Sample records for tertiary period

  1. Tertiary period in Galicia. The significance and chronostratigraphic position of the lignite deposits

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    Martin Serrano, A. (Ibergesa, dep. geol., Madrid (Spain))


    The paper points out the most significant features of the Tertiary in Galicia; analyses the role played by climate and tectonics and also the significance and position of the lignite deposits in the suggested model; and establishes a diagram of the dynamic development of the Galician block during the Tertiary period.

  2. Reasons for spectacle reassessment in a tertiary eye care centre over a period of six years. (United States)

    Arumugam, Vijayalakshmi; Singh, Sumeer; Ramani, Krishna Kumar


    To determine the spectacle reassessment rates of dissatisfied patients returning to the optical services department of a tertiary eye centre in India over a period of six years. A total of 169,567 spectacles were dispensed from the optical services department between January 2010 and December 2015. The spectacle reassessment forms of dissatisfied patients who returned to the optical services department with their spectacles were analysed. A total of 797 spectacle reassessment forms were analysed. The overall spectacle reassessment rate during the study period was found to be 0.5% (95% CI: 0.467-0.472). The mean age of patients returning back for spectacle reassessment was 48 years (SD 19.9, range 3-97 years). Error in refractive correction measurement was found to be the most common reason for spectacle reassessment (54.7%), followed by dispensing error (21.1%), documentation errors while writing the prescription from the medical records in the tertiary eye care centre (12.7%), transcription error occurring at the optical services department (10.8%) and ocular pathologies (0.8%). No statistically significant difference was observed in the year-wise spectacle reassessment rates during the study period (p = 0.14). The frequency of spectacle reassessment rate in a tertiary eye care centre was low, with errors in measuring refractive errors contributing the most to the reassessment and reorder of spectacles. © 2017 Optometry Australia.

  3. Severe acute maternal morbidity (SAMM in postpartum period requiring tertiary Hospital care

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    Seema Bibi


    Full Text Available Background: Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. Objective: To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. Materials and Methods: This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. Results: The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions. The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH (50%, preeclampsia and eclampsia (30% and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34 and maternal mortality rate was 4.8%. Conclusion: PPH, Preeclampsia, sepsis and anemia were important causes

  4. Severe acute maternal morbidity (SAMM) in postpartum period requiring tertiary Hospital care. (United States)

    Bibi, Seema; Ghaffar, Saima; Memon, Shazia; Memon, Shaneela


    Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions). The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH) (50%), preeclampsia and eclampsia (30%) and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34) and maternal mortality rate was 4.8%. PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high.

  5. Audit of Oral Histopathology Service at a Nigerian Tertiary Institution over a 24-Year Period. (United States)

    Akinyamoju, Akindayo O; Adeyemi, Bukola F; Adisa, Akinyele O; Okoli, Chidinma N


    Biopsies are often essential for definitive diagnosis of oro-facial lesions and are a part of oral diagnostic procedures carried out in histopathology laboratories. At present, there is paucity of literature on the audit of oral histopathology services in Nigeria. The objectives of this study were to determine the prevalence of biopsied oral lesions in a Nigerian tertiary institution. Also to profile the usage of oral pathology service and to identify challenges that may be present in an oral histodiagnostic service. This was a retrospective study performed at the Oral Pathology Department of the University of Ibadan/ University College Hospital, Ibadan, Nigeria. Reports of all biopsies submitted at the Oral Pathology laboratory, for the period 1990-2014, were reviewed and data extracted. Descriptive analysis was done using SPSS software, version 20. The total number of reports was 1,998; invalid reports constituting 220(11%) were subsequently excluded leaving 1,778(89%) valid reports. The mean age of patients was 36.70±19.79, while the peak age of presentation was in the 3 rd decade. Male to female ratio was 1:1.1, and the mandible was the most common site of lesions 619(34.8%). These services were mainly utilized by oral surgeons (83.9%) and ameloblastoma (11.5%) was the most frequently diagnosed lesion. CD45 (16.7%) was the most frequently requested immuno-diagnostic test. Biopsied oral lesions were more prevalent in females, while oral and maxillofacial surgeons utilized these services the most. Inadequate biopsy specimens or unrepresentative specimens and deficient documentation were challenges identified in this study.

  6. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. (United States)

    Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck


    This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

  7. [Changes in the demand for paediatric neurology care in a spanish tertiary care hospital over a 20-year period]. (United States)

    Monge Galindo, L; López-Pisón, J; Samper Villagrasa, P; Peña Segura, J L


    The purpose of this study is to determine the profile of the demand for paediatric neurology care in a Spanish tertiary hospital over the past 20 years. We studied epidemiological data, reasons for consultation, diagnoses and complementary tests from all patients examined by our Paediatric Neurology Unit in its 20 years of service (from May 1990 to March 2010). We also reviewed data from patients whose first visit took place within the last five years (2005-2010) and compared them to data obtained from a prior study carried out in this Unit from 1990 to 1995. To compare the first 5 years (group 1) with the last 5 years (group 2), we calculated confidence intervals, P<.05, for the frequency distribution (%) in each category. Main reasons for consultation and principal diagnoses for the 12726 patients evaluated in the 20-year period, as well as results from group 1 (2046 patients) and group 2 (4488 patients) corresponding to first and the last 5 years of activity respectively, are presented with their confidence intervals in a series of tables. Variations in the reasons for consultation, diagnoses and complementary tests over time reflect changes determined by medical, scientific and social progress, and organisational changes specific to each hospital. This explains the difficulty of comparing different patient series studied consecutively, which are even more pronounced between different hospitals. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  8. Historical trends in the epidemiology of candidaemia: analysis of an 11-year period in a tertiary care hospital in Brazil

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    Marcos Paulo Wille


    Full Text Available Candida species are an important cause of bloodstream infections (BSI. To evaluate the epidemiological, clinical and microbiological aspects of two cohorts {1994-1999 [period 1 (P1 ]; 2000-2004 [period 2 (P2 ]} of candidaemic patients, we performed a retrospective analysis from a laboratory-based survey. A total of 388 candidaemias were identified, with an incidence of 0.20/1,000 patient-days and a significant increase in P2 vs. P1 (0.25 vs. 0.15, p = 0.04. Cancer and prior antibiotic use were frequent and Candida albicans was the most prevalent species found (42.4%. Resistance to fluconazole was found in 2.47% of the strains. No differences were observed in the species distribution of Candida during the study periods. In the P2 cohort, there were higher prevalence of elderly individuals, cardiac, pulmonary and liver diseases, renal failure, central venous catheters and antibiotic therapy. In P1, there were higher prevalence of neurological diseases and chemotherapy. The crude mortality was 55.4%. In conclusion, our incidence rates remained high. Furthermore, the distribution pattern of Candida species and the fluconazole resistance profile remained unchanged. Moreover, we found a clear trend of higher prevalence of candidaemia among the elderly and among patients with comorbidities. Finally, it is necessary to discuss strategies for the prevention and control of Candida BSI in Brazil.

  9. A comparison of induction of labor success rates over three time periods in 20 years at a single academic tertiary care center: are we improving vaginal delivery rates? (United States)

    Fischer, Richard; Machac, Nicole; Hunter, Krystal; Adriance, Lori


    To compare the rates of successful induction of labor during three one-year periods over 20 years at a single institution. All women at 37 weeks or beyond with a living, singleton, cephalic fetus admitted for induction of labor in 1992, 2002, and 2012 were included. The use of induction agents and rates of successful vaginal delivery were compared. A total of 627 women were evaluated, 219 in 1992, 220 in 2002, and 188 in 2012. Various induction agents were employed over the 20 year period. However, the rates of successful vaginal deliveries did not significantly vary over the three time periods, 79.5% in 1992, 72.3% in 2002, 76.1% in 2012, p = .21. In subgroup analysis, no significant differences were found among women with one or more prior vaginal delivery, no prior vaginal delivery, or after excluding those with a prior cesarean section. In multiple variable logistic regression analysis, no induction agent besides amniotomy improved successful vaginal delivery rates. Despite the multiple induction agents available at our tertiary care institution over the past 20 years, we were unable to demonstrate any significant improvement in successful vaginal delivery rates after induction of labor.

  10. Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study

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    Khowaja Khurshid


    Full Text Available Abstract Background Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. Methods At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. Results During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5% followed by registered nurses (n = 283; 20.4%. Highest number of incidents was reported during blood collection (19%. An increasing trend was observed in the pre intervention years (2002–04. However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year. By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01, surgeries and procedures performed (p = 0.01, specimens collected in the laboratory (p = 0.001 and patients visits in clinics (p = 0.01. Conclusion We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project.

  11. General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy: Retrospective analysis of 504 sessions over a five-year period at a tertiary care hospital in Oman. (United States)

    Narayanan, Aravind; Lal, Chandar; Al-Sinawi, Hamed


    This study aimed to review general anaesthesia protocols for patients undergoing electroconvulsive therapy (ECT) at a tertiary care hospital in Oman, particularly with regards to clinical profile, potential drug interactions and patient outcomes. This retrospective study took place at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. The electronic medical records of patients undergoing ECT at SQUH between January 2010 and December 2014 were reviewed for demographic characteristics and therapy details. A total of 504 modified ECT sessions were performed on 57 patients during the study period. All of the patients underwent a uniform general anaesthetic regimen consisting of propofol and succinylcholine; however, they received different doses between sessions, as determined by the treating anaesthesiologist. Variations in drug doses between sessions in the same patient could not be attributed to any particular factor. Self-limiting tachycardia and hypertension were periprocedural complications noted among all patients. One patient developed aspiration pneumonitis (1.8%). All patients undergoing ECT received a general anaesthetic regimen including propofol and succinylcholine. However, the interplay of anaesthetic drugs with ECT efficacy could not be established due to a lack of comprehensive data, particularly with respect to seizure duration. In addition, the impact of concurrent antipsychotic therapy on anaesthetic dose and subsequent complications could not be determined.

  12. Non-infectious aortitis: a report of 32 cases from a single tertiary centre in a 4-year period and literature review. (United States)

    Loricera, J; Blanco, R; Hernández, J L; Carril, J M; Martínez-Rodríguez, I; Canga, A; Peiró, E; Alonso-Gutiérrez, J; Calvo-Río, V; Ortiz-Sanjuán, F; Mata, C; Pina, T; González-Vela, M C; Martínez-Amador, N; González-Gay, M A


    Non-infectious aortitis often presents with non-specific symptoms leading to inappropriate diagnostic delay. We intend to describe the clinical spectrum and outcome of patients with aortitis diagnosed at a single centre. We reviewed the clinical charts of patients diagnosed with non-infectious aortitis between January 2010 and December 2013 at the Rheumatology Division from a 1.000-bed tertiary teaching hospital from Northern Spain. The diagnosis of aortitis was usually based on FDG-PET-CT scan, and also occasionally on CT or MRI angiography or helical CT-scan. During the period of assessment 32 patients (22 women and 10 men; mean age 68 years [range, 45-87]) were diagnosed with aortitis. The median interval from the onset of symptoms to the diagnosis was 21 months. FDG-PET CT scan was the most common tool used for the diagnosis of aortitis. The underlying conditions were the following: giant cell arteritis (n=13 cases); isolated polymyalgia rheumatica (PMR) (n=11); Sjögren's syndrome (n=2), Takayasu arteritis (n= 1); sarcoidosis (n=1), ulcerative colitis (n=1), psoriatic arthritis (n=1), and large-vessel vasculitis that also involved the aorta (n=2). The most common clinical manifestations at diagnosis were: PMR features, often with atypical clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory low back pain (n=9 patients, 28%) and fever (n=7 patients, 22%). Acute phase reactants were increased in most cases (median erythrocyte sedimentation rate 46 mm/1st hour, and a median serum C-reactive protein 1.5 mg/dL). Aortitis is not an uncommon condition. The diagnosis is often delayed. Atypical PMR features, unexplained low back or limb pain, constitutional symptoms along with increased acute phase reactants should be considered 'red flags' to suspect the presence of aortitis.


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    Fleming, Scott W.; Ge Jian; De Lee, Nathan; Jiang Peng; Lee, Brian; Nelson, Ben [Department of Astronomy, University of Florida, 211 Bryant Space Science Center, Gainesville, FL 2611-2055 (United States); Barnes, Rory [Department of Astronomy, University of Washington, P.O. Box 351580, Seattle, WA 98195 (United States); Beatty, Thomas G.; Gaudi, B. Scott; Shappee, Benjamin J. [Department of Astronomy, Ohio State University, 140 West 18th Avenue, Columbus, OH 43210 (United States); Crepp, Justin R. [Department of Astronomy, California Institute of Technology, 1200 E. California Blvd., Pasadena, CA 91125 (United States); Esposito, Massimiliano; Femenia, Bruno; Gonzalez Hernandez, Jonay I. [Instituto de Astrofisica de Canarias (IAC), E-38205 La Laguna, Tenerife (Spain); Ferreira, Leticia; Porto de Mello, Gustavo F. [Observatorio do Valongo, Universidade Federal do Rio de Janeiro, Ladeira do Pedro Antonio, 43, CEP: 20080-090, Rio de Janeiro, RJ (Brazil); Gary, Bruce; Hebb, Leslie; Stassun, Keivan [Department of Physics and Astronomy, Vanderbilt University, Nashville, TN 37235 (United States); Ghezzi, Luan, E-mail: [Laboratorio Interinstitucional de e-Astronomia, LIneA, Rua Gal. Jose Cristino 77, Rio de Janeiro, RJ-20921-400 (Brazil); and others


    We report the discovery via radial velocity (RV) measurements of a short-period (P = 2.430420 {+-} 0.000006 days) companion to the F-type main-sequence star TYC 2930-00872-1. A long-term trend in the RV data also suggests the presence of a tertiary stellar companion with P > 2000 days. High-resolution spectroscopy of the host star yields T{sub eff} = 6427 {+-} 33 K, log g = 4.52 {+-} 0.14, and [Fe/H] = -0.04 {+-} 0.05. These parameters, combined with the broadband spectral energy distribution (SED) and a parallax, allow us to infer a mass and radius of the host star of M{sub 1} = 1.21 {+-} 0.08 M{sub Sun} and R{sub 1} = 1.09{sup +0.15}{sub -0.13} R{sub Sun }. The minimum mass of the inner companion is below the hydrogen-burning limit; however, the true mass is likely to be substantially higher. We are able to exclude transits of the inner companion with high confidence. Further, the host star spectrum exhibits a clear signature of Ca H and K core emission, indicating stellar activity, but a lack of photometric variability and small vsin I suggest that the primary's spin axis is oriented in a pole-on configuration. The rotational period of the primary estimated through an activity-rotation relation matches the orbital period of the inner companion to within 1.5 {sigma}, suggesting that the primary and inner companion are tidally locked. If the inner companion's orbital angular momentum vector is aligned with the stellar spin axis as expected through tidal evolution, then it has a stellar mass of {approx}0.3-0.4 M{sub Sun }. Direct imaging limits the existence of stellar companions to projected separations <30 AU. No set of spectral lines and no significant flux contribution to the SED from either companion are detected, which places individual upper mass limits of M{sub {l_brace}2,3{r_brace}} {approx}< 1.0 M{sub Sun }, provided they are not stellar remnants. If the tertiary is not a stellar remnant, then it likely has a mass of {approx}0.5-0.6 M{sub Sun

  14. Changes in the Patch Test Population Over a Ten-Year Period at the Contact Dermatitis Clinic, Siriraj Hospital: A University-Based Tertiary Care Hospital in Thailand

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    Sutasinee Phaitoonwattanakij


    Full Text Available Background: There are several factors which have an impact on patch test results. In the past, comparing the populations between different institutes, without appropriate indicators was difficult. Thus, the MOAHLFA index (Male, Occupational, Atopic dermatitis, Hand dermatitis, Leg dermatitis, Face dermatitis and Age above 40 years was developed. However, the study of this index in Thailand is limited. Objective: To investigate the MOAHLFA index in patch testing population in the Contact Dermatitis Clinic at Siriraj Hospital. Methods: The clinical parameters of patients who underwent patch testing at Contact Dermatitis Clinic, Siriraj Hospital during 10 years were studied. Results: Our patch test population showed a statistically significant increase in the proportion of male and patients aged above 40 years while a statistical decrease was found in those with occupational skin diseases with a history of atopic dermatitis, and lesions on the hands during a decade. Conclusion: This study revealed patch-test population attending Siriraj contact dermatitis clinic changed in 10-years period. According to MOAHLFA index, the changes were increasing of male, aged >40 years but decreasing of atopic, occupational-related contact allergy patients.

  15. Pyogenic arthritis of native joints in non-intravenous drug users: A detailed analysis of 268 cases attended in a tertiary hospital over a 22-year period. (United States)

    Nolla, Joan M; Lora-Tamayo, Jaime; Gómez Vaquero, Carmen; Narváez, Javier; Murillo, Oscar; Pedrero, Salvador; Cabo, Javier; Ariza, Javier


    To analyze the clinical features, microbiological spectrum, diagnostic procedures and outcomes in native joint pyogenic arthritis among non-intravenous drug users. We collected all microbiologically proved cases of infectious arthritis at our hospital between 1992 and 2013. Patients with prosthetic joint infection were excluded, as were patients with non-pyogenic arthritis and intravenous drug users. We identified 268 patients; the mean age was 61 ± 14.7 years and 62% were men. The incidence increased over the period of study. In 188 patients (70%), one or more underlying medical illnesses were found. The mean symptom duration was 8.9 ± 9.5 days. Globally, 311 affected joints were found, 232 (75%) involving peripheral joints and 79 (25%) axial joints. Staphylococci (55%) and Streptococci (29%) were the predominant microorganisms. Blood cultures were positive in 78% (173/223) of the cases. In 81 patients (30%), one or more concomitant infectious processes were found. Antimicrobial therapy was prescribed 4-8 weeks in most cases, and surgical drainage was performed in 65% of patients. Four patients relapsed and 23 (8%) died. The prevalence of pyogenic native joint arthritis in non-intravenous drug users is increasing, frequently affecting old patients with underlying medical conditions. Although large joints are the most frequently compromised, the involvement of axial joints is a relevant feature that has not been recognized in other series. Staphylococci and Streptococci are the main causative agents. Bacteremia and concomitant infectious processes are frequent complications. Diagnostic delay and mortality continue to be important concerns. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Tertiary lymphoid tissue (United States)

    Di Caro, Giuseppe; Marchesi, Federica


    Tumor-infiltrating lymphocytes influence colorectal cancer progression. We have recently documented that tertiary lymphoid tissue in the colorectal cancer microenvironment orchestrates lymphocyte infiltration and that tertiary lymphoid tissue and lymphocytes cooperate in a coordinated antitumor immune response to improve patient outcome. Thus, tertiary lymphoid tissue represents a potential target in the design of tailored immune-based therapeutic approaches. PMID:25083321

  17. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection and the molecular characteristics of MRSA bacteraemia over a two-year period in a tertiary teaching hospital in Malaysia. (United States)

    Sit, Pik San; Teh, Cindy Shuan Ju; Idris, Nuryana; Sam, I-Ching; Syed Omar, Sharifah Faridah; Sulaiman, Helmi; Thong, Kwai Lin; Kamarulzaman, Adeeba; Ponnampalavanar, Sasheela


    Methicillin-resistant Staphylococcus aureus (MRSA) is an established pathogen that causes hospital- and community-acquired infections worldwide. The prevalence rate of MRSA infections were reported to be the highest in Asia. As there is limited epidemiological study being done in Malaysia, this study aimed to determine the prevalence of MRSA infection and the molecular characteristics of MRSA bacteraemia. Two hundred and nine MRSA strains from year 2011 to 2012 were collected from a tertiary teaching hospital in Malaysia. The strains were characterized by antimicrobial susceptibility testing, staphylococcal cassette chromosome mec (SCCmec) typing, detection of Panton-Valentine leukocidin (PVL) gene, multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Patient's demographic and clinical data were collected and correlated with molecular data by statistical analysis. Male gender and patient >50 years of age (p MRSA acquisition. Fifty-nine percent of MRSA strains were HA-MRSA that carried SCCmec type II, III, IV and V while 31% were CA-MRSA strains with SCCmec III, IV and V. The prevalence of PVL gene among 2011 MRSA strains was 5.3% and no PVL gene was detected in 2012 MRSA strains. All of the strains were sensitive to vancomycin. However, vancomycin MIC creep phenomenon was demonstrated by the increased number of MRSA strains with MIC ≥1.5 μg/mL (p = 0.008) between 2011 and 2012. Skin disease (p = 0.034) and SCCmec type III (p = 0.0001) were found to be significantly associated with high vancomycin MIC. Forty-four percent of MRSA strains from blood, were further subtyped by MLST and PFGE. Most of the bacteraemia cases were primary bacteraemia and the common comorbidities were diabetes, hypertension and chronic kidney disease. The predominant pulsotype was pulsotype C exhibited by SCCmec III-ST239. This is a first study in Malaysia that reported the occurrence of MRSA clones such as SCCmec V-ST5, untypeable-ST508, SCCmec IV-ST1

  18. Patterns of antimicrobial prescribing in a tertiary care hospital in Oman

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    Al-Yamani, Abdulrahman; Khamis, Faryal; Al-Zakwani, Ibrahim; Al-Noomani, Hamed; Al-Noomani, Jaleela; Al-Abri, Seif


    ... in a tertiary care hospital in Oman. Methods: We conducted a retrospective audit of the appropriateness of antimicrobial prescribing in patients admitted to acute care settings in a tertiary care hospital in Oman over a fourweek period...

  19. Secondary and tertiary hyperparathyroidism. (United States)

    Jamal, Sophie A; Miller, Paul D


    We reviewed the etiology and management of secondary and tertiary hyperparathyroidism. Secondary hyperparathyroidism is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus, most commonly low serum calcium. In secondary hyperparathyroidism, the serum calcium is normal and the PTH level is elevated. Tertiary hyperparathyroidism is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. Tertiary hyperparathyroidism typically occurs in men and women with chronic kidney disease usually after kidney transplant. The etiology and treatment of secondary hyperparathyroidism is relatively straightforward whereas data on the management of tertiary hyperparathyroidism is limited to a few small trials with short follow-up. Copyright © 2013 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  20. Endourology in a Nigerian Tertiary Hospital – current level of ...

    African Journals Online (AJOL)

    Background: Endourology is rapidly advancing in developed countries. However, the level of practice in public tertiary hospitals in developing countries is abysmally low. Objective: To review the current practice of endourology in a Nigerian public tertiary hospital and discuss the challenges faced during the study period.

  1. 2. Tertiary Foraminifera

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    Umbgrove, J.H.F.


    In his review of the palaeozoology of Java, K. Martin could in 1919, record 49 foraminifera from tertiary strata of Java, on the strength of a critical study of the existant literature, and especially on the strength of his own studies and knowledge of the above mentioned fossils (Bibl. 49). In

  2. Visibility of natural tertiary rainbows. (United States)

    Lee, Raymond L; Laven, Philip


    Naturally occurring tertiary rainbows are extraordinarily rare and only a handful of reliable sightings and photographs have been published. Indeed, tertiaries are sometimes assumed to be inherently invisible because of sun glare and strong forward scattering by raindrops. To analyze the natural tertiary's visibility, we use Lorenz-Mie theory, the Debye series, and a modified geometrical optics model (including both interference and nonspherical drops) to calculate the tertiary's (1) chromaticity gamuts, (2) luminance contrasts, and (3) color contrasts as seen against dark cloud backgrounds. Results from each model show that natural tertiaries are just visible for some unusual combinations of lighting conditions and raindrop size distributions.

  3. Overview of the geochemistry and Rb/Sr, Sm/Nd isotopes of Middle Jurassic and Tertiary granitoid intrusions: a new insight on tectono-magmatism and mineralization of this period in Iran


    Mohammad Ali Jazi; Mohammad Hassan Karimpour; Azadeh Malekzadeh Shafaroudi


    One of the most intensive occurrences of magmatism in Iran was in the middle Jurassic period. Among the granitoid intrusions in this period as discrete bodies or complexes can be pointed to Aligoodarz, Alvand, Astaneh, Boroujerd, Malayer, and Chah-Dozdan in the Sanandaj-Sirjan zone; Shir-kuh and Ayrakan in the Central Iran zone; Shah-kuh, Sorkh-kuh and Kalateh-Ahani in the Lut Block. These granitoids are mostly peraluminous and belong to high-K calc-alkaline series. CaO/Na2O ratios (0.12 to 8...

  4. Overview of the geochemistry and Rb/Sr, Sm/Nd isotopes of Middle Jurassic and Tertiary granitoid intrusions: a new insight on tectono-magmatism and mineralization of this period in Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Jazi


    Full Text Available One of the most intensive occurrences of magmatism in Iran was in the middle Jurassic period. Among the granitoid intrusions in this period as discrete bodies or complexes can be pointed to Aligoodarz, Alvand, Astaneh, Boroujerd, Malayer, and Chah-Dozdan in the Sanandaj-Sirjan zone; Shir-kuh and Ayrakan in the Central Iran zone; Shah-kuh, Sorkh-kuh and Kalateh-Ahani in the Lut Block. These granitoids are mostly peraluminous and belong to high-K calc-alkaline series. CaO/Na2O ratios (0.12 to 8.37 mostly suggest a clay-free source for formation of the intrusive rocks magma. Chondrite-normalized Rare Earth Elements (REEs diagram do not display high enrichment of Light Rare Earth Elements (LREEs than Heavy Rare Earth Elements (HREEs and general pattern is relatively flat. In addition, diagram shows Eu negative anomaly, which can be attributed to indicate reducing conditions in formation of magma and/or magma derived from plagioclase depth as source. The lower continental crust-normalized spider diagram indicates enrichment in LILE (Rb, Cs, and K and LREE (La and Ce and depletion in Ba, Nb, Ta, Sr, and Ti. Initial 87Sr/86Sr ratios are 0.70609 to 0.71938 and initial εNd values are negative (from -6.51 to -1.1 indicating that magma derived from continental crust. Geochemical and isotopic evidence of the intrusive rocks shows continental crust origin (S-type granitoid and due to continental collision. Geological findings such as stop in sedimentation, regional metamorphism, ophiolite displacement, and continental collision-related mineralization confirm continental collision between Iranian and Arabian plates in the Middle Jurassic period.

  5. Maternal mortality audit in a tertiary health institution in Nigeria ...

    African Journals Online (AJOL)

    Maternal mortality audit in a tertiary health institution in Nigeria: Lessons from direct causes and its drivers. ... Materials and Methods: It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. ... Possible strategies to improve health financing and referral system are proffered.

  6. A Conceptual Approach for Blended Leadership for Tertiary Education Institutions (United States)

    Jones, Sandra; Harvey, Marina; Lefoe, Geraldine


    Over the last 20 years, the tertiary education sector has adopted new administrative management approaches, with the aim of improving accountable and strategic focus. Over the same period, the question of how to build leadership capacity to improve learning and teaching and research outcomes has led to discussion on what constitutes academic…

  7. Colonoscopy in a Tertiary Hospital in Nigeria | Ismaila | Journal of ...

    African Journals Online (AJOL)

    Methodology: Results of colonoscopies performed by surgeons in the endoscopic unit of the Jos University Teaching Hospital, a tertiary medical centre in Plateau State, Nigeria were retrospectively analysed for a period of 6 months. The diagnostic yield and findings were analyzed. Results: A total of 43 colonoscopies were ...

  8. Fundamentals of tertiary oil recovery. Pt. 1. Why tertiary recovery

    Energy Technology Data Exchange (ETDEWEB)

    Herbeck, E.F.; Heintz, R.C.; Hastings, J.R.


    Secondary recovery projects initiated annually by Atlantic Richfield Co. in the U.S. show a general trend somewhat characteristic of all U.S. producers. Why did the number of project starts decline. Simply because there was a lack of prospects for Atlantic Richfield to apply waterflooding economically. This raises the question of what is the next step to maintain U.S. oil producing rates. One answer is to recover a third crop of oil from those fields which have already undergone secondary recovery. It is becoming evident that tertiary recovery must be undertaken while the existing wells and surface equipment are still intact and usable. Very few prospects are expected to be so profitable that economics will permit redrilling of wells and replacement of surface equipment, but tertiary recovery will be applicable to many of the existing oil fields. Engineers and production personnel at all organizational levels must make an effort to recognize those fields under their supervision which are candidates for tertiary recovery applications.

  9. Parathyroid carcinoma in tertiary hyperparathyroidism. (United States)

    Kim, Byung Seup; Ryu, Han Suk; Kang, Kyung Ho; Park, Sung Jun


    Parathyroid carcinoma is a rare disease of unknown etiology. This study presents a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Despite a successful kidney transplantation, the intact parathyroid hormone (iPTH) level of the patient was elevated consistently and could not be controlled by medical therapy. Due to the development of tertiary hyperparathyroidism with bone pain and osteoporosis, subtotal parathyroidectomy was performed 4 months after the kidney transplantation. Histological evaluation revealed that one of four parathyroid lesions was a parathyroid carcinoma, while the others were diffuse hyperplasia. Postoperative laboratory studies indicated a decreased level of iPTH. A positron emission tomography-computed tomography performed 6 months after the operation revealed no evidence of local recurrence or distant metastasis. Copyright © 2013. Published by Elsevier Taiwan.

  10. Tertiary hypothyroidism in a dog

    Directory of Open Access Journals (Sweden)

    Shiel Robert E


    Full Text Available A nine-year-old male entire Labrador was diagnosed with pituitary dependent hyperadrenocorticism. Following seven months of successful mitotane therapy, the dog presented with marked weight gain, seborrhoea and alopecia. Routine clinicopathological analyses revealed marked hypercholesterolaemia. Serum total and free thyroxine (T4 concentrations were below their respective reference ranges. Serum thyroid stimulating hormone (cTSH concentration was within reference range. TSH and thyrotropin releasing hormone (TRH response tests revealed adequate stimulation of total T4 in both, and cTSH in the latter test. Magnetic resonance imaging revealed a mass arising from the pituitary fossa, with suprasellar extension. A diagnosis of tertiary hypothyroidism was made. Following four weeks of levothyroxine therapy, circulating cholesterol concentration had declined, weight loss had ensued and dermatological abnormalities had improved. Euthanasia was performed four months later due to the development of neurological signs. A highly infiltrative pituitary adenoma, with effacement of the overlying hypothalamus was identified on post mortem examination. Tertiary hypothyroidism has not been previously reported in dogs.

  11. Effects of Primary, Secondary and Tertiary Education on Conflict Intensity in Africa

    Directory of Open Access Journals (Sweden)

    Julius A. Agbor


    Full Text Available This study investigates the impact of different schooling dimensions (primary, secondary and tertiary on the intensity of intra-state conflicts in 25 African states during the period 1989–2008. It uses fixed-effects and Generalized Methods of Moments (GMM estimators in an annualized panel data framework. Parameter estimates suggest the following (1 primary schooling broadly mitigates conflicts in Africa. However, in environments with high natural resource rents, it could ignite conflicts; (2 there is evidence, although not overwhelming, that secondary schooling potentially drives conflicts in Africa. There is also evidence that urbanization potentially drives conflicts in Africa. However, although secondary schooling and urbanization potentially drives conflicts, in environments where secondary schooling (urbanization is high, urbanization (secondary schooling mitigates conflicts; (3 there is no evidence of a strong direct positive impact of tertiary education on conflicts and conditioning on tertiary schooling, income inequality potentially drives conflicts in African states. However, in contexts where income inequality (tertiary schooling is high, tertiary schooling (inequality mitigates conflict. Two important policy implications follow from this study. First, in contexts where income inequality is high (for instance, in South Africa, governments should strive to foster tertiary education in order to reduce conflict. Second, where urbanization rates are high, they should foster both secondary and tertiary education. This study contributes to existing knowledge by clearly demonstrating the utility of distinguishing between different educational dimensions and the contexts wherein they matter for conflict mitigation in Africa.

  12. Geological features of the Tertiary Galician Coalfields and their value in economic terms

    Energy Technology Data Exchange (ETDEWEB)

    Espinosa, J.; Rey, J. (Ibergesa, dep. mineria, Madrid (Spain))


    The article takes stock of known geological data on the Tertiary period in Galicia; indicates the importance of this period in mining terms, especially with regard to lignite; and presents a statistical picture of Galicia's energy production and consumption.

  13. Missed Injuries in Polytrauma Patients after Trauma Tertiary Survey in Trauma Intensive Care Unit. (United States)

    Tammelin, E; Handolin, L; Söderlund, T


    Injuries are often missed during the primary and secondary surveys in trauma patients. Studies have suggested that a formal tertiary survey protocol lowers the number of missed injuries. Our aim was to determine the number, severity, and consequences of injuries missed by a non-formalized trauma tertiary survey, but detected within 3 months from the date of injury in trauma patients admitted to a trauma intensive care unit. We conducted a cohort study of trauma patients admitted to a trauma intensive care unit between 1 January and 17 October 2013. We reviewed the electronic medical records of patients admitted to the trauma intensive care unit in order to register any missed injuries, their delay, and possible consequences. We classified injuries into four types: Type 0, injury detected prior to trauma tertiary survey; Type I, injury detected by trauma tertiary survey; Type II, injury missed by trauma tertiary survey but detected prior to discharge; and Type III, injury missed by trauma tertiary survey and detected after discharge. During the study period, we identified a total of 841 injuries in 115 patients. Of these injuries, 93% were Type 0 injuries, 3.9% were Type I injuries, 2.6% were Type II injuries, and 0,1% were Type III injuries. Although most of the missed injuries in trauma tertiary survey (Type II) were fractures (50%), only 2 of the 22 Type II injuries required surgical intervention. Type II injuries presumably did not cause extended length of stay in the intensive care unit or in hospital and/or morbidity. In conclusion, the missed injury rate in trauma patients admitted to trauma intensive care unit after trauma tertiary survey was very low in our system without formal trauma tertiary survey protocol. These missed injuries did not lead to prolonged hospital or trauma intensive care unit stay and did not contribute to mortality. Most of the missed injuries received non-surgical treatment. © The Finnish Surgical Society 2016.

  14. Tertiary Normal Faulting in the Canyon Range, Eastern Sevier Desert. (United States)

    Wills; Anders


    The contact between pre-Mesozoic and Tertiary rocks in the western Canyon Range, west-central Utah, has been interpreted as a large, low-angle normal fault that marks the breakaway zone of the hypothesized, basin-forming Sevier Desert detachment. Recent fieldwork suggests that the contact may in fact be depositional along much or all of its length. Deformational fabric in the supposed footwall likely traces to the Mesozoic Sevier orogeny rather than to Tertiary detachment faulting. Kinematic indicators at the range front are not generally consistent with low-angle normal-fault motion; instead, well-exposed high-angle faults are the dominant range-bounding structures. The Tertiary conglomerates of the western Canyon Range foothills, previously viewed as an evolving syntectonic deposit related to detachment faulting, are here reinterpreted as three distinct units that reflect different periods and tectonic settings. The pattern in these conglomerates, and in fault-offset gravity-slide deposits that mantle the western foothills, is consistent with block faulting and rotation along several generations of high-angle structures. Local seismic-reflection data lend qualitative support to this interpretation, and underscore the need to consider alternative working hypotheses for evolution of the Sevier Desert basin.

  15. Historiske perioder

    DEFF Research Database (Denmark)


    For at forstå fortiden og fortællingerne om den, må vi skabe en form for orden og systematik. Her spiller inddelingen af fortiden i historiske perioder en afgørende rolle – og historiske perioder er da også et kompetencemål efter 6. klasse. Videoen diskuterer forskellige principper...... for periodisering. Kronologi og sammenhænge hænger naturligt sammen med historiske perioder. Videoen handler også om forståelser og brug af synkrone og diakrone sammenhænge i faget....

  16. misconception of emergency contraception among tertiary school ...

    African Journals Online (AJOL)

    formation of reproductive health clubs in our tertiary institutions and training of peer group educators in all our communities ... social issue in.the developing worldl. In Nigeria .... and alcohol (illicit gin and stout-6. 1%). .... They are cheap, readily.

  17. Tertiary oil recovery: potential application and constraints

    Energy Technology Data Exchange (ETDEWEB)

    Geffen, C. A.


    The technology of tertiary oil recovery methods is described and potential economic and environmental constraints to future commercial application are identified. Oil recoverable by tertiary techniques represents a domestic resource of between 11- and 42-billion barrels. Estimates of additional oil supplies from tertiary methods by the year 2000 range from 1 to 8 million barrels per day, depending on the price of oil and the rate of technological development. The principal constraints to large-scale application of tertiary methods at the present time include environmental, economic and technological concerns. Regulatory action associated with the Clean Air Act Amendments of 1977 currently delay the expansion of thermal recovery operations in California and may discourage future projects. The high production costs of tertiary projects also hamper process implementation. Further testing and research is necessary to develop the technology of tertiary recovery methods and prove these techniques successful on a field-wide scale. To enable tertiary oil recovery to play a significant role in augmenting domestic energy supplies, further research and development is necessary. More accurate methods of determining reservoir structure and residual oil saturations are required, as well as means for assuring the technical feasibility and success of a tertiary method in different reservoir types. Technical process limitations must also be resolved. The severity of potential environmental impacts and constraints identified in this report should be determined. These concerns include the air pollutant emissions from steam generation in thermal processes; acceptable methods of brine disposal; damage due to runoff or accidental discharge of oil-rich chemicals into surface waters; the impacts of fluid injection on deep aquifers and the prevailing geological structure; and an adequate supply of high quality fresh water.

  18. Cervical pap smear- A prospective study in a tertiary hospital

    Directory of Open Access Journals (Sweden)

    S Pudasaini


    Full Text Available Background: Cervical cancer is a leading cause of mortality and morbidity among women worldwide and most common gynaecological cancer in developing countries. Papanicolaou smear is a simple and cost effective screening test for cervical cancer. The aim of this study is to evaluate and interpret the cervical pap smear cytology in a tertiary hospital. The interpretation and reporting of the pap smear is based on 2001Bethesda system.Materials and methods: This is a prospective study conducted in a tertiary hospital, Nepal Medical College over a period of two and a half years (January 2013 to June 2015. All cervical pap smears received in the department of Pathology in the study period were included.Results: A total of 4160 cervical pap smears were reported in the study period. Majority of the cases were Negative for Intraepithelial lesion or malignancy (87.9%. Bacterial vaginosis, atrophy and reactive cellular changes associated with inflammation were seen in 5.3%, 2.4% and 1.5% cases respectively.   Epithelial cell abnormalities (0.5% include Atypical squamous cells of undetermined significance, Low grade squamous intraepithelial lesion and High grade intraepithelial lesion. 88% of Low grade squamous intraepithelial lesion was seen in reproductive age group (20-45 years.Conclusion: Cervical cancer is the most common gynaecological cancer in the developing countries. Pap smear is the simple and cost effective screening tool to detect pre invasive cervical epithelial lesions.

  19. Radioguided parathyroidectomy for tertiary hyperparathyroidism. (United States)

    Somnay, Yash R; Weinlander, Eric; Alfhefdi, Amal; Schneider, David; Sippel, Rebecca S; Chen, Herbert


    Tertiary hyperparathyroidism (3HPT) is defined as the persistent hyperproduction of parathyroid hormone and resulting hypercalcemia after renal transplantation. Here, we examine the utility of radioguided parathyroidectomy (RGP) in patients with 3HPT. We reviewed a prospective surgery database containing 80 3HPT patients who underwent RGP from January 2001-July 2014 at our institution. We evaluated patient demographics, operative management, radioguided neoprobe utilization, and operative outcomes. Data are reported as mean ± standard error of the mean. The mean age of the patients was 52 ± 1 y, and 46% were male. A total of 69 patients had hyperplasia and received subtotal parathyroidectomy, whereas 5 patients had double adenomas and 6 patients had single adenomas. The average calcium level among 3HPT patients was 10.8 ± 0.1 mg/dL preoperatively and 8.7 ± 0.1 mg/dL postoperatively. In vivo radioguided counts normalized to background counts averaged 145 ± 4%, whereas ex vivo counts normalized to background counts averaged 69 ± 5%. All but one ex vivo count was >20%. Ectopically located glands were successfully localized in 38 patients using the gamma probe. Ex vivo percentage did not correlate with parathyroid gland weight, preoperative parathyroid hormone, or preoperative calcium. Our radioguided approach achieved normocalcemia in 96% of 3HPT patients undergoing RGP; two patients developed recurrent disease. In this series, all enlarged parathyroid glands were localized and resected using the gamma probe. Thus, RGP reliably localizes adenomatous, hyperplastic, and ectopically located glands in patients with 3HPT, resulting in high cure rate after resection. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Tertiary Logistics in the Focus of All Logistics


    Ratko Zelenika; Mirjana Grèiæ; Helga Pavliæ Skender


    Trade logistics, traffic logistics, transport logistics and warehouse logistics are just some of the tertiary logistics which enables production processes of all economic sector products and services. Tertiary logistics representing the tertiary economic sector is the most sofisticated and the most important logistics due to the characteristics of the tertiary sector as a service sector that promotes business conditions in all economic sectors. Accordingly, tertiary logistics has a crucial ro...


    Directory of Open Access Journals (Sweden)

    Suresh Chincholi


    Full Text Available BACKGROUND Hyponatraemia is defined as a serum sodium level less than 135 mEq/L. High mortality among the patients of hyponatraemia is secondary to the underlying medical condition. Frequency is high in elderly patients. MATERIALS AND METHODS The study was conducted at a tertiary care centre (Basaveshwar Teaching and General Hospital, Gulbarga, from the period September 2014 to August 2016. These patients were evaluated for the underlying cause of hyponatraemia, which included detailed history and physical examination followed by appropriate laboratory investigations. Patients were followed up till the hyponatraemia was treated or patients were discharged from the hospital. RESULTS 100 patients of hyponatraemia were included in the study. 46% of the patients were asymptomatic. 33% patients had lethargy, 28% patients had postural dizziness and 19% had abnormal behaviour. Overall incidence of hyponatraemia was 4.58% in the hospitalised population, whereas its incidence in ICU patients was 22.4%. Twelve patients of symptomatic severe hyponatraemia were treated with hypertonic saline infusion, 25% patients were given loop diuretics with oral supplementation of sodium chloride for free water excretion in SIADH cases and in patients with hypervolaemia, hyponatraemia, fluid restriction was advised to 44 patients, oral supplementation of sodium chloride was given in 36 patients and 64 patients received normal saline. 9 patients included in the study died, 5 of which had advanced cirrhosis of liver as underlying cause. One patient developed Osmotic Demyelination Syndrome (ODS. CONCLUSION The possible cause of hyponatraemia should always be sought as outcome in severe hyponatraemia is governed by aetiology, and not by the serum sodium level. Treatment of severe symptomatic hyponatraemia with hypertonic saline is safe if recommendation for the rate of correction of hyponatraemia is strictly followed.


    NARCIS (Netherlands)

    Napp, Diego; Put, Marius van der; Shankar, Shiva


    This paper studies behaviors that are defined on a torus, or equivalently, behaviors defined in spaces of periodic functions, and establishes their basic properties analogous to classical results of Malgrange, Palamodov, Oberst et al. for behaviors on R(n). These properties-in particular the

  3. Equity in an Educational Boom: Lessons from the Expansion and Marketisation of Tertiary Schooling in Poland (United States)

    Herbst, Mikolaj; Rok, Jakub


    This article shows how the probability of enrolment in tertiary schools has evolved for different social groups in Poland during the period of the educational boom. It also analyses how the socio-economic status influences the choices between full-time and part-time studies (the latter being of relatively low quality), and the probability of…

  4. Prevalence of Hepatitis C virus in HIV infected persons in a tertiary ...

    African Journals Online (AJOL)

    To assess the prevalence of hepatitis C virus (HCV) infection among HIV/AIDS patients in a tertiary hospital inNigeria. All infected persons confirmed by Elisa and aged 15 years and above seen at theUniversity of Benin Teaching Hospital were included in the study. The subjects were recruited over a period of one year.

  5. A 5 - year surveillance of wound infections at a rural tertiary hospital ...

    African Journals Online (AJOL)

    Background: Wound infections are associated with increased morbidity and mortality. Objectives: To determine the prevalence, aetiology and susceptibility profile of bacterial agents of wound infection among in- and- out patients at a rural tertiary hospital in Nigeria, within a 5 year period. Methods: Wound swabs collected ...

  6. Smart Utilization of Tertiary Instructional Modes (United States)

    Hamilton, John; Tee, Singwhat


    This empirical research surveys first year tertiary business students across different campuses regarding their perceived views concerning traditional, blended and flexible instructional approaches. A structural equation modeling approach shows traditional instructional modes deliver lower levels of student-perceived learning quality, learning…

  7. Modelling the harmonized tertiary Institutions Salary Structure ...

    African Journals Online (AJOL)

    This paper analyses the Harmonized Tertiary Institution Salary Structure (HATISS IV) used in Nigeria. The irregularities in the structure are highlighted. A model that assumes a polynomial trend for the zero step salary, and exponential trend for the incremental rates, is suggested for the regularization of the structure.

  8. Adapting Cooperative Learning in Tertiary ELT (United States)

    Ning, Huiping


    An updated guideline for tertiary ELT in China has shifted the emphasis to the development of learners' ability to communicate in English. Using group work and getting learners actively involved in the actual use of English are highlighted more than before. This article focuses on adapting cooperative learning methods for ELT with tertiary…

  9. Tertiary Aminourea-Catalyzed Enantioselective Iodolactonization (United States)

    Veitch, Gemma E.


    Binding the anion: A highly enantioselective iodolactonization of 5-hexenoic acids has been achieved using a tertiary aminourea-catalyst. The use of catalytic iodine in this process is critical to enhancing both the reactivity and enantioselectivity of the stoichiometric I+source.The mechanism is proposed to involve binding of an iodonium imidate intermediate by the H-bond donor catalyst. PMID:20803601

  10. Tertiary Education and Training in Australia, 2009 (United States)

    National Centre for Vocational Education Research (NCVER), 2011


    Sourcing data from the National VET Provider Collection and the Higher Education Statistics Collection, this publication provides a summary of participation in tertiary education and training in Australia. It covers participation in Australian Qualifications Framework certificate I qualifications through to doctorates by research, as well as…

  11. Simple tertiary phosphines to hexaphosphane ligands: Syntheses ...

    Indian Academy of Sciences (India)

    Abstract. Designing efficient phosphorus-based ligands to make catalysts for homogeneous catalysis has been a great challenge for chemists. Despite a plethora of phosphorus ligands ranging from simple tertiary phosphines to polyphosphines are known, the enthusiasm to generate new ones is mainly due to the demand.

  12. Recruitment Of International Students Into Cameroon Tertiary ...

    African Journals Online (AJOL)

    This paper highlights the importance of Cameroon\\'s tertiary institutions\\' cooperation links with other African Universities given the rebirth of Organisation of African Unity as African Union, and the New Partnership for Africa Development (NEPAD). The present system of recruiting international students is haphazardly been ...

  13. Misconception of emergency contraception among tertiary school ...

    African Journals Online (AJOL)

    Community enlightenment about emergency contraception using specifically designed programmes, the formation of reproductive health clubs in our tertiary institutions and training of peer group educators in all our communities are advocated. Patent medicine dealers in our communities should have basic training in ...

  14. Sexual promiscuity among female undergraduates in tertiary ...

    African Journals Online (AJOL)

    The study focused on sexual promiscuity among female undergraduates and the attendant health implications. It was carried out in the tertiary institutions in Imo State using 415 final year degree students drawn from four institutions in the State. Three research questions were formulated to guide the study. The design was a ...

  15. HIV test counselling at a tertiary hospital

    African Journals Online (AJOL)

    AIDS training course presented either by the medical school or an AIDS training centre. In view of the perceived lack of training in general counselling, this would perhaps be most effective as part of a formal general counselling programme for all undergraduates. In a tertiary hospital one has the added benefit of a large.

  16. Economics of Tertiary Education - Challenges and dynamics of the public tertiary education in Albania

    Directory of Open Access Journals (Sweden)

    Gledian Llatja


    Full Text Available The tertiary education is a critic mechanism for the socio-economic progress, for individuals who aspire a brighter future and it is also considered an important catalyzer of the economic mobility (Department of Treasury and Department of Education, 2012, 2. Based on the positive role and impact that the tertiary education has on the sustainable development, President Obama once stated that it is of damage to treat education as a luxurious public service. In line with the general considerations about the tertiary education in the U.S. the parallel comparison with Albania comes as a direct interpretation of utopia in the education policy-making. As policies are usually drafted based on data and findings, in the case of Albania there is a lack of data on expenses on tertiary education as share of GDP. This stands also for the main limitation of the paper.

  17. Constructing Knowledge Societies : New Challenges for Tertiary Education


    World Bank


    This report describes how tertiary education contributes to building up a country's capacity for participation in an increasingly knowledge-based world economy and investigates policy options for tertiary education that have the potential to enhance economic growth and reduce poverty. It examines the following questions: What is the importance of tertiary education for economic and social ...

  18. Tertiary fatty amides as diesel fuel substitutes

    Energy Technology Data Exchange (ETDEWEB)

    Serdari, Aikaterini; Lois, Euripides; Stournas, Stamoulis [National Technical Univ. of Athens, Dept. of Chemical Engineering, Athens (Greece)


    This paper presents experimental results regarding the impact of adding different tertiary amides of fatty acids to mineral diesel fuel; an assessment of the behaviour of these compounds as possible diesel fuel extenders is also included. Measurements of cetane number, cold flow properties (cloud point, pour point and CFPP), density, kinematic viscosity, flash point and distillation temperatures are reported, while initial experiments concerning the effects on particulate emissions are also described. Most of the examined tertiary fatty amides esters have very good performance and they can be easily prepared from fatty acids (biomass). Such compounds or their blends could be used as mineral diesel fuel or even fatty acid methylesters (FAME, biodiesel) substitutes or extenders. (Author)

  19. Missed injury and the tertiary trauma survey. (United States)

    Thomson, Charles B; Greaves, Ian


    Missed injury in the context of major trauma remains a persistent problem, both from a clinical and medico-legal point-of-view. Estimates of the incidence vary widely, dependent on the precise parameters of the studied population, the definition of missed injury and the extent of follow-up, but may be as high as 38%. The tertiary survey, in which formal repeated examination of the patient is undertaken after initial resuscitation and treatment have taken place, has been suggested as a way of identifying injuries not found at presentation. This paper appraises the concept of the tertiary survey, and also reviews the literature on missed injury in order to identify the risk factors, the types of injury and the reasons for error.

  20. Tertiary Treatment Process of Preserved Wastewater

    Directory of Open Access Journals (Sweden)

    Wang Qingyu


    Full Text Available The effects of the composite coagulants on coagulation sedimentation for the preserved wastewater was investigated by changing the composite coagulant dosages, and the coagulant was composed of polymeric ferric sulfate (PFS, polyaluminium chloride (PAC, and polyaluminum ferric silicate (PAFSC, while the effect of the tertiary treatment process on the preserved wastewater was tested, which was exceeded the standard seriously. The results showed that 400 mg/L was the optimum composite coagulant dosage. The removal rates of salt and sugar were as high as 99.1% and 99.5% respectively, and the removal rates of CODCr and SS were 99.3% and 96.0%, respectively after the preserved wastewater was treated by the tertiary treatment technology, which both reached the primary standard of “The Integrated Wastewater Discharge Standard” (GB8978-1996.

  1. Exploring Tertiary Students' Understanding of Covalent Bonding (United States)

    Coll, Richard K.; Treagust, David F.


    There has been little research into learners' mental models of chemical bonding at any level, let alone the tertiary level. Undergraduate and graduate students encounter a plethora of sophisticated and highly abstract mental models for chemical bonding, and this study sought to investigate if there are preferred mental models for the concept of covalent bonding for secondary, undergraduate, and graduate chemistry learners. In particular, it was of interest to see whether exposure to increasingly sophisticated mental models at different points in a chemistry education showed up in patterns of preference and use of models in interpreting common physical properties and phenomena. The study revealed that, despite evidencing expertise in a number of highly complex and mathematically sophisticated mental models, tertiary students, including graduates (MSc and PhD), show a strong preference for simple realistic mental models. Furthermore, the students struggled to use their mental models to explain the physical properties of covalently bonded substances.

  2. Regional tertiary cross sections: Texas Gulf Coast

    Energy Technology Data Exchange (ETDEWEB)

    Debout, D.G.; Luttrell, P.E.; Seo, J.H.


    Regional studies of the Frio Formation along the Texas Gulf Coast were conducted to evaluate potential geothermal energy from deep, geopressured sandstone reservoirs. Published regional cross sections, unpublished cross sections provided by several major oil companies, and extensive micropaleontological and electrical-log files at the Bureau of Economic Geology served as basic data. These sections are meant to show gross regional distribution of sand and shale facies both laterally and vertically throughout the entire Tertiary section along the Texas Gulf Coast.

  3. Alcohol consumption in tertiary education students

    Directory of Open Access Journals (Sweden)

    Reavley Nicola J


    Full Text Available Abstract Background Heavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC guidelines for alcohol consumption and intentions to seek help for alcohol problems. Methods Students of an Australian metropolitan university (with staff as a comparison group participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed. Results Of the completed interviews, 774 (65% were students and 422 (35% were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students. Conclusions Our findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among


    Directory of Open Access Journals (Sweden)

    Wawa Puja Prabawa


    Full Text Available Speaking is considered to be difficult thing, moreover English as a foreign language. Students' performance depends on their personalities. Students who have low participation in speaking activity in the classroom lose their opportunity to practice their speaking skill which may cause poor speaking skill and achievement. However, some of students are active in speaking activity in the classroom that leads them to have good skill and achievement in speaking. This study attempts to reveal: (1 speaking strategies used by Indonesian tertiary students in terms of speaking English and strategies to improve their speaking ability, and (2 to identify speaking strategies mostly used by the students when they speak English and improve their speaking ability. This study is a descriptive research since its purpose is to describe the Indonesian tertiary students’ learning strategies in learning speaking English. The data from 15 tertiary students, who have good performance and achievement in speaking, from one of schools of higher education in Cimahi were collected using a 21 items questionnaire of a modified version of Strategy Inventory Language Learning (SILL and 5 items interview questions. The result of the study revealed that some speaking strategies are used in terms of speaking English and improve speaking ability, namely cognitive, metacognitive and compensation strategy. In the type of speaking strategy that mostly used by the student in terms of speaking English is compensation strategy, while cognitive strategy was indicated as the mostly speaking strategies used by the Indonesian tertiary students in improving their speaking ability. Considering to the study conducted, it is recommended to students that they should know what strategies that appropriate and can help them in learning speaking English. The students should be able to choose strategies they need in learning and analyze which strategies that give better effect on their own learning.

  5. Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland


    Bloch-Infanger, Constantine; B?ttig, Veronika; Kremo, J?rg; Widmer, Andreas F.; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan


    Objective The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland. Methods At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospit...

  6. Gestational Trophoblastic Disease - Clinicopathological Study at Tertiary Care Hospital. (United States)

    Jagtap, Sunil Vitthalrao; Aher, Vidhya; Gadhiya, Suchi; Jagtap, Swati Sunil


    Gestational Trophoblastic Disease (GTD) is a term used for a group of pregnancy-related tumours. These consist of various tumours and tumour like lesions characterized by proliferation of trophoblastic tissue. Amongst GTD, hydatidiform moles are the most common form. These lesions sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma. To study the clinicopathologic characteristics and prevalence of different forms of gestational trophoblastic disease in a tertiary care hospital. The present study was descriptive, observational, analytical type done in Department of Pathology at tertiary care hospital from May 2012 to April 2016. All cases clinically suspected of GTD were included and confirmation was done by histopathological study on H&E stained slides. The cases of GTD were classified according to WHO classification. Detailed histomorphological features and beta human Chorionic Gonadotropin (hCG) levels were correlated. During study period, 18345 deliveries were reported; out of which 77 cases were diagnosed as GTD. Almost 97.40% cases were of hydatidiform moles, 1.30% cases of choriocarcinoma and 1.30% cases of Placental Site Trophoblastic Tumour (PSTT). Among the cases of hydatidiform mole 57.34% were complete mole and 41.33% cases were of partial mole. The common clinical presentation was per vaginal bleeding and amenorrhea. The blood group A was most commonly observed in patient (49.35%). In majority of cases beta hCG levels were between 50,000 to 100000 mIU/ml. The correlation between beta hCG level and GTD were done. Pregnant females clinically presenting with abnormal vaginal bleeding must be evaluated for GTD. Histopathological examination is helpful for confirmatory diagnosis. Follow up of such patients is essential for early detection of malignant trophoblastic tumours.

  7. Tertiary tectonism in the Tapajos River Area, Amazon Basin; Tectonismo terciario na area do Rio Tapajos, Bacia do Amazonas

    Energy Technology Data Exchange (ETDEWEB)

    Travassos, W.A.S. [PETROBRAS, Belem, PA (Brazil). Distrito de Exploracao do Norte; Morais Barbosa Filho, C. de [PETROBRAS, Manaus, AM (Brazil). Distrito de Exploracao da Amazonia Ocidental


    Studies of a deformed sedimentary zone occurred during the tertiary period on the Amazon Basin, its localization on the region of the Tapajos River are discussed. The origin, characteristics and identification of these zone through seismic, gravimetric and aero-magnetometric surveys are also presented. 17 figs., 25 refs.

  8. Stereoinversion of tertiary alcohols to tertiary-alkyl isonitriles and amines. (United States)

    Pronin, Sergey V; Reiher, Christopher A; Shenvi, Ryan A


    The SN2 reaction (bimolecular nucleophilic substitution) is a well-known chemical transformation that can be used to join two smaller molecules together into a larger molecule or to exchange one functional group for another. The SN2 reaction proceeds in a very predictable manner: substitution occurs with inversion of stereochemistry, resulting from the 'backside attack' of the electrophilic carbon by the nucleophile. A significant limitation of the SN2 reaction is its intolerance for tertiary carbon atoms: whereas primary and secondary alcohols are viable precursor substrates, tertiary alcohols and their derivatives usually either fail to react or produce stereochemical mixtures of products. Here we report the stereochemical inversion of chiral tertiary alcohols with a nitrogenous nucleophile facilitated by a Lewis-acid-catalysed solvolysis. The method is chemoselective against secondary and primary alcohols, thereby complementing the selectivity of the SN2 reaction. Furthermore, this method for carbon-nitrogen bond formation mimics a putative biosynthetic step in the synthesis of marine terpenoids and enables their preparation from the corresponding terrestrial terpenes. We expect that the general attributes of the methodology will allow chiral tertiary alcohols to be considered viable substrates for stereoinversion reactions.

  9. Mucormycosis at a tertiary care centre in Gujarat, India. (United States)

    Patel, Atul K; Patel, Ketan K; Patel, Kamlesh; Gohel, Swati; Chakrabarti, Arunaloke


    The prevalence of mucormycosis is reportedly high in India, although the studies are mainly from north and south India only. We analysed the mucormycosis cases at tertiary care centres of West India. We retrieved the clinical details of all the patients with probable and proven mucormycosis diagnosed at Sterling Hospital and ID clinic at Ahmedabad, Gujarat over the period from 1 January 2013 through 30 April 2015. The data were analysed to determine demography, risk factors, underlying diseases, site of infection and outcome of these patients. A total of 27 patients with the median age of 50 (16-65) years were diagnosed with mucormycosis during the period. Rhino-orbital-cerebral mucormycosis was the most common (51.9%) presentation. Majority (55.6%) of the patients had uncontrolled diabetes with or without ketoacidosis; 25.9% patients had no underlying disease and most of them (85.7%) had cutaneous mucormycosis. In this group, the mortality was 25.9% and an equal percentage of patients were lost to follow up; 14 (51.9%) patients could complete 6 weeks of amphotericin B therapy. All patients who completed antifungal therapy survived except one. Like other parts of India, uncontrolled diabetes was the predominant risk factor for mucormycosis in our group. Patients completing 6 weeks of amphotericin B treatment were likely to survive. © 2017 Blackwell Verlag GmbH.

  10. Mastalgia: Prevalence at a Sub-Saharan African Tertiary Hospital

    Directory of Open Access Journals (Sweden)

    T. Makumbi


    Full Text Available Introduction. Mastalgia is a common breast condition among women referred to breast clinics worldwide. Whereas the prevalence is known in the Western world and Asia, the prevalence of the disease is unknown in many African countries. The aim of this study therefore was to determine the prevalence and describe factors associated with mastalgia among women attending a tertiary hospital in sub-Saharan Africa. Methods. A cross-sectional study was done in Kampala, Uganda. Mastalgia was defined as self-reported breast pain (unilateral or bilateral for a period not less than two months. A pretested questionnaire was used to collect the data and statistical analysis was performed using SPSS version 11. Ethical approval was obtained. Results. Out of the 1048 women who presented to the breast clinic during the study period, 168 (16% were diagnosed with mastalgia in the absence of breast cancer. Noncyclical and cyclical mastalgia were 22/168 (13% and 5/168 (3%, respectively. The onset of noncyclical category as compared to the cyclical type of mastalgia was observed to manifest before 24 years of age (P=0.006. Conclusion. Mastalgia was a common condition among women in this sub-Saharan African setting as is elsewhere. The early onset mastalgia in this sub-Saharan African study requires further exploration for determination of its risk factors.

  11. Intestinal parasitoses in a tertiary-care hospital located in a non-endemic setting during 2006–2010


    Calderaro, Adriana; Montecchini, Sara; Rossi, Sabina; Gorrini, Chiara; De Conto, Flora; Medici, Maria Cristina; Chezzi, Carlo; Arcangeletti, Maria Cristina


    Background The aim of this study was to assess the epidemiology of intestinal parasitoses during a 5-year period in patients attending a tertiary-care hospital in a non-endemic setting. Methods In the period 2006–2010, 15,752 samples from 8,886 patients with clinically suspected parasitosis were subjected to macroscopic and microscopic examination, to parasitic antigen detection assays, and to cultures for protozoa and nematodes. Real-time PCR assays for the differentiation of Entamoeba histo...

  12. Evaluation of the Special Tertiary Admissions Test (STAT) (United States)

    Coates, Hamish; Friedman, Tim


    This paper reports findings from the first national Australian study of the predictive validity of the Special Tertiary Admissions Test (STAT). Background on tertiary admissions procedures in Australia is presented, followed by information on STAT and the research methods. The results affirm that STAT, through the provision of baseline and…

  13. Academic mentoring and the future of tertiary education in Nigeria ...

    African Journals Online (AJOL)

    Tertiary education is a major outlet for the provision of high manpower for national development. This paper therefore highlighted the challenges of tertiary education in Nigeria, early perspectives of mentoring undergraduates, the rationale for academic mentoring, the role of a mentor, and the role of library as catalyst in the ...

  14. Opinions of Nigerian students in tertiary institutions on family size ...

    African Journals Online (AJOL)

    The study examined the opinions of Nigerian students in tertiary institutions on their ideal family size. It was conducted among students in four tertiary institutions in Edo State of Nigeria. A sample size of 454 final year students was randomly drawn from the halls of residence in the institutions using the stratified sampling ...

  15. Cost-minimization analysis of antimicrobial therapy in a tertiary ...

    African Journals Online (AJOL)

    Cost Minimization Analysis of antimicrobial therapy in a tertiary health care institution in a developing economy country was carried out. The most applicable tool for generic equivalent drugs was used in Ahmadu Bello University Teaching Hospital, a tertiary healthcare Institution in Nigeria, between 2005 and 2007. Relevant ...

  16. Conceptualising English as a lingua franca (ELF) as a tertiary ...

    African Journals Online (AJOL)

    This contribution draws on the notion of English as a lingua franca, especially as discussed in James (2006) and Smit (2010), to conceptualise English-medium tertiary education in settings where English functions as additional language and where tertiary education has a history of being undertaken in other, usually ...

  17. Solvent effects on the magnetic shielding of tertiary butyl alcohol ...

    African Journals Online (AJOL)

    The magnetic shielding and its polarizabilities, have been calculated for tertiary butyl alcohol and tertiary butyl amine. These have been used to rationalise the solvent shifts of the proton spectra of the interesting cosolvent systems with water recently measured by Kipkemboi, et al. Continuum solvation calculations and ...

  18. Crime and Crime Management in Nigeria Tertiary Institutions (United States)

    Adebanjo, Margaret Adewunmi


    This paper examines crime and its management in Nigerian tertiary institutions. Tertiary institutions today have become arenas for crime activities such as rape, cultism, murder, theft, internet fraud, drug abuse, and examination malpractices. This paper delves into what crime is, and its causes; and the positions of the law on crime management.…

  19. Pursuing Discipline and Ethical Issues in Tertiary Institutions in Nigeria

    African Journals Online (AJOL)

    Discipline and ethics are twin issues that tend to undermine the provision of quality education in tertiary institutions in Nigeria. This is because the overall goals of tertiary institutions as enunciated in the National Policy of. Education can hardly be achieved by all the stakeholders without strict conformity and adherence to the ...

  20. 10 CFR 212.78 - Tertiary incentive crude oil. (United States)


    ... 10 Energy 3 2010-01-01 2010-01-01 false Tertiary incentive crude oil. 212.78 Section 212.78 Energy DEPARTMENT OF ENERGY OIL MANDATORY PETROLEUM PRICE REGULATIONS Producers of Crude Oil § 212.78 Tertiary incentive crude oil. Annual prepaid expenses report. By January 31 of each year after 1980, the project...

  1. Abdominal trauma experience over a two-year period at a tertiary ...

    African Journals Online (AJOL)

    Road traffic accidents (RTAs) were the most common cause of injury accounting for 64.9% of cases. None of our patients received any pre-hospital care. The spleen was the most commonly injured organ in blunt abdominal trauma occurring in 176 (75.9%) patients, while in penetrating injury; it was the gastrointestinal tract ...

  2. Seepage characteristics of the second tertiary combined model

    Directory of Open Access Journals (Sweden)

    Huan ZHAO


    Full Text Available The second tertiary combined model experiment zone has been developed in Block B, Field L. The percolation feature of the second tertiary combined develop model shows great importance to rational and efficient development of the reservoir. In order to clearly illuminate its percolation feature, the typical reservoir numerical model is built by Eclipse, which is a reservoir numerical simulation software. The percolation features of original and added perforation interval under the second tertiary combined model are studied, and the variation features of general water-cut, recovery percentage, wellbore pressure, reservoir pressure and water saturation on condition of higher injection rate under the second tertiary combined model are analyzed. The research indicates that the second tertiary combined enhances the recovery of remaining oil on top of thick reservoir by developing and enhancing original perforation interval under water drive, then improves development results by polymer flooding, and gains higher recovery rate by synthetic action of water driver and polymer flooding.

  3. Navigating the global space of tertiary education:

    DEFF Research Database (Denmark)

    Wilken, Lisanne

    to the Bologna model in order to ease mobility (at least within Europe). This paper which is based on some very preliminary findings from an ongoing research project exploring internationalization of university education in Denmark, discusses educational strategies of students attending internationalized English......Over the past ten years the number of students who go abroad to pursue tertiary education has more than doubled, from 1, 9 million in 2000 to 4.1 million in 2010 (OECD 2012). This growing number of students studying abroad contributes to the overall flow of individuals and ideas across borders...... at lesser known universities in smaller European countries such as Sweden, Norway, Denmark and the Netherlands where the national language is not one of the major world languages but where courses and educations are increasingly offered in English and where the educational structures are adapted...

  4. Grignard Synthesis of Various Tertiary Alcohols (United States)

    Everett, T. Stephen


    A general Grignard procedure is presented for the synthesis of aliphatic, tertiary alcohols containing six to nine carbons. Without revealing the specific starting materials, students are challenged to identify their unknown products from physical (boiling points, refractive indices) and spectral (infrared O-H, C-H and fingerprint regions) data. Once a product is identified retro-synthetic considerations point to which alkyl halide and ketone were required as starting materials. This laboratory exercise in organic synthesis incorporates anhydrous techniques, distillation, and infrared analysis. RX + Mg ---> [RMgX] + R'R"C=O ---> [RR'R"COMgX] ---> RR'R"COH Criteria RX = C2-C5 1' alkyl bromide (unbranched) R'R"C=O = C3-C5 ketone RR'R"COH = C6-C9 3' alcohol

  5. Absent menstrual periods - primary (United States)

    Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary ... nutrition Tumors In many cases, the cause of primary amenorrhea is not known.

  6. Experience of intravitreal injections in a tertiary Hospital in Oman. (United States)

    Al-Hinai, Ahmed S


    To find out statistical data regarding intravitreal injections in an outpatient department setup at a tertiary center in Oman. Retrospective chart review. Data collection of patients who underwent intravitreal injections from November 2009 to May 2013 at Sultan Qaboos University Hospital. Throughout a period of 42 months, a total of 711 intravitreal injections were performed. That included 214 patients (275 eyes). Around one-third of the eyes received two injections or more. The injected agents were bevacizumab (59.8%), ranibizumab (32.3%), triamcinolone (7.5%), and very few patients with endophthalmitis received intravitreal antibiotics and antifungal agents. The three most common indications for the injection therapy were diabetic macular edema (50.9%), choroidal neovascularization (24.3%), and retinal vein occlusive diseases (11.5%). Serious adverse events were rare, and they occurred as ocular (0.9% per patient) and systemic (3.3% per patient). There were 42 eyes received intravitreal triamcinolone, and 24% of them developed intraocular hypertension that required only medical treatment. Different intravitreal agents are currently used to treat many ocular diseases. Currently, therapy with intravitreal agents is very popular, and it carries a promising outcome with more efficiency and safety.


    Directory of Open Access Journals (Sweden)

    Subhra Ghosh


    Full Text Available BACKGROUND Birth defects are responsible for increased perinatal mortality and long-term morbidities. To reduce its incidence, which is the need of the hour we should know more about them and possible risk factors, which can be prevented. The aim of the study is to study the overall frequency of birth defects in a tertiary hospital and search for association with certain risk factors. MATERIALS AND METHODS All newborns/stillborns with birth defects during one year were enrolled for the study. Similar number of newborns without birth defect during this period was taken as control. Relevant information was documented in both the groups and analysed. RESULTS Out of 11,008 births, congenital anomaly was found in 130 cases. The prevalence of birth defects was 1.18 percent. Association of occurrence of birth defects with increased paternal age, consanguinity, fever and drug intake in first trimester was found. 57.6% of the newborns with birth defects were stillborn, born at an earlier gestational age (33.6 week v/s. 37.5 weeks. Commonest system to be affected was CNS (49.2%. CONCLUSION Screening for aneuploidy and birth defects should be universal. Routine folic acid supplementation and pregnancy termination of malformed babies will reduce the incidences.

  8. Evolution of periodicity in periodical cicadas. (United States)

    Ito, Hiromu; Kakishima, Satoshi; Uehara, Takashi; Morita, Satoru; Koyama, Takuya; Sota, Teiji; Cooley, John R; Yoshimura, Jin


    Periodical cicadas (Magicicada spp.) in the USA are famous for their unique prime-numbered life cycles of 13 and 17 years and their nearly perfectly synchronized mass emergences. Because almost all known species of cicada are non-periodical, periodicity is assumed to be a derived state. A leading hypothesis for the evolution of periodicity in Magicicada implicates the decline in average temperature during glacial periods. During the evolution of periodicity, the determinant of maturation in ancestral cicadas is hypothesized to have switched from size dependence to time (period) dependence. The selection for the prime-numbered cycles should have taken place only after the fixation of periodicity. Here, we build an individual-based model of cicadas under conditions of climatic cooling to explore the fixation of periodicity. In our model, under cold environments, extremely long juvenile stages lead to extremely low adult densities, limiting mating opportunities and favouring the evolution of synchronized emergence. Our results indicate that these changes, which were triggered by glacial cooling, could have led to the fixation of periodicity in the non-periodical ancestors.

  9. Assessing uncertainty in outsourcing clinical services at tertiary health centers. (United States)

    Billi, John E; Pai, Chih-Wen; Spahlinger, David A


    When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract. Copyright (c) 2006 John Wiley & Sons, Ltd.

  10. Association between contact precautions and delirium at a tertiary care center. (United States)

    Day, Hannah R; Perencevich, Eli N; Harris, Anthony D; Gruber-Baldini, Ann L; Himelhoch, Seth S; Brown, Clayton H; Dotter, Emily; Morgan, Daniel J


    To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors. Retrospective cohort study. A 662-bed tertiary care center. All nonpyschiatric adult patients admitted to a tertiary care center from 2007 through 2009. Generalized estimating equations were used to estimate the association between contact precautions and delirium in a retrospective cohort of 2 years of admissions to a tertiary care center. During the 2-year period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (as defined by International Classification of Diseases, Ninth Revision), medication, or restraint exposure (adjusted odds ratio [OR], 1.40 [95% confidence interval {CI}, 1.24-1.51]). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their stay (adjusted OR, 1.75 [95% CI, 1.60-1.92]; P contact precautions at admission (adjusted OR, 0.97 [95% CI, 0.86-1.09]; P = .06). Although delirium was more common in patients who were newly placed under contact precautions during the course of their hospital admission, delirium was not associated with contact precautions started at hospital admission. Patients newly placed under contact precautions after admission but during hospitalization appear to be at a higher risk and may benefit from proven delirium-prevention strategies.

  11. Potential impact of tertiary oil recovery

    Energy Technology Data Exchange (ETDEWEB)

    Kastrop, J.E.


    Tertiary oil recovery is America's energy ace-in-the-hole and the technology developed here over the past decade could well offer the rest of the world a big incremental boost in its future oil supplies. While U.S. producers are carefully engineering fields that have finished secondary phases of oil production, international operators are commencing pressure maintenance projects by water and gas injection, the first stage of improved oil recovery. Oil recovery authorities who have dealt with the problem for decades estimate that from 25 to 50 billion bbl could be recovered by relatively new sophisticated processes initially developed in the research laboratory and tested in the field. There are 4 basic processes that indicate promise of commercial applications. These are (1) hydrocarbon miscible which includes high-pressure gas drive, rich gas or LPG driven by gas; (2) carbon dioxide miscible with CO/sub 2/ driven by gas or water; (3) chemical flooding, such as surfactant, micellar slugs driven by an aqueous polymer solution; and (4) thermal processes.

  12. The Tertiary tectonics of the southeast Asia

    Energy Technology Data Exchange (ETDEWEB)

    Honza, Eiichi (Geological Survey of Japan, Tsukuba (Japan))


    Most of the terranes in eastern Asia appear to be relics of arcs, oceanic islands, and subduction complexes. They have collided and accreted from the inner (northwestern) side in China since the Silurian. They are characterized by three stages of Pacific and Tethys evolution. The first collision is related to the Pacific domain in the Permian in which these movements are not clearly reconstructed. The second collision is related to the closure of the Paleo-Tethys in the Late Triassic to Early Jurassic. The third is related to closure of the Neo-Tethys and the subsequent collision of India in the Tertiary. Southeast Asia is in one of the most enigmatic plate boundaries in the world, forming many small plates, collisions, and consumptions. This complication is also suggested to be a result of the northward movement of Australia since its break-up from Gondwanaland in the Cretaceous. During their evolution, most of them have associated with arcs. These arcs also have formed superimpositions on the older exotic blocks of terranes. They are reconstructed on the base of the regular duration on the formation of arcs and backarc basins, which can be seen in the Western Pacific Arc Chain.

  13. Instrumental vaginal delivery - an assessment of use in a tertiary ...

    African Journals Online (AJOL)


    Instrumental vaginal delivery - an assessment of use in a tertiary care centre. Constance E SHEHU. Joel C OMEMBELEDE. Dept of Obstetrics &. Gynaecology, Usmanu. Danfodiyo, University. Teaching Hospital Sokoto. NIGERIA. Author for Correspondence. Constance E SHEHU. Dept of Obstetrics &. Gynaecology, Usmanu.

  14. Aquatic Life Criteria - Methyl Tertiary-Butyl Ether (MTBE) (United States)

    Information pertaining to the 1999 Acute and Chronic Ambient Aquatic Life Water Quality Criteria for Methyl Tertiary-Butyl Ether (MTBE) for freshwater and salt water. Information includes the safe levels of MTBE that should protect the majority of species.

  15. Language and Literature in Tertiary Education: The Case for Stylistics. (United States)

    Buckledee, Steve


    Advocates the use of stylistics for teaching English-as-a-Foreign-Language at the tertiary level. Describes stylistics, discusses discourse conventions and grammatical structure, and examines stylistic analysis of a Shakespearian sonnet and a poem. (Author/VWL)


    A direct synthesis of tertiary amines is presented that proceeds expeditiously via N-alkylation of amines using alkyl halides in alkaline aqueous medium. This environmentally benign reaction is accelerated upon exposure to microwave irradiation resulting in shortened reaction tim...

  17. Pregnancy outcome in unbooked mothers at a tertiary health ...

    African Journals Online (AJOL)

    demographical characteristics and feto-maternal outcome in unbooked mothers who delivered at a tertiary referral ... Data obtained from the theatre records, delivery registers and case notes were analysed using the statistical package SPSS 20.

  18. Positive and negative impact of increased tertiary attainment

    Directory of Open Access Journals (Sweden)

    Alena Bušíková


    Full Text Available The theory of human capital clearly states that the investments into the education bring many benefits and are worth the cost. The OECD Education at a Glance analysis provides support for both public and private investing in tertiary education as the net present value is positive for all observed countries. Considering the benefits of education, a growth in tertiary education should be viewed very positively. In this context, the European Strategy Europe 2020 set up one of its main goals for EU27 countries as follows: to increase the educated population so that it reaches 40% (tertiary educated people aged 30-34. This article, on an example of Slovakia, provides an analysis of both positive and negative impact of increased tertiary attainment.

  19. Social Activities and Manifest Anxiety among Freshmen in Tertiary ...

    African Journals Online (AJOL)

    ) in tertiary institutions in Lagos state of Nigeria were analysed to determine the relationship between social activities and manifest anxiety. Social activities in the study were measured in terms of freshmen adjustment to religious activities and ...

  20. Primary Index Term Secondary Index Term Tertiary Index term ...

    Indian Academy of Sciences (India)


    Tertiary Index term. Geosciences. Solid earth. Tectonics. Structural Geology. Geodynamics. Seismology. Exploration geophysics. Seismic hazards. Geomagnetism. Mineralogy. Petrology. Metamorphic. Igneous. Sedimentary. Fossil fuels. Petroleum and coal. Isotope geology. Geochronology. Isotope geology. Landform and.

  1. Challenges with Tertiary-Level Mechatronic Fluid Power

    DEFF Research Database (Denmark)

    Dransfield, Peter; Conrad, Finn


    As authors we take the view that mechatronics, as it relates to fluid power, has three levels which we designate as primary, secondary and tertiary. A brief review of the current status of fluid power, hydraulic and pneumatic, and of electronic control of it is presented and discussed. The focus...... is then on tertiary-level mechatronic fluid power and the challenges to it being applied successfully....

  2. Positive and negative impact of increased tertiary attainment


    Alena Bušíková


    The theory of human capital clearly states that the investments into the education bring many benefits and are worth the cost. The OECD Education at a Glance analysis provides support for both public and private investing in tertiary education as the net present value is positive for all observed countries. Considering the benefits of education, a growth in tertiary education should be viewed very positively. In this context, the European Strategy Europe 2020 set up one of its main goals for ...

  3. Changes in Humoral and Cellular Immunity in Tertiary Peritonitis


    Matviychuk, Oleh


    The objective of the research was to give a comparative characteristic of parameters of humoral and cellular immunity in the development of secondary and tertiary peritonitis.Materials and methods. The research enrolled 109 patients with secondary peritonitis, 20 of whom developed tertiary peritonitis. Changes in humoral and cellular immunity were evaluated by serial blood tests for the determination of leukocyte count, the relative number of lymphocytes, Ig A, M, and G levels, as well as by ...

  4. Treatment of self-poisoning at a tertiary level hospital in Bangladesh

    DEFF Research Database (Denmark)

    Verma, Vasundhara; Paul, Sujat; Ghose, Aniruddha


    OBJECTIVES: Approximately 10,000 people die from suicide annually in Bangladesh, many from pesticide poisoning. We aimed to estimate financial costs to patients and health services of treating patients with self-poisoning. METHODS: Data on direct costs to families, sources of funds for treatment...... and family wealth were collected prospectively over a one-month period in 2016 at the tertiary Chittagong Medical College Hospital, Bangladesh. Aggregate operational costs to the government were calculated using annual budget, bed occupancy and length-of-stay data. RESULTS: Agrochemicals were the most common...

  5. Autopsy study of febrile deaths during monsoon at a tertiary care institute in India: Is malaria still a challenge?


    Anurag Gupta; Varsha Dhume; Gururaj Venkatesh Puranik; Vikas Kavishwar


    Background: To utilise an autopsy-based approach to study the febrile deaths and deaths due to malaria during monsoon period of three years at a tertiary care teaching hospital in Mumbai, India. Materials and Methods: All autopsies done at the hospital during monsoon period from 2005 to 2007 when fever was the main presenting symptom were included in the study. Monsoon period was defined from June to September. A study on the duration of hospital stay of malaria deaths was also attempted. Res...

  6. Effects of tertiary treatment by fungi on organic compounds in a kraft pulp mill effluent. (United States)

    Rocha-Santos, Teresa; Ferreira, Filipe; Silva, Lurdes; Freitas, Ana Cristina; Pereira, Ruth; Diniz, Mário; Castro, Luísa; Peres, Isabel; Duarte, Armando Costa


    Pulp and paper mills generate a plethora of pollutants depending upon the type of pulping process. Efforts to mitigate the environmental impact of such effluents have been made by developing more effective biological treatment systems in terms of biochemical oxygen demand, chemical oxygen demand, colour and lignin content. This study is the first that reports an evaluation of the effects of a tertiary treatment by fungi (Pleurotus sajor caju, Trametes versicolor and Phanerochaete chrysosporium and Rhizopus oryzae) on individual organic compounds of a Eucalyptus globulus bleached kraft pulp and paper mill final effluent after secondary treatment (final effluent). The tertiary treatment with P. sajor caju, T. versicolor and P. chrysosporium and R. oryzae was performed in batch reactors, which were inoculated with separate fungi species and monitored throughout the incubation period. Samples from effluent after secondary and after tertiary treatment with fungi were analysed for both absorbance and organic compounds. The samples were extracted for organic compounds using solid-phase extraction (SPE) and analysed by gas chromatography-mass spectrometry (GC/MS). The efficiencies of the SPE procedure was evaluated by recovery tests. A total of 38 compounds (carboxylic acids, fatty alcohols, phenolic compounds and sterols) were identified and quantified in the E. globulus bleached kraft pulp mill final effluent after secondary treatment. Recoveries from the extraction procedure were between 98.2% and 99.9%. The four fungi species showed an adequate capacity to remove organic compounds and colour. Tertiary treatment with R. oryzae was able to remove 99% of organic compounds and to reduce absorbance on 47% (270 nm) and 74% (465 nm). P. sajor caju, T. versicolor and P. chrysosporium were able to remove 97%, 92% and 99% of organic compounds, respectively, and reduce 18% (270 nm) to 77% (465 nm), 39% (270 nm) to 58% (465 nm) and 31% (270 nm) to 10% (465 nm) of absorbance

  7. Overnight Emergency CT Imaging: A 10-Year Experience at an Irish Tertiary Referral Hospital.

    LENUS (Irish Health Repository)


    In recent years there has been increased utilisation of computed tomography (CT) imaging in developed countries, however there is a paucity of data regarding the utilisation of CT in the emergency overnight setting. We retrospectively analysed trends in ‘overnight’ (midnight to 8am) CT utilisation over a ten-year period at a single Irish tertiary referral hospital. Over the study period, we observed a significant increase in the proportion of CT imaging that was carried out overnight. There was no significant variation in the yield of pathological findings over the study period, which remained low (64% of CT studies were normal or had non-critical findings). The multiple factors which have contributed to the increased utilization of overnight emergency CT in recent years, the potential for reporting errors overnight and the implications therein for patient safety warrant consideration.

  8. Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital


    C Aneke John; U Ezeh Theodora; A Nwosu Gloria; E Anumba Chika


    Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for ana...

  9. Survival following orbital exenteration at a tertiary brazilian hospital

    Directory of Open Access Journals (Sweden)

    Juliana Mika Kato

    Full Text Available Objective: to analyze the epidemiology, clinical features and survival rate of patients undergoing orbital exenteration (OE in a tertiary referral hospital. Methods : we conducted a retrospective study of all patients undergoing OE at the Hospital das Clínicas, FMUSP between January 2007 and December 2012. We collected data records related to gender, age, origin, length of stay, duration of the disease, other treatments related to the disease, number of procedures outside of the face related to the disease, follow-up and histological diagnosis. Results : we treated 37 patients in the study period. The average survival in one year was 70%, in two years, 66.1%, and 58.3% in three years. There was no significant difference in the one-year survival related to histological diagnosis (p=0.15, days of hospitalization (p=0.17, gender (p=0.43, origin (p=0.78, disease duration (p=0.27 or the number of operations for the tumor (p=0.31. Mortality was higher in elderly patients (p=0.02. The average years of life lost was 33.9 in patients under 60 years, 14.7 in patients in the 61-80 years range and 11.3 in patients over 80 years. Conclusion : the present series of cases is significant in terms of prevalence of orbital exenteration; on the other hand, it shows one of the lowest survival rates in the literature. This suggests an urgent need for improved health care conditions to prevent deforming, radical resections.

  10. Meconium aspiration syndrome - the experience of a tertiary center. (United States)

    Espinheira, M C; Grilo, M; Rocha, G; Guedes, B; Guimarães, H


    Approximately 5 % of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). The aims of this study were to analyse demographic data, morbidity and mortality associated with MAS and to identify possible risk factors. Retrospective chart review of newborns with MAS delivered at a tertiary centre from January 1st, 1997 to December 31st, 2008. MAS was responsible for 1.4 % of all Neonatal Intensive Care Unit (NICU) admissions, with a trend towards a decreasing incidence during the study duration, especially in the cases of thin meconium. Seventy two newborns were analysed during the study period: 55.6 % (n = 40) were of the female gender, 62.5 % were delivered by caesarean section, 93 % had > 36 weeks of gestational age and 91.2 % had a birth weight over 2500g. Sixty-nine percent had an Apgar score bradicardia was present in 26.4 % of the newborns and tachycardia in 1.4 %. The presence of meconium was associated with severe asphyxia and carried a bad prognosis with an increased risk of developing hypoxia (58.3 %), need of mechanical ventilatory support (43.1 %), respiratory and/or metabolic acidosis (30.6 %), pulmonary hypertension (11.1 %) and hypoxic ischemic encephalopathy (29.2 %). The mortality rate was 2.8 %. Thick meconium was associated with higher morbidity and mortality rates. The number of admissions for MAS has been decreasing mostly because of a lower admission rate due to thin meconium; the number of cases with thick meconium has remained constant throughout the years. An Apgar score < 7 at 1 minute and signs of foetal distress during labour were associated with MAS. The MAS related morbidity remains significant.

  11. Near total parathyroidectomy is effective therapy for tertiary hyperparathyroidism. (United States)

    Dewberry, Lindel Krige; Weber, Collin; Sharma, Jyotirmay


    Tertiary hyperparathyroidism (3°HPT) is defined as persistent hyperparathyroidism with hypercalcemia after renal transplantation. Near total parathyroidectomy (NTPTX) is the current standard for surgical intervention. The purpose of this study was to identify outcomes of NTPTX. A retrospective review was conducted of surgeries performed between 1994 and 2013. NTPTX resulted in resolution of 96.9 per cent of patients' hypercalcemia at a median follow-up of three years (interquartile range [IQR], 1 to 8). However, 3.1 per cent of patients remained hypercalcemic with a mean calcium of 10.5 ± 0.2 mg/dL. A total of 78.4 per cent of patients had parathyroid hormone (PTH) levels below 250 pg/mL at a median follow-up of two years (IQR, 2 to 8). The remaining 21.6 per cent had a median PTH of 535 (IQR, 345 to 857). PTH levels dropped from a median of 745 (IQR, 285.75 to 1594.25) pg/mL to 97 (IQR, 60 to 285) pg/mL one month post-NTPTX (P < 0.01). The most frequent complication was transient hypocalcemia in 27.1 per cent of patients, but no patients became permanently hypocalcemic. In the 1-month postoperative period, only one patient had a cardiac complication, and there was 0 per cent all-cause mortality. Glomerular filtration rate fell from 57.9 ± 28.3 mL/min pre-NTPTX to 53.2 ± 27.5 mL/min at 1-year post-NTPTX (P < 0.01). NTPTX effectively treats hypercalcemia in 3°HPT. However, PTH remains elevated (greater than 250) in 21.6 per cent of patients.

  12. Patterns of Antimicrobial Prescribing in a Tertiary Care Hospital in Oman. (United States)

    Al-Yamani, Abdulrahman; Khamis, Faryal; Al-Zakwani, Ibrahim; Al-Noomani, Hamed; Al-Noomani, Jaleela; Al-Abri, Seif


    Antimicrobial stewardship programs have been designed to measure and improve the use of antimicrobials to achieve optimal clinical outcomes and reduce bacterial resistance. The aim of this study was to review patterns of antimicrobial prescribing for hospitalized patients in the acute care setting and assess the appropriateness of antimicrobial use among prescribers in a tertiary care hospital in Oman. We conducted a retrospective audit of the appropriateness of antimicrobial prescribing in patients admitted to acute care settings in a tertiary care hospital in Oman over a four-week period (1 November to 28 November 2012). The data of all discharged patients were retrieved from the department databases. Patient records and prescriptions were reviewed by an infectious disease consultant. The rationality of antimicrobial use was evaluated, analyzed, and judged based on local standard guidelines and the experience of the evaluating consultant. There were 178 patients discharged from acute medical teams over the study period. Sixty-four percent of the patients received a total of 287 antimicrobial agents during admission. The average number of antimicrobials prescribed per patient in those prescribed antimicrobials was 2.5±1.1. The most commonly prescribed antimicrobial agent was piperacillin/tazobactam. Most patients had infections from gram-negative organisms, and high rates of extended spectrum beta-lactamase producing organisms were observed. Cultures were obtained before antimicrobial initiation in 25% of patients. Variability in antimicrobial selection for common infections was observed. National guidelines for the management of common infections are needed to minimize the overuse and misuse of antimicrobial agents in tertiary care hospitals. A large surveillance study on antimicrobial prescribing appropriateness in different hospital settings is warranted.


    Directory of Open Access Journals (Sweden)

    Elizabeth Joseph


    Full Text Available BACKGROUND DM WIMS is the only tertiary care referral hospital in the hilly tribal district of Wayanad. This is an observational study of 20 maternal near miss cases that presented in our hospital over a period of 4 months. MATERIALS AND METHODS This study was conducted by collecting data over a period of 4 months. Total number of live births in this period was 373. There were 20 cases of maternal near miss cases. Maternal near miss cases were chosen based on the inclusion criteria provided by WHO near miss approach for maternal health. RESULTS There were 373 live births in the 4-month observational period. In these 4 months, there were 20 cases of maternal near miss cases in our hospital. That is, maternal near miss ratio was 53.6/1000 live births. The majority were referred cases with MNM ratio of intrahospital cases being 13.4/1000 live births. The potentially life-threatening complications were obstetric haemorrhage and hypertensive disorders, which coexisted in majority of the women. The obstetric haemorrhage was mainly due to abruptio placenta, which can be attributed to the hypertensive complications. Preexisting anaemia was present in 35% of the MNM cases increasing their morbidity. CONCLUSION The maternal near miss ratio was 53.6/1000 live births, which is high. This can be attributed to the fact that our hospital is the only tertiary referral hospital in the hilly tribal district of Wayanad. Despite the MNM ratio being high, there were no cases of maternal death in this period. Low maternal mortality indicates the good first line of management given at the periphery hospital.

  14. Change in vibrato rate and extent during tertiary training in classical singing students. (United States)

    Mitchell, Helen F; Kenny, Dianna T


    Vibrato is an integral and desirable feature of the classical singing voice. For elite singing students, achieving and developing vibrato may constitute one of the essential elements of their vocal training, although it is not necessarily a focus of that training. In this longitudinal study, we measured vibrato rate (VR) and vibrato extent (VE) and regularity (SD) of VR and VE in student singers over the course of four semesters of tertiary level voice training at a conservatorium of music to determine how these parameters changed during training. Fifteen singers completed four semesters (2 years) of training. Singers performed four sustained pitches across their vocal range. Peaks and troughs of vibrato were isolated from the fundamental frequency trace to calculate VR in hertz and VE in semitones. Analysis using linear mixed models revealed significant increases in VE and decreases in VRSD over time. VR was within expected limits for classical singers in all semesters, and small VR reductions were not statistically significant between semesters over 2 years of training. VE showed significant increases between the start of year 1 and year 2. Periodicity of singers' VR (SD) improved over training, with significant decreases to VRSD over time. There was no significant change to VESD. Future studies will ascertain whether further changes to VR and VE occur over longer training periods, or whether the major changes occur early in tertiary training. Copyright (c) 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  15. Visual quasi-periodicity

    NARCIS (Netherlands)

    Pogalin, E.; Smeulders, A.W.M.; Thean, A.H.C.


    Periodicity is at the core of the recognition of many actions. This paper takes the following steps to detect and measure periodicity. 1) We establish a conceptual framework of classifying periodicity in 10 essential cases, the most important of which are flashing (of a traffic light), pulsing (of

  16. The equity imperative in tertiary education: Promoting fairness and efficiency (United States)

    Salmi, Jamil; Bassett, Roberta Malee


    While the share of the tertiary education age cohort (19-25) which is being given the opportunity to study has increased worldwide over the past two decades, this does not in fact translate into reduced inequality. For many young people, especially in the developing world, major obstacles such as disparities in terms of gender, minority population membership or disabilities as well as academic and financial barriers are still standing in their way. The authors of this article propose a conceptual framework to analyse equity issues in tertiary education and document the scope, significance and consequences of disparities in tertiary education opportunities. They throw some light on the main determinants of these inequalities and offer suggestions about effective equity promotion policies directed towards widening participation and improving the chances of success of underprivileged youths in order to create societies which uphold humanistic values.

  17. Incidence of Hospital Acquired Thrombosis (HAT) in a Tertiary Care Hospital.

    LENUS (Irish Health Repository)

    Khan, MI


    Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality in hospitalized patients. In spite of guidelines, VTE prophylaxis continues to be underutilised, and hospital acquired thrombosis (HAT) continues to be a problem. This study was conducted to estimate the incidence of HAT in a tertiary referral centre and to examine whether VTE risk assessment and thromboprophylaxis (TP) were implemented. Patients 18 years and above, with a radiologically-confirmed acute VTE during the study period of 15 weeks were included. Acute VTE was diagnosed in 100 patients and HAT was diagnosed in 48. There were 12,024 admissions over the study period, therefore the incidence of HAT was 0.4%. TP was prescribed in only 35% of patients, and 65% did not receive any or appropriate TP. Hospitals without active implementation of a formal risk assessment tool and TP policy are likely to continue to have increased incidence of HAT.

  18. Usability of cerebrospinal fluid biomarkers in a tertiary memory clinic

    DEFF Research Database (Denmark)

    Brandt, C.; Bahl, J.C.; Heegaard, N.H.


    AIM: Assays for cerebrospinal fluid (CSF) levels of total tau, phospho-tau protein and beta-amyloid 1-42 have been available for some years. The aim of the study was to assess the usability of these biomarkers in a mixed population of tertiary dementia referral patients in a university-based memory......, the sensitivity of a single abnormal value was between 33 and 66%. The specificity was high except when discriminating AD from amnestic mild cognitive impairment. Two or more abnormal markers further increased the specificity and decreased the sensitivity. CONCLUSION: In a tertiary setting, abnormal CSF biomarker...

  19. Exports of Tertiary Education Services and the Queensland Economy


    Duhs, Ted; Duhs, Alan


    Exports of tertiary education services have become a growth industry for the Queensland economy. Since a policy change in 1987 from an aid to a trade approach to overseas students, fee paying overseas students have risen from a mere 5.9 per cent of all overseas students in 1987, to 89.6 per cent in 1995. Exports of tertiary education services from the Queensland economy now rival wool and wheat in importance. A number of marketing and policy issues arise in the context of further change in th...

  20. Sexual harassment in tertiary institutions: A comparative perspective

    Directory of Open Access Journals (Sweden)

    Joseph Janice


    Full Text Available Sexual harassment is not a new phenomenon in tertiary institutions. It has been receiving considerable attention in research and the media and public awareness has increased dramatically. However, the term sexual harassment is not used uniformly across the globe because countries have defined it differently. Consequently, prevalence of sexual harassment in education varies across cultures. This paper examines sexual harassment from a comparative perspective. It specifically focuses on the definition of sexual harassment, incidence of sexual harassment of students in tertiary institutions, effects of sexual harassment on victims; and victims’ responses to sexual harassment. It also offers suggestions for curtailing sexual harassment in these institutions.

  1. Monitoring of antibiotic consumption and development of resistance by enterobacteria in a tertiary care hospital. (United States)

    Veličković-Radovanović, R; Stefanović, N; Damnjanović, I; Kocić, B; Antić, S; Dinić, M; Petrović, J; Mitić, R; Catić-Djordjević, A


    Antibiotics are the most frequently used drugs in hospitalized patients, but studies have shown that the prescribed antibiotics may be inappropriate and may contribute to antibiotic resistance. We carried out a survey of antibiotic consumption and antibiotic resistance in our tertiary care university hospital, from 2005 to 2013. We focus on cephalosporins, one of the most prescribed groups of antibiotics in the tertiary health care. The objective was to identify any relationship between ceftriaxone consumption and resistance by enterobacteria. Antibiotics consumption and antimicrobial resistance were monitored in the tertiary care university hospital from 2005 to 2013. Data on the use of antibiotics in surgical inpatients were obtained and expressed as defined daily doses per 100 bed days. Bacterial resistances were given as percentages of resistant isolates. There was an increasing trend in cephalosporins consumption from 9·56 DBD (2005) to 23·32 DBD (2013), with ceftriaxone as the most frequently used cephalosporin, 3·6 DBD (2005) to 10·78 DBD (2013). E. coli and P. mirabilis resistance to ceftriaxone increased significantly from 22% in 2005 to 47% in 2013 and from 31% in 2005 to 60% in 2013, respectively. We found a significant correlation between ceftriaxone consumption and E. coli resistance (r = 0·895, P < 0·05). Our study shows that cephalosporin consumption increased from 2005 to 2013, with ceftriaxone as the most prescribed antibiotic. E. coli and P. mirabilis resistance to ceftriaxone increased significantly over the study period. E. coli resistance increased with ceftriaxone consumption. © 2015 John Wiley & Sons Ltd.

  2. Prosthetic rehabilitation of patients with maxillary defects in a nigerian tertiary hospital. (United States)

    Omo, Jo; Sede, Ma; Enabulele, Je


    Maxillary defects are managed by prosthodontic rehabilitation using obturators. This rehabilitation goes through various stages, which invariably affects the quality-of-life of the patients. This study aims to analyze the types and design of obturators used in the rehabilitation of maxillary defects at a tertiary health institution in Nigeria. This is a retrospective study of all patients with maxillary defects treated at a tertiary institution between the period of October 2010 and May 2013. The data of interest collected from the patient's register and case notes include age, gender, type of defects, design of obturators and conditions for which treatment was offered. The collected data were analyzed using Statistical Package for Social Sciences version 16.0 (Chicago, Illinois, 2010) and result presented in frequencies and tables. A total of 19 case notes were retrieved. The age range was 5-73 years with the mean age of 46.37 ± 19.02 and peak age incidence at 41-60 years. The male: female ratio was 1:1.4. Surgical defects were the most common type of maxillary defects seen; accounting for 89.5% (17/19) of the cases, which were mostly associated with malignant tumors. Immediate surgical obturators were provided for 63.2% (12/19) of the subjects. Majority 70.6% (12/17) of those with surgical defects received immediate surgical obturators while all those with congenital defect were given feeding plate. There was a statistically significant association between the type of maxillary defect and type of obturator provided (P < 0.01). The results of this study suggest that majority of the obturators fabricated for patients with maxillary defect at the Tertiary health institution in Nigeria were immediate surgical obturators. Pre-surgical patient education and follow-up care is advocated.

  3. Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

    Directory of Open Access Journals (Sweden)

    Kotsikoris Ioannis


    Full Text Available Abstract Background The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1st January 2009 and 31st December 2010. Results Overall, 2452 (49.4% out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6% needed vascular surgical intervention. Conclusions The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.

  4. Second Period Access Report

    DEFF Research Database (Denmark)

    Maisondieu, Christophe; Giebhardt, Jochen; Tetu, Amelie

    The work described in this publication has received support from the European Community - Research Infrastructure Action under the FP7 “Capacities” Specific Programme through grant agreement number 262552, MaRINET. Project Periodic Report. 2nd Period: October 2012 – March 2014 inclusive.......The work described in this publication has received support from the European Community - Research Infrastructure Action under the FP7 “Capacities” Specific Programme through grant agreement number 262552, MaRINET. Project Periodic Report. 2nd Period: October 2012 – March 2014 inclusive....

  5. Painful menstrual periods (United States)

    Menstruation - painful; Dysmenorrhea; Periods - painful; Cramps - menstrual; Menstrual cramps ... a few days during each menstrual cycle. Painful menstruation is the leading cause of lost time from ...

  6. Students' Perception of Ceramics Education in Nigeria Tertiary ...

    African Journals Online (AJOL)


    Abstract. An investigation was conducted into the problems militating against students' enrolment in ceramics education at tertiary institutions in. Nigeria. The design of the study was a descriptive survey. The target population of the study was 8234 (eight thousand, two hundred and thirty four) students of four faculties in ...

  7. Cultism and violent behaviours in tertiary institutions in Nigeria ...

    African Journals Online (AJOL)

    Nigeria, with over one hundred and fifty tertiary institutions, has witnessed unprecedented violent behaviours occasioned by students' involvement in campus cultism. Peace on campus has been shattered due to this development of violent behaviour. Blood-letting arising from either murder or manslaughter has become ...

  8. Childhood Conduct Problem and Alcohol Use of Students in Tertiary ...

    African Journals Online (AJOL)

    Early behavioural problems in children may place them at risk of alcohol abuse in later life. The study investigated the association between childhood conduct problem and alcohol abuse of students in tertiary institutions in Nigeria. The data for this cross sectional study was collected from a randomly selected sample of ...

  9. Pursuing Discipline and Ethical Issues in Tertiary Institutions in Nigeria

    African Journals Online (AJOL)

    Nekky Umera

    Kayode Ajayi – Department of Educational Management & Business. Education, Olabisi Onabanjo University, ... way, it is said to be negative in perspective. Similarly, when discipline is viewed as a way of ... of this group. In the process of conforming. Pursuing Discipline and Ethical Issues in Tertiary Institutions in Nigeria ...

  10. Determinants of the Employability of Tertiary Institution Graduates in ...

    African Journals Online (AJOL)

    We found that (i) proportionately different labour market performance engagements existed among tertiary institution graduates; (ii) more graduates were engaged in government than private sector and self sector employments and (iii) retrogressively common entrepreneurial practices, introvert personality trait, cognitive ...

  11. Bryozoa from the Tertiary sediments of Western Kachchh, Gujarat ...

    Indian Academy of Sciences (India)

    succession of Jabal Hafit, Al Ain, United Arab Emi- rates and Arabian Peninsula; Bullettino della Societ`a. Palaeontologica Italiana 42(3) 242–265. Canu F and Bassler R S 1920 North American early Tertiary. Bryozoa; United States National Museum Bulletin 106. 1–879. Canu F and Bassler R S 1929 Contribution to the ...

  12. Postoperative nausea and vomiting at a tertiary care hospital in ...

    African Journals Online (AJOL)

    Background: Postoperative nausea and vomiting is one of the most distressing morbidities associated with surgery. This descriptive prospective study was conducted to determine the incidence, predictors and management of postoperative nausea and vomiting among patients attending a tertiary hospital in north-western ...

  13. Hand Washing Practices amongst Doctors in A Tertiary Hospital in ...

    African Journals Online (AJOL)

    Washing hand with soap and water is said to be the single most important intervention against hospital acquired infections. This study aimed to explore perceptions, attitudes and hand washing practices amongst doctors in a tertiary institution in Port Harcourt, Nigeria. This was a descriptive cross sectional survey carried out ...

  14. Patterns and Outcomes of Diabetic Admissions in a Tertiary Hospital ...

    African Journals Online (AJOL)

    The prevalence of diabetes mellitus is increasing globally. It also constitutes one of the common indications for admission into the medical wards of most hospitals. This study is aimed at examining diabetes –related admission and outcomes in a tertiary hospital located in a semi –urban community in Delta state, ...

  15. Strength and Deformation Properties of Tertiary Clay at Moesgaard Museum

    DEFF Research Database (Denmark)

    Kaufmann, Kristine Lee; Nielsen, Benjaminn Nordahl; Augustesen, Anders Hust

    The tertiary clay at Moesgaard Museum near Aarhus in the eastern part of Jutland in Denmark is a highly plastic, glacially disturbed nappe of Viborg Clay. The clay is characterised as a swelling soil, which could lead to damaging of the building due to additional heave of the soil. To take...

  16. Measuring Student Satisfaction in Higher and Tertiary Education: A ...

    African Journals Online (AJOL)

    The research set out to establish the views of students about service provision in higher and tertiary education institutions. A case study approach was used. Important parameters such as tangibles, reliability, responsiveness, assurance and empathy were used to obtain students' views about quality of service provision in ...

  17. Oesophageal squamous cell cancer in a South African tertiary hospital

    African Journals Online (AJOL)

    Oesophageal squamous cell cancer in a South African tertiary hospital: a risk factor and presentation analysis. ... Methodology: Information on patients managed at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa, between 1 October 2013 and 31 December 2014 was retrieved from a prospective ...

  18. Septic Abortion Managed in a Tertiary Hospital in West Bengal ...

    African Journals Online (AJOL)

    Background: Septic abortion is still a challenging problem and a major cause of maternal mortality and morbidity in developing countries. Aim: The present study was conducted to estimate incidence, causes, risk factors, associated microorganisms, and treatment modalities of cases of septic abortion managed in a tertiary ...

  19. Sexism and Sexual Harassment in Tertiary Institutions | Akpotor ...

    African Journals Online (AJOL)

    Sexual harassment is a recurring decimal in tertiary institutions. The paper therefore investigates the effects of sexual harassment on the academic performance of female students, using Delta State University, Abraka, as case study. The participants were randomly selected 200level – 500level students from various ...

  20. Pattern of liver disease admissions in a Nigerian tertiary hospital ...

    African Journals Online (AJOL)

    Objective: Liver disease is an important cause of morbidity and mortality globally. Its pattern varies in different geographical locations. This study aimed to determine the pattern and risk factors of liver disease in a Nigerian tertiary hospital. Study Design: Retrospective Study Site: University of Nigeria teaching hospital ...

  1. User education in tertiary institution in Nigeria | Osagie | Lagos ...

    African Journals Online (AJOL)

    ... User Education Programme. There were 300 respondents, 100 from each of three academic institutions. The criticisms, problems highlighted by the respondents and suggestions for improvement are discussed. Keywords: education, institution, nigeria, tertiary, user. Lagos Journal of Library and Information Science Vol.

  2. Building Social Justice among Academic Staffs of Tertiary ...

    African Journals Online (AJOL)

    The study investigated the influence of acculturation, networking and school management support on social justice building among university academic staffs of tertiary institutions. A descriptive survey research design was adopted for the study. The sample for the study was three hundred (300) randomly selected academic ...

  3. Breast Fine Needle Aspiration Cytology in a Nigerian Tertiary Hospital

    African Journals Online (AJOL)

    Breast Fine Needle Aspiration Cytology in a Nigerian Tertiary Hospital. ... The sociodemographic data; cytology result, final histology result and the clinical staging for breast cancer were analyzed. Results: Eight hundred and ... false negative. Also, multi-disciplinary audits of difficult case should be part of the work routine.

  4. Obstetric intensive care admissions at a tertiary hospital in Limpopo ...

    African Journals Online (AJOL)

    Objective. To determine the characteristics of obstetric patients admitted to the intensive care unit (ICU) at a tertiary hospital in the Limpopo Province, South Africa. Methods. Hospital files of all obstetric patients admitted to the Pietersburg provincial referral hospital ICU from 1 January 2008 to 31 December 2012 were ...

  5. Motivation in vocational education: a reform issue in tertiary ...

    African Journals Online (AJOL)

    Working in a non-motivating environment is a nagging issue in various tertiary institutions in Cross River State .This dampens staff morale a great deal. However, the provision of motivation in work places will be a great boost to staff morale especially in Vocational Education. This paper discusses the meaning of motivation, ...

  6. Managing tertiary institutions for the promotion of lifelong learning in ...

    African Journals Online (AJOL)

    The study investigated ways of managing tertiary institutions for the promotion of lifelong learning in Cross River State, Nigeria. One research question was raised and one hypothesis formulated to guide the study. Multistage sampling procedure was adopted for the study. Stratified random sampling technique and simple ...

  7. State of physical facilities in Nigerian tertiary educational institutions ...

    African Journals Online (AJOL)

    This paper examined the state of physical facilities in Nigerian tertiary institutions in comparison with cost of facilities management in the institutions. This was achieved by determining the availability of physical facilities in the institution, assessment of the various facilities managers in the institution, and determining if the ...

  8. Obesity and associated factors in young adults attending tertiary ...

    African Journals Online (AJOL)

    Obesity and associated factors in young adults attending tertiary institutions in south-eastern Nigeria. Patricia Ogechi Ukegbu, Ada Charity Uwaegbute, Chinyere Akudo Echendu, Chukwunonso Ejike, Julie Uche Anyika-Elekeh, Victoria Uzoamaka Asumugha, Solomon Abasiekong Kuyik, Shola Omodamiro, Blessing Nwofia, ...

  9. Utilization of Antihypertensive Drugs: A Comparison of Tertiary and ...

    African Journals Online (AJOL)

    To compare the quality of antihypertensive prescriptions at 2 different health care levels in a hypertensive Nigerian population.We carried out a retrospective comparative analysis of the quality and pattern of antihypertensive and low-dose aspirin prescription in a tertiary and two secondary health care institutions providing ...

  10. Competency Discourses: An Analysis of Secondary and Tertiary Assessments (United States)

    McNaughton, Susan M.


    Analysis of a sample of assessment tasks used in New Zealand first-year clinical and final-year secondary school Biology and Chemistry National Certificate of Educational Achievement summative assessments was conducted to assess whether similarities and differences existed in secondary and tertiary competency discourses. Findings suggested…

  11. Geological and geochemical variations in Mid-Tertiary Ethiopian ...

    African Journals Online (AJOL)

    The paper presents the results of a comprehensive major element, trace element, and Sr-Nd-Pb-Hf isotopic study of Mid-Tertiary volcanic sequences from the northwestern flood basalt province in Ethiopia. The volcanic rocks studied range in composition from basanites, alkaline basalts, and ankaramites, which form the 1st ...

  12. Influencing factors on lecture attendance at a tertiary institution ...

    African Journals Online (AJOL)

    The tendency towards decreasing class attendance by students is a concern for many tertiary institutions. Various factors contribute to the motivation of students, which in turn directly or indirectly influence them to attend lectures. The aim of the study is mainly to investigate which factors are related to the problem of low ...

  13. Dealing with difference and dissensus within the tertiary environment

    African Journals Online (AJOL)

    Dealing with difference and dissensus within the tertiary environment. Mollie Painter-Morland. Abstract. An important challenge that many South African organisations face, is to find a way of dealing with difference that allows for unity amidst diversity. To make this possible, institutional frameworks should function as guiding ...

  14. Effect of health education on knowledge and attitude of tertiary ...

    African Journals Online (AJOL)

    Background: In order to make good decisions about their sexual and reproductive health, young people need reliable information. This study assessed the effect of health education on the knowledge and attitude of tertiary school students towards sexually transmitted infections. Methods: The study employed a ...

  15. Hand hygiene amongst dental professionals in a tertiary dental clinic ...

    African Journals Online (AJOL)

    Objective: To evaluate hand washing attitude and practices among Dentists and Dental Students treating patients in a Nigerian Tertiary Dental Clinic. Materials and Methods: A cross-sectional survey of Dentists and Dental Students treating patients in University of Benin Teaching Hospital was conducted between February ...

  16. Tertiary Education and Gender Disparities in a Dollarised Economy ...

    African Journals Online (AJOL)

    Tertiary Education and Gender Disparities in a Dollarised Economy: A Case Study of the Faculty of Social Studies at the University of Zimbabwe. ... devastating impacts on the female students. This is being caused by the 'second class citizen' treatment given to the girl child by most families as caused by gender stereotypes.

  17. Breast Self Examination Practice among Female Students of Tertiary Institutions (United States)

    Agbonifoh, Julia Adesua


    Against the background of the dangers posed by breast cancer world-wide, and the importance of its early detection and therefore breast self examination (BSE), this study investigated the practice of BSE among female students in tertiary institutions in Edo state. A sample of 723 participants selected through a combination of multi-stage,…

  18. Ensuring Effective Mentoring in Tertiary Institutions in Anambra State ...

    African Journals Online (AJOL)

    One research question guided the study while one null hypothesis was tested at 0.05 level of significance using t-test statistics. A structured questionnaire ... Identified strategies should be adopted by the institutions to ensure the effectiveness of mentoring in public and private tertiary institutions in Anambra State. Key words: ...

  19. Asset Distribution and Tertiary Education Expenditure in Developing Countries (United States)

    Hwang, J.


    This paper examines whether initial asset distribution affects the composition of government expenditure on education. Using a cross-section of developing countries, it is found that a country's initial asset inequality is positively and significantly associated with the ratio of tertiary education expenditure to government education expenditure,…

  20. Spectrum of Glaucoma Presentation in a Nigerian Tertiary Hospital

    African Journals Online (AJOL)


    of African descent to be four times greater than in. Spectrum of Glaucoma Presentation in a. Nigerian Tertiary Hospital. Olusola Olawoye1,2, Sarimiye Tarella1. 1Department of Ophthalmology, University College Hospital, Ibadan, 2Department of Ophthalmology, College of Medicine,. University of Ibadan, Ibadan, Nigeria.

  1. Counselling for Sustainable Peace in Tertiary Institutions in Nigeria (United States)

    Nduka-Ozo, Stella Ngozi


    This study reviewed the nature of peace in Tertiary Institutions in Nigeria using Ebonyi State University as a case study. The purpose of the study was to review the various factors responsible for lack of peace. The sample was drawn from the three hundred level students of the Faculty of Education. Thirty students were selected from each of the…

  2. Disease pattern of hospitalized patients in two tertiary healthcare ...

    African Journals Online (AJOL)

    Background: The burden of communicable diseases is high, now the burden of non-communicable disease is also growing hence it important that the distributions of different disease in Tertiary Hospital is known. Unprecedented changes have occurred in the structure of the society that have impacted on health and ...

  3. Predictors of Attrition and Achievement in a Tertiary Bridging Program (United States)

    Whannell, Robert


    This study examines the attrition and achievement of a sample of 295 students in an on-campus tertiary bridging program at a regional university. A logistic regression analysis using enrolment status, age and the number of absences from scheduled classes at week three of the semester as predictor variables correctly predicted 92.8 percent of…

  4. Candiduria among HIV- Infected Patients Attending a Tertiary ...

    African Journals Online (AJOL)

    susceptibility to fluconazole and voriconazole in a tertiary hospital. Methods: A total of 300 subjects comprising of 200 HIV patients and 100 non-HIV individuals were used for this study. Clean catch midstream were collected from each individual and processed using standard microbiological techniques. Emergent Candida ...

  5. Tertiary Institutions, Entrepreneurship Education and Youth Empowerment in Nigeria (United States)

    Olasunkanmi, Abari Ayodeji; Olufunke, Oyetola Idowu; Adetayo, Okunuga Adedapo


    Entrepreneurship Education has recently become a global phenomenon in the development of world youths for self employment and self-reliance. The Nigerian nation cannot afford to be left out and left behind in this new trend in education both at the secondary and tertiary levels. However, while the Universal Basic Education (UBE) curriculum has…

  6. Anti Diabetic Drug Utilization by Elderly Patients in a Tertiary ...

    African Journals Online (AJOL)

    This study is intended to determine the pattern and rational use of drugs in the elderly diabetic patients in a tertiary health care facility in Western Nigeria. This was a retrospective study involving 173 case files of elderly diabetic patients treated in the Endocrinology Clinic of Olabisi Onabanjo University Teaching Hospital ...

  7. Depression in pregnancy and the puerperium in a tertiary health ...

    African Journals Online (AJOL)

    BACKGROUND: Depression is common in pregnancy in high-income-countries but rarely spoken about in Nigerian Tertiary Obstetric Centres. OBJECTIVES: This study was conducted to ascertain the prevalence and risk factors for major depression in pregnancy and puerperium at the University of Port Harcourt Teaching ...

  8. Drug Production in Tertiary Health Institutions – Needs, Constraints ...

    African Journals Online (AJOL)

    This study was carried out to investigation the needs, problem and prospects of drug production in tertiary health institutions using Lagos University Teaching Hospital as a case study and to recommend solutions to the problems so identified. The use of questionnaires was employed in the study covering all pharmacists in ...

  9. Stroke at a tertiary medical institution in Northern Nigeria: Patients ...

    African Journals Online (AJOL)

    Background: Little is known about the burden of stroke in the northern part of Nigeria as most studies in the country have been in the southern part. The objective of this study was to study the profile of stroke patients and predictors of outcome in a tertiary health centre in Katsina, North-Western Nigeria.. Patients and Method: ...

  10. Secondary and Tertiary Hyperparathyroidism, State of the Art Surgical Management (United States)

    Pitt, Susan C.; Sippel, Rebecca S.


    Synopsis This article reviews the current surgical management of patients with secondary and tertiary hyperparathyroidism. The focus is on innovative surgical strategies that have improved the care of these patients over the past 10 to 15 years. Modalities such as intraoperative parathyroid hormone monitoring and radioguided probe utilization are discussed. PMID:19836494

  11. Metastatic breast cancer in a Nigerian tertiary hospital | Adisa ...

    African Journals Online (AJOL)

    Metastatic breast cancer in a Nigerian tertiary hospital. ... Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome. Objective: To describe the pattern of clinical ... resource limitations. Improved awareness of the disease is advocated to reduce late presentation.

  12. The Impact of Cooperative Learning on Tertiary EFL Learners' Motivation (United States)

    Ning, Huiping; Hornby, Garry


    This study was aimed at investigating the impact of cooperative learning on the motivation of tertiary English learners. Participants were from two randomly assigned classes at a university in the north of China. A pre-test-post-test control group design was employed to compare the impact of the cooperative learning approach with that of…

  13. Dating Violence in South-Western Nigeria Tertiary Institutions ...

    African Journals Online (AJOL)

    This paper examined peace education as a means of curbing gap in knowledge and dating violence in South-western Nigeria tertiary institutions. Economic, social and psychological problems exert enormous pressures on students making them violent or docile in the face of challenges. These factors combine to make ...

  14. An audit of colorectal cancer histopathology reports in a Tertiary ...

    African Journals Online (AJOL)

    Objective: To audit the completeness of histopathologic reports of Colorectal Cancer for prognostic information in a tertiary care hospital in the light of the minimum reporting standards for colorectal cancer resections recently proposed for use in Nigeria. Material and Methods: Twenty–five histopathology reports of colorectal ...

  15. Trauma admissions among victims of domestic violence at a tertiary ...

    African Journals Online (AJOL)

    Trauma admissions among victims of domestic violence at a tertiary care hospital in north-western Tanzania: an urgent call to action. ... Suspecting sexual partner being unfaithful was the most common reason given by victims for domestic violence in 63.4% of cases. Blunt and sharp objects (56.8%) were the most common ...

  16. An Audit of Otorhinolaryngological Practice in a Tertiary Institution in ...

    African Journals Online (AJOL)

    Background: The Niger Delta University Teaching Hospital (NDUTH) is a young tertiary hospital with recently established department in various specialties. In spite of this it caters for the health needs of a lot of the patients in Bayelsa state and its environs. The aim of this study therefore is to audit the otorhinolaryngological ...

  17. Management of necrotizing enterocolitis: experience at a tertiary ...

    African Journals Online (AJOL)

    The aim of this study was to determine the incidence of NEC and identify the factors predicting the surgical management and also to determine the mortality due to NEC at our tertiary care neonatal unit in Oman. Materials and methods The parameters studied included sex-based differences, gestational age at birth, birth ...

  18. An Innovation Systems Perspectives on Tertiary-Level Agricultural ...

    African Journals Online (AJOL)

    An Innovation Systems Perspectives on Tertiary-Level Agricultural Education in Sub-Saharan Africa: (Evidence From Ethiopia) ... it should also play a role in building the capacity of organizations and individuals to explore new products and processes that depend on the transmission and adaptation of existing information.

  19. Auditing surgical service provision at a South African tertiary institution

    African Journals Online (AJOL)

    Conclusion: The HEMR system enabled the Pietermaritzburg Metropolitan Department of Surgery to quantify the burden of surgical disease and map district referral patterns. Thirty percent of operative procedures performed were assessed as district-level operations. Potentially correctable deficits identified within the tertiary ...

  20. Tertiary Educational Institutions for Teaching, Research and Development (United States)

    Amoo, Sikiru A.


    This paper examines the quality of teaching and research in developing human resources to facilitate the development of tertiary education in the nation. It discusses the challenges and the roles of research in higher education. The author argues that the combination of content and pedagogical knowledge could help to develop human resources for…

  1. Infection control in anaesthesia in regional, tertiary and central ...

    African Journals Online (AJOL)

    Background: Anaesthetic equipment is a potential vector for the transmission of disease. This study was undertaken to observe current infection control practices among anaesthetic nurses regarding the decontamination of anaesthetic equipment in regional, tertiary and central hospitals in KwaZulu-Natal. Method: All ...

  2. The Equity Imperative in Tertiary Education: Promoting Fairness and Efficiency (United States)

    Salmi, Jamil; Bassett, Roberta Malee


    While the share of the tertiary education age cohort (19-25) which is being given the opportunity to study has increased worldwide over the past two decades, this does not in fact translate into reduced inequality. For many young people, especially in the developing world, major obstacles such as disparities in terms of gender, minority population…

  3. Blood donation trend in a tertiary hospital in Nigeria | Olawumi ...

    African Journals Online (AJOL)

    Background: Voluntary donors who ought to be the main source of donor blood are relatively few in Nigeria. There is therefore a need to study current patterns of blood donation and design strategies for improvement. Objectives: To determine the types , age and sex distribution of blood donors in a tertiary Hospital in ...

  4. Tertiary syphilis in the lumbar spine: a case report. (United States)

    Bai, Yang; Niu, Feng; Liu, Lidi; Sha, Hui; Wang, Yimei; Zhao, Song


    The incidence of tertiary syphilis involvement in the spinal column with destructive bone lesions is very rare. It is difficult to establish the correct diagnosis from radiographs and histological examination alone. Limited data are available on surgical treatment to tertiary syphilitic spinal lesions. In this article, we report a case of tertiary syphilis in the lumbar spine with osteolytic lesions causing cauda equina compression. A 44-year-old man who suffered with low back pain for 6 months and progressive radiating pain at lower extremity for 1 week. Radiologic findings showed osteolytic lesion and new bone formation in the parts of the bodies of L4 and L5. Serum treponema pallidum hemagglutination (TPHA) test was positive. A surgery of posterior debridement, interbody and posterolateral allograft bone fusion with instrumentation from L3 to S1 was performed. The low back pain and numbness abated after operation. But the follow-up radiographs showed absorption of the bone grafts and failure of instrumentation. A Charcot's arthropathy was formed between L4 and L5. It is challenging to diagnose the tertiary syphilis in the spine. Surgery is a reasonable auxiliary method to antibiotic therapy for patients who suffered with neuropathy. Charcot's arthropathy should be considered as an operative complication.

  5. Characteristics of Inflammatory Bowel Disease in Three Tertiary ...

    African Journals Online (AJOL)

    BACKGROUND: Inflammatory bowel disease (IBD) refers to two chronic inflammatory disorders of the gastrointestinal tract which is generally believed to be rare in most African countries. The objectives of the current study were to present the experience of three tertiary gastroenterology centers in southern part of Nigeria on ...

  6. Management challenges of pelvic abscess in a tertiary health ...

    African Journals Online (AJOL)

    Background: This study was carried out to review the incidence, demographic variables and challenges in managing pelvic abscess in a tertiary health institution, the University of Benin Teaching Hospital, Benin City, Nigeria. Methods: This was a retrospective study. Gynaecological patients known to have had pelvic ...

  7. Microstructural Characterization of Alloy 617 Crept into the Tertiary Regime

    Energy Technology Data Exchange (ETDEWEB)

    Lillo, Thomas Martin [Idaho National Laboratory; Wright, Richard Neil [Idaho National Laboratory


    The microstructure of Alloy 617 was characterized following creep tests interrupted at total creep strains ranging from 2-20%. A range of creep temperatures (750-1000oC) and initial creep stresses (10-145 MPa) produced creep test durations ranging from 1 to 5800 hours. Image analysis of optical photomicrographs on longitudinal sections of the gage length was used to document the fraction of creep porosity as a function of creep parameters. Creep porosity was negligible below tertiary creep strains of 10% and increased with tertiary creep strain, thereafter. For a given temperature and total creep strain, creep porosity increased with decreasing creep stress. Creep porosity increased linearly with duration of the creep experiment. TEM performed on the gage sections did not reveal significant creep cavity formation on grain boundaries at the sub-micron level. It was concluded that the onset of tertiary creep did not result from creep cavitation and more likely arose due to the formation of low energy dislocation substructures with increasing tertiary strain.

  8. Sexual Harassment in Tertiary Science: Implications for Gender Equity

    African Journals Online (AJOL)

    The paper focuses on the incidence of sexual harassment in tertiary science education and its attendant effects on students and academics. Data from a survey of six higher institutions comprising two universities, two colleges of education and two polytechnics was used. Results indicate high rate of sexual harassment of ...

  9. Food Insecurity: Is It an Issue among Tertiary Students? (United States)

    Gallegos, Danielle; Ramsey, Rebecca; Ong, Kai Wen


    Insufficient access to food is known to compromise tertiary studies. Students often belong to groups known to have poor food security such as those renting or relying on government payments. The present study administered a cross-sectional survey incorporating the USDA food security survey module (FSSM) to 810 students at a metropolitan university…

  10. Ectopic pregnancy experience in a tertiary health facility in South ...

    African Journals Online (AJOL)

    Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: To determine the incidence, clinical presentation, risk factors and management outcomes of ectopic pregnancies in a tertiary health facility. Methods: A retrospective ...

  11. Contributory Factors to Clients' Satisfaction in a Tertiary Antenatal ...

    African Journals Online (AJOL)

    This study aimed at identifying factors that contribute to clients' satisfaction in a tertiary antenatal clinic in Plateau State. Methods: This was a facility-based, cross sectional study where 100 clients of reproductive age (15-45 years) were selected using systematic sampling technique. Data was collected using a structured, ...

  12. Cretaceous–Tertiary Mass Extinction Meteoritic Versus Volcanic ...

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 3; Issue 3. Cretaceous – Tertiary Mass Extinction Meteoritic Versus Volcanic Causes. P V Sukumaran. General Article Volume 3 Issue 3 March 1998 pp 8-17. Fulltext. Click here to view fulltext PDF. Permanent link:

  13. Patient satisfaction in neurological second opinions and tertiary referrals

    NARCIS (Netherlands)

    Wijers, D.; Wieske, L.; Vergouwen, M.D.I; Richard, E.; Stam, J.; Smets, E.M.A.


    Although the number of neurological second opinions (SOs) and tertiary referrals (TRs) is increasing, only little is known about expectations and patient satisfaction in this group of patients. Therefore, the purpose of this study was to explore expectations of patients who get a neurological SO or

  14. Self care activities among patients with diabetes attending a tertiary ...

    African Journals Online (AJOL)

    Self care activities among patients with diabetes attending a tertiary care hospital in Mangalore Karnataka, India. ... Conclusions: Self‑care practices were found to be unsatisfactory in almost all aspects except for blood sugar monitoring and treatment adherence. As these practices are essential for prevention of ...

  15. Learning Assessment in Tertiary Business Education with Revised Taxonomy (United States)

    Hossain, Md. Shajjad


    The goal of this study was to evaluate the assessment criteria of learning in tertiary education of Bangladesh. The study was aimed at identifying percentage of questions during learning assessment of business graduates following cognitive levels of Bloom's in revised Taxonomy and to test whether there was any significant difference in the…

  16. Management of necrotizing enterocolitis: experience at a tertiary ...

    African Journals Online (AJOL)

    Introduction Necrotizing enterocolitis (NEC) is the most common surgical emergency in the neonatal intensive care unit. The aim of this study was to determine the incidence of NEC and identify the factors predicting the surgical management and also to determine the mortality due to. NEC at our tertiary care neonatal unit in ...

  17. Automated Stock Control System for Bookshops in Tertiary Institutions

    African Journals Online (AJOL)

    The recent need for automated stock control system for bookshops in tertiary institutions was generated by unequal availability of books and stiff scarcity of books in some areas while in other areas books are being wasted or unsold. This research has made use of distributed database systems in developing stock control ...

  18. Sexual behaviour among students in tertiary institutions in Kano ...

    African Journals Online (AJOL)

    Conclusion: In the light of the high level of sexual activity detected, it is recommended that family life or sexuality education, starting early, through primary, secondary and tertiary education be institutionalised. This is to equip our youths with correct information to enable them make informed choices about responsible sexual ...

  19. Factors affecting utilization of University health services in a tertiary ...

    African Journals Online (AJOL)


    Jan 16, 2013 ... Objective: To determine students' perception of health care services provided in a tertiary institution and assess students' attitude towards ... distance of health facilities, waiting time and quality of. Factors affecting utilization of ... satisfaction has received little research attention, and it is unclear whether the ...

  20. Patterns of Eye Diseases in Children Visiting a Tertiary Teaching ...

    African Journals Online (AJOL)

    Background: About 19 million children worldwide live with visual impairments resulting from different ocular morbidities. This study aimed to identify the different causes of eye diseases in children visiting a tertiary eye centre at Jimma University Hospital. Methods: We conducted a retrospective review of charts of patients of ...

  1. Improving listening skills of tertiary level students for effective ...

    African Journals Online (AJOL)

    Listening is essential to the leaming process. Students in tertiary institutions of learning need to acquire effective listening and note-taking skiils in order to benefit from lectures. This paper focused on factors militating against effective listening during lectures such as poor rate of presentation, poor communication skills, ...

  2. Pattern of childhood malignant tumours in two tertiary teaching ...

    African Journals Online (AJOL)

    Background: Cancer is a public health problem worldwide affecting all categories of persons. It is the second common cause of death in developed countries and among the three leading causes of death in developing countries. Objective: To compare the patterns of malignant childhood tumours in two tertiary hospitals in ...

  3. Tertiary classes–after Chern-Simons theory

    Indian Academy of Sciences (India)

    J.N. Iyer Institute of Mathematical Sciences Chennai, India


    Nov 8, 2013 ... Euler characteristic class. In early twentieth century, the notion of local product structure, i.e. fiber spaces and their generalizations appeared, in the study of topological spaces (with additional structures). J.N. Iyer. IMSc, Chennai. Tertiary classes–after Chern-Simons theory ...

  4. Assessment of user satisfaction with library services in tertiary ...

    African Journals Online (AJOL)

    The main objective of this study was to determine the relationship between library services and user satisfaction in tertiary institution libraries in Akwa Ibom State, Nigeria. Survey research design was considered appropriate and adopted for the study To achieve the purpose of the study, two hypotheses were formulated to ...

  5. Sexual behaviours of undergraduates of tertiary institutions in Kwara ...

    African Journals Online (AJOL)

    Sexuality among youths has become a source of great concern due to its attendant effects. Thus, the objective of this study was to investigate the sexual behaviours of undergraduates of tertiary institutions in Kwara State. The study also examined whether or not variables of gender and school type had significant influence ...

  6. Nurses' communication and patient satisfaction in a tertiary hospital ...

    African Journals Online (AJOL)

    Nurses' communication of nursing care provision in tertiary health facilities and patient satisfaction are closely related. This has remained a yardstick for measuring success of the services provided in many health facilities. This study investigated the influence of nurses' communication of nursing care on patient satisfaction ...

  7. Genesis of some tertiary Indian coals from the chemical composition ...

    Indian Academy of Sciences (India)

    In the present investigation, 37 numbers of high sulphur tertiary coal samples from Meghalaya, India have been studied on the basis of proximate and ash analysis. Various statistical tools like Bivariant Analysis, Principal Component Analysis (PCA) and Hierarchical Clustering Analysis (HCA), and also the geochemical ...

  8. Learning to teach mathematical modelling in secondary and tertiary education (United States)

    Ferri, Rita Borromeo


    Since 2003 mathematical modelling in Germany is not only a topic for scientific disciplines in university mathematics courses, but also in school starting with primary school. This paper shows what mathematical modelling means in school and how it can be taught as a basis for complex modeling problems in tertiary education.

  9. Impact assessment of electronic mass communication in a tertiary ...

    African Journals Online (AJOL)

    The proliferation of computer networks and Internet access opened new communication channels such as blogs, websites, e-mail, social media and mobile apps. In view of the current economic recession in Nigeria, tertiary institutions are turning to information technology for educational and communications solutions to ...

  10. Indications for and outcomes of tertiary referrals in refractive surgery

    NARCIS (Netherlands)

    Patryn, Eliza K.; Vrijman, Violette; Nieuwendaal, Carla P.; van der Meulen, Ivanka J. E.; Mourits, Maarten P.; Lapid-Gortzak, Ruth


    To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of

  11. Equity in Tertiary Education in Central America : An Overview


    Bashir, Sajitha; Luque, Javier


    This paper analyzes the evolution in socio-economic and ethnic disparities in tertiary education attainment, participation, and completion and labor market outcomes in the six countries of Central America. There is evidence of differential progress, with Costa Rica, a middle-income country, and Nicaragua, a low-income country, having improved participation of low-income students in tertiar...

  12. Education and training in recreation management at tertiary ...

    African Journals Online (AJOL)

    Tertiary institutions should realise the gaps and opportunities that could be filled in recreation management training. The current article reviews literature focussing on the importance of recreation participation, the benefits of participation and the impact it has on society in order to lead a quality life. International and national ...

  13. Perception of patients attending a tertiary hospital in Nigeria about ...

    African Journals Online (AJOL)


    Jan 2, 2013 ... Background: Criteria for a good dental practice as expressed by patients have influence on their behavior in terms of compliance with clinical advice, less pain and anxiety and more utilization of dental care. Objective: To assess the opinion of patients attending the dental clinic of a tertiary hospital ...

  14. Cost analysis of tuberculosis treatment in two tertiary hospitals in ...

    African Journals Online (AJOL)

    Cost analysis of tuberculosis treatment in two tertiary hospitals in South-East Nigeria. ... Abia State University Medical Students' Association Journal ... How free is it? Several governmental and non-governmental agencies support tuberculosis treatment to make the services accessible and affordable to patients.

  15. managing tertiary institutions for the promotion of lifelong learning in ...

    African Journals Online (AJOL)

    Global Journal

    schools considering that each day gives birth to new challenges, problems and discoveries in the field of science and technology which have invariably altered the way in which certain tasks are carried out. Students of tertiary institutions therefore need to be provided with opportunities to upgrade and expand existing skills, ...

  16. Incidence, Pattern and Management of Ovarian Cancer at a Tertiary ...

    African Journals Online (AJOL)

    Background: The incidence of ovarian cancer is thought to be increasing in developing countries and little is known about the pattern and incidence of this disease in South‑East Nigeria. Aims: The objectives of the study were to determine the incidence, describe the pattern and management of ovarian cancer at a tertiary ...

  17. Favorability for uranium in tertiary sedimentary rocks, southwestern Montana

    Energy Technology Data Exchange (ETDEWEB)

    Wopat, M A; Curry, W E; Robins, J W; Marjaniemi, D K


    Tertiary sedimentary rocks in the basins of southwestern Montana were studied to determine their favorability for potential uranium resources. Uranium in the Tertiary sedimentary rocks was probably derived from the Boulder batholith and from silicic volcanic material. The batholith contains numerous uranium occurrences and is the most favorable plutonic source for uranium in the study area. Subjective favorability categories of good, moderate, and poor, based on the number and type of favorable criteria present, were used to classify the rock sequences studied. Rocks judged to have good favorability for uranium deposits are (1) Eocene and Oligocene strata and undifferentiated Tertiary rocks in the western Three Forks basin and (2) Oligocene rocks in the Helena basin. Rocks having moderate favorability consist of (1) Eocene and Oligocene strata in the Jefferson River, Beaverhead River, and lower Ruby River basins, (2) Oligocene rocks in the Townsend and Clarkston basins, (3) Miocene and Pliocene rocks in the Upper Ruby River basin, and (4) all Tertiary sedimentary formations in the eastern Three Forks basin, and in the Grasshopper Creek, Horse Prairie, Medicine Lodge Creek, Big Sheep Creek, Deer Lodge, Big Hole River, and Bull Creek basins. The following have poor favorability: (1) the Beaverhead Conglomerate in the Red Rock and Centennial basins, (2) Eocene and Oligocene rocks in the Upper Ruby River basin, (3) Miocene and Pliocene rocks in the Townsend, Clarkston, Smith River, and Divide Creek basins, (4) Miocene through Pleistocene rocks in the Jefferson River, Beaverhead River, and Lower Ruby River basins, and (5) all Tertiary sedimentary rocks in the Boulder River, Sage Creek, Muddy Creek, Madison River, Flint Creek, Gold Creek, and Bitterroot basins.

  18. The Living Periodic Table (United States)

    Nahlik, Mary Schrodt


    To help make the abstract world of chemistry more concrete eighth-grade students, the author has them create a living periodic table that can be displayed in the classroom or hallway. This display includes information about the elements arranged in the traditional periodic table format, but also includes visual real-world representations of the…

  19. Tertiary paediatric hospital admissions in children and young people with cerebral palsy. (United States)

    Meehan, E; Freed, G L; Reid, S M; Williams, K; Sewell, J R; Rawicki, B; Reddihough, D S


    Many previous studies that have investigated hospital admissions in children and young people with cerebral palsy lack information on cerebral palsy severity and complexity. Consequently, little is known about factors associated with the frequency and type of hospital admissions in this population. This study used hospital admission data available for all children and young people known to a population-based cerebral palsy register to describe the patterns of use of tertiary paediatric hospital services over a 5-year period. This was a retrospective cohort analysis of routinely collected admission data from the two tertiary paediatric hospitals in the Australian state of Victoria. Data on admissions of individuals born between 1993 and 2008 registered on the Victorian Cerebral Palsy Register were analysed (n = 2183). Between 2008 and 2012, 53% of the cohort (n = 1160) had at least one same-day admission, and 46% (n = 996) had one or more multi-day admissions. Those with a moderate to severe motor impairment and those with a co-diagnosis of epilepsy had more admissions, and for multi-day admissions, longer lengths of stay, P children and young people with cerebral palsy. This study highlights priority areas for prevention, early diagnosis and medical management in this group. Improved primary and secondary prevention measures may decrease non-elective hospital admissions and readmissions in this group and reduce paediatric inpatient resource use and healthcare expenditure attributable to cerebral palsy. © 2015 John Wiley & Sons Ltd.

  20. Prevalence of carbapenem resistant Enterobacteriaceae from a tertiary care hospital in Mumbai, India

    Directory of Open Access Journals (Sweden)

    Pravin K. Nair


    Full Text Available Objective: The emergence of Carbapenem Resistant Enterobacteriaceae (CRE in recent times has become a serious threat to public health due to the high mortality, potential dissemination rates and limited treatment options associated with these organisms. Thus, the present study was conducted in our tertiary care hospital in Mumbai, to retrospectively analyze the prevalence of CRE in the hospital. Methods: The study was carried out in the microbiology department of the tertiary care hospital over a period of 12 months. The samples tested were clinical samples from hospitalized and Out-Patient Department (OPD patients sent to the department for microbiological testing. CRE isolates were identified using the Vitek 2- Compact system (BioMérieux, France. Results: A CRE prevalence rate of 12.26% was obtained from the study, from which the majority of the isolates were detected in urine samples (46%. Although most of the CRE isolates were detected in patient samples from the wards (42% and the ICU (26%, a significant number of isolates was also detected from the OPD patients (19%. Conclusion:Thus, the study shows a significant rate of carbapenem resistance among Enterobacteriaceae isolated from hospitalized and OPD patients. This emphasizes the urgent need for CRE control at the hospital and community level, and to rationalize the use of antibiotics. J Microbiol Infect Dis 2013;3(4: 207-210

  1. Health Literacy Levels among Outpatients at a Tertiary Hospital in Delhi, India

    Directory of Open Access Journals (Sweden)

    Monika Sahoo


    Full Text Available Background: Health literacy is defined as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health. This study was conducted to determine health literacy levels and the associated factors among patients attending the outpatient departments of a tertiary care hospital in Delhi. Methods: A hospital-based cross-sectional study was carried out in a tertiary care teaching hospital in Delhi over a period of four months. A total of 150 patients were included in the study. Fifty patients from the Diabetes Clinic, 50 patients from the Hypertension Clinic, and 50 patients with anemia from the Antenatal Outpatient Department (OPD were selected using a convenience sampling method. Data was analyzed using Epi Info software. Statistical analysis was conducted with the chi-square test and the Fisher’s exact test. P values less than 0.05 were considered significant. Results: Out of 50 diabetic subjects, 37 (74% understood the information about their blood sugar levels as explained to them by the doctor. Similar results were found among hypertensive subjects as well. Furthermore, education status was significantly associated with health literacy. In terms of understanding the regimen of medications, significant association was seen with age, sex, and education. Conclusion: Education status, age, and gender are important determinants of health literacy. Our results support that innovative strategies of communication should be used to improve health literacy among patients.


    Directory of Open Access Journals (Sweden)

    Anjan Adhikari


    Full Text Available Antibiotics are most commonly prescribed drugs in tertiary care hospitals; more than 30% of the hospitalised patients were treated with antibiotics. Rational use of antibiotics is very important to ensure the optimum treatment outcomes and to limit the emergence of bacterial resistance. Present study is a hospital based cross-sectional study carried out for a period of three months in different clinical departments of a tertiary care hospital to find out the antibiotics prescribing pattern. Out of total 551 evaluated prescriptions, an antibiotic was prescribed in 45.5% cases. The most commonly prescribed antibiotics were Moxifloxacin 19.5%, Metronidazole 10.4% and Amoxicillin+Cloxacillin 10.2%, broad spectrum antibiotics usage was higher & 87.7% of the antibiotics were prescribed by brand names. The appropriate use of antibiotic is a greatest need of the current situation all over the world. The rising antibiotic resistance is a global problem which is directly related with the irrational prescription of antibiotics.

  3. On some periodicity effects

    DEFF Research Database (Denmark)

    Sorokin, Sergey V.


    The talk is concerned with the modelling of wave propagation in and vibration of periodic elastic structures. Although analysis of wave-guide properties of infinite periodic structures is a well establish research subject, some issues have not yet been fully addressed in the literature. The aim...... of the talk is to illustrate these issues in simple examples and to discuss possible applications and generalisations. First, the eigenfrequency spectra of finite periodic structures are compared with the location of stop-bands for their infinite counterparts for a hierarchy of four mathematical models....... In each case, special attention is paid to eigenfrequencies and eigenmodes of a single periodicity cell with appropriate boundary conditions. The influence of the amount of periodicity cells in a finite compound structure on its eigenfrequency spectrum is analyzed. Several features common...

  4. Periods and Nori motives

    CERN Document Server

    Huber, Annette


    This book casts the theory of periods of algebraic varieties in the natural setting of Madhav Nori’s abelian category of mixed motives. It develops Nori’s approach to mixed motives from scratch, thereby filling an important gap in the literature, and then explains the connection of mixed motives to periods, including a detailed account of the theory of period numbers in the sense of Kontsevich-Zagier and their structural properties. Period numbers are central to number theory and algebraic geometry, and also play an important role in other fields such as mathematical physics. There are long-standing conjectures about their transcendence properties, best understood in the language of cohomology of algebraic varieties or, more generally, motives. Readers of this book will discover that Nori’s unconditional construction of an abelian category of motives (over fields embeddable into the complex numbers) is particularly well suited for this purpose. Notably, Kontsevich's formal period algebra represents a to...

  5. Reappearance and treatment of penicillin-susceptible Staphylococcus aureus in a tertiary medical centre. (United States)

    Chabot, Matthew R; Stefan, Mihaela S; Friderici, Jennifer; Schimmel, Jennifer; Larioza, Julius


    The purpose of this study was to describe trends in the prevalence and treatment patterns of penicillin-susceptible Staphylococcus aureus (SA) infections. This was a cross-sectional study of MSSA isolates from blood cultures at a tertiary-care centre between 1 January 2003 and 31 December 2012. All blood cultures positive for MSSA drawn during the study period were used to calculate the prevalence of penicillin-susceptible SA. Repeat cultures were excluded if they were isolated within 6 weeks of the index culture. The analysis was then restricted to inpatient blood cultures to assess treatment patterns. Antibiotics administered 48-96 h after the culture were analysed. A total of 446 blood cultures positive for MSSA were included in the analysis. There was a distinct trend showing an increase in the percentage of penicillin-susceptible SA over 10 years from 13.2% (95% CI 4.1%-22.3%) in 2003 to 32.4% (95% CI 17.3%-47.5%) in 2012 (P trend penicillin use for penicillin-susceptible SA bacteraemia increased from 0.0% in 2003-04 to 50.0% in 2011-12 (P trend = 0.007). Over a decade, there was an ∼3-fold increase in penicillin susceptibility among MSSA blood cultures at a large tertiary-care facility. Although treatment with penicillin increased over the study period, only 50% of penicillin-susceptible SA was treated with penicillin in the final study period. This study suggests that while susceptibility to penicillin appears to be returning in SA, the use of penicillin for penicillin-susceptible SA bacteraemia is low. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail:


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    Full Text Available AIM To analyze the outcome of 135 patients admitted with Abruptio Placenta during a period of 9 months managed at Tertiary Referral Centre, Modern Govt. Maternity Hospital, Petalburz, Hyderabad, Telangana State. MATERIALS AND METHODS A study of 135 cases of Abruptio Placenta over a period of 9 months at a tertiary level referral centre. They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, management of Abruption and maternal and fetal outcome, and the measures to improve the condition were analyzed. RESULTS Abruptio placenta is a dreadful threat to maternal and fetal life. In our study unbooked cases were 110(81.48%, Hypertension is the main risk factor almost in 90(66.66% cases, 65% of them were between 28-36 weeks of GA, and 6 were grandmultis, 6 cases ended up with HELLP syndrome with DIC. All these 6 cases were near misses, 5 unbooked cases had eclampsia. One case of unbooked eclampsia had abruption DIC and could not be saved as it was the late referral. Total number of vaginal deliveries were 66(48.88% and total no. of abdominal deliveries were 67(49.62% in this LSCS 66 and one hysterotomy. IUD at the time of admission total were 100(74%. CONCLUSION To improve the outcome in Abruptio Placentae Good antenatal care, Educating the patient, Strengthening the Primary Health Centers in identifying the risk factors like Pre-eclampsia thereby avoiding eclampsia. Regular antenatal checkups timely delivery and availability of blood and blood products with good Neonatal care unit will help in improving the outcome of Abruptio.


    Directory of Open Access Journals (Sweden)



    Full Text Available The scientific and technical progress put its mark in a different manner on all activities that occur within contemporary economy and it was present in the entire evolution of human society, but its implications and effects were never so strong and extensive. There is no area of activity in which progress not to interfere, both as important mutations that they are happening in the all area of production factors, as well as the place and role of the human factor in the deployment of production processes. In the current period the progress has exceeded certain human limits, operating in other areas which until more now it seems unattainable by the achievements of new technology. In this paradigm are successfully integrated tertiary activities in which the scientific and technical progress entered with great difficulty.Nowadays we are witnessing spectacular evolutions whether we talk about movement of goods, education, research, health, transportation, arts and culture, etc. The purpose of this paper is to determine the degree in which scientific and technical progress. In this paper we proposed to determine the level in which the scientific and technical progress, had a decisive impact on the development of the tertiary sector in general and in Romania in particular , we shall specify which are the economic tertiary activities that adapt fast to new changes occurred in the system of informational society. In this context we have to mention the systems of intelligent transport, electronic governance, medical system based on ICT online educational systems, as a possible response of the tertiary sector to the adaptation of technological progress benefits. In the first part of this paper we focused on the conceptual delimitation of scientific concepts at which we refer often such as: technological progress and innovative services which inevitably determine the evolution of tertiary sector under the impact of new modern technologies. On this background

  8. Policy Innovation and Tertiary Education Graduation Rates: A Cross-Country Analysis (United States)

    Delaney, Jennifer A.; Yu, Patricia


    This study extends Trow's theory of higher education development to examine changes in national-level tertiary education graduation rates. Applying Trow's framework we arrive at three stages: (1) elite systems with gross tertiary graduation rates less than 15%, (2) massified systems with gross tertiary graduation rates between 15% and 50%, and (3)…

  9. The Policy Determinants of Investment in Tertiary Education. OECD Economics Department Working Papers, No. 576 (United States)

    Martins, Joaquim Oliveira; Boarini, Romina; Strauss, Hubert; de la Maisonneuve, Christine; Saadi, Clarice


    This paper assesses how policies and institutions affect private returns to invest in tertiary human capital, the ability of individuals to finance this investment and the institutional characteristics of tertiary education systems. Focusing on core tertiary education services, the paper presents new measures of private returns to tertiary…

  10. Analysis of Management Practices in Lagos State Tertiary Institutions through Total Quality Management Structural Framework (United States)

    AbdulAzeez, Abbas Tunde


    This research investigated total quality management practices and quality teacher education in public tertiary institutions in Lagos State. The study was therefore designed to analyse management practices in Lagos state tertiary institutions through total quality management structural framework. The selected public tertiary institutions in Lagos…

  11. Mean-periodic functions

    Directory of Open Access Journals (Sweden)

    Carlos A. Berenstein


    Full Text Available We show that any mean-periodic function f can be represented in terms of exponential-polynomial solutions of the same convolution equation f satisfies, i.e., u∗f=0(μ∈E′(ℝn. This extends to n-variables the work of L. Schwartz on mean-periodicity and also extends L. Ehrenpreis' work on partial differential equations with constant coefficients to arbitrary convolutors. We also answer a number of open questions about mean-periodic functions of one variable. The basic ingredient is our work on interpolation by entire functions in one and several complex variables.

  12. EEG use in a tertiary referral centre.

    LENUS (Irish Health Repository)

    O'Toole, O


    The aim of this study was to retrospectively audit all electroencephalograms (EEGs) done over a 2-month period in 2009 by the Neurophysiology Department at Cork University Hospital. There were 316 EEGs performed in total, of which 176\\/316 (56%) were done within 24 hours of request. Out of 316 EEGs, 208 (66%) were considered \\'appropriate\\' by SIGN and NICE guidelines; 79\\/208 (38%) had abnormal EEGs and 28 of these abnormal EEGs had epileptiform features. There were 108\\/316 (34%) \\'inappropriate\\' requests for EEG; of these 15\\/108 (14%) were abnormal. Of the 67\\/316 (21%) patients who had EEGs requested based on a history of syncope\\/funny turns: none of these patients had epileptiform abnormalities on their EEGs. Our audit demonstrates that EEGs are inappropriately over-requested in our institution in particular for cases with reported \\'funny turns\\' and syncope. The yield from EEGs in this cohort of patients was low as would be expected.

  13. Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

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    Cohen Eyal


    Full Text Available Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN, by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC. Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™], and family-centered care (MPOC-20®. Comparisons were made in equal (up to 1 year pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR $244 (981 per patient per month (PPPM pre-enrolment to $131 (355 PPPM post-enrolment (p=.007, driven primarily by fewer inpatient days in the tertiary care center (p=.006. Parents reported decreased out of pocket expenses (p© domains [Health Standardization Section (p=.04; Comfort and Emotions (p=.03], while total CPCHILD© score decreased between baseline and 1 year (p=.003. Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex

  14. The Periodic Table CD. (United States)

    Banks, Alton J.; Holmes, Jon L.


    Describes the characteristics of the digitized version of The Periodic Table Videodisc. Provides details about the organization of information and access to the data via Macintosh and Windows computers. (DDR)

  15. Setting the Periodic Table. (United States)

    Saturnelli, Annette


    Examines problems resulting from different forms of the periodic table, indicating that New York State schools use a form reflecting the International Union of Pure and Applied Chemistry's 1984 recommendations. Other formats used and reasons for standardization are discussed. (DH)

  16. [Imported infectious diseases in tertiary hospital]. (United States)

    Rius Gordillo, N; Martín Nalda, A; Otero Romero, S; Soler-Palacín, P; Sulleiro Igual, E; Espiau Guarner, M; Fernández-Polo, A; Figueras Nadal, C


    An Imported Diseases Clinic was created in the hospital in 2009. The aim of this study was to asses its contribution in terms of capacity, quality of care and teaching offered. A retrospective study was conducted from 2009 to 2011, analyzing: A) development of knowledge by means of protocols and publications created, and subject taught; B) capacity and quality of care offered by the analysis of patients seen, the adequacy of the protocols and accessibility. The patients were classified into 3 groups. Group 1: immigrant patient screening, group 2: patient consultation after tropical or sub-tropical travel, group 3: screening of vertical transmission of imported disease. Six protocols have been developed and disseminated on the unit website, as well as 5 scientific publications. A total of 316 patients were evaluated: 191 included in group 1 (29 Adopted and 162 Immigrants), 57 in group 2 (94.7% Visiting Friends and Relatives and 81.5% without a pre-travel consultation). They consulted due to, gastrointestinal symptoms (52.6%) and fever (43.8%), with 68 included in group 3 at risk of imported disease by vertical transmission (62 Trypanosoma cruzi, 1 Human T Lymphotropic Virus and 5 Plasmodium spp.). The overall adherence to the protocols was about 77.1%. Infectious Diseases Units must adapt to the reality of the population and be flexible in its structure. Periodic assessment of the quality of care offered is essential, as well as an evaluation on the need for additional studies. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  17. Polymer flooding effect of seepage characteristics of the second tertiary combined model of L oilfield block B

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    Huan ZHAO


    Full Text Available The second tertiary combined model is applied to develop the second and third type reservoirs which have more oil layer quantity and strong anisotropism, compared to the regular main reservoir with polymer injection, whose seepage characteristics of polymer-injection-after-water-drive shows a remarkable difference, in addition. This development appears to have a larger effect on the remaining oil development and production. Simulating the second tertiary combined model by reservoir numerical simulation under different polymer molecular weight, polymer concentration, polymer injection rate on the polymer injection period, conclusions of the influenced seepage characteristics of original and added perforated interval pressure and water saturation are drawn. The conclusion shows that the polymer molecular weight could influence water saturation of added perforated interval; polymer concentration makes a significant impact on reservoir pressure; polymer injection rate has a great influence on the separate rate of original and added perforated interval. This research provides firm science evidence to the theory of the second tertiary combined model to develop and enhance oil injection-production rate.

  18. Carrier effects on tertiary nitrifying moving bed biofilm reactor: An examination of performance, biofilm and biologically produced solids. (United States)

    Forrest, Daina; Delatolla, Robert; Kennedy, Kevin


    Increasingly stricter ammonia and nitrogen release regulations with respect to wastewater effluents are creating a need for tertiary treatment systems. The moving bed biofilm reactor (MBBR) is being considered as an upgrade option for an increasing number of wastewater treatment facilities due to its small footprint and ease of operation. Despite the MBBRs creation as a system to remove nitrogen, recent research on MBBR systems showing that the system's performance is directly related to carrier surface area and is irrespective of carrier shape and type has been performed exclusively on chemical oxygen demand (COD) removal systems. Furthermore, the influence of carrier type on the solids produced by MBBR systems has also been exclusively studied for COD removal systems. This work investigates the effects of three specific carrier types on ammonia removal rates, biofilm morphology, along with solids production and settleability of tertiary nitrifying MBBR systems. The study concludes that carrier type has no significant effect on tertiary nitrifying MBBR system performance under steady, moderate loading conditions. The research does however highlight the propensity of greater surface area to volume carriers to become clogged under high loading conditions and that the high surface area carriers investigated in this study required longer adjustment periods to changes in loading after becoming clogged.

  19. Basic Risk Factors Awareness in Non-Communicable Diseases (BRAND) Study Among People Visiting Tertiary Care Centre in Mysuru, Karnataka. (United States)

    Thippeswamy, Thippeswamy; Chikkegowda, Prathima


    Non Communicable Diseases (NCDs) are the major causes of mortality and morbidity globally. Awareness about NCDs and their risk factors has an important role in prevention and management strategies of these NCDs. 1) To assess the awareness of risk factors contributing to NCDs among the patients visiting tertiary care hospital in Mysuru district; 2) To compare the difference in awareness of risk factors for NCDs among the urban and rural patients with/ without NCD visiting the tertiary care hospital. A cross- sectional study was conducted in a tertiary care centre- JSS Hospital, Mysuru, Karnataka from March 2013 - August 2013. The patients visiting Medicine OPD during the period were the study subjects. The subjects were allocated into 4 groups: Urban without any NCD, Urban with atleast one NCD, rural without NCD, rural with atleast one NCD. A pretested questionnaire regarding awareness of risk factors for NCDs was used in the study and frequency and proportions were used to analyse the data. A total of 400 subjects, 100 subjects in each group were included in the study. Out of these subjects about 65% of the urban group and 42% of the rural group subjects were aware of the NCDs and their risk factors. Least awareness was observed among the rural subjects without any NCDs (35%). The awareness of risk factors of NCDs and knowledge regarding prevention of NCDs was not satisfactory. The results highlighted the need and scope for health education and interventions to improve the awareness about NCDs and their risk factors.

  20. Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

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    Hansen, Nienke L. [University Hospital RWTH Aachen, Department of Diagnostic and Interventional Radiology, Aachen (Germany); Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Koo, Brendan C.; Gallagher, Ferdia A. [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); Warren, Anne Y. [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital, Department of Pathology, Cambridge (United Kingdom); Doble, Andrew; Gnanapragasam, Vincent; Bratt, Ola; Kastner, Christof [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital, Department of Urology, Cambridge (United Kingdom); Barrett, Tristan [Addenbrooke' s Hospital and University of Cambridge, CamPARI Clinic, Cambridge (United Kingdom); Addenbrooke' s Hospital and University of Cambridge, Department of Radiology, Cambridge (United Kingdom); University of Cambridge School of Clinical Medicine, Department of Radiology, Box 218, Cambridge (United Kingdom)


    To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy. Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher's exact test. Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00. Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions. (orig.)

  1. Current demand of paediatric otolaryngology input for children with Down's syndrome in a tertiary referral centre. (United States)

    Khalid-Raja, M; Tzifa, K


    This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre. A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties. Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery. ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.

  2. Teenage pregnancy antenatal and perinatal morbidity: results from a tertiary centre in Greece. (United States)

    Pergialiotis, V; Vlachos, D-E G; Gkioka, E; Tsotra, K; Papantoniou, N; Vlachos, G D


    We present the experience of a tertiary referral hospital in Greece, evaluating obstetric and perinatal outcomes among teenage and average maternal age (AMA) women. We retrospectively assessed all singleton pregnancies during a twelve-month period (January-December 2012). A total of 1,704 cases were reviewed and divided into two groups: one of AMA mothers (20-34 years old) (1,460 women) and the other of teenage mothers (12-19 years old) (244 women). We observed significantly higher incidence rates of preterm births (p teenage mothers. Antenatal surveillance was decreased among teenage mothers (p Teenage pregnancy is accompanied by significant antenatal and perinatal complications that need specific obstetrical attention. Obstetricians should be aware of these complications in order to ameliorate the antenatal outcome of childbearing teenagers.

  3. Assessment of the sexually abused female children admitted to a tertiary care hospital: Eight year experience. (United States)

    Mollamahmutoglu, Leyla; Uzunlar, Ozlem; Kahyaoglu, Inci; Ozyer, Sebnem; Besli, Mustafa; Karaca, Mujdegul


    To discuss the medical, social and legal characteristics of the child sexual abuse and to provide a perspective for gynecologists on this topic. A retrospective analysis was carried out of the medicolegal records of female children below the age of 18 referred to a tertiary teaching hospital and diagnosed as being exposed to sexual abuse within the family between the years of 2004 to 2012. One hundred and thirty-nine cases were diagnosed as being exposed to sexual abuse during the 8 year period, 23 of them (16.5%) had been involved in sexual abuse within the family. Eleven out of 23 had been admitted as part of a legal process while the rest were reported by a third person. Since sexual abuse within the family is a taboo in Islamic societies, the diagnosis can take a long time. Recognition of sexually abused children, providing early performance of medicolegal examinations, and applying standardized medical guidelines are essential to protect these children.

  4. Usutu virus in cerebrospinal fluid: A 2-year survey in a Tertiary Care Hospital, Geneva, Switzerland. (United States)

    Cordey, Samuel; Vieille, Gael; Turin, Lara; Kaiser, Laurent


    In 2009, the Usutu virus (USUV) was first reported as a cause of human neuroinvasive disorders. In Switzerland, USUV has been detected in wild birds with a seroprevalence of up to 6.59% in captive specimens sampled from zoo enclosures. This study investigates the clinical prevalence of USUV in human acute neuroinvasive disorders in Switzerland. Two hundred and fifty-eight cerebrospinal fluid samples collected between 2015 and 2017 for routine clinical care in a tertiary level hospital (Geneva) were tested for USUV by rRT-PCR. No samples were found positive, suggesting the absence, or the extremely low circulation of USUV in Western Switzerland. © 2017 The Authors. Journal of Medical Virology Published by Wiley Periodicals, Inc.

  5. Periodicity in magmatic systems (United States)

    Caricchi, Luca


    Magmatic systems show periodicity in productivity, magma chemistry and dynamics of volcanic eruptions. The timescales over which such parameters change are highly variable and ranges between several tens of millions of years down to few hundredths of thousands years. While magmatic activity appears modulated at various frequencies, the lifetime of single volcanic systems, the duration of emplacement of single plutons, or the timespan over which a given volcanic region is active, appear to last for distinct but characteristic periods of time. Hundredths of thousands of years is a typical number for the range of zircon crystallisation ages in the products of large eruptions or for the lifetime of single plutons, while activity in volcanic regions or the duration of emplacement of crustal batholiths appears to last up to about 10 Ma. Several mechanisms such as variable magma productivity in the mantle, delamination, thermal and mechanical maturation of the crust have been proposed to modulate magmatic activity. All these processes indeed contribute to modulate the periodicity of magmatic activity, but because certain timescales are recurrent, some fundamental processes must play a fundamental role in regulating the "tempo" of magmatism. Are transitions of behaviour finally the product of major changes in mantle dynamics or is the crust the plays the pivotal role in modulating periodic variations observed in magmatic systems? In this contribution I will provide an overview of existing data on periodicity of magmatic systems and use thermal modelling to show that periodic variations of magma chemistry and the physical properties of magmas are an inexorable consequence of the evolution of the thermal budget of magmatic systems. I hope to trigger discussion and collaborations between experts of geodynamics and magmatism to establish relationships between periodicity, mantle and crustal processes.

  6. Is the sword moss (Bryoxiphium) a preglacial Tertiary relict? (United States)

    Patiño, Jairo; Goffinet, Bernard; Sim-Sim, Manuela; Vanderpoorten, Alain


    The disjunction of floras between East Asia, Southeast North America, West North America, and Southwest Eurasia has been interpreted in terms of the fragmentation of a once continuous mixed mesophytic forest that occurred throughout the Northern Hemisphere due to the climatic and geological changes during the late Tertiary. The sword moss, Bryoxiphium, exhibits a distribution that strikingly resembles that of the mesophytic forest elements such as Liriodendron and is considered as the only living member of an early Tertiary flora in Iceland. These hypotheses are tested here using molecular dating analyses and ancestral area estimations. The results suggest that the extant range of Bryoxiphium results from the fragmentation of a formerly wider range encompassing North America and Southeast Asia about 10 million years ago. The split of continental ancestral populations is too recent to match with a continental drift scenario but is spatially and temporally remarkably congruent with that observed in Tertiary angiosperm relict species. The timing of the colonization of Iceland from Macaronesian ancestors, about two million years ago, is, however, incompatible with the hypothesis that Bryoxiphium is the only living member of an early Tertiary flora of the island. Alaska was recurrently colonized from East Asia. The ability of Bryoxiphium to overcome large oceanic barriers is further evidenced by its occurrence on remote oceanic archipelagos. In particular, Madeira was colonized twice independently from American and East Asian ancestors, respectively. The striking range disjunction of Bryoxiphium is interpreted in terms of its mating system, as the taxon exhibits a very singular pattern of spatial segregation of the sexes. Copyright © 2015 Elsevier Inc. All rights reserved.



    Stephen; Sahajanand; Rangalakshmi; Kasim


    AIMS : The aim of this retrospective study was to analyze the rate and chara cteristics of acute poisoning cases admitted to adult intensive care unit ( ICU ) in a tertiary care medical college hospital. We report clinical features , demographic data , laboratory results , mortality rate , and the results of our treatment in cases who ca me with the history of poisoning. METHODS: The study was done in patients admitted with his...

  8. Engineering of Droplet Manipulation in Tertiary Junction Microfluidic Channels (United States)


    AFRL-AFOSR-JP-TR-2017-0055 Engineering of Droplet Manipulation in Tertiary Junction Microfluidic Channels Shalini Gupta INDIAN INSTITUTE OF...2017 2. REPORT TYPE Final 3. DATES COVERED (From - To) 14 May 2015 to 13 Nov 2016 4. TITLE AND SUBTITLE Engineering of Droplet Manipulation in...dispersed phase was increased, the critical droplet size for transition also decreased. This multivariate approach can in future be used to engineer

  9. Salt Contribution to RNA Tertiary Structure Folding Stability (United States)

    Tan, Zhi-Jie; Chen, Shi-Jie


    Accurate quantification of the ionic contribution to RNA folding stability could greatly enhance our ability to understand and predict RNA functions. Recently, motivated by the potential importance of ion correlation and fluctuation in RNA folding, we developed the tightly bound ion (TBI) model. Extensive experimental tests showed that the TBI model can lead to better treatment of multivalent ions than the Poisson-Boltzmann equation. In this study, we use the model to quantify the contribution of salt (Na+ and Mg2+) to the RNA tertiary structure folding free energy. Folding of the RNA tertiary structure often involves intermediates. We focus on the folding transition from an intermediate state to the native state, and compute the electrostatic folding free energy of the RNA. Based on systematic calculations for a variety of RNA molecules, we derive a set of formulas for the electrostatic free energy for tertiary structural folding as a function of the sequence length and compactness of the RNA and the Na+ and Mg2+ concentrations. Extensive comparisons with experimental data suggest that our model and the extracted empirical formulas are quite reliable. PMID:21723828

  10. Cryptosporidium and Giardia removal by secondary and tertiary wastewater treatment. (United States)

    Taran-Benshoshan, Marina; Ofer, Naomi; Dalit, Vaizel-Ohayon; Aharoni, Avi; Revhun, Menahem; Nitzan, Yeshayahu; Nasser, Abidelfatah M


    Wastewater disposal may be a source of environmental contamination by Cryptosporidium and Giardia. This study was conducted to evaluate the prevalence of Cryptosporidium oocysts and Giardia cysts in raw and treated wastewater effluents. A prevalence of 100% was demonstrated for Giardia cysts in raw wastewater, at a concentration range of 10 to 12,225 cysts L(-1), whereas the concentration of Cryptosporidium oocysts in raw wastewater was 4 to 125 oocysts L(-1). The removal of Giardia cysts by secondary and tertiary treatment processes was greater than those observed for Cryptosporidium oocysts and turbidity. Cryptosporidium and Giardia were present in 68.5% and 76% of the tertiary effluent samples, respectively, at an average concentration of 0.93 cysts L(-1) and 9.94 oocysts L(-1). A higher detection limit of Cryptosporidium oocysts in wastewater was observed for nested PCR as compared to immune fluorescent assay (IFA). C. hominis was found to be the dominant genotype in wastewater effluents followed by C. parvum and C. andersoni or C. muris. Giardia was more prevalent than Cryptosporidium in the studied community and treatment processes were more efficient for the removal of Giardia than Cryptosporidium. Zoonotic genotypes of Cryptosporidium were also present in the human community. To assess the public health significance of Cryptosporidium oocysts present in tertiary effluent, viability (infectivity) needs to be assessed.

  11. Mudflow utilization for construction materials of tertiary irrigation canal lining (United States)

    Azis, Subandiyah; Kustamar


    Mudflow in Siring Village, Sidoarjo Regency, Indonesia, has been in eruption since May 29, 2006. It still shows irregular large bursts which loaded in a sludge reservoir with capacity of 59 million m3. From 2007 until 2015, there were more than 20 studies which concluded that the mudflow could be used as a mixture of building materials. However, the studies were not detailed and needed further research. This research aims to investigate the use of mudflow as tertiary irrigation canal lining material. This research comes with several laboratory tests to obtain a mixture that is solid and water-resistant. The methods that were used are descriptive methods as follows: 1). Sampling of mudflow, to be analyzed in Material Testing Laboratory. 2). Sampling of soil at research site, to be analyzed in Soil Mechanics Laboratory 3). Mixing of materials which are consist of mudflow and other materials and doing strength test in the laboratory. 4). Installation of tertiary irrigation canal lining using materials that have been tested. 5). Observation of lining's strength inactive soil pressure-bearing and its impermeability. It is expected that the results of this research will be applied extensively throughout the tertiary irrigation canals, so mudflow can be utilized as raw materials that are environmentally friendly, which are able to help preserving the environment, also to reduce the removal of sand / rock in the river, which has been used for lining materials, that benefits in preventing damage to the river ecosystem.

  12. "Ictal" lateralized periodic discharges. (United States)

    Sen-Gupta, Indranil; Schuele, Stephan U; Macken, Micheal P; Kwasny, Mary J; Gerard, Elizabeth E


    Whether lateralized periodic discharges (LPDs) represent ictal or interictal phenomena, and even the circumstances in which they may represent one or the other, remains highly controversial. Lateralized periodic discharges are, however, widely accepted as being ictal when they are time-locked to clinically apparent symptoms. We sought to investigate the characteristics of "ictal" lateralized periodic discharges (ILPDs) defined by time-locked clinical symptoms in order to explore the utility of using this definition to dichotomize LPDs into "ictal" and "nonictal" categories. Our archive of all continuous EEG (cEEG) reports of adult inpatients undergoing prolonged EEG monitoring for nonelective indications between 2007 and 2011 was searched to identify all reports describing LPDs. Lateralized periodic discharges were considered ILPDs when they were reported as being consistently time-locked to clinical symptoms; LPDs lacking a clear time-locked correlate were considered to be "nonictal" lateralized periodic discharges (NILPDs). Patient charts and available neuroimaging studies were also reviewed. Neurophysiologic localization of LPDs, imaging findings, presence of seizures, discharge outcomes, and other demographic factors were compared between patients with ILPDs and those with NILPDs. p-Values were adjusted for false discovery rate (FDR). One thousand four hundred fifty-two patients underwent cEEG monitoring at our institution between 2007 and 2011. Lateralized periodic discharges were reported in 90 patients, 10 of whom met criteria for ILPDs. Nine of the patients with ILPDs demonstrated motor symptoms, and the remaining patient experienced stereotyped sensory symptoms. Ictal lateralized periodic discharges had significantly increased odds for involving central head regions (odds ratio [OR]=11; 95% confidence interval [CI]=2.16-62.6; p=0.018, FDR adjusted), with a trend towards higher proportion of lesions involving the primary sensorimotor cortex (p=0.09, FDR

  13. Periodic Table of Students. (United States)

    Johnson, Mike


    Presents an exercise in which an eighth-grade science teacher decorated the classroom with a periodic table of students. Student photographs were arranged according to similarities into vertical columns. Students were each assigned an atomic number according to their placement in the table. The table is then used to teach students about…

  14. Hereditary periodic fever syndromes

    NARCIS (Netherlands)

    McDermott, MF; Frenkel, J

    Hereditary periodic fever syndromes are defined by recurrent attacks of generalised inflammation for which no infectious or auto-immune cause can be identified. For most of these disorders, the molecular basis has recently been elucidated. This has opened the prospect of novel therapeutic

  15. Sawtooth Period Scaling

    CERN Document Server

    Connor, J W; Hastie, R J; Zocco, A


    We discuss the role of neoclassical resistivity and local magnetic shear in the prediction of the sawtooth period in tokamaks. When collisional detrapping of electrons is considered the value of the safety factor on axis, $q(t,0)$, evolves on a new time scale, $\\tau_{*}=\\tau_{\\eta}\


    Recently, two papers reported the use of solid-phase microextraction (SPME) with polydimethylsiloxane(PDMS)/Carboxen fibers to determine trace levels of methyl tertiary butyl ether (MTBE) and tertiary butyl alcohol (tBA) in water. Attempts were made to apply this technique to th...

  17. Topological constraints are major determinants of tRNA tertiary structure and dynamics and provide basis for tertiary folding cooperativity. (United States)

    Mustoe, Anthony M; Brooks, Charles L; Al-Hashimi, Hashim M


    Recent studies have shown that basic steric and connectivity constraints encoded at the secondary structure level are key determinants of 3D structure and dynamics in simple two-way RNA junctions. However, the role of these topological constraints in higher order RNA junctions remains poorly understood. Here, we use a specialized coarse-grained molecular dynamics model to directly probe the thermodynamic contributions of topological constraints in defining the 3D architecture and dynamics of transfer RNA (tRNA). Topological constraints alone restrict tRNA's allowed conformational space by over an order of magnitude and strongly discriminate against formation of non-native tertiary contacts, providing a sequence independent source of folding specificity. Topological constraints also give rise to long-range correlations between the relative orientation of tRNA's helices, which in turn provides a mechanism for encoding thermodynamic cooperativity between distinct tertiary interactions. These aspects of topological constraints make it such that only several tertiary interactions are needed to confine tRNA to its native global structure and specify functionally important 3D dynamics. We further show that topological constraints are conserved across tRNA's different naturally occurring secondary structures. Taken together, our results emphasize the central role of secondary-structure-encoded topological constraints in defining RNA 3D structure, dynamics and folding. © The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.

  18. Maternal care quality in near miss and maternal mortality in an academic public tertiary hospital in Yogyakarta, Indonesia: a retrospective cohort study


    Mawarti, Yuli; Utarini, Adi; Hakimi, Mohammad


    Background Reducing maternal mortality remains a major challenge for health care systems worldwide. The factors related to maternal mortality were extensively researched, and maternal death clusters around labour, delivery and the immediate postpartum period. Studies on the quality of maternal care in academic medical centre settings in low income countries are uncommon. Methods A retrospective cohort study of maternal deaths was conducted in an academic public tertiary hospital in Yogyakarta...


    Directory of Open Access Journals (Sweden)

    Rinku Girija


    Full Text Available BACKGROUND Perinatal mortality is an index of obstetric care. Twin pregnancy is a high-risk pregnancy since most often the foetus in born prematurely or retarded physically; it may turn out to be a dreaded event, especially in rare instances of simultaneous death of twins or death of one twin in mid trimester thereby worsening the prognosis of the surviving twin. The aim of the study is to study the perinatal mortality and morbidity of twin gestation and factors affecting the same in a tertiary care center. MATERIALS AND METHODS This is a prospective study. 100 successive cases of multiple pregnancy beyond 28 weeks of gestation admitted during the study period were followed from the antenatal period upon their admission to the antenatal ward and the labour room. 100 cases of singleton pregnancies during the same period taken as control. Detailed obstetric history, family history of twins, intake of ovulation inducing agents, time of diagnosis of twin pregnancy confirmed by USS examination were noted. Maternal antenatal complications like anaemia, hypertension, jaundice, etc. noted. The mode of onset of labour, presentation of foetus noted and if possible confirmed by USS, routine and special investigation like PIH profile, FBS, PPBS. Doppler USS done wherever necessary. Study Setting and Design- It is a prospective observational study of 100 consecutive twin gestations of gestational age 28 weeks and above at a tertiary care hospital attached to Government Medical College, Thiruvananthapuram, for a period of 6 months. Perinatal outcome including perinatal morbidity and mortality in relation to gestational age, mode of delivery, chorionicity, birth weight of the baby and NICU admission were analysed. RESULTS Data collected was analysed with descriptive statistics like percentage, proportion, rates, ratio and chi-square test. CONCLUSION In spite of so many advances in Obstetrics and Neonatology, the perinatal mortality and morbidity in twin

  20. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East. (United States)

    Chaudhry, Imtiaz A; Shamsi, Farrukh A; Elzaridi, Elsanusi; Al-Rashed, Waleed; Al-Amri, Abdulrahman; Al-Anezi, Fahad; Arat, Yonca O; Holck, David E


    vs. 9 days in patients with no loss of vision; Porbital abscesses that required either extended treatment with systemic antibiotics alone or in combination with neurosurgical intervention. Most patients received oral antibiotics on discharge for varying periods. There were 6 cases (2.7%) of strabismus and 4 cases (1.8%) of ptosis that persisted after treatment and resolution of orbital cellulitis. Untreated sinusitis and prior history of orbital trauma were the 2 major causes of orbital cellulitis in patients referred to a tertiary care eye center in the Middle East. Although rare, severe visual loss still remains a serious complication of delayed detection and intervention in most cases of orbital cellulitis.

  1. Tooth agenesis in patients referred to an Irish tertiary care clinic for the developmental dental disorders.

    LENUS (Irish Health Repository)

    Hashem, Atef A


    PURPOSE: This study was carried out to determine the prevalence, severity and pattern of hypodontia in Irish patients referred to a tertiary care clinic for developmental dental disorders. MATERIALS AND METHODS: Details of 168 patients with hypodontia referred during the period 2002-2006 were entered in a database designed as a national record. Tooth charting was completed using clinical and radiographic examinations. The age of patients ranged from 7-50 years, with a median age of 20 years (Mean: 21.79; SD: 8.005). RESULTS: Hypodontia referrals constituted 65.5% of the total referrals. Females were more commonly affected than males with a ratio of 1.3:1. The number of referrals reflected the population density in this area; the majority were referrals from the public dental service. Mandibular second premolars were the most commonly missing teeth, followed by maxillary second premolars and maxillary lateral incisors; maxillary central incisors were the least affected. Symmetry of tooth agenesis between the right and left sides was an evident feature. Slightly more teeth were missing on the left side (n = 725) than on the right side (n = 706) and in the maxillary arch (n = 768) as compared to the mandibular arch (n = 663). Some 54% of patients had severe hypodontia with more than six teeth missing; 32% had moderate hypodontia, with four to six teeth missing. The most common pattern of tooth agenesis was four missing teeth. CONCLUSION: Hypodontia was a common presentation in a population referred to this tertiary care clinic. The pattern and distribution of tooth agenesis in Irish patients appears to follow the patterns reported in the literature.

  2. Epilepsy diagnostic and treatment needs identified with a collaborative database involving tertiary centers in France. (United States)

    Chipaux, Mathilde; Szurhaj, William; Vercueil, Laurent; Milh, Mathieu; Villeneuve, Nathalie; Cances, Claude; Auvin, Stéphane; Chassagnon, Serge; Napuri, Sylvia; Allaire, Catherine; Derambure, Philippe; Marchal, Cécile; Caubel, Isabelle; Ricard-Mousnier, Brigitte; N'Guyen The Tich, Sylvie; Pinard, Jean-Marc; Bahi-Buisson, Nadia; de Baracé, Claire; Kahane, Philippe; Gautier, Agnès; Hamelin, Sophie; Coste-Zeitoun, Delphine; Rosenberg, Sarah-Dominique; Clerson, Pierre; Nabbout, Rima; Kuchenbuch, Mathieu; Picot, Marie-Christine; Kaminska, Anna


    To obtain perspective on epilepsy in patients referred to tertiary centers in France, and describe etiology, epilepsy syndromes, and identify factors of drug resistance and comorbidities. We performed a cross-sectional analysis of the characteristics of 5,794 pediatric and adult patients with epilepsy included in a collaborative database in France between 2007 and 2013. Comparisons between groups used Student's t-test or Fisher's exact test for binary or categorical variables. Factors associated with drug resistance and intellectual disability were evaluated in multi-adjusted logistic regression models. Mean age at inclusion was 17.9 years; children accounted for 67%. Epilepsy was unclassified in 20% of patients, and etiology was unknown in 65%, including those with idiopathic epilepsies. Etiologies differed significantly in adult- when compared to pediatric-onset epilepsy; however, among focal structural epilepsies, mesial temporal lobe epilepsy with hippocampal sclerosis began as often in the pediatric as in adult age range. Drug resistance concerned 53% of 4,210 patients evaluable for seizure control and was highest in progressive myoclonic epilepsy (89%), metabolic diseases (84%), focal cortical dysplasia (70%), other cortical malformations (69%), and mesial temporal lobe epilepsy with hippocampal sclerosis (67%). Fifty-nine percent of patients with focal structural epilepsy and 69% with epileptic encephalopathies were drug resistant; however, 40-50% of patients with West syndrome and epileptic encephalopathy with continuous spike-and-waves during sleep were seizure-free. Ages at onset in infancy and in young adults shared the highest risk of drug resistance. Epilepsy onset in infancy comprised the highest risk of intellectual disability, whereas specific cognitive impairment affected 36% of children with idiopathic focal epilepsy. Our study provides a snapshot on epilepsy in patients referred to tertiary centers and discloses needs for diagnosis and treatment

  3. AB Initio Protein Tertiary Structure Prediction: Comparative-Genetic Algorithm with Graph Theoretical Methods

    Energy Technology Data Exchange (ETDEWEB)

    Gregurick, S. K.


    During the period from September 1, 1998 until September 1, 2000 I was awarded a Sloan/DOE postdoctoral fellowship to work in collaboration with Professor John Moult at the Center for Advanced Research in Biotechnology (CARB). Our research project, ''Ab Initio Protein Tertiary Structure Prediction and a Comparative Genetic algorithm'', yielded promising initial results. In short, the project is designed to predict the native fold, or native tertiary structure, of a given protein by inputting only the primary sequence of the protein (one or three letter code). The algorithm is based on a general learning, or evolutionary algorithm and is called Genetic Algorithm (GAS). In our particular application of GAS, we search for native folds, or lowest energy structures, using two different descriptions for the interactions of the atoms and residues in a given protein sequence. One potential energy function is based on a free energy description, while the other function is a threading potential derived by Moult and Samudrala. This modified genetic algorithm was loosely termed a Comparative Genetic Algorithm and was designed to search for native folded structures on both potential energy surfaces, simultaneously. We tested the algorithm on a series of peptides ranging from 11 to 15 residues in length, which are thought to be independent folding units and thereby will fold to native structures independent of the larger protein environment. Our initial results indicated a modest increase in accuracy, as compared to a standard Genetic Algorithm. We are now in the process of improving the algorithm to increase the sensitivity to other inputs, such as secondary structure requirements. The project did not involve additional students and as of yet, the work has not been published.

  4. Didn’t it matter to him absolutely?: Juan Vilanova and the controversy about tertiary Man

    Directory of Open Access Journals (Sweden)

    Catalá Gorgues, Jesús I.


    Full Text Available During the founding period of palaeoanthropology, the postulate about tertiary age of humankind was an outstanding subject. First proposals were based on supposed proofs about ancient lithical industry (eoliths. Some discoveries of human fossil remains complicated that issue, because they were dated as pliocene or oldest. This controversy about so-called «tertiary man» soon arrived to Spain. Juan Vilanova y Piera, palaeontologist and professor at Madrid, dealt with it from an antievolutionist point of view. When a human fossil skeleton, included in the Botet’s collection, with several apparently primitive traits arrived to Valencia from Argentina, Vilanova got reasserted and exposed his ideas about this question more intensely.

    Un tema relevante durante el período fundacional de la paleoantropología fue el postulado de la antigüedad terciaria de la humanidad. Las primeras propuestas se basaban en supuestas evidencias de industria lítica (eolitos. La cuestión se complicó con el descubrimiento de diversos fósiles humanos que fueron datados como pliocenos o incluso de mayor antigüedad. Esta polémica sobre el llamado «hombre terciario» llegó pronto a España. El paleontólogo y catedrático de la Universidad Central, Juan Vilanova y Piera, se ocupó extensamente del asunto desde perspectivas antievolucionistas. La llegada a Valencia en 1889, formando parte de la colección paleontológica donada por José Rodrigo Botet, de un esqueleto humano fósil procedente de Argentina que mostraba rasgos aparentes de primitivismo, llevó a Vilanova a reafirmarse y exponer más intensamente sus ideas sobre esta cuestión.

  5. Assessment of medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Dilnasheen Sheikh


    Full Text Available The objective of the study is to assess the medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital. A prospective observational study was carried out for a period of 8 months from June 2015 to February 2016 at tertiary care hospital. At inpatient department regular chart review of patient case records was carried out to assess the medication errors. The observed medication errors were assessed for level of harm by using NCCMERP index. The outpatient prescriptions were screened for adherence to WHO prescription writing guidelines. Out of 200 patients, 40 patients developed medication errors. Most of the medication errors were observed in the age group above 61 years (40%. Majority of the medication errors were observed with drug class of antibiotics 9 (22.5% and bronchodilators 9 (22.5%. Most of the errors were under the NCCMERP index category C. Out of 545 outpatient prescriptions, 51 (9.37% prescriptions did not have prescriber’s name and all of the prescriptions lack prescriber’s personal contact number. Eighteen prescriptions did not have patient’s name and 426 (78.2% prescriptions did not have patient’s age. The prevalence of medication errors in this study was relatively low (20% without any fatal outcome. Omission error was the most frequently observed medication errors 31 (77.5%. In the present study, the patient’s age was missing in 78.2% of the prescriptions and none of the prescriptions had patient’s address and the drug names were not mentioned by their generic names.

  6. Prescription writing practices in a rural tertiary care hospital in Western Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Vaishali D Phalke


    Full Text Available BackgroundPrescription is a written order from physician to pharmacistwhich contains name of drug, its dose and its method ofdispensing and advice over consuming it. The frequency ofdrug prescription errors is high. Prescribing errorcontributes significantly towards adverse drug events. Thepresent study was undertaken to understand the currentprescription writing practices and to detect the commonerrors in them at a tertiary health care centre situated in arural area of Western Maharashtra, India.MethodA cross sectional study was conducted at a tertiary levelhospital located at a rural area of Maharashtra state, Indiaduring October 2009-March 2010. 499 prescriptions comingto medical store during period of one month wereconsidered for data analysis. Important informationregarding the patient, doctor, drug and the generaldescription of the prescription were obtained.ResultsAll the prescriptions were on the hospital pad. A significantnumber of the prescriptions (n=88, 17.6% were written inillegible handwriting and not easily readable. The name, ageand sex of the patient were mentioned is majority of theprescriptions. All the prescriptions (100% failed todemonstrate the presence of address, height and weight ofthe patient. Only the brand name of the drugs wasmentioned in all the prescriptions with none of them havingthe generic name. The strength, quantity and route ofadministration of the drug were found on 73.1%, 65.3% and75.2% prescriptions.ConclusionThere are widespread errors in prescription writing by thedoctors. Educational intervention programs and use ofcomputer can substantially contribute in the lowering ofsuch errors. A short course on prescription writing beforethe medical student enters the clinical field and strictmonitoring by the administrative authorities may also helpalleviate the problem.Word count: 2980Tables: 2

  7. Neuro-Ophthalmology at a Tertiary Eye Care Centre in India. (United States)

    Dhiman, Rebika; Singh, Digvijay; Gantayala, Shiva P; Ganesan, Vaitheeswaran L; Sharma, Pradeep; Saxena, Rohit


    Neuro-ophthalmology as a specialty is underdeveloped in India. The aim of our study was to determine the spectrum and profile of patients presenting to a tertiary eye care center with neuro-ophthalmic disorders. A retrospective hospital-based study was conducted, and records of all patients seen at the neuro-ophthalmology clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, over a 1-year period were retrieved and evaluated. Of a total of 30,111 patients referred to various specialty clinics in a span of 1 year, 1597 (5%) were referred for neuro-ophthalmology evaluation. The mean patient age was 30.8 ± 19.5 years, with a male dominance (M:F = 2.02:1). Among these patients, optic nerve disorders were noted in 63.8% (n = 1,020), cranial nerve palsy in 7% (n = 114), cortical visual impairment in 6.5% (n = 105), and others (eye/optic nerve hypophasia, blepharospasm, and optic disc drusen) in 6% (n = 95). Among the patients with optic nerve disorders, optic neuropathy without disc edema/(traumatic optic neuropathy, hereditary, tumor-related, retrobulbar neuritis, toxic, and idiopathic) was noted in 42.8% (n = 685) and optic neuropathy with disc edema (ischemic optic neuropathy, papilledema, post-papilledema optic atrophy, papillitis, neuroretinitis, and inflammatory optic neuropathy) in 20.9% (n = 335). Sixteen percent of patients (n = 263) were incorrect referrals. The neuro-ophthalmic clinic constitutes a significant referral unit in a tertiary eye care center in India. Traumatic and ischemic optic neuropathies are the most common diagnoses. Neuro-ophthalmology requires further development as a subspecialty in India to better serve the nation's population.

  8. Spectrum of antihypertensive therapy in South Asians at a tertiary care hospital in Pakistan

    Directory of Open Access Journals (Sweden)

    Ehtamam Anabia


    Full Text Available Abstract Background Despite available guidelines on hypertension (HTN, use of antihypertensives is variable. This study was designed to ascertain frequency of patients on monotherapy and > 1 antihypertensive therapy and also to ascertain proportion of patients on diuretic therapy. Methods It was a crossectional study conducted on 1191 adults(age > 18 yrshypertensive patients selected by computerized International Classification of Diseases -9-coordination and maintenance (ICD-9-CM presenting to a tertiary care hospital in Pakistan. Data on demographics, comorbids, type of antihypertensive drug, number of antihypertensive drug and mean duration of antihypertensive drug was recorded over 1.5 year period (2008-09. Blood pressure was recorded on admission. Primary outcome was use of combination therapy and secondary outcome was use of diuretic therapy. Results A total of 1191 participants were included. Mean age(SD was 62.55(12.47 years, 45.3%(540 were males. Diabetes was the most common comorbid; 46.3%(551. Approximately 85% of patients had controlled hypertension. On categorization of anti hypertensive use into 3 categories;41.2%(491 were on monotherapy,32.2%(384 were on 2 drug therapy,26.5%(316 were on ≥3 drug therapy. Among those who were on monotherapy for HTN;34%(167 were on calcium channel blockers,30.10%(148 were on beta blockers, 22.80%(112 were on Angiotensin converting enzyme (ACE inhibitors,12%(59 were on diuretics and 2.20%(11 were on Angiotensin receptor blockers(ARB. Use of combination antihypertensive therapy was significantly high in patients with ischemic heart disease(IHD(p Conclusion Most patients presenting to our tertiary care center were on combination therapy. Calcium channel blocker is the most common anti hypertensive drug used as monotherapy and betablockers are used as the most common antihypertensive in combination. Only a third of patients were on diuretic as an antihypertensive therapy.

  9. Going beyond expectations: banks strategies attract and retain or deter tertiary students’ clientele

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    Ketsia Lorraine Motlhabane


    Full Text Available The study assesses whether the banks’ strategies help to attract and retain or deter tertiary students from their businesses. It aims to highlight the banks’ need to go beyond expectations in nurturing their students’ clientele. The study can be the banks’ stepping-stone into the seemingly neglected tertiary student (TS market. Using observation method and bank consultants’ interviews, this study probes South Africa’s (SA major banks’ service time-lag together with student product offers and information accessibility. The study focused on whether different banks’ product offers, costing and service quality do attract and retain or deter student clients. The questions were based on students’ saving/cheque accounts, credit card and loan facilities accessibility. Findings. Product offers and information were inadequate from branch visits and website searches less informative. Queues time-lag differed from bank to bank, but, overall, unreasonable for TS market with product limitations and generalized information not specific to students’ needs. Further research can be undertaken to gain in-depth understanding of whether urban banks’ strategies for students are distinct to those of semi-rural areas, which was the scope of this study. Banks services are significant for maintaining students’ profiles, providing traceable trails, of sponsors, families and financial transactions, which will be valuable even for periods beyond their academic life. Many live away from their secured homes, expected to survive with limited resources and time constraint. Nurturing these relationship would prepare students for the financial market demands much to the benefit of all stakeholders.

  10. Prescription writing practices in a rural tertiary care hospital in Western Maharashtra, India. (United States)

    Phalke, Vaishali D; Phalke, Deepak B; Syed, M M Aarif; Mishra, Anjeney; Sikchi, Saudamini; Kalakoti, Piyush


    Prescription is a written order from physician to pharmacist which contains name of drug, its dose and its method of dispensing and advice over consuming it. The frequency of drug prescription errors is high. Prescribing error contributes significantly towards adverse drug events. The present study was undertaken to understand the current prescription writing practices and to detect the common errors in them at a tertiary health care centre situated in a rural area of Western Maharashtra, India. A cross sectional study was conducted at a tertiary level hospital located at a rural area of Maharashtra state, India during October 2009-March 2010. 499 prescriptions coming to medical store during period of one month were considered for data analysis. Important information regarding the patient, doctor, drug and the general description of the prescription were obtained. All the prescriptions were on the hospital pad. A significant number of the prescriptions (n=88, 17.6%) were written in illegible handwriting and not easily readable. The name, age and sex of the patient were mentioned is majority of the prescriptions. All the prescriptions (100%) failed to demonstrate the presence of address, height and weight of the patient. Only the brand name of the drugs was mentioned in all the prescriptions with none of them having the generic name. The strength, quantity and route of administration of the drug were found on 73.1%, 65.3% and 75.2% prescriptions. There are widespread errors in prescription writing by the doctors. Educational intervention programs and use of computer can substantially contribute in the lowering of such errors. A short course on prescription writing before the medical student enters the clinical field and strict monitoring by the administrative authorities may also help alleviate the problem.

  11. Inpatient dermatology: Characteristics of patients and admissions in a tertiary level hospital in Eastern India

    Directory of Open Access Journals (Sweden)

    Arpita Sen


    Full Text Available Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27% were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33% and infective disorders (73 patients, 19.47%. Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2% improved after hospitalization; while 29 (7.73% patients died from their illness. About 133 patients (35.64% required referral services during their stay, while 8 patients (2.13% were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.

  12. The Apprentice to Master Journey: Exploring Tertiary Music Instrument Teachers’ Reflections on Their Experiences as Learner.

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    Ryan Daniel


    Full Text Available Many students worldwide engage in lessons on a music instrument; the most common format for this type of learning isthe one-to-one or studio lesson where the master guides the apprentice. At the same time, the one-to-one or studio lesson is an isolated area of practice, given that it takes place behind closed doors. In addition, while the literature for classroom music teachers is substantial with regard to investigating how they describe their own previous teaching experiences or the general characteristics of effective teachers, in comparison there are few studies that explore what music instrument teachers believe are effective characteristics and attributes of their previous teachers and lessons. In order to address this problem, this exploratory article focuses on the reflections of current higher education performing arts teachers; specifically music instrument teachers and their experiences of teachers and lessons. Survey data were obtained from 171 practitioners from nine nations. The respondents were asked to reflect on their initial, pre-tertiary and tertiary lesson experiences and teachers, and to identify the most significant influences on their learning. The data reveal a number of findings, such as the dominance of the master-apprentice social and learning relationship, the characteristics and attributes of inspiring teachers and/or learning experiences, and the fact that some respondents do not have any positive reflections on some periods of their learning.  The data also point towards the cyclical nature of music instrument learning and teaching, with masters guiding apprentices who then become the masters.

  13. Tertiary siRNAs mediate paramutation in C. elegans. (United States)

    Sapetschnig, Alexandra; Sarkies, Peter; Lehrbach, Nicolas J; Miska, Eric A


    In the nematode Caenorhabditis elegans, different small RNA-dependent gene silencing mechanisms act in the germline to initiate transgenerational gene silencing. Piwi-interacting RNAs (piRNAs) can initiate transposon and gene silencing by acting upstream of endogenous short interfering RNAs (siRNAs), which engage a nuclear RNA interference (RNAi) pathway to trigger transcriptional gene silencing. Once gene silencing has been established, it can be stably maintained over multiple generations without the requirement of the initial trigger and is also referred to as RNAe or paramutation. This heritable silencing depends on the integrity of the nuclear RNAi pathway. However, the exact mechanism by which silencing is maintained across generations is not understood. Here we demonstrate that silencing of piRNA targets involves the production of two distinct classes of small RNAs with different genetic requirements. The first class, secondary siRNAs, are localized close to the direct target site for piRNAs. Nuclear import of the secondary siRNAs by the Argonaute HRDE-1 leads to the production of a distinct class of small RNAs that map throughout the transcript, which we term tertiary siRNAs. Both classes of small RNAs are necessary for full repression of the target gene and can be maintained independently of the initial piRNA trigger. Consistently, we observed a form of paramutation associated with tertiary siRNAs. Once paramutated, a tertiary siRNA generating allele confers dominant silencing in the progeny regardless of its own transmission, suggesting germline-transmitted siRNAs are sufficient for multigenerational silencing. This work uncovers a multi-step siRNA amplification pathway that promotes germline integrity via epigenetic silencing of endogenous and invading genetic elements. In addition, the same pathway can be engaged in environmentally induced heritable gene silencing and could therefore promote the inheritance of acquired traits.

  14. Periodic Mesoporous Organosilica Nanorice

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    Mohanty Paritosh


    Full Text Available Abstract A periodic mesoporous organosilica (PMO with nanorice morphology was successfully synthesized by a template assisted sol–gel method using a chain-type precursor. The PMO is composed of D and T sites in the ratio 1:2. The obtained mesoporous nanorice has a surface area of 753 m2 g−1, one-dimensional channels, and a narrow pore size distribution centered at 4.3 nm. The nanorice particles have a length of ca. 600 nm and width of ca. 200 nm.

  15. The postanesthetic period. Complications. (United States)

    Malamed, S F


    Postanesthetic complications can occur even in the best of circumstances. Proper preparation of the staff, aggressive monitoring of the recovering patient, and early recognition and management of the complications are essential if the outcome is to be successful. In reviewing postanesthetic complications, two factors are present in the overwhelming majority of situations--hypoxia and hypercarbia--often the direct result of inadequate monitoring during the postanesthetic period. The anesthetic procedure is not over once the anesthetic agents are discontinued. The skillful anesthetist is aware of the possibilities of postoperative complications and prevents problems by employing enhanced monitoring techniques during the recovery phase.

  16. Periods of Hecke characters

    CERN Document Server

    Schappacher, Norbert


    The starting point of this Lecture Notes volume is Deligne's theorem about absolute Hodge cycles on abelian varieties. Its applications to the theory of motives with complex multiplication are systematically reviewed. In particular, algebraic relations between values of the gamma function, the so-called formula of Chowla and Selberg and its generalization and Shimura's monomial relations among periods of CM abelian varieties are all presented in a unified way, namely as the analytic reflections of arithmetic identities beetween Hecke characters, with gamma values corresponding to Jacobi sums. The last chapter contains a special case in which Deligne's theorem does not apply.

  17. Clinical evaluation of unselected cardiac arrest survivors in a tertiary center over a 1-year period (the LAZARUZ study). (United States)

    Marstrand, Peter; Corell, Pernille; Henriksen, Finn Lund; Pehrson, Steen; Bundgaard, Henning; Theilade, Juliane


    When the cause of an aborted cardiac arrest is unclear the initiation of therapy, counseling and family screening is challenging. We included 43 unselected, prospectively identified cardiac arrest survivors with or without a diagnosis. Family history for cardiac disease and supplemental electrocardiograms were evaluated for additional diagnostic information. 43 cardiac arrest survivors were included, 34 (79%) were male and the average age was 48years (range 23-64, SD 13.0). The most common etiologies identified in cardiac arrest survivors were ischemic heart disease (33%), cardiomyopathies (14%), miscellaneous (e.g. drug induced arrhythmias, coronary spasms) (12%) and channelopathies (5%). Family history of cardiac disease - even inheritable conditions - was not indicative of etiology in cardiac arrest survivors. Supplemental ECGs were abnormal in 10 of 43 patients; in the majority of these patients (7) no conclusive diagnosis was reached. In this study 16/43 (37%) of unselected, prospectively included cardiac arrest survivors remained without a diagnosis despite exhaustive investigations. We may extract additional diagnostic information from simple maneuvers during the recording of the electrocardiogram. We suggest that these ECG derived clues be investigated in future studies including genetic test results and data from relatives. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Clinical evaluation of unselected cardiac arrest survivors in a tertiary center over a 1-year period (the LAZARUZ study)

    DEFF Research Database (Denmark)

    Marstrand, Peter; Corell, Pernille; Henriksen, Finn Lund


    and supplemental electrocardiograms were evaluated for additional diagnostic information. RESULTS: 43 cardiac arrest survivors were included, 34 (79%) were male and the average age was 48years (range 23-64, SD 13.0). The most common etiologies identified in cardiac arrest survivors were ischemic heart disease (33...... of the electrocardiogram. We suggest that these ECG derived clues be investigated in future studies including genetic test results and data from relatives....

  19. The clinical course of hepatitis E virus infection in patients of a tertiary Dutch hospital over a 5-year period

    NARCIS (Netherlands)

    Riezebos-Brilman, Annelies; Verschuuren, Erik A. M.; van Son, Willem J.; van Imhoff, Gustaaf W.; Brugemann, Johan; Blokzijl, Hans; Niesters, Hubert G. M.


    Background: Hepatitis E virus (HEV) has long been known as a major cause of acute hepatitis in developing countries with occasional travel-related cases in developed countries, most of them belonging to genotype 1. Currently, genotype 3 HEV is recognized as an emerging public health issue in

  20. From Ramachandran Maps to Tertiary Structures of Proteins. (United States)

    DasGupta, Debarati; Kaushik, Rahul; Jayaram, B


    Sequence to structure of proteins is an unsolved problem. A possible coarse grained resolution to this entails specification of all the torsional (Φ, Ψ) angles along the backbone of the polypeptide chain. The Ramachandran map quite elegantly depicts the allowed conformational (Φ, Ψ) space of proteins which is still very large for the purposes of accurate structure generation. We have divided the allowed (Φ, Ψ) space in Ramachandran maps into 27 distinct conformations sufficient to regenerate a structure to within 5 Å from the native, at least for small proteins, thus reducing the structure prediction problem to a specification of an alphanumeric string, i.e., the amino acid sequence together with one of the 27 conformations preferred by each amino acid residue. This still theoretically results in 27(n) conformations for a protein comprising "n" amino acids. We then investigated the spatial correlations at the two-residue (dipeptide) and three-residue (tripeptide) levels in what may be described as higher order Ramachandran maps, with the premise that the allowed conformational space starts to shrink as we introduce neighborhood effects. We found, for instance, for a tripeptide which potentially can exist in any of the 27(3) "allowed" conformations, three-fourths of these conformations are redundant to the 95% confidence level, suggesting sequence context dependent preferred conformations. We then created a look-up table of preferred conformations at the tripeptide level and correlated them with energetically favorable conformations. We found in particular that Boltzmann probabilities calculated from van der Waals energies for each conformation of tripeptides correlate well with the observed populations in the structural database (the average correlation coefficient is ∼0.8). An alpha-numeric string and hence the tertiary structure can be generated for any sequence from the look-up table within minutes on a single processor and to a higher level of accuracy

  1. Dioxin distribution in a tertiary sedimentary clay profile (Germany)

    Energy Technology Data Exchange (ETDEWEB)

    Schmitz, M.; Bernau, S.; Germann, K. [Technische Univ. Berlin (Germany). Inst. fuer angewandte Geowissenschaften, Abt. Oekonomische Geologie; Pernak, P. [Dr. Fechter GmbH, Umweltlabor und Ingenieurbuero, Berlin (Germany); Rotard, W. [Technische Univ. Berlin (Germany). Inst. fuer Technischen Umweltschutz, Abt. Klimachemie


    Since 1999 dioxin of possibly natural origin has repeatedly been found in kaolinitic clays of different countries. Until today it is not generally agreed how the dioxin was generated. The aim of this study is to determine the relationship between the dioxin content and the mineralogical composition of clays as well as the distribution of dioxin in different grain size fractions and its behaviour within a profile of Tertiary kaolinitic clays from Germany. The study may provide a hypothesis of dioxin formation, based on the genesis of the clays.

  2. Loop Entropy Assists Tertiary Order: Loopy Stabilization of Stacking Motifs

    Directory of Open Access Journals (Sweden)

    Daniel P. Aalberts


    Full Text Available The free energy of an RNA fold is a combination of favorable base pairing and stacking interactions competing with entropic costs of forming loops. Here we show how loop entropy, surprisingly, can promote tertiary order. A general formula for the free energy of forming multibranch and other RNA loops is derived with a polymer-physics based theory. We also derive a formula for the free energy of coaxial stacking in the context of a loop. Simulations support the analytic formulas. The effects of stacking of unpaired bases are also studied with simulations.

  3. Pediatric Mortality in a Rural Tertiary Care Center in Liberia


    Carmelle Tsai; Camila B. Walters; John Sampson; Francis Kateh; Chang, Mary P.


    Liberia is a low‐income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post‐war and pre‐Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post‐war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric ...

  4. Transformation of Tertiary Benzyl Alcohols into the Vicinal Halo-Substituted Derivatives Using N-Halosuccinimides

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    Njomza Ajvazi


    Full Text Available The efficiency of direct conversion of tertiary alcohols bearing a β-hydrogen atom to vicinal halohydrins—chlorohydrins and bromohydrins—under green reaction conditions was tested preliminarily on model tertiary benzyl alcohols. Tertiary alcohols were successfully directly halogenated to vicinal halohydrins with N-halosuccinimide in aqueous media. The efficiency of the reaction in water was significantly improved in the presence of sodium dodecyl sulphate as the surfactant.

  5. Sustainable development of low income countries through investment in tertiary education


    Kundu, Nobinkhor; Banu, Asma


    To counterbalance the challenges of globalization, raising the superiority of our tertiary education to global standard is very significant. Tertiary education is the essential enabler of the human capital of the twenty-first century that demands a set of new competencies. It draws lessons for developing countries where policy makers have set out procedure to build a tertiary education in which higher priorities and future strategies would form the center of the sustainable development strate...

  6. Adolescents with sickle cell anaemia: Experience in a private tertiary hospital serving a tertiary institution. (United States)

    John-Olabode, Sarah; Awodele, Ibironke; Oni, Omolade


    Many adolescents with sickle cell disease (SCD) have adjustment difficulties in the transition period from paediatric care to the adult system because they find themselves in unfamiliar waters where they have to learn to manage themselves. The aim of this study is to evaluate the prevalent crises and morbidities associated with SCD in adolescents in Babcock University Teaching Hospital (BUTH), to also assess the level of knowledge of these adolescents about SCD and to determine their emotional response to the disease. This was a retrospective review of case notes of adolescents with sickle cell anaemia that were seen in BUTH, from May 2013 to April 2014. Data extracted from the case notes was entered into a Microsoft (MS) Excel and analysed using descriptive statistics. Results were presented in tables. A total of 50 subjects were seen in the department during this study period. Vaso-occlusive crises in the form of bone pains (93.1%) were the commonest crises encountered. Associated morbidities were malaria 34 (85%), tonsilitis 1 (2.5%), pneumonia 1 (2.5%), leg ulcer 1 (2.5%), azotaemia 1 (2.5%) and subarachnoid haemorrhage 2 (5%). Majority (88%) had adequate knowledge about general health maintenance while knowledge on nutrition and appropriate analgesia use is still inadequate. Eleven (22%) had symptoms of depression, four (8%) had suicidal ideation while one (2%) had a history of attempted suicide. This study emphasizes the importance of psychosocial intervention as part of a comprehensive health management for people with SCD.

  7. Autopsy study of febrile deaths during monsoon at a tertiary care institute in India: Is malaria still a challenge? (United States)

    Gupta, Anurag; Dhume, Varsha; Puranik, Gururaj Venkatesh; Kavishwar, Vikas


    Background: To utilise an autopsy-based approach to study the febrile deaths and deaths due to malaria during monsoon period of three years at a tertiary care teaching hospital in Mumbai, India. Materials and Methods: All autopsies done at the hospital during monsoon period from 2005 to 2007 when fever was the main presenting symptom were included in the study. Monsoon period was defined from June to September. A study on the duration of hospital stay of malaria deaths was also attempted. Results: There were 202 autopsies of febrile illness during the study period. Malaria resulted in 20.8% of the deaths besides other causes. A majority of deaths had intrapulmonary haemorrhages as the only pathological finding. Incidence of malaria deaths was more during monsoon period than the non-monsoon period. Plasmodium falciparum was the most common species responsible for malaria deaths while cerebral malaria was the most common mode of death. In 27% of the cases, post-mortem examination helped to arrive at the correct final diagnosis. In 88.1% of the cases, malaria deaths occurred within the first 24 hours of admission to the hospital. Conclusion: The study reiterates the fact that malaria remains a preventable but major cause of death in India, predominantly during the monsoon period. The study also emphasises the importance of developing treatment protocols for malaria during such crucial times besides reinforcing the existing preventive measures. PMID:25657486

  8. Halitosis amongst students in tertiary institutions in Lagos state. (United States)

    Arinola, J E; Olukoju, O O


    Halitosis is defined as a noticeable unpleasant odor from the mouth. It is a medico-social problem that affects a significant number of people around the world. Research reveals that nearly 50% of the adult population has halitosis. To determine level of awareness of halitosis and prevalence of the condition amongst students in tertiary institutions as a baseline survey. For this project, 100 students from three tertiary institutions in Lagos state were chosen: University of Lagos, Lagos State University, Ojo campus and Yaba College of Technology. A semi-structured questionnaire and practical testing/diagnostic tool were utilized. Data collected was collated and analyzed using Microsoft Excel 2007 and SPSS statistical software. Most of the respondents were single and Christian. Level of awareness of halitosis was high. Results showed that 15%, 2% and 22% from UNILAG, LASU and YCT respectively said they had halitosis. Using the diagnostic tool, 6%, 8% and 2% respectively were positive for halitosis. There is high level of awareness of halitosis among the respondents. The prevalence of the disorder is low, however, it is recommended that enlightenment campaigns be mounted in schools to improve level of awareness and treatment seeking.

  9. Accuracy of prenatal diagnosis in a tertiary fetal medicine unit. (United States)

    Kyle, Pippa M; Coghlan, Peter; Matthews, Jeannie; de Ryke, Rex; Reid, Rosemary


    To establish the accuracy of prenatal diagnosis in a tertiary referral fetal medicine unit by comparing those diagnoses made prenatally with diagnoses made at birth until discharge, and with postmortem information from cases that resulted in termination, intrauterine, or neonatal death. All cases seen in the Fetal Medicine Unit between 1 June 2004 and 30 November 2005 were collected prospectively and sorted according to diagnosis. Relevant outcome data for these pregnancies were collected including postmortem information. 681 cases seen which accounted for 1219 visits. 198 were classified prenatally as a major abnormality, 46 cases minor, 56 with raised nuchal translucency, and 381 no abnormality. Outcome details were not available for analysis in two cases. Therefore 679 (99.7%) cases were available (711 out of 713 fetuses). Of the liveborns, 93.6% of the prenatal diagnoses were confirmed, 5.1% were resolved (predominantly soft markers), and 1.3% resulted in an additional major abnormality that had a significant clinical effect. Postmortem examinations were performed on 52% fetal or neonatal deaths with a normal or unknown karyotype. There was one new finding at postmortem that changed the fetal medicine diagnosis significantly. Accuracy of prenatal diagnosis in a tertiary fetal medicine unit is high. Parents and staff need to be aware that not all abnormalities will be detected prenatally, but inaccurate diagnosis is uncommon. Clinical indicators for benchmarking need to be developed.

  10. Tertiary Intratumor Lymphoid Tissue in Colo-Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bergomas, Francesca [Department of Immunology and Inflammation, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy); Grizzi, Fabio [Laboratory of Molecular Gastroenterology, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy); Doni, Andrea; Pesce, Samantha [Department of Immunology and Inflammation, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy); Laghi, Luigi [Laboratory of Molecular Gastroenterology, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy); Department of Gastroenterology, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy); Allavena, Paola [Department of Immunology and Inflammation, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy); Mantovani, Alberto [Department of Immunology and Inflammation, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy); Department of Translational Medicine, University of Milan, Milan 20089 (Italy); Marchesi, Federica, E-mail: [Department of Immunology and Inflammation, IRCCS Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan (Italy)


    Ectopic (or tertiary) lymphoid tissue develops at sites of inflammation or infection in non lymphoid organs and is associated with chronic inflammation. In colon mucosa, small lymphoid aggregates are already present in homeostatic conditions, as part of the gut-associated lymphoid tissue and play an essential role in the immune response to perturbations of the mucosal microenvironment. Despite the recognized role of inflammation in tumor progression, the presence and biological function of lymphoid tissue in cancer has been poorly investigated. We identified aggregates of lymphocytes resembling tertiary lymphoid tissue in human colorectal cancer specimens; intratumor accumulations of lymphocytes display a high degree of compartmentalization, with B and T cells, mature dendritic cells and a network of CD21{sup +} follicular dendritic cells (FDC). We analyzed the adaptation of colon lymphoid tissue in a murine model of colitis-associated cancer (AOM/DSS). B cell follicle formation increases in the context of the chronic inflammation associated to intestinal neoplasia, in this model. A network of lymphatic and haematic vessels surrounding B cell follicles is present and includes high endothelial venules (HEV). Future task is to determine whether lymphoid tissue contributes to the persistence of the tumor-associated inflammatory reaction, rather than represent a functional immune compartment, potentially participating to the anti tumor response.

  11. Tertiary Intratumor Lymphoid Tissue in Colo-Rectal Cancer

    Directory of Open Access Journals (Sweden)

    Federica Marchesi


    Full Text Available Ectopic (or tertiary lymphoid tissue develops at sites of inflammation or infection in non lymphoid organs and is associated with chronic inflammation. In colon mucosa, small lymphoid aggregates are already present in homeostatic conditions, as part of the gut-associated lymphoid tissue and play an essential role in the immune response to perturbations of the mucosal microenvironment. Despite the recognized role of inflammation in tumor progression, the presence and biological function of lymphoid tissue in cancer has been poorly investigated. We identified aggregates of lymphocytes resembling tertiary lymphoid tissue in human colorectal cancer specimens; intratumor accumulations of lymphocytes display a high degree of compartmentalization, with B and T cells, mature dendritic cells and a network of CD21+ follicular dendritic cells (FDC. We analyzed the adaptation of colon lymphoid tissue in a murine model of colitis-associated cancer (AOM/DSS. B cell follicle formation increases in the context of the chronic inflammation associated to intestinal neoplasia, in this model. A network of lymphatic and haematic vessels surrounding B cell follicles is present and includes high endothelial venules (HEV. Future task is to determine whether lymphoid tissue contributes to the persistence of the tumor-associated inflammatory reaction, rather than represent a functional immune compartment, potentially participating to the anti tumor response.


    Directory of Open Access Journals (Sweden)

    Aunurrahman Aunurrahman


    Full Text Available For tertiary English as a Foreign Language (EFL students, academic writing is not an easy task. It requires knowledge of the academic writing genres with their particular linguistic features. Moreover, academic writing demands good critical thinking. This research aims to explore the students' academic writing competencies that also focus on critical thinking. The research involved thirty-six first-year tertiary EFL students from a regular class of a private university in Pontianak, West Kalimantan, Indonesia. The source for data collection was the students’ texts. Three texts were selected and the students were categorized into low, medium, and high levels of writing achievement. The text analysis utilized functional grammar rooted in systemic functional linguistics (Emilia, 2014. The analysis shows that the students, regardless of their levels of writing achievement, have little control over the schematic structure and linguistic features of an argumentative writing. The text analysis also shows that the students’ texts have some limitations as regards their critical thinking capacity. Still, a few examples of academic language were detected in the texts. The findings suggest that the lecturer should incorporate explicit teaching and cooperative learning activities to alleviate the students' difficulties and develop their academic writing and critical thinking capacity.

  13. Tertiary Intratumor Lymphoid Tissue in Colo-Rectal Cancer (United States)

    Bergomas, Francesca; Grizzi, Fabio; Doni, Andrea; Pesce, Samantha; Laghi, Luigi; Allavena, Paola; Mantovani, Alberto; Marchesi, Federica


    Ectopic (or tertiary) lymphoid tissue develops at sites of inflammation or infection in non lymphoid organs and is associated with chronic inflammation. In colon mucosa, small lymphoid aggregates are already present in homeostatic conditions, as part of the gut-associated lymphoid tissue and play an essential role in the immune response to perturbations of the mucosal microenvironment. Despite the recognized role of inflammation in tumor progression, the presence and biological function of lymphoid tissue in cancer has been poorly investigated. We identified aggregates of lymphocytes resembling tertiary lymphoid tissue in human colorectal cancer specimens; intratumor accumulations of lymphocytes display a high degree of compartmentalization, with B and T cells, mature dendritic cells and a network of CD21+ follicular dendritic cells (FDC). We analyzed the adaptation of colon lymphoid tissue in a murine model of colitis-associated cancer (AOM/DSS). B cell follicle formation increases in the context of the chronic inflammation associated to intestinal neoplasia, in this model. A network of lymphatic and haematic vessels surrounding B cell follicles is present and includes high endothelial venules (HEV). Future task is to determine whether lymphoid tissue contributes to the persistence of the tumor-associated inflammatory reaction, rather than represent a functional immune compartment, potentially participating to the anti tumor response. PMID:24213222

  14. Pedagogical Study into Tertiary Learning Styles in Vietnam

    Directory of Open Access Journals (Sweden)

    Barry Ramsay


    Full Text Available Pedagogical studies for tertiary students in Vietnam are limited and no comparative benchmarking studies with other Asian tertiary students found. As a means to fill this gap and provide a better understanding the following study using Biggs (1987c Study Process Questionnaire (SPQ, a 42-item self-report survey consisting of ratings on a 5-point scale to questions relating to respondents' study motivations and their usual study patterns was conducted with 355 respondents. Findings were consistent with Hong Kong students and supports studies carried out in other countries by Kemper et al. (1989, Kemper and Gow (1991, Niles (1995, Volet and Renshaw (1996, Ramburuth (2001 and Hua, Williams and Hoi (2007. Despite learning in a “rote” manner during their formative years, students have adapted to deeper learning approaches although there is a still a slight but insignificant bias to surface learning. They desire to achieve and get good marks although strategy is limiting their progress. According to Biggs, this is commonly caused by a language problem.

  15. Improved Operating Room Efficiency via Constraint Management: Experience of a Tertiary-Care Academic Medical Center. (United States)

    Kimbrough, Charles W; McMasters, Kelly M; Canary, Jeff; Jackson, Lisa; Farah, Ian; Boswell, Mark V; Kim, Daniel; Scoggins, Charles R


    Suboptimal operating room (OR) efficiency is a universal complaint among surgeons. Nonetheless, maximizing efficiency is critical to institutional success. Here, we report improvement achieved from low-cost, low-technology measures instituted within a tertiary-care academic medical center/Level I trauma center. Improvements in preadmission testing and OR scheduling, including appointing a senior nurse anesthetist to help direct OR use, were instituted in March 2012. A retrospective review of prospectively maintained OR case data was performed to evaluate time periods before and after program implementation, as well as to assess trends over time. Operating room performance metrics were compared using Mann-Whitney and chi-squared tests. Changes over time were analyzed using linear regression. Data including all surgical cases were available for a 36-month period; 10 months (6,581 cases) before program implementation and 26 months afterward (17,574 cases). Dramatic improvement was seen in first-case on-time starts, which increased from 39.3% to 83.8% (p efficiency and case volume. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Analysis of surgically treated gastric cancers: a tertiary hospital experience in Turkey (United States)

    Alimoglu, Orhan; Sisik, Abdullah; Eren, Tunc; Aktas, Suat; Basak, Fatih; Leblebici, Metin; Bas, Gurhan


    OBJECTIVE: Gastric cancer (GC) is the fifth most common cancer worldwide, and in Turkey, GC is placed among the 10 most frequently seen cancers. However, analyzing the epidemiology of cancers and improving screening programs for cancers are not still the top priorities for healthcare professionals. This study aims to show distribution of GC based on stages in a tertiary hospital of Istanbul, Turkey. METHODS: All surgically treated GC cases in the General Surgery Department, between January 2009 and January 2014 were retrospectively reviewed. Data including the operation year, the demographic, clinical and histopathological parameters were recorded and statistically analyzed. RESULTS: The study group consisted of 111 patients. Seventy-four (66.66%) patients were men, and 37 (33.33%) patients were women with a mean age of 63.49±11.83 years. Stage 3 and 4 were the most frequently observed stages with 62 and 18 cases, respectively. Stage 3 was the most common stage found during the study period (p<0.05). During 5 years of the study period, GC was less frequently located on the cardia (n=31) when compared with other locations (n=75) for GC (p<0.05). CONCLUSION: Turkey’s population has generally advanced stage GC disease. New strategies are needed for achievement of early diagnosis and better outcomes. PMID:28058349

  17. Factors associated with hand hygiene compliance at a tertiary care teaching hospital. (United States)

    Kowitt, Benjamin; Jefferson, Julie; Mermel, Leonard A


    To identify factors associated with hand hygiene compliance during a multiyear period of intervention. Observational study. A 719-bed tertiary care teaching hospital. Nursing, physician, technical, and support staff. Light-duty staff performed hand hygiene observations during the period July 2008-December 2012. Infection control implemented hospital-wide hand hygiene initiatives, including education modules; posters and table tents; feedback to units, medical directors and the executive board; and an increased number of automated alcohol hand hygiene product dispensers. There were 161,526 unique observations; overall compliance was 83%. Significant differences in compliance were observed between physician staff (78%) and support staff (69%) compared with nursing staff (84%). Pediatric units (84%) and intensive care units (84%) had higher compliance than did medical (82%) and surgical units (81%). These findings persisted in the controlled multivariate model for noncompliance. Additional factors found to be significant in the model included greater compliance when healthcare workers were leaving patient rooms, when the patient was under contact precautions, and during the evening shift. The overall rate of compliance increased from 60% in the first year of observation to a peak of 96% in the fourth year, and it decreased to 89% in the final year, with significant improvements occurring in each of the 4 professional categories. A multipronged hand hygiene initiative is effective in increasing compliance rates among all categories of hospital workers. We identified a variety of factors associated with increased compliance. Additionally, we note the importance of continuous interventions in maintaining high compliance rates.

  18. Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland. (United States)

    Bloch-Infanger, Constantine; Bättig, Veronika; Kremo, Jürg; Widmer, Andreas F; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan


    The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland. At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations. Hundred ninety five of 2'544 and 516 of 6'243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (pmigration-associated neglected infections. Physicians should be aware of these new challenges.

  19. Subacute sclerosing panencephalitis in a tertiary care centre in post measles vaccination era. (United States)

    Sonia, Malik; Lalit, Dar; Shobha, Broor; Sheffali, Gulati; Amandeep, Salhotra; Veena, Kalra; Madhuri, Behari


    This study was conducted to observe the impact of measles vaccination on the epidemiology of subacute sclerosing panencephalitis (SSPE) in the post measles vaccination era. This is a retrospective study from a tertiary care hospital, covering a ten year period starting a decade after the introduction of the national measles immunization programme in India. We analyzed 458 serologically confirmed SSPE cases. These patients had a high cerebrospinal fluid: serum anti-measles antibody ratio. The male to female ratio in the present study was 4.4:1. The mean age at onset of SSPE was 13.3 years, showing an increase in mean age at onset of SSPE. Clinical and other demographic details, available from 72 in-patients, are discussed in this report. Of these, a history of measles could be elicited in 34 cases. Mean latent period between measles infection and onset of SSPE was 7.8 years. Six patients gave a history of measles vaccination. A sizable percentage (15.5 %) of the patients was > or = 18 years old and considered to have adult onset SSPE. The incidence of SSPE continues to be high and this report highlights the need for further strengthening routine measles immunization coverage.

  20. Pediatric tracheotomy: 3-year experience at a tertiary care center with 54 children. (United States)

    Atmaca, Sinan; Bayraktar, Cem; Aşilioğlu, Nazik; Kalkan, Gökhan; Ozsoy, Zeki


    The aim of this study was to evaluate the indications, complications and outcomes of pediatric tracheotomies at a tertiary care center. Data were obtained retrospectively from 54 patients who underwent tracheotomy from July 2007 to May 2010. Over the three-year period, 54 tracheotomies were performed. Thirty-two patients (59.3%) were male and 22 (40.7%) were female. The mean and median ages of the patients were 54 and 14 months (6 days-17 years), respectively. Twenty-six patients (48.1%) were under 1 year of age. The most common indication for tracheotomy was prolonged intubation (87%), followed by upper airway obstruction (13%). Five patients (9.2%) underwent tracheotomy under semiurgent settings. The overall complication rate was 29.6% (16/54). Early complications occurred in 7 patients (13%), including accidental decannulation in 2 patients, subcutaneous emphysema in 4 patients and hemorrhage in 1 patient. Late complications occurred in 9 patients (16.7%) (stomal granulation in 7 patients and stomal infection in 2 patients). Eight patients (14.8%) were decannulated successfully. No tracheotomy-related deaths occurred, with an overall mortality rate of 27.7% (15/54). Pediatric tracheotomy is a relatively safe procedure with a low incidence of procedure-related morbidities. The indication for the majority of the procedures was prolonged intubation (87%). The lower decannulation rate is related to the higher percentage of patients needing assisted ventilation and the relatively short follow-up period.

  1. Frequency of IgA Nephropathy Presenting at a Tertiary Care Hospital in Pakistan. (United States)

    Arshi, Shahana; Nasir, Humaira; Butt, Ghias-Ud-Din; Niazi, Aasiya; Mamoon, Nadira; Qamar, Sana Roshan; Mushtaq, Rabia


    To determine the frequency of IgAnephropathy presenting at a tertiary care hospital. Across sectional, observational study. Pakistan Institute of Medical Sciences, Islamabad and Shifa International Hospital, Islamabad, Pakistan, from November 2008 to November 2014. This was a retrospective analysis of renal biopsies for the diagnosis of nephropathy during the study period. Biopsies were stained with fluorescence isothyocyanate (FITC) labelled antibodies against IgG, IgA, IgM, C3, C4 and C1q for fluorescent microscopy. For histopathological examination, the specimens were stained with hematoxylin and eosin, Periodic acid Schiff and methanamine silver stains for light microscopy. Out of total 1,658 renal biopsy cases, 142 (8.6%) were diagnosed as IgA nephropathy on light and immunofluorescence microscopy. Majority of IgAnephropathy patients were young (mean age = 33.2) and presented with proteinuria. The frequency rose from 2% in 2008 to 9.4% in 2014. IgAnephropathy was present in younger population and has a rising trend in our population.

  2. The process, logistics and challenges of implementing clinical supervision in a generalist tertiary referral hospital. (United States)

    Brunero, Scott; Lamont, Scott


    Clinical supervision (CS) has been identified within nursing as a process for improving clinical practice and reducing the emotional burden of nursing practice. Little is known about its implementation across large tertiary referral hospitals. The purpose of this study is to evaluate the implementation of clinical supervision across several different nursing specialities at a teaching hospital in Sydney, Australia. Using a model of nursing implementation science, a process was developed at the study site that facilitated the development, implementation and evaluation of the project. After a 6-month study period, the CS groups were postevaluated using a survey tool developed for the project. A total of nine CS groups were in operation over the 6-month study period. A predominant focus within the sessions was one of the collegial support and developing standards of practice. The process was able to achieve wide hospital-based support for the role of CS from the senior nurse executives to junior nurses. Whilst there was overall positive support for the CS groups, logistical and resource challenges remain, in the effective roll out of CS to large numbers of nurses. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

  3. Indicators and outcomes of transfer to tertiary pediatric hospitals for patients with testicular torsion. (United States)

    Preece, Janae; Ching, Christina; Yackey, Katelyn; Jayanthi, Venkata; McLeod, Daryl; Alpert, Seth; DaJusta, Daniel


    Testicular torsion threatens testicular viability with increased risk of loss with delayed management. Still, healthy adolescents continue to be transferred from community hospitals to tertiary hospitals for surgical management for torsion even though adult urologists may be available. We sought to determine reasons behind patient transfer and to evaluate whether transfer to tertiary centers for testicular torsion leads to increased rates of testicular loss. A retrospective chart review was performed for patients presenting to our free-standing pediatric tertiary care facility with surgically confirmed testicular torsion during the 5-year period between January 2011 and January 2016. Data was collected regarding transfer status, patient demographics, time of presentation to our facility, duration of symptoms, patient workup, and surgical outcomes. Patients with perinatal or intermittent torsion were excluded. One-hundred and twenty-five patients met the inclusion criteria. Thirty-six of those were transferred from outside facilities while 89 presented directly to our hospital. A greater proportion of the transferred patients presented during nights or weekends than those presenting directly to our facility (77.8% versus 51.7%, p = 0.009). Eighty-nine patients presented with symptom duration of less than 24 h and had potentially viable testicles. Of those, 23 were transferred and 66 presented directly to our hospital. Differences are shown in the Table. Transferred patients had twice the rate of testicular loss as those not transferred, although the results were not significant (30.4% versus 15.2%, p = 0.129). Patients undergoing ultrasound prior to transfer had prolonged symptom duration and faced higher rates of testicular loss when compared with patients not transferred, although the latter was not significant (mean duration 8.0 versus 4.9 h, p = 0.025, and testicular loss 40.0% versus 15.2%, p = 0.065, respectively). Patients transferred over 30 miles

  4. [Childhood periodic syndromes]. (United States)

    Cuvellier, J-C; Lépine, A


    This review focuses on the so-called "periodic syndromes of childhood that are precursors to migraine", as included in the Second Edition of the International Classification of Headache Disorders. Three periodic syndromes of childhood are included in the Second Edition of the International Classification of Headache Disorders: abdominal migraine, cyclic vomiting syndrome and benign paroxysmal vertigo, and a fourth, benign paroxysmal torticollis is presented in the Appendix. The key clinical features of this group of disorders are the episodic pattern and intervals of complete health. Episodes of benign paroxysmal torticollis begin between 2 and 8 months of age. Attacks are characterized by an abnormal inclination and/or rotation of the head to one side, due to cervical dystonia. They usually resolve by 5 years. Benign paroxysmal vertigo presents as sudden attacks of vertigo, accompanied by inability to stand without support, and lasting seconds to minutes. Age at onset is between 2 and 4 years, and the symptoms disappear by the age of 5. Cyclic vomiting syndrome is characterized in young infants and children by repeated stereotyped episodes of pernicious vomiting, at times to the point of dehydration, and impacting quality of life. Mean age of onset is 5 years. Abdominal migraine remains a controversial issue and presents in childhood with repeated stereotyped episodes of unexplained abdominal pain, nausea and vomiting occurring in the absence of headache. Mean age of onset is 7 years. Both cyclic vomiting syndrome and abdominal migraine are noted for the absence of pathognomonic clinical features but also for the large number of other conditions to be considered in their differential diagnoses. Diagnostic criteria, such as those of the Second Edition of the International Classification of Headache Disorders and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, have made diagnostic approach and management easier. Their diagnosis

  5. Urological injuries during obstetric and gynaecological procedures: a retrospective analysis over a period of eleven years


    Rashmi S. Desai; Sunil Kumar K.


    Background: To determine frequency and nature of urological injuries in obstetric and gynaecological procedures and their consequences and mode of management in a tertiary care hospital SDM Medical college and hospital, Dharwad, India. Methods: A retrospective study of all obstetric and gynaecological surgeries over a period of 11 years from January 2004 to December 2014 was carried out at Department of Obstetrics and Gynaecology, SDM Medical College and Hospital, Dharwad, India. Cases wit...

  6. Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital

    Directory of Open Access Journals (Sweden)

    Jiang SP


    Full Text Available Sai-Ping Jiang,1,* Jian Chen,2,* Xing-Guo Zhang,1 Xiao-Yang Lu,1 Qing-Wei Zhao1 1Department of Pharmacy, 2Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China *These authors contributed equally to this work Background: Pharmacist interventions and medication errors potentially differ between the People’s Republic of China and other countries. This study aimed to report interventions administered by clinical pharmacists and analyze medication errors in an intensive care unit (ICU in a tertiary hospital in People’s Republic of China.Method: A prospective, noncomparative, 6-month observational study was conducted in a general ICU of a tertiary hospital in the People’s Republic of China. Clinical pharmacists performed interventions to prevent or resolve medication errors during daily rounds and documented all of these interventions and medication errors. Such interventions and medication errors were categorized and then analyzed.Results: During the 6-month observation period, a total of 489 pharmacist interventions were reported. Approximately 407 (83.2% pharmacist interventions were accepted by ICU physicians. The incidence rate of medication errors was 124.7 per 1,000 patient-days. Improper drug frequency or dosing (n=152, 37.3%, drug omission (n=83, 20.4%, and potential or actual occurrence of adverse drug reaction (n=54, 13.3% were the three most commonly committed medication errors. Approximately 339 (83.4% medication errors did not pose any risks to the patients. Antimicrobials (n=171, 35.0% were the most frequent type of medication associated with errors.Conclusion: Medication errors during prescription frequently occurred in an ICU of a tertiary hospital in the People’s Republic of China. Pharmacist interventions were also efficient in preventing medication errors. Keywords: pharmacist, medication error, preva­lence rate, type, severity, intensive care

  7. The Performance in Context Model: A 21st Century Tertiary Dance Teaching Pedagogy (United States)

    Stevens, Kym; Huddy, Avril


    Despite tertiary institutions acknowledging that reflective practice is an essential component of undergraduate dance teacher training, there is often a disparity between the tertiary students' reflective skills and the more sophisticated reflective ability needed to navigate the twenty-first-century workforce. This paper charts the evolution of a…

  8. Framework of Assessment for the Evaluation of Thinking Skills of Tertiary Level Students (United States)

    Heng, Chan Swee; Ziguang, Yan


    In the 21st century, students are required to master thinking skills in order to deal with many situations that arise in the tertiary environment which later would translate into the workplace. Nowadays, thinking skills play a vital role in tertiary education. To provide an approach for teachers, this paper identifies a 4-step model that can be…

  9. Blended Learning and Team Teaching: Adapting Pedagogy in Response to the Changing Digital Tertiary Environment (United States)

    Crawford, Renée; Jenkins, Louise


    Increased accessibility of advanced technology, the targeted use of online learning platforms, student flexible learning expectations and the pressures of faculty budget constraints and priorities have called into question the effectiveness of traditional tertiary teaching and learning models. The tertiary education context must evolve at a pace…

  10. Widening Access to Tertiary Education for Women in Ghana through Distance Education (United States)

    Kwapong, Olivia Adwoa Tiwaah Frimpong


    Distance education (DE) is seen as a tool for widening access to education at all levels. It is an educational tool that breaks most of the divides in education--age, gender, race, income, space, time etc. For the past decades, irrespective of the extensive expansion of tertiary institutions in the country, provision of tertiary education in Ghana…

  11. Who Has to Pay for Their Education? Evidence from European Tertiary Education (United States)

    Lim, Gieyoung; Kim, Chong-Uk


    In this article, we investigate a positive tertiary education externality in 18 European countries. Using a simple Cobb-Douglas-type production function with constant returns to scale, we find that there are positive spillover effects from tertiary education in European countries. According to our model prediction, on average, 72,000 new employed…

  12. Emotional Intelligence and the Conflict Resolution Repertoire of Couples in Tertiary Institutions in Imo State (United States)

    Nnodum, B. I.; Ugwuegbulam, C. N.; Agbaenyi, I. G.


    This study is a descriptive survey that investigated the relationship between emotional intelligence and conflict resolution repertoire of couples in tertiary institutions. A sample of 250 married people were drawn from the population of couples in tertiary institutions in Imo State. Two researcher made and validated instruments were used in…

  13. Willing and Enabled: The Academic Outcomes of a Tertiary Enabling Program in Regional Australia (United States)

    Andrewartha, Lisa; Harvey, Andrew


    This paper examines the achievement levels of students undertaking the Tertiary Enabling Program (TEP) at La Trobe University. The TEP is an alternative pathway program that traverses multiple institutions, campuses, and disciplinary areas, and is designed to prepare a diverse student cohort for tertiary study. The Program integrates several…

  14. Inside the Collaborative Inter-Arts Improvisatory Process: Tertiary Music Students' Perspectives (United States)

    Blom, Diana


    While research has explored aspects of inter-arts collaboration at professional and primary level, there is little on inter-arts collaboration in the tertiary environment. This article explores aspects of the learning of tertiary music students undertaking a short-term collaborative inter-arts improvisation project with dance and theater peers,…

  15. The Teaching of English in Tasmania: Building Links between Senior Secondary and Tertiary Teachers (United States)

    Fletcher, Lisa; Clarke, Robert; Crane, Ralph; Gaby, Rosemary; Milthorpe, Naomi; Stark, Hannah


    This article tells the story of two projects initiated by the University of Tasmania's English program, which were designed to investigate and improve the pathway from pre-tertiary to tertiary English studies in the state: the First Year English Survey (2012-2014) and the Teaching of English in Tasmania Community of Practice (TETCoP). The authors…

  16. Transition and Tertiary Education: A Case Study of Mzuzu University, Malawi (United States)

    Zozie, Paxton Andrew; Kayira, Peter Benwell


    This article reviews the role of guidance and counselling in Malawi in reducing dropout and easing the transition of students to tertiary education, as well as in helping them during their time in tertiary education. It begins by identifying key success factors in guidance and counselling services for learners in both developed and developing…

  17. Tertiary Educators' Voices in Australia and South Africa: Experiencing and Engaging in African Music and Culture (United States)

    Joseph, Dawn


    Music tertiary educators can foster positive experiences that promote diversity, enhance intercultural and cross-cultural understanding through our teaching. Through findings of interview data of tertiary music educators' understandings of multicultural music practice at two South African universities and at an Australia university, I used…

  18. Knowing, Performing and Holding Queerness: LGBTIQ+ Student Experiences in Australian Tertiary Education (United States)

    Waling, Andrea; Roffee, James A.


    This paper explores LGBTIQ+ students' experiences of knowing, performing and holding queerness in a tertiary educational environment. Through interviews conducted with LGBTIQ+ students at a large Australian metropolitan university, we examine the students' engagement with other LGBTIQ+ students in the tertiary educational space. Although…

  19. On Progress of Mass Tertiary Education: Case of Lebanon, Kenya and Oman (United States)

    Liu, Zhimin; Mutinda, Gladys


    Mass higher education is a huge force to be reckoned with and its existence, already in the expansion of tertiary institutions is undeniable. This study will focus on three countries: Lebanon, Kenya and Oman. The purpose of this study is to evaluate mass tertiary education progress in these countries. It will synthesize data results of gross…

  20. Evaluation of a tertiary teledermatology service between peripheral and academic dermatologists in the Netherlands

    NARCIS (Netherlands)

    van der Heijden, Job P.; de Keizer, Nicolette F.; Witkamp, Leonard; Spuls, Phyllis I.


    Tertiary teledermatology (TTD)-secondary-care to tertiary-care teleconsultation-is applied rarely compared with the frequently applied secondary teledermatology (primary to secondary care). The objective of this study was to determine the effect of TTD on referrals from peripheral dermatologists to

  1. Benchmarking Australian and New Zealand University Meta-Policy in an Increasingly Regulated Tertiary Environment (United States)

    Freeman, Brigid


    The agencies responsible for tertiary education quality assurance in Australia and New Zealand have established regulatory regimes that increasingly intersect with tertiary institution policy management. An examination of university meta-policies identified good practices guiding university policy and policy management. Most Australian and half of…

  2. The Missing Link in Australian Tertiary Education: Short-Cycle Higher Education (United States)

    Moodie, Gavin


    The blurring of the boundary between Australian vocational education and training and higher education is leading to a reconsideration of the current structure of Australian tertiary education. This paper starts with the main overlap of the Australian tertiary education sectors, diplomas and advanced diplomas. The ambiguous treatment of these…

  3. Benzoyl peroxide (BPO)-promoted oxidative trifluoromethylation of tertiary amines with trimethyl(trifluoromethyl)silane. (United States)

    Chu, Lingling; Qing, Feng-Ling


    The benzoyl peroxide (BPO)-promoted oxidative functionalization of tertiary amines under transition-metal-free reaction conditions was developed. Various 1-trifluoromethylated tetrahydroisoquinoline derivatives were prepared by employing this method. It constitutes the first example of direct trifluoromethylation of tertiary amines.

  4. Why Do Tertiary Education Graduates Regret Their Study Program? A Comparison between Spain and the Netherlands (United States)

    Kucel, Aleksander; Vilalta-Bufi, Montserrat


    In this paper we investigate the determinants of regret of study program for tertiary education graduates in Spain and the Netherlands. These two countries differ in their educational system in terms of the tracking structure in their secondary education and the strength of their education-labor market linkages in tertiary education. Therefore, by…

  5. Student Expectations of Tertiary Institutions: A Case Study of the Fiji National University (FNU) (United States)

    Khan, Shana Nigar


    Education is a human right and Fiji's tertiary education board recently declared that all tertiary institutions in Fiji must abide by the framework in order to meet student-customers' needs. The Fiji National University's (FNU's) destiny to be Fiji's leading higher education provider could be a reality if students and staff's expectations are…

  6. Assessment of Social Media Utilization and Study Habit of Students of Tertiary Institutions in Katsina State (United States)

    Olutola, Adekunle Thomas; Olatoye, Olufunke Omotoke; Olatoye, Rafiu Ademola


    This study investigated assessment of social media utilization and study habits of students of tertiary institutions in Katsina State. The descriptive survey design was adopted for this study. Three hundred and eighty-one (381) students' of tertiary institutions in Katsina State were randomly selected for the study. Researchers'-designed…

  7. A study on adverse drug reactions in a tertiary care hospital of ...

    African Journals Online (AJOL)

    Objective: Purpose of this study was to monitor adverse drug reactions reported from various departments of a tertiary care hospital in Northeast India. Reported adverse drug reactions were analysed for causality and severity assessment. Methods: This cross sectional study was conducted in a tertiary care hospital at ...

  8. A retrospective review of snake bite victims admitted in a tertiary ...

    African Journals Online (AJOL)

    Objective: Snake bite remains major public health problem worldwide. We present our experience with cases of snake bites managed in our tertiary care teaching center of South India. Materials and Methods:The details of all patients with snake bite admitted to a tertiary teaching care hospital from. 2010 to 2012 were ...

  9. A retrospective review of snake bite victims admitted in a tertiary ...

    African Journals Online (AJOL)

    Objective: Snake bite remains major public health problem worldwide. We present our experience with cases of snake bites managed in our tertiary care teaching center of South India. Materials and Methods: The details of all patients with snake bite admitted to a tertiary teaching care hospital from 2010 to 2012 were ...

  10. Entrepreneurship Education in Delta State Tertiary Institution as a Means of Achieving National Growth and Development (United States)

    Osakwe, Regina N.


    This study examined entrepreneurship education in Delta Sate tertiary institutions as a means of national growth and development. Two research questions were asked to guide the study. The population comprised all the 1,898 academic staff in eight tertiary institutions in the state. A sample of 800 lecturers was drawn through the multi stage and…

  11. The Petasis Reaction: Microscale Synthesis of a Tertiary Amine Antifungal Analog (United States)

    Koroluk, Katherine J.; Jackson, Derek A.; Dicks, Andrew P.


    Students prepare a tertiary amine antifungal analog in an upper-level undergraduate organic laboratory. A microscale Petasis reaction is performed to generate a liquid compound readily characterized via IR and proton NMR spectroscopy. The biological relevance of the product is highlighted, with the tertiary amine scaffold being an important…

  12. Aiming to be NEAT: safely improving and sustaining access to emergency care in a tertiary referral hospital. (United States)

    Sullivan, Clair M; Staib, Andrew; Flores, Judy; Aggarwal, Leena; Scanlon, Alan; Martin, Jennifer H; Scott, Ian A


    To implement and evaluate strategies for improving access to emergency department (ED) care in a tertiary hospital. A retrospective pre-post intervention study using routinely collected data involving all patients presenting acutely to the ED of a major tertiary hospital over a 2-year period. Main outcome measures were changes in: the percentage of patients exiting the ED (all patients, patients discharged directly from the ED, patients admitted to inpatient wards); mean patient transit times in the ED; inpatient mortality rates; rates of ED 'did not wait' and re-presentations within 48 h of ED discharge; and selected safety indicators. Qualitative data on staff perceptions of interventions were also gathered. Working groups focused on ED internal processes, ED-inpatient unit interface, hospital-wide discharge processes and performance monitoring and feedback. Twenty-five different reforms were enacted over a 9-month period from April to December 2012. Comparing the baseline period (January-March 2012) with the post-reform period (January-March 2013), the percentage of patients exiting the ED within 4 h rose for all patients presenting to the ED (from 32% to 62%), for patients discharged directly from the ED (from 41% to 75%) and for admitted patients (from 12% to 32%; PNEAT), which stipulate at least 70% of patients in the ED must exit the department within 4h, have spurred hospitals into implementing a wide range of reforms with varying levels of success in achieving such targets. WHAT DOES THIS PAPER ADD?: This study demonstrates how multiple reforms implemented in a poor performing tertiary hospital caused the proportion of patients exiting the ED within 4h to double within 9 months to reach levels comparable with best performing peer hospitals. This was associated with a 26% reduction in in-hospital mortality for admitted patients and no clinically significant adverse effects. It demonstrates the importance of robust governance structures, executive

  13. A TLC visualisation reagent for dimethylamphetamine and other abused tertiary amines. (United States)

    Kato, N; Ogamo, A


    Application of citric acid/acetic anhydride reagent (CAR), a colour reagent selective for tertiary amines in solution, improves detection of abused tertiary amino drugs on the TLC plate. The plate is pretreated by a brief immersion in phosphoric acid/acetone solution to suppress colouration. After suppressing, the plate is sprayed with CAR and heated at 100 degrees C, causing tertiary amines to turn red purple within 3 minutes. The sensitivity of this new CAR method is 2.5 to 15-times greater than that of conventional detection with Dragendorff reagent for some of the tertiary amines dimethylamphetamine, methylephedrine, levomepromazine, chlorpromazine, caffeine, theophylline, theobromine and nicotine. This present method provides rapid TLC detection of abused tertiary amino drugs such as phenethylamine, phenothiazine, xanthine derivative, nicotine and narcotics.

  14. Entrepreneurship Education at Tertiary Education Level: Implication to Historical Studies

    Directory of Open Access Journals (Sweden)

    Salahu Mohammed Lawal


    Full Text Available Nigeria is richly endowed with both human and material resources that when well utilized can make her one of the richest and developed nation in the world.  But poor utilization of the resources, corruption and dwindling fortune in her education system made her among the first twenty five poorest nations in the world.  Similarly, report shows that 26% of the employable population remained unemployed.  This called for the need for entrepreneurship education most especially at tertiary level where high level manpower is supposed to be trained.  It is on this premise that the paper attempts to examine entrepreneurship education and its implication to history students and graduates.

  15. Aliphatic and aromatic triterpenoid hydrocarbons in a Tertiary angiospermous lignite

    Energy Technology Data Exchange (ETDEWEB)

    Stout, S.A. (Unocal Science and Technology Division, Brea, CA (USA))


    The hydrocarbon biomarker assemblage of a liptinite-rich, early Tertiary angiospermous lignite has been characterized. The biomarker distribution for the lignite confirms the low maturity and previous paleobotanic interpretations. The aliphatic hydrocarbon fraction consists predominantly of n-alkanes showing a strong odd-carbon predominance, and numerous de-A-triterpenoids and triterpenoids derived from higher plants. Bacterially-derived triterpenoids were represented primarily by homohopanes and hopenes. The aromatic hydrocarbon fraction contains a series of mono-, di-, and triaromatic de-A-triterpenoids and mono-, tri- and tetraaromatic triterpenoids derived from higher plants. The concentration and abundance of monoaromatic triterpenoids containing one to three additional degrees of unsaturation have not been previously observed in a single deposit. As such, a diagenetic scheme for angiosperm-derived triterpenoids is presented which confirms and extends previous hypotheses. 45 refs., 10 figs., 2 tabs.

  16. Cooperative activity and its potential for learning in tertiary education

    Directory of Open Access Journals (Sweden)

    Cirila Peklaj


    Full Text Available A learning situation can be structured in different ways, as an individual, competitive, or cooperative activity. Each of these structures can be used for different purposes and can lead to different learning outcomes. This paper focuses on cooperative activity and its potential for learning in tertiary education. After defining cooperative activity (or, in a broader sense, learning in interaction and introducing the CAMS theoretical framework to analyse cooperative activity, the main discussion focuses on the theoretical reasons for the usefulness of group learning and on the research of effects of cooperative learning on cognitive (metacognitive, affective-motivational and social processes in university students. The key elements that should be established for successful cooperation are also discussed. At the end, a new direction in using cooperative activity in learning—computer supported collaborative learning (CSCL, which emerged with rapid technology development in the last two decades—is presented and discussed.

  17. Medical treatment of primary, secondary, and tertiary hyperparathyroidism

    DEFF Research Database (Denmark)

    Thomsen, Súsanna v.; Vestergaard, Peter


    Hyperparathyroidism is a condition with elevated parathyroid hormone (PTH). The increase may be due to a) primary hyperparathyroidism which is caused by adenoma of one or more parathyroid glands or hyperplasia of all four glands, b) secondary hyperparathyroidism, which may be caused by deficiency...... in vitamin D or uremia, and 3) tertiary hyperparathyroidism, which most often is the result of a long-standing, severe secondary hyperparathyroidism, which has turned autonomous once the cause of the secondary hyperparathyroidism has been removed. Many new treatment options have been introduced in recent...... years. Cinacalcet is calcium sensing receptor agonist, which by stimulating the receptor decreases PTH and calcium levels. It may be used in primary hyperparathyroidism, secondary hyperparathyroidism caused by uremia, which may not be controlled with calcium and activated vitamin D. It may also be used...

  18. Updated Simulation Studies of Damage Limit of LHC Tertiary Collimators

    CERN Document Server

    AUTHOR|(CDS)2085459; Bertarelli, Alessandro; Bruce, Roderik; Carra, Federico; Cerutti, Francesco; Gradassi, Paolo; Lechner, Anton; Redaelli, Stefano; Skordis, Eleftherios


    The tertiary collimators (TCTs) in the LHC, installed in front of the experiments, in standard operation intercept fractions of 10−3 halo particles. However, they risk to be hit by high-intensity primary beams in case of asynchronous beam dump. TCT damage thresholds were initially inferred from results of destructive tests on a TCT jaw, supported by numerical simulations, assuming simplified impact scenarios with one single bunch hitting the jaw with a given impact parameter. In this paper, more realistic failure conditions, including a train of bunches and taking into account the full collimation hierarchy, are used to derive updated damage limits. The results are used to update the margins in the collimation hierarchy and could thus potentially have an influence on the LHC performance.

  19. Tertiary alphabet for the observable protein structural universe. (United States)

    Mackenzie, Craig O; Zhou, Jianfu; Grigoryan, Gevorg


    Here, we systematically decompose the known protein structural universe into its basic elements, which we dub tertiary structural motifs (TERMs). A TERM is a compact backbone fragment that captures the secondary, tertiary, and quaternary environments around a given residue, comprising one or more disjoint segments (three on average). We seek the set of universal TERMs that capture all structure in the Protein Data Bank (PDB), finding remarkable degeneracy. Only ∼600 TERMs are sufficient to describe 50% of the PDB at sub-Angstrom resolution. However, more rare geometries also exist, and the overall structural coverage grows logarithmically with the number of TERMs. We go on to show that universal TERMs provide an effective mapping between sequence and structure. We demonstrate that TERM-based statistics alone are sufficient to recapitulate close-to-native sequences given either NMR or X-ray backbones. Furthermore, sequence variability predicted from TERM data agrees closely with evolutionary variation. Finally, locations of TERMs in protein chains can be predicted from sequence alone based on sequence signatures emergent from TERM instances in the PDB. For multisegment motifs, this method identifies spatially adjacent fragments that are not contiguous in sequence-a major bottleneck in structure prediction. Although all TERMs recur in diverse proteins, some appear specialized for certain functions, such as interface formation, metal coordination, or even water binding. Structural biology has benefited greatly from previously observed degeneracies in structure. The decomposition of the known structural universe into a finite set of compact TERMs offers exciting opportunities toward better understanding, design, and prediction of protein structure.

  20. Hospital mortality in cirrhotic patients at a tertiary care center. (United States)

    Zubieta-Rodríguez, R; Gómez-Correa, J; Rodríguez-Amaya, R; Ariza-Mejia, K A; Toloza-Cuta, N A

    Cirrhosis of the liver is known for its high risk of mortality associated with episodes of acute decompensation. There is an even greater risk in patients that present with acute-on-chronic liver failure. The identification of patients at higher risk for adverse outcomes can aid in making the clinical decisions that will improve the prognosis for these patients. To determine in-hospital mortality and evaluate the epidemiologic and clinical characteristics of patients with cirrhosis of the liver seen at a tertiary referral hospital. A descriptive, observational, cohort study was conducted on adult patients with cirrhosis of the liver, admitted to a tertiary care center in Bucaramanga, Colombia, within the time frame of March 1, 2015 and February 29, 2016. Eighty-one patients with a mean age of 62 years were included in the study. The main etiology of the cirrhosis was alcoholic (59.3%). In-hospital mortality was 23.5% and the most frequent cause of death was septic shock (68.4%), followed by hypovolemic shock (10.5%). A MELD score≥18, a leukocyte count>12,000/ul, and albumin levels below<2.5g/dl were independent factors related to hospital mortality. In-hospital mortality in cirrhotic patients is high. Sepsis and bleeding are the 2 events leading to acute-on-chronic liver failure and death. A high MELD score, elevated leukocyte count, and low level of albumin are related to poor outcome during hospitalization. Adjusted prevention-centered public health measures and early and opportune diagnosis of this disease are needed to prevent the development of complications and to improve outcome in cirrhotic patients. Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  1. PROSE for irregular corneas at a tertiary eye care center. (United States)

    Arumugam, Amudha Oli; Rajan, Rajni; Subramanian, Madhumathi; Mahadevan, Rajeswari


    The aim of this study was to report and discuss the clinical experience with PROSE (Prosthetic Replacement of Ocular Surface Ecosystem) practice at a tertiary eye care hospital. Retrospective data of patients who were prescribed PROSE during April 2011 to March 2012 in a tertiary eye care center in south India were analyzed. Data collected include patient demographics, indications of scleral lens fitting, previous correction modality, PROSE parameters, best-corrected visual acuity (BCVA) with spectacles, and BCVA with PROSE at initial assessment and few hours of wear. The BCVA before (with glasses) and after PROSE fitting was recorded in logMAR units. The age of the patients ranged between 13 and 68 years (male:female 60:25) with a mean age of 32.44±13.45 years. Mean BCVA improved by 0.3 logMAR units (3 lines) after fitting with PROSE. There was a statistically significant difference between pre- and post-PROSE BCVA (P=0.0001). Failure of rigid gas-permeable lens fitting or intolerance was the common indication for PROSE in corneas with irregular astigmatism (refractive conditions). The other reasons for which PROSE was prescribed were pain, photophobia, comfort, ghosting of images, and frequent loss of smaller lenses. Toric scleral haptic was indicated in 62 eyes. The diameter, vault, and haptic measurements of PROSE in ocular surface disorders were much less and flatter than that of refractive conditions. PROSE device is a very useful alternative for irregular corneas to improve visual acuity, to improve comfort, and for symptomatic relief.

  2. Survey of visual impairment in an Indian tertiary eye hospital

    Directory of Open Access Journals (Sweden)

    Herse Peter


    Full Text Available A retrospective survey of 4, 122 consecutive patient records was performed in a tertiary care eye hospital in Hyderabad, India. Data collected included age, gender, visual acuity after completion of treatment and diagnosis. 62.8% of the patients were male. After completion of treatment, 10.8% had low vision (best corrected visual acuity <6/18 to 3/60 in the better eye and 2.6% were blind (best correct visual acuity <3/60 in the better eye. Most cases of low vision were found in the 50 to 70 year age group (42.9%. The most common visual acuity range after treatment amongst patients with vision loss was <6/18 to 6/60 (71%. The 4 main causes of low vision were cataract (21.4% of low vision group, glaucoma (14.0%, diabetic retinopathy (13.0%, and retinitis pigmentosa (10.7%. The 4 main causes of blindness were glaucoma (16.3% of blind group, diabetic retinopathy (13.2%, corneal opacities (11.6% and retinitis pigmentosa (11.6%. It is suggested that patients with low vision at the conclusion of treatment be referred to a vision rehabilitation centre. Referral should be made in cases with a best corrected visual acuity <6/18 to 3/60 or with visual field loss to within 15° of fixation. Patients aged under 50 years of age are expected to achieve maximal rehabilitation success. Motivation and vocational requirements should be assessed in older or more complex cases before referral. The data of this study show that about 10% of patients seen at a tertiary care eye hospital in India could benefit from low vision rehabilitation.

  3. Description, measurement and evaluation of tertiary-education food environments. (United States)

    Roy, R; Hebden, L; Kelly, B; De Gois, T; Ferrone, E M; Samrout, M; Vermont, S; Allman-Farinelli, M


    Obesity in young adults is an increasing health problem in Australia and many other countries. Evidence-based information is needed to guide interventions that reduce the obesity-promoting elements in tertiary-education environments. In a food environmental audit survey, 252 outlets were audited across seven institutions: three universities and four technical and further education institutions campuses. A scoring instrument called the food environment-quality index was developed and used to assess all food outlets on these campuses. Information was collated on the availability, accessibility and promotion of foods and beverages and a composite score (maximum score=148; higher score indicates healthier outlets) was calculated. Each outlet and the overall campus were ranked into tertiles based on their 'healthiness'. Differences in median scores for each outcome measure were compared between institutions and outlet types using one-way ANOVA with post hoc Scheffe's testing, χ 2 tests, Kruskal-Wallis H test and the Mann-Whitney U test. Binomial logistic regressions were used to compare the proportion of healthy v. unhealthy food categories across different types of outlets. Overall, the most frequently available items were sugar-sweetened beverages (20 % of all food/drink items) followed by chocolates (12 %), high-energy (>600 kJ/serve) foods (10 %), chips (10 %) and confectionery (10 %). Healthy food and beverages were observed to be less available, accessible and promoted than unhealthy options. The median score across all outlets was 72 (interquartile range=7). Tertiary-education food environments are dominated by high-energy, nutrient-poor foods and beverages. Interventions to decrease availability, accessibility and promotion of unhealthy foods are needed.

  4. Impact of tertiary Gleason pattern 5 on prostate cancer aggressiveness: Lessons from a contemporary single institution radical prostatectomy series

    Directory of Open Access Journals (Sweden)

    Zachary B. Koloff


    Conclusion: Our results emphasize the importance of TP5 and suggest that criteria for tertiary pattern reporting in prostate cancer should be standardized. Further studies are needed to evaluate the role of tertiary patterns in prognostic models.

  5. Improved model of the triple system V746 Cassiopeiae that has a bipolar magnetic field associated with the tertiary (United States)

    Harmanec, P.; Brož, M.; Mayer, P.; Zasche, P.; Kotková, L.; Nemravová, J. A.; Dukes, R. J.; Korčáková, D.; Šlechta, M.; Kıran, E.; Kříček, R.; Juryšek, J.


    V746 Cas is known to be a triple system composed of a close binary with an alternatively reported period of either 25.^d4 or 27.^d8 and a distant third component in a 170 yr (62 000 d) orbit. The object was also reported to exhibit multiperiodic light variations with periods from 0.^d83 to 2.^d50, on the basis of which it was classified as a slowly pulsating B star. Interest in further investigation of this system was raised by the recent detection of a variable magnetic field. Analysing spectra from four instruments, earlier published radial velocities, and several sets of photometric observations, we arrived at the following conclusions: (1) The optical spectrum is dominated by the lines of the B-type primary (Teff 1 16 500(100) K), contributing 70% of the light in the optical region, and a slightly cooler B tertiary (Teff 3 13 620(150) K). The lines of the low-mass secondary are below our detection threshold; we estimate that it could be a normal A or F star. (2) We resolved the ambiguity in the value of the inner binary period and arrived at a linear ephemeris of Tsuper. conj.=HJD 2 443 838.78(81)+25.^d41569(42)× E. (3) The intensity of the magnetic field undergoes a sinusoidal variation in phase with one of the known photometric periods, namely 2.^d503867(19), which we identify with the rotational period of the tertiary. (4) The second dominant photometric 1.^d0649524(40) period is tentatively identified with the rotational period of the broad-lined B-type primary, but this interpretation is much less certain and needs further verification. (5) If our interpretation of photometric periods is confirmed, the classification of the object as a slowly pulsating B star should be revised. (6) Applying an N-body model to different types of available observational data, we can constrain the orbital inclination of the inner orbit to 60°

  6. Review of contributory factors in maternity admissions to intensive care at a New Zealand tertiary hospital. (United States)

    Sadler, Lynn C; Austin, Diana M; Masson, Vicki L; McArthur, Colin J; McLintock, Claire; Rhodes, Sharon P; Farquhar, Cindy M


    The purpose of this study was to identify factors that contributed to severe maternal morbidity, defined by admission of pregnant women and women in the postpartum period to the intensive care unit (ICU) from 2010-2011 at Auckland City Hospital (ACH), a tertiary hospital that delivers 7500 women/year, and to determine potentially avoidable morbidity with the use of local multidisciplinary review. All admissions of pregnant women and women in the postpartum period (to 6 weeks) to the ICU at ACH from 2010-2011 were identified from hospital databases. Case notes were summarized and discussed by a multidisciplinary team. The presence of contributory factors and potentially avoidable morbidity were determined by consensus with a tool that was developed by the New Zealand Perinatal and Maternal Mortality Review Committee for the review of maternal and perinatal deaths. Specific recommendations for clinical management were identified by the multidisciplinary group. Nine pregnant women and 33 women in the postpartum period were admitted to the ICU from 2010-2011. Contributory factors were identified in 30 cases (71%); 20 cases (48%) were considered to be potentially avoidable; personnel factors were the most commonly identified avoidable causes. Specific recommendations that resulted from the study included the need for the development of guidelines for puerperal sepsis, improved planning for women at known risk of postpartum hemorrhage, enhanced supervision of junior staff, and enhanced communication through multidisciplinary meetings. Forty-eight percent of severe maternal morbidity, which was defined as admission to the ICU at ACH from 2010-2011, was considered to be potentially avoidable by a local multidisciplinary review team; priorities were identified for improvement of local maternity services. Copyright © 2013 Mosby, Inc. All rights reserved.

  7. Impact assessment of an automated drug-dispensing system in a tertiary hospital

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    Débora de-Carvalho

    Full Text Available OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013 and post- (October 2013-October 2014 intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$ and US dollars (USD. RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444 during the first year. The initial investment (R$ 206,065; USD 88,592 would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.

  8. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs. (United States)

    Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D K; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar


    Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, pcosts for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.


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    Sheela Thomas


    Full Text Available BACKGROUND Haemolytic anaemia’s are characterised by increased RBC destruction and evidence of accelerated erythropoiesis. Haemolysis due to intrinsic RBC disorders, i.e. the inherited haemolytic anaemias are more common. Most of these anaemias are easily recognisable under the light microscope. MATERIALS AND METHODS To study the clinical and morphological profile of different types of haemolytic anaemia due to RBC defects in patients admitted in a tertiary care hospital of North Kerala, India. RESULTS A cross-sectional study was carried out among 217 patients of haemolytic anaemia admitted in a tertiary care hospital over a period of five years from January 2012 to December 2016. The data on sociodemographic profile, relevant clinical history and clinical examination were collected in predesigned and pretested standard proforma and morphological parameters were assessed by using standard guidelines. CONCLUSION Sickle cell anaemia was found to be the most common of haemolytic anaemias reported in the hospital. HbE and HbD are extremely rare entities with only a single case report each. A single case of Paroxysmal Nocturnal Haemoglobinuria (PNH was reported, this was included as it is an intrinsic RBC disorder.

  10. Energy efficiency trends in the tertiary sector impact of structural changes. Study case from France (1986-1997)

    Energy Technology Data Exchange (ETDEWEB)

    Bosseboeuf, D. [Agence de l' Environnement et de la Maitrise de l' Energie, ADEME, 75 - Paris (France); Chateau, B. [ENERDATA SA, 38 - Gieres - Grenoble (France)


    The tertiary (service) sector is the one that experienced the most rapid growth of its energy consumption since 1986, along with the transport sector. But electricity alone has captured almost all the energy consumption increase on that period, resulting in a quasi stabilisation of the CO2 emissions of this sector. Very few policy measures to improve energy efficiency have been taken in that sector, except the implementation of insulation standards for new buildings in 1989 (standards currently under revision; new standards expected in January 2001). From an economic viewpoint, the tertiary sector has been the driving force of the GDP and employment since 1986. The objective of this paper is to review the energy consumption patterns in that sector and presents a diagnosis on the energy efficiency trends. To which extent energy consumption growth is explained by the economic growth of the sector? Are there significant differences among sub-sectors as to the economic and energy growth? How the structural changes in this sector do explain the modification of its energy consumption pattern? Which consequences can be drawn as to the energy efficiency evolution? Supported by which technical and behavioural changes? (authors)


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    Asaro, Frank; Michel, Helen V.; Alvarez, Luis W.; Alvarez, Walter


    In Gubbio, Italy, a l em layer of clay between extensive limestone formations marks the boundary between the Cretaceous and Tertiary Periods. This clay layer was known to have been deposited about 65 million years ago when many life forms became extinct, but the length of time associated with the deposition was not known. In an attempt to measure this time with normally deposited meteoritic material as a clock, extensive measurements of iridium abundances (and those of many other elements) were made on the Gubbio rocks. Neutron activation analysis was the principal tool used in these studies. About 50 elements are searched for in materials like the earth's crust, about 40 are detected and about 30 are measured with useful precision. We were not able to determine exactly how long the clay deposition took. Instead the laboratory studies on the chemical and physical nature of the Cretaceous-Tertiary boundary led to the theory that an asteroid collision with the earth was responsible for the extinction of many forms of life including the dinosaurs.

  12. Proportion of injured drivers presenting to a tertiary care emergency department who engage in future impaired driving activities. (United States)

    Purssell, Roy; Brown, Douglas; Brubacher, Jeffery R; Wilson, Jean; Fang, Ming; Schulzer, Michael; Mak, Edwin; Abu-Laban, Riyad B; Simons, Richard; Walker, Tristan


    We determined the rate of, and predictive factors for, subsequent impaired driving activity (IDA) by injured drivers treated in a Canadian tertiary care emergency department (ED) following a motor vehicle crash (MVC). We retrospectively identified all drivers injured in a MVC who presented to our tertiary care, urban ED (1999-2003) and had their blood alcohol content (BAC) measured. Injured drivers were categorized by BAC: group 1, BAC = 0; group 2, 0 17.3 mM. IDA was defined as any of the following: a conviction for impaired driving; a 24-h or 90-day license suspension for impaired driving; involvement in alcohol-related MVC. Time to IDA following the index event between groups was compared with Kaplan-Meier survival analyses. Effects of covariates on time to IDA were analyzed using Cox proportional hazards models. During the study period, 1489 injured drivers met study criteria: 1171 in group 1, 51 in group 2, and 267 in group 3. During an average follow-up of 52.4 months, 82 (30.7%) group 3 drivers engaged in subsequent IDA, compared with 80 (6.8%) group 1 drivers (p impaired drivers who present to hospital engage in repeat IDA following discharge. Besides impairment at time of hospital visit, the best predictor of future IDA is a history of IDA prior to the index event.

  13. Photolysis of Periodate and Periodic Acid in Aqueous Solution

    DEFF Research Database (Denmark)

    Sehested, Knud; Kläning, U. K.


    The photochemistry of periodate and periodic acid in aqueous solution was studied (i) by quantum yield measurements at low light intensity (ii) by flash photolysis, and (iii) by photolysis of glassy samples at 77 K. The photochemical studies were supplemented with pulse radiolysis studies...... of aqueous periodate solutions and with kinetic studies using stopped-flow technique. In strongly alkaline solution the photodecomposition of periodate proceeds via formation of O– and IVI. At pH

  14. Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

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    Mosam Phirke


    Full Text Available Background: Electroconvulsive therapy (ECT is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26% showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

  15. Perception of pharmacovigilance among doctors in a tertiary care hospital: influence of an interventional lecture. (United States)

    Sanghavi, Dhara R; Dhande, Priti P; Pandit, Vijaya A


    One of the important pillars of an efficient pharmacovigilance system is contribution by healthcare professionals in the form of spontaneous reporting. This study was aimed at investigating the knowledge, attitude and practice of spontaneous ADR reporting among doctors in a teaching hospital in Pune, and to analyze the effect of an informative lecture about Pharmacovigilance on the same. This was an interventional study conducted among 220 doctors at a tertiary care teaching hospital, Pune. Each participant was explained the purpose of study and asked to fill in a questionnaire about their knowledge, attitude and practice of pharmacovigilance. Only 80 of them attended the interventional lecture on Pharmacovigilance and again filled up the questionnaire after a period of one month from this intervention. Merely 7.5% of the participants knew ADR reporting system in India. Majority of the respondents (95%) knew that, as doctors, they could report ADRs but were unaware about the methodology to report (92.5%) which affected their practice of Pharmacovigilance. All (100%) the participants expressed that proper training should be provided to clinicians for ADR reporting & 81% felt ADR reporting should be made mandatory. Only 80 participants (36.4%) attended the interventional lecture which reflected a poor response. Intervention improved their (96%) knowledge about ADR reporting system and now majority of them (92%) agreed that all sort of ADRs should be reported (p pharmacovigilance.

  16. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic

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    Vale Francisco A.C.


    Full Text Available We describe clinical and socio-demographic features of patients with dementia attended in a tertiary outpatient clinic during a three years period (56.9% of the total attendance. Most of them were men, white, from the local community, urban district. Nobody had a job at the moment, two thirds of them got social welfare benefit. They lived with their family, the caregiver being the spouse or a daughter. The education level was very low, a quarter of them being illiterate. They were referred mostly from the public health care service, by neurologists or psychiatrists due to cognitive disorders. Family history as well as individual history of previous neurological/psychiatric disorders were frequent, especially alcoholism, stroke, head trauma and dementia. The neurological exam showed abnormalities in two thirds of cases, chiefly extra-pyramidal and pyramidal signs. Alzheimer's disease was the most frequent cause, followed by cerebrovascular disorder; alcoholism and normal pressure hydrocephalus were also frequent causes. Most patients presented concomitant non-etiological neurological/psychiatric disorders, mainly alcoholism and depression, and non-neurological/psychiatric diseases, predominantly hypertension, cardiopathy and diabetes. Most patients had been referred under medication, frequently politherapy, including psychotropics.


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    Atmaja Nair


    Full Text Available BACKGROUND India is the second most populous country in the world after China. In an effort to stabilize the population, National Family Welfare Program was launched in 1951. There has been an increase in contraceptive prevalence and a reduction in total fertility rate since then. For better results, contraceptive use should start right from the post partum period. This also significantly reduces maternal and infant mortality rates. AIM To assess the knowledge and attitude about contraception in post-partum women in a tertiary care teaching hospital in North Kerala. MATERIALS AND METHODS This cross sectional study was conducted in the Department of Obstetrics and Gynaecology, IMCH, Govt. Medical College, Kozhikode, Kerala, between January 2016 and March 2016, using a prestructured questionnaire, in postpartum women. Their knowledge and attitude about contraception was assessed. RESULTS A total of 1500 postpartum women were included in the study. 80% were aware of some method of contraception. This knowledge increased with increasing education, parity and better socioeconomic class. Major source of information was health worker (46.67%. But only 18.33% had practiced any method of contraception before and 44% only showed willingness to use any contraception. The major reason for non-acceptance of contraception was the need for more children. CONCLUSION Low prevalence seen in the use of contraception can be overcome by promoting spacing methods like PPIUCD, injectables and pills. The couple should be counselled together to alleviate the anxiety in the husband.

  18. Neurological associations in auditory neuropathy spectrum disorder: Results from a tertiary hospital in South India

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    Anjali Lepcha


    Full Text Available Aims: To find out the prevalence and types of neurological abnormalities associated in auditory neuropathy spectrum disorder in a large tertiary referral center. Settings and Design: A prospective clinical study was conducted on all patients diagnosed with auditory neuropathy spectrum disorder in the ear, nose, and throat (ENT and neurology departments during a 17-month period. Patients with neurological abnormalities on history and examination were further assessed by a neurologist to determine the type of disorder present. Results: The frequency of auditory neuropathy spectrum disorder was 1.12%. Sixty percent were found to have neurological involvement. This included cerebral palsy in children, peripheral neuropathy (PN, spinocerebellar ataxia, hereditary motor-sensory neuropathy, spastic paresis, and ponto-bulbar palsy. Neurological lesions did not present simultaneously with hearing loss in most patients. Sixty-six percent of patients with auditory neuropathy spectrum disorder were born of consanguineous marriages. Conclusions: There is a high prevalence of neurological lesions in auditory neuropathy spectrum disorder which has to be kept in mind while evaluating such patients. Follow-up and counselling regarding the appearance of neuropathies is therefore important in such patients. A hereditary etiology is indicated in a majority of cases of auditory neuropathy spectrum disorder.

  19. The drug epidemic: effects on newborn infants and health resource consumption at a tertiary perinatal centre. (United States)

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


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

  20. The spectrum of leukodystrophies in children: Experience at a tertiary care centre from North India

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    Sheffali Gulati


    Full Text Available Objective: The objective of this study is to retrospectively collect and then describe the clinico-radiographical profile of confirmed cases of leukodystrophy who presented over a 5-year period to a tertiary care teaching hospital in North India. Materials and Methods: The case records of 80 confirmed cases of leukodystrophy were reviewed and the cases have been described in terms of their clinical presentation and neuroimaging findings. Results: The cases have been grouped into five categories: Hypomyelinating, demyelinating, disorders with vacuolization, cystic, and miscellaneous. The commonest leukodystrophies are megalencephalic leukoencephalopathy with subcortical cysts (MLC, Pelizaeus-Merzbacher disease (PMD, and metachromatic leukodystrophy (MLD. A notable proportion of hypomyelinating disorders were uncharacterized. Conclusions: Leukodystrophies at this point of time have no definite cure. They have a progressively downhill clinical course. Early diagnosis is imperative for appropriate genetic counseling. A simplified approach to diagnose common leukodystrophies has also been provided. It is important to develop a registry, which can provide valuable epidemiological data to prioritize research in this field, which has many unanswered questions.

  1. Breast Cancer Association with Cytomegalo Virus-A Tertiary Center Case-Control Study. (United States)

    Surendran, Anilkumar; Chisthi, Meer M


    Cytomegalo virus is a ubiquitous virus often associated with congenital infections. Some studied have claimed an association between infection with this virus and development of breast cancer. The aim of this prospective research was to study the difference in Cytomegalo virus sero-positivity among patients with breast cancer and benign breast diseases, and thereby to prove any association. This was a hospital based Case-Control study conducted at the General Surgery wards of our hospital, a tertiary level public sector health care institution. This study was done on 130 patients with breast swellings who underwent surgical excision of their lumps over a 1-year period. Patients with histologically proven malignancies were selected as cases while proven benign cases were deemed to be the controls. IgG and IgM antibodies to Cytomegalo virus were checked in the patients from both groups. All of the studied patients turned out to be positive for Immunoglobulin G against Cytomegalo virus while all the patients were found to be negative for Immunoglobulin M. There was no difference in the antibody titers among the benign and malignant cases in the study. Logistic regression calculation was also carried out including the study parameters and other known risk factors. We conclude that there is no association between Cytomegalo virus sero-positivity and breast cancer. Another conclusion is that the studied adult population has been exposed to Cytomegalo virus in some point of their lives. Further studies of a larger magnitude are essential to confirm our results.

  2. Long-term evaluation of the efficacy of digital dermatoscopy monitoring at a tertiary referral center. (United States)

    Rinner, Christoph; Tschandl, Philipp; Sinz, Christoph; Kittler, Harald


    We examined the value of monitoring patients with multiple nevi using sequential digital dermatoscopy imaging at a tertiary referral center. This is a retrospective cohort study including 2,824 patients and 23,241 monitored lesions. We calculated trends in key parameters such as the number of melanomas and nevi monitored and excised. During follow-up, we excised 1,266 lesions in 709 patients, including 146 (11.5 %) melanomas. The percentage of in situ melanomas detected at follow-up was significantly higher than at baseline (46.6 % versus 23.4 %, p ≤ 0.001). The risk of detecting a melanoma during follow-up was higher for patients with a melanoma at baseline, compared to those without (relative risk: 3.59, 95 % CI: 2.15 to 6.00). The number of documented lesions showed a positive correlation with the benign/malignant ratio, and excisions at baseline decreased significantly over the course of the study period. Digital dermatoscopy monitoring improves the detection of thin melanomas in patients with multiple nevi. Patients with a melanoma at baseline are at an increased risk of developing a melanoma during follow-up and should therefore be a target group for sequential dermatoscopy imaging. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.


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    T. V. Haridas


    Full Text Available BACKGROUND Solitary Thyroid Nodules (STN occur in 4-7% of the adult population. Owing to increasing incidence of malignancy, it is necessary to differentiate patients with benign STN from malignant ones for early intervention and better patient management. The aim of the study is to study the clinicopathological characteristics of STN for better diagnosis, evaluation and management; evaluate the efficacy of FNAC in preoperative diagnostics of solitary thyroid nodules. MATERIALS AND METHODS The study was conducted over a period of one year at a tertiary healthcare institution in South India. One hundred patients with solitary nodule of thyroid were studied by taking detailed history and conducting clinical examination, thyroid hormone assay, ultrasonogram, FNAC and histopathological examination. The chances of malignancy and age, sex and site distribution were also analysed. RESULTS Solitary thyroid nodule cases showed female preponderance (81%, presented mostly as neck swelling followed by dysphagia (11%. Most common FNAC report was of colloid nodule (61%, followed by follicular neoplasm (20% and papillary carcinoma (9%. Final HPR showed 53% as colloid nodule and 27% as papillary carcinoma. CONCLUSION Differentiating between benign and malignant lesions and their comprehensive management are the challenges presented by STN. Fine Needle Aspiration Cytology (FNAC is the diagnostic tool of choice for the initial evaluation of STN.

  4. Level of adherence to an extravasation protocol over 10 years in a tertiary care hospital. (United States)

    Molas-Ferrer, Gloria; Farré-Ayuso, Elisabet; doPazo-Oubiña, Fernando; deAndrés-Lázaro, Ana; Guell-Picazo, Jaume; Borrás-Maixenchs, Núria; Corominas-Bosch, Lourdes; Valverde-Bosch, Montserrat; Creus-Baró, Natalia


    Extravasation of chemotherapy is an undesirable complication related to the administration of antineoplastic therapy. Establishing the real incidence is difficult. Because of the importance of a quick intervention after an extravasation, every hospital should have an extravasation protocol. The purpose of this study was to determine the degree of observance of an extravasation protocol by nursing staff and to determine extravasation incidence. This descriptive, longitudinal, retrospective study was set in a tertiary-level hospital. The researchers reviewed 117 extravasation notification forms received by the pharmacy department during a 10-year period. Nursing actuation, particularly observance of the extravasation protocol, was analyzed. Protocol adherence was 89%. Twelve deviations from the protocol in the application of recommended measures were detected. An antidote was used in 41 patients, and temperature measures were applied in 14 cases. Ninety-nine patients had at least one episode of reported follow-up. No cases of necrosis or skin ulcers were described, except by one patient, who developed a delayed skin ulcer to vinorelbine. Drugs most frequently reported were etoposide, carboplatin, and paclitaxel. Nursing staff should be continuously trained in extravasation protocol because a rapid actuation can prevent skin lesions.

  5. Maternal and Fetal Outcomes of Triplet Gestation in a Tertiary Hospital in Oman

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    Maryam Al-Shukri


    Full Text Available Objectives: The aim of this study was to describe the fetal and maternal outcomes of triplet gestation and to report on the maternal characteristics of those pregnancies in a tertiary care centre in Oman. Methods: A retrospective study was undertaken of all triplet pregnancies delivered at Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2011. Results: Over the three-year study period, there were 9,140 deliveries. Of these, there were 18 triplet pregnancies, giving a frequency of 0.2%. The mean gestational age at delivery was 31.0 ± 3.0 weeks, and the mean birth weight was 1,594 ± 460 g. The most common maternal complications were preterm labour in 13 pregnancies (72.2%, gestational diabetes in 7 (39% and gestational hypertension in 5 (28%. Of the total deliveries, there were 54 neonates. Neonatal complications among these included hyaline membrane disease in 25 neonates (46%, hyperbilirubinaemia in 24 (43%, sepsis in 18 (33% and anaemia in 8 (15%. The perinatal mortality rate was 55 per 1,000 births. Conclusion: The maternal and neonatal outcomes of triplet pregnancies were similar to those reported in other studies.


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    Jog Antony


    Full Text Available BACKGROUND Haemolytic anaemia is a well-recognised clinical problem. This study looks into the clinical profile of haemolytic anaemia and also attempts to find out the common underlying causative disease. It also tries to group the patients according to the clinical manifestations and underlying causes. MATERIALS AND METHODS This is a hospital-based observational study conducted in a tertiary care centre in Northern Kerala. Forty-four adult patients with clinical manifestations and laboratory evidence of haemolytic anaemia were identified and studied for a period of one year. RESULTS Maximum number of cases were seen in the age group of 20-40 years. The overall male-female ratio was 1.1:1. The most common presenting symptoms were features of anaemia like breathlessness, easy fatigability, headache and tiredness. Family history of anaemia was present in 34.1%. The most common signs observed were pallor and jaundice. The most common causes were autoimmune haemolytic anaemia and sickle cell anaemia. CONCLUSION Haemolytic anaemia mostly affects individuals in their 3rd and 4th decade. There is no significant difference in gender distribution of haemolytic anaemia. Haemolytic anaemia most commonly presents with symptoms of anaemia and jaundice. Commonest causes of haemolytic anaemia are autoimmune haemolytic anaemia and sickle cell anaemia.

  7. Innovative activity in chosen branches of the tertiary sector in the Czech Republic

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    Eliska Jiraskova


    Full Text Available The aim of this paper is to provide a brief overview on innovation in services and their approach to the protection of intellectual property. The submitted article summarizes preparing part of a starting project mostly focused on investment environment. The area of interest is companies providing services in the territory of the Czech Republic. The aim of the project is supporting actions of promoting investment and innovative environment. It is necessary to exactly define innovation in services and to analyze innovative activity first so the aim could be achieved. A partial aim of the project will be finding out whether branches which report higher revenues from innovative activities are actively using the opportunity to patent their service because innovations are closely connected to the protection of intellectual property as well. The described part concerns innovations in selected branches of tertiary sector whereas all the branches which have been registered by Czech Statistical office, because of a validation of application for patent proceeding at least in two examined periods since 1993 are examined. Furthermore a possible dependency between an amount of patents in single regions and an amount of revenues coming from innovative companies to a region.

  8. Drug utilization study in a burn care unit of a tertiary care hospital

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    Santoshkumar R Jeevangi


    Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

  9. A Study of Cervical Pap Smears in a Tertiary Care Hospital.

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    Dr Kruti Bhut


    Full Text Available Background: Cancer of the cervix is the leading cancer among females of India. Cancer of cervix is readily preventable, and can be diagnosed at the pre-invasive stage with adequate and repetitive cytological screening with Papanicolaou (Pap smears. Objectives: This is a retrospective study aimed to evaluate all previously conducted cervical smears examined at a teaching tertiary care hospital during one year period. Methods: Detailed clinical data and Pap smear cytology reports were obtained and data noted in a structured proforma. All the smears were reported as per the 2001 Bethesda system. Results: A total of 1436 Pap smears were examined. Maximum number of patients was in the age group of 31 – 40 years (fourth decade. There were 133(9.2% unsatisfactory or inadequate samples. A total of 1187 smears were reported as Negative for Intraepithelial Lesion or Malignancy (NILM and 390(22.7% were inflammatory. Out of a total of 1436 Pap smears, only 116(8.0% cases were reported to have epithelial cell abnormality. The 116 abnormal cases comprised of 36 cases with ASC-US, 27 cases of LSIL, 36 cases of HSIL, 7 cases of invasive squamous cell carcinoma. Conclusion: Premalignant and malignant lesions of cervix can be diagnosed easily by Pap smears. The epithelial cell abnormality rate in our study was 8.0%.

  10. Spectrum of goitrous lesions in patients at a tertiary care center of Sikkim

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    Subhabrata Sengupta


    Full Text Available Background: Sikkim is declared as a goitre endemic state with an estimated prevalence of 54%. The spectrums of diseases include simple goitre, thyroiditis, adenoma, carcinoma, multinodular goitre and Graves′ disease. The present study aims to determine the pattern of thyroid swelling in a hospital setup at Sikkim. Materials and Methods: This study is a retrospective analysis of records of all patients presenting with thyroid swelling in a tertiary care hospital at Gangtok, Sikkim during the period of 4 years between 1 st January 2008 and 31 st December 2011. Patients were diagnosed by clinical examination, FNAC, USG, CT scan and hormone estimation. Histopatholgical confirmation was done in surgical cases. Clinic opathological and demographic data of 166 such patients were obtained and analyzed for the present study. Results: The most common goitrous disease was simple goitre (69.27% followed by thyroiditis (10.24%, toxic goitre (7.83% and malignancy (12.65%. Papillary variant was the commonest carcinoma. Overall female:male ratio was 4.9:1. The prevalence goitrous lesion was highest in the middle age group between 30-39 years, while the extremes of age (below 10 years and above 70 years were rarely involved. Conclusions: The prevalence of goitre in Sikkim is still very high despite iodisation programs by the Government. There is urgent need for more data on autoimmunity and goitrogens status to explain the high prevalence of goitre in this population.

  11. Clinical neurophysiology referral patterns to a tertiary hospital--a prospective audit.

    LENUS (Irish Health Repository)

    Renganathan, R


    BACKGROUND: Cork University Hospital (CUH) provides a tertiary service for all neurophysiology referrals in the Southern Health Board region. AIM: To ascertain the number, source, symptoms and diagnosis of neurophysiology referrals at CUH. METHODS: We did a prospective audit of the referral patterns to the neurophysiology department over a 12 -week period. RESULTS: Of 635 referrals, 254 had electromyograms (EMG), 359 had electro-encephalograms (EEG), 18 had visual evoked potentials (VEP), three had somato-sensory evoked potentials (SSEP) and one had multiple sleep latency tests (MSLT). We analysed the demographic pattern, reason for referrals, the average waiting time for neurophysiology tests and the patterns of diagnosis in this audit. CONCLUSIONS: Patients from County Cork are making more use of the neurophysiology services than patients from other counties within the Southern Health Board. The average waiting time for an EEG was 32 days and for an EMG was 74 days. However, more than 35% of those patients waiting for an EEG or an EMG had their tests done within four weeks of referral. The appointments of EEG and EMG were assigned on the basis of clinical need.

  12. Improving the utilization of medical crisis teams (Condition C) at an urban tertiary care hospital. (United States)

    Foraida, Mohamed I; DeVita, Michael A; Braithwaite, R Scott; Stuart, Susan A; Brooks, Maria Mori; Simmons, Richard L


    Serious clinical deterioration precedes most cardiopulmonary arrests, and there is evidence that organized responses to this deterioration may prevent a substantial proportion of in-hospital deaths. We aimed to increase the utilization of our medical crisis response team (Condition C) to impact this source of mortality. We have examined the change in numbers of Condition Cs and the main alternative response strategy (sequential stat pages) after the implementation of 4 strategies to increase Condition C utilization: (1) immediate reviews of all sequential STAT pages, (2) feedback to caregivers responsible for delays in Condition C activation, (3) creation of objective criteria for invoking a crisis response, and (4) dissemination of objective criteria through posting in units, e-mail, and in-service oral presentations. Over a 3-year period, interventions were followed by increased use of organized responses to medical crises (Condition Cs) and decreased numbers of disorganized responses (sequential STAT pages). The interventions that involved objective definition and dissemination of criteria for initiating the Condition C response were followed by 19.2 more Condition Cs monthly (95% confidence interval [CI], 12.1-26.3; Pinterventions that involved giving feedback to medical personnel based on review of their care were not associated with changes in the measures. Utilization of an important patient safety measure may be increased by focused interventions at an urban tertiary care hospital. Copyright 2003 Elsevier Inc. All rights reserved.

  13. Study on hepatitis B vaccination coverage among workforce of a tertiary care hospital in North India

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    Fazili Anjum B


    Full Text Available Hepatitis B is one of the most serious of the 20 blood borne pathogens which are the major threat to health care workers (HCWs. While a vaccine for hepatitis B exists, its utilization among HCWs and factors surrounding its utilization in many developing countries are unknown. This study was carried out to find hepatitis B vaccination coverage among work force of a tertiary care institute and various factors affecting its acceptance among health care workers. Cross-sectional study was carried for a period of six months at Sher-i-Kashmir institute of Medical Sciences (SKIMS, Soura. All the employees who consented to participate were taken up for this study. A selfadministered, pre-structured questionnaire were used to collect data from all the participants. Of the 2763 employees studied, 71.4% were males and 28.6% were females with mean age of 40.46 years. 25.76% employees were completely vaccinated and 51.24% were unvaccinated. Among high risk group only 32.7% of employees were completely vaccinated. Also among fully vaccinated employees, no one had got their post vaccination titers done. Important reasons for not taking the vaccine were no knowledge regarding the vaccine (31.80 %, low level of perceived susceptibility for getting the infection (27.0% and unwillingness to spend money or cost of the vaccine (26.24%. More awareness and education among HCW’s is warranted to clear misconceptions and promote more acceptance of vaccine.

  14. Obstetric Characteristics and Management of Patients with Postpartum Psychosis in a Tertiary Hospital Setting

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    C. E. Shehu


    Full Text Available Background. Postpartum psychosis is the most severe and uncommon form of postnatal affective illness. It constitutes a medical emergency. Acute management emphasizes hospitalization to ensure safety, antipsychotic medication adherence, and treatment of the underlying disorder. Objective. The aim of the study was to determine the obstetric characteristics and management of patients with postpartum psychosis in a tertiary centre in North-Western Nigeria. Methodology. This was a 10-year retrospective study. Records of the patients diagnosed with postpartum psychosis from January 1st, 2002, to December 31st, 2011, were retrieved and relevant data extracted and analyzed using the SPSS for Windows version 16.0. Results. There were 29 cases of postpartum psychosis giving an incidence of 1.1 per 1000 deliveries. The mean age of the patients was 20.6 ± 4 years. Twelve (55% were primiparae, 16 (72.7% were unbooked, and 13 (59% delivered at home. All had vaginal deliveries at term. There were 12 (52.2% live births, and 11 (47.8% perinatal deaths and the fetal sex ratio was equal. The most common presentation was talking irrationally. Conclusion. There is need for risk factor evaluation for puerperal psychosis during the antenatal period especially in primigravidae and more advocacies to encourage women to book for antenatal care in our environment.

  15. Unintentional injuries among children admitted in a tertiary care hospital in North Kerala. (United States)

    Sheriff, Akbar; Rahim, Asma; Lailabi, M P; Gopi, Jibin


    World Health Organization global disease update (2004) points out injuries as the sixth leading cause of morbidity and mortality in childhood. A descriptive hospital based study was conducted to find out the common types of unintentional injuries among children admitted for management of unintentional injuries in Pediatric Surgery department and Intensive Care Unit of a tertiary care hospital of North Kerala and to find out the contributing risk factors. A total of 400 children admitted during the study period of 6 months of 2009 constituted the study population. Mechanical injuries comprising of Road traffic accidents and accidental fall were the major cause of unintentional injuries (36%), followed by Poisoning (22.3%). A higher proportion of unintentional injuries were noted to occur among children of younger mothers, overactive child, children belonging to extended or joint families, child left alone or with friends, pre-school children, male child and from urban dwellings. The study highlights the need to identify the different types of unintentional injuries and the risk factors of childhood injuries which require hospitalisation. Identification of risk factors will help to formulate strategies aimed at risk reduction and prevention of childhood injuries.

  16. Diurnal variation in hand hygiene compliance in a tertiary level multidisciplinary intensive care unit. (United States)

    Sahay, Sandeep; Panja, Sauren; Ray, Sumit; Rao, B K


    Hand hygiene compliance among health care providers is considered to be the single most effective factor to reduce hospital acquired infections. Despite continuous education and awareness, compliance with hand hygiene guidelines has remained low, particularly during evening shifts. Our objective was to determine the compliance with hand hygiene guidelines among doctors, nurses, and paramedical staff during day and night duties in a multidisciplinary intensive care unit (ICU). We used a prospective, observational, 6-month study conducted in a 34-bed ICU within a tertiary care teaching hospital. All doctors, nurses, and paramedical staff in the ICU were included. An investigator, placed within the ICU setting, observed the hand hygiene practices during day and night. Day and night shift change times were 08:00 and 20:00 hours, respectively. Of the 5639 opportunities for hand hygiene, 3383 (59.9%) were properly performed. Overall rates of compliance were 66.1% for doctors, 60.7% for nurses, and 38.6% for paramedical staff. Hand hygiene compliance dropped during the night for doctors (81% vs 46%, respectively, P hand hygiene guidelines was lower at night compared with day, irrespective of discipline in all 3 groups of health care providers, both periods of compliance would benefit from additional training focusing on the importance of hand hygiene around the clock.

  17. LEARNING FROM MISTAKES Error Analysis in the English Speech of Indonesian Tertiary Students

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    Imelda Gozali


    Full Text Available This study is part of a series of Classroom Action Research conducted with the aim of improving the English speech of students in one of the tertiary institutes in Indonesia. After some years of teaching English conversation, the writer noted that students made various types of errors in their speech, which can be classified generally into morphological, phonological, and lexical. While some of the errors are still generally acceptable, some others elicit laughter or inhibit comprehension altogether. Therefore, the writer is keen to analyze the more common errors made by the students, so as to be able to compile a teaching material that could be utilized to address those errors more effectively in future classes. This research used Error Analysis by Richards (1971 as the basis of classification. It was carried out in five classes with a total number of 80 students for a period of one semester (14 weeks. The results showed that most of the errors were phonological (errors in pronunciation, while others were morphological or grammatical in nature. This prompted the writer to design simple Phonics lessons for future classes.

  18. Audit of a tertiary heart failure outpatient service to assess compliance with NICE guidelines. (United States)

    Guha, Kaushik; Allen, Christopher J; Chawla, Sumir; Pryse-Hawkins, Hayley; Fallon, Laura; Chambers, Vicki; Vazir, Ali; Lyon, Alex R; Cowie, Martin R; Sharma, Rakesh


    The National Institute for Health and Care Excellence (NICE) updated its guidelines for chronic heart failure (HF) in 2010. This re-audit assessed interim improvement as compared with an audit in 2011. Patients with HF (preserved and reduced ejection fraction) attending a tertiary cardiac centre over a 2-year period (January 2013-December 2014) were audited. The data collected included demographics, HF aetiology, medications, clinical parameters and cardiac rehabilitation. In total, 513 patients were audited. Compared with 2011, male preponderance (71%) and age (68±14 years, (Mean ± SD)) were similar. 73% of patients lived outside of London. HF aetiologies included ischaemic heart disease (37% versus 40% in 2011), dilated cardiomyopathy (26% versus 20%) primary valve disease (13% versus 12%). For patients with left ventricular systolic dysfunction (n=434, 85% of patients audited) 89% were taking beta-blockers (compared with 77% in 2011), 91% an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (86% in 2011) and 56% a mineralocorticoid receptor antagonist (44% in 2011); 6% were prescribed ivabradine. All patients were reviewed at least 6-monthly. Although 100% of patients were educated about exercise, only 21 (4%) enrolled in a supervised exercise programme. This audit demonstrated high rates of documentation, follow-up and compliance with guideline-based medical therapies. A consistent finding was poor access to cardiac rehabilitation. © Royal College of Physicians 2016. All rights reserved.

  19. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand

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    Manisha Bisht


    Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.

  20. Pediatric Admissions After Dental Care Under General Anesthesia: A Retrospective Study at a Tertiary Care Center. (United States)

    Lucy, Anna L; Gandhi, Roopa P; Gross, Lilyana; McNair, Bryan


    The purpose of this study was to identify factors associated with planned and unplanned pediatric hospital admissions following dental treatment under general anesthesia (DGA) in a tertiary care center. Dental and medical records of 100 subjects one to 20 years of age, with a known history of admission after DGA, were reviewed retrospectively for patient-, procedure-, and anesthesia-related factors as well as adverse events following DGA. During the review period (December 3, 2011 to June 30, 2015), 10,371 subjects underwent DGA, of which 100 subjects (less than one percent) required admission. A significant association was found between postoperative (PO) recovery time and unplanned admissions following DGA (P<0.001). Adverse post-operative events significantly associated with unplanned admissions included emesis (P=0.01) and hypoxia (P<0.001). Patients who were classified as having American Anesthesiology Association (ASA) III status were more frequently admitted following DGA. Adverse events such as emesis and hypoxia were significantly associated with patients with an unplanned admission.

  1. Financial Analysis of Treating Periprosthetic Joint Infections at a Tertiary Referral Center. (United States)

    Waddell, Bradford S; Briski, David C; Meyer, Mark S; Ochsner, John L; Chimento, George F


    Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. Our study compares the financial information of self-originating and referral 2-stage revision hip and knee surgeries at our tertiary referral center for hip or knee PJI over the last 4 years. We performed an in-house retrospective financial review of all patients who underwent 2-stage revision hip or knee arthroplasty for infection between January 2008 and August 2013, comparing self-originating and referral cases. We found an increasing number of referrals over the study period. There was an increased cost of treating hips over knees. All scenarios generated a positive net income; however, referral hip PJIs offered lower reimbursement and net income per case (although not statistically significant), whereas knee PJIs offered higher reimbursement and net income per case (although not statistically significant). With referral centers treating increased numbers of infected joints performed elsewhere, we show continued financial incentive in accepting referrals, although with less financial gain than when treating one's own hip PJI and an increased financial gain when treating referral knee PJIs. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Incidence of Maternal "Near-Miss" Events in a Tertiary Care Hospital of Central Gujarat, India. (United States)

    Parmar, Niyati T; Parmar, Ajay G; Mazumdar, Vihang S


    Constant decline in maternal mortality ratio has given rise to the need of a new indicator. This search has motivated investigation of severe maternal morbidity-"maternal near-miss" (MNM) event. World Health Organization (WHO) defines MNM as "a woman who, being close to death, survives a complication that occurred during pregnancy, delivery or up to 42 days after the end of her pregnancy". A hospital-based cross-sectional study was carried out at Sir Sayajirao General Hospital (SSGH), a tertiary care referral hospital in Vadodara, Central Gujarat, from May to September 2012. MNM events were identified according to either WHO or Mantel et al. criteria or both. During study period, 1929 live births, 18 maternal deaths and 46 "near-miss" cases were recorded. Among these 46 near-miss cases, 57 near-miss events were identified. Calculated MNM ratio was 23.85/1000 live births, MNM rate was 20.6/1000 obstetric admissions, the ratio of maternal death to MNM event was 1:2.6, and overall Mortality index was 28.1 %. Among near-miss cases, percentage of preterm delivery was 42 % and stillbirth rate was 35 % (16/46). Out of 46 MNM, pregnancies were continued in 3 while 43 pregnancies were terminated. (25 live births, 16 stillbirths, 2 abortions). Identification of preventable factors and special preventive actions should be taken for management of complications in such near-miss cases.

  3. Retrospective analysis of nosocomial infections in an Italian tertiary care hospital. (United States)

    Mancini, Alessio; Verdini, Daniele; La Vigna, Giorgio; Recanatini, Claudia; Lombardi, Francesca Elena; Barocci, Simone


    Nosocomial infections are one of the leading causes of morbidity and mortality in hospitalized patients. Studies of their prevalence in single institutions can reveal trends over time and help to identify risk factors. The aim of this study was to investigate the nosocomial infections trend and identify the prevalence of predominant bacterial microorganisms and their drug resistance patterns in an Italian tertiary care hospital. Infections were classified according to the Centres for Disease Control and Prevention definitions. A retrospective study was carried out from March 2011 to June 2014, based on the bacterial isolate reports of a hospital located in Central Italy. During the 40-month study period, a total of 1547 isolates were obtained from 1046 hospitalized patients and tested for their antibiotic sensitivity. The most common isolates belonged to the Enterobacteriaceae family (61.7%), followed by Enterococcus species (12.4%), Pseudomonas species (10.7%) and S. aureus (10.0%). The incidence density rate of nosocomial infections was 7.4 per 1000 patient days, with a significant difference among the 3 annual infection rates (Pinfection prevalence rate was found in Internal Medicine Unit (41.3%), followed by Intensive Care Units (12.4%), Surgical Units (9.0%,) and Cardiology (7.1%).

  4. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil. (United States)

    Schweiger, Cláudia; Manica, Denise; Becker, Carolina Fischer; Abreu, Larissa Santos Perez; Manzini, Michelle; Sekine, Leo; Kuhl, Gabriel


    Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. One hundred and twenty-three children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001). Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  5. Pregnancy Outcomes of Women Admitted to a Tertiary Care Centre with Short Cervix. (United States)

    Shea, Alison K; Simpson, Andrea N; Barrett, Jon; Ladhani, Noor; Nevo, Ori


    Our aim was to characterize the management and outcome of women admitted to a tertiary high-risk obstetrics unit with a short cervix (≤25 mm), measured on transvaginal ultrasound (TVS), and to determine the latency period from diagnosis to delivery. A retrospective chart review of women admitted to the High Risk Obstetrics Unit at Sunnybrook Health Sciences Centre between 2005-2011 with an ultrasound-identified short cervix was done. A total of 110 women admitted for a short cervix between 2005-2011 (N = 56 singletons; N = 54 twin gestations) met the inclusion criteria. The mean latency to delivery was 62.6 days; mean GA at delivery was 33.9 weeks. Following 7 and 14 days of admission, 5.5% and 11.8% of women had delivered, respectively. Preterm birth occurred in 70% of all women. Cervical length was a significant factor in predicting latency among singletons, whereas the length of stay in hospital for activity restriction was not. Although many women with a short cervix delivered preterm, only a small proportion delivered within 2 weeks of admission. Although it is not clear whether inpatient management improves the pregnancy outcome, these findings have implications for both patient care and health resources. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  6. Causes of prolonged jaundice in infancy: 3-year experience in a tertiary paediatric centre. (United States)

    Andre, Margaret; Day, Andrew S


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

  7. Anxiety and Depression in Patients with Coronary Heart Disease: A Study in a Tertiary Hospital

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    Ho Siew Eng


    Full Text Available Anxiety and depression could reduce the quality of life, and exacerbate physical symptoms and even mortality amongst patients with coronary heart disease (CHD. The aim of this study was to investigate the incidence of anxiety and depression in patients with acute CHD. In a period from March to December 2008, the views of 108 CHD patients, hospitalized in a tertiary hospital, were solicited using Hospital Anxiety and Depression Scale (HADS and sociodemographic questionnaires. Patients with CHD had a low level anxiety and depression scores. There was significant differences in the total HADS score of participants stratified for marital status (P=0.027 or co-morbidity of diseases (P=0.012. Also, there were significant differences in the scores of depression subscale stratified for marital status (P=0.021 or co-morbidity of disease (P=0.007. However, there was no significant difference between the total HADS score or depression subscale score of the participants stratified based on age, gender, race, education, or income. Moreover, unmarried CHD respondents possessed higher depression level compared to the married respondents, and CHD respondents with co-morbid diseases showed a high level of depression. The findings might be taken as evidence to suggest that CHD patients should be evaluated early for the detection of anxiety and depression for appropriate referral and support

  8. Evaluation of bone marrow in cases of pancytopenia in a tertiary care hospital

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    S Vaidya


    Full Text Available Background: A spectrum of primary and secondary disorders that affect the bone marrow may manifestwith pancytopenia. This study was carried out to identify the various causes of pancytopenia in patients attending a tertiary care hospital in Lalitpur, Nepal.Materials and Methods: A descriptive study of 83 cases of pancytopenia was carried out in the Department of Pathology, Patan Academy of Health Sciences, Lalitpur, Nepal over a two year period from August 2010 to July 2012.Results: Eighty three patients underwent bone marrow examination. Mean age of the patients was 34 years (range: 4 to 75 years. Maximum number of patients (31.33% was seen in the age group of 16 - 30 years. The commonest cause of pancytopenia was megaloblastic anemia which was seen in 34.94% (29/83 cases followed by aplastic anemia and hematological malignancies in 31.32% (26/83 and 14.46% (12/83 cases, respectively.Conclusion: This study concluded that megaloblastic anemia and aplastic anemia were the two most common causes of pancytopenia. Bone marrow aspiration is an established diagnostic modality in the evaluation of pancytopenia.Journal of Pathology of Nepal (2015 Vol. 5, 691 - 695

  9. Point Prevalence of Chronic Wounds at a Tertiary Hospital in Nigeria. (United States)

    Iyun, Ayodele O; Ademola, Samuel A; Olawoye, Olayinka A; Michael, Afie I; Oluwatosin, Odunayo M


    Chronic wounds are a drain on resources both for the patient and health institution. Management of chronic wounds based on evidence-based practice requires baseline data for adequate planning. This study was carried out to determine the point prevalence of chronic wounds in a tertiary hospital (University College Hospital, Ibadan, Nigeria) and utilize this information for subsequent wound care planning. The study was carried out within a 1-month period and included all patients seen in the hospital with chronic wounds. The data obtained was entered into a designed form and was subsequently analyzed. There were 48 patients with 78 wounds representing approximately 11% of patients seen in the Department of Plastic, Reconstructive, and Aesthetic Surgery each month. Their ages ranged from 3 months to 80 years; the median age was 48 years. The male to female ratio was 1.6 to 1. The duration of the wounds ranged from 6 weeks to 780 weeks; the median duration of the wounds was 10 weeks. The area of the wounds ranged from 1 cm(2) -1,248 cm(2) (median 24 cm(2)). The most common chronic wounds were diabetic wounds, followed by pressure ulcers, postinfection ulcers, posttraumatic ulcers, burn wounds, malignant ulcers, and venous ulcers. The point prevalence data serves as a basis for wound care planning. This, in turn, should result in improved wound management grounded in evidence-based practices.

  10. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital. (United States)

    Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha


    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.

  11. Cytopathology of neoplastic meningitis: A series of 66 cases from a tertiary care center

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    Gurdeep Singh


    Full Text Available Background: Neoplastic meningitis (NM is a condition characterized by leptomeningeal involvement by metastatic carcinoma. Detection of exfoliated malignant cells in cerebrospinal fluid (CSF due to meningeal metastasis is frequently associated with diverse neurologic presentations. Materials and Methods: In this retrospective study of all cases of NM diagnosed in CSF samples over a 20-year period at a tertiary care referral center, the cytomorphologic features were reviewed. Results: Sixty six cases of NM were identified of which 36 already had an established diagnosis of malignancy while in 30 patients, there was no previously known tumor. The most common known primary in the former group was breast followed by ovary. Single cell pattern, cellular cannibalism, moderate cytoplasm and rounded nuclei were seen in breast and lung tumors. Papillary architecture and cytoplasmic vacuolation were seen in the ovarian primaries. Melanin pigment was seen in malignant melanoma. Conclusion: CSF cytology is an important tool for diagnosis of NM. Cytomorphologic features helped in diagnosis and for prediction of the primary site. Correct identification of this condition is important as it has therapeutic and prognostic implications.

  12. English as a Foreign Language Instructors’ Induction: Early Practices of Language Teachers Teaching at Tertiary Level

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    Mustafa Öztürk


    Full Text Available This study aimed to investigate the nature of the induction process of English as a foreign language (EFL teachers teaching at tertiary level through individual interviews. In order to gather intended data, fifteen novice instructors teaching at four different public universities in Ankara were interviewed on a basis of two criteria: (a having 1 to 3 years of teaching experience, and (b teaching at higher education level. The data gathered from the interviews were transcribed, coded, and categorized under themes in a qualitative research tradition. Subsequently the Şndings were interpreted. The findings were organized around research questions and there appeared four main themes: (1 nature of induction process; (2 common concerns of novice teachers; (3 possible adaptation challenges; and (4 practices to overcome difŞculties. The results revealed that pre-service education, especially of the graduates of nonEducation Faculties, did not adequately respond to the needs of the novice teachers in induction period. Considering this insufŞcient preparation and unsatisfactory pedagogical formation processes, an effective teacher education program as well as a contributing teacher induction program was claimed to be adopted by higher education institutions

  13. English as a Foreign Language Instructors’ Induction: Early Practices of Language Teachers Teaching at Tertiary Level

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    Mustafa Öztürk


    Full Text Available This study aimed to investigate the nature of the induction process of English as a foreign language (EFL teachers teaching at tertiary level through individual interviews. In order to gather intended data, fifteen novice instructors teaching at four different public universities in Ankara were interviewed on a basis of two criteria: (a having 1 to 3 years of teaching experience, and (b teaching at higher education level. The data gathered from the interviews were transcribed, coded, and categorized under themes in a qualitative research tradition. Subsequently the findings were interpreted. The findings were organized around research questions and there appeared four main themes: (1 nature of induction process; (2 common concerns of novice teachers; (3 possible adaptation challenges; and (4 practices to overcome difficulties. The results revealed that pre-service education, especially of the graduates of non-Education Faculties, did not adequately respond to the needs of the novice teachers in induction period. Considering this insufficient preparation and unsatisfactory pedagogical formation processes, an effective teacher education program as well as a contributing teacher induction program was claimed to be adopted by higher education institutions.

  14. Periodic feedback stabilization for linear periodic evolution equations

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    Wang, Gengsheng


    This book introduces a number of recent advances regarding periodic feedback stabilization for linear and time periodic evolution equations. First, it presents selected connections between linear quadratic optimal control theory and feedback stabilization theory for linear periodic evolution equations. Secondly, it identifies several criteria for the periodic feedback stabilization from the perspective of geometry, algebra and analyses respectively. Next, it describes several ways to design periodic feedback laws. Lastly, the book introduces readers to key methods for designing the control machines. Given its coverage and scope, it offers a helpful guide for graduate students and researchers in the areas of control theory and applied mathematics.

  15. Formation Mechanism of NDMA from Ranitidine, Trimethylamine, and Other Tertiary Amines during Chloramination: A Computational Study (United States)


    Chloramination of drinking waters has been associated with N-nitrosodimethylamine (NDMA) formation as a disinfection byproduct. NDMA is classified as a probable carcinogen and thus its formation during chloramination has recently become the focus of considerable research interest. In this study, the formation mechanisms of NDMA from ranitidine and trimethylamine (TMA), as models of tertiary amines, during chloramination were investigated by using density functional theory (DFT). A new four-step formation pathway of NDMA was proposed involving nucleophilic substitution by chloramine, oxidation, and dehydration followed by nitrosation. The results suggested that nitrosation reaction is the rate-limiting step and determines the NDMA yield for tertiary amines. When 45 other tertiary amines were examined, the proposed mechanism was found to be more applicable to aromatic tertiary amines, and there may be still some additional factors or pathways that need to be considered for aliphatic tertiary amines. The heterolytic ONN(Me)2–R+ bond dissociation energy to release NDMA and carbocation R+ was found to be a criterion for evaluating the reactivity of aromatic tertiary amines. A structure–activity study indicates that tertiary amines with benzyl, aromatic heterocyclic ring, and diene-substituted methenyl adjacent to the DMA moiety are potentially significant NDMA precursors. The findings of this study are helpful for understanding NDMA formation mechanism and predicting NDMA yield of a precursor. PMID:24968236

  16. West Hackberry Tertiary Project. Annual report, September 3, 1995--September 2, 1996

    Energy Technology Data Exchange (ETDEWEB)

    Gillham, T.; Cerveny, B.; Turek, E.


    The West Hackberry Tertiary Project is a field test of the concept that air injection can be combined with the Double Displacement Process to produce a tertiary recovery process that is both low cost and economic at current oil prices. The Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil by gravity drainage. In reservoirs with pronounced bed dip such as those found in West Hackberry and other Gulf Coast salt dome fields, reservoir performance has shown that gravity drainage recoveries average 80% to 90% of the original oil in place while waterdrive recoveries average 50% to 60% of the original oil in place. The target for tertiary oil recovery in the Double Displacement Process is the incremental oil between the 50% to 60% waterdrive recoveries and the 80% to 90% gravity drainage recoveries. In previous field tests, the Double Displacement Process has proven successful in generating tertiary oil recovery. The use of air injection in this process combines the benefits of air`s low cost and universal accessibility with the potential for accelerated oil recovery from the combustion process. If successful, this project will demonstrate that utilizing air injection in the Double Displacement Process will result in an economically viable tertiary process in reservoirs (such as Gulf Coast salt dome reservoirs) where any other tertiary process is presently uneconomic.

  17. Tertiary Technical Education and Youth Integration in Brazil, Colombia and Mexico

    Directory of Open Access Journals (Sweden)

    Claudia Jacinto


    Full Text Available Vocational training versus a traditional university education. This chapter seeks to answer the question of whether ‘tertiary technical education’ has contributed to increasing economic and social opportunity for young people in Latin America, using three case studies from Brazil, Colombia and Mexico. It examines the extent to which tertiary technical education has contributed towards democratising access to education through institutional diversification, expanded enrolment and, at least theoretically, improved access to quality employment. The analysis shows that tertiary technical education has contributed to widening of opportunities by offering an alternative form of education to new generations of young people. Tertiary technical education is more accessible, shorter in duration, has a vocational orientation, and tends to be cheaper than a university education. However, the case studies also reveal that while a tertiary technical education diploma is an asset for young people seeking employment, it nonetheless does not have the same perceived value as a traditional university education. Available data appear to indicate that graduates of tertiary technical education earn less on average than university graduates and face several challenges in the labour market. Furthermore, the studies reveal that despite the presence of highly regarded tertiary technical education institutions in all three countries, these carry less prestige and status than universities.

  18. 76 FR 80312 - Periodic Reporting (United States)


    ... Distribution Center (ADC) automation flats in First-Class Mail, Periodicals, and Standard Mail. Id. at 9-10... model for Periodicals flats. Currently, cells for the coverage of mechanized ADC pallet bundle sortation...

  19. 76 FR 8325 - Periodic Reporting (United States)


    ... data for Presort First-Class Mail, and End-to-End Periodicals. Request at 1. The Request includes... Standard Mail, Outside County Periodicals, non-retail Media Mail, Library Mail, Bound Printed Matter...

  20. The redoubtable ecological periodic table (United States)

    Ecological periodic tables are repositories of reliable information on quantitative, predictably recurring (periodic) habitat–community patterns and their uncertainty, scaling and transferability. Their reliability derives from their grounding in sound ecological principle...


    Directory of Open Access Journals (Sweden)

    Ather Akhtar


    Full Text Available BACKGROUND Anaemia causes a reduction in the oxygen carrying capacity of the blood resulting in tissue hypoxia. Cardiac output at rest is not usually increased in most chronic anaemia until haemoglobin levels fall below 7 g/dL, but abnormal rise in output with exercise may occur with levels as high as 10 g/dL. The increase in cardiac output has been observed to correlate well with the degree of anaemia. Other compensatory mechanisms to chronic anaemia available to the body include decreased circulation time and increased tissue oxygen uptake. The latter is facilitated by a shift to the right of the oxygen haemoglobin dissociation curve. Cardiomegaly may also be as a result of the increased workload on the heart from the increased viscosity of blood in anaemia patients. Anaemia in the elderly is an extremely common problem that is associated with increased mortality and poorer health-related quality of life, regardless of the underlying cause of the low haemoglobin. A study of anaemia in elderly patients found a wide variation in prevalence, ranging from 2.9% to 61% in men and 3.3% to 41% in women. Higher rates were found in hospitalised patients than in community dwellers. It is easy to overlook anaemia in the elderly, since such symptoms as fatigue, weakness, or shortness of breath may be attributed to the ageing process itself. Our objective is to show the prevalence of anaemia even in a tertiary health care centre. METHODS One hundred patients were identified who were admitted in the Department of Medicine, Deccan College of Medical Sciences. Among the 100 patients, 38 were male and 62 were female. The study was conducted from Jan 2014 To Jan 2015. Patients having haemoglobin less than 10 g% in the medical wards were enrolled in the study. RESULTS Among the 100 patients, 38 were male and 62 were female. The average haemoglobin was 6.4 g%, the lowest being 2.8 g%. Peripheral blood smear showed hypochromic picture in 58, macrocytic picture in

  2. Profile of Acute Poisoning Cases Treated in a Tertiary Care Hospital: a Study in Navi Mumbai

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    Amit Patil


    Full Text Available Background: Periodic epidemiological studies are necessary to understand the pattern of poisoning in each region. This study was designed to evaluate the pattern of acute poisoning cases treated in a tertiary care hospital in Navi Mumbai, India. Methods: This cross sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre during July 2012 to July 2013. All cases of poisoning admitted to the hospital were included in this study. The patients’ data were obtained from medical records and were documented on a pre-structured proforma. Results: A total of 74 cases of acute poisoning were studied, of which 51.4% were men. Most of the patients aged 20 to 29 years (44.6%. In majority of cases, the route of exposure to poison was oral (86.5%. Most of the patients reside in urban areas (52.7%. Most of the patients were Hindus (85.1% followed by Muslims (14.9%. The exposure mostly occurred between 6:00 pm to 12:00 am (30% of cases. The majority of poisonings (44.6% was due to consumption of household products followed by pesticides (14.9% and pharmaceutical agents (13.5%. Neurologic manifestations were the most common clinical findings (64.8% followed by gastrointestinal manifestations (37%. All patients were treated successfully with no mortality. There was a significant correlation between gender and intention of poisoning (P < 0.001, as the suicidal attempts were higher in women (69.4%. Moreover, a significant relationship existed between marital status and intention of poisoning (P = 0.016 as the suicidal poisonings were most common among married individuals (45.7%.  Conclusion:The trend in poisoning is never static. Household products were identified as the main cause of poisoning in urban areas of India. Educational programs with more emphasis on preventive measures are necessary to create awareness among the general public.   How to cite this article: Patil A, Peddawad R, Verma VCS, Gandhi H. Profile of Acute

  3. Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. (United States)

    Koshy, Jacob; John, M Joseph; Thomas, Satish; Kaur, Gurvinder; Batra, Nitin; Xavier, Wilson J


    Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Subjects of leukemia presenting to a tertiary care center in India. A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular

  4. A review of inpatient urology consultations in an Irish tertiary referral centre. (United States)

    Sullivan, J F; Forde, J C; Creagh, T A; Donovan, M G; Eng, M P; Hickey, D P; Mohan, P; Power, R E; Smyth, G P; Little, D M


    Our institution is a 680-bed tertiary referral centre with broad medical and surgical subspecialty services. We retrospectively audited the pattern of inpatient consultations from all specialities within our institution to the urology department over a 1-year period. All consultations to the urology service were identified from our computerised inpatient consultation system from July 2010 to June 2011. Follow up data on investigations, interventions and subsequent outpatient appointments were also identified by review of individual patient discharge letters. Seven hundred and twenty five inpatient consultations were received over the period. The male to female ratio was 7:3. Mean age of patients was 66 (15-96) years. Seventy three percent of referrals were from medical sub-specialities, most commonly nephrology (17%), gastroenterology (11%) and respiratory medicine (9%). The remainder were from general surgery (16%) and other surgical sub specialities (11%). Interns (66%) and senior house officers (SHO) (28%) communicated the majority of consults. Male lower urinary tract/benign prostate related issues resulted in 25% of all consultations. Less than half of consults (47%) resulted in interventions initiated by urology, most commonly of which were catheter insertions (48%) and endoscopic procedures (35%). Only 43% of consultations were followed up in the outpatients setting. Inpatient consultations constitute a significant workload for urology services. The majority of these referrals did not require any urological intervention and could have been seen routinely in the outpatient setting. Providing structured referral guidelines and achieving better communication with referring teams may help to optimise this service. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  5. Diagnostic Yield of Upper and Lower Gastrointestinal Endoscopies in Children in a Tertiary Centre. (United States)

    Thomson, Mike; Sharma, Shishu


    Endoscopy is integral to the diagnosis and management of many gastrointestinal problems in children. Recently the number of endoscopic procedures performed has increased considerably worldwide raising questions about their appropriateness and cost-efficacy. The aim of the study was to determine the diagnostic yield (the likelihood that a procedure or test will provide information required to establish a diagnosis) of endoscopy in a paediatric population in a large tertiary referral centre and to determine the terminal ileum intubation (TII) rate of paediatric ileocolonosocopy (IC) in an active training environment and compare with previously calculated rates. Random selection of cases from a theatre electronic database from a 30-month period covering April 2012 to October 2014. The data were collected for initial presenting symptoms; age at diagnosis; indications for endoscopy; endoscopic findings; histopathological findings; and any change in management postendoscopic procedure. The diagnostic yield of the endoscopies and the TII rate of IC were calculated. Change in and contribution to management was assessed. Median age 9.58 (0.5-16.5) years and M:F ratio 1:1.42. The positive diagnostic yield was 18.9% for oesophago-gastro-duodenoscopy alone, 32.6% for IC alone, and 39.2% when both occurred. In 45% management was actively changed due to endoscopy/histopathology findings and a significant management contribution occurred in all patients. TII was achieved in 98% of cases, which compares favourably to a TII rate of 89% at the same centre during the period 2009 to 2011. Diagnostic yield was 32.6% for IC and 39.2% when oesophago-gastro-duodenoscopy also occurred. A TII rate of 98% should be achievable in children. A change in management occurred in 45% and as a significant negative finding may be as important as a positive diagnosis for exclusion of suspected disorders, with consequent reassurance and change in management. Contribution to management was therefore

  6. Impact winter and the Cretaceous/Tertiary extinctions: Results of a Chicxulub asteroid impact model (United States)

    Pope, Kevin O.; Baines, Kevin H.; Ocampo, Adriana C.; Ivanov, Boris A.


    The Chicxulub impact crater in Mexico is the site of the impact purported to have caused mass extinctions at the Cretaceous/Tertiary (K/T) boundary. 2-D hydrocode modeling of the impact, coupled with studies of the impact site geology, indiate that between 0.4 and 7.0 x 10(exp 17) g of sulfur were vaporized by the impact into anhydrite target rocks. A small portion of the sulfur was released as SO3 or SO4, which converted rapidly into H2SO4 aerosol and fell as acid rain. A radiative transfer model, coupled with a model of coagulation indicates that the aerosol prolonged the initial blackout period caused by impact dust only if the aerosol contained impurities. A larger portion of sulfur was released as SO2, which converted to aerosol slowly, due to the rate-limiting oxidation of SO2. Our radiative transfer calculations, combined with rates of acid production, coagulation, and diffusion indicate that solar transmission was reduced to 10-20% of normal for a period of 8-13 yr. This reduction produced a climate forcing (cooling) of -300 W/sq.m, which far exceeded the +8 W/sq.m greenhouse warming, caused by the CO2 released through the vaporization of carbonates, and therefore produced a decade of freezing and near-freezing temperatures. Several decades of moderate warming followed the decade of severe cooling due to the long residence time of CO2. The prolonged impact winter may have been a major cause of the K/T extinctions.

  7. An audit of first afebrile seizure management in an Irish tertiary pediatric setting.

    LENUS (Irish Health Repository)

    Boyle, Michael


    The objective of this study was to compare the first afebrile seizure management with internationally recognized standards in an Irish tertiary pediatric setting. Twenty-one management standards were derived from a combination of British (NICE 2004) and North American (AAN 2003) guidelines. Cases of first afebrile seizure presenting to a pediatric emergency department between July 2007 and June 2010 were assessed against the standards. On completion, the standards developed were presented to the relevant stakeholders, a nurse-developed parental advice sheet was introduced, and a re-audit was performed from July 2010 to June 2011. Forty children were identified in the initial audit period (A1) and 41 over the re-audit (A2). No case achieved full compliance with the devised standards in the audit period. A median compliance score of 15 (range 5-20) was achieved in A1 and 17 (range 11-21) in A2 [mean rank 31.93 versus 49.85; p(1,1) < 0.0001]. Optimal compliance (total score of ≥17) with devised standards was achieved in 6\\/40 patients in A1 and in 21\\/41 patients in A2 [χ (2) = 11.95; p(1,1) = 0.001]. Conclusion: We demonstrated an initial lack of compliance with international guidelines on management of a common medical presentation, first afebrile seizure, and demonstrated that improvements can be achieved by identification of appropriate standards and critical appraisal of the compliance with these standards through both formal and informal education.

  8. Study of variables affecting critical value notification in a laboratory catering to tertiary care hospital. (United States)

    Agarwal, Rachna; Chhillar, Neelam; Tripathi, Chandra B


    During post-analytical phase, critical value notification to responsible caregiver in a timely manner has potential to improve patient safety which requires cooperative efforts between laboratory personnel and caregivers. It is widely accepted by hospital accreditors that ineffective notification can lead to diagnostic errors that potentially harm patients and are preventable. The objective of the study was to assess the variables affecting critical value notification, their role in affecting it's quality and approaches to improve it. In the present study 1,187 critical values were analysed in the Clinical Chemistry Laboratory catering to tertiary care hospital for neuropsychiatric diseases. During 25 months of study period, we evaluated critical value notification with respect to clinical care area, caregiver to whom it was notified and timeliness of notification. During the study period (25 months), the laboratory obtained 1,279 critical values in clinical chemistry. The analytes most commonly notified were sodium and potassium (20.97 & 20.8 % of total critical results). Analysis of critical value notification versus area of care showed that critical value notification was high in ICU and emergency area followed by inpatients and 64.61 % critical values were notified between 30 and 120 min after receiving the samples. It was found that failure to notify the responsible caregiver in timely manner represent an important patient safety issue and may lead to diagnostic errors. The major area of concern are notification of critical value for outpatient samples, incompleteness of test requisition forms regarding illegible writing, lack of information of treating physician and location of test ordering and difficulty in contacting the responsible caregiver.

  9. Indications for Corneal Transplantation at a Tertiary Referral Center in Tehran

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    Mohammad Zare


    Full Text Available Purpose: To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period. Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. Results: During this period, 776 eyes of 756 patients (including 504 male subjects with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8% followed by bullous keratopathy (n=90, 11.6%, non-herpetic corneal scars (n=62, 8.0%, infectious corneal ulcers (n=61, 7.9%, previously failed grafts (n=61, 7.9%, endothelial and stromal corneal dystrophies (n=28, 3.6%, and trachoma keratopathy (n=26, 3.3%. Other indications including Terrien′s marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%, deep anterior lamellar keratoplasty (n=108, 13.9%, conventional lamellar keratoplasty (n=44, 5.7%, automated lamellar therapeutic keratoplasty (n=8, 1.0%, and Descemet stripping endothelial keratoplasty (n=6, 0.8% in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty. Conclusion: In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium.

  10. Nonparametric Inference for Periodic Sequences

    KAUST Repository

    Sun, Ying


    This article proposes a nonparametric method for estimating the period and values of a periodic sequence when the data are evenly spaced in time. The period is estimated by a "leave-out-one-cycle" version of cross-validation (CV) and complements the periodogram, a widely used tool for period estimation. The CV method is computationally simple and implicitly penalizes multiples of the smallest period, leading to a "virtually" consistent estimator of integer periods. This estimator is investigated both theoretically and by simulation.We also propose a nonparametric test of the null hypothesis that the data have constantmean against the alternative that the sequence of means is periodic. Finally, our methodology is demonstrated on three well-known time series: the sunspots and lynx trapping data, and the El Niño series of sea surface temperatures. © 2012 American Statistical Association and the American Society for Quality.

  11. The natural history of neural tube defects in the setting of an Irish tertiary referral foetal medicine unit. (United States)

    Anglim, B; Mandiwanza, T; Miletin, J; Turner, M; Kennelly, M M


    Neural tube defects (NTDs) carry a heavy burden for affected individuals and their family. Physical and neurological outcome measures may help in counselling couples. The aim of this audit was to review all cases of NTDs seen at a tertiary referral foetal medicine unit. Cases were identified from obstetric, neonatal and neurosurgical records. Thirty-six cases of NTDs were identified. Of the 36, 25% (n = 9, one trisomy 18) opted for termination of pregnancy abroad. Of the remaining 27, 19% (n = 5) died in the antepartum period. 81% (n = 22) were liveborn with four neonatal deaths (one trisomy 18). Of 15 cases, 14 had neurosurgical repair within a median time of 3 days and 9 of these also had a ventriculoperitoneal shunt inserted. Antenatal ultrasound accurately diagnosed lesion level in the majority of cases. The survival rate for babies diagnosed with non-lethal neural tubes defects is high when multidisciplinary care is initiated early.

  12. New interpretation of development of San Luis basin, south-central Colorado, based on petrology of Tertiary strata

    Energy Technology Data Exchange (ETDEWEB)

    Brister, B.S. (New Mexico Institute of Mining and Technology, Socorro (USA))


    A problem exists in determining which parts of the San Luis basin were depositional sites during three Tertiary tectonic events: early Tertiary (Laramide) transpression/compression, mid-Tertiary volcanism, and late Tertiary (Rio Grande rift) extension. Earlier studies have been hampered by incomplete knowledge of regional characteristics of poorly exposed early Tertiary rocks and by reliance upon inconclusive pollen age determinations. For simple petrologic analysis of well cuttings from boreholes across the basin, the authors must reinterpret the timing and mode of basin development. Applying general petrologic characteristics in well log correlations, it is apparent that the western part (Monte Vista graben) of the San Luis basin was an active depositional basin during all three of the Tertiary tectonic events, whereas the eastern part (Baca graben) is primarily a result of the late Tertiary rift episode.

  13. Submarine pyroclastic deposits in Tertiary basins, NE Slovenia

    Directory of Open Access Journals (Sweden)

    Polona Kralj


    Full Text Available In Tertiary basins of NE Slovenia, Upper Oligocene volcanic activity occurred in a submarine environment that experienced contemporaneous clastic sedimentation. Pyroclastic deposits are essentially related to gas- and watersupported eruption-fed density currents. At Trobni Dol, the Lako Basin, an over 100 m thick deposit formed by a sigle sustained volcanic explosion that fed gas-supported pyroclastic flow. Diagnostic features are large matrixshard content, normal grading of pumice lapilli, collapsed pumice lapilli and the presence of charcoal. In the Smrekovec Volcanic Complex, several but only up to 5 m thick deposits related to eruption-fed gassupported pyroclastic flows occur. Deposits settled from water-supported eruption-fed density currents form fining- and thinning-upward sedimentary units which resemble the units of volcaniclastic turbidites. Pyroclastic deposits related to gas- and water-supported density currents occur in an up to 1000 m thick succession composed of coherent volcanics, autoclastic, pyroclastic, reworked volcaniclastic and mixed volcaniclastic-siliciclastic deposits that indicate a complex explosive and depositional history of the Smrekovec Volcanic Complex.

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

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    Ikram Nasr


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

  15. Staff happiness and work satisfaction in a tertiary psychiatric centre. (United States)

    Baruch, Y; Swartz, M; Sirkis, S; Mirecki, I; Barak, Y


    Mental health professionals are at a high risk of burnout. Positive psychology outcomes of staff in acute in-patient psychiatric wards are poorly researched and unclear. To quantify the satisfaction with life and work-life satisfaction of mental health staff at a large university-affiliated tertiary psychiatric centre. We utilized the Satisfaction with Life Scale (SWLS) and the Work-Life Satisfaction Questionnaire (WLSQ). Two hundred and nine out of 450 staff members (46%) participated; mean age 48.2 + 9.9 years; 63% were male. On average the participants had been practising their speciality for 21.1 + 9.8 years (range: 2-48). The mean total SWLS scores differed significantly between professions (P happiness were reported by psychologists and social workers, followed by the administrative staff, the psychiatrists and finally the nursing staff. Staff scored the highest for work as a 'calling' followed by work as a 'career' and the lowest rating for work as a 'job'. The mean total WLSQ score differed between professions, (P happiness may contribute to increase in moral and counter burnout.

  16. Factors Hindering the Integration of CALL in a Tertiary Institution

    Directory of Open Access Journals (Sweden)

    Izaham Shah Ismail


    Full Text Available The field of Computer Assisted Language Learning (CALL is a field that is constantly evolving as it is very much dependent on the advancement of computer technologies. With new technologies being invented almost every day, experts in the field are looking for ways to apply these new technologies in the language classroom. Despite that, teachers are said to be slow at adopting technology in their classrooms and language teachers, whether at schools or tertiary institutions, are no exception. This study attempts to investigate the factors that hinder ESL instructors at an institution of higher learning from integrating CALL in their lessons. Interviews were conducted with five ESL instructors and results revealed that factors which hinder them from integrating CALL in their teaching are universal factors such as knowledge in technology and pedagogy, computer facilities and resources, absence of exemplary integration of CALL, personal beliefs on language teaching, views on the role of a computers as teacher, and evaluation of learning outcomes.

  17. [Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience]. (United States)

    Gómez-Chacón Villalba, J; Rodríguez Caraballo, L; Marco Macián, A; Segarra Llido, V; Vila Carbó, J J


    To describe our experience using Minimally Invasive Surgery (MIS) techniques in tertiary center with specific oncological pediatric surgery unit. Retrospective review of patients undergoing MIS techniques in pediatric oncology surgery unit between January 2011 and December 2014. MIS procedures were considered made by both techniques such as laparoscopy and thoracoscopy with both diagnostic and therapeutic intent. 4 procedures were diagnostic and the rest were therapeutic: During the study, 56 procedures were performed by MIS. By type of technique, 13 were thoracoscopic (7 metastasectomies, 6 thoracic masses) and 43 laparoscopic (3 hepatic masses, 3 pancreatic masses 7 abdominal masses, 2 ovarian masses, 2 typhlitis 1 splenic mass and 25 oophorectomy for ovarian cryopreservation). In 5 cases (2 thoracic masses 1 pancreatic mass abdominal masses) conversion to open surgery to complete the procedure (2 for caution in the absence of vascular control bleeding 1 and 2 for lack of space) was necessary. In all cases safety principles of oncological surgery were respected. Providing an adecuate selection of patiens, MIS techniques are safe, reproducible and fulfill the objectives of quality of cancer surgery.

  18. Wildfires and animal extinctions at the Cretaceous/Tertiary boundary (United States)

    Adair, Robert K.


    Persuasive models of the ejection of material at high velocities from the Chicxulub asteroid impact marking the Cretaceous/Tertiary boundary have led to the conclusion that upon return, that material, heated in passage through the upper atmosphere, generated a high level of infrared energy density over the Earth's surface. That radiant energy has been considered to be a direct source of universal wildfires, which were presumed to be a major cause of plant and animal species extinctions. The extinction of many animal species, especially the dinosaurs, has also been attributed to the immediate lethal effects of the radiation. I find that the absorption of the radiation by the atmosphere, by cloud formations, and by ejecta drifting in the lower atmosphere reduced the radiation at the surface to a level that cannot be expected to have generated universal fires. Although the reduced radiation will have likely caused severe injuries to many animals, such insults alone seem unlikely to have generated the overall species extinctions that have been deduced.

  19. Job satisfaction among anesthesiologists at a tertiary hospital in Nigeria

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    Ambrose Rukewe


    Full Text Available Background : We assessed job satisfaction among anesthesiologists at a tertiary hospital in Nigeria and identified elements of job stress and dissatisfaction. Methods : A cross-sectional study design was employed; a structured self-administered questionnaire was distributed, which focused on sociodemographic data, rating of job satisfaction, identification of stressors, and work relationships. Results : Out of 55 questionnaires distributed, 46 (83.6% completed questionnaires were returned. Overall, 27 (58.7% of the anesthesiologists were satisfied with their job. While 8.7% were very satisfied (grade 5, 6.5% were very dissatisfied (grade 1 with their job. The stressors identified by the respondents were time pressures, long working hours with complaints of insufficient sleep, and employment status. Among the respondents, the medical officers were the most discontented (9 out of 12, 75%, followed by senior registrars (5 out of 9, 56%. A high percentage of participants (54.1% declared that the one change if implemented that would enhance their job satisfaction was having a definite closing time. Conclusion : Our results showed that despite the demanding nature of anesthesiology as a specialty, many anesthesiologists were contented with their job.

  20. Predictors of Patient Satisfaction with Tertiary Hospitals in Korea

    Directory of Open Access Journals (Sweden)

    Hye-Sook Ham


    Full Text Available This study examined the general and system-related predictors of outpatient satisfaction with tertiary health care institutions in Korea. A cross-sectional descriptive study design was employed. The subjects were 1,194 outpatients recruited from 29 outpatient clinics of a university medical center in Korea. Measurements included 5 outpatient service domains (i.e., doctor service, nurse service, technician service, convenience, and physical environment of facility and patient satisfaction. Of the five domains, nurse service was the domain with the highest mean score M=4.21 and convenience was the domain with the lowest mean score M=3.77. The most significant predictor of patient satisfaction was the constructs of convenience β=0.21. The results of this study suggest that the concept of patient satisfaction with health care institutions in modern hospitals reflects an integrative process that includes not only the concerned health care personnel but also improved convenience such as user-friendly reservation system and comfortable waiting areas.

  1. Needle stick injuries in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Jayanth S


    Full Text Available Background: Accidental needle stick injuries (NSIs are an occupational hazard for healthcare workers (HCWs. A recent increase in NSIs in a tertiary care hospital lead to a 1-year review of the pattern of injuries, with a view to determine risk factors for injury and potential interventions for prevention. Methods: We reviewed 1-year (July 2006-June 2007 of ongoing surveillance of NSIs. Results: The 296 HCWs reporting NSIs were 84 (28.4% nurses, 27 (9.1% nursing interns, 45 (21.6% cleaning staff, 64 (21.6% doctors, 47 (15.9% medical interns and 24 (8.1% technicians. Among the staff who had NSIs, 147 (49.7% had a work experience of less than 1 year ( P < 0.001. The devices responsible for NSIs were mainly hollow bore needles ( n = 230, 77.7%. In 73 (24.6% of the NSIs, the patient source was unknown. Recapping of needles caused 25 (8.5% and other improper disposal of the sharps resulted in 55 (18.6% of the NSIs. Immediate post-exposure prophylaxis for HCWs who reported injuries was provided. Subsequent 6-month follow-up for human immunodeficiency virus showed zero seroconversion. Conclusion: Improved education, prevention and reporting strategies and emphasis on appropriate disposal are needed to increase occupational safety for HCWs.

  2. Perceived nursing service quality in a tertiary care hospital, Maldives. (United States)

    Nashrath, Mariyam; Akkadechanunt, Thitinut; Chontawan, Ratanawadee


    The present study explored nurses' and patients' expectations of nursing service quality, their perception of performance of nursing service quality performed by nurses, and compared nursing service quality, as perceived by nurses and patients. The sample consisted of 162 nurses and 383 patients from 11 inpatient wards/units in a tertiary care hospital in the Maldives. Data were collected using the Service Quality scale, and analyzed using descriptive statistics and the Mann-Whitney U-test. The results indicated that the highest expected dimension and perceived dimension for nursing service quality was Reliability. The Responsiveness dimension was the least expected dimension and the lowest performing dimension for nursing service quality as perceived by nurses and patients. There was a statistically significant difference between nursing service quality perceived by nurses and patients. The study results could be used by nurse administrators to develop strategies for improving nursing service quality so that nursing service delivery process can be formulated in such a way as to reduce differences of perception between nurses and patients regarding nursing service quality. © 2011 Blackwell Publishing Asia Pty Ltd.

  3. Terpenoid composition and class of Tertiary resins from India

    Energy Technology Data Exchange (ETDEWEB)

    Dutta, Suryendu; Mallick, Monalisa; Mathews, Runcie Paul [Department of Earth Sciences, Indian Institute of Technology Bombay, Powai, Mumbai-400076 (India); Bertram, Norbert [LTA-Labor fuer Toxikologie und Analytik, Friedrichshoeher Str. 28, D-53639 Koenigswinter (Germany); Greenwood, Paul F. [John De Laeter Mass Spectrometry and WA Biogeochemitry Centres (M090), The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009 (Australia); WA - Organic and Isotope Geochemistry Centre, Curtin University of Technology, Kent St., Bentley 6102 (Australia)


    The terpenoid composition and class of Tertiary resins preserved within lignites of Cambay, Kutch and Cauvery Basins of India have been characterized using Pyrolysis-Gas Chromatography-Mass Spectrometry (Py-GC-MS) and Fourier Transform Infrared (FTIR) Spectroscopy. Major pyrolysis products include cadalene-based C{sub 15}-bicyclic sesquiterpenoids with some C{sub 30} and C{sub 31} bicadinanes and bicadinenes typical of Class II or dammar resin. The occurrence of these terpenoids in Early Eocene sediments may extend the first appearance of Dipterocarpaceae angiosperms, the predominant source of this resin class, back to the Early Eocene epoch in India. The same terpenoid biomarkers have been detected in many SE Asian oils reflecting a close source relationship with these resins. Strong CH{sub 3} (1377 cm{sup -} {sup 1}) and other CH{sub x} (3000-2800 and 1460-1450 cm{sup -} {sup 1}) aliphatic absorptions of much larger intensity than the aromatic C = C (1560-1650 cm{sup -} {sup 1}) absorption were detected in the Indian resins by FTIR Spectroscopy, confirming the quantitative significance of the terpenoid pyrolysates. (author)

  4. Septic arthritis in adults in a tertiary care center. (United States)

    Ornelas-Aguirre, José Manuel


    To describe the history, clinical features and microorganisms involved in a group of adult subjects with and without septic arthritis (SA) at a tertiary care in Mexico. A cross-sectional descriptive study was conducted on 96 adults with clinical suspicion of AS in one or more joints. In all cases synovial fluid arthrocentesis and culture was performed. The comparison group subjects were culture negative. A descriptive statistical analysis and binary logistic regression model was performed between the variables associated with the development of AS. A value of P≤.05 was significant. A total of 49 out of 96 subjects had a positive culture, mostly of the monoarticular type (96%; P=.02). The knee was the most common site (61%; P=.06) and pain was the main clinical manifestation (59%; P=.001). Staphylococcus was the most common etiological agent (65%; P<.001). The risk factors revealed in the final regression model were SA the history of joint disease (OR=25; P=.03) and volume increase (OR=13.16; P=.06). Functional limitation (OR=8.54; P=.04) showed a significant risk among borderline for SA. Our results are consistent with previous studies, and can be generalized to geographical areas with similar clinical features to those observed in this study. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  5. Epidemiologic study of ankle fractures in a tertiary hospital. (United States)

    Sakaki, Marcos Hideyo; Matsumura, Bruno Akio Rodrigues; Dotta, Thiago De Angelis Guerra; Pontin, Pedro Augusto; Dos Santos, Alexandre Leme Godoy; Fernandes, Tulio Diniz


    To evaluate the epidemiology of ankle fractures surgically treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo. Medical records of patients admitted with foot and ankle fractures between 2006 and 2011 were revised. Seventy three ankle fractures that underwent surgical treatment were identified. The parameters analyzed included age, gender, injured side, AO and Gustilo & Anderson classification, associated injuries, exposure, need to urgent treatment, time to definitive treatment and early post-operative complications. retrospective epidemiological study. Male gender was predominant among subjects and the mean age was 27.5 years old. Thirty nine fractures resulted from traffic accidents and type B fracture according to AO classification was the most common. Twenty one were open fractures and 22 patients had associated injuries. The average time to definitive treatment was 6.5 days. Early post-operative complications were found in 21.3% of patients. Ankle fractures treated in a tertiary hospital of a large city in Brazil affect young people victims of high-energy accidents and present significant rates of associated injuries and post-operative complications. Level of Evidence IV, Cases Series.

  6. Ocular trauma: A tertiary hospital experience from Oman. (United States)

    Al-Mahrouqi, Haitham H; Al-Harthi, Naila; Al-Wahaibi, Maryam; Hanumantharayappa, Kishore


    To describe the epidemiology of ocular trauma in a tertiary hospital setting in Muscat, Oman. Medical records of all cases of ocular trauma which presented to the Emergency Department at Al-Nahdha Hospital and were seen by the ophthalmology service from January 1, 2013 to June 30, 2013 (6 months) were reviewed to collect data on ocular trauma according to the World Eye Injury Registry initial reporting form which uses the Birmingham Eye Trauma Terminology System. There were 27,951 patients seen at the Emergency Department and 611 of which were ocular trauma cases (cumulative incidence 2.2% [confidence interval 2.0-2.4]). The mean age of the patients was 23 years and males comprised the majority of the cases (72%). Thirty-two patients had bilateral injury giving a total of 643 eyes injured. More than half of all injuries were caused by either blunt or large sharp objects. The cornea was the most frequently injured tissue (49%), but most injuries were minor in nature. More than three quarters (77%) of all eyes had a visual acuity of 0.3 (LogMAR) or better on presentation. There were 35 eyes (6%) with open globe injuries (OGI) and three-quarters of them occurring in the manual laborers. Ocular trauma is a common presentation at Al-Nahdha Hospital. Although the majority of trauma cases were minor without any visual disability sequelae, OGI could have been prevented with better ocular protection in the workplace.

  7. Students’ Perceptions on a Good Tertiary Foreign Language Teacher

    Directory of Open Access Journals (Sweden)

    Siti Tarwiyah


    Full Text Available This paper investigates students’ perception of tertiary teachers’ attitude, method of teaching and classroom management in the teaching and learning of (professional, pedagogic, social and personality competence English and Arabic Language at IAIN Walisongo Semarang. This study is designed quantitavely and qualitatively using closed and open-ended questionnaire for collecting data. The subject of this research is the second semester students of the two faculties at IAIN Walisongo who, in that semester, take Arabic or English language course. The subject is chosen because based on 2012 course distribution, English and Arabic are distributed in the first and the second semester. The findings revealed that it is clearly seen that KPI (Islamic Communication & Broadcasting department students have better perception to their English language teachers. Meanwhile, students who have better perception to their Arabic Language Teachers are those from Islamic Counseling Departments (BPI of Dakwah faculty. Data of Tarbiyah Faculty shows Arabic language teachers are dominating. Arabic language teachers win 0.5 over English language teachers in almost all characteristics. This implies that expected performance of students in English Language is based on the teachers’ attitude, method of teaching the subject and classroom management. Based on the above-findings, recommendations were made.

  8. Tertiary Lymphoid Organs in Central Nervous System Autoimmunity

    Directory of Open Access Journals (Sweden)

    Meike Mitsdoerffer


    Full Text Available Multiple sclerosis (MS is an autoimmune disease characterized by chronic inflammation in the central nervous system (CNS, which results in permanent neuronal damage and substantial disability in patients. Autoreactive T cells are important drivers of the disease, however, the efficacy of B cell depleting therapies uncovered an essential role for B cells in disease pathogenesis. They can contribute to inflammatory processes via presentation of autoantigen, secretion of pro-inflammatory cytokines and production of pathogenic antibodies. Recently, B cell aggregates reminiscent of tertiary lymphoid organs (TLOs were discovered in the meninges of MS patients, leading to the hypothesis that differentiation and maturation of autopathogenic B and T cells may partly occur inside the CNS. Since these structures were associated with a more severe disease course, it is extremely important to gain insight into the mechanism of induction, their precise function and clinical significance. Mechanistic studies in patiens are limited. However, a few studies in the MS animal model experimental autoimmune encephalomyelitis (EAE recapitulate TLO formation in the CNS and provide new insight into CNS TLO features, formation and function. This review summarizes what we know so far about CNS TLOs in MS and what we have learned about them from EAE models. It also highlights the areas that are in need of further experimental work, as we are just beginning to understand and evaluate the phenomenon of CNS TLOs.

  9. After-hour physiotherapy services in a tertiary general hospital. (United States)

    Lim, Edwin C W; Liu, Jinyu; Yeung, Meredith T L; Wong, Wai Pong


    The aims of the present study were to describe the after-hour physiotherapy services in a tertiary general hospital, the patients and their demographics, and to determine which independent variables would predict physiotherapists' referrals to after-hour physiotherapy. A retrospective record review from April 1, 2004, to April 30, 2005, identified 992 patients (mean age 63.8 years; 95% confidence interval [CI] 62.6-65.0 years) who were either referred by daytime physiotherapists (68%) or referred by medical practitioners for urgent attendance after hours (32%). Pneumonia was formally diagnosed medically in 20% (n=197) of the patients. Of all the patients who had surgery, upper abdominal or thoracic incisions formed the majority (61%; n=236). Whether patients had upper abdominal/thoracic surgery (estimated odds ratio 3.4; 95% CI 2.3-4.9) and the presence of pneumonia (2.8; 95% CI 1.9-4.2) were two independent factors identified from a logistic regression model predicting daytime physiotherapists' referral of patients to after-hour service. This model correctly predicted 65.5% of the cases. Most patients were seen for mucociliary clearance. Referral behaviour by physiotherapists reflects the basis of their clinical decision making and has implications for practice, training, and further research.

  10. Reduction of secondary and tertiary phosphine oxides to phosphines. (United States)

    Hérault, Damien; Nguyen, Duc Hanh; Nuel, Didier; Buono, Gérard


    Achiral or chiral phosphines are widely used in two main domains: ligands in organometallic catalysis and organocatalysis. For this reason, the obtention of optically pure phosphine has always been challenging in the development of asymmetric catalysis. The simplest method to obtain phosphines is the reduction of phosphine oxides. The essential difficulty is the strength of the P=O bond which involves new procedures to maintain a high chemio- and stereoselectivity. The reduction can occur with retention or inversion of the stereogenic phosphorus atom depending on the nature of the reducing agent and the presence of additives. In fact, the reactivity of the phosphine oxides and the mechanism of the reduction are not always well understood. Since the first work in the 1950's, numerous studies have been realised in order to develop methodologies with different reagents or to understand the mechanism of the reaction. In the last decade, efficient stereospecific methodologies have been developed to obtain optically pure tertiary phosphines from P-stereogenic phosphine oxides. In this review, we intend to provide a comprehensive and critical overview of these methodologies.


    Directory of Open Access Journals (Sweden)

    Kiran Kumar Epari


    Full Text Available BACKGROUND In this tertiary care hospital, one of the common condition of all the patients attending the hospital is Anaemia, which is a decrease in haemoglobin content or decrease in haematocrit below the lower limit of the 95% reference range for the individual’s age and sex. The patient presents with varied symptoms of different grades, depending on the severity of anaemia, in different clinical settings. Common presenting symptoms of anaemia are generalised weakness, malaise, loss of appetite and muscular pains. METHODS All the patient samples received at the central laboratory for haemogram, complete blood counts and peripheral smear examination over the period of two years between June 2014 to May 2016 were included in the study. Anaemia cases were diagnosed depending on the criteria of the definition of anaemia, and morphological typing of anaemia was done based on the peripheral smear examination of all the cases with decreased haemoglobin level. Standard cell counter was used to estimate the Hb and other red cell indices, and corroborated with peripheral blood smear examination by standard Romanowsky stains. RESULTS A total of 810 cases of anaemia were diagnosed over the period of two years, of which morphological typing yielded 685 cases of Microcytic and hypochromic anaemia, 15 cases of Dimorphic anaemia, 22 cases of Macrocytic anaemia and 88 cases of Normocytic and normochromic anaemia. CONCLUSION Anaemia is one of the most common problems of patients attending this tertiary care hospital, and detection and morphological typing of anaemia is very helping in guiding the clinicians in diagnosis and further management of anaemias for better patient care.

  12. Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: a case-control study

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    Maria Goreth Barberino

    Full Text Available Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (± 30 days of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases, C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each. The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC, use of parenteral nutrition support (PNS, previous exposure to antibiotics, and chronic renal failure (CRF. No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity

  13. Periodicity of DNA in exons

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    Kinghorn Brian


    Full Text Available Abstract Background The periodic pattern of DNA in exons is a known phenomenon. It was suggested that one of the initial causes of periodicity could be the universal (RNYnpattern (R = A or G, Y = C or U, N = any base of ancient RNA. Two major questions were addressed in this paper. Firstly, the cause of DNA periodicity, which was investigated by comparisons between real and simulated coding sequences. Secondly, quantification of DNA periodicity was made using an evolutionary algorithm, which was not previously used for such purposes. Results We have shown that simulated coding sequences, which were composed using codon usage frequencies only, demonstrate DNA periodicity very similar to the observed in real exons. It was also found that DNA periodicity disappears in the simulated sequences, when the frequencies of codons become equal. Frequencies of the nucleotides (and the dinucleotide AG at each location along phase 0 exons were calculated for C. elegans, D. melanogaster and H. sapiens. Two models were used to fit these data, with the key objective of describing periodicity. Both of the models showed that the best-fit curves closely matched the actual data points. The first dynamic period determination model consistently generated a value, which was very close to the period equal to 3 nucleotides. The second fixed period model, as expected, kept the period exactly equal to 3 and did not detract from its goodness of fit. Conclusions Conclusion can be drawn that DNA periodicity in exons is determined by codon usage frequencies. It is essential to differentiate between DNA periodicity itself, and the length of the period equal to 3. Periodicity itself is a result of certain combinations of codons with different frequencies typical for a species. The length of period equal to 3, instead, is caused by the triplet nature of genetic code. The models and evolutionary algorithm used for characterising DNA periodicity are proven to be an effective tool

  14. Tertiary instability of zonal flows within the Wigner-Moyal formulation of drift turbulence (United States)

    Zhu, Hongxuan; Ruiz, D. E.; Dodin, I. Y.


    The stability of zonal flows (ZFs) is analyzed within the generalized-Hasegawa-Mima model. The necessary and sufficient condition for a ZF instability, which is also known as the tertiary instability, is identified. The qualitative physics behind the tertiary instability is explained using the recently developed Wigner-Moyal formulation and the corresponding wave kinetic equation (WKE) in the geometrical-optics (GO) limit. By analyzing the drifton phase space trajectories, we find that the corrections proposed in Ref. to the WKE are critical for capturing the spatial scales characteristic for the tertiary instability. That said, we also find that this instability itself cannot be adequately described within a GO formulation in principle. Using the Wigner-Moyal equations, which capture diffraction, we analytically derive the tertiary-instability growth rate and compare it with numerical simulations. The research was sponsored by the U.S. Department of Energy.

  15. Provision of an emergency theatre in tertiary hospitals is cost-effective

    African Journals Online (AJOL)

    Provision of an emergency theatre in tertiary hospitals is cost-effective: Audit and cost of cancelled planned elective general surgical operations at Pietersburg Hospital, Limpopo Province, South Africa.

  16. Tensions in Learner Support and Tutor Support in Tertiary Web-based English Education in China

    National Research Council Canada - National Science Library

    Tong Wang


      Based on the findings of a national survey conducted in 2004 designed to examine the support systems for both learners and tutors engaged in tertiary-level Web-based English education in mainland...

  17. Self-Concept as a Correlate of Career Choice of Students in Tertiary ...

    African Journals Online (AJOL)

    concept and career choice of students in Post-Secondary Institutions in Sokoto State. The sample consisted of 300 students (140 males and 160 females) deliberately selected from the population of three tertiary institutions in Sokoto State.

  18. Analysis of HIV-related mortality data in a tertiary South African ...

    African Journals Online (AJOL)

    Analysis of HIV-related mortality data in a tertiary South African neurology unit, 2006 ... At the Steve Biko Academic Hospital, Pretoria, the Neurology Department has seen a steady increase in HIV-related neurology patients. ... Article Metrics.

  19. A review of stroke admissions at a tertiary hospital in rural ...

    African Journals Online (AJOL)

    A review of stroke admissions at a tertiary hospital in rural Southwestern ... Background: Stroke is a common neurological disorder and is the third leading cause of ... Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking ...

  20. Utilisation and outcome of renal replacement therapy in an Asian tertiary intensive care unit. (United States)

    Choi, Gordon Y S; Joynt, Gavin M; Gomersall, Charles D; So, H Y


    To determine the period prevalence, demographic characteristics, cost of treatment, and outcomes of patients admitted to the intensive care unit for continuous renal replacement therapy. Descriptive case series. Intensive Care Unit in a Hong Kong tertiary referral, teaching hospital. All patients admitted to the Intensive Care Unit from January to December 2007 who underwent continuous renal replacement therapy. Period prevalence of continuous renal replacement therapy, patient demographic data, referral sources by specialty and hospital location, diagnosis, daily cost of disposable items, duration of renal replacement therapy, intensive care unit length of stay, and hospital mortality. Of 1652 patients admitted to the intensive care unit over a 12-month period, 131 (8%) underwent continuous renal replacement therapy, of whom 56% were admitted from general wards (the department of medicine being the source of 59% of referrals). The median age of these continuous renal replacement therapy patients was 67 (interquartile range, 55-76) years, with a slight male predominance (66%). The mean APACHE II score of the patients was 29 (standard deviation, 7). Chronic renal failure requiring either haemodialysis or peritoneal dialysis was present in 20/131 (15%) patients. Sepsis was the diagnosis most commonly associated with renal failure deemed to warrant continuous renal replacement therapy (43%). The median duration of such continuous therapy was 55 (interquartile range, 25-93) hours and the median intensive care unit length of stay was 120 (interquartile range, 51-289) hours. The mean daily cost of disposables for the provision of continuous renal replacement therapy was HK$3510. The overall intensive care unit mortality of patients having continuous renal replacement therapy was 38% and the hospital mortality was 53%. The corresponding rates for patients with acute renal failure were 45% and 56%, respectively. Patients undergoing continuous renal replacement therapy had

  1. Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland (United States)

    Bloch-Infanger, Constantine; Bättig, Veronika; Kremo, Jürg; Widmer, Andreas F.; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan


    Objective The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland. Methods At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations. Results Hundred ninety five of 2’544 and 516 of 6’243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (p<0.001) and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017) in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4) and bacterial skin infections (n = 2) in 2004/05; Malaria (n = 9), pneumonia (n = 6), Chickenpox (n = 5), other viral infections (n = 5) and bacterial skin infections (n = 5) in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum seekers required isolation precautions with median duration of 6–9.5 days in both study periods. Conclusions The changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges. PMID:28617860

  2. Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland.

    Directory of Open Access Journals (Sweden)

    Constantine Bloch-Infanger

    Full Text Available The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland.At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations.Hundred ninety five of 2'544 and 516 of 6'243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey and Africa (49.1%, mainly Eritrea, respectively. Median age was similar in both study periods (26.9 and 26.2 years. Infectious diseases in asylum seekers increased from 22.6% to 36.6% (p<0.001 and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017 in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4 and bacterial skin infections (n = 2 in 2004/05; Malaria (n = 9, pneumonia (n = 6, Chickenpox (n = 5, other viral infections (n = 5 and bacterial skin infections (n = 5 in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum seekers required isolation precautions with median duration of 6-9.5 days in both study periods.The changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges.

  3. Long period oscillations in sunspots (United States)

    Chorley, N.; Hnat, B.; Nakariakov, V. M.; Inglis, A. R.; Bakunina, I. A.


    Long period oscillations of the gyroresonant emission from sunspot atmospheres are studied. Time series data generated from the sequences of images obtained by the Nobeyama Radioheliograph operating at a frequency of 17 GHz for three sunspots have been analysed and are found to contain significant periods in the range of several tens of minutes. Wavelet analysis shows that these periods are persistent throughout the observation periods. The presence of the oscillations is confirmed by several methods (periodogram, wavelets, Fisher randomisation and empirical mode decomposition). Spatial analysis using the techniques of period, power, correlation and time lag mapping reveals regions of enhanced oscillatory power in the umbral regions. Also seen are two regions of coherent oscillation of about 25 pixels in size, that oscillate in anti-phase with each other. Possible interpretation of the observed periodicities is discussed, in terms of the shallow sunspot model and the leakage of the solar g-modes.

  4. From Periodic Properties to a Periodic Table Arrangement (United States)

    Besalú, Emili


    A periodic table is constructed from the consideration of periodic properties and the application of the principal components analysis technique. This procedure is useful for objects classification and data reduction and has been used in the field of chemistry for many applications, such as lanthanides, molecules, or conformers classification.…



    KWAPONG, Olivia Adwoa Tiwaah Frimpong


    Distance education (DE) is seen as a tool for widening access to education at all levels. It is an educational tool that breaks most of the divides in education – age, gender, race, income, space, time etc. For the past decades, irrespective of the extensive expansion of tertiary institutions in the country, provision of tertiary education in Ghana has not been adequate enough to absorb all qualified applicants. This situation has peculiar effect on women who for socio-cultural factors drop ...

  6. Tertiary Oximes on Brain Acetylcholinesterase and Central Excitatory Effects of Nerve Agents (United States)


    3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE Tertiary Oximes on Brain Acetylcholinesterase and Central Excitatory Effects of Nerve 5a...pralidoxime (2-PAM) to reactivate inhibited AChE. The quaternary structure of this oxime does not allow it to cross the blood brain barrier (BBB) to...propan-1-aminium chloride (DHAP), two tertiary oximes that can penetrate the BBB, could prevent or reverse the central toxic effects of three nerve

  7. Changes in private returns to education caused by the tertiary education expansion in Slovakia


    Miroslav Stefanik


    This article brings evidence on tertiary education expansion in Slovakia and explores possible effects of this expansion on private returns to education. It focuses particularly on intergenerational differences in private returns to education. The question is whether tertiary education expansion has decreased private returns to education and whether there are differences in the value of education acquired by different generations. European Union Community Statistics on Income and Living Condi...

  8. The use of tribromoisocyanuric acid to distinguish among primary, secondary and tertiary alcohols

    Directory of Open Access Journals (Sweden)

    Lívia T. C. Crespo


    Full Text Available Primary, secondary and tertiary alcohols can be easily distinguished due to their reactivity towards tribromoisocyanuric acid (TBCA. The test is performed by adding TBCA to the alcohol in a test tube heated in a boiling water bath. Orange color develops in the tube containing the primary alcohol, light yellow is observed in the tube containing the secondary alcohol while the tertiary alcohol results in a colorless mixture.

  9. West Hackberry Tertiary Project. Annual report, September 3, 1997--September 2, 1998

    Energy Technology Data Exchange (ETDEWEB)

    Gillham, T.H.


    The following report is the Project Management Plan for the fifth year of the West Hackberry Tertiary Project. The West Hackberry Tertiary Project is one of four mid-term projects selected by the United States Department of Energy (DOE) as part of the DOE`s Class 1 Program for the development of advance recovery technologies in fluvial dominated deltaic reservoirs. The West Hackberry Tertiary Project is a field test of the idea that air injection can be combined with the Double Displacement Process to produce a low cost tertiary recovery process which is economic at current oil prices. The Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil by gravity drainage. The Double Displacement Process is based upon the concept that in fields such as West Hackberry waterdrive recoveries are typically 50%-60% of the original oil in place while gravity drainage recoveries average 80%-90% of the original oil in place. Therefore, by injecting a gas into a watered out reservoir, a gas cap will form an additional oil can be recovered due to gravity drainage. Although the Double Displacement Process has been shown to be successful in recovering tertiary oil in other fields, this project will be the first to utilize air injection in the Double Displacement Process. The use of air injection in this process combines the benefits of air`s low cost and universal accessibility with the potential for accelerated oil recovery due to the combustion process. If successful, this project will demonstrate that the use of air injection in the Double Displacement Process will result in an economically viable tertiary process in reservoirs where tertiary oil recovery is presently uneconomical.

  10. Determining factors of youth unemployment in Greece with emphasis on tertiary education graduates


    Theodore Mitrakos; Panos Tsakloglou; Ioannis Cholezas


    Unemployment rates for young individuals are particularly high in Greece and an important fraction of the young unemployed are tertiary education graduates. The results of this study imply that the problem is the transition from education to the labour market, irrespective of the individual’s age and educational qualifications. By and large, unemployment rates for tertiary education graduates tend to diminish a few years after graduation, while they fall slower and remain higher for persons w...

  11. The use of tribromoisocyanuric acid to distinguish among primary, secondary and tertiary alcohols

    Energy Technology Data Exchange (ETDEWEB)

    Crespo, Livia T.C., E-mail: [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Instituto de Quimica. Departamento de Quimica Organica; Instituto Federal de Educacao, Ciencia e Tecnologia do Rio de Janeiro (IF-RJ), Duque de Caxias, RJ (Brazil); Mattos, Marcio C.S. de; Esteves, Pierre M. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Instituto de Quimica. Departamento de Quimica Organica


    Primary, secondary and tertiary alcohols can be easily distinguished due to their reactivity towards tribromoisocyanuric acid (TBCA). The test is performed by adding TBCA to the alcohol in a test tube heated in a boiling water bath. Orange color develops in the tube containing the primary alcohol, light yellow is observed in the tube containing the secondary alcohol while the tertiary alcohol results in a colorless mixture. (author)

  12. Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities. (United States)

    Chiò, A; Bottacchi, E; Buffa, C; Mutani, R; Mora, G


    To evaluate the effects of tertiary centres for amyotrophic lateral sclerosis (ALS) on ALS outcome and the use of hospital facilities. The study was based on the data of an epidemiological, prospective, population-based register on ALS (Piemonte and Valle d'Aosta Register for amyotrophic lateral sclerosis, PARALS). The 221 patients recruited between 1995 and 1996 were prospectively followed up for outcome and use of hospital-based services. In all, 97 patients were followed up by tertiary ALS centres and 124 by general neurological clinics. Patients followed up by tertiary ALS centres were found to be 4 years younger and underwent percutaneous endoscopic gastronomy and non-invasive positive-pressure ventilation more often. Patients followed up by tertiary ALS centres were found to have a considerably longer median survival time (1080 v 775 days), even when stratifying by age, site of onset and respiratory function at diagnosis. In Cox multivariate analysis, attending a tertiary ALS centre was observed to be an independent positive prognostic factor. Moreover, patients attending a tertiary ALS centre were admitted to hospital less often (1.2 v 3.3) and were more frequently admitted for planned interventions. Conversely, patients followed up by general neurological clinics were more frequently admitted for acute events. Also, the hospital stay was considerably shorter for patients attending tertiary ALS centres (5.8 v 12.4 days). Improved survival was seen in patients with ALS attending tertiary ALS centres, independently from all other known prognostic factors, possibly through a better implementation of supportive treatments. Moreover, because of these centres, the hospitalisation rate was markedly reduced, thus offering a cost-effective service to patients with ALS and to the community as a whole.

  13. Tertiary thiols from allylic thiocarbamates by tandem enantioselective [3,3]-sigmatropic rearrangement and stereospecific arylation. (United States)

    Mingat, Gaëlle; MacLellan, Paul; Laars, Marju; Clayden, Jonathan


    The synthesis of tertiary thiols in enantiomerically enriched form is accomplished by lithiation of enantiomerically enriched N-aryl allylic thiocarbamates. Formation of an allyllithium derivative promotes intramolecular N to C aryl migration to the position α to sulfur, generally with good stereospecificity. The substrates may themselves be obtained by Pd-catalyzed enantioselective [3,3]-sigmatropic rearrangement of N-aryl O-allyl thiocarbamates. Solvolysis of the product thiocarbamates yields tertiary thiols, which may be converted to sulfide derivatives.

  14. A Facile One-Pot Process for the Formation of Hindered Tertiary Amines

    Directory of Open Access Journals (Sweden)

    Jian Sun


    Full Text Available A simple and convenient method was developed for the preparation of hindered tertiary amines via direct reductive amination of ketones with secondary aryl amines, using trichlorosilane as reducing agent and tetramethylethylenediamine (TMEDA as organic Lewis base activator. A broad range of ketones were reacted with N-methylaniline to afford the corresponding tertiary amine products in high yield. An open transition model was proposed for the reductive step.

  15. Learner anxiety and EFL learning: A study of tertiary students' and teachers' perceptions in Taiwan


    Chuang, Chieh-Hsiang


    This study investigated Taiwanese university students’ and teachers’ perceptions of foreign language anxiety in the English as a foreign language (EFL) classroom. The main aims were: (a) to identify the situations, sources, effects of, and coping tactics for the anxiety of Taiwanese tertiary students and (b) to examine tertiary English teachers’ perceptions of their students’ anxiety and how they deal with it. An anxiety scale, the ELCAS, was first administered to English major and non-Englis...

  16. Pediatric intussusception in a Saudi Arabian tertiary hospital | Al ...

    African Journals Online (AJOL)

    Because of this, we reviewed the cases and management of intussusception, seen at Aseer Central Hospital over a 7-year period. Materials and methods: Thirty four pediatric patients admitted at Aseer Central Hospital over a 7-year period (from 1993 to 2000) at Aseer Central Hospital, Southwestern region of Saudi Arabia ...

  17. Applied periodization: a methodological approach


    Naclerio, Fernando; Moody, Jeremy; Chapman, Mark


    Periodization represents an optimal modality for organizing training programs in athletes, recreational and rehabilitative practitioners. The selected procedure, however, should be based on the athlete’s age, level of performance, specific goals or competition characteristics. A common theme throughout all periodization paradigms is the requirement to manipulate the entire program variables (intensity, volume, frequency, recovery periods and exercise selection) in order to progress from gener...

  18. Assessing periodicity of periodic leg movements during sleep. (United States)

    Rummel, Christian; Gast, Heidemarie; Schindler, Kaspar; Müller, Markus; Amor, Frédérique; Hess, Christian W; Mathis, Johannes


    Periodic leg movements (PLM) during sleep consist of involuntary periodic movements of the lower extremities. The debated functional relevance of PLM during sleep is based on correlation of clinical parameters with the PLM index (PLMI). However, periodicity in movements may not be reflected best by the PLMI. Here, an approach novel to the field of sleep research is used to reveal intrinsic periodicity in inter movement intervals (IMI) in patients with PLM. Three patient groups of 10 patients showing PLM with OSA (group 1), PLM without OSA or RLS (group 2) and PLM with RLS (group 3) are considered. Applying the "unfolding" procedure, a method developed in statistical physics, enhances or even reveals intrinsic periodicity of PLM. The degree of periodicity of PLM is assessed by fitting one-parameter distributions to the unfolded IMI distributions. Finally, it is investigated whether the shape of the IMI distributions allows to separate patients into different groups. Despite applying the unfolding procedure, periodicity is neither homogeneous within nor considerably different between the three clinically defined groups. Data-driven clustering reveals more homogeneous and better separated clusters. However, they consist of patients with heterogeneous demographic data and comorbidities, including RLS and OSA. The unfolding procedure may be necessary to enhance or reveal periodicity. Thus this method is proposed as a pre-processing step before analyzing PLM statistically. Data-driven clustering yields much more reasonable results when applied to the unfolded IMI distributions than to the original data. Despite this effort no correlation between the degree of periodicity and demographic data or comorbidities is found. However, there are indications that the nature of the periodicity might be determined by long-range interactions between LM of patients with PLM and OSA.

  19. Assessing periodicity of periodic leg movements during sleep

    Directory of Open Access Journals (Sweden)

    Christian eRummel


    Full Text Available Background: Periodic leg movements during sleep (PLMS consist of involuntary periodic movements of the lower extremities. The debated functional relevance of PLMS is based on correlation of clinical parameters with the PLMS index (PLMI. However, periodicity in movements may not be reflected best by the PLMI. Here, an approach novel to the field of sleep research is used to reveal intrinsic periodicity in inter movement intervals (IMI in patients with PLMS. Methods: Three patient groups of 10 patients showing PLMS with OSA (group 1, PLMS without OSA or RLS (group 2 and PLMS with RLS (group 3 were considered. Applying the ``unfolding'' procedure, a method developed in statistical physics, enhanced or even revealed intrinsic periodicity of PLMS. The degree of periodicity of PLMS was assessed by fitting one-parameter distributions to the unfolded IMI distributions. Finally, it was investigated whether the shape of the IMI distributions allows to separate patients into different groups. Results: Despite applying the unfolding procedure, periodicity was neither homogeneous within nor considerably different between the three clinically defined groups. Data-driven clustering revealed more homogeneous and better separated clusters. However, they consisted of patients with heterogeneous demographic data and comorbidities, including RLS {em and} OSA. Conclusions: The unfolding procedure may be necessary to enhance or reveal periodicity. Thus this method is proposed as a pre-processing step before analyzing PLMS statistically. Data-driven clustering yields much more reasonable results when applied to the unfolded IMI distributions than to the original data. Despite this effort no correlation between the {em degree} of periodicity and demographic data or comorbidities was found. However, there were indications that the {em nature} of the periodicity might be determined by long-range interactions between LM of patients with PLMS and OSA.

  20. West Hackberry tertiary project. Annual report, September 3, 1994--September 2, 1995

    Energy Technology Data Exchange (ETDEWEB)

    Gillham, T.; Cerveny, B.; Turek, E.


    The West Hackberry Tertiary Project is a field test of the idea that air injection can be combined with the Double Displacement Process to produce a low cost tertiary recovery process which is economic at current oil prices. The Double Displacement Process is the gas displacement of a water invaded oil column for the purpose of recovering tertiary oil by gravity drainage. The Double Displacement Process is based upon the concept that in fields such as West Hackberry waterdrive recoveries are typically 50%-60% of the original oil in place while gravity drainage recoveries average 80%-90% of the original oil in place. Therefore, by injecting a gas into a watered out reservoir, a gas cap will form and additional oil can be recovered due to gravity drainage. Although the Double Displacement Process has been shown to be successful in recovering tertiary oil in other fields, this project will be the first to utilize air injection in the Double Displacement Process. The use of air injection in this process combines the benefits of air`s low cost and universal accessibility with the potential for accelerated oil recovery due to the combustion process. If successful, this project will demonstrate that the use of air injection in the Double Displacement Process will result in an economically viable tertiary process in reservoirs where tertiary oil recovery is presently uneconomical.

  1. Quasi-periodicity in relative quasi-periodic tori (United States)

    Fassò, Francesco; García-Naranjo, Luis C.; Giacobbe, Andrea


    At variance from the cases of relative equilibria and relative periodic orbits of dynamical systems with symmetry, the dynamics in relative quasi-periodic tori (namely, subsets of the phase space that project to an invariant torus of the reduced system on which the flow is quasi-periodic) is not yet completely understood. Even in the simplest situation of a free action of a compact and abelian connected group, the dynamics in a relative quasi-periodic torus is not necessarily quasi-periodic. It is known that quasi-periodicity of the unreduced dynamics is related to the reducibility of the reconstruction equation, and sufficient conditions for it are virtually known only in a perturbation context. We provide a different, though equivalent, approach to this subject, based on the hypothesis of the existence of commuting, group-invariant lifts of a set of generators of the reduced torus. Under this hypothesis, which is shown to be equivalent to the reducibility of the reconstruction equation, we give a complete description of the structure of the relative quasi-periodic torus, which is a principal torus bundle whose fibers are tori of a dimension which exceeds that of the reduced torus by at most the rank of the group. The construction can always be done in such a way that these tori have minimal dimension and carry ergodic flow.

  2. Remote Sensing Tertiary Education Meets High Intensity Interval Training (United States)

    Joyce, K. E.; White, B.


    Enduring a traditional lecture is the tertiary education equivalent of a long, slow, jog. There are certainly some educational benefits if the student is able to maintain concentration, but they are just as likely to get caught napping and fall off the back end of the treadmill. Alternatively, a pre-choreographed interactive workshop style class requires students to continually engage with the materials. Appropriately timed breaks or intervals allow students to recover briefly before being increasingly challenged throughout the class. Using an introductory remote sensing class at Charles Darwin University, this case study presents a transition from the traditional stand and deliver style lecture to an active student-led learning experience. The class is taught at undergraduate and postgraduate levels, with both on-campus as well as online distance learning students. Based on the concept that active engagement in learning materials promotes 'stickiness' of subject matter, the remote sensing class was re-designed to encourage an active style of learning. Critically, class content was reviewed to identify the key learning outcomes for the students. This resulted in a necessary sacrifice of topic range for depth of understanding. Graduates of the class reported high levels of enthusiasm for the materials, and the style in which the class was taught. This paper details a number of techniques that were used to engage students in active and problem based learning throughout the semester. It suggests a number of freely available tools that academics in remote sensing and related fields can readily incorporate into their teaching portfolios. Moreover, it shows how simple it can be to provide a far more enjoyable and effective learning experience for students than the one dimensional lecture.

  3. Biometric Secured Result Processing Software For Nigerian Tertiary Institutions

    Directory of Open Access Journals (Sweden)

    Oladipo Oluwasegun


    Full Text Available Abstract One of the challenges facing result processing in Nigerian tertiary institutions is the problem of insecurity. Untraceable changes are made to students result and this result to various disasters such as innocent people losing their jobs since their innocence cannot be proven. Biometric based systems operate on behavioral and physiological biometric data to identify a person and grant required access to a user. Physiological characteristics such as fingerprint remains unchanged throughout an individuals life time and thus it can serve as a viable means of identifying and authenticating users who are to access a system. In this study fingerprint biometric based result processing software is developed to ensure that users are well authenticated and are made to see only what they are pre-configured to see and work with. The fingerprint authentication system was developed using visual Staff fingerprints were enrolled into the system to form a biometric template which the system validates against at every login attempt on the result processing software. The digital personal one touch ID sdk and other libraries were used in developing the authentication system. The result processing software also ensures that all write transactions to the database are confirmed and identified by forcing another biometric authentication at the point of making a write request to the web server and associated database. This ensures that the exact person initiating the transaction was the same user who logged in to the application. The users identified at login and various confirmation milestones set for write transactions are logged into a table for future reference and audit trail. Conclusively the developed system has helped to eradicate the problem of user impersonation by ensuring only authorized users are made to access the software and in-turn participate in result processing activities.

  4. Indications for and outcomes of tertiary referrals in refractive surgery. (United States)

    Patryn, Eliza K; Vrijman, Violette; Nieuwendaal, Carla P; van der Meulen, Ivanka J E; Mourits, Maarten P; Lapid-Gortzak, Ruth


    To review the spectrum of disease, symptomatology, and management offered to patients referred for a second opinion after refractive surgery. A prospective cohort study was done on all patients referred from October 1, 2006, to September 30, 2011, to a tertiary eye clinic after refractive surgery of any kind (ie, corneal laser surgery, conductive keratoplasty, radial keratotomy, phakic implants, refractive lens exchanges, or any combination thereof). Data analysis was performed on all demographic and clinical aspects of this cohort, including the initial complaint, type of referral, number of complaints, procedure previously performed, diagnosis at our center, type of advice given, and rate and type of surgical intervention. One hundred thirty-one eyes (69 patients) were included. Corneal refractive surgery was performed in 82% (108 eyes), and 11% (14 eyes) were seen after phakic intraocular lens (PIOL) implantation and 7% (9 eyes) after refractive lens exchange. The most common diagnoses were tear film dysfunction (30 eyes, 23%), residual refractive error (25 eyes, 19%), and cataract (20 eyes, 15%). Most patients (42 patients, 61%) were treated conservatively. In 27 patients (39%), 36 eyes (28%) were managed surgically. Severe visual loss was seen in 1 eye. No major problems were found in most second opinions after refractive surgery referral. Dry eyes, small residual refractive error, or higher-order aberrations were the most common complaints. Surgical intervention was needed in 36 eyes (28%), almost half of which were cataract extractions. Severe visual loss was seen in 1 eye with a PIOL. There was no incidence of severe visual loss in keratorefractive and refractive lens exchange procedures. Copyright 2014, SLACK Incorporated.

  5. Mainstreaming of Climate Change into the Ghanaian Tertiary Educational System (United States)

    Nyarko, B. K.


    The impact of Climate Change has a far-reaching implication for economies and people living in the fragile Regions of Africa analysts project that by 2020, between 75 million and 250 million people will be exposed various forms of Climate Change Stresses. Education as a key strategy identified under Agenda 21 has been incorporated into the efforts of various educational institutions as a means of mitigating climate change and enhancing sustainability. Climate Change education offers many opportunities and benefits for educators, researchers, learners, and for wider society, but there are also many challenges, which can hinder the successful mainstreaming of climate change education. The study aims at understanding barriers for Climate Change Education in selected tertiary institutions in Ghana. The study was conducted among Geoscience Departments of the 7 main public universities of Ghana. The transcript analysis identified issues that hinders the mainstreaming of Climate Change, these includes existing levels of knowledge and understanding of the concept of climate change, appreciating the threshold concepts, ineffective teaching of Climate Change and some Departments are slow in embracing Climate Change as a discipline. Hence to develop strategies to mainstream climate change education it is important to recognise that increasing the efficiency and delivery of Climate Change education requires greater attention and coordination of activities and updating the educators knowledge and skill's. Various Ministries should be challenged to develop and integrate climate change into education policies. In the design of curriculum, there is a need to integrate Climate Change Education into curricula without compromising already overstretched programmes of study. There is a need to encourage and enhance innovative teaching approaches such as Problem-based learning (PBL) is an approach that challenges students to learn through engagement in a real problem. Institutions and

  6. Mothers’ experiences of labour in a tertiary care hospital

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    M S Maputle


    Full Text Available The purpose of the study was to explore and describe experiences of mothers during childbirth in a tertiary hospital in the Limpopo Province. This was achieved through a qualitative research study which was exploratory, descriptive, contextual and inductive in nature. A sample of 24 mothers participated in this study. Data obtained from unstructured in-depth interviews were analysed according to the protocol by Tesch (1990, cited in Cresswell, 1994:155. Five themes were identified, namely mutual participation and responsibility sharing, dependency and decision-making; information sharing and empowering autonomy and informed choices; open communication and listening; accommodative/non-accommodative midwifery actions; and maximising human and material infrastructure. The themes indicated experiences that foster or promote dependency on midwifery care. Guidelines on how to transform this dependency into a mother-centered care approach during childbirth are provided. Opsomming Die doel van die studie was om moeders se belewenis van kindergeboorte in ’n tersiêre hospitaal in die Limpopo Provinsie te verken en te beskryf. Dit is gedoen deur middel van kwalitatiewe navorsing wat verkennend, beskrywend, en kontekstueel was. ‘n Steekproef van 24 moeders het aan die studie deelgeneem. Inligting is verkry deur middel van ongestruktureerde in-diepte onderhoude. Hierdie inligting is geanaliseer aan die hand van Tesch (1990: aangehaal in Creswell, 1994:155 se protokol. Die volgende kategorieë is geïdentifiseer, wedersydse deelname en gedeelde verantwoordelik- hede, afhanklikheid en besluitneming, deel van inligting, bemagtiging tot outonomie en ingeligte keuse, oop kommunikasie en luister, akkommoderende/nie-akkommoderende vroedvrou-aksies en bevordering van menslike en materiële infrastrukture. Die resultate van die onderhoude het belewenisse blootgelê wat dui op die bevordering van afhanklikheid in vroedvrouversorging. Riglyne om hierdie

  7. [Eosinophilic esophagitis--the experience in a tertiary pediatric center]. (United States)

    Guz-Mark, Anat; Zevit, Noam; Rosenbach, Yoram; Morgenstern, Sara; Reznik, Dana; Davidson, Keren; Shamir, Raanan; Livni, Gilat


    Eosinophilic esophagitis (EoE) is an inflammatory disorder with increasing prevalence. It typically presents with swallowing difficulties, heartburn or dyspepsia, and in toddlers, failure to thrive. EoE is characterized by eosinophilic infiltrates of the esophageal mucosa, and endoscopies with tissue diagnosis are mandatory. Hypersensitivity has been implicated in the pathogenesis, therefore, most treatment options include steroids and allergen avoidance. To summarize a tertiary pediatric clinic's experience with EoE in children and adolescents, describe the spectrum of clinical presentations and treatment options, and raise awareness of this disorder among medical personnel. A retrospective, descriptive study of patients diagnosed with EoE at our institute over the past 5 years. Demographic details, presenting symptoms, laboratory studies, endoscopic and pathologic findings were analyzed. Information regarding medical and nutritional therapies and response to treatment were summarized. Fifteen cases of EoE in children and adolescents are described. Average age at diagnosis was 9 years (range 0.7-161. The most common complaint was dysphagia (60%e. The majority demonstrated food allergies 19/121. Most of the patients were treated with topical ingested steroids, while others had either elemental formula or allergen elimination. Favorable responses were seen in most patients treated with steroids (8/11). Long-term results of nutritional therapy are insufficient to draw conclusions on its efficacy. EoE causes major eating difficulties and affects quality of life in children, sometimes accompanied by failure to thrive. There is a clear association with food allergies, and positive responses to steroids are common. A high index of suspicion and referral to a gastroenterologist for definite diagnosis are required. Combining medical with nutritional treatment seems promising but further studies regarding the long-term outcome are needed.

  8. Multiphoton ionization-fragmentation patterns of tertiary amines (United States)

    Parker, D. H.; Bernstein, R. B.; Lichtin, D. A.


    Multiphoton ionization (MPI)-fragmentation patterns are reported for a series of normal and caged tertiary amines. Ionization is enhanced by two-photon resonance with the 3s and 3p Rydberg states of trimethylamine, triethylamine, and the caged amines quinuclidine and triethylenediamine. Over the wavelength region λ = 400-530 nm, N(CH3)3 ionizes to the parent ion (P) and fragments only by the loss of a H atom to yield the P-H daughter ion; N(C2H5)3 ionizes to its parent ion and fragments by the loss of a methyl to form the P-CH3 ion. The branching ratio of daughter to parent ions is found to be essentially independent of laser intensity but strongly dependent on laser wavelength. The caged amines quinuclidine [N(C2H4)3CH, or ABCO] and triethylenediamine [N(C2H4)3N, or DABCO] fragment extensively over this λ range in a manner dependent on both laser wavelength and intensity. The extent of daughter ion formation in N(CH3)3 and N(C2H5)3 can be understood by consideration of the wavelength regions in which the total available energy from the initial three- or four-photon ionization event exceeds the appearance potential of the given daughter ion. For the caged amines direct observation of this mechanism is masked by fragmentation due to sequential absorption of photons (during the ˜5 ns pulse duration) by the parent and/or daughter ions. The present results show that even for molecules with broad, unstructured UV absorption and MPI spectra such as N(CH3)3 and N(C2H5)3, considerable information on photon-molecule and photon-ion interactions can still be gained by the MPI mass spectrometry technique.

  9. Spectrum of vaginal discharge in a tertiary care setting (United States)

    Sivaranjini, R; Jaisankar, TJ; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, SC; Habeebullah, S


    Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. PMID:24470998

  10. Primary salivary gland tumors in eastern Nepal tertiary care hospital. (United States)

    Nepal, A; Chettri, S T; Joshi, R R; Bhattarai, M; Ghimire, A; Karki, S


    The knowledge of the distribution and pattern of salivary gland tumors in the tertiary care center can provide overview of the disease pattern in the region. It also helps in planning the strategies to treat the disease and launch the awareness program in the community to this largely curable disease. A retrospective observational study of all the salivary gland tumors treated in the department of Otolaryngology, B. P. Koirala Institute of Health Sciences during April 2004 to March 2009 was done. Age, sex, presenting features, radiological findings, histopathological type of the tumor and type of surgery were recorded and descriptive analysis was done to calculate frequencies, percentage and their relations. Out of total 51 cases, 81% (n=41) were benign and 19% (n=10) malignant tumors. Male to female ratio was 1:2.1. Mean age for benign and malignant tumors were 32.3 and 46.5 years respectively. Parotid tumor outnumbered all other sites comprising 69%, followed by submandiibular 18% and minor glands 13%. Pleomorphic adenoma was the commonest tumor (76%) of all primary salivary gland tumors. Benign to malignant tumor ratio of parotid, submandibular and minor glands were 6:1, 3.5:1 and 1.3:1 respectively. Adenoid cystic carcinoma (40%) and mucoepidermoid carcinoma (30%) were commonest malignant tumors. The principal site for salivary gland tumors in eastern Nepal population was the parotid and the pleomorphic adenoma outnumbered all other tumors. Most of the cases in both benign and malignant group presented with painless lump often misleading the gravity of disease.

  11. Malaysian Instructors’ Assessment Beliefs in Tertiary ESL Classrooms

    Directory of Open Access Journals (Sweden)

    Niveen R. M. Elshawa


    Full Text Available Language assessment can be a valuable tool for providing information regarding language teaching. Given the importance of assessment that has undergone much change, there are important issues that warrant investigation, particularly those related to language instructors. Understanding the assessment beliefs of ESL instructors, especially at the tertiary level, is important since it can help improve the quality of assessment practices as well. Therefore, this study investigated English language instructors’ assessment beliefs in the Malaysian context. This study adopted a cross-sectional research design. The survey method was utilized to collect data from six Malaysian universities using a purposive sampling strategy. English language instructors (n=83 were selected via purposive sampling for the study. Findings of the study revealed that English language instructors believed that the purpose of assessment was to improve teaching and learning. Regarding the assessment beliefs that are related to the assessment purposes, analyses of data showed that the items that received the highest percentage of agreement were diagnosing strength and weaknesses in students, providing information about students’ progress and providing feedback to students as they learn, respectively. Although they reported using both formal and informal assessment of their students’ work, English language instructors relied heavily on paper and pencil assessment while giving more weightage on formative assessment. The majority of English language instructors reported employing marking schemes for the courses they taught, carrying out sample marking and providing feedback. Finally, English language instructors reported using different types of assessments for every language skill taught in their language unit/center. The findings highlight the fact that English instructors should be more empowered in their role as the assessors of students. Their knowledge about what, how

  12. Fetal dextrocardia: diagnosis and outcome in two tertiary centres (United States)

    Bernasconi, A; Azancot, A; Simpson, J M; Jones, A; Sharland, G K


    Objective: To evaluate the incidence of fetal dextrocardia, associated cardiac and extracardiac malformations, and outcome. Design: Retrospective echocardiographic study. Setting: Two tertiary centres for fetal cardiology. Patients: 81 consecutive fetuses with a fetal dextrocardia presenting at Guy’s Hospital, London, between 1983 and 2003 and at Hôpital Robert Debré, Paris, between 1988 and 2003. Fetal dextrocardia was defined as a condition in which the major axis of the heart points to the right. Results: The incidence was 0.22%. There were 38 fetuses (47%) with situs solitus (SS), 24 (30%) with situs ambiguus (SA), and 19 (23%) with situs inversus (SI). Structural cardiac malformations were found in 25 cases (66%) of SS, 23 cases (96%) of SA, and 12 cases (63%) of SI. Extracardiac malformations were identified in 12 cases (31%) of SS, in five cases (21%) of SA, and in two cases (10%) of SI. Of the 81 cases of fetal dextrocardia, there were 27 interrupted pregnancies (15 of 24 SA, 10 of 38 SS, and 2 of 19 SI), six intrauterine deaths (3 of 38 SS, 2 of 24 SA, and 1 of 19 SI), and five neonatal deaths (3 of 24 SA, 1 of 19 SI, and 1 of 38 SS). There were 43 survivors (24 of 38 SS, 15 of 19 SI, and 4 of 24 SA). Conclusion: The majority of fetuses with dextrocardia referred for fetal echocardiography have associated congenital heart disease. There is a broad spectrum of cardiac malformation and the incidence varies according to the atrial situs. Fetal echocardiography enables detection of complex congenital heart disease so that parents can be appropriately counselled. PMID:16287744

  13. Detecting periodicities with Gaussian processes

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    Nicolas Durrande


    Full Text Available We consider the problem of detecting and quantifying the periodic component of a function given noise-corrupted observations of a limited number of input/output tuples. Our approach is based on Gaussian process regression, which provides a flexible non-parametric framework for modelling periodic data. We introduce a novel decomposition of the covariance function as the sum of periodic and aperiodic kernels. This decomposition allows for the creation of sub-models which capture the periodic nature of the signal and its complement. To quantify the periodicity of the signal, we derive a periodicity ratio which reflects the uncertainty in the fitted sub-models. Although the method can be applied to many kernels, we give a special emphasis to the Matérn family, from the expression of the reproducing kernel Hilbert space inner product to the implementation of the associated periodic kernels in a Gaussian process toolkit. The proposed method is illustrated by considering the detection of periodically expressed genes in the arabidopsis genome.

  14. Quasi Periodic Oscillations in Blazars

    Indian Academy of Sciences (India)


    Jan 27, 2016 ... Home; Journals; Journal of Astrophysics and Astronomy; Volume 35; Issue 3. Quasi Periodic Oscillations in Blazars ... Here we report our recent discoveries of Quasi-Periodic Oscillations (QPOs) in blazars time series data in X-ray and optical electromagnetic bands. Any such detection can give important ...

  15. Surveillance of congenital rubella syndrome (CRS) in tertiary care hospitals in Hanoi, Vietnam during a rubella epidemic. (United States)

    Van Bang, Nguyen; Van Anh, Nguyen Thi; Van, Vu Thi Tuong; Thai, Trieu Thi Hong; Van Thuong, Nguyen; Khandaker, Gulam; Elliott, Elizabeth


    To describe the epidemiology and clinical features of congenital rubella syndrome (CRS) in Hanoi, Vietnam. Prospective surveillance of CRS between May 2011 and March 2012 in Hanoi, Vietnam. CRS burden was assessed by clinical examination and collection of serum samples from infants in neonatology, cardiology and pediatric departments of two tertiary care hospitals in Hanoi. All infants born during the study period with clinical manifestations of CRS and seropositivity (IgM) for rubella were included in this study. During the surveillance period 113 infants were identified with confirmed CRS (clinical features and positive rubella IgM). Their mean age at diagnosis was 38.4 days (range 1-152 days) and 61% were female. Clinical manifestations of CRS included low birth weightrubella vaccine in the past and 88.4% gave a history of rubella contact during the pregnancy under study. In most cases (84.1%) maternal infection occurred in the first trimester. During the surveillance period the estimated annual incidence of CRS was 1.13/1000 live births (95% CI 0.92-1.34). These preliminary baseline data show a high burden of CRS in Hanoi, Vietnam and the urgent need for universal vaccination. Surveillance to determine and monitor the national burden of CRS is essential. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Long-period clocks from short-period oscillators (United States)

    Labavić, Darka; Meyer-Ortmanns, Hildegard


    We analyze repulsively coupled Kuramoto oscillators, which are exposed to a distribution of natural frequencies. This source of disorder leads to closed orbits of repetitive temporary patterns of phase-locked motion, providing clocks on macroscopic time scales. The periods can be orders of magnitude longer than the periods of individual oscillators. By construction, the attractor space is quite rich. This may cause long transients until the deterministic trajectories find their stationary orbits. The smaller the width of the distribution about the common natural frequency, the longer are the emerging time scales on average. Among the long-period orbits, we find self-similar sequences of temporary phase-locked motion on different time scales. The ratio of time scales is determined by the ratio of widths of the distributions. The results illustrate a mechanism for how simple systems can provide rather flexible dynamics, with a variety of periods even without external entrainment.

  17. Optical Periodicity Analysis of 3C 446 using Period04

    Indian Academy of Sciences (India)


    Jan 27, 2016 ... All the data of the blazar 3C446 at 8, 4.8, 14 and 22 GHz, presented in publications from 1977 to 2006, have been compiled to generate light curves. The light curves show violent activity of 3C446. Using Period04 analysis method, we have found that there is a period of 7.2 yr, which is consistent with the ...

  18. Transesophageal echocardiography in anesthesiology: characterization of use profile in a tertiary hospital. (United States)

    da Silva, Alexander Alves; Segurado, Arthur; Kimachi, Pedro Paulo; Silva, Enis Donizete; Goehler, Fernando; Gregory, Fabio; Simões, Claudia


    Since its introduction in the 80s, transesophageal echocardiography (TEE) not only gained popularity but also experienced great advances in technology and currently it is an extremely valuable tool in the intraoperative period. In Brazil, there are no published data on the profile of its use in the intraoperative period by anesthesiologists. The objective of this study was to describe the use of intraoperative TEE in an Anesthesiology Service in a tertiary private hospital. Retrospective study from completed medical charts in all cases where the patient was monitored with TEE. Monitoring was applied in patients classified as I-II according to the American Society of Echocardiography and presenting no contraindication to the examination. At the end of procedure, after examination, a note on the chart classified monitoring according to its usefulness in the intraoperative period into three groups: group 1, no interference of TEE in anesthetic or surgical approach; group 2, TEE prompted change in anesthetic approach regarding the administration of volume, introduction and/or modification of vasoactive drugs (here, TEE generated change of anesthetic approach in conjunction with other monitors, but it was the deciding factor); group 3, TEE led to a change in approach or review of surgical procedure performed. From January 2009 to January 2011, 164 intraoperative TEE were performed in our service, with 41 pediatric and 123 adult patients. In all patients, the test was successful and there were no problems regarding the introduction of transesophageal tube. In pediatric sample, group I had 10 patients (24.4%), group II had 27 patients (65.8%), and group III had 4 patients (9.8%). Among adults, group I had 38 patients (30.9%), group II had 81 patients (65.9%), and group III had 4 patients (3.2%). Despite this small sample size compared to the literature, and the limitations of this study, there was agreement with other reports related to changes in anesthetic

  19. The incubation period of kuru. (United States)

    Huillard d'Aignaux, Jérôme N; Cousens, Simon N; Maccario, Jean; Costagliola, Dominique; Alpers, Michael P; Smith, Peter G; Alpérovitch, Annick


    Kuru is a transmissible spongiform encephalopathy that was identified in Papua New Guinea in the late 1950s. Several thousand cases of the disease occurred during a period of several decades. Epidemiologic investigations implicated ritual endocannibalistic funeral feasts as the likely route through which the infectious agent was spread. We estimated the incubation period distribution of kuru using a back-calculation model and explored the relation among sex, age at infection, and incubation period. Key assumptions in the model were that the number of new kuru infections in a year was proportional to the number of kuru cases dying that year, and that the epidemic arose from a single case of sporadic Creutzfeldt-Jakob Disease occurring around 1900. The mean incubation period of kuru was estimated at between 10.3 and 13.2 years. Point estimates of the 90th percentile ranged from 21.1 to 27.0 years. The incubation period in females was estimated to be shorter than that in males. The shortest incubation periods were estimated in adult women, who may have been exposed to the largest doses of infectious material. Our findings suggest that the relatively young age of cases of variant Creutzfeldt-Jakob disease probably reflects increased levels of exposure in young people, rather than age-dependency in the incubation period.

  20. Facilities management: Structuring a body of knowledge for continuing and tertiary education in South Africa

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    A. C. Hauptfleisch


    , resulting in quantified guidance regarding the perceived knowledge framework that could partially address the stated problems. The knowledge that was gained by presenting a five-day continuing education programme over a period of years and the acceptance and support it enjoyed provided guidance for the introduction of a three-year academic programme in facilities management. Further confirmation of the proposed route to follow was obtained through the literature survey, quantitative data obtained from practitioners and academics, as well as from the quantified questionnaire data. The foregoing provided a beneficial basis to support the relative “new” but most important discipline of facilities management. The results of this research found application in the enhancement of an existing continuing education programme and the introduction of a three-year tertiary education programme at the University of the Free State.

  1. Yield and complications of kidney biopsy over two decades in a tertiary pediatric center. (United States)

    Hod Feins, Roei; Tobar, Anna; Davidovits, Miriam


    Kidney biopsy serves as an adjunct for the diagnosis of renal disease, but it is not always productive. This study evaluated the yield and risks of kidney biopsies performed in 1995-2014 at a tertiary pediatric medical center. The medical files of all patients who underwent closed percutaneous biopsy for various indications in native or transplanted kidneys were retrospectively reviewed for patient characteristics, technical and histopathologic findings, biopsy yield, and biopsy complications. Biopsy yield was considered positive if findings confirmed a probable diagnosis or led to a change in clinical diagnosis, disease severity/activity grade, treatment strategy, or prognosis; and negative, if findings were non-informative and in cases of technical failure. During the study period, 216 biopsies were performed on native kidneys and 84 on transplanted kidneys. In the transplanted kidney group, the most common indications for biopsy were decreased glomerular filtration rate and suspected rejection. Rates of positive biopsy yield were 86.6% in the native kidney group and 82.1% in the transplanted kidney group; the difference was not statistically significant. Significant between-group differences were found in various technical and histopathological parameters, patient age at biopsy, and sex distribution. In the native kidney group, positive biopsy yield was associated with the presence of nephrotic-range proteinuria. Post-procedural complications occurred in three patients (1.3%) with native kidneys, and in one patient (1.1%) with a transplanted kidney. Kidney biopsy is an efficient and safe procedure in both native and transplanted kidneys and provides helpful diagnostic information in most cases in which it is deemed necessary. © 2016 Japan Pediatric Society.

  2. HIV counseling and testing in a tertiary care hospital in Ganjam district, Odisha, India

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    M Dash


    Full Text Available Background: Human immunodeficiency virus (HIV counseling and testing (HCT conducted at integrated counseling and testing centers (ICTCs is an entry point, cost-effective intervention in preventing transmission of HIV. Objectives: To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients. Materials and Methods: It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012. Results: A total of 1732 (7.5% out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7% were males, while 594 (34.3% were females. Majority (88.3% of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1% was more seropositive compared to provider-initiated (2.9%. Among discordant couples, majority (95.5% were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001. Risk factors included heterosexual promiscuous (89.3%, parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%. Conclusions: There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.

  3. Hepatopathy of Mauriac syndrome: a retrospective review from a tertiary liver centre. (United States)

    Fitzpatrick, E; Cotoi, C; Quaglia, A; Sakellariou, S; Ford-Adams, M E; Hadzic, N


    Mauriac syndrome is characterised by growth failure, cushingoid appearance and hepatomegaly which occurs in patients with insulin dependent diabetes and was first described shortly after the introduction of insulin as a treatment for the condition. To describe the clinical features, histological findings and outcome of young people with glycogenic hepatopathy, the hepatic manifestation of Mauriac syndrome (MS). Retrospective cohort study. Young people with glycogenic hepatopathy. Tertiary paediatric hepatology unit. Thirty-one young people (16 M), median age of 15.1 years (IQR 14-16.2) presented within the study period. Median age of diagnosis of diabetes was 10 years (IQR 8-11). Median insulin requirement was 1.33 units/kg/day; median HbA1c was 96.7 mmol/mol (IQR 84.7-112.0). Growth was impaired: median height z-score was -1.01 (-1.73 to 0.4) and median body mass index (BMI) z-score was 0.28 (-0.12 to 0.67). Hepatomegaly was universal with splenomegaly in 16%. Transaminases were abnormal with a median aspartate aminotransferase (AST) of 76 IU/L and gamma glutamyltransferase of 71 IU/L. Liver biopsy was undertaken in 19 (61%). All showed enlarged hepatocytes with clear cytoplasm with glycogenated nuclei in 17. Steatosis was present in the majority. Inflammation was present in 8 (42%). Fibrosis was seen in 14 (73%) and was generally mild though 2 had bridging fibrosis. Megamitochondria were described in 7. Presence of megamitochondria correlated with AST elevation (p=0.026) and fibrosis on biopsy (p=0.007). At follow-up 17 children had normal or improved transaminases, in 13 there was no change. Transaminases followed the trend of the child's HbA1c. Despite modern insulin regimens and monitoring in children with type 1 diabetes, MS still exists. Significant steatosis, inflammation and fibrosis were all seen in liver biopsies.

  4. Prevailing attitudes towards cancer: a multicultural survey in a tertiary outpatient setting. (United States)

    Tay, Kae Jack; Mohamad Zam, Nor Azhari; Cheng, Christopher W S


    Cultural influences affect attitudes towards cancer screening, diagnosis, treatment and palliation. The objective of this study is to survey the prevailing attitudes towards cancer in a multicultural tertiary outpatient setting. This is a cross-sectional study of 300 respondents visiting the Singapore General Hospital (SGH) Urology Centre over a period of 1 month. A questionnaire was developed assessing responses to various facets of cancer management and administered in English, Chinese or Malay to every 10th person visiting the centre. Institutional review board approval was obtained. Of 300 respondents, 57% were Chinese, 17% Malay, 19% Indian, and 7% others. Mean age was 54.3 years. Most respondents were male (68%) and had up to secondary education (56%). Most Chinese were Taoist/Buddhist (42%) or Christian/ Catholic (36%) while Indians were largely Hindu (47%) or Muslim (27%). Thirty-seven percent of respondents had ever participated in cancer screening. Eighty-nine percent of respondents wanted to be the first to know if they had cancer, and 76% found it unacceptable if the diagnosis of cancer was withheld from them. These were irrespective of race, religion or other factors. Forty percent of respondents believed that being diagnosed with cancer was a matter of fate. Sixty percent of respondents would undergo treatment with 50% chance of cure, even if it involved major surgery and adjuvant therapy. Eighty-one percent believed in efficacy of at least 1 form of alternative treatment. Seventy-one percent of respondents preferred to die at home and this was most marked among Malay respondents (90.4%). This better understanding of patient attitudes will allow us to help patients balance wishes for autonomy versus family involvement in dealing with cancer. This will help us achieve a more holistic and patient-centred approach to cancer care.

  5. Evaluating quality indicators of tertiary care hospitals for trauma care in Japan. (United States)

    Nakahara, Shinji; Sakamoto, Tetsuya; Fujita, Takashi; Uchida, Yasuyuki; Katayama, Yoichi; Tanabe, Seizan; Yamamoto, Yasuhiro


    This study examined the associations between trauma mortality and quality of care indicators currently used in Japan. This is a retrospective two-level discrete-time survival analysis. Quality indicators were derived from the 2012-2013 annual hospital survey conducted by the Ministry of Health, Labour and Welfare. Trauma mortality data were derived from the Japan Trauma Data Bank for the period of April 2012 to March 2013. Tertiary care centers designated as emergency and critical care centers (ECCCs) in Japan. The analysis included 12 378 patients aged ≥15 years with blunt trauma and an Injury Severity Score ≥9, registered to the data bank from 91 ECCCs. Quality of care indicators examined in the annual hospital survey. Deaths within 30 days. Of the 12 378 patients, 660 (5%) died within 30 days. Higher indicator score was significantly associated with lower mortality risk (hazard ratio [HR] for the second, third and fourth quartiles vs. lowest quartile 0.61, 0.55 and 0.52, respectively). Factors significantly associated with lower mortality risk were, higher patient volume (HR for the highest vs. lowest quartile, 0.74), director's qualification as specialist (HR 0.57) or consultant (HR 0.58), review of patient arrival process (HR 0.68), triage functions (HR 0.69), availability of psychiatrists (HR 0.75) and operating room being ready 24-h (HR 0.81). The study identified certain indicators associated with trauma patient mortality. Further refinement of indicators is required to specifically identify what needs changing.

  6. Wheat-dependent exercise-induced anaphylaxis: a retrospective case review from a tertiary hospital. (United States)

    Thalayasingam, Meera; Allameen, Nur Azizah; Soh, Jian Yi; Bigliardi, Paul; Van Bever, Hugo; Shek, Lynette Pei-Chi


    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a specific form of wheat allergy caused by the combination of wheat ingestion and physical exercise and has been reported in other parts of Asia. At present, there are no published reports of WDEIA in Singapore. The objective of this study is to characterise the common local clinical and laboratory manifestations of WDEIA. This was a retrospective descriptive study of all WDEIA who presented to a tertiary Singaporean Hospital over a 5-year-period from 1 January 2009 to 30 June 2013. Eight patients aged 9-41 years old were characterised. Six were males and the majority (5) was of Chinese ethnicity. An atopic history was found in four patients. The symptoms of anaphylaxis included cutaneous manifestations such as urticaria (n=7), angioedema (n=6), respiratory symptoms of dyspnoea and wheezing (n=5) and hypotension (n=5). The symptoms occurred 20-75 min after consumption of wheat-based products, often upon cessation of exercise [running (n=3), walking (n=4) and swimming (n=1)]. The WDEIA was recurrent in seven patients. The skin prick tests were positive to wheat in seven patients, and ω-5 gliadin test to wheat was positive in five patients. With the emergence of wheat allergy in East Asian countries, WDEIA has become an important condition for physicians and Singapore is no exception. Under-recognition combined with life-threatening symptoms warrants better public awareness measures. In addition, further studies are necessary to identify possible unique genetic and environmental exposures that could explain the inter-regional differences of WDEIA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  7. Dysphagia in healthy children: Characteristics and management of a consecutive cohort at a tertiary centre. (United States)

    Svystun, Orysya; Johannsen, Wendy; Persad, Rabin; Turner, Justine M; Majaesic, Carina; El-Hakim, Hamdy


    Whereas the literature is replete with reports on complex children with dysphagia (DP), the parameters characterizing non-neurologically impaired (NNI) children have been underreported, leaving a substantial knowledge gap. We set to characterize a consecutive cohort of NNI children, their management, and outcomes. We undertook a retrospective case series. Children (<18 years old) attending a tertiary multidisciplinary swallowing clinic were eligible. Patients with neuro-developmental, neuromuscular, or syndromic abnormalities were excluded. Primary outcomes included demographics, co-morbidities, presentations, McGill score, swallowing and airway abnormalities (and their predictors). Secondary outcomes were interventions and management response. From 171 consecutive patients (37-month period), 128 were included (69 males, median age 6.6 months (0.5-124.2)). Significant clinical presentations included recurrent pneumonias (20), cyanotic spells (14) and life-threatening events (10). Swallowing assessments revealed laryngeal penetration (67), aspiration (25). Other investigations included overnight oximetry (77), airway (70), and gastrointestinal endoscopy (24); revealing laryngomalacia (29), laryngeal mobility disorder (8), and subglottic stenosis (8). Non-surgical interventions involved oral diet modifications (85) and enteral nutrition (15). Surgical interventions included supraglottoplasties (18), endoscopic laryngeal cleft repair (14), and injection (19). 119 patients received intervention and at last follow-up (median 5.2 months (0.3-88.8)) 94 had improved. Of those treated 116 were on an unmodified oral diet, and 24 on a modified diet. ALTE and snoring predicted airway abnormalities, recurrent pneumonia predicted swallowing abnormalities, and age and airway lesions predicted the McGill score. a significant proportion of NNI children with DP harbor airway and swallowing abnormalities warranting endoscopic and instrumental assessment. Copyright © 2017 Elsevier B

  8. DICER1 syndrome: Approach to testing and management at a large pediatric tertiary care center. (United States)

    van Engelen, Kalene; Villani, Anita; Wasserman, Jonathan D; Aronoff, Laura; Greer, Mary-Louise C; Tijerin Bueno, Marta; Gallinger, Bailey; Kim, Raymond H; Grant, Ronald; Meyn, M Stephen; Malkin, David; Druker, Harriet


    To expand the current knowledge of DICER1 syndrome and to propose criteria for genetic testing based on experience at a pediatric tertiary care center. This study involved a retrospective chart review of the 78 patients (47 probands and 31 family members) seen in the Cancer Genetics Program at The Hospital for Sick Children (SickKids) who were offered genetic testing for DICER1. Of 47 probands offered genetic testing for DICER1, 46 pursued testing: 11 (23.9%) carried a pathogenic variant and one proband (2.1%) carried a missense variant of uncertain significance with evidence for pathogenicity. Thirty-one family members of variant-positive probands were offered testing: eight of the 25 who agreed to testing carried their familial variant (32.0%). Overall, 20 patients were identified to have a variant in DICER1 (eight males, 12 females). Of these, 13 (65.0%) presented with clinical manifestations associated with the syndrome. The most common lesions were pleuropulmonary blastoma (PPB) (five of 20 patients, 25.0%) and pineoblastoma (three of 20 patients, 15.0%). The average age at which individuals were diagnosed with a primary neoplasm was 5.2 years (range 0.8-20 years, median 3.0). Surveillance at our institution, with a median follow-up time of 23 months, has identified PPB in two asymptomatic individuals. These lesions were identified at early stages, thus potentially reducing treatment-related morbidity and mortality. This study further delineates the DICER1 syndrome phenotype and demonstrates the feasibility of a DICER1 syndrome surveillance protocol for the early detection of tumors. © 2017 Wiley Periodicals, Inc.

  9. Adverse drug reactions monitoring of psychotropic drugs: a tertiary care centre study

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    Hemendra Singh


    Full Text Available Background: Many new psychotropic drugs/ agents have been developed and found to be effective in the treatment of psychiatric disorders. However, these drugs also exhibit adverse drug reactions (ADRs which may affect compliance in psychiatric patients. Hence the present study was aimed at monitoring and assessing ADRs caused by psychotropic drugs. Methods: A hospital based prospective observational study was carried out in the psychiatry outpatient department of a tertiary care teaching hospital for the duration of six months. Two hundred and two patients were included in the study and ADRs were documented using a predesigned data collection form. The causality assessment was carried out as per the criteria of both the World Health Organization- Uppsala Monitoring Centre (WHO-UMC and Naranjo scale. Severity and predictability assessment of ADRs were also performed. Results: A total of 106 ADRs were observed during the study period with majority of them occurring in 25-35 years of age group (40.56%. Weight gain (18.86% followed by sedation (16.03% and insomnia (11.32% were found to be the commonest ADRs. Risperidone (19.8% and escitalopram (12.3% were the drugs responsible for majority of the ADRs. Causality assessment showed that most of ADRs were possible and probable. 94.33% of ADRs were found to be mild and 89% of them were predictable. Conclusion: A wide range of ADRs affecting central nervous and metabolic systems were reported with psychotropic drugs. The study findings necessitate the need for an active pharmacovigilance programme for the safe and effective use of psychotropics.

  10. Late Tertiary and Quaternary geology of the Tecopa basin, southeastern California

    Energy Technology Data Exchange (ETDEWEB)

    Hillhouse, J.W.


    Stratigraphic units in the Tecopa basin, located in southeastern California, provide a framework for interpreting Quaternary climatic change and tectonism along the present Amargosa River. During the late Pliocene and early Pleistocene, a climate that was appreciably wetter than today`s sustained a moderately deep lake in the Tecopa basin. Deposits associated with Lake Tecopa consists of lacustrine mudstone, conglomerate, volcanic ash, and shoreline accumulations of tufa. Age control within the lake deposits is provided by air-fall tephra that are correlated with two ash falls from the Yellowstone caldera and one from the Long Valley caldera. Lake Tecopa occupied a closed basin during the latter part, if not all, of its 2.5-million-year history. Sometime after 0.5 m.y. ago, the lake developed an outlet across Tertiary fanglomerates of the China Ranch Beds leading to the development of a deep canyon at the south end of the basin and establishing a hydrologic link between the northern Amargosa basins and Death Valley. After a period of rapid erosion, the remaining lake beds were covered by alluvial fans that coalesced to form a pediment in the central part of the basin. Holocene deposits consist of unconsolidated sand and gravel in the Amargosa River bed and its deeply incised tributaries, a small playa near Tecopa, alluvial fans without pavements, and small sand dunes. The pavement-capped fan remnants and the Holocene deposits are not faulted or tilted significantly, although basins to the west, such as Death Valley, were tectonically active during the Quaternary. Subsidence of the western basins strongly influenced late Quaternary rates of deposition and erosion in the Tecopa basin.

  11. Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital. (United States)

    Sin, Eliza I-Lin; Thong, Sze Ying; Poon, Keah-How


    Phantom limb sensations (PLS), phantom limb pain (PLP) and stump pain (SP) are well-recognised postamputation phenomena. However, there is a dearth of related epidemiological data in Asian populations. This study was conducted to fill the information gap. Telephone interviews were conducted with patients who underwent lower limb amputations at a tertiary hospital in Singapore. Information was obtained on phantom limb characteristics, perioperative pain and functional assessment. A total of 159 patients underwent amputations over a 31-month period. At the time of the interview, 47 patients had died and 66 were contactable, of whom 49 patients were interviewed. Of these, 31 (63%) patients experienced PLS. 22 patients had postoperative pain, with 9 having both PLP and SP, 3 having PLP alone and 10 having SP alone. Among the 12 patients with PLP, at least 6 (50%) experienced constant or daily pain and 7 (58%) scored their pain as moderate-to-severe. Among those with PLP and/or SP (n = 22), 5 were distressed by the pain, 11 were on analgesics and 3 received medical follow-up. 7 (32%) patients reported functional limitations secondary to PLP or SP. Altogether, 28 (57%) patients were wheelchair or bed bound. The incidence of PLP was 25% in our cohort. Although this is lower than that reported in other studies, it remains significant, as some patients suffered moderate-to-severe pain. The difference in incidence may be due to differences in the ethnic composition and/or indications for amputation in our group. Follow-up and care could improve the outcomes in these patients.

  12. Scald burn, a preventable injury: Analysis of 4306 patients from a major tertiary care center. (United States)

    Sahu, Shamendra Anand; Agrawal, Karoon; Patel, Pankaj Kumar


    Scalds have distinct epidemiological and predisposing risk factors amongst all types of burns. Though scald affects all age groups, the brunt falls on the minor age groups. It may result in major physical disabilities and significant loss of school years. Apart from the economic burden on family, major scald burn may compromise overall development of the affected children. Most of the scald injuries occur in domestic settings and are preventable. Despite improvement in living conditions, the incidence of scald burn has failed to decline. Our aim was to study the detailed epidemiology and severity of scald burn amongst all age groups. A retrospective study was carried out from the records of all burn patients who attended a tertiary burn care center from January 2013 and December 2014. Data of the patients with scald injury was segregated and analyzed using Microsoft excel spreadsheet. 10,175 burn patients attended the burn casualty during the study period, of which 42.3% had sustained scald. 56.85% of patients were under 15 years of age with preschool children (36.4%) being the prime victims of scald. The % TBSA involved is also relatively larger in children. Scald follows definite seasonal variation peaking in winters. 36.8% patients arrived to the hospital without any first aid. 74.2% of patients reported to casualty with in 24hours after sustaining scald injury. The median time interval between injury and reporting to casualty was 3hours 30minutes. This study concludes that the scald is injury of all age groups, though majority of them are children. The first aid is not given to large number of patients and late reporting is quite common. These are the factors which may affect the course of scald burn. Spreading public awareness regarding safe household practises and educating them for proper first aid management after scald may have significant impact on the burden of care and outcome. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  13. Contraceptive Awareness and Practice Among Antenatal Attendees in a Tertiary Hospital in South-South Nigeria

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    Aniekan Monday Abasiattai


    Full Text Available Background: Use of effective contraceptive methods has been shown to improve health, sexual life and partner relations and also significantly reduce maternal and infant mortality by protecting against unplanned pregnancy, high fertility and high parity. The aim of this study is to determine the degree of awareness and practice of contraception by women in Uyo, Nigeria. Materials and Methods: Semi-structured questionnaires were administered to three hundred and seventy women in the antenatal clinic of the University of Uyo Teaching Hospital. Results: Majority of the respondents were 21-30 years old (64.1%, 53.8% were multiparous and 66.5% had tertiary level education. Three hundred and twenty women (87.6% had heard about contraception (OR=49.6, P< 0.001, while only 49.5% of the respondents had practiced contraception previously (OR=0.96, P=0.76 of which the male condom (40.0% and the safe period/calendar method (31.1% were the most commonly practiced methods. Majority of the respondents (66.8% preferred to have 3 to 4 children and 78.4% of the respondents would want to used a method of contraception to either space their family or limit child bearing (OR=13.14, P< 0.001. Fear of side effects (20.0% and previous bad experience (8.8% were the most common reasons given by those respondents who would not want to practice contraception. Conclusion: This study reveals a high level of awareness of contraception but a significant unmet need among the respondents. There is need to intensify public enlightenment campaigns in our environment emphasizing the benefits and safety of modern contraceptive methods. Community leaders and heads of social groups and women organisations should be co-opted in the dissemination of accurate information on contraception. [TAF Prev Med Bull 2011; 10(1.000: 29-34


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    Purushottam Rao


    Full Text Available BACKGROUND AND OBJECTIVE: Diabetes is a chronic disease that has a prolonged prediabetic phase. Indians develop diabetes 10 years earlier tha n other ethnic groups (mean age 42.5 years . 1 Diet, environment, genetics play a major role in development of diabetes. Complications of diabetes are directly proportional to the duration of diabetes and dysglycemia. Prediabetes is a condition is which glucose levels are high to be considered as normal, eventhough they do not meet the criteria for diabetes. 10% - 50% of prediabetics may develop diabetes in 3 - 10 year period. Components of prediabetes include either an isolated impai red fasting glucose or impaired glucose tolerance or both. Microvascular complications can begin is the prediabetic stage itself. Present study has been done to know the prevalence of microalbuminuria and retinopathy is prediabetic stage and correlation of both in prediabetics. MATERIALS AND METHODS: This study was conducted in a tertiary care Hospital from June 2013 to May 2014. Screening was done and patients recruited into the study after fulfilling the inclusion and exclusion criteria. American Diabetes Association Criteria 2 was used for screening and results were correlated using various parameters to know the prevalence of microalbuminuria and retinopathy in prediabetes. Data was analyzed using statistical package for social sciences(spss version 20.0 . RESULTS: In this study, 500 patients were screened for diabetes. 100 patients were included in the study. Prevalence of prediabetes was seen in 20% of patients screened. 19% of prediabetics had microalbuminuria and 8% had retinopathy. Association of both conditions was seen is 7% of patients. CONCLUSION: Diabetic Microvascular complications like retinopathy and nephropathy in the form of microalbuminuria starts even in the prediabetic stage in a significant number of patients. Screening high risk individu als for diabetes and screening of prediabetics for microvascular

  15. Profile of catering staff at a tertiary care hospital in Mumbai. (United States)

    Bobhate, Prateek S; R Shrivastava, Saurabh; Gupta, Pankaj


    Food borne illnesses, even today, continue to be a major public health problem in both developing and developed nations. Food handlers play an important role in ensuring food safety throughout the chain of production, processing, storage and preparation.Health of food handlers is of great importance for maintaining hygienic quality of food prepared and served by them. Thus, the present study was conducted to study socio-demographic characteristics, morbidity pattern and immunization status of catering staff at a tertiary care hospital in Mumbai A cross sectional study was conducted from August 2010 to November 2010. Out of the total of 162 food handlers working in 11 food service establishments, 137 were interviewed face to face using a semi-structured questionnaire, while remaining 25 food handlers were excluded because of either their absence or not giving consent. The food handlers were assessed clinically for personal hygiene and investigated for hemoglobin, stool routine and sputum AFB examination. 82 (59.8%) food handlers were from the age group 10 - 29 years, 113 (82.5%) male, 95 (69%) married, 59 (43.1%) educated up to primary level. Only 7 (5.1%) had ever received a dose of typhoid vaccine. 103 (75.2%) had an addiction, majority consuming gutkha 59 (57.3%). Dental caries 32 (23.4%) was the most common morbidity identified. Entamoeba histolytica was isolated in 13 (9.5%) subjects. This study has confirmed an association between educational status and personal hygiene suggesting the need for greater personal hygiene in this group. Preemployment and periodical medical examination should be encouraged.

  16. Diagnostic reliability of Architect anti-HCV assay: Experience of a tertiary care hospital in India. (United States)

    Fletcher, Gnanadurai John; Raghavendran, Anantharam; Sivakumar, Jayashree; Samuel, Prasanna; Abraham, Priya


    Anti-HCV assays are prone to false positive results. Thus, accurate detection of HCV infection is critical for the timely therapeutic management. This study ascertained the reliability of Architect anti-HCV assay (Abbott) and to estimate the agreement of this assay with Ortho HCV 3.0 ELISA Test System with Enhanced SAVe (Ortho), HCV Tri-dot (Tri-dot) and HCV-PCR in a tertiary care setting. A total of 78 788 consecutive sera were routinely screened for anti-HCV antibodies using Architect. All repeatedly reactive anti-HCV sera (n=1000) and anti-HCV negative sera (n=300) were tested in Ortho and in Tri-dot assays. Representative proportions of sera (n=500) with various signal-to-cut-off (S/Co) ratio were also compared with HCV-PCR. When Architect was compared with Ortho, Tri-dot, and HCV-PCR, the level of agreement as assessed by kappa were .26, .16, and .27 respectively. Using Latent class analysis (LCA), we found that sensitivity and specificity were 100% and 36.1% for Architect, 93.8% and 100% for Ortho and 63.8% and 100% for Tri-dot respectively. The median S/CO ratio of Architect and Ortho anti-HCV assays were significantly different between HCV-PCR positive and negative results (PArchitect S/CO ratio of >8 showed higher accuracy indices in both anti-HCV assays. Architect can be used as a screening assay because of its high sensitivity, high throughput, and short turnaround time. However, S/Co ratios of ≥1 to Architect necessitates HCV PCR to identify current infection and or EIA to distinguish true positivity from false biological positivity. © 2017 Wiley Periodicals, Inc.

  17. Surface epithelial tumors of ovary - an analysis in a tertiary referral hospital

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    D Ghartimagar


    Full Text Available Background: Ovarian cancer accounts for 3% of all cancers in females. About 80% of these are benign, and they occur mostly in young women between 20 and 45 years. Borderline tumors occur at slightly older ages while incidence of malignant tumors increases with age, occurring predominantly in perimenopausal and postmenopausal women. About 190,000 new cases and 114,000 deaths from ovarian cancer are estimated to occur annually worldwide. The aim of the study was to fi nd the incidence of surface ovarian tumor in a tertiary referral centre. Materials and methods: This was a retrospective study carried out in the department of pathology, Manipal Teaching Hospital from January 2001 to December 2012. Specimens were received from the same and other hospitals. Records were retrieved from the departmental data bank and were analyzed. Results: : A total of 310 cases of ovarian tumors have been reported in the same period. Among them, 180 cases were of surface epithelial origin and out of which 24 cases had bilateral tumors. Benign tumors comprised of 148 cases, 6 were borderline and 44 were malignant. Among these, the commonest was serous cystadenoma (98 cases and the least common was malignant Brenner (2 cases. Combined or mixed tumor was seen in 9 cases. Conclusion: : In our study surface epithelial tumors comprised 58% of all ovarian tumors. In both benign and malignant cases, serous tumor was the commonest followed by mucinous tumors. Journal of Pathology of Nepal (2013 Vol. 3, No.1, Issue 5, 397-402 DOI:

  18. A clinical and microbiological study of puerperal sepsis in a tertiary care hospital in India. (United States)

    Vanukuru, Jayasree; Bagga, Rashmi; Muthyala, Tanuja; Gautam, Vikas; Sethi, Sunil; Jain, Vanita; Sikka, Pooja


    This prospective study was carried out to evaluate the clinical profile and bacterial isolates among women with puerperal sepsis in a tertiary hospital in North India. Women with puerperal sepsis (n = 45) admitted from January 2015 to April 2016 were followed prospectively. Cultures were obtained from cervix, blood, urine, and pyoperitoneum. Initial antibiotics were cefotaxime or piperacillin with tazobactam plus amikacin plus clindamycin or metronidazole and were changed according to sensitivity. Out of 7887 deliveries during this period, 45 (0.2%) women had puerperal sepsis. 16 (35.5%) delivered in the present hospital, 25 (55.5%) at another health care facility, and 4 (8.9%) at home. Delivery was by cesarean section (CS) in 24/45 (53.3%) and vaginal in 21/45 (46.6%). Grade 1 sepsis occurred in 21, grade 2 in two, and grade 3 in 22 women. Majority (29/45 or 64.5%) had no risk factor for puerperal sepsis. There were two (4.4%) deaths and 13/45 (28.8%) had near-miss morbidity. Pathogenic bacteria were isolated in 33/45 (73.3%) in cervical swab (69%), blood, urine, or pus culture with no significant difference in the bacterial yield or species isolated between cotton or polyester swabs (p > .05). Escherichia coli were the commonest isolate and was sensitive to amikacin in all. Five had stillbirths and 4/40 neonates developed sepsis but recovered. Escherichia coli was the commonest pathogen and was uniformly sensitive to amikacin, which may be included among the initial antibiotics to treat puerperal sepsis in India.

  19. Antimicrobial drugs usage in a tertiary care hospital –A descriptive study

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    Priestly Vivekkumar


    Full Text Available Background: Emergence of resistant organisms is alarmingly high all over the world. Irrational and inappropriate prescription of antimicrobials is the major contributing factor for developing drug resistance in addition to poor patient compliance. It is the high time to create awareness of antimicrobial resistance among physicians and patients. Encouraging physicians/surgeons to undergo training programmes on infectious disease control periodically would be beneficial to combat the resistant organisms, so called super bugs.Objectives: To assess the pattern of antimicrobial usage in a tertiary care hospital, to determine whether antimicrobials are prescribed judiciously.Methods: A retrospective study was conducted to determine the current antimicrobial prescribing practices at Tagore Medical College Hospital. A randomised sample of 100 inpatient case sheets of General Medicine, OBG, General Surgery, Paediatrics, Chest Medicine, Skin, and ENT from Medical Records Department was analysed with respect to oral and parenteral (iv administration of antimicrobials.Results: In this study, 53% were males and 47% were females. Majority of patients were middle aged (17-60yrs. A total of 16 antimicrobials were prescribed for 100 inpatients. The most frequently used were Metronidazole and Ciprofloxacin. Duration of treatment was minimum 3 days, maximum of 13 days and mean duration was 5.5 days. The common route by which antimicrobials were administered was Parenteral as the patients were inpatients. The Parenteral (iv drugs were Metronidazole (52%, Ciprofloxacin (42%, Cefotaxime (27%, Amikacin (7%, Ceftriaxone (7%. Among 100 prescriptions, 63% were empirical prescriptions, 12% were directed and 25% were targeted prescriptions.Conclusions: The most frequently used antimicrobials were Metronidazole and Ciprofloxacin and the condition for which the antimicrobials were commonly used was acute gastroenteritis. The proportion of targeted prescriptions was low

  20. Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions

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    Boniface Eze


    Full Text Available Boniface Eze1, Kenneth Agu2, Jones Nwosu31Department of Ophthalmology, 2Department of Surgery, 3Department of Otorhinolaryngology, University of Nigeria Teaching Hospital (UNTH, Ituku-Ozalla, Enugu, Enugu State, Nigeria Objective: To assess the sociodemographic and clinical characteristics of patients discharged against medical advice (DAMA at the University of Nigeria Teaching Hospital (UNTH, Enugu, Nigeria.Methods: The UNTH’s admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P < 0.05 (one degree of freedom was considered statistically significant.Results: Of the 64,856 admissions (45.2% male, 54.8% female, 113 (0.002%; males: 54%, females: 46% were discharged against medical advice. DAMA rate was highest in Surgery (0.4%, and lowest in Obstetrics and Gynecology (0.1% and Pediatrics (0.1%. Infections (32.7%, trauma (29.2%, and cancer (16.8% were the leading diagnoses in patients DAMA. Financial constraints (37.2%, unsatisfactory response to treatment (17.7%, and dissatisfaction with hospital environment (15.0% were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P < 0.05, patients having high levels of formal education (P < 0.05, and those who had not been previously hospitalized (P < 0.05; but not with age (P = 0.398, gender (P = 0.489, or employment (P = 0.091.Conclusion: Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate. Keywords: discharge against medical advice, tertiary center, sociodemographic characteristics, clinical