WorldWideScience

Sample records for solution limit setting

  1. HEDIS Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of Americas health plans to measure performance on important...

  2. Guidelines for setting speed limits

    CSIR Research Space (South Africa)

    Wium, DJW

    1986-02-01

    Full Text Available , parking and loading manoeuvres, access to bounding properties, intersections, width of road without central median and clear roadside area. The method should result in greater uniformity in speed limits for similar circumstances as set by different...

  3. Setting limits on supersymmetry using simplified models

    CERN Document Server

    Gutschow, C.

    2012-01-01

    Experimental limits on supersymmetry and similar theories are difficult to set because of the enormous available parameter space and difficult to generalize because of the complexity of single points. Therefore, more phenomenological, simplified models are becoming popular for setting experimental limits, as they have clearer physical implications. The use of these simplified model limits to set a real limit on a concrete theory has not, however, been demonstrated. This paper recasts simplified model limits into limits on a specific and complete supersymmetry model, minimal supergravity. Limits obtained under various physical assumptions are comparable to those produced by directed searches. A prescription is provided for calculating conservative and aggressive limits on additional theories. Using acceptance and efficiency tables along with the expected and observed numbers of events in various signal regions, LHC experimental results can be re-cast in this manner into almost any theoretical framework, includ...

  4. Health Outcomes Survey - Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Health Outcomes Survey (HOS) limited data sets (LDS) are comprised of the entire national sample for a given 2-year cohort (including both respondents...

  5. Advantages and limitations of the SETS method

    International Nuclear Information System (INIS)

    Mahaffy, J.H.

    1983-01-01

    The stability-enchancing two-step (SETS) method has been used successfully in the Transient Reactor Analysis Code (TRAC) for several years. The method consists of a basic semi-implicit step combined with a stabilizer step that, taken together, eliminate the material Courant stability limit associated with standard semi-implicit numerical methods. This approach toward stability requires significantly fewer computational operations than a fully implicit method, but currently maintains the first-order accuracy in space and time of its semi-implicit predecessors

  6. Limited parameter set IMRT for carcinoma breast

    International Nuclear Information System (INIS)

    Gopinath, M.; Sharma, Sanjiv; Vivek, T.R.; Suparna; Deka, Preeti; Manikandan; Giriraj

    2008-01-01

    Post operative radiotherapy after breast conservation surgery is an effective and widely accepted treatment modality in early stage breast cancer. The treatment is usually performed using two wedged tangential photon beams. The disadvantage of this technique is significant dose inhomogeneity as large as 15-20% in the superior and inferior regions of the breast due to lesser transmission thickness and in the medial and lateral aspect of the breast due to lower attenuation of lung tissue in the field. The aim of the study is to modify the conventional wedged tangential pair to achieve a more homogeneous dose distribution and a reduction in acute toxicity and improved cosmetic result. A comparative study is done between the conventional wedged technique and limited parameter set IMRT

  7. Establishing Medical Schools in Limited Resource Settings.

    Science.gov (United States)

    Tsinuel, Girma; Tsedeke, Asaminew; Matthias, Siebeck; Fischer, Martin R; Jacobs, Fabian; Sebsibe, Desalegn; Yoseph, Mamo; Abraham, Haileamlak

    2016-05-01

    One urgent goal of countries in sub-Saharan Africa is to dynamically scale up the education and work force of medical doctors in the training institutions and health facilities, respectively. These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical education done in the context of limited resources is thus compromising the quality of graduates. In the future, a collaborative and need-based approach involving major stakeholders such as medical educators concerned, ministries, planners and policy makers is needed. This article identifies the challenges of establishing medical schools and sustaining the quality of education through rapid scale-up in Sub-Saharan Africa in the settings of limited resources. It also outlines the minimum requirements for establishing medical schools. A consensus building workshop was conducted in Bishoftu, Ethiopia, from Nov 8-12, 2013. Participants were professionals from 13 Ethiopian medical schools, and representatives of medical schools from South Sudan, Somaliland, Somalia, and Mozambique. Participants are listed in Appendix 1. The governments and stakeholders should jointly develop strategic plans and a roadmaps for opening or expanding medical schools to scale up educational resources. It is advisable that medical schools have autonomy regarding the number of student-intake, student selection, curriculum ownership, resource allocation including for infrastructure and staff development. Health science and medical curricula should be integrated within and harmonized nationally. An educational evaluation framework needs to be embedded in the curricula, and all medical schools should have Health Science Education Development Centers.

  8. Shallow water equations: viscous solutions and inviscid limit

    Science.gov (United States)

    Chen, Gui-Qiang; Perepelitsa, Mikhail

    2012-12-01

    We establish the inviscid limit of the viscous shallow water equations to the Saint-Venant system. For the viscous equations, the viscosity terms are more degenerate when the shallow water is close to the bottom, in comparison with the classical Navier-Stokes equations for barotropic gases; thus, the analysis in our earlier work for the classical Navier-Stokes equations does not apply directly, which require new estimates to deal with the additional degeneracy. We first introduce a notion of entropy solutions to the viscous shallow water equations and develop an approach to establish the global existence of such solutions and their uniform energy-type estimates with respect to the viscosity coefficient. These uniform estimates yield the existence of measure-valued solutions to the Saint-Venant system generated by the viscous solutions. Based on the uniform energy-type estimates and the features of the Saint-Venant system, we further establish that the entropy dissipation measures of the viscous solutions for weak entropy-entropy flux pairs, generated by compactly supported C 2 test-functions, are confined in a compact set in H -1, which yields that the measure-valued solutions are confined by the Tartar-Murat commutator relation. Then, the reduction theorem established in Chen and Perepelitsa [5] for the measure-valued solutions with unbounded support leads to the convergence of the viscous solutions to a finite-energy entropy solution of the Saint-Venant system with finite-energy initial data, which is relative with respect to the different end-states of the bottom topography of the shallow water at infinity. The analysis also applies to the inviscid limit problem for the Saint-Venant system in the presence of friction.

  9. Providing anesthesia in resource-limited settings.

    Science.gov (United States)

    Dohlman, Lena E

    2017-08-01

    The article reviews the reality of anesthetic resource constraints in low and middle-income countries (LMICs). Understanding these limitations is important to volunteers from high-income countries who desire to teach or safely provide anesthesia services in these countries. Recently published information on the state of anesthetic resources in LMICs is helping to guide humanitarian outreach efforts from high-income countries. The importance of using context-appropriate anesthesia standards and equipment is now emphasized. Global health experts are encouraging equal partnerships between anesthesia health care providers working together from different countries. The key roles that ketamine and regional anesthesia play in providing well tolerated anesthesia for cesarean sections and other common procedures is increasingly recognized. Anesthesia can be safely given in LMICs with basic supplies and equipment, if the anesthesia provider is trained and vigilant. Neuraxial and regional anesthesia and the use of ketamine as a general anesthetic appear to be the safest alternatives in low-resource countries. Environmentally appropriate equipment should be encouraged and pulse oximeters should be in every anesthetizing location. LMICs will continue to need support from outside sources until capacity building has made more progress.

  10. Optimisation-Based Solution Methods for Set Partitioning Models

    DEFF Research Database (Denmark)

    Rasmussen, Matias Sevel

    The scheduling of crew, i.e. the construction of work schedules for crew members, is often not a trivial task, but a complex puzzle. The task is complicated by rules, restrictions, and preferences. Therefore, manual solutions as well as solutions from standard software packages are not always su......_cient with respect to solution quality and solution time. Enhancement of the overall solution quality as well as the solution time can be of vital importance to many organisations. The _elds of operations research and mathematical optimisation deal with mathematical modelling of di_cult scheduling problems (among...... other topics). The _elds also deal with the development of sophisticated solution methods for these mathematical models. This thesis describes the set partitioning model which has been widely used for modelling crew scheduling problems. Integer properties for the set partitioning model are shown...

  11. Future Hard Disk Storage: Limits & Potential Solutions

    Science.gov (United States)

    Lambeth, David N.

    2000-03-01

    For several years the hard disk drive technology pace has raced along at 60-100products this year and laboratory demonstrations approaching what has been estimated as a physical thermal stability limit of around 40 Gbit/in2. For sometime now the data storage industry has recogniz d that doing business as usually will not be viable for long and so both incremental evolutionary and revolutionary technologies are being explored. While new recording head materials or thermal recording techniques may allow higher coercivity materials to be recorded upon, and while high sensitivity spin transport transducer technology may provide sufficient signals to extend beyond the 100 Gigabit/in2 regime, conventional isotropic longitudinal media will show large data retention problems at less than 1/2 of this value. We have recently developed a simple model which indicates that while thermal instability issues may appear at different areal densities, they are non-discriminatory as to the magnetic recording modality: longitudinal, perpendicular, magnetooptic, near field, etc. The model indicates that a strong orientation of the media tends to abate the onset of the thermal limit. Hence, for the past few years we have taken an approach of controlled growth of the microstructure of thin film media. This knowledge has lead us to believe that epitaxial growth of multiple thin film layers on single crystalline Si may provide a pathway to nearly perfect crystallites of various, highly oriented, thin film textures. Here we provide an overview of the recording system media challenges, which are useful for the development of a future media design philosophy and then discuss materials issues and processing techniques for multi-layered thin film material structures which may be used to achieve media structures which can easy exceed the limits predicted for isotropic media.

  12. Exploring nurses' and patients' perspectives of limit setting in a forensic mental health setting.

    Science.gov (United States)

    Maguire, Tessa; Daffern, Michael; Martin, Trish

    2014-04-01

    Limit setting is an intervention that is frequently used by mental health nurses. However, limit setting is poorly conceptualized, its purpose is unclear, and there are few evidence-based guidelines to assist nurses to set limits in a safe and effective manner. What is known is that the manner in which nurses set limits influences patients' perceptions of the interactions and their emotional and behavioural responses. In this qualitative study, 12 nurses and 12 patients participated in personal, semistructured interviews that aimed to explore limit setting and to propose principles to guide practice. The findings suggested that: (i) limit setting is important to safety in mental health hospitals; (ii) engaging patients in an empathic manner is necessary when setting limits (when nurses engage in an empathic manner, the therapeutic relationship is more likely to be preserved and the risk of aggressive responses is reduced); and (iii) an authoritative (fair, respectful, consistent, and knowledgeable), rather than authoritarian (controlling and indifferent), limit-setting style enhances positive outcomes with regards to adherence, reduced likelihood of aggression, and preservation of the therapeutic relationship. In conclusion, a limit-setting style characterized by empathic responding and an authoritative, rather than authoritarian interpersonal, style is recommended. Elucidating the components of this style is critical for effective training and best practice of mental health nurses, and to reduce aggressive responses from limit setting. © 2013 Australian College of Mental Health Nurses Inc.

  13. A potential approach to solutions for set games

    NARCIS (Netherlands)

    Driessen, T.S.H.; Sun, H.

    2001-01-01

    Concerning the solution theory for set games, the paper introduces a new solution by allocating, to any player, the items (taken from an universe) that are attainable for the player, but can not be blocked (by any coalition not containing the player). The resulting value turns out to be an utmost

  14. Narrated animated solution videos in a mastery setting

    Directory of Open Access Journals (Sweden)

    Noah Schroeder

    2015-02-01

    Full Text Available Narrated animated solution videos were implemented in a clinical study that compared a mastery setting that employed repeated cycles of testing with instructional support to a group that had a single opportunity to experience the materials. The mastery setting students attempted sequential questions sets on a topic, with animated solutions between each set, until mastery was achieved, combining formative assessment with worked examples. Students showed significant improvement from their first to second tries on similar sets of problems, attributable to the feedback and solutions they were given after the first try. These improvements were shown in two topics, superposition and electric potential. The single try group was given one version of the questions and solutions, and while they were not required to watch the solutions to move forward, they chose to. On a post-test including near and far transfer questions, no significant difference was seen between the mastery group and the single try group, but both significantly outperformed a control group that received no instructional support, indicating that students successfully transferred the skills from the solutions to the post-test.

  15. A criterion on compactness of the set of bounded solutions

    International Nuclear Information System (INIS)

    Tusen Huang; Qi Zhang

    2004-01-01

    A necessary and sufficient condition that the set of bounded solutions for the ordinary differential equations ((dx)/(dt))=f(x) defined on R n is compact is given. This result generalizes the corresponding result in [(Conf. Board Math. Sci., No 38) Am. Math. Sci., Providence, 1978, p. 30

  16. Therapeutic drug monitoring of nevirapine in resource-limited settings.

    NARCIS (Netherlands)

    L'homme, R.F.A.; Muro, E.P.; Droste, J.A.H.; Wolters, L.R.; Ewijk-Beneken Kolmer, E.W.J. van; Schimana, W.; Burger, D.M.

    2008-01-01

    BACKGROUND: We developed a simple and inexpensive thin-layer chromatography (TLC) assay for semiquantitative detection of saliva concentrations of nevirapine in resource-limited settings. The method was validated in an African target population. METHODS: Paired plasma and saliva nevirapine

  17. Establishing Medical Schools in Limited Resource Settings | Girma ...

    African Journals Online (AJOL)

    Establishing Medical Schools in Limited Resource Settings. ... These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical ...

  18. Tuberculosis diagnosis in resource-limited settings: Clinical use of ...

    African Journals Online (AJOL)

    EB

    GeneXpert in the diagnosis of smear-negative PTB: a case report ... Background: The Xpert MTB/RIF test (GeneXpert) has recently been endorsed for use in resource-limited settings for the ... normochromic anemia (9.2g/dl), hypoalbuminemia.

  19. Limited Effects of Set Shifting Training in Healthy Older Adults

    Directory of Open Access Journals (Sweden)

    Petra Grönholm-Nyman

    2017-03-01

    Full Text Available Our ability to flexibly shift between tasks or task sets declines in older age. As this decline may have adverse effects on everyday life of elderly people, it is of interest to study whether set shifting ability can be trained, and if training effects generalize to other cognitive tasks. Here, we report a randomized controlled trial where healthy older adults trained set shifting with three different set shifting tasks. The training group (n = 17 performed adaptive set shifting training for 5 weeks with three training sessions a week (45 min/session, while the active control group (n = 16 played three different computer games for the same period. Both groups underwent extensive pre- and post-testing and a 1-year follow-up. Compared to the controls, the training group showed significant improvements on the trained tasks. Evidence for near transfer in the training group was very limited, as it was seen only on overall accuracy on an untrained computerized set shifting task. No far transfer to other cognitive functions was observed. One year later, the training group was still better on the trained tasks but the single near transfer effect had vanished. The results suggest that computerized set shifting training in the elderly shows long-lasting effects on the trained tasks but very little benefit in terms of generalization.

  20. Cloud computing challenges, limitations and R&D solutions

    CERN Document Server

    Mahmood, Zaigham

    2014-01-01

    This important text/reference reviews the challenging issues that present barriers to greater implementation of the cloud computing paradigm, together with the latest research into developing potential solutions. Exploring the strengths and vulnerabilities of cloud provision and cloud environments, Cloud Computing: Challenges, Limitations and R&D Solutions provides case studies from a diverse selection of researchers and practitioners of international repute. The implications of emerging cloud technologies are also analyzed from the perspective of consumers. Topics and features: presents

  1. Topological structure of the solution set for evolution inclusions

    CERN Document Server

    Zhou, Yong; Peng, Li

    2017-01-01

    This book systematically presents the topological structure of solution sets and attractability for nonlinear evolution inclusions, together with its relevant applications in control problems and partial differential equations. It provides readers the background material needed to delve deeper into the subject and explore the rich research literature.  In addition, the book addresses many of the basic techniques and results recently developed in connection with this theory, including the structure of solution sets for evolution inclusions with m-dissipative operators; quasi-autonomous and non-autonomous evolution inclusions and control systems;evolution inclusions with the Hille-Yosida operator; functional evolution inclusions; impulsive evolution inclusions; and stochastic evolution inclusions. Several applications of evolution inclusions and control systems are also discussed in detail.  Based on extensive research work conducted by the authors and other experts over the past four years, the information p...

  2. Analytical solution for a coaxial plasma gun: Weak coupling limit

    International Nuclear Information System (INIS)

    Dietz, D.

    1987-01-01

    The analytical solution of the system of coupled ODE's which describes the time evolution of an ideal (i.e., zero resistance) coaxial plasma gun operating in the snowplow mode is obtained in the weak coupling limit, i.e, when the gun is fully influenced by the driving (RLC) circuit in which it resides but the circuit is negligibly influenced by the gun. Criteria for the validity of this limit are derived and numerical examples are presented. Although others have obtained approximate, asymptotic and numerical solutions of the equations, the present analytical results seem not to have appeared previously in the literature

  3. Crossing the quality chasm in resource-limited settings.

    Science.gov (United States)

    Maru, Duncan Smith-Rohrberg; Andrews, Jason; Schwarz, Dan; Schwarz, Ryan; Acharya, Bibhav; Ramaiya, Astha; Karelas, Gregory; Rajbhandari, Ruma; Mate, Kedar; Shilpakar, Sona

    2012-11-30

    Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm"--the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

  4. Sulfonylurea herbicides – methodological challenges in setting aquatic limit values

    DEFF Research Database (Denmark)

    Rosenkrantz, Rikke Tjørnhøj; Baun, Anders; Kusk, Kresten Ole

    according to the EU Water Framework Directive, the resulting Water Quality Standards (WQSs) are below the analytical quantification limit, making it difficult to verify compliance with the limit values. However, several methodological concerns may be raised in relation to the very low effect concentrations...... and rimsulfuron. The following parameters were varied during testing: pH, exposure duration, temperature and light/dark cycle. Preliminary results show that a decrease in pH causes an increase in toxicity for all compounds. Exposure to a high concentration for 24 hours caused a reduction in growth rate, from...... for setting limit values for SUs or if more detailed information should be gained by taking methodological considerations into account....

  5. Continuous selections of set of mild solutions of evolution inclusions

    Directory of Open Access Journals (Sweden)

    Annamalai Anguraj

    2005-02-01

    Full Text Available We prove the existence of continuous selections of the set valued map $xio mathcal{S}(xi$ where $mathcal{S}(xi$ is the set of all mild solutions of the evolution inclusions of the form $$displaylines{ dot{x}(t in A(tx(t+int_0^tK(t,sF(s,x(sds cr x(0=xi ,quad tin I=[0,T], }$$ where $F$ is a lower semi continuous set valued map Lipchitzean with respect to $x$ in a separable Banach space $X$, $A$ is the infinitesimal generator of a $C_0$-semi group of bounded linear operators from $X$ to $X$, and $K(t,s$ is a continuous real valued function defined on $Iimes I$ with $tgeq s$ for all $t,sin I$ and $xi in X$.

  6. Estimating the CCSD basis-set limit energy from small basis sets: basis-set extrapolations vs additivity schemes

    Energy Technology Data Exchange (ETDEWEB)

    Spackman, Peter R.; Karton, Amir, E-mail: amir.karton@uwa.edu.au [School of Chemistry and Biochemistry, The University of Western Australia, Perth, WA 6009 (Australia)

    2015-05-15

    Coupled cluster calculations with all single and double excitations (CCSD) converge exceedingly slowly with the size of the one-particle basis set. We assess the performance of a number of approaches for obtaining CCSD correlation energies close to the complete basis-set limit in conjunction with relatively small DZ and TZ basis sets. These include global and system-dependent extrapolations based on the A + B/L{sup α} two-point extrapolation formula, and the well-known additivity approach that uses an MP2-based basis-set-correction term. We show that the basis set convergence rate can change dramatically between different systems(e.g.it is slower for molecules with polar bonds and/or second-row elements). The system-dependent basis-set extrapolation scheme, in which unique basis-set extrapolation exponents for each system are obtained from lower-cost MP2 calculations, significantly accelerates the basis-set convergence relative to the global extrapolations. Nevertheless, we find that the simple MP2-based basis-set additivity scheme outperforms the extrapolation approaches. For example, the following root-mean-squared deviations are obtained for the 140 basis-set limit CCSD atomization energies in the W4-11 database: 9.1 (global extrapolation), 3.7 (system-dependent extrapolation), and 2.4 (additivity scheme) kJ mol{sup –1}. The CCSD energy in these approximations is obtained from basis sets of up to TZ quality and the latter two approaches require additional MP2 calculations with basis sets of up to QZ quality. We also assess the performance of the basis-set extrapolations and additivity schemes for a set of 20 basis-set limit CCSD atomization energies of larger molecules including amino acids, DNA/RNA bases, aromatic compounds, and platonic hydrocarbon cages. We obtain the following RMSDs for the above methods: 10.2 (global extrapolation), 5.7 (system-dependent extrapolation), and 2.9 (additivity scheme) kJ mol{sup –1}.

  7. Estimating the CCSD basis-set limit energy from small basis sets: basis-set extrapolations vs additivity schemes

    International Nuclear Information System (INIS)

    Spackman, Peter R.; Karton, Amir

    2015-01-01

    Coupled cluster calculations with all single and double excitations (CCSD) converge exceedingly slowly with the size of the one-particle basis set. We assess the performance of a number of approaches for obtaining CCSD correlation energies close to the complete basis-set limit in conjunction with relatively small DZ and TZ basis sets. These include global and system-dependent extrapolations based on the A + B/L α two-point extrapolation formula, and the well-known additivity approach that uses an MP2-based basis-set-correction term. We show that the basis set convergence rate can change dramatically between different systems(e.g.it is slower for molecules with polar bonds and/or second-row elements). The system-dependent basis-set extrapolation scheme, in which unique basis-set extrapolation exponents for each system are obtained from lower-cost MP2 calculations, significantly accelerates the basis-set convergence relative to the global extrapolations. Nevertheless, we find that the simple MP2-based basis-set additivity scheme outperforms the extrapolation approaches. For example, the following root-mean-squared deviations are obtained for the 140 basis-set limit CCSD atomization energies in the W4-11 database: 9.1 (global extrapolation), 3.7 (system-dependent extrapolation), and 2.4 (additivity scheme) kJ mol –1 . The CCSD energy in these approximations is obtained from basis sets of up to TZ quality and the latter two approaches require additional MP2 calculations with basis sets of up to QZ quality. We also assess the performance of the basis-set extrapolations and additivity schemes for a set of 20 basis-set limit CCSD atomization energies of larger molecules including amino acids, DNA/RNA bases, aromatic compounds, and platonic hydrocarbon cages. We obtain the following RMSDs for the above methods: 10.2 (global extrapolation), 5.7 (system-dependent extrapolation), and 2.9 (additivity scheme) kJ mol –1

  8. Optimising Mycobacterium tuberculosis detection in resource limited settings.

    Science.gov (United States)

    Alfred, Nwofor; Lovette, Lawson; Aliyu, Gambo; Olusegun, Obasanya; Meshak, Panwal; Jilang, Tunkat; Iwakun, Mosunmola; Nnamdi, Emenyonu; Olubunmi, Onuoha; Dakum, Patrick; Abimiku, Alash'le

    2014-03-03

    The light-emitting diode (LED) fluorescence microscopy has made acid-fast bacilli (AFB) detection faster and efficient although its optimal performance in resource-limited settings is still being studied. We assessed the optimal performances of light and fluorescence microscopy in routine conditions of a resource-limited setting and evaluated the digestion time for sputum samples for maximum yield of positive cultures. Cross-sectional study. Facility-based involving samples of routine patients receiving tuberculosis treatment and care from the main tuberculosis case referral centre in northern Nigeria. The study included 450 sputum samples from 150 new patients with clinical diagnosis of pulmonary tuberculosis. The 450 samples were pooled into 150 specimens, examined independently with mercury vapour lamp (FM), LED CysCope (CY) and Primo Star iLED (PiLED) fluorescence microscopies, and with the Ziehl-Neelsen (ZN) microscopy to assess the performance of each technique compared with liquid culture. The cultured specimens were decontaminated with BD Mycoprep (4% NaOH-1% NLAC and 2.9% sodium citrate) for 10, 15 and 20 min before incubation in Mycobacterium growth incubator tube (MGIT) system and growth examined for acid-fast bacilli (AFB). Of the 150 specimens examined by direct microscopy: 44 (29%), 60 (40%), 49 (33%) and 64 (43%) were AFB positive by ZN, FM, CY and iLED microscopy, respectively. Digestion of sputum samples for 10, 15 and 20 min yielded mycobacterial growth in 72 (48%), 81 (54%) and 68 (45%) of the digested samples, respectively, after incubation in the MGIT system. In routine laboratory conditions of a resource-limited setting, our study has demonstrated the superiority of fluorescence microscopy over the conventional ZN technique. Digestion of sputum samples for 15 min yielded more positive cultures.

  9. Electromagnetic field limits set by the V-Curve.

    Energy Technology Data Exchange (ETDEWEB)

    Warne, Larry Kevin [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jorgenson, Roy Eberhardt [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hudson, Howard Gerald [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2014-07-01

    When emitters of electromagnetic energy are operated in the vicinity of sensitive components, the electric field at the component location must be kept below a certain level in order to prevent the component from being damaged, or in the case of electro-explosive devices, initiating. The V-Curve is a convenient way to set the electric field limit because it requires minimal information about the problem configuration. In this report we will discuss the basis for the V-Curve. We also consider deviations from the original V-Curve resulting from inductive versus capacitive antennas, increases in directivity gain for long antennas, decreases in input impedance when operating in a bounded region, and mismatches dictated by transmission line losses. In addition, we consider mitigating effects resulting from limited antenna sizes.

  10. Strengthening laboratory systems in resource-limited settings.

    Science.gov (United States)

    Olmsted, Stuart S; Moore, Melinda; Meili, Robin C; Duber, Herbert C; Wasserman, Jeffrey; Sama, Preethi; Mundell, Ben; Hilborne, Lee H

    2010-09-01

    Considerable resources have been invested in recent years to improve laboratory systems in resource-limited settings. We reviewed published reports, interviewed major donor organizations, and conducted case studies of laboratory systems in 3 countries to assess how countries and donors have worked together to improve laboratory services. While infrastructure and the provision of services have seen improvement, important opportunities remain for further advancement. Implementation of national laboratory plans is inconsistent, human resources are limited, and quality laboratory services rarely extend to lower tier laboratories (eg, health clinics, district hospitals). Coordination within, between, and among governments and donor organizations is also frequently problematic. Laboratory standardization and quality control are improving but remain challenging, making accreditation a difficult goal. Host country governments and their external funding partners should coordinate their efforts effectively around a host country's own national laboratory plan to advance sustainable capacity development throughout a country's laboratory system.

  11. Set-valued solutions for non-ideal detonation

    KAUST Repository

    Semenko, Roman; Faria, Luiz; Kasimov, Aslan R.; Ermolaev, B. S.

    2015-01-01

    The existence and structure of a steady-state gaseous detonation propagating in a packed bed of solid inert particles are analyzed in the one-dimensional approximation by taking into consideration frictional and heat losses between the gas and the particles. A new formulation of the governing equations is introduced that eliminates the difficulties with numerical integration across the sonic singularity in the reactive Euler equations. With the new algorithm, we find that when the sonic point disappears from the flow, there exists a one-parameter family of solutions parameterized by either pressure or temperature at the end of the reaction zone. These solutions (termed “set-valued” here) correspond to a continuous spectrum of the eigenvalue problem that determines the detonation velocity as a function of a loss factor.

  12. Set-valued solutions for non-ideal detonation

    KAUST Repository

    Semenko, Roman

    2015-12-11

    The existence and structure of a steady-state gaseous detonation propagating in a packed bed of solid inert particles are analyzed in the one-dimensional approximation by taking into consideration frictional and heat losses between the gas and the particles. A new formulation of the governing equations is introduced that eliminates the difficulties with numerical integration across the sonic singularity in the reactive Euler equations. With the new algorithm, we find that when the sonic point disappears from the flow, there exists a one-parameter family of solutions parameterized by either pressure or temperature at the end of the reaction zone. These solutions (termed “set-valued” here) correspond to a continuous spectrum of the eigenvalue problem that determines the detonation velocity as a function of a loss factor.

  13. A set of exact two soliton wave solutions to Einstein field equations

    International Nuclear Information System (INIS)

    Wang Youtang; He Zhixian

    1991-09-01

    A set of exact solutions of Einstein equations in vacuum is obtained. Taking this set of solutions as seed solutions and making use of the Belinsky-Zakharov generation technique a set of generated solutions is constructed. Both set of exact solutions and a set of generated solutions describe two solition waves, which propagate in opposite directions and collide with each other, and then recover their original shapes. The singularities of the two set of solutions are analyzed. The relationship between our solutions and other solutions is also discussed. (author). 11 refs, 4 figs

  14. Characterizing omega-limit sets which are closed orbits

    Science.gov (United States)

    Bautista, S.; Morales, C.

    Let X be a vector field in a compact n-manifold M, n⩾2. Given Σ⊂M we say that q∈M satisfies (P) Σ if the closure of the positive orbit of X through q does not intersect Σ, but, however, there is an open interval I with q as a boundary point such that every positive orbit through I intersects Σ. Among those q having saddle-type hyperbolic omega-limit set ω(q) the ones with ω(q) being a closed orbit satisfy (P) Σ for some closed subset Σ. The converse is true for n=2 but not for n⩾4. Here we prove the converse for n=3. Moreover, we prove for n=3 that if ω(q) is a singular-hyperbolic set [C. Morales, M. Pacifico, E. Pujals, On C robust singular transitive sets for three-dimensional flows, C. R. Acad. Sci. Paris Sér. I 26 (1998) 81-86], [C. Morales, M. Pacifico, E. Pujals, Robust transitive singular sets for 3-flows are partially hyperbolic attractors or repellers, Ann. of Math. (2) 160 (2) (2004) 375-432], then ω(q) is a closed orbit if and only if q satisfies (P) Σ for some Σ closed. This result improves [S. Bautista, Sobre conjuntos hiperbólicos-singulares (On singular-hyperbolic sets), thesis Uiversidade Federal do Rio de Janeiro, 2005 (in Portuguese)] and [C. Morales, M. Pacifico, Mixing attractors for 3-flows, Nonlinearity 14 (2001) 359-378].

  15. Three Tales about Limits to Smart Cities Solutions

    Directory of Open Access Journals (Sweden)

    Soora Rasouli

    2017-06-01

    Full Text Available This editorial is the introduction to a special issue on smart cities. The concept of a smart city is not well-defined, yet expectations among urban planners and decision-makers are high. This special issue contains three papers that discuss three different manifestations of smart cities and the success—or lack of it—of the solutions discussed. The papers highlight some limitations of the concept of smart cities, but at the same time also pinpoint some potentially beneficial solutions.

  16. Perspectives on setting limits for RF contact currents: a commentary.

    Science.gov (United States)

    Tell, Richard A; Tell, Christopher A

    2018-01-15

    Limits for exposure to radiofrequency (RF) contact currents are specified in the two dominant RF safety standards and guidelines developed by the Institute of Electrical and Electronics Engineers (IEEE) and the International Commission on Non-Ionizing Radiation Protection (ICNIRP). These limits are intended to prevent RF burns when contacting RF energized objects caused by high local tissue current densities. We explain what contact currents are and review some history of the relevant limits with an emphasis on so-called "touch" contacts, i.e., contact between a person and a contact current source during touch via a very small contact area. Contact current limits were originally set on the basis of controlling the specific absorption rate resulting from the current flowing through regions of small conductive cross section within the body, such as the wrist or ankle. More recently, contact currents have been based on thresholds of perceived heating. In the latest standard from the IEEE developed for NATO, contact currents have been based on two research studies in which thresholds for perception of thermal warmth or thermal pain have been measured. Importantly, these studies maximized conductive contact between the subject and the contact current source. This factor was found to dominate the response to heating wherein high resistance contact, such as from dry skin, can result in local heating many times that from a highly conductive contact. Other factors such as electrode size and shape, frequency of the current and the physical force associated with contact are found to introduce uncertainty in threshold values when comparing data across multiple studies. Relying on studies in which the contact current is minimized for a given threshold does not result in conservative protection limits. Future efforts to develop limits on contact currents should include consideration of (1) the basis for the limits (perception, pain, tissue damage); (2) understanding of the

  17. Defining the anesthesia gap for reproductive health procedures in resource-limited settings.

    Science.gov (United States)

    Anderson, R Eleanor; Ahn, Roy; Nelson, Brett D; Chavez, Jean; de Redon, Emily; Burke, Thomas

    2014-12-01

    In resource-limited settings, severe shortages of anesthetists and anesthesiologists lead to surgical delays that increase maternal and neonatal mortality and morbidity. To more clearly understand the individual components of the anesthesia gap pertaining to reproductive health surgeries and procedures in resource-limited settings. Medline, the Cochrane Library, CINAHL, Embase, and POPLINE were systematically searched for reports published before December 31, 2013. Search terms were related to obstetric surgery, resource-limited settings, and anesthesia. Studies that addressed the use of anesthesia in reproductive procedures in resource-limited settings were included. Reviewers independently evaluated the full text of identified studies, extracted information related to study objectives and conclusions, and identified the anesthesia gap. Overall, 14 publications met the inclusion criteria. A significant lack of infrastructure, equipment and supplies, and trained personnel were identified as key factors responsible for a lack of anesthesia services. A shortage of trained anesthesia providers, equipment, supplies, medications, and infrastructure, along with limitations in transportation in resource-limited settings have produced a wide gap between available anesthesia services and the demand for them for reproductive health surgeries and procedures. Safe, affordable, and scalable solutions to address the anesthesia gap are urgently needed. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Finite element limit analysis based plastic limit pressure solutions for cracked pipes

    International Nuclear Information System (INIS)

    Shim, Do Jun; Huh, Nam Su; Kim, Yun Jae; Kim, Young Jin

    2002-01-01

    Based on detailed FE limit analyses, the present paper provides tractable approximations for plastic limit pressure solutions for axial through-wall cracked pipe; axial (inner) surface cracked pipe; circumferential through-wall cracked pipe; and circumferential (inner) surface cracked pipe. Comparisons with existing analytical and empirical solutions show a large discrepancy in circumferential short through-wall cracks and in surface cracks (both axial and circumferential). Being based on detailed 3-D FE limit analysis, the present solutions are believed to be the most accurate, and thus to be valuable information not only for plastic collapse analysis of pressurised piping but also for estimating non-linear fracture mechanics parameters based on the reference stress approach

  19. Detection limits for nanoparticles in solution with classical turbidity spectra

    Science.gov (United States)

    Le Blevennec, G.

    2013-09-01

    Detection of nanoparticles in solution is required to manage safety and environmental problems. Spectral transmission turbidity method has now been known for a long time. It is derived from the Mie Theory and can be applied to any number of spheres, randomly distributed and separated by large distance compared to wavelength. Here, we describe a method for determination of size, distribution and concentration of nanoparticles in solution using UV-Vis transmission measurements. The method combines Mie and Beer Lambert computation integrated in a best fit approximation. In a first step, a validation of the approach is completed on silver nanoparticles solution. Verification of results is realized with Transmission Electronic Microscopy measurements for size distribution and an Inductively Coupled Plasma Mass Spectrometry for concentration. In view of the good agreement obtained, a second step of work focuses on how to manage the concentration to be the most accurate on the size distribution. Those efficient conditions are determined by simple computation. As we are dealing with nanoparticles, one of the key points is to know what the size limits reachable are with that kind of approach based on classical electromagnetism. In taking into account the transmission spectrometer accuracy limit we determine for several types of materials, metals, dielectrics, semiconductors the particle size limit detectable by such a turbidity method. These surprising results are situated at the quantum physics frontier.

  20. Unconfined versus confined speleogenetic settings: variations of solution porosity.

    Directory of Open Access Journals (Sweden)

    Klimchouk Alexander

    2006-01-01

    Full Text Available Speleogenesis in confined settings generates cave morphologies that differ much from those formed in unconfined settings. Cavesdeveloped in unconfined settings are characterised by broadly dendritic patterns of channels due to highly competing development.In contrast, caves originated under confined conditions tend to form two- or three-dimensional mazes with densely packed conduits.This paper illustrates variations of solution (channel porosity resulted from speleogenesis in unconfined and confined settings by theanalysis of morphometric parameters of typical cave patterns. Two samples of typical cave systems formed in the respective settingsare compared. The sample that represents unconfined speleogenesis consists of solely limestone caves, whereas gypsum cavesof this type tend to be less dendritic and more linear. The sample that represents confined speleogenesis consists of both limestoneand gypsum maze caves. The comparison shows considerable differences in average values of some parameters between thesettings. Passage network density (the ratio of the cave length to the area of the cave field, km/km2 is one order of magnitudegreater in confined settings than in unconfined (average 167.3 km/km2 versus 16.6 km/km2. Similarly, an order of magnitudedifference is observed in cave porosity (a fraction of the volume of a cave block, occupied by mapped cavities; 5.0 % versus 0.4 %.This illustrates that storage in maturely karstified confined aquifers is generally much greater than in unconfined. The average areal coverage (a fraction of the area of the cave field occupied by passages in a plan view is about 5 times greater in confined settingsthan in unconfined (29.7 % versus 6.4 %. This indicates that conduit permeability in confined aquifers is appreciably easier to targetwith drilling than the widely spaced conduits in unconfined aquifers.

  1. Global Health: Preparation for Working in Resource-Limited Settings.

    Science.gov (United States)

    St Clair, Nicole E; Pitt, Michael B; Bakeera-Kitaka, Sabrina; McCall, Natalie; Lukolyo, Heather; Arnold, Linda D; Audcent, Tobey; Batra, Maneesh; Chan, Kevin; Jacquet, Gabrielle A; Schutze, Gordon E; Butteris, Sabrina

    2017-11-01

    Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships. Copyright © 2017 by the American Academy of Pediatrics.

  2. Caring for the injured child in settings of limited resource.

    Science.gov (United States)

    Stephenson, Jacob

    2016-02-01

    Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. Published by Elsevier Inc.

  3. Limited-diffraction solutions to Maxwell and Schroedinger equations

    International Nuclear Information System (INIS)

    Lu, Jian-yu; Greenleaf, J.F.

    1996-10-01

    The authors have developed a new family of limited diffraction electromagnetic X-shaped waves based on the scalar X-shaped waves discovered previously. These waves are diffraction-free in theory and particle-like (wave packets), in that they maintain their shape as they propagate to an infinite distance. The 'X waves' possess (theoretically) infinitely extended 'arms' and - at least, the ones studied in this paper - have an infinite total energy: therefore, they are not physically realizable. However, they can be truncated in both space and time and 'approximated' by means of a finite aperture radiator so to get a large enough depth of interest (depth of field). In addition to the Maxwell equations, X wave solutions to the free Schroedinger equation are also obtained. Possible applications of these new waves are discussed. Finally, the authors discuss the appearance of the X-shaped solutions from the purely geometric point of view of the special relativity theory

  4. Perinatal pathology: practice suggestions for limited-resource settings.

    Science.gov (United States)

    Roberts, Drucilla J

    2013-06-01

    The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

  5. An evolutionary algorithm for tomographic reconstructions in limited data sets problems

    International Nuclear Information System (INIS)

    Turcanu, Catrinel; Craciunescu, Teddy

    2000-01-01

    The paper proposes a new method for tomographic reconstructions. Unlike nuclear medicine applications, in physical science problems we are often confronted with limited data sets: constraints in the number of projections or limited angle views. The problem of image reconstruction from projections may be considered as a problem of finding an image (solution) having projections that match the experimental ones. In our approach, we choose a statistical correlation coefficient to evaluate the fitness of any potential solution. The optimization process is carried out by an evolutionary algorithm. Our algorithm has some problem-oriented characteristics. One of them is that a chromosome, representing a potential solution, is not linear but coded as a matrix of pixels corresponding to a two-dimensional image. This kind of internal representation reflects the genuine manifestation and slight differences between two points situated in the original problem space give rise to similar differences once they become coded. Another particular feature is a newly built crossover operator: the grid-based crossover, suitable for high dimension two-dimensional chromosomes. Except for the population size and the dimension of the cutting grid for the grid-based crossover, all the other parameters of the algorithm are independent of the geometry of the tomographic reconstruction. The performances of the method are evaluated in comparison with a traditional tomographic method, based on the maximization of the entropy of the image, that proved to work well with limited data sets. The test phantom is typical for an application with limited data sets: the determination of the neutron energy spectra with time resolution in case of short-pulsed neutron emission. The qualitative judgement and also the quantitative one, based on some figures of merit, point out that the proposed method ensures an improved reconstruction of shapes, sizes and resolution in the image, even in the presence of noise

  6. LIMITS IN APPLICATION OF INTERNATIONAL STANDARDS TO INNOVATIVE CERAMIC SOLUTIONS

    Directory of Open Access Journals (Sweden)

    Cristiano Fragassa

    2015-06-01

    Full Text Available Gres Porcelain stoneware is a ceramic with a compact, hard, coloured and non-porous body. It is largely used as building materials, for a quality architecture, offering high resistance to impact, stress, wear, scratching, frost, chemical attach and stains. It is produced in flat tiles, billions of tons per year. A very prominent technology, based on a pyroclastic deformation, permits to obtain bended porcelain tiles as innovative solutions for a modern architecture. This technology is grounded on a proper combination of heavy machining by cutting tools and secondary firing in a kiln. This new element, the bended tile, can be used in several innovative applications (as steps, shelves, benches, radiators.... But, new functions require a better and in-depth knowledge of these materials, especially referring to the mechanical proprieties. This paper investigates the limits of applicability of ISO standards for the quality classification of ceramics and experimental measures of their mechanical proprieties.

  7. Solubility Limits of Dibutyl Phosphoric Acid in Uranium Solutions at SRS

    International Nuclear Information System (INIS)

    Thompson, M.C.; Pierce, R.A.; Ray, R.J.

    1998-06-01

    The Savannah River Site has enriched uranium (EU) solution which has been stored for almost 10 years since being purified in the second uranium cycle of the H area solvent extraction process. The concentrations in solution are 6 g/L U and about 0.1 M nitric acid. Residual tributylphosphate in the solutions has slowly hydrolyzed to form dibutyl phosphoric acid (HDBP) at concentrations averaging 50 mg/L. Uranium is known to form compounds with DBP which have limited solubility. The potential to form uranium-DBP solids raises a nuclear criticality safety issue. SRTC tests have shown that U-DBP solids will precipitate at concentrations potentially attainable during storage of enriched uranium solutions. Evaporation of the existing EUS solution without additional acidification could result in the precipitation of U-DBP solids if DBP concentration in the resulting solution exceeds 110 ppm at ambient temperature. The same potential exists for evaporation of unwashed 1CU solutions. The most important variables of interest for present plant operations are HNO 3 and DBP concentrations. Temperature is also an important variable controlling precipitation. The data obtained in these tests can be used to set operating and safety limits for the plant. It is recommended that the data for 0 degrees C with 0.5 M HNO 3 be used for setting the limits. The limit would be 80 mg/L which is 3 standard deviations below the average of 86 observed in the tests. The data shows that super-saturation can occur when the DBP concentration is as much as 50 percent above the solubility limit. However, super-saturation cannot be relied on for maintaining nuclear criticality safety. The analytical method for determining DBP concentration in U solutions was improved so that analyses for a solution are accurate to within 10 percent. However, the overall uncertainty of results for periodic samples of the existing EUS solutions was only reduced slightly. Thus, sampling appears to be the largest portion

  8. Setting limits and application to Higgs boson search

    International Nuclear Information System (INIS)

    Lista, L.

    2013-01-01

    This lecture summarizes the basic concept of hypothesis testing, will introduce the concepts of significance and upper limit under the frequentist and Bayesian approaches, and will discuss the benefits and limitations of the most popular approaches. Special attention will be devoted to the so-called modified frequentist approach, which is a popular method in High Energy Physics, and some application to real physics cases will be discussed. (authors)

  9. Projective limits of state spaces IV. Fractal label sets

    Science.gov (United States)

    Lanéry, Suzanne; Thiemann, Thomas

    2018-01-01

    Instead of formulating the state space of a quantum field theory over one big Hilbert space, it has been proposed by Kijowski (1977) to represent quantum states as projective families of density matrices over a collection of smaller, simpler Hilbert spaces (see Lanéry (2016) [1] for a concise introduction to this formalism). One can thus bypass the need to select a vacuum state for the theory, and still be provided with an explicit and constructive description of the quantum state space, at least as long as the label set indexing the projective structure is countable. Because uncountable label sets are much less practical in this context, we develop in the present article a general procedure to trim an originally uncountable label set down to countable cardinality. In particular, we investigate how to perform this tightening of the label set in a way that preserves both the physical content of the algebra of observables and its symmetries. This work is notably motivated by applications to the holonomy-flux algebra underlying Loop Quantum Gravity. Building on earlier work by Okołów (2013), a projective state space was introduced for this algebra in Lanéry and Thiemann (2016). However, the non-trivial structure of the holonomy-flux algebra prevents the construction of satisfactory semi-classical states (Lanéry and Thiemann, 2017). Implementing the general procedure just mentioned in the case of a one-dimensional version of this algebra, we show how a discrete subalgebra can be extracted without destroying universality nor diffeomorphism invariance. On this subalgebra, quantum states can then be constructed which are more regular than was possible on the original algebra. In particular, this allows the design of semi-classical states whose semi-classicality is enforced step by step, starting from collective, macroscopic degrees of freedom and going down progressively toward smaller and smaller scales.

  10. Limit sets for the discrete spectrum of complex Jacobi matrices

    International Nuclear Information System (INIS)

    Golinskii, L B; Egorova, I E

    2005-01-01

    The discrete spectrum of complex Jacobi matrices that are compact perturbations of the discrete Laplacian is studied. The precise stabilization rate (in the sense of order) of the matrix elements ensuring the finiteness of the discrete spectrum is found. An example of a Jacobi matrix with discrete spectrum having a unique limit point is constructed. These results are discrete analogues of Pavlov's well-known results on Schroedinger operators with complex potential on a half-axis.

  11. Upper limit set for level of lightning activity on Titan

    Science.gov (United States)

    Desch, M. D.; Kaiser, M. L.

    1990-01-01

    Because optically thick cloud and haze layers prevent lightning detection at optical wavelength on Titan, a search was conducted for lightning-radiated signals (spherics) at radio wavelengths using the planetary radioastronomy instrument aboard Voyager 1. Given the maximum ionosphere density of about 3000/cu cm, lightning spherics should be detectable above an observing frequency of 500 kHz. Since no evidence for spherics is found, an upper limit to the total energy per flash in Titan lightning of about 10 to the 6th J, or about 1000 times weaker than that of typical terrestrial lightning, is inferred.

  12. Clinical bacteriology in low-resource settings: today's solutions.

    Science.gov (United States)

    Ombelet, Sien; Ronat, Jean-Baptiste; Walsh, Timothy; Yansouni, Cedric P; Cox, Janneke; Vlieghe, Erika; Martiny, Delphine; Semret, Makeda; Vandenberg, Olivier; Jacobs, Jan

    2018-03-05

    Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Priority setting of strategies and mechanisms for limiting global warming

    International Nuclear Information System (INIS)

    Lewis, S.J.L.

    1994-01-01

    Scientific communities have reached a consensus that increases of greenhouse gas emission will result in climatic warming and sea level rises despite existing uncertainties. Major uncertainties include the sensitivities of climate changes in terms of timing, magnitude, and scales of regional changes. Socioeconomic uncertainties encompass population and economic growth, changes in technology, future reliance on fossil fuel, and policies compiled to stabilize the global warming. Moreover, increase in world population coupled with limited resources will increase the vulnerability of ecosystems and social systems. Global warming has become an international concern since the destinies of all nations are closely interwoven by this issue and how nations deal with it. Appropriate strategies and mechanisms are need to slow down the buildup of CO 2 and other greenhouse gases. Questionnaires were sent to 150 experts in 30 countries to evaluate such strategies and mechanisms for dealing with global warming, from both the domestic and international perspectives. This paper will focus primarily on strategy selection

  14. Limits to ductility set by plastic flow localization

    International Nuclear Information System (INIS)

    Needleman, A.; Rice, J.R.

    1977-11-01

    The theory of strain localization is reviewed with reference both to local necking in sheet metal forming processes and to more general three dimensional shear band localizations that sometimes mark the onset of ductile rupture. Both bifurcation behavior and the growth of initial imperfections are considered. In addition to analyses based on classical Mises-like constitutive laws, approaches to localization based on constitutive models that may more accurately model processes of slip and progressive rupturing on the microscale in structural alloys are discussed. Among these non-classical constitutive features are the destabilizing roles of yield surface vertices and of non-normality effects, arising, for example, from slight pressure sensitivity of yield. Analyses based on a constitutive model of a progressively cavitating dilational plastic material which is intended to model the process of ductile void growth in metals are also discussed. A variety of numerical results are presented. In the context of the three dimensional theory of localization, it is shown that a simple vertex model predicts ratios of ductility in plane strain tension to ductility in axisymmetric tension qualitatively consistent with experiment, and the destabilizing influence of a hydrostatic stress dependent void nucleation criterion is illustrated. In the sheet necking context, and focussing on positive biaxial stretching, it is shown that forming limit curves based on a simple vertex model and those based on a simple void growth model are qualitatively in accord, although attributing instability to very different physical mechanisms. These forming limit curves are compared with those obtained from the Mises material model and employing various material and geometric imperfections

  15. Childhood epilepsy: Management in resource-limited setting

    Directory of Open Access Journals (Sweden)

    Valvi Chhaya

    2008-01-01

    Full Text Available Objective: To optimize the use of phenobarbital and/or phenytoin as frontline drugs for treatment of childhood epilepsy. Design: Before-and -after study. Setting: Epilepsy clinic at paediatric OPD, Sassoon General Hospital, Pune. Materials and Methods: Epilepsy is a condition in which seizures are triggered recurrently from within the brain. For epidemiological classification purpose epilepsy is considered to be present when two or more unprovoked seizures occur at an interval greater than twenty four hours apart. Seizures were classified as generalized and partial seizures, with underlying etiology investigated with EEG, CT scan in majority of the patients. Follow - up rate, seizure - control and antiepileptic drugs used among 151 children enrolled as on 31 March 2005 were compared with 106 children with new onset epilepsy enrolled as on February 2006. Eight children with breakthrough convulsion after a seizure free period of five to eighteen months were followed up after injection vitamin D. Nineteen children with poor control of seizures receiving polytherapy with newer antiepileptic drugs were assessed with frontline antiepileptic medication of phenobarbital and/or phenytoin. Serum calcium, phosphorus, alkaline phosphatase were done in seventy two consecutive children with seizure disorder. Results: During post protocol period good seizure control was achieved in 84.8% as against 80.7% and use of phenobarbital and/or phenytoin increased to 65.11% from 22.87%. Of the 8 cases with breakthrough seizures seven remained seizure free after vitamin D administration and with no dose enhancement of AED medications of the nineteen. Children receiving polytherapy thirteen children could be successfully switched to phenobarbital and/or phenytoin. Forty four (61% children had hypocalcemia (less than 9 mg%, fifty seven (79% children had raised alkaline phosphatase levels (more than 270 IU. Comments: Phenobarbital and/or phenytoin have been found to be

  16. China sets sights on exporting an affordable nuclear solution

    Energy Technology Data Exchange (ETDEWEB)

    Dalton, David [NucNet, Bruessel (Belgium)

    2016-03-15

    Since the Fukushima-Daiichi accident in 2011 few western countries have been building nuclear reactors. China, however, seems to be going on something of a spree, sensing a solution for pollution at home - and unprecedented commercial opportunities abroad. There might be a general feeling in the industry that nuclear energy is on the wane in the West, but the same industry is casting increasingly envious glances to the East. A minimum of 60 nuclear power reactors are expected to start up in China over the next decade. By 2050, nuclear power should exceed 350 GW in China, with about 400 new nuclear reactors and total nuclear investment of over a trillion dollars.

  17. A Semi-Automated Workflow Solution for Data Set Publication

    Directory of Open Access Journals (Sweden)

    Suresh Vannan

    2016-03-01

    Full Text Available To address the need for published data, considerable effort has gone into formalizing the process of data publication. From funding agencies to publishers, data publication has rapidly become a requirement. Digital Object Identifiers (DOI and data citations have enhanced the integration and availability of data. The challenge facing data publishers now is to deal with the increased number of publishable data products and most importantly the difficulties of publishing diverse data products into an online archive. The Oak Ridge National Laboratory Distributed Active Archive Center (ORNL DAAC, a NASA-funded data center, faces these challenges as it deals with data products created by individual investigators. This paper summarizes the challenges of curating data and provides a summary of a workflow solution that ORNL DAAC researcher and technical staffs have created to deal with publication of the diverse data products. The workflow solution presented here is generic and can be applied to data from any scientific domain and data located at any data center.

  18. Robust Hinf control of uncertain switched systems defined on polyhedral sets with Filippov solutions

    DEFF Research Database (Denmark)

    Ahmadi, Mohamadreza; Mojallali, Hamed; Wisniewski, Rafal

    2012-01-01

    This paper considers the control problem of a class of uncertain switched systems defined on polyhedral sets known as piecewise linear systems where, instead of the conventional Carathe ́odory solutions, Filippov solutions are studied. In other words, in contrast to the previous studies, solutions...

  19. Soil solution interactions may limit Pb remediation using P ...

    Science.gov (United States)

    Lead (Pb) contaminated soils are a potential exposure hazard to the public. Amending soils with phosphorus (P) may reduce Pb soil hazards. Soil from Cleveland, OH containing 726 ± 14 mg Pb kg-1 was amended in a laboratory study with bone meal and triple super phosphate (TSP) at 5:1 P:Pb molar ratios. Soil was acidified, neturalized and re-acidified to encourage Pb phosphate formation. PRSTM-probes were used to evaluate changes in soil solution chemistry. Soil acidification did not decrease in vitro bioaccessible (IVBA) Pb using either a pH 1.5, 0.4 M glycine solution or a pH 2.5 solution with organic acids. PRSTM-probe data found soluble Pb increased 10-fold in acidic conditions compared to circumnetural pH conditions. In acidic conditions (p = 3-4), TSP treated soils increased detected P 10-fold over untreated soils. Bone meal application did not increase PRSTM-probe detected P, indicating there may have been insufficient P to react with Pb. X-ray absorption spectroscopy suggested a 10% increase in pyromorphite formation for the TSP treated soil only. Treatments increased soil electrical conductivity above 16 mS cm-1, potentially causing a new salinity hazard. This study used a novel approach by combining the human ingestion endpoint, PRSTM-probes, and X-ray absorption spectroscopy to evaluate treatment efficacy. PRSTM-probe data indicated potentially excess Ca relative to P across incubation steps that could have competed with Pb for soluble P. Mor

  20. On the continuous selections of solution sets of Lipschitzian quantum stochastic differential inclusions

    International Nuclear Information System (INIS)

    Ayoola, E.O.

    2004-05-01

    We prove that a multifunction associated with the set of solutions of Lipschitzian quantum stochastic differential inclusion (QSDI) admits a selection continuous from some subsets of complex numbers to the space of the matrix elements of adapted weakly absolutely continuous quantum stochastic processes. In particular, we show that the solution set map as well as the reachable set of the QSDI admit some continuous representations. (author)

  1. On the completeness of the set of Bethe-Hulthen solutions of the linear Heisenberg system

    International Nuclear Information System (INIS)

    Caspers, W J; Labuz, M; Wal, A

    2006-01-01

    In this work we formulate the standard form of the solutions of the Heisenberg chain with periodic boundary conditions and show that these solutions can be transformed into the well-known Bethe-Hulthen solutions. The standard form is found by solving the secular problem, separated according to the irreducible representations of the translation group. The relevant parameters exp(ik j ) of the Bethe-Hulthen solutions are found from a set of linear equations with coefficients derived from the standard solutions. This correspondence between standard and Bethe-Hulthen solutions realizes the completeness of the Bethe-Hulthen method

  2. The Intermediate Set and Limiting Superdi erential for Coalition Games: Between the Core and the Weber Set

    Czech Academy of Sciences Publication Activity Database

    Adam, Lukáš; Kroupa, T.

    2017-01-01

    Roč. 46, č. 4 (2017), s. 891-918 ISSN 0020-7276 R&D Projects: GA ČR GA15-00735S Institutional support: RVO:67985556 Keywords : coalition game * limiting superdi erential * intermediate set * core * Weber set Subject RIV: BA - General Mathematics OBOR OECD: Statistics and probability Impact factor: 0.713, year: 2016 http://library.utia.cas.cz/separaty/2016/MTR/adam-0467365.pdf

  3. A method of setting limits for the purpose of quality assurance

    International Nuclear Information System (INIS)

    Sanghangthum, Taweap; Suriyapee, Sivalee; Kim, Gwe-Ya; Pawlicki, Todd

    2013-01-01

    The result from any assurance measurement needs to be checked against some limits for acceptability. There are two types of limits; those that define clinical acceptability (action limits) and those that are meant to serve as a warning that the measurement is close to the action limits (tolerance limits). Currently, there is no standard procedure to set these limits. In this work, we propose an operational procedure to set tolerance limits and action limits. The approach to establish the limits is based on techniques of quality engineering using control charts and a process capability index. The method is different for tolerance limits and action limits with action limits being categorized into those that are specified and unspecified. The procedure is to first ensure process control using the I-MR control charts. Then, the tolerance limits are set equal to the control chart limits on the I chart. Action limits are determined using the C pm process capability index with the requirements that the process must be in-control. The limits from the proposed procedure are compared to an existing or conventional method. Four examples are investigated: two of volumetric modulated arc therapy (VMAT) point dose quality assurance (QA) and two of routine linear accelerator output QA. The tolerance limits range from about 6% larger to 9% smaller than conventional action limits for VMAT QA cases. For the linac output QA, tolerance limits are about 60% smaller than conventional action limits. The operational procedure describe in this work is based on established quality management tools and will provide a systematic guide to set up tolerance and action limits for different equipment and processes. (paper)

  4. 77 FR 69548 - Price for the 2012 Limited Edition Silver Proof SetTM

    Science.gov (United States)

    2012-11-19

    ... DEPARTMENT OF THE TREASURY United States Mint Price for the 2012 Limited Edition Silver Proof Set TM AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing a price of $149.95 for the 2012 Limited Edition Silver Proof Set TM . FOR FURTHER...

  5. On compactoid and limited sets in non-Archimedean locally convex ...

    African Journals Online (AJOL)

    In [2] and [3] spaces in which every bounded subset is a compactoid was studied. Every compactoid set is limited but the converse is not true [3]. In this paper, we shall study some spaces in which every limited set is compactoid. Journal of the Nigerian Association of Mathematical Physics Vol. 10 2006: pp. 571-574.

  6. Security in Distributed Collaborative Environments: Limitations and Solutions

    Science.gov (United States)

    Saadi, Rachid; Pierson, Jean-Marc; Brunie, Lionel

    The main goal of establishing collaboration between heterogeneous environment is to create such as Pervasive context which provide nomadic users with ubiquitous access to digital information and surrounding resources. However, the constraints of mobility and heterogeneity arise a number of crucial issues related to security, especially authentication access control and privacy. First of all, in this chapter we explore the trust paradigm, specially the transitive capability to enable a trust peer to peer collaboration. In this manner, when each organization sets its own security policy to recognize (authenticate) users members of a trusted community and provide them a local access (access control), the trust transitivity between peers will allows users to gain a broad, larger and controlled access inside the pervasive environment. Next, we study the problem of user's privacy. In fact in pervasive and ubiquitous environments, nomadic users gather and exchange certificates or credential which providing them rights to access by transitivity unknown and trusted environments. These signed documents embeds increasing number of attribute that require to be filtered according to such contextual situation. In this chapter, we propose a new morph signature enabling each certificate owner to preserve his privacy by discloses or blinds some sensitive attributes according to faced situation.

  7. Matched pairs approach to set theoretic solutions of the Yang-Baxter equation

    International Nuclear Information System (INIS)

    Gateva-Ivanova, T.; Majid, S.

    2005-08-01

    We study set-theoretic solutions (X,r) of the Yang-Baxter equations on a set X in terms of the induced left and right actions of X on itself. We give a characterization of involutive square-free solutions in terms of cyclicity conditions. We characterise general solutions in terms of an induced matched pair of unital semigroups S(X,r) and construct (S,r S ) from the matched pair. Finally, we study extensions of solutions in terms of matched pairs of their associated semigroups. We also prove several general results about matched pairs of unital semigroups of the required type, including iterated products S bowtie S bowtie S underlying the proof that r S is a solution, and extensions (S bowtie T, r Sb owtie T ). Examples include a general 'double' construction (S bowtie S,r Sb owtie S ) and some concrete extensions, their actions and graphs based on small sets. (author)

  8. Relay protection coordination with generator capability curve, excitation system limiters and power system relay protections settings

    OpenAIRE

    Buha Danilo; Buha Boško; Jačić Dušan; Gligorov Saša; Božilov Marko; Marinković Savo; Milosavljević Srđan

    2016-01-01

    The relay protection settings performed in the largest thermal powerplant (TE "Nikola Tesla B") are reffered and explained in this paper. The first calculation step is related to the coordination of the maximum stator current limiter settings, the overcurrent protection with inverse characteristics settings and the permitted overload of the generator stator B1. In the second calculation step the settings of impedance generator protection are determined, and the methods and criteria according ...

  9. Limited resources of genome sequencing in developing countries: Challenges and solutions

    Directory of Open Access Journals (Sweden)

    Mohamed Helmy

    2016-06-01

    Full Text Available The differences between countries in national income, growth, human development and many other factors are used to classify countries into developed and developing countries. There are several classification systems that use different sets of measures and criteria. The most common classifications are the United Nations (UN and the World Bank (WB systems. The UN classification system uses the UN Human Development Index (HDI, an indicator that uses statistic of life expectancy, education, and income per capita for countries' classification. While the WB system uses gross national income (GNI per capita that is calculated using the World Bank Atlas method. According to the UN and WB classification systems, there are 151 and 134 developing countries, respectively, with 89% overlap between the two systems. Developing countries have limited human development, and limited expenditure in education and research, among several other limitations. The biggest challenge facing genomic researchers and clinicians is limited resources. As a result, genomic tools, specifically genome sequencing technologies, which are rapidly becoming indispensable, are not widely available. In this report, we explore the current status of sequencing technologies in developing countries, describe the associated challenges and emphasize potential solutions.

  10. On the solution set for a class of sequential fractional differential equations

    International Nuclear Information System (INIS)

    Baleanu, Dumitru; Mustafa, Octavian G; Agarwal, Ravi P

    2010-01-01

    We establish here that under some simple restrictions on the functional coefficient a(t) the solution set of the fractional differential equation ( 0 D α t x)' + a(t)x = 0 splits between eventually small and eventually large solutions as t → +∞, where 0 D α t designates the Riemann-Liouville derivative of the order α in (0, 1).

  11. The ω-limit sets of a flow and periodic orbits

    International Nuclear Information System (INIS)

    Wang Xiaoxia; Blackmore, Denis; Wang Chengwen

    2009-01-01

    In this paper we discuss the ω-limit sets of a flow using the Conley theory, chain recurrence and Morse decompositions. Our results generalize and improve the related result in [Schropp J. A reduction principle for ω-limit sets. Z Angew Math Meth 1996;76(6):349-56], and we also show how they can be used as a basis for some new criteria for the existence of periodic orbits.

  12. THE IMPORTANCE OF LIMIT SOLUTIONS & TEMPORAL AND SPATIAL SCALES IN THE TEACHING OF TRANSPORT PHENOMENA

    Directory of Open Access Journals (Sweden)

    SÁVIO LEANDRO BERTOLI

    2016-07-01

    Full Text Available In the engineering courses the field of Transport Phenomena is of significant importance and it is in several disciplines relating to Fluid Mechanics, Heat and Mass Transfer. In these disciplines, problems involving these phenomena are mathematically formulated and analytical solutions are obtained whenever possible. The aim of this paper is to emphasize the possibility of extending aspects of the teaching-learning in this area by a method based on time scales and limit solutions. Thus, aspects relative to the phenomenology naturally arise during the definition of the scales and / or by determining the limit solutions. Aspects concerning the phenomenology of the limit problems are easily incorporated into the proposed development, which contributes significantly to the understanding of physics inherent in the mathematical modeling of each limiting case studied. Finally the study aims to disseminate the use of the limit solutions and of the time scales in the general fields of engineering.

  13. Effect of sodium carbonate solution on self-setting properties of tricalcium silicate bone cement.

    Science.gov (United States)

    Zhiguang Huan; Jiang Chang

    2008-11-01

    In this study, the effects of sodium carbonate (Na(2)CO(3) ) solution with different concentrations (10, 15, 20, and 25 wt%) as liquid phase on the setting time and compressive strength of tricalcium silicate bone cements are investigated. The in vitro bioactivity and degradability of the resultant Ca(3)SiO(5)-Na(2)CO(3) solution paste was also studied. The results indicate that as the concentration of Na(2)CO(3) solution varies from 0 to 25 wt%, the initial and final setting time of the cement decrease significantly from 90 to 20 min and from 180 to 45 min, respectively. After setting for 24 h, the compressive strength of Ca(3)SiO(5)-Na(2)CO(3) solution paste reaches 5.1 MPa, which is significantly higher than that of Ca( 3)SiO(5)-water cement system. The in vitro bioactivity of the cements is investigated by soaking in simulated body fluid (SBF) for 7 days. The results show that the Ca(3)SiO(5)-Na(2)CO( 3) solution bone cement has a good bioactivity and can degrade in Ringer's solution. The results indicate that Na(2)CO(3) solution as a liquid phase significantly improves the self-setting properties of Ca( 3)SiO(5) cement as compared to water. The Ca(3)SiO( 5) cement paste prepared using Na(2)CO(3) solution shows good bioactivity and moderate degradability, and the Ca(3)SiO( 5)-Na(2)CO(3) solution system may be used as degradable and bioactive bone defect filling materials.

  14. Challenges in the implementation of an electronic surveillance system in a resource-limited setting: Alerta, in Peru

    Directory of Open Access Journals (Sweden)

    Soto Giselle

    2008-11-01

    Full Text Available Abstract Background Infectious disease surveillance is a primary public health function in resource-limited settings. In 2003, an electronic disease surveillance system (Alerta was established in the Peruvian Navy with support from the U.S. Naval Medical Research Center Detachment (NMRCD. Many challenges arose during the implementation process, and a variety of solutions were applied. The purpose of this paper is to identify and discuss these issues. Methods This is a retrospective description of the Alerta implementation. After a thoughtful evaluation according to the Centers for Disease Control and Prevention (CDC guidelines, the main challenges to implementation were identified and solutions were devised in the context of a resource-limited setting, Peru. Results After four years of operation, we have identified a number of challenges in implementing and operating this electronic disease surveillance system. These can be divided into the following categories: (1 issues with personnel and stakeholders; (2 issues with resources in a developing setting; (3 issues with processes involved in the collection of data and operation of the system; and (4 issues with organization at the central hub. Some of the challenges are unique to resource-limited settings, but many are applicable for any surveillance system. For each of these challenges, we developed feasible solutions that are discussed. Conclusion There are many challenges to overcome when implementing an electronic disease surveillance system, not only related to technology issues. A comprehensive approach is required for success, including: technical support, personnel management, effective training, and cultural sensitivity in order to assure the effective deployment of an electronic disease surveillance system.

  15. The NANOGrav Nine-year Data Set: Limits on the Isotropic Stochastic Gravitational Wave Background

    OpenAIRE

    Arzoumanian, Zaven; Brazier, Adam; Burke-Spolaor, Sarah; Chamberlin, Sydney; Chatterjee, Shami; Christy, Brian; Cordes, Jim; Cornish, Neil; Demorest, Paul; Deng, Xihao; Dolch, Tim; Ellis, Justin; Ferdman, Rob; Fonseca, Emmanuel; Garver-Daniels, Nate

    2015-01-01

    We compute upper limits on the nanohertz-frequency isotropic stochastic gravitational wave background (GWB) using the 9-year data release from the North American Nanohertz Observatory for Gravitational Waves (NANOGrav) collaboration. We set upper limits for a GWB from supermassive black hole binaries under power law, broken power law, and free spectral coefficient GW spectrum models. We place a 95\\% upper limit on the strain amplitude (at a frequency of yr$^{-1}$) in the power law model of $A...

  16. Modeling study of solute transport in the unsaturated zone. Information and data sets. Volume 1

    International Nuclear Information System (INIS)

    Polzer, W.L.; Fuentes, H.R.; Springer, E.P.; Nyhan, J.W.

    1986-05-01

    The Environmental Science Group (HSE-12) is conducting a study to compare various approaches of modeling water and solute transport in porous media. Various groups representing different approaches will model a common set of transport data so that the state of the art in modeling and field experimentation can be discussed in a positive framework with an assessment of current capabilities and future needs in this area of research. This paper provides information and sets of data that will be useful to the modelers in meeting the objectives of the modeling study. The information and data sets include: (1) a description of the experimental design and methods used in obtaining solute transport data, (2) supporting data that may be useful in modeling the data set of interest, and (3) the data set to be modeled

  17. A perturbation method for dark solitons based on a complete set of the squared Jost solutions

    International Nuclear Information System (INIS)

    Ao Shengmei; Yan Jiaren

    2005-01-01

    A perturbation method for dark solitons is developed, which is based on the construction and the rigorous proof of the complete set of squared Jost solutions. The general procedure solving the adiabatic solution of perturbed nonlinear Schroedinger + equation, the time-evolution equation of dark soliton parameters and a formula for calculating the first-order correction are given. The method can also overcome the difficulties resulting from the non-vanishing boundary condition

  18. Limit load solution for electron beam welded joints with single edge weld center crack in tension

    Science.gov (United States)

    Lu, Wei; Shi, Yaowu; Li, Xiaoyan; Lei, Yongping

    2012-05-01

    Limit loads are widely studied and several limit load solutions are proposed to some typical geometry of weldments. However, there are no limit load solutions exist for the single edge crack weldments in tension (SEC(T)), which is also a typical geometry in fracture analysis. The mis-matching limit load for thick plate with SEC(T) are investigated and the special limit load solutions are proposed based on the available mis-matching limit load solutions and systematic finite element analyses. The real weld configurations are simplified as a strip, and different weld strength mis-matching ratio M, crack depth/width ratio a/ W and weld width 2H are in consideration. As a result, it is found that there exists excellent agreement between the limit load solutions and the FE results for almost all the mis-matching ration M, a/ W and ligament-to-weld width ratio ( W-a)/ H. Moreover, useful recommendations are given for evaluating the limit loads of the EBW structure with SEC(T). For the EBW joints with SEC(T), the mis-matching limit loads can be obtained assuming that the components are wholly made of base metal, when M changing from 1.6 to 0.6. When M decreasing to 0.4, the mis-matching limit loads can be obtained assuming that the components are wholly made of base metal only for large value of ( W-a)/ H. The recommendations may be useful for evaluating the limit loads of the EBW structures with SEC(T). The engineering simplifications are given for assessing the limit loads of electron beam welded structure with SEC(T).

  19. Stability of Solutions of Parabolic PDEs with Random Drift and Viscosity Limit

    International Nuclear Information System (INIS)

    Deck, T.; Potthoff, J.; Vage, G.; Watanabe, H.

    1999-01-01

    Let u α be the solution of the Ito stochastic parabolic Cauchy problem ∂u/∂t - L =ξ.∇u,u , where ξ is a space-time noise. We prove that u α depends continuously on α , when the coefficients in L α converge to those in L 0 . This result is used to study the diffusion limit for the Cauchy problem in the Stratonovich sense: when the coefficients of L α tend to 0 the corresponding solutions u α converge to the solution u 0 of the degenerate Cauchy problem ∂u 0 /∂t=ξ o ∇u 0 , u o . These results are based on a criterion for the existence of strong limits in the space of Hida distributions (S) * . As a by-product it is proved that weak solutions of the above Cauchy problem are in fact strong solutions

  20. The Solution Set Characterization and Error Bound for the Extended Mixed Linear Complementarity Problem

    Directory of Open Access Journals (Sweden)

    Hongchun Sun

    2012-01-01

    Full Text Available For the extended mixed linear complementarity problem (EML CP, we first present the characterization of the solution set for the EMLCP. Based on this, its global error bound is also established under milder conditions. The results obtained in this paper can be taken as an extension for the classical linear complementarity problems.

  1. Solution of the Cauchy problem for a continuous limit of the Toda lattice and its superextension

    International Nuclear Information System (INIS)

    Saveliev, M.V.; Sorba, P.

    1991-01-01

    A supersymmetric equation associated with a continuum limit of the classical superalgebra sl(n/n+1) is constructed. This equation can be considered as a superextension of a continuous limit of the Toda lattice with fixed end-points or, in other words, as a supersymmetric version of the heavenly equation. A solution of the Cauchy problem for the continuous limit of the Toda lattice and for its superextension is given using some formal reasonings. (orig.)

  2. A limit set trichotomy for order-preserving systems on time scales

    Directory of Open Access Journals (Sweden)

    Christian Poetzsche

    2004-04-01

    Full Text Available In this paper we derive a limit set trichotomy for abstract order-preserving 2-parameter semiflows in normal cones of strongly ordered Banach spaces. Additionally, to provide an example, Muller's theorem is generalized to dynamic equations on arbitrary time scales and applied to a model from population dynamics.

  3. Adjusting Limit Setting in Play Therapy with First-Generation Mexican-American Children

    Science.gov (United States)

    Perez, Roxanna; Ramirez, Sylvia Z.; Kranz, Peter L.

    2007-01-01

    This paper focuses on limit setting in play therapy with first-generation Mexican-American children in two important therapeutic environments that include the traditional indoor playroom and a proposed outdoor play area. The paper is based on a review of the literature and the authors' clinical experiences with this population. They concluded…

  4. Global patient safety and antiretroviral drug-drug interactions in the resource-limited setting.

    Science.gov (United States)

    Seden, Kay; Khoo, Saye H; Back, David; Byakika-Kibwika, Pauline; Lamorde, Mohammed; Ryan, Mairin; Merry, Concepta

    2013-01-01

    Scale-up of HIV treatment services may have contributed to an increase in functional health facilities available in resource-limited settings and an increase in patient use of facilities and retention in care. As more patients are reached with medicines, monitoring patient safety is increasingly important. Limited data from resource-limited settings suggest that medication error and antiretroviral drug-drug interactions may pose a significant risk to patient safety. Commonly cited causes of medication error in the developed world include the speed and complexity of the medication use cycle combined with inadequate systems and processes. In resource-limited settings, specific factors may contribute, such as inadequate human resources and high disease burden. Management of drug-drug interactions may be complicated by limited access to alternative medicines or laboratory monitoring. Improving patient safety by addressing the issue of antiretroviral drug-drug interactions has the potential not just to improve healthcare for individuals, but also to strengthen health systems and improve vital communication among healthcare providers and with regulatory agencies.

  5. Dynamic microscale temperature gradient in a gold nanorod solution measured by diffraction-limited nanothermometry

    Energy Technology Data Exchange (ETDEWEB)

    Li, Chengmingyue; Gan, Xiaosong; Li, Xiangping; Gu, Min, E-mail: mgu@swin.edu.au [Centre for Micro-Photonics, Faculty of Science, Engineering and Technology, Swinburne University of Technology, Hawthorn, Victoria 3122 (Australia)

    2015-09-21

    We quantify the dynamic microscale temperature gradient in a gold nanorod solution using quantum-dot-based microscopic fluorescence nanothermometry. By incorporating CdSe quantum dots into the solution as a nanothermometer, precise temperature mapping with diffraction-limited spatial resolution and sub-degree temperature resolution is achieved. The acquired data on heat generation and dissipation show an excellent agreement with theoretical simulations. This work reveals an effective approach for noninvasive temperature regulation with localized nanoheaters in microfluidic environment.

  6. Can Oxygen Set Thermal Limits in an Insect and Drive Gigantism?

    Science.gov (United States)

    Verberk, Wilco C. E. P.; Bilton, David T.

    2011-01-01

    Background Thermal limits may arise through a mismatch between oxygen supply and demand in a range of animal taxa. Whilst this oxygen limitation hypothesis is supported by data from a range of marine fish and invertebrates, its generality remains contentious. In particular, it is unclear whether oxygen limitation determines thermal extremes in tracheated arthropods, where oxygen limitation may be unlikely due to the efficiency and plasticity of tracheal systems in supplying oxygen directly to metabolically active tissues. Although terrestrial taxa with open tracheal systems may not be prone to oxygen limitation, species may be affected during other life-history stages, particularly if these rely on diffusion into closed tracheal systems. Furthermore, a central role for oxygen limitation in insects is envisaged within a parallel line of research focussing on insect gigantism in the late Palaeozoic. Methodology/Principal Findings Here we examine thermal maxima in the aquatic life stages of an insect at normoxia, hypoxia (14 kPa) and hyperoxia (36 kPa). We demonstrate that upper thermal limits do indeed respond to external oxygen supply in the aquatic life stages of the stonefly Dinocras cephalotes, suggesting that the critical thermal limits of such aquatic larvae are set by oxygen limitation. This could result from impeded oxygen delivery, or limited oxygen regulatory capacity, both of which have implications for our understanding of the limits to insect body size and how these are influenced by atmospheric oxygen levels. Conclusions/Significance These findings extend the generality of the hypothesis of oxygen limitation of thermal tolerance, suggest that oxygen constraints on body size may be stronger in aquatic environments, and that oxygen toxicity may have actively selected for gigantism in the aquatic stages of Carboniferous arthropods. PMID:21818347

  7. Can oxygen set thermal limits in an insect and drive gigantism?

    Directory of Open Access Journals (Sweden)

    Wilco C E P Verberk

    Full Text Available BACKGROUND: Thermal limits may arise through a mismatch between oxygen supply and demand in a range of animal taxa. Whilst this oxygen limitation hypothesis is supported by data from a range of marine fish and invertebrates, its generality remains contentious. In particular, it is unclear whether oxygen limitation determines thermal extremes in tracheated arthropods, where oxygen limitation may be unlikely due to the efficiency and plasticity of tracheal systems in supplying oxygen directly to metabolically active tissues. Although terrestrial taxa with open tracheal systems may not be prone to oxygen limitation, species may be affected during other life-history stages, particularly if these rely on diffusion into closed tracheal systems. Furthermore, a central role for oxygen limitation in insects is envisaged within a parallel line of research focussing on insect gigantism in the late Palaeozoic. METHODOLOGY/PRINCIPAL FINDINGS: Here we examine thermal maxima in the aquatic life stages of an insect at normoxia, hypoxia (14 kPa and hyperoxia (36 kPa. We demonstrate that upper thermal limits do indeed respond to external oxygen supply in the aquatic life stages of the stonefly Dinocras cephalotes, suggesting that the critical thermal limits of such aquatic larvae are set by oxygen limitation. This could result from impeded oxygen delivery, or limited oxygen regulatory capacity, both of which have implications for our understanding of the limits to insect body size and how these are influenced by atmospheric oxygen levels. CONCLUSIONS/SIGNIFICANCE: These findings extend the generality of the hypothesis of oxygen limitation of thermal tolerance, suggest that oxygen constraints on body size may be stronger in aquatic environments, and that oxygen toxicity may have actively selected for gigantism in the aquatic stages of Carboniferous arthropods.

  8. Relay protection coordination with generator capability curve, excitation system limiters and power system relay protections settings

    Directory of Open Access Journals (Sweden)

    Buha Danilo

    2016-01-01

    Full Text Available The relay protection settings performed in the largest thermal powerplant (TE "Nikola Tesla B" are reffered and explained in this paper. The first calculation step is related to the coordination of the maximum stator current limiter settings, the overcurrent protection with inverse characteristics settings and the permitted overload of the generator stator B1. In the second calculation step the settings of impedance generator protection are determined, and the methods and criteria according to which the calculations are done are described. Criteria used to provide the protection to fulfill the backup protection role in the event of malfunction of the main protection of the transmission system. are clarified. The calculation of all protection functions (32 functions of generator B1 were performed in the project "Coordination of relay protection blocks B1 and B2 with the system of excitation and power system protections -TENT B".

  9. Solution of the Cox-Thompson inverse scattering problem using finite set of phase shifts

    CERN Document Server

    Apagyi, B; Scheid, W

    2003-01-01

    A system of nonlinear equations is presented for the solution of the Cox-Thompson inverse scattering problem (1970 J. Math. Phys. 11 805) at fixed energy. From a given finite set of phase shifts for physical angular momenta, the nonlinear equations determine related sets of asymptotic normalization constants and nonphysical (shifted) angular momenta from which all quantities of interest, including the inversion potential itself, can be calculated. As a first application of the method we use input data consisting of a finite set of phase shifts calculated from Woods-Saxon and box potentials representing interactions with diffuse or sharp surfaces, respectively. The results for the inversion potentials, their first moments and asymptotic properties are compared with those provided by the Newton-Sabatier quantum inversion procedure. It is found that in order to achieve inversion potentials of similar quality, the Cox-Thompson method requires a smaller set of phase shifts than the Newton-Sabatier procedure.

  10. Solution of the Cox-Thompson inverse scattering problem using finite set of phase shifts

    International Nuclear Information System (INIS)

    Apagyi, Barnabas; Harman, Zoltan; Scheid, Werner

    2003-01-01

    A system of nonlinear equations is presented for the solution of the Cox-Thompson inverse scattering problem (1970 J. Math. Phys. 11 805) at fixed energy. From a given finite set of phase shifts for physical angular momenta, the nonlinear equations determine related sets of asymptotic normalization constants and nonphysical (shifted) angular momenta from which all quantities of interest, including the inversion potential itself, can be calculated. As a first application of the method we use input data consisting of a finite set of phase shifts calculated from Woods-Saxon and box potentials representing interactions with diffuse or sharp surfaces, respectively. The results for the inversion potentials, their first moments and asymptotic properties are compared with those provided by the Newton-Sabatier quantum inversion procedure. It is found that in order to achieve inversion potentials of similar quality, the Cox-Thompson method requires a smaller set of phase shifts than the Newton-Sabatier procedure

  11. Experiences from occupational exposure limits set on aerosols containing allergenic proteins

    DEFF Research Database (Denmark)

    Nielsen, Gunnar; Larsen, Søren; Hansen, Jitka S

    2012-01-01

    Occupational exposure limits (OELs) together with determined airborne exposures are used in risk assessment based managements of occupational exposures to prevent occupational diseases. In most countries, OELs have only been set for few protein-containing aerosols causing IgE-mediated allergies. ...... is available for setting OELs for proteins and protein-containing aerosols where the critical effect is IgE sensitization and IgE-mediated airway diseases.......Occupational exposure limits (OELs) together with determined airborne exposures are used in risk assessment based managements of occupational exposures to prevent occupational diseases. In most countries, OELs have only been set for few protein-containing aerosols causing IgE-mediated allergies...... for setting OELs. Our aim is to analyse prerequisites for setting OELs for the allergenic protein-containing aerosols. Opposite to the key effect of toxicological reactions, two thresholds, one for the sensitization phase and one for elicitation of IgE-mediated symptoms in sensitized individuals, are used...

  12. Constructing set-valued fundamental diagrams from jamiton solutions in second order traffic models

    KAUST Repository

    Seibold, Benjamin; Flynn, Morris R.; Kasimov, Aslan R.; Rosales, Rodolfo Rubé n

    2013-01-01

    Fundamental diagrams of vehicular traiic ow are generally multivalued in the congested ow regime. We show that such set-valued fundamental diagrams can be constructed systematically from simple second order macroscopic traiic models, such as the classical Payne-Whitham model or the inhomogeneous Aw-Rascle-Zhang model. These second order models possess nonlinear traveling wave solutions, called jamitons, and the multi-valued parts in the fundamental diagram correspond precisely to jamiton-dominated solutions. This study shows that transitions from function-valued to set-valued parts in a fundamental diagram arise naturally in well-known second order models. As a particular consequence, these models intrinsically reproduce traiic phases. © American Institute of Mathematical Sciences.

  13. Constructing set-valued fundamental diagrams from jamiton solutions in second order traffic models

    KAUST Repository

    Seibold, Benjamin

    2013-09-01

    Fundamental diagrams of vehicular traiic ow are generally multivalued in the congested ow regime. We show that such set-valued fundamental diagrams can be constructed systematically from simple second order macroscopic traiic models, such as the classical Payne-Whitham model or the inhomogeneous Aw-Rascle-Zhang model. These second order models possess nonlinear traveling wave solutions, called jamitons, and the multi-valued parts in the fundamental diagram correspond precisely to jamiton-dominated solutions. This study shows that transitions from function-valued to set-valued parts in a fundamental diagram arise naturally in well-known second order models. As a particular consequence, these models intrinsically reproduce traiic phases. © American Institute of Mathematical Sciences.

  14. The Train Driver Recovery Problem - a Set Partitioning Based Model and Solution Method

    DEFF Research Database (Denmark)

    Rezanova, Natalia Jurjevna; Ryan, David

    2010-01-01

    The need to recover a train driver schedule occurs during major disruptions in the daily railway operations. Based on data from the Danish passenger railway operator DSB S-tog A/S, a solution method to the train driver recovery problem (TDRP) is developed. The TDRP is formulated as a set...... branching strategy using the depth-first search of the Branch & Bound tree. The LP relaxation of the TDRP possesses strong integer properties. We present test scenarios generated from the historical real-life operations data of DSB S-tog A/S. The numerical results show that all but one tested instances...... partitioning problem. We define a disruption neighbourhood by identifying a small set of drivers and train tasks directly affected by the disruption. Based on the disruption neighbourhood, the TDRP model is formed and solved. If the TDRP solution provides a feasible recovery for the drivers within...

  15. Brahmaputra river basin groundwater: Solute distribution, chemical evolution and arsenic occurrences in different geomorphic settings

    Directory of Open Access Journals (Sweden)

    Swati Verma

    2015-09-01

    New hydrological insights for the region: Most groundwater solutes of RCD and YA terrains were derived from both silicate weathering and carbonate dissolution, while silicate weathering process dominates the solute contribution in OA groundwater. Groundwater samples from all terrains are postoxic with mean pe values between Fe(III and As(V–As(III reductive transition. While, reductive dissolution of (Fe–MnOOH is the dominant mechanism of As mobilization in RCD and YA aquifers, As in OA and PD aquifers could be mobilized by combined effect of pH dependent sorption and competitive ion exchange. The present study focuses on the major ion chemistry as well as the chemistry of the redox sensitive solutes of the groundwater in different geomorphic settings and their links to arsenic mobilization in groundwater.

  16. Technical solutions for mitigating security threats caused by health professionals in clinical settings.

    Science.gov (United States)

    Fernandez-Aleman, Jose Luis; Belen Sanchez Garcia, Ana; Garcia-Mateos, Gines; Toval, Ambrosio

    2015-08-01

    The objective of this paper is to present a brief description of technical solutions for health information system security threats caused by inadequate security and privacy practices in healthcare professionals. A literature search was carried out in ScienceDirect, ACM Digital Library and IEEE Digital Library to find papers reporting technical solutions for certain security problems in information systems used in clinical settings. A total of 17 technical solutions were identified: measures for password security, the secure use of e-mail, the Internet, portable storage devices, printers and screens. Although technical safeguards are essential to the security of healthcare organization's information systems, good training, awareness programs and adopting a proper information security policy are particularly important to prevent insiders from causing security incidents.

  17. Searching for optimal integer solutions to set partitioning problems using column generation

    OpenAIRE

    Bredström, David; Jörnsten, Kurt; Rönnqvist, Mikael

    2007-01-01

    We describe a new approach to produce integer feasible columns to a set partitioning problem directly in solving the linear programming (LP) relaxation using column generation. Traditionally, column generation is aimed to solve the LP relaxation as quick as possible without any concern of the integer properties of the columns formed. In our approach we aim to generate the columns forming the optimal integer solution while simultaneously solving the LP relaxation. By this we can re...

  18. An algorithm for computing the hull of the solution set of interval linear equations

    Czech Academy of Sciences Publication Activity Database

    Rohn, Jiří

    2011-01-01

    Roč. 435, č. 2 (2011), s. 193-201 ISSN 0024-3795 R&D Projects: GA ČR GA201/09/1957; GA ČR GC201/08/J020 Institutional research plan: CEZ:AV0Z10300504 Keywords : interval linear equations * solution set * interval hull * algorithm * absolute value inequality Subject RIV: BA - General Mathematics Impact factor: 0.974, year: 2011

  19. AORN Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings.

    Science.gov (United States)

    Hughes, Nancy L; Nelson, Audrey; Matz, Mary W; Lloyd, John

    2011-06-01

    Prolonged standing during surgical procedures poses a high risk of causing musculoskeletal disorders, including back, leg, and foot pain, which can be chronic or acute in nature. Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings provides recommendations for relieving the strain of prolonged standing, including the use of antifatigue mats, supportive footwear, and sit/stand stools, that are based on well-accepted ergonomic safety concepts, current research, and access to new and emerging technology. Published by Elsevier Inc.

  20. Limit Theorems and Their Relation to Solute Transport in Simulated Fractured Media

    Science.gov (United States)

    Reeves, D. M.; Benson, D. A.; Meerschaert, M. M.

    2003-12-01

    Solute particles that travel through fracture networks are subject to wide velocity variations along a restricted set of directions. This may result in super-Fickian dispersion along a few primary scaling directions. The fractional advection-dispersion equation (FADE), a modification of the original advection-dispersion equation in which a fractional derivative replaces the integer-order dispersion term, has the ability to model rapid, non-Gaussian solute transport. The FADE assumes that solute particle motions converge to either α -stable or operator stable densities, which are modeled by spatial fractional derivatives. In multiple dimensions, the multi-fractional dispersion derivative dictates the order and weight of differentiation in all directions, which correspond to the statistics of large particle motions in all directions. This study numerically investigates the presence of super- Fickian solute transport through simulated two-dimensional fracture networks. An ensemble of networks is gen

  1. Ecotoxicological assessments and the setting of limit values for chemicals in the environment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    The Committee on the Setting of Limit Values for Chemicals held its first open conference in Denmark in March 1992 at Mogenstrup Kro, Zealand. The conference proceedings were entitled `Risk Management and Risk Assessment in Different Sectors in Denmark`. The conference focused on risk assessment and the setting of limit values for chemicals in connection with human exposure to chemicals. The conference held in January 1996, which is covered by the present proceedings, dealt with the exposure of the environment to chemicals and the state-of-the-art as well as perspectives of ecotoxicological research. Special emphasis was placed on the illustration and discussion of the problems that have to be solved in order to secure satisfactory levels of protection of soil and aquatic environments in connection with exposure to chemicals. Also, problems connected with exposure through the atmosphere were discussed and exemplified by the work on the setting of limit values for tropospheric ozone. Furthermore, the global problems pertaining to what is believed to be the greenhouse effect and the degradation of the stratospheric ozone layer as well as the damage to crops caused by ozone were mentioned. (au)

  2. Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Scanlon ML

    2013-01-01

    Full Text Available Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART significantly reduced human immunodeficiency virus (HIV-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a

  3. An Efficient Implementation of Non-Linear Limit State Analysis Based on Lower-Bound Solutions

    DEFF Research Database (Denmark)

    Damkilde, Lars; Schmidt, Lotte Juhl

    2005-01-01

    Limit State analysis has been used in design for decades e.g. the yield line theory for concrete slabs or slip line solutions in geotechnics. In engineering practice manual methods have been dominating but in recent years the interest in numerical methods has been increasing. In this respect it i...

  4. Exact solutions and symmetry analysis for the limiting probability distribution of quantum walks

    International Nuclear Information System (INIS)

    Xu, Xin-Ping; Ide, Yusuke

    2016-01-01

    In the literature, there are numerous studies of one-dimensional discrete-time quantum walks (DTQWs) using a moving shift operator. However, there is no exact solution for the limiting probability distributions of DTQWs on cycles using a general coin or swapping shift operator. In this paper, we derive exact solutions for the limiting probability distribution of quantum walks using a general coin and swapping shift operator on cycles for the first time. Based on the exact solutions, we show how to generate symmetric quantum walks and determine the condition under which a symmetric quantum walk appears. Our results suggest that choosing various coin and initial state parameters can achieve a symmetric quantum walk. By defining a quantity to measure the variation of symmetry, deviation and mixing time of symmetric quantum walks are also investigated.

  5. Exact solutions and symmetry analysis for the limiting probability distribution of quantum walks

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Xin-Ping, E-mail: xuxp@mail.ihep.ac.cn [School of Physical Science and Technology, Soochow University, Suzhou 215006 (China); Ide, Yusuke [Department of Information Systems Creation, Faculty of Engineering, Kanagawa University, Yokohama, Kanagawa, 221-8686 (Japan)

    2016-10-15

    In the literature, there are numerous studies of one-dimensional discrete-time quantum walks (DTQWs) using a moving shift operator. However, there is no exact solution for the limiting probability distributions of DTQWs on cycles using a general coin or swapping shift operator. In this paper, we derive exact solutions for the limiting probability distribution of quantum walks using a general coin and swapping shift operator on cycles for the first time. Based on the exact solutions, we show how to generate symmetric quantum walks and determine the condition under which a symmetric quantum walk appears. Our results suggest that choosing various coin and initial state parameters can achieve a symmetric quantum walk. By defining a quantity to measure the variation of symmetry, deviation and mixing time of symmetric quantum walks are also investigated.

  6. Identifying finite-time coherent sets from limited quantities of Lagrangian data

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Matthew O. [Program in Applied and Computational Mathematics, Princeton University, New Jersey 08544 (United States); Rypina, Irina I. [Department of Physical Oceanography, Woods Hole Oceanographic Institute, Massachusetts 02543 (United States); Rowley, Clarence W. [Department of Mechanical and Aerospace Engineering, Princeton University, New Jersey 08544 (United States)

    2015-08-15

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that “leak” from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, “data rich” test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or “mesh-free” methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea.

  7. Identifying finite-time coherent sets from limited quantities of Lagrangian data

    International Nuclear Information System (INIS)

    Williams, Matthew O.; Rypina, Irina I.; Rowley, Clarence W.

    2015-01-01

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that “leak” from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, “data rich” test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or “mesh-free” methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea

  8. Identifying finite-time coherent sets from limited quantities of Lagrangian data.

    Science.gov (United States)

    Williams, Matthew O; Rypina, Irina I; Rowley, Clarence W

    2015-08-01

    A data-driven procedure for identifying the dominant transport barriers in a time-varying flow from limited quantities of Lagrangian data is presented. Our approach partitions state space into coherent pairs, which are sets of initial conditions chosen to minimize the number of trajectories that "leak" from one set to the other under the influence of a stochastic flow field during a pre-specified interval in time. In practice, this partition is computed by solving an optimization problem to obtain a pair of functions whose signs determine set membership. From prior experience with synthetic, "data rich" test problems, and conceptually related methods based on approximations of the Perron-Frobenius operator, we observe that the functions of interest typically appear to be smooth. We exploit this property by using the basis sets associated with spectral or "mesh-free" methods, and as a result, our approach has the potential to more accurately approximate these functions given a fixed amount of data. In practice, this could enable better approximations of the coherent pairs in problems with relatively limited quantities of Lagrangian data, which is usually the case with experimental geophysical data. We apply this method to three examples of increasing complexity: The first is the double gyre, the second is the Bickley Jet, and the third is data from numerically simulated drifters in the Sulu Sea.

  9. A Decomposition Model for HPLC-DAD Data Set and Its Solution by Particle Swarm Optimization

    Directory of Open Access Journals (Sweden)

    Lizhi Cui

    2014-01-01

    Full Text Available This paper proposes a separation method, based on the model of Generalized Reference Curve Measurement and the algorithm of Particle Swarm Optimization (GRCM-PSO, for the High Performance Liquid Chromatography with Diode Array Detection (HPLC-DAD data set. Firstly, initial parameters are generated to construct reference curves for the chromatogram peaks of the compounds based on its physical principle. Then, a General Reference Curve Measurement (GRCM model is designed to transform these parameters to scalar values, which indicate the fitness for all parameters. Thirdly, rough solutions are found by searching individual target for every parameter, and reinitialization only around these rough solutions is executed. Then, the Particle Swarm Optimization (PSO algorithm is adopted to obtain the optimal parameters by minimizing the fitness of these new parameters given by the GRCM model. Finally, spectra for the compounds are estimated based on the optimal parameters and the HPLC-DAD data set. Through simulations and experiments, following conclusions are drawn: (1 the GRCM-PSO method can separate the chromatogram peaks and spectra from the HPLC-DAD data set without knowing the number of the compounds in advance even when severe overlap and white noise exist; (2 the GRCM-PSO method is able to handle the real HPLC-DAD data set.

  10. Gene set analysis: limitations in popular existing methods and proposed improvements.

    Science.gov (United States)

    Mishra, Pashupati; Törönen, Petri; Leino, Yrjö; Holm, Liisa

    2014-10-01

    Gene set analysis is the analysis of a set of genes that collectively contribute to a biological process. Most popular gene set analysis methods are based on empirical P-value that requires large number of permutations. Despite numerous gene set analysis methods developed in the past decade, the most popular methods still suffer from serious limitations. We present a gene set analysis method (mGSZ) based on Gene Set Z-scoring function (GSZ) and asymptotic P-values. Asymptotic P-value calculation requires fewer permutations, and thus speeds up the gene set analysis process. We compare the GSZ-scoring function with seven popular gene set scoring functions and show that GSZ stands out as the best scoring function. In addition, we show improved performance of the GSA method when the max-mean statistics is replaced by the GSZ scoring function. We demonstrate the importance of both gene and sample permutations by showing the consequences in the absence of one or the other. A comparison of asymptotic and empirical methods of P-value estimation demonstrates a clear advantage of asymptotic P-value over empirical P-value. We show that mGSZ outperforms the state-of-the-art methods based on two different evaluations. We compared mGSZ results with permutation and rotation tests and show that rotation does not improve our asymptotic P-values. We also propose well-known asymptotic distribution models for three of the compared methods. mGSZ is available as R package from cran.r-project.org. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  11. Setting limits on Effective Field Theories: the case of Dark Matter

    Science.gov (United States)

    Pobbe, Federico; Wulzer, Andrea; Zanetti, Marco

    2017-08-01

    The usage of Effective Field Theories (EFT) for LHC new physics searches is receiving increasing attention. It is thus important to clarify all the aspects related with the applicability of the EFT formalism in the LHC environment, where the large available energy can produce reactions that overcome the maximal range of validity, i.e. the cutoff, of the theory. We show that this does not forbid to set rigorous limits on the EFT parameter space through a modified version of the ordinary binned likelihood hypothesis test, which we design and validate. Our limit-setting strategy can be carried on in its full-fledged form by the LHC experimental collaborations, or performed externally to the collaborations, through the Simplified Likelihood approach, by relying on certain approximations. We apply it to the recent CMS mono-jet analysis and derive limits on a Dark Matter (DM) EFT model. DM is selected as a case study because the limited reach on the DM production EFT Wilson coefficient and the structure of the theory suggests that the cutoff might be dangerously low, well within the LHC reach. However our strategy can also be applied, if needed, to EFT's parametrising the indirect effects of heavy new physics in the Electroweak and Higgs sectors.

  12. Complete set of homogeneous isotropic analytic solutions in scalar-tensor cosmology with radiation and curvature

    Science.gov (United States)

    Bars, Itzhak; Chen, Shih-Hung; Steinhardt, Paul J.; Turok, Neil

    2012-10-01

    We study a model of a scalar field minimally coupled to gravity, with a specific potential energy for the scalar field, and include curvature and radiation as two additional parameters. Our goal is to obtain analytically the complete set of configurations of a homogeneous and isotropic universe as a function of time. This leads to a geodesically complete description of the Universe, including the passage through the cosmological singularities, at the classical level. We give all the solutions analytically without any restrictions on the parameter space of the model or initial values of the fields. We find that for generic solutions the Universe goes through a singular (zero-size) bounce by entering a period of antigravity at each big crunch and exiting from it at the following big bang. This happens cyclically again and again without violating the null-energy condition. There is a special subset of geodesically complete nongeneric solutions which perform zero-size bounces without ever entering the antigravity regime in all cycles. For these, initial values of the fields are synchronized and quantized but the parameters of the model are not restricted. There is also a subset of spatial curvature-induced solutions that have finite-size bounces in the gravity regime and never enter the antigravity phase. These exist only within a small continuous domain of parameter space without fine-tuning the initial conditions. To obtain these results, we identified 25 regions of a 6-parameter space in which the complete set of analytic solutions are explicitly obtained.

  13. STACCATO: a novel solution to supernova photometric classification with biased training sets

    Science.gov (United States)

    Revsbech, E. A.; Trotta, R.; van Dyk, D. A.

    2018-01-01

    We present a new solution to the problem of classifying Type Ia supernovae from their light curves alone given a spectroscopically confirmed but biased training set, circumventing the need to obtain an observationally expensive unbiased training set. We use Gaussian processes (GPs) to model the supernovae's (SN's) light curves, and demonstrate that the choice of covariance function has only a small influence on the GPs ability to accurately classify SNe. We extend and improve the approach of Richards et al. - a diffusion map combined with a random forest classifier - to deal specifically with the case of biased training sets. We propose a novel method called Synthetically Augmented Light Curve Classification (STACCATO) that synthetically augments a biased training set by generating additional training data from the fitted GPs. Key to the success of the method is the partitioning of the observations into subgroups based on their propensity score of being included in the training set. Using simulated light curve data, we show that STACCATO increases performance, as measured by the area under the Receiver Operating Characteristic curve (AUC), from 0.93 to 0.96, close to the AUC of 0.977 obtained using the 'gold standard' of an unbiased training set and significantly improving on the previous best result of 0.88. STACCATO also increases the true positive rate for SNIa classification by up to a factor of 50 for high-redshift/low-brightness SNe.

  14. Limit load solutions for piping branch junctions under out-of-plane bending

    International Nuclear Information System (INIS)

    Xu, Ying Hu; Lee, Kuk Hee; Jeon, Jun Young; Kim, Yun Jae

    2009-01-01

    Approximate plastic limit load solutions for piping branch junctions under out-of plane bending are obtained from detailed three-dimensional (3-D) FE limit analyses based on elastic-perfectly plastic materials with the small geometry change option. Two types of bending are considered; out-of-plane bending to the branch pipe and out-of-plane bending to the run pipe. Accordingly closed-form approximations are proposed for piping branch junctions under out-of-plane bending based on the FE results. The proposed solutions are valid for the branch-to-run pipe radius and thickness from 0.0 to 1.0, and the mean radius-to-thickness ratio of the run pipe from 2.0 to 20.0. And, this study provides effects of reinforcement area on plastic limit loads.

  15. Stochastic level-set variational implicit-solvent approach to solute-solvent interfacial fluctuations

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Shenggao, E-mail: sgzhou@suda.edu.cn, E-mail: bli@math.ucsd.edu [Department of Mathematics and Mathematical Center for Interdiscipline Research, Soochow University, 1 Shizi Street, Jiangsu, Suzhou 215006 (China); Sun, Hui; Cheng, Li-Tien [Department of Mathematics, University of California, San Diego, La Jolla, California 92093-0112 (United States); Dzubiella, Joachim [Soft Matter and Functional Materials, Helmholtz-Zentrum Berlin, 14109 Berlin, Germany and Institut für Physik, Humboldt-Universität zu Berlin, 12489 Berlin (Germany); Li, Bo, E-mail: sgzhou@suda.edu.cn, E-mail: bli@math.ucsd.edu [Department of Mathematics and Quantitative Biology Graduate Program, University of California, San Diego, La Jolla, California 92093-0112 (United States); McCammon, J. Andrew [Department of Chemistry and Biochemistry, Department of Pharmacology, Howard Hughes Medical Institute, University of California, San Diego, La Jolla, California 92093-0365 (United States)

    2016-08-07

    Recent years have seen the initial success of a variational implicit-solvent model (VISM), implemented with a robust level-set method, in capturing efficiently different hydration states and providing quantitatively good estimation of solvation free energies of biomolecules. The level-set minimization of the VISM solvation free-energy functional of all possible solute-solvent interfaces or dielectric boundaries predicts an equilibrium biomolecular conformation that is often close to an initial guess. In this work, we develop a theory in the form of Langevin geometrical flow to incorporate solute-solvent interfacial fluctuations into the VISM. Such fluctuations are crucial to biomolecular conformational changes and binding process. We also develop a stochastic level-set method to numerically implement such a theory. We describe the interfacial fluctuation through the “normal velocity” that is the solute-solvent interfacial force, derive the corresponding stochastic level-set equation in the sense of Stratonovich so that the surface representation is independent of the choice of implicit function, and develop numerical techniques for solving such an equation and processing the numerical data. We apply our computational method to study the dewetting transition in the system of two hydrophobic plates and a hydrophobic cavity of a synthetic host molecule cucurbit[7]uril. Numerical simulations demonstrate that our approach can describe an underlying system jumping out of a local minimum of the free-energy functional and can capture dewetting transitions of hydrophobic systems. In the case of two hydrophobic plates, we find that the wavelength of interfacial fluctuations has a strong influence to the dewetting transition. In addition, we find that the estimated energy barrier of the dewetting transition scales quadratically with the inter-plate distance, agreeing well with existing studies of molecular dynamics simulations. Our work is a first step toward the

  16. A systematic review of portable electronic technology for health education in resource-limited settings.

    Science.gov (United States)

    McHenry, Megan S; Fischer, Lydia J; Chun, Yeona; Vreeman, Rachel C

    2017-08-01

    The objective of this study is to conduct a systematic review of the literature of how portable electronic technologies with offline functionality are perceived and used to provide health education in resource-limited settings. Three reviewers evaluated articles and performed a bibliography search to identify studies describing health education delivered by portable electronic device with offline functionality in low- or middle-income countries. Data extracted included: study population; study design and type of analysis; type of technology used; method of use; setting of technology use; impact on caregivers, patients, or overall health outcomes; and reported limitations. Searches yielded 5514 unique titles. Out of 75 critically reviewed full-text articles, 10 met inclusion criteria. Study locations included Botswana, Peru, Kenya, Thailand, Nigeria, India, Ghana, and Tanzania. Topics addressed included: development of healthcare worker training modules, clinical decision support tools, patient education tools, perceptions and usability of portable electronic technology, and comparisons of technologies and/or mobile applications. Studies primarily looked at the assessment of developed educational modules on trainee health knowledge, perceptions and usability of technology, and comparisons of technologies. Overall, studies reported positive results for portable electronic device-based health education, frequently reporting increased provider/patient knowledge, improved patient outcomes in both quality of care and management, increased provider comfort level with technology, and an environment characterized by increased levels of technology-based, informal learning situations. Negative assessments included high investment costs, lack of technical support, and fear of device theft. While the research is limited, portable electronic educational resources present promising avenues to increase access to effective health education in resource-limited settings, contingent

  17. A Regionalization Approach to select the final watershed parameter set among the Pareto solutions

    Science.gov (United States)

    Park, G. H.; Micheletty, P. D.; Carney, S.; Quebbeman, J.; Day, G. N.

    2017-12-01

    The calibration of hydrological models often results in model parameters that are inconsistent with those from neighboring basins. Considering that physical similarity exists within neighboring basins some of the physically related parameters should be consistent among them. Traditional manual calibration techniques require an iterative process to make the parameters consistent, which takes additional effort in model calibration. We developed a multi-objective optimization procedure to calibrate the National Weather Service (NWS) Research Distributed Hydrological Model (RDHM), using the Nondominant Sorting Genetic Algorithm (NSGA-II) with expert knowledge of the model parameter interrelationships one objective function. The multi-objective algorithm enables us to obtain diverse parameter sets that are equally acceptable with respect to the objective functions and to choose one from the pool of the parameter sets during a subsequent regionalization step. Although all Pareto solutions are non-inferior, we exclude some of the parameter sets that show extremely values for any of the objective functions to expedite the selection process. We use an apriori model parameter set derived from the physical properties of the watershed (Koren et al., 2000) to assess the similarity for a given parameter across basins. Each parameter is assigned a weight based on its assumed similarity, such that parameters that are similar across basins are given higher weights. The parameter weights are useful to compute a closeness measure between Pareto sets of nearby basins. The regionalization approach chooses the Pareto parameter sets that minimize the closeness measure of the basin being regionalized. The presentation will describe the results of applying the regionalization approach to a set of pilot basins in the Upper Colorado basin as part of a NASA-funded project.

  18. Comparison of different methods for the solution of sets of linear equations

    International Nuclear Information System (INIS)

    Bilfinger, T.; Schmidt, F.

    1978-06-01

    The application of the conjugate-gradient methods as novel general iterative methods for the solution of sets of linear equations with symmetrical systems matrices led to this paper, where a comparison of these methods with the conventional differently accelerated Gauss-Seidel iteration was carried out. In additon, the direct Cholesky method was also included in the comparison. The studies referred mainly to memory requirement, computing time, speed of convergence, and accuracy of different conditions of the systems matrices, by which also the sensibility of the methods with respect to the influence of truncation errors may be recognized. (orig.) 891 RW [de

  19. UNIVERSAL REGULAR AUTONOMOUS ASYNCHRONOUS SYSTEMS: ω-LIMIT SETS, INVARIANCE AND BASINS OF ATTRACTION

    Directory of Open Access Journals (Sweden)

    Serban Vlad

    2011-07-01

    Full Text Available The asynchronous systems are the non-deterministic real timebinarymodels of the asynchronous circuits from electrical engineering.Autonomy means that the circuits and their models have no input.Regularity means analogies with the dynamical systems, thus such systems may be considered to be real time dynamical systems with a’vector field’, Universality refers to the case when the state space of the system is the greatest possible in the sense of theinclusion. The purpose of this paper is that of defining, by analogy with the dynamical systems theory, the omega-limit sets, the invariance and the basins of attraction of the universal regular autonomous asynchronous systems.

  20. Theory of the high-frequency limiting viscosity of a dilute polymer solution. Pt. 2

    Energy Technology Data Exchange (ETDEWEB)

    Doi, M; Nakajima, H; Wada, Y

    1976-06-01

    High-frequency limiting viscosities of dilute polymer solutions are calculated on the basis of the author's previous theory for (1) necklace model of a chain with constant bond length and bond angle under a hindering rotational potential, and (2) broken rod model consisting of N rods with equal length connected by universal joints. Exact treatment is possible for a once-broken rod model, but the Monte Carlo method is used in the other calculations.

  1. Evaluating Diagnostic Point-of-Care Tests in Resource-Limited Settings

    Science.gov (United States)

    Drain, Paul K; Hyle, Emily P; Noubary, Farzad; Freedberg, Kenneth A; Wilson, Douglas; Bishai, William; Rodriguez, William; Bassett, Ingrid V

    2014-01-01

    Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs. PMID:24332389

  2. A global limit load solution for plates with surface cracks under combined end force and cross-thickness bending

    International Nuclear Information System (INIS)

    Lei Yuebao; Fox, Mike J.H.

    2011-01-01

    A global limit load solution for rectangular surface cracks in plates under combined end force and cross-thickness bending is derived, which allows any combination of positive/negative end force and positive/negative cross-thickness moment. The solution is based on the net-section plastic collapse concept and, therefore, gives limit load values based on the Tresca yielding criterion. Solutions for both cases with and without crack face contact are derived when whole or part of the crack is located in the compressive stress zone. From the solution, particular global limit load solutions for plates with extended surface cracks and through-thickness cracks under the same loading conditions are obtained. The solution is consistent with the limit load solution for surface cracks in plates under combined tension and positive bending due to Goodall and Webster and Lei when both the applied end force and bending moment are positive. The solution reduces to the limit load solution for plain plates under combined end force and cross-thickness bending when the crack vanishes. - Highlights: → A global limit load solution for plates with surface cracks in plates is derived. → Combined positive/negative end force and positive/negative cross-thickness moment are considered. → The solution is based on the net-section plastic collapse concept.

  3. Bush animal attacks: management of complex injuries in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Mitchell Katrina B

    2011-12-01

    Full Text Available Abstract Introduction Though animal-related injuries and fatalities have been documented throughout the world, the variety of attacks by wild animals native to rural East Africa are less commonly described. Given the proximity of our northwestern Tanzania hospital to Lake Victoria, Lake Tanganyika, and the Serengeti National Park, and presentation of several patients attacked by bush animals and suffering a variety of complex injuries, we sought to report the pattern of attacks and surgical management in a resource-limited setting. Materials and methods Four patients who were admitted to the northwestern Tanzania tertiary referral hospital, Bugando Medical Centre (BMC, in 2010-2011 suffered attacks by different bush animals: hyena, elephant, crocodile, and vervet monkey. These patients were triaged as trauma patients in the Casualty Ward, then admitted for inpatient monitoring and treatment. Their outcomes were followed to discharge. Results The age and gender of the patients attacked was variable, though all but the pediatric patient were participating in food gathering or guarding activities in rural locations at the time of the attacks. All patients required surgical management of their injuries, which included debridement and closure of wounds, chest tube insertion, amputation, and external fixation of an extremity fracture. All patients survived and were discharged home. Discussion Though human injuries secondary to encounters with undomesticated animals such as cows, moose, and camel are reported, they often are indirect traumas resulting from road traffic collisions. Snake attacks are well documented and common. However, this series of unique bush animal attacks describes the initial and surgical management of human injuries in the resource-limited setting of the developing world. Conclusion Animal attacks are common throughout the world, but their pattern may vary in Africa throughout jungle and bush environmental settings. It is

  4. Effect of solvent composition on the limiting current of anodic dissolution of tungsten in aqueous-ethanol solutions of alkali

    International Nuclear Information System (INIS)

    Konoplyantseva, N.A.; L'vova, L.A.; Davydov, A.D.; AN SSSR, Moscow. Inst. Ehlektrokhimii)

    1987-01-01

    The effect of quantitative composition of solvent on tungsten anodic dissolution in aqueous-ethanol solutions of KOH is studied. It is shown that with an increase in ethanol content in aqueous-ethanol solutions of alkali the limiting current of tungsten anodic dissolution decreases. An increase in KOH concentration in certain limits (in ethanol solutions it is the range between 0.75 and 1.0 M KOH) results in the increase of the limiting current; with further increase in solution concentration the limiting current decreases, which can be related to the change of the limiting stage. An assumption is made that total reaction of tungsten anodic dissolution and the main reasons for the limiting current appearance do not change from aqueous to aqueous-ethanol and ethanol solutions of alkali

  5. 12 CFR 714.9 - Are indirect leasing arrangements subject to the purchase of eligible obligation limit set forth...

    Science.gov (United States)

    2010-01-01

    ... the purchase of eligible obligation limit set forth in § 701.23 of this chapter? 714.9 Section 714.9....9 Are indirect leasing arrangements subject to the purchase of eligible obligation limit set forth... underwriting decision and that the lease contract is assigned to you very soon after it is signed by the member...

  6. Emerging technologies in point-of-care molecular diagnostics for resource-limited settings.

    Science.gov (United States)

    Peeling, Rosanna W; McNerney, Ruth

    2014-06-01

    Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.

  7. Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Zolfo Maria

    2010-09-01

    Full Text Available Abstract Background We present an innovative approach to healthcare worker (HCW training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones (Nokia N95 and iPhone, each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation's HIV patients in need are on treatment. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress. A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module. Methods In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction. It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning. Results With a response rate of 90% (18/20 questionnaires returned, the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone. Conclusions Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs. Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.

  8. Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Leski Tomasz A

    2012-07-01

    Full Text Available Abstract Background Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a “cold chain” and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires “leapfrogging” to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries. Methods A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays. Results The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae. Conclusions This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting.

  9. Kangaroo mother care in resource-limited settings: implementation, health benefits, and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-06-01

    Full Text Available Samuel N Uwaezuoke Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria Abstract: Kangaroo mother care (KMC represents an intervention in low birth weight infants for resource-limited settings which aims to reduce mortality rates by thermoregulation, supporting breastfeeding, and promoting early hospital discharge. In terms of cost and impact on neonatal survival, it has comparative advantages over the conventional method of care (CMC. This paper aimed to review the evidence concerning the progress of KMC implementation, its health benefits, and its cost-effectiveness, especially in developing countries. From the synthesized evidence, KMC was shown to be a useful adjunct to CMC particularly with respect to improving neonatal survival, supporting breastfeeding, and promoting early discharge from the hospital. Substantial progress has been made in its implementation in many developing countries where facility-based KMC has been institutionalized. Despite the cost-effectiveness of KMC in neonatal care, its global implementation is bedeviled with country-specific, multifaceted challenges. In developed countries, there is an implementation gap due to easy accessibility to technology-based CMC. Nevertheless, many developing countries have initiated national policies to scale up KMC services in their domain. Given the major constraints to program implementation peculiar to these resource-limited countries, it has become imperative to boost caregiver confidence and experience using dedicated spaces in the hospital, as well as dedicated staff meant for adequate ambulatory follow-up and continuous health education. Capacity training for health professionals and provision of space infrastructure thus constitute the basic needs which could be funded by International Aid Agencies in order to scale up the program in these settings. Keywords: neonatal care, low birth weight infants, thermoregulation, breastfeeding

  10. Prediction of Severe Disease in Children with Diarrhea in a Resource-Limited Setting

    Science.gov (United States)

    Levine, Adam C.; Munyaneza, Richard M.; Glavis-Bloom, Justin; Redditt, Vanessa; Cockrell, Hannah C.; Kalimba, Bantu; Kabemba, Valentin; Musavuli, Juvenal; Gakwerere, Mathias; Umurungi, Jean Paul de Charles; Shah, Sachita P.; Drobac, Peter C.

    2013-01-01

    Objective To investigate the accuracy of three clinical scales for predicting severe disease (severe dehydration or death) in children with diarrhea in a resource-limited setting. Methods Participants included 178 children admitted to three Rwandan hospitals with diarrhea. A local physician or nurse assessed each child on arrival using the World Health Organization (WHO) severe dehydration scale and the Centers for Disease Control (CDC) scale. Children were weighed on arrival and daily until they achieved a stable weight, with a 10% increase between admission weight and stable weight considered severe dehydration. The Clinical Dehydration Scale was then constructed post-hoc using the data collected for the other two scales. Receiver Operator Characteristic (ROC) curves were constructed for each scale compared to the composite outcome of severe dehydration or death. Results The WHO severe dehydration scale, CDC scale, and Clinical Dehydration Scale had areas under the ROC curves (AUCs) of 0.72 (95% CI 0.60, 0.85), 0.73 (95% CI 0.62, 0.84), and 0.80 (95% CI 0.71, 0.89), respectively, in the full cohort. Only the Clinical Dehydration Scale was a significant predictor of severe disease when used in infants, with an AUC of 0.77 (95% CI 0.61, 0.93), and when used by nurses, with an AUC of 0.78 (95% CI 0.63, 0.93). Conclusions While all three scales were moderate predictors of severe disease in children with diarrhea, scale accuracy varied based on provider training and age of the child. Future research should focus on developing or validating clinical tools that can be used accurately by nurses and other less-skilled providers to assess all children with diarrhea in resource-limited settings. PMID:24349271

  11. Ethical considerations in HIV prevention and vaccine research in resource-limited settings.

    Science.gov (United States)

    Garner, Samual A; Anude, Chuka J; Adams, Elizabeth; Dawson, Liza

    2014-09-01

    HIV prevention research has been facing increasing ethical and operational challenges. Factors influencing the design and conduct of HIV prevention trials include a rapidly changing evidence base, new biomedical prevention methods and modalities being tested, a large diversity of countries, sites and populations affected by HIV and participating in trials, and challenges of developing and making available products that will be feasible and affordable for at-risk populations. To discuss these challenges, a meeting, Ethical considerations around novel combination prevention modalities in HIV prevention and vaccine trials in resource-limited settings, was convened by NIH/NIAID/Division of AIDS on April 22-23, 2013. Several themes emerged from the meeting: (1) because of both trial design and ethical complexities, choosing prevention packages and designing combination prevention research trials will need to be evaluated on a case by case basis in different clinical trials, countries, and health systems; (2) multilevel stakeholder engagement from the beginning is vital to a fair and transparent process and also to designing ethical and relevant trials; (3) research should generally be responsive to a host country's needs, and sponsors and stakeholders should work together to address potential barriers to future access; and finally, (4) another meeting including a broader group of stakeholders is needed to address many of the outstanding ethical issues raised by this meeting. We offer an overview of the meeting and the key discussion points and recommendations to help guide the design and conduct of future HIV prevention and vaccine research in resource-limited settings.

  12. Diagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.

    Science.gov (United States)

    Riviello, Elisabeth D; Buregeya, Egide; Twagirumugabe, Theogene

    2017-02-01

    The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification. In the last 18 months, the need for a universally applicable ARDS definition was reinforced by advances in supportive care that can be implemented in resource poor settings. Research demonstrating the variable impact of positive end expiratory pressure on hypoxemia, the validity of using pulse oximetry rather than arterial blood gas to categorize hypoxemia, and the accuracy of lung ultrasound support the use of the Kigali modification of the Berlin definition. Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.

  13. Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study.

    Science.gov (United States)

    Scott, John W; Lin, Yihan; Ntakiyiruta, Georges; Mutabazi, Zeta A; Davis, William Austin; Morris, Megan A; Smink, Douglas S; Riviello, Robert; Yule, Steven

    2018-03-01

    Safe surgery should be available to all patients, no matter the setting. The purpose of this study was to explore the contextual-specific challenges to safe surgical care encountered by surgeons and surgical teams in many in low- and middle-income countries (LMICs), and to understand the ways in which surgical teams overcome them. Optimal surgical performance is highly complex and requires providers to integrate and communicate information regarding the patient, task, team, and environment to coordinate team-based care that is timely, effective, and safe. Resource limitations common to many LMICs present unique challenges to surgeons operating in these environments, but have never been formally described. Using a grounded theory approach, we interviewed 34 experienced providers (surgeons, anesthetists, and nurses) at the 4 tertiary referral centers in Rwanda, to understand the challenges to safe surgical care and strategies to overcome them. Interview transcripts were coded line-by-line and iteratively analyzed for emerging themes until thematic saturation was reached. Rwandan-described challenges related to 4 domains: physical resources, human resources, overall systems support, and communication/language. The majority of these challenges arose from significant variability in either the quantity or quality of these domains. Surgical providers exhibited examples of resilient strategies to anticipate, monitor, respond to, and learn from these challenges. Resource variability rather than lack of resources underlies many contextual challenges to safe surgical care in a LMIC setting. Understanding these challenges and resilient strategies to overcome them is critical for both LMIC surgical providers and surgeons from HICs working in similar settings.

  14. The limits of the nuclear chart set by fission and alpha decay

    Directory of Open Access Journals (Sweden)

    Möller Peter

    2016-01-01

    Full Text Available I will review how our picture of heavy-element nuclear structure has evolved through remarkably simple ideas and related models. It is well known that the Bethe-Weizsäcker semi-empirical mass model had an important role in unraveling radioactive decay and element transmutation in the heavy-element region in the 1930s. A remarkable aspect is that this model could immediately after the discovery of fission be generalized to explain this phenomenon through the consideration of deformation of a charged liquid drop. Bethe and Bacher already raised the possibility that shell structure (by them calculated in terms of a single-particle oscillator potential could give rise to noticeable deviations between results of the macroscopic mass model and experiment but limited data prevented firm conclusions. In the 1950s the single-particle models took a realistic form and also included deformation. The possibility of the existence of a relatively stable “island” of superheavy elements was raised already then. But it was not until the work by Strutinsky in the mid 1960s that a quantitative model for the nuclear potential-energy emerged in the form of the macroscopic-microscopic model. Although new elements have been discovered at an almost steady pace since 1940, theory indicates that we are close to the end of this era: repulsive Coulomb effects will set the limit of observable elements to near Z = 120.

  15. Implications for paediatric shock management in resource-limited settings: a perspective from the FEAST trial.

    Science.gov (United States)

    Houston, Kirsty Anne; George, Elizabeth C; Maitland, Kathryn

    2018-05-04

    Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty. We re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings. We established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%). The updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group

  16. Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities.

    Science.gov (United States)

    Drummond, Jennifer L; Were, Martin C; Arrossi, Silvina; Wools-Kaloustian, Kara

    2017-07-01

    Appropriate collection and use of health information is critical to the planning, scaling up, and improvement of cervical cancer programs. The health information systems implementation landscape is unique to each country; however, systems serving cervical cancer programs in low-resource settings share characteristics that present common challenges. In response, many programs have taken innovative approaches to generating the quality information needed for decision making. Recent advances in health information technology also provide feasible solutions to challenges. This article draws from the experiences of the authors and from current literature to describe outstanding challenges and promising practices in the implementation of cervical cancer data systems, and to make recommendations for next steps. Recommendations include engaging all stakeholders-including providers, program managers, implementing partners, and donors-in promoting national, district, and community information systems; building on existing systems and processes, as well as introducing new technologies; and evolving data collection and data systems as programs advance. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  17. Large-Time Behavior of Solutions to Vlasov-Poisson-Fokker-Planck Equations: From Evanescent Collisions to Diffusive Limit

    Science.gov (United States)

    Herda, Maxime; Rodrigues, L. Miguel

    2018-03-01

    The present contribution investigates the dynamics generated by the two-dimensional Vlasov-Poisson-Fokker-Planck equation for charged particles in a steady inhomogeneous background of opposite charges. We provide global in time estimates that are uniform with respect to initial data taken in a bounded set of a weighted L^2 space, and where dependencies on the mean-free path τ and the Debye length δ are made explicit. In our analysis the mean free path covers the full range of possible values: from the regime of evanescent collisions τ → ∞ to the strongly collisional regime τ → 0. As a counterpart, the largeness of the Debye length, that enforces a weakly nonlinear regime, is used to close our nonlinear estimates. Accordingly we pay a special attention to relax as much as possible the τ -dependent constraint on δ ensuring exponential decay with explicit τ -dependent rates towards the stationary solution. In the strongly collisional limit τ → 0, we also examine all possible asymptotic regimes selected by a choice of observation time scale. Here also, our emphasis is on strong convergence, uniformity with respect to time and to initial data in bounded sets of a L^2 space. Our proofs rely on a detailed study of the nonlinear elliptic equation defining stationary solutions and a careful tracking and optimization of parameter dependencies of hypocoercive/hypoelliptic estimates.

  18. A Review of Darcy's Law: Limitations and Alternatives for Predicting Solute Transport

    Science.gov (United States)

    Steenhuis, Tammo; Kung, K.-J. Sam; Jaynes, Dan; Helling, Charles S.; Gish, Tim; Kladivko, Eileen

    2016-04-01

    Darcy's Law that was derived originally empirically 160 years ago, has been used successfully in calculating the (Darcy) flux in porous media throughout the world. However, field and laboratory experiments have demonstrated that the Darcy flux employed in the convective disperse equation could only successfully predict solute transport under two conditions: (1) uniformly or densely packed porous media; and (2) field soils under relatively dry condition. Employing the Darcy flux for solute transport in porous media with preferential flow pathways was problematic. In this paper we examine the theoretical background behind these field and laboratory observations and then provide an alternative to predict solute movement. By examining the characteristics of the momentum conservation principles on which Darcy's law is based, we show under what conditions Darcy flux can predict solute transport in porous media of various complexity. We find that, based on several case studies with capillary pores, Darcy's Law inherently merges momentum and in that way erases information on pore-scale velocities. For that reason the Darcy flux cannot predict flow in media with preferential flow conduits where individual pore velocities are essential in predicting the shape of the breakthrough curve and especially "the early arrival" of solutes. To overcome the limitations of the assumption in Darcy's law, we use Jury's conceptualization and employ the measured chemical breakthrough curve as input to characterize the impact of individual preferential flow pathways on chemical transport. Specifically, we discuss how best to take advantage of Jury's conceptualization to extract the pore-scale flow velocity to accurately predict chemical transport through soils with preferential flow pathways.

  19. Heat transfer calculations for the High Flux Isotope Reactor (HFIR). Technical specifications: bases for safety limits and limiting safety system settings

    International Nuclear Information System (INIS)

    Sims, T.M.; Swanks, J.H.

    1977-09-01

    Heat transfer analyses, in support of the preparation of the HFIR technical specifications, were made to establish the bases for the safety limits and limiting safety system settings applicable to the HFIR. The results of these analyses, along with the detailed bases, are presented

  20. Weight Estimation Tool for Children Aged 6 to 59 Months in Limited-Resource Settings.

    Science.gov (United States)

    Ralston, Mark E; Myatt, Mark A

    2016-01-01

    A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers. To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries. This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992-2006 using a modified Expanded Program of Immunization two-stage cluster sample design. Locations with high prevalence of acute and chronic malnutrition. A total of 453,990 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values). Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined. Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision. Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and

  1. A New Methodology to Select the Preferred Solutions from the Pareto-optimal Set: Application to Polymer Extrusion

    International Nuclear Information System (INIS)

    Ferreira, Jose C.; Gaspar-Cunha, Antonio; Fonseca, Carlos M.

    2007-01-01

    Most of the real world optimization problems involve multiple, usually conflicting, optimization criteria. Generating Pareto optimal solutions plays an important role in multi-objective optimization, and the problem is considered to be solved when the Pareto optimal set is found, i.e., the set of non-dominated solutions. Multi-Objective Evolutionary Algorithms based on the principle of Pareto optimality are designed to produce the complete set of non-dominated solutions. However, this is not allays enough since the aim is not only to know the Pareto set but, also, to obtain one solution from this Pareto set. Thus, the definition of a methodology able to select a single solution from the set of non-dominated solutions (or a region of the Pareto frontier), and taking into account the preferences of a Decision Maker (DM), is necessary. A different method, based on a weighted stress function, is proposed. It is able to integrate the user's preferences in order to find the best region of the Pareto frontier accordingly with these preferences. This method was tested on some benchmark test problems, with two and three criteria, and on a polymer extrusion problem. This methodology is able to select efficiently the best Pareto-frontier region for the specified relative importance of the criteria

  2. Experiencing a probabilistic approach to clarify and disclose uncertainties when setting occupational exposure limits.

    Science.gov (United States)

    Vernez, David; Fraize-Frontier, Sandrine; Vincent, Raymond; Binet, Stéphane; Rousselle, Christophe

    2018-03-15

    Assessment factors (AFs) are commonly used for deriving reference concentrations for chemicals. These factors take into account variabilities as well as uncertainties in the dataset, such as inter-species and intra-species variabilities or exposure duration extrapolation or extrapolation from the lowest-observed-adverse-effect level (LOAEL) to the noobserved- adverse-effect level (NOAEL). In a deterministic approach, the value of an AF is the result of a debate among experts and, often a conservative value is used as a default choice. A probabilistic framework to better take into account uncertainties and/or variability when setting occupational exposure limits (OELs) is presented and discussed in this paper. Each AF is considered as a random variable with a probabilistic distribution. A short literature was conducted before setting default distributions ranges and shapes for each AF commonly used. A random sampling, using Monte Carlo techniques, is then used for propagating the identified uncertainties and computing the final OEL distribution. Starting from the broad default distributions obtained, experts narrow it to its most likely range, according to the scientific knowledge available for a specific chemical. Introducing distribution rather than single deterministic values allows disclosing and clarifying variability and/or uncertainties inherent to the OEL construction process. This probabilistic approach yields quantitative insight into both the possible range and the relative likelihood of values for model outputs. It thereby provides a better support in decision-making and improves transparency. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  3. Vaccination program in a resource-limited setting: A case study in the Philippines.

    Science.gov (United States)

    Chootipongchaivat, Sarocha; Chantarastapornchit, Varit; Kulpeng, Wantanee; Ceria, Joyce Anne; Tolentino, Niña Isabelle; Teerawattananon, Yot

    2016-09-14

    Implementing national-level vaccination programs involves long-term investment, which can be a significant financial burden, particularly in resource-limited settings. Although many studies have assessed the economic impacts of providing vaccinations, evidence on the positive and negative implications of human resources for health (HRH) is still lacking. Therefore, this study aims to estimate the HRH impact of introducing pneumococcal conjugate vaccine (PCV) using a model-based economic evaluation. This study adapted a Markov model from a prior study that was conducted in the Philippines for assessing the cost-effectiveness of 10-valent and 13-valent PCV compared to no vaccination. The Markov model was used for estimating the number of cases of pneumococcal-related diseases, categorized by policy options. HRH-related parameters were obtained from document reviews and interviews using the quantity, task, and productivity model (QTP model). The number of full-time equivalent (FTE) of general practitioners, nurses, and midwives increases significantly if the universal vaccine coverage policy is implemented. A universal coverage of PCV13 - which is considered to be the best value for money compared to other vaccination strategies - requires an additional 380 FTEs for general practitioners, 602 FTEs for nurses, and 205 FTEs for midwives; it can reduce the number of FTEs for medical social workers, paediatricians, infectious disease specialists, neurologists, anaesthesiologists, radiologists, ultrasonologists, medical technologists, radiologic technologists, and pharmacists by 7, 17.9, 9.7, 0.4, 0.1, 0.7, 0.1, 12.3, 2, and 9.7, respectively, when compared to the no vaccination policy. This is the first attempt to estimate the impact of HRH alongside a model-based economic evaluation study, which can be eventually applied to other vaccine studies, especially those which inform resource allocation in developing settings where not only financial resources but also HRH are

  4. Estimating health workforce needs for antiretroviral therapy in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Fullem Andrew

    2006-01-01

    Full Text Available Abstract Background Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART, for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. Methods We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. Results We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1–2 physicians, 2–7 nurses, Discussion These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

  5. Soil solution interactions may limit Pb remediation using P amendments in an urban soil.

    Science.gov (United States)

    Obrycki, John F; Scheckel, Kirk G; Basta, Nicholas T

    2017-01-01

    Lead (Pb) contaminated soils are a potential exposure hazard to the public. Amending soils with phosphorus (P) may reduce Pb soil hazards. Soil from Cleveland, OH containing 726 ± 14 mg Pb kg -1 was amended in a laboratory study with bone meal and triple super phosphate (TSP) at 5:1 P:Pb molar ratios. Soil was acidified, neturalized and re-acidified to encourage Pb phosphate formation. PRSTM-probes were used to evaluate changes in soil solution chemistry. Soil acidification did not decrease in vitro bioaccessible (IVBA) Pb using either a pH 1.5, 0.4 M glycine solution or a pH 2.5 solution with organic acids. PRSTM-probe data found soluble Pb increased 10-fold in acidic conditions compared to circumnetural pH conditions. In acidic conditions (p = 3-4), TSP treated soils increased detected P 10-fold over untreated soils. Bone meal application did not increase PRSTM-probe detected P, indicating there may have been insufficient P to react with Pb. X-ray absorption spectroscopy suggested a 10% increase in pyromorphite formation for the TSP treated soil only. Treatments increased soil electrical conductivity above 16 mS cm -1 , potentially causing a new salinity hazard. This study used a novel approach by combining the human ingestion endpoint, PRSTM-probes, and X-ray absorption spectroscopy to evaluate treatment efficacy. PRSTM-probe data indicated potentially excess Ca relative to P across incubation steps that could have competed with Pb for soluble P. More research is needed to characterize soil solutions in Pb contaminated urban soils to identify where P treatments might be effective and when competing cations, such as Ca, Fe, and Zn may limit low rate P applications for treating Pb soils. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Strong Migration Limit for Games in Structured Populations: Applications to Dominance Hierarchy and Set Structure

    Directory of Open Access Journals (Sweden)

    Dhaker Kroumi

    2015-09-01

    Full Text Available In this paper, we deduce a condition for a strategy S1 to be more abundant on average at equilibrium under weak selection than another strategy S2 in a population structured into a finite number of colonies of fixed proportions as the population size tends to infinity. It is assumed that one individual reproduces at a time with some probability depending on the payoff received in pairwise interactions within colonies and between colonies and that the offspring replaces one individual chosen at random in the colony into which the offspring migrates. It is shown that an expected weighted average equilibrium frequency of S1 under weak symmetric strategy mutation between S1 and S2 is increased by weak selection if an expected weighted payoff of S1 near neutrality exceeds the corresponding expected weighted payoff of S2. The weights are given in terms of reproductive values of individuals in the different colonies in the neutral model. This condition for S1 to be favoured by weak selection is obtained from a strong migration limit of the genealogical process under neutrality for a sample of individuals, which is proven using a two-time scale argument. The condition is applied to games between individuals in colonies with linear or cyclic dominance and between individuals belonging to groups represented by subsets of a given set.

  7. The introduction of syphilis point of care tests in resource limited settings.

    Science.gov (United States)

    Marks, Michael; Mabey, David Cw

    2017-04-01

    Syphilis remains an important and preventable cause of stillbirth and neonatal mortality. About 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby and 33% a low birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks' gestation. Areas covered: This manuscript covers the impact of syphilis on pregnancy outcome, the diagnosis of syphilis, with a special focus on point of care (POC) tests, and challenges to the introduction of POC tests, and their potential impact on the control and prevention of syphilis in resource limited settings. Expert commentary: POC tests for syphilis are available which meet the ASSURED criteria, and could make syphilis screening accessible to all women anywhere in the world who attend an antenatal clinic. High quality dual POC tests for HIV and syphilis could ensure that well-funded programmes for the prevention of mother to child transmission of HIV can contribute towards increased coverage of antenatal syphilis screening, and prevent more than 300,000 adverse pregnancy outcomes due to syphilis annually. Alongside investment to increase availability of syphilis POC tests, operational research is needed to understand how best to improve screening of pregnant women and to translate test availability into improved pregnancy outcomes.

  8. New nucleic acid testing devices to diagnose infectious diseases in resource-limited settings.

    Science.gov (United States)

    Maffert, P; Reverchon, S; Nasser, W; Rozand, C; Abaibou, H

    2017-10-01

    Point-of-care diagnosis based on nucleic acid testing aims to incorporate all the analytical steps, from sample preparation to nucleic acid amplification and detection, in a single device. This device needs to provide a low-cost, robust, sensitive, specific, and easily readable analysis. Microfluidics has great potential for handling small volumes of fluids on a single platform. Microfluidic technology has recently been applied to paper, which is already used in low-cost lateral flow tests. Nucleic acid extraction from a biological specimen usually requires cell filtration and lysis on specific membranes, while affinity matrices, such as chitosan or polydiacetylene, are well suited to concentrating nucleic acids for subsequent amplification. Access to electricity is often difficult in resource-limited areas, so the amplification step needs to be equipment-free. Consequently, the reaction has to be isothermal to alleviate the need for a thermocycler. LAMP, NASBA, HDA, and RPA are examples of the technologies available. Nucleic acid detection techniques are currently based on fluorescence, colorimetry, or chemiluminescence. For point-of-care diagnostics, the results should be readable with the naked eye. Nowadays, interpretation and communication of results to health professionals could rely on a smartphone, used as a telemedicine device. The major challenge of creating an "all-in-one" diagnostic test involves the design of an optimal solution and a sequence for each analytical step, as well as combining the execution of all these steps on a single device. This review provides an overview of available materials and technologies which seem to be adapted to point-of-care nucleic acid-based diagnosis, in low-resource areas.

  9. Voluntary limit setting and player choice in most intense online gamblers: an empirical study of gambling behaviour.

    Science.gov (United States)

    Auer, Michael; Griffiths, Mark D

    2013-12-01

    Social responsibility in gambling has become a major issue for the gaming industry. The possibility for online gamblers to set voluntary time and money limits are a social responsibility practice that is now widespread among online gaming operators. The main issue concerns whether the voluntary setting of such limits has any positive impact on subsequent gambling behaviour and whether such measures are of help to problem gamblers. In this paper, this issue is examined through data collected from a representative random sample of 100,000 players who gambled on the win2day gambling website. When opening an account at the win2day site, there is a mandatory requirement for all players to set time and cash-in limits (that cannot exceed 800 per week). During a 3-month period, all voluntary time and/or money limit setting behaviour by a subsample of online gamblers (n = 5,000) within this mandatory framework was tracked and recorded for subsequent data analysis. From the 5,000 gamblers, the 10 % most intense players (as measured by theoretical loss) were further investigated. Voluntary spending limits had the highest significant effect on subsequent monetary spending among casino and lottery gamblers. Monetary spending among poker players significantly decreased after setting a voluntary time limit. The highest significant decrease in playing duration was among poker players after setting a voluntary playing duration limit. The results of the study demonstrated that voluntary limit setting had a specific and significant effect on the studied gamblers. Therefore, voluntary limits appear to show an appropriate effect in the desired target group (i.e., the most gaming intense players).

  10. Strategic establishment of an International Pharmacology Specialty Laboratory in a resource-limited setting.

    Science.gov (United States)

    Mtisi, Takudzwa J; Maponga, Charles; Monera-Penduka, Tsitsi G; Mudzviti, Tinashe; Chagwena, Dexter; Makita-Chingombe, Faithful; DiFranchesco, Robin; Morse, Gene D

    2018-01-01

    A growing number of drug development studies that include pharmacokinetic evaluations are conducted in regions lacking a specialised pharmacology laboratory. This necessitated the development of an International Pharmacology Specialty Laboratory (IPSL) in Zimbabwe. The aim of this article is to describe the development of an IPSL in Zimbabwe. The IPSL was developed collaboratively by the University of Zimbabwe and the University at Buffalo Center for Integrated Global Biomedical Sciences. Key stages included infrastructure development, establishment of quality management systems and collaborative mentorship in clinical pharmacology study design and chromatographic assay development and validation. Two high performance liquid chromatography instruments were donated by an instrument manufacturer and a contract research organisation. Laboratory space was acquired through association with the Zimbabwe national drug regulatory authority. Operational policies, standard operating procedures and a document control system were established. Scientists and technicians were trained in aspects relevant to IPSL operations. A high-performance liquid chromatography method for nevirapine was developed with the guidance of the Clinical Pharmacology Quality Assurance programme and approved by the assay method review programme. The University of Zimbabwe IPSL is engaged with the United States National Institute of Allergy and Infectious Diseases Division of AIDS research networks and is poised to begin drug assays and pharmacokinetic analyses. An IPSL has been successfully established in a resource-limited setting through the efforts of an external partnership providing technical guidance and motivated internal faculty and staff. Strategic partnerships were beneficial in navigating challenges leading to laboratory development and training new investigators. The IPSL is now engaged in clinical pharmacology research.

  11. Setting Authorized Limits for Radioactive Discharges: Practical Issues to Consider. Report for Discussion

    International Nuclear Information System (INIS)

    2010-03-01

    Application of the principles of radioactive waste management requires the implementation of measures that afford protection of human health and of the environment, now and in the future. The IAEA has issued safety standards and other publications that provide a framework for the control of releases of radionuclides to the environment. This framework is relevant for regulatory bodies that issue authorizations and for organizations that (i) use radionuclides for medical or research purposes, (ii) operate nuclear reactors or (iii) reprocess nuclear material. An IAEA Safety Guide on Regulatory Control of Radioactive Discharges to the Environment was issued in 2000 that outlines the roles and responsibilities of regulatory bodies, licensees and registrants and provides guidance on the authorization procedure. However, there have been significant developments in radiological protection policy since the publication of this Safety Guide, most notably the issue of ICRP Publications No. 101 on Assessing Dose of the Representative Person for the Purpose of Radiation Protection of the Public and the Optimisation of Radiological Protection and No. 103 on The 2007 Recommendations of the ICRP. The objective of this IAEA-TECDOC is to stimulate discussion on the practical implementation of the control of radioactive releases in order to inform the review and revision of IAEA guidance on this subject. This IAEA-TECDOC is based on the practical experience of Member States and on information provided at Technical Committee Meetings held in 2003 and 2008 and gained by means of a questionnaire. It summarizes international experience on the optimization of discharges and the setting by the regulatory body of authorized limits on discharges for nuclear installations and non-nuclear facilities. Its issue at this stage is intended for consultation as a preparatory step pending the current process of revision of the IAEA's International Basic Safety Standards for Protection against Ionizing

  12. Kinetic-limited etching of magnesium doping nitrogen polar GaN in potassium hydroxide solution

    International Nuclear Information System (INIS)

    Jiang, Junyan; Zhang, Yuantao; Chi, Chen; Yang, Fan; Li, Pengchong; Zhao, Degang; Zhang, Baolin; Du, Guotong

    2016-01-01

    Graphical abstract: - Highlights: • Effects of Mg doping on wet etching of N-polar GaN are illustrated and analysed. • Etching process model of Mg-doped N-polar GaN in KOH solution is purposed. • It is found that Mg doping can induce tensile strain in N-polar GaN film. • N-polar p-GaN film with a hole concentration of 2.4 × 10"1"7 cm"−"3 is obtained. - Abstract: KOH based wet etchings were performed on both undoped and Mg-doped N-polar GaN films grown by metal-organic chemical vapor deposition. It is found that the etching rate for Mg-doped N-polar GaN gets slow obviously compared with undoped N-polar GaN. X-ray photoelectron spectroscopy analysis proved that Mg oxide formed on N-polar GaN surface is insoluble in KOH solution so that kinetic-limited etching occurs as the etching process goes on. The etching process model of Mg-doped N-polar GaN in KOH solution is tentatively purposed using a simplified ideal atomic configuration. Raman spectroscopy analysis reveals that Mg doping can induce tensile strain in N-polar GaN films. Meanwhile, p-type N-polar GaN film with a hole concentration of 2.4 × 10"1"7 cm"−"3 was obtained by optimizing bis-cyclopentadienyl magnesium flow rates.

  13. Kinetic-limited etching of magnesium doping nitrogen polar GaN in potassium hydroxide solution

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Junyan; Zhang, Yuantao; Chi, Chen; Yang, Fan; Li, Pengchong [State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Qianjin Street 2699, Changchun 130012 (China); Zhao, Degang [State Key Laboratory on Integrated Optoelectronics, Institute of Semiconductors, Chinese Academy of Science, PO Box 912, Beijing 100083 (China); Zhang, Baolin; Du, Guotong [State Key Laboratory on Integrated Optoelectronics, College of Electronic Science and Engineering, Jilin University, Qianjin Street 2699, Changchun 130012 (China)

    2016-01-01

    Graphical abstract: - Highlights: • Effects of Mg doping on wet etching of N-polar GaN are illustrated and analysed. • Etching process model of Mg-doped N-polar GaN in KOH solution is purposed. • It is found that Mg doping can induce tensile strain in N-polar GaN film. • N-polar p-GaN film with a hole concentration of 2.4 × 10{sup 17} cm{sup −3} is obtained. - Abstract: KOH based wet etchings were performed on both undoped and Mg-doped N-polar GaN films grown by metal-organic chemical vapor deposition. It is found that the etching rate for Mg-doped N-polar GaN gets slow obviously compared with undoped N-polar GaN. X-ray photoelectron spectroscopy analysis proved that Mg oxide formed on N-polar GaN surface is insoluble in KOH solution so that kinetic-limited etching occurs as the etching process goes on. The etching process model of Mg-doped N-polar GaN in KOH solution is tentatively purposed using a simplified ideal atomic configuration. Raman spectroscopy analysis reveals that Mg doping can induce tensile strain in N-polar GaN films. Meanwhile, p-type N-polar GaN film with a hole concentration of 2.4 × 10{sup 17} cm{sup −3} was obtained by optimizing bis-cyclopentadienyl magnesium flow rates.

  14. Kinetic-limited etching of magnesium doping nitrogen polar GaN in potassium hydroxide solution

    Science.gov (United States)

    Jiang, Junyan; Zhang, Yuantao; Chi, Chen; Yang, Fan; Li, Pengchong; Zhao, Degang; Zhang, Baolin; Du, Guotong

    2016-01-01

    KOH based wet etchings were performed on both undoped and Mg-doped N-polar GaN films grown by metal-organic chemical vapor deposition. It is found that the etching rate for Mg-doped N-polar GaN gets slow obviously compared with undoped N-polar GaN. X-ray photoelectron spectroscopy analysis proved that Mg oxide formed on N-polar GaN surface is insoluble in KOH solution so that kinetic-limited etching occurs as the etching process goes on. The etching process model of Mg-doped N-polar GaN in KOH solution is tentatively purposed using a simplified ideal atomic configuration. Raman spectroscopy analysis reveals that Mg doping can induce tensile strain in N-polar GaN films. Meanwhile, p-type N-polar GaN film with a hole concentration of 2.4 ÿ 1017 cm⿿3 was obtained by optimizing bis-cyclopentadienyl magnesium flow rates.

  15. 78 FR 70414 - Pricing for the 2013 United States Mint Limited Edition Silver Proof SetTM

    Science.gov (United States)

    2013-11-25

    ... DEPARTMENT OF THE TREASURY United States Mint Pricing for the 2013 United States Mint Limited Edition Silver Proof Set TM AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing a price of $139.95 for the 2013 United States Mint Limited...

  16. The accountability for reasonableness approach to guide priority setting in health systems within limited resources

    DEFF Research Database (Denmark)

    Byskov, Jens; Marchal, Bruno; Maluka, Stephen

    2014-01-01

    : relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). METHODS...... of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications....

  17. Comparative study on system requirements and success factors of telemedicine solutions in resource-poor settings

    OpenAIRE

    Dawson, Joanna Adobea

    2011-01-01

    Rationale: Attempts to successfully develop telemedicine solutions by specifying the require-ments and critical success factors of these solutions are on-going in sub-Saharan Africa (SSA) countries as a means of improving access to high-quality healthcare. European Space Agency (ESA) (Dario et al. 2005) have explored the challenges and benefits of telemedicine solutions in these regions in the domains of eGovernment such as billing and administrative data management to support the healthcare ...

  18. ABOUT SOME APPROXIMATIONS TO THE CLOSED SET OF NOT TRIVIAL SOLUTIONS OF THE EQUATIONS OF GINZBURG - LANDAU

    Directory of Open Access Journals (Sweden)

    A. A. Fonarev

    2014-01-01

    Full Text Available Possibility of use of a projective iterative method for search of approximations to the closed set of not trivial generalised solutions of a boundary value problem for Ginzburg - Landau's equations of the phenomenological theory of superconduction is investigated. The projective iterative method combines a projective method and iterative process. The generalised solutions of a boundary value problem for Ginzburg - Landau's equations are critical points of a functional of a superconductor free energy.

  19. On existence solutions and solution sets of differential equations and differential inclusions with delay in Banach spaces

    Directory of Open Access Journals (Sweden)

    A.M. Gomaa

    2012-07-01

    (Qx·(t∈A(tx(t+Fd(t,θtx,t∈[0,T],x=C,on[-d,0], where Fd : [0,T] × CE([−d,0] → Pfc(E, Pfc(E is the set of all nonempty closed convex subsets of E while θt : CE([−d,t] → CE([−d,0] defined by θtx(s = x(t + s ∀ x ∈ CE([−d,t], ∀s ∈ [−d,0] and {A(t : 0 ⩽ t ⩽ b} is a family of densely defined closed linear operators generating a continuous evolution operator S(t,s.

  20. EXTRA: a digital computer program for the solution of stiff sets of ordinary initial value, first order differential equations

    International Nuclear Information System (INIS)

    Sidell, J.

    1976-08-01

    EXTRA is a program written for the Winfrith KDF9 enabling the user to solve first order initial value differential equations. In this report general numerical integration methods are discussed with emphasis on their application to the solution of stiff sets of equations. A method of particular applicability to stiff sets of equations is described. This method is incorporated in the program EXTRA and full instructions for its use are given. A comparison with other methods of computation is included. (author)

  1. Effect of pH Upper Control Limit on Nutrient Solution Component and Water Spinach Growth under Hydroponics

    OpenAIRE

    Xuzhang Xue; Yinkun Li; Feng Li; Fang Zhang; Wenzhong Guo

    2015-01-01

    In this study, experiment with four levels of nutrient solution pH control upper limit was conducted to explore the optimal nutrient solution pH management scheme under hydroponics by evaluating the nutrient solution characters i.e., pH, Electric Conductivity (EC), nitrate, soluble phosphorus (soluble-P), water spinach growth and quality. The results showed that the nutrient solution pH was 8.2 and unsuitable for water spinach growth under the treatment with no pH regulation during the experi...

  2. Pollen limitation and its influence on natural selection through seed set.

    Science.gov (United States)

    Bartkowska, M P; Johnston, M O

    2015-11-01

    Stronger pollen limitation should increase competition among plants, leading to stronger selection on traits important for pollen receipt. The few explicit tests of this hypothesis, however, have provided conflicting support. Using the arithmetic relationship between these two quantities, we show that increased pollen limitation will automatically result in stronger selection (all else equal) although other factors can alter selection independently of pollen limitation. We then tested the hypothesis using two approaches. First, we analysed the published studies containing information on both pollen limitation and selection. Second, we explored how natural selection measured in one Ontario population of Lobelia cardinalis over 3 years and two Michigan populations in 1 year relates to pollen limitation. For the Ontario population, we also explored whether pollinator-mediated selection is related to pollen limitation. Consistent with the hypothesis, we found an overall positive relationship between selection strength and pollen limitation both among species and within L. cardinalis. Unexpectedly, this relationship was found even for vegetative traits among species, and was not found in L. cardinalis for pollinator-mediated selection on nearly all trait types. © 2015 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2015 European Society For Evolutionary Biology.

  3. Limit loads for piping branch junctions under internal pressure and in-plane bending-Extended solutions

    International Nuclear Information System (INIS)

    Kim, Yun-Jae; Lee, Kuk-Hee; Park, Chi-Yong

    2008-01-01

    The authors have previously proposed plastic limit load solutions for thin-walled branch junctions under internal pressure and in-plane bending, based on finite element (FE) limit loads resulting from three-dimensional (3-D) FE limit analyses using elastic-perfectly plastic materials [Kim YJ, Lee KH, Park CY. Limit loads for thin-walled piping branch junctions under internal pressure and in-plane bending. Int J Press Vessels Piping 2006;83:645-53]. The solutions are valid for ratios of the branch-to-run pipe radius and thickness from 0.4 to 1.0, and for the mean radius-to-thickness ratio of the run pipe from 10.0 to 20.0. Moreover, the solutions considered the case of in-plane bending only on the branch pipe. This paper extends the previous solutions in two aspects. Firstly, plastic limit load solutions are given also for in-plane bending on the run pipe. Secondly, the validity of the proposed solutions is extended to ratios of the branch-to-run pipe radius and thickness from 0.0 to 1.0, and the mean radius-to-thickness ratio of the run pipe from 5.0 to 20.0. Comparisons with FE results show good agreement

  4. The Train Driver Recovery Problem - a Set Partitioning Based Model and Solution Method

    DEFF Research Database (Denmark)

    Rezanova, Natalia Jurjevna; Ryan, David

    The need to recover a train driver schedule occurs during major disruptions in the daily railway operations. Using data from the train driver schedule of the Danish passenger railway operator DSB S-tog A/S, a solution method to the Train Driver Recovery Problem (TDRP) is developed. The TDRP...... the depth-first search of the Branch & Bound tree. Preliminarily results are encouraging, showing that nearly all tested real-life instances produce integer solutions to the LP relaxation and solutions are found within a few seconds....

  5. Creating Online Training for Procedures in Global Health with PEARLS (Procedural Education for Adaptation to Resource-Limited Settings).

    Science.gov (United States)

    Bensman, Rachel S; Slusher, Tina M; Butteris, Sabrina M; Pitt, Michael B; On Behalf Of The Sugar Pearls Investigators; Becker, Amanda; Desai, Brinda; George, Alisha; Hagen, Scott; Kiragu, Andrew; Johannsen, Ron; Miller, Kathleen; Rule, Amy; Webber, Sarah

    2017-11-01

    The authors describe a multiinstitutional collaborative project to address a gap in global health training by creating a free online platform to share a curriculum for performing procedures in resource-limited settings. This curriculum called PEARLS (Procedural Education for Adaptation to Resource-Limited Settings) consists of peer-reviewed instructional and demonstration videos describing modifications for performing common pediatric procedures in resource-limited settings. Adaptations range from the creation of a low-cost spacer for inhaled medications to a suction chamber for continued evacuation of a chest tube. By describing the collaborative process, we provide a model for educators in other fields to collate and disseminate procedural modifications adapted for their own specialty and location, ideally expanding this crowd-sourced curriculum to reach a wide audience of trainees and providers in global health.

  6. Effect of a limited-enforcement intelligent tutoring system in dermatopathology on student errors, goals and solution paths.

    Science.gov (United States)

    Payne, Velma L; Medvedeva, Olga; Legowski, Elizabeth; Castine, Melissa; Tseytlin, Eugene; Jukic, Drazen; Crowley, Rebecca S

    2009-11-01

    Determine effects of a limited-enforcement intelligent tutoring system in dermatopathology on student errors, goals and solution paths. Determine if limited enforcement in a medical tutoring system inhibits students from learning the optimal and most efficient solution path. Describe the type of deviations from the optimal solution path that occur during tutoring, and how these deviations change over time. Determine if the size of the problem-space (domain scope), has an effect on learning gains when using a tutor with limited enforcement. Analyzed data mined from 44 pathology residents using SlideTutor-a Medical Intelligent Tutoring System in Dermatopathology that teaches histopathologic diagnosis and reporting skills based on commonly used diagnostic algorithms. Two subdomains were included in the study representing sub-algorithms of different sizes and complexities. Effects of the tutoring system on student errors, goal states and solution paths were determined. Students gradually increase the frequency of steps that match the tutoring system's expectation of expert performance. Frequency of errors gradually declines in all categories of error significance. Student performance frequently differs from the tutor-defined optimal path. However, as students continue to be tutored, they approach the optimal solution path. Performance in both subdomains was similar for both errors and goal differences. However, the rate at which students progress toward the optimal solution path differs between the two domains. Tutoring in superficial perivascular dermatitis, the larger and more complex domain was associated with a slower rate of approximation towards the optimal solution path. Students benefit from a limited-enforcement tutoring system that leverages diagnostic algorithms but does not prevent alternative strategies. Even with limited enforcement, students converge toward the optimal solution path.

  7. Prehospital care practices for venomous snakebites in resource-limited settings: A narrative review

    Directory of Open Access Journals (Sweden)

    Godpower Chinedu Michael

    2017-01-01

    Full Text Available Venomous snakebite is a medical emergency encountered worldwide, especially in resource-limited communities. It usually leaves victims at the mercy of traditional care, whose effectiveness have come under scrutiny over time. Several of these traditional/ first aid practices have also been reported over time. Controversies over their efficacy often result in confusion among snakebite victims, their caregivers, and sometimes, among health-care providers. This narrative review describes reported prehospital interventions for venomous snakebites highlighting their usefulness, dangers, and/or limitations associated with their use and the currently widely recommended prehospital activities for venomous snakebite.

  8. An improved method for setting upper limits with small numbers of events

    International Nuclear Information System (INIS)

    Swartz, M.L.

    1990-01-01

    We note that most experimental searches for rare phenomena actually measure the ratio of the number of event candidates to the number of some normalizing events. These measurements are most naturally interpreted within the framework of binomial or trinomial statistics. We present a general expression, based upon a classical treatment, that accounts for statistical normalization errors and incorporates expected background rates. The solutions of this expression converge to the standard Poisson values when the number of normalizing events is larger than a few hundred. (orig.)

  9. Modular Laboratories—Cost-Effective and Sustainable Infrastructure for Resource-Limited Settings

    Science.gov (United States)

    Bridges, Daniel J.; Colborn, James; Chan, Adeline S. T.; Winters, Anna M.; Dengala, Dereje; Fornadel, Christen M.; Kosloff, Barry

    2014-01-01

    High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. PMID:25223943

  10. A New Global Vertical Land Movement Data Set from the TIGA Combined Solution

    Science.gov (United States)

    Hunegnaw, Addisu; Teferle, Felix Norman; Ebuy Abraha, Kibrom; Santamaría-Gómez, Alvaro; Gravelle, Médéric; Wöppelman, Guy; Schöne, Tilo; Deng, Zhiguo; Bingley, Richard; Hansen, Dionne Nicole; Sanchez, Laura; Moore, Michael; Jia, Minghai

    2017-04-01

    Globally averaged sea level has been estimated from the network of tide gauges installed around the world since the 19th century. These mean sea level (MSL) records provide sea level relative to a nearby tide gauge benchmark (TGBM), which allows for the continuation of the instrumental record in time. Any changes in the benchmark levels, induced by vertical land movements (VLM) affect the MSL records and hence sea level estimates. Over the last two decades sea level has also been observed using satellite altimeters. While the satellite observations are globally more homogeneous providing a picture of sea level not confined to coastlines, they require the VLM-corrected MSL records for the bias calibration of instrumental drifts. Without this calibration altimeter instruments from different missions cannot be combined. GPS has made it possible to obtain highly accurate estimates of VLM in a geocentric reference frame for stations at or close to tide gauges. Under the umbrella of the International GNSS Service (IGS), the Tide Gauge Benchmark Monitoring (TIGA) Working Group (WG) has been established to apply the expertise of the GNSS community to solving issues related to the accuracy and reliability of the vertical component to provide estimates of VLM in a well-defined global reference frame. To achieve this objective, five TIGA Analysis Centers (TACs) contributed re-processed global GPS network solutions to TIGA, employing the latest bias models and processing strategies in accordance with the second re-processing campaign (repro2) of the IGS. These solutions include those of the British Isles continuous GNSS Facility - University of Luxembourg consortium (BLT), the German Research Centre for Geosciences (GFZ) Potsdam, the German Geodetic Research Institute (DGF) at the Technical University of Munich, Geoscience Australia (AUT) and the University of La Rochelle (ULR). In this study we present to the sea level community an evaluation of the VLM estimates from the

  11. 17 CFR 150.5 - Exchange-set speculative position limits.

    Science.gov (United States)

    2010-04-01

    ..., straddles, or arbitrage,” of from fixing limits which apply to such positions which are different from... opportunity for arbitrage between the futures market and the cash market in the commodity underlying the... pursuant to this section shall apply to bona fide hedging positions as defined by a contract market in...

  12. ROBUST ESTIMATION OF MEAN AND VARIANCE USING ENVIRONMENTAL DATA SETS WITH BELOW DETECTION LIMIT OBSERVATIONS

    Science.gov (United States)

    Scientists, especially environmental scientists often encounter trace level concentrations that are typically reported as less than a certain limit of detection, L. Type 1, left-censored data arise when certain low values lying below L are ignored or unknown as they cannot be mea...

  13. Proposals for setting possible limits on intake of transuranium radionuclides absorbed from the gastrointestinal tract

    International Nuclear Information System (INIS)

    Zalikin, G.A.; Nisimov, P.G.

    1987-01-01

    The absorption of transuranium elements ( 238 Pu, 241 Am, 252 Cf) from the gastrointestinal (GI) tract as influenced by physiological factors (e.g. age) and physical and chemical properties of compounds incorporated has been studied in 600 white mongrel rats. Average values of absorption have been determined for simple salts and a complex citrate. A number of factors increasing absorption have been found. Thus, originally bound compounds contained in the meat of animals incorporated with 238 Pu and 241 Am when alive, 241 Am-containing potato juice and green oat stalks enhanced absorption by a factor of 5 to 30 as compared with an adequate control. Ethanol administered orally as a 20% solution increased the absorption of americium nitrate by 60% and that of citrate by 23%. Oral administratio of 241 Am nitrate solution together with ferric chloride changes the metabolic kinetics of the nuclide completely. The total absorption of americium from DI tract is 7.1 times that of the control, but a considerable fraction absorbed into blood is excreted with urine (4.2% over 8 days). Among physiological factors age effects the absorption of transuranics from the GI tract to acertain degree. The absorption of 252 Cf in 7 day-old young rats proves to be 8.1 times that of adults. Gestation brought about a 2.7 fold increase of 241 Am absorption

  14. Control-free control: Manipulating a quantum system using only a limited set of measurements

    International Nuclear Information System (INIS)

    Ashhab, S.; Nori, Franco

    2010-01-01

    We present and discuss different protocols for preparing an arbitrary quantum state of a qubit using only a restricted set of measurements, with no unitary operations at all. We show that an arbitrary state can indeed be prepared, provided that the available measurements satisfy certain requirements. Our results shed light on the role that measurement-induced back-action plays in quantum feedback control and the extent to which this back-action can be exploited in quantum-control protocols.

  15. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings

    OpenAIRE

    Raghubanshi, Bijendra Raj; Sapkota, Supriya; Adhikari, Arjab; Dutta, Aman; Bhattarai, Utsuk; Bhandari, Rastriyata

    2017-01-01

    Abstract Background In developing countries like Nepal, 90% ethanol is cheap and is available in most hospitals. The unavailability of isopropyl alcohol (IPA) in these settings led us to compare the efficacy between 90% ethanol and isopropyl alcohol pads in reducing the bacterial contamination of diaphragm of stethoscope. Methods A randomized blinded experimental study was carried out to determine the difference between cleaning stethoscopes with 90% ethanol and IPA. Cultures of diaphragm wer...

  16. Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings.

    Science.gov (United States)

    Bennett, Desmond J; Carroll, Ryan W; Kacmarek, Robert M

    2018-04-01

    Respiratory compromise is a leading contributor to global neonatal death. CPAP is a method of treatment that helps maintain lung volume during expiration, promotes comfortable breathing, and improves oxygenation. Bubble CPAP is an effective alternative to standard CPAP. We sought to determine the reliability and functionality of a low-cost bubble CPAP device designed for low-resource settings. The low-cost bubble CPAP device was compared to a commercially available bubble CPAP system. The devices were connected to a lung simulator that simulated neonates of 4 different weights with compromised respiratory mechanics (∼1, ∼3, ∼5, and ∼10 kg). The devices' abilities to establish and maintain pressure and flow under normal conditions as well as under conditions of leak were compared. Multiple combinations of pressure levels (5, 8, and 10 cm H 2 O) and flow levels (3, 6, and 10 L/min) were tested. The endurance of both devices was also tested by running the systems continuously for 8 h and measuring the changes in pressure and flow. Both devices performed equivalently during the no-leak and leak trials. While our testing revealed individual differences that were statistically significant and clinically important (>10% difference) within specific CPAP and flow-level settings, no overall comparisons of CPAP or flow were both statistically significant and clinically important. Each device delivered pressures similar to the desired pressures, although the flows delivered by both machines were lower than the set flows in most trials. During the endurance trials, the low-cost device was marginally better at maintaining pressure, while the commercially available device was better at maintaining flow. The low-cost bubble CPAP device evaluated in this study is comparable to a bubble CPAP system used in developed settings. Extensive clinical trials, however, are necessary to confirm its effectiveness. Copyright © 2018 by Daedalus Enterprises.

  17. Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings.

    Science.gov (United States)

    Graham, Stephen M; English, Mike; Hazir, Tabish; Enarson, Penny; Duke, Trevor

    2008-05-01

    Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

  18. Regulatory challenges associated with conducting multicountry clinical trials in resource-limited settings.

    Science.gov (United States)

    Ndebele, Paul; Blanchard-Horan, Christina; Shahkolahi, Akbar; Sanne, Ian

    2014-01-01

    International public health and infectious diseases research has expanded to become a global enterprise transcending national and continental borders in organized networks addressing high-impact diseases. In conducting multicountry clinical trials, sponsors and investigators have to ensure that they meet regulatory requirements in all countries in which the clinical trials will be conducted. Some of these requirements include review and approval by national drug regulatory authorities and recognized research ethics committees. A limiting factor to the efficient conduct of multicountry clinical trials is the regulatory environment in each collaborating country, with significant differences determined by various factors including the laws and the procedures used in each country. The long regulatory processes in resource-limited countries may hinder the efficient implementation of multisite clinical trials, delaying research important to the health of populations in these countries and costing millions of dollars a year.

  19. A Program to Provide Vocational Training to Limited English Speaking Adults in a Correctional Setting. Final Report.

    Science.gov (United States)

    Murray, Lane

    The Windham School System implemented a pilot project designed to provide bilingual vocational training to limited English-speaking adults in a correctional setting. Inmate students enrolled in Windham bilingual academic classes on the Eastham Unit of the Texas Department of Corrections were interviewed, and procedures for student screening and…

  20. Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting

    NARCIS (Netherlands)

    van Zyl, Gert Uves; van Mens, Thijs E.; McIlleron, Helen; Zeier, Michele; Nachega, Jean B.; Decloedt, Eric; Malavazzi, Carolina; Smith, Peter; Huang, Yong; van der Merwe, Lize; Gandhi, Monica; Maartens, Gary

    2011-01-01

    In resource-limited settings, many patients, with no prior protease inhibitor (PI) treatment on a second-line, high genetic barrier, ritonavir-boosted PI-containing regimen have virologic failure. We conducted a cross-sectional survey to investigate the aetiology of virologic failure in 2 public

  1. Acceptability of donated breast milk in a resource limited South African setting

    OpenAIRE

    Coutsoudis Anna; Petrites Alissa; Coutsoudis Irene

    2011-01-01

    Abstract Background The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of th...

  2. Modular laboratories--cost-effective and sustainable infrastructure for resource-limited settings.

    Science.gov (United States)

    Bridges, Daniel J; Colborn, James; Chan, Adeline S T; Winters, Anna M; Dengala, Dereje; Fornadel, Christen M; Kosloff, Barry

    2014-12-01

    High-quality laboratory space to support basic science, clinical research projects, or health services is often severely lacking in the developing world. Moreover, the construction of suitable facilities using traditional methods is time-consuming, expensive, and challenging to implement. Three real world examples showing how shipping containers can be converted into modern laboratories are highlighted. These include use as an insectary, a molecular laboratory, and a BSL-3 containment laboratory. These modular conversions have a number of advantages over brick and mortar construction and provide a cost-effective and timely solution to offer high-quality, user-friendly laboratory space applicable within the developing world. © The American Society of Tropical Medicine and Hygiene.

  3. Extending the charge-flipping method towards structure solution from incomplete data sets

    Czech Academy of Sciences Publication Activity Database

    Palatinus, Lukáš; Steurer, W.; Chapuis, G.

    2007-01-01

    Roč. 40, - (2007), s. 456-462 ISSN 0021-8898 Institutional research plan: CEZ:AV0Z10100521 Keywords : ab initio structure solution * density modification * maximum entropy method * intensity extrapolation Subject RIV: BM - Solid Matter Physics ; Magnetism Impact factor: 3.629, year: 2007

  4. Social construction and materiality: the limits of indeterminacy in therapeutic settings.

    Science.gov (United States)

    Lannamann, J W

    1998-01-01

    By drawing parallels between the courtroom testimony of a Christian Science practitioner and an intersession conversation between systemic family therapists, I critique the abstract idealism of language-centered social constructionism. I argue that social constructionist inquiry that highlights the indeterminacy of meaning without a corresponding emphasis on the responsive embodied practices of family members glosses over the material conditions shaping the politics of interaction. The implications of this problem are discussed as they relate to the setting of family therapy, where social construction theory is often used to guide practical interventions.

  5. Optimal allocation of the limited oral cholera vaccine supply between endemic and epidemic settings.

    Science.gov (United States)

    Moore, Sean M; Lessler, Justin

    2015-10-06

    The World Health Organization (WHO) recently established a global stockpile of oral cholera vaccine (OCV) to be preferentially used in epidemic response (reactive campaigns) with any vaccine remaining after 1 year allocated to endemic settings. Hence, the number of cholera cases or deaths prevented in an endemic setting represents the minimum utility of these doses, and the optimal risk-averse response to any reactive vaccination request (i.e. the minimax strategy) is one that allocates the remaining doses between the requested epidemic response and endemic use in order to ensure that at least this minimum utility is achieved. Using mathematical models, we find that the best minimax strategy is to allocate the majority of doses to reactive campaigns, unless the request came late in the targeted epidemic. As vaccine supplies dwindle, the case for reactive use of the remaining doses grows stronger. Our analysis provides a lower bound for the amount of OCV to keep in reserve when responding to any request. These results provide a strategic context for the fulfilment of requests to the stockpile, and define allocation strategies that minimize the number of OCV doses that are allocated to suboptimal situations. © 2015 The Authors.

  6. MMPI-2 Symptom Validity (FBS) Scale: psychometric characteristics and limitations in a Veterans Affairs neuropsychological setting.

    Science.gov (United States)

    Gass, Carlton S; Odland, Anthony P

    2014-01-01

    The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

  7. Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

    Science.gov (United States)

    Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

    2018-01-01

    Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  8. Lumbar Radiculopathy in the Setting of Degenerative Scoliosis: MIS Decompression and Limited Correction are Better Options.

    Science.gov (United States)

    Fontes, Ricardo B; Fessler, Richard G

    2017-07-01

    Surgery for adult spinal deformity (ASD) has emerged as an efficient treatment alternative, but it is fraught with potential perioperative morbidity, incompletely mitigated by emerging minimally invasive surgical techniques. In mild-to-moderate ASD balanced in the sagittal plane, there are situations in which the counterintuitive simple decompression through a foraminotomy or laminectomy, or even a short-segment fusion may be an attractive treatment. This article presents a case example and the authors' treatment rationale and reviews the limited available literature supporting it. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. The zero mass limit of Kerr and Kerr-(anti-)de-Sitter space-times: exact solutions and wormholes

    Science.gov (United States)

    Birkandan, T.; Hortaçsu, M.

    2018-03-01

    Heun-type exact solutions emerge for both the radial and the angular equations for the case of a scalar particle coupled to the zero mass limit of both the Kerr and Kerr-(anti)de-Sitter spacetime. Since any type D metric has Heun-type solutions, it is interesting that this property is retained in the zero mass case. This work further refutes the claims that M going to zero limit of the Kerr metric is both locally and globally the same as the Minkowski metric.

  10. Analytical steady-state solutions for water-limited cropping systems using saline irrigation water

    Science.gov (United States)

    Skaggs, T. H.; Anderson, R. G.; Corwin, D. L.; Suarez, D. L.

    2014-12-01

    Due to the diminishing availability of good quality water for irrigation, it is increasingly important that irrigation and salinity management tools be able to target submaximal crop yields and support the use of marginal quality waters. In this work, we present a steady-state irrigated systems modeling framework that accounts for reduced plant water uptake due to root zone salinity. Two explicit, closed-form analytical solutions for the root zone solute concentration profile are obtained, corresponding to two alternative functional forms of the uptake reduction function. The solutions express a general relationship between irrigation water salinity, irrigation rate, crop salt tolerance, crop transpiration, and (using standard approximations) crop yield. Example applications are illustrated, including the calculation of irrigation requirements for obtaining targeted submaximal yields, and the generation of crop-water production functions for varying irrigation waters, irrigation rates, and crops. Model predictions are shown to be mostly consistent with existing models and available experimental data. Yet the new solutions possess advantages over available alternatives, including: (i) the solutions were derived from a complete physical-mathematical description of the system, rather than based on an ad hoc formulation; (ii) the analytical solutions are explicit and can be evaluated without iterative techniques; (iii) the solutions permit consideration of two common functional forms of salinity induced reductions in crop water uptake, rather than being tied to one particular representation; and (iv) the utilized modeling framework is compatible with leading transient-state numerical models.

  11. Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti.

    Science.gov (United States)

    Rouhani, Shada A; Israel, Kerling; Leandre, Fernet; Pierre, Sosthène; Bollman, Brennan; Marsh, Regan H

    2018-04-06

    In many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists. In conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care. Fourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful. Key components to our program's success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels. Medium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings.

  12. Modelling of Split Condenser Heat Pump with Limited Set of Plate Heat Exchanger Dimensions

    DEFF Research Database (Denmark)

    Christensen, Stefan Wuust; Elmegaard, Brian; Markussen, Wiebke Brix

    2017-01-01

    in parallel to different temperature levels, whereas only one stream is heated in a THP. The length/width ratio of the plate heat exchangers on the high pressure side of a SCHP was investigated to find the optimal plate dimensions with respect to minimum area of the heat exchangers. The total heat exchanger...... area was found to decrease with an increasing length/width ratio of the plates. The marginal change in heat exchanger area was shown to be less significant for heat exchangers with high length/width ratios. In practice only a limited number of plate dimensions are available and feasible...... in the production. This was investigated to find the practical potential of a SCHP compared to a THP. Using plates optimized for a SCHP in a THP, the total required heat exchanger area increased by approximately 100% for the conditions investigated in this study, indicating that available plate dimensions influence...

  13. Rules and recent trends for setting health-based occupational exposure limits for chemicals

    Directory of Open Access Journals (Sweden)

    Jolanta Skowroń

    2015-04-01

    Full Text Available The working environment is the special case of the non-natural environment created by man in which the increased production activity brings about the concentration of stimulators particularly aggressive to the human organism, such as chemical hazards, noise, vibration, extreme temperatures, and finally, intensified psychological and emotional stress. Depending on the nature and intensity, working environment factors have been classified into dangerous, harmful and annoying. The workers are more and more frequently exposed to dangerous chemicals in the working environment. The chemicals cause many diseases including, in the 1st place, respiratory insufficiency, inflammatory skin conditions, psychoneurological disorders and neoplastic diseases. Occupational exposure limit values (OELs, the main criteria for occupational exposure assessment, constitute an important factor for the safe use of chemicals in the working environment. In Poland, to date there are 524 chemical substances and 19 dusts for which maximum admissible concentrations (MAC have been established.

  14. Setting limits: Using air pollution thresholds to protect and restore US ecosystems

    Science.gov (United States)

    Fenn, Mark E.; Lambert, Kathleen F.; Blett, Tamara F.; Burns, Douglas A.; Pardo, Linda H.; Lovett, Gary M.; Haeuber, Richard A.; Evers, David C.; Driscoll, Charles T.; Jeffries, Dean S.

    2011-01-01

    More than four decades of research provide unequivocal evidence that sulfur, nitrogen, and mercury pollution have altered, and will continue to alter, our nation's lands and waters. The emission and deposition of air pollutants harm native plants and animals, degrade water quality, affect forest productivity, and are damaging to human health. Many air quality policies limit emissions at the source but these control measures do not always consider ecosystem impacts. Air pollution thresholds at which ecological effects are observed, such as critical loads, are effective tools for assessing the impacts of air pollution on essential ecosystem services and for informing public policy. U.S. ecosystems can be more effectively protected and restored by using a combination of emissions-based approaches and science-based thresholds of ecosystem damage.

  15. Setting Up a Limited Liability Company with Sole Shareholder in the European Union Countries

    Directory of Open Access Journals (Sweden)

    Simona Petrina GAVRILA

    2011-11-01

    Full Text Available Given the importance of legal rules as closely as possible to the legal systems of the European Union Member States in respect of the companies, several directives have been adopted, of which twelve present the essence of the operational mechanisms harmonization . The consecration of single-member company in positive law is determined by multiple motivations, and the relevance of its objectives is complex, for the reason of the diverse role it plays in the economic and social life, from which the existence of different single-member business derives:limited liability company, joint stock company, simplified joint stock company, dedicated assets, subjected to a personal legal system, difficult to compare, each of them to be therefore studied in the legal, economic, social and tax context of each country.

  16. Implications for Firms with Limited Information to Take Advantage of Reference Price Effect in Competitive Settings

    Directory of Open Access Journals (Sweden)

    Junhai Ma

    2017-01-01

    Full Text Available This paper studies internal reference price effects when competitive firms face reference price effects and make decisions based on partial information, where their decision-making mechanism is modeled by a dynamic adjustment process. It is shown that the evolution of this dynamic adjustment goes to stabilization if both adjustment speeds are small and the complexity of this evolution increases in adjustment speeds. It is proved that the necessary condition for flip bifurcation or Neimark-Sacker bifurcation will occur with the increase of adjustment speed in two special cases. What is more, numerical simulations show that these bifurcations do occur. Then, the impacts of parameters on stability and profits are investigated and some management insights for firms with limited information to take advantage of reference price effects are provided.

  17. Internal Dosimetry Monitoring- Detection Limits for a Selected Set of Radionuclides and Their Translation Into Committed Effective Dose

    International Nuclear Information System (INIS)

    Brandl, A.; Hrnecek, E.; Steger, F.

    2004-01-01

    To harmonize the practice of internal dosimetry monitoring across the country, the Austrian Standards Institute is currently drafting a new set of standards which are concerned with occupational incorporation monitoring of individuals handling non-sealed radioactive material. This set of standards is expected to consist of three parts discussing the general necessity and frequency, the requirements for monitoring institutions, and the determination and rigorous calculation of committed effective dose after incorporation of radioactive material, respectively. Considerations of the requirements for routine monitoring laboratories have led to an evaluation of the detection limits for routine monitoring equipment. For a selected set of radionuclides, these detection limits are investigated in detail. The main emphasis is placed on the decay chains of naturally occurring radionuclides showing some significant potential for being out of equilibrium due to chemical processes in certain mining industries. The radionuclides considered in this paper are 226Ra, 228Ra, 228Th, 232Th, 234U, 235U, and 238U. Given the routine monitoring intervals of the Austrian Standard, these detection limits are translated into information on committed effective dose. This paper investigates whether routine monitoring equipment is sufficient to ensure compliance with EC directive 96/29/Euratom for this selected set of radionuclides. (Author) 9 refs

  18. A Within-Group Analysis of African American Mothers’ Authoritarian Attitudes, Limit-Setting and Children's Self-Regulation

    Science.gov (United States)

    LeCuyer, Elizabeth A.; Swanson, Dena Phillips

    2016-01-01

    Research suggests that higher levels of authoritarian parenting exist in African American (AA) families than in European American (EA) families, and that authoritarian attitudes may be associated with more positive outcomes in AA families than EA families. However, less is known about authoritarian attitudes and children's development within AA families. This within-group study of 50 African American mothers and their 3-year-old children examined associations between maternal authoritarian attitudes, observed maternal limit-setting strategies, and children's self-regulation during a limit-setting interaction. The findings indicate that while AA families may hold more authoritarian attitudes than EA families, the direction of effect of authoritarian attitudes on children's outcomes appears to be the same in both ethnic groups. In this sample, when examining AA authoritarian attitudes relative to those of other AA mothers, less or lower authoritarian attitudes were associated with authoritative limit-setting behavior (firm limits within the context of overall warmth and responsiveness) and better children's self-regulation. PMID:28408794

  19. A Within-Group Analysis of African American Mothers' Authoritarian Attitudes, Limit-Setting and Children's Self-Regulation.

    Science.gov (United States)

    LeCuyer, Elizabeth A; Swanson, Dena Phillips

    2017-03-01

    Research suggests that higher levels of authoritarian parenting exist in African American (AA) families than in European American (EA) families, and that authoritarian attitudes may be associated with more positive outcomes in AA families than EA families. However, less is known about authoritarian attitudes and children's development within AA families. This within-group study of 50 African American mothers and their 3-year-old children examined associations between maternal authoritarian attitudes, observed maternal limit-setting strategies, and children's self-regulation during a limit-setting interaction. The findings indicate that while AA families may hold more authoritarian attitudes than EA families, the direction of effect of authoritarian attitudes on children's outcomes appears to be the same in both ethnic groups. In this sample, when examining AA authoritarian attitudes relative to those of other AA mothers, less or lower authoritarian attitudes were associated with authoritative limit-setting behavior (firm limits within the context of overall warmth and responsiveness) and better children's self-regulation.

  20. Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Campbell Timothy C

    2012-09-01

    Full Text Available Abstract Background Emerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness. Methods As components of its Suite for Automated Global bioSurveillance (SAGES program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies. Results ESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system. Conclusions OpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations.

  1. The effective application of contingency theory in health settings: problems and recommended solutions.

    Science.gov (United States)

    Strasser, S

    1983-01-01

    Contingency theory as a managerial perspective is conceptually elegant, but it may cause a number of unforeseen problems when applied in real work settings. Health care administrators can avoid many of these problems by using a hybrid contingency theory framework that blends the manager's own perceptions and experience with established contingency models.

  2. Gestalt Therapy in a Social Psychiatric Setting: The 'Oil & Water' Solution.

    Science.gov (United States)

    Neill, R. B.

    1979-01-01

    In this case study of a residential treatment center for emotionally disturbed adolescents, evaluative data demonstrated that Gestalt Therapy was neither designed nor intended for use in an institutional setting with severely disturbed young adolescents, with people of lower socioeconomic status or of low verbal skill and intelligence. (Author/SJL)

  3. Setting an Upper Limit on Gas Exchange Through Sea-Spray

    Science.gov (United States)

    Vlahos, P.; Monahan, E. C.; Andreas, E. L.

    2016-02-01

    Air-sea gas exchange parameterization is critical to understanding both climate forcing and feedbacks and is key in biogeochemistry cycles. Models based on wind speed have provided empirical estimates of gas exchange that are useful though it is likely that at high wind speeds of over 10 m/s there are important gas exchange parameters including bubbles and sea spray that have not been well constrained. Here we address the sea-spray component of gas exchange at these high wind speeds to set sn upper boundary condition for the gas exchange of the six model gases including; nobel gases helium, neon and argon, diatomic gases nitrogen and oxygen and finally, the more complex gas carbon dioxide. Estimates are based on the spray generation function of Andreas and Monahan and the gases are tested under three scenarios including 100 percent saturation and complete droplet evaporation, 100 percent saturation and a more realistic scenario in which a fraction of droplets evaporate completely, a fraction evaporate to some degree and a fraction returns to the water side without significant evaporation. Finally the latter scenario is applied to representative under saturated concentrations of the gases.

  4. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings

    Directory of Open Access Journals (Sweden)

    Bijendra Raj Raghubanshi

    2017-06-01

    Full Text Available Abstract Background In developing countries like Nepal, 90% ethanol is cheap and is available in most hospitals. The unavailability of isopropyl alcohol (IPA in these settings led us to compare the efficacy between 90% ethanol and isopropyl alcohol pads in reducing the bacterial contamination of diaphragm of stethoscope. Methods A randomized blinded experimental study was carried out to determine the difference between cleaning stethoscopes with 90% ethanol and IPA. Cultures of diaphragm were taken before and after cleaning with one of the cleaning agent. Colony forming units (CFU count and organism identification was done by a blinded investigator. CFU before and after cleaning were compared using Wilcoxon signed–rank test. Mann Whitney U test was used to compare the decrease in CFU count between the cleaning agents. Results About 30% of the stethoscopes harbored potential pathogens. Significant reduction in CFU was observed with both IPA (Wilcoxon signed–rank test, P value 0.05. Conclusions Both 90% ethanol and IPA are equally effective in decontaminating the diaphragm of stethoscope. Selection of agent should be done on the basis of cost and availability.

  5. [Development of a software standardizing optical density with operation settings related to several limitations].

    Science.gov (United States)

    Tu, Xiao-Ming; Zhang, Zuo-Heng; Wan, Cheng; Zheng, Yu; Xu, Jin-Mei; Zhang, Yuan-Yuan; Luo, Jian-Ping; Wu, Hai-Wei

    2012-12-01

    To develop a software that can be used to standardize optical density to normalize the procedures and results of standardization in order to effectively solve several problems generated during standardization of in-direct ELISA results. The software was designed based on the I-STOD method with operation settings to solve the problems that one might encounter during the standardization. Matlab GUI was used as a tool for the development. The software was tested with the results of the detection of sera of persons from schistosomiasis japonica endemic areas. I-STOD V1.0 (WINDOWS XP/WIN 7, 0.5 GB) was successfully developed to standardize optical density. A serial of serum samples from schistosomiasis japonica endemic areas were used to examine the operational effects of I-STOD V1.0 software. The results indicated that the software successfully overcame several problems including reliability of standard curve, applicable scope of samples and determination of dilution for samples outside the scope, so that I-STOD was performed more conveniently and the results of standardization were more consistent. I-STOD V1.0 is a professional software based on I-STOD. It can be easily operated and can effectively standardize the testing results of in-direct ELISA.

  6. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings.

    Science.gov (United States)

    Raghubanshi, Bijendra Raj; Sapkota, Supriya; Adhikari, Arjab; Dutta, Aman; Bhattarai, Utsuk; Bhandari, Rastriyata

    2017-01-01

    In developing countries like Nepal, 90% ethanol is cheap and is available in most hospitals. The unavailability of isopropyl alcohol (IPA) in these settings led us to compare the efficacy between 90% ethanol and isopropyl alcohol pads in reducing the bacterial contamination of diaphragm of stethoscope. A randomized blinded experimental study was carried out to determine the difference between cleaning stethoscopes with 90% ethanol and IPA. Cultures of diaphragm were taken before and after cleaning with one of the cleaning agent. Colony forming units (CFU) count and organism identification was done by a blinded investigator. CFU before and after cleaning were compared using Wilcoxon signed-rank test. Mann Whitney U test was used to compare the decrease in CFU count between the cleaning agents. About 30% of the stethoscopes harbored potential pathogens. Significant reduction in CFU was observed with both IPA (Wilcoxon signed-rank test, P value Wilcoxon signed-rank test, P value test; U = 1357, P value >0.05). Both 90% ethanol and IPA are equally effective in decontaminating the diaphragm of stethoscope. Selection of agent should be done on the basis of cost and availability.

  7. Rules and recent trends for setting health-based occupational exposure limits for chemicals.

    Science.gov (United States)

    Skowroń, Jolanta; Czerczak, Sławomir

    2015-01-01

    The working environment is the special case of the non-natural environment created by man in which the increased production activity brings about the concentration of stimulators particularly aggressive to the human organism, such as chemical hazards, noise, vibration, extreme temperatures, and finally, intensified psychological and emotional stress. Depending on the nature and intensity, working environment factors have been classified into dangerous, harmful and annoying. The workers are more and more frequently exposed to dangerous chemicals in the working environment. The chemicals cause many diseases including, in the 1st place, respiratory insufficiency, inflammatory skin conditions, psychoneurological disorders and neoplastic diseases. Occupational exposure limit values (OELs), the main criteria for occupational exposure assessment, constitute an important factor for the safe use of chemicals in the working environment. In Poland, to date there are 524 chemical substances and 19 dusts for which maximum admissible concentrations (MAC) have been established. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  8. Emergency Sonography Aids Diagnostic Accuracy of Torso Injuries: A Study in a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Charles Edward Tunuka

    2014-01-01

    Full Text Available Introduction. Clinical evaluation of patients with torso trauma is often a diagnostic challenge. Extended focused assessment with sonography for trauma (EFAST is an emergency ultrasound scan that adds to the evaluation of intrathoracic abdominal and pericardial cavities done in FAST (focused assessment with sonography for trauma. Objective. This study compares EFAST (the index test with the routine standard of care (SoC investigations (the standard reference test for torso trauma injuries. Methods. A cross-sectional descriptive study was conducted over a 3-month period. Eligible patients underwent EFAST scanning and the SoC assessment. The diagnostic accuracy of EFAST was calculated using sensitivity and specificity scores. Results. We recruited 197 patients; the M : F ratio was 5 : 1, with mean age of 27 years (SD 11. The sensitivity of EFAST was 100%, the specificity was 97%, the PPV was 87%, and the NPV was 100%. It took 5 minutes on average to complete an EFAST scan. 168 (85% patients were EFAST-scanned. Most patients (82 (48% were discharged on the same day of hospitalization, while 7 (4% were still at the hospital after two weeks. The mortality rate was 18 (9%. Conclusion. EFAST is a reliable method of diagnosing torso injuries in a resource limited context.

  9. A pharmacology guided approach for setting limits on product-related impurities for bispecific antibody manufacturing.

    Science.gov (United States)

    Rajan, Sharmila; Sonoda, Junichiro; Tully, Timothy; Williams, Ambrose J; Yang, Feng; Macchi, Frank; Hudson, Terry; Chen, Mark Z; Liu, Shannon; Valle, Nicole; Cowan, Kyra; Gelzleichter, Thomas

    2018-04-13

    bFKB1 is a humanized bispecific IgG1 antibody, created by conjoining an anti-Fibroblast Growth Factor Receptor 1 (FGFR1) half-antibody to an anti-Klothoβ (KLB) half-antibody, using the knobs-into-holes strategy. bFKB1 acts as a highly selective agonist for the FGFR1/KLB receptor complex and is intended to ameliorate obesity-associated metabolic defects by mimicking the activity of the hormone FGF21. An important aspect of the biologics product manufacturing process is to establish meaningful product specifications regarding the tolerable levels of impurities that copurify with the drug product. The aim of the current study was to determine acceptable levels of product-related impurities for bFKB1. To determine the tolerable levels of these impurities, we dosed obese mice with bFKB1 enriched with various levels of either HMW impurities or anti-FGFR1-related impurities, and measured biomarkers for KLB-independent FGFR1 signaling. Here, we show that product-related impurities of bFKB1, in particular, high molecular weight (HMW) impurities and anti-FGFR1-related impurities, when purposefully enriched, stimulate FGFR1 in a KLB-independent manner. By taking this approach, the tolerable levels of product-related impurities were successfully determined. Our study demonstrates a general pharmacology-guided approach to setting a product specification for a bispecific antibody whose homomultimer-related impurities could lead to undesired biological effects. Copyright © 2018. Published by Elsevier Inc.

  10. Gastroenterology training in a resource-limited setting: Zambia, Southern Africa.

    Science.gov (United States)

    Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul

    2013-07-07

    awareness in areas where resources are limited.

  11. Effect of African- and European-American maternal attitudes and limit-setting strategies on children's self-regulation.

    Science.gov (United States)

    LeCuyer, Elizabeth A; Swanson, Dena P; Cole, Robert; Kitzman, Harriet

    2011-12-01

    The effect of maternal attitudes and limit-setting strategies on children's self-regulation (measured as committed compliance) was compared in 151 African-American (AA) and 108 European-American (EA) mothers and their 3-year-old children. There were no ethnic differences in children's compliance, however ethnicity moderated the relationship between maternal authoritarian attitudes and children's compliance. Higher authoritarian attitudes predicted less children's compliance in the EA sample, but greater compliance in the AA sample. Observational limit-setting data revealed that in both ethnic groups, maternal authoritarian attitudes influenced children's self-regulation through maternal use of lower-power (gentle) verbal strategies, fewer physical strategies, and judicious use of higher-power verbal strategies. The findings indicate that the meaning and purpose of authoritarian attitudes varies across these mothers' socio-cultural contexts. Copyright © 2011 Wiley Periodicals, Inc.

  12. Acceptability of donated breast milk in a resource limited South African setting.

    Science.gov (United States)

    Coutsoudis, Irene; Petrites, Alissa; Coutsoudis, Anna

    2011-02-22

    The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants. The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability. This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily

  13. Acceptability of donated breast milk in a resource limited South African setting

    Directory of Open Access Journals (Sweden)

    Coutsoudis Anna

    2011-02-01

    Full Text Available Abstract Background The importance of breast milk for infants' growth, development and overall health is widely recognized. In situations where women are not able to provide their infants with sufficient amounts of their own breast milk, donor breast milk is the next preferred option. Although there is considerable research on the safety and scientific aspects of donor milk, and the motivations and experiences of donors, there is limited research addressing the attitudes and experiences of the women and families whose infants receive this milk. This study therefore examined attitudes towards donated breast milk among mothers, families and healthcare providers of potential recipient infants. Methods The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants. Results Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability. Conclusions This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the

  14. Weak solutions of magma equations

    International Nuclear Information System (INIS)

    Krishnan, E.V.

    1999-01-01

    Periodic solutions in terms of Jacobian cosine elliptic functions have been obtained for a set of values of two physical parameters for the magma equation which do not reduce to solitary-wave solutions. It was also obtained solitary-wave solutions for another set of these parameters as an infinite period limit of periodic solutions in terms of Weierstrass and Jacobian elliptic functions

  15. Setting limits: Using air pollution thresholds to protect and restore U.S. ecosystems

    Science.gov (United States)

    Fenn, M.E.; Lambert, K.F.; Blett, T.F.; Burns, Douglas A.; Pardo, L.H.; Lovett, Gary M.; Haeuber, R. A.; Evers, D.C.; Driscoll, C.T.; Jeffries, D.S.

    2011-01-01

    More than four decades of research provide unequivocal evidence that sulfur, nitrogen, and mercury pollution have altered, and will continue to alter, our nation's lands and waters. The emission and deposition of air pollutants harm native plants and animals, degrade water quality, affect forest productivity, and are damaging to human health. Many air quality policies limit emissions at the source but these control measures do not always consider ecosystem impacts. Air pollution thresholds at which ecological effects are observed, such as critical loads, are effective tools for assessing the impacts of air pollution on essential ecosystem services and for informing public policy. U.S. ecosystems can be more effectively protected and restored by using a combination of emissions-based approaches and science-based thresholds of ecosystem damage. Based on the results of a comprehensive review of air pollution thresholds, we conclude: ??? Ecosystem services such as air and water purification, decomposition and detoxification of waste materials, climate regulation, regeneration of soil fertility, production and biodiversity maintenance, as well as crop, timber and fish supplies are impacted by deposition of nitrogen, sulfur, mercury and other pollutants. The consequences of these changes may be difficult or impossible to reverse as impacts cascade throughout affected ecosystems. ??? The effects of too much nitrogen are common across the U.S. and include altered plant and lichen communities, enhanced growth of invasive species, eutrophication and acidification of lands and waters, and habitat deterioration for native species, including endangered species. ??? Lake, stream and soil acidification is widespread across the eastern United States. Up to 65% of lakes within sensitive areas receive acid deposition that exceeds critical loads. ??? Mercury contamination adversely affects fish in many inland and coastal waters. Fish consumption advisories for mercury exist in all 50

  16. Results on neutrinoless double beta decay search in GERDA. Background modeling and limit setting

    Energy Technology Data Exchange (ETDEWEB)

    Becerici Schmidt, Neslihan

    2014-07-22

    The search for the neutrinoless double beta decay (0νββ) process is primarily motivated by its potential of revealing the possible Majorana nature of the neutrino, in which the neutrino is identical to its antiparticle. It has also the potential to yield information on the intrinsic properties of neutrinos, if the underlying mechanism is the exchange of a light Majorana neutrino. The Gerda experiment is searching for 0νββ decay of {sup 76}Ge by operating high purity germanium (HPGe) detectors enriched in the isotope {sup 76}Ge (∝ 87%), directly in ultra-pure liquid argon (LAr). The first phase of physics data taking (Phase I) was completed in 2013 and has yielded 21.6 kg.yr of data. A background index of B∼10{sup -2} cts/(keV.kg.yr) at Q{sub ββ}=2039 keV has been achieved. A comprehensive background model of the Phase I energy spectrum is presented as the major topic of this dissertation. Decomposition of the background energy spectrum into the individual contributions from different processes provides many interesting physics results. The specific activity of {sup 39}Ar has been determined. The obtained result, A=(1.15±0.11) Bq/kg, is in good agreement with the values reported in literature. The contribution from {sup 42}K decays in LAr to the background spectrum has yielded a {sup 42}K({sup 42}Ar) specific activity of A=(106.2{sub -19.2}{sup +12.7}) μBq/kg, for which only upper limits exist in literature. The analysis of high energy events induced by α decays in the {sup 226}Ra chain indicated a total {sup 226}Ra activity of (3.0±0.9) μBq and a total initial {sup 210}Po activity of (0.18±0.01) mBq on the p{sup +} surfaces of the enriched semi-coaxial HPGe detectors. The half life of the two-neutrino double beta (2νββ) decay of {sup 76}Ge has been determined as T{sub 1/2}{sup 2ν}=(1.926±0.094).10{sup 21} yr, which is in good agreement with the result that was obtained with lower exposure and has been published by the Gerda collaboration

  17. Results on neutrinoless double beta decay search in GERDA. Background modeling and limit setting

    International Nuclear Information System (INIS)

    Becerici Schmidt, Neslihan

    2014-01-01

    The search for the neutrinoless double beta decay (0νββ) process is primarily motivated by its potential of revealing the possible Majorana nature of the neutrino, in which the neutrino is identical to its antiparticle. It has also the potential to yield information on the intrinsic properties of neutrinos, if the underlying mechanism is the exchange of a light Majorana neutrino. The Gerda experiment is searching for 0νββ decay of 76 Ge by operating high purity germanium (HPGe) detectors enriched in the isotope 76 Ge (∝ 87%), directly in ultra-pure liquid argon (LAr). The first phase of physics data taking (Phase I) was completed in 2013 and has yielded 21.6 kg.yr of data. A background index of B∼10 -2 cts/(keV.kg.yr) at Q ββ =2039 keV has been achieved. A comprehensive background model of the Phase I energy spectrum is presented as the major topic of this dissertation. Decomposition of the background energy spectrum into the individual contributions from different processes provides many interesting physics results. The specific activity of 39 Ar has been determined. The obtained result, A=(1.15±0.11) Bq/kg, is in good agreement with the values reported in literature. The contribution from 42 K decays in LAr to the background spectrum has yielded a 42 K( 42 Ar) specific activity of A=(106.2 -19.2 +12.7 ) μBq/kg, for which only upper limits exist in literature. The analysis of high energy events induced by α decays in the 226 Ra chain indicated a total 226 Ra activity of (3.0±0.9) μBq and a total initial 210 Po activity of (0.18±0.01) mBq on the p + surfaces of the enriched semi-coaxial HPGe detectors. The half life of the two-neutrino double beta (2νββ) decay of 76 Ge has been determined as T 1/2 2ν =(1.926±0.094).10 21 yr, which is in good agreement with the result that was obtained with lower exposure and has been published by the Gerda collaboration. According to the model, the background in Q ββ ±5 keV window is resulting from close

  18. Compiled data set of exact NOE distance limits, residual dipolar couplings and scalar couplings for the protein GB3

    Directory of Open Access Journals (Sweden)

    Beat Vögeli

    2015-12-01

    Full Text Available We compiled an NMR data set consisting of exact nuclear Overhauser enhancement (eNOE distance limits, residual dipolar couplings (RDCs and scalar (J couplings for GB3, which forms one of the largest and most diverse data set for structural characterization of a protein to date. All data have small experimental errors, which are carefully estimated. We use the data in the research article Vogeli et al., 2015, Complementarity and congruence between exact NOEs and traditional NMR probes for spatial decoding of protein dynamics, J. Struct. Biol., 191, 3, 306–317, doi:10.1016/j.jsb.2015.07.008 [1] for cross-validation in multiple-state structural ensemble calculation. We advocate this set to be an ideal test case for molecular dynamics simulations and structure calculations.

  19. Dissipative solutions and the incompressible inviscid limits of the compressible magnetohydrodynamic system in unbounded domains

    Czech Academy of Sciences Publication Activity Database

    Feireisl, Eduard; Novotný, A.; Sun, Y.

    2014-01-01

    Roč. 34, č. 1 (2014), s. 121-143 ISSN 1078-0947 R&D Projects: GA ČR GA201/09/0917 Institutional support: RVO:67985840 Keywords : compressible MHD system * inviscid limit * incompressible limit Subject RIV: BA - General Mathematics Impact factor: 0.826, year: 2014 http://aimsciences.org/journals/displayArticlesnew.jsp?paperID=8717

  20. Solution of the spherically symmetric linear thermoviscoelastic problem in the inertia-free limit

    DEFF Research Database (Denmark)

    Christensen, Tage Emil; Dyre, J. C.

    2008-01-01

    paper-the thermoviscoelastic  problem may be solved analytically in the inertia-free limit, i.e., the limit where the sample is much smaller than the wavelength of sound waves at the frequencies of interest. As for the one-dimensional thermoviscoelastic problem [Christensen et al., Phys. Rev. E 75...

  1. SAGES: a suite of freely-available software tools for electronic disease surveillance in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Sheri L Lewis

    Full Text Available Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations.

  2. Reliability issues and solutions for coding social communication performance in classroom settings.

    Science.gov (United States)

    Olswang, Lesley B; Svensson, Liselotte; Coggins, Truman E; Beilinson, Jill S; Donaldson, Amy L

    2006-10-01

    To explore the utility of time-interval analysis for documenting the reliability of coding social communication performance of children in classroom settings. Of particular interest was finding a method for determining whether independent observers could reliably judge both occurrence and duration of ongoing behavioral dimensions for describing social communication performance. Four coders participated in this study. They observed and independently coded 6 social communication behavioral dimensions using handheld computers. The dimensions were mutually exclusive and accounted for all verbal and nonverbal productions during a specified time frame. The technology allowed for coding frequency and duration for each entered code. Data were collected from 20 different 2-min video segments of children in kindergarten through 3rd-grade classrooms. Data were analyzed for interobserver and intraobserver agreements using time-interval sorting and Cohen's kappa. Further, interval size and total observation length were manipulated to determine their influence on reliability. The data revealed interval sorting and kappa to be a suitable method for examining reliability of occurrence and duration of ongoing social communication behavioral dimensions. Nearly all comparisons yielded medium to large kappa values; interval size and length of observation minimally affected results. Implications The analysis procedure described in this research solves a challenge in reliability: comparing coding by independent observers of both occurrence and duration of behaviors. Results indicate the utility of a new coding taxonomy and technology for application in online observations of social communication in a classroom setting.

  3. Salty solutions: their effects on thermal set points in behavioral repertoires of albino rats.

    Science.gov (United States)

    Vitulli, W F; Aker, R; Howard, S W; Jones, W M; Kimball, M W; Quinn, J M

    1994-08-01

    Salt (sodium chloride) has been linked to increased blood pressure and a rise in core body temperature. The objective of this study was to investigate the role played by salt in altering behavioral thermoregulation in albino rats. Different doses of sodium chloride were administered (ip) prior to fixed-interval 2-min. schedules of microwave reinforcement in rats tested in a cold Skinner Box. Three Sprague-Dawley rats were conditioned to regulate their thermal environment with 5-sec. exposures of MW reinforcement in a repeated-measures reversal design. Friedman's non-parametric test showed significant differences among sodium chloride doses and physiologically normal saline. Post hoc sign tests showed that all doses of NaCl suppressed operant behavior for heat except 60 mg/kg. The hypothesis that sodium chloride lowers hypothalamic set point for heat was partially supported.

  4. Application of integer programming on logistics solution for load transportation: the solver tool and its limitations in the search for the optimal solution

    Directory of Open Access Journals (Sweden)

    Ricardo França Santos

    2012-01-01

    Full Text Available This work tries to solve a typical logistics problem of Navy of Brazil regards the allocation, transportation and distribution of genera refrigerated for Military Organizations within Grande Rio (RJ. After a brief review of literature on Linear/Integer Programming and some of their applications, we proposed the use of Integer Programming, using the Excel’s Solver as a tool for obtaining the optimal load configuration for the fleet, obtaining the lower distribution costs in order to meet the demand schedule. The assumptions were met in a first attempt with a single spreadsheet, but it could not find a convergent solution, without degeneration problems and with a reasonable solution time. A second solution was proposed separating the problem into three phases, which allowed us to highlight the potential and limitations of the Solver tool. This study showed the importance of formulating a realistic model and of a detailed critical analysis, which could be seen through the lack of convergence of the first solution and the success achieved by the second one.

  5. The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings.

    Science.gov (United States)

    Campbell, Jeffrey I; Aturinda, Isaac; Mwesigwa, Evans; Burns, Bridget; Santorino, Data; Haberer, Jessica E; Bangsberg, David R; Holden, Richard J; Ware, Norma C; Siedner, Mark J

    2017-11-01

    Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention's acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability. Interviews guided development of a proposed conceptual framework, the technology acceptance model for resource-limited settings (TAM-RLS). This framework incorporates both classic technology acceptance model categories as well as novel factors affecting use in this setting. Participants described how SMS message language, phone characteristics, and experience with similar technologies contributed to the system's ease of use. Perceived usefulness was shaped by the perception that the system led to augmented HIV care services and improved access to social support from family and colleagues. Emergent themes specifically related to mHealth acceptance among PLWH in Uganda included (1) the importance of confidentiality, disclosure, and stigma, and (2) the barriers and facilitators downstream from the intervention that impacted achievement of the system's target outcome. The TAM-RLS is a proposed model of mHealth technology acceptance based upon end-user experiences in rural Uganda. Although the proposed model requires validation, the TAM

  6. An approximative solution for limit load of piping branch junctions with circumferential crack and finite element validation

    International Nuclear Information System (INIS)

    Xuan Fuzhen; Liu Changjun; Li Peining

    2005-01-01

    This paper is concerned with the prediction of limit load of the piping branch junctions with circumferential crack under internal pressure. Recently, we have developed a new approach for predicting the limit load of two-cylinder intersection structures with diameter ratio larger than 0.5, which has been successfully applied to defect free cases under various loading conditions. In the present work, we consider the extension of the approach to cover cracked piping branch junctions. On the basis of stress analysis in the vicinity of intersection line, a closed form of limit load solution for piping branch junctions with circumferential crack was developed. Then, 36 finite element (FE) models of piping branch junction with various dimensions of structure and crack were analyzed by using nonlinear finite element software. The limit loads from FE analysis and the proposed solution are compared with each other. Overall good agreement between the estimated solutions and the FE results provides confidence in the use of the proposed formulae for defect assessment of piping branch junctions in practice

  7. How to Achieve the Best SRF Performance: (Practical) Limitations and Possible Solutions

    International Nuclear Information System (INIS)

    Antoine, Claire Z

    2014-01-01

    This chapter presents in the first part the requirement for the surface preparation of RF Niobium cavities and its justification in term s of physical origin of limitation (e.g. cleanliness and field emission, influence of the surface treatments, morphology and surface damage, etc.). In the second part we discuss the different models describing the ultimate limits of SRF cavities, and we present one of the possible ways to overcome Niobium monopoly toward higher performances

  8. How to Achieve the Best SRF Performance: (Practical) Limitations and Possible Solutions

    Energy Technology Data Exchange (ETDEWEB)

    Antoine, Claire Z [IRFU, Saclay (France)

    2014-07-01

    This chapter presents in the first part the requirement for the surface preparation of RF Niobium cavities and its justification in term s of physical origin of limitation (e.g. cleanliness and field emission, influence of the surface treatments, morphology and surface damage, etc.). In the second part we discuss the different models describing the ultimate limits of SRF cavities, and we present one of the possible ways to overcome Niobium monopoly toward higher performances.

  9. New self-similar radiation-hydrodynamics solutions in the high-energy density, equilibrium diffusion limit

    International Nuclear Information System (INIS)

    Lane, Taylor K; McClarren, Ryan G

    2013-01-01

    This work presents semi-analytic solutions to a radiation-hydrodynamics problem of a radiation source driving an initially cold medium. Our solutions are in the equilibrium diffusion limit, include material motion and allow for radiation-dominated situations where the radiation energy is comparable to (or greater than) the material internal energy density. As such, this work is a generalization of the classical Marshak wave problem that assumes no material motion and that the radiation energy is negligible. Including radiation energy density in the model serves to slow down the wave propagation. The solutions provide insight into the impact of radiation energy and material motion, as well as present a novel verification test for radiation transport packages. As a verification test, the solution exercises the radiation–matter coupling terms and their v/c treatment without needing a hydrodynamics solve. An example comparison between the self-similar solution and a numerical code is given. Tables of the self-similar solutions are also provided. (paper)

  10. Discriminator setting and cocktail preparation for analysis of alpha and beta emitters in aqueous solution using liquid scintillation counter

    International Nuclear Information System (INIS)

    Zaini Hamzah; Masitah Alias; Zaharudin Ahmad

    2011-01-01

    Liquid scintillation counting (LSC) is not only being used to measure pure beta emitters, but it can be used to measure both alpha and beta emitters simultaneously. Measurement of alpha and beta emitters in aqueous solution is done using a single sample. For the sample preparation, colorless detergent or emulsifier was used to incorporate the water into an organic based scintillator to produce a clear homogeneous solution, since this is the best form to give the highest count rate and detection efficiency. The instrument also need some attention, where after calibration, the LSC was set for the discriminator level which is suitable for measurement of both alpha and beta radiations. In this study, the focus is on the development of the best scintillation cocktail and establishes the best discriminator setting. From this study the best proportion of scintillation cocktail is 2:4:4 for water, toluene, and Triton-N101 (emulsifier) respectively and the best discriminator setting for alpha and beta counting are 120. (author)

  11. Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions.

    Science.gov (United States)

    Radhakrishnan, Kavita; Topaz, Maxim; Masterson Creber, Ruth

    2014-07-01

    Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses. The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing. Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds. We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations. Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

  12. Issues and Solutions for Bringing Heterogeneous Water Cycle Data Sets Together

    Science.gov (United States)

    Acker, James; Kempler, Steven; Teng, William; Belvedere, Deborah; Liu, Zhong; Leptoukh, Gregory

    2010-01-01

    The water cycle research community has generated many regional to global scale products using data from individual NASA missions or sensors (e.g., TRMM, AMSR-E); multiple ground- and space-based data sources (e.g., Global Precipitation Climatology Project [GPCP] products); and sophisticated data assimilation systems (e.g., Land Data Assimilation Systems [LDAS]). However, it is often difficult to access, explore, merge, analyze, and inter-compare these data in a coherent manner due to issues of data resolution, format, and structure. These difficulties were substantiated at the recent Collaborative Energy and Water Cycle Information Services (CEWIS) Workshop, where members of the NASA Energy and Water cycle Study (NEWS) community gave presentations, provided feedback, and developed scenarios which illustrated the difficulties and techniques for bringing together heterogeneous datasets. This presentation reports on the findings of the workshop, thus defining the problems and challenges of multi-dataset research. In addition, the CEWIS prototype shown at the workshop will be presented to illustrate new technologies that can mitigate data access roadblocks encountered in multi-dataset research, including: (1) Quick and easy search and access of selected NEWS data sets. (2) Multi-parameter data subsetting, manipulation, analysis, and display tools. (3) Access to input and derived water cycle data (data lineage). It is hoped that this presentation will encourage community discussion and feedback on heterogeneous data analysis scenarios, issues, and remedies.

  13. Commentary Considerations for Recommending Extended Use and Limited Reuse of Filtering Facepiece Respirators in Health Care Settings

    Science.gov (United States)

    Fisher, Edward M.; Shaffer, Ronald E.

    2015-01-01

    Public health organizations, such as the Centers for Disease Control and Prevention (CDC), are increasingly recommending the use of N95 filtering facepiece respirators (FFRs) in health care settings. For infection control purposes, the usual practice is to discard FFRs after close contact with a patient (“single use”). However, in some situations, such as during contact with tuberculosis patients, limited FFR reuse (i.e., repeated donning and doffing of the same FFR by the same person) is practiced. A related practice, extended use, involves wearing the same FFR for multiple patient encounters without doffing. Extended use and limited FFR reuse have been recommended during infectious disease outbreaks and pandemics to conserve FFR supplies. This commentary examines CDC recommendations related to FFR extended use and limited reuse and analyzes available data from the literature to provide a relative estimate of the risks of these practices compared to single use. Analysis of the available data and the use of disease transmission models indicate that decisions regarding whether FFR extended use or reuse should be recommended should continue to be pathogen- and event-specific. Factors to be included in developing the recommendations are the potential for the pathogen to spread via contact transmission, the potential that the event could result in or is currently causing a FFR shortage, the protection provided by FFR use, human factors, potential for self-inoculation, the potential for secondary exposures, and government policies and regulations. While recent findings largely support the previous recommendations for extended use and limited reuse in certain situations, some new cautions and limitations should be considered before issuing recommendations in the future. In general, extended use of FFRs is preferred over limited FFR reuse. Limited FFR reuse would allow the user a brief respite from extended wear times, but increases the risk of self-inoculation and

  14. Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions

    Directory of Open Access Journals (Sweden)

    Andrew W. Kiragu

    2018-06-01

    Full Text Available Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs 3–6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.

  15. Statistical solutions of the Navier endash Stokes equations on the phase space of vorticity and the inviscid limits

    International Nuclear Information System (INIS)

    Constantin, P.; Wu, J.

    1997-01-01

    Using the methods of Foias [Sem. Math. Univ. Padova 48, 219 endash 343 (1972); 49, 9 endash 123 (1973)] and Vishik endash Fursikov [Mathematical Problems of Statistical Hydromechanics (Kluwer, Dordrecht, 1988)], we prove the existence and uniqueness of both spatial and space endash time statistical solutions of the Navier endash Stokes equations on the phase space of vorticity. Here the initial vorticity is in Yudovich space and the initial measure has finite mean enstrophy. We show under further assumptions on the initial vorticity that the statistical solutions of the Navier endash Stokes equations converge weakly and the inviscid limits are the corresponding statistical solutions of the Euler equations. copyright 1997 American Institute of Physics

  16. On the predictions and limitations of the Becker–Döring model for reaction kinetics in micellar surfactant solutions

    KAUST Repository

    Griffiths, I.M.

    2011-08-01

    We investigate the breakdown of a system of micellar aggregates in a surfactant solution following an order-one dilution. We derive a mathematical model based on the Becker-Döring system of equations, using realistic expressions for the reaction constants fit to results from Molecular Dynamics simulations. We exploit the largeness of typical aggregation numbers to derive a continuum model, substituting a large system of ordinary differential equations for a partial differential equation in two independent variables: time and aggregate size. Numerical solutions demonstrate that re-equilibration occurs in two distinct stages over well-separated timescales, in agreement with experiment and with previous theories. We conclude by exposing a limitation in the Becker-Döring theory for re-equilibration of surfactant solutions. © 2011 Elsevier Inc.

  17. The PLUS family: A set of computer programs to evaluate analytical solutions of the diffusion equation and thermoelasticity

    International Nuclear Information System (INIS)

    Montan, D.N.

    1987-02-01

    This report is intended to describe, document and provide instructions for the use of new versions of a set of computer programs commonly referred to as the PLUS family. These programs were originally designed to numerically evaluate simple analytical solutions of the diffusion equation. The new versions include linear thermo-elastic effects from thermal fields calculated by the diffusion equation. After the older versions of the PLUS family were documented a year ago, it was realized that the techniques employed in the programs were well suited to the addition of linear thermo-elastic phenomena. This has been implemented and this report describes the additions. 3 refs., 14 figs

  18. Limitation of liability for maritime claims: Chronological critical review (international instruments and Croatian solutions

    Directory of Open Access Journals (Sweden)

    Vasilj Aleksandra V.

    2016-01-01

    Full Text Available Limitation of liability of shipowner can based on property or can be personal - shipowner responds to certain part of the property (for example ship or his entire assets to a certain amount. In the first case it is a real, and in the other the personal limitation of liability. On these principles all international instruments in this legal field have been developed. One of the well-known 'universal' principle of civil law says that the injurer must pay for a damage in full, in full extent and amount. However, when we are applying provisions of maritime law (as well as transport law in general on the liability for damages and its compensation, the situation is quite opposite. Though, that the amount of suffered damages is coming closer to said universal principle of civil law has been confirmed by Amendments to the Protocol to the Convention on Limitation of Liability for Maritime Claims 1996 (LLMC 1996. These Amendments increased amount of general (global limitation of liability for maritime claims by 51% compared to the amounts in LLMC. Increased amounts are applicable from 8th June 2015. Regarding these amendments, a number of issues can be placed: justification for introducing the institute of limitation of liability in general; reasons why the injurer is privileged in maritime (and broader in transport, in the context of the amount of the obligation of compensation for damage; and whether the application of the institute undermine the principle that is enshrined in the legal system of every modern country, according to which the injured party has the right to just compensation. On the other hand, justice can be taken as well as an argument just to implement the limitation of liability system.

  19. Limitations of amorphous content quantification by isothermal calorimetry using saturated salt solutions to control relative humidity: alternative methods.

    Science.gov (United States)

    Khalef, Nawel; Pinal, Rodolfo; Bakri, Aziz

    2010-04-01

    Despite the high sensitivity of isothermal calorimetry (IC), reported measurements of amorphous content by this technique show significant variability even for the same compound. An investigation into the reasons behind such variability is presented using amorphous lactose and salbutamol sulfate as model compounds. An analysis was carried out on the heat evolved as a result of the exchange of water vapor between the solid sample during crystallization and the saline solution reservoir. The use of saturated salt solutions as means of control of the vapor pressure of water within sealed ampoules bears inherent limitations that lead in turn to the variability associated with the IC technique. We present an alternative IC method, based on an open cell configuration that effectively addresses the limitations encountered with the sealed ampoule system. The proposed approach yields an integral whose value is proportional to the amorphous content in the sample, thus enabling reliable and consistent quantifications. 2009 Wiley-Liss, Inc. and the American Pharmacists Association

  20. Limit Properties of Solutions of Singular Second-Order Differential Equations

    Directory of Open Access Journals (Sweden)

    Weinmüller Ewa

    2009-01-01

    Full Text Available We discuss the properties of the differential equation , a.e. on , where , and satisfies the -Carathéodory conditions on for some . A full description of the asymptotic behavior for of functions satisfying the equation a.e. on is given. We also describe the structure of boundary conditions which are necessary and sufficient for to be at least in . As an application of the theory, new existence and/or uniqueness results for solutions of periodic boundary value problems are shown.

  1. Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases.

    Science.gov (United States)

    Schwartz, Noah G; Rattner, Adi; Schwartz, Alan R; Mokhlesi, Babak; Gilman, Robert H; Bernabe-Ortiz, Antonio; Miranda, J Jaime; Checkley, William

    2015-09-01

    Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. There were 2,682 adults aged 35 to 92 y. Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms. Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong

  2. Solid dispersions in oncology: a solution to solubility-limited oral drug absorption

    NARCIS (Netherlands)

    Sawicki, Emilia

    2017-01-01

    This thesis discusses the formulation method solid dispersion and how it works to resolve solubility-limited absorption of orally dosed anticancer drugs. Dissolution in water is essential for drug absorption because only dissolved drug molecules are absorbed. The problem is that half of the arsenal

  3. A decision-making tool for exchange transfusions in infants with severe hyperbilirubinemia in resource-limited settings.

    Science.gov (United States)

    Olusanya, B O; Iskander, I F; Slusher, T M; Wennberg, R P

    2016-05-01

    Late presentation and ineffective phototherapy account for excessive rates of avoidable exchange transfusions (ETs) in many low- and middle-income countries. Several system-based constraints sometimes limit the ability to provide timely ETs for all infants at risk of kernicterus, thus necessitating a treatment triage to optimize available resources. This article proposes a practical priority-setting model for term and near-term infants requiring ET after the first 48 h of life. The proposed model combines plasma/serum bilirubin estimation, clinical signs of acute bilirubin encephalopathy and neurotoxicity risk factors for predicting the risk of kernicterus based on available evidence in the literature.

  4. Managing the diabetic foot in resource-poor settings: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Abbas ZG

    2017-10-01

    Full Text Available Zulfiqarali G Abbas1,2 1Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Internal Medicine, Abbas Medical Centre, Dar es Salaam, Tanzania Abstract: Diabetes mellitus is one of the most common noncommunicable diseases globally. In Africa, rates of diabetes are increasing, so there is a parallel increase of foot complications. Peripheral neuropathy is the main risk factor for foot ulceration in people with diabetes in developing nations, but peripheral arterial disease is also increasing in number owing to the change in lifestyle and increasing urbanization. Ulceration arising from peripheral neuropathy, peripheral arterial disease, and trauma are highly susceptible to secondary infection and gangrene, and are hence associated with increased morbidity and mortality. Government funding is very limited in many developing countries, and diabetes and its complications impose a heavy burden on health services. In particular, the outcomes of foot complications are often poor, and this is the result of various factors including lack of awareness of the need for foot care among patients, relatives, and health care providers; relatively few professionals with an interest in the diabetic foot and with the training to provide specialist treatment; nonexistent podiatry services; long distances for patients to travel to the clinic; delays among patients in seeking medical care, or the late referral of patients for specialist opinion; and lack of the awareness of the importance of a team approach to care, and the lack of training programs for health care professionals. Many of these can, however, potentially be tackled without exorbitant spending of financial resources. Cost-effective educational efforts should be targeted at both health care workers and patients. These include implementation of sustainable training programs for health care professionals with a special interest in foot

  5. Performance Evaluation of Distributed Mobility Management Protocols: Limitations and Solutions for Future Mobile Networks

    Directory of Open Access Journals (Sweden)

    J. Carmona-Murillo

    2017-01-01

    Full Text Available Mobile Internet data traffic has experienced an exponential growth over the last few years due to the rise of demanding multimedia content and the increasing number of mobile devices. Seamless mobility support at the IP level is envisioned as a key architectural requirement in order to deal with the ever-increasing demand for data and to efficiently utilize a plethora of different wireless access networks. Current efforts from both industry and academia aim to evolve the mobility management protocols towards a more distributed operation to tackle shortcomings of fully centralized approaches. However, distributed solutions face several challenges that can result in lower performance which might affect real-time and multimedia applications. In this paper, we conduct an analytical and simulated evaluation of the main centralized and proposed Distributed Mobility Management (DMM solutions. Our results show that, in some scenarios, when users move at high speed and/or when the mobile node is running long-lasting applications, the DMM approaches incur high signaling cost and long handover latency.

  6. A set of nutrient limitations trigger yeast cell death in a nitrogen-dependent manner during wine alcoholic fermentation.

    Directory of Open Access Journals (Sweden)

    Camille Duc

    Full Text Available Yeast cell death can occur during wine alcoholic fermentation. It is generally considered to result from ethanol stress that impacts membrane integrity. This cell death mainly occurs when grape musts processing reduces lipid availability, resulting in weaker membrane resistance to ethanol. However the mechanisms underlying cell death in these conditions remain unclear. We examined cell death occurrence considering yeast cells ability to elicit an appropriate response to a given nutrient limitation and thus survive starvation. We show here that a set of micronutrients (oleic acid, ergosterol, pantothenic acid and nicotinic acid in low, growth-restricting concentrations trigger cell death in alcoholic fermentation when nitrogen level is high. We provide evidence that nitrogen signaling is involved in cell death and that either SCH9 deletion or Tor inhibition prevent cell death in several types of micronutrient limitation. Under such limitations, yeast cells fail to acquire any stress resistance and are unable to store glycogen. Unexpectedly, transcriptome analyses did not reveal any major changes in stress genes expression, suggesting that post-transcriptional events critical for stress response were not triggered by micronutrient starvation. Our data point to the fact that yeast cell death results from yeast inability to trigger an appropriate stress response under some conditions of nutrient limitations most likely not encountered by yeast in the wild. Our conclusions provide a novel frame for considering both cell death and the management of nutrients during alcoholic fermentation.

  7. Infinite set of relevant operators for an exact solution of the time-dependent Jaynes-Cummings Hamiltonian

    International Nuclear Information System (INIS)

    Gruver, J.L.; Aliaga, J.; Cerdeira, H.A.; Proto, A.N.

    1995-03-01

    The dynamics and thermodynamics of a quantum time-dependent field coupled to a two-level system, well known as the Jaynes-Cummings Hamiltonian, is studied, using the maximum entropy principle. In the framework of this approach we found three different infinite sets of relevant operators that describe the dynamics of the system for any temporal dependence. These sets of relevant operators are connected by isomorphisms, which allow us to consider the case of mixed initial conditions. A consistent set of initial conditions is established using the maximum entropy principle density operator, obtaining restrictions to the physically feasible initial conditions of the system. The behaviour of the population inversion is shown for different time dependencies of the Hamiltonian and initial conditions. For the time-independent case, an explicit solution for the population inversion in terms of the relevant operators of one of the sets is given. It is also shown how the well-known formulas for the population inversion are recovered for the special cases where the initial conditions correspond to a pure, coherent, and thermal field. (author). 35 refs, 9 figs

  8. Use of local and global limit load solutions for plates with surface cracks under tension

    Energy Technology Data Exchange (ETDEWEB)

    Lei, Y. [British Energy Generation Ltd, Barnett Way, Bamwood, Gloucester GL4 3RS (United Kingdom)], E-mail: yuebao.lei@british-energy.com

    2007-09-15

    Some available experimental results for the ductile failure of plates with surface cracks under tension are reviewed. The response of crack driving force, J, and the ligament strain near the local and global limit loads are investigated by performing elastic-perfectly plastic finite element (FE) analysis of a plate with a semi-elliptical crack under tension. The results show that a ligament may survive until the global collapse load is reached when the average ligament strain at the global collapse load, which depends on the uniaxial strain corresponding to the flow stress of the material and the crack geometry, is less than the true fracture strain of the material obtained from uniaxial tension tests. The FE analysis shows that ligament yielding corresponding to the local limit load has little effect on J and the average ligament strain, whereas approach to global collapse corresponds to a sharp increase in both J and the average ligament strain. The prediction of the FE value of J using the reference stress method shows that the global limit load is more relevant to J-estimation than the local one.

  9. Use of local and global limit load solutions for plates with surface cracks under tension

    International Nuclear Information System (INIS)

    Lei, Y.

    2007-01-01

    Some available experimental results for the ductile failure of plates with surface cracks under tension are reviewed. The response of crack driving force, J, and the ligament strain near the local and global limit loads are investigated by performing elastic-perfectly plastic finite element (FE) analysis of a plate with a semi-elliptical crack under tension. The results show that a ligament may survive until the global collapse load is reached when the average ligament strain at the global collapse load, which depends on the uniaxial strain corresponding to the flow stress of the material and the crack geometry, is less than the true fracture strain of the material obtained from uniaxial tension tests. The FE analysis shows that ligament yielding corresponding to the local limit load has little effect on J and the average ligament strain, whereas approach to global collapse corresponds to a sharp increase in both J and the average ligament strain. The prediction of the FE value of J using the reference stress method shows that the global limit load is more relevant to J-estimation than the local one

  10. Accurate Ionization Potentials and Electron Affinities of Acceptor Molecules I. Reference Data at the CCSD(T) Complete Basis Set Limit

    KAUST Repository

    Richard, Ryan M.

    2016-01-05

    © 2016 American Chemical Society. In designing organic materials for electronics applications, particularly for organic photovoltaics (OPV), the ionization potential (IP) of the donor and the electron affinity (EA) of the acceptor play key roles. This makes OPV design an appealing application for computational chemistry since IPs and EAs are readily calculable from most electronic structure methods. Unfortunately reliable, high-accuracy wave function methods, such as coupled cluster theory with single, double, and perturbative triples [CCSD(T)] in the complete basis set (CBS) limit are too expensive for routine applications to this problem for any but the smallest of systems. One solution is to calibrate approximate, less computationally expensive methods against a database of high-accuracy IP/EA values; however, to our knowledge, no such database exists for systems related to OPV design. The present work is the first of a multipart study whose overarching goal is to determine which computational methods can be used to reliably compute IPs and EAs of electron acceptors. This part introduces a database of 24 known organic electron acceptors and provides high-accuracy vertical IP and EA values expected to be within ±0.03 eV of the true non-relativistic, vertical CCSD(T)/CBS limit. Convergence of IP and EA values toward the CBS limit is studied systematically for the Hartree-Fock, MP2 correlation, and beyond-MP2 coupled cluster contributions to the focal point estimates.

  11. Thermodynamic limits set relevant constraints to the soil-plant-atmosphere system and to optimality in terrestrial vegetation

    Science.gov (United States)

    Kleidon, Axel; Renner, Maik

    2016-04-01

    The soil-plant-atmosphere system is a complex system that is strongly shaped by interactions between the physical environment and vegetation. This complexity appears to demand equally as complex models to fully capture the dynamics of the coupled system. What we describe here is an alternative approach that is based on thermodynamics and which allows for comparatively simple formulations free of empirical parameters by assuming that the system is so complex that its emergent dynamics are only constrained by the thermodynamics of the system. This approach specifically makes use of the second law of thermodynamics, a fundamental physical law that is typically not being considered in Earth system science. Its relevance to land surface processes is that it fundamentally sets a direction as well as limits to energy conversions and associated rates of mass exchange, but it requires us to formulate land surface processes as thermodynamic processes that are driven by energy conversions. We describe an application of this approach to the surface energy balance partitioning at the diurnal scale. In this application the turbulent heat fluxes of sensible and latent heat are described as the result of a convective heat engine that is driven by solar radiative heating of the surface and that operates at its thermodynamic limit. The predicted fluxes from this approach compare very well to observations at several sites. This suggests that the turbulent exchange fluxes between the surface and the atmosphere operate at their thermodynamic limit, so that thermodynamics imposes a relevant constraint to the land surface-atmosphere system. Yet, thermodynamic limits do not entirely determine the soil-plant-atmosphere system because vegetation affects these limits, for instance by affecting the magnitude of surface heating by absorption of solar radiation in the canopy layer. These effects are likely to make the conditions at the land surface more favorable for photosynthetic activity

  12. Level-set reconstruction algorithm for ultrafast limited-angle X-ray computed tomography of two-phase flows.

    Science.gov (United States)

    Bieberle, M; Hampel, U

    2015-06-13

    Tomographic image reconstruction is based on recovering an object distribution from its projections, which have been acquired from all angular views around the object. If the angular range is limited to less than 180° of parallel projections, typical reconstruction artefacts arise when using standard algorithms. To compensate for this, specialized algorithms using a priori information about the object need to be applied. The application behind this work is ultrafast limited-angle X-ray computed tomography of two-phase flows. Here, only a binary distribution of the two phases needs to be reconstructed, which reduces the complexity of the inverse problem. To solve it, a new reconstruction algorithm (LSR) based on the level-set method is proposed. It includes one force function term accounting for matching the projection data and one incorporating a curvature-dependent smoothing of the phase boundary. The algorithm has been validated using simulated as well as measured projections of known structures, and its performance has been compared to the algebraic reconstruction technique and a binary derivative of it. The validation as well as the application of the level-set reconstruction on a dynamic two-phase flow demonstrated its applicability and its advantages over other reconstruction algorithms. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

  13. Reaching the end of the line: Operational issues with implementing phone-based unannounced pill counts in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Yael Hirsch-Moverman

    Full Text Available Accurate measurement of adherence is necessary to ensure that therapeutic outcomes can be attributed to the recommended treatment. Phone-based unannounced pill counts were shown to be feasible and reliable measures of adherence in developed settings; and have been further used as part of medication adherence interventions. However, it is not clear whether this method can be implemented successfully in resource-limited settings, where cellular network and mobile phone coverage may be low. Our objective is to describe operational issues surrounding the use of phone-based unannounced pill counts in Lesotho and Ethiopia.Phone-based monthly unannounced pill counts, using an adaptation of a standardized protocol from previous US-based studies, were utilized to measure anti-TB and antiretroviral medication adherence in two implementation science studies in resource-limited settings, START (Lesotho and ENRICH (Ethiopia.In START, 19.6% of calls were completed, with 71.9% of participants reached at least once; majority of failed call attempts were due to phones not being available (54.8% or because participants were away from the pills (32.7%. In ENRICH, 33.5% of calls were completed, with 86.7% of participants reached at least once; the main reasons for failed call attempts were phones being switched off (31.5%, participants not answering (27.3%, participants' discomfort speaking on the phone (15.4%, and network problems (13.2%. Structural, facility-level, participant-level, and data collection challenges were encountered in these settings.Phone-based unannounced pill counts were found to be challenging, and response rates suboptimal. While some of these challenges were specific to local contexts, most of them are generalizable to resource-limited settings. In a research study context, a possible solution to ease operational challenges may be to focus phone-based unannounced pill count efforts on a randomly selected sample from participants who are

  14. Quantum perturbation solution of sextic nonlinear oscillator and its classical limit

    International Nuclear Information System (INIS)

    Jafarpour, M.; Ashrafpour, M.

    2000-01-01

    We consider the time evolution of the perturbed coherent states to solve the quantum sex tic nonlinear oscillator, in the framework of time dependent perturbation theory. An appropriate limit, h-bar → 0, (absolute value of α)→ ∞,(absolute value of α )√h-bar fixed, is then taken and the classical Poincare'-Landsat series is retrieved. We observe that a proper renormalization of the amplitude and the frequency is needed, if a meaningful comparison between the quantum and the classical results are to be made

  15. Evaluating the Auto-MODS Assay, a Novel Tool for Tuberculosis Diagnosis for Use in Resource-Limited Settings

    Science.gov (United States)

    Wang, Linwei; Mohammad, Sohaib H.; Li, Qiaozhi; Rienthong, Somsak; Rienthong, Dhanida; Nedsuwan, Supalert; Mahasirimongkol, Surakameth; Yasui, Yutaka

    2014-01-01

    There is an urgent need for simple, rapid, and affordable diagnostic tests for tuberculosis (TB) to combat the great burden of the disease in developing countries. The microscopic observation drug susceptibility assay (MODS) is a promising tool to fill this need, but it is not widely used due to concerns regarding its biosafety and efficiency. This study evaluated the automated MODS (Auto-MODS), which operates on principles similar to those of MODS but with several key modifications, making it an appealing alternative to MODS in resource-limited settings. In the operational setting of Chiang Rai, Thailand, we compared the performance of Auto-MODS with the gold standard liquid culture method in Thailand, mycobacterial growth indicator tube (MGIT) 960 plus the SD Bioline TB Ag MPT64 test, in terms of accuracy and efficiency in differentiating TB and non-TB samples as well as distinguishing TB and multidrug-resistant (MDR) TB samples. Sputum samples from clinically diagnosed TB and non-TB subjects across 17 hospitals in Chiang Rai were consecutively collected from May 2011 to September 2012. A total of 360 samples were available for evaluation, of which 221 (61.4%) were positive and 139 (38.6%) were negative for mycobacterial cultures according to MGIT 960. Of the 221 true-positive samples, Auto-MODS identified 212 as positive and 9 as negative (sensitivity, 95.9%; 95% confidence interval [CI], 92.4% to 98.1%). Of the 139 true-negative samples, Auto-MODS identified 135 as negative and 4 as positive (specificity, 97.1%; 95% CI, 92.8% to 99.2%). The median time to culture positivity was 10 days, with an interquartile range of 8 to 13 days for Auto-MODS. Auto-MODS is an effective and cost-sensitive alternative diagnostic tool for TB diagnosis in resource-limited settings. PMID:25378569

  16. Parental influences on adolescent video game play: a study of accessibility, rules, limit setting, monitoring, and cybersafety.

    Science.gov (United States)

    Smith, Lisa J; Gradisar, Michael; King, Daniel L

    2015-05-01

    Adolescents' video gaming is increasing at a rapid rate. Yet, little is known about what factors contribute toward more hours of gaming per week, as well as what factors may limit or protect adolescents from excessive gaming. The aim of the present study was to examine associations between adolescents' accessibility to video gaming devices, the locations played (i.e., bedroom, shared rooms), parental regulation of technology use, and the amount of hours spent video gaming during the week (weekdays vs. weekends). Adolescents (N=422; age 16.3±2.0 years, 41% male) completed an online questionnaire battery, including demographics, video gaming behaviors (e.g., hours played weekdays/weekends, time of day played, devices owned, locations played, etc.), and a questionnaire measuring aspects of parents' regulation of game playing (e.g., rules, limit setting, co-gaming). Accessibility to the adolescents' own devices, but not shared devices or device portability, was predictive of hours gaming on weekdays and weekends. Location (i.e., bedroom) was associated with increased gaming across the week. Parents discussing cybersafety was predictive of lower hours of gaming (weekdays and weekends). However, limit setting, monitoring, and co-gaming showed no significant effects. Adolescents' access to their own gaming equipped devices, as well as gaming in their bedrooms, were linked to increased hours of gaming. The findings suggest that in order to curb the increase in hours gaming, parents are advised to delay the ownership of adolescents' devices, encourage use in shared rooms, and discuss aspects of cybersafety with their teenage children.

  17. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Nana Ama Amissah

    2017-10-01

    Full Text Available Objectives:Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa.Methods:Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana.Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA. Notably, 25 (81% of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%, aminoglycosides (33%, oxacillin (33%, chloramphenicol (50%, tetracycline (59% and fluoroquinolones (100%.Conclusion: Population genomics uncovered multiple transmission events of S. aureus, especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  18. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit: The Importance of Active Surveillance in Resource-Limited Settings.

    Science.gov (United States)

    Amissah, Nana Ama; Buultjens, Andrew H; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L; Bulach, Dieter; Tetteh, Caitlin S; Prah, Isaac; van der Werf, Tjip S; Friedrich, Alexander W; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P; Rossen, John W

    2017-01-01

    Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low- and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the present study was to apply population genomics to precisely define, for the first time, the transmission of antibiotic resistant S. aureus in a resource-limited setting in sub-Saharan Africa. Methods: Staphylococcus aureus surveillance was performed amongst burn patients and healthcare workers during a 7-months survey within the burn unit of the Korle Bu Teaching Hospital in Ghana. Results: Sixty-six S. aureus isolates (59 colonizing and 7 clinical) were obtained from 31 patients and 10 healthcare workers. Twenty-one of these isolates were ST250-IV methicillin-resistant S. aureus (MRSA). Notably, 25 (81%) of the 31 patients carried or were infected with S. aureus within 24 h of admission. Genome comparisons revealed six distinct S. aureus clones circulating in the burn unit, and demonstrated multiple transmission events between patients and healthcare workers. Further, the collected S. aureus isolates exhibited a wide range of genotypic resistances to antibiotics, including trimethoprim (21%), aminoglycosides (33%), oxacillin (33%), chloramphenicol (50%), tetracycline (59%) and fluoroquinolones (100%). Conclusion: Population genomics uncovered multiple transmission events of S. aureus , especially MRSA, within the investigated burn unit. Our findings highlight lapses in infection control and prevention, and underscore the great importance of active surveillance to protect burn victims against multi-drug resistant pathogens in resource-limited settings.

  19. Validation of a pediatric early warning system for hospitalized pediatric oncology patients in a resource-limited setting.

    Science.gov (United States)

    Agulnik, Asya; Méndez Aceituno, Alejandra; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

    2017-12-15

    Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital

  20. Techniques to limit gaseous releases in case of reactor accident. Choice criteria - present solutions

    International Nuclear Information System (INIS)

    Billard, Francois; Lavie, Jean-Marie

    1964-10-01

    Within the frame of the study of radiological risks associated with a reactor accident in order to define the required responses, this study comprises, on the one hand, an analysis of the different accident types in order to select typical accidents, and on the other hand, a site-based analysis to define the maximum admissible radioactivity release for a given site. The determination of minimum required coefficient of risk reduction results from a compromise between the choice of reactor configuration type and the efficiency of purification devices, while taking into account minimum characteristics of the enclosure mechanical strength, local release conditions, and nature of gaseous effluents to be processed. After a review of available containment techniques, the author applies this analysis method to the different French reactor types. He gives a brief description of adopted solutions for the most typical French reactors in terms of characteristics of venting and filtration devices. As data quality is a crucial requirement, the author outlines the need for further studies regarding fission product emission and transfer, the purification of gaseous effluents and their diffusion in the atmosphere [fr

  1. Contribution of modifiable risk factors for hypertension and type-2 diabetes in Peruvian resource-limited settings.

    Science.gov (United States)

    Bernabé-Ortiz, Antonio; Carrillo-Larco, Rodrigo M; Gilman, Robert H; Checkley, William; Smeeth, Liam; Miranda, J Jaime

    2016-01-01

    It is important to understand the local burden of non-communicable diseases including within-country heterogeneity. The aim of this study was to characterise hypertension and type-2 diabetes profiles across different Peruvian geographical settings emphasising the assessment of modifiable risk factors. Analysis of the CRONICAS Cohort Study baseline assessment was conducted. Cardiometabolic outcomes were blood pressure categories (hypertension, prehypertension, normal) and glucose metabolism disorder status (diabetes, prediabetes, normal). Exposures were study setting and six modifiable factors (smoking, alcohol drinking, leisure time and transport-related physical activity levels, TV watching, fruit/vegetables intake and obesity). Poisson regression models were used to report prevalence ratios (PR). Population attributable risks (PAR) were also estimated. Data from 3238 participants, 48.3% male, mean age 45.3 years, were analysed. Age-standardised (WHO population) prevalence of prehypertension and hypertension was 24% and 16%, whereas for prediabetes and type-2 diabetes it was 18% and 6%, respectively. Outcomes varied according to study setting (pdiabetes. PAR showed that obesity was an important determinant for hypertension (15.7%) and type-2 diabetes (23.9%). There is an evident heterogeneity in the prevalence of and risk factors for hypertension and diabetes within Peru. Prehypertension and prediabetes are highly prevalent across settings. Our results emphasise the need of understanding the epidemiology of cardiometabolic conditions to appropriately implement interventions to tackle the burden of non-communicable diseases. 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/

  2. Evaluation of a four-item DSM-5 Limited Prosocial Emotions specifier scale within and across settings with Spanish children.

    Science.gov (United States)

    Seijas, Raquel; Servera, Mateu; García-Banda, Gloria; Barry, Christopher T; Burns, G Leonard

    2018-04-01

    The objective was to evaluate a 4-item measure of the DSM-5 Limited Prosocial Emotions (LPE) specifier (a 4-item measure of prosocial emotions). Mothers, fathers, primary teachers, and ancillary teachers completed measures of prosocial emotions (PE), oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity/impulsivity (HI), academic and social impairment on 811 Spanish first-grade children (46% girls). Confirmatory factor and structural regression analyses showed PE symptom scores to have (a) good reliability for the 4 sources (80% to 89% true score variance), (b) invariance of like-symptom loadings and intercepts across the 4 sources, (c) strong convergent and discriminant validity within home and school settings, (d) no convergent validity across settings, and (e) associations with academic and social impairment independent of the ODD dimension (the unique effects of PE also remained significant after controlling for ODD, ADHD-IN, and ADHD-HI for mothers and ancillary teachers). A graded response item response theory analysis indicated that PE scores provided an accurate measure of the PE trait across a wide trait range and especially at low PE trait levels (i.e., scores in the clinical range). Findings also supported the DSM-5 diagnostic criteria of 2 or more LPE symptoms in 2 or more settings (e.g., high levels of the LPE trait were associated with the occurrence of 2 or more symptoms with 4% of the sample showing 2 or more symptoms in both settings). Although additional studies are still required, the PE measure appears useful as a brief measure of the LPE specifier. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  3. TransCanada PipeLines Limited 1998 annual report : TransCanada energy solutions

    International Nuclear Information System (INIS)

    1999-01-01

    Financial information from TransCanada PipeLines Limited and a review of the company's 1998 operations was made available for the benefit of shareholders. TransCanada's pipeline system transports natural gas and crude oil from Western Canada Sedimentary Basin to North America's major energy markets. Net earnings from continuing operations for 1998, before unusual charges, were $575 million ($ 355 million after unusual charges) compared to $522 million for 1997. Solid performances from the energy transmission and international business, when compared to 1997, were more than offset by a decreased contribution from energy processing. TransCanada recorded integration costs of $166 million, after tax, related to the merger with NOVA in 1998, which was the major operational accomplishment during the year, creating a seamless economic energy delivery, processing and marketing system from the wellhead to the market. tabs., figs

  4. Parallel Jacobian-free Newton Krylov solution of the discrete ordinates method with flux limiters for 3D radiative transfer

    International Nuclear Information System (INIS)

    Godoy, William F.; Liu Xu

    2012-01-01

    The present study introduces a parallel Jacobian-free Newton Krylov (JFNK) general minimal residual (GMRES) solution for the discretized radiative transfer equation (RTE) in 3D, absorbing, emitting and scattering media. For the angular and spatial discretization of the RTE, the discrete ordinates method (DOM) and the finite volume method (FVM) including flux limiters are employed, respectively. Instead of forming and storing a large Jacobian matrix, JFNK methods allow for large memory savings as the required Jacobian-vector products are rather approximated by semiexact and numerical formulations, for which convergence and computational times are presented. Parallelization of the GMRES solution is introduced in a combined memory-shared/memory-distributed formulation that takes advantage of the fact that only large vector arrays remain in the JFNK process. Results are presented for 3D test cases including a simple homogeneous, isotropic medium and a more complex non-homogeneous, non-isothermal, absorbing–emitting and anisotropic scattering medium with collimated intensities. Additionally, convergence and stability of Gram–Schmidt and Householder orthogonalizations for the Arnoldi process in the parallel GMRES algorithms are discussed and analyzed. Overall, the introduction of JFNK methods results in a parallel, yet scalable to the tested 2048 processors, and memory affordable solution to 3D radiative transfer problems without compromising the accuracy and convergence of a Newton-like solution.

  5. Estimation of glucose kinetics in fetal-maternal studies: Potential errors, solutions, and limitations

    International Nuclear Information System (INIS)

    Menon, R.K.; Bloch, C.A.; Sperling, M.A.

    1990-01-01

    We investigated whether errors occur in the estimation of ovine maternal-fetal glucose (Glc) kinetics using the isotope dilution technique when the Glc pool is rapidly expanded by exogenous (protocol A) or endogenous (protocol C) Glc entry and sought possible solutions (protocol B). In protocol A (n = 8), after attaining steady-state Glc specific activity (SA) by [U-14C]glucose (period 1), infusion of Glc (period 2) predictably decreased Glc SA, whereas. [U-14C]glucose concentration unexpectedly rose from 7,208 +/- 367 (means +/- SE) in period 1 to 8,558 +/- 308 disintegrations/min (dpm) per ml in period 2 (P less than 0.01). Fetal endogenous Glc production (EGP) was negligible during period 1 (0.44 +/- 1.0), but yielded a physiologically impossible negative value of -2.1 +/- 0.72 mg.kg-1.min-1 during period 2. When the fall in Glc SA during Glc infusion was prevented by addition of [U-14C]glucose admixed with the exogenous Glc (protocol B; n = 7), EGP was no longer negative. In protocol C (n = 6), sequential infusions of four increasing doses of epinephrine serially decreased SA, whereas tracer Glc increased from 7,483 +/- 608 to 11,525 +/- 992 dpm/ml plasma (P less than 0.05), imposing an obligatory underestimation of EGP. Thus a tracer mixing problem leads to erroneous estimations of fetal Glc utilization and Glc production via the three-compartment model in sheep when the Glc pool is expanded exogenously or endogenously. These errors can be minimized by maintaining the Glc SA relatively constant

  6. International Neurocognitive Normative Study: Neurocognitive Comparison Data in Diverse Resource Limited Settings: AIDS Clinical Trials Group A5271

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, SR; Marra, CM; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, TB; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S.; Kumarasamy, N; La Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L.; Amod, F; Walawander, A

    2016-01-01

    Summary ACTG A5271 collected neurocognitive normative comparison test data in 2400 at-risk HIV seronegative participants from Brazil, India, Malawi, Peru, South Africa, Thailand and Zimbabwe. The participants were enrolled in strata by site (10 levels), age (2 levels), education (2 levels), and gender (2 levels). These data provide necessary normative data infrastructure for future clinical research and care in these diverse resource limited settings. Infrastructure for conducting neurological research in resource limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment, and normative data needed for clinical interpretation impede research and clinical care. Here we report on ACTG 5271, which provided neurological training of clinical site personnel, and collected neurocognitive normative comparison data in diverse settings. At 10 sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n=240), India (n=480), Malawi (n=481), Peru (n=239), South Africa (480), Thailand (n=240) and Zimbabwe (n=240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline, and 770 at six-months. Participants were enrolled in 8 strata, gender (female and male), education (<10 years and ≥ 10 years), and age (<35 years and ≥35 years). Of 2400 enrolled, 770 completed the six-month follow up. As expected, significant between-country differences were evident in all the neurocognitive test scores (p<.0001). There was variation between the age, gender and education strata on the neurocognitive tests. Age and education were important variables for all tests; older participants had poorer performance and those with higher education had better performance. Women had better performance on verbal learning/memory and speed of processing tests, while men performed better on motor tests. This study provides the

  7. Optical Frequency Comb Fourier Transform Spectroscopy with Resolution Exceeding the Limit Set by the Optical Path Difference

    Science.gov (United States)

    Foltynowicz, Aleksandra; Rutkowski, Lucile; Johanssson, Alexandra C.; Khodabakhsh, Amir; Maslowski, Piotr; Kowzan, Grzegorz; Lee, Kevin; Fermann, Martin

    2015-06-01

    Fourier transform spectrometers (FTS) based on optical frequency combs (OFC) allow detection of broadband molecular spectra with high signal-to-noise ratios within acquisition times orders of magnitude shorter than traditional FTIRs based on thermal sources. Due to the pulsed nature of OFCs the interferogram consists of a series of bursts rather than a single burst at zero optical path difference (OPD). The comb mode structure can be resolved by acquiring multiple bursts, in both mechanical FTS systems and dual-comb spectroscopy. However, in all existing demonstrations the resolution was ultimately limited either by the maximum available OPD between the interferometer arms or by the total acquisition time enabled by the storage memory. We present a method that provides spectral resolution exceeding the limit set by the maximum OPD using an interferogram containing only a single burst. The method allows measurements of absorption lines narrower than the OPD-limited resolution without any influence of the instrumental lineshape function. We demonstrate this by measuring undistorted CO2 and CO absorption lines with linewidth narrower than the OPD-limited resolution using OFC-based mechanical FTS in the near- and mid-infrared wavelength ranges. The near-infrared system is based on an Er:fiber femtosecond laser locked to a high finesse cavity, while the mid-infrared system is based on a Tm:fiber-laser-pumped optical parametric oscillator coupled to a multi-pass cell. We show that the method allows acquisition of high-resolution molecular spectra with interferometer length orders of magnitude shorter than traditional FTIR. Mandon, J., G. Guelachvili, and N. Picque, Nat. Phot., 2009. 3(2): p. 99-102. Zeitouny, M., et al., Ann. Phys., 2013. 525(6): p. 437-442. Zolot, A.M., et al., Opt. Lett., 2012. 37(4): p. 638-640.

  8. A Dilute-Limit Heat of Solution of 3d Transition Metals in Iron Studied with 57Fe Moessbauer Spectroscopy

    International Nuclear Information System (INIS)

    Chojcan, Jan

    2004-01-01

    The room-temperature 57 Fe Moessbauer spectra for binary iron-based solid solutions Fe 1-x D x with D=V, Cr, Mn and Co, were analysed in terms of binding energy E b between two D atoms in the Fe-D system. The extrapolated values of E b for x=0 were used for computation of the dilute-limit heat of solution of D metals in iron. The results were compared with those derived from calorimetric data concerning the heat of formation of the systems mentioned as well as with those resulting from the Miedema's model of alloys. The comparison shows that our Moessbauer spectroscopy findings are in a qualitative agreement with the available calorimetric data and they are at variance with corresponding Miedema's values for Fe-Mn and Fe-Co systems.

  9. Achieving a Green Solution: Limitations and Focus Points for Sustainable Algal Fuels

    Directory of Open Access Journals (Sweden)

    Blanca Antizar-Ladislao

    2012-05-01

    Full Text Available Research investigating the potential of producing biofuels from algae has been enjoying a recent revival due to heightened oil prices, uncertain fossil fuel sources and legislative targets aimed at reducing our contribution to climate change. If the concept is to become a reality however, many obstacles need to be overcome. Recent studies have suggested that open ponds provide the most sustainable means of cultivation infrastructure due to their low energy inputs compared to more energy intensive photobioreactors. Most studies have focused on strains of algae which are capable of yielding high oil concentrations combined with high productivity. Yet it is very difficult to cultivate such strains in open ponds as a result of microbial competition and limited radiation-use efficiency. To improve viability, the use of wastewater has been considered by many researchers as a potential source of nutrients with the added benefit of tertiary water treatment however productivity rates are affected and optimal conditions can be difficult to maintain year round. This paper investigates the process streams which are likely to provide the most viable methods of energy recovery from cultivating and processing algal biomass. The key findings are the importance of a flexible approach which depends upon location of the cultivation ponds and the industry targeted. Additionally this study recommends moving towards technologies producing higher energy recoveries such as pyrolysis or anaerobic digestion as opposed to other studies which focused upon biodiesel production.

  10. Relationship between Perceived Limit-Setting Abilities, Autism Spectrum Disorder Severity, Behaviour Problems and Parenting Stress in Mothers of Children with Autism Spectrum Disorder

    Science.gov (United States)

    Reed, Phil; Howse, Jessie; Ho, Ben; Osborne, Lisa A.

    2017-01-01

    Parenting stress in mothers of children with autism spectrum disorder (ASD) is high and impacts perceptions about parenting. This study examined the relationship between parenting stress and observer-perceived limit-setting ability. Participants' perceptions of other parents' limit-setting ability were assessed by showing participants video clips…

  11. Low-cost matched sibling bone marrow transplant for standard-risk thalassemia in a limited-resource setting

    Directory of Open Access Journals (Sweden)

    Stalin Ramprakash

    2017-12-01

    Full Text Available Thalassemias are the most common inherited genetic disorder in India and a major public health burden with bone marrow transplant (BMT considered the only established curative therapy. We describe outcomes for patients (n = 71 with standard-risk thalassemia (liver size 80 at the last follow up. 5 patients (7% died, mortality related to transplant. Enough data existed for 2 centers in India (36/71 transplants to analyze overall costs from admission up to one-year post-BMT which revealed a median cost of Rs 7,30,445 ($11519 [Range Rs 4,52,821–10,32,842 ($ 7079–16147]. In conclusion, children with thalassemia in resource limited settings can achieve good outcomes with BMT at a reasonable cost.

  12. Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

    Directory of Open Access Journals (Sweden)

    Mahalu William

    2011-09-01

    Full Text Available Abstract Background Oesophageal perforation is a condition associated with a high mortality. Its management is still controversial with operative treatment being favoured but a shift to conservative management is occurring. Very little exists in medical literature about its management in Sub-Saharan Africa, where the paucity of thoracic surgeons is compounded by limited diagnostic and therapeutic facilities. Case Presentation We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy, nil by mouth with feeding gastrostomy, intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia. Conclusion In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations.

  13. Dry Blood Spots a Reliable Method for Measurement of Hepatitis B Viral Load in Resource-Limited Settings.

    Directory of Open Access Journals (Sweden)

    Kathrine Stene-Johansen

    Full Text Available Hepatitis B virus (HBV quantification is essential in the management of chronic hepatitis B, both to determine treatment eligibility and in the monitoring of treatment effect. This test, however, is rarely available in resource-limited settings due to high costs and stringent requirements for shipment and storage of plasma. Dried Blood Spots (DBS can be a convenient alternative to plasma, but its use for HBV monitoring has not been investigated under real-life conditions in Africa.The performance of DBS in HBV quantification was investigated using a modified commercial test (Abbott RealTime HBV assay. Paired DBS and plasma samples were collected from an HBV positive cohort in Addis Ababa, Ethiopia. DBS were stored at ambient temperature for 4-39 days before shipment to the laboratory.Twenty-six paired samples were selected covering the total range of quantification, from 2.14 log IU/ml to >7 log IU/ml. HBV was detected in 21 of 21 (100% DBS from patients with a corresponding plasma viral load above 2.70 log IU/ml. The mean difference between plasma and DBS was 0.59 log IU/ml, and the correlation was strong (R2 = 0.92. In stability studies there was no significant change in DBS viral load after storage at room temperature for up to 12 weeks.This study suggests that DBS can be a feasible and reliable alternative to plasma for quantification of HBV in resource-limited settings. DBS can expand access to antiviral treatment for patients in low- and middle-income countries.

  14. Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk pasteurization in resource-limited settings.

    Science.gov (United States)

    Naicker, Mageshree; Coutsoudis, Anna; Israel-Ballard, Kiersten; Chaudhri, Rohit; Perin, Noah; Mlisana, Koleka

    2015-03-01

    Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa. For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated. In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth. Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives.

  15. Limiting financial disincentives in live organ donation: a rational solution to the kidney shortage.

    Science.gov (United States)

    Gaston, R S; Danovitch, G M; Epstein, R A; Kahn, J P; Matas, A J; Schnitzler, M A

    2006-11-01

    Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of 'valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes.

  16. A new analytical approach for limit cycles and quasi-periodic solutions of nonlinear oscillators: the example of the forced Van der Pol Duffing oscillator

    International Nuclear Information System (INIS)

    Shukla, Anant Kant; Ramamohan, T R; Srinivas, S

    2014-01-01

    In this paper we propose a technique to obtain limit cycles and quasi-periodic solutions of forced nonlinear oscillators. We apply this technique to the forced Van der Pol oscillator and the forced Van der Pol Duffing oscillator and obtain for the first time their limit cycles (periodic) and quasi-periodic solutions analytically. We introduce a modification of the homotopy analysis method to obtain these solutions. We minimize the square residual error to obtain accurate approximations to these solutions. The obtained analytical solutions are convergent and agree well with numerical solutions even at large times. Time trajectories of the solution, its first derivative and phase plots are presented to confirm the validity of the proposed approach. We also provide rough criteria for the determination of parameter regimes which lead to limit cycle or quasi-periodic behaviour. (papers)

  17. BeerOz, a set of Matlab routines for the quantitative interpretation of spectrophotometric measurements of metal speciation in solution

    Science.gov (United States)

    Brugger, Joël

    2007-02-01

    The modelling of the speciation and mobility of metals under surface and hydrothermal conditions relies on the availability of accurate thermodynamic properties for all relevant minerals, aqueous species, gases and surface species. Spectroscopic techniques obeying the Beer-Lambert law can be used to obtain thermodynamic properties for reactions among aqueous species (e.g., ligand substitution; protonation). BeerOz is a set of Matlab routines designed to perform both qualitative and quantitative analysis of spectroscopic data following the Beer-Lambert law. BeerOz is modular and can be customised for particular experimental strategies or for simultaneous refinement of several datasets obtained using different techniques. Distribution of species calculations are performed using an implementation of the EQBRM code, which allows for customised activity coefficient calculations. BeerOz also contains routines to study the n-dimensional solution space, in order to provide realistic estimates of errors and test for the existence of multiple local minima and correlation between the different refined variables. The paper reviews the physical principles underlying the qualitative and quantitative analysis of spectroscopic data collected on aqueous speciation, in particular for studying successive ligand replacement reactions, and presents the non-linear least-squares algorithm implemented in BeerOz. The discussion is illustrated using UV-Vis spectra collected on acidic Fe(III) solutions containing varying LiCl concentrations, and showing the change from the hexaaquo Fe(H 2O) 63+ complex to the tetrahedral FeCl 4- complex.

  18. Linking chloride mass balance infiltration rates with chlorofluorocarbon and SF6 groundwater dating in semi-arid settings: potential and limitations.

    Science.gov (United States)

    Stadler, Susanne; Osenbruck, Karsten; Duijnisveld, Wilhelmus H M; Schwiede, Martin; Bottcher, Jurgen

    2010-09-01

    In the framework of the investigation of enrichment processes of nitrate in groundwater of the Kalahari of Botswana near Serowe, recharge processes were investigated. The thick unsaturated zone extending to up to 100 m of mostly unconsolidated sediments and very low recharge rates pose a serious challenge to study solute transport related to infiltration and recharge processes, as this extends past the conventional depths of soil scientific investigations and is difficult to describe using evidence from the groundwater due to the limitations imposed by available tracers. To determine the link between nitrate in the vadose zone and in the uppermost groundwater, sediment from the vadose zone was sampled up to a depth of 15-20 m (in one case also to 65 m) on several sites with natural vegetation in the research area. Among other parameters, sediment and water were analysed to determine chloride and nitrate concentration depth profiles. Using the chloride mass balance method, an estimation of groundwater infiltration rates produced values of 0.2-4 mm a(-1). The uncertainty of these values is, however, high. Because of the extreme thickness of the vadose zone, the travel time in the unsaturated zone might reach extreme values of up to 500 years and more. For investigations using groundwater, we applied the chlorofluorocarbons CFC-113, CFC-12, sulphur hexafluoride (SF(6)) and tritium to identify potential recharge, and found indications for some advective transport of the CFCs and SF(6), which we accounted for as constituting potential active localised recharge. In our contribution, we show the potential and limitations of the applied methods to determine groundwater recharge and coupled solute transport in semi-arid settings, and compare travel time ranges derived from soil science and groundwater investigations.

  19. The 'My five moments for hand hygiene' concept for the overcrowded setting in resource-limited healthcare systems.

    Science.gov (United States)

    Salmon, S; Pittet, D; Sax, H; McLaws, M L

    2015-10-01

    Hand hygiene is a core activity of patient safety for the prevention of healthcare-associated infections (HCAIs). To standardize hand hygiene practices globally the World Health Organization (WHO) released Guidelines on Hand Hygiene in Health Care and introduced the 'My five moments for hand hygiene' concept to define indications for hand hygiene rooted in an evidence-based model for transmission of micro-organisms by healthcare workers' (HCWs) hands. Central to the concept is the division of the healthcare environment into two geographical care zones, the patient zone and the healthcare zone, that requires the HCW to comply with specific hand hygiene moments. In resource-limited, overcrowded healthcare settings inadequate or no spatial separation between beds occurs frequently. These conditions challenge the HCW's ability to visualize and delineate patient zones. The 'My five moments for hand hygiene' concept has been adapted for these conditions with the aim of assisting hand hygiene educators, auditors, and HCWs to minimize ambiguity regarding shared patient zones and achieve the ultimate goal set by the WHO Guidelines--the reduction of infectious risks. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  20. Epidemiology, Diagnosis, and Treatment of HIV-Associated Non-Hodgkin Lymphoma in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Matthew Ulrickson

    2012-01-01

    Full Text Available Lymphoma was a common complication of HIV infection in the pre-antiretroviral era, and the incidence of HIV-associated lymphoma has dropped dramatically since the introduction of combination antiretroviral therapy (cART in resource-rich regions. Conversely, lymphoma is an increasingly common complication of HIV infection in resource-limited settings where the prevalence of HIV infection is high. Relatively little is known, however, about the true incidence and optimal treatment regimens for HIV-associated lymphoma in resource-poor regions. We review the epidemiology, diagnosis, and treatment of HIV-associated non-Hodgkin lymphoma in developing nations and highlight areas for further research that may benefit care in both settings. Examples include risk modification and dose modification of chemotherapy based on HIV risk factors, improving our understanding of the current burden of disease through national cancer registries, and developing cost-effective hematopathological diagnostic strategies to optimize care delivery and maximize use of available chemotherapy.

  1. Design of a Novel Low Cost Point of Care Tampon (POCkeT) Colposcope for Use in Resource Limited Settings

    Science.gov (United States)

    Lam, Christopher T.; Krieger, Marlee S.; Gallagher, Jennifer E.; Asma, Betsy; Muasher, Lisa C.; Schmitt, John W.; Ramanujam, Nimmi

    2015-01-01

    Introduction Current guidelines by WHO for cervical cancer screening in low- and middle-income countries involves visual inspection with acetic acid (VIA) of the cervix, followed by treatment during the same visit or a subsequent visit with cryotherapy if a suspicious lesion is found. Implementation of these guidelines is hampered by a lack of: trained health workers, reliable technology, and access to screening facilities. A low cost ultra-portable Point of Care Tampon based digital colposcope (POCkeT Colposcope) for use at the community level setting, which has the unique form factor of a tampon, can be inserted into the vagina to capture images of the cervix, which are on par with that of a state of the art colposcope, at a fraction of the cost. A repository of images to be compiled that can be used to empower front line workers to become more effective through virtual dynamic training. By task shifting to the community setting, this technology could potentially provide significantly greater cervical screening access to where the most vulnerable women live. The POCkeT Colposcope’s concentric LED ring provides comparable white and green field illumination at a fraction of the electrical power required in commercial colposcopes. Evaluation with standard optical imaging targets to assess the POCkeT Colposcope against the state of the art digital colposcope and other VIAM technologies. Results Our POCkeT Colposcope has comparable resolving power, color reproduction accuracy, minimal lens distortion, and illumination when compared to commercially available colposcopes. In vitro and pilot in vivo imaging results are promising with our POCkeT Colposcope capturing comparable quality images to commercial systems. Conclusion The POCkeT Colposcope is capable of capturing images suitable for cervical lesion analysis. Our portable low cost system could potentially increase access to cervical cancer screening in limited resource settings through task shifting to community

  2. A New Zealand Scientific Perspective on 20+ Years of Efforts to Introduce Policies Setting Limits on Emissions: What's the Way Forward?

    Science.gov (United States)

    Baisden, T. W.

    2013-12-01

    Setting limits on pollution is an inherently political process negotiated between stakeholders within society. Science has a critical, but not dominant role in setting environmental limits. Over the past 20 years, nations have had the opportunity to build on a period of major international successes, limiting ozone-depleting chemicals and sulphur emissions causing acid rain. The science and politics of solutions attempted during this time has become vastly more complicated, and the outcome has been disappointing: global greenhouse gas emissions remain at business-as-usual trajectories. It seems logical and timely to examine the landscape before forging onward. In a brief review of lessons learned from the perspective of earth-system science within New Zealand, I highlight key examples and opportunities for creating more promising way forward. Among the lessons are that small-scale limit setting can host important innovation, while collapses can occur when systems that are too-big-to-fail but lack critical pre-requisites. In this sense, implementation of cap-and-trade for water quality may represent the former, while the collapse of C prices highlight the latter. Of critical importance is the simple observation that perceived uncertainties must be brought within bounds that make decisions possible. The way in which system are framed scientifically can be of overarching significance. Cap and trade for nutrients in New Zealand catchments has enabled small-scale illustrations of how the system frame can be vital in successful policy. For example, the N budget of Lake Taupo is simplified by focusing on inputs to the land, while 100-year forcing equivalence still raises questions about managing climate change. Relationships between emissions and activity must be distilled based on sound science, in a manner simple and certain enough for people and businesses to meaningfully consider in decisions that are made every day. With trust becoming a major limiting factor in the

  3. TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.

    Science.gov (United States)

    Pathmanathan, I; Ahmedov, S; Pevzner, E; Anyalechi, G; Modi, S; Kirking, H; Cavanaugh, J S

    2018-06-01

    Tuberculosis (TB) is the leading cause of death for persons living with the human immunodeficiency virus (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children and has been recommended as an international standard of care for over a decade, it remains highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of tuberculous infection, especially in those, such as PLHIV, who are most likely to progress to TB disease. To do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. Here we review available evidence to address several commonly stated obstacles to TPT scale-up, including the need for the tuberculin skin test, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to monitor for and prevent adverse events, a 'one size fits all' option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how best to tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.

  4. Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study.

    Science.gov (United States)

    Abubakar, Amina; Van de Vijver, Fons; Van Baar, Anneloes; Mbonani, Leonard; Kalu, Raphael; Newton, Charles; Holding, Penny

    2008-09-01

    Sub-optimal physical growth has been suggested as a key pathway between the effect of environmental risk and developmental outcome. To determine if anthropometric status mediates the relation between socioeconomic status and psychomotor development of young children in resource-limited settings. A cross-sectional study design was used. A total of 204 (105 girls) children from two resource-limited communities in the Coast Province, Kenya. The mean age of these children was 29 months (SD = 3.43; range: 24-35 months). Psychomotor functioning was assessed using a locally developed and validated measure, the Kilifi Developmental Inventory. A significant association was found between anthropometric status (as measured by weight-for-age, height-for-age, mid-upper arm circumference, and head circumference) and psychomotor functioning and also between socioeconomic status and anthropometric status; no direct effects were found between socioeconomic status and developmental outcome. The models showed that weight, height and to a lesser extent mid-upper arm circumference mediate the relation between socioeconomic status and developmental outcome, while head circumference did not show the same effect. Among children under 3 years living in poverty, anthropometric status shows a clear association with psychomotor development while socioeconomic status may only have an indirect association.

  5. Large reptiles and cold temperatures: Do extreme cold spells set distributional limits for tropical reptiles in Florida?

    Science.gov (United States)

    Mazzotti, Frank J.; Cherkiss, Michael S.; Parry, Mark; Beauchamp, Jeff; Rochford, Mike; Smith, Brian J.; Hart, Kristen M.; Brandt, Laura A.

    2016-01-01

    Distributional limits of many tropical species in Florida are ultimately determined by tolerance to low temperature. An unprecedented cold spell during 2–11 January 2010, in South Florida provided an opportunity to compare the responses of tropical American crocodiles with warm-temperate American alligators and to compare the responses of nonnative Burmese pythons with native warm-temperate snakes exposed to prolonged cold temperatures. After the January 2010 cold spell, a record number of American crocodiles (n = 151) and Burmese pythons (n = 36) were found dead. In contrast, no American alligators and no native snakes were found dead. American alligators and American crocodiles behaved differently during the cold spell. American alligators stopped basking and retreated to warmer water. American crocodiles apparently continued to bask during extreme cold temperatures resulting in lethal body temperatures. The mortality of Burmese pythons compared to the absence of mortality for native snakes suggests that the current population of Burmese pythons in the Everglades is less tolerant of cold temperatures than native snakes. Burmese pythons introduced from other parts of their native range may be more tolerant of cold temperatures. We documented the direct effects of cold temperatures on crocodiles and pythons; however, evidence of long-term effects of cold temperature on their populations within their established ranges remains lacking. Mortality of crocodiles and pythons outside of their current established range may be more important in setting distributional limits.

  6. Spherically symmetric solutions, Newton's Law, and the infrared limit λ→1 in covariant Horava-Lifshitz gravity

    International Nuclear Information System (INIS)

    Alexandre, Jean; Pasipoularides, Pavlos

    2011-01-01

    In this note we examine whether spherically symmetric solutions in covariant Horava-Lifshitz gravity can reproduce Newton's Law in the IR limit λ→1. We adopt the position that the auxiliary field A is independent of the space-time metric [J. Alexandre and P. Pasipoularides, Phys. Rev. D 83, 084030 (2011).][J. Greenwald, V. H. Satheeshkumar, and A. Wang, J. Cosmol. Astropart. Phys. 12 (2010) 007.], and we assume, as in [A. M. da Silva, Classical Quantum Gravity 28, 055011 (2011).], that λ is a running coupling constant. We show that under these assumptions, spherically symmetric solutions fail to restore the standard Newtonian physics in the IR limit λ→1, unless λ does not run, and has the fixed value λ=1. Finally, we comment on the Horava and Melby-Thompson approach [P. Horava and C. M. Melby-Thompson, Phys. Rev. D 82, 064027 (2010).] in which A is assumed as a part of the space-time metric in the IR.

  7. Approximation of a Common Element of the Fixed Point Sets of Multivalued Strictly Pseudocontractive-Type Mappings and the Set of Solutions of an Equilibrium Problem in Hilbert Spaces

    Directory of Open Access Journals (Sweden)

    F. O. Isiogugu

    2016-01-01

    Full Text Available The strong convergence of a hybrid algorithm to a common element of the fixed point sets of multivalued strictly pseudocontractive-type mappings and the set of solutions of an equilibrium problem in Hilbert spaces is obtained using a strict fixed point set condition. The obtained results improve, complement, and extend the results on multivalued and single-valued mappings in the contemporary literature.

  8. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings

    Science.gov (United States)

    Meyer, Ana-Claire L.; Dua, Tarun; Boscardin, John; Escarce, José J.; Saxena, Shekhar; Birbeck, Gretchen L.

    2013-01-01

    Purpose Epilepsy is one of the most common serious neurological disorders worldwide. Our objective was to determine which economic, healthcare, neurology and epilepsy specific resources were associated with untreated epilepsy in resource-constrained settings. Methods A systematic review of the literature identified community-based studies in resource-constrained settings that calculated the epilepsy treatment gap, the proportion with untreated epilepsy, from prevalent active epilepsy cases. Economic, healthcare, neurology and epilepsy specific resources were taken from existing datasets. Poisson regression models with jackknifed standard errors were used to create bivariate and multivariate models comparing the association between treatment status and economic and health resource indicators. Relative risks were reported. Key Findings Forty-seven studies of 8285 individuals from 24 countries met inclusion criteria. Bivariate analysis demonstrated that individuals residing in rural locations had significantly higher risks of untreated epilepsy [Relative Risk(RR)=1.63; 95% confidence interval(CI):1.26,2.11]. Significantly lower risks of untreated epilepsy were observed for higher physician density [RR=0.65, 95% CI:0.55,0.78], presence of a lay [RR=0.74, 95%CI:0.60,0.91] or professional association for epilepsy [RR=0.73, 95%CI:0.59,0.91], or post-graduate neurology training program [RR=0.67, 95%CI:0.55, 0.82]. In multivariate models, higher physician density maintained significant effects [RR=0.67; 95%CI:0.52,0.88]. Significance Even among resource-limited regions, people with epilepsy in countries with fewer economic, healthcare, neurology and epilepsy specific resources are more likely to have untreated epilepsy. Community-based epilepsy care programs have improved access to treatment but in order to decrease the epilepsy treatment gap, poverty and inequalities of healthcare, neurological and epilepsy resources must be dealt with at the local, national, and global

  9. Post procedural complications of cardiac implants done in a resource limited setting under 'C' arm: A single centre experience.

    Science.gov (United States)

    Jayachandra, A; Aggarwal, Vivek; Kumar, Sandeep; Nagesh, I V

    2018-04-01

    Cardiology interventions in peripheral hospitals is a challenging task where cardiologist have to fight against time and limited resources. Most of the sudden cardiac deaths occur due to arrhythmia and heart blocks/sinus node dysfunction. Our study is a single peripheral center experience of cardiac devices implantation using a 'C' Arm. The aim of this study was to post procedural complications of cardiac implants done in aresource limited setting under 'C' arm. This study is done at a peripheral cardiology center with no cardiac catheterization laboratory (CCL) facilities. Consecutive patients reporting to cardiology center, between Jan 2015 and Oct 2016, with a definite indication for cardiac device implant were included in the study. All the procedure of implantation was done in the operation theatre under 'C' arm under local anesthesia with continuous cardiac monitoring and critical care back up. Total 58 device implantations were done from Jan 2015 to Oct 2016. The mean age of the patients was 67.15 ± 10.85 years. Males constituted almost two third (68.9%) of patients. The commonest indication for device implantation was sinus node dysfunction in 60.34% followed by complete heart block in 25.86% and ventricular tachycardia in 12.06%. No post procedure infection was observed in our study. Device implantation constitute a major group of life saving interventions in cardiology practice. Our study has emphasised that when appropriate aseptic measures are taken during device implantation at peripheral centres, the complications rate are comparable to interventions done at advance cardiac centres.

  10. Characterization of HIV-1 antiretroviral drug resistance after second-line treatment failure in Mali, a limited-resources setting

    Science.gov (United States)

    Maiga, Almoustapha Issiaka; Fofana, Djeneba Bocar; Cisse, Mamadou; Diallo, Fodié; Maiga, Moussa Youssoufa; Traore, Hamar Alassane; Maiga, Issouf Alassane; Sylla, Aliou; Fofana, Dionke; Taiwo, Babafemi; Murphy, Robert; Katlama, Christine; Tounkara, Anatole; Calvez, Vincent; Marcelin, Anne-Geneviève

    2012-01-01

    Objectives We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) or resistance testing. Methods We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm. Results Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm3. Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P < 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P < 0.0001) and darunavir (P = 0.06). Conclusion Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings. PMID:22888273

  11. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

    Science.gov (United States)

    Modi, Payal; Glavis-Bloom, Justin; Nasrin, Sabiha; Guy, Allysia; Chowa, Erika P; Dvor, Nathan; Dworkis, Daniel A; Oh, Michael; Silvestri, David M; Strasberg, Stephen; Rege, Soham; Noble, Vicki E; Alam, Nur H; Levine, Adam C

    2016-01-01

    Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy. To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children. A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity. 850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor. Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

  12. Xpert MTB/RIF testing in a low tuberculosis incidence, high-resource setting: limitations in accuracy and clinical impact.

    Science.gov (United States)

    Sohn, Hojoon; Aero, Abebech D; Menzies, Dick; Behr, Marcel; Schwartzman, Kevin; Alvarez, Gonzalo G; Dan, Andrei; McIntosh, Fiona; Pai, Madhukar; Denkinger, Claudia M

    2014-04-01

    Xpert MTB/RIF, the first automated molecular test for tuberculosis, is transforming the diagnostic landscape in low-income countries. However, little information is available on its performance in low-incidence, high-resource countries. We evaluated the accuracy of Xpert in a university hospital tuberculosis clinic in Montreal, Canada, for the detection of pulmonary tuberculosis on induced sputum samples, using mycobacterial cultures as the reference standard. We also assessed the potential reduction in time to diagnosis and treatment initiation. We enrolled 502 consecutive patients who presented for evaluation of possible active tuberculosis (most with abnormal chest radiographs, only 18% symptomatic). Twenty-five subjects were identified to have active tuberculosis by culture. Xpert had a sensitivity of 46% (95% confidence interval [CI], 26%-67%) and specificity of 100% (95% CI, 99%-100%) for detection of Mycobacterium tuberculosis. Sensitivity was 86% (95% CI, 42%-100%) in the 7 subjects with smear-positive results, and 28% (95% CI, 10%-56%) in the remaining subjects with smear-negative, culture-positive results; in this latter group, positive Xpert results were obtained a median 12 days before culture results. Subjects with positive cultures but negative Xpert results had minimal disease: 11 of 13 had no symptoms on presentation, and mean time to positive liquid culture results was 28 days (95% CI, 25-47 days) compared with 14 days (95% CI, 8-21 days) in Xpert/culture-positive cases. Our findings suggest limited potential impact of Xpert testing in high-resource, low-incidence ambulatory settings due to lower sensitivity in the context of less extensive disease, and limited potential to expedite diagnosis beyond what is achieved with the existing, well-performing diagnostic algorithm.

  13. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

    Directory of Open Access Journals (Sweden)

    Payal Modi

    Full Text Available Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b. Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60, sensitivity (67%, and specificity (49%, for predicting severe dehydration were all poor.Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

  14. Stroke mortality and its determinants in a resource-limited setting: A prospective cohort study in Yaounde, Cameroon.

    Science.gov (United States)

    Nkoke, Clovis; Lekoubou, Alain; Balti, Eric; Kengne, Andre Pascal

    2015-11-15

    About three quarters of stroke deaths occur in developing countries including those in sub-Saharan African. Short and long-term stroke fatality data are needed for health service and policy formulation. We prospectively followed up from stroke onset, 254 patients recruited from the largest reference hospitals in Yaounde (Cameroon). Mortality and determinants were investigated using the accelerated failure time regression analysis. Stroke mortality rates at one-, six- and 12 months were respectively 23.2% (Ischemic strokes: 20.4%, hemorrhagic strokes: 26.1%, and undetermined strokes: 34.8, p=0.219), 31.5% (ischemic strokes: 31.5%, hemorrhagic strokes: 30.4%, and undetermined strokes: 34.8%, p=0.927), and 32.7% (ischemic strokes: 32.1%, hemorrhagic strokes: 30.4%, undetermined strokes: 43.5%, p=0.496). Fever, swallowing difficulties, and admission NIHSS independently predicted mortality at one month, six and 12 months. Elevated systolic blood pressure (BP) predicted mortality at one month. Elevated diastolic blood pressure was a predictor of mortality at one month in participants with hemorrhagic stroke. Low hemoglobin level on admission only predicted long term mortality. In this resource-limited setting, post-stroke mortality was high with 1 out of 5 deaths occurring at one month and up to 30% deaths at six and twelve months after the index event. Fever, stroke severity, elevated BP and anemia increased the risk of death. Our findings add to the body of evidence for the poor outcome after stroke in resource limited environments. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Biomarkers to Stratify Risk Groups among Children with Malnutrition in Resource-Limited Settings and to Monitor Response to Intervention.

    Science.gov (United States)

    McGrath, Christine J; Arndt, Michael B; Walson, Judd L

    2017-01-01

    Despite global efforts to reduce childhood undernutrition, current interventions have had little impact on stunting and wasting, and the mechanisms underlying growth faltering are poorly understood. There is a clear need to distinguish populations of children most likely to benefit from any given intervention and to develop tools to monitor response to therapy prior to the development of morbid sequelae. In resource-limited settings, environmental enteric dysfunction (EED) is common among children, contributing to malnutrition and increasing childhood morbidity and mortality risk. In addition to EED, early alterations in the gut microbiota can adversely affect growth through nutrient malabsorption, altered metabolism, gut inflammation, and dysregulation of the growth hormone axis. We examined the evidence linking EED and the gut microbiome to growth faltering and explored novel biomarkers to identify subgroups of children at risk of malnutrition due to underlying pathology. These and other biomarkers could be used to identify specific groups of children at risk of malnutrition and monitor response to targeted interventions. © 2017 S. Karger AG, Basel.

  16. Systematic review of electronic surveillance of infectious diseases with emphasis on antimicrobial resistance surveillance in resource-limited settings.

    Science.gov (United States)

    Rattanaumpawan, Pinyo; Boonyasiri, Adhiratha; Vong, Sirenda; Thamlikitkul, Visanu

    2018-02-01

    Electronic surveillance of infectious diseases involves rapidly collecting, collating, and analyzing vast amounts of data from interrelated multiple databases. Although many developed countries have invested in electronic surveillance for infectious diseases, the system still presents a challenge for resource-limited health care settings. We conducted a systematic review by performing a comprehensive literature search on MEDLINE (January 2000-December 2015) to identify studies relevant to electronic surveillance of infectious diseases. Study characteristics and results were extracted and systematically reviewed by 3 infectious disease physicians. A total of 110 studies were included. Most surveillance systems were developed and implemented in high-income countries; less than one-quarter were conducted in low-or middle-income countries. Information technologies can be used to facilitate the process of obtaining laboratory, clinical, and pharmacologic data for the surveillance of infectious diseases, including antimicrobial resistance (AMR) infections. These novel systems require greater resources; however, we found that using electronic surveillance systems could result in shorter times to detect targeted infectious diseases and improvement of data collection. This study highlights a lack of resources in areas where an effective, rapid surveillance system is most needed. The availability of information technology for the electronic surveillance of infectious diseases, including AMR infections, will facilitate the prevention and containment of such emerging infectious diseases. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. 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.

  18. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings

    Science.gov (United States)

    Nadeem, Sayyada Ghufrana; Hakim, Shazia Tabassum; Kazmi, Shahana Urooj

    2010-01-01

    Introduction Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal–tween 80 agar and biochemical methods by using API 20 C AUX. Results The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients. PMID:21483597

  19. A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting.

    Science.gov (United States)

    Flood, David; Douglas, Kate; Goldberg, Vera; Martinez, Boris; Garcia, Pablo; Arbour, MaryCatherine; Rohloff, Peter

    2017-08-01

    Quality improvement (QI) is a key strategy for improving diabetes care in low- and middle-income countries (LMICs). This study reports on a diabetes QI project in rural Guatemala whose primary aim was to improve glycemic control of a panel of adult diabetes patients. Formative research suggested multiple areas for programmatic improvement in ambulatory diabetes care. This project utilized the Model for Improvement and Agile Global Health, our organization's complementary healthcare implementation framework. A bundle of improvement activities were implemented at the home, clinic and institutional level. Control charts of mean hemoglobin A1C (HbA1C) and proportion of patients meeting target HbA1C showed improvement as special cause variation was identified 3 months after the intervention began. Control charts for secondary process measures offered insights into the value of different components of the intervention. Intensity of home-based diabetes education emerged as an important driver of panel glycemic control. Diabetes QI work is feasible in resource-limited settings in LMICs and can improve glycemic control. Statistical process control charts are a promising methodology for use with panels or registries of diabetes patients. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  20. Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances.

    Science.gov (United States)

    Campbell, Jeffrey I; Haberer, Jessica E

    2015-12-01

    Numerous cell phone-based and adherence monitoring technologies have been developed to address barriers to effective HIV prevention, testing, and treatment. Because most people living with HIV and AIDS reside in resource-limited settings (RLS), it is important to understand the development and use of these technologies in RLS. Recent research on cell phone-based technologies has focused on HIV education, linkage to and retention in care, disease tracking, and antiretroviral therapy adherence reminders. Advances in adherence devices have focused on real-time adherence monitors, which have been used for both antiretroviral therapy and pre-exposure prophylaxis. Real-time monitoring has recently been combined with cell phone-based technologies to create real-time adherence interventions using short message service (SMS). New developments in adherence technologies are exploring ingestion monitoring and metabolite detection to confirm adherence. This article provides an overview of recent advances in these two families of technologies and includes research on their acceptability and cost-effectiveness when available. It additionally outlines key challenges and needed research as use of these technologies continues to expand and evolve.

  1. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings

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    Sayyada Ghufrana Nadeem

    2010-02-01

    Full Text Available Introduction: Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. Material and methods: A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal–tween 80 agar and biochemical methods by using API 20 C AUX. Results: The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. Conclusion: The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients.

  2. Use of CHROMagar Candida for the presumptive identification of Candida species directly from clinical specimens in resource-limited settings.

    Science.gov (United States)

    Nadeem, Sayyada Ghufrana; Hakim, Shazia Tabassum; Kazmi, Shahana Urooj

    2010-02-09

    Identification of yeast isolated from clinical specimens to the species level has become increasingly important. Ever-increasing numbers of immuno-suppressed patients, a widening range of recognized pathogens, and the discovery of resistance to antifungal drugs are contributing factors to this necessity. A total of 487 yeast strains were studied for the primary isolation and presumptive identification, directly from clinical specimen. Efficacy of CHROMagar Candida has been evaluated with conventional methods including morphology on Corn meal-tween 80 agar and biochemical methods by using API 20 C AUX. The result of this study shows that CHROMagar Candida can easily identify three species of Candida on the basis of colonial color and morphology, and accurately differentiate between them i.e. Candida albicans, Candida tropicalis, and Candida krusei. The specificity and sensitivity of CHROMagar Candida for C. albicans calculated as 99%, for C. tropicalis calculated as 98%, and C. krusei it is 100%. The data presented supports the use of CHROMagar Candida for the rapid identification of Candida species directly from clinical specimens in resource-limited settings, which could be very helpful in developing appropriate therapeutic strategy and management of patients.

  3. Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review.

    Science.gov (United States)

    Lawn, Stephen D; Meintjes, Graeme; McIlleron, Helen; Harries, Anthony D; Wood, Robin

    2013-12-02

    The HIV-associated tuberculosis (TB) epidemic remains a huge challenge to public health in resource-limited settings. Reducing the nearly 0.5 million deaths that result each year has been identified as a key priority. Major progress has been made over the past 10 years in defining appropriate strategies and policy guidelines for early diagnosis and effective case management. Ascertainment of cases has been improved through a twofold strategy of provider-initiated HIV testing and counseling in TB patients and intensified TB case finding among those living with HIV. Outcomes of rifampicin-based TB treatment are greatly enhanced by concurrent co-trimoxazole prophylaxis and antiretroviral therapy (ART). ART reduces mortality across a spectrum of CD4 counts and randomized controlled trials have defined the optimum time to start ART. Good outcomes can be achieved when combining TB treatment with first-line ART, but use with second-line ART remains challenging due to pharmacokinetic drug interactions and cotoxicity. We review the frequency and spectrum of adverse drug reactions and immune reconstitution inflammatory syndrome (IRIS) resulting from combined treatment, and highlight the challenges of managing HIV-associated drug-resistant TB.

  4. Maximizing the benefit of health workforce secondment in Botswana: an approach for strengthening health systems in resource-limited settings

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    Grignon JS

    2014-05-01

    Full Text Available Jessica S Grignon,1,2 Jenny H Ledikwe,1,2 Ditsapelo Makati,2 Robert Nyangah,2 Baraedi W Sento,2 Bazghina-werq Semo1,2 1Department of Global Health, University of Washington, Seattle, WA, USA; 2International Training and Education Center for Health, Gaborone, Botswana Abstract: To address health systems challenges in limited-resource settings, global health initiatives, particularly the President's Emergency Plan for AIDS Relief, have seconded health workers to the public sector. Implementation considerations for secondment as a health workforce development strategy are not well documented. The purpose of this article is to present outcomes, best practices, and lessons learned from a President's Emergency Plan for AIDS Relief-funded secondment program in Botswana. Outcomes are documented across four World Health Organization health systems' building blocks. Best practices include documentation of joint stakeholder expectations, collaborative recruitment, and early identification of counterparts. Lessons learned include inadequate ownership, a two-tier employment system, and ill-defined position duration. These findings can inform program and policy development to maximize the benefit of health workforce secondment. Secondment requires substantial investment, and emphasis should be placed on high-level technical positions responsible for building systems, developing health workers, and strengthening government to translate policy into programs. Keywords: human resources, health policy, health worker, HIV/AIDS, PEPFAR

  5. Geometric Energy Derivatives at the Complete Basis Set Limit: Application to the Equilibrium Structure and Molecular Force Field of Formaldehyde.

    Science.gov (United States)

    Morgan, W James; Matthews, Devin A; Ringholm, Magnus; Agarwal, Jay; Gong, Justin Z; Ruud, Kenneth; Allen, Wesley D; Stanton, John F; Schaefer, Henry F

    2018-03-13

    Geometric energy derivatives which rely on core-corrected focal-point energies extrapolated to the complete basis set (CBS) limit of coupled cluster theory with iterative and noniterative quadruple excitations, CCSDTQ and CCSDT(Q), are used as elements of molecular gradients and, in the case of CCSDT(Q), expansion coefficients of an anharmonic force field. These gradients are used to determine the CCSDTQ/CBS and CCSDT(Q)/CBS equilibrium structure of the S 0 ground state of H 2 CO where excellent agreement is observed with previous work and experimentally derived results. A fourth-order expansion about this CCSDT(Q)/CBS reference geometry using the same level of theory produces an exceptional level of agreement to spectroscopically observed vibrational band origins with a MAE of 0.57 cm -1 . Second-order vibrational perturbation theory (VPT2) and variational discrete variable representation (DVR) results are contrasted and discussed. Vibration-rotation, anharmonicity, and centrifugal distortion constants from the VPT2 analysis are reported and compared to previous work. Additionally, an initial application of a sum-over-states fourth-order vibrational perturbation theory (VPT4) formalism is employed herein, utilizing quintic and sextic derivatives obtained with a recursive algorithmic approach for response theory.

  6. Generation of a suite of 3D computer-generated breast phantoms from a limited set of human subject data

    International Nuclear Information System (INIS)

    Hsu, Christina M. L.; Palmeri, Mark L.; Segars, W. Paul; Veress, Alexander I.; Dobbins, James T. III

    2013-01-01

    Purpose: The authors previously reported on a three-dimensional computer-generated breast phantom, based on empirical human image data, including a realistic finite-element based compression model that was capable of simulating multimodality imaging data. The computerized breast phantoms are a hybrid of two phantom generation techniques, combining empirical breast CT (bCT) data with flexible computer graphics techniques. However, to date, these phantoms have been based on single human subjects. In this paper, the authors report on a new method to generate multiple phantoms, simulating additional subjects from the limited set of original dedicated breast CT data. The authors developed an image morphing technique to construct new phantoms by gradually transitioning between two human subject datasets, with the potential to generate hundreds of additional pseudoindependent phantoms from the limited bCT cases. The authors conducted a preliminary subjective assessment with a limited number of observers (n= 4) to illustrate how realistic the simulated images generated with the pseudoindependent phantoms appeared. Methods: Several mesh-based geometric transformations were developed to generate distorted breast datasets from the original human subject data. Segmented bCT data from two different human subjects were used as the “base” and “target” for morphing. Several combinations of transformations were applied to morph between the “base’ and “target” datasets such as changing the breast shape, rotating the glandular data, and changing the distribution of the glandular tissue. Following the morphing, regions of skin and fat were assigned to the morphed dataset in order to appropriately assign mechanical properties during the compression simulation. The resulting morphed breast was compressed using a finite element algorithm and simulated mammograms were generated using techniques described previously. Sixty-two simulated mammograms, generated from morphing

  7. Scaling up the 2010 World Health Organization HIV Treatment Guidelines in resource-limited settings: a model-based analysis.

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    Rochelle P Walensky

    2010-12-01

    Full Text Available The new 2010 World Health Organization (WHO HIV treatment guidelines recommend earlier antiretroviral therapy (ART initiation (CD4<350 cells/µl instead of CD4<200 cells/µl, multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible.We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl. For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line. We rank-in survival, cost-effectiveness, and equity terms-all 12 possible combinations of the following: (1 stavudine replacement with tenofovir, (2 ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl, and (3 one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival compared with stavudine/WHO/two-lines (66% and tenofovir/WHO/one-line (66%. The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo, stavudine/<350/µl/two-lines (177.6 mo, and tenofovir/<350/µl/two-lines (193.6 mo. Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS], tenofovir/<350/µl/one-line (US$1,140/YLS, and tenofovir/<350/µl/two-lines (US$2,370/YLS.In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long

  8. Incidence of WHO stage 3 and 4 conditions following initiation of anti-retroviral therapy in resource limited settings.

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    Andrea J Curtis

    Full Text Available OBJECTIVES: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART in resource limited settings (RLS. DESIGN/SETTING: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. SUBJECTS/PARTICIPANTS: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41. OUTCOME MEASURES: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. RESULTS: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4. The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4. During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years and children aged 5-14 years (25.76 and oral candidiasis was the most common in children <5 years (25.79. Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001. Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia. CONCLUSIONS: The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly

  9. Operations for Suspected Neoplasms in a Resource-Limited Setting: Experience and Challenges in the Eastern Democratic of Congo.

    Science.gov (United States)

    Kalisya, Luc Malemo; Bake, Jacques Fadhili; Bigabwa, Richard; Rothstein, David H; Cairo, Sarah B

    2018-07-01

    faces a multitude of challenges. Access to surgical services for diagnosis and management as well as chemotherapeutic agents is prohibitively limited. Increased collaboration with local clinicians and remote specialist consultants is needed to deliver subspecialty care in resource-poor settings.

  10. Assessing the quality of informed consent in a resource-limited setting: A cross-sectional study

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    Kiguba Ronald

    2012-08-01

    Full Text Available Abstract Background The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University. Methods Data were collected using semi-structured interviewer-administered questionnaires on clinic days after initial or repeat informed consent procedures for the respective clinical studies had been administered to each study participant. Results Of the 600 participants interviewed, two thirds (64.2%, 385/600 were female. Overall mean age of study participants was 37.6 (SD = 7.7 years. Amongst all participants, less than a tenth (5.9%, 35/598 reported that they were not given enough information before making a decision to participate. A similar proportion (5.7%, 34/597 reported that they had not signed a consent form prior to making a decision to participate in the study. A third (33.7%, 201/596 of the participants were not aware that they could, at any time, voluntarily withdraw participation from these studies. Participants in clinical trials were 50% less likely than those in observational studies [clinical trial vs. observational; (odds ratio, OR = 0.5; 95% CI: 0.35-0.78] to perceive that refusal to participate in the parent research project would affect their regular medical care. Conclusions Most of the participants signed informed consent forms and a vast majority felt that they received enough information before deciding to participate. On the contrary, several were not aware that they could voluntarily withdraw their participation. Participants in observational studies were more likely than those in clinical trials to perceive that refusal to participate in the parent study would affect their regular medical care.

  11. Assessing the quality of informed consent in a resource-limited setting: a cross-sectional study.

    Science.gov (United States)

    Kiguba, Ronald; Kutyabami, Paul; Kiwuwa, Stephen; Katabira, Elly; Sewankambo, Nelson K

    2012-08-21

    The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University. Data were collected using semi-structured interviewer-administered questionnaires on clinic days after initial or repeat informed consent procedures for the respective clinical studies had been administered to each study participant. Of the 600 participants interviewed, two thirds (64.2%, 385/600) were female. Overall mean age of study participants was 37.6 (SD = 7.7) years. Amongst all participants, less than a tenth (5.9%, 35/598) reported that they were not given enough information before making a decision to participate. A similar proportion (5.7%, 34/597) reported that they had not signed a consent form prior to making a decision to participate in the study. A third (33.7%, 201/596) of the participants were not aware that they could, at any time, voluntarily withdraw participation from these studies. Participants in clinical trials were 50% less likely than those in observational studies [clinical trial vs. observational; (odds ratio, OR = 0.5; 95% CI: 0.35-0.78)] to perceive that refusal to participate in the parent research project would affect their regular medical care. Most of the participants signed informed consent forms and a vast majority felt that they received enough information before deciding to participate. On the contrary, several were not aware that they could voluntarily withdraw their participation. Participants in observational studies were more likely than those in clinical trials to perceive that refusal to participate in the parent study would affect their regular medical care.

  12. Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.

    Science.gov (United States)

    Ndayizigiye, M; Fawzi, M C Smith; Lively, C Thompson; Ware, N C

    2017-03-15

    Family planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere. We investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7). Contraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services. Where resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

  13. Approaching the theoretical limit in periodic local MP2 calculations with atomic-orbital basis sets: the case of LiH.

    Science.gov (United States)

    Usvyat, Denis; Civalleri, Bartolomeo; Maschio, Lorenzo; Dovesi, Roberto; Pisani, Cesare; Schütz, Martin

    2011-06-07

    The atomic orbital basis set limit is approached in periodic correlated calculations for solid LiH. The valence correlation energy is evaluated at the level of the local periodic second order Møller-Plesset perturbation theory (MP2), using basis sets of progressively increasing size, and also employing "bond"-centered basis functions in addition to the standard atom-centered ones. Extended basis sets, which contain linear dependencies, are processed only at the MP2 stage via a dual basis set scheme. The local approximation (domain) error has been consistently eliminated by expanding the orbital excitation domains. As a final result, it is demonstrated that the complete basis set limit can be reached for both HF and local MP2 periodic calculations, and a general scheme is outlined for the definition of high-quality atomic-orbital basis sets for solids. © 2011 American Institute of Physics

  14. A Complete First-Order Analytical Solution for Optimal Low-Thrust Limited-Power Transfers Between Coplanar Orbits with Small Eccentricities

    Science.gov (United States)

    Da Silva Fernandes, Sandro; Das Chagas Carvalho, Francisco; Vilhena de Moraes, Rodolpho

    The purpose of this work is to present a complete first order analytical solution, which includes short periodic terms, for the problem of optimal low-thrust limited power trajectories with large amplitude transfers (no rendezvous) between coplanar orbits with small eccentricities in Newtonian central gravity field. The study of these transfers is particularly interesting because the orbits found in practice often have a small eccentricity and the problem of transferring a vehicle from a low earth orbit to a high earth orbit is frequently found. Besides, the analysis has been motivated by the renewed interest in the use of low-thrust propulsion systems in space missions verified in the last two decades. Several researchers have obtained numerical and sometimes analytical solutions for a number of specific initial orbits and specific thrust profiles. Averaging methods are also used in such researches. Firstly, the optimization problem associated to the space transfer problem is formulated as a Mayer problem of optimal control with Cartesian elements - position and velocity vectors - as state variables. After applying the Pontryagin Maximum Principle, successive Mathieu transformations are performed and suitable sets of orbital elements are introduced. The short periodic terms are eliminated from the maximum Hamiltonian function through an infinitesimal canonical transformation built through Hori method - a perturbation canonical method based on Lie series. The new Hamiltonian function, which results from the infinitesimal canonical transformation, describes the extremal trajectories for long duration maneuvers. Closed-form analytical solutions are obtained for the new canonical system by solving the Hamilton-Jacobi equation through the separation of variables technique. By applying the transformation equations of the algorithm of Hori method, a first order analytical solution for the problem is obtained in non-singular orbital elements. For long duration maneuvers

  15. On the front line of HIV virological monitoring: barriers and facilitators from a provider perspective in resource-limited settings.

    Science.gov (United States)

    Rutstein, S E; Golin, C E; Wheeler, S B; Kamwendo, D; Hosseinipour, M C; Weinberger, M; Miller, W C; Biddle, A K; Soko, A; Mkandawire, M; Mwenda, R; Sarr, A; Gupta, S; Mataya, R

    2016-01-01

    Scale-up of viral load (VL) monitoring for HIV-infected patients on antiretroviral therapy (ART) is a priority in many resource-limited settings, and ART providers are critical to effective program implementation. We explored provider-perceived barriers and facilitators of VL monitoring. We interviewed all providers (n = 17) engaged in a public health evaluation of dried blood spots for VL monitoring at five ART clinics in Malawi. All ART clinics were housed within district hospitals. We grouped themes at patient, provider, facility, system, and policy levels. Providers emphasized their desire for improved ART monitoring strategies, and frustration in response to restrictive policies for determining which patients were eligible to receive VL monitoring. Although many providers pled for expansion of monitoring to include all persons on ART, regardless of time on ART, the most salient provider-perceived barrier to VL monitoring implementation was the pressure of work associated with monitoring activities. The work burden was exacerbated by inefficient data management systems, highlighting a critical interaction between provider-, facility-, and system-level factors. Lack of integration between laboratory and clinical systems complicated the process for alerting providers when results were available, and these communication gaps were intensified by poor facility connectivity. Centralized second-line ART distribution was also noted as a barrier: providers reported that the time and expenses required for patients to collect second-line ART frequently obstructed referral. However, provider empowerment emerged as an unexpected facilitator of VL monitoring. For many providers, this was the first time they used an objective marker of ART response to guide clinical management. Providers' knowledge of a patient's virological status increased confidence in adherence counseling and clinical decision-making. Results from our study provide unique insight into provider

  16. Minimal intervention for controlling nosocomial transmission of methicillin-resistant staphylococcus aureus in resource limited setting with high endemicity.

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    Vincent Chi-Chung Cheng

    Full Text Available OBJECTIVE: To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA in resource-limited healthcare setting with high endemicity. METHODS: Three phases of infection control interventions were implemented in a University-affiliated hospital between 1-January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per-1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model. Usage density of broad-spectrum antibiotics was monitored. RESULTS: During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3% were hospital-acquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001, 30.4% (p<0.001, and 19.6% (p = 0.040, while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001, 24.1% (p<0.001, and 21.9% (p = 0.041 respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1 to 168.99 per 1000 patient-days (phase 3. CONCLUSIONS: Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing

  17. Facilitating responsible gambling: the relative effectiveness of education-based animation and monetary limit setting pop-up messages among electronic gaming machine players.

    Science.gov (United States)

    Wohl, Michael J A; Gainsbury, Sally; Stewart, Melissa J; Sztainert, Travis

    2013-12-01

    Although most gamblers set a monetary limit on their play, many exceed this limit--an antecedent of problematic gambling. Responsible gambling tools may assist players to gamble within their means. Historically, however, the impact of such tools has been assessed in isolation. In the current research, two responsible gambling tools that target adherence to a monetary limit were assessed among 72 electronic gaming machine (EGM) players. Participants watched an educational animation explaining how EGMs work (or a neutral video) and then played an EGM in a virtual reality environment. All participants were asked to set a monetary limit on their play, but only half were reminded when that limit was reached. Results showed that both the animation and pop-up limit reminder helped gamblers stay within their preset monetary limit; however, an interaction qualified these main effects. Among participants who did not experience the pop-up reminder, those who watched the animation stayed within their preset monetary limits more than those who did not watch the animation. For those who were reminded of their limit, however, there was no difference in limit adherence between those who watched the animation and those who did not watch the animation. From a responsible gambling perspective, the current study suggests that there is no additive effect of exposure to both responsible gambling tools. Therefore, for minimal disruption in play, a pop-up message reminding gamblers of their preset monetary limit might be preferred over the lengthier educational animation.

  18. 1H and 15N NMR assignment and solution structure of the SH3 domain of spectrin: Comparison of unrefined and refined structure sets with the crystal structure

    International Nuclear Information System (INIS)

    Blanco, Francisco J.; Ortiz, Angel R.; Serrano, Luis

    1997-01-01

    The assignment of the 1 H and 15 Nnuclear magnetic resonance spectra of the Src-homology region 3 domain of chicken brain α-spectrin has been obtained. A set of solution structures has been determined from distance and dihedral angle restraints,which provide a reasonable representation of the protein structure in solution, as evaluated by a principal component analysis of the global pairwise root-mean-square deviation (rmsd) in a large set of structures consisting of the refined and unrefined solution structures and the crystal structure. The solution structure is well defined, with a lower degree of convergence between the structures in the loop regions than in the secondary structure elements. The average pairwise rmsd between the 15 refined solution structures is 0.71 ± 0.13 A for the backbone atoms and 1.43 ± 0.14 A for all heavy atoms. The solution structure is basically the same as the crystal structure. The average rmsd between the 15 refined solution structures and the crystal structure is 0.76 A for the backbone atoms and 1.45 ± 0.09 A for all heavy atoms. There are, however, small differences probably caused by intermolecular contacts in the crystal structure

  19. Simulation of population response to ionizing radiation in an ecosystem with a limiting resource – Model and analytical solutions

    International Nuclear Information System (INIS)

    Sazykina, Tatiana G.; Kryshev, Alexander I.

    2016-01-01

    A dynamic mathematical model is formulated, predicting the development of radiation effects in a generic animal population, inhabiting an elemental ecosystem ‘population-limiting resource’. Differential equations of the model describe the dynamic responses to radiation damage of the following population characteristics: gross biomass; intrinsic fractions of healthy and reversibly damaged tissues in biomass; intrinsic concentrations of the self-repairing pool and the growth factor; and amount of the limiting resource available in the environment. Analytical formulae are found for the steady states of model variables as non-linear functions of the dose rate of chronic radiation exposure. Analytical solutions make it possible to predict the expected severity of radiation effects in a model ecosystem, including such endpoints as morbidity, mortality, life shortening, biosynthesis, and population biomass. Model parameters are selected from species data on lifespan, physiological growth and mortality rates, and individual radiosensitivity. Thresholds for population extinction can be analytically calculated for different animal species, examples are provided for generic mice and wolf populations. The ecosystem model demonstrates a compensatory effect of the environment on the development of radiation effects in wildlife. The model can be employed to construct a preliminary scale ‘radiation exposure-population effects’ for different animal species; species can be identified, which are vulnerable at a population level to chronic radiation exposure. - Highlights: • Mathematical model is formulated predicting radiation effects in elemental ecosystem. • Analytical formulae are found for steady states of variables as functions of exposure. • Severity of radiation effects are calculated, including population extinction. • Model parameterization is made for generic mice and wolf populations.

  20. STATISTICAL METHODS FOR ENVIRONMENTAL APPLICATIONS USING DATA SETS WITH BELOW DETECTION LIMIT OBSERVATIONS AS INCORPORTED IN PROUCL 4.0

    Science.gov (United States)

    Nondetect (ND) or below detection limit (BDL) results cannot be measured accurately, and, therefore, are reported as less than certain detection limit (DL) values. However, since the presence of some contaminants (e.g., dioxin) in environmental media may pose a threat to human he...

  1. Informatics solutions for bridging the gap between clinical and laboratory services in a low-resource setting

    Directory of Open Access Journals (Sweden)

    Julia Driessen

    2015-06-01

    Full Text Available Background: There has been little formal analysis of laboratory systems in resource-limited settings, despite widespread consensus around the importance of a strong laboratory infrastructure. Objectives: This study details the informational challenges faced by the laboratory at Kamuzu Central Hospital, a tertiary health facility in Malawi; and proposes ways in which informatics can bolster the efficiency and role of low-resource laboratory systems. Methods: We evaluated previously-collected data on three different aspects of laboratory use. A four-week quality audit of laboratory test orders quantified challenges associated with collecting viable specimens for testing. Data on tests run by the laboratory over a one yearperiod described the magnitude of the demand for laboratory services. Descriptive information about the laboratory workflow identified informational process breakdowns in the pre-analytical and post-analytical phases and was paired with a 24-hour sample of laboratory data on results reporting. Results: The laboratory conducted 242 242 tests over a 12-month period. The four-week quality audit identified 54% of samples as untestable. Prohibitive paperwork errors were identified in 16% of samples. Laboratory service workflows indicated a potential process breakdown in sample transport and results reporting resulting from the lack of assignment of these tasks to any specific employee cadre. The study of result reporting time showed a mean of almost six hours, with significant variation. Conclusions: This analysis identified challenges in each phase of laboratory testing. Informatics could improve the management of this information by streamlining test ordering and the communication of test orders to the laboratory and results back to the ordering physician.

  2. Limited evidence for intranasal fentanyl in the emergency department and the prehospital setting--a systematic review

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Dahl, Jørgen Berg

    2013-01-01

    The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management. Fentanyl demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of acute pain, and IN fentanyl may be of value in the prehospital setting. The aim...... of this systematic review was to evaluate the current evidence for the use of IN fentanyl in the emergency department (ED) and prehospital setting....

  3. A risk modelling approach for setting microbiological limits using enterococci as indicator for growth potential of Salmonella in pork

    DEFF Research Database (Denmark)

    Bollerslev, Anne Mette; Nauta, Maarten; Hansen, Tina Beck

    2017-01-01

    Microbiological limits are widely used in food processing as an aid to reduce the exposure to hazardous microorganisms for the consumers. However, in pork, the prevalence and concentrations of Salmonella are generally low and microbiological limits are not considered an efficient tool to support...... for this purpose includes the dose-response relationship for Salmonella and a reduction factor to account for preparation of the fresh pork. By use of the risk model, it was estimated that the majority of salmonellosis cases, caused by the consumption of pork in Denmark, is caused by the small fraction of pork...... products that has enterococci concentrations above 5. log. CFU/g. This illustrates that our approach can be used to evaluate the potential effect of different microbiological limits and therefore, the perspective of this novel approach is that it can be used for definition of a risk-based microbiological...

  4. Global health leadership training in resource-limited settings: a collaborative approach by academic institutions and local health care programs in Uganda.

    Science.gov (United States)

    Nakanjako, Damalie; Namagala, Elizabeth; Semeere, Aggrey; Kigozi, Joanitor; Sempa, Joseph; Ddamulira, John Bosco; Katamba, Achilles; Biraro, Sam; Naikoba, Sarah; Mashalla, Yohana; Farquhar, Carey; Sewankambo, Nelson

    2015-11-18

    Due to a limited health workforce, many health care providers in Africa must take on health leadership roles with minimal formal training in leadership. Hence, the need to equip health care providers with practical skills required to lead high-impact health care programs. In Uganda, the Afya Bora Global Health Leadership Fellowship is implemented through the Makerere University College of Health Sciences (MakCHS) and her partner institutions. Lessons learned from the program, presented in this paper, may guide development of in-service training opportunities to enhance leadership skills of health workers in resource-limited settings. The Afya Bora Consortium, a consortium of four African and four U.S. academic institutions, offers 1-year global health leadership-training opportunities for nurses and doctors. Applications are received and vetted internationally by members of the consortium institutions in Botswana, Kenya, Tanzania, Uganda, and the USA. Fellows have 3 months of didactic modules and 9 months of mentored field attachment with 80% time dedicated to fellowship activities. Fellows' projects and experiences, documented during weekly mentor-fellow meetings and monthly mentoring team meetings, were compiled and analyzed manually using pre-determined themes to assess the effect of the program on fellows' daily leadership opportunities. Between January 2011 and January 2015, 15 Ugandan fellows (nine doctors and six nurses) participated in the program. Each fellow received 8 weeks of didactic modules held at one of the African partner institutions and three online modules to enhance fellows' foundation in leadership, communication, monitoring and evaluation, health informatics, research methodology, grant writing, implementation science, and responsible conduct of research. In addition, fellows embarked on innovative projects that covered a wide spectrum of global health challenges including critical analysis of policy formulation and review processes

  5. Methicillin Resistant Staphylococcus aureus Transmission in a Ghanaian Burn Unit : The Importance of Active Surveillance in Resource-Limited Settings

    NARCIS (Netherlands)

    Amissah, Nana Ama; Buultjens, Andrew H.; Ablordey, Anthony; van Dam, Lieke; Opoku-Ware, Ampomah; Baines, Sarah L.; Bulach, Dieter; Tetteh, Caitlin S.; Prah, Isaac; van der Werf, Tjip S.; Friedrich, Alexander W.; Seemann, Torsten; van Dijl, Jan Maarten; Stienstra, Ymkje; Stinear, Timothy P.; Rossen, John W.

    2017-01-01

    . Objectives: Staphylococcus aureus infections in burn patients can lead to serious complications and death. The frequency of S. aureus infection is high in low-and middle-income countries presumably due to limited resources, misuse of antibiotics and poor infection control. The objective of the

  6. Basis Set Convergence of Indirect Spin-Spin Coupling Constants in the Kohn-Sham Limit for Several Small Molecules

    Czech Academy of Sciences Publication Activity Database

    Kupka, T.; Nieradka, M.; Stachów, M.; Pluta, T.; Nowak, P.; Kjaer, H.; Kongsted, J.; Kaminský, Jakub

    2012-01-01

    Roč. 116, č. 14 (2012), s. 3728-3738 ISSN 1089-5639 R&D Projects: GA ČR GPP208/10/P356 Institutional research plan: CEZ:AV0Z40550506 Keywords : consistent basis-sets * density-functional methods * ab-inition calculations * polarization propagator approximation Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 2.771, year: 2012

  7. Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia.

    Science.gov (United States)

    Devi, B C R; Tang, T S; Corbex, M

    2008-12-01

    The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from 1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

  8. On the Feasibility and Limitations of Just-in-Time Instruction Set Extension for FPGA-Based Reconfigurable Processors

    Directory of Open Access Journals (Sweden)

    Mariusz Grad

    2012-01-01

    Full Text Available Reconfigurable instruction set processors provide the possibility of tailor the instruction set of a CPU to a particular application. While this customization process could be performed during runtime in order to adapt the CPU to the currently executed workload, this use case has been hardly investigated. In this paper, we study the feasibility of moving the customization process to runtime and evaluate the relation of the expected speedups and the associated overheads. To this end, we present a tool flow that is tailored to the requirements of this just-in-time ASIP specialization scenario. We evaluate our methods by targeting our previously introduced Woolcano reconfigurable ASIP architecture for a set of applications from the SPEC2006, SPEC2000, MiBench, and SciMark2 benchmark suites. Our results show that just-in-time ASIP specialization is promising for embedded computing applications, where average speedups of 5x can be achieved by spending 50 minutes for custom instruction identification and hardware generation. These overheads will be compensated if the applications execute for more than 2 hours. For the scientific computing benchmarks, the achievable speedup is only 1.2x, which requires significant execution times in the order of days to amortize the overheads.

  9. A risk modelling approach for setting microbiological limits using enterococci as indicator for growth potential of Salmonella in pork.

    Science.gov (United States)

    Bollerslev, Anne Mette; Nauta, Maarten; Hansen, Tina Beck; Aabo, Søren

    2017-01-02

    Microbiological limits are widely used in food processing as an aid to reduce the exposure to hazardous microorganisms for the consumers. However, in pork, the prevalence and concentrations of Salmonella are generally low and microbiological limits are not considered an efficient tool to support hygiene interventions. The objective of the present study was to develop an approach which could make it possible to define potential risk-based microbiological limits for an indicator, enterococci, in order to evaluate the risk from potential growth of Salmonella. A positive correlation between the concentration of enterococci and the prevalence and concentration of Salmonella was shown for 6640 pork samples taken at Danish cutting plants and retail butchers. The samples were collected in five different studies in 2001, 2002, 2010, 2011 and 2013. The observations that both Salmonella and enterococci are carried in the intestinal tract, contaminate pork by the same mechanisms and share similar growth characteristics (lag phase and maximum specific growth rate) at temperatures around 5-10°C, suggest a potential of enterococci to be used as an indicator of potential growth of Salmonella in pork. Elevated temperatures during processing will lead to growth of both enterococci and, if present, also Salmonella. By combining the correlation between enterococci and Salmonella with risk modelling, it is possible to predict the risk of salmonellosis based on the level of enterococci. The risk model used for this purpose includes the dose-response relationship for Salmonella and a reduction factor to account for preparation of the fresh pork. By use of the risk model, it was estimated that the majority of salmonellosis cases, caused by the consumption of pork in Denmark, is caused by the small fraction of pork products that has enterococci concentrations above 5logCFU/g. This illustrates that our approach can be used to evaluate the potential effect of different microbiological

  10. Relationship between perceived limit-setting abilities, autism spectrum disorder severity, behaviour problems and parenting stress in mothers of children with autism spectrum disorder.

    Science.gov (United States)

    Reed, Phil; Howse, Jessie; Ho, Ben; Osborne, Lisa A

    2017-11-01

    Parenting stress in mothers of children with autism spectrum disorder (ASD) is high and impacts perceptions about parenting. This study examined the relationship between parenting stress and observer-perceived limit-setting ability. Participants' perceptions of other parents' limit-setting ability were assessed by showing participants video clips of parenting behaviours. Mothers of 93 children with autism spectrum disorder completed an online survey regarding the severity of their own child's autism spectrum disorder (Social Communication Questionnaire), their child's behaviour problems (Strengths and Difficulties Questionnaire) and their own levels of parenting stress (Questionnaire on Resources and Stress). They were shown five videos of other parents interacting with children with autism spectrum disorder and were asked to rate the limit-setting abilities observed in each video using the Parent-Child Relationship Inventory. Higher parenting stress negatively related to judgements about others' limit-setting skills. This mirrors the literature regarding the relationship between self-reported parenting stress and rating child behaviour more negatively. It suggests that stress negatively impacts a wide range of judgements and implies that caution may be required when interpreting the results of studies in which parenting skills are assessed by self-report.

  11. Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings

    NARCIS (Netherlands)

    Revell, A. D.; Wang, D.; Wood, R.; Morrow, C.; Tempelman, H.; Hamers, R. L.; Alvarez-Uria, G.; Streinu-Cercel, A.; Ene, L.; Wensing, A. M. J.; DeWolf, F.; Nelson, M.; Montaner, J. S.; Lane, H. C.; Larder, B. A.

    2013-01-01

    Genotypic HIV drug-resistance testing is typically 6065 predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART

  12. A reliable incremental method of computing the limit load in deformation plasticity based on compliance: Continuous and discrete setting

    Czech Academy of Sciences Publication Activity Database

    Haslinger, Jaroslav; Repin, S.; Sysala, Stanislav

    2016-01-01

    Roč. 303, September 2016 (2016), s. 156-170 ISSN 0377-0427 R&D Projects: GA MŠk LQ1602; GA ČR GA13-18652S Institutional support: RVO:68145535 Keywords : variational problems with linear growth energy * incremental limit analysis * elastic-perfectly plastic problems * finite element approximation Subject RIV: BA - General Mathematics Impact factor: 1.357, year: 2016 http://www.sciencedirect.com/science/article/pii/S0377042716300917

  13. Approaching the basis set limit for DFT calculations using an environment-adapted minimal basis with perturbation theory: Formulation, proof of concept, and a pilot implementation

    International Nuclear Information System (INIS)

    Mao, Yuezhi; Horn, Paul R.; Mardirossian, Narbe; Head-Gordon, Teresa; Skylaris, Chris-Kriton; Head-Gordon, Martin

    2016-01-01

    Recently developed density functionals have good accuracy for both thermochemistry (TC) and non-covalent interactions (NC) if very large atomic orbital basis sets are used. To approach the basis set limit with potentially lower computational cost, a new self-consistent field (SCF) scheme is presented that employs minimal adaptive basis (MAB) functions. The MAB functions are optimized on each atomic site by minimizing a surrogate function. High accuracy is obtained by applying a perturbative correction (PC) to the MAB calculation, similar to dual basis approaches. Compared to exact SCF results, using this MAB-SCF (PC) approach with the same large target basis set produces <0.15 kcal/mol root-mean-square deviations for most of the tested TC datasets, and <0.1 kcal/mol for most of the NC datasets. The performance of density functionals near the basis set limit can be even better reproduced. With further improvement to its implementation, MAB-SCF (PC) is a promising lower-cost substitute for conventional large-basis calculations as a method to approach the basis set limit of modern density functionals.

  14. Global limit load solutions for thick-walled cylinders with circumferential cracks under combined internal pressure, axial force and bending moment − Part II: Finite element validation

    International Nuclear Information System (INIS)

    Li, Yuebing; Lei, Yuebao; Gao, Zengliang

    2014-01-01

    Global limit load solutions for thick-walled cylinders with circumferential internal/external surface and through-wall defects under combined positive/negative axial force, positive/negative global bending moment and internal pressure have been developed in Part I of this paper. In this Part II, elastic-perfectly plastic 3-D finite element (FE) analyses are performed for selected cases, covering a wide range of geometries and load combinations, to validate the developed limit load solutions. The results show that these limit load solutions can predict the FE data very well for the cases with shallow or deep and short cracks and are conservative. For the cases with very long and deep cracks, the predictions are reasonably accurate and more conservative. -- Highlights: • Elastic-perfectly plastic 3D finite element limiting analyses of cylinders. • Thin/thick-walled cylinders with circumferential surface defects. • Combined loading for pressure, end-force and global bending moment. • Totally 1458 cases analysed and tabulated normalised results provided. • Results used to validate the developed limit load solutions in Part I of this paper

  15. Allocating limited resources in a time of fiscal constraints: a priority setting case study from Dalhousie University Faculty of Medicine.

    Science.gov (United States)

    Mitton, Craig; Levy, Adrian; Gorsky, Diane; MacNeil, Christina; Dionne, Francois; Marrie, Tom

    2013-07-01

    Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.

  16. Assessment of semiempirical enthalpy of formation in solution as an effective energy function to discriminate native-like structures in protein decoy sets.

    Science.gov (United States)

    Urquiza-Carvalho, Gabriel Aires; Fragoso, Wallace Duarte; Rocha, Gerd Bruno

    2016-08-05

    In this work, we tested the PM6, PM6-DH+, PM6-D3, and PM7 enthalpies of formation in aqueous solution as scoring functions across 33 decoy sets to discriminate native structures or good models in a decoy set. In each set these semiempirical quantum chemistry methods were compared according to enthalpic and geometric criteria. Enthalpically, we compared the methods according to how much lower was the enthalpy of each native, when compared with the mean enthalpy of its set. Geometrically, we compared the methods according to the fraction of native contacts (Q), which is a measure of geometric closeness between an arbitrary structure and the native. For each set and method, the Q of the best decoy was compared with the Q0 , which is the Q of the decoy closest to the native in the set. It was shown that the PM7 method is able to assign larger energy differences between the native structure and the decoys in a set, arguably because of a better description of dispersion interactions, however PM6-DH+ was slightly better than the rest at selecting geometrically good models in the absence of a native structure in the set. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. Push it to the limit: Characterizing the convergence of common sequences of basis sets for intermolecular interactions as described by density functional theory

    Energy Technology Data Exchange (ETDEWEB)

    Witte, Jonathon [Department of Chemistry, University of California, Berkeley, California 94720 (United States); Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Neaton, Jeffrey B. [Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Department of Physics, University of California, Berkeley, California 94720 (United States); Kavli Energy Nanosciences Institute at Berkeley, Berkeley, California 94720 (United States); Head-Gordon, Martin, E-mail: mhg@cchem.berkeley.edu [Department of Chemistry, University of California, Berkeley, California 94720 (United States); Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States)

    2016-05-21

    With the aim of systematically characterizing the convergence of common families of basis sets such that general recommendations for basis sets can be made, we have tested a wide variety of basis sets against complete-basis binding energies across the S22 set of intermolecular interactions—noncovalent interactions of small and medium-sized molecules consisting of first- and second-row atoms—with three distinct density functional approximations: SPW92, a form of local-density approximation; B3LYP, a global hybrid generalized gradient approximation; and B97M-V, a meta-generalized gradient approximation with nonlocal correlation. We have found that it is remarkably difficult to reach the basis set limit; for the methods and systems examined, the most complete basis is Jensen’s pc-4. The Dunning correlation-consistent sequence of basis sets converges slowly relative to the Jensen sequence. The Karlsruhe basis sets are quite cost effective, particularly when a correction for basis set superposition error is applied: counterpoise-corrected def2-SVPD binding energies are better than corresponding energies computed in comparably sized Dunning and Jensen bases, and on par with uncorrected results in basis sets 3-4 times larger. These trends are exhibited regardless of the level of density functional approximation employed. A sense of the magnitude of the intrinsic incompleteness error of each basis set not only provides a foundation for guiding basis set choice in future studies but also facilitates quantitative comparison of existing studies on similar types of systems.

  18. Global existence of classical solutions to the Vlasov-Poisson system in a three dimensional, cosmological setting

    OpenAIRE

    Rein, Gerhard; Rendall, Alan D.

    1993-01-01

    The initial value problem for the Vlasov-Poisson system is by now well understood in the case of an isolated system where, by definition, the distribution function of the particles as well as the gravitational potential vanish at spatial infinity. Here we start with homogeneous solutions, which have a spatially constant, non-zero mass density and which describe the mass distribution in a Newtonian model of the universe. These homogeneous states can be constructed explicitly, and we consider d...

  19. Behaviour of symmetric solutions of a nonlinear elliptic field equation in the semi-classical limit: Concentration around a circle

    Directory of Open Access Journals (Sweden)

    Teresa D'Aprile

    2000-11-01

    Full Text Available In this paper we study the existence of concentrated solutions of the nonlinear field equation $$ -h^{2}Delta v+V(xv-h^{p}Delta_{p}v+ W'(v=0,, $$ where $v:{mathbb R}^{N}o{mathbb R}^{N+1}$, $Ngeq 3$, $p>N$, the potential $V$ is positive and radial, and $W$ is an appropriate singular function satisfying a suitable symmetric property. Provided that $h$ is sufficiently small, we are able to find solutions with a certain spherical symmetry which exhibit a concentration behaviour near a circle centered at zero as $ho 0^{+}$. Such solutions are obtained as critical points for the associated energy functional; the proofs of the results are variational and the arguments rely on topological tools. Furthermore a penalization-type method is developed for the identification of the desired solutions.

  20. Life, limb or off-label recombinant VIIa use in the setting of limited blood assets: a case study.

    Science.gov (United States)

    Carr, Marcus E; Vickaryous, Brian

    2013-06-01

    Due to the lack of adequate controlled trials, the off-label use of recombinant factor VIIa (rFVIIa) to control hemorrhage in trauma patients remains controversial. The decision regarding when to initiate rFVIIa therapy is particularly problematic. Whereas most reports and trials have delayed use until significant bleeding has occurred, there is some evidence that coagulopathy develops early in some trauma patients, raising the possibility that early rFVIIa use may be more clinically efficacious. Herein, we report the case of a hemodynamically unstable patient with massive blood loss from multiple gunshot wounds and who had a potentially salvageable upper extremity. Rapid hemorrhage despite efforts to surgically control the bleeding resulted in virtual exhaustion of the facilities' limited blood component supply. Hemorrhage was controlled when rFVIIa was added to hypotensive resuscitation allowing salvage of the arm and significant conservation of blood products. This case raises the question as to whether earlier off-label use of this agent should be considered when amputation for hemorrhage control is being considered and/or conservation of limited blood assets is needed.

  1. Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization.

    Science.gov (United States)

    Baumann, L M; Romero, K M; Robinson, C L; Hansel, N N; Gilman, R H; Hamilton, R G; Lima, J J; Wise, R A; Checkley, W

    2015-01-01

    Allergic rhinitis is a disease with a high global disease burden, but risk factors that contribute to this condition are not well understood. To assess the prevalence and risk factors of allergic rhinitis in two Peruvian populations with disparate degrees of urbanization. We conducted a population-based, cross-sectional study on 1441 children aged 13-15 years at enrollment (mean age 14.9 years, 51% boys) to investigate the prevalence of allergic disease. We used a standardized, Spanish validated questionnaire to determine the prevalence of allergic rhinitis and asked about sociodemographics and family history of allergies. Children also underwent spirometry, exhaled nitric oxide, allergy skin testing to 10 common household allergens and provided a blood sample for measurement of 25OH vitamin D and total serum IgE. Overall prevalence of allergic rhinitis was 18% (95% CI 16% to 20%). When stratified by site, the prevalence of allergic rhinitis was 23% Lima vs. 13% in Tumbes (P overweight (1.5, 1.0-2.3); exhaled nitric oxide ≥ 20 ppb (1.9, 1.3-2.7); and total serum IgE ≥ 95th percentile (2.4, 1.2-4.8). Population attributable risk of important factors for allergic rhinitis were 25% for high exhaled nitric oxide, 22% for allergic sensitization to common household aeroallergens, 22% for paternal rhinitis, 10% for being overweight and 7% for an elevated total serum IgE. Allergic rhinitis was prevalent in both settings, and important risk factors include elevated exhaled nitric oxide, allergic sensitization to common household aeroallergens, parental rhinitis, being overweight and high total serum IgE. When considering subject-specific factors, the difference in prevalence between the urban and rural settings became non-important. © 2014 John Wiley & Sons Ltd.

  2. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme

    Science.gov (United States)

    Brukner, Peter; Nealon, Andrew; Morgan, Christopher; Burgess, Darren; Dunn, Andrew

    2014-01-01

    Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme—biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence. PMID:23322894

  3. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme.

    Science.gov (United States)

    Brukner, Peter; Nealon, Andrew; Morgan, Christopher; Burgess, Darren; Dunn, Andrew

    2014-06-01

    Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme-biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence.

  4. Simplification of antiretroviral therapy: a necessary step in the public health response to HIV/AIDS in resource-limited settings.

    Science.gov (United States)

    Vitoria, Marco; Ford, Nathan; Doherty, Meg; Flexner, Charles

    2014-01-01

    The global scale-up of antiretroviral therapy (ART) over the past decade represents one of the great public health and human rights achievements of recent times. Moving from an individualized treatment approach to a simplified and standardized public health approach has been critical to ART scale-up, simplifying both prescribing practices and supply chain management. In terms of the latter, the risk of stock-outs can be reduced and simplified prescribing practices support task shifting of care to nursing and other non-physician clinicians; this strategy is critical to increase access to ART care in settings where physicians are limited in number. In order to support such simplification, successive World Health Organization guidelines for ART in resource-limited settings have aimed to reduce the number of recommended options for first-line ART in such settings. Future drug and regimen choices for resource-limited settings will likely be guided by the same principles that have led to the recommendation of a single preferred regimen and will favour drugs that have the following characteristics: minimal risk of failure, efficacy and tolerability, robustness and forgiveness, no overlapping resistance in treatment sequencing, convenience, affordability, and compatibility with anti-TB and anti-hepatitis treatments.

  5. Focus stacking: Comparing commercial top-end set-ups with a semi-automatic low budget approach. A possible solution for mass digitization of type specimens.

    Science.gov (United States)

    Brecko, Jonathan; Mathys, Aurore; Dekoninck, Wouter; Leponce, Maurice; VandenSpiegel, Didier; Semal, Patrick

    2014-01-01

    In this manuscript we present a focus stacking system, composed of commercial photographic equipment. The system is inexpensive compared to high-end commercial focus stacking solutions. We tested this system and compared the results with several different software packages (CombineZP, Auto-Montage, Helicon Focus and Zerene Stacker). We tested our final stacked picture with a picture obtained from two high-end focus stacking solutions: a Leica MZ16A with DFC500 and a Leica Z6APO with DFC290. Zerene Stacker and Helicon Focus both provided satisfactory results. However, Zerene Stacker gives the user more possibilities in terms of control of the software, batch processing and retouching. The outcome of the test on high-end solutions demonstrates that our approach performs better in several ways. The resolution of the tested extended focus pictures is much higher than those from the Leica systems. The flash lighting inside the Ikea closet creates an evenly illuminated picture, without struggling with filters, diffusers, etc. The largest benefit is the price of the set-up which is approximately € 3,000, which is 8 and 10 times less than the LeicaZ6APO and LeicaMZ16A set-up respectively. Overall, this enables institutions to purchase multiple solutions or to start digitising the type collection on a large scale even with a small budget.

  6. Focus stacking: Comparing commercial top-end set-ups with a semi-automatic low budget approach. A possible solution for mass digitization of type specimens

    Directory of Open Access Journals (Sweden)

    Jonathan Brecko

    2014-12-01

    Full Text Available In this manuscript we present a focus stacking system, composed of commercial photographic equipment. The system is inexpensive compared to high-end commercial focus stacking solutions. We tested this system and compared the results with several different software packages (CombineZP, Auto-Montage, Helicon Focus and Zerene Stacker. We tested our final stacked picture with a picture obtained from two high-end focus stacking solutions: a Leica MZ16A with DFC500 and a Leica Z6APO with DFC290. Zerene Stacker and Helicon Focus both provided satisfactory results. However, Zerene Stacker gives the user more possibilities in terms of control of the software, batch processing and retouching. The outcome of the test on high-end solutions demonstrates that our approach performs better in several ways. The resolution of the tested extended focus pictures is much higher than those from the Leica systems. The flash lighting inside the Ikea closet creates an evenly illuminated picture, without struggling with filters, diffusers, etc. The largest benefit is the price of the set-up which is approximately € 3,000, which is 8 and 10 times less than the LeicaZ6APO and LeicaMZ16A set-up respectively. Overall, this enables institutions to purchase multiple solutions or to start digitising the type collection on a large scale even with a small budget.

  7. Lessons learned developing a diagnostic tool for HIV-associated dementia feasible to implement in resource-limited settings: pilot testing in Kenya.

    Directory of Open Access Journals (Sweden)

    Judith Kwasa

    Full Text Available To conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD for use by primary health care workers (HCW which would be feasible to implement in resource-limited settings.In resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests. Thus, a simple diagnostic tool which is practical to implement in resource-limited settings is an urgent need.A convenience sample of 30 HIV-infected outpatients was enrolled in Western Kenya. We assessed the sensitivity and specificity of a diagnostic tool for HAD as administered by a primary HCW. This was compared to an expert clinical assessment which included examination by a physician, neuropsychological testing, and in selected cases, brain imaging. Agreement between HCW and an expert examiner on certain tool components was measured using Kappa statistic.The sample was 57% male, mean age was 38.6 years, mean CD4 T-cell count was 323 cells/µL, and 54% had less than a secondary school education. Six (20% of the subjects were diagnosed with HAD by expert clinical assessment. The diagnostic tool was 63% sensitive and 67% specific for HAD. Agreement between HCW and expert examiners was poor for many individual items of the diagnostic tool (K = .03-.65. This diagnostic tool had moderate sensitivity and specificity for HAD. However, reliability was poor, suggesting that substantial training and formal evaluations of training adequacy will be critical to enable HCW to reliably administer a brief diagnostic tool for HAD.

  8. Burden of chronic kidney disease in resource-limited settings from Peru: a population-based study.

    Science.gov (United States)

    Francis, Elizabeth R; Kuo, Chin-Chi; Bernabe-Ortiz, Antonio; Nessel, Lisa; Gilman, Robert H; Checkley, William; Miranda, J Jaime; Feldman, Harold I

    2015-07-24

    The silent progression of chronic kidney diseases (CKD) and its association with other chronic diseases, and high treatment costs make it a great public health concern worldwide. The population burden of CKD in Peru has yet to be fully described. We completed a cross sectional study of CKD prevalence among 404 participants (total study population median age 54.8 years, 50.2 % male) from two sites, highly-urbanized Lima and less urbanized Tumbes, who were enrolled in the population-based CRONICAS Cohort Study of cardiopulmonary health in Peru. Factors potentially associated with the presence of CKD were explored using Poisson regression, a statistical methodology used to determine prevalence ratios. In total, 68 participants (16.8 %, 95 % CI 13.5-20.9 %) met criteria for CKD: 60 (14.9%) with proteinuria, four (1%) with eGFR diabetes and hypertension was 19.1 % and 42.7 %, respectively. After multivariable adjustment, CKD was associated with older age, female sex, greater wealth tertile (although all wealth strata were below the poverty line), residence in Lima, and presence of diabetes and hypertension. The high prevalence rates of CKD identified in Lima and Tumbes are similar to estimates from high-income settings. These findings highlight the need to identify occult CKD and implement strategies to prevent disease progression and secondary morbidity.

  9. Limitations when use chloramphenicol-bcyclodextrins complexes in ophtalmic solutions buffered with boric acid/borax system

    Directory of Open Access Journals (Sweden)

    Todoran Nicoleta

    2014-12-01

    Full Text Available Chloramphenicol eye drops are commonly prescribed in concentrations of 0.5-1% in the treatment of infectious conjunctivitis. In terms of ophthalmic solution preparation, the major disadvantage of chloramphenicol consists in its low solubility in water. The solubility is increased by substances that form chloramphenicol-complexes, for example: boric acid/borax or cyclodextrins. Objective: Experimental studies aimed to evaluate the potential advantages of enhancing the solubility and stability of chloramphenicol (API by molecular encapsulation in b-cyclodextrin (CD, in formulation of ophthalmic solutions buffered with boric acid/borax system. Methods and Results: We prepared four APIb- CD complexes, using two methods (kneading and co-precipitation and two molar ratio of API/b-cyclodextrin (1:1 and 1:2. The formation of complexes was proved by differential scanning calorimetry (DSC and the in vitro dissolution tests. Using these compounds, we prepared eight ophthalmic solutions, formulated in two variants of chloramphenicol concentrations (0.4% and 0.5%. Each solution was analyzed, by the official methods, at preparation and periodically during three months of storing in different temperature conditions (4°C, 20°C and 30°C. Conclusions: Inclusion of chloramphenicol in b-cyclodextrin only partially solves the difficulties due to the low solubility of chloramphenicol. The protection of chloramphenicol molecules is not completely ensured when the ophthalmic solutions are buffered with the boric acid/borax system.

  10. Study of boron detection limit using the in-air PIGE set-up at LAMFI-USP

    Energy Technology Data Exchange (ETDEWEB)

    Moro, M. V.; Silva, T. F.; Trindade, G. F.; Added, N.; Tabacniks, M. H. [Institute of Physics, University of São Paulo, SP (Brazil)

    2014-11-11

    The quantification of small amounts of boron in materials is of extreme importance in different areas of materials science. Boron is an important contaminant and also a silicon dopant in the semiconductor industry. Boron is also extensively used in nuclear power plants, either for neutron shielding or for safety control and boron is an essential nutrient for life, either vegetable or animal. The production of silicon solar cells, by refining metallurgical-grade silicon (MG-Si) requires the control and reduction of several silicon contaminants to very low concentration levels. Boron is one of the contaminants of solar-grade silicon (SG-Si) that must be controlled and quantified at sub-ppm levels. In the metallurgical purification, boron quantification is usually made by Inductive Coupled Plasma Mass Spectrometry, (ICP-MS) but the results need to be verified by an independent analytical method. In this work we present the results of the analysis of silicon samples by Particle Induced Gamma-Ray Emission (PIGE) aiming the quantification of low concentrations of boron. PIGE analysis was carried out using the in-air external beam line of the Laboratory for Materials Analysis with Ion Beams (LAMFI-USP) by the {sup 10}B(p,αγ({sup 7}Be nuclear reaction, and measuring the 429 keV γ-ray. The in-air PIGE measurements at LAMFI have a quantification limit of the order of 10{sup 16} at/cm{sup 2}.

  11. Could self-measured office blood pressure be a hypertension screening tool for limited-resources settings?

    Science.gov (United States)

    Salazar, Martin R; Espeche, Walter G; Stavile, Rodolfo N; Balbín, Eduardo; Leiva Sisnieguez, Betty C; Leiva Sisnieguez, Carlos E; March, Carlos E; Cor, Susana; Eugenio Acero, Irma; Carbajal, Horacio A

    2018-05-01

    Blood pressure (BP) was assessed by patients themselves in recently published trials. Self-measured office blood pressure (SMOBP) seems particularly interesting for limited health resources regions. The aim of our study was to evaluate the relationship between SMOBP values and those estimated by ambulatory blood pressure monitoring (ABPM). Six hundred seventy-seven patients were evaluated using both, SMOBP and ABPM. The differences between SMOBP and daytime ABPM were evaluated with paired "t" test. The correlations among SMOBP and ABPM were estimated using Pearson's r. The accuracy of SMOBP to identify abnormal ABPM was determined using area under ROC curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated for different SMOBP cut-points. Using the average of three readings, systolic SMOBP was higher (3.7 (14.2) mmHg, p 95%) to identify individuals with hypertension in the ABPM; SMOBP < 130/80 mmHg reasonably discarded abnormal ABPM. In conclusion, a high proportion of individuals could be classified adequately using SMOBP, reducing the necessity of healthcare resources and supporting its utility for screening purposes.

  12. Study of boron detection limit using the in-air PIGE set-up at LAMFI-USP

    Science.gov (United States)

    Moro, M. V.; Silva, T. F.; Trindade, G. F.; Added, N.; Tabacniks, M. H.

    2014-11-01

    The quantification of small amounts of boron in materials is of extreme importance in different areas of materials science. Boron is an important contaminant and also a silicon dopant in the semiconductor industry. Boron is also extensively used in nuclear power plants, either for neutron shielding or for safety control and boron is an essential nutrient for life, either vegetable or animal. The production of silicon solar cells, by refining metallurgical-grade silicon (MG-Si) requires the control and reduction of several silicon contaminants to very low concentration levels. Boron is one of the contaminants of solar-grade silicon (SG-Si) that must be controlled and quantified at sub-ppm levels. In the metallurgical purification, boron quantification is usually made by Inductive Coupled Plasma Mass Spectrometry, (ICP-MS) but the results need to be verified by an independent analytical method. In this work we present the results of the analysis of silicon samples by Particle Induced Gamma-Ray Emission (PIGE) aiming the quantification of low concentrations of boron. PIGE analysis was carried out using the in-air external beam line of the Laboratory for Materials Analysis with Ion Beans (LAMFI-USP) by the 10B ( p ,αγ(7Be nuclear reaction, and measuring the 429 keV γ-ray. The in-air PIGE measurements at LAMFI have a quantification limit of the order of 1016 at/cm2.

  13. Study of boron detection limit using the in-air PIGE set-up at LAMFI-USP

    International Nuclear Information System (INIS)

    Moro, M. V.; Silva, T. F.; Trindade, G. F.; Added, N.; Tabacniks, M. H.

    2014-01-01

    The quantification of small amounts of boron in materials is of extreme importance in different areas of materials science. Boron is an important contaminant and also a silicon dopant in the semiconductor industry. Boron is also extensively used in nuclear power plants, either for neutron shielding or for safety control and boron is an essential nutrient for life, either vegetable or animal. The production of silicon solar cells, by refining metallurgical-grade silicon (MG-Si) requires the control and reduction of several silicon contaminants to very low concentration levels. Boron is one of the contaminants of solar-grade silicon (SG-Si) that must be controlled and quantified at sub-ppm levels. In the metallurgical purification, boron quantification is usually made by Inductive Coupled Plasma Mass Spectrometry, (ICP-MS) but the results need to be verified by an independent analytical method. In this work we present the results of the analysis of silicon samples by Particle Induced Gamma-Ray Emission (PIGE) aiming the quantification of low concentrations of boron. PIGE analysis was carried out using the in-air external beam line of the Laboratory for Materials Analysis with Ion Beams (LAMFI-USP) by the 10 B(p,αγ( 7 Be nuclear reaction, and measuring the 429 keV γ-ray. The in-air PIGE measurements at LAMFI have a quantification limit of the order of 10 16 at/cm 2

  14. The use of Minilabs to improve the testing capacity of regulatory authorities in resource limited settings: Tanzanian experience.

    Science.gov (United States)

    Risha, Peter Gasper; Msuya, Zera; Clark, Malcolm; Johnson, Keith; Ndomondo-Sigonda, Margareth; Layloff, Thomas

    2008-08-01

    The Tanzania Food and Drugs Authority piloted the use of Minilab kits, a thin-layer-chromatographic based drug quality testing technique, in a two-tier quality assurance program. The program is intended to improve testing capacity with timely screening of the quality of medicines as they enter the market. After 1 week training of inspectors on Minilab screening techniques, they were stationed at key Ports-of-Entry (POE) to screen the quality of imported medicines. In addition, three non-Ports-of-Entry centres were established to screen samples collected during Post-Marketing-Surveillance. Standard operating procedures (SOPs) were developed to structure and standardize the implementation process. Over 1200 samples were tested using the Minilab outside the central quality control laboratory (QCL), almost doubling the previous testing capacity. The program contributed to increased regulatory reach and visibility of the Authority throughout the country, serving as a deterrent against entry of substandard medicines into market. The use of Minilab for quality screening was inexpensive and provided a high sample throughput. However, it suffers from the limitation that it can reliably detect only grossly substandard or wrong drug samples and therefore, it should not be used as an independent testing resource but in conjunction with a full-service quality control laboratory capable of auditing reported substandard results.

  15. Challenges in the use of the mental health information system in a resource-limited setting: lessons from Ghana.

    Science.gov (United States)

    Kpobi, Lily; Swartz, Leslie; Ofori-Atta, Angela L

    2018-02-08

    One of the most successful modes of record-keeping and data collection is the use of health management information systems, where patient information and management plans are uniformly entered into a database to streamline the information and for ease of further patient management. For mental healthcare, a Mental Health Information System (MHIS) has been found most successful since a properly established and operational MHIS is helpful for developing equitable and appropriate mental health care systems. Until 2010, the system of keeping patient records and information in the Accra Psychiatric Hospital of Ghana was old and outdated. In light of this and other factors, a complete reforming of the mental health information systems in three psychiatric hospitals in Ghana was undertaken in 2010. Four years after its implementation, we explored user experiences with the new system, and report here the challenges that were identified with use of the new MHIS. Individual semi-structured interviews were conducted with nine clinical and administrative staff of the Accra Psychiatric Hospital to examine their experiences with the new MHIS. Participants in the study were in three categories: clinical staff, administrator, and records clerk. Participants' knowledge of the system and its use, as well as the challenges they had experienced in its use were explored using an interpretative phenomenological approach. The data suggest that optimal use of the current MHIS had faced significant implementation challenges in a number of areas. Central challenges reported by users included increased workload, poor staff involvement and training, and absence of logistic support to keep the system running. Setting up a new system does not guarantee its success. As important as it is to have a mental health information system, its usefulness is largely dependent on proper implementation and maintenance. Further, the system can facilitate policy transformation only when the place of mental

  16. Pathogen reduction and blood transfusion safety in Africa: strengths, limitations and challenges of implementation in low-resource settings.

    Science.gov (United States)

    Ware, A D; Jacquot, C; Tobian, A A R; Gehrie, E A; Ness, P M; Bloch, E M

    2018-01-01

    Transfusion-transmitted infection risk remains an enduring challenge to blood safety in Africa. A high background incidence and prevalence of the major transfusion-transmitted infections (TTIs), dependence on high-risk donors to meet demand, suboptimal testing and quality assurance collectively contribute to the increased risk. With few exceptions, donor testing is confined to serological evaluation of human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) and syphilis. Barriers to implementation of broader molecular methods include cost, limited infrastructure and lack of technical expertise. Pathogen reduction (PR), a term used to describe a variety of methods (e.g. solvent detergent treatment or photochemical activation) that may be applied to blood following collection, offers the means to diminish the infectious potential of multiple pathogens simultaneously. This is effective against different classes of pathogen, including the major TTIs where laboratory screening is already implemented (e.g. HIV, HBV and HCV) as well pathogens that are widely endemic yet remain unaddressed (e.g. malaria, bacterial contamination). We sought to review the available and emerging PR techniques and their potential application to resource-constrained parts of Africa, focusing on the advantages and disadvantages of such technologies. PR has been slow to be adopted even in high-income countries, primarily given the high costs of use. Logistical considerations, particularly in low-resourced parts of Africa, also raise concerns about practicality. Nonetheless, PR offers a rational, innovative strategy to contend with TTIs; technologies in development may well present a viable complement or even alternative to targeted screening in the future. © 2017 International Society of Blood Transfusion.

  17. The importance of inclusion of kinetic information in the extrapolation of high-to-low concentrations for human limit setting.

    Science.gov (United States)

    Geraets, Liesbeth; Zeilmaker, Marco J; Bos, Peter M J

    2018-01-05

    Human health risk assessment of inhalation exposures generally includes a high-to-low concentration extrapolation. Although this is a common step in human risk assessment, it introduces various uncertainties. One of these uncertainties is related to the toxicokinetics. Many kinetic processes such as absorption, metabolism or excretion can be subject to saturation at high concentration levels. In the presence of saturable kinetic processes of the parent compound or metabolites, disproportionate increases in internal blood or tissue concentration relative to the external concentration administered may occur resulting in nonlinear kinetics. The present paper critically reviews human health risk assessment of inhalation exposure. More specific, it emphasizes the importance of kinetic information for the determination of a safe exposure in human risk assessment of inhalation exposures assessed by conversion from a high animal exposure to a low exposure in humans. For two selected chemicals, i.e. methyl tert-butyl ether and 1,2-dichloroethane, PBTK-modelling was used, for illustrative purposes, to follow the extrapolation and conversion steps as performed in existing risk assessments for these chemicals. Human health-based limit values based on an external dose metric without sufficient knowledge on kinetics might be too high to be sufficiently protective. Insight in the actual internal exposure, the toxic agent, the appropriate dose metric, and whether an effect is related to internal concentration or dose is important. Without this, application of assessment factors on an external dose metric and the conversion to continuous exposure results in an uncertain human health risk assessment of inhalation exposures. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Mentorship needs at academic institutions in resource-limited settings: a survey at makerere university college of health sciences

    Directory of Open Access Journals (Sweden)

    Nakwagala Fred

    2011-07-01

    Full Text Available Abstract Background Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS. Methods Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees registered with the Uganda Society for Health Scientists (USHS. Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes. Results Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses. Up to 77% (17/22 of mentors had Master's-level training and only 18% (4/22 had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions. Conclusions

  19. The semi-classical limit of the time dependent Hartree-Fock equation. II. The Wick symbol of the solution

    OpenAIRE

    Amour, Laurent; Khodja, Mohamed; Nourrigat, Jean

    2011-01-01

    We study the Wick symbol of a solution of the time dependent Hartree Fock equation, under weaker hypotheses than those needed for the Weyl symbol in the first paper with thesame title. With similar, we prove some kind of Ehrenfest theorem for observables that are not pseudo-differential operators.

  20. Treatment of elephantiasis of the leg by fasciotomy and lymphangiectomy with skin preservation in a resource-limited setting: a case report and review.

    Science.gov (United States)

    Kibadi, K

    2018-02-01

    The author reports the surgical management of a patient with elephantiasis of the leg in the Democratic Republic of Congo. A fasciotomy and lymphangiectomy with skin preservation, combined with compression therapy, resulted in significant cosmetic, functional, and social improvement. Although challenging in a resource-limited setting, development of surgical management may make it possible to reduce beliefs that elephantiasis is incurable or due to witchcraft and may reduce time to consultation.

  1. Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

    Directory of Open Access Journals (Sweden)

    Jane W. Muchiri

    2012-10-01

    Full Text Available Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary

  2. Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

    Directory of Open Access Journals (Sweden)

    Jane W. Muchiri

    2012-10-01

    Full Text Available Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary

  3. Radionuclide transport in fractured porous media -- Analytical solutions for a system of parallel fractures with a kinetic solubility-limited dissolution model

    International Nuclear Information System (INIS)

    Li, S.H.; Chen, C.T.

    1997-01-01

    Analytical solutions are developed for the problem of radionuclide transport in a system of parallel fractures situated in a porous rock matrix. A kinetic solubility-limited dissolution model is used as the inlet boundary condition. The solutions consider the following processes: (a) advective transport in the fractures, (b) mechanical dispersion and molecular diffusion along the fractures, (c) molecular diffusion from a fracture to the porous matrix, (d) molecular diffusion within the porous matrix in the direction perpendicular to the fracture axis, (e) adsorption onto the fracture wall, (f) adsorption within the porous matrix, and (g) radioactive decay. The solutions are based on the Laplace transform method. The general transient solution is in the form of a double integral that is evaluated using composite Gauss-Legendre quadrature. A simpler transient solution that is in the form of a single integral is also presented for the case that assumes negligible longitudinal dispersion along the fractures. The steady-state solutions are also provided. A number of examples are given to illustrate the effects of the following important parameters: (a) fracture spacings, (b) dissolution-rate constants, (c) fracture dispersion coefficient, (d) matrix retardation factor, and (e) fracture retardation factor

  4. Limitations when use chloramphenicol-bcyclodextrins complexes in ophtalmic solutions buffered with boric acid/borax system

    OpenAIRE

    Todoran Nicoleta; Ciurba Adriana; Rédai Emőke; Ion V.; Lazăr Luminița; Sipos Emese

    2014-01-01

    Chloramphenicol eye drops are commonly prescribed in concentrations of 0.5-1% in the treatment of infectious conjunctivitis. In terms of ophthalmic solution preparation, the major disadvantage of chloramphenicol consists in its low solubility in water. The solubility is increased by substances that form chloramphenicol-complexes, for example: boric acid/borax or cyclodextrins. Objective: Experimental studies aimed to evaluate the potential advantages of enhancing the solubility and stability ...

  5. Classical solutions and extended supergravity

    International Nuclear Information System (INIS)

    de Alfaro, V.; Fubini, S.; Furlan, G.

    1980-03-01

    The existence and properties of classical solutions for gravity coupled to matter fields have been investigated previously with the limitation to conformally flat solutions. In the search for a guiding criterion to determine the form of the coupling among the fields, one is led to consider supersymmetric theories, and the question arises whether classical solutions persist in these models. It is found that a discrepancy persists between supergravity and standard meron solutions. Owing to the appearance of the scalar field, a new set of meron solutions exists for particular Lagrangian models. In conclusion, the form of solutions in Minkowski space is discussed

  6. Potential Impact of a Free Online HIV Treatment Response Prediction System for Reducing Virological Failures and Drug Costs after Antiretroviral Therapy Failure in a Resource-Limited Setting

    Directory of Open Access Journals (Sweden)

    Andrew D. Revell

    2013-01-01

    Full Text Available Objective. Antiretroviral drug selection in resource-limited settings is often dictated by strict protocols as part of a public health strategy. The objective of this retrospective study was to examine if the HIV-TRePS online treatment prediction tool could help reduce treatment failure and drug costs in such settings. Methods. The HIV-TRePS computational models were used to predict the probability of response to therapy for 206 cases of treatment change following failure in India. The models were used to identify alternative locally available 3-drug regimens, which were predicted to be effective. The costs of these regimens were compared to those actually used in the clinic. Results. The models predicted the responses to treatment of the cases with an accuracy of 0.64. The models identified alternative drug regimens that were predicted to result in improved virological response and lower costs than those used in the clinic in 85% of the cases. The average annual cost saving was $364 USD per year (41%. Conclusions. Computational models that do not require a genotype can predict and potentially avoid treatment failure and may reduce therapy costs. The use of such a system to guide therapeutic decision-making could confer health economic benefits in resource-limited settings.

  7. Eco-innovation of a wooden childhood furniture set: an example of environmental solutions in the wood sector.

    Science.gov (United States)

    González-García, Sara; García Lozano, Raúl; Moreira, M Teresa; Gabarrell, Xavier; Rieradevall i Pons, Joan; Feijoo, Gumersindo; Murphy, Richard J

    2012-06-01

    The environmental profile of a set of wood furniture was carried out to define the best design criteria for its eco-design. A baby cot convertible into a bed, a study desk and a bedside table were the objects of study. Two quantitative and qualitative environmental approaches were combined in order to propose improvement alternatives: Life Cycle Assessment (LCA) and Design for Environment (DfE). In the first case Life Cycle Assessment (LCA) was applied to identify the hot spots in the product system. As a next step, LCA information was used in eco-briefing to determine several improvement alternatives. A wood products company located in Catalonia (NE Spain) was assessed in detail, dividing the process into three stages: assembly, finishing and packaging. Ten impact categories were considered in the LCA study: abiotic depletion, acidification, eutrophication, global warming, ozone layer depletion, human toxicity, fresh water aquatic ecotoxicity, marine aquatic ecotoxicity, terrestrial ecotoxicity and photochemical oxidant formation. Two processes can be considered the key environmental factors: the production of the wooden boards and electricity, with contributions of 45-68% and 14-33% respectively depending on the impact categories. Subsequently, several improvement alternatives were proposed in the eco-design process (DfE) to achieve reductions in a short-medium period of time in the environmental impact. These eco-design strategies could reduce the environmental profile of the setup by 14%. The correct methodological adaptation of the concept of eco-briefing, as a tool for communication among environmental technicians and designers, the simplification of the analytical tool used and the LCA, could facilitate the environmental analysis of a product. The results obtained provide information that can help the furniture sector to improve their environmental performance. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. The solution to avoid protection fuses' failure of the driving motor of the turbine-generator set during its startup in Daya Bay Nuclear Power Station

    International Nuclear Information System (INIS)

    Chen Jisheng

    2005-01-01

    Based on a detailed analysis of the inter-relationship in the current, voltage, electromagnetic torque and ratio of the difference between the speed of rotor and the speed of rotary magnetic field to the later in the motor, the root cause was point out, which leads to the protection fuses' failure of the motor in the starting stage, which drives the turbine-generator set to rotate at low speed before its startup. Two solutions to avoid the situation are proposed, too. (authors)

  9. An accurate and affordable test for the rapid diagnosis of sickle cell disease could revolutionize the outlook for affected children born in resource-limited settings.

    Science.gov (United States)

    Williams, Thomas N

    2015-09-23

    Each year, at least 280,000 children are born with sickle cell disease (SCD) in resource-limited settings. For cost, logistic and political reasons, the availability of SCD testing is limited in such settings and consequently 50-90 % of affected children die undiagnosed before their fifth birthday. The recent development of a point of care method for the diagnosis of SCD - the Sickle SCAN™ device - could afford such children the prompt access to appropriate services that has transformed the outlook for affected children in resource-rich areas. In research published in BMC Medicine, Kanter and colleagues describe a small but carefully conducted study involving 208 children and adults, in which they found that by using Sickle SCAN™ it was possible to diagnose the common forms of SCD with 99 % sensitivity and 99 % specificity, in under 5 minutes. If repeatable both in newborn babies and under real-life conditions, and if marketed at an affordable price, Sickle SCAN™ could revolutionize the survival prospects for children born with SCD in resource-limited areas.Please see related article: http://dx.doi.org/10.1186/s12916-015-0473-6.

  10. Protocol for the systematic review of the prevention, treatment and public health management of impetigo, scabies and fungal skin infections in resource-limited settings.

    Science.gov (United States)

    May, Philippa; Bowen, Asha; Tong, Steven; Steer, Andrew; Prince, Sam; Andrews, Ross; Currie, Bart; Carapetis, Jonathan

    2016-09-23

    Impetigo, scabies, and fungal skin infections disproportionately affect populations in resource-limited settings. Evidence for standard treatment of skin infections predominantly stem from hospital-based studies in high-income countries. The evidence for treatment in resource-limited settings is less clear, as studies in these populations may lack randomisation and control groups for cultural, ethical or economic reasons. Likewise, a synthesis of the evidence for public health control within endemic populations is also lacking. We propose a systematic review of the evidence for the prevention, treatment and public health management of skin infections in resource-limited settings, to inform the development of guidelines for the standardised and streamlined clinical and public health management of skin infections in endemic populations. The protocol has been designed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. All trial designs and analytical observational study designs will be eligible for inclusion. A systematic search of the peer-reviewed literature will include PubMed, Excertpa Medica and Global Health. Grey literature databases will also be systematically searched, and clinical trials registries scanned for future relevant studies. The primary outcome of interest will be the clinical cure or decrease in prevalence of impetigo, scabies, crusted scabies, tinea capitis, tinea corporis or tinea unguium. Two independent reviewers will perform eligibility assessment and data extraction using standardised electronic forms. Risk of bias assessment will be undertaken by two independent reviewers according to the Cochrane Risk of Bias tool. Data will be tabulated and narratively synthesised. We expect there will be insufficient data to conduct meta-analysis. The final body of evidence will be reported against the Grades of Recommendation, Assessment, Development and Evaluation grading system. The evidence

  11. Limiting cases of the small-angle scattering approximation solutions for the propagation of laser beams in anisotropic scattering media

    Science.gov (United States)

    Box, M. A.; Deepak, A.

    1981-01-01

    The propagation of photons in a medium with strongly anisotropic scattering is a problem with a considerable history. Like the propagation of electrons in metal foils, it may be solved in the small-angle scattering approximation by the use of Fourier-transform techniques. In certain limiting cases, one may even obtain analytic expressions. This paper presents some of these results in a model-independent form and also illustrates them by the use of four different phase-function models. Sample calculations are provided for comparison purposes

  12. Chronic air-flow limitation does not increase respiratory epithelial permeability assessed by aerosolized solute, but smoking does

    International Nuclear Information System (INIS)

    Huchon, G.J.; Russell, J.A.; Barritault, L.G.; Lipavsky, A.; Murray, J.F.

    1984-01-01

    To determine the separate influences of smoking and severe air-flow limitation on aerosol deposition and respiratory epithelial permeability, we studied 26 normal nonsmokers, 12 smokers without airway obstruction, 12 nonsmokers with chronic obstructive pulmonary disease (COPD), and 11 smokers with COPD. We aerosolized 99mTc-labeled diethylene triamine pentaacetic acid to particles approximately 1 micron activity median aerodynamic diameter. Levels of radioactivity were plotted semilogarithmically against time to calculate clearance as percent per minute. The distribution of radioactivity was homogeneous in control subjects and in smokers, but patchy in both groups with COPD. No difference was found between clearances of the control group (1.18 +/- 0.31% min-1), and nonsmoker COPD group (1.37 +/- 0.82% min-1), whereas values in smokers without COPD (4.00 +/- 1.70% min-1) and smokers with COPD (3.62 +/- 2.88% min-1) were significantly greater than in both nonsmoking groups. We conclude that (1) small particles appear to deposit peripherally, even with severe COPD; (2) respiratory epithelial permeability is normal in nonsmokers with COPD; (3) smoking increases permeability by a mechanism unrelated to air-flow limitation

  13. Limitations and Extensions of the Lock-and-Key Principle: Differences between Gas State, Solution and Solid State Structures

    Directory of Open Access Journals (Sweden)

    Hans-Jörg Schneider

    2015-03-01

    Full Text Available The lock-and-key concept is discussed with respect to necessary extensions. Formation of supramolecular complexes depends not only, and often not even primarily on an optimal geometric fit between host and guest. Induced fit and allosteric interactions have long been known as important modifications. Different binding mechanisms, the medium used and pH effects can exert a major influence on the affinity. Stereoelectronic effects due to lone pair orientation can lead to variation of binding constants by orders of magnitude. Hydrophobic interactions due to high-energy water inside cavities modify the mechanical lock-and-key picture. That optimal affinities are observed if the cavity is only partially filled by the ligand can be in conflict with the lock-and-key principle. In crystals other forces than those between host and guest often dominate, leading to differences between solid state and solution structures. This is exemplified in particular with calixarene complexes, which by X-ray analysis more often than other hosts show guest molecules outside their cavity. In view of this the particular problems with the identification of weak interactions in crystals is discussed.

  14. Heparin and albumin as part of the priming solution limits exposure to anticoagulation during hemodialysis: in vitro studies.

    Science.gov (United States)

    Kyrk, Tobias; Bechara, Alex; Skagerlind, Malin; Stegmayr, Bernd

    2014-10-01

    Hemodialysis patients who are subject to increased risk of hemorrhage may need specific dialysis regimes to avoid bleeding. The aim of this study was to determine in vitro which of various anticoagulation options were most beneficial. 60 in vitro hemodialyses (HD) were performed in parallel using blood from healthy donors. The dialysis circuits were rinsed with either 1 L of 0.9% NaCl alone (n = 6), or with 1 L saline and the addition of either 5 mL 20% albumin (Alb, n = 6), 5,000 U of heparin (Hep, n = 6), Hep and Alb in combination (HA, n = 30), 20,000 U of Hep and Alb (4H-A, n = 6), and finally Hep and 20 mL 20% albumin (H-4A, n = 6). The blood was recirculated for a maximum of 192 min. Clotting was graded. A 192 min dialysis was completed with all series of HA, 4H-A, and H-4A, all with a slight grade of clotting. In contrast to the above settings (p = 0.002, Fisher's test), a total clotting of the dialysis circuit occurred for all series using the NaCl rinsing alone (median time to stop: 21, range:18-27 min, p = 0.026 compared to the HA setting) and for the Alb rinsing (median 26, range: 19-35 min, p = 0.028). Priming using HA, Hep, 4H-A, and H-4A reduced clotting and allowed 192 min of HD. Clinical studies need to confirm these data in vivo.

  15. Exact solution for the inhomogeneous Dicke model in the canonical ensemble: Thermodynamical limit and finite-size corrections

    Energy Technology Data Exchange (ETDEWEB)

    Pogosov, W.V., E-mail: walter.pogosov@gmail.com [N.L. Dukhov All-Russia Research Institute of Automatics, Moscow (Russian Federation); Institute for Theoretical and Applied Electrodynamics, Russian Academy of Sciences, Moscow (Russian Federation); Moscow Institute of Physics and Technology, Dolgoprudny (Russian Federation); Shapiro, D.S. [N.L. Dukhov All-Russia Research Institute of Automatics, Moscow (Russian Federation); Moscow Institute of Physics and Technology, Dolgoprudny (Russian Federation); V.A. Kotel' nikov Institute of Radio Engineering and Electronics, Russian Academy of Sciences, Moscow (Russian Federation); National University of Science and Technology MISIS, Moscow (Russian Federation); Bork, L.V. [N.L. Dukhov All-Russia Research Institute of Automatics, Moscow (Russian Federation); Institute for Theoretical and Experimental Physics, Moscow (Russian Federation); Onishchenko, A.I. [Bogoliubov Laboratory of Theoretical Physics, Joint Institute for Nuclear Research, Dubna (Russian Federation); Moscow Institute of Physics and Technology, Dolgoprudny (Russian Federation); Skobeltsyn Institute of Nuclear Physics, Moscow State University, Moscow (Russian Federation)

    2017-06-15

    We consider an exactly solvable inhomogeneous Dicke model which describes an interaction between a disordered ensemble of two-level systems with single mode boson field. The existing method for evaluation of Richardson–Gaudin equations in the thermodynamical limit is extended to the case of Bethe equations in Dicke model. Using this extension, we present expressions both for the ground state and lowest excited states energies as well as leading-order finite-size corrections to these quantities for an arbitrary distribution of individual spin energies. We then evaluate these quantities for an equally-spaced distribution (constant density of states). In particular, we study evolution of the spectral gap and other related quantities. We also reveal regions on the phase diagram, where finite-size corrections are of particular importance.

  16. A Standardized Needs Assessment Tool to Inform the Curriculum Development Process for Pediatric Resuscitation Simulation-Based Education in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Nicole Shilkofski

    2018-02-01

    Full Text Available IntroductionUnder five mortality rates (UFMR remain high for children in low- and middle-income countries (LMICs in the developing world. Education for practitioners in these environments is a key factor to improve outcomes that will address United Nations Sustainable Development Goals 3 and 10 (good health and well being and reduced inequalities. In order to appropriately contextualize a curriculum using simulation, it is necessary to first conduct a needs assessment of the target learner population. The World Health Organization (WHO has published a tool to assess capacity for emergency and surgical care in LMICs that is adaptable to this goal.Materials and methodsThe WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was modified to assess pediatric resuscitation capacity in clinical settings in two LMICs: Uganda and Myanmar. Modifications included assessment of self-identified learning needs, current practices, and perceived epidemiology of disease burden in each clinical setting, in addition to assessment of pediatric resuscitation capacity in regard to infrastructure, procedures, equipment, and supplies. The modified tool was administered to 94 respondents from the two settings who were target learners of a proposed simulation-based curriculum in pediatric and neonatal resuscitation.ResultsInfectious diseases (respiratory illnesses and diarrheal disease were cited as the most common causes of pediatric deaths in both countries. Self-identified learning needs included knowledge and skill development in pediatric airway/breathing topics, as well as general resuscitation topics such as CPR and fluid resuscitation in shock. Equipment and supply availability varied substantially between settings, and critical shortages were identified in each setting. Current practices and procedures were often limited by equipment availability or infrastructural considerations.Discussion and conclusionEpidemiology of disease

  17. Fundamental energy limits of SET-based Brownian NAND and half-adder circuits. Preliminary findings from a physical-information-theoretic methodology

    Science.gov (United States)

    Ercan, İlke; Suyabatmaz, Enes

    2018-06-01

    The saturation in the efficiency and performance scaling of conventional electronic technologies brings about the development of novel computational paradigms. Brownian circuits are among the promising alternatives that can exploit fluctuations to increase the efficiency of information processing in nanocomputing. A Brownian cellular automaton, where signals propagate randomly and are driven by local transition rules, can be made computationally universal by embedding arbitrary asynchronous circuits on it. One of the potential realizations of such circuits is via single electron tunneling (SET) devices since SET technology enable simulation of noise and fluctuations in a fashion similar to Brownian search. In this paper, we perform a physical-information-theoretic analysis on the efficiency limitations in a Brownian NAND and half-adder circuits implemented using SET technology. The method we employed here establishes a solid ground that enables studying computational and physical features of this emerging technology on an equal footing, and yield fundamental lower bounds that provide valuable insights into how far its efficiency can be improved in principle. In order to provide a basis for comparison, we also analyze a NAND gate and half-adder circuit implemented in complementary metal oxide semiconductor technology to show how the fundamental bound of the Brownian circuit compares against a conventional paradigm.

  18. Eddy current imaging. Limits of the born approximation and advantages of an exact solution to the inverse problem

    International Nuclear Information System (INIS)

    Hamman, E.; Zorgati, R.

    1995-01-01

    Eddy current non-destructive testing is used by EDF to detect flaws affecting conductive objects such as steam generator tubes. With a view to obtaining ever more accurate information on equipment integrity, thereby facilitating diagnosis, studies aimed at using measurements to reconstruct an image of the flaw have been proceeding now for about ten years. In this context, our approach to eddy current imaging is based on inverse problem formalism. The direct problem, involving a mathematical model linking measurements provided by a probe with variables characterizing the defect, is dealt with elsewhere. Using the model results, we study the possibility of inverting it, i.e. of reconstructing an image of the flaw from the measurements. We first give an overview of the different inversion techniques, representative of the state of the art and all based on linearization of the inverse problem by means of the Born approximation. The model error resulting from an excessive Born approximation nevertheless severely limits the quantity of the images which can be obtained. In order to counteract this often critical error and extend the eddy current imaging application field, we have to del with the non-linear inverse problem. A method derived from recent research is proposed and implemented to ensure consistency with the exact model. Based on an 'optimization' type approach and provided with a convergence theorem, the method is highly efficient. (authors). 17 refs., 7 figs., 1 append

  19. Providing Anesthesia Care in Resource-limited Settings: A 6-year Analysis of Anesthesia Services Provided at Médecins Sans Frontières Facilities.

    Science.gov (United States)

    Ariyo, Promise; Trelles, Miguel; Helmand, Rahmatullah; Amir, Yama; Hassani, Ghulam Haidar; Mftavyanka, Julien; Nzeyimana, Zenon; Akemani, Clemence; Ntawukiruwabo, Innocent Bagura; Charles, Adelin; Yana, Yanang; Moussa, Kalla; Kamal, Mustafa; Suma, Mohamed Lamin; Ahmed, Mowlid; Abdullahi, Mohamed; Wong, Evan G; Kushner, Adam; Latif, Asad

    2016-03-01

    Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed. Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively. A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.

  20. The Role of Credibility In the Design of Mobile Solutions To Enhance the Social Skill-Set of Teenagers Diagnosed with Autism

    DEFF Research Database (Denmark)

    Gerdes, Anne; Øhrstrøm, Peter

    2011-01-01

    Purpose – Helping Autism-diagnosed teenagers navigate and develop socially (HANDS) is an EU research project in progress. The aim of HANDS is to investigate the potential of persuasive technology as a tool to help young people diagnosed, to whatever degree, as autistic. The HANDS project set out...... the necessity of certain preconditions requisite for evaluating the credibility of a system; and, in this way, seek to establish an ethically sound evaluation procedure for analysing credibility, by combining quantitative (i.e. electronic footprints) and qualitative assessments (i.e. dialogue between teacher...... to develop mobile ICT solutions to help young people with autism become more fully integrated into society and the purpose of this paper is to present an overview of the design behind the HANDS toolset. Design/methodology/approach – The topic of credibility is approached from an analytical, as well...

  1. Solid solution limits and selected mechanical properties of the quaternary L12 trialuminide Al-Ti-Mn-Mo

    International Nuclear Information System (INIS)

    Schneibel, J.H.

    1994-01-01

    Intermetallics based on the trialuminide Al 3 Ti, or on Al 11 Ti 5 , have been extensively researched in recent years. Alloying with approximately 10 at.% of first-row transition elements, such as Cr or Mn, converts the DO 22 structure of Al 3 Ti to L1 2 . Although this transition to the L1 2 structure increases the number of independent slip systems to five and causes substantial softening, room-temperature tensile ductilities and fracture toughnesses remain low. Typical values for the room-temperature ductilities of Al-25Ti-8Cr and Al-25Ti-9Mn are 0.2% and room-temperature fracture toughnesses of trialuminides range from 2 to 5 MPa m 1/2 . Reasons for the low fracture toughness of trialuminides have been discussed by Turner et al. and George et al. On a phenomenological basis, it appears that fracture toughnesses might improve, if either Poisson's ratio or the ratio of the bulk and shear moduli can be increased. In principle, this might be achieved by macroalloying ternary L1 2 trialuminides, while at the same time maintaining the L1 2 crystal structure. Focusing on first-row transition elements, Kumar and Brown investigated a range of such quaternary compounds. They did not observe any improvement in ductility, as compared to the ternary compounds. In the present work, it was decided to focus on a second-row transition element, namely, 2 molybdenum. As compared to Cr and Mn, which are only slightly soluble in Al 3 Ti, up to 20 at. % Mo dissolves in Al 3 Ti at 1,198 K. This raises the question whether substantial amounts of Mo also dissolve in the cubic ternary trialuminides such as Al-Ti-Mn. In order to verify this possibility, the extent of the single-phase region of cubic Al-Ti-Mn-Mo intermetallic was mapped out at 1,473 K. In addition, a limited characterization of room-temperature mechanical properties was carried out

  2. Local innovation for improving primary care cardiology in resource-limited African settings: an insight on the Cardio Pad(®) project in Cameroon.

    Science.gov (United States)

    Noubiap, Jean Jacques N; Jingi, Ahmadou M; Kengne, André Pascal

    2014-10-01

    Cardiovascular disease (CVD) is an emerging threat to the health of populations in Africa. With the inadequate health infrastructures, understaffed and underfunded health systems, African countries are ill-prepared to cope with the increasing demand for care for CVD, particularly for populations in remote and underserved rural areas, where 60% of the population currently reside. Task shifting and telehealth have been suggested as strategies to overcome the current health workforce shortage in African countries, and to increase access to prevention and curative services for emerging CVD. However, strategies for promoting their incorporation into the existing health systems, have yet to be developed. The Cardio Pad(®) initiative (originating from Cameroon) seeks to provide appropriate solutions to improve the application of telemedicine for CVD prevention and control in remote African settings. The Cardio Pad(®) is a tele-cardiology device which provides a number of advantages in terms of cost, ease of use, autonomy and reduced technology requirements. It is a fully touch screen medical device which enables cardiac tests such as electrocardiograms (ECG) to be performed in remote underserved areas (rural areas for instance), while the test results are transferred wirelessly via mobile phone connection, to specialist physicians who can interpret them and provide assistance with case management. While most of the current telemedicine clinical services on the African continent receive most expertise from developed countries, the Cardio Pad(®), a local invention by a 26-year-old Cameroon-trained engineer demonstrates how much innovative solutions to combat CVD and other health issues could and should be developed locally in Africa.

  3. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yalda Jafari

    Full Text Available Rapid and point-of-care (POC tests for syphilis are an invaluable screening tool, yet inadequate evaluation of their diagnostic accuracy against best reference standards limits their widespread global uptake. To fill this gap, a systematic review and meta-analysis was conducted to evaluate the sensitivity and specificity of rapid and POC tests in blood and serum samples against Treponema pallidum (TP specific reference standards.Five electronic databases (1980-2012 were searched, data was extracted from 33 articles, and Bayesian hierarchical models were fit.In serum samples, against a TP specific reference standard point estimates with 95% credible intervals (CrI for the sensitivities of popular tests were: i Determine, 90.04% (80.45, 95.21, ii SD Bioline, 87.06% (75.67, 94.50, iii VisiTect, 85.13% (72.83, 92.57, and iv Syphicheck, 74.48% (56.85, 88.44, while specificities were: i Syphicheck, 99.14% (96.37, 100, ii Visitect, 96.45% (91.92, 99.29, iii SD Bioline, 95.85% (89.89, 99.53, and iv Determine, 94.15% (89.26, 97.66. In whole blood samples, sensitivities were: i Determine, 86.32% (77.26, 91.70, ii SD Bioline, 84.50% (78.81, 92.61, iii Syphicheck, 74.47% (63.94, 82.13, and iv VisiTect, 74.26% (53.62, 83.68, while specificities were: i Syphicheck, 99.58% (98.91, 99.96, ii VisiTect, 99.43% (98.22, 99.98, iii SD Bioline, 97.95%(92.54, 99.33, and iv Determine, 95.85% (92.42, 97.74.Rapid and POC treponemal tests reported sensitivity and specificity estimates comparable to laboratory-based treponemal tests. In resource limited settings, where access to screening is limited and where risk of patients lost to follow up is high, the introduction of these tests has already been shown to improve access to screening and treatment to prevent stillbirths and neonatal mortality due to congenital syphilis. Based on the evidence, it is concluded that rapid and POC tests are useful in resource limited settings with poor access to laboratories or screening

  4. The clinical and economic impact of point-of-care CD4 testing in mozambique and other resource-limited settings: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Emily P Hyle

    2014-09-01

    Full Text Available Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique.We use a validated model of HIV testing, linkage, and treatment (CEPAC-International to examine two strategies of immunological staging in Mozambique: (1 laboratory-based CD4 testing (LAB-CD4 and (2 point-of-care CD4 testing (POC-CD4. Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs. Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%, probability of correctly detecting antiretroviral therapy (ART eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90% or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%, and test cost (LAB-CD4, US$10; POC-CD4, US$24. In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570 to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%, increasing to 65.0% (95% CI, 64.9%-65.1% with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y and US$2,440 (95% CI, US$2,440-US$2,450 and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y and US$2,800 (95% CI, US$2,790-US$2,800; the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS (95% CI, US$480-US$520/YLS. POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published

  5. Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study

    Directory of Open Access Journals (Sweden)

    Keuky Lim

    2009-07-01

    Full Text Available Abstract Background Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008. Methods We calculated the mean and proportion of patients who met the recommended treatment targets, and the drop from baseline values for random blood glucose (RBG, hemoglobin A1c (HbA1c, blood pressure (BP, and body mass index (BMI at regular intervals. Analysis was restricted to patients not lost to follow-up. We used the t test to compare baseline and subsequent paired values. Results Of 4404 patients enrolled, 2,872 (65% were still in care at the time of the study, 24 (0.5% had died, and 1,508 (34% were lost tofollow-up. Median age was 53 years, 2,905 (66% were female and 4,350 (99% had type 2 diabetes. Median (interquartile range (IQR follow-up was 20 months (5 to 39.5 months. A total of 24% (51/210 of patients had a HbA1c concentration of P P P P 2 after 1 year. Factors associated with loss to follow-up were male sex, age >60 years, living outside the province, normal BMI on admission, high RBG on last visit, and coming late for the last consultation. Conclusion Significant and clinically important improvements in glycemia and BP were observed, but a relatively low proportion of diabetic patients reached treatment targets. These results and the high loss to follow-up rate highlight the challenges of delivering diabetic care in rural, resource-limited settings.

  6. Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

    Science.gov (United States)

    Zakumumpa, Henry; Taiwo, Modupe Oladunni; Muganzi, Alex; Ssengooba, Freddie

    2016-10-19

    Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009. A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis. The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment. Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.

  7. Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings.

    Science.gov (United States)

    Shrivastava, Rakesh; Sen, Sourav; Banerji, Debabrata; Praharaj, Ashok K; Chopra, Gurvinder Singh; Gill, Satyajit Singh

    2013-01-01

    A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. The aim of this study is to assess the utility of non-invasive mathematical models of liver fibrosis in chronic hepatitis B (CHB). Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. A cross-sectional study carried out at a tertiary care center. A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gama glutamyl transpeptidase (GGT), total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI), Fibrosis 4 (FIB-4) and Forn's index were calculated. Outcomes were compared for the assessment of best predictor of fibrosis by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each index. Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for significance. P value value of all 3 indices were significantly higher in patients group as compare with the controls (P model for excluding significant liver fibrosis while FIB-4 with a PPV of 61% showed fair correlation with significant fibrosis. Thus, these two non-invasive models for predicting of liver fibrosis, namely APRI and FIB-4, can be utilized in combination as screening tools in monitoring of CHB patients, especially in resource limiting settings.

  8. Improved Neuropsychological and Neurological Functioning Across Three Antiretroviral Regimens in Diverse Resource-Limited Settings: AIDS Clinical Trials Group Study A5199, the International Neurological Study

    Science.gov (United States)

    Robertson, K.; Jiang, H.; Kumwenda, J.; Supparatpinyo, K.; Evans, S.; Campbell, T. B.; Price, R.; Tripathy, S.; Kumarasamy, N.; La Rosa, A.; Santos, B.; Silva, M. T.; Montano, S.; Kanyama, C.; Faesen, S.; Murphy, R.; Hall, C.; Marra, C. M.; Marcus, C.; Berzins, B.; Allen, R.; Housseinipour, M.; Amod, F.; Sanne, I.; Hakim, J.; Walawander, A.; Nair, A.

    2012-01-01

    Background. AIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings. Methods. Participants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations. Results. The median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P  .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01). Conclusions. The study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization –recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction. Clinical trials registration.  NCT00096824. PMID:22661489

  9. Particle size distributions of lead measured in battery manufacturing and secondary smelter facilities and implications in setting workplace lead exposure limits.

    Science.gov (United States)

    Petito Boyce, Catherine; Sax, Sonja N; Cohen, Joel M

    2017-08-01

    Inhalation plays an important role in exposures to lead in airborne particulate matter in occupational settings, and particle size determines where and how much of airborne lead is deposited in the respiratory tract and how much is subsequently absorbed into the body. Although some occupational airborne lead particle size data have been published, limited information is available reflecting current workplace conditions in the U.S. To address this data gap, the Battery Council International (BCI) conducted workplace monitoring studies at nine lead acid battery manufacturing facilities (BMFs) and five secondary smelter facilities (SSFs) across the U.S. This article presents the results of the BCI studies focusing on the particle size distributions calculated from Personal Marple Impactor sampling data and particle deposition estimates in each of the three major respiratory tract regions derived using the Multiple-Path Particle Dosimetry model. The BCI data showed the presence of predominantly larger-sized particles in the work environments evaluated, with average mass median aerodynamic diameters (MMADs) ranging from 21-32 µm for the three BMF job categories and from 15-25 µm for the five SSF job categories tested. The BCI data also indicated that the percentage of lead mass measured at the sampled facilities in the submicron range (i.e., lead) was generally small. The estimated average percentages of lead mass in the submicron range for the tested job categories ranged from 0.8-3.3% at the BMFs and from 0.44-6.1% at the SSFs. Variability was observed in the particle size distributions across job categories and facilities, and sensitivity analyses were conducted to explore this variability. The BCI results were compared with results reported in the scientific literature. Screening-level analyses were also conducted to explore the overall degree of lead absorption potentially associated with the observed particle size distributions and to identify key issues

  10. Translating vaccine policy into action: a report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings.

    Science.gov (United States)

    Ortiz, Justin R; Neuzil, Kathleen M; Ahonkhai, Vincent I; Gellin, Bruce G; Salisbury, David M; Read, Jennifer S; Adegbola, Richard A; Abramson, Jon S

    2012-11-26

    Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life. In April 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended revisions to the WHO position paper on influenza vaccines. For the first time, SAGE recommended pregnant women should be made the highest priority for inactivated seasonal influenza vaccination. However, the variable maternal influenza vaccination coverage in countries with pre-existing maternal influenza vaccine recommendations underscores the need to understand and to address the discrepancy between recommendations and implementation success. We present the outcome of a multi-stakeholder expert consultation on inactivated influenza vaccination in pregnancy. The creation and implementation of vaccine policies and regulations require substantial resources and capacity. As with all public health interventions, the existence of perceived and real risks of vaccination will necessitate effective and transparent risk communication. Potential risk allocation and sharing mechanisms should be addressed by governments, vaccine manufacturers, and other stakeholders. In resource-limited settings, vaccine-related issues concerning supply, formulation, regulation, evidence evaluation, distribution, cost-utility, and post-marketing safety surveillance need to be addressed. Lessons can be learned from the Maternal and Neonatal Tetanus Elimination Initiative as well as efforts to increase vaccine coverage among pregnant

  11. Reactions of nitroxide radicals in aqueous solutions exposed to non-thermal plasma: limitations of spin trapping of the plasma induced species

    Science.gov (United States)

    Gorbanev, Yury; Stehling, Nicola; O'Connell, Deborah; Chechik, Victor

    2016-10-01

    Low temperature (‘cold’) atmospheric pressure plasmas have gained much attention in recent years due to their biomedical effects achieved through the interactions of plasma-induced species with the biological substrate. Monitoring of the radical species in an aqueous biological milieu is usually performed via electron paramagnetic resonance (EPR) spectroscopy using various nitrone spin traps, which form persistent radical adducts with the short-lived radicals. However, the stability of these nitroxide radical adducts in the plasma-specific environment is not well known. In this work, chemical transformations of nitroxide radicals in aqueous solutions using a model nitroxide 4-oxo-TEMPO were studied using EPR and LC-MS. The kinetics of the nitroxide decay when the solution was exposed to plasma were assessed, and the reactive pathways proposed. The use of different scavengers enabled identification of the types of reactive species which cause the decay, indicating the predominant nitroxide group reduction in oxygen-free plasmas. The 2H adduct of the PBN spin trap (PBN-D) was shown to decay similarly to the model molecule 4-oxo-TEMPO. The decay of the spin adducts in plasma-treated solutions must be considered to avoid rendering the spin trapping results unreliable. In particular, the selectivity of the decay indicated the limitations of the PTIO/PTI nitroxide system in the detection of nitric oxide.

  12. Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings

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    Rakesh Shrivastava

    2013-01-01

    Full Text Available Context: A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. Aim: The aim of this study is to assess the utility of non-invasive mathematical models of liver fibrosis in chronic hepatitis B (CHB. Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. Settings and Design: A cross-sectional study carried out at a tertiary care center. Subjects and Methods: A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST, Alanine aminotransferase (ALT, Gama glutamyl transpeptidase (GGT, total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI, Fibrosis 4 (FIB-4 and Forn′s index were calculated. Outcomes were compared for the assessment of best predictor of fibrosis by calculating the sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of each index. Statistical Analysis Used: Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for significance. P value < 0.05 was taken as significant. Results: While the serum levels of AST, ALT and GGT were significantly higher in patients group as compare with the healthy controls (P < 0.01, the platelet counts were significantly lower in patient group as compared to the control group (P < 0.01. Mean value of all 3 indices were significantly higher in patients group as compare with the controls (P < 0.01. Conclusions: Out of the three indices, APRI index with a NPV of 95% appeared to be a better model

  13. Dilution testing using rapid diagnostic tests in a HIV diagnostic algorithm: a novel alternative for confirmation testing in resource limited settings.

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    Shanks, Leslie; Siddiqui, M Ruby; Abebe, Almaz; Piriou, Erwan; Pearce, Neil; Ariti, Cono; Masiga, Johnson; Muluneh, Libsework; Wazome, Joseph; Ritmeijer, Koert; Klarkowski, Derryck

    2015-05-14

    Current WHO testing guidelines for resource limited settings diagnose HIV on the basis of screening tests without a confirmation test due to cost constraints. This leads to a potential risk of false positive HIV diagnosis. In this paper, we evaluate the dilution test, a novel method for confirmation testing, which is simple, rapid, and low cost. The principle of the dilution test is to alter the sensitivity of a rapid diagnostic test (RDT) by dilution of the sample, in order to screen out the cross reacting antibodies responsible for falsely positive RDT results. Participants were recruited from two testing centres in Ethiopia where a tiebreaker algorithm using 3 different RDTs in series is used to diagnose HIV. All samples positive on the initial screening RDT and every 10th negative sample underwent testing with the gold standard and dilution test. Dilution testing was performed using Determine™ rapid diagnostic test at 6 different dilutions. Results were compared to the gold standard of Western Blot; where Western Blot was indeterminate, PCR testing determined the final result. 2895 samples were recruited to the study. 247 were positive for a prevalence of 8.5 % (247/2895). A total of 495 samples underwent dilution testing. The RDT diagnostic algorithm misclassified 18 samples as positive. Dilution at the level of 1/160 was able to correctly identify all these 18 false positives, but at a cost of a single false negative result (sensitivity 99.6 %, 95 % CI 97.8-100; specificity 100 %, 95 % CI: 98.5-100). Concordance between the gold standard and the 1/160 dilution strength was 99.8 %. This study provides proof of concept for a new, low cost method of confirming HIV diagnosis in resource-limited settings. It has potential for use as a supplementary test in a confirmatory algorithm, whereby double positive RDT results undergo dilution testing, with positive results confirming HIV infection. Negative results require nucleic acid testing to rule out false

  14. Early neonatal mortality and neurological outcomes of neonatal resuscitation in a resource-limited setting on the Thailand-Myanmar border: A descriptive study.

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    Sophie Janet

    Full Text Available Of the 4 million neonatal deaths worldwide yearly, 98% occur in low and middle-income countries. Effective resuscitation reduces mortality and morbidity but long-term outcomes in resource-limited settings are poorly described. This study reports on newborn neurological outcomes following resuscitation at birth in a resource-limited setting where intensive newborn care including intubation is unavailable.Retrospective analysis of births records from 2008 to 2015 at Shoklo Malaria Research Unit (SMRU on the Thailand-Myanmar border.From 21,225 newbonrs delivered, 15,073 (71% met the inclusion criteria (liveborn, singleton, ≥28 weeks' gestation, delivered in SMRU. Neonatal resuscitation was performed in 460 (3%; 422 basic, 38 advanced cases. Overall early neonatal mortality was 6.6 deaths per 1000 live births (95% CI 5.40-8.06. Newborns receiving basic and advanced resuscitation presented an adjusted rate for death of 1.30 (95%CI 0.66-2.55; p = 0.442, and 6.32 (95%CI 3.01-13.26; p<0.001 respectively, compared to newborns given routine care. Main factors related to increased need for resuscitation were breech delivery, meconium, and fetal distress (p<0.001. Neurodevelopmental follow-up to one year was performed in 1,608 (10.5% of the 15,073 newborns; median neurodevelopmental scores of non-resuscitated newborns and those receiving basic resuscitation were similar (64 (n = 1565 versus 63 (n = 41; p = 0.732, while advanced resuscitation scores were significantly lower (56 (n = 5; p = 0.017.Newborns requiring basic resuscitation at birth have normal neuro-developmental outcomes at one year of age compared to low-risk newborns. Identification of risk factors (e.g., breech delivery associated with increased need for neonatal resuscitation may facilitate allocation of staff to high-risk deliveries. This work endorses the use of basic resuscitation in low-resource settings, and supports on-going staff training to maintain bag-and-mask ventilation skills.

  15. Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh.

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    Teresa Bleakly Kortz

    Full Text Available Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay.This was a retrospective cohort study of children 1-59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation.404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72. The adjusted odds ratio (AOR for post-protocol mortality was 1.55 (95% CI, 0.88-2.71. The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04-5.85, as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43-14.29 and having a longer median length of stay (AOR 1.81, 95% CI 1.10-2.96. There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4 or antibiotic administration between the cohorts (pre- 16.08% vs

  16. A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting.

    Science.gov (United States)

    Mazmanyan, P; Mellor, K; Doré, C J; Modi, N

    2016-01-01

    The variable-flow flow driver (FD; EME) and continuous-flow bubble (Fisher-Paykel) continuous positive airway pressure (CPAP) systems are widely used. As these differ in cost and technical requirements, determining comparative efficacy is important particularly where resources are limited. We performed a randomised, controlled, equivalence trial of CPAP systems. We specified the margin of equivalence as 2 days. We analysed binary variables by logistical regression adjusted for gestation, and log transformed continuous variables by multiple linear regression adjusted for gestation, sex and antenatal steroids. A neonatal unit with no blood gas analyser or surfactant availability and limited X-ray and laboratory facilities Neonates CPAP at delivery followed by randomisation to FD or bubble (B). Primary outcome included total days receiving CPAP; secondary outcomes included days receiving CPAP, supplemental oxygen, ventilation, death, pneumothorax and nasal excoriation. We randomised 125 infants (B 66, FD 59). Differences in infant outcomes on B and FD were not statistically significant. The median (range) for CPAP days for survivors was B 0.8 (0.04 to 17.5), FD 0.5 (0.04 to 5.3). B:FD (95% CI) ratios were CPAP days 1.3 (0.9 to 2.1), CPAP plus supplementary oxygen days 1.2 (0.7 to 1.9). B:FD (95% CI) ORs were death 2.3 (0.2 to 28), ventilation 2.1 (0.5 to 9), nasal excoriation 1.2 (0.2 to 8) and pneumothorax 2.4 (0.2 to 26). In a resource-limited setting we found B CPAP equivalent to FD CPAP in the total number of days receiving CPAP within a margin of 2 days. ISRCTN22578364. 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/

  17. How does organic matter occurrence set limit onto the use of Ce anomaly as a reliable proxy of redox conditions in shallow groundwaters?

    Science.gov (United States)

    Dia, A.; Gruau, G.; Davranche, M.; Vidy, A.; Henin, O.; Petitjean, P.; Le Coz-Bouhnik, M.

    2003-04-01

    This study is dedicated to the effects of organic matter on the hydrochemistry of Rare Earth Elements (REE) and the ability of using the Ce anomaly as a reliable proxy of redox conditions in surface waters when organic matter occurs. The data include a : i) two-year survey of SREE and Ce anomalies in organic-rich waters recovered from a catchment located in Brittany (western Europe) and (ii) experimental incubation of organic soils from this catchment set under controlled conditions, as well as, (iii) a REE speciation calculation in both the natural organic-rich waters from the wetlands and the experimental solutions. Field and experimental data appear to be extremely coherent, displaying good correlation between the SREE, the Dissolved Organic Carbon (DOC) contents and the redox state. The field data show a strong increase of the SREE and DOC concentrations in soil waters when the environment becomes more reducing. The onset of DOC and SREE contents is seen to be in phase with the increase of dissolved Fe and Mn. The role of Fe-, Mn-oxyhydroxides is confirmed by the experimental data as the maximum of DOC and SREE content is reached when Fe2+ reaches a maximum in the soil solution, suggesting that reductive dissolution of Fe, Mn-oxyhydroxides happens. Despite the strong redox changes and the known redox sensitive behaviour of Ce as compared to other REE, none Ce anomaly variation is observed during either, the experimental procedure, or the field survey through time. Speciation calculations were performed showing that in both such pH range and moderately oxidizing waters in DOC-rich waters, REE should have an organic speciation. Such an organic speciation prevents the formation of Ce(IV) and therefore the development of any Ce anomaly. However, since the studied waters are highly oxidizing (high nitrate contents), the nitrates impose the redox formation of Ce(IV) and a Ce anomaly should appear. Therefore, Ce(IV) is not formed in these waters either because (i) the

  18. Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting.

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    Swain, JaBaris D; Sinnott, Colleen; Breakey, Suellen; Hasson Charles, Rian; Mody, Gita; Nyirimanzi, Napthal; Patton-Bolman, Ceeya; Come, Patricia; Ganza, Gapira; Rusingiza, Emmanuel; Ruhamya, Nathan; Mucumbitsi, Joseph; Borges, Jorge; Zammert, Martin; Muehlschlegel, Jochen D; Oakes, Robert; Leavitt, Bruce; Bolman, R Morton

    2018-06-01

    Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease. Humanitarian surgical outreach in this region can improve the delivery of cardiovascular care by providing sustainability through mentorship, medical expertise, training, and knowledge transfer, and ultimately the creation of a cardiac center. We describe the experience of consecutive annual visits to Rwanda since 2008 and report the outcomes of a collaborative approach to enable sustainable cardiac surgery in the region. The Ferrans and Powers Quality of Life Index tool's Cardiac Version (http://www.uic.edu/orgs/qli/) was administered to assess the postoperative quality of life. Ten visits have been completed, performing 149 open procedures, including 200 valve implantations, New York Heart Association class III or IV, with 4.7% 30-day mortality. All procedures were performed with the participation of local Rwandan personnel, expatriate physicians, nurses, residents, and support staff. Early complications included cerebrovascular accident (n = 4), hemorrhage requiring reoperation (n = 6), and death (n = 7). Quality of life was assessed to further understand challenges encountered after cardiac surgery in this resource-limited setting. Four major domains were considered: health and functioning, social and economic, psychologic/spiritual, and family. The mean total quality of life index was 20.79 ± 4.07 on a scale from 0 to 30, for which higher scores indicated higher quality of life. Women had significantly lower "social and economic" subscores (16.81 ± 4.17) than men (18.64 ± 4

  19. RBiomirGS: an all-in-one miRNA gene set analysis solution featuring target mRNA mapping and expression profile integration

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    Jing Zhang

    2018-01-01

    Full Text Available Background With the continuous discovery of microRNA’s (miRNA association with a wide range of biological and cellular processes, expression profile-based functional characterization of such post-transcriptional regulation is crucial for revealing its significance behind particular phenotypes. Profound advancement in bioinformatics has been made to enable in depth investigation of miRNA’s role in regulating cellular and molecular events, resulting in a huge quantity of software packages covering different aspects of miRNA functional analysis. Therefore, an all-in-one software solution is in demand for a comprehensive yet highly efficient workflow. Here we present RBiomirGS, an R package for a miRNA gene set (GS analysis. Methods The package utilizes multiple databases for target mRNA mapping, estimates miRNA effect on the target mRNAs through miRNA expression profile and conducts a logistic regression-based GS enrichment. Additionally, human ortholog Entrez ID conversion functionality is included for target mRNAs. Results By incorporating all the core steps into one package, RBiomirGS eliminates the need for switching between different software packages. The modular structure of RBiomirGS enables various access points to the analysis, with which users can choose the most relevant functionalities for their workflow. Conclusions With RBiomirGS, users are able to assess the functional significance of the miRNA expression profile under the corresponding experimental condition by minimal input and intervention. Accordingly, RBiomirGS encompasses an all-in-one solution for miRNA GS analysis. RBiomirGS is available on GitHub (http://github.com/jzhangc/RBiomirGS. More information including instruction and examples can be found on website (http://kenstoreylab.com/?page_id=2865.

  20. Feasibility of establishing a biosafety level 3 tuberculosis culture laboratory of acceptable quality standards in a resource-limited setting: an experience from Uganda.

    Science.gov (United States)

    Ssengooba, Willy; Gelderbloem, Sebastian J; Mboowa, Gerald; Wajja, Anne; Namaganda, Carolyn; Musoke, Philippa; Mayanja-Kizza, Harriet; Joloba, Moses Lutaakome

    2015-01-15

    Despite the recent innovations in tuberculosis (TB) and multi-drug resistant TB (MDR-TB) diagnosis, culture remains vital for difficult-to-diagnose patients, baseline and end-point determination for novel vaccines and drug trials. Herein, we share our experience of establishing a BSL-3 culture facility in Uganda as well as 3-years performance indicators and post-TB vaccine trials (pioneer) and funding experience of sustaining such a facility. Between September 2008 and April 2009, the laboratory was set-up with financial support from external partners. After an initial procedure validation phase in parallel with the National TB Reference Laboratory (NTRL) and legal approvals, the laboratory registered for external quality assessment (EQA) from the NTRL, WHO, National Health Laboratories Services (NHLS), and the College of American Pathologists (CAP). The laboratory also instituted a functional quality management system (QMS). Pioneer funding ended in 2012 and the laboratory remained in self-sustainability mode. The laboratory achieved internationally acceptable standards in both structural and biosafety requirements. Of the 14 patient samples analyzed in the procedural validation phase, agreement for all tests with NTRL was 90% (P 80% in all years from NTRL, CAP, and NHLS, and culture was 100% for CAP panels and above regional average scores for all years with NHLS. Quarterly DST scores from WHO-EQA ranged from 78% to 100% in 2010, 80% to 100% in 2011, and 90 to 100% in 2012. From our experience, it is feasible to set-up a BSL-3 TB culture laboratory with acceptable quality performance standards in resource-limited countries. With the demonstrated quality of work, the laboratory attracted more research groups and post-pioneer funding, which helped to ensure sustainability. The high skilled experts in this research laboratory also continue to provide an excellent resource for the needed national discussion of the laboratory and quality management systems.

  1. Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting

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    Tsima BM

    2016-08-01

    Full Text Available Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better

  2. Scope and Limits of an anamnestic questionnaire in a control-induced low-endemicity helminthiasis setting in south-central Côte d'Ivoire.

    Science.gov (United States)

    Fürst, Thomas; Ouattara, Mamadou; Silué, Kigbafori D; N'Goran, Dje N; Adiossan, Lukas G; Bogoch, Isaac I; N'Guessan, Yao; Koné, Siaka; Utzinger, Jürg; N'Goran, Eliézer K

    2014-01-01

    Schistosomiasis and soil-transmitted helminthiasis are two high-burden neglected tropical diseases. In highly endemic areas, control efforts emphasize preventive chemotherapy. However, as morbidity, infection, and transmission begin to decrease, more targeted treatment is likely to become more cost-effective, provided that comparatively cheap diagnostic methods with reasonable accuracy are available. Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d'Ivoire. Questions pertaining to risk factors and signs and symptoms for schistosomiasis and soil-transmitted helminthiasis were included. The individuals' helminth infection status and their belonging to three different anthelmintic treatment groups were compared with the questionnaire results (i) to inform the local health authorities about the epidemiological and clinical footprint of locally prevailing helminthiases, and (ii) to explore the scope and limits of an anamnestic questionnaire as monitoring tool, which eventually could help guiding the control of neglected tropical diseases in control-induced low-endemicity settings. Our study sample consisted of 195 adults (101 males, 94 females). We found prevalences of hookworm, Trichuris trichiura, Schistosoma haematobium, and Schistosoma mansoni of 39.0%, 2.7%, 2.1%, and 2.1%, respectively. No Ascaris lumbricoides infection was found. Helminth infection intensities were generally very low. Seven, 74 and 79 participants belonged to three different treatment groups. Multivariable logistic regression models revealed statistically significant (p<0.05) associations between some risk factors, signs, and symptoms, and the different helminth infections and treatment groups. However, the risk factors, signs, and symptoms showed weak diagnostic properties. The generally low prevalence and intensity of helminth infection in this part of

  3. The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border.

    Science.gov (United States)

    Chalmers, Lauren; Cross, Jessica; Chu, Cindy S; Phyo, Aung Pyae; Trip, Margreet; Ling, Clare; Carrara, Verena; Watthanaworawit, Wanitda; Keereecharoen, Lily; Hanboonkunupakarn, Borimas; Nosten, François; McGready, Rose

    2015-10-01

    Published literature from resource-limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point-of-care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. One-year retrospective analysis in three clinics on the Thailand-Myanmar border of non-pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >10(5)  CFU/ml. In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended-spectrum β-lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. One rapid, cost-effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  4. Computational models can predict response to HIV therapy without a genotype and may reduce treatment failure in different resource-limited settings.

    Science.gov (United States)

    Revell, A D; Wang, D; Wood, R; Morrow, C; Tempelman, H; Hamers, R L; Alvarez-Uria, G; Streinu-Cercel, A; Ene, L; Wensing, A M J; DeWolf, F; Nelson, M; Montaner, J S; Lane, H C; Larder, B A

    2013-06-01

    Genotypic HIV drug-resistance testing is typically 60%-65% predictive of response to combination antiretroviral therapy (ART) and is valuable for guiding treatment changes. Genotyping is unavailable in many resource-limited settings (RLSs). We aimed to develop models that can predict response to ART without a genotype and evaluated their potential as a treatment support tool in RLSs. Random forest models were trained to predict the probability of response to ART (≤400 copies HIV RNA/mL) using the following data from 14 891 treatment change episodes (TCEs) after virological failure, from well-resourced countries: viral load and CD4 count prior to treatment change, treatment history, drugs in the new regimen, time to follow-up and follow-up viral load. Models were assessed by cross-validation during development, with an independent set of 800 cases from well-resourced countries, plus 231 cases from Southern Africa, 206 from India and 375 from Romania. The area under the receiver operating characteristic curve (AUC) was the main outcome measure. The models achieved an AUC of 0.74-0.81 during cross-validation and 0.76-0.77 with the 800 test TCEs. They achieved AUCs of 0.58-0.65 (Southern Africa), 0.63 (India) and 0.70 (Romania). Models were more accurate for data from the well-resourced countries than for cases from Southern Africa and India (P < 0.001), but not Romania. The models identified alternative, available drug regimens predicted to result in virological response for 94% of virological failures in Southern Africa, 99% of those in India and 93% of those in Romania. We developed computational models that predict virological response to ART without a genotype with comparable accuracy to genotyping with rule-based interpretation. These models have the potential to help optimize antiretroviral therapy for patients in RLSs where genotyping is not generally available.

  5. Assessment of the impact of adherence and other predictors during HAART on various CD4 cell responses in resource-limited settings

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    Abrogoua DP

    2012-03-01

    Full Text Available Danho Pascal Abrogoua1,2, Brou Jerome Kablan1, Boua Alexis Thierry Kamenan1,3, Gilles Aulagner4, Konan N'Guessan1, Christian Zohoré11Laboratoire de Pharmacie Clinique, Pharmacologie et Therapeutique – UFR Sciences Pharmaceutiques et Biologiques, 2Laboratoire de Pharmacologie Clinique, CHU de Cocody, 3Service de Pharmacie, CHU de Cocody, Abidjan, Cote d'Ivoire, 4Service Pharmaceutique Hopital Louis Pradel, Lyon, FranceObjective: The aim of this study was to quantify, by modeling, the impact of significant predictors on CD4 cell response during antiretroviral therapy in a resource-limited setting.Methods: Modeling was used to determine which antiretroviral therapy response predictors (baseline CD4 cell count, clinical state, age, and adherence significantly influence immunological response in terms of CD4 cell gain compared to a reference value at different periods of monitoring.Results: At 6 months, CD4 cell response was significantly influenced by baseline CD4 count alone. The probability of no increase in CD4 cells was 2.6 higher in patients with a baseline CD4 cell count of ≥200/mm3. At 12 months, CD4 cell response was significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was three times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.15 times lower with adherent patients. At 18 months, CD4 cell response was also significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was 5.1 times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.28 times lower with adherent patients. At 24 months, optimal CD4 cell response was significantly influenced by adherence alone. Adherence increased the probability (by 5.8 of an optimal increase in CD4 cells. Age and baseline clinical state had no significant influence on immunological response.Conclusion: The relationship between adherence and CD4

  6. Factors influencing use of long-acting versus short-acting contraceptive methods among reproductive-age women in a resource-limited setting.

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    Tibaijuka, Leevan; Odongo, Robert; Welikhe, Emma; Mukisa, Wilber; Kugonza, Lilian; Busingye, Imelda; Nabukalu, Phelomena; Ngonzi, Joseph; Asiimwe, Stephen B; Bajunirwe, Francis

    2017-04-04

    Unplanned pregnancy remains a common problem in many resource-limited settings, mostly due to limited access to modern family planning (FP) services. In particular, use of the more effective long-acting reversible contraceptive (LARC) methods (i.e., intrauterine devices and hormonal implants) remains low compared to the short-acting methods (i.e., condoms, hormonal pills, injectable hormones, and spermicides). Among reproductive-age women attending FP and antenatal care clinics in Uganda, we assessed perceptions and practices regarding the use of modern contraceptive methods. We specifically aimed to evaluate factors influencing method selection. We performed a mixed-methods cross-sectional study, in which we administered structured interviews to 180 clients, and conducted 4 focus group discussions (FGDs) with 36 clients and 8 in-depth personal qualitative interviews with health service providers. We summarized quantitative data and performed latent content analysis on transcripts from the FGDs and qualitative interviews. The prevalence of ever use for LARC methods was 23%. Method characteristics (e.g., client control) appeared to drive method selection more often than structural factors (such as method availability) or individual client characteristics (such as knowledge and perceptions). The most common reasons for choosing LARC methods were: longer protection; better child-spacing; and effectiveness. The most common reasons for not choosing LARC methods included requiring a client-controlled method and desiring to conceive in the near future. The most common reasons for choosing short-acting methods were ease of access; lower cost; privacy; perceived fewer side effects; and freedom to stop using a method without involving the health provider. The personal characteristics of clients, which appeared to be important were client knowledge and number of children. The structural factor which appeared to be important was method availability. Our results suggest that

  7. Diagnostic accuracy of two multiplex real-time polymerase chain reaction assays for the diagnosis of meningitis in children in a resource-limited setting.

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    Jermaine Khumalo

    Full Text Available Accurate etiological diagnosis of meningitis is important, but difficult in resource-limited settings due to prior administration of antibiotics and lack of viral diagnostics. We aimed to develop and validate 2 real-time multiplex PCR (RT-PCR assays for the detection of common causes of community-acquired bacterial and viral meningitis in South African children.We developed 2 multiplex RT- PCRs for detection of S. pneumoniae, N. meningitidis, H. influenzae, enteroviruses, mumps virus and herpes simplex virus. We tested residual CSF samples from children presenting to a local paediatric hospital over a one-year period, whose CSF showed an abnormal cell count. Results were compared with routine diagnostic tests and the final discharge diagnosis. We calculated accuracy of the bacterial RT-PCR assay compared to CSF culture and using World Health Organisation definitions of laboratory-confirmed bacterial meningitis.From 292 samples, bacterial DNA was detected in 12 (4.1% and viral nucleic acids in 94 (32%. Compared to CSF culture, the sensitivity and specificity of the bacterial RT-PCR was 100% and 97.2% with complete agreement in organism identification. None of the cases positive by viral RT-PCR had a bacterial cause confirmed on CSF culture. Only 9/90 (10% of patients diagnosed clinically as bacterial meningitis or partially treated bacterial meningitis tested positive with the bacterial RT-PCR.In this population the use of 2 multiplex RT-PCRs targeting 6 common pathogens gave promising results. If introduced into routine diagnostic testing, these multiplex RT-PCR assays would supplement other diagnostic tests, and have the potential to limit unnecessary antibiotic therapy and hospitalisation.

  8. Utility of CD4 cell counts for early prediction of virological failure during antiretroviral therapy in a resource-limited setting

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    Lawn Stephen D

    2008-07-01

    Full Text Available Abstract Background Viral load monitoring is not available for the vast majority of patients receiving antiretroviral therapy in resource-limited settings. However, the practical utility of CD4 cell count measurements as an alternative monitoring strategy has not been rigorously assessed. Methods In this study, we used a novel modelling approach that accounted for all CD4 cell count and VL values measured during follow-up from the first date that VL suppression was achieved. We determined the associations between CD4 counts (absolute values and changes during ART, VL measurements and risk of virological failure (VL > 1,000 copies/ml following initial VL suppression in 330 patients in South Africa. CD4 count changes were modelled both as the difference from baseline (ΔCD4 count and the difference between consecutive values (CD4 count slope using all 3-monthly CD4 count measurements during follow-up. Results During 7093.2 patient-months of observation 3756 paired CD4 count and VL measurements were made. In patients who developed virological failure (n = 179, VL correlated significantly with absolute CD4 counts (r = - 0.08, P = 0.003, ΔCD4 counts (r = - 0.11, P P P = 0.99, P = 0.92 and P = 0.75, respectively. Moreover, in a receiver operating characteristic (ROC curve, the association between a negative CD4 count slope and virological failure was poor (area under the curve = 0.59; sensitivity = 53.0%; specificity = 63.6%; positive predictive value = 10.9%. Conclusion CD4 count changes correlated significantly with VL at group level but had very limited utility in identifying virological failure in individual patients. CD4 count is an inadequate alternative to VL measurement for early detection of virological failure.

  9. Evaluation of a manual DNA extraction protocol and an isothermal amplification assay for detecting HIV-1 DNA from dried blood spots for use in resource-limited settings.

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    Jordan, Jeanne A; Ibe, Christine O; Moore, Miranda S; Host, Christel; Simon, Gary L

    2012-05-01

    In resource-limited settings (RLS) dried blood spots (DBS) are collected on infants and transported through provincial laboratories to a central facility where HIV-1 DNA PCR testing is performed using specialized equipment. Implementing a simpler approach not requiring such equipment or skilled personnel could allow the more numerous provincial laboratories to offer testing, improving turn-around-time to identify and treat infected infants sooner. Assess performances of a manual DNA extraction method and helicase-dependent amplification (HDA) assay for detecting HIV-1 DNA from DBS. 60 HIV-1 infected adults were enrolled, blood samples taken and DBS made. DBS extracts were assessed for DNA concentration and beta globin amplification using PCR and melt-curve analysis. These same extracts were then tested for HIV-1 DNA using HDA and compared to results generated by PCR and pyrosequencing. Finally, HDA limit of detection (LOD) studies were performed using DBS extracts prepared with known numbers of 8E5 cells. The manual extraction protocol consistently yielded high concentrations of amplifiable DNA from DBS. LOD assessment demonstrated HDA detected ∼470 copies/ml of HIV-1 DNA extracts in 4/4 replicates. No statistical difference was found using the McNemar's test when comparing HDA to PCR for detecting HIV-1 DNA from DBS. Using just a magnet, heat block and pipettes, the manual extraction protocol and HDA assay detected HIV-1 DNA from DBS at levels that would be useful for early infant diagnosis. Next steps will include assessing HDA for non-B HIV-1 subtypes recognition and comparison to Roche HIV-1 DNA v1.5 PCR assay. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Impact of antimicrobial wipes compared with hypochlorite solution on environmental surface contamination in a health care setting: A double-crossover study.

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    Siani, Harsha; Wesgate, Rebecca; Maillard, Jean-Yves

    2018-05-11

    Antimicrobial wipes are increasingly used in health care settings. This study evaluates, in a clinical setting, the efficacy of sporicidal wipes versus a cloth soaked in a 1,000 ppm chlorine solution. A double-crossover study was performed on 2 different surgical and cardiovascular wards in a 1,000-bed teaching hospital over 29 weeks. The intervention period that consisted of surface decontamination with the preimpregnated wipe or cloth soaked in chlorine followed a 5-week baseline assessment of microbial bioburden on surfaces. Environmental samples from 11 surfaces were analyzed weekly for their microbial content. A total of 1,566 environmental samples and 1,591 ATP swabs were analyzed during the trial. Overall, there were significant differences in the recovery of total aerobic bacteria (P < .001), total anaerobic bacteria (P < .001), and ATP measurement (P < .001) between wards and between the different parts of the crossover study. Generally, the use of wipes produced the largest reduction in the total aerobic and anaerobic counts when compared with the baseline data or the use of 1,000 ppm chlorine. Collectively, the introduction of training plus daily wipe disinfection significantly reduced multidrug-resistant organisms recovered from surfaces. Reversion to using 1,000 ppm chlorine resulted in the number of sites positive for multidrug-resistant organisms rising again. This double-crossover study is the first controlled field trial comparison of using preimpregnated wipes versus cotton cloth dipped into a bucket of hypochlorite to decrease surface microbial bioburden. The results demonstrate the superiority of the preimpregnated wipes in significantly decreasing microbial bioburden from high-touch surfaces. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Melt-and-mold fabrication (MnM-Fab) of reconfigurable low-cost devices for use in resource-limited settings.

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    Li, Zhi; Tevis, Ian D; Oyola-Reynoso, Stephanie; Newcomb, Lucas B; Halbertsma-Black, Julian; Bloch, Jean-Francis; Thuo, Martin

    2015-12-01

    Interest in low-cost analytical devices (especially for diagnostics) has recently increased; however, concomitant translation to the field has been slow, in part due to personnel and supply-chain challenges in resource-limited settings. Overcoming some of these challenges require the development of a method that takes advantage of locally available resources and/or skills. We report a Melt-and-mold fabrication (MnM Fab) approach to low-cost and simple devices that has the potential to be adapted locally since it requires a single material that is recyclable and simple skills to access multiple devices. We demonstrated this potential by fabricating entry level bio-analytical devices using an affordable low-melting metal alloy, Field's metal, with molds produced from known materials such as plastic (acrylonitrile-butadiene-styrene (ABS)), glass, and paper. We fabricated optical gratings then 4×4 well plates using the same recycled piece of metal. We then reconfigured the well plates into rapid prototype microfluidic devices with which we demonstrated laminar flow, droplet generation, and bubble formation from T-shaped channels. We conclude that this MnM-Fab method is capable of addressing some challenges typically encountered with device translation, such as technical know-how or material supply, and that it can be applied to other devices, as needed in the field, using a single moldable material. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Get the Basics Right: A Description of the Key Priorities for Establishing a Neonatal Service in a Resource-Limited Setting in Cambodia.

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    Fox-Lewis, Shivani; Genasci Smith, Wyatt; Lor, Vary; McKellar, Gregor; Phal, Chea; Fox-Lewis, Andrew; Turner, Paul; Neou, Leakhena; Turner, Claudia

    2018-05-28

    Worldwide, reduction in under-five mortality has not sufficiently included neonates, who represent 45% of deaths in children of age under five years. The least progress has been observed in resource-limited settings. This mixed methods study conducted at a Cambodian non-governmental paediatric hospital described the key priorities of the ongoing neonatal service. Routinely collected data from the hospital and microbiology databases included the number of admissions, discharges and deaths and the number of cases of bacteraemias (2011-2016). Semi-structured interviews with the management staff explored the essential features of the service. There were 2127 neonatal admissions and 247 deaths. The incidence of facility-based neonatal mortality decreased by 81%. Bacteraemic healthcare-associated infections decreased by 68%. A dedicated area for neonatal care was perceived as crucial, allowing better infection control and delivery of staff training. In this hospital, the neonatal service prioritized basic measures, particularly, having a dedicated neonatal area. Facility-based mortality and bacteraemic healthcare-associated infections decreased.

  13. Impact of a psychoeducative intervention on adherence to HAART among low-literacy patients in a resource-limited setting: the case of an Arab country--Morocco.

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    Khachani, Imane; Harmouche, Hicham; Ammouri, Wafa; Rhoufrani, Fatima; Zerouali, Latifa; Abouqal, Redouane; Tazi-Mezalek, Zoubida; Adnaoui, Mohamed; Aouni, Mohamed; Maouni, Abdelaziz

    2012-01-01

    Research has demonstrated that strict adherence is necessary to maximize highly active antiretroviral therapy (HAART) benefits. This is particularly challenging for low-literacy populations in resource-limited settings like Morocco and motivated the implementation of a psychoeducative program for patients under HAART at Rabat University Hospital. The study aimed at assessing the program's impact on adherence to antiretroviral medication, knowledge of HIV/AIDS and HAART, quality of life, and biological parameters. It included patients under treatment for at least 2 months that benefited from 3 to 5 educational and psychological support sessions. Data were collected at baseline, 3 and 6 months. In all, 50 patients were included. The mean age was 38 years; 52% were illiterate and 62% unemployed. Adherence scores were high at baseline (98%) and showed no significant change throughout the study. Knowledge of HAART and HIV/AIDS, and quality of life improved significantly both at months 3 and 6. Significant increase for CD4 count rates and decrease for viral load rates were also reported. The program had no significant impact on adherence but substantively developed patients' knowledge of HIV/AIDS and HAART and improved their quality of life.

  14. Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru: a prospective evaluation

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    Quispe Jose A

    2009-03-01

    Full Text Available Abstract Background A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. However, current surveillance systems may not be prepared to accomplish this goal, especially in resource limited settings. As data quality and timeliness are attributes that improve outbreak detection capacity, we assessed the effect of two interventions on such attributes in Alerta, an electronic disease surveillance system in the Peruvian Navy. Methods 40 Alerta reporting units (18 clinics and 22 ships were included in a 12-week prospective evaluation project. After a short refresher course on the notification process, units were randomly assigned to either a phone, visit or control group. Phone group sites were called three hours before the biweekly reporting deadline if they had not sent their report. Visit group sites received supervision visits on weeks 4 & 8, but no phone calls. The control group sites were not contacted by phone or visited. Timeliness and data quality were assessed by calculating the percentage of reports sent on time and percentage of errors per total number of reports, respectively. Results Timeliness improved in the phone group from 64.6% to 84% in clinics (+19.4 [95% CI, +10.3 to +28.6]; p Conclusion Regular phone reminders significantly improved timeliness of reports in clinics and ships, whereas supervision visits led to improved data quality only among clinics. Further investigations are needed to establish the cost-effectiveness and optimal use of each of these strategies.

  15. Exploring the condom gap: is supply or demand the limiting factor - condom access and use in an urban and a rural setting in Kilifi district, Kenya.

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    Papo, Jacqueline K; Bauni, Evasius K; Sanders, Eduard J; Brocklehurst, Peter; Jaffe, Harold W

    2011-01-14

    to explore the extent of the condom gap, investigating the relative roles of supply-side and demand-side factors in determining condom use. GPS mapping of condom outlets, and population-based survey. an urban and a rural site were selected within the Epidemiological and Demographic Surveillance Site in Kilifi district, Kenya. Potential condom outlets (n = 281) were mapped and surveyed, and questionnaires on condom access and use (n = 630) were administered to a random sample of men and women aged 15-49. Multivariate logistic regression was performed to assess the relative roles of supply-side and demand-side barriers on condom use. the median straight-line distance to free condoms was 18-fold higher in the rural versus urban site. Among sexually active respondents, 42% had ever used a condom, and 23% had used a condom over the past 12 months, with lower levels among rural versus urban respondents (P supply-side or demand-side barriers, compared with individuals experiencing both types of barriers. Despite low levels of usage and the presence of supply-side and demand-side barriers, reported unmet need for condoms was low. there is an urgent need for renewed condom promotion efforts aimed at building demand, in addition to improving physical access, in resource-limited settings with generalized HIV epidemics in sub-Saharan Africa. 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  16. Utility of the heteroduplex assay (HDA) as a simple and cost-effective tool for the identification of HIV type 1 dual infections in resource-limited settings.

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    Powell, Rebecca L R; Urbanski, Mateusz M; Burda, Sherri; Nanfack, Aubin; Kinge, Thompson; Nyambi, Phillipe N

    2008-01-01

    The predominance of unique recombinant forms (URFs) of HIV-1 in Cameroon suggests that dual infection, the concomitant or sequential infection with genetically distinct HIV-1 strains, occurs frequently in this region; yet, identifying dual infection among large HIV cohorts in local, resource-limited settings is uncommon, since this generally relies on labor-intensive and costly sequencing methods. Consequently, there is a need to develop an effective, cost-efficient method appropriate to the developing world to identify these infections. In the present study, the heteroduplex assay (HDA) was used to verify dual or single infection status, as shown by traditional sequence analysis, for 15 longitudinally sampled study subjects from Cameroon. Heteroduplex formation, indicative of a dual infection, was identified for all five study subjects shown by sequence analysis to be dually infected. Conversely, heteroduplex formation was not detectable for all 10 HDA reactions of the singly infected study subjects. These results suggest that the HDA is a simple yet powerful and inexpensive tool for the detection of both intersubtype and intrasubtype dual infections, and that the HDA harbors significant potential for reliable, high-throughput screening for dual infection. As these infections and the recombinants they generate facilitate leaps in HIV-1 evolution, and may present major challenges for treatment and vaccine design, this assay will be critical for monitoring the continuing pandemic in regions of the world where HIV-1 viral diversity is broad.

  17. Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

    Science.gov (United States)

    Abdelaziz, Adel; Hany, Mohamed; Atwa, Hani; Talaat, Wagdy; Hosny, Somaya

    2016-01-01

    In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

  18. Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource-limited setting.

    Science.gov (United States)

    Eleje, George U; Adinma, Joseph I; Ghasi, Samuel; Ikechebelu, Joseph I; Igwegbe, Anthony O; Okonkwo, John E; Okafor, Charles I; Ezeama, Chukwuemeka O; Ezebialu, Ifeanyichukwu U; Ogbuagu, Chukwuanugo N

    2014-10-01

    To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource-limited settings. A prospective cross-sectional study was undertaken involving women with (n=105) and without (n=105) a confirmed diagnosis of PPROM admitted to Nnamdi Azikiwe University Teaching Hospital, southeast Nigeria, between January 1, 2011, and April 30, 2013. Endocervical swabs were collected from all participants and examined microbiologically. Antibiotic sensitivity testing was performed using Kirby-Bauer disk diffusion. Streptococcus spp., Staphylococcus aureus, and Escherichia coli were significantly more prevalent among women with PPROM than among those without PPROM (P<0.01). Among the antibiotics considered safe to use during pregnancy, the bacteria were most sensitive to ampicillin-sulbactam, cefixime, cefuroxime, and erythromycin. For the first 48hours, women with PPROM should receive an intravenous dose combining ampicillin-sulbactam, cefixime, cefuroxime, or erythromycin with metronidazole followed by oral administration of the chosen antibiotic combination to complete a 7-day course. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  19. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

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    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

  20. Intra-facility linkage of HIV-positive mothers and HIV-exposed babies into HIV chronic care: rural and urban experience in a resource limited setting.

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    Christine Mugasha

    Full Text Available INTRODUCTION: Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID to inform strategic scale up of PMTCT programs. METHODS: A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI. HIV-infected pregnant mothers, identified through routine antenatal care (ANC and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. RESULTS: Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26% in rural and 743/1,025 (74% in urban facilities. Of these 375/1,025 (37% were linked to HIV clinics [67/267(25% rural and 308/758(41% urban]. Of 636 HIV-exposed babies, 193 (30% were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636; 8/179 (4.5%] in rural and 93/457(20.3% in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1, p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. CONCLUSION: Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to

  1. Scope and Limits of an anamnestic questionnaire in a control-induced low-endemicity helminthiasis setting in south-central Côte d'Ivoire.

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    Thomas Fürst

    Full Text Available BACKGROUND: Schistosomiasis and soil-transmitted helminthiasis are two high-burden neglected tropical diseases. In highly endemic areas, control efforts emphasize preventive chemotherapy. However, as morbidity, infection, and transmission begin to decrease, more targeted treatment is likely to become more cost-effective, provided that comparatively cheap diagnostic methods with reasonable accuracy are available. METHODOLOGY: Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d'Ivoire. Questions pertaining to risk factors and signs and symptoms for schistosomiasis and soil-transmitted helminthiasis were included. The individuals' helminth infection status and their belonging to three different anthelmintic treatment groups were compared with the questionnaire results (i to inform the local health authorities about the epidemiological and clinical footprint of locally prevailing helminthiases, and (ii to explore the scope and limits of an anamnestic questionnaire as monitoring tool, which eventually could help guiding the control of neglected tropical diseases in control-induced low-endemicity settings. PRINCIPAL FINDINGS: Our study sample consisted of 195 adults (101 males, 94 females. We found prevalences of hookworm, Trichuris trichiura, Schistosoma haematobium, and Schistosoma mansoni of 39.0%, 2.7%, 2.1%, and 2.1%, respectively. No Ascaris lumbricoides infection was found. Helminth infection intensities were generally very low. Seven, 74 and 79 participants belonged to three different treatment groups. Multivariable logistic regression models revealed statistically significant (p<0.05 associations between some risk factors, signs, and symptoms, and the different helminth infections and treatment groups. However, the risk factors, signs, and symptoms showed weak diagnostic properties. CONCLUSIONS

  2. Scope and Limits of an Anamnestic Questionnaire in a Control-Induced Low-Endemicity Helminthiasis Setting in South-Central Côte d’Ivoire

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    Fürst, Thomas; Ouattara, Mamadou; Silué, Kigbafori D.; N’Goran, Dje N.; Adiossan, Lukas G.; Bogoch, Isaac I.; N’Guessan, Yao; Koné, Siaka; Utzinger, Jürg; N’Goran, Eliézer K.

    2013-01-01

    Background Schistosomiasis and soil-transmitted helminthiasis are two high-burden neglected tropical diseases. In highly endemic areas, control efforts emphasize preventive chemotherapy. However, as morbidity, infection, and transmission begin to decrease, more targeted treatment is likely to become more cost-effective, provided that comparatively cheap diagnostic methods with reasonable accuracy are available. Methodology Adults were administered an anamnestic questionnaire in mid-2010 during a cross-sectional epidemiological survey in the Taabo health demographic surveillance system in south-central Côte d’Ivoire. Questions pertaining to risk factors and signs and symptoms for schistosomiasis and soil-transmitted helminthiasis were included. The individuals’ helminth infection status and their belonging to three different anthelmintic treatment groups were compared with the questionnaire results (i) to inform the local health authorities about the epidemiological and clinical footprint of locally prevailing helminthiases, and (ii) to explore the scope and limits of an anamnestic questionnaire as monitoring tool, which eventually could help guiding the control of neglected tropical diseases in control-induced low-endemicity settings. Principal Findings Our study sample consisted of 195 adults (101 males, 94 females). We found prevalences of hookworm, Trichuris trichiura, Schistosoma haematobium, and Schistosoma mansoni of 39.0%, 2.7%, 2.1%, and 2.1%, respectively. No Ascaris lumbricoides infection was found. Helminth infection intensities were generally very low. Seven, 74 and 79 participants belonged to three different treatment groups. Multivariable logistic regression models revealed statistically significant (p<0.05) associations between some risk factors, signs, and symptoms, and the different helminth infections and treatment groups. However, the risk factors, signs, and symptoms showed weak diagnostic properties. Conclusions/Significance The generally

  3. Multiple-level stakeholder engagement in malaria clinical trials: addressing the challenges of conducting clinical research in resource-limited settings.

    Science.gov (United States)

    Mtove, George; Kimani, Joshua; Kisinza, William; Makenga, Geofrey; Mangesho, Peter; Duparc, Stephan; Nakalembe, Miriam; Phiri, Kamija S; Orrico, Russell; Rojo, Ricardo; Vandenbroucke, Pol

    2018-03-22

    Multinational clinical trials are logistically complex and require close coordination between various stakeholders. They must comply with global clinical standards and are accountable to multiple regulatory and ethical bodies. In resource-limited settings, it is challenging to understand how to apply global clinical standards to international, national, and local factors in clinical trials, making multiple-level stakeholder engagement an important element in the successful conduct of these clinical trials. During the planning and implementation of a large multinational clinical trial for intermittent preventive treatment of malaria in pregnancy in resource-limited areas of sub-Saharan Africa, we encountered numerous challenges, which required implementation of a range of engagement measures to ensure compliance with global clinical and regulatory standards. These challenges included coordination with ongoing global malaria efforts, heterogeneity in national regulatory structures, sub-optimal healthcare infrastructure, local practices and beliefs, and perspectives that view healthcare providers with undue trust or suspicion. In addition to engagement with international bodies, such as the World Health Organization, the Malaria in Pregnancy Consortium, the Steve Biko Centre for Bioethics, and the London School of Hygiene and Tropical Medicine, in order to address the challenges just described, Pfizer Inc. and Medicines for Malaria Venture (the "Sponsoring Entities" for these studies) and investigators liaised with national- and district-level stakeholders such as health ministers and regional/local community health workers. Community engagement measures undertaken by investigators included local meetings with community leaders to explain the research aims and answer questions and concerns voiced by the community. The investigators also engaged with family members of prospective trial participants in order to be sensitive to local practices and beliefs. Engagement

  4. Change in Vitamin D Levels Occurs Early after Antiretroviral Therapy Initiation and Depends on Treatment Regimen in Resource-Limited Settings

    Science.gov (United States)

    Havers, Fiona P.; Detrick, Barbara; Cardoso, Sandra W.; Berendes, Sima; Lama, Javier R.; Sugandhavesa, Patcharaphan; Mwelase, Noluthando H.; Campbell, Thomas B.; Gupta, Amita

    2014-01-01

    Study Background Vitamin D has wide-ranging effects on the immune system, and studies suggest that low serum vitamin D levels are associated with worse clinical outcomes in HIV. Recent studies have identified an interaction between antiretrovirals used to treat HIV and reduced serum vitamin D levels, but these studies have been done in North American and European populations. Methods Using a prospective cohort study design nested in a multinational clinical trial, we examined the effect of three combination antiretroviral (cART) regimens on serum vitamin D levels in 270 cART-naïve, HIV-infected adults in nine diverse countries, (Brazil, Haiti, Peru, Thailand, India, Malawi, South Africa, Zimbabwe and the United States). We evaluated the change between baseline serum vitamin D levels and vitamin D levels 24 and 48 weeks after cART initiation. Results Serum vitamin D levels decreased significantly from baseline to 24 weeks among those randomized to efavirenz/lamivudine/zidovudine (mean change: −7.94 [95% Confidence Interval (CI) −10.42, −5.54] ng/ml) and efavirenz/emtricitabine/tenofovir-DF (mean change: −6.66 [95% CI −9.40, −3.92] ng/ml) when compared to those randomized to atazanavir/emtricitabine/didanosine-EC (mean change: −2.29 [95% CI –4.83, 0.25] ng/ml). Vitamin D levels did not change significantly between week 24 and 48. Other factors that significantly affected serum vitamin D change included country (p<0.001), season (p<0.001) and baseline vitamin D level (p<0.001). Conclusion Efavirenz-containing cART regimens adversely affected vitamin D levels in patients from economically, geographically and racially diverse resource-limited settings. This effect was most pronounced early after cART initiation. Research is needed to define the role of Vitamin D supplementation in HIV care. PMID:24752177

  5. A Systematic Review of Non-Traumatic Spinal Cord Injuries in Sub-Saharan Africa and a Proposed Diagnostic Algorithm for Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Abdu Kisekka Musubire

    2017-12-01

    Full Text Available BackgroundNon-traumatic myelopathy is common in Africa and there are geographic differences in etiology. Clinical management is challenging due to the broad differential diagnosis and the lack of diagnostics. The objective of this systematic review is to determine the most common etiologies of non-traumatic myelopathy in sub-Saharan Africa to inform a regionally appropriate diagnostic algorithm.MethodsWe conducted a systemic review searching Medline and Embase databases using the following search terms: “Non traumatic spinal cord injury” or “myelopathy” with limitations to epidemiology or etiologies and Sub-Saharan Africa. We described the frequencies of the different etiologies and proposed a diagnostic algorithm based on the most common diagnoses.ResultsWe identified 19 studies all performed at tertiary institutions; 15 were retrospective and 13 were published in the era of the HIV epidemic. Compressive bone lesions accounted for more than 48% of the cases; a majority were Pott’s disease and metastatic disease. No diagnosis was identified in up to 30% of cases in most studies; in particular, definitive diagnoses of non-compressive lesions were rare and a majority were clinical diagnoses of transverse myelitis and HIV myelopathy. Age and HIV were major determinants of etiology.ConclusionCompressive myelopathies represent a majority of non-traumatic myelopathies in sub-Saharan Africa, and most were due to Pott’s disease. Non-compressive myelopathies have not been well defined and need further research in Africa. We recommend a standardized approach to management of non-traumatic myelopathy focused on identifying treatable conditions with tests widely available in low-resource settings.

  6. Prevalence of low bone mineral density among HIV patients on long-term suppressive antiretroviral therapy in resource limited setting of western India.

    Science.gov (United States)

    Dravid, Ameet; Kulkarni, Milind; Borkar, Amit; Dhande, Sachin

    2014-01-01

    Bone mineral density (BMD) assessment in HIV patients is sparsely done in resource limited settings. We conducted a cross-sectional study of BMD amongst HIV patients following up in our clinic from 1 June to 1 December 2013 by performing dual-energy X-ray absorptiometry scan (Lunar Prodigy Advanced DXA System, GE Healthcare) of lumbar spine and hip. Patients on long term (≥12 months), virologically suppressive antiretroviral therapy (ART) were included. Patients who were ART naïve were included as control population. Virologic failures were excluded. Low BMD was defined by WHO T-score criteria (normal: T score ≥-1;osteopenia: T score between -1 and -2.5 SD; osteoporosis: T score ≤-2.5 SD). Baseline risk factors associated with low BMD like age, low BMI, lipoatrophy, diabetes mellitus, current smoking, current alcohol intake, steroid exposure and menopause were recorded. ART-related factors associated with low BMD like ART duration, exposure to tenofovir and exposure to protease inhibitors (PI) were studied. A total of 536 patients (66% males, 496 ART experienced and 40 ART naïve) were included in this analysis. Median age was 42 years, mean BMI 23.35 kg/m(2) and median CD4 count 146 cells/mm(3). All ART experienced patients had plasma viral loadpatients in our cohort is a matter of deep concern due to its association with pathological fractures. Bone mineral loss was seen irrespective of ART used. Association of low BMD with low baseline CD4 count strengthens the case for early ART.

  7. Pulse shape analysis for the GERDA experiment to set a new limit on the half-life of 0νββ decay of {sup 76}Ge

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Victoria Elisabeth

    2017-01-25

    The GERDA experiment searches for neutrinoless double beta (0νββ) decay of {sup 76}Ge using high purity germanium (HPGe) detectors operated in liquid argon (LAr). The aim is to explore half-lives of the order of 10{sup 26} yr. Therefore, GERDA relies on improved active background reduction techniques such as pulse shape discrimination (PSD) in which the time structure of the germanium signals is analyzed to discriminate signal- from background-like events. Two types of HPGe detectors are operated: semi-coaxial detectors previously used in the Heidelberg-Moscow and IGEX experiments and new Broad Energy Germanium (BEGe) detectors which feature an improved energy resolution and enhanced PSD. In Phase I of the experiment, five enriched BEGe detectors were used for the first time in the search for 0νββ decay. A PSD based on a single parameter, the ratio of the maximum current amplitude over the energy A/E is applied. 83% of the background events in a 232 keV region around Q{sub ββ} are rejected with a high signal efficiency of (92.1 ± 1.9) %. The achieved background index (BI) is (5.4{sup +4.1}{sub -3.4}) . 10{sup -3} (counts)/(keV.kg.yr). This is an improvement by a factor of 10 compared to previous germanium based 0νββ experiments. Phase II of the experiment includes a major upgrade: for further background rejection, the LAr cryostat is instrumented to detect argon scintillation light. Additional 25 BEGe detectors are installed. After PSD and LAr veto a BI of (0.7{sup +1.3}{sub -0.5}) . 10{sup -3} (counts)/(keV.kg.yr) is achieved. This is the best BI achieved in 0νββ experiments so far. A frequentist statistical analysis is performed on the combined data collected in GERDA Phase I and the first Phase II release. A new limit on the half-life of 0νββ decay of {sup 76}Ge is set to T{sup 0ν}{sub 1/2}>5.3.10{sup 25} yr at 90% C.L., with a median sensitivity of T{sup 0ν}{sub 1/2}>4.0.10{sup 25} yr at 90% C.L.

  8. On the property of being a basis for a denumerable set of solutions of a nonlinear Schroedinger-type boundary-value problem

    International Nuclear Information System (INIS)

    Zhidkov, P.E.

    1998-01-01

    We consider the problem u''=f(u 2 )u (0 2 ) (for r→∞) = -∞. It is known that this problem possesses a sequence of solutions {u n } n=0,1,2... such that the nth solution u x (x) has precisely n roots in the interval (0,1). We prove the existence of a constant s 0 0 , an arbitrary above-described sequence of solutions of our problem is a basis of the space H s (0, 1)

  9. Estimation of isotropic nuclear magnetic shieldings in the CCSD(T) and MP2 complete basis set limit using affordable correlation calculations

    DEFF Research Database (Denmark)

    Kupka, Teobald; Stachów, Michal; Kaminsky, Jakub

    2013-01-01

    , estimated from calculations with the family of polarizationconsistent pcS-n basis sets is reported. This dependence was also supported by inspection of profiles of deviation between CBS estimated nuclear shieldings and obtained with significantly smaller basis sets pcS-2 and aug-cc-pVTZ-J for the selected......A linear correlation between isotropic nuclear magnetic shielding constants for seven model molecules (CH2O, H2O, HF, F2, HCN, SiH4 and H2S) calculated with 37 methods (34 density functionals, RHF, MP2 and CCSD(T) ), with affordable pcS-2 basis set and corresponding complete basis set results...... set of 37 calculation methods. It was possible to formulate a practical approach of estimating the values of isotropic nuclear magnetic shielding constants at the CCSD(T)/CBS and MP2/CBS levels from affordable CCSD(T)/pcS-2, MP2/pcS-2 and DFT/CBS calculations with pcS-n basis sets. The proposed method...

  10. Cost tradeoffs in consequence management at nuclear power plants: A risk based approach to setting optimal long-term interdiction limits for regulatory analyses

    International Nuclear Information System (INIS)

    Mubayi, V.

    1995-05-01

    The consequences of severe accidents at nuclear power plants can be limited by various protective actions, including emergency responses and long-term measures, to reduce exposures of affected populations. Each of these protective actions involve costs to society. The costs of the long-term protective actions depend on the criterion adopted for the allowable level of long-term exposure. This criterion, called the ''long term interdiction limit,'' is expressed in terms of the projected dose to an individual over a certain time period from the long-term exposure pathways. The two measures of offsite consequences, latent cancers and costs, are inversely related and the choice of an interdiction limit is, in effect, a trade-off between these two measures. By monetizing the health effects (through ascribing a monetary value to life lost), the costs of the two consequence measures vary with the interdiction limit, the health effect costs increasing as the limit is relaxed and the protective action costs decreasing. The minimum of the total cost curve can be used to calculate an optimal long term interdiction limit. The calculation of such an optimal limit is presented for each of five US nuclear power plants which were analyzed for severe accident risk in the NUREG-1150 program by the Nuclear Regulatory Commission

  11. Comparison of the frequency of functional SH3 domains with different limited sets of amino acids using mRNA display.

    Directory of Open Access Journals (Sweden)

    Junko Tanaka

    Full Text Available Although modern proteins consist of 20 different amino acids, it has been proposed that primordial proteins consisted of a small set of amino acids, and additional amino acids have gradually been recruited into the genetic code. This hypothesis has recently been supported by comparative genome sequence analysis, but no direct experimental approach has been reported. Here, we utilized a novel experimental approach to test a hypothesis that native-like globular proteins might be easily simplified by a set of putative primitive amino acids with retention of its structure and function than by a set of putative new amino acids. We performed in vitro selection of a functional SH3 domain as a model from partially randomized libraries with different sets of amino acids using mRNA display. Consequently, a library rich in putative primitive amino acids included a larger number of functional SH3 sequences than a library rich in putative new amino acids. Further, the functional SH3 sequences were enriched from the primitive library slightly earlier than from a randomized library with the full set of amino acids, while the function and structure of the selected SH3 proteins with the primitive alphabet were comparable with those from the 20 amino acid alphabet. Application of this approach to various combinations of codons in protein sequences may be useful not only for clarifying the precise order of the amino acid expansion in the early stages of protein evolution but also for efficiently creating novel functional proteins in the laboratory.

  12. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru.

    Science.gov (United States)

    Jaganath, Devan; Miranda, J Jaime; Gilman, Robert H; Wise, Robert A; Diette, Gregory B; Miele, Catherine H; Bernabe-Ortiz, Antonio; Checkley, William

    2015-03-18

    It is unclear how geographic and social diversity affects the prevalence of chronic obstructive pulmonary disease (COPD). We sought to characterize the prevalence of COPD and identify risk factors across four settings in Peru with varying degrees of urbanization, altitude, and biomass fuel use. We collected sociodemographics, clinical history, and post-bronchodilator spirometry in a randomly selected, age-, sex- and site-stratified, population-based sample of 2,957 adults aged ≥35 years (median age was 54.8 years and 49.3% were men) from four resource-poor settings: Lima, Tumbes, urban and rural Puno. We defined COPD as a post-bronchodilator FEV1/FVC Peru was not uniform and, unlike other settings, was not predominantly explained by tobacco smoking. This study emphasizes the role of biomass fuel use, and highlights pulmonary tuberculosis as an often neglected risk factor in endemic areas.

  13. Setting up the Brazilian Evaluation Network: a challenging work with no boundaries Estabelecendo a Rede Brasileira de Avaliação: um trabalho desafiador sem limites

    Directory of Open Access Journals (Sweden)

    Angela Cristina Dannemann

    2005-12-01

    Full Text Available Evaluation may be a relevant tool for the practice of democracy. In order for it to occur, quality and proper utilization of its results must be assured (PATTON, 1997. Therefore, the consolidation of democratic principles in a society and the promotion of effective social interactions (FETTERMAN; WANDERSMAN, 2005 will benefit enormously from a greater and better use of evaluation in all possible formats. The Brazilian Evaluation Network was created approximately three years ago in a country with a recent history of democratic practice. Within a theoretical framework networks do not have boundaries or limits for debate. However, cultural and historical aspects create limits for the discussions and boundaries among its participants. This paper intends to shed light into some of these limits and boundaries, reflecting over how they are being overcome.Uma avaliação pode ser um importante instrumento para o exercício da democracia. Para que isso ocorra é preciso assegurar a qualidade da avaliação, bem como a utilização apropriada dos seus resultados (PATTON,1997. Desta forma, a construção de uma sociedade democrática, que busca a melhoria permanente dos seus processos sociais (FETTERMAN; WANDERSMAN, 2005, depende do aprimoramento contínuo da sua prática de avaliação, em suas variadas manifestações. No Brasil, há aproximadamente 3 anos, foi criada a Rede Brasileira de Avaliação. Uma rede que, em sua concepção teórica, não possui limites ou fronteiras de discussão. Contudo, existem aspectos culturais e históricos (envolvendo valores, que criam limites para as referidas discussões e estabelecem fronteiras entre as diferentes instâncias. Este trabalho apresenta alguns destes limites e fronteiras, refletindo sobre a forma como aqueles que encomendam e que conduzem avaliações vêm contornando os limites e ultrapassando fronteiras.

  14. PROBLEM SETTING AND SOLUTION OF THE RESPONSE CORRECTION OF ARRIVAL AND DEPARTURE AIR TRAFFIC FLOW IN THE VICINITY OF THE FIELD BY MEANS OF THE GENETIC ALGORITHM

    Directory of Open Access Journals (Sweden)

    Georgii N. Lebedev

    2017-01-01

    Full Text Available The improvement in the effectiveness of airfield operation largely depends on the problem solving quality on the interaction boundaries of different technological sections. One of such hotspots is the use of the same runway by inbound and outbound aircraft. At certain intensity of outbound and inbound air traffic flow the conflict of aircraft interests appears, where it may be quite difficult to sort out priorities even for experienced controllers, in consequence of which mistakes in decision-making unavoidably appear.In this work the task of response correction of landing and takeoff time of the aircraft using the same RW, in condition of the conflict of interests “arrival – departure” at the increased operating intensity is formulated. The choice of optimal solution is made taking into account mutual interests without the complete sorting and the evaluation of all solutions.Accordingly, the genetic algorithm, which offers a simple and effective approach to optimal control problem solution by providing flight safety at an acceptably high level, is proposed. The estimation of additional aviation fuel consumption is used as optimal choice evaluation criterion.The advantages of the genetic algorithm application at decision-making in comparison with today’s “team” solution of the conflict “departure – arrival” in the airfield area are shown.

  15. Quench limits

    International Nuclear Information System (INIS)

    Sapinski, M.

    2012-01-01

    With thirteen beam induced quenches and numerous Machine Development tests, the current knowledge of LHC magnets quench limits still contains a lot of unknowns. Various approaches to determine the quench limits are reviewed and results of the tests are presented. Attempt to reconstruct a coherent picture emerging from these results is taken. The available methods of computation of the quench levels are presented together with dedicated particle shower simulations which are necessary to understand the tests. The future experiments, needed to reach better understanding of quench limits as well as limits for the machine operation are investigated. The possible strategies to set BLM (Beam Loss Monitor) thresholds are discussed. (author)

  16. Global trends in antiretroviral resistance in treatment-naive individuals with HIV after rollout of antiretroviral treatment in resource-limited settings: a global collaborative study and meta-regression analysis

    NARCIS (Netherlands)

    Gupta, Ravindra K.; Jordan, Michael R.; Sultan, Binta J.; Hill, Andrew; Davis, Daniel H. J.; Gregson, John; Sawyer, Anthony W.; Hamers, Raph L.; Ndembi, Nicaise; Pillay, Deenan; Bertagnolio, Silvia

    2012-01-01

    Background The emergence and spread of high levels of HIV-1 drug resistance in resource-limited settings where combination antiretroviral treatment has been scaled up could compromise the effectiveness of national HIV treatment programmes. We aimed to estimate changes in the prevalence of HIV-1 drug

  17. Novel approach for efficient predictions properties of large pool of nanomaterials based on limited set of species: nano-read-across

    International Nuclear Information System (INIS)

    Gajewicz, Agnieszka; Puzyn, Tomasz; Cronin, Mark T.D; Rasulev, Bakhtiyor; Leszczynski, Jerzy

    2015-01-01

    Creating suitable chemical categories and developing read-across methods, supported by quantum mechanical calculations, can be an effective solution to solving key problems related to current scarcity of data on the toxicity of various nanoparticles. This study has demonstrated that by applying a nano-read-across, the cytotoxicity of nano-sized metal oxides could be estimated with a similar level of accuracy as provided by quantitative structure-activity relationship for nanomaterials (nano-QSAR model(s)). The method presented is a suitable computational tool for the preliminary hazard assessment of nanomaterials. It also could be used for the identification of nanomaterials that may pose potential negative impact to human health and the environment. Such approaches are especially necessary when there is paucity of relevant and reliable data points to develop and validate nano-QSAR models. (paper)

  18. From proton nuclear magnetic resonance spectra to pH. Assessment of {sup 1}H NMR pH indicator compound set for deuterium oxide solutions

    Energy Technology Data Exchange (ETDEWEB)

    Tynkkynen, Tuulia, E-mail: tuulia.tynkkynen@uku.fi [Laboratory of Chemistry, Department of Biosciences, University of Kuopio, PO Box 1627, 70211 Kuopio (Finland); Tiainen, Mika; Soininen, Pasi; Laatikainen, Reino [Laboratory of Chemistry, Department of Biosciences, University of Kuopio, PO Box 1627, 70211 Kuopio (Finland)

    2009-08-19

    In this study, a protocol for pH determination from D{sub 2}O samples using {sup 1}H NMR pH indicator compounds was developed and assessed by exploring the pH-dependency of 13 compounds giving pH-dependent {sup 1}H NMR signals. The indicators cover the pH range from pH* 0 to 7.2. Equations to transform the indicator chemical shifts to pH estimates are given here for acetic acid, formic acid, chloroacetic acid, dichloroacetic acid, creatine, creatinine, glycine, histidine, 1,2,4-triazole, and TSP (2,2,3,3-tetradeutero-3-(trimethylsilyl)-propionic acid). To characterize the method in presence of typical solutes, the effects of common metabolites, albumin and ionic strength were also evaluated. For the ionic strengths, the effects were also modelled. The experiments showed that the use of pH sensitive {sup 1}H NMR chemical shifts allows the pH determination of typical metabolite solutions with accuracy of 0.01-0.05 pH units. Also, when the ionic strength is known with accuracy better than 0.1 mol dm{sup -3} and the solute concentrations are low, pH{sub nmr}{sup *} (the NMR estimate of pH) can be assumed to be within 0.05 pH units from potentiometrically determined pH.

  19. The impact of threshold language assistance programming on the accessibility of mental health services for persons with limited English proficiency in the Medi-Cal setting.

    Science.gov (United States)

    McClellan, Sean R; Wu, Frances M; Snowden, Lonnie R

    2012-06-01

    Title VI of the 1964 Civil Rights Act prohibits federal funds recipients from providing care to limited English proficiency (LEP) persons more limited in scope or lower in quality than care provided to others. In 1999, the California Department of Mental Health implemented a "threshold language access policy" to meet its Title VI obligations. Under this policy, Medi-Cal agencies must provide language assistance programming in a non-English language where a county's Medical population contains either 3000 residents or 5% speakers of that language. We examine the impact of threshold language policy-required language assistance programming on LEP persons' access to mental health services by analyzing the county-level penetration rate of services for Russian, Spanish, and Vietnamese speakers across 34 California counties, over 10 years of quarterly data. Exploiting a time series with nonequivalent control group study design, we studied this phenomena using linear regression with random county effects to account for trends over time. Threshold language policy-required assistance programming led to an immediate and significant increase in the penetration rate of mental health services for Russian (8.2, P language speaking persons. Threshold language assistance programming was effective in increasing mental health access for Russian and Vietnamese, but not for Spanish-speaking LEP persons.

  20. On the accuracy of density-functional theory exchange-correlation functionals for H bonds in small water clusters: Benchmarks approaching the complete basis set limit

    Science.gov (United States)

    Santra, Biswajit; Michaelides, Angelos; Scheffler, Matthias

    2007-11-01

    The ability of several density-functional theory (DFT) exchange-correlation functionals to describe hydrogen bonds in small water clusters (dimer to pentamer) in their global minimum energy structures is evaluated with reference to second order Møller-Plesset perturbation theory (MP2). Errors from basis set incompleteness have been minimized in both the MP2 reference data and the DFT calculations, thus enabling a consistent systematic evaluation of the true performance of the tested functionals. Among all the functionals considered, the hybrid X3LYP and PBE0 functionals offer the best performance and among the nonhybrid generalized gradient approximation functionals, mPWLYP and PBE1W perform best. The popular BLYP and B3LYP functionals consistently underbind and PBE and PW91 display rather variable performance with cluster size.

  1. Novel molecular diagnostic tools for malaria elimination: a review of options from the point of view of high-throughput and applicability in resource limited settings.

    Science.gov (United States)

    Britton, Sumudu; Cheng, Qin; McCarthy, James S

    2016-02-16

    As malaria transmission continues to decrease, an increasing number of countries will enter pre-elimination and elimination. To interrupt transmission, changes in control strategies are likely to require more accurate identification of all carriers of Plasmodium parasites, both symptomatic and asymptomatic, using diagnostic tools that are highly sensitive, high throughput and with fast turnaround times preferably performed in local health service settings. Currently available immunochromatographic lateral flow rapid diagnostic tests and field microscopy are unlikely to consistently detect infections at parasite densities less than 100 parasites/µL making them insufficiently sensitive for detecting all carriers. Molecular diagnostic platforms, such as PCR and LAMP, are currently available in reference laboratories, but at a cost both financially and in turnaround time. This review describes the recent progress in developing molecular diagnostic tools in terms of their capacity for high throughput and potential for performance in non-reference laboratories for malaria elimination.

  2. Clean solutions to the incoming wafer quality impact on lithography process yield limits in a dynamic copper/low-k research and development environment

    Science.gov (United States)

    Lysaght, Patrick S.; Ybarra, Israel; Sax, Harry; Gupta, Gaurav; West, Michael; Doros, Theodore G.; Beach, James V.; Mello, Jim

    2000-06-01

    The continued growth of the semiconductor manufacturing industry has been due, in large part, to improved lithographic resolution and overlay across increasingly larger chip areas. Optical lithography continues to be the mainstream technology for the industry with extensions of optical lithography being employed to support 180 nm product and process development. While the industry momentum is behind optical extensions to 130 nm, the key challenge will be maintaining an adequate and affordable process latitude (depth of focus/exposure window) necessary for 10% post-etch critical dimension (CD) control. If the full potential of optical lithography is to be exploited, the current lithographic systems can not be compromised by incoming wafer quality. Impurity specifications of novel Low-k dielectric materials, plating solutions, chemical-mechanical planarization (CMP) slurries, and chemical vapor deposition (CVD) precursors are not well understood and more stringent control measures will be required to meet defect density targets as identified in the National Technology Roadmap for Semiconductors (NTRS). This paper identifies several specific poor quality wafer issues that have been effectively addressed as a result of the introduction of a set of flexible and reliable wafer back surface clean processes developed on the SEZ Spin-Processor 203 configured for processing of 200 mm diameter wafers. Patterned wafers have been back surface etched by means of a novel spin process contamination elimination (SpCE) technique with the wafer suspended by a dynamic nitrogen (N2) flow, device side down, via the Bernoulli effect. Figure 1 illustrates the wafer-chuck orientation within the process chamber during back side etch processing. This paper addresses a number of direct and immediate benefits to the MicraScan IIITM deep-ultraviolet (DUV) step-and-scan system at SEMATECH. These enhancements have resulted from the resolution of three significant problems: (1) back surface

  3. Target Product Profile for a Diagnostic Assay to Differentiate between Bacterial and Non-Bacterial Infections and Reduce Antimicrobial Overuse in Resource-Limited Settings: An Expert Consensus.

    Directory of Open Access Journals (Sweden)

    Sabine Dittrich

    Full Text Available Acute fever is one of the most common presenting symptoms globally. In order to reduce the empiric use of antimicrobial drugs and improve outcomes, it is essential to improve diagnostic capabilities. In the absence of microbiology facilities in low-income settings, an assay to distinguish bacterial from non-bacterial causes would be a critical first step. To ensure that patient and market needs are met, the requirements of such a test should be specified in a target product profile (TPP. To identify minimal/optimal characteristics for a bacterial vs. non-bacterial fever test, experts from academia and international organizations with expertise in infectious diseases, diagnostic test development, laboratory medicine, global health, and health economics were convened. Proposed TPPs were reviewed by this working group, and consensus characteristics were defined. The working group defined non-severely ill, non-malaria infected children as the target population for the desired assay. To provide access to the most patients, the test should be deployable to community health centers and informal health settings, and staff should require 90% and >80% for sensitivity and specificity, respectively. Other key characteristics, to account for the challenging environment at which the test is targeted, included: i time-to-result <10 min (but maximally <2 hrs; ii storage conditions at 0-40°C, ≤90% non-condensing humidity with a minimal shelf life of 12 months; iii operational conditions of 5-40°C, ≤90% non-condensing humidity; and iv minimal sample collection needs (50-100μL, capillary blood. This expert approach to define assay requirements for a bacterial vs. non-bacterial assay should guide product development, and enable targeted and timely efforts by industry partners and academic institutions.

  4. On a connection between the limit set of the Moebius-Klein transformation, periodic continued fractions, El Naschie's topological theory of high energy particle physics and the possibility of a new axion-like particle

    International Nuclear Information System (INIS)

    Marek-Crnjac, L.

    2004-01-01

    In the present work we first give a general representation of the derivatives of the irrational number phi, for instance ((1)/(phi)), ((1)/(phi 2 )), ((1)/(phi 3 )) etc., as periodic continued fractions. Any irrational number can then be expanded in an infinite continued fraction. The limit set of the Kleinian transformation acting on the E-infinity Cantorian spacetime turned out to be this set of periodic continued fractions, consequently the vacuum of the E-infinity is described by this limit set. As discussed by El Naschie, every particle can be interpreted geometrically as a scaling of another. This is done using the topology of hyperbolic Kleinian space of VAK, which is nothing but our limit set. Here we will present the ratios of the theoretical masses of certain elementary particles to that of some chosen particles in term of phi. Many of these masses are quite close to integer multiples of the mass of a chosen particle. Finally we discuss the possibility of new transfinite, axion-like particles as discussed recently by Krauss and El Naschie [Quintessence, Vintage, London, 1999

  5. Using the Lives Saved Tool (LiST) to Model mHealth Impact on Neonatal Survival in Resource-Limited Settings

    Science.gov (United States)

    Jo, Youngji; Labrique, Alain B.; Lefevre, Amnesty E.; Mehl, Garrett; Pfaff, Teresa; Walker, Neff; Friberg, Ingrid K.

    2014-01-01

    While the importance of mHealth scale-up has been broadly emphasized in the mHealth community, it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals, not merely to expand programs. We used the Lives Saved Tool (LiST)–an evidence-based modeling software–to identify priority areas for maternal and neonatal health services, by formulating six individual and combined interventions scenarios for two countries, Bangladesh and Uganda. Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios. Although further validation of this model is desirable, tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives. PMID:25014008

  6. Using the lives saved tool (LiST to model mHealth impact on neonatal survival in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Youngji Jo

    Full Text Available While the importance of mHealth scale-up has been broadly emphasized in the mHealth community, it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals, not merely to expand programs. We used the Lives Saved Tool (LiST--an evidence-based modeling software--to identify priority areas for maternal and neonatal health services, by formulating six individual and combined interventions scenarios for two countries, Bangladesh and Uganda. Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios. Although further validation of this model is desirable, tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives.

  7. Ethics and Rationing Access to Dialysis in Resource-Limited Settings: The Consequences of Refusing a Renal Transplant in the South African State Sector.

    Science.gov (United States)

    Etheredge, Harriet; Paget, Graham

    2015-12-01

    Resource constraints in developing countries compel policy makers to ration the provision of healthcare services. This article examines one such set of Guidelines: A patient dialysing in the state sector in South Africa may not refuse renal transplantation when a kidney becomes available. Refusal of transplantation can lead to exclusion from the state-funded dialysis programme. This Guideline is legally acceptable as related to Constitutional stipulations which allow for rationing healthcare resources in South Africa. Evaluating the ethical merit of the Guideline, and exploring the ethical dilemma it poses, proves a more complex task. We examine the actions of healthcare professionals as constrained by the Guideline. From a best interests framework, we argue that in these circumstances directing patient decision making (pressurising a patient to undergo renal transplantation) is not necessarily unethical or unacceptably paternalistic. We then scrutinise the guideline itself through several different ethical 'lenses'. Here, we argue that bioethics does not provide a definitive answer as to the moral merit of rationing dialysis under these circumstances, however it can be considered just in this context. We conclude by examining a potential pitfall of the Guideline: Unwilling transplant recipients may not comply with immunosuppressive medication, which raises questions for policies based on resource management and rationing. © 2014 John Wiley & Sons Ltd.

  8. VITAL NMR: using chemical shift derived secondary structure information for a limited set of amino acids to assess homology model accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Brothers, Michael C.; Nesbitt, Anna E.; Hallock, Michael J. [University of Illinois at Urbana-Champaign, Department of Chemistry (United States); Rupasinghe, Sanjeewa G. [University of Illinois at Urbana-Champaign, Department of Cell and Developmental Biology (United States); Tang Ming [University of Illinois at Urbana-Champaign, Department of Chemistry (United States); Harris, Jason; Baudry, Jerome [University of Tennessee, Department of Biochemistry, Cellular and Molecular Biology (United States); Schuler, Mary A. [University of Illinois at Urbana-Champaign, Department of Cell and Developmental Biology (United States); Rienstra, Chad M., E-mail: rienstra@illinois.edu [University of Illinois at Urbana-Champaign, Department of Chemistry (United States)

    2012-01-15

    Homology modeling is a powerful tool for predicting protein structures, whose success depends on obtaining a reasonable alignment between a given structural template and the protein sequence being analyzed. In order to leverage greater predictive power for proteins with few structural templates, we have developed a method to rank homology models based upon their compliance to secondary structure derived from experimental solid-state NMR (SSNMR) data. Such data is obtainable in a rapid manner by simple SSNMR experiments (e.g., {sup 13}C-{sup 13}C 2D correlation spectra). To test our homology model scoring procedure for various amino acid labeling schemes, we generated a library of 7,474 homology models for 22 protein targets culled from the TALOS+/SPARTA+ training set of protein structures. Using subsets of amino acids that are plausibly assigned by SSNMR, we discovered that pairs of the residues Val, Ile, Thr, Ala and Leu (VITAL) emulate an ideal dataset where all residues are site specifically assigned. Scoring the models with a predicted VITAL site-specific dataset and calculating secondary structure with the Chemical Shift Index resulted in a Pearson correlation coefficient (-0.75) commensurate to the control (-0.77), where secondary structure was scored site specifically for all amino acids (ALL 20) using STRIDE. This method promises to accelerate structure procurement by SSNMR for proteins with unknown folds through guiding the selection of remotely homologous protein templates and assessing model quality.

  9. VITAL NMR: Using Chemical Shift Derived Secondary Structure Information for a Limited Set of Amino Acids to Assess Homology Model Accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Brothers, Michael C [University of Illinois, Urbana-Champaign; Nesbitt, Anna E [University of Illinois, Urbana-Champaign; Hallock, Michael J [University of Illinois, Urbana-Champaign; Rupasinghe, Sanjeewa [University of Illinois, Urbana-Champaign; Tang, Ming [University of Illinois, Urbana-Champaign; Harris, Jason B [ORNL; Baudry, Jerome Y [ORNL; Schuler, Mary A [University of Illinois, Urbana-Champaign; Rienstra, Chad M [University of Illinois, Urbana-Champaign

    2011-01-01

    Homology modeling is a powerful tool for predicting protein structures, whose success depends on obtaining a reasonable alignment between a given structural template and the protein sequence being analyzed. In order to leverage greater predictive power for proteins with few structural templates, we have developed a method to rank homology models based upon their compliance to secondary structure derived from experimental solid-state NMR (SSNMR) data. Such data is obtainable in a rapid manner by simple SSNMR experiments (e.g., (13)C-(13)C 2D correlation spectra). To test our homology model scoring procedure for various amino acid labeling schemes, we generated a library of 7,474 homology models for 22 protein targets culled from the TALOS+/SPARTA+ training set of protein structures. Using subsets of amino acids that are plausibly assigned by SSNMR, we discovered that pairs of the residues Val, Ile, Thr, Ala and Leu (VITAL) emulate an ideal dataset where all residues are site specifically assigned. Scoring the models with a predicted VITAL site-specific dataset and calculating secondary structure with the Chemical Shift Index resulted in a Pearson correlation coefficient (-0.75) commensurate to the control (-0.77), where secondary structure was scored site specifically for all amino acids (ALL 20) using STRIDE. This method promises to accelerate structure procurement by SSNMR for proteins with unknown folds through guiding the selection of remotely homologous protein templates and assessing model quality.

  10. Peer Mentoring at the Uganda Cancer Institute: A Novel Model for Career Development of Clinician-Scientists in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Warren Phipps

    2018-03-01

    Full Text Available Cancer centers are beginning to emerge in low- and middle-income countries despite having relatively few oncologists and specialists in related fields. Uganda, like many countries in sub-Saharan Africa, has a cadre of highly motivated clinician-scientists-in-training who are committed to developing the capacity for cancer care and research. However, potential local mentors for these trainees are burdened with uniquely high demands on their time for clinical care, teaching, institutional development, advocacy, and research. Facilitated peer mentoring helps to fill skills and confidence gaps and teaches mentoring skills so that trainees can learn to support one another and regularly access a more senior facilitator/role model. With an added consultant component, programs can engage limited senior faculty time to address specific training needs and to introduce junior investigators to advisors and even potential dyadic mentors. Two years after its inception, our facilitated peer mentoring career development program at the Uganda Cancer Institute in Kampala is successfully developing a new generation of researchers who, in turn, are now providing role models and mentors from within their group. This program provides a practical model for building the next generation of clinical scientists in developing countries.

  11. The Limited English Proficiency Patient Family Advocate Role: Fostering Respectful and Effective Care Across Language and Culture in a Pediatric Oncology Setting.

    Science.gov (United States)

    Gil, Stephanie; Hooke, Mary C; Niess, Dawn

    2016-01-01

    Patients and families with limited English proficiency (LEP) face a multitude of barriers both inside and outside the hospital walls. These barriers can contribute to difficulty accessing care and understanding/adhering to treatment recommendations, ultimately placing them at higher risk for poorer outcomes than their English-speaking counterparts. The LEP Patient Family Advocate role was created with the aim of improving access, promoting effective communication, and equalizing care for children with cancer from families with LEP. The goal of this mixed methods study was to describe the level of satisfaction and experiences of parents and health care providers who used the LEP Patient Family Advocate while receiving or providing care. Twelve parents and 15 health care providers completed quantitative surveys and an open-ended question about their experiences. High levels of satisfaction were reported. Themes about the role from qualitative responses included its positive effect on communication, trust, and connectedness between parents and staff. Continuity of care and safety were improved, and parents thought the role helped decrease their stress. The LEP Patient Family Advocate has a positive influence on family-centered cultural care. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

  12. The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting.

    Science.gov (United States)

    Busari, Jamiu O; Duits, Ashley J

    2015-01-21

    Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system. Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training. In order to achieve a VBHC system in a resource-limited environment, the standard of physicians' competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended.

  13. Challenges in Providing Treatment and Care for Viral Hepatitis among Individuals Co-Infected with HIV in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Wirach Maek-a-Nantawat

    2012-01-01

    Full Text Available Hepatitis B and C infections are prevalent among HIV-infected individuals with different epidemiologic profiles, modes of transmission, natural histories, and treatments. Southeast Asian countries are classified as “highly prevalent zones,” with a rate of hepatitis B and C coinfection in people living with HIV/AIDS of approximately 3.2–11%. Majority of hepatitis B coinfection is of genotype C. Most of the patients infected with hepatitis C in Thailand have genotype 3 which is significantly related to intravenous drug use whereas, in Vietnam, it is genotype 6. The options for antiretroviral drugs are limited and rely on global funds and research facilities. Only HBV treatment is available for free through the national health scheme. Screening tests for HBV and HCV prior to commencing antiretroviral treatment are low. Insufficient concern on hepatitis-virus-related liver malignancy and long-term hepatic morbidities is noted. Cost-effective HCV treatment can be incorporated into the national health program for those who need it by utilizing data obtained from clinical research studies. For example, patients infected with HCV genotype 2/3 with a certain IL-28B polymorphism can be treated with a shorter course of interferon and ribavirin which can also help reduce costs.

  14. Evaluating the utility of provider-recorded clinical status in the medical records of HIV-positive adults in a limited-resource setting

    Science.gov (United States)

    Stonbraker, Samantha; Befus, Montina; Nadal, Leonel Lerebours; Halpern, Mina; Larson, Elaine

    2016-01-01

    Provider-reported summaries of clinical status may assist with clinical management of HIV in resource poor settings if they reflect underlying biological processes associated with HIV disease progression. However, their ability to do so is rarely evaluated. Therefore, we aimed to assess the relationship between a provider-recorded summary of clinical status and indicators of HIV progression. Data were abstracted from 201 randomly selected medical records at a large HIV clinic in the Dominican Republic. Multivariable logistic regressions were used to examine the relationship between provider-assigned clinical status and demographic (gender, age, nationality, education) and clinical factors (reported medication adherence, CD4 cell count, viral load). The mean age of patients was 41.2 (SD = ±10.9) years and most were female (n = 115, 57%). None of the examined characteristics were significantly associated with provider-recorded clinical status. Higher CD4 cell counts were more likely for females (OR = 2.2 CI: 1.12–4.31) and less likely for those with higher viral loads (OR = 0.33 CI: 0.15–0.72). Poorer adherence and lower CD4 cell counts were significantly associated with higher viral loads (OR = 4.46 CI: 1.11–20.29 and 6.84 CI: 1.47–37.23, respectively). Clinics using provider-reported summaries of clinical status should evaluate the performance of these assessments to ensure they are associated with biologic indicators of disease progression. PMID:27495146

  15. Benefits and limitations of fine needle aspiration cytology in the diagnosis and classification of leprosy in primary and secondary healthcare settings.

    Science.gov (United States)

    Ray, R; Mondal, R K; Pathak, S

    2015-08-01

    The goal of the World Health Organization (WHO) is to eliminate leprosy as a public health problem. This will only be possible when all patients are detected and cured using multidrug therapy, which requires accurate diagnosis prior to treatment. The objective of this study was to evaluate the possibility of the diagnosis of leprosy lesions by fine needle aspiration cytology according to a modification of the Ridley-Jopling scale, as it can be used in primary and secondary healthcare centres, especially in low-resource settings in which leprosy is prevalent. A prospective study comprising 54 cases with cardinal features of leprosy was performed. Among the 54 cases, 27 patients consented to a histopathological biopsy procedure. The slides were stained with Giemsa, modified Ziehl-Neelsen, Papanicolaou and haematoxylin and eosin methods. Among the 54 cases, 34 were reported as tuberculoid leprosy, five as mid-borderline (BB), three as borderline lepromatous (BL) and eight as lepromatous leprosy (LL); four were unsatisfactory. Histopathological study was performed in 27 cases, which showed cyto-histological correlation in 21 cases (78%). Agreement between histological and cytological diagnosis was achieved in 12 of the 15 tuberculoid cases, one of the three BB cases, one of the two BL cases and all seven LL cases. With the implementation of the WHO classification based on patch counting, there is the possibility of the over-treatment of paucibacillary cases and under-treatment of multibacillary cases. Cytology in terms of cellular type morphology and bacteriological study can complement the WHO classification. © 2014 John Wiley & Sons Ltd.

  16. Building operative care capacity in a resource limited setting: The Mongolian model of the expansion of sustainable laparoscopic cholecystectomy.

    Science.gov (United States)

    Wells, Katie M; Lee, Yu-Jin; Erdene, Sandag; Erdene, Sarnai; Sanchin, Urjin; Sergelen, Orgoi; Zhang, Chong; Rodriguez, Brandon P; deVries, Catherine R; Price, Raymond R

    2016-08-01

    The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic cholecystectomy throughout Mongolia. A cross-sectional, retrospective review was conducted of demographic patient data, diagnosis type, and operation performed (laparoscopic versus open cholecystectomy) from 2005-2013. Trends were analyzed from 6 of the 21 provinces (aimags) throughout Mongolia, and data were culled from 7 regional diagnostic referral and treatment centers and 2 tertiary academic medical centers. The data were analyzed by individual training center and by year before being compared between rural and urban centers. We analyzed and compared 14,522 cholecystectomies (n = 4,086 [28%] men, n = 10,436 [72%] women). Men and women were similar in age (men 52.2, standard deviation 14.8; women 49.4, standard deviation 15.7) and in the percentage undergoing laparoscopic cholecystectomy (men 39%, women 42%). By 2013, 58% of gallbladders were removed laparoscopically countrywide compared with only 2% in 2005. In 2011, laparoscopic cholecystectomy surpassed open cholecystectomy as the primary method for gallbladder removal countrywide. More than 315 Mongolian health care practitioners received laparoscopic training in 19 of the country's 21 aimags (states). By 2013, 58% of cholecystectomies countrywide were performed laparoscopically, a dramatic increase over 9 years. The expansion of laparoscopic cholecystectomy has transformed the care of biliary tract disease in Mongolia despite the country's limited resources. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. A Survey of Structural Design of Diagnostic X-ray Imaging Facilities and Compliance to Shielding Design Goals in a Limited Resource Setting

    Directory of Open Access Journals (Sweden)

    Flavious B. Nkubli

    2017-11-01

    Full Text Available Purpose: To survey structural designs of x-ray rooms and compliance to shielding design goals of three x-ray imaging facilities. Methods and Materials: The survey was conducted in three radiodiagnostic centers in South East Nigeria, labeled X, Y and Z for anonymity. A stretchable non-elastic meter rule was used to measure x-ray room dimensions. A Vernier caliper was used to measure lead thickness while a calibrated digital survey meter Radalert 100x was used for radiation survey of controlled and uncontrolled areas. Simple statistical tools such as mean and standard deviation were used for analysis with the aid of Microsoft Excel version 2007. Results: Center X had a room dimension of 2.4 m × 2.1 m, Center Y had an x-ray room dimension of 3.6 m × 3.3 m, and Center Z had two x-ray rooms with identical dimensions of 6.3 m × 3.6 m. Measured exit radiation doses for controlled areas in all the centers were: 0.00152 mSv/wk; 0.00496 mSv/wk; 0.00168 mSv/wk; 0.00224 mSv/wk respectively. Lead was the common shielding material used. Conclusion: Based on the parameters studied, Center Z had the ideal room size and layout. Relative distances from the x-ray tubes to the nearest walls were not optimized in all the centers except in Center Z. Measured exit doses were within recommended limits except in Center Y. The location of the control consoles and measured doses were appropriate and within recommended design goals.

  18. FIFI 3: A digital computer code for the solution of sets of first order differential equations and the analysis of process plant dynamics

    International Nuclear Information System (INIS)

    Sumner, H.M.

    1965-11-01

    FIFI 3 is a FORTRAN Code embodying a technique for the analysis of process plant dynamics. As such, it is essentially a tool for the integration of sets of first order ordinary differential equations, either linear or non-linear; special provision is made for the inclusion of time-delayed variables in the mathematical model of the plant. The method of integration is new and is centred on a stable multistep predictor-corrector algorithm devised by the late Mr. F.G. Chapman, of the UKAEA, Winfrith. The theory on which the Code is based and detailed rules for using it are described in Parts I and II respectively. (author)

  19. Transport coefficients and cross sections for electrons in water vapour: Comparison of cross section sets using an improved Boltzmann equation solution

    Science.gov (United States)

    Ness, K. F.; Robson, R. E.; Brunger, M. J.; White, R. D.

    2012-01-01

    This paper revisits the issues surrounding computation of electron transport properties in water vapour as a function of E/n0 (the ratio of the applied electric field to the water vapour number density) up to 1200 Td. We solve the Boltzmann equation using an improved version of the code of Ness and Robson [Phys. Rev. A 38, 1446 (1988)], facilitating the calculation of transport coefficients to a considerably higher degree of accuracy. This allows a correspondingly more discriminating test of the various electron-water vapour cross section sets proposed by a number of authors, which has become an important issue as such sets are now being applied to study electron driven processes in atmospheric phenomena [P. Thorn, L. Campbell, and M. Brunger, PMC Physics B 2, 1 (2009)] and in modeling charged particle tracks in matter [A. Munoz, F. Blanco, G. Garcia, P. A. Thorn, M. J. Brunger, J. P. Sullivan, and S. J. Buckman, Int. J. Mass Spectrom. 277, 175 (2008)].

  20. Influence of Proton and Salt Concentration on the Chromonic Liquid Crystal Phase Diagram of Disodium Cromoglycate Solutions: Prospects and Limitations of a Host for DNA Nanostructures.

    Science.gov (United States)

    Zhang, Bingru; Kitzerow, Heinz-S

    2016-03-31

    Lyotropic chromonic liquid crystals have recently been suggested for use as a self-organized host for dispersing and aligning self-organized DNA origami nanostructures. However, an appropriate pH value and a suitable cation concentration are necessary to stabilize such nanostructures and to avoid unfolding of the DNA. The present study shows that the nematic and columnar liquid crystal phases appearing in aqueous solutions of disodium cromoglycate are robust against the replacement of deionized water by a neutral or alkaline buffer solution. However, disodium cromoglycate precipitates when an acidic buffer is used or when the concentration of magnesium cations exceeds a critical concentration of about 0.6-0.7 mmol/L.

  1. Limiting partition coefficients of solutes in biphasic trihexyltetradecylphosphonium chloride ionic liquid-supercritical CO2 system: measurement and LSER-based correlation

    Czech Academy of Sciences Publication Activity Database

    Planeta, Josef; Karásek, Pavel; Roth, Michal

    2007-01-01

    Roč. 111, č. 26 (2007), s. 7620-7625 ISSN 1520-6106 R&D Projects: GA AV ČR KJB400310504; GA ČR GA203/05/2106; GA ČR GA203/07/0886 Institutional research plan: CEZ:AV0Z40310501 Keywords : phosphonium ionic liquid * supercritical carbon dioxide * solute partition coefficient Subject RIV: CB - Analytical Chemistry, Separation Impact factor: 4.086, year: 2007

  2. Moral Limits of the Market

    DEFF Research Database (Denmark)

    Ooi, Can-Seng

    2017-01-01

    that the current pragmatic solutions to sustainable tourism development could not resolve issues of authenticity, equity, rights and fairness. There are three in-built moral limits in the tourism market, and namely: the market assumes it can price everything including culture and nature; the market distributes......Scholars and the practice community unanimously advocate sustainable balanced and sensitive tourism development. Engaging with locals and setting up public-private partnerships are frequently championed. This working paper introduces a set of lenses in the moral philosophy tradition and argues...

  3. Asymptotic Comparison of the Solutions of Linear Time-Delay Systems with Point and Distributed Lags with Those of Their Limiting Equations

    Directory of Open Access Journals (Sweden)

    M. De la Sen

    2009-01-01

    Full Text Available This paper investigates the relations between the particular eigensolutions of a limiting functional differential equation of any order, which is the nominal (unperturbed linear autonomous differential equations, and the associate ones of the corresponding perturbed functional differential equation. Both differential equations involve point and distributed delayed dynamics including Volterra class dynamics. The proofs are based on a Perron-type theorem for functional equations so that the comparison is governed by the real part of a dominant zero of the characteristic equation of the nominal differential equation. The obtained results are also applied to investigate the global stability of the perturbed equation based on that of its corresponding limiting equation.

  4. Provenance and fate of arsenic and other solutes in the Chaco-Pampean Plain of the Andean foreland, Argentina: From perspectives of hydrogeochemical modeling and regional tectonic setting

    Science.gov (United States)

    Raychowdhury, Nilasree; Mukherjee, Abhijit; Bhattacharya, Prosun; Johannesson, Karen; Bundschuh, Jochen; Sifuentes, Gabriela Bejarano; Nordberg, Erika; Martin, Raúl A.; Storniolo, Angel del Rosario

    2014-10-01

    Extensive arsenic (As) enriched groundwater is known to occur in the aquifers of the Chaco-Pampean Plain of Argentina. Previous studies speculated that the As mobilization in these groundwaters was a direct result of their elevated pH and oxidative conditions. The volcanic glass layers present in the aquifer matrix were hypothesized as one of the possible sources of As to the groundwaters. Here, we examine the groundwater chemistry of the Santiago del Estero province of Chaco-Pampean Plains of Argentina, and test these hypotheses by using hydrogeochemical modeling within the framework of the regional geologic-tectonic setting. The study area is located in the active foreland of the Andean orogenic belt, which forms a continental arc setting, and is dotted with several hot springs. Rhyolitic volcanic glass fragments derived from arc volcanism are abundant within the aeolian-fluvial aquifer sediments, and are related to the paleo-igneous extrusion in the vicinity. Hydrogeochemical analyses show that the groundwater is in predominantly oxidative condition. In addition, some of the groundwaters exhibit very high Na, Cl- and SO42- concentrations. It is hypothesized in this study that the groundwater chemistry has largely evolved by dissolution of rhyolitic volcanic glass fragments contained within the aquifer sediments along with mixing with saline surface waters from, adjoining salinas, which are thought to be partially evaporated remnants of a paleo inland sea. Flow path modeling, stability diagrams, and thermodynamic analyses undertaken in this study indicate that the dominant evolutionary processes include ion exchange reactions, chemical weathering of silicate and evaporites, in monosialitization-dominated weathering. Geochemical modeling predicts that plagioclase feldspar and volcanic glass are the major solids phases that contribute metal cations and dissolved silica to the local groundwaters. Co-influxed oxyanions, with similar ionic radii and structure (e.g. Mo

  5. Scalar-tensor theory of gravitation: generalizations and experimental limitations

    International Nuclear Information System (INIS)

    Duruisseau, J.P.

    1983-01-01

    Several theories with scalar field can be derived from different variational principles. Here a very general variational principle is considered and it is proved that, in the exterior case without electromagnetic field, the solution for a particular case generates the set of solutions for the general case. This is applied to the exterior solution in the static case with spherical symmetry without electromagnetic field. The predictions are investigated for the classic effects and the event horizons and some limitations for the variational principles which generalize the usual limitations are obtained. In all these cases the Schwarzschild solution with his horizon appears as a very particular case. (author)

  6. High Power Efficiency Solution-Processed Blue Phosphorescent Organic Light-Emitting Diodes Using Exciplex-Type Host with a Turn-on Voltage Approaching the Theoretical Limit.

    Science.gov (United States)

    Ban, Xinxin; Sun, Kaiyong; Sun, Yueming; Huang, Bin; Ye, Shanghui; Yang, Min; Jiang, Wei

    2015-11-18

    Three solution-processable exciplex-type host materials were successfully designed and characterized by equal molar blending hole transporting molecules with a newly synthesized electron transporting material, which possesses high thermal stability and good film-forming ability through a spin-coating technique. The excited-state dynamics and the structure-property relationships were systematically investigated. By gradually deepening the highest occupied molecular orbital (HOMO) level of electron-donating components, the triplet energy of exciplex hosts were increased from 2.64 to 3.10 eV. Low temperature phosphorescence spectra demonstrated that the excessively high triplet energy of exciplex would induce a serious energy leakage from the complex state to the constituting molecule. Furthermore, the low energy electromer state, which only exists under the electroexcitation, was found as another possible channel for energy loss in exciplex-based phosphorescent organic light-emitting diodes (OLEDs). In particular, as quenching of the exciplex-state and the triplet exciton were largely eliminated, solution-processed blue phosphorescence OLEDs using the exciplex-type host achieved an extremely low turn-on voltage of 2.7 eV and record-high power efficiency of 22.5 lm W(-1), which were among the highest values in the devices with identical structure.

  7. Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

    Directory of Open Access Journals (Sweden)

    Veen Robert ER

    2011-07-01

    Full Text Available Abstract Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs. Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs within 13 European Countries. General Practitioners (GPs recruited consecutive patients with an acute cough. GPs completed a case report form (CRF and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i selecting, setting up and maintaining PCNs; ii designing local context-appropriate data collection tools and efficient data management systems; and iii gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i appointing key individuals (National Network Facilitator and Coordinator with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos

  8. Analytical solutions in the two-cavity coupling problem

    International Nuclear Information System (INIS)

    Ayzatsky, N.I.

    2000-01-01

    Analytical solutions of precise equations that describe the rf-coupling of two cavities through a co-axial cylindrical hole are given for various limited cases.For their derivation we have used the method of solution of an infinite set of linear algebraic equations,based on its transformation into dual integral equations

  9. Generalized closed form solutions for feasible dimension limit and pull-in characteristics of nanocantilever under the Influences of van der Waals and Casimir forces

    Science.gov (United States)

    Mukherjee, Banibrata; Sen, Siddhartha

    2018-04-01

    This paper presents generalized closed form expressions for determining the dimension limit for the basic design parameters as well as the pull-in characteristics of a nanocantilever beam under the influences of van der Waals and Casimir forces. The coupled nonlinear electromechanical problem of electrostatic nanocantilever is formulated in nondimensional form with Galerkin’s approximation considering the effects of these intermolecular forces and fringe field. The resulting integrals and higher order polynomials are solved numerically to derive the closed form expressions for maximum permissible detachment length, minimum feasible gap spacing and critical pull-in limit. The derived expressions are compared and validated as well with several reported literature showing reasonable agreement. The major advantages of the proposed closed form expressions are that, they do not contain any complex mathematical term or operation unlike in reported literature and thus they will serve as convenient tools for the NEMS community in successful design of various electrostatically actuated nanosystems.

  10. Medicare Current Beneficiary Survey - Limited Data Set

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a representative national sample of the Medicare population. There are two...

  11. Novel composition above the limit of Bi:Zr solid solution; synthesis and physical properties of Bi1.33Zr0.67O3+δ

    International Nuclear Information System (INIS)

    Meatza, Iratxe de; Chapman, Jon P.; Mauvy, Fabrice; Larramendi, Jose I. Ruiz de; Arriortua, Maria I.; Rojo, Teofilo

    2004-01-01

    This paper presents an increase to x = 0.67 of the zirconium content in the conductive Bi 2-x Zr x O 3+δ solid solution. Complete incorporation of Zr in the β III -Bi 2 O 3 structure, confirmed by X-ray powder diffraction, has produced a phase with a lower volume and superior conductivity than those predicted by an earlier study. The observed β III -δ Bi 2-x Zr x O 3+δ phase transition around 730 deg. C has been characterised for the first time and shows a segregation of a mixture of predominantly γ-Bi 2 O 3 and approximately 30% of the ZrO 2 , before total reincorporation of the Zr in the high temperature δ-phase

  12. Approximate transient and long time limit solutions for the band broadening induced by the thin sidewall-layer in liquid chromatography columns.

    Science.gov (United States)

    Broeckhoven, Ken; Desmet, Gert

    2007-11-16

    Using a combination of both analytical and numerical techniques, approximate analytical expressions have been established for the transient and long time limit band broadening, originating from the presence of a thin disturbed sidewall layer in liquid chromatography columns, including packed, monolithic as well as microfabricated columns. The established expressions can be used to compare the importance of a thin disturbed sidewall layer with that of other radial heterogeneity effects (such as transcolumn packing density variations due to the relief of packing stresses). The expressions are independent of the actual velocity profile inside the layer as long as the disturbed sidewall layer occupies less than 2.5% of the column width.

  13. Existence of solutions for quasistatic problems of unilateral contact with nonlocal friction for nonlinear elastic materials

    Directory of Open Access Journals (Sweden)

    Alain Mignot

    2005-09-01

    Full Text Available This paper shows the existence of a solution of the quasi-static unilateral contact problem with nonlocal friction law for nonlinear elastic materials. We set up a variational incremental problem which admits a solution, when the friction coefficient is small enough, and then by passing to the limit with respect to time we obtain a solution.

  14. Surface microstructures on planar substrates and textile fibers guide neurite outgrowth: a scaffold solution to push limits of critical nerve defect regeneration?

    Directory of Open Access Journals (Sweden)

    Stefan Weigel

    Full Text Available The treatment of critical size peripheral nerve defects represents one of the most serious problems in neurosurgery. If the gap size exceeds a certain limit, healing can't be achieved. Connection mismatching may further reduce the clinical success. The present study investigates how far specific surface structures support neurite outgrowth and by that may represent one possibility to push distance limits that can be bridged. For this purpose, growth cone displacement of fluorescent embryonic chicken spinal cord neurons was monitored using time-lapse video. In a first series of experiments, parallel patterns of polyimide ridges of different geometry were created on planar silicon oxide surfaces. These channel-like structures were evaluated with and without amorphous hydrogenated carbon (a-C:H coating. In a next step, structured and unstructured textile fibers were investigated. All planar surface materials (polyimide, silicon oxide and a-C:H proved to be biocompatible, i.e. had no adverse effect on nerve cultures and supported neurite outgrowth. Mean growth cone migration velocity measured on 5 minute base was marginally affected by surface structuring. However, surface structure variability, i.e. ridge height, width and inter-ridge spacing, significantly enhanced the resulting net velocity by guiding the growth cone movement. Ridge height and inter-ridge distance affected the frequency of neurites crossing over ridges. Of the evaluated dimensions ridge height, width, and inter-ridge distance of respectively 3, 10, and 10 µm maximally supported net axon growth. Comparable artificial grooves, fabricated onto the surface of PET fibers by using an excimer laser, showed similar positive effects. Our data may help to further optimize surface characteristics of artificial nerve conduits and bioelectronic interfaces.

  15. The Significance of HIV ‘Blips’ in Resource-Limited Settings: Is It the Same? Analysis of the Treat Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD)

    Science.gov (United States)

    Kanapathipillai, Rupa; McManus, Hamish; Kamarulzaman, Adeeba; Lim, Poh Lian; Templeton, David J.; Law, Matthew; Woolley, Ian

    2014-01-01

    Introduction Magnitude and frequency of HIV viral load blips in resource-limited settings, has not previously been assessed. This study was undertaken in a cohort from a high income country (Australia) known as AHOD (Australian HIV Observational Database) and another cohort from a mixture of Asian countries of varying national income per capita, TAHOD (TREAT Asia HIV Observational Database). Methods Blips were defined as detectable VL (≥ 50 copies/mL) preceded and followed by undetectable VL (failure (VF) was defined as two consecutive VL ≥50 copies/ml. Cox proportional hazard models of time to first VF after entry, were developed. Results 5040 patients (AHOD n = 2597 and TAHOD n = 2521) were included; 910 (18%) of patients experienced blips. 744 (21%) and 166 (11%) of high- and middle/low-income participants, respectively, experienced blips ever. 711 (14%) experienced blips prior to virological failure. 559 (16%) and 152 (10%) of high- and middle/low-income participants, respectively, experienced blips prior to virological failure. VL testing occurred at a median frequency of 175 and 91 days in middle/low- and high-income sites, respectively. Longer time to VF occurred in middle/low income sites, compared with high-income sites (adjusted hazards ratio (AHR) 0.41; pfailure (p = 0.360 for blip 50–≤1000, p = 0.309 for blip 50–≤400 and p = 0.300 for blip 50–≤200). 209 of 866 (24%) patients were switched to an alternate regimen in the setting of a blip. Conclusion Despite a lower proportion of blips occurring in low/middle-income settings, no significant difference was found between settings. Nonetheless, a substantial number of participants were switched to alternative regimens in the setting of blips. PMID:24516527

  16. Assessment of a New Lower-Cost Real-Time PCR Assay for Detection of High-Risk Human Papillomavirus: Useful for Cervical Screening in Limited-Resource Settings?

    Science.gov (United States)

    Fokom Domgue, Joel; Schiffman, Mark; Wentzensen, Nicolas H; Gage, Julia C; Castle, Philip E; Raine-Bennett, Tina R; Fetterman, Barbara; Lorey, Thomas; Poitras, Nancy E; Befano, Brian; Xie, Yi; Miachon, Lais S; Dean, Michael

    2017-08-01

    Inexpensive and easy-to-perform human papillomavirus (HPV) tests are needed for primary cervical cancer screening in lower-resource regions. In a convenience sample of 516 residual exfoliative cervical specimens from the Kaiser Permanente Northern California and U.S. National Cancer Institute Persistence and Progression Study, we assessed the agreement and clinical performance of a simple, inexpensive real-time PCR assay for the detection of 13 carcinogenic HPV types (the H13 assay; Hybribio, Hong Kong) that is marketed in limited-resource settings compared to previous testing by the Hybrid Capture 2 assay (HC2; Qiagen, Germantown, MD) and the Onclarity assay (BD Diagnostics, Sparks, MD). The test set was chosen to include many HPV-positive specimens. The reference standard was a combination of HC2 and Onclarity results for HPV detection and histologic diagnosis of controls (less than cervical intraepithelial neoplasia grade 2 [limited-resource settings. Copyright © 2017 American Society for Microbiology.

  17. Eastern Caribbean Physicians' Responses to Providing HIV/AIDS Care in Resource-Limited Settings: We've Come a Long Way, but We're Not There Yet.

    Science.gov (United States)

    Reddock, Jennifer

    2016-09-01

    Physicians' ability to provide care to patients living with HIV/AIDS (PLWHA) in the Eastern Caribbean is influenced by economic constraints, sociocultural norms that govern interpersonal interactions, and the pervasive stigma linked to the disease. Although the economic environment determines national capacity to acquire various treatment and monitoring technologies, Eastern Caribbean physicians respond to practicing in a resource-limited setting by making choices that are influenced by the collectivist ethos that governs interpersonal relationships. Through qualitative interviews, the study finds that the social stigma associated with the disease requires physicians to "go the extra mile" to provide care in ways that allow PLWHA to protect their privacy in small, closely networked societies. © The Author(s) 2014.

  18. Is diabetes and hypertension screening worthwhile in resource-limited settings? An economic evaluation based on a pilot of a Package of Essential Non-communicable disease interventions in Bhutan.

    Science.gov (United States)

    Dukpa, Wangchuk; Teerawattananon, Yot; Rattanavipapong, Waranya; Srinonprasert, Varalak; Tongsri, Watsamon; Kingkaew, Pritaporn; Yothasamut, Jomkwan; Wangchuk, Dorji; Dorji, Tandin; Wangmo, Kinzang

    2015-10-01

    In response to a lack of cost-effective data on screening and early treatment of diabetes and hypertension in resource-limited settings, a model-based economic evaluation was performed on the World Health Organization (WHO)'s Package of Essential Non-communicable (PEN) disease interventions for primary health care in Bhutan. Both local and international data were applied in the model in order to derive lifetime costs and outcomes resulting from the early treatment of diabetes and hypertension. The results indicate that the current screening option (where people who are overweight, obese or aged 40 years or older who visit primary care facilities are screened for diabetes and hypertension) represents good value for money compared to 'no screening'. The study findings also indicate that expanding opportunistic screening (70% coverage of the target population) to universal screening (where 100% of the target population are screened), is likely to be