); trichloroethylene (1,800); 1,2-trans- dichloroethylene (1,200); 1,1-dichloroethylene (4.4); vinyl chloride (140); benzene (70); and chlorobenzene (39). On the basis of information on past activities in the study area, some sources of the volatile organic compounds include: (1) decontaminants and degreasers; (2) clothing-impregnating operations; (3) the manufacture of impregnite material; (4) the manufacture of tear gas; and (5) fuels used in garages and at

  7. The Importance of “Corpus Delicti” in Proving “Causation” in Homicide Cases in Nigeria

    Directory of Open Access Journals (Sweden)

    Ngozi Alili

    2017-08-01

    Full Text Available In homicide cases, it may be difficult to prove the cause of death if the body of the victim of an alleged murderous attack is not made available for medical examination. It is therefore obvious that there are instances and circumstances where persons accused of committing the offence of culpable homicide punishable with death take steps to destroy the body of their victims in order to avoid prosecution or conviction and punishment if prosecuted. It would seem that the legal perception and meaning of the body of the deceased in homicide cases otherwise called “corpus delicti” is largely misconstrued by lawyers and laymen alike. This paper examined this identified problem and attempted to correct same and also considered the importance of “corpus delicti” in criminal trials generally and in homicide cases in particular. It also considered the importance and relevance of the legal presumption of death which is of evidential value in both civil and criminal proceedings in bridging the gap that may be created by the absence of corpus delicti. The views of the courts in some decided cases to the effect that it is not in all homicide cases that the prosecution case may fail simply because the body of the deceased was not produced or medically examined, was challenged and it was argued that conviction in homicide cases in the absence of the corpus delicti can only be sustained where evidence of its destruction by the accused is established and this may also require the production of some parts or pieces of what was destroyed. It was observed that corpus delicti and causation are twin legal concepts in criminal law constituting the physical element (octus reus of result offences, such as culpable homicide punishable with death, with the result that one cannot exist in isolation from the other without a resultant miscarriage of justice. The courts were urged to sparingly and cautiously convict persons alleged to have committed culpable homicide

  8. CTP-based tissue outcome. Promising tool to prove the beneficial effect of mechanical recanalization in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Drewer-Gutland, F.; Niederstadt, T.U.; Heindel, W. [University Hospital Muenster (Germany). Inst. for Clinical Radiology; Kemmling, A. [University Hospital Schleswig-Holstein, Luebeck (Germany). Dept. of Neuroradiology; Ligges, S. [Muenster Univ. (Germany). Inst. of Biostatistics and Clinical Research; Ritter, M.; Dziewas, R.; Ringelstein, E.B. [University Hospital Muenster (Germany). Dept. of Neurology; Hesselmann, V. [Asklepios-Clinic North, Hamburg (Germany). Radiology/Neuroradiology

    2015-06-15

    To prove the tissue-protecting effect of mechanical recanalization, we assessed the CT perfusion-based tissue outcome (''TO'') and correlated this imaging parameter with the 3-month clinical outcome (''CO''). 159 patients with large intracranial artery occlusions revealing mechanical recanalization were investigated by CCT, CT angiography (CTA) and CT perfusion (CTP) upon admission. For the final infarct volume, native CCT was repeated after 24h. The ''TO'' (''percentage mismatch loss'' = %ML) was defined as the difference between initial penumbral tissue on CTP and final infarct volume on follow-up CCT. We monitored the three-month modified Rankin Scale (mRS), age, bleeding occurrence, time to recanalization, TICI score and collateralization grade, infarct growth and final infarct volume. Spearman's correlation and nominal regression analysis were used to evaluate the impact of these parameters on mRS Significant correlations were found for %ML and mRS (c=0.48, p<0.001), for final infarct volume and mRS (c=0.52, p<0.001), for TICI score and mRS (c=-0.35, p<0.001), for initial infarct core and mRS (c=0.14, p=0.039) as well as for age and mRS (c=0.37, p<0.001). According to the regression analysis, %ML predicted the classification of mRS correctly in 38.5% of cases. The subclasses mRS 1 and 6 could be predicted by %ML with 86.4% and 60.9% reliability, respectively. No correlations were found for time to recanalization and mRS, for collateralization grade and mRS, and for post-interventional bleeding and mRS. Better than the TICI score, CT-based TO predicts the clinical success of mechanical recanalization, showing that not recanalization, but reperfusion should be regarded as a surrogate parameter for stroke therapy.

  9. Military Base Realignments and Closures: Army is Developing Plans to Transfer Functions from Fort Monmouth, New Jersey, to Aberdeen Proving Ground, Maryland, but Challenges Remain

    National Research Council Canada - National Science Library

    2008-01-01

    ...) close Fort Monmouth, New Jersey, and realign most of its technical functions to Aberdeen Proving Ground, Maryland, as one of 182 recommendations in the 2005 base realignment and closure (BRAC) round...

  10. The Public Stigma of Mental Illness: What Do We Think; What Do We Know; What Can We Prove?

    Science.gov (United States)

    Pescosolido, Bernice

    2015-01-01

    By the 1990s, sociology faced a frustrating paradox. Classic work on mental illness stigma and labeling theory reinforced that the “mark” of mental illness created prejudice and discrimination for individuals and family members. Yet that foundation, coupled with deinstitutionalization of mental health care, produced contradictory responses. Claims that stigma was dissipating were made, while others argued that intervention efforts were needed to reduce stigma. While signaling the critical role of theory-based research in establishing the pervasive effects of stigma, both claims directed resources away from social science research. Yet the contemporary scientific foundation underlying both claims was weak. A reply came in a resurgence of research directed toward mental illness stigma nationally and internationally, bringing together researchers from different disciplines for the first time. The author reports on the general population’s attitudes, beliefs, and behavioral dispositions that targeted public stigma and implications for the next decade of research and intervention efforts. PMID:23325423

  11. The U.S. Army Occupational and Environmental Medicine Residency at Aberdeen Proving Ground, Maryland: 1960-1996.

    Science.gov (United States)

    Gaydos, Joel C; Mallon, Timothy M; Rice, William A

    2016-11-01

    Reorganization of the Army and critical assessment of Army Graduate Medical Education programs prompted the Occupational and Environmental Medicine (OEM) Consultant to the Army Surgeon General to initiate a review of current Army OEM residency training. Available information indicated the Army OEM residency at Aberdeen Proving Ground, MD, was the first and longest operating Army OEM residency. Describing this residency was identified as the first step in the review, with the objectives of determining why the residency was started and sustained and its relevance to the needs of the Army. Records possibly related to the residency were reviewed, starting with 1954 since certification of physicians as Occupation Medicine specialists began in 1955. Interviews were conducted with selected physicians who had strong affiliations with the Army residency and the practice of Army OEM. The Army OEM residency began in 1960 and closed in 1996 with the transfer of Army OEM residency training to the Uniformed Services University of the Health Sciences, Bethesda, MD. Over 36 years, 47 uniformed residency graduates were identified; 44 were from the Army. Forty graduated between 1982 and 1996. The OEM residency was part of a dynamic cycle. Uniformed OEM leaders identified the knowledge and skills required of military OEM physicians and where these people should be stationed in the global Army. Rotations at military sites to acquire the needed knowledge and skills were integrated into the residency. Residency graduates were assigned to positions where they were needed. Having uniformed residents and preceptors facilitated the development of trust with military leaders and access to areas where OEM physician skills and knowledge could have a positive impact. Early reports indicated the residency was important in recruiting and retaining OEM physicians, with emphasis placed on supporting the Army industrial base. The late 1970s into the 1990s was a more dynamic period. There was

  12. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  13. Managed Care

    Science.gov (United States)

    Managed care plans are a type of health insurance. They have contracts with health care providers and ... probably cost more. There are three types of managed care plans: Health Maintenance Organizations (HMO) usually only ...

  14. Anticipatory Caring

    OpenAIRE

    Anna Sandgren, RN, MSc, PhD Candidate; Hans Thulesius, MD, PhD; Kerstin Petersson, RNT, Ph.D.; Bengt Fridlund, RNT, Ph.D.

    2008-01-01

    Today, more and more people die in own homes and nursing homes, which fundamentally affects community nursing. The aim of this study was to develop a grounded theory of palliative home nursing care and we analyzed interviews and data related to the behavior of community nurses caring for palliative cancer patients. Doing Good Care emerged as the pattern of behavior through which nurses deal with their main concern, their desire to do good care. The theory Doing Good Care involves three caring...

  15. Respite Care

    Science.gov (United States)

    ... respite care. Your local AAA will have more information on whether financial assistance is available, depending on your situation and ... home or an assisted living facility. For more information on the NFCSP visit the ... Care is Quality Care? When evaluating a respite care program, family ...

  16. Transitional Care

    Science.gov (United States)

    Naylor, Mary; Keating, Stacen A.

    2008-01-01

    Transitional care encompasses a broad range of services and environments designed to promote the safe and timely passage of patients between levels of health care and across care settings. High-quality transitional care is especially important for older adults with multiple chronic conditions and complex therapeutic regimens, as well as for their…

  17. Anticipatory Caring

    Directory of Open Access Journals (Sweden)

    Anna Sandgren, RN, MSc, PhD Candidate

    2008-11-01

    Full Text Available Today, more and more people die in own homes and nursing homes, which fundamentally affects community nursing. The aim of this study was to develop a grounded theory of palliative home nursing care and we analyzed interviews and data related to the behavior of community nurses caring for palliative cancer patients. Doing Good Care emerged as the pattern of behavior through which nurses deal with their main concern, their desire to do good care. The theory Doing Good Care involves three caring behaviors; anticipatory caring, momentary caring andstagnated caring. In anticipatory caring, which is the optimal caring behavior, nurses are doing their best or even better than necessary, in momentary caring nurses are doing best momentarily and in stagnated caring nurses are doing good but from the perspective of what is expected of them. When nurses fail in doing good, they experience a feeling of letting the patient down, which can lead to frustration and feelings of powerlessness. Depending on the circumstances, nurses can hover between the three different caring behaviors. We suggest that healthcare providers increase the status of palliative care and facilitate for nurses to give anticipatory care by providing adequate resources and recognition.

  18. The Caring School Leadership Questionnaire (CSLQ

    Directory of Open Access Journals (Sweden)

    C.P van der Vyver

    2014-03-01

    Full Text Available The purpose of this research was to develop the Caring School Leadership Questionnaire (CSLQ as a valid and reliable instrument to measure the extent of care being given by school leaders (principals to teachers. The research involved 1,041 teachers and 65 principals from 68 primary schools in the North-West Province of South Africa. The construct validity of the CSLQ was determined by means of a confirmatory factor analysis. The three main constructs regarding caring that emerged from the factor analysis proved to be the same as those theoretically identified as the three main determinants of care. Cronbach's Alpha coefficients furthermore proved the CSLQ to be reliable. The key finding flowing from the investigation was that the CSLQ may be applied with good effect in 180°-, 360°-, as well as self-evaluations of school leaders.

  19. 20 CFR 30.231 - How does a claimant prove employment-related exposure to a toxic substance at a DOE facility or a...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How does a claimant prove employment-related exposure to a toxic substance at a DOE facility or a RECA section 5 facility? 30.231 Section 30.231 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF...

  20. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit

  1. NIDCAP and developmental care

    Directory of Open Access Journals (Sweden)

    Dominique Haumont

    2014-06-01

    Full Text Available Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC, emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs. The Neonatal Individualized Developmental Care Assessment Program (NIDCAP is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  2. Sexual selection favours male parental care, when females can choose.

    Science.gov (United States)

    Alonzo, Suzanne H

    2012-05-07

    Explaining the evolution of male care has proved difficult. Recent theory predicts that female promiscuity and sexual selection on males inherently disfavour male care. In sharp contrast to these expectations, male-only care is often found in species with high extra-pair paternity and striking variation in mating success, where current theory predicts female-only care. Using a model that examines the coevolution of male care, female care and female choice; I show that inter-sexual selection can drive the evolution of male care when females are able to bias mating or paternity towards parental males. Surprisingly, female choice for parental males allows male care to evolve despite low relatedness between the male and the offspring in his care. These results imply that predicting how sexual selection affects parental care evolution will require further understanding of why females, in many species, either do not prefer or cannot favour males that provide care.

  3. Residential Care

    Science.gov (United States)

    ... nursing homes have services and staff to address issues such as nutrition, care planning, recreation, spirituality and medical care. Different nursing homes have different staff-to-resident ratios. Also, ...

  4. Pregnancy care

    Science.gov (United States)

    ... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Pregnancy care URL of this page: //medlineplus.gov/ency/article/007214.htm Pregnancy care To use the sharing ...

  5. Proving the Ocean Nourishment Concept

    Science.gov (United States)

    Jones, I. S.

    2007-12-01

    Vast regions of the sea are barren because of a lack of essential nutrients. Ocean Nourishment is the concept of injecting nutrients into the photic zone of the ocean to store carbon and increase the base of the marine food web. It is elaborated in Jones & Young (1997). The first step in demonstrating this concept is to see if the limiting nutrients can be recognised and provided to the oligotrophic ocean. To this end water samples from three sites were collected in ultraclean polycarbonate culture bottles and enriched with various mixtures of nutrients. They were then placed in a water bath and subjected to natural sunlight for a number of days. Fluorescence levels were measured daily. Previously Thomas (1969) carried out enrichment experiments in and out of high nutrient water in the North Pacific and again Thomas (1970) cultured on the deck of his ship nutrient poor waters in the Pacific. He found nitrogen was the most important limiting nutrient in the poor waters but that micronutrients produced growth in the nutrient rich waters. Ryther and Dunstan (1971) in the Atlantic cultured coastal water with only nitrogen and phosphorus separately. The addition of nitrogen without phosphate produced growth in all cases. To increase the geographic coverage of enrichment experiments, samples were collected off Morocco twice, in the Tasman Sea and in the Sulu Sea. The samples enriched with different concentrations of urea (typically 10 microM) and phosphorous. An increase concentration of chlorophyll is the result of growth of phytoplankton exceeding death and grazing by zooplankton. At five sites an increase of chlorophyll was observed in the macronutrient enriched bottles over that in the control. At the sixth site the control grew at much the same rate as the enriched sample possibly due to contamination by the fluorometer. The maximum chlorophyll level was observed after 4 or 5 days. Replicate samples showed different levels of chlorophyll growths. It was concluded that there were sufficient micronutrients present to support some additional photosynthesis at the sites investigated. These results suggest that it will be practical to nourish broad regions of the ocean to increase primary production. References Jones, I. S. F. and H. E. Young (1997) Engineering a large sustainable world fishery.Environmental Conservation, 24, 99-104. Ryther, J.H. and W. M.Dunstan (1971) Nitrogen, Phosphorus and Eutrophication in the coastal marine environment, Science, 171, 1008-1013. Thomas, W H (1970) Effect of Ammonium and Nitrate Concentration on Chlorophyll increase in Natural Tropical Pacific Phytoplankton Populations, Limnology and Oceanography, 15, 386-394. Thomas, W.H., (1969). Phytoplankton nutrient enrichment experiments off Baja California and in the eastern equatorial Pacific Ocean. J. Fish Res. Bd. Can., 26: 1133-1145. Acknowledgement A Eddington made a number of the obsevations. The Ocean Nourishment Corporation Pty Ltd funded some of the reearch.

  6. Combining norms to prove termination

    DEFF Research Database (Denmark)

    Genaim, S.; Codish, M.; Gallagher, John Patrick

    2002-01-01

    Automatic termination analysers typically measure the size of terms applying norms which are mappings from terms to the natural numbers. This paper illustrates howt o enable the use of size functions defined as tuples of these simpler norm functions. This approach enables us to simplify the problem...

  7. A Local Feud Proves Toxic

    Science.gov (United States)

    Jacobson, Linda

    2008-01-01

    A school leadership crisis that has dragged on since last fall is threatening Clayton County public school system to lose its accreditation. Loss of this accreditation could mean future Clayton County graduates would have trouble being accepted to college or would miss out on merit scholarships. Clayton County's members have feuded with each…

  8. Project management skills prove invaluable.

    Science.gov (United States)

    Corfield, Louise

    2008-09-01

    IHEEM business development manager Louise Corfield examines the role of project management in the skill set of today's healthcare estates and facilities manager, and explains how the Institute has joined forces with a number of organisations to offer members access to training in this increasingly vital area.

  9. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... and professionals, and they instigate change in organization and professional identities. Studies, which more specifically deal with telecare, stress how virtualization alters the character of the observations care workers are able to make, and how the validity of the patients’ own measurements and observations...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  10. Intermediate care

    Directory of Open Access Journals (Sweden)

    Afro Salsi

    2013-04-01

    Full Text Available Background: In most cases intermediate care is represented by a residential care service that faces needs of people, mainly older people, between discharge from the hospital and the return to home. Discussion: Some authors have a negative opinion of this system due to the risk of omission of care and malpractice for the elderly as a consequence of early discharge from the hospital. There are different models of implementation based on the resources locally available and on the particular facilities network. Conclusion: The multidimensional assessment of clinical, functional and social problems is the key for a favourable outcome of intermediate care. If appropriately built as organisational care, intermediate care can become a positive chance for patients’ health. The key for success is to operate in a patient-centered mode, by accurately defining the individual plan of care.

  11. Who Cares for Care Leavers?

    Science.gov (United States)

    Askew, Julie; Rodgers, Paul; West, Andrew

    2016-01-01

    This chapter describes a programme of learning and development at the University of Sheffield, United Kingdom, to support looked-after children and care leavers (youth previously provided care outside or beyond family) throughout the student lifecycle. In this context, looked-after children are those cared for by a town/city authority where…

  12. Family matters? The effect of kinship care on foster care disruption rates.

    Science.gov (United States)

    Andersen, Signe Hald; Fallesen, Peter

    2015-10-01

    Compared with other types of out-of-home care, kinship care is cheap, and offers the child a more familiar environment. However, little is known about the causal effect of kinship care on important outcomes. This study is the first to estimate causal effects of kinship care on placement stability, using full-sample administrative data (N=13,157) and instrumental variables methods. Results show that, in a sample of children of age 0-17 years, kinship care is as stable as other types of care, and only when the kin caregiver is particularly empathic and dutiful does this type of care prove more stable. Thus, in terms of stability, most children do not benefit additionally from being placed with kin. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Palliative Care in Cancer

    Science.gov (United States)

    ... NCI support palliative care research? What is palliative care? Palliative care is care given to improve the quality ... the direction of a physician. Who gives palliative care ? Palliative care is usually provided by palliative care specialists, ...

  14. Obstetric admissions to an integrated general intensive care unit in a quaternary maternity facility.

    Science.gov (United States)

    Crozier, Tim M; Wallace, Euan M

    2011-06-01

    Monash Medical Centre (MMC) is a university-affiliated tertiary referral hospital in Melbourne, Victoria, Australia. The hospital has a large obstetric service and is the only quarternary obstetric unit in Victoria. The intensive care unit (ICU) is a busy 21-bed general unit with a broad casemix. While there is no designated state service obstetric ICU in Victoria, MMC ICU has increasingly tried to accept all obstetric patients referred, from both MMC and externally. To provide a local perspective on obstetric intensive care in Australia. A retrospective audit of obstetric ICU admissions over 2 years. Sixty women were admitted, of whom 46 were postpartum. Twenty-nine women were transferred from external sites. Mean maternal age was 30.7 years, mean gestational age 34.5 weeks and mean Acute Physiology and Chronic Health Evaluation (APACHE) version IIIj score 33. Obstetric haemorrhage was the most common admission diagnosis, followed by hypertensive spectrum disorders. Three women were admitted for induction of labour. Median length of stay was 35 h. Twenty-seven women (45%) required mechanical ventilation. No woman died in the ICU, although one died in hospital post-ICU discharge. No data were collected on neonatal outcomes. Critically ill obstetric patients can be managed successfully in a general ICU with obstetric input. It may be sensible to cluster these patients into units that are best equipped to deal with them, especially in the ante- and peripartum period. © 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  15. Morbidity: Changing the Outcome Paradigm for Pediatric Critical Care.

    Science.gov (United States)

    Heneghan, Julia A; Pollack, Murray M

    2017-10-01

    The focus of critical care has evolved from saving lives to preservation of function. Morbidity rates in pediatric critical care are approximately double mortality rates. Morbidity includes complications of disease and medical care. In pediatric critical care, functional status morbidity is an intermediate outcome in the progression toward death and is the result of the same factors associated with mortality, including physiologic profiles and case-mix factors. The Functional Status Scale developed by Collaborative Pediatric Critical Care Research Network is a validated, granular, age-independent measure of functional status that has proved valuable and practical even in large outcome studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Test of the electric vehicles at the roller bench; Prove al banco a rulli del veicolo elettrico porter Piaggio/Microvett

    Energy Technology Data Exchange (ETDEWEB)

    Cervati, L.; Cipolletta, L.; De Andreis, L.; Indiano, E. [ENEA, Centro Ricerche Casaccia, RM (Italy). Dipt. Energia

    1999-07-01

    Starting from the existing international regulations on the test of the electric vehicles a series of specific test to carry out at the roller bench of ENEA (National Agency for New Technology, Energy and the Environment) has been defined. The paper presents the numeric result applying such procedures to the test on an electric vehicles, whose main performances are described. [Italian] Partendo dalle normative internazionali esistenti sulla prova dei veicoli elettrici sono state definite una serie di prove specifiche da effettuare presso il banco a rulli dell'ENEA. Il presente lavoro riporta i risultati ottenuti applicando le procedure ad un veicolo elettrico. Le principali prestazioni sono messe in evidenza.

  17. Journeys in the Country of the Blind: Entanglement Theory and the Effects of Blinding on Trials of Homeopathy and Homeopathic Provings

    Directory of Open Access Journals (Sweden)

    Lionel R. Milgrom

    2007-01-01

    Full Text Available The idea of quantum entanglement is borrowed from physics and developed into an algebraic argument to explain how double-blinding randomized controlled trials could lead to failure to provide unequivocal evidence for the efficacy of homeopathy, and inability to distinguish proving and placebo groups in homeopathic pathogenic trials. By analogy with the famous double-slit experiment of quantum physics, and more modern notions of quantum information processing, these failings are understood as blinding causing information loss resulting from a kind of quantum superposition between the remedy and placebo.

  18. Evaluation of a laser equipped rifle for the US Army Human Engineering Laboratory, Aberdeen Proving Ground, Maryland, January 1977. Nonionizing radiation protection special study

    Energy Technology Data Exchange (ETDEWEB)

    Lyon, T.L.; Del Valle, P.F.

    1977-01-01

    A special study of the optical radiation hazards associated with the operation of a He-Ne laser mounted to an American International Corporation Model 180 Law Enforcement Rifle was performed by this Agency. Radiometric measurements were conducted on 11 January 1977, for the US Army Human Engineering Laboratory at Aberdeen Proving Ground. It was determined that the protection standards for momentary viewing were exceeded out to a hazard distance of 9 m and to 100 m when viewing through an optical instrument. Long-term staring at the laser from within the beam exceeded the protection standards out to a caution distance of 490 m. (Author)

  19. In situ analysis of soil at an open burning/open detonation disposal facility: J-Field, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Martino, L.; Cho, E. [Argonne National Lab., Washington, DC (United States); Wrobel, J. [US Army Directorate of Safety, Health, and the Environment, Aberdeen Proving Ground, MD (United States)

    1994-10-01

    Investigators have used a field-portable X-Ray Fluorescence (XRF) Analyzer to screen soils for a suite of metals indicative of the open burning and open detonation (OB/OD) activities that occurred at the J-Field site at Aberdeen Proving Ground, Maryland. The field XRF results were incorporated into a multiphase investigation of contaminants at the Toxic Burning Pits Area of Concern at J-Field. The authors determined that the field-portable XRF unit used for the study and the general concept of field XRF screening are invaluable tools for investigating an OB/OD site where intrusive sampling techniques could present unacceptable hazards to site workers.

  20. The Care management Information system for the home Care Network (SI GESCAD): support for care coordination and continuity of care in the Brazilian Unified health system (SUS).

    Science.gov (United States)

    Pires, Maria Raquel Gomes Maia; Gottems, Leila Bernarda Donato; Vasconcelos Filho, José Eurico; Silva, Kênia Lara; Gamarski, Ricardo

    2015-06-01

    The present article describes the development of the initial version of the Brazilian Care Management Information System for the Home Care Network (SI GESCAD). This system was created to enhance comprehensive care, care coordination and the continuity of care provided to the patients, family and caretakers of the Home Care (HC) program. We also present a reflection on the contributions, limitations and possibilities of the SI GESCAD within the scope of the Home Care Network of the Brazilian Unified Health System (RAS-AD). This was a study on technology production based on a multi-method protocol. It discussed software engineering and human-computer interaction (HCI) based on user-centered design, as well as evolutionary and interactive software process (prototyping and spiral). A functional prototype of the GESCAD was finalized, which allowed for the management of HC to take into consideration the patient's social context, family and caretakers. The system also proved to help in the management of activities of daily living (ADLs), clinical care and the monitoring of variables associated with type 2 HC. The SI GESCAD allowed for a more horizontal work process for HC teams at the RAS-AD/SUS level of care, with positive repercussions on care coordination and continuity of care.

  1. Developing a decision support system for tobacco use counselling using primary care physicians

    Directory of Open Access Journals (Sweden)

    Theodore Marcy

    2008-07-01

    Conclusions A multi-method evaluation process utilising primary care physicians proved useful for developing a CDSS that was acceptable to physicians and patients, and feasible to use in their clinical environment.

  2. Neonatal intensive care and radiation

    Energy Technology Data Exchange (ETDEWEB)

    Mazzi, E.; Herrera, A.J.; Herbert, L.

    1978-01-01

    Radiography plays an important role in a neonatal intensive care nursery. Diagnostic radiation was measured in 96 newborns. Mean exposure per neonate was 68.1 milliroentgens (mR) (SD = 132.7) with a median exposure per neonate of 28 mR. Radiation received by neonates was low, but further studies are needed to show the safety of radiation or its delayed effects. The measurement of radiation is simple, and routine radiation recording can prove useful in future evaluations of this high-risk population.

  3. Continuing Care

    Science.gov (United States)

    ... Drugs When Alzheimer’s Leads to Legal Wrangles Coordinated Care Lets Alzheimer’s Patients Stay at Home Longer FOR MORE ARTICLES CLICK ... Aricept Ranks Highest Among Drugs to Treat Alzheimer’s Patients Often Fail to Adhere to ... Can Aid in Alzheimer’s Care Two-Drug Combo May Ease the Agitation of ...

  4. Palliative Care

    Science.gov (United States)

    ... among the care team social workers who offer counseling, help families navigate the health care system, and provide ... to spiritual beliefs; they can also provide grief counseling massage therapists who promote relaxation, help patients and families manage stress, and provide pain ...

  5. Il Servizio Nazionale di Valutazione e le prove Invalsi. Stato dell’arte e proposte per una valutazione come agente di cambiamento

    Directory of Open Access Journals (Sweden)

    Roberto Trinchero

    2014-12-01

    Full Text Available Qual è la funzione del Servizio Nazionale di Valutazione formativa degli istituti scolastici? A cosa servono davvero le prove Invalsi? Le critiche che spesso vengono mosse a queste prove sono veramente fondate? Come può la valutazione dell’offerta formativa scolastica costituire davvero un agente di miglioramento? Il presente articolo intende fornire alcune risposte a queste domande, partendo dalle istanze che hanno ispirato l’autonomia scolastica e offrendo spunti per un utilizzo non fazioso della valutazione. La valutazione può essere davvero agente di cambiamento a patto che: i sia attribuito ai dati il corretto significato; ii la scuola sia in grado di comprendere i potenziali suggerimenti che la valutazione può dare e si apra al cambiamento positivo. La valutazione applicata ad una “scuola che si difende” non può che provocare inutili esiti di facciata. La valutazione applicata ad una “scuola che apprende” può davvero aiutarla ad esplicare appieno tutte le proprie potenzialità.

  6. Drug-eluting or bare-metal stents for large coronary vessel stenting? The BASKET-PROVE (PROspective Validation Examination) trial: Study protocol and design

    DEFF Research Database (Denmark)

    Pfisterer, M.; Bertel, O.; Bonetti, P.O.

    2008-01-01

    Background Based on a subgroup analysis of 18-month BAsel Stent Kosten Effektivitats Trial (BASKET) outcome data, we hypothesized that very late (>12 months) stent thrombosis occurs predominantly after drug-eluting stent implantation in large native coronary vessel stenting. Methods To prove or r...... to cobalt-chromium bare-metal stents in this relevant, low-risk group of everyday patients. In addition, a comparison with similar BASKET patients will allow to estimate the impact of 12-versus 6-month dual antiplatelet therapy on these outcomes Udgivelsesdato: 2008/4......Background Based on a subgroup analysis of 18-month BAsel Stent Kosten Effektivitats Trial (BASKET) outcome data, we hypothesized that very late (>12 months) stent thrombosis occurs predominantly after drug-eluting stent implantation in large native coronary vessel stenting. Methods To prove...... or refute this hypothesis, we set up an 11-center 4-country prospective trial of 2260 consecutive patients treated with >= 3.0-mm stents only, randomized to receive Cypher (Johnson & Johnson, Miami Lakes, FL), Vision (Abbott Vascular, Abbott Laboratories, IL), or Xience stents (Abbott Vascular). Only...

  7. Palliative Care Questions and Answers (Hospice Care Comparison)

    Science.gov (United States)

    ... Grief & Loss Resources Hospice and Palliative Care > Palliative Care Palliative Care Palliative Care Questions and Answers Palliative Care Questions and Answers Question Palliative Care Hospice Care ...

  8. The use of peracetic acid in drinking water systems: flow tests; L'acido peracetico in potabilizzazione: prove in flusso

    Energy Technology Data Exchange (ETDEWEB)

    Ragazzo, P. [Consorzio per l' Acquedotto del Basso Piave, San Dona' di Piave, VE (Italy); Navazio, G. [Padua Univ., Padua (Italy). Dipt. dei Processi Chimici dell' Ingegneria; Cavadone, A. [Solvay Chimica Italia S.p.A., Milan (Italy)

    2000-09-01

    In a previous research, a preliminary study was carried out on the disinfection efficiency of peracetic acid (PAA), comparing it to that of other disinfectants that are typically used, in batch tests with dosage values ranging from 0.5 to 5 ppm. The study was carried out on samples of water collected from several significant points of the treatment process at the main water treatment plant in Jesolo (Venice, Italy). On the basis of results (basically positive at that time) obtained from these tests, a 400 litre/hour pilot plant was built, as a lower scale reproduction of the drink water treatment system mentioned earlier, in order to study the characteristics of PAA even in tests that could more realistically simulate the flow of water along the process. These tests essentially confirmed the kinetics of the spontaneous hydrolysis to CH{sub 3} COOH+H{sub 2}O{sub 2} and those of dismutation to CH{sub 3}COOH+O{sub 2}, with half-life time values ranging from 3 to 12 hours, depending on the characteristics of the water (especially the pH factor) and the PAA concentration values. [Italian] In un precedente lavoro e' stato effettuato un preventivo studio sull'efficienza disinfettiva dell'acido peracetico, anche in confronto con gli altri piu' usuali disinfettanti, in prove condotte in batch, con dosaggi compresi tra 0.5 e 5 ppm, su campioni di acqua prelevati dai diversi punti significativi della linea di trattamento della centrale di Jesolo (Torre Caligo), gestita dal Consorzio Acquedottistico del Basso Piave di S. Dona' di Piave (Venezia). Sulla base dei risultati, sostanzialmente positivi, e' stato costruito un impianto pilota da 400l/h, riproducente, in scala, la linea di potabilizzazione su ricordata, per studiare le caratteristiche del PAA anche in prove piu' probanti condotte in flusso. In tali prove sono state sostanzialmente riconfermate le cinetiche delle reazioni spontanee di dirolisi a CH{sub 3}COOH+H{sub 2}O{sub 2} e di

  9. Stepped psychological care after stroke.

    Science.gov (United States)

    Kneebone, Ian I

    2016-09-01

    Emotional difficulties are common after stroke and have an impact on rehabilitation outcome. It is a challenge to manage these problems effectively, particularly in times of resource stringency. One proposal for how to do this has arisen out of an approach to general mental health management: a system of 'stepped care'. Such a system directs intervention by considering level of need, thereby making the most efficient use of available resources. It is the purpose of this article to articulate a stepped psychological care approach for emotional problems after stroke. Narrative review and elaboration of the model proposed by the Department of Health in England for the management of emotional problems after stroke. A stepped care model for the management of emotional problems after stroke is presented in detail, including descriptions of specific interventions and guidance to inform the level of management. The stepped psychological care proposal for emotional problems after stroke requires evaluation but is potentially of use within comparable healthcare systems. Implications for Rehabilitation Emotional problems are common after stroke and effect rehabilitation outcomes. A stepped care approach to these problems offers the ability to cater to all according to need. Greater specification of the services at each step can be outlined. While recommended, such an approach requires evaluation to prove its efficacy.

  10. Focused feasibility study for surface soil at the main pits and pushout area, J-field toxic burning pits area, Aberdeen Proving Ground, Maryland

    Energy Technology Data Exchange (ETDEWEB)

    Patton, T.; Benioff, P.; Biang, C.; Butler, J. [and others

    1996-06-01

    The Environmental Management Division of Aberdeen Proving Ground (APG), Maryland, is conducting a remedial investigation and feasibility study of the J-Field area at APG pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act, as amended (CERCLA). J-Field is located within the Edgewood Area of APG in Harford County, Maryland. Since World War II, activities in the Edgewood Area have included the development, manufacture, testing, and destruction of chemical agents and munitions. These materials were destroyed at J-Field by open burning/open detonation. Portions of J-Field continue to be used for the detonation and disposal of unexploded ordnance (UXO) by open burning/open detonation under authority of the Resource Conservation and Recovery Act.

  11. Preliminary assessment of microbial communities and biodegradation of chlorinated volatile organic compounds in wetlands at Cluster 13, Lauderick Creek area, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Lorah, Michelle M.; Voytek, Mary A.; Spencer, Tracey A.

    2003-01-01

    A preliminary assessment of the microbial communities and biodegradation processes for chlorinated volatile organic compounds was con-ducted by the U.S. Geological Survey in wetlands at the Cluster 13, Lauderick Creek area at Aberdeen Proving Ground, Maryland. The U.S. Geological Survey collected wetland sediment samples from 11 sites in the Lauderick Creek area for microbial analyses, and used existing data to evaluate biodegradation processes and rates. The bacterial and methanogen communities in the Lauderick Creek wetland sediments were similar to those observed in a previous U.S. Geological Survey study at the West Branch Canal Creek wet-land area, Aberdeen Proving Ground. Evaluation of the degradation rate of 1,1,2,2-tetrachloroethane and the daughter compounds produced also showed similar results for the two wetlands. How-ever, a vertical profile of contaminant concentra-tions in the wetlands was available at only one site in the Lauderick Creek area, and flow velocities in the wetland sediment are unknown. To better evaluate natural attenuation processes and rates in the wetland sediments at Lauderick Creek, chemi-cal and hydrologic measurements are needed along ground-water flowpaths in the wetland at additional sites and during different seasons. Nat-ural attenuation in the wetlands, enhanced biore-mediation, and constructed wetlands could be feasible remediation methods for the chlorinated volatile organic compounds discharging in the Lauderick Creek area. The similarities in the microbial communities and biodegradation pro-cesses at the Lauderick Creek and West Branch Canal Creek areas indicate that enhanced bioreme-diation techniques currently being developed for the West Branch Canal Creek wetland area would be transferable to this area.

  12. Cyber security risk management: public policy implications of correlated risk, imperfect ability to prove loss, and observability of self-protection.

    Science.gov (United States)

    Oğüt, Hulisi; Raghunathan, Srinivasan; Menon, Nirup

    2011-03-01

    The correlated nature of security breach risks, the imperfect ability to prove loss from a breach to an insurer, and the inability of insurers and external agents to observe firms' self-protection efforts have posed significant challenges to cyber security risk management. Our analysis finds that a firm invests less than the social optimal levels in self-protection and in insurance when risks are correlated and the ability to prove loss is imperfect. We find that the appropriate social intervention policy to induce a firm to invest at socially optimal levels depends on whether insurers can verify a firm's self-protection levels. If self-protection of a firm is observable to an insurer so that it can design a contract that is contingent on the self-protection level, then self-protection and insurance behave as complements. In this case, a social planner can induce a firm to choose the socially optimal self-protection and insurance levels by offering a subsidy on self-protection. We also find that providing a subsidy on insurance does not provide a similar inducement to a firm. If self-protection of a firm is not observable to an insurer, then self-protection and insurance behave as substitutes. In this case, a social planner should tax the insurance premium to achieve socially optimal results. The results of our analysis hold regardless of whether the insurance market is perfectly competitive or not, implying that solely reforming the currently imperfect insurance market is insufficient to achieve the efficient outcome in cyber security risk management. © 2010 Society for Risk Analysis.

  13. Home Care

    Science.gov (United States)

    ... and respiratory ), social workers, personal care aides, home medical equipment suppliers, and most importantly, informal caregivers (e.g., ... also available to help with home assessment. Assistive Technology to improve home safety can also be an ...

  14. Hospice care

    Science.gov (United States)

    ... death. The goal is to give comfort and peace instead of a cure. Hospice care provides: Support ... D.A.M. is among the first to achieve this important distinction for online health information and ...

  15. Hospice Care

    Science.gov (United States)

    ... offer health care services on a sliding fee scale basis for patients with limited income and resources. ... a social worker and a clergyman to provide spiritual and grief counseling for Lynda and Sara. Lynda ...

  16. CARES Foundation

    Science.gov (United States)

    ... html CLICK HERE for article from USA Today Magazine HELP US MAKE A DIFFERENCE IN THE LIVES ... as “Congenital Adrenal Hyperplasia Research Educ & Support Found, Inc aka CARES Foundation” Support Our Mission Research, education ...

  17. Dysarthria - care

    Science.gov (United States)

    Speech and language disorder - dysarthria care; Slurred speech - dysarthria; Articulation disorder - dysarthria ... Dysarthria is a condition that occurs when there are problems with the muscles that help you talk. ...

  18. Performance and burnout in intensive care units

    OpenAIRE

    Keijsers, G.J.; Schaufeli, W.B.; Leblanc, P; Zwerts, C.; Miranda, D.R.

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit performance. Subjective performance measures relate negatively to burnout levels of nurses, whereas an objective performance measure relates positively to burnout. Furthermore, subjectively assessed...

  19. Dyspnoea at Term in an Obese Mother

    Directory of Open Access Journals (Sweden)

    Vicky O'Dwyer

    2011-01-01

    Full Text Available Peripartum cardiomyopathy is a serious, potentially life-threatening heart disease of uncertain aetiology in previously healthy women. We report a morbidly obese woman who presented with peripartum shortness of breath. We discuss the differential diagnosis of dyspnoea in pregnancy and highlight the complexity of care of the morbidly obese woman.

  20. Managing Cancer Care - Finding Health Care Services

    Science.gov (United States)

    ... Caregivers Questions to Ask about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Costs & Medical ... Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer Care Finding Health Care Services Managing Costs ...

  1. Role of radiotherapy in hospice care

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Tetsuo; Sugiyama, Akira; Shimizu, Teppei; Ichinohe, Kenji; Teshima, Takeshi; Kaneko, Masao; Hara, Yoshio; Chihara, Satoshi.

    1989-01-01

    The aim of palliative radiotherapy for the terminally ill is to improve the quality of the remaining span of life. From November 1982 to September 1987, 69 patients in the Seirei Hospice have been treated with such radiotherapy, and symptomatic relief was obtained in 64% of these patients. Radiotherapy also proved useful in achieving an improvement in their performance status. While the aim of hospice care is not directed towards treatment of the underlying disease, the use of radiotherapy is considered to have an important role in hospice care.

  2. Integrating Palliative Care into Primary Care.

    Science.gov (United States)

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey

    NARCIS (Netherlands)

    de Graaff, F.M.; Francke, A.L.

    2009-01-01

    Background Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care

  4. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey.

    NARCIS (Netherlands)

    Graaff, F.M. de; Francke, A.L.

    2009-01-01

    BACKGROUND: Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care

  5. Cancer Patients Use Hospital-Based Care Until Death : A Further Analysis of the Dutch Bone Metastasis Study

    NARCIS (Netherlands)

    Meeuse, Jan J.; van der Linden, Yvette M.; Post, Wendy J.; Wanders, Rinus; Gans, Rijk O. B.; Leer, Jan Willem H.; Reyners, Anna K. L.

    2011-01-01

    Purpose: To describe health care utilization (HCU) at the end of life in cancer patients. These data are relevant to plan palliative care services, and to develop training programs for involved health care professionals. Methods: The Dutch Bone Metastasis Study (DBMS) was a nationwide study proving

  6. Characterization of Preferential Ground-Water Seepage From a Chlorinated Hydrocarbon-Contaminated Aquifer to West Branch Canal Creek, Aberdeen Proving Ground, Maryland, 2002-04

    Science.gov (United States)

    Majcher, Emily H.; Phelan, Daniel J.; Lorah, Michelle M.; McGinty, Angela L.

    2007-01-01

    Wetlands act as natural transition zones between ground water and surface water, characterized by the complex interdependency of hydrology, chemical and physical properties, and biotic effects. Although field and laboratory demonstrations have shown efficient natural attenuation processes in the non-seep wetland areas and stream bottom sediments of West Branch Canal Creek, chlorinated volatile organic compounds are present in a freshwater tidal creek at Aberdeen Proving Ground, Maryland. Volatile organic compound concentrations in surface water indicate that in some areas of the wetland, preferential flow paths or seeps allow transport of organic compounds from the contaminated sand aquifer to the overlying surface water without undergoing natural attenuation. From 2002 through 2004, the U.S. Geological Survey, in cooperation with the Environmental Conservation and Restoration Division of the U.S. Army Garrison, Aberdeen Proving Ground, characterized preferential ground-water seepage as part of an ongoing investigation of contaminant distribution and natural attenuation processes in wetlands at this site. Seep areas were discrete and spatially consistent during thermal infrared surveys in 2002, 2003, and 2004 throughout West Branch Canal Creek wetlands. In these seep areas, temperature measurements in shallow pore water and sediment more closely resembled those in ground water than those in nearby surface water. Generally, pore water in seep areas contaminated with chlorinated volatile organic compounds had lower methane and greater volatile organic compound concentrations than pore water in non-seep wetland sediments. The volatile organic compounds detected in shallow pore water in seeps were spatially similar to the dominant volatile organic compounds in the underlying Canal Creek aquifer, with both parent and anaerobic daughter compounds detected. Seep locations characterized as focused seeps contained the highest concentrations of chlorinated parent compounds

  7. Palliative Care in Iran: Moving Toward the Development of Palliative Care for Cancer.

    Science.gov (United States)

    Rassouli, Maryam; Sajjadi, Moosa

    2016-04-01

    Cancer is the third leading cause of death in Iran and its incidence has been increasing in recent years. Patients' quality of life is altered rather enormously due to cancer, which doubles the importance of and the need for providing palliative care in Iran. Although many steps have been taken toward the development and providing of palliative care in Iran, there is still a large gap between the status quo and the desirable state. This study presents the current state of palliative care for cancer patients and discusses the barriers, challenges and outlook of palliative care in Iran. If infrastructural projects that have recently been launched prove successful, proper advancement toward the providing of palliative care services in Iran will then not far on the horizon. © The Author(s) 2014.

  8. Palliative care

    Directory of Open Access Journals (Sweden)

    Mônica Estuque Garcia de Queiroz

    2012-09-01

    Full Text Available According to the World Health Organization (WHO, palliative care can be defined as active and totalcare measures that improve the life quality of patients with terminal diseases and their family/relatives, throughprevention and suffering relieve by means of early identification, adequate evaluation, and treatment of painand other physical, psychosocial and spiritual problems. This article deals with the attention of the occupationaltherapist in palliative care, as from the definition of this philosophy and its principles. The occupational therapist’spractice is described through the author’s theoretical and practical references. In palliative care, occupationaltherapy helps the patient and caregiver to deal with the difficulties mentioned and observed in order to achievegreater comfort, dignity and quality of life in the hospital or at home, in order to promote the maximum levelof independence and/or occupational performance with autonomy with the aim to improve the quality of life,despite the functional loss, cognitive, emotional and social.

  9. Proceedings of the 1993 Scientific Conference on Obscuration and Aerosol Research Held in Aberdeen Proving Ground on 22-24 Jun 1993

    Science.gov (United States)

    1994-03-01

    other nations with resource management plans for economic and ecological stability and medical care and food distribution as well as optimal running of...in the paper of Frenklach, Wang. and Rabinowitz (129]) The paper of Smooke and Giovangigli ([70]) and Peters ([591) describe methane coi,’,b- sion. The...1981) [69] Smaller, Joel. Shock waves and reaceion diffusion equations New York: Springer Verlag (1983) [70] Smooke . Mitchell D. and Vincent

  10. Coplanar surface barrier discharge ignited in water vapor—a selective source of OH radicals proved by (TA)LIF measurement

    Science.gov (United States)

    Procházka, V.; Tučeková, Z.; Dvořák, P.; Kováčik, D.; Slavíček, P.; Zahoranová, A.; Voráč, J.

    2018-01-01

    Coplanar dielectric barrier discharge (DBD) was ignited in pure water vapor at atmospheric pressure in order to generate highly oxidizing plasma with one specific type of reactive radicals. In order to prevent water condensation the used plasma reactor was heated to 120 {}\\circ C. The composition of the radical species in the discharge was studied by methods based on laser-induced fluorescence (LIF) and compared with analogous measurements realized in the same coplanar DBD ignited in air. Fast collisional processes and laser-surface interaction were taken into account during LIF data processing. It was found that coplanar DBD ignited in water vapor produces hydroxyl (OH) radicals with concentration in the order of 1020 m‑3, which is 10× higher than the value measured in discharge in humid air (40% relative humidity at 21 {}\\circ C). The concentration of atomic hydrogen radicals in the DBD ignited in water vapor was below the detection limit, which proves that the generation of oxidizing plasma with dominance of one specific type of reactive radicals was achieved. The temporal evolution, spatial distribution, power dependence and rotational temperature of the OH radicals was determined in the DBD ignited in both water vapor and air.

  11. Practice and prospects of proving harm to human health caused by atmospheric air pollution and indoor air in pre-trial and trial

    Directory of Open Access Journals (Sweden)

    E.V. Sedusova

    2015-12-01

    Full Text Available Analysis of judicial practice on established cases of injuries caused by the negative impact of atmospheric air and indoor air and compensation of damages for the past 10 years has been made. The most common causes of complaints of citizens to the court with a request for compensation for damage to health due to the negative impact of air pollution are revealed. The most common causes are: the presence of odors in the implementation of the production activities of enterprises and organizations; violation of hygienic standards in residential areas; location of residential buildings within the boundaries of the sanitary protection zone; mismatch of construction, decoration materials and furniture requirements of the legislation; implementation of industrial activity in a residential area in violation of the law; and the deterioration of human health caused by the described violations. It has been shown that more than half of the requests for compensation for harm caused by the air pollution are not to be fulfilled. The compensation of damage is denied due to lack of evidence of noncompliance of air quality to hygienic requirements, the causal link between the activities of the entity and violation of the right to a healthy environment, and / or failure to prove the fact of harm to public health or the threat of such damage.

  12. Toward standardization of carbohydrate-deficient transferrin (CDT) measurements: III. Performance of native serum and serum spiked with disialotransferrin proves that harmonization of CDT assays is possible.

    Science.gov (United States)

    Weykamp, Cas; Wielders, Jos P M; Helander, Anders; Anton, Raymond F; Bianchi, Vincenza; Jeppsson, Jan-Olof; Siebelder, Carla; Whitfield, John B; Schellenberg, François

    2013-05-01

    Carbohydrate-deficient transferrin (CDT) is a generic term that refers to the transferrin glycoforms whose concentration in blood is temporarily increased by sustained alcohol consumption. Due to high clinical specificity, CDT was proposed as a biomarker of heavy alcohol use and has been available for about 20 years. A number of methods have been developed for CDT measurement based on different analytical techniques and principles and without any harmonization or calibration to a reference method. As a consequence, neither the reference limits nor the cut-off values have been similar across assays, hampering understanding of the diagnostic value of CDT and its routine use. This prompted the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) to initiate a Working Group on Standardization of CDT (WG-CDT). This third publication of the WG-CDT is devoted to testing the commutability of native and disialotransferrin-spiked serum panels as candidate secondary reference materials, in order to prove the harmonization potential of commercial CDT methods. The results showed that assay harmonization reduced the inter-laboratory imprecision in a network of reference laboratories running the HPLC candidate reference method. In the seven commercial methods evaluated in this study, the use of multi-level secondary calibrators of human serum origin significantly reduced the between-method imprecision. Thus, harmonization of CDT measurements by different methods can be achieved using this calibration system, opening the way for a full standardization of commercial methods against a reference method by use of certified reference materials.

  13. Water-quality and water-level data for a freshwater tidal wetland, West Branch Canal Creek, Aberdeen Proving Ground, Maryland, October 1998-September 1999

    Science.gov (United States)

    Spencer, Tracey A.; Olsen, Lisa D.; Lorah, Michelle M.; Mount, Mastin M.

    2000-01-01

    This report presents water-quality data for ground-water and surface-water samples and water-level data collected by the U.S. Geological Survey from October 1998 through September 1999 at West Branch Canal Creek, Aberdeen Proving Ground, Maryland. The report also provides a description of the sampling and analytical methods that were used to collect and analyze the samples, and includes an evaluation of the quality-assurance data. The ground-water sampling network includes 88 wells or piezometers, including four 2-inch wells, two 4-inch wells, thirty 0.75-inch piezo-meters, and fifty-two 0.25-inch piezometers. Water levels were measured in 105 wells or piezometers. Surface-water samples were collected at five sites. Samples were collected from wells and 0.75-inch piezometers for measurement of field parameters, and analysis of inorganic and organic constituents during three sampling rounds: March, May through June, and July through August of 1999. Inorganic constituents and organic constituents were analyzed in samples collected from 0.25-inch piezometers during three sampling rounds in February through March, May, and September of 1999. Water levels were measured in October and November of 1998, and in February and May of 1999. Surface-water samples were collected between February and August of 1999 for analysis of organic constituents.

  14. Long-term ground-water monitoring program and performance-evaluation plan for the extraction system at the former Nike Missile Battery Site, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Senus, Michael P.; Tenbus, Frederick J.

    2000-01-01

    This report presents lithologic and ground-water-quality data collected during April and May 2000 in the remote areas of the tidal wetland of West Branch Canal Creek, Aberdeen Proving Ground, Maryland. Contamination of the Canal Creek aquifer with volatile organic compounds has been documented in previous investigations of the area. This study was conducted to investigate areas that were previously inaccessible because of deep mud and shallow water, and to support ongoing investigations of the fate and transport of volatile organic compounds in the Canal Creek aquifer. A unique vibracore drill rig mounted on a hovercraft was used for drilling and ground-water sampling. Continuous cores of the wetland sediment and of the Canal Creek aquifer were collected at five sites. Attempts to sample ground water were made by use of a continuous profiler at 12 sites, without well installation, at a total of 81 depths within the aquifer. Of those 81 attempts, only 34 sampling depths produced enough water to collect samples. Ground-water samples from two sites had the highest concentrations of volatile organic compounds?with total volatile organic compound concentrations in the upper part of the aquifer ranging from about 15,000 to 50,000 micrograms per liter. Ground-water samples from five sites had much lower total volatile organic compound concentrations (95 to 2,100 micrograms per liter), whereas two sites were essentially not contaminated, with total volatile organic compound concentrations less than or equal to 5 micrograms per liter.

  15. Contamination of ground water, surface water, and soil, and evaluation of selected ground-water pumping alternatives in the Canal Creek area of Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Lorah, Michelle M.; Clark, Jeffrey S.

    1996-01-01

    Chemical manufacturing, munitions filling, and other military-support activities have resulted in the contamination of ground water, surface water, and soil in the Canal Creek area of Aberdeen Proving Ground, Maryland. Chlorinated volatile organic compounds, including 1,1,2,2-tetrachloroethane and trichloroethylene, are widespread ground-water contaminants in two aquifers that are composed of unconsolidated sand and gravel. Distribution and fate of chlorinated organic compounds in the ground water has been affected by the movement and dissolution of solvents in their dense immiscible phase and by microbial degradation under anaerobic conditions. Detection of volatile organic contaminants in adjacent surface water indicates that shallow contaminated ground water discharges to surface water. Semivolatile organic compounds, especially polycyclic aromatic hydrocarbons, are the most prevalent organic contaminants in soils. Various trace elements, such as arsenic, cadmium, lead, and zinc, were found in elevated concentrations in ground water, surface water, and soil. Simulations with a ground-water-flow model and particle tracker postprocessor show that, without remedial pumpage, the contaminants will eventually migrate to Canal Creek and Gunpowder River. Simulations indicate that remedial pumpage of 2.0 million gallons per day from existing wells is needed to capture all particles originating in the contaminant plumes. Simulated pumpage from offsite wells screened in a lower confined aquifer does not affect the flow of contaminated ground water in the Canal Creek area.

  16. Effect of Fe(III) on 1,1,2,2-Tetrachloroethane degradation and vinyl chloride accumulation in wetland sediments of the Aberdeen Proving Ground

    Science.gov (United States)

    Jones, Elizabeth; Voytek, Mary; Lorah, Michelle

    2004-01-01

    1,1,2,2-Tetrachloroethane (TeCA) contaminated groundwater at the Aberdeen Proving Ground discharges through an anaerobic wetland in West Branch Canal Creek (MD), where dechlorination occurs. Two microbially mediated pathways, dichloroelimination and hydrogenolysis, account for most of the TeCA degradation at this site. The dichloroelimination pathways lead to the formation of vinyl chloride (VC), a recalcitrant carcinogen of great concern. The goal of this investigation was to determine whether microbially-available Fe(III) in the wetland surface sediment influenced the fate of TeCA and its daughter products. Differences were identified in the TeCA degradation pathway between microcosms treated with amorphous ferric oxyhydroxide (AFO-treated) and untreated (no AFO) microcosms. TeCA degradation was accompanied by a lower accumulation of VC in AFO-treated microcosms than untreated microcosms. The microcosm incubations and subsequent experiments with the microcosm materials showed that AFO treatment resulted in lower production of VC by (1) shifting TeCA degradation from dichloroelimination pathways to production of a greater proportion of chlorinated ethane products, and (2) decreasing the microbial capability to produce VC from 1,2-dichloroethene (DCE). VC degradation was not stimulated in the presence of Fe(III). Rather, VC degradation occurred readily under methanogenic conditions and was inhibited under Fe(III)-reducing conditions.

  17. Lithologic and ground-water-quality data collected using Hoverprobe drilling techniques at the West Branch Canal Creek wetland, Aberdeen Proving Ground, Maryland, April-May 2000

    Science.gov (United States)

    Phelan, Daniel J.; Senus, Michael P.; Olsen, Lisa D.

    2001-01-01

    This report presents lithologic and groundwater- quality data collected during April and May 2000 in the remote areas of the tidal wetland of West Branch Canal Creek, Aberdeen Proving Ground, Maryland. Contamination of the Canal Creek aquifer with volatile organic compounds has been documented in previous investigations of the area. This study was conducted to investigate areas that were previously inaccessible because of deep mud and shallow water, and to support ongoing investigations of the fate and transport of volatile organic compounds in the Canal Creek aquifer. A unique vibracore drill rig mounted on a hovercraft was used for drilling and groundwater sampling. Continuous cores of the wetland sediment and of the Canal Creek aquifer were collected at five sites. Attempts to sample ground water were made by use of a continuous profiler at 12 sites, without well installation, at a total of 81 depths within the aquifer. Of those 81 attempts, only 34 sampling depths produced enough water to collect samples. Ground-water samples from two sites had the highest concentrations of volatile organic compounds?with total volatile organic compound concentrations in the upper part of the aquifer ranging from about 15,000 to 50,000 micrograms per liter. Ground-water samples from five sites had much lower total volatile organic compound concentrations (95 to 2,100 micrograms per liter), whereas two sites were essentially not contaminated, with total volatile organic compound concentrations less than or equal to 5 micrograms per liter.

  18. Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Ferrando, Carlos; Soro, Marina; Canet, Jaume; Unzueta, Ma Carmen; Suárez, Fernando; Librero, Julián; Peiró, Salvador; Llombart, Alicia; Delgado, Carlos; León, Irene; Rovira, Lucas; Ramasco, Fernando; Granell, Manuel; Aldecoa, César; Diaz, Oscar; Balust, Jaume; Garutti, Ignacio; de la Matta, Manuel; Pensado, Alberto; Gonzalez, Rafael; Durán, M Eugenia; Gallego, Lucia; Del Valle, Santiago García; Redondo, Francisco J; Diaz, Pedro; Pestaña, David; Rodríguez, Aurelio; Aguirre, Javier; García, Jose M; García, Javier; Espinosa, Elena; Charco, Pedro; Navarro, Jose; Rodríguez, Clara; Tusman, Gerardo; Belda, Francisco Javier

    2015-04-27

    Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra- and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra- and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications. Registered on 5 June 2014 with identification no. NCT02158923 .

  19. New and improved methods for monitoring air quality and the terrestrial environment: Applications at Aberdeen Proving Ground-Edgewood area. Annual report, 1 April--14 November 1997

    Energy Technology Data Exchange (ETDEWEB)

    Bromenshenk, J.J.; Smith, G.C.

    1998-03-01

    Honey bees (Apis mellifera L.) have been shown to be multi-media monitors of chemical exposures and resultant effects. This five-year project has developed an automated system to assess in real-time colony behavioral responses to stressors, both anthropogenic and natural, including inclement weather. Field trials at the Aberdeen Proving Ground-Edgewood included the Old O Field and J field landfills, the Canal Creek and Bush River areas, and a Churchville, MD reference site. Preliminary results show varying concentrations of bioavailable inorganic elements and chlorinated hydrocarbons in bee colonies from all Maryland sites. Industrial solvents in the air inside beehives exhibited the greatest between site differences, with the highest levels occurring in hives near landfills at Old O Field, J Field, and at some sites in the Bush River and Canal Creek areas. Compared to 1996, the 1997 levels of solvents in Old O Field hives decreased by an order of magnitude, and colony performance significantly improved, probably as a consequence of capping the landfill. Recent chemical monitoring accomplishments include development of a new apparatus to quantitatively calibrate TD/GC/MS analysis, a QA/QC assessment of factors that limit the precision of these analyses, and confirmation of transport of aqueous contaminants into the hive. Real-time effects monitoring advances include development of an extensive array of software tools for automated data display, inspection, and numerical analysis and the ability to deliver data from remote locations in real time through Internet or Intranet connections.

  20. An Electrosurgical Endoknife with a Water-Jet Function (Flushknife Proves Its Merits in Colorectal Endoscopic Submucosal Dissection Especially for the Cases Which Should Be Removed En Bloc

    Directory of Open Access Journals (Sweden)

    Yoji Takeuchi

    2013-01-01

    Full Text Available Background. Previously, we reported that the Flushknife (electrosurgical endoknife with a water-jet function could reduce the operation time of colorectal endoscopic submucosal dissection (ESD however, suitable situation for the Flushknife was obscure. This subgroup analysis of a prospective randomized controlled trial was aimed to investigate the suitable situation for the Flushknife. Methods. A total of 48 superficial colorectal neoplasms that underwent ESD using either the Flexknife or the Flushknife in a referral center were enrolled. The differences of operation time between the Flexknife and the Flushknife groups in each subgroup (tumor size, location, and macroscopic type were analyzed. Results. Median (95% CI operation time calculated using survival curves was significantly shorter in the Flushknife group than in the Flexknife group (55.5 min [41, 78] versus 74.0 [57, 90] min; , Hazard Ratio HR: 0.53; 95% CI (0.29–0.97. In particular, the HR in patients with laterally spreading tumors-nongranular type (LST-NG in the Flushknife group was significantly smaller than in the Flexknife group (HR: 0.1650.17; 95% CI (0.04–0.66. There was a trend of decreasing HRs according to larger lesion size. Conclusions. The Flushknife proved its merits in colorectal ESD especially for the lesions which should be removed en bloc (LST-NG and large lesion.

  1. Caring Science or Science of Caring.

    Science.gov (United States)

    Turkel, Marian C; Watson, Jean; Giovannoni, Joseph

    2018-01-01

    The concepts caring science and science of caring have different meanings; however, they are often used interchangeably. The purpose of this paper is to present an overview of the synthesis of the scholarly literature on the definitions of the science of caring and caring science and to affirm the authors' perspective relating to the language of caring science. Caring science advances the epistemology and ontology of caring. Ideas related to caring science inquiry are presented, and the authors acknowledge the future of caring science as unitary caring science.

  2. Enacting Care

    Czech Academy of Sciences Publication Activity Database

    Urban, Petr

    2015-01-01

    Roč. 9, č. 2 (2015), s. 216-222 ISSN 1749-6535 R&D Projects: GA ČR(CZ) GPP401/12/P544 Institutional support: RVO:67985955 Keywords : ethics of care * enactivism * autonomy * social institutions * autism * exclusion Subject RIV: AA - Philosophy ; Religion http://dx.doi.org/10.1080/17496535.2015.1022356

  3. Just caring.

    Science.gov (United States)

    Hussey, Trevor

    2012-01-01

    Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: 'Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.' This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. © 2011 Blackwell Publishing Ltd.

  4. Pharmaceutical health care and Inuit language communications in Nunavut, Canada

    OpenAIRE

    Romain, Sandra J.

    2013-01-01

    Background. Pharmaceutical communication is an essential component of pharmaceutical health care, optimally ensuring patients understand the proper administration and side effects of their medications. Communication can often be complicated by language and culture, but with pharmaceuticals, misunderstandings can prove particularly harmful. In Nunavut, to ensure the preservation and revitalization of Inuit languages, the Inuit Language Protection Act and Official Languages Act were passed requ...

  5. Motivation for primary health care in Machinga district

    African Journals Online (AJOL)

    Chancellor College proved to be fruitful for all parties concerned, villagers, PHC workers and students. Health through theatre for development. This article describes work which has taken place in Liwonde recently in using theatre for. Primary Health Care education. Malawi's. P.H.C. problems are so pressing that theatre.

  6. Training future anesthesiologists in obstetric care.

    Science.gov (United States)

    Vasco Ramírez, Mauricio

    2017-06-01

    In order for the obstetric anesthesiologist to become a true perioperative / peripartum physician, a change in formative programs and certification process in anesthesia are needed. Anesthesia training programs are migrating to competency based medical education (CBME) worldwide. The traditional model of attending lectures, grand rounds, reading textbooks and journal papers should be complemented by virtual modalities such as massive open online courses or online teaching tools. The gold standard for assessment of procedural skills in anesthesia consists of a combination of global rating scales and previously validated checklists. Behaviors in the perioperative environment not directly related to the use of drugs, equipment or medical expertise are known as anesthesiologist nontechnical skills and trainees must learn and practice these skills; nontechnical skills can determine 50-80% of adverse events in high-risk professions, including medicine. Regular certification programs are also an important component of the new approach in medical education, in some high-income countries, the specialist anesthesiologist is undertaking regular certification but the impact of these programs on overall outcomes is still unknown. The obstetric population is becoming a higher risk population, requiring an obstetric anesthesiologist taking on the role of a perioperative / peripartum physician. It is essential that anesthesia training programs migrate to CBME through simulation-based curriculum that allow the achievement of nontechnical skills and team work competencies. It is also essential that regular certification for specialist anesthesiologists occur throughout their entire career.

  7. Design and analysis of a natural-gradient ground-water tracer test in a freshwater tidal wetland, West Branch Canal Creek, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Olsen, Lisa D.; Tenbus, Frederick J.

    2005-01-01

    A natural-gradient ground-water tracer test was designed and conducted in a tidal freshwater wetland at West Branch Canal Creek, Aberdeen Proving Ground, Maryland. The objectives of the test were to characterize solute transport at the site, obtain data to more accurately determine the ground-water velocity in the upper wetland sediments, and to compare a conservative, ionic tracer (bromide) to a volatile tracer (sulfur hexafluoride) to ascertain whether volatilization could be an important process in attenuating volatile organic compounds in the ground water. The tracer test was conducted within the upper peat unit of a layer of wetland sediments that also includes a lower clayey unit; the combined layer overlies an aquifer. The area selected for the test was thought to have an above-average rate of ground-water discharge based on ground-water head distributions and near-surface detections of volatile organic compounds measured in previous studies. Because ground-water velocities in the wetland sediments were expected to be slow compared to the underlying aquifer, the test was designed to be conducted on a small scale. Ninety-seven ?-inch-diameter inverted-screen stainless-steel piezometers were installed in a cylindrical array within approximately 25 cubic feet (2.3 cubic meters) of wetland sediments, in an area with a vertically upward hydraulic gradient. Fluorescein dye was used to qualitatively evaluate the hydrologic integrity of the tracer array before the start of the tracer test, including verifying the absence of hydraulic short-circuiting due to nonnatural vertical conduits potentially created during piezometer installation. Bromide and sulfur hexafluoride tracers (0.139 liter of solution containing 100,000 milligrams per liter of bromide ion and 23.3 milligrams per liter of sulfur hexafluoride) were co-injected and monitored to generate a dataset that could be used to evaluate solute transport in three dimensions. Piezometers were sampled 2 to 15 times

  8. Microbial Consortia Development and Microcosm and Column Experiments for Enhanced Bioremediation of Chlorinated Volatile Organic Compounds, West Branch Canal Creek Wetland Area, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Lorah, Michelle M.; Majcher, Emily H.; Jones, Elizabeth J.; Voytek, Mary A.

    2008-01-01

    Chlorinated solvents, including 1,1,2,2-tetrachloroethane, tetrachloroethene, trichloroethene, carbon tetrachloride, and chloroform, are reaching land surface in localized areas of focused ground-water discharge (seeps) in a wetland and tidal creek in the West Branch Canal Creek area, Aberdeen Proving Ground, Maryland. In cooperation with the U.S. Army Garrison, Aberdeen Proving Ground, Maryland, the U.S. Geological Survey is developing enhanced bioremediation methods that simulate the natural anaerobic degradation that occurs without intervention in non-seep areas of the wetland. A combination of natural attenuation and enhanced bioremediation could provide a remedy for the discharging ground-water plumes that would minimize disturbance to the sensitive wetland ecosystem. Biostimulation (addition of organic substrate or nutrients) and bioaugmentation (addition of microbial consortium), applied either by direct injection at depth in the wetland sediments or by construction of a permeable reactive mat at the seep surface, were tested as possible methods to enhance anaerobic degradation in the seep areas. For the first phase of developing enhanced bioremediation methods for the contaminant mixtures in the seeps, laboratory studies were conducted to develop a microbial consortium to degrade 1,1,2,2-tetrachloroethane and its chlorinated daughter products under anaerobic conditions, and to test biostimulation and bioaugmentation of wetland sediment and reactive mat matrices in microcosms. The individual components required for the direct injection and reactive mat methods were then combined in column experiments to test them under groundwater- flow rates and contaminant concentrations observed in the field. Results showed that both direct injection and the reactive mat are promising remediation methods, although the success of direct injection likely would depend on adequately distributing and maintaining organic substrate throughout the wetland sediment in the seep

  9. Design and Performance of an Enhanced Bioremediation Pilot Test in a Tidal Wetland Seep, West Branch Canal Creek, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Majcher, Emily H.; Lorah, Michelle M.; Phelan, Daniel J.; McGinty, Angela L.

    2009-01-01

    Because of a lack of available in situ remediation methods for sensitive wetland environments where contaminated groundwater discharges, the U.S. Geological Survey, in cooperation with the U.S. Army Garrison, Aberdeen Proving Ground, Maryland, conceived, designed, and pilot tested a permeable reactive mat that can be placed horizontally at the groundwater/surface-water interface. Development of the reactive mat was part of an enhanced bioremediation study in a tidal wetland area along West Branch Canal Creek at Aberdeen Proving Ground, where localized areas of preferential discharge (seeps) transport groundwater contaminated with carbon tetrachloride, chloroform, tetrachloroethene, trichloroethene, and 1,1,2,2-tetrachloroethane from the Canal Creek aquifer to land surface. The reactive mat consisted of a mixture of commercially available organic- and nutrient-rich peat and compost that was bioaugmented with a dechlorinating microbial consortium, WBC-2, developed for this study. Due to elevated chlorinated methane concentrations in the pilot test site, a layer of zero-valent iron mixed with the peat and compost was added at the base of the reactive mat to promote simultaneous abiotic and biotic degradation. The reactive mat for the pilot test area was designed to optimize chlorinated volatile organic compound degradation efficiency without altering the geotechnical and hydraulic characteristics, or creating undesirable water quality in the surrounding wetland area, which is referred to in this report as achieving geotechnical, hydraulic, and water-quality compatibility. Optimization of degradation efficiency was achieved through the selection of a sustainable organic reactive matrix, electron donor, and bioaugmentation method. Consideration of geotechnical compatibility through design calculations of bearing capacity, settlement, and geotextile selection showed that a 2- to 3-feet tolerable thickness of the mat was possible, with 0.17 feet settlement predicted for

  10. Changes in microstructure of two ammonium-based protic ionic liquids proved by in situ variable-temperature 1 H NMR spectroscopy: influence of anion.

    Science.gov (United States)

    Tang, Xiaochen; Xu, Yingjie; Zhu, Xiao; Lu, Yueqing

    2017-04-22

    In this work, changes in microstructure of two protic ionic liquids (PILs), namely n-butylammonium acetate (N4Ac) and n-butylammonium nitrate (N4NO3 ), are proved by in situ variable-temperature 1 H NMR spectroscopy at the temperature range from 25 to 115 °C, and the influence of the nature of anion is discussed accordingly. The results demonstrate that 1 H NMR chemical shifts of alkyl protons of both N4Ac and N4NO3 are almost not changed with the increasing of temperature, due to the absence of hydrogen bond interaction between alkyl protons with anions. Whereas those of + N-H of cation decrease linearly with the temperature increasing, indicating that the hydrogen bond interaction between + N-H and anion weakens gradually. In addition, the strength of hydrogen bond interaction between + N-H and NO3- is stronger than that between + N-H and Ac- , suggesting that anions have a significant influence on microstructure due to the acidity of a Brønsted acid. Consequently, the proton transfer from cation to anion is much easier in N4Ac compared to N4NO3 . Further analyses of 1 H NMR chemical shifts of + N-H in N4Ac at the temperature range from 100 to 115 °C suggest that the splitting of + N-H peak may be attributed to obvious evidence of the existence of the proton transfer from + N-H to Ac- , which leads to dissociate the contact ion-pair in N4Ac to form the neutral ion-pair 'molecule'. The results will help us to extensively understand the behavior of proton transfer and offer us some valuable information for the design of PILs. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  11. 3-D Waveguide Effects of Topographical Structural Variation on Full Waveform Propagation: 3-D Finite Difference Modeling Comparisons with Field Data From Yuma Proving Ground, Arizona

    Science.gov (United States)

    Anderson, T. S.; Miller, R.; Greenfield, R.; Fisk, D.

    2002-12-01

    The propagation of seismic waves through regions of complex topography is not thoroughly understood. Surface waves, are of particular interest, as they are large in amplitude and can characterize the source depth, magnitude, and frequency content. The amplitude and frequency content of seismic waves that propagate in regions with large topographical variations are affected by both the scattering and blockage of the wave energy. The ability to predict the 3-d scattering due to topography will improve the understanding of both regional scale surface wave magnitudes, and refine surface wave discriminants as well as at the local scale (Smart Weapons Test Range, Yuma Proving Ground, Arizona. The result of the KGS characterization study is a high-resolution 3-d model that is used in our seismic simulations. The velocities Vs, Vp are calculated by tomography and refraction, attenuation coefficients estimated from the surface wave and from p-waves and are provided in a model with attributes resolved in 3-d to 0.5 meters. In the present work, we present comparisons of synthetic data with seismic data collected at the Smart Weapons Test Range to benchmark the accuracy achieved in simulating 3-d wave propagation in the vicinity of a topographical anomaly (trench). Synthetic seismograms are generated using a 3-d 8th order staggered grid visco-elastic finite difference code that accounts for topography. The geologic model is based on the Yuma site characterization. The size of these calculations required use of the DoD High Performance Computers and parallelized code. Results are compared with field data. Preliminary results show an excellent match with field data using the 3-d fdtd technique.

  12. Background chemistry for chemical warfare agents and decontamination processes in support of delisting waste streams at the U.S. Army Dugway Proving Ground, Utah

    Energy Technology Data Exchange (ETDEWEB)

    Rosenblatt, D.H.; Small, M.J.; Kimmell, T.A.; Anderson, A.W.

    1996-04-01

    The State of Utah, Department of Environmental Quality (DEQ), Division of Solid and Hazardous Waste (DSHW), has declared residues resulting from the demilitarization, treatment, cleanup, and testing of military chemical agents to be hazardous wastes. These residues have been designated as corrosive, reactive, toxic, and acute hazardous (Hazardous Waste No. F999). The RCRA regulations (40 Code of Federal Regulations [CFR] 260-280), the Utah Administrative Code (R-315), and other state hazardous waste programs list specific wastes as hazardous but allow generators to petition the regulator to {open_quotes}delist,{close_quotes} if it can be demonstrated that such wastes are not hazardous. The U.S. Army Test and Evaluation Command (TECOM) believes that certain categories of F999 residues are not hazardous and has obtained assistance from Argonne National Laboratory (Argonne) to make the delisting demonstration. The objective of this project is to delist chemical agent decontaminated residues resulting from materials testing activities and to delist a remediation residue (e.g., contaminated soil). To delist these residues, it must be demonstrated that the residues (1) do not contain hazardous quantities of the listed agents; (2) do not contain hazardous quantities of constituents listed in 40 CFR Part 261, Appendix VIII; (3) do not exhibit other characteristics that could define the residues as hazardous; and (4) do not fail a series of acute toxicity tests. The first phase will focus on a subset of the F999 wastes generated at the U.S. Army Dugway Proving Ground (DPG), where the Army tests the effects of military chemical agents and agent-decontamination procedures on numerous military items. This effort is identified as Phase I of the Delisting Program. Subsequent phases will address other DPG chemical agent decontaminated residues and remediation wastes and similar residues at other installations.

  13. Prasugrel vs. clopidogrel in contemporary Western European patients with acute coronary syndromes receiving drug-eluting stents: Comparative cost-effectiveness analysis from the BASKET-PROVE cohorts.

    Science.gov (United States)

    Wein, Bastian; Coslovsky, Michael; Jabbari, Reza; Galatius, Søren; Pfisterer, Matthias; Kaiser, Christoph

    2017-12-01

    Clinical and cost-effectiveness of prasugrel vs. clopidogrel in acute coronary syndrome (ACS) was only evaluated using TRITON-TIMI 38 event rates. A comparative analysis of both drugs in contemporary European ACS patients is lacking. To address this issue, cardiac and bleeding events of 2 "sister" multicenter stent trials, BASKET-PROVE (BP) I with clopidogrel and BPII with prasugrel (for 12months each) were used in a hybrid analysis. Medication costs were 2015 sales prices, event costs modelled for Denmark (DNK), Germany (GER) and Switzerland (SUI) and quality adjusted life years (QALY) by EQ-5D-3L questionnaire. In BPI and II, 1012 and 985 ACS-patients received drug eluting stents, respectively, followed-up for 2years. Compared to clopidogrel, prasugrel-treated patients had no more major cardiac events (5.2% vs. 6.4%, p=0.422) nor cardiac deaths (1.6% vs. 1.0%, p=0.255), but more major bleedings (4.0% vs. 1.7%, pclopidogrel with ratios of -45,907 (DNK), -39,909 (GER) and -33,435 (SUI) EURO/QALY gained, making clopidogrel an economically dominant strategy, even after accounting for the non-randomized comparison. Findings of this contemporary European ACS-cohort showed markedly lower cardiac event rates than TRITON-TIMI 38 and no significant difference in 2-year QALYs between prasugrel and clopidogrel-treated patients. At current drug prices, clopidogrel use resulted in an economically dominant treatment strategy in Western European patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Development of a simultaneous analytical method for selected anorectics, methamphetamine, MDMA, and their metabolites in hair using LC-MS/MS to prove anorectics abuse.

    Science.gov (United States)

    Lee, Sooyeun; Kim, Jihyun; In, Sanghwan; Choi, Hwakyung; Oh, Seung Min; Jang, Choon-Gon; Chung, Kyu Hyuck

    2012-05-01

    Owing to the tight control of methamphetamine, it is presumed that phentermine, an amphetamine-type anorectic, has recently been considered a supplement for methamphetamine abusers in Korea. In addition, the abuse of other anorectics obtained by inappropriate means has become a social issue. Hair is a useful specimen to prove chronic drug use. Therefore, an analytical method for the simultaneous detection of phentermine, phendimetrazine, amfepramone, fenfluramine, mazindol, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA), as well as their metabolites, which covers the major amphetamines and anorectic agents in Korea, in hair was established and validated using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The drugs and their metabolites in hair were extracted using 1 % HCl in methanol and then filtered and analyzed by LC-MS/MS with electrospray ionization in positive mode. The validation results for selectivity, linearity, matrix effect, recovery, process efficiency, intra- and interassay precision and accuracy, and processed sample stability were satisfactory. The limits of detection ranged from 0.025 to 1 ng/10 mg hair and the limits of quantification were 0.25 ng/10 mg hair for every analyte except mazindol and phentermine, for which they were 10 ng/10 mg hair. The method was successfully applied for the segmental determination of selected anorectics, methamphetamine, MDMA, and their metabolites in hair from 39 drug suspects. Among the anorectics, phentermine and/or phendimetrazine were identified with or without methamphetamine in the hair samples. Closer supervision of the inappropriate use of anorectics is necessary. Also, hair analysis is useful for monitoring the abuse potential of unnoticed drugs.

  15. Interaction of palliative care and primary care.

    Science.gov (United States)

    Ghosh, Amrita; Dzeng, Elizabeth; Cheng, M Jennifer

    2015-05-01

    Primary care physicians are often the first medical providers patients seek out, and are in an excellent position to provide primary palliative care. Primary palliative care encompasses basic skills including basic evaluation and management of symptoms and discussions about goals of care and advance care planning. Specialty palliative care consultation complements primary care by assisting with complex psychosocial-spiritual patient and family situations. This article reviews primary palliative care skill sets and criteria for when to consider referring patients to specialty palliative care and hospice services. Published by Elsevier Inc.

  16. Fast care

    Directory of Open Access Journals (Sweden)

    Hoppstock Sabrina

    2017-09-01

    Full Text Available The project fast care is working on a real-time capable sensor data analysis-framework in the fields of "Ambient Assisted Living" (AAL, "Human-Technology Interaction" (MTI and "eHealth". The aim is to provide a medical valid - integrated real-time picture of the patient’s situation by using an ad hoc interconnected sensor – actor infrastructure with a latency period of less than 10 ms.

  17. [Postacute care].

    Science.gov (United States)

    Admetlla Falgueras, Margarita; Fusté Sugrañes, Josep

    2014-07-07

    The aging of the population and changes in family and social structures have led to increasing care needs for elderly persons following an acute disease or accident, with consequent concerns regarding costs and sustainability within the public health system. The main objective of postacute care (PAC) is to restore the functional capabilities of the patient after an acute event and contribute to determine the patient's outcome and future healthcare requirements. With this background, we carried out a systematic review of the published literature from 1990 to 2011 focused on the following aspects of PAC: a) objectives; b) estimations of the need and the indicators for access to it, and c) transfer strategies from acute care to PAC. The results of this review indicate that PAC is an efficient approach to improve patients' quality of life and to sustain the public healthcare system. The choice of candidates for PAC should be based on both health and social indicators, and the overall process viewed in a cross-sectional manner in order to avoid increases in total cost. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Changes in ground-water quality in the Canal Creek Aquifer between 1995 and 2000-2001, West Branch Canal Creek area, Aberdeen Proving Ground, Maryland

    Science.gov (United States)

    Phelan, Daniel J.; Fleck, William B.; Lorah, Michelle M.; Olsen, Lisa D.

    2002-01-01

    Since 1917, Aberdeen Proving Ground, Maryland has been the primary chemical-warfare research and development center for the U.S. Army. Ground-water contamination has been documented in the Canal Creek aquifer because of past disposal of chemical and ordnance manufacturing waste. Comprehensive sampling for volatile organic compounds in ground water by the U.S. Geological Survey in the West Branch Canal Creek area was done in June?October 1995 and June?August 2000. The purpose of this report is (1) to compare volatile organic compound concentrations and determine changes in the ground-water contaminant plumes along two cross sections between 1995 and 2000, and (2) to incorporate data from new piezometers sampled in spring 2001 into the plume descriptions. Along the southern cross section, total concentrations of volatile organic compounds in 1995 were determined to be highest in the landfill area east of the wetland (5,200 micrograms per liter), and concentrations were next highest deep in the aquifer near the center of the wetland (3,300 micrograms per liter at 35 feet below land surface). When new piezometers were sampled in 2001, higher carbon tetrachloride and chloroform concentrations (2,000 and 2,900 micrograms per liter) were detected deep in the aquifer 38 feet below land surface, west of the 1995 sampling. A deep area in the aquifer close to the eastern edge of the wetland and a shallow area just east of the creek channel showed declines in total volatile organic compound concentrations of more than 25 percent, whereas between those two areas, con-centrations generally showed an increase of greater than 25 percent between 1995 and 2000. Along the northern cross section, total concentrations of volatile organic compounds in ground water in both 1995 and 2000 were determined to be highest (greater than 2,000 micrograms per liter) in piezometers located on the east side of the section, farthest from the creek channel, and concentrations were progressively lower

  19. Use and Evaluation of Psuedo-Geostationary Lightning Mapping Data within the 2010 Experimental Warning Program and GOES-R Proving Ground

    Science.gov (United States)

    Kuhlman, K. M.; Siewert, C.; Stano, G. T.; Bruning, E. C.; Kingfield, D.; Baranowski, B.

    2010-12-01

    The primary objective of the Experimental Warning Program (EWP) is to evaluate the accuracy and the operational utility of new science, technology, and products in a testbed setting in order to gain feedback for improvements prior to their potential implementation into National Weather Service (NWS) operations. A developmental product for the GOES-R Geostationary Lightning Mapper (GLM) was demonstrated during the Spring 2010 EWP as part of the GOES-R Proving Ground. This product was created using data from ground-based Lightning Mapping Array (LMA) networks sorted into flashes and displayed at the 8 km resolution expected with the GLM. During the EWP, forecasters were able to examine the lightning data in AWIPS in conjunction with radar and other multi-sensor products as part of their warning-decision process for both real-time and archive events. Forecasters were then asked to provide feedback through both online surveys following the event and discussion with lead scientists. In general, the PGLM products provided a strong support tool for the forecasters and helped increase forecaster confidence to warn or not warn on a storm. Forecasters viewed future GLM data as a “great tool” or a possible “mainstream product” for “situational awareness.” Multiple forecaster comments echoed the idea of using the GLM data as an additional tool to radar, particularly during the early stages of storm development. Suggestions were given regarding display of the data as well as for future product integration. This feedback will help shape the design of the products and educational tools concerning lightning data ahead of the availability of GOES-R data in the local NWS offices. In addition to the individual forecaster feedback, all warnings issued by the forecasters during the EWP have been scored (POD, FAR) and compared with the official NWS warnings to determine what type of influence the GOES-R products may have had on the warning decision process as well as on

  20. Palliative Care: Delivering Comprehensive Oncology Nursing Care.

    Science.gov (United States)

    Dahlin, Constance

    2015-11-01

    To describe palliative care as part of comprehensive oncology nursing care. A review of the palliative care, oncology, and nursing literature over the past 10 years. Palliative care is mandated as part of comprehensive cancer care. A cancer diagnosis often results in distress in the physical, psychosocial, spiritual, and emotional domains of care. Oncology nurses are essential in providing palliative care from diagnosis to death to patients with cancer. They address the myriad aspects of cancer. With palliative care skills and knowledge, oncology nurses can provide quality cancer care. There are many opportunities in which oncology nurses can promote palliative care. Oncology nurses must obtain knowledge and skills in primary palliative care to provide comprehensive cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  2. Palliative care in the intensive care unit.

    Science.gov (United States)

    Restau, Jame; Green, Pamela

    2014-12-01

    Most patients who receive terminal care in the intensive care setting die after withdrawing or limiting of life-sustaining measures provided in the intensive care setting. The integration of palliative care into the intensive care unit (ICU) provides care, comfort, and planning for patients, families, and the medical staff to help decrease the emotional, spiritual, and psychological stress of a patient's death. Quality measures for palliative care in the ICU are discussed along with case studies to demonstrate how this integration is beneficial for a patient and family. Integrating palliative care into the ICU is also examined in regards to the complex adaptive system. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Primary palliative care in neonatal intensive care.

    Science.gov (United States)

    Marc-Aurele, Krishelle L; English, Nancy K

    2017-03-01

    This article explores the 2014 Institute of Medicine׳s recommendation concerning primary palliative care as integral to all neonates and their families in the intensive care setting. We review trends in neonatology and barriers to implementing palliative care in intensive care settings. Neonatal primary palliative care education should address the unique needs of neonates and their families. The neonatal intensive care unit needs a mixed model of palliative care, where the neonatal team provides primary palliative care and the palliative subspecialist consults for more complex or refractory situations that exceed the primary team׳s skills or available time. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Careful science?

    DEFF Research Database (Denmark)

    Jespersen, Astrid P; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2014-01-01

    the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives...

  5. Barriers to home care for terminally ill Turkish and Moroccan migrants, perceived by GPs and nurses: a survey

    OpenAIRE

    de Graaff Fuusje M; Francke Anneke L

    2009-01-01

    Abstract Background Previous qualitative research proved that relatives of elderly terminally ill Turkish and Moroccan immigrants experience several barriers to the use of Dutch professional home care. The aim of this study was to explore how general practitioners and home care nurses perceive the home care for terminally ill Turkish and Moroccan migrants and their families in the Netherlands. Methods Questionnaires were sent to home care organizations and GPs working in areas where most of t...

  6. PERCORSI DI SCRITTURA PER COMUNICARE, INVENTARE, IMPARARE. ATTIVITÀ DIDATTICHE E PROVE DI VERIFICA DALLA SCUOLA PRIMARIA AL BIENNIO DELLA SCUOLA SECONDARIA DI SECONDO GRADO

    Directory of Open Access Journals (Sweden)

    Feliciana Cicardi (a cura di

    2015-07-01

    Full Text Available Da una ricerca condotta inizialmente nell’ambito dell’IRRE Lombardia, e successivamente ripresa e aggiornata alla luce dei più recenti documenti per la scuola primaria e secondaria, nascono questi percorsi di scrittura destinati alla scuola dell’obbligo e guidati dall’idea che saper scrivere, in quanto strumento essenziale per l’esercizio di una cittadinanza consapevole, sia una competenza da introdurre, fondare e praticare fin dai primi anni di scuola, perché ciascuno possa poi svilupparla per tutto il corso della vita.L’ipotesi curricolare si articola in tre filoni “verticali”, dal primo al decimo anno di scolarità, orientati rispetto ad uno scopo: scrivere per comunicare, scrivere per inventare, scrivere per imparare. Il curricolo si struttura in unità di apprendimento, in cui la scrittura viene sviluppata in situazioni significative e per lo più autentiche, con attività via via più complesse in ragione del livello scolare e in modo integrato alle altre abilità d’uso della lingua.In questa proposta tipologie e forme testuali vengono analizzate e utilizzate come strumenti efficaci per raggiungere un risultato comunicativo e non come dispositivi per esercitazioni tecniche e/o decontestualizzate.Al termine dei tre percorsi complessivi si sono predisposte delle prove di verifica, strutturate per livelli di scolarizzazione, in modo da poter testare, per gli allievi, le competenze specifiche dichiarate per i tre filoni e in modo da poter offrire all’insegnante una visione articolata dello sviluppo dell’abilità di scrittura negli anni e rispetto a scopi e testi differenziati.Using writing to communicate, invent, learnFrom a study conducted initially within IRRE Lombardia which was subsequently resumed and updated in the light of the most recent documents for primary and secondary school, these experiences in writing at school are guided by the idea that knowing how to write is an essential tool for becoming aware

  7. What is palliative care?

    Science.gov (United States)

    Comfort care; End of life - palliative care; Hospice - palliative care ... The goal of palliative care is to help people with serious illnesses feel better. It prevents or treats symptoms and side effects of disease ...

  8. Palliative or Comfort Care

    Science.gov (United States)

    ... and communication among family members and providers of care. Palliative care can improve your quality of life when ... control Need help understanding your situation and coordinating care PALLIATIVE OR COMFORT CARE Often a team of specialists ...

  9. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help ...

  10. 52 years of kindergarten – the structure has proved successful and must not disappear – let’s save our nursery and school together!

    CERN Multimedia

    Staff Association

    2017-01-01

    Since the beginning of 2016, the Staff Association has been in discussions with the Management to save and sustain our Nursery and School, located on the CERN site in Meyrin. Where are we now with the discussions and what does the future hold for our Children’s Day-Care Centre and School (EVEE)? A closer look at the creation of the Kindergarten and its management A group of parents founded the Kindergarten at CERN in the 1960s, and in 1969, the CERN Staff Association took the structure under its aegis. This change in management resulted in a partnership agreement between CERN and the Staff Association. The agreement defined the rights and duties of both parties with regard to the Staff Association operating a kindergarten on the CERN site. Since then, the Staff Association has been the employer and manager of the structure providing early childhood services. Development of the structure over time In 1977, the Kindergarten changed premises and a new agreement was signed between CERN and the Staff As...

  11. Pregnancy and Parenthood in Radiation Oncology, Views and Experiences Survey (PROVES): Results of a Blinded Prospective Trainee Parenting and Career Development Assessment.

    Science.gov (United States)

    Holliday, Emma B; Ahmed, Awad A; Jagsi, Reshma; Stentz, Natalie Clark; Woodward, Wendy A; Fuller, Clifton D; Thomas, Charles R

    2015-07-01

    Medical training spans nearly a decade, during which many physicians traditionally begin families. Although childrearing responsibilities are shared by men and women in the modern era, differences in time allocated to child care by sex and its potential impact on residency experience merit discussion. An anonymous, voluntary, 102-item survey was distributed to 540 current radiation oncology residents and 2014 graduates that asked about marital and parental status, pregnancy during residency, publication productivity, career aspirations, and experiences working with pregnant co-residents. Respondents with children were asked about childcare arrangements, and women who were pregnant during residency were asked about radiation safety, maternity leave, and breastfeeding experiences. A total of 190 respondents completed the survey, 107 men (56.3%) and 84 women (43.7%). Ninety-seven respondents (51.1%) were parents, and 84 (44.2%) reported a pregnancy during residency. Respondents with children more often were male (65% vs 47.3%; P=.014), in a higher level of training (79.3% vs 54.8% were PGY4 or higher; P=.001), were older (median age of 32, interquartile range [IQR]:31-35] vs age 30 [IQR: 29-33]; Pcareer by parental status. Among parents, men more frequently had partners who did not work (38.1% vs 0%, respectively; Pcareer aspirations. Further investigation is critical to elucidate gender disparities in parenthood and career development. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Pharmacokinetics of clindamycin in pregnant women in the peripartum period

    NARCIS (Netherlands)

    Muller, A.E.; Mouton, J.W.; Oostvogel, P.M.; Dorr, P.J.; Voskuyl, R.A.; DeJongh, J.; Steegers, E.A.P.; Danhof, M.

    2010-01-01

    The study presented here was performed to determine the pharmacokinetics of intravenously administered clindamycin in pregnant women. Seven pregnant women treated with clindamycin were recruited. Maternal blood and arterial and venous umbilical cord blood samples were obtained. Maternal clindamycin

  13. Peripartum hysterectomy: two years experience at Nelson Mandela ...

    African Journals Online (AJOL)

    EB

    2009-01-31

    Jan 31, 2009 ... global survey on maternal and perinatal health in Latin America. Lancet 2006; 367:1819-29. 16. Day C, Barron P, Monticelli F, Sello E, editors. The District Health Barometer 2007/2008. Durban: Health System Trust; June 2009. 17. Department of Obstetrics and Gynaecology,. Walter Sisulu University, South ...

  14. Emergency management of term pregnant female with decompensated peripartum cardiomyopathy

    Directory of Open Access Journals (Sweden)

    I. Lata*

    2013-12-01

    Discussion: An interesting case of 37-year-old female (primigravida G1P0L0 presented at 37 weeks gestation with chief complaint of progressively increasing breathlessness for 15 days and swelling in both lower limbs for 7 days presented in ED. Her general condition – poor, blood pressure – 180⧹110 mmHg, pulse – 136⧹ min irregular, RR 36⧹min, Pallor ++, JVP raised, pedal oedema  +  cardiovascular exam showed S3 gallop rhythm, P2 loud (pulmonary hypertension and chest with bilateral crepitation’s (pulmonary oedema. She was managing on the line of preeclampsia toxaemia elsewhere. We diagnose her having CHF due to PPCM that was managed only with timely diagnosis and prompt management and save two lives with help of multidisciplinary team. Lesson from successful case management will help others to differentiate physiological changes during pregnancy with other life threatening disease that can be with or during pregnancy. The detailed management and discussion will be presented at time of presentation.

  15. Sepsis: Primary indication for peripartum hysterectomies in a South ...

    African Journals Online (AJOL)

    Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa ..... Curr Opin HIV. AIDS 2013;8(5):474-489. http://dx.doi.org/10.1097/coh.0b013e328363a8f2. 34. Knight M, Kurinczuk JJ, Spark P, Brocklehurst P, United Kingdom Obstetric Surveillance.

  16. Peripartum hysterectomy: Two years experience at Nelson Mandela ...

    African Journals Online (AJOL)

    The indications for the operation were uterine atony 19/63 (30.2%), secondary haemorrhage/puerperal sepsis 17/63 (27%) and ruptured uterus 16/63 (23.4%). The main intra operative complication was haemorrhage 13/63 (20.6%). Repeat laparotomy was done in 10/63 (15%) of patients due to haemorrhage. Admission to ...

  17. Rates and determinants of peripartum and puerperal anemia in ...

    African Journals Online (AJOL)

    Data were analyzed with descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences computer software version 20.0 for Windows (IBM Corporation, Armonk, NY, USA). Results: A total of 202 women were studied. The mean hemoglobin levels at term, 48 h, and 6 weeks ...

  18. Efeito da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no periparto Effect of propylene glycol, cobalt and vitamin B12 on the metabolic profile and enzymatic in Santa Inês ewes in peripartum

    Directory of Open Access Journals (Sweden)

    Rogério Adriano dos Santos

    2012-12-01

    Full Text Available O presente estudo teve por objetivo avaliar a influência da administração de propileno glicol e cobalto associado à vitamina B12 sobre o perfil metabólico e a atividade enzimática de ovelhas da raça Santa Inês no período do periparto. Foram utilizadas 18 ovelhas prenhes, pesando em torno de 40kg. Aproximadamente 30 dias antes da data prevista para o parto foram separadas de maneira aleatória em três grupos e administrados os suplementos conforme a seguir: (G1/n=6 grupo que recebeu propileno glicol (30mL por via oral diariamente; (G2/n=6 grupo que recebeu cobalto (1mg de cloreto de cobalto a 1%, via oral diariamente associado a vitamina B12 (2mg via intramuscular, semanalmente e (G3/n=6 grupo controle. As amostras de sangue das ovelhas para avaliação do perfil metabólico e enzimático (glicose, β-hidroxibutirato-BHB, NEFA, proteína total, albumina, uréia, creatinina, AST, GGT, FA e CK foram colhidas 30 dias antes da data prevista para o parto, uma semana antes (ante-parto, no parto, às 24h, 72h, 5 dias, 15 dias e 30 dias após o parto. Não foi observado cetonúria nos momentos que antecederam ao parto. A administração dos suplementos não influenciou sobre o perfil metabólico, protéico e energético, assim como não houve comprometimento hepático das ovelhas no período do periparto.The aim of this study was to evaluate the influence of the administration of propylene glycol and cobalt associated with vitamin B12 on the metabolic profile and enzymatic activity of Santa Inês ewes in the peripartum period. A total of 18 pregnant ewes, weighing around 40kg were used. Approximately 30 days before the expected date of delivery were randomly separated into three groups and administered supplements as follows: (G1/n = 6 group received propylene glycol (30mL orally daily; (G2/n = 6 group receiving cobalt (1mg cobalt chloride 1%, orally daily associated with vitamin B12 (2mg intramuscular weekly and (G3/n = 6 control group. Blood

  19. [Admission of women to an intensive care unit during pregnancy or the postpartum period: circumstances and prognosis. A retrospective series of 96 cases].

    Science.gov (United States)

    Lelong, E; Pourrat, O; Pinsard, M; Goudet, V; Badin, J; Mimoz, O; Pierre, F

    2013-03-01

    Very few studies had been published about admission of obstetric patients in French intensive care units (ICU). Files of women who had been admitted during pregnancy or the postpartum period to ICU of an academic hospital between January 1st 1997 and 31st December 2006 were analyzed. Diagnosis at admission, severity, main treatments and outcome were studied during two successive periods of 5 years. There were 96 admissions (0.95% of all admissions to ICU). They included 34 complications due to arterial hypertension (35%), among them 10 cases of pre-eclampsia, eight of eclampsia, seven of Hemolysis-Liver Enzymes-Low Platelet (HELLP) syndrome and two of retroplacental hematoma ; 26 postpartum haemorrhages (27%); and 36 miscellaneous diagnosis including two sepsis, four acute pulmonary oedema, four cardiomyopathy, three pulmonary embolism, and three acute liver steatosis. Mean Simplified Acute Physiologic Score (SAPS II) was 18.5±11.2 and mean Sequential Organ Failure Assessment (SOFA) 2.1±2.3. The main treatments were mechanical ventilation (50% of all cases) and transfusion (32%). The average ICU stay was 5.7±5.4 days. Two maternal deaths were observed (aortic dissection and peripartum cardiomyopathy). The number of patients admitted for postpartum haemorrhage increased from five to 21 over the two successive periods of the study. The number of women admitted to ICU during pregnancy or the postpartum period is low. Admissions for hemorrhage have increased. Regular monitoring of maternal morbidity and mortality gives relevant clues for assessing the quality of obstetrical care. Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  20. [P3S: Secured fitness trail set up in Guadeloupe, a tool to fight against physical inactivity: A device that has proved itself].

    Science.gov (United States)

    Atallah, A; Pinay, M; Virolan, K; Bedouet, F; Gatibelza, S

    2016-06-01

    The objective is to introduce an original device already set up in Guadeloupe, the P3S: it is a secured fitness trail; it aims to raise awareness of the harmful effects of physical inactivity and to fight against physical inactivity. The P3S device was financed by the Regional Council of Guadeloupe and includes: (1) a first space to perform a warm-up and gymnastics; (2) the route to the market; (3) 8 physical activity workshops. Coaching by educators sportsmen and teachers of activity physics adapted is proposed, provided by the ARS of Guadeloupe. Coordination is organized by the network of care, the HTA-GWAD network - Gip.Raspeg. A first evaluation of the device was conducted following the establishment on 10 routes drivers. The very encouraging results of these P3S led to extend the device to all communes of Guadeloupe who have at least a P3S. The proximity of these P3S, their free, and coaching provided by exercise teachers trained in sport health explains the success of these devices. The P3S are currently well known by the Guadeloupean population that well integrates this device. The supervision of educators is a source of motivation and makes P3S, a place where physical activities in group are practiced free of charge and in a friendly state of mind. This device might be known from other regions that could also set them up. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Oral care.

    Science.gov (United States)

    Hitz Lindenmüller, Irène; Lambrecht, J Thomas

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable. Copyright © 2011 S. Karger AG, Basel.

  2. Palliative care in Africa: a global challenge.

    Science.gov (United States)

    Ntizimira, Christian R; Nkurikiyimfura, Jean Luc; Mukeshimana, Olive; Ngizwenayo, Scholastique; Mukasahaha, Diane; Clancy, Clare

    2014-01-01

    We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said 'in the middle of difficulty lies opportunity' and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, Rwandan healthcare workers are proving how palliative care can be successfully integrated into a healthcare system. As a global healthcare community, we should be asking what opportunities exist to do this across the African continent. Champions of palliative care have a chance to forge lasting collaborations between international experts and African healthcare workers. This global network could not only advocate for palliative care programmes but it would also help to create a culture where palliative care is viewed as a necessary part of all healthcare systems.

  3. Pregnancy and Parenthood in Radiation Oncology, Views and Experiences Survey (PROVES): Results of a Blinded Prospective Trainee Parenting and Career Development Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Holliday, Emma B. [Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ahmed, Awad A. [Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (United States); Jagsi, Reshma [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Stentz, Natalie Clark [Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Woodward, Wendy A.; Fuller, Clifton D. [Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Thomas, Charles R., E-mail: thomasch@ohsu.edu [Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon (United States)

    2015-07-01

    Purpose: Medical training spans nearly a decade, during which many physicians traditionally begin families. Although childrearing responsibilities are shared by men and women in the modern era, differences in time allocated to child care by sex and its potential impact on residency experience merit discussion. Methods and Materials: An anonymous, voluntary, 102-item survey was distributed to 540 current radiation oncology residents and 2014 graduates that asked about marital and parental status, pregnancy during residency, publication productivity, career aspirations, and experiences working with pregnant co-residents. Respondents with children were asked about childcare arrangements, and women who were pregnant during residency were asked about radiation safety, maternity leave, and breastfeeding experiences. Results: A total of 190 respondents completed the survey, 107 men (56.3%) and 84 women (43.7%). Ninety-seven respondents (51.1%) were parents, and 84 (44.2%) reported a pregnancy during residency. Respondents with children more often were male (65% vs 47.3%; P=.014), in a higher level of training (79.3% vs 54.8% were PGY4 or higher; P=.001), were older (median age of 32, interquartile range [IQR]:31-35] vs age 30 [IQR: 29-33]; P<.001), had a PhD (33% vs 19.3%, respectively; P=.033), were married (99% vs 43%, respectively; P<.001), and had a partner who did not work (24.7% vs 1.9%, respectively; <.001). There were no differences in the number of manuscripts published or the number of residents who expressed likelihood of pursing an academic career by parental status. Among parents, men more frequently had partners who did not work (38.1% vs 0%, respectively; P<.001) and reported that their partner performed a greater percentage of childcare duties (70% [IQR: 60%-80%] vs 35% [IQR: 20%-50%], respectively; P<.001). Conclusions: Pregnancy and parenthood are common during residency. Female residents are frequently responsible for more childcare duties than males

  4. The disruptive administrator: tread with care

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-08-01

    Full Text Available Although the extent of disruptive behavior in healthcare is unclear, the courts are beginning to recognize that administrators can wrongfully restrain a physician's ability to practice. Disruptive conduct is often difficult to prove. However, when administration takes action against an individual physician, they are largely powerless, with governing boards and courts usually siding with the administrators. As long as physicians remain vulnerable to retaliation and administration remains exempt for inappropriate actions, physicians should carefully consider the consequences before displaying any opposition to an administrative action.

  5. Perioperative Care of Prisoners: Providing Safe Care.

    Science.gov (United States)

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  6. Palliative Care Practice in Neurocritical Care.

    Science.gov (United States)

    Knies, Andrea K; Hwang, David Y

    2016-12-01

    Many neurocritically ill patients and their families have high amounts of palliative care needs. Multiple professional societies relevant to neurocritical care have released consensus statements on meeting palliative care needs in neuroscience intensive care units. In this review, the authors discuss the ongoing debate regarding what model of palliative care delivery is optimal, focus on the process of shared decision making during goals-of-care discussions, and briefly comment on transitions from intensive care to comfort care. Regardless of an institution's model of palliative care practice, every neurocritical care clinician should possess core competencies necessary to provide basic, integrative palliative care for neurocritically ill patients. Given the high proportion of neurocritically ill patients who lack decision-making capacity, communication skills that enable clinicians to facilitate shared decision making with patients' surrogates are of particular relevance, especially when the limitation of life support is in the discussion. High-quality decision aids to assist neurocritical care teams and surrogate decision makers during common goals-of-care discussions may have the potential for further promotion of best palliative care practices. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  7. RFID Continuance Usage Intention in Health Care Industry.

    Science.gov (United States)

    Iranmanesh, Mohammad; Zailani, Suhaiza; Nikbin, Davoud

    Radio-frequency identification (RFID) has been proved to be an effective tool both for improving operational efficiency and for gaining competitive advantage in the health care industry despite its relatively low-usage rate in hospitals. The sustained use of RFID by health care professionals will promote its development in the long term. This study evaluates the acceptance continuance of RFID among health care professionals through technology continuance theory (TCT). Data were collected from 178 medical professionals in Malaysia and were then analyzed using the partial least squares technique. The analysis showed that the TCT model provided not only a thorough understanding of the continuance behavior of health care professionals toward RFID but also the attitudes, satisfaction, and perceived usefulness of professionals toward it. The results of this study are expected to assist policy makers and managers in the health care industry in implementing the RFID technology in hospitals by understanding the determinants of continuance of RFID usage intention.

  8. Quality of care in European home care programs using the second generation interRAI Home Care Quality Indicators (HCQIs).

    Science.gov (United States)

    Foebel, Andrea D; van Hout, Hein P; van der Roest, Henriëtte G; Topinkova, Eva; Garms-Homolova, Vjenka; Frijters, Dinnus; Finne-Soveri, Harriet; Jónsson, Pálmi V; Hirdes, John P; Bernabei, Roberto; Onder, Graziano

    2015-11-14

    Evaluating the quality of care provided to older individuals is a key step to ensure that needs are being met and to target interventions to improve care. To this aim, interRAI's second-generation home care quality indicators (HCQIs) were developed in 2013. This study assesses the quality of home care services in six European countries using these HCQIs as well as the two derived summary scales. Data for this study were derived from the Aged in Home Care (AdHOC) study - a cohort study that examined different models of community care in European countries. The current study selected a sub-sample of the AdHOC cohort from six countries whose follow-up data were complete (Czech Republic, Denmark, Finland, Germany, Italy and the Netherlands). Data were collected from the interRAI Home Care instrument (RAI-HC) between 2000 and 2002. The 23 HCQIs of interest were determined according to previously established methodology, including risk adjustment. Two summary measures, the Clinical Balance Scale and Independence Quality Scale were also determined using established methodology. A total of 1,354 individuals from the AdHOC study were included in these analyses. Of the 23 HCQIs that were measured, the highest proportion of individuals experienced declines in Instrumental Activities of Daily Living (IADLs) (48.4 %). Of the clinical quality indicators, mood decline was the most prevalent (30.0 %), while no flu vaccination and being alone and distressed were the most prevalent procedural and social quality indicators, respectively (33.4 and 12.8 %). Scores on the two summary scales varied by country, but were concentrated around the median mark. The interRAI HCQIs can be used to determine the quality of home care services in Europe and identify areas for improvement. Our results suggest functional declines may prove the most beneficial targets for interventions.

  9. Nursing Care and Parents Contribution in the Care of their Childern with Hypospadias

    Directory of Open Access Journals (Sweden)

    Marianna Orfanidou

    2010-01-01

    Full Text Available The term hypospadias is derived from the Greek language and refers to the pathological condition of urethra, which the vestibule, by the time of embryology is imperfect. Approximately 1 to 300 male births appear this problem. The aim of this study is the best quality of nursing management. It is proved that the child recover earlier when the parents involved in care, so it is important to explain the procedure, educate parents about the care after leaving the hospital and to make sure that there are no questions unanswered. The new techniques, the nursing management and the parents’ contribution in care promote to reduce hypospadias hospitalization and so, the less suffering.

  10. Acne - self-care

    Science.gov (United States)

    Acne vulgaris - self-care; Cystic acne - self-care; Pimples - self-care; Zits - self-care ... If daily skin care does not clear up blemishes, try over-the-counter acne medicines that you apply to your skin. These products ...

  11. Performance-enhancing sports supplements: role in critical care.

    Science.gov (United States)

    Weitzel, Lindsay-Rae B; Sandoval, Paul A; Mayles, W Jonathan; Wischmeyer, Paul E

    2009-10-01

    Many performance-enhancing supplements and/or drugs are increasing in popularity among professional and amateur athletes alike. Although the uncontrolled use of these agents can pose health risks in the general population, their clearly demonstrated benefits could prove helpful to the critically ill population in whom preservation and restoration of lean body mass and neuromuscular function are crucial. Post-intensive care unit weakness not only impairs post-intensive care unit quality of life but also correlates with intensive care unit mortality. This review covers a number of the agents known to enhance athletic performance, and their possible role in preservation of muscle function and prevention/treatment of post-intensive care unit weakness in critically ill patients. These agents include testosterone analogues, growth hormone, branched chain amino acid, glutamine, arginine, creatine, and beta-hydryoxy-beta-methylbutyrate. Three of the safest and most effective agents in enhancing athletic performance in this group are creatine, branched-chain amino acid, and beta-hydryoxy-beta-methylbutyrate. However, these agents have received very little study in the recovering critically ill patient suffering from post-intensive care unit weakness. More placebo-controlled studies are needed in this area to determine efficacy and optimal dosing. It is very possible that, under the supervision of a physician, many of these agents may prove beneficial in the prevention and treatment of post-intensive care unit weakness.

  12. The mapping competences of the nurse Case/Care Manager in the context of Intensive Care.

    Science.gov (United States)

    Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo

    2017-03-15

    's profile has been drafted on the basis of the comparative analysis conducted. It has been noted how the Case/Care Manager's professional profile can really improve relationships and communications between medical staff and patients, promoting a major unity among the working team. According to the present research, the Case/Care Manager's profile has been proved helpful in positively influencing the team activity and to elicit major satisfaction both in patients and their family.

  13. Preventive Care Benefits (Affordable Care Act)

    Science.gov (United States)

    ... For children Footer Resources About the Affordable Care Act Regulatory and Policy Information For Navigators, Assisters & Partners ... gov USA.gov Resources About the Affordable Care Act Regulatory and Policy Information For Navigators, Assisters & Partners ...

  14. Child Care Aware

    Science.gov (United States)

    ... this special celebration at the conclusion of our 2018 Symposium. Learn More + Breaking News Transforming the Financing of Early Care and Education ... Child Care Workforce Back Emergency Preparedness Child Care Disaster Relief ... Resources August Recess Public Policy Research Calendar ...

  15. Adoption & Foster Care

    Science.gov (United States)

    ... Family Life > Family Dynamics > Adoption & Foster Care Adoption & Foster Care Article Body ​Each year, many children join families through adoption and foster care. These families may face unique challenges. The acceptance ...

  16. End of Life Care

    Science.gov (United States)

    ... the person is not terminally ill. An informed refusal of medical treatment should always be respected. (Read ... to dry up secretions may also be used. Care and Treatment Palliative Care Palliative care is specialized ...

  17. Palliative or Comfort Care

    Science.gov (United States)

    ... emotional distress. A special type of care called palliative care is available to help you get relief from these and other symptoms. You can receive palliative care at any stage of your serious illness, including ...

  18. Palliative care - managing pain

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000532.htm Palliative care - managing pain To use the sharing features on this page, please enable JavaScript. Palliative care is a holistic approach to care that focuses ...

  19. Community-Based Care

    Science.gov (United States)

    ... our e-newsletter! Aging & Health A to Z Community-Based Care Basic Facts & Information A variety of ... Adult Day Care Adult day care is a community-based option that has become more common. It ...

  20. Kangaroo mother care.

    Science.gov (United States)

    Bailey, Sarah

    2012-05-01

    Kangaroo mother care is a safe, simple method to care for low birth weight infants. This article looks at its origins, what is involved in kangaroo mother care and reviews the evidence for improved outcomes resulting from its implementation.

  1. Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country

    OpenAIRE

    Gamboa Moreno, Estibaliz; del Campo Pena, Emma; Ochoa de Retana Garcia, Lourdes; Arbonies Ortiz, Juan Carlos; Piñera Elorriaga, Koldo; Rua Portu, Mª Angeles; Urquiza Bengoa, Miren Nekane; Mendez Sampedro, Tomas; Oses Portu, Ana; Zenarutzabeitia Pikatza, Amaya; Gorostidi Fano, Lourdes; Aguirre Sorondo, Bakarne; Mateo-Abad, Maider; Rotaeche Del Campo, Rafael

    2016-01-01

    Introduction: Type 2 diabetes mellitus (DM2) is a disease with high prevalence and significant impact in terms of mortality and morbidity. The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management. The Spanish Diabetes Self-Management Program (SDSMP) proved to be effective in other settings. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care settings within the Basque Healt...

  2. [Humanized care in the teaching of nursing].

    Science.gov (United States)

    Motta, Maria da Graça

    2004-01-01

    This 'teaching experience' report addresses contents related to the humanized care given to children/adolescents and to their family. It was made in collaboration with students of the Undergraduate Course in Nursing. The Creativity and Awareness workshops proposed by Cabra I (1999) have been used as methodology because they proved adequate to approaching complex themes such as prevention of violence against children/adolescents and assistance to families that experience child sickness. During the workshops, the aim is to create an environment for reflection on humanized care on the basis of students' experiences. We found out that it is important to introduce alternative methodologies into the teaching/learning process of students, seeking the construction of knowledge and giving priority to their experiences.

  3. Emergency medical care in The Netherlands.

    Science.gov (United States)

    Boom, P S

    1999-09-01

    In The Netherlands a serious effort is underway to improving the performance of the emergency medical care system by functionally integrating ambulance services and hospitals into a comprehensive care network. Ambulance services are actively stimulated to join regional bodies offering adequate resources to deal with a whole range of incidents from day-to-day accidents to large-scale disasters. At the same time the development of a network of 'Accident and Emergency' hospitals is being promoted. Such networks will be centred around government-appointed traumacentres. Regional ambulance bodies and 'A&E-network' will be geographically attuned into an integral EMC-system, supervised by an EMC-officer assigned by the local authorities that constitute the regional authority. The Dutch government has initiated a project to streamline and monitor the developments. The project has proved to be a stimulating example of effective collaboration between the government and various involved professional disciplines.

  4. Palliative Care In Romania.

    Science.gov (United States)

    Mosoiu, Daniela; Mitrea, Nicoleta; Dumitrescu, Malina

    2017-08-17

    Hospice Casa Sperantei has been pioneering palliative care development in Romania since 1992. The have developed specialist palliative care services in home-based settings, inpatient units, day care centers and as hospital support teams. They have provided national and international education programs for professionals in the palliative care field, as well as promoting palliative care integration in the healthcare system. Legislative improvements were adopted including funding mechanisms for the reimbursement of palliative care services through the health insurance funds, review of opioid policy, and quality standards of care. By the end of 2015, Romania had 115 specialist palliative care services (78 palliative care inpatient units, 24 home-based palliative care services, 5 outpatient palliative care clinics, 4 day care centers and 4 hospital support teams). A palliative care subspecialty for doctors was recognized as early as 2000, and a multidisciplinary Master's Degree program has been available at Transilvania University since 2010, when the first palliative care academic position was established. Nursing education includes mandatory palliative care modules in nursing schools. For coordinated development of palliative care at the national level a national strategy was proposed defining three levels of palliative care provision, local, district and national. The implementation of the palliative care strategy is partially funded through a World Bank loan. Copyright © 2017. Published by Elsevier Inc.

  5. Attitudes towards infection control among dental health care professionals

    OpenAIRE

    Rimkuvienė, Jūratė

    2011-01-01

    The oral flora is one of the most ecologically diverse microbial populiations known to man. It has been proved that any dental intervention: dental preparation, professional oral hygiene, extraction of teeth, regular prophylactic examination of patient‘s mouth is related with a possible spread of infection. Therefore, one of the most important tasks for the dental care professionals is to prevent the spread of infection and create safe environment for a patient, the dentist himself and other ...

  6. Primary health care centres in Madagascar.

    Science.gov (United States)

    Andrianarisoa, A O; Rampanjato, M

    1994-01-01

    In 1976, Madagascar promised to establish 1500 primary health care centers to be run by a community health agent. The communities selected sites for the centers, nominated health agent candidates, built and maintained the centers and accommodation for the health agents, supplied the centers, and undertook their operation. The government organized the recruitment and training of the agents, paid their wages, and provided equipment and drugs. The candidates were 18-28 years old and had completed two years of secondary education. Training lasted 14 months and enabled the new agents to provide basic health care in the curative, preventive, and educational fields. The health agents can deal with normal births, family planning, vaccination, and health education. In 1991 the country had 1935 facilities that were providing primary care. Some 85% of the health agents have remained in the primary health care centers for over 10 years; 50 agents have moved out to become nurses or midwives. Financial support for the program comes from the state and external donors. Of the 1500 planned primary health care centers, 461 stopped functioning, mostly because the communities concerned have not adequately built and maintained premises for the health agents. The primary health care centers are less frequently attended than formerly because equipment is aging and drugs are in short supply. Cost recovery should be widely adopted in the national health system. More in-service training should be provided for health agents, and more tours of inspection should be carried out. Community health workers should be managed entirely by the community, and the Ministry of Health should take charge of their training. Primary health care in Madagascar has largely proved its worth; if the economic handicaps can be overcome, the program is likely to contribute to the achievement of the health-for-all goals.

  7. A Laptop Computer Application for Neonatal Intensive Care

    Science.gov (United States)

    Stoeckeler, Joel S.; Ellis, Lynda B.M.

    1989-01-01

    A laptop computer system has been developed for the acquisition, calculation, and reporting of pediatric health care maintenance parameters used to assess fluid and caloric metabolic balance in ward and intensive care environments. A pilot study with inexperienced users of the system demonstrated shorter calculation and report generation times at all but the least complex test cases. More importantly, the system significantly reduces the proportion of errors made at all levels of complexity (p < 0.001). This system has proved to be a valuable bedside companion.

  8. Spiritual Care Education of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino

    2015-05-01

    Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.

  9. Promoting patient care: work engagement as a mediator between ward service climate and patient-centred care.

    Science.gov (United States)

    Abdelhadi, Nasra; Drach-Zahavy, Anat

    2012-06-01

      To test a model that suggests the ward's climate of service facilitates nurses' patient-centred care behaviours through its effect on nurses' work engagement.   Organizational efforts to promote patient-centred care focused on interventions aimed to improve nurses' communication skills, or to improve patient's participation in the decision-making process. These interventions have been only partially successful, as they do not take the ward context into account; so caring professionals who attend workshops can rarely apply their newly acquired skills due to the daily pressures of the ward.   A nested cross-sectional research design (nursing staff within wards) was adopted, with three measures of the care behaviour of nurses. Data were collected in 2009, from 158 nurses working in 40 wards of retirement homes in northern Israel. Nurses' work engagement, ward's climate for service and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations.   The findings supported our model: service climate proved a link to nurses' work engagement and patient-centred care behaviours. Nurses' work engagement mediated the service-climate patient-centred care behaviours.   The research is pioneering in demonstrating a close relation between ward service climate and patient-centred care. In practice, to improve patient-centred care managers should invest in facilitating ward service climate, highlighting the importance of service to the organization through appropriate rewards, guidance and administrative practices. © 2011 Blackwell Publishing Ltd.

  10. Health care operations management

    NARCIS (Netherlands)

    Carter, M.W.; Hans, Elias W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  11. In Care, Aftercare and Caring for Those in Care: My Successful Care Journey

    Science.gov (United States)

    Morrison, Shelley

    2016-01-01

    Coyle and Pinkerton identify gaps in the care leaving system in Northern Ireland regarding social work training and meeting the challenges of transitioning from care. The primary focus of this article is to provide a perspective of care and leaving care which could contribute to social work education and practice in these areas. Framed within a…

  12. Settings for Terminal Care.

    Science.gov (United States)

    Corless, Inge B.

    1988-01-01

    Examines topics related to delivery of terminal care services: ability of various hospice programs to survive financially, contributions of various models of hospice care, impact of Medicare legislation on hospice movement, demonstration of unique hospice intervention, integration of spiritual care into hospice, and role of hospice in care of…

  13. Palliative Care in Dementia.

    Science.gov (United States)

    Aquilina, Francesca Falzon; Agius, Mark

    2015-09-01

    The Dementias are common neurodegenerative diseases which gradually deteriorate and eventually become fatal. However, hospice care is usually made available to patients suffering from Cancer, while patients who suffer from other chronic conditions such as dementia are not usually offered such care. However the lessons which have been learnt regarding hospice palliative care could be applied with some modification to the care of patients with Dementia. This article attempts to discuss the present literature about palliative care in Dementia, in order to clarify the evidence which underlies the European Association for Palliative Care 'White paper defining optimal palliative care in older people with dementia'.

  14. Has the Agrotherm method proved useful

    Energy Technology Data Exchange (ETDEWEB)

    Schikora, G.

    1982-03-19

    The author reports on the Agrotherm project. It was planned not to carry off the waste heat of power plants via conventional cooling towers but to use the heat for heating agricultural areas by conducting the hot waste water through pipes buried in the ground. One hopes to improve the yield by this measure.

  15. Has the Effect of Mesotherapy Been Proved?

    OpenAIRE

    Gonca Gökdemir

    2009-01-01

    Mesotherapy is a medical technique that consist of the intracutaneous or subcutaneous injection to the diseased area. It has become as a populer treatment method in cosmetic dermatology recently. Mesotherapy has been used in the treatment of skin rejuvenation, cellulite and localized fat reduction. Substances using in mesotherapy are plant extracts, homeopathic agents, vitamins, and some pharmaceuticals. The effect of these agents are not completely known. There are few experimental and clini...

  16. Eternity Variables to Prove Simulation of Specifications

    NARCIS (Netherlands)

    Hesselink, Wim H.

    2005-01-01

    Simulations of specifications are introduced as a unification and generalization of refinement mappings, history variables, forward simulations, prophecy variables, and backward simulations. A specification implements another specification if and only if there is a simulation from the first one to

  17. Using NFC phones for proving credentials

    NARCIS (Netherlands)

    Alpár, G.; Batina, L.; Verdult, R.

    2012-01-01

    In this paper we propose a new solution for mobile payments called Tap2 technology. To use it, users need only their NFC-enabled mobile phones and credentials implemented on their smart cards. An NFC device acts like a bridge between service providers and secure elements and the secure credentials

  18. Proving the ecosystem value through hydrological modelling

    Science.gov (United States)

    Dorner, W.; Spachinger, K.; Porter, M.; Metzka, R.

    2008-11-01

    Ecosystems provide valuable functions. Also natural floodplains and river structures offer different types of ecosystem functions such as habitat function, recreational area and natural detention. From an economic stand point the loss (or rehabilitation) of these natural systems and their provided natural services can be valued as a damage (or benefit). Consequently these natural goods and services must be economically valued in project assessments e.g. cost-benefit-analysis or cost comparison. Especially in smaller catchments and river systems exists significant evidence that natural flood detention reduces flood risk and contributes to flood protection. Several research projects evaluated the mitigating effect of land use, river training and the loss of natural flood plains on development, peak and volume of floods. The presented project analysis the hypothesis that ignoring natural detention and hydrological ecosystem services could result in economically inefficient solutions for flood protection and mitigation. In test areas, subcatchments of the Danube in Germany, a combination of hydrological and hydrodynamic models with economic evaluation techniques was applied. Different forms of land use, river structure and flood protection measures were assed and compared from a hydrological and economic point of view. A hydrodynamic model was used to simulate flows to assess the extent of flood affected areas and damages to buildings and infrastructure as well as to investigate the impacts of levees and river structure on a local scale. These model results provided the basis for an economic assessment. Different economic valuation techniques, such as flood damage functions, cost comparison method and substation-approach were used to compare the outcomes of different hydrological scenarios from an economic point of view and value the ecosystem service. The results give significant evidence that natural detention must be evaluated as part of flood mitigation projects. In addition can be stated that the loss of detention due to land use and dikes can be called an externality and results in economic inefficiencies.

  19. Type Theory, Computation and Interactive Theorem Proving

    Science.gov (United States)

    2015-09-01

    prover (system description).” 25th International Conference on Automated Deduction ( CADE -25), Berlin, Germany, 2015. [13] Leonardo de Moura, Jeremy...Deduction ( CADE -25), Berlin, Germany, 2015. 13) Leonardo de Moura, Jeremy Avigad, Soonho Kong, and Cody Roux, "Elaboration in dependent type

  20. Proving Properties of Rule-Based Systems

    National Research Council Canada - National Science Library

    Waldinger, Richard J; Stickel, Mark E

    1990-01-01

    Rule-based systems are being applied to tasks of increasing responsibility. Deductive methods are being applied to their validation, to detect flaws in these systems and enable us to use them with more...

  1. Has the Effect of Mesotherapy Been Proved?

    Directory of Open Access Journals (Sweden)

    Gonca Gökdemir

    2009-06-01

    Full Text Available Mesotherapy is a medical technique that consist of the intracutaneous or subcutaneous injection to the diseased area. It has become as a populer treatment method in cosmetic dermatology recently. Mesotherapy has been used in the treatment of skin rejuvenation, cellulite and localized fat reduction. Substances using in mesotherapy are plant extracts, homeopathic agents, vitamins, and some pharmaceuticals. The effect of these agents are not completely known. There are few experimental and clinical studies evaluating the efficacy of mesotherapy in any form. In this report, it has been reviewed studies about the effect of compounds commonly used in mesotherapy in literature.

  2. Combination proves effective for acute post-

    African Journals Online (AJOL)

    Adele

    effect that is greater than either individual component. The combination formulation also had significantly lower NNT. (number-needed-to-treat) than the components alone, compa- rable to ibuprofen (400mg), the gold standard for this pain model. Tramadol alone and acetaminophen (paracetamol) alone had. NNT of about ...

  3. Proving that We Make a Difference

    Science.gov (United States)

    Spear, Richard

    2012-01-01

    Over the last decade, Adult Learners' Week in Wales has attracted 183,925 people back into learning. With the help of its partners, annual participants have gone from around 4,000 in 2001 to 25,155 in 2011. Despite this success, however, the campaign needs continually to evolve, adapt and demonstrate value for money. It also needs to be open to…

  4. Proving correctness of compilers using structured graphs

    DEFF Research Database (Denmark)

    Bahr, Patrick

    2014-01-01

    We present an approach to compiler implementation using Oliveira and Cook’s structured graphs that avoids the use of explicit jumps in the generated code. The advantage of our method is that it takes the implementation of a compiler using a tree type along with its correctness proof and turns...

  5. The proving grounds: combat nursing in Vietnam.

    Science.gov (United States)

    Levasseur, Jeanne J

    2003-01-01

    The profession of nursing has been greatly influenced by war, and the heroic nature of the work of nursing is often emphasized during war. The purpose of this research was to examine the stories of nurses' experiences during combat in Vietnam and identify themes that would corroborate, refute, or expand prior historical research. A content analysis to determine recurrent themes was performed on 18 oral histories of military nurses who served in Vietnam that were previously collected and published. Analysis of these collections of oral histories was conducted, and thick quotes contextualize and substantiate the thematic claims. This research confirms the analysis of prior historical research on nursing in Vietnam by finding similar experiences recorded in oral histories and further claims that an authentic professional identity is often forged during the hardships and heroic opportunities of war.

  6. Additional Soil Evaluations at Yuma Proving Ground

    National Research Council Canada - National Science Library

    Kurtz, James

    1997-01-01

    .... These tests were performed for the Army Research Laboratory. The objectives of this effort were primarily to characterize the soil conditions, particularly moisture and dielectric permittivity, in support of anticipated unexploded ordnance (UXO...

  7. Speak Up: Help Prevent Errors in Your Care: Home Care

    Science.gov (United States)

    SpeakUP TM Help Prevent Errors in Your Care Home Care To prevent health care errors, patients are urged ... family members, caregivers, doctors and health care professionals. Home care organizations all across the country are working to ...

  8. Palliative Care: Video Tells a Mother's Story of Caring Support

    Science.gov (United States)

    ... Does my child have to be in hospice care to receive palliative care? No, your child can receive palliative care in ... at any time during their illness. How can palliative care help my child and our family? Palliative care ...

  9. About Skin-to-Skin Care (Kangaroo Care)

    Science.gov (United States)

    ... skin care, also called kangaroo care. What is Kangaroo Care? Kangaroo care was developed in South America ... between their warm breasts. The surprising benefits of kangaroo care for the infant include: Warmth Stability of ...

  10. CareCoor

    DEFF Research Database (Denmark)

    Bossen, Claus; Christensen, Lars Rune; Grönvall, Erik

    2013-01-01

    of the actors involved, (2) the network of care around elderly can be augmented with new technology that allows all members of the network to follow, influence and be a part of the cooperative care of the elderly, and (3) CareCoor, the prototype introduced in this study, shows promise as it was well received...... technology such as CareCoor. The pilot tests of CareCoor revealed promising results and will be further developed and evaluated in a larger test....

  11. Substitute family care

    OpenAIRE

    Petrů, Jaroslava

    2015-01-01

    The bachelor thesis focuses on substitute family care in the Czech Republic and its importance for the child. The theoretical part defines the basic terms, describes history and the forms of substitute family care. It also deals with the process of placing a child in substitute family care, the preparation of foster parents and the legislation regulating substitute family care. The practical part is based on qualitative research in families with children in foster and tutelary care, in famili...

  12. Pediatric Neurocritical Care

    OpenAIRE

    Murphy, Sarah

    2011-01-01

    Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, n...

  13. Pregnancy care: an apprenticeship for palliative care?

    Science.gov (United States)

    Clark, W David

    2008-01-01

    The American Board of Medical Specialties has recently recognized palliative medicine as a new subspecialty. Family Medicine was one of 10 specialty boards cosponsoring this certification process. The role of the family physician has many parallels in the care of pregnant and dying patients. The family physician that has provided maternity care can apply his or her experiences to their care of the dying. The reader is invited to consider this possibility as part of an intentional transition to palliative medicine.

  14. Balancing personalized medicine and personalized care.

    Science.gov (United States)

    Cornetta, Kenneth; Brown, Candy Gunther

    2013-03-01

    The current description of personalized medicine by the National Institutes of Health is "the science of individualized prevention and therapy." Although physicians are beginning to see the promise of genetic medicine coming to fruition, the rapid pace of sequencing technology, informatics, and computer science predict a revolution in the ability to care for patients in the near future. The enthusiasm expressed by researchers is well founded, but the expectations voiced by the public do not center on advancing technology. Rather, patients are asking for personalized care: a holistic approach that considers physical, mental, and spiritual well-being. This perspective considers psychological, religious, and ethical challenges that may arise as the precision of preventive medicine improves. Psychological studies already highlight the barriers to single gene testing and suggest significant barriers to the predictive testing envisioned by personalized medicine. Certain religious groups will likely mount opposition if they believe personalized medicine encourages embryo selection. If the technology prompts cost-containment discussions, those concerned about the sanctity of life may raise ethical objections. Consequently, the availability of new scientific developments does not guarantee advances in treatment because patients may prove unwilling to receive and act on personalized genetic information. This perspective highlights current efforts to incorporate personalized medicine and personalized care into the medical curriculum, genetic counseling, and other aspects of clinical practice. Because these efforts are generally independent, the authors offer recommendations for physicians and educators so that personalized medicine can be implemented in a manner that meets patient expectations for personalized care.

  15. Exploring project management as a practical solution to long-term care service.

    Science.gov (United States)

    Su, Chun-Hsien; Yeh, Nai-Ching

    2008-01-01

    The main purpose of this study is to explore the project management methodology as a practical solution for the field of long-term care management. This research was conducted by gathering data from reviewed literature and written documents. The conclusion suggests that project management methodology is applicable for long-term care service implementation. Moreover, the project management methodology discussed in this article could be applied to other Medicare practices to prove its validity in the future.

  16. The origins of casualty evacuation and echelons of care: lessons learned from the American Civil War.

    Science.gov (United States)

    Blansfield, J S

    1999-01-01

    The American Civil War produced many victims of battle who challenged the medical community. Not long after the war started the medical community was forced to make rapid, significant changes in how soldiers were evacuated, how they were cared for both immediately and long-term, and how the spread of fatal infectious diseases was controlled. This was the era in which nurses proved their importance and became a permanent segment of trauma care.

  17. Redesigning nighttime care for personal care residents.

    Science.gov (United States)

    O'Rourke, D J; Klaasen, K S; Sloan, J A

    2001-07-01

    This study investigated the effects of non-disruptive nighttime care for residents in a personal care setting. The sample consisted of 18 personal care home residents in an urban, 388-bed, long-term care facility located in Winnipeg, Manitoba, Canada. The study used a quasi-experimental, single-arm design, exposing all residents to both intervention and control conditions. Independent variables were the current nighttime routine of regular rounds to turn and change residents, and a non-disruptive plan of care in which residents were checked hourly by staff and necessary care was provided when they were awake. Outcome variables included total sleep from evening bedtime to morning awakening, longest period of uninterrupted sleep at night, amount of time spent sleeping during the day, self-reported restfulness of cognitively intact residents, and skin condition. Findings suggested that the non-disruptive nighttime care routine increased total sleep by an average of 30 minutes a night for each resident. The amount of uninterrupted sleep increased by approximately 45 minutes with the new routine. No significant differences were noted in the amount of time spent sleeping during the day. There was no evidence of skin breakdown during any phase of the study. Clinical implications of this study demonstrate a need for gerontological nurses to re-evaluate nighttime care routines in personal care settings.

  18. Using timelines to depict patient journeys: a development for research methods and clinical care review.

    Science.gov (United States)

    Momen, Natalie; Kendall, Marilyn; Barclay, Stephen; Murray, Scott

    2013-10-01

    Graphical displays of investigations are increasingly used in clinical care. Summaries of medical records for research or clinical review purposes can generate unmanageably large amounts of data, which may be helpfully summarised and displayed using timelines. During a prospective study of cancer care in primary care, care timelines were generated in Microsoft Visio, using data collected retrospectively from general practice records. Data from primary and secondary care consultations were included. Thirteen timelines were created, which proved valuable in summarising and analysing the data concerning the cases studied. Timelines provide a clear, concise way of displaying large amounts of diverse data, although some selectivity is required to facilitate interpretation. Generation of timelines in the software was time consuming: if they could be automatically generated within clinical IT systems, they would enable clinicians to generate useful summaries of care of complex cases, facilitating care reviews.

  19. Care Aides' Relational Practices and Caring Contributions.

    Science.gov (United States)

    Andersen, Elizabeth A; Spiers, Jude

    2016-11-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Care Aides' Relational Practices and Caring Contributions" found on pages 24-30, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Define the application of Swanson's Middle Range Theory of Caring in care aides' relational care practices for nursing home

  20. A changed climate for mental health care delivery in South Africa ...

    African Journals Online (AJOL)

    cultural and multi-cosmological context for health and mental health care delivery has come to pass. To health administrators, though, the inclusion of traditional healers into the formal public health system and mental health may still prove to be ...