WorldWideScience

Sample records for resource centre experience

  1. Networking Resource Centre

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 14; Issue 9. Networking Resource Centre. Information and Announcements Volume 14 Issue 9 September 2009 pp 930-930. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/014/09/0930-0930. Resonance ...

  2. The Importance of Brain Banks for Molecular Neuropathological Research: The New South Wales Tissue Resource Centre Experience

    Directory of Open Access Journals (Sweden)

    Antony Harding

    2009-01-01

    Full Text Available New developments in molecular neuropathology have evoked increased demands for postmortem human brain tissue. The New South Wales Tissue Resource Centre (TRC at The University of Sydney has grown from a small tissue collection into one of the leading international brain banking facilities, which operates with best practice and quality control protocols. The focus of this tissue collection is on schizophrenia and allied disorders, alcohol use disorders and controls. This review highlights changes in TRC operational procedures dictated by modern neuroscience, and provides examples of applications of modern molecular techniques to study the neuropathogenesis of many different brain disorders.

  3. Experiences of Telebased Information Centres

    DEFF Research Database (Denmark)

    Falch, Morten

    1999-01-01

    Tele-based information community centres or just tele-centres have been seen as the killer application to empower local communities in developed and developing countries to meet the challenges of the information society. This paper will present a number of models for introducing such centres...... and discuss the different models and national strategies used for setting up tele-based information in relation to the Ghana experience....

  4. Nganyi Community Resource Centre: Community radio station ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-05-04

    May 4, 2016 ... ... in Africa program (jointly funded by IDRC and the UK's Department for International Development—DFID), which brought together communities, institutions, and individuals in Vihiga County, western Kenya, to build their capacity to manage climate risk. The resource centre is a legacy of that initiative.

  5. Surgery for Conditions of Infectious Etiology in Resource-Limited Countries Affected by Crisis: The Médecins Sans Frontières Operations Centre Brussels Experience.

    Science.gov (United States)

    Sharma, Davina; Hayman, Kate; Stewart, Barclay T; Dominguez, Lynette; Trelles, Miguel; Saqeb, Sanaulhaq; Kasonga, Cheride; Hangi, Theophile Kubuya; Mupenda, Jerome; Naseer, Aamer; Wong, Evan; Kushner, Adam L

    2015-12-01

    Surgery for infection represents a substantial, although undefined, disease burden in low- and middle-income countries (LMICs). Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) provides surgical care in LMICs and collects data useful for describing operative epidemiology of surgical need otherwise unmet by national health services. This study aimed to describe the experience of MSF-OCB operations for infections in LMICs. By doing so, the results might aid effective resource allocation and preparation of future humanitarian staff. Procedures performed in operating rooms at facilities run by MSF-OCB from July 2008 through June 2014 were reviewed. Projects providing specialty care only were excluded. Procedures for infection were described and related to demographics and reason for humanitarian response. A total of 96,239 operations were performed at 27 MSF-OCB sites in 15 countries between 2008 and 2014. Of the 61,177 general operations, 7,762 (13%) were for infections. Operations for skin and soft tissue infections were the most common (64%), followed by intra-abdominal (26%), orthopedic (6%), and tropical infections (3%). The proportion of operations for skin and soft tissue infections was highest during natural disaster missions (pcrisis. This study found that infections require greater than expected surgical input given frequent need for serial operations to overcome contextual challenges and those associated with limited resources in other areas (e.g., ward care). Furthermore, these results demonstrate that the pattern of operations for infections is related to nature of the crisis. Incorporating training into humanitarian preparation (e.g., surgical sepsis care, ultrasound-guided drainage procedures) and ensuring adequate resources for the care of surgical infections are necessary components for providing essential surgical care during crisis.

  6. Laparoscopic adrenalectomy: Single centre experience.

    LENUS (Irish Health Repository)

    O'Farrell, N J

    2012-02-01

    BACKGROUND: Laparoscopic adrenalectomy is an attractive alternative to the traditional open approach in the surgical excision of an adrenal gland. It has replaced open adrenalectomy in our institution and we review our experience to date. METHODS: All cases of laparoscopic adrenalectomies in our hospital over eight years (from 2001 to May 2009) were retrospectively reviewed. Patient demographics, diagnosis, length of hospital stay, histology and all operative and post-operative details were evaluated. RESULTS: Fifty-five laparoscopic adrenalectomies (LA) were performed on 51 patients over eight years. The mean age was 48 years (Range 16-86 years) with the male: female ratio 1:2. Twenty-three cases had a right adrenalectomy, 24 had a left adrenalectomy and the remaining four patients had bilateral adrenalectomies. 91% were successfully completed laparoscopically with five converted to an open approach. Adenomas (functional and non functional) were the leading indication for LA, followed by phaeochromocytomas. Other indications for LA included Cushing\\'s disease, adrenal malignancies and rarer pathologies. There was one mortality from necrotising pancreatitis following a left adrenalectomy for severe Cushing\\'s disease, with subsequent death 10 days later. CONCLUSION: Laparoscopic adrenalectomy is effective for the treatment of adrenal tumours, fulfilling the criteria for the ideal minimally invasive procedure. It has replaced the traditional open approach in our centre and is a safe and effective alternative. However, in the case of severe Cushing\\'s disease, laparoscopic adrenalectomy has the potential for significant adverse outcomes and mortality.

  7. USABILITY OF INTANGIBLE RESOURCES IN LOGISTICS CENTRES STRATEGY

    OpenAIRE

    BEATA SKOWRON-GRABOWSKA; MONIKA OSYRA

    2013-01-01

    RBusiness stability of the logistics centres in the twenty first century highly depends on the kind and quality of intangible resources. As the variety of services outsourced to logistics and distribution centres increase, success strategies for these companies should be revised. This study explores and illustrates a framework to evaluate the intangible resources in logistics and distribution centres as well as in their partnership companies through a strategic view. The intangible resources ...

  8. The European Resource Centre for Alternatives in Higher Education.

    Science.gov (United States)

    de Boo, Jasmijn; Dewhurst, David; van der Valk, Jan

    2004-06-01

    The European Resource Centre for Alternatives in Higher Education (EURCA: http://www.eurca.org) is an exciting new project, which aims to enable teachers using animals in teaching to be more creative and innovative in their approach to teaching and learning, to foster high-quality training for science students, and to significantly reduce the number of animals used, often unnecessarily, in teaching. This will be achieved by: a) establishing a resource centre--a collection of mainly electronic alternatives, and taking this to relevant scientific meetings in Europe, where it would function as a drop-in advice centre for teachers; b) creating a network of academic teachers who actively use alternatives, to take responsibility for disseminating information about alternatives to other teachers in the European Union, to participate in the activity outlined above, and to share experiences and good practice; c) setting up an Internet website with an expansive, information-rich database (peer-reviews, demos, peer-evaluations, peer-recommendations, links to users, etc.) on selected "tried and tested" alternatives; and d) encouraging and promoting the findings of evaluative studies on the effectiveness of alternatives in higher education teaching and learning.

  9. Experience Building and Operating the CMS Tier-1 Computing Centres

    CERN Document Server

    Albert, M; Bonacorsi, D; Brew, C; Charlot, C; Huang, Chih-Hao; Colling, D; Dumitrescu, C; Fagan, D; Fassi, F; Fisk, I; Flix, J; Giacchetti, L; Gomez-Ceballos, G; Gowdy, S; Grandi, C; Gutsche, O; Hahn, K; Holzman, B; Jackson, J; Kreuzer, P; Kuo, C M; Mason, D; Pukhaeva, N; Qin, G; Quast, G; Rossman, P; Sartirana, A; Scheurer, A; Schott, G; Shih, J; Tader, P; Thompson, R; Tiradani, A; Trunov, A

    2010-01-01

    The CMS Collaboration relies on 7 globally distributed Tier-1 computing centres located at large universities and national laboratories for a second custodial copy of the CMS RAW data and primary copy of the simulated data, data serving capacity to Tier-2 centres for analysis, and the bulk of the reprocessing and event selection capacity in the experiment. The Tier-1 sites have a challenging role in CMS because they are expected to ingest and archive data from both CERN and regional Tier-2 centres, while they export data to a global mesh of Tier-2s at rates comparable to the raw export data rate from CERN. The combined capacity of the Tier-1 centres is more than twice the resources located at CERN and efficiently utilizing this large distributed resources represents a challenge. In this article we will discuss the experience building, operating, and utilizing the CMS Tier-1 computing centres. We will summarize the facility challenges at the Tier-1s including the stable operations of CMS services, the ability ...

  10. Resources | IDRC - International Development Research Centre

    International Development Research Centre (IDRC) Digital Library (Canada)

    Through IDRC's resource library, we share our results, provide support to researchers, and offer tools for development actors. IDRC supports research that addresses critical development issues, finds sustainable solutions, and builds knowledge. Sharing that knowledge is one important way that IDRC and our grantees can ...

  11. Training science centre Explainers. The Techniquest experience

    Directory of Open Access Journals (Sweden)

    Colin Johnson

    2005-12-01

    Full Text Available Techniquest was established in 1986, and in 1995 moved to its current premises at Cardiff Bay, South Wales. This was the first purpose-built science centre in the UK. It receives around 200,000 visitors every year to its exhibition, and to its programmes for schools and public audiences in the theatre, laboratory, discovery room and planetarium. The author joined the Techniquest project in 1985, became a staff member in 1990 and was the Chief Executive from 1997 until his retirement in 2004. Techniquest has three “out-stations” in Wales, and is responsible for the supply and maintenance of exhibits to the Look Out Discovery Centre in Bracknell, England. There is a Techniquest gallery at the Lisbon Pavilhão do Conhecimento - Ciência Viva, and a traveling exhibition, SciQuest, in South Africa which was also supplied by Techniquest. All these centres rely on the effective intervention of “Explainers” (at Techniquest we call them “Helpers” to provide the best possible experience for visitors. At its most demanding, the tasks of an Explainer are varied and intensive, yet there may be times when the duties are mundane or even dull. When you rely on people to act as both hosts and housekeepers, to provide both support and stimulus, and to be both welcoming and watchful, you are asking a great deal. This article raises some of the issues concerned with the recruitment and retention of Explainers, their training and management, and the way in which their role is recognized and valued by the science centre as a whole.

  12. Resource centre at the South African museum | Harrison | Southern ...

    African Journals Online (AJOL)

    Southern African Journal of Environmental Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 8 (1988) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Resource centre at the South African ...

  13. LHCb: Self managing experiment resources

    CERN Multimedia

    Stagni, F

    2013-01-01

    Within this paper we present an autonomic Computing resources management system used by LHCb for assessing the status of their Grid resources. Virtual Organizations Grids include heterogeneous resources. For example, LHC experiments very often use resources not provided by WLCG and Cloud Computing resources will soon provide a non-negligible fraction of their computing power. The lack of standards and procedures across experiments and sites generated the appearance of multiple information systems, monitoring tools, ticket portals, etc... which nowadays coexist and represent a very precious source of information for running HEP experiments Computing systems as well as sites. These two facts lead to many particular solutions for a general problem: managing the experiment resources. In this paper we present how LHCb, via the DIRAC interware addressed such issues. With a renewed Central Information Schema hosting all resources metadata and a Status System ( Resource Status System ) delivering real time informatio...

  14. Student-Centred Experiments with Stream Invertebrates

    Science.gov (United States)

    Vaughan, Ian; Larsen, Stefano; Durance, Isabelle; Ormerod, Steve

    2011-01-01

    Field experiments are at the core of ecology, yet rarely find their way into education, probably due to a combination of technical challenges and risks associated with fieldwork. This may compromise student education and perception of the subject, making interesting, readily manageable experiments extremely important. We describe how the daily…

  15. The experience of work in a call centre environment

    Directory of Open Access Journals (Sweden)

    Sanet Hauptfleisch

    2006-02-01

    Full Text Available This qualitative research study explored the work experience in a call centre environment in an information technology call centre based in South Africa, which service foreign customers exclusively. Three data collection methods were used, namely narratives, in-depth interviews with call centre consultants, and observation. Following a grounded theory approach, four themes were elicited, namely the perceptions of team members, uncertainty created by a constantly changing environment, perceived distances due to management practices, and depersonalisation experienced while actually dealing with customers. In addition to this, the reported impact of these themes on work performance was explored and compared to existing research.

  16. Work experiences among attendees of day centres for people with psychiatric disabilities.

    Science.gov (United States)

    Eklund, Mona; Sandlund, Mikael

    2015-01-01

    It is possible that people with psychiatric disabilities who visit day centres have previous work experiences that may be seen as resources for their current engagement in day centre activities. Research in this respect seems to lack, however. To investigate work experiences among attendees at day centres for people with psychiatric disabilities and relationships with current type of day centre (work-oriented, meeting place-oriented or mixed), engagement in day centre activities, motivation and socio-demographic and health-related factors. Seventy-seven attendees responded to questionnaires. Global Assessment of Functioning, GAF, was also used. Work was categorised into Group I (professionals, semi-professionals), Group II (clerical support, services workers) and Group III (e.g. craft workers, elementary occupations). Almost everyone had previously had open-market employment; more than half for ≥ 10 years. Group I was more common in mixed centres, Group II in meeting place-oriented ones and Group III in work-oriented ones. Group I more frequently had college degree and was rated high on GAF functioning. Women were over-represented in Group II, and men in Group III and in meeting place-oriented centres. Attending mixed centres was more likely when having a college degree, scoring high on GAF functioning and being highly engaged in activities. Attendees at work-oriented day centres were characterised by being motivated for spending time alone and reporting a diagnosis of psychosis. The participants had unused working capacity. No clear-cut relationships were found between work experiences and the investigated correlates.

  17. Single-centre experience of allogeneic haemopoietic stem cell ...

    African Journals Online (AJOL)

    NC 4.0. Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa. A van Eyssen,1 MB ChB, DCH (SA), FC Paed (SA), Cert Medical Oncology Paediatrics (SA); N Novitsky,2 FCP ...

  18. Simple, Concept-Centred, Innovative, Open-Ended Experiments in ...

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 8; Issue 9. Simple, Concept-Centred, Innovative, Open-Ended Experiments in Physics – 2. A W Joshi Vijay H Raybagkar F I Surve. Classroom Volume 8 Issue 9 September 2003 pp 81-87 ...

  19. Networking of Biological Resource Centers: WDCM experiences

    Directory of Open Access Journals (Sweden)

    Satoru Miyazaki

    2006-01-01

    Full Text Available The WFCC-MIRCEN World Data Centre for Microorganisms (WDCM was set up more than 30 years ago as a data center of the World Federation for Culture Collections (WFCC. It published the World Directory of Collections of Cultures of Microorganisms when it was established and now provides a portal site for microbial resource centers and their customers by fully utilizing Internet technology. This paper introduces international initiatives on biological resources centers together with the activities of WDCM.

  20. Farmers'perception of the farmer resource centre as a source of ...

    African Journals Online (AJOL)

    The study examined the perception farmers have of the Farmers' Resource Centre (FRC) In Ago-are Atisbo Local Government Area of Oyo State as an alternative source of information for improving their agricultural production. Eighty (80) farmers were randomly sampled from a list of 108 farmers obtained from the centre, ...

  1. Registered nurses' experiences of their decision-making at an Emergency Medical Dispatch Centre.

    Science.gov (United States)

    Ek, Bosse; Svedlund, Marianne

    2015-04-01

    To describe registered nurses' experiences at an Emergency Medical Dispatch Centre. It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patient's arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses. A qualitative design was used for this study. Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used. Two themes emerged during the analysis: 'Having a profession with opportunities and obstacles' and 'Meeting serious and difficult situations', with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned. Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses. Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame

  2. Location-based solutions in the Experience centre

    DEFF Research Database (Denmark)

    Witzner Hansen, Dan; Alapetite, Alexandre Philippe Bernard; Holdgaard, Nanna

    2008-01-01

    In this paper we present a prototype system for location-based guiding. A user survey has been conducted and the observations are used to support design choices. The prototype allows for both indoor and outdoor navigation at and in the vicinity of the experience centre NaturBornholm1 in Denmark u...... using a combination of Bluetooth, GPS and QRcodes. Bluetooth and GPS are used for location-based information and QR-codes are used to convey user preferences....

  3. Location-based solutions in the Experience centre

    DEFF Research Database (Denmark)

    Hansen, Dan Witzner; Alapetite, Alexandre; Holdgaard, Nanna

    In this paper we present a prototype system for location-based guiding. A user survey has been conducted and the observations are used to support design choices. The prototype allows for both indoor and outdoor navigation at and in the vicinity of the experience centre NaturBornholm1 in Denmark u...... using a combination of Bluetooth, GPS and QR-codes. Bluetooth and GPS are used for location-based information and QR-codes are used to convey user preferences....

  4. The job demands-resources model of work engagement in South African call centres

    Directory of Open Access Journals (Sweden)

    Yolandi Janse van Rensburg

    2013-01-01

    Full Text Available Orientation: A ‘sacrificial human resource strategy’ is practised in call centres, resulting in poor employee occupational health. Consequently, questions are posed in terms of the consequences of call centre work and which salient antecedent variables impact the engagement and wellbeing of call centre representatives.Research purpose: Firstly, to gauge the level of employee engagement amongst a sample of call centre representatives in South Africa and, secondly, to track the paths through which salient personal and job resources affect this engagement. More specifically, the relationships between sense of coherence, leadership effectiveness, team effectiveness and engagement were investigated, thus testing the Job Demands-Resources model of work engagement.Motivation for the study: To present an application of the Job Demands-Resources model of work engagement in a call centre environment in order to diagnose current ills and consequently propose remedies.Research design: A cross-sectional survey design was used and a non-probability convenient sample of 217 call centre representatives was selected. The measuring instruments comprise the Utrecht Work Engagement Scale to measure engagement, the Team Diagnostic Survey to measure team effectiveness, the leadership practices inventory to gauge leadership effectiveness, and the Orientation to Life Questionnaire to measure sense of coherence. A series of structural equation modelling analyses were performed.Main findings: Contrary to the ‘electronic sweatshop’ image attached to call centre jobs depicted in the literature, results show a high level of employee engagement for call centre representatives in the sample. Also, personal resources such as sense of coherence and job resources such as team effectiveness related significantly to engagement. A non-significant relationship exists between leadership effectiveness and engagement.Practical/managerial implications: Both the content and

  5. The job demands-resources model of work engagement in South African call centres

    Directory of Open Access Journals (Sweden)

    Yolandi Janse van Rensburg

    2013-09-01

    Full Text Available Orientation: A ‘sacrificial human resource strategy’ is practised in call centres, resulting in poor employee occupational health. Consequently, questions are posed in terms of the consequences of call centre work and which salient antecedent variables impact the engagement and wellbeing of call centre representatives.Research purpose: Firstly, to gauge the level of employee engagement amongst a sample of call centre representatives in South Africa and, secondly, to track the paths through which salient personal and job resources affect this engagement. More specifically, the relationships between sense of coherence, leadership effectiveness, team effectiveness and engagement were investigated, thus testing the Job Demands-Resources model of work engagement.Motivation for the study: To present an application of the Job Demands-Resources model of work engagement in a call centre environment in order to diagnose current ills and consequently propose remedies.Research design: A cross-sectional survey design was used and a non-probability convenient sample of 217 call centre representatives was selected. The measuring instruments comprise the Utrecht Work Engagement Scale to measure engagement, the Team Diagnostic Survey to measure team effectiveness, the leadership practices inventory to gauge leadership effectiveness, and the Orientation to Life Questionnaire to measure sense of coherence. A series of structural equation modelling analyses were performed.Main findings: Contrary to the ‘electronic sweatshop’ image attached to call centre jobs depicted in the literature, results show a high level of employee engagement for call centre representatives in the sample. Also, personal resources such as sense of coherence and job resources such as team effectiveness related significantly to engagement. A non-significant relationship exists between leadership effectiveness and engagement.Practical/managerial implications: Both the content and

  6. towards participant-centred resource development for environmental

    African Journals Online (AJOL)

    time and sustained participant engagement (Moodie,. 1987). The essential difference in this perspective is that it does not set out to train or to transmit, but to facili- tate interactive meaning-making among teachers and the pool of environmental education resource materials, ideas and methodologies. This proposition is not ...

  7. Scaling out Natural Resource Outputs in Asia | CRDI - Centre de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    A coalition of partners (innovators, researchers, academics, media advocacy specialists and developers of forest product enterprises) will promote innovations for active, equitable and effective management of natural resources within the framework of community forestry in three districts of Nepal. Researchers will identify ...

  8. From School Libraries to Multimedia Resource Centres: The ...

    African Journals Online (AJOL)

    School libraries have remained a necessary adjunct of academic excellence. The Nigerian education system has recorded a steady decline over the years and this could be closely linked to the state of the school libraries. However, the term school library has globally given way to a broader term - Multimedia Resource ...

  9. Business Information Centres: New Resources Are Not Used.

    Science.gov (United States)

    Drummond, Janet

    1984-01-01

    Presents findings from survey of Canadian information centers specializing in business, economics, or finance (corporate library, government department library, fee-based service, commercial database, association information center). Questions focused on three broad categories: human resources organization, relative use of different types of…

  10. Human Resources for Health Research in Africa | CRDI - Centre de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Governments, policymakers and donors are increasingly recognizing that human resources are the critical driver of health research in developing countries. This grant will support a consultation and symposium on the subject. Expert teams will carry out a review and consultation on such themes as: the skills needed to ...

  11. Location-based solutions in the Experience centre

    DEFF Research Database (Denmark)

    Hansen, Dan Witzner; Alapetite, Alexandre; Holdgaard, Nanna

    2009-01-01

    In this paper we present a prototype system for location-based guiding. A user survey has been conducted and the observations are used to support design choices. The prototype allows for both indoor and outdoor navigation at and in the vicinity of the NaturBornholm' experience centre in Denmark u...... using a combination of Bluetooth, Near Field Communication (NFC), GPS and QR codes. Bluetooth, NFC and GPS are used for location-based information and QR codes are used to convey user preferences....

  12. Unmanned in situ experiment on lunar resources

    Science.gov (United States)

    Iwata, Tsutomu; Ohuchi, Hideo

    A robotic experiment on lunar materials in the context of lunar base and lunar resources utilization is designed. A mobile robotic laboratory is sent to the lunar surface by an H-2 rocket to perform exploration for resources and experimental processing/handling of the surface materials.

  13. Resourcing of Experience in Co-Design

    DEFF Research Database (Denmark)

    Ylirisku, Salu; Revsbæk, Line; Buur, Jacob

    2017-01-01

    , knowledge to benefit its cultivation is expected to be highly valuable in contemporary multi-cultural design work. This paper approaches the study of the involvement of various stakeholders in design projects through a lens of resourcing experience. Building from G. H. Mead’s pragmatist theory, we devise......Involving different people is fundamental in today’s multi-stakeholder endeavours, but the process through which people’s experiences are being resourced in co-creation has gained little attention. As rich involvement of various stakeholders is an increasingly essential skill of designers...... an analytical framework for the study of articulated experience in situated interaction. We situate our exploration of resourcing of participant experience in the DTRS11 dataset covering a concept design project by a European Car Manufacturer conducting workshops in China and project meetings in both China...

  14. The importance of material resources and qualified trainers in adult non-formal education and training centres in South Africa

    Science.gov (United States)

    Mayombe, Celestin; Lombard, Antoinette

    2016-04-01

    Non-formal education and training (NFET) programmes in public and private centres in South Africa aim to meet the training needs of adults who have been deprived of formal education which would have fostered skills acquisition and access to employment earlier in their lives. The concern which informs this paper is that adults who face long-term unemployment due to a lack of marketable skills often remain unemployed after completing NFET programmes. The paper assesses the extent to which material and human resources have affected skills acquisition and graduate employment in KwaZulu-Natal, South Africa. The results show that material and human resource challenges in most public and some private centres have led to gaps in skills training. Programmes focus too strongly on academic credits and certificates and not enough on employment as an end goal. The authors argue that the existence of suitable training materials and qualified trainers with practical experience and specific technical skills constitutes favourable conditions ("enabling environments") for graduate employment. Without improvement in material and human resources, adult trainees will continue to experience difficulties integrating into the labour market, and the cycle of poverty and social exclusion will remain unbroken.

  15. Scaffolding Students’ Initial Self-Access Language Centre Experiences

    Directory of Open Access Journals (Sweden)

    Robert Croker

    2012-09-01

    Full Text Available As the number of self-access language centres (SALCs in Japanese universities continues to grow, so too does the challenge of successfully introducing them to first-year university students, whose initial experiences of self-access language learning may otherwise be confusing and even unsettling. One approach is to carefully scaffold students’ first SALC encounters by connecting them with their classroom learning experiences. This paper discusses one such approach developed at a private university in central Japan, which was based upon a two-stage ‘push-pull’ ‘materials-light, people-focused’ strategy. Teachers initially ‘pushed’ their students to visit the SALC by giving them speaking ‘homework’ to be done there. The SALC then also offered interesting interactive events designed to ‘pull’ learners to continue to come. These push-pull activities could be done with few or no materials, and emphasized interaction with people rather than materials. This two-stage, push-pull strategy served as a bridge between the language classroom and a SALC, helping learners make the first steps in their transition from being a ‘classroom English learner’ to becoming a ‘SALC English user’.

  16. Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre

    Directory of Open Access Journals (Sweden)

    Patterson C

    2013-05-01

    Full Text Available Christine Patterson,1 Heather Arthur,1,2 Gladys Peachey,1 Julie Vohra,1 David Price,3 Dave Pearson,4 Rob Mariani51School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; 2Heart and Stroke Foundation of Ontario/Michael G DeGroote Endowed Chair in Cardiovascular Nursing Research, McMaster University, Hamilton, ON, Canada; 3Department of Family Medicine, McMaster University, Hamilton, ON, Canada; 4Central West Local Health Integration Network, Brampton, ON, Canada; 5Ascentum Consulting, Ottawa, ON, CanadaImportance: Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs which involve multiple health disciplines working together to provide team-based care.Objective: The purpose of this project was: (1 to explore the use of an online resource, the Interprofessional Resource Centre (IRC, when planning for interprofessional change and; (2 to explore the experience of planning interprofessional change.Design and setting: Six FHTs organized under the structure of one Local Health Integrated Network (LHIN in Ontario, Canada.Intervention: Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity.Results: Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support.Conclusion and

  17. Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience

    Directory of Open Access Journals (Sweden)

    Ikram Nasr

    2015-12-01

    Full Text Available Refractory coeliac disease (RCD is a rare complication of coeliac disease (CD and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal by PCR (polymerase chain reaction for T cell receptors (TCR at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL, the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody, and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre’s experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals.

  18. The experience of starting a poison control centre in Africa--the Ghana experience.

    Science.gov (United States)

    Clarke, E E K

    2004-05-20

    The need for a poison centre in Ghana has been well demonstrated over the years as evidenced by the occurrence of a variety of cases of poisoning. Important causes are accidental poisoning from mishandling of pesticides, accidental poisoning among children from kerosene and pesticide' ingestion due to unsafe storage methods in the home, use of herbal potions of unknown composition, overdoses of certain pharmaceuticals for illegal abortion, and accidental food poisonings. Bites from venomous animals particularly snakes are also common. Though preparations toward the establishment of a poison control centre started in mid 1999, it was not until early 2002 that the operations of a modest information centre commenced. Major roles the centre are currently performing include providing: an information service for health professionals on management advice in cases of poisoning; training for primary health personnel in the management of common poisonings; training for agricultural personnel in prevention and first aid management of pesticide poisoning; public awareness education and information programmes for prevention of poisoning. Some of the important challenges being faced include ensuring adequate sensitization on the need for centers particularly among health professionals, difficulties in acquiring adequate numbers of and appropriate training for staff of the centre, dedicated phone lines, literature and timely acquisition of toxicological data-bases. Others are poor networking among centers in the region and the absence of clinical and laboratory toxicology services dedicated to managing poisonings. The key lessons learned include the need for multi-sectoral involvement and support from the onset, the need to learn from experiences of established centers and the need to model requirements to suit local conditions without compromising the effectiveness of services.

  19. Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review

    OpenAIRE

    Rowa Fathelrahman Omer; Nancy Seif El Din; Fadwa Awad Abdel Rahim; Ahmed Hassan Fahal

    2016-01-01

    Mycetoma is a devastating, neglected tropical disease characterised by extensive tissue involvement resulting in destruction, deformities and disabilities in the affected patients. The hand is commonly affected by mycetoma thus compromises its functionality and hinder the patient's daily activities of living. In this communication, we report on 533 patients with hand mycetoma managed over a period of 24 years at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan. Eumycetoma...

  20. Singapore National Medical Image Resource Centre (SN.MIRC): a world wide web resource for radiology education.

    Science.gov (United States)

    Yang, Guo-Liang; Lim, C C Tchoyoson

    2006-08-01

    Radiology education is heavily dependent on visual images, and case-based teaching files comprising medical images can be an important tool for teaching diagnostic radiology. Currently, hardcopy film is being rapidly replaced by digital radiological images in teaching hospitals, and an electronic teaching file (ETF) library would be desirable. Furthermore, a repository of ETFs deployed on the World Wide Web has the potential for e-learning applications to benefit a larger community of learners. In this paper, we describe a Singapore National Medical Image Resource Centre (SN.MIRC) that can serve as a World Wide Web resource for teaching diagnostic radiology. On SN.MIRC, ETFs can be created using a variety of mechanisms including file upload and online form-filling, and users can search for cases using the Medical Image Resource Center (MIRC) query schema developed by the Radiological Society of North America (RSNA). The system can be improved with future enhancements, including multimedia interactive teaching files and distance learning for continuing professional development. However, significant challenges exist when exploring the potential of using the World Wide Web for radiology education.

  1. Investment into the future of microbial resources: culture collection funding models and BRC business plans for biological resource centres.

    Science.gov (United States)

    Smith, David; McCluskey, Kevin; Stackebrandt, Erko

    2014-01-01

    Through their long history of public service, diverse microbial Biological Resource Centres (mBRCs) have made myriad contributions to society and science. They have enabled the maintenance of specimens isolated before antibiotics, made available strains showing the development and change of pathogenicity toward animals, humans and plants, and have maintained and provided reference strains to ensure quality and reproducibility of science. However, this has not been achieved without considerable financial commitment. Different collections have unique histories and their support is often tied to their origins. However many collections have grown to serve large constituencies and need to develop novel funding mechanisms. Moreover, several international initiatives have described mBRCs as a factor in economic development and have led to the increased professionalism among mBRCs.

  2. Addressing Grand Challenges in Earth Observation Science: The Earth Observation Data Centre for Water Resources Monitoring

    Science.gov (United States)

    Wagner, W.; Fröhlich, J.; Wotawa, G.; Stowasser, R.; Staudinger, M.; Hoffmann, C.; Walli, A.; Federspiel, C.; Aspetsberger, M.; Atzberger, C.; Briese, C.; Notarnicola, C.; Zebisch, M.; Boresch, A.; Enenkel, M.; Kidd, R.; von Beringe, A.; Hasenauer, S.; Naeimi, V.; Mücke, W.

    2014-09-01

    Earth observation is entering a new era where the increasing availability of free and open global satellite data sets combined with the computing power offered by modern information technologies opens up the possibility to process high-resolution data sets at global scale and short repeat intervals in a fully automatic fashion. This will not only boost the availability of higher level earth observation data in purely quantitative terms, but can also be expected to trigger a step change in the quality and usability of earth observation data. However, the technical, scientific, and organisational challenges that need to be overcome to arrive at this point are significant. First of all, Petabyte-scale data centres are needed for storing and processing complete satellite data records. Second, innovative processing chains that allow fully automatic processing of the satellite data from the raw sensor records to higher-level geophysical products need to be developed. Last but not least, new models of cooperation between public and private actors need to be found in order to live up to the first two challenges. This paper offers a discussion of how the Earth Observation Data Centre for Water Resources Monitoring (EODC) - a catalyser for an open and international cooperation of public and private organisations - will address these three grand challenges with the aim to foster the use of earth observation for monitoring of global water resources.

  3. An exploration of physiotherapists' experiences of robotic therapy in upper limb rehabilitation within a stroke rehabilitation centre.

    Science.gov (United States)

    Stephenson, Andrew; Stephens, John

    2017-04-01

    Strokes are the world's leading cause of adult disability, with movement impairment being more common in the upper limb (UL). Robotic therapy (RT) is identified as an effective adjunct to promote movement but with limited effect on functional capabilities. There is currently limited research in user experience of RT, specifically that of physiotherapists. This study sought to explore physiotherapists' experience of using RT in rehabilitation of the UL, within a stroke rehabilitation centre in the north of England. Physiotherapists (n = 6) shared their experiences of working with the InMotion2 robot through semi-structured interviews. Thematic analysis was employed to interpret data, identify emergent themes and interdependent relationships between them. Five interdependent themes were identified focused around individualized care, influenced by evidence for practice, human relationships, skill mix, and resources and resource management. All physiotherapists valued the use of RT as an adjunct to conventional therapy, although barriers to successful implementation seemed to dominate the views of some. RT was perceived positively by physiotherapists, regarded as an adjunct to conventional therapy. A framework to summarize the relationships of participants' views and experiences is proposed in an attempt to understand the influences on the clinical use of RT. Implications for Rehabilitation Robotic therapy (RT) is valued as an adjunct to (conventional) person-centred rehabilitation. Resource management and skill mix are viewed as two key challenges to the successful implementation of RT. The production of evidence-based guidelines would be a useful development in the advancement.

  4. The CMS experiment inaugurated a new visitor centre at its Cessy site on 14 June

    CERN Multimedia

    2001-01-01

    The CMS visitor centre has been built on a platform overlooking CMS construction. It contains a set of clear descriptive posters describing the experiment, along with a video projection showing animations and movies about CMS construction.

  5. Effects of people-centred factors on enterprise resource planning implementation project success: empirical evidence from Sri Lanka

    Science.gov (United States)

    Wickramasinghe, Vathsala; Gunawardena, Vathsala

    2010-08-01

    Extant literature suggests people-centred factors as one of the major areas influencing enterprise resource planning (ERP) implementation project success. Yet, to date, few empirical studies attempted to validate the link between people-centred factors and ERP implementation project success. The purpose of this study is to empirically identify people-centred factors that are critical to ERP implementation projects in Sri Lanka. The study develops and empirically validates a framework for people-centred factors that influence the success of ERP implementation projects. Survey research methodology was used and collected data from 74 ERP implementation projects in Sri Lanka. The people-centred factors of 'project team competence', 'rewards' and 'communication and change' were found to predict significantly the ERP implementation project success.

  6. A national, cross-sectional survey of children's hospital-based safety resource centres.

    Science.gov (United States)

    Kendi, Sadiqa; Zonfrillo, Mark R; Seaver Hill, Karen; Arbogast, Kristy B; Gittelman, Michael A

    2014-03-25

    To describe the location, staffing, clientele, safety product disbursement patterns, education provided and sustainability of safety resource centres (SRCs) in US children's hospitals. A cross-sectional survey was distributed to children's hospital-based SRC directors. Survey categories included: funding sources, customer base, items sold, items given free of charge, education provided and directors' needs. 32/38 (84.2%) SRC sites (affiliated with 30 hospitals) completed the survey. SRCs were in many hospital locations including lobby (28.1%), family resource centres (12.5%), gift shop/retail space (18.8%), mobile units (18.8%) and patient clinics (12.5%). 19% of respondents reported that their SRC was financially self-sustainable. Sales to patients predominated (mean of 44%); however, hospital employees made up a mean of 20% (range 0-60%) of sales. 78.1% of SRCs had products for children with special healthcare needs. Documentation kept at SRC sites included items purchased (96.9%), items given free of charge (65.6%) and customer demographics (50%). 56.3% of SRCs provided formal injury prevention education classes. The SRCs' directors' most important needs were finances (46.9%), staffing (50%) and space (46.9%). All of the directors were 'somewhat interested' or 'very interested' in each of the following: creation of a common SRC listserv, national SRC data bank and multisite SRC research platform. SRCs are located in many US children's hospitals, and can be characterised as heterogeneous in location, products sold, data kept and ability to be financially sustained. Further research is needed to determine best practices for SRCs to maximise their impact on injury prevention.

  7. Knowledge Translation of Interprofessional Collaborative Patient-Centred Practice: The Working Together Project Experience

    Science.gov (United States)

    MacDonald, Colla J.; Archibald, Douglas; Stodel, Emma; Chambers, Larry W.; Hall, Pippa

    2008-01-01

    The Working Together (WT) project involved the design and delivery of an online learning resource for healthcare teams in long-term care (LTC) so that knowledge regarding interprofessional collaborative patient-centred practice (ICPCP) could be readily accessed and then transferred to the workplace. The purpose of this paper is to better…

  8. HUMAN RESOURC EVALUATION: THE INDIAN EXPERIENCE

    National Research Council Canada - National Science Library

    Sandeep

    2012-01-01

      Human resource is one of the most important resources of any organization. It is equally true that their valuation is one of the most cumbersome tasks and therefore, most of the organizations shy away from their valuation...

  9. Head and neck mycetoma: the mycetoma research centre experience.

    Directory of Open Access Journals (Sweden)

    Ahmed Fahal

    2015-03-01

    Full Text Available Mycetoma is a unique neglected tropical disease which is endemic in what is known as the "mycetoma belt". The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.

  10. Head and neck mycetoma: the mycetoma research centre experience.

    Science.gov (United States)

    Fahal, Ahmed; Mahgoub, El Sheikh; El Hassan, Ahmed Mohamed; Jacoub, Angom Osman; Hassan, Doaa

    2015-03-01

    Mycetoma is a unique neglected tropical disease which is endemic in what is known as the "mycetoma belt". The disease has many devastating impacts on patients and communities in endemic area and is characterised by massive deformity, destruction and disability. Mycetoma is commonly seen in the foot and hand and less frequent in other parts of the body. Mycetoma of the head and neck is a rarity and is associated with high morbidity and even mortality if not treated early. In this communication we report on 49 patients with head and neck mycetoma followed up at the Mycetoma Research Centre in Khartoum. Most of the reported patients had actinomycetoma and the majority were young adult males from mycetoma endemic areas in the Sudan. Most of them were students, farmers and workers. Prior to presentation the majority had long disease duration and the cause was multifactorial. Advanced disease with massive lesion, deformity and disability was the common presentation. There was no obvious history of local trauma, familial tendency or other predisposing factor identified in this group of patients. MRI and CT scan were the most accurate diagnostic tools to determine the disease extent. The treatment outcome was rather poor and characterised by low cure rate, poor outcome and high follows-up dropout. Such a gloomy outcome calls for structured and objective health education programs.

  11. Persons with Haemophilia in Sweden- Experiences and Strategies in Everyday Life. A Single Centre Study.

    Directory of Open Access Journals (Sweden)

    Elisabeth Brodin

    Full Text Available Haemophilia is caused by deficiency in coagulation factor VIII or IX. Treatment with the missing coagulation factors has been available in most developed countries for several decades. The aim was to explore the experiences of adults living with severe or moderate haemophilia and their coping strategies at a single centre in Sweden.The interview study had a qualitative empirical approach and was analyzed on the basis of the method empirical phenomenological psychology. The sample included 14 participants, mean age 42 (19-80 y, who met the inclusion criteria and to saturation of information.General characteristics were; All were satisfied with and grateful for access to medication. An acceptance of the disorder and willingness to live a normal life was identified among all participants. They were all content with the care provided by Haemophilia Treatment Centre (HTC and felt supported by its multidisciplinary team. Four typologies were identified; Protective adults and assertive children during up-bringing, finding a role in social context, symptoms and treatments, fear of limited resources in the future. Task-, emotional- and avoidance coping strategies were seen in the interviews. The most prominent coping strategy was task oriented.This interview study with Swedish PWH shows that they strive for normality and adaptation in social activities throughout life finding their own niche. The PWH expressed the importance of knowledge and support from the comprehensive medical team at HTC and therefore it seems important to continue comprehensive medical care at HTC in order to follow-up the haemophilia persons regularly.

  12. Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review.

    Science.gov (United States)

    Omer, Rowa Fathelrahman; Seif El Din, Nancy; Abdel Rahim, Fadwa Awad; Fahal, Ahmed Hassan

    2016-08-01

    Mycetoma is a devastating, neglected tropical disease characterised by extensive tissue involvement resulting in destruction, deformities and disabilities in the affected patients. The hand is commonly affected by mycetoma thus compromises its functionality and hinder the patient's daily activities of living. In this communication, we report on 533 patients with hand mycetoma managed over a period of 24 years at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan. Eumycetoma was the commonest type of mycetoma (83.3%) encountered. Males were predominately affected (69.2%) with a sex ratio of 2.2:1. The majority of the patients (84%) were young adult below the age of 40 years old at presentation. The generality of patients (86.4%) were from the Sudan mycetoma belt. Children and adolescents (28.1%), farmers (18.2%) and workers (17.4%) were more frequently affected. The majority of patients (67.4%) had disease duration of less than 5 years at presentation. The study, did not document significant history of local trauma, familial tendency, concomitant medical diseases or other predisposing cause for mycetoma in this population. Pain (23.1%) was not a disease feature in this series and 52% of patients had past surgery for mycetoma and recurrence. The right hand was affected most (60.4%), and 64% of them had small lesion at presentation. Conventional x-ray was only helpful in patients with advanced disease and the MRI accurately determined the disease extension. Cytological smears, surgical biopsies histopathological examination and grains culture were the principal diagnostic tools for causative organisms' identification. In the present series it was difficult to determine the treatment outcome due to high patients follow up dropout.

  13. Hand Mycetoma: The Mycetoma Research Centre Experience and Literature Review.

    Directory of Open Access Journals (Sweden)

    Rowa Fathelrahman Omer

    2016-08-01

    Full Text Available Mycetoma is a devastating, neglected tropical disease characterised by extensive tissue involvement resulting in destruction, deformities and disabilities in the affected patients. The hand is commonly affected by mycetoma thus compromises its functionality and hinder the patient's daily activities of living. In this communication, we report on 533 patients with hand mycetoma managed over a period of 24 years at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan. Eumycetoma was the commonest type of mycetoma (83.3% encountered. Males were predominately affected (69.2% with a sex ratio of 2.2:1. The majority of the patients (84% were young adult below the age of 40 years old at presentation. The generality of patients (86.4% were from the Sudan mycetoma belt. Children and adolescents (28.1%, farmers (18.2% and workers (17.4% were more frequently affected. The majority of patients (67.4% had disease duration of less than 5 years at presentation. The study, did not document significant history of local trauma, familial tendency, concomitant medical diseases or other predisposing cause for mycetoma in this population. Pain (23.1% was not a disease feature in this series and 52% of patients had past surgery for mycetoma and recurrence. The right hand was affected most (60.4%, and 64% of them had small lesion at presentation. Conventional x-ray was only helpful in patients with advanced disease and the MRI accurately determined the disease extension. Cytological smears, surgical biopsies histopathological examination and grains culture were the principal diagnostic tools for causative organisms' identification. In the present series it was difficult to determine the treatment outcome due to high patients follow up dropout.

  14. Bilateral adrenal masses: a single-centre experience

    Directory of Open Access Journals (Sweden)

    Nilesh Lomte

    2016-05-01

    Full Text Available Background Bilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited. Aims To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses. Methods Retrospective analysis of 70 patients with bilateral adrenal masses presenting to a single tertiary care endocrine centre from western India (2002–2015. Results The most common aetiology was pheochromocytoma (40%, followed by tuberculosis (27.1%, primary adrenal lymphoma (PAL (10%, metastases (5.7%, non-functioning adenomas (4.3%, primary bilateral macronodular adrenal hyperplasia (4.3%, and others (8.6%. Age at presentation was less in patients with pheochromocytoma (33 years and tuberculosis (41 years compared with PAL (48 years and metastases (61 years (P<0.001. The presenting symptoms for pheochromocytoma were hyperadrenergic spells (54% and abdominal pain (29%, whereas tuberculosis presented with adrenal insufficiency (AI (95%. The presenting symptoms for PAL were AI (57% and abdominal pain (43%, whereas all cases of metastasis had abdominal pain. Mean size of adrenal masses was the largest in lymphoma (5.5cm followed by pheochromocytoma (4.8cm, metastasis (4cm and tuberculosis (2.1cm (P<0.001. Biochemically, most patients with pheochromocytoma (92.8% had catecholamine excess. Hypocortisolism was common in tuberculosis (100% and PAL (71.4% and absent with metastases (P<0.001. Conclusion In evaluation of bilateral adrenal masses, age at presentation, presenting symptoms, lesion size, and biochemical features are helpful in delineating varied underlying aetiologies.

  15. Clenbuterol toxicity: a NSW poisons information centre experience.

    Science.gov (United States)

    Brett, Jonathan; Dawson, Andrew H; Brown, Jared A

    2014-03-03

    To describe the epidemiology and toxicity of clenbuterol in exposures reported to the NSW Poisons Information Centre (NSWPIC). Retrospective observational study analysing data from all calls about clenbuterol exposure recorded in the NSWPIC database from 1 January 2004 to 31 December 2012. The NSWPIC coversthe Australian jurisdictions New South Wales, Tasmania and the Australian Capital Territory 24 hours a day and provides after-hours cover for the rest of Australia for 7 nights each fortnight. Total number of exposures, source of call (hospital, health care worker, member of the public), time from exposure to call, reasons for drug use, clinical features and advice given. Callers reported 63 exposures to clenbuterol, with a dramatic increase from three in 2008 to 27 in 2012. Of the 63 calls, 35 were from hospital, two from paramedics, one from general practice and 21 direct from the public. At least 53 patients (84%) required hospitalisation. The commonest reasons for use were bodybuilding and slimming. The most common features were tachycardia (24 patients), gastrointestinal disturbance (16) and tremor (11). Exposure was also associated with cardiotoxicity including one cardiac arrest in a 21-year-old man. Although a well recognised doping issue among elite athletes, clenbuterol use has spread out into the general public, especially during 2012, and should be considered in patients using bodybuilding or slimming products who present with protracted sympathomimetic features. The potential for misuse of this substance requires reconsideration of its current poison schedule registration and its availability.

  16. Experiences of violence, burnout and job satisfaction in Korean nurses in the emergency medical centre setting.

    Science.gov (United States)

    Yoon, Hee Sook; Sok, Sohyune R

    2016-12-01

    The aim of this study was to examine the experience of violence in relation to burnout and job satisfaction in Korean nurses in the emergency medical centre setting. Participants were 236 nurses in the emergency medical centre setting of three metropolitan areas in Korea. Measures included a general characteristics form, characteristics related to experiences of violence, the Maslach Burnout Inventory and the Minnesota Satisfaction Questionnaire. Data were collected from June 2013 to February 2014. In the prediction model, 33.4% of burnout was explained and 35.7% for job satisfaction. The greatest influence on burnout was handling violence, followed by verbal abuse. The greatest influence on job satisfaction was physical threat, followed by handling violence. The study shows that burnout and job satisfaction of Korean nurses in the emergency medical centre setting are related to experiences of violence such as verbal abuse, physical threat and physical violence, as well as handling violence. © 2016 John Wiley & Sons Australia, Ltd.

  17. Discussion on the Implementation of the Patient Centred Medical Home model - Experiences from Australia

    Directory of Open Access Journals (Sweden)

    Safa Majidi Rahbar

    2017-07-01

    adaptation of PCMH model to Australian context Trial and evaluation of tools for transitioning practices to HCHs using an action based research approach, leading to improvements in the handbook. Workshop objective: To share insights and facilitate a structured discussion about practical experience in implementing the elements of the Patient Centred Medical Home, tools that have been effective, challenges that have emerged and approaches used to overcome these challenges. Discussion generated through the workshop will be used to inform further work on the Australian Handbook for Transitioning to the Health Care Home. Workshop outcome: As a result of the workshop it is anticipated that participants will have an increased understanding of the medical home model, hear rich implementation experiences from different contexts and become aware of further tools for model implementation and refinement. Workshop structure: - Brief overview of model implementation taking place in Australia - Smaller group discussion about medical home implementation challenges and successes - Structured workshop group discussion drawing together key insights, common challenges and practical steps, resources or further research needed for address these challenges. Target audience: Policy makers, Primary Health Networks/Organisations, clinicians, practice staff and anyone interested in how to support practices to transition into Medical Homes

  18. Heterotopic heart transplantation: a single-centre experience.

    Science.gov (United States)

    Boffini, M; Ragni, T; Pellegrini, C; Goggi, C; D'Armini, A M; Rinaldi, M; Viganò, M

    2004-04-01

    Orthotopic heart transplantation (OHTx) represents the therapy of choice for end-stage heart disease not treatable with medical or conservative surgical approach. Heterotopic heart transplantation (HHTx) is a surgical procedure in which the graft is connected to the native heart in a parallel fashion and it was especially employed in precyclosporine era. The aim of this paper is to present our experience with HHTx. From November 1985 till May 2003, 713 heart transplanted patients included 12 (1.7%) received HHTx. Eleven were male, mean age was 50.7 +/- 5.8 years. Five patients suffered from dilated cardiomyopathy and seven from ischemic cardiomyopathy. Indication for HHTx was: a body size mismatch in 11 cases and availability of a marginal organ in one case. Mean ischemic time was 149 +/- 48 minutes and mean cross-clamp time was 82.3 +/- 19.1 minutes. In four cases left ventricle aneurysm resection was associated with HHTx. Hospital mortality was 8.3% (one patient due to multiorgan failure). The actuarial survival rates were 92% and 64% at 1 and 5 years, respectively. The causes of death were: liver cancer, liver cirrosis, aortic dissection, cerebrovascular accident, and chronic rejection. In our experience, HHTx survival rate is comparable to OHTx. Because of the scarcity of donors, use of an undersized or marginal graft is a valid option to increase the number of transplanted patients. The major disadvantages of HHTx are the need for anticoagulant therapy, the more difficult hemodynamic and immunologic follow-up, and the presence of the diseased native heart.

  19. Paediatric palliative care at home: a single centre's experience.

    Science.gov (United States)

    Chong, Lee Ai; Khalid, Farah

    2016-02-01

    There is increased awareness of paediatric palliative care in Malaysia, but no local published data on home care services. We aimed to describe the paediatric experience at Hospis Malaysia, a community-based palliative care provider in Malaysia. We conducted a retrospective case note review of patients aged up to 21 years who were referred to Hospis Malaysia from 2009 to 2013. A total of 137 patients (92 male, 45 female) with a median age of 140 (3-250) months were included in this study. The majority (71.5%) had malignancies. At referral, 62 patients were still in hospital and 17 died prior to discharge. A total of 108 patients received home visits. At the first home visit, 89.8% of patients had at least one physical symptom. Pain was the most common (52.5%) symptom. Patients had various supportive devices: 39 were on feeding tubes, ten had tracheostomies, five were on bilevel positive airway pressure and ten had urinary catheters. 66 families discussed the preferred location of care at end-of-life. Among those who died, 78.9% died at home, as they preferred (p home death and age, diagnosis and number of home visits. Bereavement follow-up occurred for 93.3% of families. Community care referrals tend to occur late, with 25.5% of patients dying within two weeks of referral. At referral, patients often had untreated physical symptoms. The majority of families preferred and had a home death. Copyright © Singapore Medical Association.

  20. Kasabach-Merritt phenomenon: a single centre experience.

    LENUS (Irish Health Repository)

    Ryan, Clodagh

    2012-01-31

    OBJECTIVE: Kasabach-Merritt phenomenon (KMP) can lead to life-threatening bleeding, and its optimum treatment has not been established. We review the experience of managing KMP in a single institution. METHODS: A retrospective chart review on all children with KMP treated at the Hospital for Sick Children, Toronto, over an 18 yr period was carried out. RESULTS: All 15 patients had profound thrombocytopenia and hypofibrinogenemia at presentation, half had bleeding symptoms, and three had cardiac failure. All patients received corticosteroids. Five responded to steroids alone, given for an average of 13 wk, increasing platelets to >20 x 10(9)\\/L at a mean of 6.2 d and fibrinogen >1 g\\/dL at 25.6 d. Ten patients received at least one other therapeutic modality in addition to steroids, including vincristine, interferon, anti-platelet agents and pentoxifylline. Five patients received vincristine, for a mean of 6 wk, with two patients responding. Eight patients received interferon, for a mean of 4 months, with two patients responding. Overall, the mean time to increasing platelets >20 x 10(9)\\/L was 56 d, to >150 x 10(9)\\/L was 88 d and fibrinogen >1 g\\/dL 49 d. Ten patients showed a partial response to embolisation, with a mean of 2.8 procedures performed. Thrombotic complications occurred in 7%. Twelve patients remain alive, with relapse in six patients, all treated successfully. One patient died, and two patients have been lost to follow-up. CONCLUSION: KMP is a rare condition, with significant morbidity and mortality. The therapeutic approach should include a multidisciplinary team and consensus on guidelines.

  1. The drug epidemic: effects on newborn infants and health resource consumption at a tertiary perinatal centre.

    Science.gov (United States)

    Kelly, J J; Davis, P G; Henschke, P N

    2000-06-01

    Illicit drug taking in Australia, with its attendant social and medical consequences, is increasing and the effects extend to maternity hospitals where infants born to addicted mothers have more health problems in the neonatal period. The aims of this study were to evaluate (1) the patterns of illness of such infants and (2) the burden imposed on the neonatal department of a large tertiary maternity centre. An audit was conducted of all Chemical Dependency Unit (CDU) mothers and babies delivered at the Royal Women's Hospital, Melbourne, Australia during 1997. Data were compared with those from a concurrent control group of mothers and babies randomly generated from the hospital's obstetric database. Ninety-six infants born to CDU mothers were compared with a control group of 200 infant/mother pairs. The majority of women in the CDU clinic were treated for narcotic addiction with methadone (90%) but most continued to use heroin during pregnancy (68%). Infants born to CDU mothers were significantly less mature and lighter than control infants. Fifty-three (55%) CDU infants required admission to the Special Care Nursery either because of neonatal abstinence syndrome (n = 29) or other medical reasons (n = 24). The median length of hospital stay was significantly longer in CDU compared with control infants (8 vs 3 days, P drug dependent mothers have more neonatal problems requiring specialized medical and nursing expertise, compared with control infants. These infants are large consumers of scarce health resources.

  2. Psychological career resources and subjective work experiences of ...

    African Journals Online (AJOL)

    The objective of this study was to determine the relationship between the psychological career resources (as measured by the. Psychological Career Resources Inventory) and the subjective work experiences of a sample of working adults (as measured by a fouritem global work experiences scale). The research also aimed ...

  3. Code of Conduct on Biosecurity for Biological Resource Centres: procedural implementation.

    Science.gov (United States)

    Rohde, Christine; Smith, David; Martin, Dunja; Fritze, Dagmar; Stalpers, Joost

    2013-07-01

    A globally applicable code of conduct specifically dedicated to biosecurity has been developed together with guidance for its procedural implementation. This is to address the regulations governing potential dual-use of biological materials, associated information and technologies, and reduce the potential for their malicious use. Scientists researching and exchanging micro-organisms have a responsibility to prevent misuse of the inherently dangerous ones, that is, those possessing characters such as pathogenicity or toxin production. The code of conduct presented here is based on best practice principles for scientists and their institutions working with biological resources with a specific focus on micro-organisms. It aims to raise awareness of regulatory needs and to protect researchers, their facilities and stakeholders. It reflects global activities in this area in response to legislation such as that in the USA, the PATRIOT Act of 2001, Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001; the Anti-Terrorism Crime and Security Act 2001 and subsequent amendments in the UK; the EU Dual-Use Regulation; and the recommendations of the Organization for Economic Co-operation and Development (OECD), under their Biological Resource Centre (BRC) Initiative at the beginning of the millennium (OECD, 2001). Two project consortia with international partners came together with experts in the field to draw up a Code of Conduct on Biosecurity for BRCs to ensure that culture collections and microbiologists in general worked in a way that met the requirements of such legislation. A BRC is the modern day culture collection that adds value to its holdings and implements common best practice in the collection and supply of strains for research and development. This code of conduct specifically addresses the work of public service culture collections and describes the issues of importance and the controls or

  4. Progress in mind: focus on alcohol use disorders, an elsevier resource centre.

    Science.gov (United States)

    Nutt, D J; Rehm, J; van den Brink, W; Gorwood, P; Buchsbaum, M S

    2015-04-30

    Harmful use of alcohol is one of the top five risks for burden of disease globally and in Europe; in 2012, 3.3 million net deaths (approximately 6% of all global deaths) were attributable to this risk factor. It is also linked to the development of a wide spectrum of alcohol use disorders, ranging from mild manifestations to a severe disease known as alcohol dependence. Alcohol dependence is a progressive, chronic, and relapsing brain disease resulting from the prolonged effects of alcohol on the brain. Alcohol dependence imposes a significant societal burden, with indirect societal costs reaching up to 0.64% of European countries׳ annual gross domestic product. With these facts in mind, it is important to recognize and manage alcohol dependence. Although the biological mechanisms behind the development of alcohol dependence are not fully known, factors that have been shown to influence its development include genetic predisposition, psychological problems, and social interactions. Alcohol use has also been linked to the development of hypertension, liver cirrhosis, chronic pancreatitis, multiple types of cancer, and psychiatric comorbidities such as depression and anxiety disorders. With such severe effects on both individuals and society, it is important to recognize the characteristic signs and symptoms of alcohol dependence and explore new ways to better manage patients with this brain disease. Effective treatment approaches for alcohol dependence include biological, behavioral, and social components addressing the multiple aspects of this disease. Comprehensive, educational platforms in which to explore the many facets of this disease such as the Progress in Mind: Focus on Alcohol Use Disorders Resource Centre, will provide clinicians with the tools necessary for recognizing patients with alcohol dependence and managing their disease along with related comorbidities. Online Access: http://progressinmind.elsevierresource.com. Copyright © 2015. Published by

  5. How Do Quality Practices Affect the Results?: The Experience of Thalassotherapy Centres in Spain

    Directory of Open Access Journals (Sweden)

    José Álvarez-García

    2017-04-01

    Full Text Available Most thalassotherapy centres in Spain do not have any quality certification but they are carrying out several actions of quality management in an attempt to obtain better results. Consequently, the aim of this research is to study if the implementation of quality practices on thalassotherapy centres has the same impact on companies’ results as on the results of those companies that got the quality certifications. In addition, the relationships between different factors considered are going to be studied. Our sample is composed of Spanish thalassotherapy centres, and the statistical technique used is based on structural equation modelling, in particular partial least squares (PLS regression. The data were provided by the answers given by 31 managers (70.45% of the selected sample to a structured questionnaire based on previous research and statistically validated. The results of this research allow us to conclude that these kinds of organizations have implemented informal practices to improve the quality of the service in terms of leadership, personnel management, alliances, and resources and show that the practices that have been carried out by these centres to enhance the quality of the service have an impact on companies’ results. Managers of these kinds of establishments that want to improve customer results should focus their efforts on continuous improvement, whereas, if they are pursuing enhancement of other results, their efforts should be focused on process management.

  6. Two experiments for the measurement of the centre of percussion of a physical pendulum

    Science.gov (United States)

    Malgieri, Massimiliano; Onorato, Pasquale; Mascheretti, Paolo; De Ambrosis, Anna

    2016-09-01

    In this article we describe two experiments, performed with instrumentation commonly available in undergraduate laboratories, to measure the position of the centre of percussion of a physical pendulum. The first one makes use of a constant external force provided by a common spring dynamometer, and allows for a straightforward analysis founded on basic concepts of rigid body dynamics. The second one is, more properly, an experiment based on a percussion, i.e. a collision involving an almost impulsive force, and displays the typical difficulties, but also the physical richness, of this type of phenomena. We provide an historical overview of the problem of the centre of percussion, starting from its first formulation given by Bernardino Baldi at the end of the 16th century, and we show how the mathematical model built for analysing the impact between a physical pendulum and a localised object is helpful in understanding that such a problem, in its original formulation, does not have a unique answer.

  7. Astronaut Gerald Carr trains with Earth Resources Experiments Package

    Science.gov (United States)

    1973-01-01

    Astronaut Gerald P. Carr, Skylab 4 commander, changes a dial on the control and display panel for the Earth Resources Experiments package (EREP) during a training exercise in the Multiple Docking Adapter (MDA) one-G trainer at JSC.

  8. Peer tutoring in patient-centred interviewing skills: experience of a project for first-year students.

    Science.gov (United States)

    Nestel, Debra; Kidd, Jane

    2003-07-01

    Peer tutoring is a potentially valuable resource in higher education. There are few published accounts of the impact of peer tutoring in medical education. College-wide experience of peer tutoring together with difficulties recruiting medical teachers for a communication programme led to the development of a peer-tutoring project. This paper reports the impact on first-year medical students of peer tutoring in patient-centred interviewing. After attending a preparatory workshop, third-year medical students co-facilitated their first-year colleagues in a session:Interviewing a Simulated Patient. First-year students completed written evaluations immediately after the session and two months later randomly selected students were assessed in patient-centred interviews. The impact of the peer-tutoring experience was evaluated by comparing these outcomes for students in groups co-facilitated by peer tutors with those who worked in groups facilitated by medical teachers. The eight learning objectives were completely met by more than 56% of students. However, there were statistically significant differences for four objectives with more students in groups facilitated by medical teachers completely meeting these objectives. Although the seven educational techniques used in the session were rated favourably by all students, two were rated as more effective in achieving the learning objectives by students in groups facilitated by medical teachers. Free-text comments revealed no differences between groups. Two months after the session, there were no differences between students in terms of interviewing skills as rated by trained observers and simulated patients, whilst simulated patients were more satisfied with interviews from students facilitated by peer tutors (p Peer tutors can support the acquisition of basic patient-centred interviewing skills in first-year medical students when contributing to one session of a structured programme. First-year students were receptive and

  9. The experience of two European preimplantation genetic diagnosis centres on human leukocyte antigen typing.

    Science.gov (United States)

    Van de Velde, Hilde; De Rycke, Martine; De Man, Caroline; De Hauwere, Kim; Fiorentino, Francesco; Kahraman, Semra; Pennings, Guido; Verpoest, Willem; Devroey, Paul; Liebaers, Inge

    2009-03-01

    Two European centres report on human leukocyte antigen (HLA) typing of preimplantation embryos for haematopoietic stem cell (HSC) transplantation: 'UZ Brussel' in Brussels and 'Genoma' in Rome. Both centres have 6 years' experience with technical and clinical aspects of this type of genetic analysis on single blastomeres. Both centres apply a similar technique for preimplantation HLA typing using short tandem repeats linked to the HLA locus in multiplex PCR for haplotyping. At present, a conclusive HLA diagnosis could be assured in 92.8% and 90.3% of the embryos at UZ Brussel and at Genoma, respectively. The implantation rates were 32.4% and 28.2%, respectively, and the birth rates per cycle were 9.4% and 18.6%, respectively. The HLA programme at UZ Brussel and at Genoma resulted in the birth of 9 babies and 3 successful HSC transplantations, and 42 babies and 7 successful HSC transplantations, respectively, so far. Drastic embryo selection for preimplantation HLA typing (in theory 1/4 for HLA, 1/8 for HLA in combination with sexing for X-linked recessive diseases, 3/16 for HLA in combination with autosomal recessive disorders) resulted overall in the birth of 51 babies (15.9% live birth rate per started cycle) in two European centres.

  10. Applying the Visitor Experience and Resource Protection (VERP) framework to cultural resources in the national parks

    Science.gov (United States)

    William Valliere; Robert Manning

    2003-01-01

    The National Park Service has developed the Visitor Experience and Resource Protection (VERP) framework for addressing carrying capacity in the National Parks. This framework has been successfully applied to natural and recreational resources in diverse units of the National Park System. However, most units of the National Park System also contain significant cultural...

  11. Long-term Field Experiments as Important Source of Knowledge - Aims of the BonaRes Data Centre

    Science.gov (United States)

    Grosse, Meike; Hierold, Wilfried

    2017-04-01

    BonaRes is short for "soil as a sustainable resource for the bioeconomy". It is funded by the German Federal Ministry of Education and Research (BMBF) under the umbrella of the National Research Strategy BioEconomy 2030. BonaRes consists of ten interdisciplinary research project consortia and the 'BonaRes - Centre for Soil Research' (see also Wollschläger et al 2016). It is one task of the BonaRes Data Centre as part of the 'BonaRes - Centre for Soil Research', to collect data and meta-data of agricultural long-term field experiments (LTFE) in Germany. The definition of LTFE in the context of BonaRes is a minimum duration of twenty years and a static design. LTFE are essential research infrastructures for agricultural sciences and soil sciences amongst other disciplines. Some LTFE run since a very long time; the start of the oldest one in Germany was 1878. Therefore, in many cases valuable time series exist. Data sets of LTFE shall be compiled and made publicly available by the BonaRes Data Centre. The public availability together with an easy access will lead to an enhanced usability of the data. This probably makes the LTFE itself more valuable through an improved visibility and may also help to maintain the LTFE. Beyond the data compilation there is the possibility for every data owner to make a data publication, which offers an additional value for the data owner after his first right of use. A first step towards a joint database is a compilation of all existing LTFE in Germany with meta information to each trial. This information is shown in an interactive web map, what is completely new in that context. Besides the exact position of the LTFE the following metadata are shown: name of the LTFE, website (if available), institution, land use category, participation in existing networks, research theme, start (and maybe end) of the trial, and research parameters. Details on the meta information will be presented in the speech. Literature Wollschläger, U; Helming

  12. ATLAS Visitors Centre

    CERN Multimedia

    claudia Marcelloni

    2009-01-01

    ATLAS Visitors Centre has opened its shiny new doors to the public. Officially launched on Monday February 23rd, 2009, the permanent exhibition at Point 1 was conceived as a tour resource for ATLAS guides, and as a way to preserve the public’s opportunity to get a close-up look at the experiment in action when the cavern is sealed.

  13. Woman-centred care during pregnancy and birth in Ireland: thematic analysis of women's and clinicians' experiences.

    LENUS (Irish Health Repository)

    Hunter, Andrew

    2017-09-25

    Recent policy and service provision recommends a woman-centred approach to maternity care. Midwife-led models of care are seen as one important strategy for enhancing women\\'s choice; a core element of woman-centred care. In the Republic of Ireland, an obstetric consultant-led, midwife-managed service model currently predominates and there is limited exploration of the concept of women centred care from the perspectives of those directly involved; that is, women, midwives, general practitioners and obstetricians. This study considers women\\'s and clinicians\\' views, experiences and perspectives of woman-centred maternity care in Ireland.

  14. Psychological career resources and subjective work experiences of ...

    African Journals Online (AJOL)

    success. Key words: career drivers; career harmonisers; career preferences; happiness; job/career satisfaction; life satisfaction; psychological career resources; subjective work experiences. Prof. M. Coetzee and Mr Z.C. Bergh are in the Department of Industrial and Organisational Psychology, University of South Africa.

  15. Random Experiment Program Resource Impact (REPRI) program: User's manual

    Science.gov (United States)

    Pease, W. T.; Alford, R. A.

    1972-01-01

    A complete user and programmer guide for the REPRI program is presented. This program was developed to perform mission concept, subsystem capability, and experiment support compatibility studies for a space station. The program utilizes Monte Carlo techniques to randomly schedule events in discrete intervals. Resources, logistics, cost, and space station volume are considered.

  16. User experience in libraries applying ethnography and human-centred design

    CERN Document Server

    Borg, Matt

    2016-01-01

    Modern library services can be incredibly complex. Much more so than their forebears, modern librarians must grapple daily with questions of how best to implement innovative new services, while also maintaining and updating the old. The efforts undertaken are immense, but how best to evaluate their success? In this groundbreaking new book from Routledge, library practitioners, anthropologists, and design experts combine to advocate a new focus on User Experience (or UX ) research methods. Through a combination of theoretical discussion and applied case studies, they argue that this ethnographic and human-centred design approach enables library professionals to gather rich evidence-based insights into what is really going on in their libraries, allowing them to look beyond what library users say they do to what they actually do. Edited by the team behind the international UX in Libraries conference, "User Experience in Libraries" will ignite new interest in a rapidly emerging and game-changing area of resear...

  17. Tokens of trauma: The ageing experience of Shoah survivors in a Jewish support centre.

    Directory of Open Access Journals (Sweden)

    Ben Kasstan

    2015-05-01

    Full Text Available This paper explores the traumatic memories of ageing Shoah survivors who attend a Jewish social and therapeutic support facility in London (UK. The study investigates the perceived differences in trauma within a diverse group of members who partake in the day centre. The difference in Shoah experience contextualises how survivors of ghettos and concentration camps possess a salient relationship with food, notably bread which acts as an enduring symbol of catastrophe for participants. The meanings that underlie death amongst camp survivors are evaluated, where decisions regarding the end of life stage can be interpreted as a shared experience with those who perished during the Shoah. Results exemplify how religious and cultural elements of Judaism mediate the trauma that has become thoroughly embodied for participants. survival is steeped in intersubjective acts of remembrance, offering a novel contribution to the anthropological study of genocide.

  18. Queer periods: attitudes toward and experiences with menstruation in the masculine of centre and transgender community.

    Science.gov (United States)

    Chrisler, Joan C; Gorman, Jennifer A; Manion, Jen; Murgo, Michael; Barney, Angela; Adams-Clark, Alexis; Newton, Jessica R; McGrath, Meaghan

    2016-11-01

    Menstruation has long been viewed as an important aspect of women's health. However, scholars and healthcare providers have only recently begun to recognise that transgender men and people with masculine gender identities also menstruate, thus little is known about their attitudes toward and experiences with menstruation. A sample of masculine of centre and transgender individuals with a mean age of 30 years was recruited online to complete measures of attitudes toward menstruation and menstrual suppression and to answer exploratory questions about their experiences managing menstruation. Participants reported mixed attitudes toward menstruation, but generally positive attitudes toward menstrual suppression. Many participants said that they try to avoid public restrooms during menstruation because of practical and psychological concerns. Implications of our findings for the transgender health are discussed.

  19. Virtual community centre for power wheelchair training: Experience of children and clinicians.

    Science.gov (United States)

    Torkia, Caryne; Ryan, Stephen E; Reid, Denise; Boissy, Patrick; Lemay, Martin; Routhier, François; Contardo, Resi; Woodhouse, Janet; Archambault, Phillipe S

    2017-11-02

    To: 1) characterize the overall experience in using the McGill immersive wheelchair - community centre (miWe-CC) simulator; and 2) investigate the experience of presence (i.e., sense of being in the virtual rather than in the real, physical environment) while driving a PW in the miWe-CC. A qualitative research design with structured interviews was used. Fifteen clinicians and 11 children were interviewed after driving a power wheelchair (PW) in the miWe-CC simulator. Data were analyzed using the conventional and directed content analysis approaches. Overall, participants enjoyed using the simulator and experienced a sense of presence in the virtual space. They felt a sense of being in the virtual environment, involved and focused on driving the virtual PW rather than on the surroundings of the actual room where they were. Participants reported several similarities between the virtual community centre layout and activities of the miWe-CC and the day-to-day reality of paediatric PW users. The simulator replicated participants' expectations of real-life PW use and promises to have an effect on improving the driving skills of new PW users. Implications for rehabilitation Among young users, the McGill immersive wheelchair (miWe) simulator provides an experience of presence within the virtual environment. This experience of presence is generated by a sense of being in the virtual scene, a sense of being involved, engaged, and focused on interacting within the virtual environment, and by the perception that the virtual environment is consistent with the real world. The miWe is a relevant and accessible approach, complementary to real world power wheelchair training for young users.

  20. Resources

    Science.gov (United States)

    ... disease - resources Hemophilia - resources Herpes - resources Incest - resources Incontinence - resources Infertility - resources Interstitial cystitis - resources Kidney disease - resources Leukemia - resources Liver disease - resources Loss ...

  1. PanDA: Exascale Federation of Resources for the ATLAS Experiment at the LHC

    Science.gov (United States)

    Barreiro Megino, Fernando; Caballero Bejar, Jose; De, Kaushik; Hover, John; Klimentov, Alexei; Maeno, Tadashi; Nilsson, Paul; Oleynik, Danila; Padolski, Siarhei; Panitkin, Sergey; Petrosyan, Artem; Wenaus, Torre

    2016-02-01

    After a scheduled maintenance and upgrade period, the world's largest and most powerful machine - the Large Hadron Collider(LHC) - is about to enter its second run at unprecedented energies. In order to exploit the scientific potential of the machine, the experiments at the LHC face computational challenges with enormous data volumes that need to be analysed by thousand of physics users and compared to simulated data. Given diverse funding constraints, the computational resources for the LHC have been deployed in a worldwide mesh of data centres, connected to each other through Grid technologies. The PanDA (Production and Distributed Analysis) system was developed in 2005 for the ATLAS experiment on top of this heterogeneous infrastructure to seamlessly integrate the computational resources and give the users the feeling of a unique system. Since its origins, PanDA has evolved together with upcoming computing paradigms in and outside HEP, such as changes in the networking model, Cloud Computing and HPC. It is currently running steadily up to 200 thousand simultaneous cores (limited by the available resources for ATLAS), up to two million aggregated jobs per day and processes over an exabyte of data per year. The success of PanDA in ATLAS is triggering the widespread adoption and testing by other experiments. In this contribution we will give an overview of the PanDA components and focus on the new features and upcoming challenges that are relevant to the next decade of distributed computing workload management using PanDA.

  2. Monitoring the delivery of virtualized resources to the LHC experiments

    Science.gov (United States)

    Cordeiro, C.; Di Girolamo, A.; Giordano, D.; Field, L.; Spiga, D.; Villazon, L.

    2015-12-01

    The adoption of cloud technologies by the LHC experiments places the fabric management burden of monitoring virtualized resources upon the VO. In addition to monitoring the status of the virtual machines and triaging the results, it must be understood if the resources actually provided match with any agreements relating to the supply. Monitoring the instantiated virtual machines is therefore a fundamental activity and hence this paper describes how the Ganglia monitoring system can be used for the cloud computing resources of the LHC experiments. Expanding upon this, it is then shown how the integral of the time-series monitoring data obtained can be re-purposed to provide a consumer-side accounting record, which can then be compared with the concrete agreements that exist between the supplier of the resources and the consumer. From this alone, it is not clear though how the performance of the resources differ both within and between providers. Hence, the case is made for a benchmarking metric to normalize the data along with some results from a preliminary investigation on obtaining such a metric.

  3. The relationship between women-centred care and women's birth experiences: a comparison between birth centres, clinics, and hospitals in Japan.

    Science.gov (United States)

    Iida, Mariko; Horiuchi, Shigeko; Porter, Sarah E

    2012-08-01

    the goal of women-centred care (WCC) is respect, safety, holism, partnership and the general well-being of women, which could lead to women's empowerment. The first step in providing WCC to all pregnant women is to describe women's perceptions of WCC during pregnancy in different health facilities. The objectives of this study were to ask (a) what are the perceptions and comparison of WCC at Japanese birth centres, clinics, and hospitals and (b) what are the relationships between WCC and three dimensions of women's birth experience: (1) satisfaction with care they received during pregnancy and birth, (2) sense of control during labour and birth, and (3) attachment to their new born babies. this was a cross-sectional study using self-completed retrospective questionnaires. three types of health facility: birth centres (n=7), clinics (n=4), and hospitals (n=2). participants were women who had a singleton birth and were admitted to one of the study settings. Women who were seriously ill were excluded. Data were analysed on 482 women. instrumentation included: a researcher-developed WCC-pregnancy questionnaire, Labour Agentry Scale, Maternal Attachment Questionnaire, and a researcher-developed Care Satisfaction Scale. among the three types of settings, women who delivered at birth centres rated WCC highly and were satisfied with care they received compared to those who gave birth at clinics and hospitals. WCC was positively associated with women's satisfaction with the care they received. women giving birth at birth centres had the most positive perceptions of WCC. This was related to the respectful communication during antenatal checkups and the continuity of care by midwives, which were the core elements of WCC. health-care providers should consider the positive correlation of WCC and women's perception of satisfaction. Every woman should be provided continuity of care with respectful communication, which is a core element of WCC. Copyright © 2011 Elsevier Ltd. All

  4. Dental students' perceptions of their experience at a residential outreach centre.

    Science.gov (United States)

    Radford, D R; Hellyer, P

    2015-08-28

    The Portsmouth Dental Academy delivers an interprofessional education to dental students on outreach placement from King's College London Dental Institute. To establish what the dental students' attitudes to the placement are and how these correlate to the perceptions of the staff who work with them. Using Delphi consensus procedures, a simple, closed, two-question questionnaire was developed. The questionnaire was completed by the students and then, to triangulate the results, was subsequently applied to staff who teach and assist them on clinic. To the question: Why do you think the experience that is commonly termed the 'Portsmouth experience' is so successful 'in the eyes of the students'?, the students ranked first the response: 'Students gain experience in primary dental care clinical practice under the current NHS contract - UDAs and KPIs'. To the second question: What do you think the students most enjoyed about working in Portsmouth?, the students ranked first: 'A sense of independence - being made to make their own decisions'. The students' major perception of the 'Portsmouth experience' centres around the placement being a realistic preparation for their future practising career. This is combined with a strong sense of belonging when studying and working at the Academy.

  5. Civil society participation in the management of the common good: a case of ethics in biological resource centres

    Directory of Open Access Journals (Sweden)

    Patrici Calvo Cabezas

    2014-10-01

    Full Text Available The management of commons is now at the centre of researchers’ attention in many branches of science, particularly those related to the human or social sciences. This paper seeks to demonstrate how civil society participation in common goods or resources is not only possible but is also desirable for society because of the medium and long-term benefits it offers involved and/or affected parties. To this end, we examine the falsity of the discourse underlying the supposed incompetence of civil society to cooperate interpersonally in the pursuit of common objectives, and also analyse a specific example of the necessary and possible participation of civil society in managing common goods through biobanks.

  6. A common-pool resource experiment in acequia communities

    Directory of Open Access Journals (Sweden)

    Nejem Raheem

    2015-03-01

    Full Text Available Farmers and rural advocates in New Mexico assert that traditional irrigators are better adapted to water scarcity and variability than other communities. Data to actually test this are often scarce, but such information could be useful for planning the state’s water future, especially as climate change predictions tend toward less reliable supplies. This paper reports results from a common pool resource (CPR experiment that simulates irrigating behavior using two groups: rural irrigators and undergraduate students. Despite predictions to the opposite, there was no significant difference between mean withdrawals or predictions of other players’ behavior. On average, both groups withdrew above the social optimum but below the Nash equilibrium. This work appears to be the first example of a common pool resource experiment conducted with traditional New Mexican irrigators.

  7. Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study.

    Science.gov (United States)

    Brennan, Aline; Jackson, Arthur; Horgan, Mary; Bergin, Colm J; Browne, John P

    2015-04-03

    It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses. The average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938-€1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis. This study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision.

  8. Monitoring of computing resource utilization of the ATLAS experiment

    OpenAIRE

    Rousseau, D; Dimitrov, G; Vukotic, I; Aidel, O; Schaffer, RD; Albrand, S

    2012-01-01

    Due to the good performance of the LHC accelerator, the ATLAS experiment has seen higher than anticipated levels for both the event rate and the average number of interactions per bunch crossing. In order to respond to these changing requirements, the current and future usage of CPU, memory and disk resources has to be monitored, understood and acted upon. This requires data collection at a fairly fine level of granularity: the performance of each object written and each algorithm run, as wel...

  9. Current Solutions: Recent Experience in Interconnecting Distributed Energy Resources

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, M.

    2003-09-01

    This report catalogues selected real-world technical experiences of utilities and customers that have interconnected distributed energy assets with the electric grid. This study was initiated to assess the actual technical practices for interconnecting distributed generation and had a particular focus on the technical issues covered under the Institute of Electrical and Electronics Engineers (IEEE) 1547(TM) Standard for Interconnecting Distributed Resources With Electric Power Systems.

  10. United Nations Office on Drugs and Crime International Network of Drug Dependence Treatment and Rehabilitation Resource Centres: Treatnet

    Science.gov (United States)

    Tomas-Rossello, Juana; Rawson, Richard A.; Zarza, Maria J.; Bellows, Anne; Busse, Anja; Saenz, Elizabeth; Freese, Thomas; Shawkey, Mansour; Carise, Deni; Ali, Robert; Ling, Walter

    2010-01-01

    Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created…

  11. The impact of services that offer individualised funds, shared management, person-centred relationships, and self-direction on the lived experiences of consumers with mental illness.

    Science.gov (United States)

    Peterson, Sunila; Buchanan, Angus; Falkmer, Torbjorn

    2014-01-01

    Mental health service providers across Australia, including Western Australia (WA), have begun to offer individualised funds, shared management, person-centred and self-directed (SPS) services. No research exists on the impact of SPS services on the lived experiences of these particular consumers. This study explored the impact of a SPS service offered for the first time in WA to consumers with mental illness. Data on sixteen consumers' lived experiences were analysed using an abbreviated grounded theory approach. These data had been developed by the consumers, Guides (staff) and an independent evaluator, and most of it had been collected in the past prior to the commencement of the study. Three over-arching categories, and related subcategories, emerged indicating that 1) access to individualised funds enabled practical and psychological benefits to consumers; 2) consistent contact in shared management and person-centred relationships enhanced the provision of timely and meaningful staff support to consumers; and 3) high quality shared management and person-centred relationships with staff and the opportunity to self-direct enabled consumers' change and growth. SPS services enhanced consumers' lived experiences and enabled staff to provide and consumers to experience timely access to recovery resources, consistent contact, responsive and high quality support, and self-direction of services. In this, consumers changed, grew and achieved desired recovery experiences. The overall impact of the SPS service seemed to be founded on the goodness of fit between person characteristics of staff and consumers, which enabled rich support that provided for corrective emotional experiences. This enabled consumers to build meaningful and hopeful lives where they started to live with, and beyond, their mental illness.

  12. The "basic" approach: a single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation.

    Science.gov (United States)

    Padalino, Massimo A; Tessari, Chiara; Guariento, Alvise; Frigo, Anna C; Vida, Vladimiro L; Marcolongo, Andrea; Zanella, Fabio; Harvey, Michael J; Thiagarajan, Ravi R; Stellin, Giovanni

    2017-04-01

    Extracorporeal membrane oxygenation (ECMO) is a lifesaving but expensive therapy in terms of financial, technical and human resources. We report our experience with a 'basic' ECMO support model, consisting of ECMO initiated and managed without the constant presence of a bedside specialist, to assess safety, clinical outcomes and financial impact on our health system. We did a retrospective single-centre study of paediatric cardiac ECMO between January 2001 and March 2014. Outcomes included postimplant complications and survival at weaning and at discharge. We used activity based costing to compare the costs of current basic ECMO with those of a 'full optional' dedicated ECMO team (hypothesis 1); ECMO with a bedside nurse and perfusionist (hypothesis 2), and ECMO with a bedside perfusionist (hypothesis 3). Basic cardiac ECMO was required for 121 patients (median age 75 days, median weight 4.4 kg). A total of 107 patients (88%) had congenital heart disease; 37 had univentricular physiology. The median duration of ECMO was 7 days (interquartile range [IQR], 4-15 days). Overall survival at weaning and at 30 days in the neonatal and paediatric age groups was 58.6% and 30.6%, respectively; these results were not significantly different from Extracorporeal Life Support Organization data. Cost analysis revealed a saving of €30 366, €22 144 and €13 837 for each patient on basic ECMO for hypotheses 1, 2 and 3, respectively. Despite reduced human, technical and economical resources, a basic ECMO model without a bedside specialist was associated with satisfactory survival and lower costs.

  13. Experiences with Resource Provisioning for Scientific Workflows Using Corral

    Directory of Open Access Journals (Sweden)

    Gideon Juve

    2010-01-01

    Full Text Available The development of grid and workflow technologies has enabled complex, loosely coupled scientific applications to be executed on distributed resources. Many of these applications consist of large numbers of short-duration tasks whose runtimes are heavily influenced by delays in the execution environment. Such applications often perform poorly on the grid because of the large scheduling overheads commonly found in grids. In this paper we present a provisioning system based on multi-level scheduling that improves workflow runtime by reducing scheduling overheads. The system reserves resources for the exclusive use of the application, and gives applications control over scheduling policies. We describe our experiences with the system when running a suite of real workflow-based applications including in astronomy, earthquake science, and genomics. Provisioning resources with Corral ahead of the workflow execution, reduced the runtime of the astronomy application by up to 78% (45% on average and of a genome mapping application by an order of magnitude when compared to traditional methods. We also show how provisioning can benefit applications both on a small local cluster as well as a large-scale campus resource.

  14. Production Experiences with the Cray-Enabled TORQUE Resource Manager

    Energy Technology Data Exchange (ETDEWEB)

    Ezell, Matthew A [ORNL; Maxwell, Don E [ORNL; Beer, David [Adaptive Computing

    2013-01-01

    High performance computing resources utilize batch systems to manage the user workload. Cray systems are uniquely different from typical clusters due to Cray s Application Level Placement Scheduler (ALPS). ALPS manages binary transfer, job launch and monitoring, and error handling. Batch systems require special support to integrate with ALPS using an XML protocol called BASIL. Previous versions of Adaptive Computing s TORQUE and Moab batch suite integrated with ALPS from within Moab, using PERL scripts to interface with BASIL. This would occasionally lead to problems when all the components would become unsynchronized. Version 4.1 of the TORQUE Resource Manager introduced new features that allow it to directly integrate with ALPS using BASIL. This paper describes production experiences at Oak Ridge National Laboratory using the new TORQUE software versions, as well as ongoing and future work to improve TORQUE.

  15. Electric dipole centres and colour centres in natural sodalite

    NARCIS (Netherlands)

    Brom, W.E. van den; Kerssen, J.; Volger, J.

    1974-01-01

    Experiments on an electric dipole centre, exhibiting multiple relaxation, in the natural mineral sodalite, are described. The concentration of the dipole centres is reduced upon X irradiation, whereas simultaneously colour centres and paramagnetic centres arise. Thermal bleaching restores the

  16. Decreasing incidence of cutaneous chemical burns in a resource limited burn centre: is this a positive effect of modernization?

    Science.gov (United States)

    Nnabuko, R E E; Okoye, C P; Ogbonnaya, I S; Isiwele, Egi

    2017-01-01

    Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this. The records of all acute burn patients seen at the Burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times. A total of 624 acute burn cases were treated during the period; among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were  recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reasons. There appears to be

  17. Internatioanl Experiences of Resource Management in the North

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus Ole

    The paper outlines some general characteristics regarding resource development and resource management in the Circumpolar North.......The paper outlines some general characteristics regarding resource development and resource management in the Circumpolar North....

  18. PanDA: Exascale Federation of Resources for the ATLAS Experiment

    CERN Document Server

    Barreiro Megino, Fernando Harald; The ATLAS collaboration; Maeno, Tadashi; Wenaus, Torre; Nilsson, Paul; Klimentov, Alexei; Oleynik, Danila; Panitkin, Sergey; Petrosyan, Artem; Vukotic, Ilija

    2015-01-01

    After a scheduled maintenance and upgrade period, the world’s largest and most powerful machine - the Large Hadron Collider(LHC) - is about to enter its second run at unprecedented energies. In order to exploit the scientific potential of the ma- chine, the experiments at the LHC face computational challenges with enormous data volumes that need to be analysed by thousand of physics users and compared to simulated data. Given diverse funding constraints, the computational resources for the LHC have been deployed in a worldwide mesh of data centres, connected to each other through Grid technologies. The PanDA (Production and Distributed Analysis) system was developed in 2005 for the ATLAS experiment on top of this heterogeneous infrastructure to seamlessly integrate the computational resources and give the users the feeling of a unique system. Since its origins, PanDA has evolved together with upcoming computing paradigms in and outside HEP, such as changes in the networking model, cloud computing and HPC. I...

  19. PanDA: Exascale Federation of Resources for the ATLAS Experiment at the LHC

    CERN Document Server

    AUTHOR|(SzGeCERN)643806; The ATLAS collaboration; Caballero-Bejar, Jose; De, Kaushik; Hover, John; Klimentov, Alexei; Maeno, Tadashi; Nilsson, Paul; Oleynik, Danila; Padolski, Siarhei; Panitkin, Sergey; Petrosyan, Artem; Wenaus, Torre

    2016-01-01

    After a scheduled maintenance and upgrade period, the world’s largest and most powerful machine - the Large Hadron Collider(LHC) - is about to enter its second run at unprecedented energies. In order to exploit the scientific potential of the machine, the experiments at the LHC face computational challenges with enormous data volumes that need to be analysed by thousand of physics users and compared to simulated data. Given diverse funding constraints, the computational resources for the LHC have been deployed in a worldwide mesh of data centres, connected to each other through Grid technologies. The PanDA (Production and Distributed Analysis) system was developed in 2005 for the ATLAS experiment on top of this heterogeneous infrastructure to seamlessly integrate the computational resources and give the users the feeling of a unique system. Since its origins, PanDA has evolved together with upcoming computing paradigms in and outside HEP, such as changes in the networking model, Cloud Computing and HPC. It ...

  20. Experiences related to the role of a cost centre manager in a public ...

    African Journals Online (AJOL)

    A cost centre in a hospital setting is an identifiable department, for example a nursing care unit, which has been practically assigned an account number in the hospital accounting system. The purpose of a cost centre is to control clinical and administrative costs, as well as accumulated expenses by that identified ...

  1. User Experience for Disabled Users in Open Educational Resources Websites

    Directory of Open Access Journals (Sweden)

    Rosa Navarrete

    2015-11-01

    Full Text Available Open Educational Resources (OER are digital materials for teaching-learning purpose released under an open license that are available through websites. In the last decade, some governments have encouraged the development and using of OER in order to contribute to the achievement of the right to education for everyone, a fundamental right included in The Universal Declaration of Human Rights. Besides, inclusion of people with disabilities is a global concern that need to be addressed in all living aspects including education. In this research we address the user experience in OER websites —considering the perspective of users with disabilities— in order to recognize possible barriers in web design. The conformance criteria considered for this reviewing are mandatory aspects of user experience in relation to Web accessibility and Web usability.

  2. User Experience for Disabled Users in Open Educational Resources Websites

    Directory of Open Access Journals (Sweden)

    Rosa Navarrete

    2015-11-01

    Full Text Available Open Educational Resources (OER are digital materials for teaching-learning purpose released under an open license that are available through websites. In the last decade, some governments have encouraged the development and using of OER in order to contribute to the achievement of the right to education for everyone, a fundamental right included in The Universal Declaration of Human Rights. Besides, inclusion of people with disabilities is a global concern that need to be addressed in all living aspects including education.In this research we address the user experience in OER websites —considering the perspective of users with disabilities— in order to recognize possible barriers in web design. The conformance criteria considered for this reviewing are mandatory aspects of user experience in relation to Web accessibility and Web usability.

  3. Bone Anchored Hearing Aid (BAHA) in children: Experience of a tertiary referral centre in Portugal.

    Science.gov (United States)

    Rosa, Francisco; Silva, Ana; Reis, Cláudia; Coutinho, Miguel; Oliveira, Jorge; Almeida E Sousa, Cecília

    The aim of this study is to describe the experience of a tertiary referral centre in Portugal, of the placement of BAHA in children. The authors performed a retrospective analysis of all children for whom hearing rehabilitation with BAHA was indicated at a central hospital, between January 2003 and December 2014. 53 children were included. The most common indications for placement of BAHA were external and middle ear malformations (n=34, 64%) and chronic otitis media with difficult to control otorrhea (n=9, 17%). The average age for BAHA placement was 10.66±3.44 years. The average audiometric gain was 31.5±7.20dB compared to baseline values, with average hearing threshold with BAHA of 19.6±5.79dB. The most frequent postoperative complications were related to the skin (n=15, 28%). There were no major complications. This study concludes that BAHA is an effective and safe method of hearing rehabilitation in children. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  4. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience.

    Science.gov (United States)

    Montella, Silvia; Corcione, Adele; Santamaria, Francesca

    2017-01-29

    Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%-9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.

  5. A 6-YEAR EXPERIENCE OF HEART TRANSPLANTATION IN FEDERAL ALMAZOV NORTH-WEST MEDICAL RESEARCH CENTRE

    Directory of Open Access Journals (Sweden)

    E. V. Shlyakhto

    2016-01-01

    Full Text Available Aim. To estimate the results of 6-year experience of heart transplantation (HT in Federal Almazov North-West Medical Research Centre. Methods. From 2010 to 2015 we have performed 65 HT. Mean age was 44.3 ± 14 years old (from 10 to 64 years old. We used biventricular assist device (BIVAD, Berlin Heart Excor support in 7 heart transplant candidates before HT. 19 patients (29% received thymoglobulin, whereas 46 patients (71% had basiliximab to induce immunosuppression.Results. Extracorporeal membrane oxygenation machines were implanted in 5 patients (7.7% after HT due to acute right ventricular failure. Suture annuloplasty (the Batista procedure for tricuspid valve repair was carried out in 3 cases (4.6%. Venovenous hemodiafi ltration was used in 11 patients (16.9%. A total of 598 endomyocardial biopsies (EMB were performed after HT. Evidence of cellular rejection (R1 and R2 was presented in 286 biopsies (48%. The 30-day in-hospital mortality rate was 3.1%. The 6-month survival rate after HT was 92%, 1-year – 91% and overall survival for the 6-year period of observation – 89.2%. Maximum observation period was 71 months.Conclusions. The 6-year experience of HT in our Center has shown a high level of survival. BIVAD Excor support can be effectively used as a «bridge» to HT. Prevention of graft loss due to acute rejection in heart transplant recipients can be achieved only through regular EMB monitoring. The rate of viral infection increased in 2 months after HT.

  6. Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

    Directory of Open Access Journals (Sweden)

    Chalya Phillipo L

    2012-01-01

    Full Text Available Abstract Background Splenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients. Methods A prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0. Results A total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8% had blunt trauma and road traffic accidents (63.6% were the most frequent cause of injuries. Most patients sustained grade III (39.0% and IV (38.1% splenic injuries. Majority of patients (86.4% were treated operatively with splenectomy (97.1% being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6 and those with associated injuries stayed longer in the hospital (P 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P Conclusion Trauma resulting from road traffic accidents (RTAs remains the most common cause of splenic injuries in our setting. Most of the splenic injuries were Grade III & IV and splenectomy was performed in majority of

  7. Cold burn injuries in the UK: the 11-year experience of a tertiary burns centre.

    Science.gov (United States)

    Nizamoglu, Metin; Tan, Alethea; Vickers, Tobias; Segaren, Nicholas; Barnes, David; Dziewulski, Peter

    2016-01-01

    Guidance for the management of thermal injuries has evolved with improved understanding of burn pathophysiology. Guidance for the management of cold burn injuries is not widely available. The management of these burns differs from the standard management of thermal injuries. This study aimed to review the etiology and management of all cold burns presenting to a large regional burn centre in the UK and to provide a simplified management pathway for cold burns. An 11-year retrospective  analysis (1 January 2003-31 December 2014)  of all cold injuries presenting to a regional burns centre in the UK was conducted. Patient case notes were reviewed for injury mechanism, first aid administered, treatment outcomes and time to healing. An anonymized nationwide survey on aspects of management of cold burns was disseminated between 13 July 2015-5 October 2015 to British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) and Plastic Surgery Trainees Association (PLASTA) members in the UK. Electronic searches of MEDLINE, EMBASE and the Cochrane Library were performed to identify relevant literature to provide evidence for a management pathway for cold burn injuries. Twenty-three patients were identified. Age range was 8 months-69 years. Total body surface area (TBSA) burn ranged from 0.25 to 5 %. Twenty cases involved peripheral limbs. Seventeen (73.9 %)cases were accidental, with the remaining six (26.1 %) cases being deliberate self-inflicted injuries. Only eight patients received first aid. All except one patient were managed conservatively. One case required skin graft application due to delayed healing. We received 52 responses from a total of 200 questionaires. Ninety percent of responders think clearer guidelines should exist. We present a simplified management pathway based on evidence identified in our literature search. Cold burns are uncommon in comparison to other types of burn injuries. In the UK, a disproportionate number of cold

  8. Challenges in interprofessional collaboration: experiences of care providers and policymakers in a newly set-up Dutch assault centre.

    Science.gov (United States)

    Zijlstra, Elza; Lo Fo Wong, Sylvie; Teerling, Anne; Hutschemaekers, Giel; Lagro-Janssen, Antoine

    2017-08-03

    Sexual and family violence are problems that affect many women and men, and the negative health consequences of violence are numerous. As adequate acute interprofessional care can prevent negative health consequences and improve forensic medical examination, a Centre for Sexual and Family Violence was set up. We aimed to improve our understanding of the challenges in interprofessional collaboration in a newly set-up centre for sexual and family violence. We conducted a qualitative study with semi-structured interviews about the experiences with interprofessional collaboration of 16 stakeholders involved in the Centre for Sexual and Family Violence Nijmegen. Participants were selected by purposive sampling. Participants found that the interprofessional collaboration had improved communication and competences. However, there were challenges too. Firstly, the interprofessional collaboration had brought parties closer together, but the collaboration also forced professionals to strongly define their boundaries. Mutual trust and understanding needed to be built up. Secondly, a balance had to be struck between pursuing the shared vision - which was to improve quality of care for victims - and giving space to organizations' and professionals' own interest. Thirdly, care for victims of sexual and family violence could be demanding on healthcare providers in an emotional sense, which might jeopardize professional's initial motivation for joining the Centre for Sexual and Family Violence Nijmegen. The interprofessional collaboration in an assault centre improves quality of care for victims, but there are also challenges. The tasks of an assault centre are to create opportunities to discuss professional roles and professional interests, to build up good interpersonal relations in which trust and understanding can grow, to formulate a strong and shared victim-centred vision and to support care providers with training, feedback and supervision. © 2017 Nordic College of Caring

  9. Accelerated Capacity Development in Water Resources Education: the experiences of the Ethiopian Institute of Water Resources

    Science.gov (United States)

    Alamirew, T.; Mekonnen, G.; Viglione, A.

    2012-04-01

    Ethiopia recently recognises that the water resources development is the major entry point in poverty alleviation and sustainable development. Water in Ethiopia plays a key role in the Water-Energy-Food-nexus. Over 98% of the electricity in the country is generated using hydropower and yet about 2000 MW has been developed. Out of the 3.5 Mha potentially irrigable land, only 0.25 Mha has been developed to date. Access to drinking water supply coverage is among the lowest in the world. One of the limiting factors in harnessing the resource base is the absence of water professionals to face the fast growing demand in education, research, development in the water sector. Recognising this, in collaboration with University of Connecticut of the United States, Addis Ababa University launched the Ethiopian Institute of Water Resources (EIWR) by enrolling 18 PhD and 24 MSc students. The program is unique in that much of the course instructors are coming from US and European Universities, but deliver courses together with Ethiopian collaborators. This is supposed to facilitate knowledge and experience transfer from the US/EU scientist to Ethiopian counterparts. The theses/dissertations are designed to focus on Ethiopia's immediate hydrological problems on selected basins, and will be coordinated by three advisors for each PhD - one from US/EU, one from Ethiopian Universities, and one water professional from the sector. We report here the lessons learned in setting up the EIWR institute and the education program.

  10. Monitoring of computing resource utilization of the ATLAS experiment

    CERN Document Server

    Rousseau, D; The ATLAS collaboration; Vukotic, I; Aidel, O; Schaffer, RD; Albrand, S

    2012-01-01

    Due to the good performance of the LHC accelerator, the ATLAS experiment has seen higher than anticipated levels for both the event rate and the average number of interactions per bunch crossing. In order to respond to these changing requirements, the current and future usage of CPU, memory and disk resources has to be monitored, understood and acted upon. This requires data collection at a fairly fine level of granularity: the performance of each object written and each algorithm run, as well as a dozen per-job variables, are gathered for the different processing steps of Monte Carlo generation and simulation and the reconstruction of both data and Monte Carlo. We present a system to collect and visualize the data from both the online Tier-0 system and distributed grid production jobs. Around 40 GB of performance data are expected from up to 200k jobs per day, thus making performance optimization of the underlying Oracle database of utmost importance.

  11. Flagstaff, Arizona seen in Earth Resources Experiments package

    Science.gov (United States)

    1974-01-01

    A spectacular winter view of the Flagstaff, Arizona area is seen in this Skylab 4 Earth Resources Experiments package S190-B (five-inch earth terrain camera) infrared photograph taken from the Skylab space station in Earth orbit. Included in the scene are the San Francisco Mountains, Oak Creek Canyon, Painted Desert and Meteor Crater. The infrared picture depicts in red living vegetation, in white the snow, and in bright blue the water. Major features identified in this photograph are Humphrey's peak, top center, Flagstaff at foot of the peak, Sunset Crater volcanic field with numerous vents and craters right of Flagstaff and Meteor Crater (right center). Within the mountainous areas several clear areas generally rectangular are visible and represent the areas where lumbering has removed the forest. The thin white line extending from left corner to Sunset Crater fields is the power transmission line cleared area. Roads are subdued and are not easily visible.

  12. Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience.

    Science.gov (United States)

    Gestic, Martinho Antonio; Callejas-Neto, Francisco; Chaim, Elinton Adami; Utrini, Murillo Pimentel; Cazzo, Everton; Pareja, Jose Carlos

    2011-04-01

    Surgical treatment of chronic pancreatitis is indicated for intractable pain. Frey's procedure is an accepted treatment for this disease. The aim of the present study was to describe a single-centre experience in the treatment of chronic pancreatitis using Frey's procedure. A retrospective analysis of 73 patients who underwent a Frey's procedure between 1991 to 2007 and had at least 1 year of follow-up. Demographics, indication for surgery, peri-operative complications and late outcomes were analysed. The median age was 39.9 years. Seventy out of the 73 (95.8%) patients were male. The median pre-operative body mass index (BMI) was 19.1 kg/m(2). All patients had abdominal pain, 34 (46.6%) of them daily and 13 (17.8%) weekly, with moderate or severe intensity in 98.6% (n= 72). The aetiology was secondary to alcohol in 70 patients (95.9%), with a median consumption of 278 g per day. The surgical morbidity rate was 28.7%; there were no deaths. Median post-operative follow-up was 77.0 months; 64 patients (91.4%) had complete pain relief and post-operative BMI was 22.4 kg/m(2) (P<0.001). All patients with pre-operative endocrine and exocrine insufficiencies showed no reversal of the situation. New onset insufficiencies appeared late. Frey's procedure was a safe and effective therapeutic option for the surgical treatment of patients with intractable pain caused by chronic pancreatitis. © 2011 International Hepato-Pancreato-Biliary Association.

  13. Single-centred experience with levosimendan in paediatric decompensated dilated cardiomyopathy.

    Science.gov (United States)

    Séguéla, Pierre-Emmanuel; Mauriat, Philippe; Mouton, Jean-Baptiste; Tafer, Nadir; Assy, Jana; Poncelet, Géraldine; Nubret, Karine; Iriart, Xavier; Thambo, Jean-Benoit

    2015-01-01

    Children with dilated cardiomyopathy in advanced heart failure may spend a long time awaiting heart transplantation. Consequently, mechanical circulatory support is sometimes required as a bridge to transplantation. Levosimendan, a positive inotropic agent, has been reported to be safe and efficient for the treatment of paediatric heart failure. To report our experience with levosimendan in children with decompensated dilated cardiomyopathy. Paediatric patients with dilated cardiomyopathy on the transplant waiting list and with criteria for mechanical support were included in this single-centred retrospective study. Each patient received at least one 24-hour infusion of levosimendan before mechanical circulatory support was considered. Biological and echocardiographic data were analysed. Six patients were included over a 24-month period. The median age was 25.5months (7.7-34.2months); 82 infusions were performed. Median B-type natriuretic peptide concentration decreased significantly between days 0 and 2 (2443ng/L [1458-3819ng/L] vs 1358ng/L [1025-2534ng/L]; P=0.003). While only a trend was noted in left ventricular ejection fraction improvement (P=0.054 by Simpson's method and P=0.068 by the Teicholz method), the subaortic velocity time integral rose significantly between days 0 and 8 (12.8cm/s [10-14.5cm/s] vs 15.3cm/s [14.3-16.9cm/s]; P=0.041). Levosimendan seems to improve haemodynamics in children with decompensated dilated cardiomyopathy; repeated infusions may delay the need for mechanical circulatory support while awaiting heart transplantation. This therapeutic agent should be systematically considered in this setting, in addition to conventional inotropic drugs. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Fully automated, clinical-grade bone marrow processing: a single-centre experience

    Science.gov (United States)

    Mazzanti, Benedetta; Urbani, Serena; Dal Pozzo, Simone; Bufano, Paola; Ballerini, Lara; Gelli, Alessia; Sodi, Irene; Donnini, Irene; Di Gioia, Massimo; Guidi, Stefano; Camisani, Julien; Saccardi, Riccardo

    2017-01-01

    Background Clinical grade processing of harvested bone marrow is required in various clinical situations, particularly in the management of ABO mismatching in allogeneic haematopoietic stem cell transplantation (HSCT) and in regenerative medicine. Material and methods We report a single-centre experience using a fully automated, clinical grade, closed system (Sepax, Biosafe, Switzerland). From 2003 to 2015, 125 procedures were performed in our laboratory, including buffy-coat production for HSCT (n=58), regenerative medicine in an orthopaedic setting (n=54) and density-gradient separation in a trial for treatment of critical limb ischaemia (n=13). Results Buffy coat separation resulted in a median volume reduction of 85% (range, 75–87%), providing satisfactory red blood cell depletion (69%, range 30–88%) and a median recovery of CD34 cells of 96% (range, 81–134%) in the setting of allogeneic HSCT. Significantly greater volume reduction (90%; range, 90–92%) and red blood cell depletion (88%; range, 80–93%) were achieved by the new SmartRedux software released for Sepax2, validated in the last eight allogeneic HSCT. The density gradient separation programme resulted in complete red blood cell depletion associated with high CD34 recovery (69%; range, 36–124%). No reactions related to the quality of the product were reported. Time to engraftment following allogeneic HSCT was in the normal range. No cases of microbiological contamination related to the manipulation were reported. Discussion Clinical grade, automated bone marrow manipulation with Sepax was shown to be effective, giving operator-independent results and could be used for a broad range of clinical applications. PMID:27723450

  15. Patients’ priorities for ambulatory hospital care centres. A survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital

    Science.gov (United States)

    Albada, Akke; Triemstra, Mattanja

    2009-01-01

    Abstract Objective  This study established patients’ preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients’ choice to visit this centre instead of the regional hospital. Methods  A questionnaire survey among 1477 elderly and chronically ill people (response 72%) assessed patients’ expectations regarding (a) quality of hospital care, (b) facilities in centres for ambulatory hospital care, and (c) future use of these centres. Additionally, 75 patients participated in discrete choice experiments about their decision to visit a centre for ambulatory hospital care or the regional hospital. Results  Respondents prioritized facilities for examination and medical consultations in the ambulatory care centres. Half of the respondents also valued paramedic care, information desks and pharmacies as centre facilities. Most patients living near a future centre for ambulatory care would rather visit this centre than the regional hospital. However, they favoured seeing their familiar physician, short waiting lists and appointments scheduled consecutively on 1 day. If these aspects were not guaranteed at the adjacent centres, more patients chose to visit the hospital. Conclusions  Although patients value most facilities, they set clear priorities. Furthermore, this study showed three important conditions in the decision to visit an ambulatory care centre; (1) the possibility to see their familiar physician, (2) to have consecutive appointments, and (3) a short waiting list. These three factors were more important to patients than proximity. Thus, when choosing between a hospital and an adjacent centre for ambulatory care, quality aspects matter. PMID:19250155

  16. Patients' priorities for ambulatory hospital care centres. A survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital.

    Science.gov (United States)

    Albada, Akke; Triemstra, Mattanja

    2009-03-01

    This study established patients' preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients' choice to visit this centre instead of the regional hospital. A questionnaire survey among 1477 elderly and chronically ill people (response 72%) assessed patients' expectations regarding (a) quality of hospital care, (b) facilities in centres for ambulatory hospital care, and (c) future use of these centres. Additionally, 75 patients participated in discrete choice experiments about their decision to visit a centre for ambulatory hospital care or the regional hospital. Respondents prioritized facilities for examination and medical consultations in the ambulatory care centres. Half of the respondents also valued paramedic care, information desks and pharmacies as centre facilities. Most patients living near a future centre for ambulatory care would rather visit this centre than the regional hospital. However, they favoured seeing their familiar physician, short waiting lists and appointments scheduled consecutively on 1 day. If these aspects were not guaranteed at the adjacent centres, more patients chose to visit the hospital. Although patients value most facilities, they set clear priorities. Furthermore, this study showed three important conditions in the decision to visit an ambulatory care centre; (1) the possibility to see their familiar physician, (2) to have consecutive appointments, and (3) a short waiting list. These three factors were more important to patients than proximity. Thus, when choosing between a hospital and an adjacent centre for ambulatory care, quality aspects matter.

  17. Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources?

    Science.gov (United States)

    Abdelrahman, Islam; Elmasry, Moustafa; Steinvall, Ingrid; Fredrikson, Mats; Sjoberg, Folke

    2017-06-01

    The aim of this study was to find out whether the charging costs (calculated using interventional burn score) increased as mortality decreased.During the last 2 decades, mortality has declined significantly in the Linköping Burn Centre. The burn score that we use has been validated as a measure of workload and is used to calculate the charging costs of each burned patient.We compared the charging costs and mortality in 2 time periods (2000-2007 and 2008-2015). A total of 1363 admissions were included. We investigated the change in the burn score, as a surrogate for total costs per patient. Multivariable regression was used to analyze risk-adjusted mortality and burn score.The median total body surface area % (TBSA%) was 6.5% (10-90 centile 1.0-31.0), age 33 years (1.3-72.2), duration of stay/ TBSA% was 1.4 days (0.3-5.3), and 960 (70%) were males. Crude mortality declined from 7.5% in 2000-2007 to 3.4% in 2008-2015, whereas the cumulative burn score was not increased (P  =  .08). Regression analysis showed that risk-adjusted mortality decreased (odds ratio 0.42, P  =  .02), whereas the adjusted burn score did not change (P  =  .14, model R 0.86).Mortality decreased but there was no increase in the daily use of resources as measured by the interventional burn score. The data suggest that the improvements in quality obtained have been achieved within present routines for care of patients (multidisciplinary/orientated to patients' safety).

  18. Experiences from a communication training programme of paid carers in a residential rehabilitation centre for people with traumatic brain injury.

    Science.gov (United States)

    Behn, Nicholas; Togher, Leanne; Power, Emma

    2015-01-01

    To determine the impact of a communication training programme by exploring the experiences of paid carers who attended the programme in a residential rehabilitation centre for people with traumatic brain injury (TBI). Five paid carers attended a communication training programme which comprised 17 hours (across 8 weeks). Semi-structured interviews were conducted pre- and post-training. Analysis used a generic procedure with constant comparative analysis to identify categories across and within interview transcripts. Paid carers described improved knowledge and use of strategies, improved communication, positive emotional experiences and barriers and facilitators to consider for future communication training programmes. Training communication skills of paid carers in a residential rehabilitation centre had a positive impact on their conversations with people with TBI. These positive changes support quantitative findings for the effectiveness of communication training.

  19. How do people with learning disability experience the city centre? A Sheffield case study.

    Science.gov (United States)

    McClimens, Alex; Partridge, Nick; Sexton, Ed

    2014-07-01

    The use of city centre spaces by people with learning disability is not much debated in the literature. Here we include the thoughts and opinions of groups of people with learning disability as we undertook some guided walks through Sheffield city centre. We found that few of the participants had independent access to the city centre. Many cited concerns over personal safety and the most, on few occasions when they did visit, did so with family and/or paid staff for pre-planned purposes, usually linked to shopping. The need for appropriate support figured prominently. There is also a need to re-assess what we mean by social inclusion for this cohort. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Living Lab Research Landscape: From User Centred Design and User Experience towards User Cocreation

    OpenAIRE

    Pallot, Marc; Trousse, Brigitte; Senach, Bernard; Scapin, Dominique

    2010-01-01

    International audience; New paradigms, such as Open Innovation (Chesbrough, 2003) and Web 2.0 (O'Reilly, 2004) as well as Living Labs operating as a User Centred Open Innovation Ecosystem (Pallot, 2009), promote a more proactive role of users in the R&D process. However, a number of existing methods for involving users are abundantly described in the literature, such as Lead User (Von Hippel, 2005), User Driven Innovation (Von Hippel, 1986), User Centred Design (Von Hippel, 2005) and User Cre...

  1. Fundamentals of human resource management : emerging experiences from Africa

    NARCIS (Netherlands)

    Itika, J.

    2011-01-01

    The fundamentals of human resource management are extensively described in European and American literature. This book summarises the general human resource management philosophies, theories, strategies and techniques and links them to the specific African context. The usefulness of these general

  2. Early clinical experiences with nintedanib in three UK tertiary interstitial lung disease centres.

    Science.gov (United States)

    Toellner, Hannah; Hughes, G; Beswick, W; Crooks, M G; Donaldson, C; Forrest, I; Hart, S P; Leonard, C; Major, M; Simpson, A J; Chaudhuri, N

    2017-11-03

    Nintedanib has been shown to slow disease progression in patients with idiopathic pulmonary fibrosis (IPF). It was approved by the National Institute for Health and Care Excellence (NICE) in January 2016 for IPF patients with a forced vital capacity (FVC) of 50-80% in the United Kingdom (UK). To report real world data about our early clinical experience using nintedanib in 187 patients with a multi-disciplinary (MDT) diagnosis of IPF in a manufacturer funded patient in need scheme (three UK centres) prior to NICE approval. All patients with a MDT diagnosis of IPF from December 2014 to January 2016 commenced on nintedanib were included. Demographic details, adverse events (AEs) and where available lung function results were retrospectively collected from clinical letters. 187 patients (76% males) with a median age of 72 years (49-89) were treated with nintedanib. The average pre-treatment FVC was 81.1 ± 19.8% and diffusion capacity of the lungs for carbon monoxide was 43.9 ± 15% (n = 82). Fifty percent of patients started nintedanib because they were ineligible for pirfenidone due to an FVC > 80%. The median treatment course was 8 ± 4 months. The majority of patients experienced 1-3 AEs with nintedanib (52%, n = 97). The most frequent AEs were diarrhoea (50%), nausea (36%), reduced appetite (24%), tiredness (20%) and gastro-oesophageal reflux (18%). The majority of AEs resulted in no change in treatment (64%, n = 461). 21% (n = 150) of AEs resulted in a dose reduction and 13% (n = 94) necessitated discontinuation of treatment. 1 in 5 patients discontinued treatment either temporarily or on a permanent basis during the monitoring period. In a select cohort of patients, a statistically significant greater proportion of patients remained stable or improved and a lower proportion declined, as depicted by FVC changes of > 5% after nintedanib commencement (P Nintedanib is well tolerated and has an acceptable safety profile. Only 8% of those

  3. Laparoscopic surgery for complicated diverticular disease: a single-centre experience.

    LENUS (Irish Health Repository)

    Royds, J

    2012-10-01

    The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery.

  4. Grammar Correction in the Writing Centre: Expectations and Experiences of Monolingual and Multilingual Writers

    Science.gov (United States)

    Eckstein, Grant

    2016-01-01

    Although most writing centres maintain policies against providing grammar correction during writing tutorials, it is undeniable that students expect some level of grammar intervention there. Just how much students expect and receive is a matter of speculation. This article examines the grammar-correction issue by reporting on a survey of L1, L2,…

  5. Embracing Student Experience in Inclusive Design Education through Learner-Centred Instruction

    Science.gov (United States)

    Altay, Burçak; Ballice, Gülnur; Bengisu, Ebru; Alkan-Korkmaz, Sevinç; Paykoç, Eda

    2016-01-01

    This paper explores the process and outcome of using learner-centred methods to develop students' empathic design abilities during an educational workshop on inclusive design. In the first section of the paper, we suggest the significance of incorporating inclusive design within the education of design disciplines. Then, we introduce a workshop on…

  6. Can a Discrete Choice Experiment contribute to person-centred healthcare?

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Nielsen, Jesper Bo; Salkeld, Glenn

    2015-01-01

    system or service decisions, but the suggestion that they have clinical relevance is a serious deterrent to the development and provision of effective means of individual preference elicitation and specification at the point of decision. Those who wish to foster person-centred care should be alert...

  7. Observatory/data centre partnerships and the VO-centric archive: The JCMT Science Archive experience

    OpenAIRE

    Economou, Frossie; Gaudet, Severin; Jenness, Tim; Redman, Russell O.; Goliath, Sharon; Dowler, Patrick; Currie, Malcolm J.; Bell, Graham S.; Graves, Sarah F.; Ouellette, John; Johnstone, Doug; Schade, David; Chrysostomou, Antonio

    2014-01-01

    We present, as a case study, a description of the partnership between an observatory (JCMT) and a data centre (CADC) that led to the development of the JCMT Science Archive (JSA). The JSA is a successful example of a service designed to use Virtual Observatory (VO) technologies from the start. We describe the motivation, process and lessons learned from this approach.

  8. Steroid-free immunosuppression after renal transplantation-long-term experience from a single centre

    DEFF Research Database (Denmark)

    El-Faramawi, Mohamad; Rohr, Nils; Jespersen, Bente

    2006-01-01

    BACKGROUND: A steroid-free immunosuppressive protocol may improve the general well-being of patients, but long-term renal graft survival has been a concern. METHODS: In a retrospective clinical study, 329 consecutive transplantations with renal grafts at our centre during the period 1995-2004, we...

  9. Attracting foreign R&D through international centres of excellence: early experiences from Chile

    NARCIS (Netherlands)

    Klerkx, Laurens; Guimón, José

    2017-01-01

    International centres of excellence (ICE) in which foreign research organizations are attracted to developing and emerging countries via dedicated funding schemes to support technological catching-up and strengthening of innovation systems, can have benefits for both host countries and their

  10. International Experience of Resource Management in the North

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus Ole

    2005-01-01

    : - Distorted economies: - Property rights, resource access and traditional resource usage: - Human resource impact: - Social impact: - Institutional impact: - New settlement patterns Besides raising the general question of the need for research on the environmental and social impact of development in the North......The ongoing changes in the Arctic communities, and the impact of globalization on both resource exploitation and development practices, obviously raises the question of increased need for scientific and engineering efforts on several fronts. It is evident, however, that many of the contemporary......, and to respond to other stakeholders in a manner which reflects the seriousness of the current disturbance of the arctic environment. The prime factors in such an integrated assessment is suggested to include: - Arctic resources in the world resource consumption pattern: - Population impact: - Economic impacts...

  11. Natural resources endowment and economic growth: The West African Experience

    OpenAIRE

    Mohamed Jalloh

    2013-01-01

    This study aims at investigating the nexus between natural resource endowment and economic growth using a sample of West African countries. The study adopted a Barrow-type growth model to analyse the impact of natural resource wealth on economic growth. A dynamic panel estimation technique was employed using relevant data from West African Countries. The results from the panel regressions indicate that natural resource endowments have very minimal impact in terms of promoting economic growth ...

  12. User-centred health design: reflections on D4D's experiences and challenges.

    Science.gov (United States)

    Moody, Louise

    2014-01-01

    There is increasing recognition of the importance of user-centred design and testing in the healthcare technology domain. Challenges associated with user and stakeholder involvement in designing solutions for healthcare are recognized in the literature and need to be addressed to facilitate the development of new technology that is usable and acceptable to the end-user. The Devices for Dignity Health Technology Cooperative (D4D) has been involved in a range of technology development projects with an underpinning approach of addressing unmet needs through user involvement. This paper provides practical examples of some of the challenges that occur at different stages during a user-centred design process including ethical approval processes; stakeholder and user recruitment and involvement; eliciting needs from users regarding sensitive and personal issues; and interdisciplinary working. The paper will describe some of the strategies that have been employed by D4D to overcome these challenges and facilitate technology development.

  13. Linguistic Resource Creation for Research and Technology Development: A Recent Experiment

    National Research Council Canada - National Science Library

    Strassel, Stephanie; Maxwell, Mike; Cieri, Christopher

    2003-01-01

    .... Experiments in porting technologies to handle new natural languages have revealed a great potential for multilingual computing, but also a frustrating lack of linguistic resources for most languages...

  14. 17th May 2011 - Minister of Natural Resources of the Kingdom of Lesotho M. Moleleki signing the guest book with Head of International Relations F. Pauss and in the ATLAS visitor centre with Deputy Collaboration Spokesperson A. Lankford.

    CERN Multimedia

    Maximilien Brice

    2011-01-01

    17th May 2011 - Minister of Natural Resources of the Kingdom of Lesotho M. Moleleki signing the guest book with Head of International Relations F. Pauss and in the ATLAS visitor centre with Deputy Collaboration Spokesperson A. Lankford.

  15. Single-centre experience of 101 paediatric and adult Ross procedures: mid-term results

    OpenAIRE

    McBrien, Angela; Chaudhari, Milind; Crossland, David S.; Aspey, Helen; Heads-Baister, Alison; Griselli, Massimo; O'Sullivan, John; Hasan, Asif

    2012-01-01

    We aimed to determine outcomes for the Ross procedure in paediatric and adult patients, with particular emphasis on survival, complication and reintervention rates. A retrospective review of 101 patients who had the Ross procedure in a congenital cardiac surgical centre serving a population of approximately 2.5 million was performed. There were 69 adults and 32 children with a mean age of 24.8 ± 13.9 years. Indications for surgery were aortic stenosis (48), regurgitation (10), mixed disease (...

  16. Letting go of an old habit: group leaders' experiences of a client-centred multidisciplinary falls-prevention programme.

    Science.gov (United States)

    Johansson, Erika; Borell, Lena; Jonsson, Hans

    2014-03-01

    It has been suggested that the prevention of disability and falls should be conducted from a client-centred approach, especially when it includes how individuals learn new strategies in everyday life. In addition, programmes for the prevention of falls need to be multi-professional and multidisciplinary in order to be effective. In preventive work with clients, using the approach of client-centredness, the therapists work together with the clients to enable them to achieve occupational goals. There are few studies in fall prevention that have explored group leaders' experiences, i.e., studies that focus on the experiences of group leaders when working from a client-centred approach. This study aims to explore, by the use of focus-group interviews, the therapists' experiences of being group leaders in a fall-prevention programme that applied the ideas and approaches described above. The analysis revealed that a change in the role of being a group leader had taken place during the intervention process. Three primary categories pertaining to this process were identified: (i) the group leaders moved between the role of expert and the role of facilitator; the group climate (ii) facilitated the translation of expert knowledge to applied knowledge; and (iii) increased awareness as a prerequisite for change.

  17. An experience of virtual leadership development for human resource managers

    OpenAIRE

    Sherk, Karen E; Nauseda, Fiona; Johnson, Sarah; Liston, Delphine

    2009-01-01

    Abstract Problem Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR) managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management. Approach Management Sciences for Health (MSH) developed the Virtual Leadership Development Program (VLDP) with support from the United States Agency for International Development (U...

  18. Previous experiences and emotional baggage as barriers to lifestyle change - a qualitative study of Norwegian Healthy Life Centre participants.

    Science.gov (United States)

    Følling, Ingrid S; Solbjør, Marit; Helvik, Anne-S

    2015-06-23

    Changing lifestyle is challenging and difficult. The Norwegian Directorate of Health recommends that all municipalities establish Healthy Life Centres targeted to people with lifestyle issues. Little is known about the background, experiences and reflections of participants. More information is needed about participants to shape effective lifestyle interventions with lasting effect. This study explores how participants in a lifestyle intervention programme describe previous life experiences in relation to changing lifestyle. Semi-structured qualitative in-depth interviews were performed with 23 participants (16 women and 7 men) aged 18 - 70 years. The data were analysed using systematic text condensation searching for issues describing participants' responses, and looking for the essence, aiming to share the basis of life-world experiences as valid knowledge. Participants identified two main themes: being stuck in old habits, and being burdened with emotional baggage from their previous negative experiences. Participants expressed a wish to change their lifestyles, but were unable to act in accordance with the health knowledge they possessed. Previous experiences with lifestyle change kept them from initiating attempts without professional assistance. Participants also described being burdened by an emotional baggage with problems from childhood and/or with family, work and social life issues. Respondents said that they felt that emotional baggage was an important explanation for why they were stuck in old habits and that conversely, being stuck in old habits added load to their already emotional baggage and made it heavier. Behavioural change can be hard to perform as psychological distress from life baggage can influence the ability to change. The study participants' experience of being stuck in old habits and having substantial emotional baggage raises questions as to whether or not Healthy Life Centres are able to help participants who need to make a lifestyle

  19. Human Resources and Vaccine Management at Provincial Health Office, District/City Health Office and Primary Health Centre

    Directory of Open Access Journals (Sweden)

    Andi Leny Susyanty

    2015-03-01

    (GAIN UCI 2010–2014 stated that the general problems of decline in immunization coverage and quality of service were caused by several things, one of which is the lack of quantity, quality and distribution of human resources. Methods: A cross-sectional mix-method study to investigate human resources in vaccine management had been conducted in two provinces in 2012. Primary data were collected by interviewing stakeholders thoroughly, secondary data collection and observation were also carried out. Analysis was done by scoring for data concerning education, length of employment, training experience and knowledge. Result:The number of Vaccine management officers are still lacking. While the immunization guidelines required minimal two officers for each health centers. Officers’ knowledge in primary health centers is still inadequate, especially in terms of the vaccine and Coldchain (Ice Lined Refrigerators. Officers at Provincial Health Office had been trained in vaccine management, but not all officers at District Health Office and Primary Health Centers had received training yet. Suggestion: This study suggests the addition of the quantity and quality of human resources in vaccine management, because the officers can affect the quality of the vaccines, because vaccines need a special handling to maintain the quality to provide immunity and prevent the occurrence of diseases that can be prevented by immunization (PD3I.Key words: vaccine, human resources, training, knowledge

  20. Operative treatment of congenital pseudarthrosis of the clavicle: a single-centre experience.

    Science.gov (United States)

    Studer, Kathrin; Baker, Markus P; Krieg, Andreas H

    2017-05-01

    Congenital pseudarthrosis of the clavicle (CPC) is a very rare condition with a predilection for the right clavicle. Young children are often only symptomatic with activities and as they grow. Operative management in an asymptomatic child is debatable, with various techniques reported in the literature. This is a retrospective, single-centre case series study. All children with CPC treated surgically by resection, bone grafting (nonvascular iliac crest) and plate fixation between 2004 and 2012 at our centre were included. Excluded conditions were traumatic or obstetric fractures of the clavicle, children with musculoskeletal or neurological disorders and children lost to follow-up. Clinical and radiological examination was performed at 6 weeks, 3 months and between 6 and 12 months postoperatively. A total of eight clavicles in seven children (four girls and three boys), with a mean age of 7.1 years (5-8 years), were operated with a mean follow-up of 7 years (4-10 years). In six children, the right (dominant) side was affected, with one child affected bilaterally. Overall, 85% of our patients showed good functional results 6 weeks postoperatively and complete radiographic consolidation at a mean of 8.5 months (3-25 months) postoperatively. One female child showed delayed union, but without clinical deficit. There was low donor-site morbidity. We recommend early operative treatment of CPC with a nonvascularized bone graft from the iliac crest and plate fixation. IV.

  1. Experiences from a Community Based Substance Use Treatment Centre in an Urban Resettlement Colony in India

    Directory of Open Access Journals (Sweden)

    Yatan Pal Singh Balhara

    2014-01-01

    Full Text Available Background. There are limited community based treatment services for drug dependence in India. Rural areas and urban resettlement colonies are in particular deficient in such services. Aims. The current study aimed at preliminary assessment of substance use disorder management services at a community based substance use treatment clinic in an urban resettlement colony. Methods. The study was carried out at community based substance use treatment centre in a resettlement colony in India. The records of the centre were chart reviewed. Results. A total of 754 patients were registered at the clinic during the study period. Heroin was the primary drug of abuse for 63% of the patients. The mean duration of follow-up for the patients with opioid and alcohol dependence was 13.47 (SD±10.37; range 0–39 months. A total of 220 patients of opioid dependence were prescribed substation or abstinence directed therapy. Buprenorphine (87, slow release oral morphine (SROM (16, and dextropropoxyphene (98 were used for opioid substitution. Conclusion. It is possible to deliver substance use disorder treatment services in community setting. There is a need to develop area specific community based treatment services for substance abuse in socially disadvantaged populations such as urban resettlement colonies.

  2. Experiences and Lessons Learnt with Collaborative e-Research Infrastructure and the application of Identity Management and Access Control for the Centre for Environmental Data Analysis

    Science.gov (United States)

    Kershaw, P.

    2016-12-01

    CEDA, the Centre for Environmental Data Analysis, hosts a range of services on behalf of NERC (Natural Environment Research Council) for the UK environmental sciences community and its work with international partners. It is host to four data centres covering atmospheric science, earth observation, climate and space data domain areas. It holds this data on behalf of a number of different providers each with their own data policies which has thus required the development of a comprehensive system to manage access. With the advent of CMIP5, CEDA committed to be one of a number of centres to host the climate model outputs and make them available through the Earth System Grid Federation, a globally distributed software infrastructure developed for this purpose. From the outset, a means for restricting access to datasets was required, necessitating the development a federated system for authentication and authorisation so that access to data could be managed across multiple providers around the world. From 2012, CEDA has seen a further evolution with the development of JASMIN, a multi-petabyte data analysis facility. Hosted alongside the CEDA archive, it provides a range of services for users including a batch compute cluster, group workspaces and a community cloud. This has required significant changes and enhancements to the access control system. In common with many other examples in the research community, the experiences of the above underline the difficulties of developing collaborative e-Research infrastructures. Drawing from these there are some recurring themes: Clear requirements need to be established at the outset recognising that implementing strict access policies can incur additional development and administrative overhead. An appropriate balance is needed between ease of access desired by end users and metrics and monitoring required by resource providers. The major technical challenge is not with security technologies themselves but their effective

  3. Epidemiology and outcome of burns: early experience at the country's first national burns centre.

    Science.gov (United States)

    Iqbal, Tariq; Saaiq, Muhammad; Ali, Zahid

    2013-03-01

    This study aims to document the epidemiologic pattern and outcome of burn injuries in the country's first national burn centre. This case series study was conducted over a 2-year period at Burns Care Centre (BCC), Pakistan Institute of Medical Sciences (PIMS), Islamabad. The study included all burn injury patients who primarily presented to and were managed at the centre. Those patients who presented more than 24 h after injury or those who were initially managed at some other hospital were excluded from the study. Initial assessment and diagnosis was made by thorough history, physical examination and necessary investigations. Patients with major burns, high voltage electric burns and those needing any surgical interventions were admitted for indoor management. Patients with minor burns were discharged home after necessary emergency management, home medication and follow-up advice. The sociodemographic profile of the patients, site of sustaining burn injury, type and extent (total body surface area (TBSA), skin thickness involved and associated inhalational injury) of burn and outcome in terms of survival or mortality, etc., were all recorded on a proforma. The data were subjected to statistical analysis. Out of a total of 13,295 patients, there were 7503 (56.43%) males and 5792 (43.56%) females. The mean age for adults was 33.63±10.76 years and for children it was 6.71±3.47 years. The household environment constituted the commonest site of burns (68%). Among all age groups and both genders, scalds were the commonest burns (42.48%), followed by flame burns (39%) and electrical burns (9.96%). The affected mean TBSA was 10.64±11.45% overall, while for the hospitalised subset of patients the mean TBSA was 38.04±15.18%. Most of the burns were partial thickness (67%). Inhalation injury was found among 149 (1.12%) patients. Most of the burns were non-intentional and only 96 (0.72%) were intentional. A total of 1405 patients (10.58%) were admitted while the remainder

  4. Assessing Quality Outcome Measures in Children with Coeliac Disease—Experience from Two UK Centres

    Directory of Open Access Journals (Sweden)

    Alexander Ross

    2013-11-01

    Full Text Available Improved diagnosis of coeliac disease has increased incidence and therefore burden on the health care system. There are no quality outcome measures (QOM in use nationally to assess hospital management of this condition. This study applied QOM devised by the East of England paediatric gastroenterology network to 99 patients reviewed at two tertiary hospitals in the Network, to assess the quality of care provided by nurse led and doctor led care models. The average performance across all QOM was 96.2% at Addenbrooke’s Hospital (AH, and 98.7% at Norfolk and Norwich Hospital (NNUH, whilst 95% (n = 18 of QOM were met. Patient satisfaction was high at both sites (uptake of questionnaire 53 of 99 patients in the study. The study showed a comparably high level of care delivered by both a nurse and doctor led service. Our quality assessment tools could be applied in the future by other centres to measure standards of care.

  5. Less equal than others? Experiences of AYUSH medical officers in primary health centres in Andhra Pradesh.

    Science.gov (United States)

    Lakshmi, J K

    2012-01-01

    The National Rural Health Mission (NRHM) includes, inter alia, the establishment of an AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) component (practitioner, trained assistants, drugs and equipment) in every primary health centre (PHC). However, five years following the launch of the NRHM, the AYUSH mainstreaming scenario is below expectations, riddled with ethical and governance issues. Accounts from AYUSH practitioners at PHCs in various regions of the state of Andhra Pradesh reveal enormous lacunae in implementation: unfilled positions, inequitable emoluments, inadequate or absent infrastructure, assistance and supplies, unethical interpersonal arrangements, and limited support from non-AYUSH personnel. The widespread negative impact of these conditions undermines the value of AYUSH, demotivating both practitioners and patients, and failing to provide the intended support to the public health system.

  6. A person-centred intervention for providing information to parents of children with cancer. Experiences and effects.

    Science.gov (United States)

    Ringnér, Anders; Karlsson, Stig; Hällgren Graneheim, Ulla

    2015-06-01

    The aim of this paper is to describe the experiences of participating in a person-centred information intervention aimed at parents of children with cancer. Eight parents participated in the intervention, beginning two months after their child's diagnosis. The intervention was based upon the representational approach to patient education and a mixed method approach was employed in the study. The experiences of parents and intervention nurses were captured via qualitative interviews and the effects of the intervention on parental psychosocial measures, primarily perceived stress, were evaluated using a single-case design with web-based questionnaires. Parents expressed high satisfaction with the intervention, as reported in the follow-up interviews and on the scale measuring satisfaction. However, no changes were seen in the quantitative measures of psychosocial distress. The nurses performing the intervention felt it was useful and feasible. A representational approach to providing person-centred information to parents of children with cancer was appreciated and considered feasible by both the parents and the intervention nurses. However, further research is needed considering the lack of effect on the parents' perceived stress. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Improving mortality outcomes of Stevens Johnson syndrome/toxic epidermal necrolysis: A regional burns centre experience.

    Science.gov (United States)

    Nizamoglu, M; Ward, J A; Frew, Q; Gerrish, H; Martin, N; Shaw, A; Barnes, D; Shelly, O; Philp, B; El-Muttardi, N; Dziewulski, P

    2017-10-10

    Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. A retrospective case review was performed for all patients with a clinical diagnosis of TEN or SJS/TEN overlap admitted to our paediatric and adult burns centre between June 2004 and December 2016. Patient demographics, percentage total body surface area (%TBSA), mucosal involvement, causation, severity of illness score (SCORTEN), length of stay and survival were appraised with appropriate statistical analysis performed using Graph Pad Prism 7.02 Software. During the study period, 42 patients (M26; F: 16) with TEN (n=32) and SJS/TEN overlap (n=10) were managed within our burns service. Mean %TBSA of cutaneous involvement was 57% (range 10-100%) and mean length of stay (LOS) was 27 days (range 1-144 days). We observed 4 deaths in our series compared to 16 predicted by SCORTEN giving a standardised mortality ratio (SMR) of 24%. Management in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  8. HIV/AIDS in ophthalmic patients: The Guinness Eye Centre Onitsha experience.

    Science.gov (United States)

    Nwosu, N N

    2008-03-01

    To determine the incidence and pattern of ocular problems of HIV/AIDS at the Guinness Eye Centre Onitsha, Nigeria. The case files of all patients who had HIV test at the Guinness Eye Centre Onitsha over a 6-year period were examined. Those who tested positive for HIV were further analysed. Information obtained included patients' demographic characteristics, clinical diagnosis, ocular and systemic co-morbidity, visual acuity and follow-up. Of 1011 patients, 100 (9.9%), 51 males and 49 females, were confirmed HIV-positive. The age range was 21 - 80 years; median -31 years. Fifty-five patients (55%) were or had been married; 45 (45%) were single. Herpetic eye disease constituted 50% of the cases with herpes zoster ophthalmicus accounting for 48%. Bilateral ocular disease occurred in 19 patients (19%) viz: cytomegalovirus (CMV) retinitis (6%); corneal ulcers (6%); uveitis (4%); ocular motor palsy (2%) and ocular gunshot injury (1%). Non-HIV ocular lesions occurred in 20 patients (20%) as follows: bacterial corneal ulcer (8%); globe laceration (6%); non-CMV associated rhegmatogenous retinal detachment, cataract, and secondary orbital tumour (2% each). Systemic co-morbidities were present in 10 patients (10%), namely, emaciation (6%), pulmonary tuberculosis and abdominal malignancy with orbital metastases (2% each). Twenty three patients (23%) had bilateral blindness; 45 (45%) had uniocular blindness; 73.4% of the affected eyes were blind at presentation with 25% having no light perception (NPL). The incidence of HIV seropositivity doubled in the hospital over nearly 10-year period. Herpes zoster ophthalmicus remains the commonest ocular manifestation although CMV retinitis is becoming common. Since 20% of the patients had non-HIV ocular lesions, eye-health workers are advised to always take universal precautions in order to prevent the spread of the infection within and outside the hospital.

  9. Swine flu outbreak 2015-Paediatric Experience in a Tertiary Care Centre.

    Directory of Open Access Journals (Sweden)

    Dr. Anuya Chauhan

    2016-12-01

    Full Text Available Background & Aim: To study and analyse the clinical profile and outcome of children admitted with Influenza A positive cases at our Tertiary Care Centre in 2015. Materials & Methods: Prospective study conducted in a tertiary care centre (Civil Hospital B. J. Medical College, Ahmedabad from Jan 2015 to March 2015. 340 Children presenting with clinical features compatible with category C were admitted and 199 patients having laboratory confirmed influenza A (H1N1 were included in our study. Details regarding clinical features, examination findings, investigations, complications and treatment were recorded and analysed in a systemic manner. Results: Study showed that highest incidence of influenza A was seen in 1-3 years age group (41.7% Male-female ratio was 1.18:1 indicating similar affection of both sexes. Maximum patients presented within first 3 days of illness (53.2% with fever (82.9% followed by dry cough (74.6% and sore throat (52.7% as presenting symptoms. Leucopenia (79.4% was the most common laboratory finding and lobar pneumonia (81.1% was the most common radiological finding followed by bronchopneumonia (18.9%. Conjunctivitis (20.1% and otitis media (6.03% were the common complications. Mortality rate in our set up was 6.5% (13 out of 199; with maximum from 1-3 year age group (46.1%, most common cause being ARDS (46.1%. Conclusion: The outbreak of influenza A (H1N1 2015 predominantly affected young population with significant morbidity and mortality. With the efforts of healthcare authorities worldwide, we have still not lost the race against fighting this virus.

  10. Gait analysis in children with haemophilia: first Italian experience at the Turin Haemophilia Centre.

    Science.gov (United States)

    Forneris, E; Andreacchio, A; Pollio, B; Mannucci, C; Franchini, M; Mengoli, C; Pagliarino, M; Messina, M

    2016-05-01

    To investigate the functional status in haemophilia patients referred to an Italian paediatric haemophilia centre using gait analysis, verifying any differences between mild, moderate or severe haemophilia at a functional level. Forty-two patients (age 4-18) presenting to the Turin Paediatric Haemophilia Centre who could walk independently were included. Therapy included prophylaxis (n = 21), on-demand (n = 17) or immune tolerance induction + inhibitor (n = 4). Patients performed a test of gait analysis. Temporal, spatial and kinematic parameters were calculated for patient subgroups by disease severity and background treatment, and compared with normal values. Moderate (35.7%) or severe (64.3%) haemophilia patients showed obvious variations from normal across a variety of temporal and spatial gait analysis parameters, including step speed and length, double support, swing phase, load asymmetry, stance phase, swing phase and speed. Kinematic parameters were characterized by frequent foot external rotation with deficient plantar flexion during the stance phase, retropelvic tilt, impaired power generation distally and reduced ground reaction forces. Both Gait Deviation Index and Gait Profile Score values for severe haemophilia patients indicated abnormal gait parameters, which were worst in patients with a history of past or current use of inhibitors and those receiving on-demand therapy. Functional evaluation identified changes in gait pattern in patients with severe and moderate haemophilia, compared with normal values. Gait analysis may be a useful tool to facilitate early diagnosis of joint damage, prevent haemophilic arthropathy, design a personalized rehabilitative treatment and monitor functional status over time. © 2016 John Wiley & Sons Ltd.

  11. Client Centred Desing

    DEFF Research Database (Denmark)

    Ørngreen, Rikke; Nielsen, Janni; Levinsen, Karin

    2008-01-01

    In this paper we argue for the use of Client Centred preparation phases when designing complex systems. Through Client Centred Design human computer interaction can extend the focus on end-users to alse encompass the client's needs, context and resources.......In this paper we argue for the use of Client Centred preparation phases when designing complex systems. Through Client Centred Design human computer interaction can extend the focus on end-users to alse encompass the client's needs, context and resources....

  12. Community Health Centre-Based Outreach Clinic for undergraduate dental education: Experience in Helsinki over 8 years.

    Science.gov (United States)

    Goswami, S; Karaharju-Suvanto, T; Kaila, M; Tseveenjav, B

    2017-09-30

    The University Dental Clinic of the City of Helsinki (UDC) developed a Community Health Centre-Based Outreach Clinic, with emphasis on paediatric dentistry. This study aimed to summarise the experiences and explore the student perspectives of the health centre-based outreach teaching clinic. The study data were from the years 2010 to 2016. The dental procedures carried out by the third- to fifth-year dental students were based on electronic health record of patients. The students' self-perceived benefits and free-text comments on the outreach training were collected as part of a yearly questionnaire survey. A vast majority of the paediatric dental procedures that are required for competencies of dental students were performed in the outreach clinic. The most common procedures were fillings with local anaesthesia followed by preventive procedures. The majority of the students were very motivated to participate in the outreach training and reported that it was a useful educational approach to broaden their understanding of oral diseases and clinical experience. The outreach clinic gives dental students a chance to gain valuable clinical experience through the number and diversity of the dental procedures they carry out. They gain confidence and get an opportunity to get acquainted with the primary healthcare system and social determinants of oral diseases. Outreach appears to provide complementary clinical experiences that fulfil learning outcomes. Learning objectives should be taken into account when planning the outreach programme in order to offer meaningful and motivating education. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Intestinal obstruction in children due to Ascariasis: A tertiary health centre experience

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    Mishra P

    2008-01-01

    Full Text Available Background: Ascariasis is the infestation by the largest intestinal nematode of man, a common problem in the tropics attributed to poor hygienic and low socioeconomic conditions. The aim of this research is to analyse the presentation, diagnosis and management of bowel obstruction caused by Ascaris lumbricoides, with special emphasis on the role of conservative management. Materials and Methods: This is a single centre, two consultant based 5 year retrospective study of childhood intestinal obstruction due to worms. Diagnosis in the suspected patients was based on history of passage of worms per mouth or rectum and on x-ray and ultrasonography findings. Only the patients of intestinal obstruction with documented evidence of roundworm infestation were included in the study and were followed for one year. Results: One hundred and three children with intestinal obstruction due to Ascaris lumbricoides were treated in the past five years at our centre. Abdominal pain was the most common presentation seen in 96 children followed by vomiting in 77 children. 20 children had history of vomiting worms and another 43 had history of passing worms in stool. Abdominal tenderness was present in 50 children, 48 had abdominal distension of varying degree, 50 had abdominal mass due to worm bolus, and 16 had or developed abdominal guarding or rigidity. All the children were managed as for acute intestinal obstruction along with hypertonic saline enema. The aim of management was "to starve the worm and hydrate the patient". 87 patients (84.47% responded favourably and were relieved of the obstruction by the conservative management, 16 children (15.53% had abdominal guarding or rigidity and underwent emergency exploration. Conclusion: Roundworm obstruction should be considered in the differential diagnoses of all cases of intestinal obstruction in children. Clinical history and examination along with X-ray and ultrasonography are very helpful for diagnosis of this

  14. Health status of internationally adopted children. The experience of an Italian “GLNBI” paediatric centre

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    Piero Valentini

    2012-09-01

    Full Text Available

    Background: according to ISTAT (National Institute of Statistics-Italy, in 2011 20.7% of the foreign population in Italy is composed by children, either coming along with their families or alone, like in international adoptions. Immigrant children have some peculiarities related to their previous living conditions, although there are no significant differences between immigrant and native children’ diseases.

    Methods: in 3.5 years we evaluated every adoptee that reached our university centre, by using GLNBI (Gruppo di Lavoro Nazionale del Bambino Immigrato diagnostic – aiding protocol, in order to assess infectious diseases, nutritional deficiencies, immunization status, intestinal parasitosis or other pathologies; this protocol is actually applied only in research centres.

    Results: we evaluated 358 international adoptees from 4 different Zones of the world; average age at first visit was approximately 5 years. Health certifications concerning vaccination history records were considered “valid” in 59.2% (212/358, 49.5% (105/212 of which had a complete panel of immunization. QuantiFERON®_TB Gold In-Tube (QTF test resulted negative in 94.0% cases (313/333 and positive in 6.0% (20/333. HIV, HCV and Syphilis tests resulted in 0.3% positive test for each serology (1/358. Cysticercosis’ serology was positive in 8.9% (32/358 using immunoenzymatic assay (not confirmed by immunoblotting and Toxocariasis in 13.1% (47/358. Parasitological investigation of faeces were found positive on 42.7% (153/358 children, throat swabs in 11.5% (41/358 children. There were 82.4% (295/358 abnormal blood count, 41.9% (150/358 low ferritin, 89.9% (322/358 endocrine abnormalities and 20.4% (73/358 various pathologies evaluated by specialists.

    Conclusions: pathologies affecting our study group are the same affecting other categories of immigrant children, because they often

  15. Commercial renal transplantation: A risky venture? A single Canadian centre experience.

    Science.gov (United States)

    Kapoor, Anil; Kwan, Kevin G; Whelan, J Paul

    2011-10-01

    Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed. Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre. Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery. Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any documentation; therefore, timely, goal

  16. Community resource centres to improve the health of women and children in informal settlements in Mumbai: a cluster-randomised, controlled trial.

    Science.gov (United States)

    More, Neena Shah; Das, Sushmita; Bapat, Ujwala; Alcock, Glyn; Manjrekar, Shreya; Kamble, Vikas; Sawant, Rijuta; Shende, Sushma; Daruwalla, Nayreen; Pantvaidya, Shanti; Osrin, David

    2017-03-01

    Around 105 million people in India will be living in informal settlements by 2017. We investigated the effects of local resource centres delivering integrated activities to improve women's and children's health in urban informal settlements. In a cluster-randomised controlled trial in 40 clusters, each containing around 600 households, 20 were randomly allocated to have a resource centre (intervention group) and 20 no centre (control group). Community organisers in the intervention centres addressed maternal and neonatal health, child health and nutrition, reproductive health, and prevention of violence against women and children through home visits, group meetings, day care, community events, service provision, and liaison. The primary endpoints were met need for family planning in women aged 15-49 years, proportion of children aged 12-23 months fully immunised, and proportion of children younger than 5 years with anthropometric wasting. Census interviews with women aged 15-49 years were done before and 2 years after the intervention was implemented. The primary intention-to-treat analysis compared cluster allocation groups after the intervention. We also analysed the per-protocol population (all women with data from both censuses) and assessed cluster-level changes. This study is registered with ISRCTN, number ISRCTN56183183, and Clinical Trials Registry of India, number CTRI/2012/09/003004. 12 614 households were allocated to the intervention and 12 239 to control. Postintervention data were available for 8271 women and 5371 children younger than 5 years in the intervention group, and 7965 women and 5180 children in the control group. Met need for family planning was greater in the intervention clusters than in the control clusters (odds ratio [OR] 1·31, 95% CI 1·11-1·53). The proportions of fully immunised children were similar in the intervention and control groups in the intention-to-treat analysis (OR 1·30, 95% CI 0·84-2·01), but were greater in

  17. Natural Resource Curse: Special Experience Of The Persian Gulf States

    OpenAIRE

    Eghbalnia, Yeganeh

    2006-01-01

    This paper attempts to study precisely the natural resource (oil& gas reserves) effect on economic development profile in Persian Gulf region. Health, education and political economic variables in these countries have been tested empirically as to what extent has been influenced by oil wealth. First, we will test if economic growth and development is positively changing with more level of oil and gas reserves in cross-country dataset. Second, we try to chase the oil revenue foo...

  18. An experience of virtual leadership development for human resource managers

    Directory of Open Access Journals (Sweden)

    Johnson Sarah

    2009-01-01

    Full Text Available Abstract Problem Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management. Approach Management Sciences for Health (MSH developed the Virtual Leadership Development Program (VLDP with support from the United States Agency for International Development (USAID. The VLDP is a Web-based leadership development programme that combines face-to-face and distance-learning methodologies to strengthen the capacity of teams to identify and address health challenges and produce results. Relevant changes The USAID-funded Leadership, Management and Sustainability (LMS Program, implemented by MSH, and the USAID-funded Capacity Project, implemented by IntraHealth, adapted the VLDP for HR managers to help them identify and address HR challenges that ministries of health, other public-sector organizations and nongovernmental organizations are facing. Local settings Three examples illustrate the results of the VLDP for teams of HR managers: 1. the Uganda Protestant and Catholic Medical Bureaus 2. the Christian Health Association of Malawi 3. the Developing Human Resources for Health Project in Uganda. Lessons learnt The VLDP is an effective programme for developing the management and leadership capacity of HR managers in health.

  19. Antimicrobial susceptibility testing of rapidly growing mycobacteria by microdilution - Experience of a tertiary care centre

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    Set R

    2010-01-01

    Full Text Available Purpose: The objective of the study was to perform antimicrobial susceptibility testing of rapidly growing mycobacteria (RGM isolated from various clinically suspected cases of extrapulmonary tuberculosis, from January 2007 to April 2008, at a tertiary care centre in Mumbai. Materials and Methods: The specimens were processed for microscopy and culture using the standard procedures. Minimum inhibitory concentrations (MIC were determined by broth microdilution, using Sensititre CA MHBT. Susceptibility testing was also carried out on Mueller Hinton agar by the Kirby Bauer disc diffusion method. Results: Of the 1062 specimens received for mycobacterial cultures, 104 (9.79% grew mycobacteria. Of the mycobacterial isolates, six (5.76% were rapid growers. M. abscessus and M. chelonae appeared to be resistant organisms, with M. chelonae showing intermediate resistance to amikacin and minocycline. However, all the six isolates showed sensitivity to vancomycin and gentamicin by the disc diffusion test. Also all three isolates of M. abscessus were sensitive to piperacillin and erythromycin. Further studies are required to test their sensitivity to these four antimicrobials by using the microbroth dilution test, before they can be prescribed to patients. Conclusions: We wish to emphasize that reporting of rapidly growing mycobacteria from clinical settings, along with their sensitivity patterns, is an absolute need of the hour.

  20. Single-centre experience of 101 paediatric and adult Ross procedures: mid-term results.

    Science.gov (United States)

    McBrien, Angela; Chaudhari, Milind; Crossland, David S; Aspey, Helen; Heads-Baister, Alison; Griselli, Massimo; O'Sullivan, John; Hasan, Asif

    2012-05-01

    We aimed to determine outcomes for the Ross procedure in paediatric and adult patients, with particular emphasis on survival, complication and reintervention rates. A retrospective review of 101 patients who had the Ross procedure in a congenital cardiac surgical centre serving a population of approximately 2.5 million was performed. There were 69 adults and 32 children with a mean age of 24.8 ± 13.9 years. Indications for surgery were aortic stenosis (48), regurgitation (10), mixed disease (35) and complex left outflow tract obstruction (8). The mean follow-up duration was 4.7 ± 3.7 years. The mini-inclusion technique was used to incorporate the autograft, and in all cases, pulmonary homografts were placed in the right ventricular outflow tract. Sub-aortic resection was also performed in six and Ross-Konno operations in eight patients. There were no early deaths and there was one late death secondary to endocarditis. Freedom from reintervention was 92% at 5 years and 77% at 10 years. Children were significantly more likely to require reintervention (16%, 5 of 32 versus 4%, 3 of 69, P = 0.05). The Ross procedure carries low early and mid-term mortality, and reintervention rates appear acceptable. The Ross procedure should be considered a feasible alternative to prosthetic valves in patients who require aortic valve replacement.

  1. Renal diseases in adults with cystic fibrosis: a 40 year single centre experience.

    Science.gov (United States)

    Wilcock, M J; Ruddick, A; Gyi, K M; Hodson, M E

    2015-10-01

    There is a sizable literature describing renal disease in patients with cystic fibrosis. Previous studies have focused on single disease processes alone, most commonly renal stone disease or acute kidney injury. In this study we report for the first time on the prevalence of all forms of renal disease in a cystic fibrosis population. A retrospective review of adult patients with cystic fibrosis attending the Adult Cystic Fibrosis Department at the Royal Brompton Hospital was carried out by searching the department's database to identify patients with renal problems and subsequently retrieving clinical information from medical notes. The prevalence of all renal diseases in our population was 5.1 %. The most commonly identified problem was renal stones. At 2.0 % the prevalence of renal stones in adult patients with cystic fibrosis was comparable to the general population. A range of other renal diseases were identified, the next most common being drug-induced acute kidney injury. A range of cystic fibrosis independent and attributable diseases has been identified but no cystic fibrosis specific disease. In contrast to other cystic fibrosis centres no increased prevalence of renal stones was found.

  2. Cleft lip and palate repair: the experience from two West African sub-regional centres.

    Science.gov (United States)

    Onah, I I; Opara, K O; Olaitan, P B; Ogbonnaya, I S

    2008-08-01

    Compliance with primary surgical treatment in people with cleft lip and palate is a well-known problem, especially in developing countries fraught with poverty and ignorance. Different protocols of treatment exist. In this paper, we retrospectively review a cohort from two centres, with a discussion on the outcome and its implications. The records of all patients with cleft lip and palate seen in the National Orthopaedic Hospital, Enugu, Nigeria, from January 1993 to December 1999, were sought, and all available case notes reviewed retrospectively. This included new cases seen in the period, and also cases operated during this period. Follow up took place until January 2005, when the data were collated. The records of all such patients seen at Ladoke Akintola University Teaching Hospital Osogbo, Nigeria, from September 2004 to June 2006 were also collated and analysed. During this period, 102 patients were seen (93 at Enugu and nine at Osogbo). Fifteen had isolated cleft palate, 42 had isolated cleft lip and 45 had combined cleft lip and palate. Presentation time ranged from 1 day to 43 years. The palate was not repaired in 20 people after lip repair; two patients with cleft lip and palate completely defaulted; and only one person with isolated cleft palate failed to undergo surgery in this period. Two patients in Osogbo absconded. The West African sub-region has a high drop out rate after lip repair.

  3. Outcome following Resection of Biliary Cystadenoma: A Single Centre Experience and Literature Review

    Directory of Open Access Journals (Sweden)

    M. Pitchaimuthu

    2015-01-01

    Full Text Available Background. Biliary cystadenomas (BCAs are rare, benign, potentially malignant cystic lesions of the liver, accounting for less than 5% of cystic liver tumours. We report the outcome following resection of biliary cystadenoma from a single tertiary centre. Methods. Data of patients who had resection of BCA between January 1993 and July 2014 were obtained from liver surgical database. Patient demographics, clinicopathological characteristics, operative data, and postoperative outcome were analysed. Results. 29 patients had surgery for BCA. Male : female ratio was 1 : 28. Clinical presentation was abdominal pain (74%, jaundice (20%, abdominal mass (14%, and deranged liver function tests (3%. Cyst characteristics included septations (48%, wall thickening (31%, wall irregularity (38%, papillary projections (10%, and mural nodule (3%. Surgical procedures included atypical liver resection (52%, left hemihepatectomy (34%, right hemihepatectomy (10%, and left lateral segmentectomy (3%. Median length of stay was 7 (IQ 6.5–8.5 days. Two patients developed postoperative bile leak. No patients had malignancy on final histology. Median follow-up was 13 (IQ 6.5–15.7 years. One patient developed delayed biliary stricture and one died of cholangiocarcinoma 11 years later. Conclusion. Biliary cystadenomas can be resected safely with significantly low morbidity. Malignant transformation and recurrence are rare. Complete surgical resection provides a cure.

  4. Outcome following Resection of Biliary Cystadenoma: A Single Centre Experience and Literature Review

    Science.gov (United States)

    Pitchaimuthu, M.; Aidoo-Micah, G.; Coldham, C.; Sutcliffe, R.; Roberts, J. K.; Muiesan, P.; Isaac, J.; Mirza, D.; Marudanayagam, R.

    2015-01-01

    Background. Biliary cystadenomas (BCAs) are rare, benign, potentially malignant cystic lesions of the liver, accounting for less than 5% of cystic liver tumours. We report the outcome following resection of biliary cystadenoma from a single tertiary centre. Methods. Data of patients who had resection of BCA between January 1993 and July 2014 were obtained from liver surgical database. Patient demographics, clinicopathological characteristics, operative data, and postoperative outcome were analysed. Results. 29 patients had surgery for BCA. Male : female ratio was 1 : 28. Clinical presentation was abdominal pain (74%), jaundice (20%), abdominal mass (14%), and deranged liver function tests (3%). Cyst characteristics included septations (48%), wall thickening (31%), wall irregularity (38%), papillary projections (10%), and mural nodule (3%). Surgical procedures included atypical liver resection (52%), left hemihepatectomy (34%), right hemihepatectomy (10%), and left lateral segmentectomy (3%). Median length of stay was 7 (IQ 6.5–8.5) days. Two patients developed postoperative bile leak. No patients had malignancy on final histology. Median follow-up was 13 (IQ 6.5–15.7) years. One patient developed delayed biliary stricture and one died of cholangiocarcinoma 11 years later. Conclusion. Biliary cystadenomas can be resected safely with significantly low morbidity. Malignant transformation and recurrence are rare. Complete surgical resection provides a cure. PMID:26839708

  5. Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres.

    Science.gov (United States)

    Subasi, M; Isik, M; Bulut, M; Cebesoy, O; Uludag, A; Karakurt, L

    2015-07-01

    Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Robert's criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Robotic assisted laparoscopic adrenalectomy: Initial experience from a tertiary care centre in India

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    Mrinal Pahwa

    2015-01-01

    Full Text Available Introduction: Laparoscopic adrenalectomy (LA is now considered the standard for treatment of surgically correctable adrenal disorders. Robotic adrenalectomy has been performed worldwide and has established itself as safe, feasible and effective approach. We hereby present the first study in robotic transperitoneal LA from Indian subcontinent. Materials and Methods: We conducted a retrospective evaluation of 25 patients who had undergone robotic assisted LA at a tertiary health centre by a single surgeon. Demographic, clinical, histopathological and perioperative outcome data were collected and analysed. Results: Mean age of the patients was 45 years (range: 27-65 years. Eleven male and 14 female patients were operated. Mean operative time was 139 min ± 30 min (range: 110-232 min and mean blood loss was 85 ml ± 12 ml (range: 34-313 ml. Mean hospital stay was 2.5 ± 1.05 days (range: 2-6 days. Mean visual analogue scale score was 3.2 (range: 1-6 mean analgesic requirement was 50 mg diclofenac daily (range: 0-150 mg. Histopathological evaluation revealed 11 adenomas, eight phaeochromocytomas, two adrenocortical carcinomas, and four myelolipomas. According to Clavien-Dindo classification, three patients developed Grade I post-operative complications namely hypotension and pleural effusion. Conclusion: Robotic adrenalectomy is safe, technically feasible and comfortable to the surgeon. It is easier to perform with a short learning curve.

  7. Early Experience in Da Vinci Robot-Assisted Partial Nephrectomy: An Australian Single Centre Series

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    Francis Ting

    2015-01-01

    Full Text Available Introduction and Objectives. To demonstrate the safety and efficacy of the robot-assisted partial nephrectomy (RAPN technique in an Australian setting. Methods. Between November 2010 and July 2014, a total of 76 patients underwent 77 RAPN procedures using the Da Vinci Surgical System© at our institution. 58 of these procedures were performed primarily by the senior author (PB and are described in this case series. Results. Median operative time was 4 hours (range 1.5–6 and median warm ischaemic time (WIT was 8 minutes (range 0–30 including 11 cases with zero ischaemic time. All surgical margins were clear with the exception of one patient who had egress of intravascular microscopic tumour outside the capsule to the point of the resection margin. Complications were identified in 9 patients (15.8%. Major complications included conversion to open surgery due to significant venous bleeding (n=1, reperfusion injury (n=1, gluteal compartment syndrome (n=1, DVT/PE (n=1, and readmission for haematuria (n=1. Conclusion. This series demonstrates the safety and efficacy of the RAPN technique in an Australian setting when performed by experienced laparoscopic surgeons in a dedicated high volume robotic centre.

  8. Early Experience in Da Vinci Robot-Assisted Partial Nephrectomy: An Australian Single Centre Series.

    Science.gov (United States)

    Ting, Francis; Savdie, Richard; Chopra, Sam; Yuen, Carlo; Brenner, Phillip

    2015-01-01

    Introduction and Objectives. To demonstrate the safety and efficacy of the robot-assisted partial nephrectomy (RAPN) technique in an Australian setting. Methods. Between November 2010 and July 2014, a total of 76 patients underwent 77 RAPN procedures using the Da Vinci Surgical System© at our institution. 58 of these procedures were performed primarily by the senior author (PB) and are described in this case series. Results. Median operative time was 4 hours (range 1.5-6) and median warm ischaemic time (WIT) was 8 minutes (range 0-30) including 11 cases with zero ischaemic time. All surgical margins were clear with the exception of one patient who had egress of intravascular microscopic tumour outside the capsule to the point of the resection margin. Complications were identified in 9 patients (15.8%). Major complications included conversion to open surgery due to significant venous bleeding (n = 1), reperfusion injury (n = 1), gluteal compartment syndrome (n = 1), DVT/PE (n = 1), and readmission for haematuria (n = 1). Conclusion. This series demonstrates the safety and efficacy of the RAPN technique in an Australian setting when performed by experienced laparoscopic surgeons in a dedicated high volume robotic centre.

  9. Role of clinical skill centre in undergraduate medical education: Initial experience at Rehman Medical College Peshawar.

    Science.gov (United States)

    Shafiq, Zainab; Mufti, Tariq Saeed; Qayum, Iftikhar

    2017-01-01

    To assess the performance of students on clinical skill factors and to measure the satisfaction level of students related to the training. The descriptive study was conducted at Rehman Medical College, Peshawar, Pakistan, from August 1 to September 15, 2013, and comprised all third-year medical students who had undergone clinical skill training. Their performance was evaluated through end-of-module objective structured clinical examination. Students' feedback measuring satisfaction on a five-point Likert scale was obtained on a designed validated tool. Monitoring of the clinical skills centre training programme was done by the quality enhancement cell at the college. SPSS 16 was used for statistical analysis. Of the 98 students who took the examinations, 94(96%) cleared generic stations and 70(72%) to 96(98%) discipline-based stations. Overall, 94(96%) cleared the first objective structured clinical examination, ranging from 83(84.6%) for Persian language conversation training to 98(100%) for general physical examination. In the second examination, 90(92%) students passed; ranging from 72(73%) for Gynaecology to 97(98.7%) each for Surgery and Ear, Nose and Throat. There was no significant difference between mean results of the two exams (p>0.05). Clinical skills training achieved the desired objectives and outcomes. However, continuing studies need to be done to establish reliability of the programme.

  10. Causes of prolonged jaundice in infancy: 3-year experience in a tertiary paediatric centre.

    Science.gov (United States)

    Andre, Margaret; Day, Andrew S

    2016-01-29

    Although prolonged jaundice (PJ) commonly occurs in infancy, there is not yet agreement as to the appropriate extent of investigations, particularly in otherwise well children. Significant pathologies may present with PJ in this age group and need to be considered. The aim of this retrospective study was to ascertain the causes of PJ in infants referred to a single tertiary paediatric centre. Infants referred with PJ over a 3-year period were identified. Clinical documentation, electronic notes and results of investigations performed prior to and after referral were reviewed. One hundred and sixty-seven infants with PJ were seen. Fifty-eight percent were over 28 days of age. Four patients had conjugated hyperbilirubinaemia. Eighteen percent of patients were found to have a specific medical diagnosis causing or contributing to PJ, almost half of whom had normal clinical examination. The single most common pathological cause for PJ was hypothyroidism found in six patients. This study demonstrates that normal clinical examination and exclusion of conjugated hyperbilirubinaemia are insufficient to exclude pathological causes of PJ. Overall, these children were referred late. Guidelines, in conjunction with education initiatives, are required to optimise the management of prolonged jaundice in infancy.

  11. Management of Epistaxis – A Single Centre Experience and Economic Considerations

    LENUS (Irish Health Repository)

    Keane, E

    2016-06-01

    Epistaxis represents the most common ENT emergency and its management has been a focus of audit recently, with consideration given to the associated economic burden. The aim of our study is to evaluate the management of epistaxis in terms of treatments used, duration of stay, recurrence and cost. A retrospective review of hospital inpatient enquiry (HIPE) data from a single secondary referral centre was undertaken during a four year period. Four hundrefd and thirty-four patients were identified. The majority (n= 262, 60.3%) were male and the average age was 64.2 years. The vast majority (n=362, 83.4%) were managed non-operatively. Only 15 patients (3.4%) were managed surgically. The average length of stay was 2.5 days and did not vary greatly between the treatment groups. The recurrence rate was 8.2% (n=36). Approximate costs of packing vs EUA and cautery suggest that packing alone is more economical but more data is needed to fully compare the options.

  12. Psycho-social Features of Chronic Dialysis Patients in Saudi Arabia: Experience of one Centre

    Directory of Open Access Journals (Sweden)

    AL-Homrany Mohammed

    2001-01-01

    Full Text Available The goals of chronic dialysis treatment for end-stage renal disease (ESRD patients include restoration of the highest achievable state of personal physical health and preservation as well as restoration and development of the highest level of psychological and social functions. We conducted this study to evaluate factors influencing the process of adaptation such as religious faith, economic status and extended family-tribal system. It was hoped that studying these factors might provide further dimension to our understanding of the psychopathology of ESRD patients, and to help offer new ideas to improve the quality of their lives. A sample comprising 54 patients with ESRD was studied in Abha hemodialysis centre in Southern Saudi Arabia. The socio-demographic characteristics, clinical and laboratory data were collected. The psychiatric status of the patients was evaluated using a structured "The Comprehensive Psychiatric Rating Scale" (CPRS clinical interview. The result indicated that the major co-morbidity (in 60% of these patients was a depressive illness due to renal failure diagnosable according to DSM-IV criteria. Our study suggests the need for specific anti-depressant treatment in order to ameliorate many distressing symptoms, which may affect the quality of these patients′ life. Concomitant social problems of poverty, absence of spouse and illiteracy, dictate a more prompt attitude in initiating support systems and attention to providing leisure activities.

  13. Transvenous extraction of cardiac rhythm device leads: a report of the experience from a single referral centre in Greece.

    Science.gov (United States)

    Sideris, Skevos; Kasiakogias, Alexandros; Pirounaki, Maria; Gatzoulis, Kostas; Sotiropoulos, Ilias; Dilaveris, Polichronis; Traxanas, Kostas; Vouliotis, Apostolos-Ilias; Voliotis, Apostolos; Manakos, Kostas; Konstantinidis, Dimitris; Trantalis, George; Lymperiadis, Dimitrios; Stavropoulos, George; Tousoulis, Dimitrios; Kallikazaros, Ioannis

    2015-01-01

    As rates of implanted cardiac electronic devices continue to rise, lead extraction procedures are crucial for the management of complications. The optimal method for such procedures has been constantly debated. We sought to review our experience of lead extraction using a conventional technique. This was a retrospective study of lead extraction procedures in a major referral centre in Greece. Leads were extracted in a series of 66 consecutive patients (69% men, age range 53-90 years) who visited our centre between August 2008 and June 2012. The extraction procedure was performed in the catheterization lab with a widely used system composed of a locking stylet and sheath. A total of 120 leads were extracted (51 atrial, 69 ventricular) including 19 defibrillator leads and 9 coronary sinus leads. The most frequent indication for lead extraction was infective endocarditis (28 patients, 42%), followed by generator pocket infection (22 patients, 33%), and lead malfunction (16 patients, 24%). Extraction was achieved through the venous entry-site approach in all procedures. The leads were completely extracted in 65 patients (98.5%). Only one complication was recorded: perforation of the right atrium in one patient (1.5%), who eventually underwent emergency cardiac surgery with a good outcome. Our data confirm that a conventional mechanical technique is highly effective for successful extraction of all types of implanted cardiac electronic device leads and is associated with very limited complications.

  14. Le Pseudomonas: Experience du Centre des Brules D’Annaba et Revue de la Litterature

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    Chaibdraa, A.; Medjellekh, M.S.; Saouli, A.; Bentakouk, M.C.

    2008-01-01

    Summary Le Pseudomonasest un agent pathogène à l'origine d'infections nosocomiales graves dans les centres des brûlés. Son opportunisme et sa virulence en font une préoccupation majeure. Ce travail se propose d'évaluer la place de cette bactérie dans l'écologie bactérienne locale et d'en apprécier la sensibilité aux antibiotiques. Cette étude rétrospective préliminaire porte sur la période de juin 2003 à décembre 2005. Elle intéresse l'ensemble des prélèvements bactériologiques ayant pu être réalisés au centre des brûlés d'Annaba. L'effectif est de 633 micro-organismes isolés dont 128 Pseudomonas (20,2%): 127 aeruginosa (99,2%), 1 fluorescens (0,8%); distribution selon le site de prélèvement: écouvillon (87,5%), prélèvement trachéobronchique (4,6%), hémoculture (3,1%), cathéters (1,6%), urine (1,6%) et sonde urinaire (1,6%). Le pyocyanique se situe après le staphylocoque pour les prélèvements précoces et repasse en tête après un séjour supérieur à une semaine, où 89% des pyocyaniques sont identifiés. Il est en première position dans les pneumopathies sous ventilation assistée invasive. Il se classe troisième dans les hémocultures et les cultures de cathéters. Dans les infections urinaires il est devancé par Candida et la flore périnéale. Les 128 antibiogrammes regroupent 314 réponses sensibles. La sensibilité à plus de deux antibiotiques est de 68%, à deux antibiotiques 24% et à un antibiotique 8%. Seules quatre molécules restent actives: ciprofloxacine > péfloxacine > pipéracilline > ceftazidime. Une résistance absolue est retrouvée pour trois Pseudomonas (2,4%). Le pronostic sévère des infections nosocomiales à pyocyanique et les risques d'options thérapeutiques très limitées font toute leur gravité, d'où l'intérêt de respecter des règles strictes de prescription des antibiotiques et des mesures de prévention. PMID:21991140

  15. Decreasing incidence of coronary heart disease in extreme obesity (BMI≥40)-A single centre experience.

    Science.gov (United States)

    Barth, Sebastian; Zacher, Michael; Reinecke, Holger; Hautmann, Martina B; Kerber, Sebastian; Gietzen, Frank; Halbfass, Philipp; Schade, Anja; Deneke, Thomas; Schieffer, Bernhard; Hamm, Karsten

    The aim of our comprehensive single centre analysis was to evaluate the incidence of coronary heart disease (CHD) in extremely obese patients. Between 2005 and 2015 we investigated retrospectively 23,359 patients undergoing cardiac catheterisation in our institution. Patients were divided in six weight classes according to World Health Organization (WHO) criteria [1] (WHO, 2000). Cardiovascular risk factors, comorbidities, CCS stadium [2] (Cox and Naylor, 1992) and NYHA functional class [3] (The Criteria Committee of the New York Heart Association, 1994) were retrieved from electronic patient records. Using multivariable analysis the odds ratio for the target variable CHD with presence of >50% angiographic stenosis was ≥1 with regard to age (OR 1.049, 95% CI 1.045-1.052), male sex (OR 2.507, 95% CI 2.329-2.699), cardiovascular risk factors, atherosclerosis (OR 1.651, 95% CI 1.498-1.820), and presence of angina (OR 4.408, 95% CI 3.892-4.993). NYHA functional class I-IV, absence of angina (OR 0.818, 95% CI 0.729-0.918), and BMI≥40 (OR 0.592, 95% CI 0.494-0.709) resulted in an odds ratio of ≤1. Underweight patients had a higher (5.3%) and overweight (1.2%) and obese patients (class I 0.9% and II 1.1%) a slightly lower all-cause in-hospital mortality compared to extremely obese patients (1.6%). Severely obese patients treated in our hospital surprisingly showed a decreased incidence of CHD (46.1% in normal weight and 38.6% in extremely obese patients) while comorbidities increased CHD as expected. Although CHD burden was lower, obesity and associated comorbidities resulted in higher all-cause-in-hospital mortality. Copyright © 2016 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  16. Ten-year single-centre experience with type II endoleaks: Intervention versus observation.

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    Haq, Ikram-Ul; Kelay, Arun; Davis, Meryl; Brookes, Jocelyn; Mastracci, Tara M; Constantinou, Jason

    2017-08-01

    Our objective was to determine the relative merits of intervention or observation of type II endoleaks (T2Ls). A retrospective analysis was performed on 386 infra-renal endovascular aneurysm repair (IR-EVAR) patients from 2006 to 2015. Annual surveillance imaging of patients undergoing EVAR at our centre were analysed, and all endoleaks were subjected to a multidisciplinary team meeting for consideration and treatment. In the 10-year time frame, 386 patients (79.5±8.7 years) underwent an IR-EVAR. Eighty-one patients (21.0%) developed a T2L and intervention was undertaken in 28 (34.6%): 17 (60.7%) were treated via a transarterial approach (TA) and 11 (39.3%) using the translumbar approach (TL). Fifty-three patients (65.4%) with T2Ls were managed conservatively. Patients who received T2L treatment had a greater proportion of recurrent T2Ls than patients who were conservatively managed ( p=0.032). T2Ls associated with aneurysmal growth were more resistant to treatment than those where there was no change or a decrease in aneurysm size during follow-up (0.033). There was no significant difference in the TA and TL approach with respect to endoleak repair success ( p=0.525). Treatment of a T2L did not confer a survival advantage compared to conservative management ( p=0.449) nor did the choice of either the TA or TL approach ( p=0.148). Our study suggests the development of a T2L associated with aneurysm growth may represent an aggressive phenotype that is resistant to treatment. However, this did not lead to an increased risk of mortality over follow-up. Neither a transarterial nor a translumbar approach to treating a T2L conferred superiority.

  17. Experience of the Irish National Centre for hereditary haemorrhagic telangiectasia 2003-2008.

    LENUS (Irish Health Repository)

    Ni Bhuachalla, C F

    2012-01-31

    Hereditary haemorrhagic telangiectasia (HHT) is a group of autosomal dominant disorders of vascular structure. The Irish National Centre for HHT at the Mercy University Hospital, Cork, Ireland was founded in 2003. From 2003 to 2008, screening of 164 patients with contrast echocardiography, thoracic computerised tomography (CT) and cerebral magnetic resonance imaging (MRI) has identified 88 patients with definite HHT, 72 (82%) of whom had epistaxis, 70 (80%) had telangiectasia and 81 (92%) had a first-degree relative with HHT. We sought to describe the manifestations of HHT in an Irish population and to determine differences between internationally reported data. The HHT patient database was analysed to describe demographics, clinical manifestations and interventional procedures performed in all referred patients. Contrast echocardiography and\\/or CT were performed in 86 patients with definite HHT, identifying 27 patients (31%) with pulmonary arteriovenous malformations (pAVMs). Nineteen patients with single or multiple pAVMs had 28 embolisation procedures performed, with 1-6 pAVMs embolised per procedure. Cerebral MRI was performed in 78 (89%) patients and 2 (2.3%) had cerebral arteriovenous malformations (cAVMs). HHT prevalence is thought to be 1 in 2500-8000, suggesting that there are many undiagnosed cases in Irish patients. Internationally published data suggest a prevalence of 15-35% for pAVMs and 10-23% for cAVMs in patients with HHT. While the prevalence of pAVMs in our group is consistent with these data, the prevalence of cAVMs is considerably lower, suggesting that Irish patients with HHT may differ genotypically and phenotypically from those in other countries.

  18. OBSERVATIONS WITH SURGICAL MANAGEMENT OF GYNAECOLOGICAL CANCERS- AH REGIONAL CANCER CENTRE EXPERIENCE

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    Jita Parija

    2017-07-01

    Full Text Available BACKGROUND Oncosurgery plays a very important role in management of gynaecological cancers. With modern anaesthetic techniques, blood transfusion services and intensive care facilities, gyn-oncosurgery in the form of primary radical/secondary cytoreductive or palliative surgery can be offered to patients in all stages of cancer. This is a retrospective analysis of gynaecologic cancer cases who underwent surgery with or without chemotherapy. The study aims at observing the response of these individual cancers to surgery alone or surgery and adjuvant therapy and calculates the 5-year disease-free survival of these cases. MATERIALS AND METHODS A total number of 2242 gynaecological cancer patients who underwent various surgical procedures during April 2006-March 2011 were taken up for studying their individual response to the particular surgery. The patients were categorised into sitespecific gynaecological cancers and the type of surgery they underwent was noted. Adjuvant treatment if given was noted. All patients were followed up for 5 years or more. RESULTS It was observed that of the total number of female genital cancers attending the gyn-oncology OPD of A.H. Regional Cancer Centre over a period of 5 years, only 11.6% were operable. In case of uterine cancers, postoperative adjuvant radiotherapy was required in 28.4% of cancer cervix and in 23.7% cancer corpus patients. All cases of cancer ovary needed adjuvant therapy (chemotherapy/chemotherapy and radiotherapy. All cases of cancer vagina required postoperative adjuvant radiotherapy, whereas none of the vulval cancers needed radiotherapy. Five-year disease-free survival was 75.4% in cancer cervix, 100% with cancer uterine corpus and vulvovaginal cancers and 66.7% with ovarian cancers. CONCLUSION This retrospective analysis reveals that surgery alone should be the primary mode of treatment for all operative gynaecological cancers. Adjuvant treatment should be offered when and wherever necessary.

  19. Prevalence of Hepatitis C among Multi-transfused Thalassaemic Patients in Oman: Single centre experience

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    Khalid Al-Naamani

    2015-01-01

    Full Text Available Objectives: Regular blood transfusions are essential for patients with thalassaemia major. However, infections with hepatotropic viruses remain a major concern. The objective of this study was to evaluate the prevalence and characteristics of hepatitis C viral (HCV infection among patients with homozygous beta thalassaemia in a single centre in Oman. Methods: A retrospective chart review of 200 patients treated at the Thalassemia Unit of Sultan Qaboos University Hospital (SQUH in Muscat, Oman, between August 1991 and December 2011 was performed. Relevant demographic and clinical characteristics were collected, including age, gender, HCV status and the presence of endocrinopathies. Results: A total of 81 patients (41% were found to be anti-HCV-antibody (anti-HCV-positive. HCV ribonucleic acid tests were performed on 65 anti-HCV-positive patients and were positive among 33 (51%; the remaining 16 patients died before these tests were available. Anti-HCV-positive patients were significantly older than anti-HCV-negative patients (P <0.001 and were more likely to be diabetic than anti-HCV-negative patients (27% versus 8%; P <0.001. A total of 100 patients had been transfused before they were transferred to SQUH in 1991; of these, 70 (70% were anti-HCV-positive. Only 11 (11.5% of the 96 patients who were seronegative in 1991, or who were transfused later, became seropositive. Conclusion: It is likely that the high prevalence of HCV among multi-transfused thalassaemic patients in Oman is due to blood transfusions dating from before the implementation of HCV screening in 1991 as the risk of HCVassociated transfusions has significantly reduced since then. Additionally, results showed that anti-HCV-positive patients were more likely to be diabetic than anti-HCV-negative patients.

  20. Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre.

    Science.gov (United States)

    Tandon, A; Rajendran, I; Aziz, M; Kolamunnage-Dona, R; Nunes, Q M; Shrotri, M

    2017-04-01

    BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.

  1. Changing trends in the management of intertrochanteric hip fractures - A single centre experience.

    Science.gov (United States)

    Page, Piers R J; Lord, Roxana; Jawad, Ahsin; Dawe, Edward; Stott, Philip; Rogers, Benedict; Gill, Richie

    2016-07-01

    With an annual incidence greater than 65,000 in the United Kingdom, hip fractures are a common but debilitating injury predominantly affecting those over 65. Treatment is based on the anatomical location of the fracture relative to the capsule of the hip joint - fractures occurring within it are treated by arthroplasty, while extracapsular fractures are an indication for fixation. Intertrochanteric fractures are further grouped as stable (AO/OTA 31A1/A2) or unstable (31A3) which in turn governs in the current UK guidelines whether this fixation is achieved with a dynamic hip screw or intramedullary device. Anecdotally, some units are tending towards intramedullary devices for 31A2 fractures as well, a practice which from the evidence does not appear to confer benefit and carries an excess cost. We reviewed our data submitted to the National Hip Fracture Database over the last five years and identified all intertrochanteric fractures, from which cohort we identified all patients with 31A2 fractures by review of radiographs. The cohort comprised 370 patients. We then recorded age, gender, ASA grade, abbreviated mental test score, residence from where admitted, length of stay, destination on discharge and whether any further operations were required. There was no significant difference in the demographics of the groups, year-on-year, except gender mix. There was a significant, twenty-fold rise in the use of intramedullary devices between 2011 and 2015. Length of stay, length of overall episode of care, revision rates, mortality and destination on discharge were unchanged. This use is not supported by NICE guidelines and this study offers no evidence to contradict this position. We advocate all centres examine their practice to avoid a costly intervention without clinical benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Sildenafil add-on therapy in paediatric pulmonary arterial hypertension, experiences of a national referral centre.

    Science.gov (United States)

    Douwes, Johannes M; Roofthooft, Marcus T R; Van Loon, Rosa L E; Ploegstra, Mark-Jan; Bartelds, Beatrijs; Hillege, Hans L; Berger, Rolf M F

    2014-02-01

    In paediatric pulmonary arterial hypertension (PAH), the effectiveness of add-on combination PAH-therapy has not yet been systematically studied. The purpose of this study was to determine the effect of sildenafil add-on therapy in paediatric PAH patients treated with bosentan. In this observational study within a national paediatric patient cohort, follow-up data of 24 consecutive paediatric PAH patients initially treated with bosentan monotherapy and prospectively followed at the Dutch national referral centre for paediatric PAH in 2007-2013, were reviewed. Patients received add-on sildenafil therapy in case of clinical worsening. Fifteen children received add-on sildenafil therapy; nine remained on bosentan monotherapy. Patient characteristics, 6-minute walk distance (6MWD), WHO functional class (WHO-FC), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), and haemodynamic measurements at bosentan start were similar in both patient groups. In children with clinical worsening, sildenafil add-on therapy improved 6MWD at 5, 10, 15 and 21 months of follow-up, improved WHO-FC at 10, 15 and 21 months and stabilised NT-proBNP. Patients who received add-on sildenafil therapy had more advanced disease progression during bosentan monotherapy. Despite that, they had better or, at least, no worse survival compared to patients who remained on bosentan monotherapy. In children with PAH, sildenafil add-on therapy indicated by clinical deterioration on bosentan monotherapy, was associated with a significant improvement of WHO-functional class and 6MWD. Despite clinical deterioration on bosentan monotherapy, patients receiving sildenafil add-on therapy, had either better or, at least, no worse survival than patients remaining on bosentan monotherapy.

  3. Treatment with immunosuppressive therapy in patients with pars planitis: experience of a reference centre in Mexico.

    Science.gov (United States)

    Serna-Ojeda, Juan Carlos; Pedroza-Seres, Miguel

    2014-11-01

    To evaluate the clinical course of the patients with pars planitis that received immunosuppressive drugs. We retrospectively analysed the data of 10 years from 374 patients with pars planitis in a large reference centre in Mexico City and included 49 patients (92 eyes). Median age at presentation was 8 years. 35 patients (71.4%) were male and 43 patients (87.7%) had bilateral disease. Diverse immunosuppressive medications were used, mainly methotrexate (69.4%) and azathioprine (63.3%) with 18 patients requiring more than one drug. The main indications for starting immunosuppressive therapy were lack of response to initial treatment and advance disease at presentation. The results showed good response with steroid reduction (69.3% of patients), visual acuity improvement (51% of patients) and inflammatory disease reduction (59.1% of patients). In 25 patients (51%), steroids were started previous to immunosuppressors and in 24 (49%) at the same time without significant difference in clinical improvement (p=0.210) or visual outcome (p=0.498). Thirteen patients (26.5%) presented mild adverse effects. The median of the final visual acuity was 20/40. The median follow-up time was 44 months (range 13-115 months). Immunosuppressive therapy allows an adequate control of inflammatory disease in pars planitis, with clinical and visual improvement and steroid dose reduction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Cardiopulmonary exercise testing in children with cystic fibrosis: one centre's experience.

    Science.gov (United States)

    Weir, Elise; Burns, Paul D; Devenny, Anne; Young, David; Paton, James Y

    2017-05-01

    While exercise testing is increasingly used as a prognostic indicator in cystic fibrosis (CF), it is reported to be underused in UK CF centres, particularly in children. Here, we evaluated the cardiopulmonary exercise testing (CPET) results in children and young people with CF at CF annual review and its possible clinical value. An observational study comparing CPET results using a cycle ergometer ramp test (peak oxygen uptake (Vo 2peak )) and pulmonary function (forced expiratory volume in 1 s (FEV 1 )) was performed with body mass index (BMI) used as a disease severity marker. Data were identified from clinical case notes and our CF database. Thirty-eight children and young people (mean age 11±2.4, range 7-14 years; 17 males and 21 females) completed at least one CPET with 95% achieving technically satisfactory tests allowing measurement of Vo 2peak . Mean Vo 2peak was 107 ±17.6% predicted, range 74%-150% predicted, with 8% having a reduced Vo 2peak of children and young people achieving technically satisfactory assessments starting from age 7. In this group with relatively mild CF, mean Vo 2peak was normal with no significant correlation between Vo 2peak and FEV 1 or BMI, as markers of disease severity. The majority demonstrated a normal Vo 2peak . However, 71% showed a downward trend on repeat testing 12-18 months later. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

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    Coyle Catherine

    2010-12-01

    Full Text Available Abstract Background Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil. Methods A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone. Results Median age was 55 years (range 34-76 years and 28 (68% patients were male. 35/41 patients (85% received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78% had a clinical response. Concomitant chemotherapy was given to 30/41 (73%. All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15% patients had gastrostomy tubes placed before treatment, and 22 (54% required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85% patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months. Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8% patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively. Conclusion Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer.

  6. Coeliac disease in patients with short stature: A tertiary care centre experience.

    Science.gov (United States)

    Singh, Prashant; Sharma, Piyush Kumar; Agnihotri, Abhishek; Jyotsna, Viveka P; Das, Prasenjit; Gupta, Siddhartha Datta; Makharia, Govind K; Khadgawat, Rajesh

    2015-01-01

    We aimed to determine the prevalence of coeliac disease among children with short stature at a tertiary care centre and to define the predictors for coeliac disease, if any, in them. In this retrospective study, we reviewed the case records of children and adolescents with growth retardation attending the Paediatric Endocrinology Clinic from January 2008 to June 2011. All patients underwent the multi-tier stratified diagnostic protocol for complete evaluation of short stature. Coeliac disease was screened using IgA-anti-tissue transglutaminase antibody. The diagnosis of coeliac disease was made on the basis of the modified European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. Of 432 patients (238 boys) who presented with short stature, 72 (16.7%) had physiological, while 360 (83.3%) had pathological causes. Endocrine causes were growth hormone deficiency (86 patients, 19.9%), hypopituitarism (31, 7.2%), hypothyroidism (22, 5.1%) and others (7, 1.6%). The systemic causes were: coeliac disease (47, 10.9%), haematological diseases (14, 3.2%), renal diseases (11, 2.5%) and others (24, 5.6%). Chronic diarrhoea (OR 15.7, 95% CI 7.8-31.5) and anaemia (OR 4.9, 95% CI 1.9-12.7]) were significant predictors for coeliac disease in patients with short stature. There was a definite response to gluten-free diet in them and the mean (SD) growth velocity measured over at least 6 months of gluten-free diet was 8.1 (3.0) cm/year. Nearly 11% of patients presenting with short stature have coeliac disease. In these patients chronic diarrhoea and anaemia were significant predictors of coeliac disease. Copyright 2015, NMJI.

  7. Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience.

    Science.gov (United States)

    de Sousa Fontes, Aderito; Sandrea Jiménez, Minaret; Urdaneta Lafée, Nelson; Abreu Durán, Perfecto A; Quintana Páez, Liwven E; de Sousa de Abreu, Andreina Carmina

    To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up. Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  8. Congenital coronary artery anomalies in adults: review of 111 cases from a single-centre experience.

    Science.gov (United States)

    Çanga, Yiğit; Güvenç, Tolga S; Karataş, Mehmet B; Çalık, Ali N; Onuk, Tolga; Tanık, Veysel O; Güngör, Barış; Bolca, Osman

    2017-08-01

    Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre. We retrospectively reviewed coronary angiograms performed between 2011 and 2015 for the presence of a coronary anomaly. A total of 111 patients with a final diagnosis of coronary anomaly were included in the study group. We also recruited 110 age- and sex-matched patients who underwent coronary angiography because of symptomatic coronary artery disease as controls. Among 36,893 coronary angiograms, 111 (0.30%) major coronary anomalies were found. Compared with controls, the prevalence of significant atherosclerotic coronary disease was lower in patients with coronary anomalies and stable symptoms (p=0.02); however, the prevalence of significant coronary atherosclerosis was similar among patients admitted with unstable angina or myocardial infarction (p>0.05). Compared with controls, patients with an anomalous left anterior descending coronary artery had significantly less atherosclerotic involvement than those in whom the left anterior descending artery was not anomalous (p=0.005). Although coronary artery anomalies are cited as a cause for myocardial ischaemia, atherosclerotic coronary artery disease is also frequent and may offer an alternative explanation to ischaemic symptoms. No predisposition to accelerated atherosclerosis was found, however, and atherosclerotic involvement was less frequent in some anomalous vessels.

  9. Adverse reactions in blood and apheresis donors: experience from two Italian transfusion centres.

    Science.gov (United States)

    Crocco, Isabella; Franchini, Massimo; Garozzo, Giovanni; Gandini, Anna Rosa; Gandini, Giorgio; Bonomo, Pietro; Aprili, Giuseppe

    2009-01-01

    Blood and apheresis donations are widely considered to be safe with a low incidence of adverse reactions and injuries; however, data reported in the medical literature on the prevalence of adverse events in donors and studies on the predictive risk factors for donor reactions are limited and contradictory. From January 2002 to December 2006 we recorded every adverse reaction verified during 240,596 consecutive blood and apheresis donations (183,855 homologous whole blood donations, 6,669 autologous whole blood donations, 38,647 plasmapheresis, 2,641 plateletpheresis and 8,784 multicomponent donations) at the Italian Transfusion Centres of Verona and Ragusa,. Using a special, pre-arranged form within the quality system, a total of 686 adverse reactions (related to 0.28% of all donations) were recorded. Vasovagal reactions, mostly of mild intensity, were the most commonly observed adverse reactions, with a frequency of 0.20% (487/ 240,596). The frequency of the vasovagal reactions varied according to the different types of donation, being 0.19% (346/183,855) for homologous whole blood donations, 0.24% (16/6,669) for autologous whole blood donations, 0.16% (63/38,647) for plasmapheresis, 0.68% (18/2,641) for plateletpheresis and 0.49 (43/8,784) for multicomponent donations. Citrate toxicity was reported in 0.38% (189/50,072) of apheresis donations. Severe adverse reactions were very rare, as they occurred in 0.004% of the donations (10/240,596). In conclusion, the results of our 5-year survey document that apheresis and blood donation are safe procedures for the donor with a low incidence of adverse reactions; the adverse reactions that did occur were mostly mild and resolved rapidly.

  10. The scholastic experiences of the children of moroccan inmigrants at Centres of Compulsory Secundary Education

    Directory of Open Access Journals (Sweden)

    Cristóbal Ruiz Román

    2009-10-01

    Full Text Available The following work is the fruit of an investigation was developed in the Department of Educational Theory and History in the University of Málaga, which focus of attention has been to understand the experiences of these adolescents in creating their identity in a series of contexts which, culturally speaking, are extremely diverse: essentially the family, the peer group and school. This article will concentrate on the experiences of the children of Moroccan immigrants in centers of Secondary Education of Málaga and on the expectations, perceptions, difficulties and conflicts that they encounter there.

  11. Peer Mentoring Experiences of Psychology Students at the London Metropolitan University Writing Centre

    Science.gov (United States)

    Bakhshi, Savita; Harrington, Kathy; O'Neill, Peter

    2008-01-01

    "It really helps knowing that you are going to have someone around to help you..." This short article reports on research taking place into peer writing tutorials at London Metropolitan University and examines in particular, the experiences of psychology students who have taken part in the scheme. Some of the implications of this…

  12. Factors Impacting Students' Online Learning Experience in a Learner-Centred Course

    Science.gov (United States)

    Wu, Y.

    2016-01-01

    Technologies bring a new era of content presentation for online teaching and learning. With more instructors adopting new tools to design online teaching materials, students are often put into learning contexts with certain new design components. Assessing learner experience and outcome in these contexts is challenging because of the complexity…

  13. User Experiences And Perceptions Of Online Information Resources ...

    African Journals Online (AJOL)

    This study was conducted at Sokoine National Agricultural Library (SNAL) to find out student experiences and perceptions towards the Internet in meeting their learning needs. A total of one hundred and two (102) students participated in this study. Convenience and purposive sampling techniques were used to select ...

  14. CDC Kerala 5: Developmental therapy clinic experience--use of Child Development Centre grading for motor milestones.

    Science.gov (United States)

    Nair, M K C; Resmi, V R; Krishnan, Rajee; Harikumaran Nair, G S; Leena, M L; Bhaskaran, Deepa; George, Babu; Russell, Paul Swamidhas Sudhakar

    2014-12-01

    To document the experiences of the intervention given to children who attended the developmental therapy clinic of Child Development Centre (CDC) Kerala, a specialized clinic for providing developmental intervention/therapy for babies less than two years with developmental delay/disability. All the babies referred to this speciality clinic from developmental screening/evaluation clinics of CDC were registered in the clinic and re-evaluation was done using CDC grading for head holding, sitting, standing, Amiel Tison passive angles, and Trivandrum Developmental Screening Chart (TDSC) 0-2 y. Out of a total of 600 consecutive babies below 2 y with developmental delay/disability referred to developmental therapy clinic, on comparing the test results at enrollment and after 6 mo of intervention, a statistically significant reduction was observed (i) in the 2-4 mo age group with regard to abnormal TDSC (25.5%), (ii) in the 4-8 mo age group with regard to abnormal head holding grade (87.1%) and abnormal TDSC (19.4%), (iii) in the 8-12 mo age group, with regard to abnormal sitting grade (71.7%) and (iv) in the above 12 mo age group with regard to abnormal sitting grade (35.3%) and abnormal standing grade (78.8%). The experience of organizing the developmental intervention/therapy clinic at CDC Kerala has shown that therapy services by developmental therapists in a centre and supportive therapy by mother at home is useful in improving the developmental status of children with developmental delay.

  15. Management of Cushing syndrome in children and adolescents: experience of a single tertiary centre.

    Science.gov (United States)

    Güemes, Maria; Murray, Philip G; Brain, Caroline E; Spoudeas, Helen A; Peters, Catherine J; Hindmarsh, Peter C; Dattani, Mehul T

    2016-07-01

    The diagnosis and management of paediatric Cushing syndrome (CS) is highly challenging. This study aims to characterise its presentation, diagnosis, management and outcome by a retrospective case review of 30 patients (14 females) followed at a single tertiary paediatric endocrinology centre over a 30-year period. At presentation, median age was 8.9 years (0.2-15.5) and the commonest manifestations were weight gain (23/30), hirsutism (17/30), acne (15/30) and hypertension (15/30). Growth retardation was present in 11/30. Median body mass index (BMI) was +2.1 standard deviation score (SDS) (-6.5 to +4.6). Urinary free cortisol (UFC) was abnormal in 17/18 (94 %), midnight cortisol in 27/27 (100 %) and low-dose dexamethasone suppression (LDDS) test in 20/20 (100 %). High-dose dexamethasone suppression (HDDS) test was abnormal in 6/6 (100 %) of adrenal tumours, 1/10 (10 %) of Cushing disease (CD) and 1/2 (50 %) of ectopic tumours. Bilateral inferior petrosal sinus sampling (IPSS) identified five CD cases and one ectopic tumour. All patients underwent surgery and subsequently required cortisol replacement. Final diagnoses were 16 CD, 11 adrenal disease, 2 ectopic ACTH-secreting lesions and 1 case of unidentified aetiology. One year post-diagnosis, median BMI was 0.5 SDS (-2.5 to +3.7), hypertension was present in 4/14 (28 %), and 43 % (12/30) of individuals were off hydrocortisone. The prevalence of the clinical manifestations differs from that reported in other series. Screening tests were highly sensitive, with UFC, midnight cortisol and LDDS performing well. One year post-treatment, BMI and BP normalised in the majority of patients and almost half of them were able to discontinue replacement hydrocortisone. •Cushing syndrome is an extremely rare entity in the paediatric and adolescent age groups, so not many cohort studies have been published in this population. •Several tests can be employed to firstly diagnose hypercortisolaemia and secondly identify

  16. Re: Factors Predicting Outcomes of Micropercutaneous Nephrolithotomy: Results from a Large Single-Centre Experience

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    Yakup Bostancı

    2016-09-01

    Full Text Available The recently developed micropercutaneous nephrolithotomy (microperc is the miniaturized version of mini-percutaneous nephrolithotomy (PCNL and standard-PCNL that allows for safe access and stone disintegration under direct vision. In this single-centre study, the authors aimed to define the role of microperc in the management of renal calculi and analyse factors predicting outcomes. A total of 139 patients, who underwent microperc between June 2010 and November 2014, were enrolled in this study. Microperc was successful in 119 (91.53% patients, while in 11 patients (8.46% some residual fragments were seen on imaging. Of the total study group, conversion to mini- or standard PCNL was required in nine patients (6.47%. Overall complication rate of 11.53%, primarily minor complications comprising renal colic and urinary tract infection. On multivariate analysis, stone density (HU, stone number and stone volume were significantly associated with the dependent variable stone clearance. Multivariate analysis showed that intra-operative complications and stone number were significantly associated with conversion to mini- or standard PCNL. Stone volume threshold of 1.000 mm3 was a significant predictor of stone clearance in univariate and multivariate analyses, regardless of the stone location. Some limitations of this study, relatively small sample size and particularly the retrospective and non-comparative design, should be highlighted. EAU guidelines recommend shockwave lithotripsy (SWL or retrograde intrarenal surgery as the primary treatment modality for stones <10 mm in size. Although microperc is presently being used for small to moderate stones, the very indication that holds for SWL as well, it is notable that SWL is influenced by stone location and pelvicalyceal anatomy, and may require multiple sessions. Nevertheless, microperc has an inherent limitation in that the stone fragments cannot be retrieved for analysis. It has been noted that the

  17. When Study-Abroad Experience Fails to Deliver: The Internal Resources Threshold Effect

    Science.gov (United States)

    Sunderman, Gretchen; Kroll, Judith F.

    2009-01-01

    Some second language (L2) learners return from study-abroad experiences (SAEs) with seemingly no change in their L2 ability. In this study we investigate whether a certain level of internal cognitive resources is necessary in order for individuals to take full advantage of the SAE. Specifically, we examine the role of working memory resources in…

  18. Christ-centred ethical behaviour and ecological crisis: What resources do the concepts of order in creation and eschatological hope offer?

    Directory of Open Access Journals (Sweden)

    Martinus P. de Wit

    2013-04-01

    Full Text Available The ecological crisis, as well as a limited ethical response, forces a reflection on the transformative potential of Christian ethics on an idolatrous society largely shaped by a dominant economic culture. The aim of the article was to explore how the concepts of creation order and eschatological hope may be helpful in the understanding and formulation of a Christ-centred ethical response to the ecological crisis. A review of the relevant literature was presented, limited to insights from Reformational philosophy and eco-theology into the concepts of creation order and eschatology. The main internal tensions of using the concepts of creation order and eschatological hope as resources in Christ-centred eco-ethics were highlighted and discussed. Some implications for the further explanation and development of Christ-centred eco-ethics are outlined.Christosentriese etiese gedrag en ekologiese krisis: Watter hulpbronne bied die konsepte van orde in die skepping en eskatologiese hoop? Die ekologiese krisis, asook ’n beperkte etiese antwoord hierop, dwing ’n besinning oor die vernuwende potensiaal van Christelike etiek vir ’n afgodiese samelewing wat grootliks gevorm is deur ’n dominante ekonomiese kultuur. Die doel van hierdie artikel was om te ondersoek hoe die konsepte van orde in die skepping en eskatologiese hoop nuttig kan wees in die verstaan en die formulering van ’n Christus- gesentreerde etiese antwoord op die ekologiese krisis. ’n Oorsig van die relevante literatuur, beperk tot insigte uit die Reformatoriese filosofie en ekoteologie oor die konsepte van orde in die skepping en eskatologie, is aangebied. Die belangrikste interne spanningsvelde in die gebruik van die konsepte skeppingsorde en eskatologiese hoop in ’n Christus-gesentreerde eko-etiek is uitgelig en bespreek. Sekere implikasies vir die verdere verduideliking en die ontwikkeling van ’n Christus-gesentreerde eko-etiek is beskryf.

  19. USING INTERNET-RESOURCES FOR SCHOOL PHYSICS EXPERIMENTS

    Directory of Open Access Journals (Sweden)

    Nina P. Dementievska

    2012-06-01

    Full Text Available Using virtual computer simulation of physics processes and phenomena is becoming increasingly popular among teachers of science around the world. Such simulation for school experiment has several advantages, but teaching needs improvement of methodology for using in modern school. In order to computer simulations were successful in education it requires compliance with a number of conditions. Educators around the world collaborate on the web site Phet (http://phet.colorado.edu/, which provides science-based and effective computer simulations for studying the natural sciences in different languages, as well as the methodology for use in secondary school.

  20. Dose-response relationship between physiotherapy resource provision with function and balance improvements in patients following stroke: a multi-centre observational study.

    Science.gov (United States)

    Haines, Terry P; Kuys, Suzanne; Clarke, Jane; Morrison, Greg; Bew, Paul

    2011-02-01

    Inpatient rehabilitation of patients following stroke can be resource intensive, with optimal models of service delivery unclear. This study investigates the dose-response curves between physiotherapy service delivery variables and balance and function clinical outcomes. This was a multi-centre (15 sites), prospective, cohort study involving patients (n = 288) admitted for rehabilitation following stroke conducted across two states in Australia. Physiotherapy department resource provision variables were collected and examined for association with change in patient function and balance outcomes (Functional Independence Measure, step test, functional reach test) measured at admission and discharge from inpatient care. A greater amount of log-transformed physiotherapy department resource provision was associated with greater improvement in the functional independence measure [Regression coefficient (95% CI): 4.05 (1.15, 6.95)] and functional reach test [46.43 (17.03, 75.84)], while physiotherapist time provided to patients was associated with greater improvement for the step test [0.15 (0.03, 0.28)], and functional reach [0.35 (0.19, 0.52)]. Receiving a higher rate of physiotherapist input is an important factor in attaining a greater amount of recovery in function and balance outcomes; however, the improvement by patients who received the greatest amount of input was highly variable. © 2010 Blackwell Publishing Ltd.

  1. Patients' experience of a nurse-led lifestyle clinic at a Swedish health centre.

    Science.gov (United States)

    Nymberg, Peter; Drevenhorn, Eva

    2016-06-01

    In Sweden, 56% of the population aged 16-84 have an unhealthy lifestyle. The primary health care (PHC) has been instructed to offer citizens health promotion and disease-preventive actions. Very few studies have been conducted about how individuals experience interventions from the PHC intended to help them to change lifestyle. The purpose of the study was to explore patients' experiences of visiting a nurse-led lifestyle clinic. Patients (n = 137), who participated in a screening test at a lifestyle clinic, were invited to focus group interviews. Of these, 14 patients agreed to participate. The data were analysed using content analysis. The patients felt that the visit to the lifestyle clinic gave insight into their habits and diminished their fear of not being healthy. Primary health care was seen as a safe provider in this matter. Disappointment was occasioned by the unfulfilled expectations of blood tests, lack of follow-up visit and inconsistencies of approach during the visit to the lifestyle clinic. Personal chemistry was perceived to be crucial for how the encounter with the public health nurse evolved. Lifestyle clinics can give patients opportunity to change lifestyle and also to confirm the good habits. It may also be important to have follow-up visits to give the patients' support when changing lifestyle. Nurses counselling patients about lifestyle changes need to have recurrent training in Motivational Interviewing. © 2015 Nordic College of Caring Science.

  2. Professional services for child rape survivors: A child-centred perspective on helpful and harmful experiences.

    Science.gov (United States)

    Collings, Steven J

    2011-06-01

    The aim of this study was to explore child rape survivors' perceptions of helpful and harmful experiences at the hands of professional service providers. Focused interviews were conducted with a convenience sample of 20 child rape survivors who had presented for counselling services at a non-governmental organisation located in the coastal region of KwaZulu-Natal, South Africa. For each case, information was obtained regarding children's perceptions of helpful and harmful experiences at the hands of police, medical and criminal justice system personnel. A thematic analysis of children's responses indicated that the concerns expressed by respondents reflected four basic inter-related needs and rights including the need and right: to be given a voice, to be informed and consulted, to be protected from harm, and for competent and efficient service provision. Study findings provided little support to the view that the medico-legal examination or the adversarial nature of legal proceedings are likely to be experienced as particularly distressing or traumatising for the child. Study findings indicate that the professional services provided to some child rape survivors fail to adequately address the child's basic needs and rights, with there being an associated need for improved codes of practice designed to better serve the interests of child rape survivors.

  3. The Border as a Resource for the Development of Borderland: A Comparative Analysis of Two Polish Urban Centres at the External Border of the European Union

    Directory of Open Access Journals (Sweden)

    Studzińska Dominika

    2016-12-01

    Full Text Available The entry into force of the Agreement between the Republic of Poland and the Russian Federation on visa- free movement in 2012 caused an increase in border permeability, and hence a sudden increase in border crossings. The border which used to divide the neighbouring states started linking them instead. Crossing the border became part of the everyday life of local communities. Actors on both sides benefited from the commercial services of the other country. For Kaliningrad citizens, border-crossing points became gates to Europe, and for Poles, a resource improving the quality of life via petty trade. The aim of this article is to compare two border cities: Braniewo, a town located in the immediate vicinity of the border-crossing point, and Tri-City, which has become a new border centre after the introduction of small border traffic. Two viewpoints on the effect of local border traffic are presented. The first is the perspective of a typical border city. The other is that of the effect of an increase in border permeability on a major urban centre - Tri-City.

  4. Retrograde approach to coronary chronic total occlusions: preliminary single European centre experience.

    Science.gov (United States)

    Di Mario, Carlo; Barlis, Peter; Tanigawa, Jun; Locca, Didier; Bucciarelli-Ducci, Chiara; Kaplan, Sahin; Katoh, Osamu

    2007-08-01

    The retrograde approach via septal or epicardial collaterals holds promise in improving the success rate of chronic total occlusion (CTO) recanalisation but is still viewed as an esoteric practice reserved to a selected group of operators using materials not available in Western countries. We sought to introduce the novel technique of retrograde CTO recanalisation to our institution using materials and resources available outside Japan. Between April 2005 and 2007, all patients with a failed antegrade attempt at CTO recanalisation were considered and selected based on their appropriateness to have a retrograde procedure. Seventeen patients were included. Average age was 65.3 years. The mean occlusion duration was 33.3 months. Successful CTO recanalisation was achieved in 15 of 17 (88.2%) patients. A retrograde wire was successfully advanced into the distal occluded vessel and facilitated successful CTO recanalisation in 13 (76.5%) patients. Final retrograde wire crossing was achieved in seven cases, while in the remaining cases, the CART technique (n=4) and 'knuckle' technique (n=2) were successful. In two cases (11.8%), the retrograde wire did not reach the distal occlusion because of septal tortuosity but a repeat antegrade attempt, aided by contralateral visualisation, was successful. In two (11.8%) patients, the procedure was unsuccessful. Cardiac magnetic resonance imaging performed in five of the successfully treated retrograde cases (45.5%) showed variable degrees of fibrosis in the territory of the occluded artery with no significant change after the procedure with the exception of one case of contained contrast extravasation within the septum. The novel method of retrograde recanalisation of CTOs was performed with a high procedural success in this series and was applicable in 37.1% of previously failed antegrade procedures. This technique can also be successfully employed despite newly created dissections immediately following a failed antegrade attempt.

  5. Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study.

    Science.gov (United States)

    Talabani, Naghada; Ängerud, Karin Hellström; Boman, Kurt; Brännström, Margareta

    2017-07-07

    Patients with severe heart failure (HF) suffer from a high symptom burden and high mortality. European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients' experiences of a new model of person-centred integrated HF and palliative care at home. Interviews were conducted with 12 patients with severe HF (New York Heart Association class IIIâ€"IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis. Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members' ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one's care and receiving help for symptoms of both HF and comorbidities. CONCLUSIONS: Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population. NCT01304381; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Avoiding steroids in pediatric renal transplantation: long-term experience from a single centre

    DEFF Research Database (Denmark)

    Pedersen, Erik Bo; El-Faramawi, Mohamad; Foged, Nils

    2007-01-01

    We report our experience in pediatric renal transplantation avoiding steroids whenever possible. Immunosuppression consisted of an initial induction with antithymocyte globulin followed by maintenance therapy with a calcineurin inhibitor and MMF. Steroids were only given to selected patients......). Unfortunately PTLD occurred in three patients, but all survived with functioning grafts. Accordingly, our findings indicate that steroid avoidance in pediatric renal transplantation is possible with good results with respect to acute graft rejection as well as long-term graft survival....... because of the primary disease, recurrence, rejection, or PTLD. Thirty-four transplants grafted into 32 recipients between 1995 and 2005 were followed for a median of 3.5 yr (range 1-9.8). All patients survived. Graft rejection occurred in 10 cases during the first year post-transplantation and graft...

  7. Does Early Decompressive Craniectomy Improve Outcome? Experience from an Active UK Recruiter Centre

    Directory of Open Access Journals (Sweden)

    E. García Vicente

    2013-01-01

    Full Text Available Introduction. The results of the recent DECRA study suggest that although craniectomy decreases ICP and ICU length of stay, it is also associated with worst outcomes. Our experience, illustrated by these two striking cases, supports that early decompressive craniectomy may significantly improve the outcome in selected patients. Case Reports. The first patient, a 20-year-old man who suffered severe brain contusion and subarachnoid haemorrhage after a fall downstairs, with refractory ICP of 35 mmHg, despite maximal medical therapy, eventually underwent decompressive craniectomy. After 18 days in intensive care, he was discharged for rehabilitation. The second patient, a 23-year-old man was found at the scene of a road accident with a GCS of 3 and fixed, dilated pupils who underwent extensive unilateral decompressive craniectomy for refractory intracranial hypertension. After three weeks of cooling, paralysis, and neuroprotection, he eventually left ICU for rehabilitation. Outcomes. Four months after leaving ICU, the first patient abseiled 40 m down the main building of St. Mary’s Hospital to raise money for the Trauma Unit. He has returned to part-time work. The second patient, was decannulated less than a month later and made a full cognitive recovery. A year later, with a titanium skull prosthesis, he is back to part-time work and to playing football. Conclusions. Despite the conclusions of the DECRA study, our experience of the use of early decompressive craniectomy has been associated with outstanding outcomes. We are currently actively recruiting patients into the RESCUEicp trial and have high hopes that it will clarify the role of the decompressive craniectomy in traumatic brain injury and whether it effectively improves outcomes.

  8. Surgically managed idiopathic intracranial hypertension in adults: a single centre experience.

    Science.gov (United States)

    Matloob, Samir A; Toma, Ahmed K; Thorne, Lewis; Watkins, Laurence D

    2015-12-01

    Idiopathic intracranial hypertension (IIH) is a rare condition that is often managed conservatively. In patients with aggressive progression of the disease surgical options are considered. There are few data on the outcomes of these patients when surgically managed. We describe our experience of surgically managed IIH and the outcomes of these patients, in particular the surgical revision rate and interventions required for resolution of symptoms. A retrospective review of all patient files coded with benign intracranial hypertension, idiopathic intracranial hypertension or pseudotumour cerebri was undertaken. Files were searched with the date of diagnosis and the date these patients were referred for surgical intervention. The surgical interventions and complications were then documented and note was made of the number of inpatient admissions and days spent in hospital. From 2000-2013, 79 patients were identified as patients with IIH that had required surgical intervention; 52 % required further surgical intervention. The average number of surgical interventions was 5.6. For patients requiring further intervention the average number of surgical interventions was 8.6. On average patients with IIH also spent 42 inpatient days in neurosurgical beds, whilst those patients who required further intervention spent 63 days on average in neurosurgical beds. The length of the average individual admission was longer for patients requiring repeated surgical interventions. Based on our experience, patients that require surgical management of IIH frequently require further surgical interventions to control symptoms and manage complications of CSF diversion surgery. Those that require such further intervention on average will have six further operations and spend significantly longer in hospital. Lumboperitoneal (LP) shunting is an effective first line surgical intervention for 52 % of our patient cohort. This sub-group of patients therefore requires specialist neurosurgical

  9. Robotic-assisted laparoscopic partial nephrectomy: A single centre Indian experience

    Directory of Open Access Journals (Sweden)

    Arvind P Ganpule

    2015-01-01

    Full Text Available Background: We summarise our experience with RPN emphasising on learning curve, techniques and outcomes. Patients and Methods: A retrospective chart review of 57 patients was done. The preoperative workup included a triple phase CT angiography. The parameters analyzed were demographics, tumor characteristics, operative details, postoperative outcome, histopathology and follow-up. The data were compared with historical cohort of the laparoscopic partial nephrectomy (LPN. Results: 58 renal units in 57 patients (45 males and 12 females underwent RPN. The mean age was 53.08 ± 13.6 (30-71 years. The mean tumor size was 4.96 ± 2.33 (2-15.5 cm. Average operative time was 129.4 ± 29.9 (70-200 min.; mean warm ischemia time was 20.9 ± 7.34 (9-39 min. 8 renal units in 7 patients were operated with the zero ischemia technique. The average follow-up was 5.15 months (1-18. There was no recurrence. 15 patients underwent LPN. The mean tumor size was 4.3 ± 1.6 (1.6-8 cm. operative time was 230.7 ± 114.8 (150-300 min.; mean warm ischemia time was 31.8 ± 9 min. The nephromerty score in the LPN group was 7.1 ± 0.89, in the RPN group was 8.75 ± 1.21. Conclusion: Our results suggest that prior experience of LPN shortens the learning curve for RPN as seen by shorter warm ischemia time and operative time in our series. The nephrometry score in RPN were higher suggesting that complex tumour can be managed with robotic approach.

  10. Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience.

    Science.gov (United States)

    Leonardi, M; Cirillo, L; Toni, F; Dall'olio, M; Princiotta, C; Stafa, A; Simonetti, L; Agati, R

    2011-09-01

    The Silk stent (Balt, Montmorency, France) is a retractable device designed to achieve curative reconstruction of the parent artery associated with an intracranial aneurysm. We present our initial experience with the Silk flow-diverting stent in the management and follow-up of 25 patients presenting with intracranial aneurysms.Twenty-five patients (age range, 34-81 years; 24 female) were treated with the Silk flow-diverting device. Aneurysms ranged in size from small (5), large (10) and giant (10) and included wide-necked aneurysms, multiple, nonsaccular, and recurrent intracranial aneurysms. Nine aneurysms were treated for headache, 14 for mass effect. None presented with haemorrhage. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least three months after treatment. A total of 25 Silk stents were used. Control MR angiography and/or CT angiography was typically performed prior to discharge and at one, three, six and 12 months post treatment. A follow-up digital subtraction angiogram was performed between six and 19 months post treatment.Complete angiographic occlusion or subtotal occlusion was achieved in 15 patients in a time frame from three days to 12 months. Three deaths and one major complication were encountered during the study period. Two patients, all with cavernous giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the Silk treatment. Both were treated with corticosteroids, and symptoms resolved completely within a month.In our experience the Silk stent has proven to be a valuable tool in the endovascular treatment of intracranial giant partially thrombosed aneurysms and aneurysms of the internal carotid artery cavernous segment presenting with mass effect. The time of complete occlusion of the aneurysms and the risk of the bleeding is currently not predictable.

  11. OGUMI-A new mobile application to conduct common-pool resource experiments in continuous time.

    Science.gov (United States)

    Brandt, Gunnar; Kulesz, Micaela M; Nissen, Dennis; Merico, Agostino

    2017-01-01

    OGUMI is an Android-based open source mobile application for conducting Common-Pool Resource Experiments, Choice Experiments, and Questionnaires in the field, in the laboratory, and online. A main feature of OGUMI is its capacity to capture real-time changes in human behaviour in response to a dynamically varying resource. OGUMI is simple (for example, likewise other existing software, it does not require expertise in behavioural game theory), stable, and extremely flexible with respect to the user-resource model running in the background. Here we present the motivation for the development of OGUMI and we discuss its main features with an example application.

  12. Self-administered methoxyflurane for procedural analgesia: experience in a tertiary Australasian centre.

    Science.gov (United States)

    Gaskell, A L; Jephcott, C G; Smithells, J R; Sleigh, J W

    2016-04-01

    Methoxyflurane, an agent formerly used as a volatile anaesthetic but that has strong analgesic properties, will soon become available again in the UK and Europe in the form of a small hand-held inhaler. We describe our experience in the use of inhaled methoxyflurane for procedural analgesia within a large tertiary hospital. In a small pilot crossover study of patients undergoing burns-dressing procedures, self-administered methoxyflurane inhalation was preferred to ketamine-midazolam patient-controlled analgesia by five of eight patients. Patient and proceduralist outcomes and satisfaction were recorded from a subsequent case series of 173 minor surgical and radiological procedures in 123 patients performed using inhaled methoxyflurane. The procedures included change of dressing, minor debridement, colonoscopy and incision-and-drainage of abscess. There was a 97% success rate of methoxyflurane analgesia to facilitate these procedures. Limitations of methoxyflurane include maximal daily and weekly doses, and uncertainty regarding its safety in patients with pre-existing renal disease. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  13. Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre

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    Cox, Brian; Chhabra, Avneesh [UT Southwestern Medical Center, Department of Radiology, Dallas, TX (United States); Zuniga, John R. [UT Southwestern Medical Center, Department of Oral and Maxillofacial Surgery, Surgery, Neurology and Neurotherapeutics, Dallas, TX (United States); Panchal, Neeraj [University of Pennsylvania, Department of Oral Maxillofacial Surgery, Philadelphia, PA (United States); Cheng, Jonathan [UT Southwestern Medical Center, Department of Plastic Surgery, Dallas, TX (United States)

    2016-10-15

    This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies. Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed. Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases. MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings. (orig.)

  14. Oesophageal foreign body in children: 15 years experience in a tertiary care paediatric centre

    Directory of Open Access Journals (Sweden)

    Amit Singh

    2014-01-01

    Full Text Available Background: The objective of this study was to report our experience and outcome in the management of oesophageal foreign body (EFB in suspected cases of foreign body (FB ingestion. Materials and Methods: Records of children with documented EFB ingestion treated in the Department of Pediatric surgery from January 1997 to December 2012 were analysed. Diagnosis was made on the basis of history, clinical examination and radiological evaluation. Stronger index of suspicion was kept in cases of sudden onset of symptoms with an inappropriate history of FB ingestion. Results: A total of 317 children underwent emergency rigid oesophagoscopy for EFB. Out of these, 206 were males and 111 were females. The most common EFB found was coins in 209 (65.9% cases, followed by food bolus obstruction in 54 (17%, metallic FB in 29 (9.1%, plastic FB in 21 (6.6%, and button batteries in 14 (4.4% cases. The most common site of FB impaction was found to be cricopharynx in 291 (92% cases. Conclusions: High index of suspicion should be kept for EFB in children who present with unavailable history of FB ingestion. The wait-and-watch policy in cases of FB oesophagus is not always the correct approach, especially when it presents as respiratory distress of sudden onset.

  15. Emergency endovascular treatment of emergent or ruptured aortic aneurysms: A single centre experience

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    England, Andrew [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)]. E-mail: andrew.england@smtr.nhs.uk; Butterfield, John S. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Nasim, Akhtar [Department of Vascular Surgery, South Manchester University Hospitals, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Welch, Mark [Department of Vascular Surgery, South Manchester University Hospitals, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); McCollum, Charles N. [Department of Vascular Surgery, South Manchester University Hospitals, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Ashleigh, Raymond J. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)

    2007-05-15

    Objective: To report our experience with emergency endovascular repair (eEVAR) in patients with ruptured or acutely symptomatic AA. Methods: From August 1998 to June 2004, 22 high-risk patients (21 men, median age 74 years, range 15-84 years) with ruptured or acutely symptomatic aneurysms underwent eEVAR using Talent endoprostheses. All procedures were performed in the operating theatre by a surgical/radiology team. Indications for repair, co-morbidities and outcomes were recorded with follow-up by US and CT scanning. Results: Of 22 eEVARs, 13 patients had abdominal AA and nine patients had thoracic AA. Nineteen (86.4%) repairs were technically successful, there was one patient with a type I proximal endoleak treated conservatively and two patients died during their inpatient period (myocardial infarction and broncho-pneumonia). On follow-up of the 20 survivors (median 7 months, range 0-48 months), there were three further deaths, and two further endoleaks. The 1-year survival by life-table analysis is 75 {+-} 9.8% and 13 patients are free from reintervention at last follow-up. Conclusion: eEVAR had encouraging initial results in selected high-risk patients.

  16. Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience.

    Science.gov (United States)

    Wrench, I J; Allison, A; Galimberti, A; Radley, S; Wilson, M J

    2015-05-01

    The widespread adoption of enhanced recovery programmes in various surgical specialties has resulted in patient benefits including reduced morbidity, reduced length of stay and an earlier return to normal activities. This evidence, along with the increased financial pressures in the UK National Health Service, has led many units to consider introducing such a programme for obstetric surgery. We report our experience in setting up an enhanced recovery programme for women undergoing elective caesarean section and a prospective analysis of factors that influence length of stay. An enhanced recovery pathway was designed by a multidisciplinary team and introduced in March 2012. Factors influencing length of stay were determined using a log normal model. The proportion of women discharged on Day 1 increased from 1.6% in the first quarter of 2012 to 25.2% in the first quarter of 2014. The 30-day readmission rate was 4.4% for those discharged on Day 1 and 5.6% for Day 2. Earlier gestation, multiple birth, intention to breast feed, longer surgery and more time in the post-anaesthesia recovery unit were all independently associated with a longer postoperative stay. Women presenting for obstetric surgery with the indication "one previous caesarean section" were more likely to leave hospital earlier compared to most other indications. An enhanced recovery programme was successfully introduced into our unit. Many of the interventions were straightforward and could be adopted easily elsewhere. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Immediate primary anastomosis for isolated oesophageal atresia: A single-centre experience

    Directory of Open Access Journals (Sweden)

    Ibrahim Uygun

    2015-01-01

    Full Text Available Background: Isolated oesophageal atresia without tracheo-oesophageal fistula represents a major challenge for most paediatric surgeons. Here, we present our experience with six neonates with isolated oesophageal atresia who successfully underwent immediate primary anastomosis using multiple Livaditis circular myotomy. Materials and Methods: All six neonates were gross type A isolated oesophageal atresia (6%, from among 102 neonates with oesophageal atresia, treated between January 2009 and December 2013. Five neonates were female; one was male. The mean birth weight was 2300 (range 1700-3100 g. Results: All six neonates successfully underwent immediate primary anastomosis using multiple myotomies (mean 3; range 2-4 within 10 (median 3 days after birth. The gap under traction ranged from 6 to 7 cm. One neonate died of a major cardiac anomaly. Another neonate was lost to follow-up after being well for 3 months. Three anastomotic strictures were treated with balloon dilatation, and four anastomotic leaks were treated conservatively. The mean duration of follow-up was 33 months. Conclusions: To treat isolated oesophageal atresia, an immediate primary anastomosis can be achieved using multiple myotomies. Although, this approach is associated with high complication rates, as are other similar approaches, these complications can be overcome.

  18. Hyperspectral Imaging of Forest Resources: The Malaysian Experience

    Science.gov (United States)

    Mohd Hasmadi, I.; Kamaruzaman, J.

    2008-08-01

    Remote sensing using satellite and aircraft images are well established technology. Remote sensing application of hyperspectral imaging, however, is relatively new to Malaysian forestry. Through a wide range of wavelengths hyperspectral data are precisely capable to capture narrow bands of spectra. Airborne sensors typically offer greatly enhanced spatial and spectral resolution over their satellite counterparts, and able to control experimental design closely during image acquisition. The first study using hyperspectral imaging for forest inventory in Malaysia were conducted by Professor Hj. Kamaruzaman from the Faculty of Forestry, Universiti Putra Malaysia in 2002 using the AISA sensor manufactured by Specim Ltd, Finland. The main objective has been to develop methods that are directly suited for practical tropical forestry application at the high level of accuracy. Forest inventory and tree classification including development of single spectral signatures have been the most important interest at the current practices. Experiences from the studies showed that retrieval of timber volume and tree discrimination using this system is well and some or rather is better than other remote sensing methods. This article reviews the research and application of airborne hyperspectral remote sensing for forest survey and assessment in Malaysia.

  19. Untapped resources: refugee employment experiences in central North Carolina.

    Science.gov (United States)

    Sienkiewicz, Holly C; Mauceri, Kelly G; Howell, Emma Catherine; Bibeau, Daniel L

    2013-01-01

    The objective of this study was to elucidate a comprehensive understanding of the pre-migration expectations and current realities of refugees resettled in the United States (U.S). Employment expectations and the current work situations experienced by African refugee populations recently resettled in Greensboro, NC are examined. Ten French-speaking refugees of African descent who had resided in Central North Carolina for less than three years were selected to participate. A phenomenological approach was used; semi-structured interviews were conducted with participants in spring 2010. Interviews needing interpretation were translated throughout the course of the interview in real time. All interviews were transcribed verbatim or word for word. All participants expected to find work in their fields with relative ease, but were either unemployed or under-employed compared to their professional training and/or previous occupation in their country of origin at the time of their interview. Emergent themes from the interviews included financial stability, ease of finding work, identity concerns, English language comprehension, the economy, and navigating a new system. Refugees in this sample were not prepared for the challenges they encountered when searching for gainful employment. Their experiences appear to be common with available anecdotal evidence. Adjustments to the cultural orientation programs received prior to migration, and enhancements to social networks in addition to an increased focus on English language comprehension post-migration have the potential to positively impact employment outcomes for newly arrived refugees.

  20. Outcome of traumatic brain injury in elderly population: A tertiary centre experience from a developing country.

    Science.gov (United States)

    Prasad, G Lakshmi; Anmol, N; Menon, Girish R

    2017-12-16

    The increasing ratio of elderly population has contributed to increased incidence of TBI in this cohort. Authors put forward their institutional experience in the management of elderly TBI. A 3-year retrospective analysis of 73 consecutive patients aged ≥ 65 years admitted with TBI at our university hospital was performed. The following were excluded-concussion injuries, chronic subdural hematomas (SDH), patients discharged against medical advice (DAMA) and declared dead soon after arrival (within 6 hours). Mode of injury, clinico-radiological features, management and outcomes were analysed. Glasgow outcome scale (GOS) was used to assess outcome. Males predominated (82%). Mean age was 72.1 years (range 65-97 years) and 20 were aged≥75 years. There were 37 mild, 18 moderate and 18 severe head injuries (HI). Contusions constituted the majority. Fifty-five(75%) cases were managed conservatively while 18(25%) underwent surgery. There were 7 deaths(9.5%). Overall, poor outcome was 26%, while being 45% in patients aged ≥75years. Poor outcome in severe HI for the entire cohort was 83% (15/18) but was 100% (7/7) for the very elderly patients. On univariate analysis, age≥75 years, severe HI, acute SDH and surgical management were significantly associated with poor outcome while acute SDH and surgical management were significant on multilogistic regression analysis. Age ≥75 years, severe HI and acute SDH are poor prognostic factors. Benefit of surgery in such conditions is unlikely and surgery needs to be judiciously considered keeping in mind the economics involved and fate of caregivers, especially in developing countries. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Oncologic results, functional outcomes, and complication rates of transperitoneal robotic assisted radical prostatectomy: single centre's experience.

    Science.gov (United States)

    Ihsan-Tasci, A; Simsek, A; Dogukan-Torer, M B; Sokmen, D; Sahin, S; Bitkin, A; Tugcu, V

    2015-03-01

    We report the operative details and short term oncologic and functional outcome of the first 334 Robotic-assisted radical prostatectomy experiences for organ confined prostate cancer From August 2009 to December 2012, details of 334 consecutive patients were retrospectively analyzed. The analyzed parameters included: preoperative, per-operative characteristics, postoperative minor and major complications, positive surgical margin continence, potency, and biochemical progression at the follow-up period. The classical extrafascial, interfascial, intrafascial and fascia sparing radical prostatectomy were performed in 31, 41, 200, and 62 cases, respectively. The mean operation time was 213.8±90.1minutes, and the mean estimated blood loss was 116.1±58.9cc during operation. A nerve-sparing procedure was performed bilaterally in 198 (59.3%) cases and unilaterally in 126 (37.7%) cases. The catheter was removed on postoperative day 9, 1±1.9. Surgical margin was positive in 36 (10.7%) patients. The overall, pT2, pT3a and pT3b PSM rates were 8 (2.4%), 12 (3.6%), 16 (4.8%) respectively and PSM and BCR rates were not statistically different among four approach (P>.05). At the follow-up period, the continence rates were 74.4%, 80.4%, 80.5%, and 96.7% (P.05), in classic extrafascial, interfascial, intrafascial, and fascia sparing intrafascial prostatectomy, respectively. RARP is a safe and feasible technique in treatment of localized prostate cancer. Fascia sparing approach has better continence rate. This results need to be supported by new prospective, randomized studies. Copyright © 2013 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Voriconazole dosing and therapeutic drug monitoring in children: experience from a paediatric tertiary care centre.

    Science.gov (United States)

    Boast, Alison; Curtis, Nigel; Cranswick, Noel; Gwee, Amanda

    2016-07-01

    Therapeutic drug monitoring (TDM) of voriconazole is recommended to achieve trough concentrations of 1-5 mg/L. In children, this is challenging due to age-related variability in voriconazole pharmacokinetics. This study describes our experience with voriconazole, focusing on dosing regimens, dose adjustment and TDM. We reviewed the medical records of immunocompromised children who received voriconazole from July 2009 to January 2015 and had TDM. Demographic, clinical and voriconazole dosing and monitoring data were collected. Fifty-five children received 62 courses of voriconazole and had TDM, with a total of 256 samples taken. Only 71.0% of courses (44/62) had TDM at the correct time, and at least one therapeutic level was achieved in only 52.3% (23/44) of these. Twenty-six courses had at least one sub-therapeutic level and in only 61.5% was the dose adjusted. Patients aged 12 years required median intravenous doses of 8.8, 7.5 and 4.0 mg/kg twice daily, respectively (P 12 years required median doses of 4.7 and 4.3 mg/kg twice daily, respectively (P = 0.307). Levels within the target range were observed to fall below 1 mg/L in 36.4% of unchanged dosing regimens. Photosensitive skin reactions (20.0%) and hepatotoxicity (12.7%) were the most frequent adverse events and occurred in children with voriconazole levels voriconazole concentrations in children, particularly in children <6 years of age. This warrants repeated TDM throughout treatment. Standardized guidelines for TDM and dose adjustment are required in children. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. Experience with the SynCardia total artificial heart in a Canadian centre.

    Science.gov (United States)

    Nguyen, Anthony; Pellerin, Michel; Perrault, Louis P; White, Michel; Ducharme, Anique; Racine, Normand; Carrier, Michel

    2017-12-01

    The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. We retrospectively analyzed the demographics, clinical characteristics and survival of all patients receiving the TAH. From September 2004 to November 2016, 13 patients (12 men, mean age 45 ± 13 yr) received the TAH for refractory cardiogenic shock secondary to idiopathic (56%) or ischemic (17%) cardiomyopathy and to other various causes (33%). Before implantation, mean ejection fraction was 14% ± 4%, 7 (54%) patients had previous cardiac surgery, 4 (31%) were on mechanical ventilation, and 3 (23%) patients were on dialysis. The mean duration of TAH support was 46 ± 40 days. Three (23%) patients died while on support after a mean of 15 days. Actuarial survival on support was 77% ± 12% at 30 days after implantation. Complications on support included stroke ( n = 1, 8%), acute respiratory distress syndrome requiring prolonged intubation ( n = 5, 38%) and acute renal failure requiring temporary dialysis ( n = 5, 38%). Ten (77%) patients survived to be transplanted after a mean of 52 ± 42 days of support. Actuarial survival rates after transplant were 67% ± 16% at 1 month and 56% ± 17% at 1 year after transplantation. The TAH provides an alternative with low incidence of neurologic events in extremely fragile and complex patients waiting for heart transplantation. Complex and unusual anatomic conditions explained the current use of TAH.

  4. Non-Hodgkin lymphoma in Romania: a single-centre experience.

    Science.gov (United States)

    Fetica, Bogdan; Achimas-Cadariu, Patriciu; Pop, Bogdan; Dima, Delia; Petrov, Ljubomir; Perry, Anamarija M; Nathwani, Bharat N; Müller-Hermelink, Hans K; Diebold, Jacques; MacLennan, Kenneth A; Fulop, Annamaria; Blaga, Mihaiela L; Coza, Daniela; Nicula, Florian Al; Irimie, Alexandru; Weisenburger, Dennis D

    2017-06-01

    Epidemiologic studies of non-Hodgkin lymphoma (NHL) in Eastern Europe are scarce in the literature. We report the experience of the "Ion Chiricuta" Institute of Oncology in Cluj-Napoca (IOCN), Romania, in the diagnosis and outcome of patients with NHL. We studied 184 consecutive NHL patients diagnosed in the Pathology Department of IOCN during the years 2004-2006. We also obtained epidemiological data from the Northwestern (NW) Cancer Registry. In the IOCN series, the most common lymphoma subtype was diffuse large B-cell lymphoma (43.5%), followed by the chronic lymphocytic leukaemia/small lymphocytic lymphoma (21.2%). T-cell lymphomas represented a small proportion (8.2%). The median age of the patients was 57 years, with a male-to-female ratio of 0.94. Patients with indolent B-cell lymphomas had the best overall survival, whereas those with mantle cell lymphoma had the worst survival. The NW Cancer Registry data showed that the occurrence of NHL in the NW region of Romania was higher in men [world age-standardized incidence rate/100 000 (ASR)-5.9; 95% CI 5.1-6.6] than in women (ASR-4.1; 95% CI 3.5-4.7) with age-standardized male-to-female ratio of 1.44 (p = 0.038). Chronic lymphocytic leukaemia/small lymphocytic lymphoma was the most common NHL in the NW region of Romania, accounting for 43% of all cases, followed by diffuse large B-cell lymphoma (36%). The 5-year, age-standardized cumulative relative survival for NHL in the County of Cluj in NW Romania, for the period of 2006-2010, was 51.4%, with 58.4% survival for men and 43.2% for women. Additional studies of NHL in Eastern Europe are needed. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  5. An Experiment on Enforcement Strategies for Managing a Local Environment Resource

    Science.gov (United States)

    Murphy, James J.; Cardenas, Juan-Camilo

    2004-01-01

    Managing local environmental resources with moderately enforced government regulations can often be counterproductive, whereas nonbinding communications can be remarkably effective. The authors describe a classroom experiment that illustrates these points. The experiment is rich in its institutional settings and highlights the challenges that…

  6. Supervised Occupational Experience Record Book for Agricultural Resource Conservation, Environmental Management and Forestry.

    Science.gov (United States)

    Nickles, Tom

    The record book was designed to meet the occupational experience recordkeeping requirements of vocational agriculture students enrolled in forestry, environmental management, or agriculture resource conservation programs in Ohio. It provides guidelines and forms for recording on-the-job, in-the-school lab, and occupational experience project data.…

  7. Narrow band imaging (NBI cystoscopy and assisted bipolar TURBT: A preliminary experience in a single centre

    Directory of Open Access Journals (Sweden)

    Roberto Giulianelli

    2017-10-01

    Full Text Available Objective: The aim of this study was to compare, in order to increase our ability to detect bladder cancer, the predictive power of narrow band imaging (NBI versus white light cystoscopy (WL. The secondary objective was to evaluate how the preoperative use of NBI cystoscopy can increase the ability to detect bladder lesions in terms of status, multi-focality and dimensions. Materials and methods: Between June 2010 and April 2012, 797 consecutive patients, 423 male and 374 female, affected by suspected bladder cancer lesions, underwent to WL plus NBI cystoscopy and subsequently to WL Bipolar Gyrus PK (Olympus, Tokyo, Japan transurethral resection of bladder tumour (WL-TURBT. The average follow-up was 24 (16-38 months. Mean age was 67.7 yrs. (range 46-88. All the patients underwent by same surgeon to WL resection (WL-TURBT of the previously identified lesions by same surgeon. All the removed tissue was sent separately for histological evaluation after mapping the areas of resection on a topographic sheet. Results: In our study we considered 797 patients that matched our inclusion criteria. Through the use of WL cystoscopy, we identified 603 patients (75.53% with suspicious lesions, instead, with the use of light NBI, we found 786 patients with suspicious lesions (98.49%.The use of NBI cystoscopy increases by approximately 30% the specific ability to detect lesions not otherwise visible with WL cystoscopy (OR 21.9 and RR 1.30, in particular for patients with lesions size < 3 cm (OR 24.00; RR 1.40, unifocal (OR: 22.28; RR 1.47 and recurrent (OR 58.4; RR 1.34. Pathology demonstrated the presence of cancer in 512 (64.2% patients, of whom 412 (51.8% were visible both with WL cystoscopy and NBI cystoscopy. In our experience, only 11 (1.38% lesions were only positive at WL cystoscopy (negative at NBI cystoscopy thus 501 (62.8%, OR 10.13; RR 1.21 patients showed bladder oncological lesions positive at NBI cystoscopy. In these patients, the use the NBI

  8. Comparison of Environmental Attitudes and Experiences of Five-Year-Old Children Receiving Preschool Education in the Village and City Centre

    Science.gov (United States)

    Durkan, Nazmi; Güngör, Hande; Fetihi, Leyla; Erol, Ahmet; Gülay Ogelman, Hülya

    2016-01-01

    The purpose of the study is to compare environmental attitudes and experiences of five-year-old children receiving preschool education in the village and city centre. The first group comprised 54 five-year-old children who received preschool education and attended kindergartens of two primary schools in the Karateke and Kocabas villages of Honaz…

  9. Student Experience and Academic Success: Comparing a Student-Centred and a Lecture-Based Course Programme

    Science.gov (United States)

    Severiens, Sabine; Meeuwisse, Marieke; Born, Marise

    2015-01-01

    Past research has shown that, under certain conditions, student-centred and small-scale course programmes result in more academic success. The present study investigates these conditions in further detail. It is examined whether, in comparison to a course programme that is relatively more lecture-based, a student-centred course programme promotes…

  10. Challenges in the management of extremity vascular injuries: A wartime experience from a tertiary centre in Sri Lanka

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    Weerasinghe CW

    2011-08-01

    Full Text Available Abstract Background Management of peripheral vascular injuries often present critical challenges in resource limited settings of developing countries. The additional burden from a military conflict poses further challenges. Delays in presentation often result in the loss of limb and even life, in what is usually a young active population. The objective of this report is to analyse the early outcome of vascular intervention at a tertiary referral centre in Sri Lanka. Methods A retrospective descriptive review of eighty one consecutive extremity vascular injuries in seventy patients during a seven month period was performed with regards to the cause of injury, types of presentations, ischaemia time, interventional procedures, complications and early outcome. Results Mean age was 31.2 years (9-72 years and 96% were males. Injuries were caused by blasts in 41%, cuts in 26%, gunshots in 17% and road traffic injuries in 9%. Indications for revascularization were acute ischaemia in 44%, active bleeding in 43% and pseudo-aneurysms in 13%. Six patients underwent primary amputations due to non-viable limbs. 64 patients underwent vascular intervention. Fifty one percent needed vein grafts while 46% had direct repairs. Bleeding was often (73% from upper extremity injuries. Median time to revascularization was 5.5 (2-16 hours with all limbs salvaged. Acute ischaemia (40% was often from popliteal injuries. Median time to revascularization was 10 (5-18 hours and viability was prejudged at fasciotomy. 92% of revascularized limbs were salvaged. There was no perioperative mortality. Conclusions Results from vascular repairs are encouraging despite significant delays.

  11. Student experiences in learning person-centred care of patients with Alzheimer's disease as perceived by nursing students and supervising nurses.

    Science.gov (United States)

    Skaalvik, Mari W; Normann, Hans Ketil; Henriksen, Nils

    2010-09-01

    The aims and objectives of this paper are to illuminate and discuss the experiences and perceptions of nursing students and supervising nurses regarding the students' learning of person- centred care of patients with Alzheimer's disease in a teaching nursing home. This information is then used to develop recommendations as to how student learning could be improved. The clinical experiences of nursing students are an important part of learning person-centred care. Caring for patients with Alzheimer's disease may cause frustration, sadness, fear and empathy. Person-centred care can be learned in clinical practice. A qualitative study. The study was performed in 2006 using field work with field notes and qualitative interviews with seven-fifth-semester nursing students and six supervising nurses. This study determined the variation in the perceptions of nursing students and supervising nurses with regards to the students' expertise in caring for patients with Alzheimer's disease. The nursing students experienced limited learning regarding person-centred approaches in caring for patients with Alzheimer's disease. However, the supervising nurses perceived the teaching nursing home as a site representing multiple learning opportunities in this area. Nursing students perceived limited learning outcomes because they did not observe or experience systematic person-centred approaches in caring for patients with Alzheimer's disease. It is important that measures of quality improvements in the care of patients with Alzheimer's disease are communicated and demonstrated for nursing students working in clinical practices in a teaching nursing home. Introduction of person-centred approaches is vital regarding learning outcomes for nursing students caring for patients with Alzheimer's disease. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  12. Single-centre experience of stereotactic radiosurgery and fractionated stereotactic radiotherapy for prolactinomas with the linear accelerator.

    Science.gov (United States)

    Wilson, Peter J; Williams, Janet Rosemary; Smee, Robert Ian

    2015-06-01

    Primary management of prolactinomas is usually medical, with surgery a secondary option where necessary. This study is a review of a single centre's experience with focused radiotherapy where benefit was not gained by medical or surgical approaches. Radiotherapy as an alternative and adjuvant treatment for prolactinomas has been performed at our institution with the linear accelerator since 1990. We present a retrospective review of 13 patients managed with stereotactic radiosurgery (SRS) and 5 managed with fractionated stereotactic radiotherapy (FSRT), as well as 5 managed with conventional radiotherapy, at the Prince of Wales Hospital. Patients with a histopathologically diagnosed prolactinoma were eligible. Those patients who had a confirmed pathological diagnosis of prolactinoma following surgical intervention, a prolactin level elevated above 500 μg/L, or a prolactin level persistently elevated above 200 μg/L with exclusion of other causes were represented in this review. At the end of documented follow-up (SRS median 6 years, FSRT median 2 years), no SRS patients showed an increase in tumour volume. After FSRT, 1 patient showed an increase in size, 2 showed a decrease in size and 2 patients showed no change. Prolactin levels trended towards improvement after SRS and FSRT, but no patients achieved the remission level of stereotactic radiation were very low in this series. © 2014 The Royal Australian and New Zealand College of Radiologists.

  13. Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme.

    Science.gov (United States)

    Öst Nilsson, Annika; Eriksson, Gunilla; Johansson, Ulla; Hellman, Therese

    2017-09-01

    In Sweden, less than 50% of those getting stroke in working age return to work (RTW). Effective rehabilitation programmes need to be developed and therapeutic aspects understood. To explore and describe how persons with stroke experience their RTW process while participating in a person-centred rehabilitation programme focusing on RTW. Seven persons with mild or moderate stroke were interviewed twice during the intervention in the vocational training phase using semi-structured interviews. Data were analysed using grounded theory. Having a coordinator by their side gave support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication created a structure for the RTW process. Expressing one's own wishes increased opportunities to influence and decide which path to follow in order to reach the goal. Straightforward, open and recurring communication facilitated the possibility to adapt to the situation. These aspects increased insight and awareness which facilitated the RTW process. The findings indicate that a precondition for a fruitful RTW process was that suitable platforms at work were created in which the actors involved could cooperate. This knowledge might also be valuable in the RTW process for people with other diagnosis.

  14. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    Energy Technology Data Exchange (ETDEWEB)

    Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz; Renc, O., E-mail: ondrejrenc@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Strýček, M., E-mail: m.strycek@gmail.com [Faculty of Medicine at Charles University (Czech Republic); Dvořák, P., E-mail: petr.dvorak@fnhk.cz; Hoffmann, P., E-mail: hoffmpet@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Guňka, I., E-mail: gunka@email.cz; Ferko, A., E-mail: a.ferko@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Surgery (Czech Republic); Ryška, P., E-mail: ryska@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Omran, N., E-mail: nidal81@gmail.com [Faculty of Medicine at Charles University and University Hospital, Department of Cardiac Surgery (Czech Republic); Krajina, A., E-mail: krajina@fnhk.cz; Čabelková, P., E-mail: pavla.cabelkova@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Čermáková, E., E-mail: cermakovae@lfhk.cuni.cz [Faculty of Medicine at Charles University, Computer Technology Center (Czech Republic); Malý, R., E-mail: malyr@volny.cz [Faculty of Medicine at Charles University and University Hospital, Department of Medicine (Czech Republic)

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  15. Factors affecting the views and experiences of women living in the city centre of Manisa, Turkey, regarding domestic violence.

    Science.gov (United States)

    Özpinar, Saliha; Dinç Horasan, Gönül; Baydur, Hakan; Canbay, Tülin

    2016-11-01

    Domestic violence against women is an important social and public health problem worldwide resulting from unequal power relationships between men and women. The purpose of the present cross-sectional descriptive study was to determine the factors affecting the views and experiences of women living in the city centre of Manisa, Turkey, regarding domestic violence. The data were collected from a representative sample of women (n=873) in 2012. The socio-demographic questionnaire and the World Health Organization's Multi-country Study on Women's Health and Domestic Violence Against Women were used for data collection. The study results revealed that of the women, 14.8% were exposed to physical violence, 7.9% to sexual violence, 20.2% to emotional violence/abuse and 11.2% to economic violence/abuse within the last 12 months. Lower income level, lower social status, lower educational level, unemployment, being exposed to parental violence during childhood and being married to husbands exposed to parental violence during childhood were associated risk factors with domestic violence. The study results indicate that domestic violence against women is a common phenomenon in Manisa.

  16. Single-centre experience of retroperitoneoscopic approach in urology with tips to overcome the steep learning curve

    Directory of Open Access Journals (Sweden)

    Aneesh Srivastava

    2016-01-01

    Full Text Available Context: The retroperitoneoscopic or retroperitoneal (RP surgical approach has not become as popular as the transperitoneal (TP one due to the steeper learning curve. Aims: Our single-institution experience focuses on the feasibility, advantages and complications of retroperitoneoscopic surgeries (RS performed over the past 10 years. Tips and tricks have been discussed to overcome the steep learning curve and these are emphasised. Settings and Design: This study made a retrospective analysis of computerised hospital data of patients who underwent RP urological procedures from 2003 to 2013 at a tertiary care centre. Patients and Methods: Between 2003 and 2013, 314 cases of RS were performed for various urological procedures. We analysed the operative time, peri-operative complications, time to return of bowel sound, length of hospital stay, and advantages and difficulties involved. Post-operative complications were stratified into five grades using modified Clavien classification (MCC. Results: RS were successfully completed in 95.5% of patients, with 4% of the procedures electively performed by the combined approach (both RP and TP; 3.2% required open conversion and 1.3% were converted to the TP approach. The most common cause for conversion was bleeding. Mean hospital stay was 3.2 ± 1.2 days and the mean time for returning of bowel sounds was 16.5 ± 5.4 h. Of the patients, 1.4% required peri-operative blood transfusion. A total of 16 patients (5% had post-operative complications and the majority were grades I and II as per MCC. The rates of intra-operative and post-operative complications depended on the difficulty of the procedure, but the complications diminished over the years with the increasing experience of surgeons. Conclusion: Retroperitoneoscopy has proven an excellent approach, with certain advantages. The tips and tricks that have been provided and emphasised should definitely help to minimise the steep learning curve.

  17. Factors associated with "Ikigai" among members of a public temporary employment agency for seniors (Silver Human Resources Centre) in Japan; gender differences.

    Science.gov (United States)

    Shirai, Kokoro; Iso, Hiroyasu; Fukuda, Hideki; Toyoda, Yasuhiro; Takatorige, Toshio; Tatara, Kozo

    2006-02-27

    "Ikigai" is culturally defined in the society of Japan as a comprehensive concept describing subjective well-being. It is considered to be related to life-satisfaction, self-esteem, morale, happiness as well as evaluation towards meaning of one's life. Although previous studies examined factors associated with Ikigai with smaller samples, consistent results have not been obtained, especially from the viewpoint of gender differences. Identification of gender-specific factors related with Ikigai among the elderly, may be of value to enhance subjective well-being. Self-administered questionnaires were distributed among 4,737 randomly selected members of the Silver Human Resources Centre (SHRC), a public temporary employment agency for seniors, in Osaka, Japan. This represents about 10% of all registered members (n = 41,593) in the 38 SHRC centres in Osaka. A total of 4,376 subjects (male: 2,913; female: 1,463) provided a satisfactory response to the questionnaire (response rate: 92%). The status whether they have "Ikigai" or not was evaluated by self-anchoring scale ranging from 0 to 5 (0 = lowest rate and 5 = highest rate of having "Ikigai"). Also, self-rated life-change score through work (-3 to 3) was evaluated by three items, i.e.) changes in (1) the number of friends through work, (2) social interests and (3) the quantity of conversation with others (1 = increase, 0 = no change, and -1 = decrease). The factors associated with "Ikigai" for total subjects were the number of rooms in one's residence, annual income, healthy life style score (Breslow), the number of working days through SHRC, satisfaction with one's life history and life-change sore through work. The multivariable odds ratio (95% CI) of having "Ikigai" was 1.9 (1.1-3.3) for persons with no change in life thorough work compared with subjects with a score of elder male and female.

  18. Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study.

    Science.gov (United States)

    Alameddine, Mohamad; Khodr, Hiba; Mourad, Yara; Yassoub, Rami; Abi Ramia, Jinane

    2016-05-01

    The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success

  19. General-purpose computer networks and resource sharing in ERDA. Volume 3. Remote resource-sharing experience and findings

    Energy Technology Data Exchange (ETDEWEB)

    1977-07-15

    The investigation focused on heterogeneous networks in which a variety of dissimilar computers and operating systems were interconnected nationwide. Homogeneous networks, such as MFE net and SACNET, were not considered since they could not be used for general purpose resource sharing. Issues of privacy and security are of concern in any network activity. However, consideration of privacy and security of sensitive data arise to a much lesser degree in unclassified scientific research than in areas involving personal or proprietary information. Therefore, the existing mechanisms at individual sites for protecting sensitive data were relied on, and no new protection mechanisms to prevent infringement of privacy and security were attempted. Further development of ERDA networking will need to incorporate additional mechanisms to prevent infringement of privacy. The investigation itself furnishes an excellent example of computational resource sharing through a heterogeneous network. More than twenty persons, representing seven ERDA computing sites, made extensive use of both ERDA and non-ERDA computers in coordinating, compiling, and formatting the data which constitute the bulk of this report. Volume 3 analyzes the benefits and barriers encountered in actual resource sharing experience, and provides case histories of typical applications.

  20. Ethics in human resource management: potential for burnout among healthcare workers in ART and community care centres.

    Science.gov (United States)

    Mala, Ramanathan; Santhosh, Kumar M; Anshul, Avijit; Aarthy, R

    2010-01-01

    This paper examines ethical dilemmas in providing care for people with HIV/AIDS. Healthcare providers in this sector are overworked, particularly in the high prevalence states. They are faced with the dual burden of the physical and the emotional risks of providing this care. The emotional risks result from their inability to control their work environment, while having to deal with the social and cultural dimensions of patients' experiences. The physical risk is addressed to some extent by post exposure prophylaxis. But the emotional risk is largely left to the individual and there is little by way of institutional responsibility for minimising this. The guidelines for training workers in care and support programmes do not include any detailed institutional mechanisms for reducing workplace stress. This aspect of the programme needs to be examined for its ethical justification. The omission of institutional mechanisms to reduce the emotional risks experienced by healthcare providers in the HIV/AIDS sector could be a function of lack of coordination across different stakeholders in programme development. This can be addressed in further formulations of the programme. Whatever the reasons may be for overlooking these needs, the ethics of this choice need to be carefully reviewed.

  1. The influence of resource subsidies on cave invertebrates: results from an ecosystem-level manipulation experiment.

    Science.gov (United States)

    Schneider, Katie; Christman, Mary C; Fagan, William F

    2011-03-01

    Spatial resource subsidies can greatly affect the composition and dynamics of recipient communities. Caves are especially tractable for studying spatial subsidies because primary productivity is absent. Here, we performed an ecosystem-level manipulation experiment to test the direct influence of detrital subsidies on community structure in terrestrial cave ecosystems. After performing baseline censuses of invertebrates, we removed all organic material from 12 caves and constructed exclusion boxes to prevent natural resource inputs. Next, we stocked each cave with standardized quantities of two major natural subsidies to caves: leaves (leaf packs) and carcasses (commercially supplied rodents), and measured the invertebrate colonization and utilization of these resources for 23 months. Over the course of the experiment, 102 morphospecies were observed. Diplopods and collembolans were most abundant on leaf packs, and dipteran larvae and collembolans were most abundant on the rats. On average, caves receiving either treatment did not differ in species richness, but abundance was significantly higher in rat caves over both the duration of the experiment and the temporal "life" of the individual resources, which were restocked upon exhaustion. Post-manipulation invertebrate communities differed predictably depending on the type of subsidy introduced. Over the course of the experiment, caves that received the same subsidy clustered together based on community composition. In addition, the invertebrate community utilizing the resource changed over the duration of the two-year experiment, and evidence of succession (i.e., directional change) was observed. Results from this study demonstrate how allochthonous resources can drive the community dynamics of terrestrial invertebrates in cave ecosystems and highlight the need for consideration of the surface environment when managing and protecting these unique habitats.

  2. Stapled Mesh stomA Reinforcement Technique (SMART) in the prevention of parastomal hernia: a single-centre experience.

    Science.gov (United States)

    Ng, Z Q; Tan, P; Theophilus, M

    2017-06-01

    Parastomal hernia remains a frequent complication following creation of an abdominal stoma. Previous interests have centred around the exploration of methods to repair; however, prophylactic mesh placement has demonstrated its efficacy in reduction of parastomal hernia. The aim of this retrospective analysis was to evaluate the outcomes of Stapled Mesh stomA Reinforcement Technique (SMART) in terms of parastomal hernia occurrence rate and mesh-related complications. All patients operated with an abdominal perineal resection or Hartmann's procedure with SMART from November 2013 to March 2016 were included. Patient demographics, operative details and stoma-related symptoms were collected. Patients were examined clinically by the medical team and also reviewed independently by a specialist stoma care nurse for signs of stoma-related complications. As part of oncological follow-up, CT scans were available for review for evidence of parastomal herniation. 14 patients (mean age 76 years) were included in the analysis. All the SMART cases were successfully completed with no intraoperative or immediate post-operative complications. No cases of mesh-related complications such as infection, immediate stomal prolapse, stenosis, retraction, stomal obstruction, mesh erosion or fistulation were observed. No mesh removal was required. There were two cases of parastomal hernia detected on CT scan. Both cases have remained asymptomatic no intervention was required at this stage. Median follow-up was 24 months. Our medium-term experience has demonstrated the efficacy of SMART in the reduction of parastomal hernia occurrence. With appropriate learning curve, parastomal hernia can be prevented.

  3. Epidemiological Study Of Burn Cases And Their Mortality Experiences Amongst Adults From A Tertiary Level Care Centre

    Directory of Open Access Journals (Sweden)

    Kumar P

    1997-01-01

    Full Text Available Research question: How to use hospital statistics in establishing epidemiology of burns amongst adults? Objectives: To identify epidemiological determinants for Ii Various burn injuries and ii their mortality experiences. Study design: Hospital based study carried out for a period of one year (1st January 1991 to 31st December 1991. Settings: Wards of department of Burn & Plastic Surgery, BJ Medical College, Ahmedabad. Participants: 386 adults (20 years and above admitted at the centre for burn injuries during 1991. Study variables: Epidemiological determinants (age, sex, temporal, place, etc. for various burn injuries and the determinants of mortality (type of burn, extent of burn, referral time lag etc. Outcome profile: Common profile of burn victims with relation to the epidemiological factors and other factors responsible for high mortality in burn cases. Statistical analysis: Chi- square and Z tests. Results:Burns occured more in females specially in the age group of 20-24 years. Eighty five percent were flame burns. Flame burns were more in females, while electric burns were more in males. Burns were less during monsoon (27.7% than winter (32.6% and summer (39.6%, but electric burns were twice more common during monsoon. Maximum burns (81.9% were domestic, occurring mainly either in kitchen or living room. They were seen more in late evening. Sixty two percent cases were severe as total burn surface area (TBSA was >40%. Case fatality correlated positively with TBSA and death was almost universal with TBSA >60%. Early referral reduced fatality significantly in less severe burns (TBSA<40% but failed to influence it in severe burns. Appraisal of alleged suicide cases (2.6% and of stove bursting (4.4% revealed that young females carry additional risk of burn injuries.

  4. Single-Centre Experience with Percutaneous Cryoablation of Breast Cancer in 23 Consecutive Non-surgical Patients

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: r.cazzato@unicampus.it [Institut Bergonié, Comprehensive Cancer Centre, Department of Medical Imaging (France); Lara, Christine Tunon de, E-mail: c.tunondelara@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Centre, Department of Surgery (France); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr; Ferron, Stéphane, E-mail: s.ferron@bordeaux.unicancer.fr; Hurtevent, Gabrielle, E-mail: g.hurtevent@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Centre, Department of Medical Imaging (France); Fournier, Marion, E-mail: m.fournier@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Centre, Department of Surgery (France); Debled, Marc, E-mail: m.debled@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Centre, Department of Medical Oncology (France); Palussière, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Centre, Department of Medical Imaging (France)

    2015-10-15

    AimTo present our single-centre prospective experience on the use of cryoablation (CA) applied to treat primary breast cancer (BC) in a cohort of patients unsuitable for surgical treatment.Materials and MethodsTwenty-three consecutive post-menopausal female patients (median age 85 years; range 56–96) underwent percutaneous CA of unifocal, biopsy-proven BC, under ultrasound/computed tomography (US/CT) guidance. Clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) follow-ups were systematically scheduled at 3, 12, 18 and 24 months. Local tumour control was assessed by comparing baseline and follow-up DCE-MRI.ResultsTwenty-three BC (median size 14 mm) were treated under local anaesthesia (78.3 %) or local anaesthesia and conscious sedation (21.7 %). Median number of cryo-probes applied per session was 2.0. A “dual-freezing” protocol was applied for the first ten patients and a more aggressive “triple-freezing” protocol for the remaining 13. Median follow-up was 14.6 months. Five patients recurred during follow-up and two were successfully re-treated with CA. Five patients presented immediate CA-related complications: four hematomas evolved uneventfully at 3-month follow-up and one skin burn resulted in skin inflammation and skin retraction at 3 and 12 months, respectively.ConclusionsPercutaneous CA is safe and well tolerated for non-resected elderly BC patients. Procedures can be proposed under local anaesthesia only. Given the insulation properties of the breast gland, aggressive CA protocols are required. Prospective studies are needed to better understand the potential role of CA in the local treatment of early BC.

  5. Including Alternative Resources in State Renewable Portfolio Standards: Current Design and Implementation Experience

    Energy Technology Data Exchange (ETDEWEB)

    Heeter, J.; Bird, L.

    2012-11-01

    Currently, 29 states, the District of Columbia, and Puerto Rico have instituted a renewable portfolio standard (RPS). An RPS sets a minimum threshold for how much renewable energy must be generated in a given year. Each state policy is unique, varying in percentage targets, timetables, and eligible resources. This paper examines state experience with implementing renewable portfolio standards that include energy efficiency, thermal resources, and non-renewable energy and explores compliance experience, costs, and how states evaluate, measure, and verify energy efficiency and convert thermal energy. It aims to gain insights from the experience of states for possible federal clean energy policy as well as to share experience and lessons for state RPS implementation.

  6. German adaptation of the Resources for Enhancing Alzheimer's Caregiver Health II: study protocol of a single-centred, randomised controlled trial.

    Science.gov (United States)

    Heinrich, Stephanie; Berwig, Martin; Simon, Anke; Jänichen, Jenny; Hallensleben, Nina; Nickel, Witiko; Hinz, Andreas; Brähler, Elmar; Gertz, Hermann-Josef

    2014-02-12

    Caring for a family member with dementia is extremely stressful, and contributes to psychiatric and physical illness among caregivers. Therefore, a comprehensive programme called Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) was developed in the United States to enhance the health of Alzheimer's caregivers. REACH II causes a clear reduction of the stress and burdens faced by informal caregivers at home. The aim of this protocol is to adapt, apply, and evaluate this proven intervention programme in a German-speaking area for the first time. This newly adapted intervention is called Deutsche Adaption der Resources for Enhancing Alzheimer's Caregiver Health (DeREACH). A total of 138 informal caregivers at home are recruited in a single-centred, randomised controlled trial. The intervention (DeREACH) consists of nine home visits and three telephone contacts over six months, all of which focus on safety, psychological well-being and self-care, social support, problem behaviour and preventive health-related behaviours. A complex intervention assessment on effectiveness will be adopted when the primary outcome - namely, the reduction of caregiver burden - and other secondary outcomes, including changes with regard to anxiety and depression, somatisation, health-related quality of life, and perceived social support, are measured at baseline, as well as immediately and three months after the intervention. The change from baseline to post-intervention assessment with regard to the primary outcome will be compared between treatment and control group using t-tests for independent samples. It is anticipated that this study will show that DeREACH effectively reduces caregiver burden and therefore works under the conditions of a local German health-care system. If successful, this programme will provide an effective intervention programme in the German-speaking area to identify and develop the personal capabilities of informal caregivers to cope with the

  7. Morphological, Phenological And Agronomical Characterisation Of Variability Among Common Bean (Phaseolus Vulgaris L. Local Populations From The National Centre For Plant Genetic Resources: Polish Genebank

    Directory of Open Access Journals (Sweden)

    Boros Lech

    2014-12-01

    Full Text Available The main purpose of this work was to analyse the morphological, phenological and agronomical variability among common bean local populations from The National Centre for Plant Genetic Resources, Polish Genebank, in order to know the relation among them, and to identify potentially useful accessions for future production and breeding. A considerable genotypic variation for number of seeds per plant, number of pods per plant and weight of seeds per plant were found. Studied bean accessions differed significantly in terms of thousand seeds weight (TSW as well as severity of bacterial halo blight and anthracnose, the major bean diseases. The lowest genotypic diversity was found for the percentage of protein in the seeds, the length of the vegetation period and lodging. The cluster analysis allowed identification of five groups of bean accessions. Genotypes from the first cluster (POLPOD 98-77, KOS 002 and Raba cv. and from the second cluster (WUKR 06-573a, KRA 4, WUKR 06-0534 together with Prosna cv. are of the highest usefulness for breeding purposes. There was no grouping of local populations depending on region of origin.

  8. Identification and assessment of potentially high-mortality intensive care units using the ANZICS Centre for Outcome and Resource Evaluation clinical registry.

    Science.gov (United States)

    McClean, Kerry; Mullany, Daniel; Huckson, Sue; van Lint, Allison; Chavan, Shaila; Hicks, Peter; Hart, Graeme; Paul, Eldho; Pilcher, David

    2017-09-01

    A hospital's highest-risk patients are managed in the intensive care unit. Outcomes are determined by patients' severity of illness, existing comorbidities and by processes of care delivered. The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE) manages a binational clinical registry to benchmark performance, and report and assess ICUs which appear to have worse outcomes than others. A descriptive retrospective cohort study was undertaken to detail processes, outcomes, limitations and practical lessons learnt from monitoring ICU performance throughout Australia and New Zealand. All ICUs contributing to the ANZICS Adult Patient Database between 2009 and 2014 were included. A potential outlier ICU was defined as one with a statistically significantly higher standardised mortality ratio (SMR) than its peer group. There were 757 188 admissions to 168 ICUs. Of these, 27 ICUs (16%) were identified as potential outlier ICUs at least once. Data quality problems led to inaccurate or artificially elevated SMRs at 16/27 ICUs. Variation in diagnostic casemix partly or completely explained the elevated SMR at 15/27 ICUs. At nine ICUs where data quality and casemix differences did not explain the elevated SMR, process-of-care problems were identified. A combination of routine monitoring techniques, statistical analysis and contextual interpretation of findings is required to ensure potential outlier ICUs are appropriately identified. This ensures engagement and understanding from clinicians and jurisdictional health departments, while contributing to the improvement of ICU practices throughout Australia and New Zealand.

  9. Study on the extension of experiment resources in the MAUS project

    Science.gov (United States)

    Anderle, H.; Boerchers, G.; Fechner, G.; Groth, V.; Haase, B.; Stolze, H.; Vits, P.

    1984-12-01

    Concepts for the extensions of the MAUS-experiment-resource-limits were analyzed. The limits for the experiment parameters such as volume, mass, energy and dissipation are increased by connecting several get away special (GAS) containers to MAUS-clusters. The analyzed concepts are discussed and for one selected concept the development phase are prepared by the design of hardware, by electronic layouts and by planning of the procurement (with working scheme and schedule).

  10. When study abroad experience fails to deliver: The internal resources threshold effect

    Science.gov (United States)

    Sunderman, Gretchen; Kroll, Judith F.

    2009-01-01

    Some second language (L2) learners return from study abroad experiences with seemingly no change in their L2 ability. In this study we investigate whether a certain level of internal cognitive resources is necessary in order for individuals to take full advantage of the study abroad experience. Specifically, we examined the role of working memory resources in lexical comprehension and production for learners who had or had not studied abroad. Participants included native English learners of Spanish. Participants completed a translation recognition task and a picture-naming task. The results suggest that individuals who lack a certain threshold of working memory resources are unable to benefit from the study abroad context in terms of being able to produce accurately in the L2. PMID:19714256

  11. When study abroad experience fails to deliver: The internal resources threshold effect.

    Science.gov (United States)

    Sunderman, Gretchen; Kroll, Judith F

    2009-01-01

    Some second language (L2) learners return from study abroad experiences with seemingly no change in their L2 ability. In this study we investigate whether a certain level of internal cognitive resources is necessary in order for individuals to take full advantage of the study abroad experience. Specifically, we examined the role of working memory resources in lexical comprehension and production for learners who had or had not studied abroad. Participants included native English learners of Spanish. Participants completed a translation recognition task and a picture-naming task. The results suggest that individuals who lack a certain threshold of working memory resources are unable to benefit from the study abroad context in terms of being able to produce accurately in the L2.

  12. Exploring the effect of experience use history and place bonding on resource substitution

    Science.gov (United States)

    Christopher J. Wynveen; Gerard T. Kyle; William E. Hammitt; James D. Absher

    2008-01-01

    Although place bonding has been a prominent aspect of human dimensions research for over 25 years, there remains a need to understand the construct's behavioral implications. One area that has received attention is the relationship between experience-use history (EUH), place bonding, and resource substitution. To further examine the relationships among these...

  13. Supervised Occupational Experience Record Book for Agricultural Resources Conservation, Environmental Management and Forestry: Teacher's Guide.

    Science.gov (United States)

    Nickles, Tom

    The guide is designed to aid the instructor in implementing the student guide entitled "Supervised Occupational Experience Record Book For Agricultural Resource Conservation, Environmental Management and Forestry". Intended for use in the secondary level vocational agriculture curriculum, general concepts, student record-keeping skills,…

  14. Resources.

    Science.gov (United States)

    Stewart, John; MacDonald, Ian

    1980-01-01

    Presents a guide to resources on television drama available to teachers for classroom use in television curriculum. Lists American and British television drama videorecordings of both series and individual presentations and offers a bibliography of "one-off" single fiction plays produced for British television. (JMF)

  15. Third-Generation Cephalosporin-Resistant Spontaneous Bacterial Peritonitis: A single-Centre Experience and Summary of Existing Studies

    Directory of Open Access Journals (Sweden)

    Jennifer Chaulk

    2014-01-01

    Full Text Available BACKGROUND: Spontaneous bacterial peritonitis (SBP is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.

  16. More than 20 years' experience of left ventricular assist device implantation at a non-transplant Centre.

    Science.gov (United States)

    Holmberg, Erica; Ahn, Henrik; Peterzén, Bengt

    2017-12-01

    Over recent decades implantable left ventricular assist devices (LVAD) have increased the possibility of improved survival in patients with advanced heart failure who also benefit from a better quality of life. The aim of this retrospective survey was to review the clinical results of LVAD implantation at a low-volume non-transplant centre (Linköping, Sweden) between 1993 and 2016. Our aim was also to assess the mortality and morbidity rates associated with implantation of three LVAD versions at our centre, and to compare our results with those from transplant centres. A retrospective cohort study was performed examining the medical records of patients who had a HeartMate(®) (HMI, HMII, HMIII) LVAD implanted as a bridge to heart transplantation (BTT) or as destination therapy (DT) at the University Hospital, Linköping. Our main finding was a survival to heart transplantation rate of 82% among our BTT LVAD patients. The most common adverse event among our patients was infection. A higher frequency of temporary dialysis was seen in the HMII group compared to the HMI group, and the frequency of right ventricular failure was higher in our HMII material. Our data suggests that patients requiring long-term LVAD support can safely have their device implanted and cared for at a non-transplant centre.

  17. Hepatic transplantation outcomes for carefully selected cirrhotic patients with hepatocellular carcinoma: experience at a small- to medium-volume centre.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Hepatic transplantation outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) at a small- to medium-volume centre are not fully known due to relative novelty of patient selection criteria. AIM: To determine hepatic transplantation outcomes for HCC at a small- to medium-volume centre. Patients and methods Hepatocellular carcinoma patients were listed for transplantation according to the International Guideline and further categorized as those fulfilling or exceeding Milan or University of San Francisco (UCSF) criteria on explanted liver morphology. Outcomes including mortality, retransplantation, and tumour recurrence rate were analysed. RESULTS: Twenty-six patients had HCC and on explanted liver morphology, Milan and UCSF criteria met 15 and 18 patients, respectively. Patients and graft survival at 3 months, 1 and 5 years were 100, 96, 84, and 88, 84, 77%, respectively. Outcomes favoured Milan criteria but did not reach statistical significance. CONCLUSIONS: Hepatic transplantation for HCC at a small-to medium-volume transplant centre had comparable survival outcomes to high-volume centres.

  18. Student experience and academic success: comparing a student-centred and a lecture-based course programme

    NARCIS (Netherlands)

    Severiens, S.; Meeuwisse, M.; Born, M.

    2015-01-01

    Past research has shown that, under certain conditions, student-centred and small-scale course programmes result in more academic success. The present study investigates these conditions in further detail. It is examined whether, in comparison to a course programme that is relatively more

  19. Factors associated with "Ikigai" among members of a public temporary employment agency for seniors (Silver Human Resources Centre in Japan; gender differences

    Directory of Open Access Journals (Sweden)

    Toyoda Yasuhiro

    2006-02-01

    Full Text Available Abstract Background "Ikigai" is culturally defined in the society of Japan as a comprehensive concept describing subjective well-being. It is considered to be related to life-satisfaction, self-esteem, morale, happiness as well as evaluation towards meaning of one's life. Although previous studies examined factors associated with Ikigai with smaller samples, consistent results have not been obtained, especially from the viewpoint of gender differences. Identification of gender-specific factors related with Ikigai among the elderly, may be of value to enhance subjective well-being. Methods Self-administered questionnaires were distributed among 4,737 randomly selected members of the Silver Human Resources Centre (SHRC, a public temporary employment agency for seniors, in Osaka, Japan. This represents about 10% of all registered members (n = 41,593 in the 38 SHRC centres in Osaka. A total of 4,376 subjects (male: 2,913; female: 1,463 provided a satisfactory response to the questionnaire (response rate: 92%. The status whether they have "Ikigai" or not was evaluated by self-anchoring scale ranging from 0 to 5 (0 = lowest rate and 5 = highest rate of having "Ikigai". Also, self-rated life-change score through work (-3 to 3 was evaluated by three items, i.e. changes in (1 the number of friends through work, (2 social interests and (3 the quantity of conversation with others (1 = increase, 0 = no change, and -1 = decrease. Results The factors associated with "Ikigai" for total subjects were the number of rooms in one's residence, annual income, healthy life style score (Breslow, the number of working days through SHRC, satisfaction with one's life history and life-change sore through work. The multivariable odds ratio (95%CI of having "Ikigai" was 1.9 (1.1–3.3 for persons with no change in life thorough work compared with subjects with a score of ≦-1. Moreover, the multivariable odds ratios were 3.5 (1.9–6.6 for a life-change score = 1, 3.1 (1

  20. Resource unpredictability promotes species diversity and coexistence in an avian scavenger guild: a field experiment.

    Science.gov (United States)

    Cortés-Avizanda, A; Jovani, R; Carrete, M; Donázar, J A

    2012-12-01

    Chance per se plays a key role in ecology and evolution, e.g., genetic mutation, resource spatiotemporal unpredictability. In community ecology, chance is recognized as a key factor in community assemblage, but less is known about its role in intraguild processes leading to species coexistence. Here we study the relevance of resource unpredictability per se as a promoter of intraguild positive interspecific interactions and as a biodiversity enhancer in an Old World avian scavenger guild, which has evolved to feed upon spatially and temporally unpredictable resources, i.e., carcasses. We performed a large-scale field experiment in which 58 carcasses were disposed of and observed until complete consumption, either in continuously active supplementary feeding stations (predictable carcasses) or disposed of at random in the field (unpredictable carcasses). Richness of scavenger species was similar at unpredictable and predictable carcasses, but their relative abundances were highly uneven at predictable carcasses leading to higher scavenger diversity (Shannon index) at unpredictable carcasses. Facilitatory interspecific processes only occurred at unpredictable resources but were disrupted in predictable conditions because the dominant specialist species (in our case, the Griffon Vulture Gyps fulvus) arrived earlier and in larger numbers, monopolizing the resource. Small, endangered scavengers congregated at supplementary feeding stations but profited less compared to unpredictable carcasses, suggesting that they could constitute an ecological trap. Our findings offer new insights into the relevance of unpredictability of trophic resources in promoting both positive facilitatory interspecific interactions and species diversity and thus maintaining the function of guilds. Finally, the preservation of randomness in resource availability and the processes associated with its exploitation should be a major goal of conservation strategies aimed to preserve scavenger guilds

  1. Loss of resources and hurricane experience as predictors of postpartum depression among women in southern Louisiana.

    Science.gov (United States)

    Ehrlich, Matthew; Harville, Emily; Xiong, Xu; Buekens, Pierre; Pridjian, Gabriella; Elkind-Hirsch, Karen

    2010-05-01

    After a natural disaster, mental disorders often become a long-term public health concern. Previous studies under smaller-scale natural disaster conditions suggest loss of psychosocial resources is associated with psychological distress. We examined the occurrence of depression 6 and 12 months postpartum among 208 women residing in New Orleans and Baton Rouge, Louisiana, who were pregnant during or immediately after Hurricane Katrina's landfall. Based on the Conservation of Resources (COR) theory, we explored the contribution of both tangible/financial and nontangible (psychosocial) loss of resources (LOR) on the outcome of depression, measured using the Edinburgh Postnatal Depression Scale (EPDS). We also investigated the influence on depression of individuals' hurricane experience through a Hurricane Experience Score (HES) that includes such factors as witnessing death, contact with flood waters, and injury to self or family members. Both tangible and nontangible LOR were associated with depression cross-sectionally and prospectively. Severe hurricane exposure (high HES) was also associated with depression. Regression analysis showed LOR-associated depression was explained almost entirely by nontangible rather than tangible factors. Consistent with COR theory, however, nontangible LOR explained some of the association between severe hurricane exposure and depression in our models. A similar result was seen prospectively for depression at 12 months, even controlling for depression symptoms at 6 months. These results suggest the need for preventive measures aimed at preserving psychosocial resources to reduce the long-term effects of disasters.

  2. Resources and constraints for addressing ethical issues in medical humanitarian work: experiences of expatriate healthcare professionals.

    Science.gov (United States)

    Hunt, Matthew R

    2009-01-01

    International nongovernmental organizations frequently provide emergency assistance in settings where armed conflict or natural disaster overwhelm the capacity of local and national agencies to respond to health and related needs of affected communities. Healthcare practice in humanitarian settings presents distinct clinical, logistical, and ethical challenges for clinicians and differs in important ways from clinical practice in the home countries of expatriate healthcare professionals. The aim of this research was to examine the moral experience of healthcare professionals who participate in humanitarian relief work. I conducted a qualitative research study using interpretive description methodology. Fifteen Canadian healthcare professionals and three human resource or field coordination officers for nongovernmental organizations were interviewed. In this article, I present findings related to expatriate healthcare professionals' experiences of resources and constraints for addressing ethical issues in humanitarian crises. Resources for ethics deliberation and reflection include the following: opportunities for discussion; accessing and understanding local perspectives; access to outside perspectives; attitudes, such as humility, open-mindedness, and reflexivity; and development of good moral "reflexes." Constraints for deliberation and reflection relate to three domains: individual considerations, contextual features of humanitarian relief work, and local team and project factors. These findings illuminate the complex nature of ethical reflection, deliberation, and decision-making in humanitarian healthcare practice. Healthcare professionals and relief organizations should seek to build upon resources for addressing ethical issues. When possible, they should minimize the impact of features that function as constraints.

  3. PanDA: Exascale Federation of Resources for the ATLAS Experiment at the LHC

    Directory of Open Access Journals (Sweden)

    Megino Fernando Barreiro

    2016-01-01

    The PanDA (Production and Distributed Analysis system was developed in 2005 for the ATLAS experiment on top of this heterogeneous infrastructure to seamlessly integrate the computational resources and give the users the feeling of a unique system. Since its origins, PanDA has evolved together with upcoming computing paradigms in and outside HEP, such as changes in the networking model, Cloud Computing and HPC. It is currently running steadily up to 200 thousand simultaneous cores (limited by the available resources for ATLAS, up to two million aggregated jobs per day and processes over an exabyte of data per year. The success of PanDA in ATLAS is triggering the widespread adoption and testing by other experiments. In this contribution we will give an overview of the PanDA components and focus on the new features and upcoming challenges that are relevant to the next decade of distributed computing workload management using PanDA.

  4. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting.

    Science.gov (United States)

    Scheepers, Renée A; Lases, Lenny S S; Arah, Onyebuchi A; Heineman, Maas Jan; Lombarts, Kiki M J M H

    2017-10-01

    Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.

  5. Activities and experience of the Federal Resource Center for Organizing Comprehensive Support for Children with ASD

    Directory of Open Access Journals (Sweden)

    Khaustov A.V.

    2016-12-01

    Full Text Available This article presents basic activities and experience of the Federal Resource Center for Organizing Comprehensive Sup¬port for Children with ASD of Moscow state university of psychology & education, amassed during 22 years of practice. Some statistic data on the center’s activity are displayed. Emphasis is done on multidirectional work and developing ways of interdepartmental and networking interaction for the sake of founding a system of complex support for autistic children in Russian Federation.

  6. Experiences from implementation of ICT for resource management in small construction companies

    DEFF Research Database (Denmark)

    Svidt, Kjeld; Christiansson, Per

    2006-01-01

    in a number of small and medium sized enterprises in Denmark. The findings are derived from the Danish project 'IT at the Construction site' started in 2003 and ended in may 2005. The project has involved a number of small to medium sized construction enterprises organizations and institutions within......This paper summarizes experiences from the process of implementation of ICT-based systems for resource management in small construction companies. The initial decision process, system requirements specification and integration, education and staff training, and end user experiences were followed...

  7. Visitor experience and resource protection framework in the National Park System: rationale, current status, and future direction

    Science.gov (United States)

    Marilyn Hof; David W. Lime

    1997-01-01

    The Visitor Experience and Resource Protection (VERP) framework was developed by the National Park Service to address carrying capacity questions associated with visitation-related resource impacts and impacts to the quality of visitor experiences. The framework can be applied as part of a park’s general management planning process (general management plans, GMPs), to...

  8. Indirect Reciprocity, Resource Sharing, and Environmental Risk: Evidence from Field Experiments in Siberia.

    Directory of Open Access Journals (Sweden)

    E Lance Howe

    Full Text Available Integrating information from existing research, qualitative ethnographic interviews, and participant observation, we designed a field experiment that introduces idiosyncratic environmental risk and a voluntary sharing decision into a standard public goods game. Conducted with subsistence resource users in rural villages on the Kamchatka Peninsula in Northeast Siberia, we find evidence consistent with a model of indirect reciprocity and local social norms of helping the needy. When participants are allowed to develop reputations in the experiments, as is the case in most small-scale societies, we find that sharing is increasingly directed toward individuals experiencing hardship, good reputations increase aid, and the pooling of resources through voluntary sharing becomes more effective. We also find high levels of voluntary sharing without a strong commitment device; however, this form of cooperation does not increase contributions to the public good. Our results are consistent with previous experiments and theoretical models, suggesting strategic risks tied to rewards, punishments, and reputations are important. However, unlike studies that focus solely on strategic risks, we find the effects of rewards, punishments, and reputations are altered by the presence of environmental factors. Unexpected changes in resource abundance increase interdependence and may alter the costs and benefits of cooperation, relative to defection. We suggest environmental factors that increase interdependence are critically important to consider when developing and testing theories of cooperation.

  9. Indirect Reciprocity, Resource Sharing, and Environmental Risk: Evidence from Field Experiments in Siberia.

    Science.gov (United States)

    Howe, E Lance; Murphy, James J; Gerkey, Drew; West, Colin Thor

    2016-01-01

    Integrating information from existing research, qualitative ethnographic interviews, and participant observation, we designed a field experiment that introduces idiosyncratic environmental risk and a voluntary sharing decision into a standard public goods game. Conducted with subsistence resource users in rural villages on the Kamchatka Peninsula in Northeast Siberia, we find evidence consistent with a model of indirect reciprocity and local social norms of helping the needy. When participants are allowed to develop reputations in the experiments, as is the case in most small-scale societies, we find that sharing is increasingly directed toward individuals experiencing hardship, good reputations increase aid, and the pooling of resources through voluntary sharing becomes more effective. We also find high levels of voluntary sharing without a strong commitment device; however, this form of cooperation does not increase contributions to the public good. Our results are consistent with previous experiments and theoretical models, suggesting strategic risks tied to rewards, punishments, and reputations are important. However, unlike studies that focus solely on strategic risks, we find the effects of rewards, punishments, and reputations are altered by the presence of environmental factors. Unexpected changes in resource abundance increase interdependence and may alter the costs and benefits of cooperation, relative to defection. We suggest environmental factors that increase interdependence are critically important to consider when developing and testing theories of cooperation.

  10. [Examples of migrant-related health education. Experiences in the development of materials by the German Federal Centre of Health Education].

    Science.gov (United States)

    Berrut, S; Blümel, S; Erath, A

    2006-09-01

    Migrants in Germany are a very heterogeneous population. This has to be taken into account when developing and distributing materials. Linguistic and cultural barriers lead to the conclusion that personal communication is the best way to approach some of the migrant groups--especially in sensitive fields like HIV and other sexually transmitted infections. The German Federal Centre of Health Education (BZgA) supports multipliers with special material for prevention and counselling. New methods for translation and distribution were developed for a family planning brochure in Turkish. Furthermore, a newsletter provides a forum for exchange of information and experiences among those working in the field of migration and health.

  11. The Case for Information Brokering During Major Change: The Experience of the Transition Support Office of the McGill University Health Centre.

    Science.gov (United States)

    Klag, Malvina; Richer, Marie-Claire

    2016-01-01

    This paper describes the emergence of an "information brokerage" in the project management office of the McGill University Health Centre (MUHC) in Montreal. This process evolved during unprecedented transformation linked to a redevelopment project. Information brokering became a core function in the MUHC's context of major change. To develop an information brokering model, the paper draws upon the literature on knowledge brokering, applies Daft and Lengel's (1986) seminal framework on information processing in organizations, and builds on the MUHC experience. The paper proposes that knowledge brokering and information brokering are related, yet distinct in content, purpose and structure.

  12. Science requirements for free-flying imaging radar (FIREX) experiment for sea ice, renewable resources, nonrenewable resources and oceanography

    Science.gov (United States)

    Carsey, F.

    1982-01-01

    A future bilateral SAR program was studied. The requirements supporting a SAR mission posed by science and operations in sea-ice-covered waters, oceanography, renewable resources, and nonrenewable resources are addressed. The instrument, mission, and program parameters were discussed. Research investigations supporting a SAR flight and the subsequent overall mission requirements and tradeoffs are summarized.

  13. In-Situ Resource Utilization Experiment for the Asteroid Redirect Crewed Mission

    Science.gov (United States)

    Elliott, J.; Fries, M.; Love, S.; Sellar, R. G.; Voecks, G.; Wilson, D.

    2015-10-01

    The Asteroid Redirect Crewed Mission (ARCM) represents a unique opportunity to perform in-situ testing of concepts that could lead to full-scale exploitation of asteroids for their valuable resources [1]. This paper describes a concept for an astronautoperated "suitcase" experiment to would demonstrate asteroid volatile extraction using a solar-heated oven and integral cold trap in a configuration scalable to full-size asteroids. Conversion of liberated water into H2 and O2 products would also be demonstrated through an integral processing and storage unit. The plan also includes development of a local prospecting system consisting of a suit-mounted multi-spectral imager to aid the crew in choosing optimal samples, both for In-Situ Resource Utilization (ISRU) and for potential return to Earth.

  14. Audit of the use of IVC filters in the UK: experience from three centres over 12 years

    Energy Technology Data Exchange (ETDEWEB)

    Hammond, C.J. [Leeds General Infirmary, Leeds (United Kingdom)], E-mail: chris.hammond@doctors.org.uk; Bakshi, D.R. [Royal Liverpool University Hospital, Liverpool (United Kingdom); Currie, R.J. [Royal Devon and Exeter Hospital, Exeter (United Kingdom); Patel, J.V. [Leeds General Infirmary, Leeds (United Kingdom); Kinsella, D. [Royal Devon and Exeter Hospital, Exeter (United Kingdom); McWilliams, R.G. [Royal Liverpool University Hospital, Liverpool (United Kingdom); Watkinson, A. [Royal Devon and Exeter Hospital, Exeter (United Kingdom); Nicholson, A.A. [Leeds General Infirmary, Leeds (United Kingdom)

    2009-05-15

    Aim: To audit the use of inferior vena cava (IVC) filter insertions at three UK centres over 12 years to assess whether trends in filter use in the UK mirrored those seen elsewhere. Materials and methods: Radiology department databases were interrogated for IVC filter insertions and removals between 1994 and 2006. Reports for these interventions, along with prior and subsequent imaging reports, were analysed. Follow-up data were obtained when available. Results: Five hundred and sixteen filters were placed with a significant year-on-year trend towards increasing use. Fifty-seven percent of filters placed were for absolute indications and 37% for relative indications. The filters were used for prophylaxis in 6% of patients in the absence of proven pulmonary embolism (PE) or deep vein thrombosis (DVT). A retrievable filter was used in 74% of cases with retrieval attempted in 40% of these and no evidence of an increasing rate of retrieval over time. A significant complication related to insertion or retrieval was encountered in 0.4 and 1% of procedures, respectively. Mean 24 h and 30 day mortalities were 1 and 8%, respectively. There was an absence of organized follow-up at all three centres. Conclusion: IVC filter use in the UK is increasing. The use of retrievable filters has not resulted in increased filter retrieval. Filter insertion and retrieval is associated with a low risk of significant complication, but lack of systematic follow-up limits conclusions regarding safety and efficacy.

  15. The model of localized business community economic development under limited financial resources: computer model and experiment

    Directory of Open Access Journals (Sweden)

    Berg Dmitry

    2016-01-01

    Full Text Available Globalization processes now affect and are affected by most of organizations, different type resources, and the natural environment. One of the main restrictions initiated by these processes is the financial one: money turnover in global markets leads to its concentration in the certain financial centers, and local business communities suffer from the money lack. This work discusses the advantages of complementary currency introduction into a local economics. By the computer simulation with the engineered program model and the real economic experiment it was proved that the complementary currency does not compete with the traditional currency, furthermore, it acts in compliance with it, providing conditions for the sustainable business community development.

  16. Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: a single-centre experience and summary of existing studies.

    Science.gov (United States)

    Chaulk, Jennifer; Carbonneau, Michelle; Qamar, Hina; Keough, Adam; Chang, Hsiu-Ju; Ma, Mang; Kumar, Deepali; Tandon, Puneeta

    2014-02-01

    Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America. To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature. SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality. In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality. Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.

  17. Clinical Experiences with the FRONT Formula for Pre-Operative Airway Assessment and Documentation: a Multi-Centre Study.

    Science.gov (United States)

    Mitre, Calin; Mitre, Ileana; Gyöngyösi, Zoltán; Fülesdi, Béla; Zdrehus, Claudiu; Breazu, Caius; Biro, Peter

    2017-08-01

    The prediction of difficult airway is one of the most important challenges before general anaesthesia. This study aimed to assess the clinical usefulness of the FRONT score, a recently developed scoring system to predict and document airway difficulties. This multi-centre, inter-observer, prospective and double-blinded study included 976 patients from two university centres. The pre-operative evaluation of the patients was performed by a pre-operative team of anaesthesiologists (team A) who evaluated and scored the expected difficulty of airway management. An intra-operative team of evaluators (team B) working independently of team A, performed the actual instrumentation of the airway and scored the actual findings. Both teams used the FRONT scoring system and worked independently of each other to ensure blinded assessments. The statistical analysis of the pre- and intra-operative FRONT scores was performed in an off-line blinded manner. Our results show a fair and promising association between pre-operative composite FRONT score and that observed at the induction phase (Spearman=0.43). Among the score components, the best correlation was observed for the F and R components (kappa=0.44 and 0.36, respectively), and the worse correlation was observed for the O and T components (kappa=0.25 and 0.24, respectively). The FRONT formula for the prediction and documentation of the airway status is a simple and effective method for assessing and defining airway management difficulties. Further prospective studies are required to assess the sensitivity and specificity of the system.

  18. [The natural resources of the expedition bay as a basis for the creation of the health resort centre at the coast of the Peter the Great Bay, the Sea of Japan].

    Science.gov (United States)

    Vasil'chenko, V F; Badalov, N G; Derkacheva, L N

    2014-01-01

    The present article presents characteristics of the therapeutic and health promoting potential of the Expedition Bay, (part of the Peter the Great Bay, the Sea of Japan), known to be a deposit of therapeutic sea muds. The great variety of local therapeutic natural resources, viz. sea muds, sea weeds, friendly climate, beeches, etc., can be used for the treatment and prevention of various diseases. The Expedition Bay was designated as a local area of recreational and therapeutic value that can be used as a basis for the creation and further development of the multi-field health resort centre (or medical spa) that would attract patients from other regions of Russia and the surrounding countries. The future centre would provide medical services based in the first place on the classical methods of climatic and peloid therapy, thalassotherapy (heliotherapy, aeroionotherapy, bathing, marine algae therapy, etc.) as well as the modern balneotherapeutic and spa technologies, therapeutic tourism for the purpose of rehabilitation and health promotion.

  19. Utilising the resources of the International Knockout Mouse Consortium: the Australian experience.

    Science.gov (United States)

    Cotton, Leanne M; Meilak, Michelle L; Templeton, Tanya; Gonzales, Jose G; Nenci, Arianna; Cooney, Melissa; Truman, Dirk; Rodda, Fleur; Lynas, Alyce; Viney, Elizabeth; Rosenthal, Nadia; Bianco, Deborah M; O'Bryan, Moira K; Smyth, Ian M

    2015-04-01

    Mouse models play a key role in the understanding gene function, human development and disease. In 2007, the Australian Government provided funding to establish the Monash University embryonic stem cell-to-mouse (ES2M) facility. This was part of the broader Australian Phenomics Network, a national infrastructure initiative aimed at maximising access to global resources for understanding gene function in the mouse. The remit of the ES2M facility is to provide subsidised access for Australian biomedical researchers to the ES cell resources available from the International Knockout Mouse Consortium (IKMC). The stated aim of the IKMC is to generate a genetically modified mouse ES cell line for all of the ~23,000 genes in the mouse genome. The principal function of the Monash University ES2M service is to import genetically modified ES cells into Australia and to convert them into live mice with the potential to study human disease. Through advantages of economy of scale and established relationships with ES cell repositories worldwide, we have created over 110 germline mouse strains sourced from all of the major ES providers worldwide. We comment on our experience in generating these mouse lines; providing a snapshot of a "clients" perspective of using the IKMC resource and one which we hope will serve as a guide to other institutions or organisations contemplating establishing a similar centralised service.

  20. Perceived effects of organizational downsizing and staff cuts on the stress experience: the role of resources.

    Science.gov (United States)

    Boyd, Carolyn M; Tuckey, Michelle R; Winefield, Anthony H

    2014-02-01

    In response to global financial pressures, retail companies have introduced measures to reduce costs by cutting staff allocations to individual outlets. On the basis of interview data from four employees of a large retail organization, this paper employs an ideographic case-study approach to illustrate how the processes linking job characteristics to job-related strain and well-being (e.g. appraisal, action regulation, coping, resource utilization) unfold within four individual workers, as they attempt to manage perceived increases in demands resulting from staff cuts. We highlight the importance that these employees place on their own psychological resources (e.g. self-efficacy) and coping mechanisms (e.g. disengagement) in dealing with these changes, as well as how the perceived availability or absence of job resources (e.g. social support, decision authority, organizational justice) influences their ability to cope with increased demands. We use the insights gained from the case studies to illustrate the value of integrating multiple theoretical perspectives towards achieving a nuanced understanding of the intricacies involved in these experiences and to suggest ways in which the coping capacities of individual employees might be increased. Copyright © 2013 John Wiley & Sons, Ltd.

  1. Fertilization effects of organic waste resources and bottom wood ash: results from a pot experiment

    Directory of Open Access Journals (Sweden)

    Eva Brod

    2012-12-01

    Full Text Available We conducted a pot experiment to study the fertilization effects of four N- and P-rich organic waste resources alone and in combination with K-rich bottom wood ash at two application rates (150 kg N ha–1 + 120 kg K ha–1, 300 kg N ha-1 + 240 kg K ha–1. Plant-available N was the growth-limiting factor. 48–73% of N applied with meat and bone meal (MBM and composted fish sludge (CFS was taken up in aboveground biomass, resulting in mineral fertilizer equivalents (MFE% of 53–81% for N uptake and 61–104% for yield. MFE% of MBM and CFS decreased for increasing application rates. Two industrial composts had weak N fertilization effects and are to be considered soil conditioners rather than fertilizers. Possible P and K fertilization effects of waste resources were masked by the soil’s ability to supply plant-available P and K, but effects on plant-available P and K contents in soil suggest that the waste resources may have positive effects under more nutrient-deficient conditions.

  2. Cisplatin chemotherapy for haemostasis in bleeding cervical cancer: experience from a resource-poor setting.

    Science.gov (United States)

    Adewuyi, Sunday Adeyemi; Shittu, Oladapo S; Rafindadi, A H; Zayyan, M S; Samaila, M O A; Oguntayo, A O

    2010-06-01

    Cervical cancer is the commonest cancer in northern Nigeria. There are only two radiotherapy centers in the north and four centres in the south, each with only one megavoltage machine for a population of over 140 million. The number of patients requiring radiotherapy for various malignancies is beyond the available facilities and expertise leading to long waiting time and disease progression with its attendant sequelae. This is the basis of using other orthodox treatment modalities as first line. Between January 2006 and December 2007, 116 patients with histologically confirmed cervical cancer with vaginal bleeding as the predominant symptom were treated. Patients presenting with torrential haemorrhage were excluded from this study as they constitute oncologic emergencies. Patients were interviewed with a structured pro forma on a 3-weekly basis during chemotherapy schedules to assess and evaluate per vaginal bleeding and discharge. Dose of chemotherapy was 70 mg/m² every 3 weeks. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. The median age was 49 years (27-80 yrs). 62 patients were having per vagina bleeding for more than 6 months before commencement of chemotherapy (range 1-60 months). 49 patients had blood transfusion before chemotherapy, average of 2.7 pints of blood transfused per patient. 84 had at least FIGO stage IIIA disease. Squamous cell carcinoma is the commonest histology type followed by adenocarcinoma with 95 and 16 patients respectively. 81 patients had complete cessation of per vagina bleeding with 69 having complete cessation on or before 4th course of chemotherapy (9th week) and complete cessation of per vagina discharges was seen in 52 patients. 115 patients had a performance status KPS of below 80 prior to chemotherapy, and after completing 6 cycles, 100 patients had KPS of 80 and above. In resource-poor setting, Cisplatin based chemotherapy can be used by medical, gynaecological oncologists and general

  3. Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

    Science.gov (United States)

    Kakyo, Tracy Alexis; Xiao, Lily Dongxia

    2017-06-01

    Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

  4. Decision Support Systems for Water Resources Management in Developing Countries: Learning from Experiences in Africa

    Directory of Open Access Journals (Sweden)

    Carlo Giupponi

    2013-06-01

    Full Text Available Decision support system (DSS tools are rather popular in the literature on water resources management. The European Project “Splash” conducted a survey of the literature and of DSS implementation in developing countries with specific reference on Africa. Experts in the field were consulted through an ad hoc questionnaire and interviews. The results of the survey indicate that the exchange of experiences amongst projects with similar objectives or even the same case study is very limited, with a tendency towards restarting every time from scratch. As a consequence, it seems that DSS developments have produced only limited positive impacts. Most experts contacted shared either the frustration deriving from the limited impacts on intended end-users, who rarely used the tool after the project end, or in the case of ongoing projects, the preoccupation for future maintenance. Responses from the questionnaires indicate that priority efforts should not focus on developing the tools, but rather on improving the effectiveness and applicability of integrated water resource management legislative and planning frameworks, training and capacity building, networking and cooperation, harmonization of transnational data infrastructures and, very importantly, learning from past experiences and adopting enhanced protocols for DSS development.

  5. CATERING STUDENTS' NEEDS TO PROMOTE AESTHETIC EXPERIENCE IN EFL LITERATURE CLASS WITH REFERENCE TO RESPONSE-CENTRED CURRICULUM

    National Research Council Canada - National Science Library

    Ishkak Said

    2015-01-01

    ... with. In this respect, the existing literature curricula should ideally reflect aesthetic experiences that enhance students' freedom and enjoyment with literary works assigned The present study examines...

  6. Experience of health-system pharmacy administration residents in a longitudinal human resource management program.

    Science.gov (United States)

    Amerine, Lindsey B Poppe; Granko, Robert P; Savage, Scott W; Daniels, Rowell; Eckel, Stephen F

    2014-12-15

    The experience of health-system pharmacy administration (HSPA) residents in a longitudinal human resource (HR) management program is described. The subsequent benefits to the residents, department, and profession are also discussed. Postgraduate year 2 HSPA residents at an academic medical center desired more responsibility for managing an operational area. To this end, a program was created in which these residents directly manage a small group of pharmacy technicians and report to a clinical manager or assistant director with oversight responsibility. These "resident managers" are responsible, under the direction of the area's clinical manager, for the personnel, schedule, time and attendance, and HR activities of the area. Resident managers have led and sustained operational improvement projects in their areas. In addition to providing learning experiences to residents, the HSPA residency program has also improved the operations of the areas in which these residents work. Benefits to the residents include conducting annual performance evaluations for employees with whom they have a relationship as it is a task every administrator completes. Resident managers at UNC have consistently stated that this longitudinal HR experience is one of the most rewarding and most challenging experiences offered in the two-year HSPA residency. The involvement of HSPA residents in longitudinal management responsibilities furthers residents' leadership success by providing trained managers who are ready to immerse themselves into practice postresidency, having employee engagement and HR skills as well as experiences with leading operational improvements. A longitudinal HR management experience was successfully incorporated into an HSPA residency combined Master of Science degree program. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. Providing International Research Experiences in Water Resources Through a Distributed REU Program

    Science.gov (United States)

    Judge, J.; Sahrawat, K.; Mylavarapu, R.

    2012-12-01

    Research experiences for undergraduates offer training in problem solving and critical thinking via hands-on projects. The goal of the distributed Research Experience for Undergraduates (REU) Program in the Agricultural and Biological Engineering Department (ABE) at the University of Florida (UF) is to provide undergraduate students a unique opportunity to conduct research in water resources using interdisciplinary approaches, integrating research and extension, while the cohort is not co-located. The eight-week REU Program utilizes the extensive infrastructure of UF - Institute of Food and Agricultural Sciences (IFAS) through the Research and Education Centers (RECs). To provide international research and extension experience, two students were located at the International Crop Research Institute for the Semi-Arid Tropics (ICRISAT), in India. Prior to the beginning of the Program, the students worked closely with their research mentors at University of Florida and ICRISAT to develop a project plan for understanding the water quality issues in two watersheds. The students were co-located during the Orientation week at the University of Florida. During the Program, they achieved an enriching cohort experience through social networking, daily blogs, and weekly video conferences to share their research and other REU experiences. The group meetings and guest lectures are conducted via synchronously through video conferencing. The students who were distributed across Florida benefited from the research experiences of the students who were located in India, as their project progressed. They described their challenges and achievements during the group meetings and in the blogs. This model of providing integrated research and extension opportunities in hydrology where not all the REU participants are physically co-located, is unique and can be extended to other disciplines.

  8. Estonian Experience on Establishment of a Modern National Poison Information Centre: One-year Profile of Phone Calls in 2012

    Directory of Open Access Journals (Sweden)

    Mare Oder

    2013-06-01

    Full Text Available Background: Initiating a National Poisoning Information Centre (PIC in Estonia took about 12 years of challenging work on research, training and attracting governmental support and funding. In this study we described the establishment process and the profile of phone calls in the first year which the PIC started to be available full time (24h/day 7days/week.  Methods: This was a descriptive retrospective study. Relevant documents from 2000-2012 were reviewed. The documents were categorized into 5 main issues against establishment of PIC. Data of all inquiries related to toxic agent exposures regarding patient’s demographic, intention of poisoning and type of toxic substances in 2012 were collected. The data were reported with frequency and percentage. Results: During establishment process, 386 documents including governmental regulations and contracts, memorandums from meetings, professional e-mails, newspaper articles, interviews, annual reports and program sheets of other poison centres and conference presentations were collected. Funding was provided form PHARE and BTox projects (2000-2003, and government of Estonia (2004-2012. Educational programs were held to train specialists in clinical toxicology and poisoning information to direct the PIC. The active phase of establishment started in 2004; however, the services of PIC became available at the beginning of 2008. In 2012, total number of calls was 1118. 20% of calls were related to general questions about pharmaceuticals and non-toxic agents. 894 calls were related to acute poisoning cases. Most of them (87.9% were due to accidental poisoning. The most common types of substances responsible for poisoning were pharmaceutical products (30.2%, household products (29.5% and plant toxins (11.1%. Conclusion: To establish a stable PIC, it is crucial to have a wide range data backbone, clear support and direct funding from the government, assistance from collaborative PICs, active international

  9. Student-centred learning in Community Medicine: An experience from Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry.

    Science.gov (United States)

    Kar, S S; Premarajan, K C; L, Subitha; Archana, R; Iswarya, S; A, Sujiv

    2014-01-01

    Student-centred learning (SCL) places the student at the centre of policies, practices and decision-making in the teaching-learning process. SCL methodology also advocates active involvement of students in the curriculum planning, selection of teaching-learning methods and assessment process. We planned an education innovation project to assess the perception of fifth semester undergraduate medical students towards implementation of an SCL methodology. The study was done among 87 fifth semester undergraduate medical students (batch of 2010-11) in the noncommunicable disease epidemiology section of Community Medicine at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. The students divided themselves into seven groups and developed the learning objectives, selected teaching-learning methods and assessment process for each session. The facilitators had 3-5 rounds of interaction with each group before the session. Qualitative analysis of feedback collected from students and external faculty after each session was done. The effect of implementing the SCL methodology was assessed by the reaction level of Kirkpatrick's training evaluation model by using a rating scale Results. Of the 87 eligible students, 73 (83.9%) returned the forms for evaluation. All seven groups were able to formulate the learning objectives. Most of the groups had used PowerPoint slides and videos as a teaching-learning tool. Innovative assessment methods such as crosswords and 'chocopati' were used by some groups. In general, the perception of students was favourable towards SCL compared to conventional methods and they felt that this methodology should be adopted more often. Time management and organization of sessions were the main problems encountered by the students. The mean (SD) score for the items 'sessions were useful', 'sessions were enjoyable' and 'sessions improved my knowledge' were 6.2 (1.8), 7.1 (1.8) and 6.3 (1.9), respectively. The

  10. ERCP in a cohort of 759 cases: A 6-year experience of a single tertiary centre in Libya.

    Science.gov (United States)

    Tumi, Ali; Magadmi, Masoud; Elfageih, Salah; Rajab, Abdul-Fatah; Azzabi, Masoud; Elzouki, Abdel-Naser

    2015-03-01

    The aim of this study was to review the indications, findings, technical success, and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures in a large cohort of patients admitted to a single tertiary centre in Libya. A total of 759 consecutive ERCP procedures were performed in 704 patients from January 2005 through December 2010 at the Endoscopy Unit of Central Hospital, Tripoli, Libya. The patients' demographic characteristics, clinical information, ERCP indications, laboratory parameters, and post-ERCP complications were reviewed. Formal written consent was obtained from all patients prior to each procedure. The study included 280 (36.9%) males and 479 (63.1%) females with mean age ± standard deviation (SD) of 56.8 ± 18.7 years. Papillotomy was performed in 670 (88.3%) cases of the ERCP procedures. Common bile duct (CBD) stones were reported in 389 (51.3%) cases and were more frequent in females (234 cases, 60.1%) than males (155, 39.9%) (p = 0.01). The majority of the CBD stones were successfully retrieved with balloon extraction (304 cases, 78.2%), while mechanical lithotripsy (67 cases, 17.2%) and Dormia basket (11 cases, 2.8%) were used for difficult stones. Only seven (1.8%) cases were referred for surgery. Malignancy was found in 151 (19.9%) of the cases and was significantly more common in males than females (102, 67.5% vs. 49, 32.5%, respectively, p = 0.001). Stents for bile drainage were inserted in 26 (17.2%) of these cases. The complications encountered were acute pancreatitis in 30 cases (3.9%), minor bleeding in nine cases (1.2%), major bleeding in one case (0.15%), cholangitis in four cases (0.52%), and perforation in one case (0.15). Mortality was reported in three cases (0.4%). The ERCP indications and the related complications, in our centre in Libya, are comparatively consistent with those reported data in other countries. Successful biliary cannulation was achieved in most of the patients, and post-ERCP complications

  11. The Second Victim Experience and Support Tool: Validation of an Organizational Resource for Assessing Second Victim Effects and the Quality of Support Resources.

    Science.gov (United States)

    Burlison, Jonathan D; Scott, Susan D; Browne, Emily K; Thompson, Sierra G; Hoffman, James M

    2017-06-01

    Medical errors and unanticipated negative patient outcomes can damage the well-being of health care providers. These affected individuals, referred to as "second victims," can experience various psychological and physical symptoms. Support resources provided by health care organizations to prevent and reduce second victim-related harm are often inadequate. In this study, we present the development and psychometric evaluation of the Second Victim Experience and Support Tool (SVEST), a survey instrument that can assist health care organizations to implement and track the performance of second victim support resources. The SVEST (29 items representing 7 dimensions and 2 outcome variables) was completed by 303 health care providers involved in direct patient care. The survey collected responses on second victim-related psychological and physical symptoms and the quality of support resources. Desirability of possible support resources was also measured. The SVEST was assessed for content validity, internal consistency, and construct validity with confirmatory factor analysis. Confirmatory factor analysis results suggested good model fit for the survey. Cronbach α reliability scores for the survey dimensions ranged from 0.61 to 0.89. The most desired second victim support option was "A respected peer to discuss the details of what happened." The SVEST can be used by health care organizations to evaluate second victim experiences of their staff and the quality of existing support resources. It can also provide health care organization leaders with information on second victim-related support resources most preferred by their staff. The SVEST can be administered before and after implementing new second victim resources to measure perceptions of effectiveness.

  12. Supporting Shared Resource Usage for a Diverse User Community: the OSG Experience and Lessons Learned

    Science.gov (United States)

    Garzoglio, Gabriele; Levshina, Tanya; Rynge, Mats; Sehgal, Chander; Slyz, Marko

    2012-12-01

    The Open Science Grid (OSG) supports a diverse community of new and existing users in adopting and making effective use of the Distributed High Throughput Computing (DHTC) model. The LHC user community has deep local support within the experiments. For other smaller communities and individual users the OSG provides consulting and technical services through the User Support area. We describe these sometimes successful and sometimes not so successful experiences and analyze lessons learned that are helping us improve our services. The services offered include forums to enable shared learning and mutual support, tutorials and documentation for new technology, and troubleshooting of problematic or systemic failure modes. For new communities and users, we bootstrap their use of the distributed high throughput computing technologies and resources available on the OSG by following a phased approach. We first adapt the application and run a small production campaign on a subset of “friendly” sites. Only then do we move the user to run full production campaigns across the many remote sites on the OSG, adding to the community resources up to hundreds of thousands of CPU hours per day. This scaling up generates new challenges - like no determinism in the time to job completion, and diverse errors due to the heterogeneity of the configurations and environments - so some attention is needed to get good results. We cover recent experiences with image simulation for the Large Synoptic Survey Telescope (LSST), small-file large volume data movement for the Dark Energy Survey (DES), civil engineering simulation with the Network for Earthquake Engineering Simulation (NEES), and accelerator modeling with the Electron Ion Collider group at BNL. We will categorize and analyze the use cases and describe how our processes are evolving based on lessons learned.

  13. Low-target tacrolimus in de novo standard risk renal transplant recipients: A single-centre experience.

    Science.gov (United States)

    Størset, Elisabet; Åsberg, Anders; Hartmann, Anders; Reisaeter, Anna V; Holdaas, Hallvard; Skauby, Morten; Bergan, Stein; Midtvedt, Karsten

    2016-10-01

    Optimal tacrolimus exposure in transplant recipients is not well established. The results from the Symphony study indicated that low-target tacrolimus (trough concentrations 3-7 µg/L) in de novo standard risk renal transplant recipients should be appropriate. The aim of this study was to evaluate real-life outcomes when applying a similar strategy in a clinical setting. A single-centre analysis was conducted in standard risk renal transplant recipients receiving low-target tacrolimus, mycophenolate mofetil, glucocorticoids and basiliximab induction. One-year estimated glomerular filtration rate (eGFR, Cockcroft-Gault), one-year biopsy-proven acute rejection rate and graft- and patient survival up to 3 years post-transplant were compared with the outcomes in the Symphony study. From 1 January 2009 to 31 March 2013, we included 406 patients. One year after transplantation, the mean ± SD eGFR was 76.8 ± 28.3 mL/min (Symphony: 65.4 ± 27.0 mL/min, P tacrolimus-based immunosuppression is safe and effective also in a standard clinical setting in de novo standard risk renal transplant recipients. © 2016 Asian Pacific Society of Nephrology.

  14. Cochlear re-implant rates in children: 20 years experience in a quaternary paediatric cochlear implant centre.

    Science.gov (United States)

    Trozzi, Marilena; Powell, Harry R F; Toma, Shamim; Ahmed, Waseem; Jephson, Christopher G; Rajput, Kaukab; Cochrane, Lesley A

    2015-10-01

    The aim of this study is to determine the incidence and causes for cochlear explantation/re-implantation in children as a retrospective case review in a Quaternary paediatric Cochlear Implant (CI) Centre. The subjects included in the study were Paediatric CI patients requiring cochlear explantation/re-implantation. Outcome measurements were incidence and aetiology of device explantation/re-implantation. Patient age at implantation, aetiology of deafness, CI manufacturer, and timing of explantation/re P implantation were the independent variables. 778 paediatric cochlear implants were performed in 653 children between 1992 and January 2013. There were a total of 40 (5.1%) failed implants in 38 patients. The most common reason for explantation was device failure in 22 (2.8%). Risk factors for device failure were known manufacturing defect/device recall. Medical/surgical issues accounted for 18 (2.3%) implant failures. The mean time to explantation was 3 years 10 months. The incidence of explantation/re-implantation in our paediatric cochlear implant population is comparable to other published studies. The most common reason for explantation was device failure, however, the aetiology of deafness, in particular meningitis, does not appear to increase the risk of explantation as described in previous series.

  15. Mortality on the Waiting List for Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis: A Single-Centre Experience.

    Science.gov (United States)

    Bennett, David; Fossi, Antonella; Bargagli, Elena; Refini, Rosa Metella; Pieroni, Maria; Luzzi, Luca; Ghiribelli, Claudia; Paladini, Piero; Voltolini, Luca; Rottoli, Paola

    2015-10-01

    Lung transplantation (LTX) is nowadays accepted as a treatment option for selected patients with end-stage pulmonary disease. Idiopathic pulmonary fibrosis (IPF) is characterized by the radiological and histologic appearance of usual interstitial pneumonia. It is associated with a poor prognosis, and LTX is considered an effective treatment to significantly modify the natural history of this disease. The aim of the present study was to analyse mortality during the waiting list in IPF patients at a single institution. A retrospective analysis on IPF patients (n = 90) referred to our Lung Transplant Program in the period 2001-2014 was performed focusing on patients' characteristics and associated risk factors. Diagnosis of IPF was associated with high mortality on the waiting list with respect to other diagnosis (p Pulmonary function tests failed to predict mortality and no other medical conditions were associated with survival. Patients newly diagnosed with IPF, especially in small to medium lung transplant volume centres and in Countries where a long waiting list is expected, should be immediately referred to transplantation, delay results in increased mortality. Early identification of IPF patients with a rapid progressive phenotype is strongly needed.

  16. Implementation of resources to support patient physical activity through diabetes centres in Nova Scotia: the effectiveness of enhanced support for exercise participation.

    Science.gov (United States)

    Fowles, Jonathon R; Shields, Chris; d'Entremont, Lisette; McQuaid, Stephanie; Barron, Brittany; Dunbar, Peggy

    2014-12-01

    The purpose of this study was to determine the effectiveness of enhancing support for physical activity counselling and exercise participation at diabetes centres in Nova Scotia on physical activity and exercise behaviours and clinical outcomes in patients with type 2 diabetes mellitus. In all, 180 patients at 8 diabetes centres participated in this observational study. A range of enhanced supports for exercise were offered at these centres. A kinesiologist was added to the diabetes care team to primarily provide extra physical activity counselling and exercise classes. Patient physical activity and exercise levels, efficacy perceptions and mean glycated hemoglobin (A1C) were evaluated at baseline and 6 months. We compared changes in these variables for patients who participated in the enhanced supports versus patients who did not. Participants who attended exercise classes (n=46), increased moderate physical activity by 27% and doubled resistance exercise participation (1.0±1.8 to 2.0±2.1 days per week) whereas those who did not attend exercise classes (n=49) reduced moderate physical activity by 26% and did not change resistance exercise participation (interactions, p=0.04 and p=0.07, respectively). Patients who received resistance band instruction (n=15) from a kinesiologist had reductions in A1C (from 7.5±1.4 to 7.1±1.2; p=0.04), whereas other subgroups did not have significant changes in A1C. Offering enhanced support for exercise at diabetes centres produced improvements in physical activity and exercise in type 2 diabetes patients. Resistance band instruction from a kinesiologist combined with participating in a walking and resistance training program improved glycemic control, which underscores the importance of including exercise professionals in diabetes management. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  17. Centralized resources for nurse practitioners: common early experiences among leaders of six large health systems.

    Science.gov (United States)

    Bahouth, Mona N; Ackerman, Michael; Ellis, Elizabeth F; Fuchs, Janet; McComiskey, Carmel; Stewart, Elizabeth S; Thomson-Smith, Clare

    2013-04-01

    This article describes common experiences of institutions that have pioneered the work of integrating nurse practitioners (NPs) into complex hospital environments and addresses effective strategies in achieving a centralized leadership model. We conducted an informal, written survey and focus group discussions comparing experiences of leaders who were first in the position of centralizing resources and providing leadership for NPs in a hospital-based setting. Experiences were compared and common practices summarized. The numbers of NPs required to provide patient care in an ever-growing, complex hospital environment are increasing rapidly. To meet the professional needs of these hospital-based NPs, a strong centralized leadership approach should be utilized. An organized and centralized approach to credentialing, program development, orientation, and evaluation processes will become necessary as hospitals continue to hire increased numbers of NPs. This article summarizes important considerations for formulating centralized leadership models for hospital-based NPs and provides a guide for administrators and NPs who are attempting to build similar models. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

  18. EPIDEMIOLOGICAL ANALYSIS AND CLINICAL CHARACTERISTICS OF TRAUMATIC BRAIN INJURIES IN RURAL JAIPUR: THE FIRST SINGLE CENTRE EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Pankaj

    2015-11-01

    Full Text Available BACKGROUND Trauma is one of the leading causes of death and disability in the Indian Population. OBJECTIVE To evaluate and describe the epidemiological and clinical characteristics of patients with traumatic brain injury and their clinical outcomes following admission to a rural tertiary care teaching hospital in India. STUDY DESIGN Retrospective, cross-sectional, hospital based analysis of 1713 patients of Traumatic Brain Injury [TBI] admitted to the Department of Neurosurgery in a tertiary health centre in Jaipur from January 2014 to August 2015. METHOD The medical records of all eligible patients were reviewed and data collected on age, sex, mechanism of injury, severity of injury Glasgow Coma Scale (GCS and Outcome (GOS score, Computed Tomography (CT scan results, modality of management and type of surgical intervention and outcome. RESULTS Among the 1713 patients admitted, age of patients varied >1 year to 92 years (mean age 21 years, majority of TBI’s were reported in the age group 20–29 years (34.38%, followed by 30–39 years (26.97%, 40–49 years (16.70%, p value <0.05. Most of the patients were male (63.46%, mostly unmarried. Majority lived in sub-urban areas (51.26% followed by rural (26.85% and urban (21.89%. Patients were mostly from middle class (46.58% and poor socio-economic background (42.62%, upper class only accounted for 10.8% of the cases. In terms of occupation, servicemen and farmers accounted for the majority (54.73%. Patients were brought to the hospital mainly by known persons (68% and rest by bystanders and policemen. The most common mechanism of injury was road traffic accidents (RTA 1199 (69.99%, followed by assault 251 (14.65%, 15.35% accounted for fall from height and fall of object on head. Mean hospital stay was 7.6±9.3 days (range <1 day to 87 days. In our study, patients were classified by GCS as mild TBI in 983(57.38% patients; moderate in 488 (28.48% and severe in 242 (14.12. 1481 (86.46% patients

  19. Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre.

    Science.gov (United States)

    Nachira, Dania; Chiappetta, Marco; Fuso, Leonello; Varone, Francesco; Leli, Ilaria; Congedo, Maria T; Margaritora, Stefano; Granone, Pierluigi

    2017-02-01

    The bronchopleural fistula (BPF) is a rare but potentially fatal complication of major thoracic surgery. The purpose of this work is to investigate the risk factors associated with the development of fistulas after lobectomy and pneumonectomy. We retrospectively reviewed the records of 835 patients who underwent major anatomic lung resection at our centre from January 2003 to December 2013. Of these, 49 underwent pneumonectomy (P group) and 786 lobectomy (L group). A total of 18 patients (2.6%) developed a BPF in the postoperative period, of which there were 11 in the L group (1.3%) and seven in the P group (14.28%). The 30-day mortality was 0.05% (one patient after right pneumonectomy). In the L group, three patients developed a fistula after a left lobectomy and eight after a right one, of which four developed after bilobectomy. Univariate analysis showed that induction therapy, lower lobectomy, manual suture of the bronchus, 'not covered' bronchial stump, empyema, postoperative anaemia and pulmonary infections and mechanical ventilation >24 h are associated with the development of fistulas after lobectomy. Multivariate analysis confirmed that induction therapy, manual closure of the bronchus, postoperative pulmonary infections and anaemia are the main risk factors involved in our series. In the P group, four patients developed a fistula after a right pneumonectomy and three after a left one. Postoperative empyema and pulmonary infections, mechanical ventilation >24 h and female gender emerged as the main risk factors on univariate analysis, while on multivariate analysis, only the female gender presented a trend towards significance. Postoperative pulmonary infections, empyema and mechanical ventilation >24 h are strongly associated with the development of BPFs after both pneumonectomy and lobectomy in our series. © 2017 Royal Australasian College of Surgeons.

  20. Error reporting from the da Vinci surgical system in robotic surgery: A Canadian multispecialty experience at a single academic centre

    Science.gov (United States)

    Rajih, Emad; Tholomier, Côme; Cormier, Beatrice; Samouëlian, Vanessa; Warkus, Thomas; Liberman, Moishe; Widmer, Hugues; Lattouf, Jean-Baptiste; Alenizi, Abdullah M.; Meskawi, Malek; Valdivieso, Roger; Hueber, Pierre-Alain; Karakewicz, Pierre I.; El-Hakim, Assaad; Zorn, Kevin C.

    2017-01-01

    Introduction The goal of the study is to evaluate and report on the third-generation da Vinci surgical (Si) system malfunctions. Methods A total of 1228 robotic surgeries were performed between January 2012 and December 2015 at our academic centre. All cases were performed by using a single, dual console, four-arm, da Vinci Si robot system. The three specialties included urology, gynecology, and thoracic surgery. Studied outcomes included the robotic surgical error types, immediate consequences, and operative side effects. Error rate trend with time was also examined. Results Overall robotic malfunctions were documented on the da Vinci Si systems event log in 4.97% (61/1228) of the cases. The most common error was related to pressure sensors in the robotic arms indicating out of limit output. This recoverable fault was noted in 2.04% (25/1228) of cases. Other errors included unrecoverable electronic communication-related in 1.06% (13/1228) of cases, failed encoder error in 0.57% (7/1228), illuminator-related in 0.33% (4/1228), faulty switch in 0.24% (3/1228), battery-related failures in 0.24% (3/1228), and software/hardware error in 0.08% (1/1228) of cases. Surgical delay was reported only in one patient. No conversion to either open or laparoscopic occurred secondary to robotic malfunctions. In 2015, the incidence of robotic error rose to 1.71% (21/1228) from 0.81% (10/1228) in 2014. Conclusions Robotic malfunction is not infrequent in the current era of robotic surgery in various surgical subspecialties, but rarely consequential. Their seldom occurrence does not seem to affect patient safety or surgical outcome. PMID:28503234

  1. Prognostic factors for long-term infliximab treatment in Crohn's disease patients: a 20-year single centre experience.

    Science.gov (United States)

    Billiet, T; Cleynen, I; Ballet, V; Ferrante, M; Van Assche, G; Gils, A; Vermeire, S

    2016-10-01

    The long-term efficacy of infliximab in patients with Crohn's disease is suboptimal. To study prognostic factors for real-life long-term effcacy of infliximab in Crohn's disease. All consecutive Crohn's disease patients treated with infliximab at a tertiary centre were retrospectively analysed. Only patients who received scheduled infliximab maintenance treatment were considered. Patient- and disease-related factors were used to identify independent predictors of infliximab failure-free survival using Cox proportional hazards regression. Of 1031 patients with Crohn's disease, 261 were eligible for inclusion. Median time on infliximab was 2.4 [IQR 1.4-4.7] years, and 65 (24.9%) patients experienced infliximab failure. Estimated 5-year infliximab failure-free survival was 65.9% (95% CI 58.3-73.5). Multivariate Cox regression identified disease duration ≥1 year (HR 2.5 (95% CI 1.2-5.2), P = 0.02), L1 disease location [HR 2.0 (1.1-3.5), P = 0.02], prior anti-TNF use [HR 2.3 (1.1-4.8), P = 0.03], haemoglobin infliximab failure-free survival. Stratifying patients into risk groups resulted in estimated 3-year infliximab failure-free survival rates ranging from 95.3% (94.2-96.4) to 26.3% (8.6-44.0) depending on the number of risk factors (P = 8 × 10(-13) ). This study identified several easy to obtain predictors of infliximab failure in patients with Crohn's disease, and these are in line with previous reports. Those with a high-risk profile for infliximab failure in whom infliximab initiation is considered, should be treated as early as possible making use of therapeutic drug monitoring. © 2016 John Wiley & Sons Ltd.

  2. Junctional ectopic tachycardia following repair of congenital heart defects-experience in multimodal management from a West African Centre.

    Science.gov (United States)

    Entsua-Mensah, Kow; Aniteye, Ernest; Sereboe, Lawrence Agyemang; Tettey, Mark Mawutor; Edwin, Frank; Tamatey, Martin; Delia, Ibrahim; Gyan, Kofi Bafoe

    2012-01-01

    Postoperative junctional ectopic tachycardia (JET) is a rare and transient phenomenon occurring after repair of congenital heart defects. Report on this arrhythmia in the subregion is rare. We set out to determine the incidence of this arrhythmia and review the treatment and outcomes of treatment in our centre. Retrospective search of the records of all patients aged 18 years and below admitted into the intensive care unit (ICU) following repair or palliation of a congenital heart defect over 5 years, from January 1, 2006 to December 31, 2010. A review of clinical notes, operative records, anaesthetic charts, cardiopulmonary bypass (CPB) records, nursing observation charts, electrocardiograms (ECGs) and out-patient follow-up records was undertaken. 510 children under 18 years were enlisted. 7 cases of postoperative JET were recorded, (1.37%). 184 (36.1%) of these were performed under CPB. All JET cases were from cases done under CPB, 3.8%. Median age was 3 years and median weight 11.3 kg. No patient was febrile at diagnosis. 4 patients had amiodarone administration, 5 had magnesium sulphate infusion, 2 patients had direct current shock (DCS) whilst 3 patients had all three therapeutic modalities. All patients had control of the arrhythmia with conversion to sinus rhythm and no recurrence. We report a JET incidence of 1.37% among children undergoing CPB for repair of congenital heart defects. We demonstrate the therapeutic effectiveness of amiodarone, magnesium sulphate infusions and DCS alone or in combination in the management of JET on various substrates with good outcome.

  3. Preimplantation genetic diagnosis and screening by array comparative genomic hybridisation: experience of more than 100 cases in a single centre.

    Science.gov (United States)

    Chow, J Fc; Yeung, W Sb; Lee, V Cy; Lau, E Yl; Ho, P C; Ng, E Hy

    2017-04-01

    Preimplantation genetic screening has been proposed to improve the in-vitro fertilisation outcome by screening for aneuploid embryos or blastocysts. This study aimed to report the outcome of 133 cycles of preimplantation genetic diagnosis and screening by array comparative genomic hybridisation. This study of case series was conducted in a tertiary assisted reproductive centre in Hong Kong. Patients who underwent preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening between 1 April 2012 and 30 June 2015 were included. They underwent in-vitro fertilisation and intracytoplasmic sperm injection. An embryo biopsy was performed on day-3 embryos and the blastomere was subject to array comparative genomic hybridisation. Embryos with normal copy numbers were replaced. The ongoing pregnancy rate, implantation rate, and miscarriage rate were studied. During the study period, 133 cycles of preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening were initiated in 94 patients. Overall, 112 cycles proceeded to embryo biopsy and 65 cycles had embryo transfer. The ongoing pregnancy rate per transfer cycle after preimplantation genetic screening was 50.0% and that after preimplantation genetic diagnosis was 34.9%. The implantation rates after preimplantation genetic screening and diagnosis were 45.7% and 41.1%, respectively and the miscarriage rates were 8.3% and 28.6%, respectively. There were 26 frozen-thawed embryo transfer cycles, in which vitrified and biopsied genetically transferrable embryos were replaced, resulting in an ongoing pregnancy rate of 36.4% in the screening group and 60.0% in the diagnosis group. The clinical outcomes of preimplantation genetic diagnosis and screening using comparative genomic hybridisation in our unit were comparable to those reported internationally. Genetically transferrable embryos replaced in a natural cycle may improve the ongoing pregnancy rate

  4. Implantable cardioverter defibrillator therapy in paediatric practice: a single-centre UK experience with focus on subcutaneous defibrillation.

    Science.gov (United States)

    Griksaitis, Michael J; Rosengarten, James A; Gnanapragasam, James P; Haw, Marcus P; Morgan, John M

    2013-04-01

    Sudden cardiac death (SCD) risk can be managed by implantable cardioverter defibrillators (ICD). Defibrillation shocks can be delivered via ICD generator and/or intracardiac or subcutaneous coil configurations. We present our single-centre use of childhood ICDs. Twenty-three patients had ICD implantation, with median age and weight of 12.96 years and 41.35 kg. Indications included eight long QT; four hypertrophic cardiomyopathy; three Brugada syndrome; two idiopathic ventricular fibrillation; two post-congenital heart repair; two family history of SCD with abnormal repolarization; one catecholaminergic polymorphic ventricular tachycardia; and one left ventricle non-compaction. Twelve had out of hospital cardiac arrests prior to implantation. Techniques included 13 conventional ICD implants (pre-pectoral device with endocardial leads), 7 with subcutaneous defibrillation coils (sensing via epicardial or endocardial leads tunnelled to the ICD), and 3 with exclusive subcutaneous ICD (sensing and defibrillation via the same subcutaneous lead). Satisfactory defibrillation efficacy and ventricular arrhythmia sensing was confirmed at implantation. Follow-up ranged from 0.17 to 11.08 years. One child died with the ICD in situ. Ten children received appropriate shocks; five on more than one occasion. Five received inappropriate shocks (for inappropriate recognition of sinus tachycardia or supraventricular tachycardia). Five children underwent six further interventions; all had intracardiac leads. Innovative shock delivery systems can be used in children requiring an ICD. The insertion technique and device used need to accommodate the age and weight of the child, and concomitant need for pacing therapy. We have demonstrated effective defibrillation with shocks delivered via configurations employing subcutaneous coils in children.

  5. Experiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province

    Directory of Open Access Journals (Sweden)

    Anne Kumurenzi

    2015-02-01

    Full Text Available Background: Rehabilitation is important for persons with disabilities as it contributes to their sense of autonomy, self-worth and social participation, and improves their quality of life. Improving the quality of rehabilitation services requires the dialogue of patients’ perceptions with those of service providers, in order to recommend informed reform. Objective: The objective was to explore the experiences of persons with physical disabilities and service providers, regarding the multi-disciplinary rehabilitation services provided at a community-based out-patient rehabilitation centre. Methods: A qualitative, exploratory study design was used to collect the data. A focus group was conducted with conveniently selected persons with physical disabilities. Three in-depth interviews were conducted with purposively selected key informants. All ethical considerations were adhered to during the implementation of the study.Results: Patients and service providers had different experiences regarding accessibility to rehabilitation services, and similar experiences with patient education and intensity of rehabilitation. Although the patients experienced that the service providers had sufficient knowledge and skills to manage them, services providers expressed that they lacked certain skills.Conclusions: The experiences expressed highlighted the need to improve rehabilitation services in terms of increasing the capacity of service providers and providing transport services for persons with disabilities.

  6. Potential Lunar In-Situ Resource Utilization Experiments and Mission Scenarios

    Science.gov (United States)

    Sanders, Gerald B.

    2010-01-01

    The extraction and use of resources on the Moon, known as In-Situ Resource Utilization (ISRU), can potentially reduce the cost and risk of human lunar exploration while also increasing science achieved. By not having to bring all of the shielding and mission consumables from Earth and being able to make products on the Moon, missions may require less mass to accomplish the same objectives, carry more science equipment, go to more sites of exploration, and/or provide options to recover from failures not possible with delivery of spares and consumables from Earth alone. While lunar ISRU has significant potential for mass, cost, and risk reduction for human lunar missions, it has never been demonstrated before in space. To demonstrate that ISRU can meet mission needs and to increase confidence in incorporating ISRU capabilities into mission architectures, terrestrial laboratory and analog field testing along with robotic precursor missions are required. A stepwise approach with international collaboration is recommended. This paper will outline the role of ISRU in future lunar missions, and define the approach and possible experiments to increase confidence in ISRU applications for future human lunar exploration

  7. Red mason bees cannot compete with honey bees for floral resources in a cage experiment.

    Science.gov (United States)

    Hudewenz, Anika; Klein, Alexandra-Maria

    2015-11-01

    Intensive beekeeping to mitigate crop pollination deficits and habitat loss may cause interspecific competition between bees. Studies show negative correlations between flower visitation of honey bees (Apis mellifera) and wild bees, but effects on the reproduction of wild bees were not proven. Likely reasons are that honey bees can hardly be excluded from controls and wild bee nests are generally difficult to detect in field experiments. The goal of this study was to investigate whether red mason bees (Osmia bicornis) compete with honey bees in cages in order to compare the reproduction of red mason bees under different honey bee densities. Three treatments were applied, each replicated in four cages of 18 m³ with 38 red mason bees in all treatments and 0, 100, and 300 honey bees per treatment with 10-20% being foragers. Within the cages, the flower visitation and interspecific displacements from flowers were observed. Niche breadths and resource overlaps of both bee species were calculated, and the reproduction of red mason bees was measured. Red mason bees visited fewer flowers when honey bees were present. Niche breadth of red mason bees decreased with increasing honey bee density while resource overlaps remained constant. The reproduction of red mason bees decreased in cages with honey bees. In conclusion, our experimental results show that in small and isolated flower patches, wild bees can temporarily suffer from competition with honey bees. Further research should aim to test for competition on small and isolated flower patches in real landscapes.

  8. Hadron production in nuclear collisions from the NA49 experiment at 158GeV/c centre dot A

    CERN Document Server

    Siklér, F; Barna, D; Barnby, L S; Bartke, Jerzy; Barton, R A; Betev, L; Bialkowska, H; Billmeier, A; Blume, C; Blyth, C O; Boimska, B; Bracinik, J; Brady, F P; Brun, R; Buncic, P; Carr, L; Cebra, D; Cooper, G E; Cramer, J G; Csató, P; Eckardt, V; Eckhardt, F; Ferenc, D; Fischer, H G; Fodor, Z; Foka, P; Freund, P; Friese, V; Ftácnik, J; Gál, J; Ganz, R E; Gazdzicki, M; Gladysz-Dziadus, E; Grebieszkow, J; Harris, J W; Hegyi, S; Hlinka, V; Höhne, C; Igo, G; Ivanov, M; Jacobs, P; Janik, R; Jones, P G; Kadija, K; Kolesnikov, V I; Kowalski, M; Lasiuk, B; Lednicky, R; Lévai, Peter; Malakhov, A I; Margetis, S; Markert, C; Mayes, B W; Melkumov, G L; Molnár, J; Nelson, J M; Odyniec, Grazyna Janina; Oldenburg, M; Pálla, G; Panagiotou, A D; Petridis, A; Pikna, M; Pinsky, L; Poskanzer, A M; Prindle, D J; Pühlhofer, F; Reid, J G; Renfordt, R E; Retyk, W; Ritter, H G; Röhrich, D; Roland, C; Roland, G; Rybicki, A; Sammer, T; Sandoval, A; Sann, H; Semenov, A Yu; Schäfer, E; Schmitz, N; Seyboth, P; Sitár, B; Skrzypczak, E; Snellings, R; Squier, G T A; Stock, R; Strmen, P; Ströbele, H; Susa, T; Szarka, I; Szentpétery, I; Sziklai, J; Toy, M; Trainor, T A; Trentalange, S; Ullrich, T; Varga, D; Vassiliou, Maria; Veres, G I; Vesztergombi, G; Voloshin, S A; Vranic, D; Wang, F; Weerasundara, D D; Wenig, S; Whitten, C; Xu, N; Yates, T A; Yoo, I K; Zimányi, J

    1999-01-01

    With its large acceptance and particle identification coverage the NA49 experiment (Fig. 1) can study hadron production in a wide range of high energy reactions [1]. Originally aimed at examining central Pb+Pb collisions for signatures of quark-gluon plasma formation, the scope of the experiment has been enhanced with a systematic study of impact parameter and projectile size dependence, as well as the inclusion of the more elementary p+p and p+A interactions. The question is: are predicted signals of the quark-gluon plasma observed and are there discontinuities which would support the concept of hadronic phase transition?

  9. In-situ experiments for the determination of rock properties and behaviour at the Meuse/Haute Marne Centre

    Directory of Open Access Journals (Sweden)

    Conil N.

    2010-06-01

    Full Text Available Andra is in charge of studying the feasibility of a disposal facility for longlived high-level nuclear waste (LL-HLW in a deep geological environment. With this aim, dedicated experiments have been carried out for several years at the Meuse/Haute Marne Underground Research Laboratory excavated in a 500 m deep argillaceous rock formation. These experiments include determining the feasibility of the excavation of disposal cells for LL-HLW, consisting of 40 meter long, 70 cm in diameter, horizontal cased micro tunnels. The hydro mechanical impact of the excavation of such openings on the rock mass behaviour is continuously monitored as well as their mean term mechanical behaviour. Since LL-HLW produce heat, the impact of temperature on the surrounding rock mass and on the micro tunnel steel casing will also be studied. Specific instrumentation has been developed to study this impact. The first step of the microtunnel excavation tests, carried out in 2009, has led to improving the excavation method and the drilling machine. These improvements will be tested in the next step of the excavation tests planned for 2010. The THM experiment dedicated to studying the behaviour of the rock mass under thermal solicitation started early 2010. The behaviour of a steel casing in contact with the rock mass and under thermal solicitation will be studied in an experiment scheduled to start in September 2010.

  10. Navigating a strange and complex environment: experiences of Sudanese refugee women using a new nutrition resource

    Directory of Open Access Journals (Sweden)

    Mannion CA

    2014-04-01

    Full Text Available Cynthia A Mannion, Shelley Raffin-Bouchal, Christena Jane HenshawFaculty of Nursing, University of Calgary, Calgary, Alberta, CanadaBackground: Refugees experience dietary changes as part of the daily challenges they face resettling in a new country. Sudanese women seek to care and feed their families, but face language barriers in the marketplace, limited access to familiar foods, and forced new food choices. This study aimed to understand the acceptability of a purse-sized nutrition resource, “The Market Guide”, which was developed to help recently immigrated Sudanese refugee women identify and purchase healthy foods and navigate grocery stores.Methods: Eight women participated in a focus group, four of whom were also observed during accompanied grocery store visits. Individual interviews were conducted with four health care workers at the resettlement center to gather perceptions about the suitability of The Market Guide. Focus groups and interviews were audiotaped and transcribed. Data from field notes and transcripts were analyzed using grounded theory for preliminary open codes, followed by selective and theoretical coding.Results: The Market Guide was of limited use to Sudanese women. Their response to this resource revealed the struggles of women acculturating during their first year in Calgary, Canada. We discovered the basic social process, “Navigating through a strange and complex environment: learning ways to feed your family.” Language, transportation, and an unfamiliar marketplace challenged women and prevented them from exercising their customary role of “knowing” which foods were “safe and good” for their families. The nutrition resource fell short of informing food choices and purchases, and we discovered that “learning to feed your family” is a relational process where trusted persons, family, and friends help navigate dietary acculturation.Conclusion: Emergent theory based on the basic social process may

  11. GSI Helmholz Centre for Heavy Ion Research - ALFA: Next generation concurrent framework for ALICE and FAIR experiments

    CERN Multimedia

    CERN. Geneva

    2015-01-01

    FAIR is a new, unique international accelerator facility for the research with antiprotons and ions. It is being built at the GSI Darmstadt in Hesse, Germany. The commonalities between the ALICE and FAIR experiments and their computing requirements led to the development of a common software framework in an experiment independent way; ALFA (ALICE-FAIR framework). ALFA is designed for high quality parallel data processing and reconstruction on heterogeneous computing systems. It provides a data transport layer and the capability to coordinate multiple data processing components. ALFA is a flexible, elastic system which balances reliability and ease of development with performance by using a message based multi-processing in addition to multi-threading. The framework allows for usage of heterogeneous computing architectures by offloading (portions of code are accelerated on the device) or natively (where the full program is executed on the device ).

  12. Assumption Centred Modelling of Ecosystem Responses to CO2 at Six US Atmospheric CO2 Enrichment Experiments.

    Science.gov (United States)

    Walker, A. P.; De Kauwe, M. G.; Medlyn, B. E.; Zaehle, S.; Luus, K. A.; Ryan, E.; Xia, J.; Norby, R. J.

    2015-12-01

    Plant photosynthetic rates increase and stomatal apertures decrease in response to elevated atmospheric CO[2] (eCO2), increasing both plant carbon (C) availability and water use efficiency. These physiological responses to eCO2 are well characterised and understood, however the ecological effects of these responses as they cascade through a suite of plant and ecosystem processes are complex and subject to multiple interactions and feedbacks. Therefore the response of the terrestrial carbon sink to increasing atmospheric CO[2] remains the largest uncertainty in global C cycle modelling to date, and is a huge contributor to uncertainty in climate change projections. Phase 2 of the FACE Model-Data Synthesis (FACE-MDS) project synthesises ecosystem observations from five long-term Free-Air CO[2] Enrichment (FACE) experiments and one open top chamber (OTC) experiment to evaluate the assumptions of a suite of terrestrial ecosystem models. The experiments are: The evergreen needleleaf Duke Forest FACE (NC), the deciduous broadleaf Oak Ridge FACE (TN), the prairie heating and FACE (WY), and the Nevada desert FACE, and the evergreen scrub oak OTC (FL). An assumption centered approach is being used to analyse: the interaction between eCO2 and water limitation on plant productivity; the interaction between eCO2 and temperature on plant productivity; whether increased rates of soil decomposition observed in many eCO2 experiments can account for model deficiencies in N uptake shown during Phase 1 of the FACE-MDS; and tracing carbon through the ecosystem to identify the exact cause of changes in ecosystem C storage.

  13. From margins to centre: an oral history of the wartime experience of Iranian nurses in the Iran-Iraq War, 1980-1988.

    Science.gov (United States)

    Peyrovi, Hamid; Parsa-Yekta, Zohreh; Vosoughi, Mohammad Bagher; Fathyian, Nasrollah; Ghadirian, Fataneh

    2015-01-01

    The extensive nature of the Iraq-Iran war converted to a human tragedy with large casualties; it has affected nursing discipline dramatically. To analyse the history of the wartime experience of Iranian nurses in Iran-Iraq War. The current study was conducted with oral history. The study sample consisted of 13 Iranian nurses who served in the war zones during the wartime. Purposive and snowball sampling were used to recruit the participants. During the face-to-face interviews, participants were asked to describe their experience in the war zones during the war years. Data collection and analysis took place from April to August 2013, when saturation was reached. All interviews were tape recorded and transcribed and then analysed with thematic content analysis. Finally, five themes and 18 subthemes emerged from data analysis of significant statements from 17 interviews. The five emerged themes included (1) 'From margin to centre', (2) 'Development of referral care', (3) 'Personal and professional growth and development', (4) 'The emerging pillar of culture in war nursing' and (5) 'Threats to nursing at the war'. Nursing in Iran at wartime has a difficult path to development. There are powerful implications for clinical practice. It is recommended to continue collection, archiving and analysing the wartime experiences of Iranian nurses.

  14. Access to resources shapes maternal decision making: evidence from a factorial vignette experiment.

    Directory of Open Access Journals (Sweden)

    Geoff Kushnick

    Full Text Available The central assumption of behavioral ecology is that natural selection has shaped individuals with the capacity to make decisions that balance the fitness costs and benefits of behavior. A number of factors shape the fitness costs and benefits of maternal care, but we lack a clear understanding how they, taken together, play a role in the decision-making process. In animal studies, the use of experimental methods has allowed for the tight control of these factors. Standard experimentation is inappropriate in human behavioral ecology, but vignette experiments may solve the problem. I used a confounded factorial vignette experiment to gather 640 third-party judgments about the maternal care decisions of hypothetical women and their children from 40 female karo Batak respondents in rural Indonesia. This allowed me to test hypotheses derived from parental investment theory about the relative importance of five binary factors in shaping maternal care decisions with regard to two distinct scenarios. As predicted, access to resources--measured as the ability of a woman to provide food for her children--led to increased care. A handful of other factors conformed to prediction, but they were inconsistent across scenarios. The results suggest that mothers may use simple heuristics, rather than a full accounting for costs and benefits, to make decisions about maternal care. Vignettes have become a standard tool for studying decision making, but have made only modest inroads to evolutionarily informed studies of human behavior.

  15. Access to resources shapes maternal decision making: evidence from a factorial vignette experiment.

    Science.gov (United States)

    Kushnick, Geoff

    2013-01-01

    The central assumption of behavioral ecology is that natural selection has shaped individuals with the capacity to make decisions that balance the fitness costs and benefits of behavior. A number of factors shape the fitness costs and benefits of maternal care, but we lack a clear understanding how they, taken together, play a role in the decision-making process. In animal studies, the use of experimental methods has allowed for the tight control of these factors. Standard experimentation is inappropriate in human behavioral ecology, but vignette experiments may solve the problem. I used a confounded factorial vignette experiment to gather 640 third-party judgments about the maternal care decisions of hypothetical women and their children from 40 female karo Batak respondents in rural Indonesia. This allowed me to test hypotheses derived from parental investment theory about the relative importance of five binary factors in shaping maternal care decisions with regard to two distinct scenarios. As predicted, access to resources--measured as the ability of a woman to provide food for her children--led to increased care. A handful of other factors conformed to prediction, but they were inconsistent across scenarios. The results suggest that mothers may use simple heuristics, rather than a full accounting for costs and benefits, to make decisions about maternal care. Vignettes have become a standard tool for studying decision making, but have made only modest inroads to evolutionarily informed studies of human behavior.

  16. Calibration of the cameras of the H.E.S.S. {gamma}-ray astronomy experiment and observations of the Galactic Centre above 100 GeV; Etalonnage des cameras de l'experience d'astronomie {gamma} H.E.S.S. et observations du centre galactique au-dela de 100 GeV

    Energy Technology Data Exchange (ETDEWEB)

    Rolland, L

    2005-05-15

    The H.E.S.S. experiment (High Energy Stereoscopic System) consists of four imaging atmospheric Cherenkov telescopes to study the southern astrophysical sources above 100 GeV. This thesis presents the detector as well as the analysis chain. The calibration methods are described in details and the systematic errors on the image amplitude are derived. Then, an analysis based on a semi-analytical model of the electromagnetic shower development in the atmosphere is presented. Tools to reconstruct the energy spectrum and the morphology of the very high energy {gamma}-ray sources are presented and applied to the Crab Nebula. Systematic errors associated to the spectrum analysis are estimated. All these techniques were applied to study the Galactic Centre emission above 100 GeV. The nature of the source detected in 2003 and 2004 observations is still unknown and its spectrum, variability and morphology are studied. Various candidates are proposed, among them the supermassive black hole Sgr A* located at the dynamical centre of the Milky Way, the supernova remnant Sgr A Est or interactions of accelerated particles with the dense medium of this region. In this thesis, the signal was interpreted in terms of dark matter annihilation (neutralinos or Kaluza-Klein bosons) in a dense halo located at the Galactic Centre. This analysis showed that, in the framework of these models, dark matter annihilation alone can not explain the H.E.S.S. signal. The main component would thus come from astrophysical sources. (author)

  17. Oesophageal manometry: 10-year audit from a specialist centre, and early experience with high-resolution manometry.

    Science.gov (United States)

    Moran, T; Lawlor, P; Brennan, M; Ravi, N; Reynolds, J V

    2015-06-01

    Manometry is the gold standard investigation of innate or acquired motility disorders in the oesophagus. New technology in the form of high-resolution manometry (HRM) may supplant traditional water-perfused manometry and enhance standardisation of manometric interpretation and reporting. This study reports on a 10-year experience of 5,184 consecutive patients using the traditional methods, and an early experience with HRM. Of 5,184 patients assessed, 4,509 (87%) had both pH and manometry and 675 (13%) had manometry only. 3,523 (78%) of the pH /manometry group had normal motility, 635 (14%) showed ineffective motility (IM), 213 (5%) a non-specific motility disturbance (NSMD), 42 (0.9%) achalasia, 58 (1.3%) nutcracker oesophagus, 22 (0.5%) hypertensive LOS (HLOS), 8 (0.2%) diffuse oesophageal spasm (DOS) and 8 (0.2 %) had scleroderma. For those referred solely for manometry only, 324 (48%) had normal motility, 72 (11%) IM, 51 (8%) NSMD, 175 (26%) achalasia, 16 (2%) nutcracker oesophagus, 32 (5%) HLOS, 1 (0.1%) DOS and 4 (0.6%) had scleroderma. 92 patients to date have been studied with HRM, with enhanced definition of lower oesophageal sphincter (LOS) function. For patients referred for reflux related symptoms, motility disorders are present in 22% of the cases. Conversely, of the patients referred for dysphagia, motility disturbances are detected in 52% of the cases sent for manometry. Our initial experience shows that HRM technology is adding a valuable dimension and clearer understanding of motility patterns in the dysphagic patient.

  18. COMPLICATIONS OF ENDONASAL ENDOSCOPIC TRANSSPHENOIDAL APPROACH FOR PITUITARY ADENOMAS: OUR EXPERIENCE IN 50 PATIENTS TREATED AT OUR TERTIARY CENTRE

    Directory of Open Access Journals (Sweden)

    Mani Ram

    2015-12-01

    Full Text Available INTRODUCTION Between September 2013 and October 2014, we conducted a retrospective analysis to assess the complications related to endoscopic pituitary surgery in a series of 50 patients. We analysed the complications in preoperative, postoperative and endocrinological categories. We had a follow up of 1-2 years. Endonasal endoscopic transsphenoidal surgery (ETSS is an effective option for pituitary tumors. Complications do occur, but they can be reduced with experience & expertise and there is a steep learning curve. It demands a multidisciplinary approach.

  19. Creating, curating, and sharing online faculty development resources: the medical education in cases series experience.

    Science.gov (United States)

    Chan, Teresa M; Thoma, Brent; Lin, Michelle

    2015-06-01

    It is difficult to engage clinicians in continuing medical education that does not focus on clinical expertise. Evolving online technologies (e.g., massive open online courses [MOOCs]) are disrupting and transforming medical education, but few online nonclinical professional development resources exist. In August 2013, the Academic Life in Emergency Medicine Web site launched the Medical Education in Cases (MEdIC) series to engage clinicians in an online professional development exercise. Each month, a complex, realistic scenario featuring a nonclinical medical education dilemma is published with accompanying discussion questions. A weeklong discussion is moderated on Twitter and the Web site. This discussion is curated to create a community commentary, which is published alongside presolicited expert responses. Case resources are available for download. The first six MEdIC cases (published August 2013-January 2014) emphasized different CanMEDS and/or Accreditation Council on Graduate Medical Education competencies. Median reader engagement metrics (interquartile range 25%-75%) in the first week following publication were 861 (634-1,114) pageviews, 767 (518-953) unique visitors from 326 (218-405) cities in 45 (32-50) countries, 30 (24-39) comments, 52 (40-56) tweets, 17 (13-30) Facebook Likes, and 5 (5-7) Google Plus +1s. The MEdIC series is proof of concept that online activities can engage clinicians in nonclinical professional development. The early experience suggests the connectivist nature of MEdIC allows for crowdsourcing solutions to ill-defined problems via the wisdom of readers. This methodology may also be effective for other nonclinical and medical education topics.

  20. Building cancer registries in a lower resource setting: The 10-year experience of Golestan, Northern Iran.

    Science.gov (United States)

    Roshandel, Gholamreza; Semnani, Shahryar; Fazel, Abdolreza; Honarvar, Mohammadreza; Taziki, MohammadHossein; Sedaghat, SeyedMehdi; Abdolahi, Nafiseh; Ashaari, Mohammad; Poorabbasi, Mohammad; Hasanpour, Susan; Hosseini, SeyedAhmad; Mansuri, SeyedMohsen; Jahangirrad, Ataollah; Besharat, Sima; Moghaddami, Abbas; Mirkarimi, Honeyehsadat; Salamat, Faezeh; Ghasemi-Kebria, Fatemeh; Jafari, Nastaran; Shokoohifar, Nesa; Gholami, Masoomeh; Sadjadi, Alireza; Poustchi, Hossein; Bray, Freddie; Malekzadeh, Reza

    2018-02-01

    The Golestan population-based cancer registry (GPCR) was established in Golestan province, Northern Iran, within the Asian belt with predominance of upper-gastrointestinal cancers. We aimed to present the experiences of the registry in a resource-limited setting over the 10 years since its inception (2004-2013). The GPCR was established as a research project to enable sustainable funding. A clear plan was developed for use of the GPCR data. New primary cancers were registered based on international standards, indices of data quality were routinely assessed and age-standardized incidence rates (ASR) per 100,000 person-years calculated using IARC's CanReg-5 software. Overall, 19807 new cancer cases were registered during the study period, an average of 1981 cases per annum, with overall ASR of 175.0 and 142.4 in males and females, respectively. The GPCR data suggested gastrointestinal and breast cancers as the most common malignancies in Golestan province. We observed increasing incidence rates of breast and colorectal cancers but declining trends of esophageal cancer. Overall, indices of data quality were within acceptable ranges. The GPCR data have been included in IARC's Cancer Incidence in Five Continents series, were used in 21 research projects, and published as 30 research papers. The key ingredients for the successful establishment and maintenance of the GPCR included sustainable sources of funding, a clear action plan for the use of data as well as stakeholder cooperation across all areas of the registration. The GPCR may be considered as a model for planning population-based cancer registries in lesser-resourced settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora.

    Science.gov (United States)

    Sabri, Bushra; Huerta, Julia; Alexander, Kamila A; St Vil, Noelle M; Campbell, Jacquelyn C; Callwood, Gloria B

    2015-11-01

    This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels. There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

  2. Unified storage systems for distributed Tier-2 centres

    Science.gov (United States)

    Cowan, G. A.; Stewart, G. A.; Elwell, A.

    2008-07-01

    The start of data taking at the Large Hadron Collider will herald a new era in data volumes and distributed processing in particle physics. Data volumes of hundreds of Terabytes will be shipped to Tier-2 centres for analysis by the LHC experiments using the Worldwide LHC Computing Grid (WLCG). In many countries Tier-2 centres are distributed between a number of institutes, e.g., the geographically spread Tier-2s of GridPP in the UK. This presents a number of challenges for experiments to utilise these centres efficaciously, as CPU and storage resources may be subdivided and exposed in smaller units than the experiment would ideally want to work with. In addition, unhelpful mismatches between storage and CPU at the individual centres may be seen, which make efficient exploitation of a Tier-2's resources difficult. One method of addressing this is to unify the storage across a distributed Tier-2, presenting the centres' aggregated storage as a single system. This greatly simplifies data management for the VO, which then can access a greater amount of data across the Tier-2. However, such an approach will lead to scenarios where analysis jobs on one site's batch system must access data hosted on another site. We investigate this situation using the Glasgow and Edinburgh clusters, which are part of the ScotGrid distributed Tier-2. In particular we look at how to mitigate the problems associated with 'distant' data access and discuss the security implications of having LAN access protocols traverse the WAN between centres.

  3. The construction of work–life balance: The experience of Black employees in a call-centre environment

    Directory of Open Access Journals (Sweden)

    Sonia C.B. Potgieter

    2010-03-01

    Full Text Available Orientation: Work–life balance, as a crucial aspect of employee and organisational wellness, remains an interesting field of research, especially due to the changing demographic employee profile.Research purpose: The objective of the study was to explore Black employees’ construction of work–life balance in a customer care environment.Motivation for the study: The conceptual debate regarding the construct of work–life balance in general as well as limited qualitative research with regard to Black employees’ experience of work–life balance in a South African context motivated the study.Research design, approach and method: This qualitative study was designed from an interpretivist perspective. Ten employees, selected through purposeful sampling, participated in the study. Data was gathered through in-depth interviews and grounded theory was applied during data analysis.Main findings: The grounded theory analysis of the data yielded six themes central to participants’ construction of work–life balance. The findings suggest that work–life balance is conceptualised as a continuous, subjective and holistic valuation of satisfaction derived from multiple roles in relation to the importance to the individual at a given point in time.Practical/managerial implications: Findings provide valuable managerial information to guide suitable strategies enhancing the work–life balance experience and by implication employees’ general wellbeing, job satisfaction and commitment.Contributions/value-add: This study contributes to the evolving body of knowledge with regard to work–life balance and provides a unique context-specific perspective to the conceptual understanding of the construct.

  4. CATERING STUDENTS' NEEDS TO PROMOTE AESTHETIC EXPERIENCE IN EFL LITERATURE CLASS WITH REFERENCE TO RESPONSE-CENTRED CURRICULUM

    Directory of Open Access Journals (Sweden)

    Ishkak Said

    2015-02-01

    Full Text Available The success of literature instruction is dependent upon not only the teaching strategies, but also the well-developed curriculum, which accommodates student needs. Teaching practice of literature in the multicultural contexts has to do with teachers' belieft in approaching to their day-to-day practice endowed in the curriculum they are concerned with. In this respect, the existing literature curricula should ideally reflect aesthetic experiences that enhance students' freedom and enjoyment with literary works assigned The present study examines how three case High School English teachers from different sites with different multicultural entities in West Java, Indonesia, developed literature curricula in such a way that their students got 'free room' to express what they wanted and needed to say and to do. Following the traditions of a qualitative multi-case and -site study, the present study investigated the process of teaching literature in language studies streams of the three sites by occupying classroom observation and interview, and administering questionnaires as well. The findings revealed that, in their classroom practices, the three cases endeavored to cater their students' needs through developing negotiated response-based literature curriculum that led to varied and unique activities in the forms of celebrations showing their personal engagements in responding to.Jiterature assigned. Yet, their different schooling systems and contextual factors, and the subjects' perspectives in literature pedagogy and their lived-through literary. reading experiences, have made each case indicate typical and unique phenomena, which is in accordance with the spirit of school-based curriculum.

  5. Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    A van Eyssen

    2017-03-01

    SA donors. Eight transplants used umbilical cord blood from international registries. OS for patients with non-oncological disorders was 91.3% (median follow-up 3.9 years, while that for oncology patients was 56.8% (1.9 years. Two of the survivors developed chronic graft-versus-host disease. Conclusions. OS for non-oncological conditions was excellent, while outcomes for oncological disorders were on par with those in high-income settings. Transplantation offers many patients the opportunity for long-term survival and has been shown to be both feasible and rewarding in a less well-resourced environment servicing an economically diverse population.

  6. Single-centre experience of allogeneic haemopoietic stem cell transplant in paediatric patients in Cape Town, South Africa.

    Science.gov (United States)

    Van Eyssen, A; Novitsky, N; De Wit, P; Schlaphoff, T; Thomas, V; Pillay, D; Hendricks, M; Davidson, A

    2017-02-27

    from international registries. OS for patients with non-oncological disorders was 91.3% (median follow-up 3.9 years), while that for oncology patients was 56.8% (1.9 years). Two of the survivors developed chronic graft-versus-host disease. OS for non-oncological conditions was excellent, while outcomes for oncological disorders were on par with those in high-income settings. Transplantation offers many patients the opportunity for long-term survival and has been shown to be both feasible and rewarding in a less well-resourced environment servicing an economically diverse population.

  7. Undergraduates' self-reported clinical experience, confidence and perspectives of hospital and outreach paediatric dentistry: a three-year multi-centre evaluation.

    Science.gov (United States)

    Walley, S; Bailey, J R; Albadri, S; Mackie, I C; Gilchrist, F; Rodd, H D

    2014-03-01

    A variety of educational approaches exist within U.K. dental schools, and institutions are constantly striving to improve the quality of their graduates. This study aimed to evaluate the self-reported confidence in, and clinical exposure to, paediatric dentistry at three U.K. dental schools (Liverpool, Manchester and Sheffield) over a three year period. Seventy-five percent of final year BDS undergraduates at the three dental schools completed an anonymous questionnaire capturing student self-reported clinical experience in seven core paediatric dentistry treatment skills, both in hospital and outreach settings. Visual analogue scales were used to record self-assessed confidence levels in aspects of paediatric dentistry and students were also asked to provide a written reflection of both their hospital and outreach placements. The results revealed that despite the variety of educational approaches taken, undergraduates reported very similar levels of clinical experience and confidence. Significant interschool differences in student experience were found with respect to the management of carious primary molars, believed to be a result of individual schools favouring different treatment regimes. Although outreach placements were seen as essential for gaining adequate student experience, the need to improve the consistency of teaching between hospital and outreach centres was highlighted. The study also emphasises the need to take care when using clinical targets in undergraduate teaching and identifies the potential benefits of undergraduate training in inhalation sedation. Finally, despite changes to the paediatric programmes with respect to dental trauma management, students remained lacking in confidence suggesting the need for further development.

  8. Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication, teamwork, and patient-centred care.

    Science.gov (United States)

    Thomson, Krist; Outram, Sue; Gilligan, Conor; Levett-Jones, Tracy

    2015-01-01

    Achieving safe, quality health care is highly dependent on effective communication between all members of the healthcare team. This study explored the attitudes and experiences of recent healthcare graduates regarding interprofessional teamwork and communication within a clinical setting. A total of 68 pharmacy, nursing, and medicine graduates participated in 12 semi-structured focus group discussions in clinical workplaces across three Australian states. Discussion focussed on graduates' experiences of interprofessional education and its impact on their capacity for interprofessional teamwork and communication. The Social Identity and Realistic Conflict theories were used as a framework for qualitative data analysis. A consistent pattern of profession-focussed, rather than patient- or team-focussed goals was revealed along with reports of negative stereotyping, hierarchical communication, and competition for time with the patient. Graduates acknowledged the importance of communication, teamwork, and patient-centred care and felt a better understanding of the roles of other health professionals would assist them to work together for patients' wellbeing. Identifying workplace identities and differential goals has uncovered possible motivations underlying health professionals' behaviour. These insights may help improve interprofessional collaboration by focusing attention on common team goals, increasing feelings of worth and being valued among different professionals, and decreasing the need for competition.

  9. Role models and professional development in dentistry: an important resource: The views of early career stage dentists at one academic health science centre in England.

    Science.gov (United States)

    Mohamed Osama, O; Gallagher, J E

    2017-02-08

    The importance of role models, and their differing influence in early, mid- and late careers, has been identified in the process of professional development of medical doctors. There is a paucity of evidence within dentistry on role models and their attributes. To explore the views of early career dentists on positive and negative role models across key phases of professional development, together with role models' attributes and perceived influence. This is a phenomenological study collecting qualitative data through semi-structured interviews based on a topic guide. Dentists in junior (core training) hospital posts in one academic health science centre were all invited to participate. Interviews were recorded, transcribed verbatim and analysed using framework analysis. Twelve early career stage dentists, 10 of whom were female, reported having role models, mainly positive, in their undergraduate and early career phases. Participants defined role models' attributes in relation to three distinct domains: clinical attributes, personal qualities and teaching skills. Positive role models were described as "prioritising the patient's best interests", "delivering learner-centred teaching and training" and "exhibiting a positive personality", whilst negative role models demonstrated the converse. Early career dentists reported having largely positive dentist role models during- and post-dental school and report their impact on professional values and aspirations, learning outcomes and career choice. The findings suggest that these early career dentists in junior hospital posts have largely experienced and benefitted from positive role models, notably dentists, perceived as playing an important and creative influence promoting professionalism and shaping the career choices of early career stage dentists. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Organ retrieval and banking in brain dead trauma patients: Our experience at level-1 trauma centre and current views

    Science.gov (United States)

    Sawhney, Chhavi; Kaur, Manpreet; Lalwani, Sanjeev; Gupta, Babita; Balakrishnan, Ira; Vij, Aarti

    2013-01-01

    Background: Organ retrieval from brain dead patients is getting an increased attention as the waiting list for organ recipients far exceeds the organ donor pool. In our country, despite a large population the number of brain dead donors undergoing organ donation is very less (2% in our study). Aims: The present study was undertaken to address issues related to organ donation and share our experience for the same. Methods: A retrospective case record analysis of over 5 years from September 2007 to August 2012 was performed and the patients fulfilling brain death criterion as per Transplantation of Human Organs and Tissue (Amendment) Act were included. Patient demographics (age, sex), mode of injury, time from injury to the diagnosis of brain death, time from diagnosis of brain death to organ retrieval and complications were analysed. Statistics Analysis: Student's t test was used for parametric data and Chi square was used for categorical data. Results: Out of 205 patients who were identified as brain dead, only 10 patients became potential organ donors. Conclusion: Aggressive donor management, increasing public awareness about the concept of organ donation, good communication between clinician and the family members and a well-trained team of transplant coordinators can help in improving the number of organ donations. PMID:23983281

  11. Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience.

    LENUS (Irish Health Repository)

    2012-02-01

    BACKGROUND: We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen. Patients and methods. Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study. RESULTS: The incidence of biopsy proven 3-month acute rejections was 30 (12.5%) in MMF group and 22 (16%) in AZA group respectively (P = 0.307). Patient survival rates at 1 and 5 years for the MMF group were 97 and 94%, respectively, compared to 100% and 91% at 1 and 5 years respectively for the AZA group (P = 0.61). Graft survival rates at 1 and 5 years for the MMF group were 95 and 83%, respectively, compared to 97 and 84% at 1 and 5 years, respectively for the AZA group (P = 0.62). CONCLUSION: There was no difference in acute rejection episodes between MMF and AZA based immunotherapy. Additionally, we observed no significant difference concerning graft survival in the MMF group when compared to AZA group.

  12. Multi-disciplinary management of complex pressure sore reconstruction: 5-year review of experience in a spinal injuries centre.

    Science.gov (United States)

    Thomson, C H; Choudry, M; White, C; Mecci, M; Siddiqui, H

    2017-02-01

    INTRODUCTION In our regional spinal injuries unit, complex pressure ulcer reconstruction is facilitated by a monthly multidisciplinary team clinic. This study reviews a series of the more complex of these patients who underwent surgery as a joint case between plastics and other surgical specialties, aiming to provide descriptive data as well as share the experience of treating these complex wounds. MATERIALS AND METHODS Patients operated on as a joint case from 2010 to 2014 were identified through a locally held database and hospital records were then retrospectively reviewed for perioperative variables. Descriptive statistics were collected. RESULTS 12 patients underwent 15 procedures as a joint collaboration between plastic surgery and other surgical specialties: one with spinal surgery, 12 with orthopaedic and two with both orthopaedic and urology involvement. Ischial and trochanteric wounds accounted for 88% of cases with five Girdlestone procedures being performed and 12 requiring soft-tissue flap reconstruction. Mean operative time was 3.8hours. Four patients required high-dependency care and 13 patients received long-term antibiotics. Only three minor complications (20%) were seen with postoperative wound dehiscence. DISCUSSION The multidisciplinary team clinic allows careful assessment and selection of patients appropriate for surgical reconstruction and to help match expectations and limitations imposed by surgery, which are likely to influence their current lifestyle in this largely independent patient group. Collaboration with other specialties gives the best surgical outcome both for the present episode as well as leaving avenues open for potential future reconstruction.

  13. Our experience using primary oral antibiotics in the management of orbital cellulitis in a tertiary referral centre.

    Science.gov (United States)

    Cannon, P S; Mc Keag, D; Radford, R; Ataullah, S; Leatherbarrow, B

    2009-03-01

    Orbital cellulitis is conventionally managed by intravenous (i.v.) antibiotic therapy, followed by oral antibiotics once the infection shows signs of significant improvement. We report 4 years of experience using primary oral ciprofloxacin and clindamycin in cases of orbital cellulitis. Oral ciprofloxacin and clindamycin have a similar bioavailability to the i.v. preparations and provide an appropriate spectrum of antibiotic cover for the pathogens responsible for orbital cellulitis. A retrospective review was performed that identified all patients with orbital cellulitis and treated with primary oral antibiotic therapy admitted to the Manchester Royal Eye Hospital between March 2003 and March 2007. Age, stage of disease, surgical intervention, hospital duration, and complications were obtained. A comparison was made with patients admitted to our unit with orbital cellulitis and treated with primary i.v. antibiotics between March 2000 and March 2003. Nineteen patients were included in the review for the period March 2003 to March 2007, which comprised of 7 children and 12 adults. Five patients required surgical intervention. All patients responded to the oral regimen, 18 patients had no change to their oral antibiotic therapy. Mean hospital stay was 4.4 days. There were no complications. Empirical oral ciprofloxacin and clindamycin combination may be as safe and effective as i.v. therapy in the management of orbital cellulitis. Oral treatment can offer the advantages of rapid delivery of the first antibiotic dose, fewer interruptions in treatment, and simplified delivery of medication particularly in children.

  14. End-of-life decision making: withdrawing from dialysis: a 12-year retrospective single centre experience from the UK.

    Science.gov (United States)

    Aggarwal, Y; Baharani, J

    2014-12-01

    Withdrawal from dialysis is a common mode of death in patients undergoing dialysis. Anecdotally most patients have a physician-directed dialysis withdrawal (DW) following an acute medical precipitant, rather than a patient-narrated planned withdrawal as part of a collaborative end-of-life care plan. We report a 12-year retrospective experience of patients undergoing dialysis who died following DW, and suggest clinical parameters which can be used to identify patients who are able to direct their end-of-life care process. Retrospective 12-year review of inhouse electronic and paper records. 867 patients undergoing dialysis died during the study period. 93 patients died from DW. 9 (10%) patients electively withdrew in the absence of an acute medical precipitant and 84(90%) withdrew from dialysis for medical reasons. Patients who chose to withdraw were 10 years younger at dialysis initiation and withdrawal, had greater reported sessional difficulties/intolerances (pdialysis (pdialysis withdrawn for medical reasons (pdialysis tolerance, cognitive decline, rehabilitation post an acute medical precipitant and, place of residence are parameters which differentiate between patients who choose to withdraw from dialysis and those who have dialysis withdrawn for medical reasons. These parameters can be used to identify terminal patients on dialysis who are able to be directive in their end-of-life advanced care planning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2011-05-28

    BACKGROUND: We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen. Patients and methods. Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study. RESULTS: The incidence of biopsy proven 3-month acute rejections was 30 (12.5%) in MMF group and 22 (16%) in AZA group respectively (P = 0.307). Patient survival rates at 1 and 5 years for the MMF group were 97 and 94%, respectively, compared to 100% and 91% at 1 and 5 years respectively for the AZA group (P = 0.61). Graft survival rates at 1 and 5 years for the MMF group were 95 and 83%, respectively, compared to 97 and 84% at 1 and 5 years, respectively for the AZA group (P = 0.62). CONCLUSION: There was no difference in acute rejection episodes between MMF and AZA based immunotherapy. Additionally, we observed no significant difference concerning graft survival in the MMF group when compared to AZA group.

  16. An evaluation of multimodal spinal cord monitoring in scoliosis surgery: a single centre experience of 354 operations.

    Science.gov (United States)

    Bhagat, S; Durst, A; Grover, H; Blake, J; Lutchman, L; Rai, A S; Crawford, R

    2015-07-01

    To evaluate the effectiveness of multimodal intraoperative neuromonitoring in the early detection of impending spinal cord injury during surgery for spinal deformity. A retrospective review of prospectively collected data in 354 consecutive spinal deformity operations from June 2003 to October 2013. Patients were sub-grouped according to demographics, diagnosis and operative features. Post-operative neurological deficit was defined as either spinal cord, nerve root or transient deficit. Combined monitoring with SSEPs and MEPs was possible in 315 cases. The overall incidence of significant alerts was 7.1 % and overall permanent neurological deficit was 1.6 %. When results were collated, the overall combined sensitivity of multimodal monitoring was 100 % with a specificity of 99.3 %. Multimodal monitoring allows early detection of impending neurological deficit that is superior to a single monitoring modality. To achieve optimal use of monitoring, continuous communication between surgical, anaesthetic and neurophysiology teams are required. As a result of our experience we have incorporated in our consent procedure the discussion of monitoring and the possibility of needing to abandon the procedure, and completing in a staged fashion at a later date. We believe multimodal monitoring is the current gold standard for complex spinal deformity surgery.

  17. Short-term side-effects of brain MR examination at 7 T: a single-centre experience

    Energy Technology Data Exchange (ETDEWEB)

    Cosottini, M. [University of Pisa, Department of Translational Research and New Technologies in Medicine and Surgery, Pisa (Italy); Frosini, D. [Santa Chiara Hospital, Unit of Neurology, Pisa (Italy); Biagi, L.; Tosetti, M. [IRCCS Stella Maris, Pisa (Italy); Pesaresi, I. [Santa Chiara Hospital, Unit of Neuroradiology, Pisa (Italy); Costagli, M.; Tiberi, G. [IMAGO7 Research Foundation, Pisa (Italy); Symms, M. [General Electric ASL Scientist (EMEA), Pisa (Italy)

    2014-08-15

    To study patient tolerability of brain imaging that employs an ultrahigh field (7 T) MR system We examined 180 subjects that underwent brain MR examination at 7 T. A tolerability test consisting of two parts (during patient table motion and during the examination) was administered to all subjects in order to monitor their discomfort. The scores range from 0 to 5 for the first part, and from 0 to 10 for the second part, the total score of each subject therefore ranging from 0 (no side effects reported) to 15 (lowest tolerability) A total of 51 % of subjects reported at least one side effect but all were mild in intensity and did not require examination interruption. No serious adverse event was reported. The total score (mean ± standard deviation) was 1.1 ± 1.5 out of 15 (mean score 0.4 ± 0.7 out of 5 during patient table motion and 0.7 ± 1.1 out of 10 during MR). Patient discomfort was not related to gender or health status, but it was reduced with time after system installation with increasing operator experience in performing UHF MR examinations. Ultrahigh field MRI is well tolerated without excessive discomfort to subjects. (orig.)

  18. Organ retrieval and banking in brain dead trauma patients: Our experience at level-1 trauma centre and current views

    Directory of Open Access Journals (Sweden)

    Chhavi Sawhney

    2013-01-01

    Full Text Available Background: Organ retrieval from brain dead patients is getting an increased attention as the waiting list for organ recipients far exceeds the organ donor pool. In our country, despite a large population the number of brain dead donors undergoing organ donation is very less (2% in our study. Aims: The present study was undertaken to address issues related to organ donation and share our experience for the same. Methods: A retrospective case record analysis of over 5 years from September 2007 to August 2012 was performed and the patients fulfilling brain death criterion as per Transplantation of Human Organs and Tissue (Amendment Act were included. Patient demographics (age, sex, mode of injury, time from injury to the diagnosis of brain death, time from diagnosis of brain death to organ retrieval and complications were analysed. Statistics Analysis: Student′s t test was used for parametric data and Chi square was used for categorical data. Results: Out of 205 patients who were identified as brain dead, only 10 patients became potential organ donors. Conclusion: Aggressive donor management, increasing public awareness about the concept of organ donation, good communication between clinician and the family members and a well-trained team of transplant coordinators can help in improving the number of organ donations.

  19. Trauma-exposed firefighters: relationships among posttraumatic growth, posttraumatic stress, resource availability, coping and critical incident stress debriefing experience.

    Science.gov (United States)

    Sattler, David N; Boyd, Bill; Kirsch, Julie

    2014-12-01

    This project examines protective factors associated with resilience/posttraumatic growth and risk factors associated with posttraumatic stress among firefighters exposed to critical incidents. The participants were 286 (257 men and 29 women) volunteer and paid firefighters in Whatcom County, Washington. Participants completed an anonymous survey asking about demographics, critical incident exposure, posttraumatic stress symptoms, posttraumatic growth, resource availability, coping, occupational stress and critical incident stress debriefing experience. Most participants had significant critical incident exposure, and about half had attended critical incident stress debriefing sessions. Posttraumatic growth was associated with being female, critical incident exposure, critical incident stress debriefing attendance, posttraumatic stress symptoms (negative association), occupational support, occupation satisfaction, occupational effort, problem-focused coping, emotion-focused coping and personal characteristic resources. Posttraumatic stress symptoms were positively associated with years of firefighting, burnout, occupational effort and disengagement coping and negatively associated with critical incident stress debriefing attendance, posttraumatic growth, social support, internal locus of control, personal characteristic resources, energy resources and condition resources. The findings support conservation of resources stress theory and show that the maintenance and acquisition of resources can offset losses and facilitate resilience/posttraumatic growth. Implications of the findings for enhancing firefighter resources, facilitating resilience and minimizing occupational stressors are discussed. © 2014 John Wiley & Sons, Ltd.

  20. Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia

    Directory of Open Access Journals (Sweden)

    Maja Stachura

    2017-09-01

    Discussion: In this urban, low-resource, academic EC in Ethiopia, POCUS provided clinically relevant information for patient management, particularly for polytrauma, undifferentiated shock and undifferentiated dyspnea. Results have subsequently been used to develop a locally relevant emergency department ultrasound curriculum for Ethiopia’s first emergency medicine residency program.

  1. Effectiveness of a Science Agricultural Summer Experience (SASE) in Recruiting Students to Natural Resources Management

    Science.gov (United States)

    Martinez, Edward; Lindline, Jennifer; Petronis, Michael S.; Pilotti, Maura

    2012-12-01

    The Bureau of Labor Statistics projects an increase in Natural Resource Management (NRM) jobs within the next 10 years due to baby-boomer retirements and a 12% increase in demand for these occupations. Despite this trend, college enrollment in NRM disciplines has declined. Even more critical is the fact that the soon-to-be-majority Hispanic population is underrepresented in NRM disciplines. The goal of the present study was to determine if an in-residence, two-week, summer science program for underrepresented minorities would not only increase interest in science, actual science knowledge, and perceived science knowledge, but also have an overall impact on underrepresented minority students' decisions to attend college, major in a scientific discipline and pursue a career in science. During a four-year period, 76 high school students participated in a Science Agricultural Summer Experience (SASE) in Northern New Mexico. A pre/post science-knowledge exam and satisfaction survey were administered to participants. We demonstrate that participants improved significantly ( p age ( n = 44), all graduated from high school; and 86% enrolled in college. These findings suggest that the implemented SASE initiative was effective in recruiting and increasing the confidence and abilities of underrepresented minority students in science.

  2. Water resources development and management: an experience in rural hilly area.

    Science.gov (United States)

    Khadse, G K; Talkhande, A V; Andey, S P; Kelkar, P S

    2010-01-01

    The Himalayan region of Tehri Garhwal in India has scattered habitations in the villages with scanty, non-perennial and unsafe water resources like springs and streams. Poor environmental conditions arising from unsafe drinking water, inadequate sanitary measures, unhygienic disposal of excreta, sullage and accumulation of solid wastes have resulted in poor public health. The experiences gained through water supply and sanitation studies carried out especially in this rural area have been shared in this paper so as to enable adoption of relevant practices and technologies developed by the National Environmental Engineering Research Institute (NEERI, India) in the affected areas. Environmental protection of the streams and springs for sustained water availability and safe drinking water supply was ensured with active public participation, training, and awareness programs. Various surface rainwater harvesting structures were constructed at suitable sites along with ferro-cement roofwater harvesting tanks in selected villages. The activities related to designing and commissioning of a small slow sand filtration unit were carried out at Chhati (Nakot) village for safe drinking water supply. Chlorination pots were demonstrated and installed in rainwater harvesting tanks for disinfection of water for drinking purpose. Water quality assessment and health survey (parasitic and hemoglobin investigation) in the affected villages were carried out before and after technological intervention. The training and awareness programs were organised for people of 23 villages in the study area covering water and sanitation related topics. The beneficiary's opinions, perceptions, apprehensions, as well as expectations reflected positive approach towards the achievement of anticipated benefits and impacts.

  3. A new educational resource to improve veterinary students' animal welfare learning experience.

    Science.gov (United States)

    Kerr, Annie J; Mullan, Siobhan M; Main, David C J

    2013-01-01

    A computer-aided learning (CAL) educational resource based on experiential learning principles has been developed. Its aim is to improve veterinary students' ability to critically review the effect on welfare of husbandry systems observed during their work placement on sheep farms. The CAL consisted of lectures, multiple-choice questions, video recordings of animals in various husbandry conditions, open questions, and concept maps. An intervention group of first-year veterinary students (N=31) was selected randomly to access the CAL before their sheep farm placement, and a control group (N=50) received CAL training after placement. Assessment criteria for the categories remember, understand, apply, analyze, evaluate, and create, based on Bloom's revised taxonomy, were used to evaluate farm reports submitted by all students after their 2-week placement. Students in the intervention group were more likely than their untrained colleagues (panimal-based measurements relating to the freedom from hunger and thirst; the freedom from discomfort; and the freedom from pain, injury, or disease. Intervention group students were also more likely to analyze the freedom from pain, injury, or disease and the freedom to exhibit normal behavior and to evaluate the freedom from fear and distress. Relatively few students in each group exhibited creativity in their reports. These findings indicate that use of CAL before farm placement improved students' ability to assess and report animal welfare as part of their extramural work experience.

  4. Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience.

    Science.gov (United States)

    da Costa, L; Thines, L; Dehdashti, A R; Wallace, M C; Willinsky, R A; Tymianski, M; Schwartz, M L; ter Brugge, K G

    2009-04-01

    Posterior fossa brain arteriovenous malformations (PFbAVMs) are rare lesions. Management is complicated by eloquence of adjacent neurological structures, multimodality treatment is often necessary, and obliteration is not always possible. We describe a 15-year experience in the management of posterior fossa brain AVMs with a focus on clinical outcome. From 1989 to 2004, prospectively collected information on 106 patients with diagnosis of a PFbAVMs was obtained. Clinical and angioarchitectural characteristics, management options and complications are described and reviewed to evaluate their impact on final outcome as measured by the Modified Rankin Score (mRS). Ninety-eight patients were followed for an average of 3.3 years (1-14.6). The male-to-female ratio was 1:1. Ninety-five out of 98 patients (96.9%) were symptomatic at presentation, with 61 (62.2%) intracranial haemorrhages. Sixty-two patients were treated (46 cerebellar, 16 brainstem). Ten haemorrhages occurred in follow-up (4.1%/year). The mRS was obtained in 62 patients and was classified as low (good, mRSor=3). Haemorrhage was the only predictor of poor mRS at presentation (p = 0.0229). A poor clinical outcome was correlated with the presence of AA (p = 0.0276), a poor initial mRS (p<0.0001) and the number of treatments needed (p = 0.0434). Patients were significantly more likely to improve than to deteriorate over time (p = 0.0201). The final clinical outcome in PFbAVMs relates directly with the presence of associated aneurysms, number of treatments needed to obliterate the AVM and mRS at presentation. Despite the fact that patients tend to improve after brain AVM haemorrhage, the relationship of MRS at presentation and final outcome suggests that an expedited, more definitive treatment is probably a better choice, especially in patients with good grades after the initial bleeding.

  5. German adaptation of the Resources for Enhancing Alzheimer’s Caregiver Health II: study protocol of a single-centred, randomised controlled trial

    OpenAIRE

    Heinrich, Stephanie; Berwig, Martin; Simon, Anke; Jänichen, Jenny; Hallensleben, Nina; Nickel, Witiko; Hinz, Andreas; Brähler, Elmar; Gertz, Hermann-Josef

    2014-01-01

    Background Caring for a family member with dementia is extremely stressful, and contributes to psychiatric and physical illness among caregivers. Therefore, a comprehensive programme called Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II) was developed in the United States to enhance the health of Alzheimer’s caregivers. REACH II causes a clear reduction of the stress and burdens faced by informal caregivers at home. The aim of this protocol is to adapt, apply, and evaluate ...

  6. Human resource development: the Asian experience in employment and manpower planning - an overview

    OpenAIRE

    Amjad, Rashid

    1987-01-01

    The overview based on country studies included in this volume investigates the extent to which it has been possible to integrate human resource development and give priority to this important goal within the overall planning process. While it is clear that the development of human resources has to compete with other pressing demands for limited resources available for development, the key question still remains whether overall socioeconomic development undertaken has incorporated the preferre...

  7. Project for a renewable energy research centre

    Directory of Open Access Journals (Sweden)

    Andrea Giachetta

    2011-04-01

    Full Text Available In Liguria, where sustainable approaches to the design, construction and management of buildings enjoy scant currency, the idea of a company from Milan (FERA s.r.l. setting up a research centre for studies into renewable energy resources, could well open up very interesting development opportunities.The project includes: environmental rehabilitation (restoration projects; strategies for the protection of water resources and waste management systems; passive and active solar systems (solar thermal and experiments with thermodynamic solar energy; hyperinsulation systems, passive cooling of buildings; use of natural materials; bio-climatic use of vegetation. The author describes the project content within the context of the multidisciplinary work that has gone into it.

  8. An Investigative Study into Perspectives and Experiences of Incubates at the Chandaria Business Innovation and Incubation Centre at the Kenyatta University

    Science.gov (United States)

    Munyanyiwa, Takaruza; Mutsau, Morgen; Rudhumbu, Norman; Svotwa, Douglas

    2016-01-01

    The study presents results from an investigative study undertaken at the Kenyatta University (KU) Chandaria Business Innovation and Incubation Centre. A total of 10 incubates representing 10 projects were engaged in face to face interviews. The incubates were appreciative of the value that incubation centre such as the one at KU contributed to…

  9. Patients' priorities for ambulant hospital care centres: a survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital.

    NARCIS (Netherlands)

    Albada, A.; Triemstra, M.

    2009-01-01

    Objective: This study established patients' preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients' choice to visit this centre instead of the regional hospital. Methods: A questionnaire survey among 1477 elderly and

  10. Increase in the neutron yield from a dense plasma-focus experiment performed with a conical tip placed in the centre of the anode end

    Science.gov (United States)

    Kubes, P.; Paduch, M.; Cikhardt, J.; Cikhardtova, B.; Klir, D.; Kravarik, J.; Rezac, K.; Zielinska, E.; Sadowski, M. J.; Szymaszek, A.; Tomaszewski, K.; Zaloga, D.

    2017-09-01

    The paper describes the evolution of self-organized structures inside a pinched plasma column during the phase of the effective production of fusion neutrons, as observed in the mega-ampere plasma focus experiment performed with a conical tip placed in the centre of the anode face. In a comparison with the plane anode face configuration, the described anode shape facilitated transformations in the pinch column during the neutron production and increased the neutron yield several times. Simultaneously, it decreased the minimal diameter and the length of the pinched column, and it depressed the first neutron pulse. It also induced shorter pulses of X-rays and neutrons, which enabled the determination of a temporal difference between the emission of electron and deuteron beams. The fast electrons were produced mainly during a disruption of the pinch constriction, while the fast deuterons - during the formation and explosion of plasmoids. The paper also presents the temporal evolution of a current distribution in the plasmoid during the neutron production, as well as the appearance and stable positions of current filaments traces upon the surface of the conical anode tip.

  11. SOFIA Technology: The NASA Airborne Astronomy Ambassador (AAA) Experience and Online Resources

    Science.gov (United States)

    Clark, C.; Harman, P. K.; Backman, D. E.

    2016-12-01

    SOFIA, an 80/20 partnership of NASA and the German Aerospace Center (DLR), consists of a modified Boeing 747SP carrying a reflecting telescope with an effective diameter of 2.5 meters. SOFIA is the largest airborne observatory in the world, capable of observations impossible for even the largest and highest ground-based telescopes. The SOFIA Program Office is at NASA ARC, Moffett Field, CA; the aircraft is based in Palmdale, CA. During its planned 20-year lifetime, SOFIA will foster development of new scientific instrumentation and inspire the education of young scientists and engineers. Astrophysicists are awarded time on SOFIA to study many kinds of astronomical objects and phenomena. Among the most interesting are: Star birth, evolution, and death Formation of new planetary systems Chemistry of complex molecules in space Planet and exoplanet atmospheres Galactic gas & dust "ecosystems" Environments around supermassive black holes SOFIA currently has eight instruments, five US-made and three German. The instruments — cameras, spectrometers, and a photometer,— operate at near-, mid- and far-infrared wavelengths, each spectral range being best suited to studying particular celestial phenomena. NASA's Airborne Astronomy Ambassadors' (AAAs) experience includes a STEM immersion component. AAAs are onboard during two overnight SOFIA flights that provide insight into the acquisition of scientific data as well as the interfaces between the telescope, instrument, & aircraft. AAAs monitor system performance and view observation targets from their dedicated workstation during flights. Future opportunities for school district partnerships leading to selection of future AAA cohorts will be offered in 2018-19. AAAs may access public archive data via the SOFIA Data Cycle System (DCS) https://dcs.sofia.usra.edu/. Additional SOFIA science and other resources are available at: www.sofia.usra.edu, including lessons that use photovoltaic circuits, and other technology for the

  12. From Research Resources to Learning Objects: Process Model and Virtualization Experiences

    Science.gov (United States)

    Sierra, Jose Luis; Fernandez-Valmayor, Alfredo; Guinea, Mercedes; Hernanz, Hector

    2006-01-01

    Typically, most research and academic institutions own and archive a great amount of objects and research related resources that have been produced, used and maintained over long periods of time by different types of "domain experts" (e.g. lecturers and researchers). Although the potential educational value of these resources is very…

  13. Establishment of an endobronchial ultrasound-guided transbronchial fine needle aspiration service with rapid on-site evaluation: 2 years experience of a single UK centre.

    Science.gov (United States)

    Thiryayi, S A; Rana, D N; Narine, N; Najib, M; Bailey, S

    2016-10-01

    Endobronchial ultrasound (EBUS)-guided transbronchial fine needle aspiration (TBFNA) is now well established as a minimally invasive, effective investigation which can provide information on both diagnosis and stage of lung cancer and is also useful in the investigation of mediastinal lymphadenopathy of uncertain aetiology. The service can be provided with or without rapid on-site evaluation (ROSE) for specimen triage and provisional diagnosis. We outline our experience from the first 2 years of providing an EBUS service with ROSE, highlighting the practicalities of service provision, pitfalls encountered and lessons learned. Aspirates from all EBUS procedures performed during the first 2 years of our service from 16 October 2012 to 15 October 2014 are included. We describe the activities undertaken prior to each EBUS list, the EBUS TBFNA procedure, specimen handling and procedure for ROSE. A total of 591 aspirates were performed from 352 patients, including 573 (97%) lymph node aspirates, 17 (2.9%) lung mass samples and one aspirate from a retrosternal thyroid cyst (0.1%). There were 498 (84.1%) adequate samples at ROSE, 82 (13.9%) inadequate, one (0.2%) abandoned and 11 (1.9%) where ROSE was not performed. Four hundred and seventy (79.5%) samples showed concordance between the ROSE and final diagnoses. No adequate samples were obtained for 11 patients (3.1%) after final cytological analysis, resulting in a final adequacy rate of 96.9%. In our experience, ROSE provides a clear advantage in providing a patient-centred EBUS service by facilitating specimen triage, ensuring adequate sampling and providing a rapid provisional diagnosis, however, there is a learning curve for both the clinicians and cytopathologists involved. © 2016 John Wiley & Sons Ltd.

  14. Virtual patients design and its effect on clinical reasoning and student experience: a protocol for a randomised factorial multi-centre study

    Directory of Open Access Journals (Sweden)

    Bateman James

    2012-08-01

    Full Text Available Abstract Background Virtual Patients (VPs are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent and structured clinical reasoning feedback (present or absent. Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent, and structured clinical reasoning feedback (present or absent.The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for

  15. Subjective Experience and Resources for Coping With Stigma in People With a Diagnosis of Schizophrenia: An Intersectional Approach.

    Science.gov (United States)

    Mora-Rios, Jazmín; Ortega-Ortega, Miriam; Natera, Guillermina

    2016-04-01

    In this study, we investigate the subjective experience of a group of individuals, diagnosed with schizophrenia, undergoing outpatient treatment in four psychiatric clinics in Mexico City. Our objective is to use the paradigm of intersectionality to explore the most common forms of stigma and discrimination faced by people with this illness, as well as the coping resources they employ. The major contribution of this study is its use of in-depth interviews and thematic analysis of the information obtained to identify the importance of sociocultural aspects of participants' experience of their illness. Schizophrenia, for them, was a problem of "nerves," whose origins were linked to magical or religious elements they attributed to their illness and which influenced their response to it. This resignification was useful to participants as a coping resource; it helped them find meaning and significance in their experience of the illness. © The Author(s) 2015.

  16. Nurses' experiences of caring for the suddenly bereaved in adult acute and critical care settings, and the provision of person-centred care: A qualitative study.

    Science.gov (United States)

    Walker, Wendy; Deacon, Kate

    2016-04-01

    To explore nursing interventions for person-centred bereavement care in adult acute and critical care settings. A descriptive exploratory study, involving focused, face-to-face interviews. Participants comprised nine registered nurses and one auxiliary nurse, working in environments where sudden death was known to occur, i.e. emergency, cardiac and critical care. Interviews were transcribed verbatim and data subjected to directed content analysis. The provision of person-centred care was examined by applying a validated Person-Centred Nursing Framework. Five main themes were identified. Participants' accounts contained descriptions of bereavement care and the presence of person-centred interventions. Contextual, professional and attitudinal factors influenced the degree to which person-centred care operated. Caring for suddenly bereaved families was important to nurses, but also a source of tension and unrest. An important consideration for person-centred practice is movement away from sudden bereavement as a 'here and now' event, towards a pathway of supportive care that envisions the longer-term. Further research is required to gain a deeper understanding of person-centred care for the suddenly bereaved and the perceived effectiveness of nursing interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Interdisciplinary Pedagogical Experience for Health Human Resources Focused on the Holistic Promotion of Health and the Prevention of the Disease

    Directory of Open Access Journals (Sweden)

    Ruth Pérez Hernández

    2006-10-01

    Full Text Available The object of this experience is to offer thestudents the opportunity to take part in theconstruction of a pedagogic strategy centred onthe ludic, for the promotion of the integral healthand the prevention of the disease with aneducational community; directed to supportingand qualifying the well-being so much individuallyas group. The project is designed to fiveyears, about interdisciplinary character (SpeechTherapy, Medicine, Psychology, Nursery,Occupational Therapy, interinstitutional (Universidaddel Rosario, Universidad de San Buenaventuray Universidad de Cundinamarca andintersectorial (Education and Health. It considersthe different actors of the educationalcommunity and school and the home as propitiousscenes for the strengthening potential,beside being the fundamental spaces for theconstruction of knowledges and learnings concerningthe integral health.To achieve the target, one has come constructingfrom the second semester of 2003, onepedagogic strategy centred on the ludic and thecreativity, from which they are planned, theydevelop and evaluate the actions of promotionof skills, values, behaviors and attitudes in thecare of the health and the prevention of disease,orientated to the early, opportune and effectivedetection of risk factors and problematic of thedevelopment that they affect the integral health.The above mentioned strategy raises a socalled scene Bienestarópolis: A healthy worldfor conquering, centred on prominent figures,spaces and elements that alternate between thefantasy and the reality to facilitate the approximation,the interiorización and the appropriationof the integral health. Across this one, thechildren motivated by the adults enter an imaginaryworld in that theirs desires, knowledgesand attitudes are the axis of his development.Since Vigotsky raises it, in the game the childrealizes actions in order to adapt to the world thatsurrounds it acquiring skills for the learning. Theactions of the project have involved

  18. Experiences with the Application of Services Oriented Approaches to the Federation of Heterogeneous Geologic Data Resources

    Science.gov (United States)

    Cervato, C.; Fils, D.; Bohling, G.; Diver, P.; Greer, D.; Reed, J.; Tang, X.

    2006-12-01

    The federation of databases is not a new endeavor. Great strides have been made e.g. in the health and astrophysics communities. Reviews of those successes indicate that they have been able to leverage off key cross-community core concepts. In its simplest implementation, a federation of databases with identical base schemas that can be extended to address individual efforts, is relatively easy to accomplish. Efforts of groups like the Open Geospatial Consortium have shown methods to geospatially relate data between different sources. We present here a summary of CHRONOS's (http://www.chronos.org) experience with highly heterogeneous data. Our experience with the federation of very diverse databases shows that the wide variety of encoding options for items like locality, time scale, taxon ID, and other key parameters makes it difficult to effectively join data across them. However, the response to this is not to develop one large, monolithic database, which will suffer growth pains due to social, national, and operational issues, but rather to systematically develop the architecture that will enable cross-resource (database, repository, tool, interface) interaction. CHRONOS has accomplished the major hurdle of federating small IT database efforts with service-oriented and XML-based approaches. The application of easy-to-use procedures that allow groups of all sizes to implement and experiment with searches across various databases and to use externally created tools is vital. We are sharing with the geoinformatics community the difficulties with application frameworks, user authentication, standards compliance, and data storage encountered in setting up web sites and portals for various science initiatives (e.g., ANDRILL, EARTHTIME). The ability to incorporate CHRONOS data, services, and tools into the existing framework of a group is crucial to the development of a model that supports and extends the vitality of the small- to medium-sized research effort that is

  19. Evaluating broad scale patterns among related species using resource experiments in tropical hummingbirds.

    Science.gov (United States)

    Weinstein, Ben G; Graham, Catherine H

    2016-08-01

    A challenge in community ecology is connecting biogeographic patterns with local scale observations. In Neotropical hummingbirds, closely related species often co-occur less frequently than expected (overdispersion) when compared to a regional species pool. While this pattern has been attributed to interspecific competition, it is important to connect these findings with local scale mechanisms of coexistence. We measured the importance of the presence of competitors and the availability of resources on selectivity at experimental feeders for Andean hummingbirds along a wide elevation gradient. Selectivity was measured as the time a bird fed at a feeder with a high sucrose concentration when presented with feeders of both low and high sucrose concentrations. Resource selection was measured using time-lapse cameras to identity which floral resources were used by each hummingbird species. We found that the increased abundance of preferred resources surrounding the feeder best explained increased species selectivity, and that related hummingbirds with similar morphology chose similar floral resources. We did not find strong support for direct agonism based on differences in body size or phylogenetic relatedness in predicting selectivity. These results suggest closely related hummingbird species have overlapping resource niches, and that the intensity of interspecific competition is related to the abundance of those preferred resources. If these competitive interactions have negative demographic effects, our results could help explain the pattern of phylogenetic overdispersion observed at regional scales. © 2016 by the Ecological Society of America.

  20. Mobile phone use for a social strategy to improve antiretroviral refill experience at a low-resource HIV clinic: patient responses from Nigeria.

    Science.gov (United States)

    Adetunji, Adedotun A; Muyibi, Sufiyan A; Imhansoloeva, Martins; Ibraheem, Olusola M; Sunmola, Adegbenga; Kolawole, Olubunmi O; Akinrinsola, Oluwasina O; Ojo-Osagie, James O; Mosuro, Olusola A; Abiolu, Josephine O; Irabor, Achiaka E; Okonkwo, Prosper; Adewole, Isaac F; Taiwo, Babafemi O

    2017-05-01

    In sub-Saharan African areas where antiretroviral (ARV) drugs are not available through community pharmacies, clinic-based pharmacies are often the primary source of ARV drug refills. Social pressure is mounting on treatment providers to adjust ARV refill services towards user-friendly approaches which prioritize patients' convenience and engage their resourcefulness. By this demand, patients may be signalling dissatisfaction with the current provider-led model of monthly visits to facility-based pharmacies for ARV refill. Mobile phones are increasingly popular in sub-Saharan Africa, and have been used to support ARV treatment goals in this setting. A patient-centred response to on-going social pressure requires treatment providers to view ARV refill activities through the eyes of patients who are negotiating the challenges of day-to-day life while contemplating their next refill appointment. Using focus groups of five categories of adult patients receiving combination ARV therapy, we conducted this cross-sectional qualitative study to provide insight into modifiable gaps between patients' expectations and experiences of the use of mobile phones in facility-based ARV refill service at a public HIV clinic in Nigeria. A notable finding was patients' preference for harnessing informal social support (through intermediaries with mobile phones) to maintain adherence to ARV refill appointments when they could not present in person. This evolving social support strategy also has the potential to enhance defaulter tracking. Our study findings may inform the development of ARV refill strategies and the design of future qualitative studies on client-provider communication by mobile phones in under-resourced HIV treatment programmes.

  1. Australian International Food Security Research Centre | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Australian International Food Security Research Centre. Australian International Food Security Research Centre. http://aciar.gov.au/aifsc/ · What we do · Funding · Resources · About IDRC. Knowledge. Innovation. Solutions. Careers · Contact Us · Site map. Sign up now for IDRC news and views sent directly to your inbox ...

  2. Forensic science and the right to access to justice: Testing the efficacy of self-examination intimate DNA swabs to enhance victim-centred responses to sexual violence in low-resource environments.

    Science.gov (United States)

    Smith, Lisa L; Wetton, Jon H; Lall, Gurdeep K M; Flowe, Heather D; Jobling, Mark A

    2017-09-01

    In developed countries, DNA profiling routinely forms part of the forensic strategy in the investigation of sexual violence. Medical examinations provide opportunities for recovering DNA evidence from intimate swabs, which can be particularly probative in cases where the identity of the perpetrator is unknown and proof of intercourse between two people is required. In low-resource environments, such as developing countries, remote geographic locations, conflict (and post-conflict) affected regions and displaced communities where access to medical examinations is lacking, DNA evidence is not available to support prosecutions and perpetrators are rarely identified and held accountable for crimes of sexual violence. This paper reports the results of a proof-of-concept study testing the efficacy of a novel self-examination intimate swab designed for recovering DNA following unprotected sexual intercourse. The results of this study corroborate previous research which has demonstrated that male DNA profiles can be successfully recovered by post-coital, self-examination methods, and discusses how this novel approach could enable the integration of DNA evidence into victim-centred approaches to investigating and prosecuting sexual violence in low-resource environments. The results and discussion challenge the prevailing assumption that intimate DNA swabs must be collected by trained medical professionals in order to be of evidential value. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  3. Exploring External Validity of Common Pool Resource Experiments: Insights from Artisanal Benthic Fisheries in Chile

    Directory of Open Access Journals (Sweden)

    Stefan Gelcich

    2013-09-01

    This study provided insight on the experimental analysis of cooperation in artisanal fisheries and suggested that the capacity to internalize norms is important to the sustainable exploitation of artisanal fisheries common pool resources.

  4. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting

    NARCIS (Netherlands)

    Scheepers, Renée A.; Lases, Lenny S. S.; Arah, Onyebuchi A.; Heineman, Maas Jan; Lombarts, Kiki M. J. M. H.

    2017-01-01

    Purpose Physician work engagement is associated with better work performance and fewer medical errors; however, whether workengaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision

  5. To Get or Not to Get the Kaust Library E-Resources Acquisition Experience

    OpenAIRE

    Ramli, Rindra M.; Kabli, Ola A.

    2014-01-01

    In the challenging times of budget cuts and reviews, libraries are faced with issues such as justifying acquisition, negotiating deals and reviewing current subscriptions (pertaining to electronic resources) among others. With the rapid growth of electronic resources, libraries have to continuously assess their acquisition models and policies to constantly ensure that they are balancing their budget and users’ needs as well. This paper highlights the role played by Technical and Digital Servi...

  6. Applying innovative educational principles when classes grow and resources are limited: Biochemistry experiences at Muhimbili University of Allied Health Sciences.

    Science.gov (United States)

    Omer, Selma; Hickson, Gilles; Taché, Stephanie; Blind, Raymond; Masters, Susan; Loeser, Helen; Souza, Kevin; Mkony, Charles; Debas, Haile; O'Sullivan, Patricia

    2008-11-01

    Teaching to large classes is often challenging particularly when the faculty and teaching resources are limited. Innovative, less staff intensive ways need to be explored to enhance teaching and to engage students. We describe our experience teaching biochemistry to 350 students at Muhimbili University of Health and Allied Sciences (MUHAS) under severe resource limitations and highlight our efforts to enhance the teaching effectiveness. We focus on peer assisted learning and present three pilot initiatives that we developed to supplement teaching and facilitate student interaction within the classroom. These included; instructor-facilitated small group activities within large group settings, peer-led tutorials to provide supplemental teaching and peer-assisted instruction in IT skills to enable access to online biochemistry learning resources. All our efforts were practical, low cost and well received by our learners. They may be applied in many different settings where faculties face similar challenges. Copyright © 2008 International Union of Biochemistry and Molecular Biology, Inc.

  7. Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy - a single-centre experience.

    Science.gov (United States)

    Henkenberens, C; Janssen, S; Lavae-Mokhtari, M; Leni, K; Meyer, A; Christiansen, H; Bremer, M; Dickgreber, N

    2016-02-02

    To assess efficacy of our single-centre experience with inhalative steroids (IS) in lung cancer patients with symptomatic radiation pneumonitis (RP) grade II. Between 05/09 and 07/10, 24 patients (female, n = 8; male, n = 16) with lung cancer (non-small cell lung carcinoma [NSCLC]: n = 19; small cell lung cancer [SCLC]: n = 3; unknown histology: n = 2) and good performance status (ECOG ≤1) received definitive radiotherapy to the primary tumour site and involved lymph nodes with concurrent chemotherapy (n = 18), sequential chemotherapy (n = 2) or radiation only (n = 4) and developed symptomatic RP grade II during follow-up. No patient presented with oxygen requiring RP grade III. The mean age at diagnosis was 66 years (range: 50-82 years). Nine patients suffered from chronic obstructive pulmonary disease (COPD) before treatment, and 18 patients had a smoking history (median pack years: 48). The mean lung dose was 15.5 Gy (range: 3.0-23.1 Gy). All patients were treated with IS. If a patient's clinical symptoms did not significantly improve within two weeks of IS therapy initiation, their treatment was switched to oral prednisolone. All 24 patients were initially treated with a high dose IS (budesonide 800 μg 1-0-1) for 14 days. Of the patients, 18 showed a significant improvement of clinical symptoms and 6 patients did not show significant improvement of clinical symptoms and were classified as non-responders to IS. Their treatment was switched to oral steroids after two weeks (starting with oral prednisolone, 0.5 mg/kg bodyweight; at least 50 mg per day). All of these patients responded to the prednisolone. None of non-responders presented with increased symptoms of RP and required oxygen and / or hospitalization (RP grade III). The median follow-up after IS treatment initiation was 18 months (range: 4-66 months). The median duration of IS treatment and prednisolone treatment was 8.2 months (range: 3.0-48.3 months) and 11.4 months (range: 5.0-44.0 months

  8. Safety and effectiveness of percutaneous sacroplasty: a single-centre experience in 58 consecutive patients with tumours or osteoporotic insufficient fractures treated under fluoroscopic guidance.

    Science.gov (United States)

    Pereira, Licia Pacheco; Clarençon, Frédéric; Cormier, Evelyne; Rose, Michèle; Jean, Beatrix; Le Jean, Lise; Chiras, Jacques

    2013-10-01

    To report our experience in percutaneous sacroplasty (PSP) for tumours and insufficiency fractures of the sacrum. Single-centre retrospective analysis of 58 consecutive patients who underwent 67 PSPs for intractable pain from sacral tumours (84.5 %) or from osteoporotic fractures (15.5 %). The following data were assessed: visual analogue scale (VAS) before and after the procedure for global pain; short-term (1-month) clinical follow-up using a four-grade patient satisfaction scale (worse, unchanged, mild improvement and significant improvement); modification in analgesics consumption; referred short-term walking mobility. Minor and major complications were systematically assessed. The mean VAS score was 5.3 ± 2.0 in pre-procedure and 1.7 ± 1.8 in post-procedure. At 1-month follow-up, 34/58 (58.5 %) patients experienced a mild improvement; 15/58 (26 %) presented a significant improvement while 4/58 (7 %) and 5/58 (8.5 %) patients had unchanged or worse pain, respectively. Decreased analgesic consumption was observed in 34 % (20/58) of the patients. Eighty percent of patients with walking limitation experienced improvement, 16 % remained unchanged and 4 % were worse. We noted minor complications in 2/58 patients (3.4 %) and major complications in 2/58 patients (3.4 %). Percutaneous sacroplasty for metastatic and osteoporotic fractures is a safe and effective technique in terms of pain relief and functional outcome. • Percutaneous sacroplasty provides pain relief and functional improvement for insufficiency sacral fractures. • Percutaneous sacroplasty provides pain relief and function improvement for sacral tumours. • The major complication rate is acceptable (3.4 %), and is higher in sacral tumours. • Posterior wall/cortical sacral bone disruption is not statistically associated with more complications. • However, osteolytic tumours seem to be associated with higher risk of complications.

  9. Living through conflict and post-conflict: experiences of health workers in northern Uganda and lessons for people-centred health systems.

    Science.gov (United States)

    Namakula, Justine; Witter, Sophie

    2014-09-01

    Providing people-centred health systems--or any systems at all--requires specific measures to protect and retain healthcare workers during and after the conflict. This is particularly important when health staff are themselves the target of violence and abduction, as is often the case. This article presents the perspective of health workers who lived through conflict in four districts of northern Uganda--Pader, Gulu, Amuru, and Kitgum. These contained more than 90% of the people displaced by the decades of conflict, which ended in 2006. The article is based on 26 in-depth interviews, using a life history approach. This participatory tool encouraged participants to record key events and decisions in their lives, and to explore areas such as their decision to become a health worker, their employment history, and their experiences of conflict and coping strategies. These were analyzed thematically to develop an understanding of how to protect and retain staff in these challenging contexts. During the conflict, many health workers lost their lives or witnessed the death of their friends and colleagues. They also experienced abduction, ambush and injury. Other challenges included disconnection from social and professional support systems, displacement, limited supplies and equipment, increased workload and long working days and lack of pay. Health workers were not passive in the face of these challenges, however. They adopted a range of safety measures, such as mingling with community members, sleeping in the bush, and frequent change of sleeping place, in addition to psychological and practical coping strategies. Understanding their motivation and their views provides an important insight how to maintain staffing and so to continue to offer essential health care during difficult times and in marginalized areas. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  10. Implementation of new Healthy Conversation Skills to support lifestyle changes - what helps and what hinders? Experiences of Sure Start Children's Centre staff.

    Science.gov (United States)

    Tinati, Tannaze; Lawrence, Wendy; Ntani, Georgia; Black, Christina; Cradock, Sue; Jarman, Megan; Pease, Anna; Begum, Rufia; Inskip, Hazel; Cooper, Cyrus; Baird, Janis; Barker, Mary

    2012-07-01

    Effective communication is necessary for good relationships between healthcare practitioners and clients. This study examined barriers and facilitators to implementing new communication skills. One hundred and ten Sure Start Children's Centre staff attended one of 13 follow-up workshops in Southampton, UK between May 2009 and February 2011 to reflect on the use of new skills following a training course in communication, reflection and problem-solving. Barriers and facilitators were assessed with an adapted Problematic Experiences of Therapy scale (PETS). Staff reported frequency of skill use, and described what made it more difficult or easier to use the skills. Complete data were available for 101 trainees. The PETS indicated that staff had confidence in using the skills, but felt that there were practical barriers to using them, such as lack of time. Skills were used less often when staff perceived parents not to be engaging with them (Spearman's correlation r(s) = -0.42, P PETS, content analysis of free text responses suggested that the main barrier was a perceived lack of time to implement new skills. Facilitators included seeing the benefits of using the skills, finding opportunities and having good relationships with parents. Understanding the range of barriers and facilitators to implementation is essential when developing training to facilitate ongoing support and sustain skill use. Special attention should be given to exploring trainees' perceptions of time, to be able to address this significant barrier to skill implementation. Staff training requires a multi-faceted approach to address the range of perceived barriers. © 2012 Blackwell Publishing Ltd.

  11. Using Post-Visit Action Resources to Support Family Conservation Learning Following a Wildlife Tourism Experience

    Science.gov (United States)

    Hughes, Karen; Packer, Jan; Ballantyne, Roy

    2011-01-01

    Wildlife tourism experiences are often promoted for their ability to enhance visitors' conservation knowledge, attitudes and behaviour; yet, studies exploring the long-term influence of such experiences are rare. This research explores the impact of a wildlife tourism experience and post-visit support on families' adoption of conservation…

  12. To get or not to get: the KAUST library e-resources acquisition experience

    KAUST Repository

    Ramli, Rindra M.

    2014-06-01

    In the challenging times of budget cuts and reviews, libraries are faced with issues, among others, such as justifying acquisition, negotiating deals and reviewing current subscriptions (pertaining to electronic resources). With the rapid increase in growth of electronic resources, libraries have to continuously assess their acquisition models and policies to constantly ensure that they are balancing their budget and users’ needs as well. This paper highlights the role played by Technical and IT department of King Abdullah University of Science and Technology (KAUST) library (Saudi Arabia) in acquiring the electronic resources (electronic books, electronic journals, databases, image and reference) for the community. It will describe the processes during the early days when KAUST library was inaugurated; how electronic resources were acquired and what went through during those days. The paper will elaborate further how the acquisition model has evolved and the various important roles played by the library staff in ensuring that acquisitions/subscriptions are justified, within the budget and provides ROI for the library. King Abdullah University is a graduate research university which opened in September 2009 with its first cohort of 800 graduate students (25% female) taught by 100 faculties. The focus of study and research in the university are: Mathematics and Computer Science, Physical Sciences and Life Sciences. The university library started with 10 staff. The library has a “state-of-the-art learning and information resource center supporting graduate education and advanced scientific research” (KAUST, 2010).

  13. Balancing the resources of the High Level Trigger farm of the ATLAS experiment

    CERN Document Server

    Garelli, N; The ATLAS collaboration; Vandelli, W

    2012-01-01

    The ATLAS High Level Trigger (HLT) is organized in two trigger levels running different selection algorithms on heterogeneous farms composed of off-the-shelf processing units. The processing units have varying computing power and network connectivities. The ATLAS working conditions are changing due to the continuous optimization of the LHC operations and the consequent trigger adjustment. In addition, the rolling expansion and replacement of the HLT hardware changes the HLT farm composition. Therefore, balancing the available resources is essential for optimizing the HLT farm exploitation. In this paper, a tool for managing the HLT resources will be presented. The tool allows for showing, modifying and generating the HLT farm configuration, keeping the resource balance, in terms of computing power and bandwidth, across the farms under control.

  14. Teachers' Centres.

    Science.gov (United States)

    Thornbury, Robert, Ed.

    Teacher centers in England are professional laboratories where inservice teachers (freed from their classrooms by a release program) can share ideas, experiences, and problems with their colleagues and participate in the development and testing of teaching materials. The evolution of the teacher centers, their functioning, their projects, and…

  15. THE DEVELOPMENT OF CORPORATE CULTURE OF GAS COMPANY BASED ON THE USE OF RESOURCES OF TRAINING CENTRE OF VOCATIONAL EDUCATION (ON THE EXAMPLE OF OJSC «SURGUTNEFTEGAS»

    Directory of Open Access Journals (Sweden)

    S. P. Zaitseva

    2016-01-01

    Full Text Available The aim of the presented article consists in justification of the need of level increase of the corporate culture providing preserving competitiveness of any organization, and attraction for this purpose of resources of training centers of vocational education.Methods. While researching the problem the comparative, structural and system analysis, sociological methods (poll, questioning, and individual conversations, methods of project management were used.Results and scientific novelty. The brief summary of scientific and statistical sources argumentative for a direct connection between internal culture in corporation and its production indicators: a level of the income, stock value, size of a net profit. Development of a corporate culture of the companies of an oil-and-gas sector of economy ofRussia is considered. The problem zones of development of a corporate culture are revealed on the example of functioning of structural divisions of OJSC «Surgutneftegas»; pedagogical conditions of its improvement on the base of theCenter ofPolytechnic Training are shown. Based on the models of a corporate culture recognized in developed countries, the cyclic system of forming of this type of culture is offered; recommendations on activization of the available potential of the intra-corporate centers of vocational training are developed (earlier in similar divisions these aspects of activity organization were scarcely discussed.Practical significance. The proposed option of increase of effective management of the staff and a further strategic development of the company is acceptable not only for oil and gas companies, but also for the organizations of a wide range of activities which are engaged in fixed or periodic retraining and advanced training of the employees. At the same time, both own corporate centers of vocational training and other educational institutions can be involved in this activity. The described scheme of interaction between business

  16. Effectiveness of a Science Agricultural Summer Experience (SASE) in Recruiting Students to Natural Resources Management

    Science.gov (United States)

    Martinez, Edward; Lindline, Jennifer; Petronis, Michael S.; Pilotti, Maura

    2012-01-01

    The Bureau of Labor Statistics projects an increase in Natural Resource Management (NRM) jobs within the next 10 years due to baby-boomer retirements and a 12% increase in demand for these occupations. Despite this trend, college enrollment in NRM disciplines has declined. Even more critical is the fact that the soon-to-be-majority Hispanic…

  17. Scheduling sampling to maximize information about time dependence in experiments with limited resources

    DEFF Research Database (Denmark)

    Græsbøll, Kaare; Christiansen, Lasse Engbo

    2013-01-01

    Looking for periodicity in sampled data requires that periods (lags) of different length are represented in the sampling plan. We here present a method to assist in planning of temporal studies with sparse resources, which optimizes the number of observed time lags for a fixed amount of samples w...

  18. International Students Using Online Information Resources to Learn: Complex Experience and Learning Needs

    Science.gov (United States)

    Hughes, Hilary

    2013-01-01

    This paper reports the findings of a qualitative study that investigated 25 international students' use of online information resources for study purposes at two Australian universities. Using an expanded critical incident approach, the study viewed international students through an information literacy lens, as information-using learners. The…

  19. Understanding learning in natural resource management : experiences with a contextualised responsive evaluation approach

    NARCIS (Netherlands)

    Kouévi, T.A.

    2013-01-01

    This dissertation may be located in the wide debate on the effectiveness of policy interventions in developing countries, in the field of natural resource management (NRM). It is especially concerned with contributing to the understanding of the limited effectiveness of fishery management

  20. Implementation of Open Educational Resources in a Nursing Programme: Experiences and Reflections

    Science.gov (United States)

    Elf, Marie; Ossiannilsson, Ebba; Neljesjö, Maria; Jansson, Monika

    2015-01-01

    The IMPOER project (implementation of open educational resources, OER) aimed to implement OER in a nursing programme at Dalarna University, Sweden. The university and its nursing programme have long engaged in e-learning, and the nursing programme has recently been awarded the European Association of Distance Teaching Universities E-xcellence…

  1. Formative Life Experiences and the Recruitment of Natural Resource Conservation Professionals

    Science.gov (United States)

    Jackson, Marc

    2013-01-01

    Recruiting young people to serve as future leaders is a major concern for many organizations involved in natural resource conservation. One of the primary reasons for this concern is that youth are becoming less connected to the natural world because of the synergistic effects of urbanization, electronic media, and reduced opportunities to explore…

  2. Swedish or English? Migrants' Experiences of the Exchangeability of Language Resources

    Science.gov (United States)

    Henry, Alastair

    2016-01-01

    Patterns of transmigration emerging as a consequence of globalization are creating new and complex markets for communicative resources in which languages and language varieties are differently valued. In a Swedish context, where lingua franca English can facilitate communication but where monolingual norms prevail and Swedish is positioned as the…

  3. Postgraduate and research programmes in Medicine and Public Health in Rwanda: an exciting experience about training of human resources for health in a limited resources country.

    Science.gov (United States)

    Kakoma, Jean Baptiste

    2016-01-01

    The area of Human Resources for Health (HRH) is the most critical challenge for the achievement of health related development goals in countries with limited resources. This is even exacerbated in a post conflict environment like Rwanda. The aim of this commentary is to report and share the genesis and outcomes of an exciting experience about training of qualified health workers in medicine and public health as well as setting - up of a research culture for the last nine years (2006 - 2014) in Rwanda. Many initiatives have been taken and concerned among others training of qualified health workers in medicine and public health. From 2006 to 2014, achievements were as follows: launching and organization of 8 Master of Medicine programmes (anesthesiology, family and community medicine, internal medicine, obstetrics & gynecology, otorhinolaryngology, pediatrics, psychiatry and surgery) and 4 Master programmes in public health (MPH, MSc Epidemiology, MSc Field Epidemiology & Laboratory Management, and Master in Hospital and Healthcare Administration); training to completion of more than 120 specialists in medicine, and 200 MPH, MSc Epidemiology, and MSc Field Epidemiology holders; revival of the Rwanda Medical Journal; organization of graduate research training (MPhil and PhD); 3 Master programmes in the pipeline (Global Health, Health Financing, and Supply Chain Management); partnerships with research institutions of great renown, which contributed to the reinforcement of the institutional research capacity and visibility towards excellence in leadership, accountability, and self sustainability. Even though there is still more to be achieved, the Rwanda experience about postgraduate and research programmes is inspiring through close interactions between main stakeholders. This is a must and could allow Rwanda to become one of the rare examples to other more well-to-do Sub - Saharan countries, should Rwanda carry on doing that.

  4. Town Centre Redevelopment Strategies

    DEFF Research Database (Denmark)

    Vagnby, Bo Hellisen

    urban planning and design strategieswhich have been practised in most of the larger Danish towns: pedestrian streets, shopping centres, preservation of historic features, waterfronts, concentration of offices, conference and sports facilities, improvement og traffic and transport conditions as well...... as slum clearence and urban renewal. To a certain extent parallels are drawn to international experiences, especially where these are of such a nature that they can be assumed transferred to Danish connctions. Conclusively, the strategies are discussed in the light of the turn of Danish urban planning...

  5. Development of gastrointestinal endoscopy in Malaysia: a historical perspective with special reference to the experience at the University of Malaya Medical Centre.

    Science.gov (United States)

    Goh, Khean-Lee

    2011-05-01

    Gastrointestinal endoscopy started in the early 1970s in Malaysia with the help of Japanese doctors. It has evolved over the past 30 years. The gastrointestinal endoscopy unit at the University of Malaya Medical Centre has been in the forefront in providing endoscopy services to patients as well as training doctors in endoscopy in the country. In recent years, trainees have included those from neighboring countries in South-East Asia. Among our most significant achievements is the organization of regular international therapeutic endoscopy workshops since 1993 where leading endoscopists from throughout the world have accepted our invitation as teaching faculty. In 2008, the World Organization of Digestive Endoscopy accorded the high distinction of Centre of Excellence to the endoscopy unit of the University of Malaya Medical Centre. © 2011 The Author. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society.

  6. A brief overview of the Chemistry-Aerosol Mediterranean Experiment (ChArMEx) database and campaign operation centre (ChOC)

    Science.gov (United States)

    Ferré, Hélène; Dulac, François; Belmahfoud, Nizar; Brissebrat, Guillaume; Cloché, Sophie; Descloitres, Jacques; Fleury, Laurence; Focsa, Loredana; Henriot, Nicolas; Ramage, Karim; Vermeulen, Anne

    2016-04-01

    Initiated in 2010 in the framework of the multidisciplinary research programme MISTRALS (Mediterranean Integrated Studies at Regional and Local Scales; http:www.mistrals-home.org), the Chemistry-Aerosol Mediterranean Experiment (ChArMEx, http://charmex.lsce.ipsl.fr/) aims at federating the scientific community for an updated assessment of the present and future state of the atmospheric environment in the Mediterranean Basin, and of its impacts on the regional climate, air quality, and marine biogeochemistry. The project combines mid- and long-term monitoring, intensive field campaigns, use of satellite data, and modelling studies. In this presentation we provide an overview of the campaign operation centre (http://choc.sedoo.fr/) and project database (http://mistrals.sedoo.fr/ChArMEx), at the end of the first experimental phase of the project that included a series of large campaigns based on airborne means (including balloons and various aircraft) and a network of surface stations. Those campaigns were performed mainly in the western Mediterranean basin in the summer of 2012, 2013 and 2014 with the help of the ChArMEx Operation Centre (ChOC), an open web site that has the objective to gather and display daily quick-looks from model forecasts and near-real time in situ and remote sensing observations of physical and chemical weather conditions relevant for the everyday campaign operation decisions. The ChOC is also useful for post campaign analyses and can be completed with a number of quick-looks of campaign results obtained later in order to offer an easy access to, and comprehensive view of all available data during the campaign period. The items included are selected according to the objectives and location of the given campaigns. The second experimental phase of ChArMEx from 2015 on is more focused on the eastern basin. In addition, the project operation centre is planned to be adapted for a joint MERMEX-ChArMEx oceanographic cruise (PEACETIME) for a study at

  7. [Need-based resource allocation--experiences with the RAWP formula in Great Britain].

    Science.gov (United States)

    Brand, H; Menke, R

    1997-07-01

    The RAWP formula used for resource allocation in Great Britain between 1976 and 1991 is a morbidity-oriented instrument of controlling, which has so far received only little attention in Germany. The development of this model was supported by the intention to intervene in the regional pattern of hospital supply by means of resource allocation and to refine it according to the guiding principles of equity and efficiency. The basic elements-regional population, average bed use, ICD chapter-specific SMRs-are discussed and the various modifications outlined. The RAWP formula's potentials of controlling resulted in a progressive reduction of the apparent disparities between regions in hospital supply, and knee was considered to be a "qualified success". The future development in the sense of an internal market addressed.

  8. Storage Resource Managers Recent International Experience on Requirements and Multiple Co-Operating Implementations

    CERN Document Server

    Abadie, Lana; Baud, Jean-Philippe; Corso, Ezio; Crawford, Matt; De Witt, Shaun; Donno, Flavia; Forti, Alberto; Fuhrmann, Patrick; Grosdidier, Gilbert; Gu, Junmin; Jensen, Jens; Lemaitre, Sophie; Litmaath, Maarten; Litvinsev, Dmitry; Lo Presti, Giuseppe; Magnoni, Luca; Mkrtchan, Tigran; Moibenko, Alexander; Natarajan, Vijaya; Oleynik, Gene; Perelmutov, Timur; Petravick, Don; Shoshani, Arie; Sim, Alex; Sponza, Massimo; Zappi, Riccardo; CERN. Geneva. IT Department

    2007-01-01

    Storage management is one of the most important enabling technologies for large-scale scientific investigations. Having to deal with multiple heterogeneous storage and file systems is one of the major bottlenecks in managing, replicating, and accessing files in distributed environments. Storage Resource Managers (SRMs), named after their web services control protocol, provide the technology needed to manage the rapidly growing distributed data volumes, as a result of faster and larger computational facilities. SRMs are Grid storage services providing interfaces to storage resources, as well as advanced functionality such as dynamic space allocation and file management on shared storage systems. They call on transport services to bring files into their space transparently and provide effective sharing of files. SRMs are based on a common specification that emerged over time and evolved into an international collaboration. This approach of an open specification that can be used by various institutions to adapt ...

  9. Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

    Directory of Open Access Journals (Sweden)

    Bernard Nkrumah

    2014-11-01

    Full Text Available Background: In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. Objectives: To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Method: Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental trainingon internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM. Results: The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’salaries, SLMTA training and improvement project support. Conclusion: Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such modelspromote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

  10. Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

    Directory of Open Access Journals (Sweden)

    Bernard Nkrumah

    2014-09-01

    Full Text Available Background: In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources.Objectives: To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources.Method: Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental trainingon internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM.Results: The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’salaries, SLMTA training and improvement project support.Conclusion: Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such modelspromote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

  11. Institutional Support: Centre for Economic and Social Research ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The Centre d'études de documentation et de recherches économiques et sociales (CEDRES) established in 1977 is an autonomous university-based research centre located in Ougadougou, Burkina Faso. The centre lacks sufficient resources to fulfil its mandate. This grant from IDRC's Think Tank Initiative (TTI) will enable ...

  12. Developing Human Resources Through Hidden Curriculum: The experience of Pondok Modern Darussalam Gontor, Indonesia

    Directory of Open Access Journals (Sweden)

    M. Akrim Mariyat

    2011-06-01

    Full Text Available Pondok Modern Gontor, as a modern type of pesantren, grows very fast inthe term of quality and quantity, the amount of applicants is growing everyyear, and its graduates spread through Indonesian provincies. They take variouskinds of role e.g politicians, traders, civil-servants, rectors, deans, teachers,lecturers, doctors, muballighs, religious leadders, head of pesantrens etc.Due to the variety of occupation they take, and status they gain, it raisedsome questions related to the notion as well as the phylosophy of PondokModern, the curriculum they provide and the process they carried out. One ofthe answers is probably because the Pondok run boarding school system whichmakes Pondok Modern different from other educational institutions in general.By this system many kinds of educational process in the form of pro grammeand activities could be easily undertaken, because the three centres of education(home - school - community are mixed in one campus. Students are accustomedto practice “learning by doing” method and are supervised by their elders andteachers.Questions emerge due to the uniqueness of Pondok Modern eg. Whydid Gontor adopt boarding school system? How was the curriculum constructedand applied? And there are still a lot more questions related to this matter. Thispaper tries to offer some answers to these questions.

  13. Reflective Dialogues in Community Music Engagement: An Exploratory Experience in a Singapore Nursing Home and Day-Care Centre for Senior Citizens

    Science.gov (United States)

    Lum, Chee-Hoo

    2011-01-01

    This study documents a reflective journey of a community music programme initiated by a university music education faculty member and an occupational therapist within the setting of a nursing home and day-care centre in Singapore. Weekly music interaction sessions in conjunction with reminiscence therapy were conducted over a period of five…

  14. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience

    Directory of Open Access Journals (Sweden)

    Michael Gregory

    2015-05-01

    Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world.In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care.I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

  15. Exploring Water Resources as a Study Abroad Experience in Northern India

    Science.gov (United States)

    Vulava, V. M.; Callahan, T. J.

    2013-12-01

    Water and environmental resources are of high interest for students at the College of Charleston. These issues are covered in varying levels of detail in the Geology Department in introductory to advanced courses, some of which include field and laboratory components. While courses stress the importance of understanding global water resource issues, students are rarely given hands-on exposure beyond local problems. To address this, we designed a course that explored water resource issues along the entire length of the Ganges River from headwaters to the mouth, a region in which water is seen as a critical economic, environmental, and cultural resource. The 2500-km long Ganges River in northern India is stressed due to large demand and cyclical, yet unpredictable, supply. This region has a population of over 700 million who speak different languages, have diverse cultures, and varied states of development, economic access, and planning, and diverse geologic and ecological settings. Poor river management, inconsistent precipitation during monsoons likely affected by climate change and pollution from insufficient waste management practices and a burgeoning population has resulted in additional stress on the river and its ecosystems. A three-week travel-intensive study abroad course covered three important reaches of the river in the headwaters (Himalayan glaciers, steep mountain landscapes, and large hydroelectric dams in Uttarakhand state), the plains (industrial heartland and large population centers in Uttar Pradesh state), and the mouth (coastal development, Sunderbans mangrove forest, and coastal hazards near Bay of Bengal in West Bengal state). The course was timed to coincide with the pre-monsoon summer season to show students the importance of the monsoon season to this region. The course had two modules: (1) water resource and hydrology principles that delve into specific issues, including impacts of river management for economic development and associated

  16. Use of blog as a supplementary study material resource in dentistry: An Indian experience

    Directory of Open Access Journals (Sweden)

    Thavarajah Rooban

    2014-01-01

    Full Text Available Objective: Social networking sites (SNS are emerging as an alternate teaching resource. The reach and access characteristics of SNS for a noninstitutional, academic blog in an Indian setting has not been documented and this manuscript aim to address this lacunae. Materials and Methods: A blog for oral histology, an integral basic dental subject and its Facebook promotional page was created. The access characteristics were observed using Google analytics. The Facebook promotional pages of the blog access characteristics are presented. Results: A total of 582 people visited the blog during the study period. Majority of them used Google Chrome from desktop/laptop to access the blog. There were 2723 page visits in all. Visitors from 36 countries and 99 cities across the globe accessed the blog. In all through Facebook, the promotional page reached 36,543 people. The total number of people engaged through Facebook promotion page was 10,757. Conclusion: Access characteristics of the noninstitutional, academic blog have been described for the first time in dentistry. The lessons learnt through this exercise would be helpful in designing e-mentoring courses as well promotional pages of such events in the future. The necessity of making the mentors and students to adapt to e-learning and digital learning resources before drawing such programs is highlighted.

  17. Capacity building in human resources for health: The experience of the region of the Americas.

    Science.gov (United States)

    Godue, Charles; Cameron, Rick; Borrell, Rosa Maria

    2016-12-27

    Since the year 2003, most countries of the Region of the Americas have experienced sustained economic growth and inclusive development policies. In the health sector, achieving universal access became the overarching goal. However, the structural limitations of the health workforce represented a formidable obstacle to change. National Health Authorities were confronted with the challenge of developing critical capacities to redress entrenched inequalities in access to qualified health personnel. Under the auspices of the Pan American Health Organization, the Ministers of Health of the Region adopted, in September 2007, twenty regional goals for Human Resources for Health 2007-2015, aligned with the renewed strategy of Primary Health Care. Subsequently, a set of indicators and a methodology were developed to assess the goals and to monitor progress at the country level. Fifteen countries carried out a baseline assessment in 2009 or 2010 and conducted a second assessment in 2013. Although differences were noted across goals and between countries, the results suggested improvements in all twenty goals overall. The goals linked to the distribution of personnel, the management of migration, and the cooperation with education institutions appeared to be more resilient to change. The twenty Regional Goals for Human Resources for Health provided a common vision for action and a framework for cooperation within and among countries, and was a catalyst for change. Faced with evolving challenges, the countries should consider adopting a new shared agenda that builds on progress made and further supports intergovernmental policy alignment and capacity building in health workforce development, governance and management.

  18. RESOURCE CENTRE AT THE SOUTH AFRICAN MUSEUM

    African Journals Online (AJOL)

    are able to touch most of them. A small collection of such specimens are available for loan to teachers from local schools. Other articles of interest. Articles and pictures from newspapers and magazines on natural history, conservation, archaeology, ethnography and education are collected and filed for reference purposes.

  19. Women in natural resource collection: Experience from rural Jharkhand in India

    Science.gov (United States)

    Ghosh, Bhola Nath; De, Utpal Kumar

    2015-02-01

    Women living in rural areas are closely associated with the natural environment. Poor families are mostly dependent on natural resources for their survival activities viz. grazing of cattle, collection of water for drinking and cooking purposes and collection of fuel wood. In the poor families due to the compulsion of earning, adult males mostly go for outside activities and sometimes female members of the family also join them. The aforementioned natural resource collection activities are considered to be inferior, less remunerative and hence suitable for the women or young kids to perform. Thus, they are found to be more close to the nature than men and this very close relationship makes them perfect managers of the eco-system in their vicinity. The life of rural women is so much intertwined with the environment that they can't even think of her survival without it. However, there might be significant inter-household differences in the distribution of such activities between male and female members of the families, depending upon their socio-economic characteristics, cultural and religious beliefs and attitude towards women and children. The involvement of women in such activities is also found to be more in the tribal dominated societies. This paper tried to examine the extent to which women in rural Jharkhand are involved in such natural resource collection and management activities. Also, we tried to unearth various economic and cultural reasons and their impact on the involvement of women in such activities across various social and economic groups. The analysis of primary data collected from the rural areas of tribal dominated Jharkhand reveals that income, occupation and status of the families have significant inverse link with the involvement of women and also of girl children at the cost of their educational prospects. Religious and cultural beliefs also enter in the determination of extent of involvement of women and children in the rural society. It is

  20. Effect of experience, expectation and resource availability on perceptions of crowding among trout anglers in Pennsylvania

    Science.gov (United States)

    Craig A. Miller

    1995-01-01

    Crowding research has suggested expectancy theory as one explanation to perceptions of crowding expressed by participants in outdoor recreation activities. Expectancy theory states that an individual enters into an activity with a preconceived set of expectations for the outcome of the experience. In this study, anglers fishing on the opening day of Pennsylvania's...

  1. Resourcing Lab Experiments for New Ventures: The Potential of a Start-Up Database

    Science.gov (United States)

    Pietrobon, Alberto

    2009-01-01

    This article responds to "Laboratory experiments as a tool in the empirical economic analysis of high-expectation start-ups" by Martin Curley and Piero Formica, published in the December 2008 issue of "Industry and Higher Education". Curley and Formica introduce a new concept for high-expectation start-ups, involving the use of "laboratory…

  2. Terminology Standardization in Education and the Construction of Resources: The Welsh Experience

    Directory of Open Access Journals (Sweden)

    Tegau Andrews

    2016-01-01

    Full Text Available This paper describes developments in Welsh-language terminology within the education system in Wales. Following an outline of historical terminology work, it concentrates on the consolidation of terminology standardization at the Language Technologies Unit, Bangor University, with particular reference to two projects, one concerned with terminology for school-age and further education, the second concerned with higher education. The developments described include the adoption of international standards in terminology standardization and their incorporation in an online terminology standardization environment and dissemination platform that enable access to the centralized terminological dictionaries via a number of sophisticated websites, portals and mobile apps featuring rich dictionary entries. Some of the issues in managing large term collections are explored, and usage statistics are presented for the resources described.

  3. Yield of chest X-ray tuberculosis screening of immigrants during the European refugee crisis of 2015: a single-centre experience

    Energy Technology Data Exchange (ETDEWEB)

    Weinrich, Julius Matthias; Sauer, Markus; Henes, Frank Oliver; Adam, Gerhard; Bannas, Peter [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Hamburg (Germany); Diel, Roland [University Medical Hospital Schleswig-Holstein, Airway Research Center North (ARCN), Institute for Epidemiology, Kiel (Germany); Meywald-Walter, Karen [Public Health Department Hamburg Central, Hamburg (Germany); Schoen, Gerhard [University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg (Germany)

    2017-08-15

    Our aim was to determine the prevalence of tuberculosis (TB), the number needed to screen (NNS), and the diagnostic accuracy of chest X-ray (CXR) screening to detect active pulmonary TB during the 2015 European refugee crisis. We evaluated data of all refugees who underwent CXR screening in a single-centre of one German metropolitan area in 2015. We determined the prevalence of TB, NNS, and accuracy of CXR to detect active pulmonary TB. Reference method for active TB was the database of all definite TB cases registered at the Department of Public Health. A total of 17,487 immigrants underwent single-centre CXR screening in 2015; prevalence of definite pulmonary TB was 0.103%. The NNS for detecting one case of active pulmonary TB was 1749. CXR had a sensitivity of 55.6% 95% confidence interval (CI 30.8-78.5%) and a specificity 98.3% (CI 98.1-98.5%) to reveal one case of active TB. Our single-centre study indicates that chest X-ray screening for TB during the 2015 European refugee crisis was of low yield due the low prevalence of TB and high number needed to screen, thus implicating the need for improved screening algorithms adapted to the overwhelming number of refugees. (orig.)

  4. ASSESSING THE EFFECTS OF USING GAGNE‘S EVENTS OF INSTRUCTIONS IN A MULTIMEDIA STUDENT-CENTRED ENVIRONMENT: A Malaysian Experience

    Directory of Open Access Journals (Sweden)

    Tse-Kian NEO

    2010-01-01

    Full Text Available The inclusion of digital multimedia into teaching and learning has changed instructional strategies in the classroom. While this course has been traditionally given in lecture-based environment, an attempt was made to move it towards a more multimedia-mediated environment to provide a student-centred approach in teaching the principles of animation. The aim of this project is to incorporate Gagne’s 9 Events of Instructions in a multimedia-mediated student-centred learning environment to teach an animation course and to study its impact on student learning. The study assesses the effects the learning environment has on the students’ learning outcome as well as their perceptions in this learning environment. Therefore, data was gathered through various research instruments including surveys and questionnaires to garner their perceptions and their feedback on the learning environment. Furthermore, tests were administrated to the students to gauge their learning outcome. The results were later analysed using a paired t-test. The results were positive and encouraging. They show that the students were motivated and were actively pursuing their learning at their own pace. They enjoyed this self-directed learning approach and liked using multimedia to stimulate and enhance their learning process. The paper also provides evidence that will benefit those wanting to switch from traditional classroom to a more technological and multimedia oriented student-centred learning environment as this learning environment proves to be a viable alternative teaching approach to learning the principles of animation.

  5. The management of open tibial fractures in children: a retrospective case series of eight years' experience of 61 cases at a paediatric specialist centre.

    Science.gov (United States)

    Nandra, R S; Wu, F; Gaffey, A; Bache, C E

    2017-04-01

    Following the introduction of national standards in 2009, most major paediatric trauma is now triaged to specialist units offering combined orthopaedic and plastic surgical expertise. We investigated the management of open tibia fractures at a paediatric trauma centre, primarily reporting the risk of infection and rate of union. A retrospective review was performed on 61 children who between 2007 and 2015 presented with an open tibia fracture. Their mean age was nine years (2 to 16) and the median follow-up was ten months (interquartile range 5 to 18). Management involved IV antibiotics, early debridement and combined treatment of the skeletal and soft-tissue injuries in line with standards proposed by the British Orthopaedic Association. There were 36 diaphyseal fractures and 25 distal tibial fractures. Of the distal fractures, eight involved the physis. Motor vehicle collisions accounted for two thirds of the injuries and 38 patients (62%) arrived outside of normal working hours. The initial method of stabilisation comprised: casting in nine cases (15%); elastic nailing in 19 (31%); Kirschner (K)-wiring in 13 (21%); intramedullary nailing in one (2%); open reduction and plate fixation in four (7%); and external fixation in 15 (25%). Wound management comprised: primary wound closure in 24 (39%), delayed primary closure in 11 (18%), split skin graft (SSG) in eight (13%), local flap with SSG in 17 (28%) and a free flap in one. A total of 43 fractures (70%) were Gustilo-Anderson grade III. There were four superficial (6.6%) and three (4.9%) deep infections. Two deep infections occurred following open reduction and plate fixation and the third after K-wire fixation of a distal fracture. No patient who underwent primary wound closure developed an infection. All the fractures united, although nine patients required revision of a mono-lateral to circular frame for delayed union (two) or for altered alignment or length (seven). The mean time to union was two weeks longer

  6. Allocating health care resources: a questionnaire experiment on the predictive success of rules.

    Science.gov (United States)

    Ahlert, Marlies; Schwettmann, Lars

    2017-06-26

    The topic of this paper is related to equity in health within a country. In public health care sectors of many countries decisions on priority setting with respect to treatment of different types of diseases or patient groups are implicitly or explicitly made. Priorities are realized by allocation decisions for medical resources where moral judgments play an important role with respect to goals and measures that should be applied. The aim of this study is to explore the moral intuitions held in the German society related to priorities in medical treatment. We use an experimental questionnaire method established in the Empirical Social Choice literature. Participants are asked to make decisions in a sequence of distributive problems where a limited amount of treatment time has to be allocated to hypothetically described patients. The decision problems serve as an intuition pump. Situations are systematically varied with respect to patients' initial health levels, their ability to benefit from treatment time, and the amount of treatment time available. Subjects are also asked to describe their deliberations. We focus on the acceptance of different allocation principles including equity concepts and utilitarian properties. We investigate rule characteristics like order preservation or monotonicity with respect to resources, severity, or effectiveness. We check the consistency of individual choices with stated reasoning. The goals and allocation principles revealed show that the moral intuitions held by our experimental subjects are much more complex than the principles commonly applied in health economic theory. Especially, cost-utility principles are rarely applied, whereas the goal of equality of health gain is observed more often. The principle not to leave any patient untreated is very dominant. We also observe the degrees to which extent certain monotonicity principles, known from welfare economics, are followed. Subjects were able to describe their moral

  7. Occurrence, aetiology and challenges in the management of congestive heart failure in sub-Saharan Africa: experience of the Cardiac Centre in Shisong, Cameroon.

    Science.gov (United States)

    Tantchou Tchoumi, Jacques Cabral; Ambassa, Jean Claude; Kingue, Samuel; Giamberti, Alessandro; Cirri, Sylvia; Frigiola, Alessandro; Butera, Gianfranco

    2011-01-01

    The aim of the study was to investigate the occurrence, the aetiology and the management of congestive heart failure in the cardiac centre of the St. Elizabeth catholic general hospital Shisong in Cameroon. Between November 2002 and November 2008, a population of 8121 patients was consulted in the referral cardiac centre of St. Elizabeth Catholic General Hospital. Of these patients, 462 were diagnosed with congestive heart failure according to the modified Framingham criteria for the diagnosis of heart failure. Complementary investigations used to confirm and establish the aetiology of the disease were the chest X-ray, electrocardiography, bi-dimensional Doppler echocardiography. The results showed that the occurrence of congestive heart failure in our centre was 5.7%. Congestive heart failure was diagnosed in 198 females and 264 males, aged between 8 and 86 years old (42.5±18 years old). Post rheumatic valvulopathies (14.6%) and congenital heart diseases (1.9%) were the first aetiologic factor of congestive heart failure in the young, meanwhile cardiomyopathies (8.3%) in elderly followed by hypertensive cardiomyopathy (4.4%). Congestive heart failure was also seen in adults with congenital heart diseases in 0.01%. In this zone of Cameroon, we discovered that HIV cardiomyopathy (1.6%) and Cor pulmonale (8%) were represented, aetiological factors not mentioned in previous studies conducted in urban areas of Cameroon. The mean duration of hospital stay for the compensation treatment was thirteen days, ranging between 7 and 21 days), the mortality being 9.2%. All the medications recommended for the treatment of congestive heart failure are available in our centre but many patients are not compliant to the therapy or cannot afford them. Financial limitation is causing the exacerbation of the disease and premature death. Our data show a high incidence of congestive heart failure mainly due to post rheumatic valvulopathies in young patients in our centre. National

  8. Occurrence, aetiology and challenges in the management of congestive heart failure in sub-saharan Africa: experience of the Cardiac Centre in Shisong, Cameroon

    Directory of Open Access Journals (Sweden)

    Tantchou Tchoumi Jacques Cabral

    2011-02-01

    Full Text Available INTRODUCTION: The aim of the study was to investigate the occurrence, the aetiology and the management of congestive heart failure in the cardiac centre of the St. Elizabeth catholic general hospital Shisong in Cameroon. METHODS: Between November 2002 and November 2008, a population of 8121 patients was consulted in the referral cardiac centre of St. Elizabeth Catholic General Hospital. Of these patients, 462 were diagnosed with congestive heart failure according to the modified Framingham criteria for the diagnosis of heart failure. Complementary investigations used to confirm and establish the aetiology of the disease were the chest X-ray, electrocardiography, bi-dimensional Doppler echocardiography. RESULTS: The results showed that the occurrence of congestive heart failure in our centre was 5,7%. Congestive heart failure was diagnosed in 198 females and 264 males, aged between 8 and 86 years old (42.5, plus or minus 18 years old. Post rheumatic valvulopathies (14.6% and congenital heart diseases (1.9% were the first aetiologic factor of congestive heart failure in the young, meanwhile cardiomyopathies (8,3% in elderly followed by hypertensive cardiomyopathy (4.4%. Congestive heart failure was also seen in adults with congenital heart diseases in 0.01%. In this zone of Cameroon, we discovered that HIV cardiomyopathy (1.6% and Cor pulmonale (8% were represented, aetiological factors not mentioned in previous studies conducted in urban areas of Cameroon. The mean duration of hospital stay for the compensation treatment was thirteen days, ranging between 7 and 21 days, the mortality being 9.2%. All the medications recommended for the treatment of congestive heart failure are available in our centre but many patients are not compliant to the therapy or cannot afford them. Financial limitation is causing the exacerbation of the disease and premature death. CONCLUSION: Our data show a high incidence of congestive heart failure mainly due to post

  9. Assessing the Impact of Integrated Natural Resource Management: Challenges and Experiences

    Directory of Open Access Journals (Sweden)

    María Verónica Gottret

    2002-01-01

    Full Text Available Assessing the impact of integrated natural resource management (INRM research poses a challenge to scientists. The complexity of INRM interventions requires a more holistic approach to impact assessment, beyond the plot and farm levels and beyond traditional analysis of economic returns. Impact assessment for INRM combines the traditional "what" and "where" factors of economic and environmental priorities with newer "who" and "how" aspects of social actors and institutions. This paper presents an analytical framework and methodology for assessing the impact of INRM. A key feature of the proposed methodology is that it starts with a detailed planning process that develops a well-defined, shared, and holistic strategy to achieve development impact. This methodology, which is known as the "paths of development impact" methodology, includes the mapping of research outputs, intermediate outcomes, and development impacts. A central challenge is to find a balance between the use of generalizable measures that facilitate cross-site comparison and slower participatory process methods that empower local stakeholders. Sufficient funding for impact assessment and distinct stakeholder interests are also challenges. Two hillside sites in Central America and one forest margin site in Peru serve as case studies.

  10. STATEWIDE INVENTORIES OF HERITAGE RESOURCES: MACRIS AND THE EXPERIENCE IN MASSACHUSETTS

    Directory of Open Access Journals (Sweden)

    P. H. Stott

    2017-08-01

    Full Text Available The Massachusetts Historical Commission (MHC is the State Historic Preservation Office for Massachusetts. Established in 1963, MHC has been inventorying historic properties for over half a century. Since 1987, it has maintained a heritage database, the Massachusetts Cultural Resource Information System, or MACRIS. Today MACRIS holds over 206,000 records from the 351 towns and cities across the Commonwealth. Since 2004, a selection of the more than 150 MACRIS fields has been available online at mhcmacris. net. MACRIS is widely used by independent consultants preparing project review files, by MHC staff in its regulatory responsibilities, by local historical commissions monitoring threats to their communities, as well as by scholars, historical organizations, genealogists, property owners, reporters, and the general public interested in the history of the built environment. In 2016 MACRIS began migration off of its three-decade old Pick multivalue database to SQL Server, and in 2017, the first redesign of its thirteen-year old web interface should start to improve usability. Longer-term improvements have the goal of standardizing terminology and ultimately bringing interoperability with other heritage databases closer to reality.

  11. Statewide Inventories of Heritage Resources: Macris and the Experience in Massachusetts

    Science.gov (United States)

    Stott, P. H.

    2017-08-01

    The Massachusetts Historical Commission (MHC) is the State Historic Preservation Office for Massachusetts. Established in 1963, MHC has been inventorying historic properties for over half a century. Since 1987, it has maintained a heritage database, the Massachusetts Cultural Resource Information System, or MACRIS. Today MACRIS holds over 206,000 records from the 351 towns and cities across the Commonwealth. Since 2004, a selection of the more than 150 MACRIS fields has been available online at mhcmacris. net. MACRIS is widely used by independent consultants preparing project review files, by MHC staff in its regulatory responsibilities, by local historical commissions monitoring threats to their communities, as well as by scholars, historical organizations, genealogists, property owners, reporters, and the general public interested in the history of the built environment. In 2016 MACRIS began migration off of its three-decade old Pick multivalue database to SQL Server, and in 2017, the first redesign of its thirteen-year old web interface should start to improve usability. Longer-term improvements have the goal of standardizing terminology and ultimately bringing interoperability with other heritage databases closer to reality.

  12. User and group storage management the CMS CERN T2 centre

    Science.gov (United States)

    Cerminara, G.; Franzoni, G.; Pfeiffer, A.

    2015-12-01

    A wide range of detector commissioning, calibration and data analysis tasks is carried out by CMS using dedicated storage resources available at the CMS CERN Tier-2 centre. Relying on the functionalities of the EOS disk-only storage technology, the optimal exploitation of the CMS user/group resources has required the introduction of policies for data access management, data protection, cleanup campaigns based on access pattern, and long term tape archival. The resource management has been organised around the definition of working groups and the delegation to an identified responsible of each group composition. In this paper we illustrate the user/group storage management, and the development and operational experience at the CMS CERN Tier-2 centre in the 2012-2015 period.

  13. User and group storage management the CMS CERN T2 centre

    CERN Document Server

    Cerminara, G; Pfeiffer, A

    2015-01-01

    A wide range of detector commissioning, calibration and data analysis tasks is carried out by CMS using dedicated storage resources available at the CMS CERN Tier-2 centre. Relying on the functionalities of the EOS disk-only storage technology, the optimal exploitation of the CMS user/group resources has required the introduction of policies for data access management, data protection, cleanup campaigns based on access pattern, and long term tape archival. The resource management has been organised around the definition of working groups and the delegation to an identified responsible of each group composition. In this paper we illustrate the user/group storage management, and the development and operational experience at the CMS CERN Tier-2 centre in the 2012-2015 period.

  14. The effects of Crew Resource Mangement (CRM) training in airline maintenance: Results following three years' experience

    Science.gov (United States)

    Taylor, J. C.; Robertson, M. M.

    1995-01-01

    This report describes three years' evaluation of the effects of one airline's Crew Resources Management (CRM) training operation for maintenance. This evaluation focuses on the post-training attitudes of maintenance managers' and technical support professionals, their reported behaviors, and the safety, efficiency and dependable maintenance performance of their units. The results reveal a strong positive effect of the training. The overall program represents the use of CRM training as a long-term commitment to improving performance through effective communication at all levels in airline maintenance operations. The initial findings described in our previous progress reports are reinforced and elaborated here. The current results benefit from the entire pre-post training survey, which now represents total attendance of all managers and staff professionals. Additionally there are now full results from the two-month, six-month, and 12-month follow-up questionnaires, together with as many as 33 months of post-training performance data, using several indicators. In this present report, we examine participants' attitudes, their reported behaviors following the training, the performance of their work units, and the relationships among these variables. Attitudes include those measured immediately before and after the training as well as participants' attitudes months after their training. Performance includes measures, by work units, of on-time flight departures, on-schedule maintenance releases, occupational and aircraft safety, and efficient labor costs. We report changes in these performance measures following training, as well their relationships with the training participants' attitudes. Highlights of results from this training program include increased safety and improved costs associated with positive attitudes about the use of more assertive communication, and the improved management of stress. Improved on-time performance is also related to those improved

  15. Experiences of Biographical Crises as a Resource for Professional Interventions. An Exemplary Analysis of Lawyer's Acting

    Directory of Open Access Journals (Sweden)

    Claudia Scheid

    2008-01-01

    Full Text Available In the empirical part of the following paper, professional service is shown in the context of a biographical experience of a professional—a family law attorney. In terms of method, this undertaking is precarious. Its sense lies in gaining an understanding of the biographically and historically motivated potentials and limits of professional services. A differentiated look at professional services is facilitated when you know the stories out of which specific procedures have resulted. In overcoming the crude classification of "professionalized," "not professionalized," and "de-professionalized," it is possible to further differentiate theories of professionalization (Talcott PARSONS, Ulrich OEVERMANN, Fritz SCHÜTZE. Up until now detailed examinations are missing of the genesis of concrete professional acting, even though the topic has been worked out clearly, especially in studies of teachers' work. URN: urn:nbn:de:0114-fqs0801537

  16. "Making the best of what we have": The lived experiences of community psychiatric nurses, day centre managers and social workers supporting clients with dementia attending a generic day care service.

    Science.gov (United States)

    Laird, Elizabeth A; McGurk, Phyllis; Reid, Bernie; Ryan, Assumpta

    2017-12-01

    This study explored the experiences and perspectives of community psychiatric nurses, day centre managers and social workers about supporting clients living with and without dementia attending a generic day care service. The purpose of the study was to elucidate approaches that enable clients living with dementia to access and derive benefit from the service. In the light of international ageing demographics and strategy towards social inclusion, it is anticipated that demand for generic day care services for clients living with and without dementia will increase. A descriptive qualitative design utilised three focus groups for data collection. Community psychiatric nurses (n = 4), day centre mangers (n = 4) and social workers (n = 12) participated in the study. Data analysis informed a narrative description of the approaches that support adults living with dementia in day care. An exhaustive description is encapsulated in five key themes. These are "easing the transition to day care," "proactively managing supervision and complexity of need," "sustaining the person and family carer," making the best of what we have" and "encountering a need for change," The data conveyed a sensitivity to the life story and needs of clients with dementia. Whilst the data revealed deficits in the physical environment of the centres, there were indications of the generation of a positive social environment. A generic day care service that provides an integrated blend of care and treatment and social and recreational support to older adults, irrespective of whether they have or have not dementia, is realistic and manageable. The routine of day centre attendance may have value in sustaining clients with dementia and family care-giving relationships. Approaches to support the attendance of clients with dementia at day care include home visits, life story work, proactive supervision and careful planning of social groupings and recreational activities. © 2017 John Wiley & Sons Ltd.

  17. Human-centred Governance

    DEFF Research Database (Denmark)

    Bason, Christian

    2017-01-01

    Design approaches are now being applied all over the world as a powerful approach to innovating public policies and services. Christian Bason, author of Leading public design: Discovering human-centred governance, argues that by bringing design methods into play, public managers can lead change...... with citizens at the centre, and discover a new model for steering public organisations: human-centred governance....

  18. The Search for Centre

    Science.gov (United States)

    Nunes, April

    2006-01-01

    This paper acknowledges the importance of a dancer's centre but likewise highlights the problematic nature of the communication of this concept from dance teacher to student. After a brief introduction of orthodox approaches in finding centre, this paper suggests a method of locating centre through the ancient somatic technique.

  19. CMS Centres Worldwide a New Collaborative Infrastructure

    CERN Document Server

    Taylor, Lucas

    2009-01-01

    The CMS Experiment at the LHC is establishing a global network of inter-connected "CMS Centres" for controls, operations and monitoring. These support: (1) CMS data quality monitoring, detector calibrations, and analysis; and (2) computing operations for the processing, storage and distribution of CMS data. We describe the infrastructure, computing, software, and communications systems required to create an effective and affordable CMS Centre. We present our highly successful operations experiences with the major CMS Centres at CERN, Fermilab, and DESY during the LHC first beam data-taking and cosmic ray commissioning work. The status of the various centres already operating or under construction in Asia, Europe, Russia, South America, and the USA is also described. We emphasise the collaborative communications aspects. For example, virtual co-location of experts in CMS Centres Worldwide is achieved using high-quality permanently-running "telepresence" video links. Generic Web-based tools have been developed ...

  20. Humour, beauty, and culture as personal health resources: experiences of elderly Swedish women.

    Science.gov (United States)

    Forssén, Annika S K

    2007-01-01

    This paper explores how a group of elderly women used humour, beauty, and cultural activities to maintain physical and mental well-being. The paper reports on one aspect of a qualitative study on women's work and health in a lifetime perspective. Interviews with 20 strategically selected Swedish women, aged 63 to 83 years, were audiotaped and analysed according to a phenomenological approach. During the interview process, the researchers became increasingly aware that the women had clear ideas about what enabled them to feel well and healthy - even when actually quite diseased. Creating and enjoying humour, beauty, and culture formed part of such strategies. Joking with workmates made hard, low-status jobs easier, helped them endure pain, and helped balance marital difficulties. Creating a nice and comfortable home gave pleasure and a little luxury in a life filled with necessities. Making articles for everyday use more beautiful was regarded as worthwhile, because it gave delight to them and their families. Gains from cultural activities were social, aesthetic, and existential - the latter through a feeling of self-recognition and being heard. Humour, beauty, and culture formed a greater part of these women's survival strategies than expected. Making everyday life more aesthetic is an undervalued aspect of women's health-creating work in the family. Through their lifelong experience as carers and homemakers, elderly women possess special knowledge regarding what may promote health, a knowledge that should be tapped. When supplying elderly women with social care, their needs for humour, beauty, and culture should be respected.

  1. Numerical Forecasting Experiment of the Wave Energy Resource in the China Sea

    Directory of Open Access Journals (Sweden)

    Chong Wei Zheng

    2016-01-01

    Full Text Available The short-term forecasting of wave energy is important to provide guidance for the electric power operation and power transmission system and to enhance the efficiency of energy capture and conversion. This study produced a numerical forecasting experiment of the China Sea wave energy using WAVEWATCH-III (WW3, the latest version 4.18 wave model driven by T213 (WW3-T213 and T639 (WW3-T639 wind data separately. Then the WW3-T213 and WW3-T639 were verified and compared to build a short-term wave energy forecasting structure suited for the China Sea. Considering the value of wave power density (WPD, “wave energy rose,” daily and weekly total storage and effective storage of wave energy, this study also designed a series of short-term wave energy forecasting productions. Results show that both the WW3-T213 and WW3-T639 exhibit a good skill on the numerical forecasting of the China Sea WPD, while the result of WW3-T639 is much better. Judging from WPD and daily and weekly total storage and effective storage of wave energy, great wave energy caused by cold airs was found. As there are relatively frequent cold airs in winter, early spring, and later autumn in the China Sea and the surrounding waters, abundant wave energy ensues.

  2. A model to forecast data centre infrastructure costs.

    Science.gov (United States)

    Vernet, R.

    2015-12-01

    The computing needs in the HEP community are increasing steadily, but the current funding situation in many countries is tight. As a consequence experiments, data centres, and funding agencies have to rationalize resource usage and expenditures. CC-IN2P3 (Lyon, France) provides computing resources to many experiments including LHC, and is a major partner for astroparticle projects like LSST, CTA or Euclid. The financial cost to accommodate all these experiments is substantial and has to be planned well in advance for funding and strategic reasons. In that perspective, leveraging infrastructure expenses, electric power cost and hardware performance observed in our site over the last years, we have built a model that integrates these data and provides estimates of the investments that would be required to cater to the experiments for the mid-term future. We present how our model is built and the expenditure forecast it produces, taking into account the experiment roadmaps. We also examine the resource growth predicted by our model over the next years assuming a flat-budget scenario.

  3. Ansab Resource Centre: A Sustainable way for Resource Generation

    International Development Research Centre (IDRC) Digital Library (Canada)

    lremy

    ANSAB), an. IDRC partner, headquartered in ... funding but also explore more sustainable and 'independent' sources of fund generation. .... and informal discussion forums at ANSAB including the coffee shop, restaurant, lunch gatherings, and ...

  4. Games as an educational resource in the teaching and learning of mathematics: an educational experiment in Portuguese middle schools

    Science.gov (United States)

    Campos, Helena; Moreira, Rute

    2016-04-01

    This article is based on an experiment using the game 'Caminhando e Calculando' (Moving and Calculating) in order to analyse the potential of the game as an educational resource for the teaching and learning of mathematics in Portuguese middle schools, where most students are 10 or 11 years old. Students' data obtained during the games will be used to analyse the different options used for solving the game, identifying its potential and its weaknesses. We start with a theoretical analysis of games as an inherent element of human culture. Combining our innate desire for fun with the different types of teaching and learning styles allows for fun and knowledge to be combined into more efficient and meaningful types of knowledge. Playing games are a primordial aspect of what it means to be a child and they develop within a motivating environment; therefore, not to take advantage of games as a learning resource would be to neglect an important asset. With regard to mathematics, emphasis will be given to the advantages that this teaching and learning tool provides for certain mathematical processes, such as problem-solving.

  5. Developing antitobacco mass media campaign messages in a low-resource setting: experience from the Kingdom of Tonga.

    Science.gov (United States)

    Sugden, C; Phongsavan, P; Gloede, S; Filiai, S; Tongamana, V O

    2017-05-01

    Tobacco use has become the leading cause of preventable death in Tonga, a small island nation in the South Pacific. One pragmatic and economical strategy to address this worrying trend is to adapt effective antitobacco mass media materials developed in high-income countries for local audiences. Using Tonga as an example, this paper shares the practical steps involved in adapting antitobacco campaign materials for local audiences with minimal resources, a limited budget and without the need for an external production team. The Tongan experience underscores the importance of an adaptation process that draws from evidence-based best-practice models and engages local and regional stakeholders to ensure that campaign materials are tailored to the local context and are embedded within a mix of antitobacco strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  6. A model of resilience and meaning after military deployment: personal resources in making sense of war and peacekeeping experiences.

    Science.gov (United States)

    Schok, Michaela L; Kleber, Rolf J; Lensvelt-Mulders, Gerty J L M

    2010-04-01

    The aim of the present study was to examine whether the specific personal resources of self-esteem, optimism and perceived control, combined in the latent variable called 'resilience', were associated with cognitive processing of war-zone experiences. Data were collected by questionnaires from a sample of 1.561 veterans who had participated in various war or peacekeeping operations. Structural equation modelling was performed to assess the expected relationships between the observed and latent variables. The construct of resilience was well-defined and proved to be strongly associated with both construals of meaning, comprehensibility versus personal significance, after military deployment. According to our model, higher resilience predicted less distrust in others and the world, more personal growth and less intrusions and avoidance after military deployment.

  7. Planetary Radars Operating Centre PROC

    Science.gov (United States)

    Catallo, C.; Flamini, E.; Seu, R.; Alberti, G.

    2007-12-01

    Planetary exploration by means of radar systems, mainly using Ground Penetrating Radars (GPR) plays an important role in Italy. Numerous scientific international space programs are currently carried out jointly with ESA and NASA by Italian Space Agency, the scientific community and the industry. Three important experiments under Italian leadership ( designed and manufactured by the Italian industry), provided by ASI either as contribution to ESA programs either within a NASA/ASI joint venture framework, are now operating: MARSIS on-board Mars Express, SHARAD on-board Mars Reconnaissance Orbiter and CASSINI Radar on-board Cassini spacecraft. In order to support all the scientific communities, institutional customers and experiment teams operation three Italian dedicated operational centers have been realized, namely SHOC, (Sharad Operating Centre), MOC (Marsis Operating Center) and CASSINI PAD ( Processing Altimetry Data). Each center is dedicated to a single instrument management and control, data processing and distribution. Although they had been conceived to operate autonomously and independently one from each other, synergies and overlaps have been envisaged leading to the suggestion of a unified center, the Planetary Radar Processing Center (PROC). PROC is conceived in order to include the three operational centers, namely SHOC, MOC and CASSINI PAD, either from logistics point of view and from HW/SW capabilities point of view. The Planetary Radar Processing Center shall be conceived as the Italian support facility to the scientific community for on-going and future Italian planetary exploration programs. Therefore, scalability, easy use and management shall be the design drivers. The paper describes how PROC is designed and developed, to allow SHOC, MOC and CASSINI PAD to operate as before, and to offer improved functionalities to increase capabilities, mainly in terms of data exchange, comparison, interpretation and exploitation. Furthermore, in the frame of

  8. CMS Centre at CERN

    CERN Multimedia

    2007-01-01

    A new "CMS Centre" is being established on the CERN Meyrin site by the CMS collaboration. It will be a focal point for communications, where physicists will work together on data quality monitoring, detector calibration, offline analysis of physics events, and CMS computing operations. Construction of the CMS Centre begins in the historic Proton Synchrotron (PS) control room. The historic Proton Synchrotron (PS) control room, Opened by Niels Bohr in 1960, will be reused by CMS to built its control centre. TThe LHC@FNAL Centre, in operation at Fermilab in the US, will work very closely with the CMS Centre, as well as the CERN Control Centre. (Photo Fermilab)The historic Proton Synchrotron (PS) control room is about to start a new life. Opened by Niels Bohr in 1960, the room will be reused by CMS to built its control centre. When finished, it will resemble the CERN Contro...

  9. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Chalya Phillipo L

    2012-03-01

    Full Text Available Abstract Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1. Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8% perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2% patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5% patients. The majority of patients (84.6% had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (P Conclusion

  10. Empowering patients of a mental rehabilitation center in a low-resource context: a Moroccan experience as a case study

    Directory of Open Access Journals (Sweden)

    Khabbache H

    2017-04-01

    Full Text Available Hicham Khabbache,1 Abdelhak Jebbar,2,* Nadia Rania,3,* Marie-Chantal Doucet,4 Ali Assad Watfa,5 Joël Candau,6 Mariano Martini,7 Anna Siri,8,* Francesco Brigo,9,10,* Nicola Luigi Bragazzi1,2,4–8,11,* 1Faculty of Literature and Humanistic Studies, Sais, Sidi Mohamed Ben Abdellah University, Fez, 2Faculty of Art and Humanities, Sultan Moulay Slimane University, Beni-Mellal, Morocco; 3School of Social Sciences, Department of Education Sciences, University of Genoa, Genova, Italy; 4Faculty of Human Sciences, School of Social Work, University of Québec-Montréal, Montreal, QC, Canada; 5Faculty of Education, Kuwait University, Kuwait City, Kuwait; 6Laboratory of Anthropology and Cognitive and Social Psychology, University of Nice Sophia Antipolis, Nice, France; 7Department of Health Sciences (DISSAL, Section of Bioethics, University of Genoa, 8UNESCO Chair “Health Anthropology, Biosphere and Healing Systems”, Genova, 9Department of Neurology, Franz Tappeiner Hospital, Merano, 10Department of Neurological, Biomedical, and Movement Sciences, University of Verona, Verona, 11School of Public Health, Department of Health Sciences (DISSAL, University of Genoa, Genova, Italy *These authors contributed equally to this work Abstract: Mental, neurological and substance use (MNS disorders represent a major source of disability and premature mortality worldwide. However, in developing countries patients with MNS disorders are often poorly managed and treated, particularly in marginalized, impoverished areas where the mental health gap and the treatment gap can reach 90%. Efforts should be made in promoting help by making mental health care more accessible. In this article, we address the challenges that psychological and psychiatric services have to face in a low-resource context, taking our experience at a Moroccan rehabilitation center as a case study. A sample of 60 patients were interviewed using a semi-structured questionnaire during the period of

  11. Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Christopher R. Stark

    2017-06-01

    Full Text Available Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda. Methods and Materials: Imaging the World Africa (ITWA is the registered non-governmental organization division of Imaging the World (ITW, a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits. Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD. Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.

  12. President | IDRC - International Development Research Centre

    International Development Research Centre (IDRC) Digital Library (Canada)

    International Development Research Centre Selection Criteria Education A degree from a recognized university in a relevant field of study, or an acceptable combination of education, job-related training and/or experience. A post graduate degree would be considered an asset. Experience Leadership experience in a ...

  13. Director, Human Resources | IDRC - International Development ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Job Summary. Under the direction of the VP, Resources Branch and Chief Financial Officer, provides leadership and establishes within the Centre's strategic planning horizon clear directions for the deployment of the human resources function within the Centre, and for the management of staff as the key resource in the ...

  14. Sustaining an Online, Shared Community Resource for Models, Robust Open source Software Tools and Data for Volcanology - the Vhub Experience

    Science.gov (United States)

    Patra, A. K.; Valentine, G. A.; Bursik, M. I.; Connor, C.; Connor, L.; Jones, M.; Simakov, N.; Aghakhani, H.; Jones-Ivey, R.; Kosar, T.; Zhang, B.

    2015-12-01

    Over the last 5 years we have created a community collaboratory Vhub.org [Palma et al, J. App. Volc. 3:2 doi:10.1186/2191-5040-3-2] as a place to find volcanology-related resources, and a venue for users to disseminate tools, teaching resources, data, and an online platform to support collaborative efforts. As the community (current active users > 6000 from an estimated community of comparable size) embeds the tools in the collaboratory into educational and research workflows it became imperative to: a) redesign tools into robust, open source reusable software for online and offline usage/enhancement; b) share large datasets with remote collaborators and other users seamlessly with security; c) support complex workflows for uncertainty analysis, validation and verification and data assimilation with large data. The focus on tool development/redevelopment has been twofold - firstly to use best practices in software engineering and new hardware like multi-core and graphic processing units. Secondly we wish to enhance capabilities to support inverse modeling, uncertainty quantification using large ensembles and design of experiments, calibration, validation. Among software engineering practices we practice are open source facilitating community contributions, modularity and reusability. Our initial targets are four popular tools on Vhub - TITAN2D, TEPHRA2, PUFF and LAVA. Use of tools like these requires many observation driven data sets e.g. digital elevation models of topography, satellite imagery, field observations on deposits etc. These data are often maintained in private repositories that are privately shared by "sneaker-net". As a partial solution to this we tested mechanisms using irods software for online sharing of private data with public metadata and access limits. Finally, we adapted use of workflow engines (e.g. Pegasus) to support the complex data and computing workflows needed for usage like uncertainty quantification for hazard analysis using physical

  15. Medical, psychological and social features in a large cohort of adults with Prader-Willi syndrome: experience from a dedicated centre in France.

    Science.gov (United States)

    Laurier, V; Lapeyrade, A; Copet, P; Demeer, G; Silvie, M; Bieth, E; Coupaye, M; Poitou, C; Lorenzini, F; Labrousse, F; Molinas, C; Tauber, M; Thuilleaux, D; Jauregi, J

    2015-05-01

    Prader-Willi syndrome (PWS) is a developmental genetic disorder characterised by a variable expression of medical, cognitive and behavioural symptoms. In adulthood, the prevalence and severity of these symptoms determine the quality of life of the affected persons. Because of their rare disease condition, data on health and social problems in adults with PWS are scarce. In this research, we present medical, psychological and social features of a large cohort of adults admitted to a specialised PWS centre in France and analyse the differences according to genotype, gender and age. Data from 154 patients (68 men/86 women), with a median age of 27 years (range 16-54), were collected during their stay in our centre. Clinical histories were completed using information from parents or main caregivers, and the same medical team performed the diagnosis of different clinical conditions. Statistical analyses were performed to determine the influence of factors such as genotype, age or gender. Paternal deletion genotype was the most frequent (65%) at all ages. Most patients had mild or moderate intellectual disability (87%). Only 30% had studied beyond primary school and 70% were in some special educational or working programme. Most of them lived in the family home (57%). The most prevalent somatic comorbidities were scoliosis (78%), respiratory problems (75%), dermatological lesions (50%), hyperlipidaemia (35%), hypothyroidism (26%), Type 2 diabetes mellitus (25%) and lymph oedema (22%). Some form of psychotropic treatment was prescribed in 58% of subjects, and sex hormones in 43%. Patients with deletion had a higher body mass index (44 vs. 38.9 kg/m(2)) and displayed higher frequency of sleep apnoeas. Non-deletion patients received insulin treatment (19% vs. 4%) and antipsychotic treatment (54.8% vs. 32.7%) more frequently. No difference was observed in the prevalence of Type 2 diabetes between the two genotype groups. Patients >27 years of age had a higher rate of

  16. A review of therapy-related myelodysplastic syndromes and acute myeloid leukaemia (t-MDS/AML) in Irish patients: a single centre experience.

    Science.gov (United States)

    Maung, Su W; Burke, Cathie; Hayde, Jennifer; Walshe, Janice; McDermott, Ray; Desmond, Ronan; McHugh, Johnny; Enright, Helen

    2017-07-01

    To demonstrate the incidence, characteristics, treatment and outcomes of patients with therapy-related myelodysplastic syndromes and therapy-related acute myeloid leukaemia (t-MDS/AML) in a tertiary referral centre. Patients meeting the diagnostic criteria for t-MDS/AML from 2003 to 2014 were reviewed to analyse their diagnostic features, details of antecedent disorder and treatment, approach to management and survival. 39 patients who developed t-MDS/AML were identified with incidence of 8.7%. Median age and gender distribution were similar to de novo MDS but t-MDS/AML patients had greater degree of cytopenia and adverse karyotypes. Time to development of t-MDS/AML was shortest for patients with antecedent haematological malignancy compared to solid tumours and autoimmune disorders (46, 85 and 109 months). Patients with prior acute leukaemia had the shortest latency and poor overall survival. Treatment options included best supportive care (56%), Azacitidine (31%) or intensive chemotherapy/allogeneic transplant (13%). Median OS of all patients was 14 months. Survival declined markedly after two years and 5-year OS was 13.8%. Longer survival was associated with blast count MDS/AML patients showed unique characteristics which influenced their treatment and outcomes. IPSS-R may be useful in risk-adapted treatment approaches and can predict outcomes. Survival remains poor but improved outcomes were seen with allogeneic transplantation. Azacitidine may be effective in patients unfit for intensive therapies.

  17. Anticoagulation use and predictors of stroke, bleeding and mortality in multi-ethnic Asian patients with atrial fibrillation: A single centre experience.

    Science.gov (United States)

    Chia, P L; Teoh, X; Hua, C M; Ching, M E; Foo, D

    2016-10-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia in singapore. We describe a cohort of multi-ethnic Asian patients with AF, with the aim to evaluate anticoagulation use and to identify factors predictive of stroke, bleeding and all-cause mortality. this was a single centre, retrospective cohort study. All patients with an admission diagnosis of AF between 1 January 2000 and 31 December 2010 were identified. Of these patients, those who had follow-up data up to 31 December 2012 were included in the study. there were 1095 eligible patients. the mean age was 67±14 years, mean cHADs2 score was 2±1 and mean HAs-bLED score 2±1. Of the 1095 patients, 657 (62.0%) had a cHADs2 score ≥ 2 but only 215 (32.7%) were eventually prescribed warfarin. Patients not on warfarin were older (p<0.0001) and were more likely females (p<0.0001). Among patients not on warfarin, 52% had HAs-bLED score ≤3. Multivariate analysis revealed that warfarin use and high HAs-bLED score were associated with increased bleeding risk. Age, Indian ethnicity and cHADs2 score were predictive of ischemic stroke. All-cause mortality was significantly related to age, presence of heart failure and HAs-bLED score. Anticoagulation management of AF patients remains inadequate. Objective assessment of bleeding risks should be performed before withholding anticoagulation.

  18. Pseudotumour cerebri in acute promyelocytic leukemia on treatment with all-trans-retinoic acid (ATRA) - an experience from a tertiary care centre.

    Science.gov (United States)

    Ahmad Tali, Manzoor; Bashir, Yasir; Bhat, Shuaeb; Manzoor, Fahim; Bashir, Nusrat; Geelani, Sajad; Rasool, Javid; Waheed Mir, Abdul

    2015-08-01

    Acute promyelocytic leukemia (APML) is considered to be sensitive to all-trans-retinoic acid (ATRA) which acts as a differentiating agent. ATRA is considered to be a well-tolerated agent and is known to achieve complete remission in acute promyelocytic leukemia. However, a few cases on long term all-trans-retinoic acid (ATRA) use can develop pseudotumor cerebri. Out of 32 patients with APML who were treated in our Centre over a 4-year-period, we encountered 6 patients who developed ATRA-related pseudotumor cerebri while on maintenance treatment. The patients ranged from 12 to 40 years of age. 3 patients complained of unbearable headache, 2 of diplopia and 1 of gross reduction in visual acuity. CT scans and MRI did not reveal any intracranial lesions. Cerebrospinal fluid (CSF) examination was normal with CSF manometry revealing a high CSF pressure (average of 345mmH2O). Fundoscopy revealed papilledema in 5 patients and optic atrophy in 1 patient. The patients were successfully managed with decrease dose/discontinuation of ATRA, use of acetazolamide, corticosteroids and therapeutic CSF drainage.

  19. Xpert MTB/Rif for the diagnosis of extrapulmonary tuberculosis--an experience from a tertiary care centre in South India.

    Science.gov (United States)

    Suzana, Shirly; Ninan, Marilyn M; Gowri, Mahasampath; Venkatesh, Krishnan; Rupali, Priscilla; Michael, Joy S

    2016-03-01

    The Xpert MTB/Rif, with a detection limit of 131 CFU/ml, plays a valuable role in the diagnosis of extrapulmonary tuberculosis, both susceptible and resistant. This study aims at evaluating the Xpert MTB/Rif for the same, at a tertiary care centre in south India, assessing it against both culture and a composite gold standard (CGS). We tested consecutive samples from patients suspected of extrapulmonary tuberculosis with Xpert MTB/Rif, evaluated its sensitivity and specificity against solid and/or liquid culture and CGS. An individual analysis of different sample types (tissue biopsies, fluids, pus, lymph node biopsies and CSF) given an adequate sample size, against both culture and CGS, was also performed. In total, 494 samples were analysed against culture. Compared to culture, the sensitivity of Xpert MTB/Rif was 89% (95% CI 0.81-0.94) and its specificity was 74% (95% CI 0.70-0.78). When Xpert MTB/Rif was compared to the CGS, pooled sensitivity was 62% (95% CI 0.56-0.67) and specificity was 100% (95% CI 0.91-1.00). This assay performs better than the currently available conventional laboratory methods. The rapidity with which results are obtained is an added advantage, and its integration into a routine diagnostic protocol must be considered. © 2015 John Wiley & Sons Ltd.

  20. Project for a renewable energy research centre

    OpenAIRE

    Andrea Giachetta

    2011-01-01

    In Liguria, where sustainable approaches to the design, construction and management of buildings enjoy scant currency, the idea of a company from Milan (FERA s.r.l.) setting up a research centre for studies into renewable energy resources, could well open up very interesting development opportunities.The project includes: environmental rehabilitation (restoration) projects; strategies for the protection of water resources and waste management systems; passive and active solar systems (solar t...

  1. TWO EXPERIENCES IN SPANISH AS A SECOND LANGUAGE TEACHING. CENTRES, STUDENTS AND ANECDOTES / DOS EXPERIENCIAS DIDÁCTICAS EN ENSEÑANZA DEL ESPAÑOL COMO SEGUNDA LENGUA. CENTROS, ALUMNOS Y ANÉCDOTAS

    Directory of Open Access Journals (Sweden)

    Patricia Fernández Martín

    2013-12-01

    Full Text Available The aim of this paper is to contribute to the improvement of educational effectiveness in teaching Spanish as a second language, by analyzing a classroom experience made in the 2011-2012 academic year. In that classroom experience we follow a course in Spanish phonetics and spelling for Morroccan immigrants, which was designed five years ago for a different centre. For that, after introduction we have divided the text into two parts. In the first one, we expose the contextual factors of each case, considering as essential pillars the characteristics of each centre as well as the human factors of the students. In the second part, we show, firstly, the way we have applicated the contents and the objectives in the second one of the centres and, secondly, we offer some didactic anecdotes taken from daily classroom experience. The conclusions suggest that the course, in general, can be useful for every pupil, regardless of their mother tongue, provided they have been literate and are used to a certain learning style. RESUMEN El objetivo de este texto es contribuir, mediante el análisis de una experiencia de aula realizada en el curso 2011-2012, a la mejora de la eficacia educativa en la enseñanza del Español como segunda lengua. Concretamente, en dicha experiencia de aula se sigue un curso de fonética y ortografía españolas para inmigrantes marroquíes diseñado hace cinco años para un centro distinto a aquél en el que se ha impartido en el presente año académico. Para ello, tras la introducción dividimos el texto en dos claras partes. Por un lado, exponemos los factores contextuales de ambos casos, tomando como pilares esenciales las características de cada centro, de una parte, y las de sendos alumnos, de otra. Por otro lado, mostramos la aplicación didáctica correspondiente en cada uno de los centros, atendiendo tanto a los objetivos y los contenidos del curso diseñado como a algunas anécdotas de aula. Las conclusiones apuntan a

  2. Regional Dermatology Training Centre in Moshi, Tanzania ...

    African Journals Online (AJOL)

    31 No. 7. Regional Dermatology Training Centre in Moshi, Tanzania – pursuing a dream. Skin disease is common in the community, particularly in resource-poor areas. R J Hay, DM, FRCP, FRCPath. Chairman, International Foundation for Dermatology, London, UK. Corresponding author: R Hay (roderick.hay@ifd.org).

  3. Community Pharmacies As Possible Centres For Routine ...

    African Journals Online (AJOL)

    Community Pharmacies As Possible Centres For Routine Immunization. R I Aderemi-Williams, C I Igwilo. Abstract. Background: Nigeria has embraced the primary healthcare movement and has committed its resources to the provision of cost effective community based primary healthcare strategy which recognizes the need ...

  4. Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section; Experience of a single tertiary centre in Oman

    Directory of Open Access Journals (Sweden)

    Hazel Gonsalves

    2016-11-01

    Full Text Available Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. Results: Most women were 25–35 years old (76.5% and 20 women had had one previous vaginal delivery (29.4%. The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%. Most women delivered after 40 gestational weeks (48.5% and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%, although a few had vaginal bleeding (5.9%, intrapartum fever (4.4%, rupture of the membranes (2.9% and cord prolapse shortly after insertion of the Foley catheter (1.5%. However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%. Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications.

  5. Disorders of sex development in children in KwaZulu-Natal Durban South Africa: 20-year experience in a tertiary centre.

    Science.gov (United States)

    Ganie, Yasmeen; Aldous, Colleen; Balakrishna, Yusentha; Wiersma, Rinus

    2017-01-01

    The objective of the study was to describe the prevalence, clinical characteristics and aetiological diagnosis in children with disorders of sex development (DSDs) presenting to a tertiary referral centre. This is a retrospective review of all cases of DSD referred to the Paediatric Endocrine Unit in Inkosi Albert Luthuli Central Hospital (IALCH) from January 1995 to December 2014. A total of 416 children (15.1%; CI: 13.8%-16.5%) were diagnosed with DSD. The aetiological diagnosis based on the current classification [Lawson Wilkins Paediatric Endocrine Society (LWPES) and European Society for Paediatric Endocrinology (ESPE)] was sex chromosome DSD in 9.5% (n=33), 46 XX DSD in 33% (n=114) and 46 XY DSD in 57.5% (n=199). The most common diagnoses in descending order were a disorder in androgen synthesis and action (not classified) in 53% (n=182), ovotesticular DSD in 22% (n=75) and congenital adrenal hyperplasia (CAH) in 10% (n=36). Overall the median age of presentation was 10 months (IQR: 1 month-4.5 years). There was a significant relationship (p<0.001) between the age of presentation and aetiological diagnosis. The majority (97%) of African patients had a diagnosis of 46 XX DSD. Prematurity was present in 47% (n=83) of children with 46 XY DSD (p<0.001). DSD is not an uncommon diagnosis in African patients in sub-Saharan Africa. The most common aetiological diagnosis is 46 XY DSD in androgen synthesis and action, followed by ovotesticular DSD. CAH is only the third most common disorder.

  6. User experiences of evidence-based online resources for health professionals: User testing of The Cochrane Library

    Directory of Open Access Journals (Sweden)

    Glenton Claire

    2008-07-01

    ' experiences of this and other evidence-based online resources can be improved by applying existing principles for web usability, prioritizing the development of simple search functionality, emitting "researcher" jargon, consistent marking of site ownership, and clear signposting of different document types and different content quality.

  7. TTI Phase 2 Institutional Support: Public Affairs Centre | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    For PAC, this project will help enhance its research quality, organizational performance, and policy engagement. Better research, performance, and engagement Through this support over the next 4.5 years, the Public Affairs Centre is expected to -establish itself as a primary resource centre, with a strong team of ...

  8. Urbanising Africa: the city centre revisited: Experiences with inner-city revitalisation from Johannesburg (South Africa), Mbabane (Swaziland), Lusaka (Zambia), Harare and Bulawayo (Zimbabwe)

    NARCIS (Netherlands)

    P. Ahmad (Peter); I. Chirisa (Innocent); L. Magwaro-Ndiweni (Linda); M.W. Michundu (Mazuba); W.N. Ndela (William); M. Nkonge (Mphangela); D. Sachs (Daniella)

    2010-01-01

    textabstractDrawing on practical experiences of almost 15 years working within Gauteng Province and the City of Johannesburg my paper will focus on the location of poor communities within Johannesburg in relation to selected Inner-City areas and public transportation networks. The introduction notes

  9. Pre-operative MR evaluation of features that indicate the need of adjuvant therapies in early stage cervical cancer patients. A single-centre experience

    Energy Technology Data Exchange (ETDEWEB)

    Rizzo, Stefania, E-mail: stefania.rizzo@ieo.it [Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan (Italy); Calareso, Giuseppina [Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan (Italy); Maccagnoni, Sara; Angileri, Salvatore Alessio [Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan (Italy); Landoni, Fabio [Division of Gynecology, European Institute of Oncology, via Ripamonti 435, 20141 Milan (Italy); Raimondi, Sara; Pasquali, Elena [Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milan (Italy); Lazzari, Roberta [Division of Radiotherapy, European Institute of Oncology, via Ripamonti 435, 20141 Milan (Italy); Bellomi, Massimo [Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan (Italy); Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan (Italy)

    2014-05-15

    Objectives: This study compared the MR measurement of minimum uninvolved cervical stroma and maximum stromal invasion, and the detection of positive lymph nodes with the pathological results. In addition, tumour type and grade were correlated with nodal status and apparent diffusion coefficient (ADC) values. Methods: Patients who underwent surgery and MR at our centre for early stage cervical cancer (FIGO IA1-IIB) were included. Data recorded included: age, date of MR, clinical FIGO (International Federation of Gynacology and Obstetrics) stage, histological type and grade, adjuvant therapy, pre-surgical conisation. MR evaluation included: measurement of the minimum uninvolved stroma, maximum thickness of stromal involvement, presence and site of positive pelvic lymph nodes, calculation of ADC values. Statistical analysis was performed to compare MR and pathological results. The agreement between MR and pathology in measuring depth of stromal invasion was analysed by Bland–Altman plot, calculating the limits of agreement (LoA). Results: 113/217 patients underwent adjuvant therapies. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MR in evaluation of minimum thickness of uninvolved cervical stroma were 88%, 75%, 70%, 90% and 80%; the same values in evaluation of pelvic positive lymph nodes were 64%, 85%, 65%, 84% and 78%. The mean difference between MR and pathological results in measuring maximum depth of stromal invasion was −0.65 mm (95% LoA: −9.37 mm; 8.07 mm). Depth of stromal invasion was strongly related to positive nodal status (p < 0.001). ADC values (available in 51/217 patients) were not associated with the features assessed. Conclusions: Pre-surgical MR is accurate (80%) in evaluating the minimum thickness of uninvolved cervical stroma; MR measurements of maximum depth of stromal invasion differed ±9 mm from the pathological results in 95% of cases. Furthermore, a strong association was found between

  10. Are falls more common than road traffic accidents in pediatric trauma? Experience from a Level 1 trauma centre in New Delhi, India.

    Science.gov (United States)

    Babu, Annu; Rattan, Amulya; Ranjan, Piyush; Singhal, Maneesh; Gupta, Amit; Kumar, Subodh; Mishra, Biplab; Sagar, Sushma

    2016-04-01

    The epidemiology of pediatric trauma is different in different parts of the world. Some re- searchers suggest falls as the most common mechanism, whereas others report road traffic accidents (RTAs) as the most common cause. The aim of this study is to find out the leading cause of pediatric admissions in Trauma Surgery in New Delhi, India. Inpatient data from January 2012 to September 2014 was searched retrospectively in Jai Prakash Narayan Apex Trauma Centre Trauma Registry. All patients aged 18 years or less on index presentation admitted to surgical ward/ICU or later taken transfer by the Department of Trauma Surgery were included. Data were retrieved in predesigned proformas. Information thus compiled was coded in unique alphanumeric codes for each variable and subjected to statistical analysis using SPSS version 21. We had 300 patients over a 33 month period. Among them, 236 (78.6%) were males and 64 (21.3%) females. Overall the predominant cause was RTAs in 132 (43%) patients. On subgroup analysis of up to 12 years age group (n = 147), the most common cause was found to be RTAs again. However, falls showed an incremental upward trend (36.05% in up to 12 age group versus 27% overall), catching up with RTAs (44.89%). Pediatric Trauma Score (PTS) ranged from 0 to 12 with a mean of 8.12 ± 2.022. 223 (74.33%) patients experienced trauma limited to one anatomic region only, whereas 77 (25.66%) patients suffered polytrauma. 288 patients were discharged to home care. Overall, 12 patients expired in the cohort. Median hospital stay was 6 days (range 1-182). Pediatric trauma is becoming a cause of increasing concern, especially in the developing countries. The leading cause of admissions in Trauma Surgery is RTAs (43%) as compared to falls from height (27%); however, falls from height are showing an increasing trend as we move to younger age groups. Enhancing road safety alone may not be a lasting solution for prevention of pediatric trauma and local injury patterns

  11. Search | Page 4 | IDRC - International Development Research Centre

    International Development Research Centre (IDRC) Digital Library (Canada)

    Search | Page 3 | IDRC - International Development Research Centre. The project will involve data collection on water resources, water quality, pollution ... featuring an ecosystem approach to human health in West Africa ( 100772).

  12. Recherche | Page 4 | CRDI - Centre de recherches pour le ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    IDRC on climate change adaptation | CRDI - Centre de recherches ... The relationship among the allocation of water resources, climate variability, and health risks — such as vector-borne disease — both in West Africa and in .

  13. Challenges in recruiting participants in a multi-centre study on symptom experiences and self care strategies of bowel symptoms following colo-rectal surgery

    OpenAIRE

    Landers, Margaret; McCarthy, Geraldine; Savage, Eileen

    2012-01-01

    Aim: The purpose of this paper is to present some of the challenges found to be problematic in recruiting individuals following sphincter saving surgery for rectal cancer for a multicentre study. While the focus of the study is on symptom experiences and management of bowel symptoms following colo-rectal surgery, the paper will concentrate solely on the challenges experienced in recruiting a sample for the study. Background Recruitment of an adequate number of participants is a challenge for ...

  14. Increasing access to kidney transplantation in countries with limited resources: the Indian experience with kidney paired donation.

    Science.gov (United States)

    Kute, Vivek B; Vanikar, Aruna V; Shah, Pankaj R; Gumber, Manoj R; Patel, Himanshu V; Engineer, Divyesh P; Modi, Pranjal R; Shah, Veena R; Trivedi, Hargovind L

    2014-10-01

    According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen (HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation (KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy. © 2014 Asian Pacific Society of Nephrology.

  15. Patient-centred care is a way of doing things: How healthcare employees conceptualize patient-centred care.

    Science.gov (United States)

    Fix, Gemmae M; VanDeusen Lukas, Carol; Bolton, Rendelle E; Hill, Jennifer N; Mueller, Nora; LaVela, Sherri L; Bokhour, Barbara G

    2018-02-01

    Patient-centred care is now ubiquitous in health services research, and healthcare systems are moving ahead with patient-centred care implementation. Yet, little is known about how healthcare employees, charged with implementing patient-centred care, conceptualize what they are implementing. To examine how hospital employees conceptualize patient-centred care. We conducted qualitative interviews about patient-centred care during site four visits, from January to April 2013. We interviewed 107 employees, including leadership, middle managers, front line providers and staff at four US Veteran Health Administration (VHA) medical centres leading VHA's patient-centred care transformation. Data were analysed using grounded thematic analysis. Findings were then mapped to established patient-centred care constructs identified in the literature: taking a biopsychosocial perspective; viewing the patient-as-person; sharing power and responsibility; establishing a therapeutic alliance; and viewing the doctor-as-person. We identified three distinct conceptualizations: (i) those that were well aligned with established patient-centred care constructs surrounding the clinical encounter; (ii) others that extended conceptualizations of patient-centred care into the organizational culture, encompassing the entire patient-experience; and (iii) still others that were poorly aligned with patient-centred care constructs, reflecting more traditional patient care practices. Patient-centred care ideals have permeated into healthcare systems. Additionally, patient-centred care has been expanded to encompass a cultural shift in care delivery, beginning with patients' experiences entering a facility. However, some healthcare employees, namely leadership, see patient-centred care so broadly, it encompasses on-going hospital initiatives, while others consider patient-centred care as inherent to specific positions. These latter conceptualizations risk undermining patient-centred care

  16. Communicating integrated water resources management: From global discourse to local practice - Chronicling an experience from the Boteti River sub-Basin, Botswana

    Science.gov (United States)

    Swatuk, Larry A.; Motsholapheko, Moseki

    The Boteti River is an ephemeral outflow of the Okavango River. It lies in the north-western part of Botswana where about 25,000 people reside across a number of widely scattered villages and informal settlements. The river, with its seasonal streams and pans, is vital to the livelihoods of these people, their livestock, and the wildlife that share this physical space. A combination of factors has led to widespread degradation of the physical resource base - both in the river bed itself and in the wider environment. As part of its outreach role, the Harry Oppeheimer Okavango Research Centre has undertaken a multi-year project along the Boteti River to assist people there with the rehabilitation of their resource base. The globally influential concept of integrated water resources management (IWRM) provides the analytical framework, in particular its emphasis on dialogue and stakeholder participation. The project has three primary aspects: facilitation of a dialogue platform; action-research; outreach and information dissemination. After two years of implementation, the project has collected a good deal of data and established a River Basin Forum with a common vision. However, the project continues to face difficulties in implementation: participation is limited; myths regarding resource degradation are difficult to dispel; meaningful communication among differently empowered actors is hard to achieve; and there are numerous human, financial and technological limitations. The primary researchers continue to alter their methods in the hope of achieving a functioning River Basin Committee (RBC), but observe that the globalized ideals of IWRM are, in this particular case at least, of limited use when attempting to alter localized management practices in basins with deeply embedded social and cultural practices.

  17. Malformação congénita das vias aéreas pulmonares: Experiência de cinco centros Congenital cystic adenomatoid malformation of the lung: The experience of five medical centres

    Directory of Open Access Journals (Sweden)

    Gustavo Rocha

    2007-07-01

    lesão assintomática é controverso; a cirurgia está indicada devido à baixa morbilidade e possibilidade de prevenção de complicações tardias, como a degenerescência maligna.Background: The clinical spectrum of congenital cystic adenomatoid malformation of the lung (CCAML ranges from asymptomatic lesions to neonatal respiratory distress and hydrops fetalis. Aim: To review our experience with CCAML, emphasising natural history, management and outcome. Material and methods: A retrospective chart review of all CCAML-diagnosed neonates admitted to the neonatal intensive care units of five tertiary medical centres in the north of Portugal between 1996 and 2005. Results: Fifteen neonates with CCAML were identified, 9F/6M, birth weight 3100 g (645-3975, gestational age 38 weeks (24-40. The incidence of CCAML was 1: 9300 births. There were 11 (73% cases of cystic lung lesion diagnosed during pregnancy, median age 22 weeks (19-30. The lesion was right sided in six (40% and left sided in nine (60% cases. In utero spontaneous regression of the lesion was observed in two cases. Antenatal intervention (pleurocentesis and thoracoamniotic shunting was performed in one foetus with impending hydrops. Normal lung radiographic findings at birth were present in five cases, with an abnormal CT scan. Three (20% neonates became symptomatic during the neonatal period (respiratory distress and one (70% after the neonatal period (spontaneous pneumothorax. Two neonates (13% died. Six (40% patients underwent thoracotomy and appropriate excisional surgery. Histological examination showed definitive features of CCAML (Stocker classification: type I = 4; type II = 1; type III = 2. Eight (53% patients remain asymptomatic and did not undergo surgery. Conclusions: Antenatally diagnosed CCAML has a good prognosis in the absence of severe foetal distress; normal radiographic findings at birth do not rule out CCAML; treatment of asymptomatic CCAML is controversial; surgery may be advocated

  18. Institutionalization of conflict capability in the management of natural resources : theoretical perspectives and empirical experience in Indonesia

    NARCIS (Netherlands)

    Yasmi, Y.

    2007-01-01

    Keywords: natural resource conflict, conflict capability, impairment, escalation   This study concerns natural resource management (NRM) conflict particularly conflict in forestry sector and how such conflict can be addressed effectively. It consists of two major parts. The first deals with the

  19. Use of Digital Resources in an Academic Environment: A Qualitative Study of Students' Perceptions, Experiences, and Digital Literacy Skills

    Science.gov (United States)

    Matusiak, Krystyna K.

    2010-01-01

    The use of information resources for teaching and learning in an academic environment is undergoing a dramatic transformation. The development of digital technologies and the growth of the Internet have changed the format as well as the dissemination methods of scholarly resources. Digital libraries have been created as part of the transition from…

  20. The Perceptions and Experiences of School Management Teams and Teachers of the Management of Physical Resources in Public Schools

    Science.gov (United States)

    Mestry, Raj; Bodalina, Kishan

    2015-01-01

    The effective management of physical resources significantly impacts on the quality of teaching and learning in schools. The procurement, utilization and maintenance of physical resources through organized structures, well-designed policies and rigid processes are critical for quality education. According to the South African Schools Act 1996, a…

  1. Results and experience with four years of development work on a filmless department in Mjölby health care centre.

    Science.gov (United States)

    Karner, G; Olsson, S

    1998-01-01

    Since the end of 1994, the radiology department in Mjölby has been running their activity without X-ray films. When the film developing machine at the department was discarded in April 1995, after six months of test-running of the new system, the film epoch was definitely abandoned. The practical experiences from working with digital images are all good. The background to this change lays in a four years development work, which has been supported financially by the Ostergötland County Council, Swedish National Board for Industrial and Technical Development (NUTEK), and a regional foundation for development of new ways to organise and perform work (Arbetslivsfonden).

  2. Design of Community Resource Inventories as a Component of Scalable Earth Science Infrastructure: Experience of the Earthcube CINERGI Project

    Science.gov (United States)

    Zaslavsky, I.; Richard, S. M.; Valentine, D. W., Jr.; Grethe, J. S.; Hsu, L.; Malik, T.; Bermudez, L. E.; Gupta, A.; Lehnert, K. A.; Whitenack, T.; Ozyurt, I. B.; Condit, C.; Calderon, R.; Musil, L.

    2014-12-01

    EarthCube is envisioned as a cyberinfrastructure that fosters new, transformational geoscience by enabling sharing, understanding and scientifically-sound and efficient re-use of formerly unconnected data resources, software, models, repositories, and computational power. Its purpose is to enable science enterprise and workforce development via an extensible and adaptable collaboration and resource integration framework. A key component of this vision is development of comprehensive inventories supporting resource discovery and re-use across geoscience domains. The goal of the EarthCube CINERGI (Community Inventory of EarthCube Resources for Geoscience Interoperability) project is to create a methodology and assemble a large inventory of high-quality information resources with standard metadata descriptions and traceable provenance. The inventory is compiled from metadata catalogs maintained by geoscience data facilities, as well as from user contributions. The latter mechanism relies on community resource viewers: online applications that support update and curation of metadata records. Once harvested into CINERGI, metadata records from domain catalogs and community resource viewers are loaded into a staging database implemented in MongoDB, and validated for compliance with ISO 19139 metadata schema. Several types of metadata defects detected by the validation engine are automatically corrected with help of several information extractors or flagged for manual curation. The metadata harvesting, validation and processing components generate provenance statements using W3C PROV notation, which are stored in a Neo4J database. Thus curated metadata, along with the provenance information, is re-published and accessed programmatically and via a CINERGI online application. This presentation focuses on the role of resource inventories in a scalable and adaptable information infrastructure, and on the CINERGI metadata pipeline and its implementation challenges. Key project

  3. Boreal Wood Centre, Manning, Alberta: Project update, 1995-1996

    Energy Technology Data Exchange (ETDEWEB)

    Seaton, H.

    1996-12-31

    The Boreal Wood Centre in Manning, Alberta was created to promote the wise use of timber resources in the boreal forest of north-west Alberta. The Centre encourages sustainable practices in woodlands operations and assists manufacturers of solid wood to add more value to their products. The Centre carries out its mandate by applied research, training in forestry or wood products manufacturing, and educating the public and industry on the importance of value-added manufacturing. This report outlines the progress of the Centre in its first year of development. It includes a draft action plan for 1996-97.

  4. Virtual particle therapy centre

    CERN Multimedia

    2015-01-01

    Particle therapy is an advanced technique of cancer radiation therapy, using protons or other ions to target the cancerous mass. This advanced technique requires a multi-disciplinary team working in a specialised centre. 3D animation: Nymus3D

  5. CENTRE FOR GEOMETRICAL METROLOGY

    DEFF Research Database (Denmark)

    De Chiffre, Leonardo

    The objective of this Annual Report is to give a general introduction to CGM as well as to give an account of the tasks carried out using the facilities of CGM's Instrument Centre during 1998 and 1999....

  6. Transfusion in CMV seronegative T-depleted allogeneic stem cell transplant recipients with CMV-unselected blood components results in zero CMV transmissions in the era of universal leukocyte reduction: a U.K. dual centre experience.

    Science.gov (United States)

    Hall, S; Danby, R; Osman, H; Peniket, A; Rocha, V; Craddock, C; Murphy, M; Chaganti, S

    2015-12-01

    To establish rates of cytomegalovirus (CMV) transmission with use of CMV-unselected (CMV-U), leukocyte-reduced blood components transfused to CMV-seronegative patient/CMV-seronegative donor (CMV neg/neg) allogeneic stem cell transplantation (SCT) recipients including those receiving T-depleted grafts. CMV infection remains a major cause of morbidity following SCT. CMV-seronegative SCT recipients are particularly at risk of transfusion transmitted CMV (TT-CMV) and until recently they have received blood components from CMV-seronegative donors with significant resource implications. Although leukocyte reduction of blood components is reported to minimise risk of TT-CMV, its efficacy in high-risk situations, such as in T-depleted transplant recipients, is unknown. We retrospectively analysed the incidence of TT-CMV in CMV neg/neg allogeneic SCT recipients transfused with CMV-U, leukocyte-reduced blood components in two transplantation centres in the UK. Patients were monitored for CMV infection by weekly CMV polymerase chain reaction testing. Leukocyte reduction of blood components was in accordance with current UK standards. Among 76 patients, including 59 receiving in vivo T-depletion, no episodes of CMV infection were detected. Patients were transfused with 1442 CMV-unselected, leukocyte-reduced components, equating to 1862 donor exposures. Our findings confirm the safety of leukocyte reduction as a strategy in preventing TT-CMV in high-risk allogeneic SCT recipients. © 2015 British Blood Transfusion Society.

  7. Pretoria Centre Reaches Out

    Science.gov (United States)

    Olivier, Bosman

    2014-08-01

    On 5 July 2014 six members of the Pretoria Centre of ASSA braved the light pollution of one of the shopping malls in Centurion to reach out to shoppers a la John Dobson and to show them the moon, Mars and Saturn. Although the centre hosts regular monthly public observing evenings, it was felt that we should take astronomy to the people rather than wait for the people to come to us.

  8. Successful Aging as the Intersection of Individual Resources, Age, Environment, and Experiences of Well-being in Daily Activities.

    Science.gov (United States)

    Mejía, Shannon T; Ryan, Lindsay H; Gonzalez, Richard; Smith, Jacqui

    2017-03-01

    We conceptualize successful aging as a cumulative index of individual resources (the absence of disease and disability, high cognitive and physical functioning, social embeddedness) in the service of successful aging outcomes (global well-being, experienced well-being, and vital status), and conditioned by age, social structure, and environment. The study used baseline and follow-up data from the 2008-2014 waves of the Health and Retirement Study (N = 17,230; age = 51-101). Linear, multilevel, and logistic models compared individual resources at baseline as independent, cumulative, and binary predictors of outcomes 4 years later. Individual resources were unequally distributed across age group and social structures (education, wealth, race, gender) and had a cumulative effect on all successful aging outcomes. For experienced well-being, individual resources were most important at midlife and for groups with lower education. Person-environment congruence (social cohesion, city satisfaction) was associated with all successful aging outcomes and conditioned the effect of individual resources on experienced well-being. A cumulative index allows for gradations in resources that can be compensated for by external factors such as person-environment congruence. This index could guide policy and interventions to enhance resources in vulnerable subgroups and diminish inequalities in successful aging outcomes.

  9. Experience in Implementing Resource-Based Learning in Agrarian College of Management and Law Poltava State Agrarian Academy

    Directory of Open Access Journals (Sweden)

    Natalia KONONETS

    2015-04-01

    Full Text Available The introduction of resource-based learning disciplines of computer cycles in Agrarian College. The article focused on the issue of implementation of resource-based learning courses in the agricultural cycle computer college. Tested approach to creating elearning resources through free hosting and their further use in the classroom. Noted that the use of Internet technology makes it possible to create educational environment Agrarian College is through the development and deployment of electronic educational resources on the Web, because the Internet is constantly expanding its capabilities, services, hosted with them information that is relevant in terms of education. The author proposes to consider e-learning resource "Інформатика+="Information+": http://informatika-resurs.jimdo.com which combines the characteristics and principles of creation of electronic media for educational purposes and is a modern didactic resource for the study of the disciplines of computer cycle. Demonstrates Cloud resources from the disciplines of computer cycle, e-learning content "IT–education", developed with the help of Google services for online learning. Cloud resource is a collection of electronic teaching systems such disciplines of "Computer Science and Computer Engineering", "E-commerce", "Data Protection", "Computer technologies in legal activity". The study is focused on free hosting for the development of electronic learning resources (Jimdo, uCoz, which enable the creation of a site (does not require special skills and knowledge of programming languages, fast and, most importantly, free of charge, which is particularly important given the current financial support of agricultural colleges.

  10. Petroleum industry experiences with the land resource management planning (LRMP) process in north eastern B.C

    Energy Technology Data Exchange (ETDEWEB)

    Parsons, B.; Land, P. [Mobil Oil Canada, Calgary, AB (Canada)

    1996-10-01

    Initiatives taken by the province of British Columbia towards enhanced land and resource planning were summarized. Main initiatives included C.O.R.E., regional land use planning, land and resource management planning, protected area strategy, and environmental impact assessment legislation. It is believed that the impact of these initiatives will be substantial on the economic development in the province. It was suggested that if the land use strategy achieves its objectives, the energy industry would benefit from greater certainty and predictability. The policy of active involvement by the public, aboriginal groups, and government agencies in land resource management was highlighted. 2 figs.

  11. Petroleum industry experiences with the land resource management planning (LRMP) process in northeastern B.C; CD-ROM ed.

    Energy Technology Data Exchange (ETDEWEB)

    Parsons, B.; Land, P. [Mobil Oil Canada, Calgary, AB (Canada)

    1996-06-01

    Initiatives taken by the province of British Columbia towards enhanced land and resource planning were summarized. The five main initiatives were C.O.R.E., regional land use planning, land and resource management planning, protected area strategy, and environmental impact assessment legislation. It is believed that the impact of these initiatives will be substantial on the economic development in the province. It was suggested that if the land use strategy achieves its objectives, the energy industry will benefit from greater certainty and predictability. The continued involvement by the public, aboriginal groups, and government agencies, in land resource management was emphasized. 2 figs.

  12. Optimal catchment area and primary PCI centre volume revisited

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Pedersen, Frants; Holmvang, Lene

    2015-01-01

    AIMS: The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres....... The quality of a centre reflects governance, training, resources and pre-hospital triage, rather than catchment population and STEMI incidence, as long as a minimum volume is guaranteed. Resources can be utilised better by merging neighbouring centres, without negative effects on quality of care....... stable at 32 minutes. Up to 75.1% of patients were directly transferred by pre-hospital triage, of whom 82.7% had ECG-to-balloon volume...

  13. Enhanced case management can be delivered for patients with EVD in Africa: Experience from a UK military Ebola treatment centre in Sierra Leone.

    Science.gov (United States)

    Dickson, S J; Clay, K A; Adam, M; Ardley, C; Bailey, M S; Burns, D S; Cox, A T; Craig, D G; Espina, M; Ewington, I; Fitchett, G; Grindrod, J; Hinsley, D E; Horne, S; Hutley, E; Johnston, A M; Kao, R L C; Lamb, L E; Lewis, S; Marion, D; Moore, A J; Nicholson-Roberts, T C; Phillips, A; Praught, J; Rees, P S; Schoonbaert, I; Trinick, T; Wilson, D R; Simpson, A J; Wang, D; O'Shea, M K; Fletcher, T E

    2017-12-14

    -threatening electrolyte imbalance and organ dysfunction. We believe that the enhanced levels of protocolized care, scale and range of medical interventions we report, offer a blueprint for the future management of EVD in resource-limited settings. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  14. Direct-acting antiviral agents in the treatment of chronic Hepatitis C - "Real-life" experience from an academic centre and two specialized clinical practices.

    Science.gov (United States)

    Groß, Manuel Jonathan; Härter, Georg; Backhus, Johanna; Zizer, Eugen; Seufferlein, Thomas; Ludwig, Leopold; Dikopoulos, Nektarios

    2017-11-07

    The introduction of the new direct antiviral agents has revolutionized the therapy of chronic hepatitis C. Today we are able to cure the vast majority of our patients with an 8- to 12-week therapy course of an antiviral combination therapy with an excellent safety profile. Real-life data are very important to further develop our experience with the new therapeutics and help us to improve the care of our patients in our everyday clinical practice.In our study, we present the retrospective analysis of a representative German cohort of 344 patients with chronic hepatitis C treated with the new direct antiviral agents. The patients were recruited in an academic center of southern Germany (University Clinic of Ulm, Clinic of Internal Medicine I) and in 2 highly specialized clinical practices in the city center and the near region of Ulm. Within this in-detail characterized study cohort, we analyzed the efficacy and safety of antiviral therapy under real-life conditions.In 322 patients, we could document SVR12 data and found an excellent overall SVR12 rate of 97.8 % across all genotypes. In more detail, we could show comparable SVR12 results of 99 % and 99.2 % in patients with the hepatitis C virus subtypes 1a and 1b of and an excellent SVR12 rate of 93.1 % in genotype 3 patients without liver cirrhosis. Nevertheless, SVR12 rates tend to be lower in patients with the presence of liver cirrhosis, especially in genotype 3 patients with the lowest SVR12 rate in the whole study group of only 80 %. In general, there were no major safety issues except of 1 patient treated with a protease-inhibitor-based regimen who developed a generalized skin reaction and needed hospitalization and premature end of antiviral therapy.In summary, our analysis of this well characterized representative cohort of 344 patients adds more information in the field of real-life experience with the new antiviral therapeutics and could therefore contribute to improve the care of our patients

  15. The use of port-a-caths in adult patients with Lysosomal Storage Disorders receiving Enzyme Replacement Therapy-one centre experience

    Directory of Open Access Journals (Sweden)

    Mairead McLoughlin

    2017-12-01

    Full Text Available Port-a-cath is a widely used device in patients with long-term venous access demand such as frequent or continuous administration of medications such as Enzyme Replacement Therapy (ERT, chemotherapy delivery, blood transfusions, blood products, and fluids. Patients with Lysosomal Storage Diseases (LSDs often require recurrent courses of ERT. We reviewed our experience of using port-a-caths in patients with LSDs with the focus on challenges and complications associated with these catheters. Among 245 adult patients who were treated with ERT, twenty patients (8.2% had a port-a-cath inserted due to poor venous access. Six patients were using their first port whereas five other patients had their port-a-caths replaced at least once. The remaining six patients had inactive port-a-caths. The majority of patients with active port-a-caths never missed more than one consecutive infusion, although one patient missed 2 consecutive infusions whilst on holiday. We identified significant gaps in patients' and their families' understanding of the management of port-a-caths and risks associated with them. It resulted in producing a leaflet and designing an educational program for our LSD patients.

  16. Single-Centre Experience of Systemic Treatment with Vincristine, Ifosfamide, and Doxorubicin Alternating with Etoposide, Ifosfamide, and Cisplatin in Adult Patients with Ewing Sarcoma

    Directory of Open Access Journals (Sweden)

    Annelies Requilé

    2017-01-01

    Full Text Available The treatment of Ewing sarcoma (ES in adult patients requires a multidisciplinary approach. Systemic therapy remains an important component of clinical management of this disease. ES is extremely rare in adult patients. Due to the rarity of the disease, no standard of care in terms of chemotherapy for the adult population exists, and the level of evidence for individual agents or some multidrug combinations is limited. Most regimens that are used in both adults and children include anthracyclines, etoposide, vincristine, cyclophosphamide, and ifosfamide. In this report, we describe our experience with the alternating use of triple combination therapies based on vincristine, ifosfamide, and doxorubicin (VIA and an etoposide, ifosfamide, and cisplatin combination (VIP. We retrospectively evaluated the response rates, outcome, and tolerance of adult patients (n = 64 treated with VIA/VIP between 1990 and 2014. The patients included were treated with perioperative chemotherapy (53.1% neoadjuvant therapy and 17.2% adjuvant therapy or had synchronous metastases at diagnosis (29.7%. Five-year overall survival rate was 52.2% for all patients, 72.2% for patients with localized disease, and 5.3% in patients with synchronous metastases. Overall response rate (ORR was 37% after 2 cycles of VIA and 2 cycles of VIP. There were no patients with progressive disease (PD.

  17. Assessing the role of learning devices and geovisualisation tools for collective action in natural resource management: Experiences from Vietnam.

    Science.gov (United States)

    Castella, Jean-Christophe

    2009-02-01

    In northern Vietnam uplands the successive policy reforms that accompanied agricultural decollectivisation triggered very rapid changes in land use in the 1990s. From a centralized system of natural resource management, a multitude of individual strategies emerged which contributed to new production interactions among farming households, changes in landscape structures, and conflicting strategies among local stakeholders. Within this context of agrarian transition, learning devices can help local communities to collectively design their own course of action towards sustainable natural resource management. This paper presents a collaborative approach combining a number of participatory methods and geovisualisation tools (e.g., spatially explicit multi-agent models and role-playing games) with the shared goal to analyse and represent the interactions between: (i) decision-making processes by individual farmers based on the resource profiles of their farms; (ii) the institutions which regulate resource access and usage; and (iii) the biophysical and socioeconomic environment. This methodological pathway is illustrated by a case study in Bac Kan Province where it successfully led to a communication platform on natural resource management. In a context of rapid socioeconomic changes, learning devices and geovisualisation tools helped embed the participatory approach within a process of community development. The combination of different tools, each with its own advantages and constraints, proved highly relevant for supporting collective natural resource management.

  18. Automated cardiopulmonary resuscitation using a load-distributing band external cardiac support device for in-hospital cardiac arrest: a single centre experience of AutoPulse-CPR.

    Science.gov (United States)

    Spiro, J R; White, S; Quinn, N; Gubran, C J; Ludman, P F; Townend, J N; Doshi, S N

    2015-02-01

    Poor quality cardiopulmonary resuscitation (CPR) predicts adverse outcome. During invasive cardiac procedures automated-CPR (A-CPR) may help maintain effective resuscitation. The use of A-CPR following in-hospital cardiac arrest (IHCA) remains poorly described. Firstly, we aimed to assess the efficiency of healthcare staff using A-CPR in a cardiac arrest scenario at baseline, following re-training and over time (Scenario-based training). Secondly, we studied our clinical experience of A-CPR at our institution over a 2-year period, with particular emphasis on the details of invasive cardiac procedures performed, problems encountered, resuscitation rates and in-hospital outcome (AutoPulse-CPR Registry). Scenario-based training: Forty healthcare professionals were assessed. At baseline, time-to-position device was slow (mean 59 (±24) s (range 15-96s)), with the majority (57%) unable to mode-switch. Following re-training time-to-position reduced (28 (±9) s, p<0.01 vs baseline) with 95% able to mode-switch. This improvement was maintained over time. AutoPulse-CPR Registry: 285 patients suffered IHCA, 25 received A-CPR. Survival to hospital discharge following conventional CPR was 28/260 (11%) and 7/25 (28%) following A-CPR. A-CPR supported invasive procedures in 9 patients, 2 of whom had A-CPR dependant circulation during transfer to the catheter lab. A-CPR may provide excellent haemodynamic support and facilitate simultaneous invasive cardiac procedures. A significant learning curve exists when integrating A-CPR into clinical practice. Further studies are required to better define the role and effectiveness of A-CPR following IHCA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. The DIY Digital Medical Centre.

    Science.gov (United States)

    Timmis, James Kenneth; Timmis, Kenneth

    2017-09-01

    Healthcare systems worldwide are confronted with major economic, organizational and logistical challenges. Historic evolution of health care has led to significant healthcare sector fragmentation, resulting in systemic inefficiencies and suboptimal resource exploitation. To attain a sustainable healthcare model, fundamental, system-wide improvements that effectively network, and ensure fulfilment of potential synergies between sectors, and include and facilitate coherent strategic planning and organisation of healthcare infrastructure are needed. Critically, they must be specifically designed to sustainably achieve peak performance within the current policy environment for cost-control, and efficiency and quality improvement for service delivery. We propose creation of a new healthcare cluster, to be embedded in existing healthcare systems. It consists of (i) local 24/7 walk-in virtually autonomous do-it-yourself Digital Medical Centres performing routine diagnosis, monitoring, prevention, treatment and standardized documentation and health outcome assessment/reporting, which are online interfaced with (ii) regional 24/7 eClinician Centres providing on-demand clinical supervision/assistance to Digital Medical Centre patients. Both of these are, in turn, online interfaced with (iii) the National Clinical Informatics Centre, which houses the national patient data centre (cloud) and data analysis units that conduct patient- and population-level, personalized and predictive(-medicine) intervention optimization analyses. The National Clinical Informatics Centre also interfaces with biomedical research and prioritizes and accelerates the translation of new discoveries into clinical practice. The associated Health Policy Innovation and Evaluation Centre rapidly integrates new findings with health policy/regulatory discussions. This new cluster would synergistically link all health system components in a circular format, enable not only access by all arms of the health

  20. Clinical outcomes in patients after extracorporeal membrane oxygenation support for post-cardiotomy cardiogenic shock: a single-centre experience of 92 cases.

    Science.gov (United States)

    Guihaire, Julien; Dang Van, Simon; Rouze, Simon; Rosier, Sébastien; Roisne, Antoine; Langanay, Thierry; Corbineau, Hervé; Verhoye, Jean-Philippe; Flécher, Erwan

    2017-09-01

    Post-cardiotomy cardiogenic shock is a major concern in cardiac surgery. We reviewed our experience of extracorporeal membrane oxygenation (ECMO) as temporary circulatory support in post-cardiotomy cardiogenic shock. Between January 2005 and December 2014, adult patients implanted with ECMO after cardiac surgical procedures were included. Indications for ECMO were failure to be withdrawn from cardiopulmonary bypass or refractory cardiogenic shock occurring during postoperative Days 1 and 2. Patients' characteristics and outcomes were prospectively collected in a local ECMO database. Ninety-two patients, median age of 63 years (17-83 years), were supported by ECMO following valvular surgery (66%), acute aortic dissection (10%) and coronary artery bypass grafting (9%). A total of 37% were combined surgical procedures, 24% were redo procedures and 33% were emergent procedures. The median duration of ECMO support was 6 days (1-28 days). The weaning rate from mechanical support was 48%. Overall 1-month and 6-month survival rates were, respectively, 42% and 39%. Survivors were younger (57 vs 63 years old, P = 0.02) and had a higher preoperative left ventricular ejection fraction (52.5 vs 44.1%, P = 0.017). There was a trend for lower serum creatinine levels and total bilirubin rates in the survivors' group 24 h after initiation of ECMO (respectively, 162 vs 212 µmol/l, P = 0.06; 25.3 vs 54.2 mg/dl, P = 0.08). Valvular surgery and peak lactic acid serum level were associated with poor outcomes. The mean health-related quality of life EuroQoL scale was 68 ± 16/100 at 2 years. Refractory cardiogenic shock requiring ECMO was most frequently observed after redo valvular surgery in the present study. The overall 6-month survival rate was 39% after ECMO support for post-cardiotomy cardiogenic shock with acceptable health-related quality of life. Improved kidney and liver functions after 24 h of support were associated with favourable outcomes.

  1. Combined treatment with APCC (FEIBA®) and tranexamic acid in patients with haemophilia A with inhibitors and in patients with acquired haemophilia A--a two-centre experience.

    Science.gov (United States)

    Holmström, M; Tran, H T T; Holme, P A

    2012-07-01

    The management of bleeding in haemophilia patients with inhibitors can be challenging when using monotherapy with either activated prothrombin complex concentrate (APCC) or recombinant activated FVII (rFVIIa) fail. The antifibrinolytic agent tranexamic acid (TXA) increases clot stability and is used concomitantly with coagulation factor replacement to improve haemostasis in haemophilia patients without inhibitors in many countries in Europe. Combined treatment with TXA and rFVIIa is not contraindicated in haemophilia patients with inhibitors. However, the combined approach of TXA and APCC has not been investigated due to safety concerns of increased risk of thrombosis or disseminated intravasal coagulation (DIC). The aim of this study is to report our experience of concomitant use of APCC and TXA in haemophilia A patients with inhibitor and in patients with acquired haemophilia A with respect to safety and efficacy. Seven (n = 6) haemophilia A patients with inhibitors and one (n = 1) with acquired haemophilia A from Oslo (Norway) and Stockholm (Sweden) were included in the study. The APCC was given at doses consistent to the manufacturers' recommendation. TXA was administered concomitantly either 10 mg kg(-1) every 6-8 h intravenously or 20 mg kg(-1) every 6-8 h orally. Haemostatic response was assessed by thromboelastography (TEG) and thrombin generation assay (TGA) in three of the patients. A total number of three bleeding episodes and two minor and six major surgical procedures were performed under the coverage with APCC and TXA. Haemostatic outcome was rated excellent or good in 10 of 11 (91%) treatment episodes. One episode was rated with poor effect. No episodes of arterial, venous thrombosis or DIC occurred during or after the treatment. Data from TEG and TGA analysis showed no signs of hypercoagulability following the combined treatment. This report demonstrates that, in a limited number of patients, combined treatment with APCC and TXA seemed to be safe

  2. Direct utilization of geothermal resources field experiments at Monroe, Utah. Final report, July 14, 1978-July 13, 1981

    Energy Technology Data Exchange (ETDEWEB)

    Blair, C.K.; Owen, L.B. (eds.)

    1982-12-01

    The City of Monroe, Utah undertook a project to demonstrate the economic and technical viability of utilizing a low temperature geothermal resource to provide space and hot water heating to commercial, municipal, and domestic users within the community. During the course of the project, resource development and assessment, including drilling of a production well, was successfully completed. Upon completion of the field development and assessment phase of the program and of a preliminary design of the district heating system, it was determined that the project as proposed was not economically viable. This was due to: (1) a significant increase in estimated capital equipment costs resulting from the general inflation in construction costs, the large area/low population density in Monroe, and a more remote fluid disposal well site than planned, could not balance increased construction costs, (2) a lower temperature resource than predicted, and (3) due to predicted higher pumping and operating costs. After a thorough investigation of alternatives for utilizing the resource, further project activities were cancelled because the project was no longer economical and an alternative application for the resource could not be found within the constraints of the project. The City of Monroe, Utah is still seeking a beneficial use for the 600 gpm, 164/sup 0/F geothermal well. A summary of project activities included.

  3. What Drives Innovation and Use of Big Data in the Small Satellite Industry? The Role of Technological Resources and Managerial Experience

    OpenAIRE

    SONG, Yue; Gnyawali, Devi

    2017-01-01

    The rapid growth of the small satellite industry has led to many new firm entries and an increased number of innovations. While some companies have focus their innovation efforts on improving the satellite systems, others have devoted their efforts on finding novel applications of small satellites. In this paper, we examine what factors drive companies’ innovation choices, and how technological resources and top management team experience influence companies’ pursuit of innovation. We categor...

  4. Association of Finnish Members of Parliament and Researchers: Social Democratic Parliamentary group MP K. Olin, Former Finnish MP M. Tiuri, Finnish Centre Party MP P. Vilkuna, Senior Assistant Professor I. Ruostetsaari and Finnish Parliament Committee of Future Researcher U. Gabrielsson at ATLAS experiment with P. Jenn, M. Nordberg and M. Kotamaki on 15 September 2006.

    CERN Multimedia

    Maximilien Brice

    2006-01-01

    Association of Finnish Members of Parliament and Researchers: Social Democratic Parliamentary group MP K. Olin, Former Finnish MP M. Tiuri, Finnish Centre Party MP P. Vilkuna, Senior Assistant Professor I. Ruostetsaari and Finnish Parliament Committee of Future Researcher U. Gabrielsson at ATLAS experiment with P. Jenn, M. Nordberg and M. Kotamaki on 15 September 2006.

  5. Challenges to uptake of cancer education resources by rural Aboriginal Health Workers: the Cancer Healing Messages flipchart experience.

    Science.gov (United States)

    Bierbaum, Mia; Plueckhahn, Tania; Roth, Firona; McNamara, Carmel; Ramsey, Imogen; Corsini, Nadia

    2017-12-01

    The Australian Aboriginal and Torres Strait Islander (Aboriginal) population has a higher age-standardised cancer mortality rate and a significantly lower 5-year survival rate for all cancers than the non-Aboriginal population. Aboriginal people from regional and remote South Australia and the Northern Territory, are often required to travel to Adelaide to access specialist cancer care services. The burden and expenses associated with transport and accommodation and cultural and linguistic factors have been identified as barriers to accessing medical treatment and health services. In collaboration with community and stakeholders, Cancer Council South Australia led the development of the Cancer Healing Messages flipchart and patient flyer to assist health professionals in explaining cancer and the cancer journey to Aboriginal cancer patients and their families. This study examined the usage, acceptability and perceived usefulness of the resources, barriers to uptake, and strategies to improve their utilisation and sustainability. An evaluation survey was conducted among Aboriginal Health Workers (AHWs) and other health professionals working with Aboriginal clients in South Australia (n=18). Participants indicated whether they agreed that the resources are valuable, culturally appropriate, helpful for explaining aspects of cancer to Aboriginal cancer patients, and useful with regard patient outcomes, how frequently they used or would use the resources for information, and how they use the flipchart in practice. Participants were also asked to report any usage barriers. The resources were considered useful, valuable and culturally appropriate by almost all participants; however, there was a discrepancy between intentions to use the resources and actual uptake, which was low. The most commonly reported barriers related to appropriateness for certain patients and lack of availability of resources in some contexts. The Cancer Healing Messages flipchart and patient flyer

  6. Visits to Tier-1 Computing Centres

    CERN Multimedia

    Dario Barberis

    At the beginning of 2007 it became clear that an enhanced level of communication is needed between the ATLAS computing organisation and the Tier-1 centres. Most usual meetings are ATLAS-centric and cannot address the issues of each Tier-1; therefore we decided to organise a series of visits to the Tier-1 centres and focus on site issues. For us, ATLAS computing management, it is most useful to realize how each Tier-1 centre is organised, and its relation to the associated Tier-2s; indeed their presence at these visits is also very useful. We hope it is also useful for sites... at least, we are told so! The usual participation includes, from the ATLAS side: computing management, operations, data placement, resources, accounting and database deployment coordinators; and from the Tier-1 side: computer centre management, system managers, Grid infrastructure people, network, storage and database experts, local ATLAS liaison people and representatives of the associated Tier-2s. Visiting Tier-1 centres (1-4). ...

  7. Incident and Emergency Centre of the IAEA.

    Science.gov (United States)

    Baciu, Florian; Buglova, Elena; Martincic, Rafael; Spiegelberg Planer, Rejane; Stern, Warren; Winkler, Guenther

    2010-06-01

    The Incident and Emergency Centre of the International Atomic Emergency Agency is the global focal point for preparedness, event reporting, and response to nuclear and radiological incidents and emergencies irrespective of their cause. The Centre continuously works to develop standards and guidance for strengthening Member States' preparedness; develops practical tools and training programs to assist Member States in promptly applying the standards and guidance; and organizes a variety of training events and exercises. The Centre evaluates national plans and assists in their development; facilitates effective communication between countries; develops response procedures; and supports national exercises. The Centre provides access to multiple information resources; assesses trends that may influence crisis and consequence management plans and response; and develops and continuously enhances methodology for identifying conditions needed for early warning and response. The Centre provides around-the-clock assistance to Member States in dealing with nuclear and radiological events, including security related events through timely and efficient services and the provision of a coordinated international response to such emergencies.

  8. Academic Drug Discovery Centres

    DEFF Research Database (Denmark)

    Kirkegaard, Henriette Schultz; Valentin, Finn

    2014-01-01

    Academic drug discovery centres (ADDCs) are seen as one of the solutions to fill the innovation gap in early drug discovery, which has proven challenging for previous organisational models. Prior studies of ADDCs have identified the need to analyse them from the angle of their economic and organi......Academic drug discovery centres (ADDCs) are seen as one of the solutions to fill the innovation gap in early drug discovery, which has proven challenging for previous organisational models. Prior studies of ADDCs have identified the need to analyse them from the angle of their economic...

  9. Implementation of a competency-based residency curriculum : experiences from a resource-limited environment in the Caribbean

    NARCIS (Netherlands)

    Busari, Jamiu O.; Verhagen, Eduard A. A.; Muskiet, Fred D.; Duits, Ashley J.

    2008-01-01

    Background: The introduction of competency-based curricula in institutions situated in resource-limited environments is likely to pose new challenges for the implementation process. The St. Elisabeth Hospital (SEHOS) in Curacao, Dutch Caribbean, is affiliated to university teaching hospitals in the

  10. Economic and Political Exploitation of Marine Resources. A Learning Experience for Coastal and Oceanic Awareness Studies, No. 235. [Project COAST].

    Science.gov (United States)

    Delaware Univ., Newark. Coll. of Education.

    This unit was designed for use by secondary school students in social studies classes. Materials are provided for four class periods. Emphasized is exploitation of mineral, food, and animal resources found in the sea. Included are suggestions to the teacher, student activities, assessment materials, and a selective bibliography. (RH)

  11. Utilizing Immersive Visualization Systems: How to Dynamically Revolutionize Site-based Professional Development Experiences within Human Resources Management?

    Science.gov (United States)

    Craft, Kirby A.

    2009-01-01

    How can we train today's workforce with innovative technologies when families are surrounded by state-of-the-art video games and high-definition televisions? Human resource managers and administrators are faced with difficult challenges to prepare beneficial and relevant professional development exercises that engage the minds of their employees.…

  12. Productive diversification in natural resource abundant countries : limitations, policies and the experience of Argentina in the 2000s

    NARCIS (Netherlands)

    L.A. Serino (Leandro)

    2009-01-01

    textabstractThe debate on the pattern of specialization in natural resource abundant countries has re-emerged as demand for raw materials and food products from the rapidly growing East Asian countries, speculation in financial markets, and changes in production techniques augmented the

  13. Opening a Can of wERMS: Texas A&M University's Experiences in Implementing Two Electronic Resource Management Systems

    Science.gov (United States)

    Hartnett, Eric; Price, Apryl; Smith, Jane; Barrett, Michael

    2010-01-01

    Over the past few years, Texas A&M University (TAMU) has searched for a way to administer its electronic subscriptions as well as the electronic subscriptions shared among the TAMU System. In this article, we address our attempts to implement an effective electronic resource management system (ERMS), both for subscriptions on the main campus…

  14. Sensitivity of the ATLAS experiment in pp-collisions at a centre of mass energy of 14 TeV at the LHC to a Higgs boson with large decay-width to invisible final states

    CERN Document Server

    Ludwig, Andreas; Brock, I

    2011-01-01

    So far experimentally not ruled out, the stealthy Higgs scenario proposes a hidden scalar sector, to which only the Higgs has non-vanishing and possibly large couplings. Due to decays into the scalars the Higgs acquires a possibly large extra invisible width and thus can be hidden at colliders. We present a sensitivity study of the ATLAS experiment at the LHC for invisible decays of a Higgs boson produced in weak boson fusion, with the non-standard coupling being a free parameter. Signal hypotheses are generated for Higgs masses between 130 GeV and 800 GeV and for coupling strengths to the hidden scalars from 0.1 to the very large value of 25. The study using a detailed detector simulation assumes 30 inverse femtobarn of data collected at a centre of mass energy of 14 TeV. An artificial neural network is designed, aiming to exploit adaptively shape differences in the input variables distributions and their correlations in order to allow for discrimination between the signal hypotheses and background. The unc...

  15. Fisheries Research Centre: Report for 1992

    OpenAIRE

    Marine, Department of the

    1993-01-01

    This report of the Fishery Research Centre's 1992 programme reflects not only the wide range of the work carried out, but also the extensive multidisciplinary expertise available at the FRC which we deploy in support of resource-based industries and other marine-oriented commercial enterprises. The report also provides information on the important scientific activities which the FRC has been able to initiate or expand by means of the valuable funding received under the EC STRIDE initiative...

  16. CMS centres worldwide: A new collaborative infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Lucas; /Northeastern U.; Gottschalk, Erik; /Fermilab

    2010-01-01

    The CMS Experiment at the LHC is establishing a global network of inter-connected 'CMS Centres' for controls, operations and monitoring. These support: (1) CMS data quality monitoring, detector calibrations, and analysis; and (2) computing operations for the processing, storage and distribution of CMS data. We describe the infrastructure, computing, software, and communications systems required to create an effective and affordable CMS Centre. We present our highly successful operations experiences with the major CMS Centres at CERN, Fermilab, and DESY during the LHC first beam data-taking and cosmic ray commissioning work. The status of the various centres already operating or under construction in Asia, Europe, Russia, South America, and the USA is also described. We emphasise the collaborative communications aspects. For example, virtual co-location of experts in CMS Centres Worldwide is achieved using high-quality permanently-running 'telepresence' video links. Generic Web-based tools have been developed and deployed for monitoring, control, display management and outreach.

  17. Enhancing person-centred communication in NICU

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

    2015-01-01

    Aims of this article were (a) to explore how parents of premature infants experience guided family-centred care (GFCC), and (b) to compare how parents receiving GFCC versus standard care (SC) describe nurse-parent communication in the neonatal intensive care unit....

  18. Sarwat Salem | IDRC - International Development Research Centre

    International Development Research Centre (IDRC) Digital Library (Canada)

    Two years later he moved to the Centre's Regional Office of East and Central Africa, where he served for 10 years before returning to the Cairo office. Sarwat has extensive finance, administrative, and management experience. He is a member of the Order of Chartered Professional Accountants of Quebec and he holds a ...

  19. CENTRE FOR CONTEMPORARY STUDIES

    Indian Academy of Sciences (India)

    ROOPA

    Venue: Seminar Hall, Centre for Contemporary Studies,. Indian Institute of Science, Bangalore 560 012. All are cordially invited. Tea/Coffee will be served at 10:30 a.m.. Jean Taylor is Professor of Mathematics Emerita of the Rutgers University and currently a visitor at the Courant Institute for Mathematical Sciences, NYU.

  20. Print Centre Event 2

    OpenAIRE

    Hadbavny, Michelle

    2012-01-01

    During Institutions by Artists, Fillip was pleased to present a series of free, parallel events in the lobby of SFU Woodward’s that investigated the material culture produced by the institutional practices of artists. The Print Centre featured talks, launches, and screenings by conference presenters and attendees. Presented in collaboration with a temporary book store hosted by Motto Books (Berlin).