veil initial case: Topics by Science.gov

Sample records for veil initial case

VEIL Surgical Steps.

PubMed

Raghunath, S K; Nagaraja, H; Srivatsa, N

2017-03-01

Inguinal lymphadenectomy remains the standard of care for metastatic nodal disease in cases of penile, urethral, vulval and vaginal cancers. Outcomes, including cure rates and overall and progression-free survivals, have progressively improved in these diseases with extending criteria to offer inguinal lymph node dissection for patients 'at-risk' for metastasis or loco-regional recurrence. Hence, despite declining incidence of advanced stages of these cancers, many patients will still need to undergo lymphadenectomy for optimal oncological outcomes. Inguinal node dissection is a morbid procedure with operative morbidity noted in almost two third of the patients. Video endoscopic inguinal lymphadenectomy (VEIL) was described and currently practiced with proven equivalent oncological outcomes. We describe our technique of VEIL using laparoscopic and robotic access as well as various new surgical strategies.
A veil (hijab) as a public symbol of a Muslim woman modern identity.

PubMed

Kulenović, Tarik

2006-12-01

In this article the author explains the social role of Muslim woman in a postmodern society through a public symbol of her identity--the veil. The article's thesis is that the Muslim women's manifestation of their Islamic denomination through veiling and wearing appropriate clothes (in the case of men through growing beards and wearing clothes considered appropriate for them) signifies an expression of a new, Islamic shaped identity. This is a postmodern identity based on modernity rather than a fundamental reaction to modernity. The veil, a public symbol of Muslim identity, is often given a different meaning by its observers than the person actually wearing it. Therefore, the intention of this article is to analyze the elements of a particular, postmodern identity that a Muslim woman's veil, as a public symbol, represents.
The veil of ignorance and health resource allocation.

PubMed

Soto, Carlos

2012-08-01

Some authors view the veil of ignorance as a preferred method for allocating resources because it imposes impartiality by stripping deliberators of knowledge of their personal identity. Using some prominent examples of such reasoning in the health care sector, I will argue for the following claims. First, choice behind a veil of ignorance often fails to provide clear guidance regarding resource allocation. Second, regardless of whether definite results could be derived from the veil, these results do not in themselves have important moral standing. This is partly because the veil does not determine which features are morally relevant for a given distributive problem. Third, even when we have settled the question of what features to count, choice behind a veil of ignorance arguably fails to take persons seriously. Ultimately, we do not need the veil to solve distributive problems, and we have good reason to appeal to some other distributive model.
Line-dependent veiling in very active classical T Tauri stars

NASA Astrophysics Data System (ADS)

Rei, A. C. S.; Petrov, P. P.; Gameiro, J. F.

2018-02-01

Context. The T Tauri stars with active accretion disks show veiled photospheric spectra. This is supposedly due to non-photospheric continuum radiated by hot spots beneath the accretion shocks at stellar surface and/or chromospheric emission lines radiated by the post-shocked gas. The amount of veiling is often considered as a measure of the mass-accretion rate. Aim. We analysed high-resolution photospheric spectra of accreting T Tauri stars LkHα 321, V1331 Cyg, and AS 353A with the aim of clarifying the nature of the line-dependent veiling. Each of these objects shows a strong emission line spectrum and powerful wind features indicating high rates of accretion and mass loss. Methods: Equivalent widths of hundreds of weak photospheric lines were measured in the observed spectra of high quality and compared with those in synthetic spectra of appropriate models of stellar atmospheres. Results: The photospheric spectra of the three T Tauri stars are highly veiled. We found that the veiling is strongly line-dependent: larger in stronger photospheric lines and weak or absent in the weakest ones. No dependence of veiling on excitation potential within 0 to 5 eV was found. Different physical processes responsible for these unusual veiling effects are discussed in the framework of the magnetospheric accretion model. Conclusions: The observed veiling has two origins: (1) an abnormal structure of stellar atmosphere heated up by the accreting matter, and (2) a non-photospheric continuum radiated by a hot spot with temperature lower than 10 000 K. The true level of the veiling continuum can be derived by measuring the weakest photospheric lines with equivalent widths down to ≈10 mÅ. A limited spectral resolution and/or low signal-to-noise ratio results in overestimation of the veiling continuum. In the three very active stars, the veiling continuum is a minor contributor to the observed veiling, while the major contribution comes from the line-dependent veiling.
The effect of veiled cells on lymphocyte function.

PubMed

Balfour, B; O'Brien, J A; Perera, M; Clarke, J; Sumerska, T; Knight, S C

1982-01-01

The response of lymphocytes to stimulation with Con A has been studied in the presence of veiled cells collected from the afferent lymph. In these enriched cultures the response occurred earlier with smaller numbers of lymphocytes and at lower concentrations of Con A. Veiled cells also caused clumping of lymphocytes in unstimulated cultures. In stimulated cultures small cells with veil-like projections appeared after 48 hr, but were not seen in unstimulated cultures.
Determining health care rights from behind a veil of ignorance.

PubMed

Korobkin, R

1998-01-01

Should our society establish positive rights to health care that each citizen could claim, as many health policy analysts believe? Or should it provide only background rules of contract and property law and leave the provision of health care to the free market, as Richard Epstein advocates in Mortal Peril? In this article, Professor Korobkin argues that this question should be addressed from the Rawlsian "veil of ignorance" perspective. That is, the question should be answered by asking what kind of society would individuals agree to form if they had no knowledge of their individual skills or endowments; if they did not know whether they were rich or poor, healthy or sick, weak or strong. Professor Korobkin contends that individuals behind such a veil of ignorance would balance their inherent risk aversion (which favors a safety net of "rights") against the inefficient incentives created by rights regimes that would reduce net social wealth (which favors a free market). Whether they would choose to establish rights to health care or not is ultimately an empirical question that turns on how inefficient any particular right would be. The question thus requires a case-by-case analysis of proposed rights. The article then considers the policy issues of (1) community rating of private health insurance and (2) the mandated provision of emergency medical care. It concludes that in these cases the inefficient incentives created by establishing rights are probably smaller and/or controllable enough to lead individuals behind the veil of ignorance to favor a regime of positive rights.
Automatic Detection of Blue-White Veil and Related Structures in Dermoscopy Images

PubMed Central

Celebi, M. Emre; Iyatomi, Hitoshi; Stoecker, William V.; Moss, Randy H.; Rabinovitz, Harold S.; Argenziano, Giuseppe; Soyer, H. Peter

2011-01-01

Dermoscopy is a non-invasive skin imaging technique, which permits visualization of features of pigmented melanocytic neoplasms that are not discernable by examination with the naked eye. One of the most important features for the diagnosis of melanoma in dermoscopy images is the blue-white veil (irregular, structureless areas of confluent blue pigmentation with an overlying white “ground-glass” film). In this article, we present a machine learning approach to the detection of blue-white veil and related structures in dermoscopy images. The method involves contextual pixel classification using a decision tree classifier. The percentage of blue-white areas detected in a lesion combined with a simple shape descriptor yielded a sensitivity of 69.35% and a specificity of 89.97% on a set of 545 dermoscopy images. The sensitivity rises to 78.20% for detection of blue veil in those cases where it is a primary feature for melanoma recognition. PMID:18804955
Odontogenesis in the Veiled Chameleon (Chamaeleo calyptratus).

PubMed

Buchtová, Marcela; Zahradníček, Oldřich; Balková, Simona; Tucker, Abigail S

2013-02-01

Replacement teeth in reptiles and mammals develop from a successional dental lamina. In monophyodont (single generation) species such as the mouse, no successional lamina develops. We have selected a reptilian monophyodont species - the Veiled Chameleon (Chamaeleo calyptratus) - to investigate whether this is a common characteristic of species that do not have replacement teeth. Furthermore, we focus on the sequence of tooth initiation along the jaw, and tooth attachment to the bones. Embryos of the Veiled Chameleon were collected during the first 6 months of incubation (from the 5th to 24th week) at 7-day intervals. After five weeks of incubation, an epithelial thickening was present as a shallow protrusion into the mesenchyme. A week later, the epithelium elongated more deeply into the mesenchyme to form the dental lamina. The formation of all tooth germs along the jaw was initiated from the tip of the dental lamina. Development of a successional dental lamina was initiated during the pre-hatching period but this structure became markedly reduced during juvenile stages. MicroCT analysis showed the presence of a heterodont dentition in young chameleons with multicuspid teeth in the caudal jaw area and simpler monocuspid teeth rostrally. Unlike the pleurodont teeth of most reptilian species, chameleon teeth are acrodontly ankylosed to the bones of the jaw. Odontoblasts produced a layer of predentine that connected the dentine to the supporting bone, with both tooth and bone protruding out of the oral cavity and acting as a functional unit. Chameleons may provide new and useful information to study the molecular interaction at the tooth-bone interface in physiological as well as pathological conditions. Copyright © 2012 Elsevier Ltd. All rights reserved.
Less is more? Detecting lies in veiled witnesses.

PubMed

Leach, Amy-May; Ammar, Nawal; England, D Nicole; Remigio, Laura M; Kleinberg, Bennett; Verschuere, Bruno J

2016-08-01

Judges in the United States, the United Kingdom, and Canada have ruled that witnesses may not wear the niqab-a type of face veil-when testifying, in part because they believed that it was necessary to see a person's face to detect deception (Muhammad v. Enterprise Rent-A-Car, 2006; R. v. N. S., 2010; The Queen v. D(R), 2013). In two studies, we used conventional research methods and safeguards to empirically examine the assumption that niqabs interfere with lie detection. Female witnesses were randomly assigned to lie or tell the truth while remaining unveiled or while wearing a hijab (i.e., a head veil) or a niqab (i.e., a face veil). In Study 1, laypersons in Canada (N = 232) were more accurate at detecting deception in witnesses who wore niqabs or hijabs than in those who did not wear veils. Concealing portions of witnesses' faces led laypersons to change their decision-making strategies without eliciting negative biases. Lie detection results were partially replicated in Study 2, with laypersons in Canada, the United Kingdom, and the Netherlands (N = 291): observers' performance was better when witnesses wore either niqabs or hijabs than when witnesses did not wear veils. These findings suggest that, contrary to judicial opinion, niqabs do not interfere with-and may, in fact, improve-the ability to detect deception. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Effects of religious veiling on Muslim men's attractiveness ratings of Muslim women.

PubMed

Pazhoohi, Farid; Hosseinchari, Masoud

2014-08-01

Hijab and other Islamic veiling clothing are important social and political symbols for Muslim women's identity. Although recently there has been a large body of literature on the social and political aspects of hijab in Western countries, there has been no investigation of the origin and function of veiling itself. This article hypothesized that religious veiling, which eliminates the estrogen-induced body curves of reproductive age women, decreases men's perceptions of women's physical attractiveness, thereby serving mate guarding functions against rival men. To test this hypothesis. Measures of the motivational appeal and self-reported perceived attractiveness of women exhibiting different degrees of veiling were obtained from 80 Muslim male participants. The results showed that men were more motivated to view women exhibiting the less veiling and rated them more attractive than those women whose bodily curves were less apparent. These results support veiling serving a mate guarding function and reinforcing the marital bond.
Volcanic Loading: The Dust Veil Index (1985) (NDP-013)

DOE Data Explorer

Lamb, H. H. [University of East Anglia, Norwich, United Kingdom; Boden, Thomas A. [CDIAC, Oak Ridge National Laboratory; Watts, Julia A. [Oak Ridge National Laboratory

1985-09-01

Lamb's Dust Veil Index (DVI) is a numerical index that quantifies the impact of a particular volcanic eruption's release of dust and aerosols over the years following the event, especially the impact on the Earth's energy balance. DVIs have been calculated for eruptions occurring from 1500 through 1983. The methods used to calculate the DVI have been intercalibrated to give a DVI of 1000 for the eruption of Krakatoa in 1883. The DVI for any volcanic eruption is based on a review of the observational, empirical, and theoretical studies of the possible impact on climate of volcanic dust veils. The DVI allows one to compare volcanic eruptions by a single numerical index. The data base includes the name of the erupting volcano, year of eruption, volcano latitude and longitude, maximum extent of the dust veil, veil duration, DVI for the entire globe, DVI for the Northern Hemisphere, and DVI for the Southern Hemisphere. The data are in one file (22.6 kB).
Creating In-Depth Learning Experiences by Using Rawls' "Veil of Ignorance"

ERIC Educational Resources Information Center

Sanger, Michael; Rossiter, Carol F.

2011-01-01

Combining a variation of John Rawls' "veil of ignorance" mind experiment with role-playing and case studies allows instructors to create assignments that engage students in the full range of learning processes, encourage them to consider a wide range of viewpoints, provide them with opportunities to apply the cognitive and the affective components…
ORION’S VEIL. IV. H{sub 2} EXCITATION AND GEOMETRY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abel, N. P.; Ferland, G. J.; Troland, T. H.

2016-03-10

The foreground Veil of material that lies in front of the Orion Nebula is the best studied sample of the interstellar medium because we know where it is located, how it is illuminated, and the balance of thermal and magnetic energy. In this work, we present high-resolution STIS observations toward the Trapezium, with the goal of better understanding the chemistry and geometry of the two primary Veil layers, along with ionized gas along the line of sight. The most complete characterization of the rotational/vibrational column densities of H{sub 2} in the almost purely atomic components of the Veil are presented,more » including updates to the Cloudy model for H{sub 2} formation on grain surfaces. The observed H{sub 2} is found to correlate almost exclusively with Component B. The observed H{sub 2}, observations of CI, CI*, and CI**, and theoretical calculations using Cloudy allow us to place the tightest constraints yet on the distance, density, temperature, and other physical characteristics for each cloud component. We find the H{sub 2} excitation spectrum observed in the Veil is incompatible with a recent study that argued that the Veil was quite close to the Trapezium. The nature of a layer of ionized gas lying between the Veil and the Trapezium is characterized through the emission and absorption lines it produces, which we find to be the blueshifted component observed in S iii and P iii absorption. We deduce that, within the next 30–60 thousand years, the blueshifted ionized layer and Component B will merge, which will subsequently merge with Component A in the next one million years.« less
A veil over the East.

PubMed

1995-01-01

The economic modernization process in Indonesia and Malaysia has been accompanied by the emergence of a new class of intensely religious (but not fundamentalist) female professionals, many of whom wear veils. Signs of Islamic revivalism co-exist with expanded employment opportunities for women. The Muslim resurgence in Indonesia has been interpreted as a new form of nationalism and a direct reflection of the aspirations of a new middle class. Many ambiguities have resulted from this convergence of modernization and traditionalism. At the same time that the government is encouraging a culture of modernity, laws governing personal behaviors such as adultery are more strictly enforced, often to the detriment of women. Sisters of Islam was established in 1987 to address women's legal disadvantage in family matters of divorce and maintenance payments. Debate on whether veiling circumscribes women's behavior continues.
TEARING THE VEIL: INTERACTION OF THE ORION NEBULA WITH ITS NEUTRAL ENVIRONMENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van der Werf, Paul P.; Goss, W. M.; O'Dell, C. R.

2013-01-10

We present H I 21 cm observations of the Orion Nebula, obtained with the Karl G. Jansky Very Large Array, at an angular resolution of 7.''2 Multiplication-Sign 5.''7 and a velocity resolution of 0.77 km s{sup -1}. Our data reveal H I absorption in the Veil toward the radio continuum of the H II region, and H I emission arising from the Orion Bar photon-dominated region (PDR) and from the Orion-KL outflow. In the Orion Bar PDR, the H I signal peaks in the same layer as the H{sub 2} near-infrared vibrational line emission, in agreement with models of themore » photodissociation of H{sub 2}. The gas temperature in this region is approximately 540 K, and the H I abundance in the interclump gas in the PDR is 5%-10% of the available hydrogen nuclei. Most of the gas in this region therefore remains molecular. Mechanical feedback on the Veil manifests itself through the interaction of ionized flow systems in the Orion Nebula, in particular the Herbig-Haro object HH 202, with the Veil. These interactions give rise to prominent blueward velocity shifts of the gas in the Veil. The unambiguous evidence for interaction of this flow system with the Veil shows that the distance between the Veil and the Trapezium stars needs to be revised downward to about 0.4 pc. The depth of the ionized cavity is about 0.7 pc, which is much smaller than the depth and the lateral extent of the Veil. Our results reaffirm the blister model for the M42 H II region, while also revealing its relation to the neutral environment on a larger scale.« less
Lifting the veil. Reform vs tradition in Turkey. An interview with Nilofer Gole.

PubMed

1997-01-01

This article is based on an interview with a Turkish sociologist, Nilofer Gole, concerning the practice of veiling of women in Turkey. Turks have argued about the permissibility of veiling for over a decade. The issue of veiling marks the intersection between modernization and the Islamic movement and is a symbolic marker of the meaning of women's bodies. Turkish women wear a traditional long head scarf that has nothing to do with a modern Islamic head scarf. Turkish and Indian women are pressured by fathers, husbands, and brothers to completely cover themselves. Turkish women who put on the veil come from modest social origins, peripheral cities, and small towns with a conservative background. Turkish women wearing the veil do so when they move to urban areas and pass the university entrance exams. Rural women maintain the classical head scarf. Urban women wearing veils are leaving the domestic space and private sphere and distancing themselves from traditional women's roles. These Islamic radical women are a small minority of about 10% of the population. Most of the population follow a modern way of life with a different ideology. Modernization began in Turkey in 1876, and the formation of a secular, republican nation-state began with Mustafa Attaturk in 1923. Attaturk based the Turkish civil code on the Swiss civil code, which was the most progressive at that time and promoted the emancipation of women. Turkey, unlike Iran, had a "very rich democratic life, the defeat of a monarchy, and the growth of the middle class." Religious law and marriage were abolished. The veil was not allowed in public places and its use discouraged.
Veiled communication: is uncovering necessary for psychiatric assessment?

PubMed

Mistry, Himanshu; Bhugra, Dinesh; Chaleby, Kutaiba; Khan, Farooq; Sauer, Justin

2009-12-01

Facial expressions are significant to decipher information during a dialogue and more so in a clinical consultation. Veils (Niqab) worn by Muslim women may pose a clinical dilemma for the psychiatric assessment especially if clinicians are not aware of their religious significance. To investigate whether clinical judgment is affected if full facial expressions are not accessible, we conducted an email survey of psychiatrists and psychologists across the world who frequently work in these situations. Of 25 colleagues contacted 16 responded and 11 of them agreed for their comments to be included in the study. Nine out of 11 believed clinical assessment may be compromised, although respondents were aware of cultural sensitivity around the issue. Two out of 11 however, felt fully able to assess the mental state of a veiled woman. Some professionals reported that they feel unable to assess or treat if the request to take the veil off is declined. This small survey demonstrates the diverse opinions on whether unveiling is necessary for psychiatric assessment. Further qualitative examination of this area is needed to develop wider consensus and guidance to mental health care professionals who may be dealing with these groups.
Two-dimensional patterns in bacterial veils arise from self-generated, three-dimensional fluid flows.

PubMed

Cogan, N G; Wolgemuth, C W

2011-01-01

The behavior of collections of oceanic bacteria is controlled by metabolic (chemotaxis) and physical (fluid motion) processes. Some sulfur-oxidizing bacteria, such as Thiovulum majus, unite these two processes via a material interface produced by the bacteria and upon which the bacteria are transiently attached. This interface, termed a bacterial veil, is formed by exo-polymeric substances (EPS) produced by the bacteria. By adhering to the veil while continuing to rotate their flagella, the bacteria are able to exert force on the fluid surroundings. This behavior induces a fluid flow that, in turn, causes the bacteria to aggregate leading to the formation of a physical pattern in the veil. These striking patterns are very similar in flavor to the classic convection instability observed when a shallow fluid is heated from below. However, the physics are very different since the flow around the veil is mediated by the bacteria and affects the bacterial densities. In this study, we extend a model of a one-dimensional veil in a two-dimensional fluid to the more realistic two-dimensional veil in a three-dimensional fluid. The linear stability analysis indicates that the Peclet number serves as a bifurcation parameter, which is consistent with experimental observations. We also solve the nonlinear problem numerically and are able to obtain patterns that are similar to those observed in the experiments.
The influence of social networking technologies on female religious veil-wearing behavior in Iran.

PubMed

Young, Sean D; Shakiba, Abbas; Kwok, Justin; Montazeri, Mohammad Sadegh

2014-05-01

Abstract Social networking technologies can influence attitudes, behaviors, and social norms. Research on this topic has been conducted primarily among early adopters of technology and within the United States. However, it is important to evaluate how social media might affect people's behaviors in international settings, especially among countries with longstanding, government recommended, cultural and religious traditions and behaviors, such as Iran. This study seeks to assess whether Iranian women who have been using social networking technologies for a longer time (compared to those who have recently joined) would be less likely to cover themselves with a veil and be more comfortable publicly displaying pictures of this behavior on Facebook. Iranian females (N=253) were selected through snowball sampling from nongovernmental organizations in November 2011 and asked to complete a survey assessing their use of Facebook, concerns about not wearing a veil in Facebook pictures, and their actual likelihood of wearing a veil. Items were combined to measure lack of interest in wearing a veil. Length of time as a Facebook user was significantly associated with not wearing a veil (b=0.16, p<0.01), controlling for age, education, and frequency of using Facebook. Results also revealed a significant relationship such that older people were more likely to adhere to the religious behavior of wearing a veil (b=-0.45, p<0.01). Social networking technologies can affect attitudes and behaviors internationally. We discuss methods of using social media for self-presentation and expression, as well as the difficulties (and importance) of studying use of technologies, such as social media, internationally.
The Influence of Social Networking Technologies on Female Religious Veil-Wearing Behavior in Iran

PubMed Central

Shakiba, Abbas; Kwok, Justin; Montazeri, Mohammad Sadegh

2014-01-01

Abstract Social networking technologies can influence attitudes, behaviors, and social norms. Research on this topic has been conducted primarily among early adopters of technology and within the United States. However, it is important to evaluate how social media might affect people's behaviors in international settings, especially among countries with longstanding, government recommended, cultural and religious traditions and behaviors, such as Iran. This study seeks to assess whether Iranian women who have been using social networking technologies for a longer time (compared to those who have recently joined) would be less likely to cover themselves with a veil and be more comfortable publicly displaying pictures of this behavior on Facebook. Iranian females (N=253) were selected through snowball sampling from nongovernmental organizations in November 2011 and asked to complete a survey assessing their use of Facebook, concerns about not wearing a veil in Facebook pictures, and their actual likelihood of wearing a veil. Items were combined to measure lack of interest in wearing a veil. Length of time as a Facebook user was significantly associated with not wearing a veil (b=0.16, p<0.01), controlling for age, education, and frequency of using Facebook. Results also revealed a significant relationship such that older people were more likely to adhere to the religious behavior of wearing a veil (b=−0.45, p<0.01). Social networking technologies can affect attitudes and behaviors internationally. We discuss methods of using social media for self-presentation and expression, as well as the difficulties (and importance) of studying use of technologies, such as social media, internationally. PMID:24611768

Trifunctional Epoxy Resin Composites Modified by Soluble Electrospun Veils: Effect on the Viscoelastic and Morphological Properties

PubMed Central

Ognibene, Giulia; Mannino, Salvatore

2018-01-01

Electrospun veils from copolyethersulfones (coPES) were prepared as soluble interlaminar veils for carbon fiber/epoxy composites. Neat, resin samples were impregnated into coPES veils with unmodified resin, while dry carbon fabrics were covered with electrospun veils and then infused with the unmodified epoxy resin to prepare reinforced laminates. The thermoplastic content varied from 10 wt% to 20 wt%. TGAP epoxy monomer showed improved and fast dissolution for all the temperatures tested. The unreinforced samples were cured first at 180 °C for 2 h and then were post-cured at 220 °C for 3 h. These sample showed a high dependence on the curing cycle. Carbon reinforced samples showed significant differences compared to the neat resin samples in terms of both viscoelastic and morphological properties. PMID:29522444
Teaching about Sexuality and Veiling in Islam

ERIC Educational Resources Information Center

Defibaugh, Amy; Krutzsch, Brett

2017-01-01

This article proposes strategies for teaching about sexuality in Islam through student-centered learning activities, such as self-reflection, multimedia presentations, and small group discussions. We focus on a diversity of perspectives related to veiling in Islam. The approaches we describe help students deconstruct and reevaluate common U.S.…
The formulation of Lamb's Dust Veil Index

NASA Technical Reports Server (NTRS)

Kelly, P. M.; Sear, C. B.

1982-01-01

A catalog of the major explosive volcanic eruptions since 1500 AD and formulated the Dust Veil Index (DVI) is presented. The DVI quantifies the impact on the Earth's energy balance of changes in atmospheric composition due to explosive volcanic eruptions. The DVI for a particular eruption quantifies the climatic impact of the dust and aerosol injection from the eruption integrated over the years following the event. The formulation of the DVI is described. All references are to Lamb (1970). A distinction is made between the catalog of volcanic activity, and the tabulation of the northern hemisphere DVI apportioned over the years. The DVI data are updated to 1975 for any particular eruption, the catalog gives three DVI values: global, Southern Hemisphere, and Northern Hemisphere. The global DVI given in the catalog is considered. The other two DVIs relate to the impact on the hemispheres considered separately and their estimation involves an additional factor apportioning the dust veil between the hemispheres on the basis of the latitude of injection.
Hijab and Depression: Does the Islamic Practice of Veiling Predict Higher Levels of Depressive Symptoms?

PubMed

Hodge, David R; Husain, Altaf; Zidan, Tarek

2017-07-01

Hijab or veiling is commonly practiced by Muslim women but remains controversial in the broader secular society. Some Western feminists argue that veiling is an oppressive behavior that negatively affects women by, for example, engendering depression. This article tests this hypothesis with a national sample of American Muslim women (N = 194). The results of the regression analysis did not support the hypothesis. Indeed, women who veiled more frequently reported lower, rather than higher, levels of depressive symptoms. In other words, wearing the hijab appears to be a protective factor in the area of depression. Given the prevalence of depression among women, the results have important implications for practice with Muslim women at both the micro and the macro levels. © 2017 National Association of Social Workers.
Biophysical basis for convergent evolution of two veil-forming microbes.

PubMed

Petroff, Alexander P; Pasulka, Alexis L; Soplop, Nadine; Wu, Xiao-Lun; Libchaber, Albert

2015-11-01

Microbes living in stagnant water typically rely on chemical diffusion to draw nutrients from their environment. The sulfur-oxidizing bacterium Thiovulum majus and the ciliate Uronemella have independently evolved the ability to form a 'veil', a centimetre-scale mucous sheet on which cells organize to produce a macroscopic flow. This flow pulls nutrients through the community an order of magnitude faster than diffusion. To understand how natural selection led these microbes to evolve this collective behaviour, we connect the physical limitations acting on individual cells to the cell traits. We show how diffusion limitation and viscous dissipation have led individual T. majus and Uronemella cells to display two similar characteristics. Both of these cells exert a force of approximately 40 pN on the water and attach to boundaries by means of a mucous stalk. We show how the diffusion coefficient of oxygen in water and the viscosity of water define the force the cells must exert. We then show how the hydrodynamics of filter-feeding orient a microbe normal to the surface to which it attaches. Finally, we combine these results with new observations of veil formation and a review of veil dynamics to compare the collective dynamics of these microbes. We conclude that this convergent evolution is a reflection of similar physical limitations imposed by diffusion and viscosity acting on individual cells.
ORION’S VEIL: MAGNETIC FIELD STRENGTHS AND OTHER PROPERTIES OF A PDR IN FRONT OF THE TRAPEZIUM CLUSTER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Troland, T. H.; Goss, W. M.; Brogan, C. L.

2016-07-01

We present an analysis of physical conditions in the Orion Veil, an atomic photon-dominated region (PDR) that lies just in front (≈2 pc) of the Trapezium stars of Orion. This region offers an unusual opportunity to study the properties of PDRs, including the magnetic field. We have obtained 21 cm H i and 18 cm (1665 and 1667 MHz) OH Zeeman effect data that yield images of the line-of-sight magnetic field strength B {sub los} in atomic and molecular regions of the Veil. We find B {sub los} ≈ −50 to −75 μ G in the atomic gas across muchmore » of the Veil (25″ resolution) and B {sub los} ≈ −350 μ G at one position in the molecular gas (40″ resolution). The Veil has two principal H i velocity components. Magnetic and kinematical data suggest a close connection between these components. They may represent gas on either side of a shock wave preceding a weak-D ionization front. Magnetic fields in the Veil H i components are 3–5 times stronger than they are elsewhere in the interstellar medium where N (H) and n (H) are comparable. The H i components are magnetically subcritical (magnetically dominated), like the cold neutral medium, although they are about 1 dex denser. Comparatively strong fields in the Veil H i components may have resulted from low-turbulence conditions in the diffuse gas that gave rise to OMC-1. Strong fields may also be related to magnetostatic equilibrium that has developed in the Veil since star formation. We also consider the location of the Orion-S molecular core, proposing a location behind the main Orion H{sup +} region.« less
Unveiled Sentiments: Gendered Islamophobia and Experiences of Veiling among Muslim Girls in a Canadian Islamic School

ERIC Educational Resources Information Center

Zine, Jasmin

2006-01-01

The practice of veiling has made Muslim women subject to dual oppressions--racism and Islamophobia--in society at large and patriarchal oppression and sexism from within their communities. Based on a narrative analysis of the politics of veiling in schools and society, the voices of young Muslim women attending a Canadian Islamic school speak to…
Interaction of cesium adatoms with free-standing graphene and graphene-veiled SiO 2 surfaces

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weck, Philippe F.; Kim, Eunja; Biedermann, Grant W.

2015-04-21

In this study, the interaction of Cs adatoms with mono- or bi-layered graphene (MLG and BLG), either free-standing or on a SiO 2 substrate, was investigated using density functional theory. The most stable adsorption sites for Cs are found to be hollow sites on both graphene sheets and graphene-veiled SiO 2(0001). In addition, larger dipole moments are created when a MLG-veiled SiO 2(0001) substrate is used for adsorption of Cs atoms compared to the adsorption on free-standing MLG, due to charge transfer occurring between the MLG and the SiO 2 substrate. For the adsorption of Cs on BLG-veiled SiO 2(0001)more » substrate, these differences are smoothed out and the binding energies corresponding to different sites are nearly degenerate; smaller dipole moments created by the Cs adatoms on BLG compared to MLG are also predicted.« less
Early humans' egalitarian politics: runaway synergistic competition under an adapted veil of ignorance.

PubMed

Harvey, Marc

2014-09-01

This paper proposes a model of human uniqueness based on an unusual distinction between two contrasted kinds of political competition and political status: (1) antagonistic competition, in quest of dominance (antagonistic status), a zero-sum, self-limiting game whose stake--who takes what, when, how--summarizes a classical definition of politics (Lasswell 1936), and (2) synergistic competition, in quest of merit (synergistic status), a positive-sum, self-reinforcing game whose stake becomes "who brings what to a team's common good." In this view, Rawls's (1971) famous virtual "veil of ignorance" mainly conceals politics' antagonistic stakes so as to devise the principles of a just, egalitarian society, yet without providing any means to enforce these ideals (Sen 2009). Instead, this paper proposes that human uniqueness flourished under a real "adapted veil of ignorance" concealing the steady inflation of synergistic politics which resulted from early humans' sturdy egalitarianism. This proposition divides into four parts: (1) early humans first stumbled on a purely cultural means to enforce a unique kind of within-team antagonistic equality--dyadic balanced deterrence thanks to handheld weapons (Chapais 2008); (2) this cultural innovation is thus closely tied to humans' darkest side, but it also launched the cumulative evolution of humans' brightest qualities--egalitarian team synergy and solidarity, together with the associated synergistic intelligence, culture, and communications; (3) runaway synergistic competition for differential merit among antagonistically equal obligate teammates is the single politically selective mechanism behind the cumulative evolution of all these brighter qualities, but numerous factors to be clarified here conceal this mighty evolutionary driver; (4) this veil of ignorance persists today, which explains why humans' unique prosocial capacities are still not clearly understood by science. The purpose of this paper is to start lifting
Comparison of Body Dissatisfaction and Cosmetic Rhinoplasty with levels of Veil Practicing in Islamic Women

PubMed Central

Rastmanesh, Reza; Gluck, Marci E; Shadman, Zhaleh

2009-01-01

Objective The relationship between Islamic veiling, body dissatisfaction and desire for cosmetic rhinoplasty (CR) has not been studied. We therefore compared body dissatisfaction (BD), depression, self-esteem, and prevalence and desire to have CR in 1771 Iranian females. Method A battery of questionnaires was administered and participants were categorized into three groups of Islamic veil practicing: voluntarily and ideologically (IVP), non-complete (NCIVP) and Inconsiderate (IIVP). Results Despite a similar BMI, the IVP group scored significantly lower on BD, prevalence of dieting and exercising in order to be sexually appealing, and depression, higher on self-esteem, and had a lower desire for a CR than the two other groups. Prevalence of CR was significantly higher in the IIVP group than the other groups. Conclusions Women who practiced more strict Islamic veiling techniques had increased body satisfaction and self esteem, and decreased depression scores and desire for CR. Consistent with other studies, our findings show that observance of a strict religious practice has a protective effect on psychological health. PMID:19115373
The Invisible Veil: Changing Paradigms in the Art Therapy Profession

ERIC Educational Resources Information Center

Talwar, Savneet; Iyer, Jayashree; Doby-Copeland, Cheryl

2004-01-01

According to Sue and Sue (1999), the invisible veil is a worldview which affects all individuals as products of cultural conditioning and which operates outside the level of conscious awareness. Further, they state that the "values, assumptions, beliefs, and practices of our society are structured in a manner as to serve only one narrow segment of…
Biophysical basis for convergent evolution of two veil-forming microbes

PubMed Central

Petroff, Alexander P.; Pasulka, Alexis L.; Soplop, Nadine; Wu, Xiao-Lun; Libchaber, Albert

2015-01-01

Microbes living in stagnant water typically rely on chemical diffusion to draw nutrients from their environment. The sulfur-oxidizing bacterium Thiovulum majus and the ciliate Uronemella have independently evolved the ability to form a ‘veil’, a centimetre-scale mucous sheet on which cells organize to produce a macroscopic flow. This flow pulls nutrients through the community an order of magnitude faster than diffusion. To understand how natural selection led these microbes to evolve this collective behaviour, we connect the physical limitations acting on individual cells to the cell traits. We show how diffusion limitation and viscous dissipation have led individual T. majus and Uronemella cells to display two similar characteristics. Both of these cells exert a force of approximately 40 pN on the water and attach to boundaries by means of a mucous stalk. We show how the diffusion coefficient of oxygen in water and the viscosity of water define the force the cells must exert. We then show how the hydrodynamics of filter-feeding orient a microbe normal to the surface to which it attaches. Finally, we combine these results with new observations of veil formation and a review of veil dynamics to compare the collective dynamics of these microbes. We conclude that this convergent evolution is a reflection of similar physical limitations imposed by diffusion and viscosity acting on individual cells. PMID:26716000
Veiling glare reduction methods compared for ophthalmic applications

NASA Technical Reports Server (NTRS)

Buchele, D. R.

1981-01-01

Veiling glare in ocular viewing was simulated by viewing the retina of an eye model through a sheet of light-scattering material lit from the front. Four methods of glare reduction were compared, namely, optical scanning, polarized light, viewing and illumination paths either coaxial or intersecting at the object, and closed circuit TV. Photographs show the effect of these methods on visibility. Polarized light was required to eliminate light specularly reflected from the instrument optics. The greatest glare reduction was obtained when the first three methods were utilized together. Glare reduction using TV was limited by nonuniform distribution of scattered light over the image.
Enhanced electromagnetic interference shielding properties of carbon fiber veil/Fe3O4 nanoparticles/epoxy multiscale composites

NASA Astrophysics Data System (ADS)

Chen, Wei; Wang, Jun; Zhang, Bin; Wu, Qilei; Su, Xiaogang

2017-12-01

The multiscale approach has been adapted to enhance the electromagnetic interference shielding properties of carbon fiber (CF) veil epoxy-based composites. The Fe3O4 nanoparticles (NPs) were homogeneously dispersed in the epoxy matrix after surface modification by using silane coupling agent. The CF veil/Fe3O4 NPs/epoxy multiscale composites were manufactured by impregnating the CF veils with Fe3O4 NPs/epoxy mixture to prepare prepreg followed by vacuum bagging process. The electromagnetic interference shielding properties combined with the complex permittivity and complex permeability of the composites were investigated in the X-band (8.2-12.4 GHz) range. The total shielding effectiveness (SET) increases with increasing Fe3O4 NPs loadings and the maximum SET is 51.5 dB at low thickness of 1 mm. The incorporation of Fe3O4 NPs into the composites enhances the complex permittivity and complex permeability thus enhancing the electromagnetic wave absorption capability. The increased SET dominated by absorption loss SEA is attributed to the enhanced magnetic loss and dielectric loss generated by Fe3O4 NPs and multilayer construction of the composites. The microwave conductivity increases and the skin depth decreases with increasing Fe3O4 NPs loadings.
Body Covering and Body Image: A Comparison of Veiled and Unveiled Muslim Women, Christian Women, and Atheist Women Regarding Body Checking, Body Dissatisfaction, and Eating Disorder Symptoms.

PubMed

Wilhelm, Leonie; Hartmann, Andrea S; Becker, Julia C; Kişi, Melahat; Waldorf, Manuel; Vocks, Silja

2018-02-21

Although Islam is the fastest growing religion worldwide, only few studies have investigated body image in Muslim women, and no study has investigated body checking. Therefore, the present study examined whether body image, body checking, and disordered eating differ between veiled and unveiled Muslim women, Christian women, and atheist women. While the groups did not differ regarding body dissatisfaction, unveiled Muslim women reported more checking than veiled Muslim and Christian women, and higher bulimia scores than Christian. Thus, prevention against eating disorders should integrate all women, irrespective of religious affiliation or veiling, with a particular focus on unveiled Muslim women.
Fungal dermatitis, glossitis and disseminated visceral mycosis caused by different Metarhizium granulomatis genotypes in veiled chameleons (Chamaeleo calyptratus) and first isolation in healthy lizards.

PubMed

Schmidt, Volker; Klasen, Linus; Schneider, Juliane; Hübel, Jens; Pees, Michael

2017-08-01

Metarhizium (M.) granulomatis (formerly Chamaeleomyces granulomatis) invariably causes fatal fungal glossitis and systemic mycosis in veiled chameleons (Chamaeleo calyptratus). Isolation of M. granulomatis in other lizards thus far has not been described. The aim of this study therefore was to obtain information on the presence of M. granulomatis in reptiles kept as pets, and to examine whether there was an association between specific genotypes and clinical/pathological outcomes. Besides 18S ribosomal (r) DNA (SSU) and internal transcribed spacer1-5.8S (ITS1-5.8S) rDNA, a fragment of the large subunit of the 28S rDNA (LSU), including the domains 1 (D1) and D2, were sequenced for identification of the fungus and phylogenetic analysis. Metarhizium granulomatis was isolated from 23 veiled chameleons, two panther chameleons (Furcifer pardalis) and one central bearded dragon (Pogona vitticeps). Only the veiled chameleons revealed corresponding pathological findings in the form of glossal hemorrhage, granulomatous glossitis, pharyngitis, dermatitis and/or visceral mycosis. The infection site correlated to survival times of infected veiled chameleons. Combined long-term treatment with terbinafine and nystatin based on susceptibility testing may be helpful for prevention of disease and visceral spreading of the fungus, but elimination of the fungal pathogen or successful treatment of diseased veiled chameleons have not been achieved yet. Sequencing of the ribosomal genes yielded five different genotypes, with genotype A being strongly correlated with dermatitis, and remaining genotypes with pharyngitis and glossitis. However, disseminated visceral mycosis developed irrespective of the genotypes. Copyright © 2017 Elsevier B.V. All rights reserved.
Preferences for equity in health behind a veil of ignorance.

PubMed

Andersson, F; Lyttkens, C H

1999-08-01

Individual attitudes to distributions of life years between two groups in a society are explored by means of an experiment. Subjects are asked to place themselves behind a veil of ignorance which is specified in terms of risk (known probabilities) for some subjects and in terms of uncertainty (unknown probabilities) for some subjects. The latter is argued to be the appropriate interpretation of Rawls' notion. It is found that subjects exhibit convex preferences over life years for the two groups, and that preferences do not differ between the risk and the uncertainty specifications.
What is like to be a devoted doctor? An analysis of book reports on The Painted Veil.

PubMed

Hwang, Kun; Kim, Hun; Kim, Ae Yang; Hwang, Se Won; Hwang, Se Ho

2016-03-01

The aim of this study is to see what medical students think about the role of spouse of a devoted medical doctor through the book reports of The Painted Veil (1925). The 53 medical students were asked to read Maugham's The Painted Veil and to have a discussion. In their book reports, following questions were asked to be included: What it is like to be married a devoted medical doctor? Do you think that patients realize, value, and respect the importance of doctor's work? In the outbreak of highly infectious and fatal disease, can you carry out a heroic fight to control it? Among the 53 respondents, seven students (13%) answered that they would be happy if they marry a devoted doctor and scientist and 34 (64%) unhappy. The remaining 12 (23%) could not make a decision. The six students (11%) answered that doctor is valued and respected by patients while 46 (87%) answered doctor is neither valued nor respected. The remaining one (2%) could not decide. The 20 students (38%) answered that they would fight for the infectious disease and the remaining 30 (57%) answered that they would not. The remaining three (5%) could not determine their mind. The Painted Veil induced a virtue of "life of balance and harmony" and "attitude of doctor who give superiority to responsibility and duty over prestige and wealth" from the medical students. It could be a good teaching material for medical humanity.
Double jeopardy, the equal value of lives and the veil of ignorance: a rejoinder to Harris.

PubMed Central

McKie, J; Kuhse, H; Richardson, J; Singer, P

1996-01-01

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient. PMID:8863144
Double jeopardy, the equal value of lives and the veil of ignorance: a rejoinder to Harris.

PubMed

McKie, J; Kuhse, H; Richardson, J; Singer, P

1996-08-01

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient.

What is like to be a devoted doctor? An analysis of book reports on The Painted Veil

PubMed Central

Hwang, Kun; Kim, Hun; Kim, Ae Yang; Hwang, Se Won; Hwang, Se Ho

2016-01-01

Purpose: The aim of this study is to see what medical students think about the role of spouse of a devoted medical doctor through the book reports of The Painted Veil (1925). Methods: The 53 medical students were asked to read Maugham’s The Painted Veil and to have a discussion. In their book reports, following questions were asked to be included: What it is like to be married a devoted medical doctor? Do you think that patients realize, value, and respect the importance of doctor’s work? In the outbreak of highly infectious and fatal disease, can you carry out a heroic fight to control it? Results: Among the 53 respondents, seven students (13%) answered that they would be happy if they marry a devoted doctor and scientist and 34 (64%) unhappy. The remaining 12 (23%) could not make a decision. The six students (11%) answered that doctor is valued and respected by patients while 46 (87%) answered doctor is neither valued nor respected. The remaining one (2%) could not decide. The 20 students (38%) answered that they would fight for the infectious disease and the remaining 30 (57%) answered that they would not. The remaining three (5%) could not determine their mind. Conclusion: The Painted Veil induced a virtue of “life of balance and harmony” and “attitude of doctor who give superiority to responsibility and duty over prestige and wealth” from the medical students. It could be a good teaching material for medical humanity. PMID:26838574
Lifting the Green Veil: A Fresh Look at Synoptic Vegetation Dynamics

NASA Astrophysics Data System (ADS)

Henebry, G. M.; Vina, A.; Gitelson, A. A.

2003-12-01

Observing the dynamics of the vegetated land surface synoptically from spaceborne sensors plays a key role in understanding the global water, carbon, and nitrogen cycles, land cover and land use change, and biodiversity mapping. For the past three decades the study of global and regional vegetation dynamics has relied on satellite observations of the distinctive spectral contrast between red and near infrared reflectance exhibited by photosynthetically active green vegetation. It has long been recognized, however, that the spectral vegetation index with the widest currency-the Normalized Difference Vegetation Index (NDVI)-suffers a rapid decrease of sensitivity even at moderate Leaf Area Index (LAI) values of 2 to 4, as are commonly encountered in croplands and woodlands. This decrease in NDVI sensitivity casts a green veil over the land surface that obscures vegetation dynamics across vast areas during much of the growing season. This veil has important consequences for monitoring vegetation dynamics, developing land surface climatologies, and detecting significant changes. A straightforward modification of the NDVI, developed to increase its sensitivity under higher green biomass conditions, was applied to a standard, widely available AVHRR NDVI dataset for the conterminous US. The new Wide Dynamic Range Vegetation Index (WDRVI) exhibited increases in sensitivity between 30%-50% for Omernik Level III ecoregions dominated by woodlands, croplands, and grasslands. Ecoregions with lower aboveground net primary production, such as aridlands and semi-arid grasslands, showed no increase in sensitivity of the WDRVI over the NDVI. This powerful, new but simple approach creates an opportunity for a fresh look at the satellite data record. Further, it offers the possibility for significant improvements in the retrievals of canopy variables for carbon and nitrogen models, more accurate land surface characterizations for numerical weather prediction models, more sensitive
The Veil of Professionalism: An Autoethnographic Critique of White Positional Identities in the Figured Worlds of White Research Performance

ERIC Educational Resources Information Center

Pennington, Julie L.; Prater, Kathryn

2016-01-01

Two white researchers critique the professional veil of silence they created as they reflected on a qualitative study they performed 12 years earlier. Autoethnography and performance ethnography are utilized to examine the ways in which whiteness can remain unexamined throughout the research process due to the construction of white positional…
Dilemmas in the (un)veiling of the diagnosis of Alzheimer's disease: walking an ethical and professional tight rope.

PubMed

Karnieli-Miller, Orit; Werner, Perla; Aharon-Peretz, Judith; Eidelman, Shmuel

2007-08-01

To enhance the understanding and effect of physician's difficulties, attitudes and communication styles on the disclosure of the diagnosis of AD in practice. Qualitative, phenomenological study, combining pre-encounter interviews with physicians, observations of actual encounters of diagnosis disclosure of AD, and post-encounter interviews. There were various ways or tactics to (un)veil the bad news that may be perceived as different ways of dulling the impact and avoiding full and therefore problematic statements. In the actual encounters this was accomplished by keeping encounters short, avoiding elaboration, confirmation of comprehension and explicit terminology and using fractured sentences. The present study's findings highlight the difficulties encountered in breaking the news about AD, in the way it is actually done, and the problems that may arise from this way of un/veiling the news. The main problem is that the reluctance to make a candid disclosure of the diagnosis as was demonstrated in this study may violate basic moral and legal rights and may also deprive patients and caregivers of some of the benefits of early disclosure of diagnosis. There is a need for assisting physicians to cope with their personal difficulties, problems and pitfalls in breaking the news.
The Veiled Chameleon (Chamaeleo calyptratus Duméril and Duméril 1851): A Model for Studying Reptile Body Plan Development and Evolution.

PubMed

Diaz, Raul E; Anderson, Christopher V; Baumann, Diana P; Kupronis, Richard; Jewell, David; Piraquive, Christina; Kupronis, Jill; Winter, Kristy; Bertocchini, Federica; Trainor, Paul A

2015-08-26

Vertebrate model organisms have facilitated the discovery and exploration of morphogenetic events and developmental pathways that underpin normal and pathological embryological events. In contrast to amniotes such as Mus musculus (Mammalia) and Gallus gallus (Aves), our understanding of early patterning and developmental events in reptiles (particularly nonavians) remains weak. Squamate reptiles (lizards, snakes, and amphisbaenians) comprise approximately one-third of all living amniotes. But studies of early squamate development have been limited because, in most members of this lineage, embryo development at the time of oviposition is very advanced (limb bud stages and older). In many cases, squamates give birth to fully developed offspring. However, in the veiled chameleon (Chamaeleo calyptratus), embryos have progressed only to a primitive pregastrula stage at the time of oviposition. Furthermore, the body plan of the veiled chameleon is highly specialized for climbing in an arboreal environment. It possesses an entire suite of skeletal and soft anatomical modifications, including cranioskeletal ornamentation, lingual anatomy and biomechanics for projection, autopodial clefting for grasping, adaptations for rapid integumental color changes, a prehensile tail with a lack of caudal autotomy, the loss of the tympanum in the middle ear, and the acquisition of turreted eyes. Thus, C. calyptratus is an important model organism for studying the role of ecological niche specialization, as well as genetic and morphological evolution within an adaptive framework. More importantly, this species is easily bred in captivity, with only a small colony (<10 individuals) needed to obtain hundreds of embryos every year. © 2015 Cold Spring Harbor Laboratory Press.
Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

PubMed

Goold, S D

1996-01-01

Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.
First records of Hygrophoraceae from Panama including a new species of Camarophyllus and a new veiled species in Hygrocybe section Firmae

Treesearch

D.J. Lodge; C.L. Ovrebo

2008-01-01

Six species of Hygrophoraceae were collected on Barro Colorado Island, representing the first fully documented records for the family from Panama. A species with a pink pileus and stipe, a glutinous partial veil, and dimorphic spores and basidia, Hygrocybe roseopallida Lodge & Ovrebo sp. nov. is described in H...
A spectrum of the veiled T Tauri star CY Tau

NASA Technical Reports Server (NTRS)

Stuewe, J. A.; Schultz, R.

1994-01-01

We present a flux calibrated spectrum of the star listed as CY Tau in the `General Catalog of Variable Stars 4th ed.' in the spectral range 3700 A less than or equal to lambda less than or equal to 6400 A with a resolution of approximately equals 15 A showing the Balmer-Series from H(sub beta) to H(sub 10) as well as the CaII H (in blend with H(sub epsilon) and K lines in emission. Apart from the emission lines the spectrum is composed of a continuum equivalent to that of an ordinary pre-main sequence star (i.e. a `naked' T Tau) of spectral type M2 V with emission lines plus a `blue' veiling continuum that can be described as black body radiation of temperature T(sub BL) approximately equals 7000K due to accretion onto a boundary layer at a rate of M-dot(sub acc) greater than or approximately = 2.18 10(exp -8) solar mass/a.
HST eclipse mapping of dwarf nova OY Carinae in quiescence: An 'Fe II curtain' with Mach approx. = 6 velocity dispersion veils the white dwarf

NASA Technical Reports Server (NTRS)

Horne, Keith; Marsh, T. R.; Cheng, F. H.; Hubeny, Ivan; Lanz, Theirry

1994-01-01

Hubble Space Telescope (HST) observations of the eclipsing dwarf nova OY Car in its quiescent state are used to isolate the ultraviolet spectrum (1150-2500 A at 9.2 A Full Width at Half Maximum (FWHM) resolution) of the white dwarf, the accretion disk, and the bright spot. The white dwarf spectrum has a Stark-broadened photospheric L(alpha) absorption, but is veiled by a forest of blended Fe II features that we attribute to absorption by intervening disk material. A fit gives T(sub w) approx. = 16.5 x 10(exp 3) K for the white dwarf with a solar-abundance, log g = 8 model atmosphere, and T approx. = 10(exp 4) K, n(sub e) approx. = 10(exp 13)/cu cm, N(sub H) approx. = 10(exp 22) sq cm, and velocity dispersion delta V approx. = 60 km/s for the veil of homogeneous solar-abundance local thermodynamic equilibrium (LTE) gas. The veil parameters probably measure characteristic physical conditions in the quiescent accretion disk or its chromosphere. The large velocity dispersion is essential for a good fit; it lowers (chi square)/778 from 22 to 4. Keplerian shear can produce the velocity dispersion if the veiling gas is located at R approx. = 5 R(sub W) with (delta R)/R approx. = 0.3, but this model leaves an unobscured view to the upper hemisphere of the white dwarf, incompatible with absorptions that are up to 80% deep. The veiling gas may be in the upper atmosphere of the disk near its outer rim, but we then require supersonic (Mach approx. = 6) but sub-Keplerian (delta V/V(sub Kep) approx. = 0.07) velocity disturbances in this region to produce both the observed radial velocity dispersion and vertical motions sufficient to elevate the gas to z/R = cos i = 0.12. Such motions might be driven by the gas stream, since it may take several Kepler periods to reestablish the disk's vertical hydrostatic equilibrium. The temperature and column density of the gas we see as Fe II absorption in the ultraviolet are similar to what is required to produce the strong Balmer jump and
The Campus Diversity Initiative: A Case Study

ERIC Educational Resources Information Center

Nayak, Sharada

2005-01-01

This Case Study presents the Campus Diversity Initiative (CDI), a three-phase project lead by the Educational Resources Project Centre Trust, in New Delhi, India. In a historic and cultural context different from that of India, the American Diversity Initiative was launched by the Ford Foundation in 1990 and addressed their diversity issues by…
An open, prospective, randomized pilot investigation evaluating pain with the use of a soft silicone wound contact layer vs bridal veil and staples on split thickness skin grafts as a primary dressing.

PubMed

Patton, Mary Lou; Mullins, Robert Fred; Smith, David; Korentager, Richard

2013-01-01

An open, prospective, randomized, pilot investigation was implemented to evaluate the pain, cost-effectiveness, ease of use, tolerance, efficacy, and safety of a soft silicone wound contact layer (Mepitel One) vs Bridal Veil and staples used on split thickness skin grafts in the treatment of deep partial or full-thickness thermal burns. Individuals aged between 18 and 70 years with deep partial or full-thickness thermal burns (1-25% TBSA) were randomized into two groups and treated for 14 days or until greater than 95% graft take was achieved, whichever occurred first. Data were obtained and analyzed on pain experienced before, during, and after dressing removal. Secondary considerations included the overall cost (direct), graft take and healing, the ease of product use, overall experience of the dressing, and adverse events. A total of 43 subjects were recruited. There were no significant differences in burn area profiles within the groups. The pain level during dressing removal was significant between the groups (P = .0118) with the removal of Mepitel One being less painful. The staff costs were lower in the group of patients treated with Mepitel One (P = .0064) as reflected in the shorter time required for dressing removal (P = .0005), with Mepitel One taking on average less than a quarter of the time to remove. There was no significant difference in healing between the two groups, with 99.0% of the Mepitel One group and 93.1% of the Bridal Veil and staples group showing greater than 95% graft take at post-op day 7 (+/-1) (P = .2373). Clinicians reported that the soft silicone dressing was easier to use, more conformable, and demonstrated better ability to stay in place, compared with the Bridal Veil and staples regime. Both treatments were well tolerated, with no serious adverse events in either treatment group. Mepitel One was at least as effective in the treatment of patients as the standard care (Bridal Veil and staples). In addition, the group of patients
Scatter and veiling glare corrections for quantitative digital subtraction angiography

NASA Astrophysics Data System (ADS)

Ersahin, Atila; Molloi, Sabee Y.; Qian, Yao-Jin

1994-05-01

In order to quantitate anatomical and physiological parameters such as vessel dimensions and volumetric blood flow, it is necessary to make corrections for scatter and veiling glare (SVG), which are the major sources of nonlinearities in videodensitometric digital subtraction angiography (DSA). A convolution filtering technique has been investigated to estimate SVG distribution in DSA images without the need to sample the SVG for each patient. This technique utilizes exposure parameters and image gray levels to estimate SVG intensity by predicting the total thickness for every pixel in the image. At this point, corrections were also made for variation of SVG fraction with beam energy and field size. To test its ability to estimate SVG intensity, the correction technique was applied to images of a Lucite step phantom, anthropomorphic chest phantom, head phantom, and animal models at different thicknesses, projections, and beam energies. The root-mean-square (rms) percentage error of these estimates were obtained by comparison with direct SVG measurements made behind a lead strip. The average rms percentage errors in the SVG estimate for the 25 phantom studies and for the 17 animal studies were 6.22% and 7.96%, respectively. These results indicate that the SVG intensity can be estimated for a wide range of thicknesses, projections, and beam energies.
Measuring the health of populations: the veil of ignorance approach.

PubMed

Pinto-Prades, José-Luis; Abellán-Perpiñán, José-María

2005-01-01

We report the results from two surveys designed to explore whether an application of Harsanyi's principle of choice form behind a veil of ignorance (VEI) can be used in order to measure the health of populations. This approach was tentatively recommended by Murray et al. (Bull. World Health Organ 2000; 78: 981-994; Summary Measures of population health: Concepts, Ethics, Measurement and Applications, WHO, 2002.) as an appropriate way of constructing summary measures of population health (SMPH) for comparative purposes. The operationalization of the VEI approach used in this paper was suggested by Nord (Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications, WHO, 2002.). We test if VEI and person trade-off (PTO) methods generate similar quality-of-life weights. In addition, we compare VEI and PTO weights with individual utilities estimated by means of the conventional standard gamble (SG) and a variation of it we call double gamble. Finally, psychometric properties like feasibility, reliability, and consistency are examined. Our main findings are next: (1) VEI and PTO approaches generate very different weights; (2) it seems that differences between PTO and VEI are not due to the 'rule of rescue'; (3) the VEI resembled more a DG than a classical SG; (4) PTO, VEI, and DG exhibited good feasibility, reliability and consistency. Copyright 2004 John Wiley & Sons, Ltd.
Spectrum of dermoscopic patterns in lichen planus: a case series from China.

PubMed

Tan, Cheng; Min, Zhong-Sheng; Xue, Yanning; Zhu, Wen-Yuan

2014-01-01

Dermoscopy has been shown to be a promising method to facilitate the diagnosis of lichen planus (LP) outside of China. To investigate the spectrum of dermoscopic patterns in Chinese LP patients. The clinical data and dermoscopic patterns of nine LP cases with a total of 43 lesions were evaluated. To the naked eye, 20.97% of the lesions exhibited graying Wickham striae (WS); however, 37.5% presented with white streaks of annular, reticular, or leaf venation patterns under dermoscopy. Blue-white veils were occasionally observed in the center. Pigment patterns varied from dots, globules, and peppered pigment to pigmented lines, which were unrelated to the pigment network of the skin. At the periphery of the WS, red fine lines ran parallel to the delicate white streaming lines. WS exhibits five morphological patterns (leaf venation, reticular, white dots, circular and radial streaming) and three color patterns (homogeneous crystalline white, blue-white veil and yellowish-white). The pigment patterns consisted of dots/globules, peppered pigments and pigment. streaming lines.
Accessory cells with a veiled morphology and movement pattern generated from monocytes after avoidance of plastic adherence and of NADPH oxidase activation. A comparison with GM-CSF/IL-4-induced monocyte-derived dendritic cells.

PubMed

Ruwhof, Cindy; Canning, Martha O; Grotenhuis, Kristel; de Wit, Harm J; Florencia, Zenovia Z; de Haan-Meulman, Meeny; Drexhage, Hemmo A

2002-07-01

Veiled cells (VC) present in afferent lymph transport antigen from the periphery to the draining lymph nodes. Although VC in lymph form a heterogeneous population, some of the cells clearly belong on morphological grounds to the Langerhans cell (LC)/ dendritic cell (DC) series. Here we show that culturing monocytes for 24 hrs while avoiding plastic adherence (polypropylene tubes) and avoiding the activation of NADPH oxidase (blocking agents) results in the generation of a population of veiled accessory cells. The generated VC were actively moving cells like lymph-borne VC in vivo. The monocyte (mo)-derived VC population existed of CD14(dim/-) and CD14(brighT) cells. Of these the CD14(dim/-) VC were as good in stimulating allogeneic T cell proliferation as immature DC (iDC) obtained after one week of adherent culture of monocytes in granulocyte-macrophage-colony stimulating factor (GM-CSF)/interleukin (IL)-4. This underscores the accessory cell function of the mo-derived CD14(dim/-) VC. Although the CD14(dim/-)VC had a modest expression of the DC-specific marker CD83 and were positive for S100, expression of the DC-specific markers CD1a, Langerin, DC-SIGN, and DC-LAMP were absent. This indicates that the here generated CD14(dim/-) VC can not be considered as classical LC/DC. It was also impossible to turn the CD14(dim/-) mo-derived VC population into typical DC by culture for one week in GM-CSF/IL-4 or LPS. In fact the cells died tinder such circumstances, gaining some macrophage characteristics before dying. The IL-12 production from mo-derived CD14(dim/-) VC was lower, whereas the production of IL-10 was higher as compared to iDC. Consequently the T cells that were stimulated by these mo-derived VC produced less IFN-gamma as compared with T cells stimulated by iDC. Our data indicate that it is possible to rapidly generate a population of CD14(dim/-) veiled accessory cells from monocytes. The marker pattern and cytokine production of these VC indicate that this
Double jeopardy and the veil of ignorance--a reply.

PubMed

Harris, J

1995-06-01

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data.
Double jeopardy and the veil of ignorance--a reply.

PubMed Central

Harris, J

1995-01-01

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify some of the central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data. PMID:7674279
Workplace Education Initiative: Case Studies and Observations.

ERIC Educational Resources Information Center

Astrein, Bruce; And Others

Seven workplace education projects funded in the first year of the Massachusetts Workplace Education Initiative are reported. This report includes both general observations and specific information in case studies of the projects. Overall information is provided on students served, the importance of partnerships, the emphasis on…
29 CFR 101.17 - Initiation of representation cases and petitions for clarification and amendment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 2 2011-07-01 2011-07-01 false Initiation of representation cases and petitions for... BOARD STATEMENTS OF PROCEDURES Representation Cases Under Section 9(c) of the Act and Petitions for... Initiation of representation cases and petitions for clarification and amendment. The investigation of the...
29 CFR 101.17 - Initiation of representation cases and petitions for clarification and amendment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 2 2014-07-01 2014-07-01 false Initiation of representation cases and petitions for... BOARD STATEMENTS OF PROCEDURES Representation Cases Under Section 9(c) of the Act and Petitions for... Initiation of representation cases and petitions for clarification and amendment. The investigation of the...

The scaling of tongue projection in the veiled chameleon, Chamaeleo calyptratus.

PubMed

Herrel, Anthony; Redding, Chrystal L; Meyers, J Jay; Nishikawa, Kiisa C

2014-08-01

Within a year of hatching, chameleons can grow by up to two orders of magnitude in body mass. Rapid growth of the feeding mechanism means that bones, muscles, and movements change as chameleons grow while needing to maintain function. A previous morphological study showed that the musculoskeletal components of the feeding apparatus grow with negative allometry relative to snout-vent length (SVL) in chameleons. Here, we investigate the scaling of prey capture kinematics and muscle physiological cross-sectional area in the veiled chameleon, Chamaeleo calyptratus. The chameleons used in this study varied in size from approximately 3 to 18 cm SVL (1-200 g). Feeding sequences of 12 chameleons of different sizes were filmed and the timing of movements and the displacements and velocities of the jaws, tongue, and the hyolingual apparatus were quantified. Our results show that most muscle cross-sectional areas as well as tongue and hyoid mass scaled with isometry relative to mandible length, yet with negative allometry relative to SVL. Durations of movement also scaled with negative allometry relative to SVL and mandible length. Distances and angles generally scaled as predicted under geometric similarity (slopes of 1 and 0, respectively), while velocities generally scaled with slopes greater than 0 relative to SVL and mandible length. These data indicate that the velocity of jaw and tongue movements is generally greater in adults compared to juveniles. The discrepancy between the scaling of cross-sectional areas versus movements suggests changes in the energy storage and release mechanisms implicated in tongue projection. Copyright © 2014 Elsevier GmbH. All rights reserved.
Green University Initiatives in China: A Case of Tsinghua University

ERIC Educational Resources Information Center

Zhao, Wanxia; Zou, Yonghua

2015-01-01

Purpose: The purpose of this paper is to examine green university initiatives in the context of China, using Tsinghua University, which is China's green university pioneer, as a case study. Design/methodology/approach: The research method used for this paper is a case study based on participant observation and document analysis. The approach to…
Veiling and Accretion Around the Young Binary Stars S and VV Corona Australis

NASA Astrophysics Data System (ADS)

Sullivan, Kendall; Prato, Lisa; Avilez, Ian

2018-01-01

S CrA and VV CrA are two young binary star systems with separations of 170 AU and 250 AU, respectively, in the southern star-forming region Corona Australis. The spectral types of the four stars in these two systems are similar, approximately K7 to M1, hence the stellar masses are also similar. The study of young stars just emerging from their natal cloud cores at the very limits of observability allows us to probe the extreme environments in which planet formation begins to occur. Stars in this early evolutionary stage can have circumstellar or circumbinary disks, and sometimes remnants of the envelopes which surrounded them during the protostellar stage. Envelopes accrete onto disks and disks in turn accrete onto the central stars, triggering elevated continuum emission, line emission, outflows, and stellar winds. This violent stage marks the onset of the epoch of planet formation. Using high-resolution near-infrared, H-band spectroscopy from the Keck II telescope using the NIRSPEC instrument over 4-6 epochs, we are probing the chaotic environment surrounding the four stars in these systems. We determine the spectral types for VV CrA A and B for the first time, and examine the variable veiling and emission occurring around each of these stars. This research was supported in part by NSF grants AST-1461200 and AST-1313399.
The Veils of Titan

NASA Image and Video Library

2004-05-06

The veils of Saturn's most mysterious moon have begun to lift in Cassini's eagerly awaited first glimpse of the surface of Titan, a world where scientists believe organic matter rains from hazy skies and seas of liquid hydrocarbons dot a frigid surface. Surface features previously observed only from Earth-based telescopes are now visible in images of Titan taken in mid-April by Cassini through one of the narrow angle camera's spectral filters specifically designed to penetrate the thick atmosphere. The image scale is 230 kilometers (143 miles) per pixel, and it rivals the best Earth-based images. The two images displayed here show Titan from a vantage point 17 degrees below its equator, yielding a view from 50 degrees north latitude all the way to its south pole. The image on the left was taken four days after the image on the right. Titan rotated 90 degrees in that time. The two images combined cover a region extending halfway around the moon. The observed brightness variations suggest a diverse surface, with variations in average reflectivity on scales of a couple hundred kilometers. The images were taken through a narrow filter centered at 938 nanometers, a spectral region in which the only obstacle to light is the carbon-based, organic haze. Despite the rather long 38-second exposure times, there is no noticeable smear due to spacecraft motion. The images have been magnified 10 times and enhanced in contrast to bring out details. No further processing to remove the effects of the overlying atmosphere has been performed. The superimposed grid over the images illustrates the orientation of Titan -- north is up and rotated 25 degrees to the left -- as well as the geographical regions of the satellite that are illuminated and visible. The yellow curve marks the position of the boundary between day and night on Titan. The enhanced image contrast makes the region within 20 degrees of this day and night division darker than usual. The Sun illuminates Titan from the
A case of imported tungiasis in Scotland initially mimicking verrucae vulgaris.

PubMed

Wardhaugh, A D; Norris, J F

1994-10-01

A case is described of Tunga penetrans infection in the feet of a tourist returning from South America to Scotland. The condition had initially mimicked verrucae vulgaris, but microscopic examination of the lesions together with the travel history allowed the diagnosis of tungiasis to be made. This is the first case reported in Scotland.
Beacon Communities’ Public Health Initiatives: A Case Study Analysis

PubMed Central

Massoudi, Barbara L.; Marcial, Laura H.; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

2014-01-01

Introduction: The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. Background: The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Methods: Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Findings: Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7–14) present for each Beacon compared to barriers (range = 4–6). Discussion: Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. Conclusions: A common weakness was the lack of a framework or model for
Beacon communities' public health initiatives: a case study analysis.

PubMed

Massoudi, Barbara L; Marcial, Laura H; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

2014-01-01

The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6). Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach
78 FR 58546 - State System Development Initiative (SSDI) Grant Program; Single-Case Deviation From Competition...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-24

... Development Initiative (SSDI) Grant Program; Single- Case Deviation From Competition Requirements AGENCY...). ACTION: Notice of Single-Case Deviation from Competition Requirements for the Maternal and Child Health (MCH) Bureau's States System Development Initiative (SSDI) Grant. SUMMARY: HRSA will be issuing a non...
14 CFR 302.211 - Procedures in certificate cases involving initial or continuing fitness.

Code of Federal Regulations, 2010 CFR

2010-01-01

... initial or continuing fitness. 302.211 Section 302.211 Aeronautics and Space OFFICE OF THE SECRETARY... Disposition of Applications § 302.211 Procedures in certificate cases involving initial or continuing fitness... applicant's fitness to operate. Where such applications propose the operation of scheduled service in...
14 CFR 302.211 - Procedures in certificate cases involving initial or continuing fitness.

Code of Federal Regulations, 2011 CFR

2011-01-01

... initial or continuing fitness. 302.211 Section 302.211 Aeronautics and Space OFFICE OF THE SECRETARY... Disposition of Applications § 302.211 Procedures in certificate cases involving initial or continuing fitness... applicant's fitness to operate. Where such applications propose the operation of scheduled service in...
14 CFR 302.211 - Procedures in certificate cases involving initial or continuing fitness.

Code of Federal Regulations, 2012 CFR

2012-01-01

... initial or continuing fitness. 302.211 Section 302.211 Aeronautics and Space OFFICE OF THE SECRETARY... Disposition of Applications § 302.211 Procedures in certificate cases involving initial or continuing fitness... applicant's fitness to operate. Where such applications propose the operation of scheduled service in...
14 CFR 302.211 - Procedures in certificate cases involving initial or continuing fitness.

Code of Federal Regulations, 2014 CFR

2014-01-01

... initial or continuing fitness. 302.211 Section 302.211 Aeronautics and Space OFFICE OF THE SECRETARY... Disposition of Applications § 302.211 Procedures in certificate cases involving initial or continuing fitness... applicant's fitness to operate. Where such applications propose the operation of scheduled service in...
14 CFR 302.211 - Procedures in certificate cases involving initial or continuing fitness.

Code of Federal Regulations, 2013 CFR

2013-01-01

... initial or continuing fitness. 302.211 Section 302.211 Aeronautics and Space OFFICE OF THE SECRETARY... Disposition of Applications § 302.211 Procedures in certificate cases involving initial or continuing fitness... applicant's fitness to operate. Where such applications propose the operation of scheduled service in...
Effects of incubation temperature on growth and performance of the veiled chameleon (Chamaeleo calyptratus).

PubMed

Andrews, Robin M

2008-10-01

I evaluated the effect of incubation temperature on phenotypes of the veiled chameleon, Chamaeleo calyptratus. I chose this species for study because its large clutch size (30-40 eggs or more) allows replication within clutches both within and among experimental treatments. The major research objectives were (1) to assess the effect of constant low, moderate, and high temperatures on embryonic development, (2) to determine whether the best incubation temperature for embryonic development also produced the "best" hatchlings, and (3) to determine how a change in incubation temperature during mid-development would affect phenotype. To meet these objectives, I established five experimental temperature regimes and determined egg survival and incubation length and measured body size and shape, selected body temperatures, and locomotory performance of lizards at regular intervals from hatching to 90 d, or just before sexual maturity. Incubation temperature affected the length of incubation, egg survival, and body mass, but did not affect sprint speed or selected body temperature although selected body temperature affected growth in mass independently of treatment and clutch. Incubation at moderate temperatures provided the best conditions for both embryonic and post-hatching development. The highest incubation temperatures were disruptive to development; eggs had high mortality, developmental rate was low, and hatchlings grew slowly. Changes in temperature during incubation increased the among-clutch variance in incubation length relative to that of constant temperature treatments. Copyright 2008 Wiley-Liss, Inc.
Preventing Delays in First-Case Starts on the Neurosurgery Service: A Resident-Led Initiative at an Academic Institution.

PubMed

Han, Seunggu J; Rolston, John D; Zygourakis, Corinna C; Sun, Matthew Z; McDermott, Michael W; Lau, Catherine Y; Aghi, Manish K

2016-01-01

On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time. In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases. In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays. Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect. Copyright © 2015 Association of Program Directors in Surgery. Published by
Breast mass as the initial presentation of esophageal carcinoma: a case report

PubMed Central

Norooz, Mohammad Tayefeh; Ahmadi, Hamed; Zavarei, Mansour Jamali; Daryaei, Parviz

2009-01-01

Introduction Esophageal cancer is considered as a fatal malignancy. It mostly metastasizes to lung, liver, and bone while breast metastasis has been rarely reported. This is the fifth report of metastatic breast cancer from esophageal cancer, which differs from previous reported cases in terms of initial presentation with metastatic breast mass and no metastatic involvement of other organs. Case presentation We present a 35-year-old Caucasian woman who initially complained of a painful breast mass. Squamous pearls on cytologic evaluation suggested a metastatic lesion. Two months history of dysphagia was extracted through detailed interview with patient and further investigation revealed a stage IV esophageal squamous cell carcinoma. Conclusion In this case, breast lesion as an unusual presentation of esophageal carcinoma emphasizes the great role of thorough medical history taking and cytologic study in evaluating an accidentally detected breast mass. The increasing reports of breast metastasis in patients with esophageal carcinoma necessitate the careful breast examination in visits after treatment of the primary tumor. PMID:19829901
Two case reports of severe myocarditis associated with the initiation of dolutegravir treatment in HIV patients

PubMed Central

Mahlab-Guri, Keren; Asher, Ilan; Rosenberg-Bezalel, Shira; Elbirt, Daniel; Burke, Michael; Sthoeger, Zev M.

2016-01-01

Abstract Rationale: The integrase inhibitor dolutegravir is now recommended as first-line treatment for HIV. A single case of myocarditis after treatment with dolutegravir was reported in the FLAMINGO trial. We present here 2 cases of severe myocarditis that occurred shortly after the initiation of dolutegravir treatment. Patients concerns: The first case is a 45-year-old female who developed severe congestive heart failure and died, weeks after the initiation of dolutegravir treatment (for simplification of her antiretroviral regimen). The second case was a 51-year-old male who presented with effort dyspnea 3 weeks after the initiation of dolutegravir treatment and was later diagnosed as severe congestive heart failure. The treatment was changed and the patient survived, but he still suffers from severe heart failure with functional impairment. Diagnosis and Outcome: Patient 1 died, patient 2 suffers from severe heart failure. Lessons: We discuss here the possible relationship between the initiation of dolutegravir treatment and the development of lymphocytic myocarditis in our patients, and we suggest a possible mechanism. PMID:27893693
Making a Case for Organizational Change in Patient Safety Initiatives

DTIC Science & Technology

2005-05-01

or medical staff could be required to directly observe patient care processes. Such firsthand encounters with process flaws are particularly...can actually make patient safety worse. Take, for example, the previously described situation where nurses stopped reporting when the medication ...455 Making a Case for Organizational Change in Patient Safety Initiatives Rangaraj Ramanujam, Donna J. Keyser, Carl A. Sirio Abstract
Progressing From Initially Ambiguous Functional Analyses: Three Case Examples

PubMed Central

Tiger, Jeffrey H.; Fisher, Wayne W.; Toussaint, Karen A.; Kodak, Tiffany

2009-01-01

Most often functional analyses are initiated using a standard set of test conditions, similar to those described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994). These test conditions involve the careful manipulation of motivating operations, discriminative stimuli, and reinforcement contingencies to determine the events related to the occurrence and maintenance of problem behavior. Some individuals display problem behavior that is occasioned and reinforced by idiosyncratic or otherwise unique combinations of environmental antecedents and consequences of behavior, which are unlikely to be detected using these standard assessment conditions. For these individuals, modifications to the standard test conditions or the inclusion of novel test conditions may result in clearer assessment outcomes. The current study provides three case examples of individuals whose functional analyses were initially undifferentiated; however, modifications to the standard conditions resulted in the identification of behavioral functions and the implementation of effective function-based treatments. PMID:19233611
A Case Study of One-to-One Laptop Initiatives in Midwest Public High Schools

ERIC Educational Resources Information Center

Danielsen, Jeff Eugene

2009-01-01

The purpose of this case study was to discover the types of leadership policies and practices that make one-to-one laptop initiatives sustainable in three schools in South Dakota and Kansas. In order to implement a one-to-one initiative, administrators must determine what needs should be met ahead of the implementation. The needs may include…

Volcanic dust veils from sixth century tree-ring isotopes linked to reduced irradiance, primary production and human health.

PubMed

Helama, Samuli; Arppe, Laura; Uusitalo, Joonas; Holopainen, Jari; Mäkelä, Hanna M; Mäkinen, Harri; Mielikäinen, Kari; Nöjd, Pekka; Sutinen, Raimo; Taavitsainen, Jussi-Pekka; Timonen, Mauri; Oinonen, Markku

2018-01-22

The large volcanic eruptions of AD 536 and 540 led to climate cooling and contributed to hardships of Late Antiquity societies throughout Eurasia, and triggered a major environmental event in the historical Roman Empire. Our set of stable carbon isotope records from subfossil tree rings demonstrates a strong negative excursion in AD 536 and 541-544. Modern data from these sites show that carbon isotope variations are driven by solar radiation. A model based on sixth century isotopes reconstruct an irradiance anomaly for AD 536 and 541-544 of nearly three standard deviations below the mean value based on modern data. This anomaly can be explained by a volcanic dust veil reducing solar radiation and thus primary production threatening food security over a multitude of years. We offer a hypothesis that persistently low irradiance contributed to remarkably simultaneous outbreaks of famine and Justinianic plague in the eastern Roman Empire with adverse effects on crop production and photosynthesis of the vitamin D in human skin and thus, collectively, human health. Our results provide a hitherto unstudied proxy for exploring the mechanisms of 'volcanic summers' to demonstrate the post-eruption deficiencies in sunlight and to explain the human consequences during such calamity years.
Learning through Cases: Adopting a Nested Approach to Case-Study Work in the Gold Fields Participatory Course Initiative

ERIC Educational Resources Information Center

Lotz-Sisitka, Heila; Raven, Glenda

2004-01-01

This paper argues that there is a need, in southern Africa, to develop in-depth understanding in educational reform initiatives. Through ongoing reflexive development of a professional development programme in environmental education, we have found that case-study methodology, which emphasizes context-dependent knowledge, is significant for…
Physicians' Initial Forensic Impressions of Hypothetical Cases of Pediatric Traumatic Brain Injury

ERIC Educational Resources Information Center

Laskey, Antoinette L.; Sheridan, Michael J.; Hymel, Kent P.

2007-01-01

Objective: To describe physicians' initial forensic impressions of hypothetical cases of pediatric traumatic brain injury (TBI) and to compare the responses of pathologists and pediatricians. Method: A survey was administered to physicians who attended workshops on pediatric TBI; were members of two national internet list serves; and were members…
As Green as We Think? The Case of the College of Charleston Green Building Initiative

ERIC Educational Resources Information Center

Owens, Katharine A.; Halfacre-Hitchcock, Angela

2006-01-01

Purpose: This paper seeks to disseminate knowledge regarding the experiences of a student team in implementing a campus-level sustainability initiative, outlining the strategy to measure the potential impact of this initiative. Design/methodology/approach: Project design is a case study. Via interviewing and surveys, the study observed student and…
Paradise nearly Gained. Volume 2: Case Studies of Impact and Diversity for Frontline Management Initiative Practice.

ERIC Educational Resources Information Center

Barratt-Pugh, Llandis; Soutar, Geoffrey N.

This document presents the case studies from a multi-phase study of the impact of Australia's Frontline Management Initiative (FMI), which provides a framework for competency-based development of frontline managers in Australian enterprises. Nineteen organizational case studies and one individual case study of the FMI's impacts are included. The…
Eukaryotic cell encystation and cancer cell dormancy: is a greater devil veiled in the details of a lesser evil?

PubMed

Baig, Abdul Mannan; Khan, Naveed Ahmed; Abbas, Farhat

2015-03-01

Cancer cell dormancy is the main cause of cancer recurrence and failure of therapy as dormant cells evade not only the anticancer drugs but also the host immune system. These dormant cells veil themselves from detection by imaging and/or using biomarkers, which imposes an additional problem in targeting such cells. A similar form of hibernation process known as encystation is studied in detail for pathogenic unicellular eukaryotic microorganisms. By examination using microarray gene expression profiles, immunocytochemistry tools, and siRNAs during the process of encystation, understanding the covert features of cancer cell dormancy as proposed could be possible. This knowledge can be extended to dormant cancer cells to uncover the mechanisms that underlie this ghost, yet dangerous state of human cancers. We propose a strategy to induce dormancy and exit this state by application of knowledge gained from the encystation induction and retrieval processes in pathogenic eukaryotic microorganisms. Given that early detection and characterization of dormant malignant tumor cells is important as a general strategy to monitor and prevent the development of overt metastatic disease, this homology may enable the design of therapies that could either awake the dormant cell from dormancy to make it available for therapies or prolong such a phase to make cancer appear as a chronic disease.
Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and
Progressing from initially ambiguous functional analyses: three case examples.

PubMed

Tiger, Jeffrey H; Fisher, Wayne W; Toussaint, Karen A; Kodak, Tiffany

2009-01-01

Most often functional analyses are initiated using a standard set of test conditions, similar to those described by Iwata, Dorsey, Slifer, Bauman, and Richman [Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197-209 (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3-20, 1982)]. These test conditions involve the careful manipulation of motivating operations, discriminative stimuli, and reinforcement contingencies to determine the events related to the occurrence and maintenance of problem behavior. Some individuals display problem behavior that is occasioned and reinforced by idiosyncratic or otherwise unique combinations of environmental antecedents and consequences of behavior, which are unlikely to be detected using these standard assessment conditions. For these individuals, modifications to the standard test conditions or the inclusion of novel test conditions may result in clearer assessment outcomes. The current study provides three case examples of individuals whose functional analyses were initially undifferentiated; however, modifications to the standard conditions resulted in the identification of behavioral functions and the implementation of effective function-based treatments.
An Empirical Case Study of a Child Sexual Abuse Prevention Initiative in Georgia

ERIC Educational Resources Information Center

Schober, Daniel J.; Fawcett, Stephen B.; Thigpen, Sally; Curtis, Anna; Wright, Renee

2012-01-01

Objective: This empirical case study describes Prevent Child Abuse Georgia's effort to prevent child sexual abuse (CSA) by educating communities throughout the state on supporting preventive behaviour. The initiative consisted of three major components: (1) dissemination of CSA prevention messages and materials; (2) a statewide helpline that…
Here Today Gone Tomorrow: Conceptualizing Instructional Leadership through Case Studies of Unsustained Initiatives

ERIC Educational Resources Information Center

Shulman, Vivian; Sullivan, Susan

2015-01-01

This study examines two case studies of failed leadership in school-based professional development. We describe the two initiatives and look to current leadership theories to help account for the events that occurred. The sociologist Bourdieu's concept of "habitus" offers an approach to understanding the relationship between individual…
Initiating Transdisciplinarity in Academic Case Study Teaching: Experiences from a Regional Development Project in Salzburg, Austria

ERIC Educational Resources Information Center

Muhar, Andreas; Vilsmaier, Ulli; Glanzer, Michaela; Freyer, Bernhard

2006-01-01

Purpose: The purpose of this paper is to describe experiences with the initiation of transdisciplinarity in academic case study teaching with special reference to regional planning, based on the case study "Leben 2014 (Life 2014)--perspectives for regional development in the national park region Ober-pinz-gau, Salzburg".…
Penis deformity after intra-urethral liquid paraffin administration in a young male: a case report

PubMed Central

Kokkonouzis, Ioannis; Antoniou, Georgios; Droulias, Athanasios

2008-01-01

Background Self-induced injections of liquid substances mainly for penis enlargement is a well-documented but still rather uncommon practice in the western world. Case presentation Herein we present the case of a 30-year-old male who self-inflicted, twice in a six-month-period, intra-urethral liquid paraffin and tied up his penis with a cord in order to achieve both enlargement and elongation. He arrived in our emergency department suffering from suprapubic pain; physical examination revealed a rather unique deformity of the penis. He finally refused any treatment and absconded. Conclusion Side effects after paraffin administration are various and sometimes severe. Most of the times surgical treatment is needed and radical excision together with follow-up seems the best modality. Such practices emphasize on the public's misbelieves and that some aspects of sexual medicine are yet covered with the veil of misconception. PMID:18840268
Parental Involvement in Active Transport to School Initiatives: A Multi-Site Case Study

ERIC Educational Resources Information Center

Eyler, Amy; Baldwin, Julie; Carnoske, Cheryl; Nickelson, Jan; Troped, Philip; Steinman, Lesley; Pluto, Delores; Litt, Jill; Evenson, Kelly; Terpstra, Jennifer; Brownson, Ross; Schmid, Thomas

2008-01-01

Background: Increasing physical activity in youth is a recommended approach to curbing the childhood obesity epidemic. One way to help increase children's daily activity is to promote active transportation to and from school (ATS). Purpose: The purpose of this case study was to explore parental perception of, and participation in, ATS initiatives.…
Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm*

PubMed Central

da Silva, Vanessa Priscilla Martins; Ikino, Juliana Kida; Sens, Mariana Mazzochi; Nunes, Daniel Holthausen; Di Giunta, Gabriella

2013-01-01

BACKGROUND Dermoscopy allows the early detection of melanomas. The preoperative determination of Breslow index by dermoscopy could be useful in planning the surgical approach and in selecting patients for sentinel lymph node biopsy. OBJECTIVES This study aims at describing the dermoscopic features of thin melanomas and comparing melanomas in situ with invasive melanomas less than or equal to 1 mm thick. METHODS This was an observational retrospective study in which the dermoscopy photographs of 41 thin melanomas were evaluated. Three observers evaluated together 14 dermoscopic criteria. RESULTS Among thin melanomas, the most frequent criteria were presence of asymmetry in two axes in 95% of cases (39 cases), 3 or more colors in 80.4% of cases (33 cases), atypical dots or globules in 58.5% of cases (24 cases) and atypical network or streaks in 53.6% of cases (22 cases). The group of invasive melanomas presented with a higher frequency and statistical significance (p <0.05) 3 or more colors (OR: 16.1), milky red areas (OR: 4.8) and blue-white veil (OR: 20.4), and a greater tendency to have streaks or atypical network (OR: 3.66). CONCLUSIONS Thin melanomas tend to have asymmetry in the two axes, 3 or more colors, atypical dots or globules and atypical network or streaks. Melanomas in situ tend to have up to 2 colors, no blue-white veil and no milky red area. Invasive melanomas tend to have 3 or more colors, a milky red area, blue-white veil, and atypical network or streaks. Further studies are needed to confirm these findings. PMID:24173175
The Forces Shaping National Response(s) to Global Educational Regulatory Initiatives: The Case for Germany and Ontario

ERIC Educational Resources Information Center

Adam, Edmund G.

2017-01-01

This article argues that the stance toward global regulatory initiatives is influenced by the extent to which these regulatory initiatives threaten the comparative institutional advantages of the national economy. The cases through which this proposition is examined are the showpieces of Germany and Ontario: their system of vocational education…
Production flush of Agaricus blazei on Brazilian casing layers

PubMed Central

Colauto, Nelson Barros; da Silveira, Adriano Reis; da Eira, Augusto Ferreira; Linde, Giani Andrea

2011-01-01

This study aimed to verify the biological efficiency and production flushes of Agaricus blazei strains on different casing layers during 90 cultivation days. Four casing layers were used: mixture of subsoil and charcoal (VCS), lime schist (LSC), São Paulo peat (SPP) and Santa Catarina peat (SCP); and two genetically distant A. blazei strains. The fungus was grown in composted substratum and, after total colonization, a pasteurized casing layer was added over the substratum, and fructification was induced. Mushrooms were picked up daily when the basidiocarp veil was stretched, but before the lamella were exposed. The biological efficiency (BE) was determined by the fresh basidiocarp mass divided by the substratum dry mass, expressed in percentage. The production flushes were also determined over time production. The BE and production flushes during 90 days were affected by the strains as well as by the casing layers. The ABL26 and LSC produced the best BE of 60.4%. Although VCS is the most used casing layer in Brazil, it is inferior to other casing layers, for all strains, throughout cultivation time. The strain, not the casing layer, is responsible for eventual variations of the average mushroom mass. In average, circa 50% of the mushroom production occurs around the first month, 30% in the second month, and 20% in third month. The casing layer water management depends on the casing layer type and the strain. Production flush responds better to water reposition, mainly with ABL26, and better porosity to LSC and SCP casing layers. PMID:24031673
Tics as an initial manifestation of juvenile Huntington's disease: case report and literature review.

PubMed

Cui, Shi-Shuang; Ren, Ru-Jing; Wang, Ying; Wang, Gang; Chen, Sheng-Di

2017-08-08

Huntington's disease (HD) is an autosomal dominant disorder, typically characterized by chorea due to a trinucleotide repeat expansion in the HTT gene, although the clinical manifestations of patients with juvenile HD (JHD) are atypical. A 17-year-old boy with initial presentation of tics attended our clinic and his DNA analysis demonstrated mutation in the HTT gene (49 CAG repeats). After treatment, his symptoms improved. Furthermore, we performed literature review through searching the databases and summarized clinical features in 33 JHD patients. The most prevalent symptoms are ataxia, and two cases reported that tics as initial and prominent manifestation in JHD. Among them, 88% patients carried CAG repeats beyond 60 and most of them have family history. This case here illustrates the variable range of clinical symptoms of JHD and the necessity of testing for the HD mutation in young patients with tics with symptoms unable to be explained by Tourette's syndrome (TS).
Eagle's syndrome veiling as pain of odontogenic origin: Report of two cases with cone beam computed tomography illustration

PubMed Central

Ranjan, Vikash; Rai, Shalu; Misra, Deepankar; Panjwani, Sapna

2015-01-01

Eagle's syndrome, also known as an elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of facial neuralgia and or oral, dental, and temporomandibular joint diseases. In this paper, there are two cases, which reported to the Department of Oral Medicine, Diagnosis, and Maxillofacial Radiology, with a chief complaint of radiating pain in the preauricular region of the face. After radiographic investigation, these cases are considered as a case of Eagle's syndrome because of increase in the size of the styloid process. PMID:27390501
Technology Integration in a One-to-One Laptop Initiative: A Multiple Case Study Analysis

ERIC Educational Resources Information Center

Jones, Marsha B.

2013-01-01

The purpose of this multiple case study analysis was to examine teachers' experiences and perceptions in order to understand what actions and interactions supported or inhibited technology integration during a one-to-one laptop initiative. This research sought to gain teachers' perspectives on the challenges and successes they faced as classroom…
Meditative Vail Painting: A Finnish Creative Arts Therapist's Transpersonal Journey

ERIC Educational Resources Information Center

Sky Hiltunen, Sirkku M.

2006-01-01

Anthroposophy has made the spiritual a living experience by producing numerous practical applications, such as veil painting, initially created by Liane Collot d'Herbois (1988). Its theoretical framework has been substantially simplified by the author and crucial meditative and contemplative steps have been added. European and American…

Exploring Readiness, Motivation, and Capacity for Implementing an iPad Campus Initiative: A Rural Community College Case Study

ERIC Educational Resources Information Center

Smith, Douglas A.; Coleman, Dawn

2018-01-01

This intrinsic case study explored organizational readiness to implement a campus-wide technology initiative. Specifically, this research examined a rural community college's implementation of an "iPad campus" initiative in which all students, faculty, and staff were required to adopt iPad technology. We apply a heuristic for…
Targeting the initial investigation and management in cases of acute pulmonary embolism.

PubMed

Moore, Nicholas; Hawkins, Peter

2013-01-01

It was noted by consultants in our hospital that the early investigation of suspected pulmonary embolism (PE) lacked structure. This was causing delays in definitive diagnosis and early management. The resulting unnecessary use of investigation was also wasting resources. In particular, the inappropriate use of serum d-dimer tests was causing concern. The National Institute of Clinical Excellence (NICE) guidelines recommend use of the 2-level Well's score to target investigation in suspected PE. A baseline audit against the NICE guideline revealed that Well's scores were rarely used (only calculated in 12% of cases) and confirmed the suspicion that early investigation was poorly targeted. This project intervened using educational talks promoting the use of Well's scores in cases of suspected PE. Well's score proformas were placed in the emergency department and emergency assessment unit for reference. Their availability was advertised. This significantly increased the use of Well's scores (46% vs 11%, p<0.001). Fewer patients underwent unnecessary d-dimer measurements in cases of likely PE (65% vs 86%). Initial investigation was more targeted in cases where a Well's score had been calculated than in cases without a Well's score. For example, significantly fewer unnecessary d-dimer tests were performed in these cases (45% vs 100%, p<0.05). The cost of unnecessary investigation in suspected PE is not only significant financially but also in the resulting delay in definitive diagnosis and management for the patient. The simple intervention used here was effective in addressing this problem.
Learning from Experience: A Cross-Case Comparison of School-to-Work Transition Reform Initiatives.

ERIC Educational Resources Information Center

Rogers, Anne M.; And Others

A cross-case study approach was used to determine how school-to-work reform affects clients and participants and to identify elements critical to the success of school-to-work systems. Fourteen school-to-work reform initiatives in communities across the United States were examined by using a research protocol that included individual interviews,…
Personal Development Planning in Initial Teacher Training: A Case Study from Post-Compulsory Education

ERIC Educational Resources Information Center

Thompson, Ron; Hallwood, Linda; Clements, Christine; Rivron, Helen

2009-01-01

This paper provides a case study of personal development planning (PDP) within an initial teacher training course for the post-compulsory sector, delivered through a large consortium in the north of England. The paper reviews conceptual and empirical studies of PDP in higher education and reports on the practice and perceptions of students and…
[Constraints and opportunities for inter-sector health promotion initiatives: a case study].

PubMed

Magalhães, Rosana

2015-07-01

This article analyzes the implementation of inter-sector initiatives linked to the Family Grant, Family Health, and School Health Programs in the Manguinhos neighborhood in the North Zone of Rio de Janeiro, Brazil. The study was conducted in 2010 and 2011 and included document review, local observation, and 25 interviews with program managers, professionals, and staff. This was an exploratory case study using a qualitative approach that identified constraints and opportunities for inter-sector health experiences, contributing to the debate on the effectiveness of health promotion and poverty relief programs.
A Case Study of Team-Initiated Problem Solving Addressing Student Behavior in One Elementary School

ERIC Educational Resources Information Center

Todd, Anne W.; Horner, Robert H.; Berry, Dorothy; Sanders, Carol; Bugni, Michelle; Currier, Allison; Potts, Nicky; Newton, J. Stephen; Algozzine, Bob; Algozzine, Kate

2012-01-01

Team-Initiated Problem Solving (TIPS) is an approach for organizing school team meetings to improve identification of targeted problems, use of data in the development of solutions, and development of implemented action plans. TIPS has been demonstrated in single-case and randomized controlled trial studies to improve the effectiveness of teams to…
Organizational Context Matters: A Research Toolkit for Conducting Standardized Case Studies of Integrated Care Initiatives

PubMed Central

Grudniewicz, Agnes; Gray, Carolyn Steele; Wodchis, Walter P.; Carswell, Peter; Baker, G. Ross

2017-01-01

Introduction: The variable success of integrated care initiatives has led experts to recommend tailoring design and implementation to the organizational context. Yet, organizational contexts are rarely described, understood, or measured with sufficient depth and breadth in empirical studies or in practice. We thus lack knowledge of when and specifically how organizational contexts matter. To facilitate the accumulation of evidence, we developed a research toolkit for conducting case studies using standardized measures of the (inter-)organizational context for integrating care. Theory and Methods: We used a multi-method approach to develop the research toolkit: (1) development and validation of the Context and Capabilities for Integrating Care (CCIC) Framework, (2) identification, assessment, and selection of survey instruments, (3) development of document review methods, (4) development of interview guide resources, and (5) pilot testing of the document review guidelines, consolidated survey, and interview guide. Results: The toolkit provides a framework and measurement tools that examine 18 organizational and inter-organizational factors that affect the implementation and success of integrated care initiatives. Discussion and Conclusion: The toolkit can be used to characterize and compare organizational contexts across cases and enable comparison of results across studies. This information can enhance our understanding of the influence of organizational contexts, support the transfer of best practices, and help explain why some integrated care initiatives succeed and some fail. PMID:28970750
An initially unidentified case of urinary tract infection due to Aerococcus urinae.

PubMed

Meletis, Georgios; Chatzidimitriou, Dimitrios; Tsingerlioti, Fani; Chatzopoulou, Fani; Tzimagiorgis, Georgios

2017-07-01

Aerococcus urinae is a microorganism responsible for urinary tract and blood stream infections which are rarely reported in clinical practice. However, it has been proposed that the infrequency of such reports may be partially due to difficulties related to pathogen identification. We present here a case of an elderly male patient with urinary tract infection where A. urinae was initially not identified by a private microbiology laboratory. Our report highlights the need to consider A. urinae as a causative agent of urinary tract infections because if not identified and properly treated it may lead to endocarditis or septicemia.
Syncope as initial symptom for nephrotic syndrome: a case report

PubMed Central

Wu, Xuemei; Wang, Guangliang; Feng, Jiachun

2015-01-01

Although syncope and nephrotic syndrome are frequently encountered independently in pediatric practice, syncope as the initial symptom for nephrotic syndrome is rarely observed in the pediatric age group. In this report, we present the case of 3-year-old boy with nephrotic syndrome who presented with a history of three episodes of syncope before admission. The syncope occurred after excessive fluid loss or inadequate intake of fluids and was relieved spontaneously. History taking revealed that the early morning palpebral edema, and laboratory tests showed decreased plasma protein levels and elevated serum lipid levels. Nephrotic syndrome was diagnosed, but could not be confirmed histopathologically because the patient’s parent refused consent for biopsy. The patient was managed with fluid expansion, correction of acidosis, and improvement of microcirculation to prevent recurrence of syncope, and glucocorticoids were administered to prevent disease progression. PMID:26629237
Penis deformity after intra-urethral liquid paraffin administration in a young male: a case report.

PubMed

Kokkonouzis, Ioannis; Antoniou, Georgios; Droulias, Athanasios

2008-10-07

Self-induced injections of liquid substances mainly for penis enlargement is a well-documented but still rather uncommon practice in the western world. Herein we present the case of a 30-year-old male who self-inflicted, twice in a six-month-period, intra-urethral liquid paraffin and tied up his penis with a cord in order to achieve both enlargement and elongation. He arrived in our emergency department suffering from suprapubic pain; physical examination revealed a rather unique deformity of the penis. He finally refused any treatment and absconded. Side effects after paraffin administration are various and sometimes severe. Most of the times surgical treatment is needed and radical excision together with follow-up seems the best modality. Such practices emphasize on the public's misbelieves and that some aspects of sexual medicine are yet covered with the veil of misconception.
[Periorbital edema as the initial symptom of lupus erythematosus profundus. Case report and discussion of the literature].

PubMed

Franke, W; Kuhn, A; Megahed, M; Krutmann, J; Ruzicka, T; Lehmann, P

1999-12-01

Periorbital edema may occur initially or in the course of a wide variety of diseases. One of these diseases is lupus panniculitis, a variant of lupus erythematosus, characterized by firm subcutaneous nodules that may ulcerate with subsequent scar formation. We present a case of lupus panniculitis in which the periorbital edema was the initial manifestation. Knowledge about the differential diagnostic possibilities of periorbital edema as well as the different variants of cutaneous lupus erythematosus is important to reach the correct diagnosis.
Spectral Variations of T Tauri stars

NASA Astrophysics Data System (ADS)

Guenther, E.

1994-02-01

continuum is determined by subtracting a flux calibrated, scaled template spectrum from the flux calibrated, deredened T Taui star spectrum. The spectra of the veiling continuum exhibit a strong, variable Balmer Jump, but no Pashen Jump is seen. Hα is the only emission line in the spectrum of BM And, all other Balmer lines and the lines of He I appear in absorption, and are redshifted by at least 100 km/s. While the correlation between Hα and the veiling continuum is high, the correlation between all redshifted absorption lines and the veiling continuum is very low. From a comparison of observed and computed profiles of He I it is concluded that this line might form close to an accretion shock, and so should the higher Balmer. Since no redshifted absorption component is seen in Hα, the emission component must be optically thick, and should then be formed at a larger distance from the star than the redshifted absorption components, and hence the veiling continuum. The observations of BM And clearly show that the magnetic model is valid in this case, but the veiling continuum is not the emission of the accretion shock itself. DG Tau and DI Cep show the same kind of behavior. All emission lines have correlation factors between about 0.3 and 0.8. The highest correlations are found in the Balmer lines and low excitation Fe I and Fe II lines. There are no delay effects between the lines, all lines reach their maxima and minima at the same time. From the large Balmer decrement, and calculation of the Balmer lines and the veiling continuum in a simple slab model, it is concluded that the emitting region that is responsible for the emission lines and the veiling continuum has a temperature of 10000 K, and a density of 3**1018m-3 or less. In the slab geometry this corresponds to an emitting region which is at least 10000 km (≅ 0.01 R*) thick. It can thus be concluded that the region emitting the veiling continuum is relatively large and thin.
Reconstructing mantle volatile contents through the veil of degassing

NASA Astrophysics Data System (ADS)

Tucker, J.; Mukhopadhyay, S.; Gonnermann, H. M.

2014-12-01

The abundance of volatile elements in the mantle reveals critical information about the Earth's origin and evolution such as the chemical constituents that built the Earth and material exchange between the mantle and exosphere. However, due to magmatic degassing, volatile element abundances measured in basalts usually do not represent those in undegassed magmas and hence in the mantle source of the basalts. While estimates of average mantle concentrations of some volatile species can be obtained, such as from the 3He flux into the oceans, volatile element variability within the mantle remains poorly constrained. Here, we use CO2-He-Ne-Ar-Xe measurements in basalts and a new degassing model to reconstruct the initial volatile contents of 8 MORBs from the Mid-Atlantic Ridge and Southwest Indian Ridge that span a wide geochemical range from depleted to enriched MORBs. We first show that equilibrium degassing (e.g. Rayleigh degassing), cannot simultaneously fit the measured CO2-He-Ne-Ar-Xe compositions in MORBs and argue that kinetic fractionation between bubbles and melt lowers the dissolved ratios of light to heavy noble gas species in the melt from that expected at equilibrium. We present a degassing model (after Gonnermann and Mukhopadhyay, 2007) that explicitly accounts for diffusive fractionation between melt and bubbles. The model computes the degassed composition based on an initial volatile composition and a diffusive timescale. To reconstruct the undegassed volatile content of a sample, we find the initial composition and degassing timescale which minimize the misfit between predicted and measured degassed compositions. Initial 3He contents calculated for the 8 MORB samples vary by a factor of ~7. We observe a correlation between initial 3He and CO2 contents, indicating relatively constant CO2/3He ratios despite the geochemical diversity and variable gas content in the basalts. Importantly, the gas-rich popping rock from the North Atlantic, as well as the
Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis.

PubMed

Burton, Rachel A; Lallemand, Nicole M; Peters, Rebecca A; Zuckerman, Stephen

2018-02-05

Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by
Serial magnetic resonance imaging findings in subarachnoid hemorrhage due to an initially angiographically occult type II spinal aneurysm: Case report.

PubMed

Kogan, Michael; Morr, Simon; Siddiqui, Adnan H

2017-04-28

Spinal aneurysms are rare causes of spontaneous subarachnoid hemorrhage. We present an unusual, initially occult, case of an upper thoracic intradural extramedullary isolated aneurysm arising from the T2 intercostal-radicular circulation that was initially angiographically occult but was discovered due to unique, albeit nonspecific, magnetic resonance imaging findings of spinal cord T2 hyperintensity and contrast enhancement that were noted to progress with a clinical picture of ictal rehemorrhage. Repeat spinal angiography revealed a spinal aneurysm that was treated surgically. In cases of sufficient clinical suspicion and nonspecific imaging findings, continued vigilance is advised in seeking an underlying pathoanatomic etiology.
Peripolesis followed by cytotoxicity in chronic idiopathic inflammatory bowel disease.

PubMed Central

Wilders, M M; Drexhage, H A; Kokjé, M; Verspaget, H W; Meuwissen, S G

1984-01-01

Antigen presenting veiled cells have recently been described in cell suspensions prepared from the gut wall of patients with chronic idiopathic inflammatory bowel disease (CIBD). The normal gut wall is virtually devoid of these cells. In this report we describe a phenomenon known as peripolesis studied by phase contrast cinematography. This is a process in which lymphocytes are seen to wander around larger target cells. These could be identified ultrastructurally as Ia positive veiled cells. In most cases peripolesis was followed by lysis of the target cell. Peripolesis was recorded in cell suspensions of three out of seven patients with ulcerative colitis and in three out of nine patients with Crohn's disease; furthermore peripolesis was observed in one out of two patients with non-classifiable CIBD. In four cell suspensions showing peripolesis, cell lysis could be recorded and was especially striking in ulcerative colitis. Peripolesis involving veiled cells was previously described in delayed hypersensitivity reactions. This study lends support to the concept that delayed allergic reactivity plays a part in chronic inflammatory bowel disease. The antigens involved are, however, completely unknown. Images Fig. 1 Fig. 2 Fig. 3 PMID:6380839
Big Earth Data Initiative: Metadata Improvement: Case Studies

NASA Technical Reports Server (NTRS)

Kozimor, John; Habermann, Ted; Farley, John

2016-01-01

Big Earth Data Initiative (BEDI) The Big Earth Data Initiative (BEDI) invests in standardizing and optimizing the collection, management and delivery of U.S. Government's civil Earth observation data to improve discovery, access use, and understanding of Earth observations by the broader user community. Complete and consistent standard metadata helps address all three goals.
ICT Integration in Mathematics Initial Teacher Training and Its Impact on Visualization: The Case of GeoGebra

ERIC Educational Resources Information Center

Dockendorff, Monika; Solar, Horacio

2018-01-01

This case study investigates the impact of the integration of information and communications technology (ICT) in mathematics visualization skills and initial teacher education programmes. It reports on the influence GeoGebra dynamic software use has on promoting mathematical learning at secondary school and on its impact on teachers' conceptions…
Case of recurrent paracoccidioidomycosis in female. 10 years after initial treatment.

PubMed

De Azevedo Izidoro, Ana Claudia Santos; Da Silva, Paulo Cesar; De Oliveira Ribas, Marina; De Azevedo, Luciana Reis; Machado, Maria Angela Naval; De Lima, Antonio Adilson Soares

2007-05-01

This report describes a case of recurrence of chronic paracoccidioidomycosis 10 years following the initial diagnosis. A 56-year-old female was admitted to the Dental Clinic of the Pontifical Catholic University of Paraná complaining of oral soreness. Mulberry-like ulcerations were observed on the gingiva, right labial comissura, and vermillion of the lip. The patient reported persistent chronic cough, weight loss, appetite loss and fever. The anamnesis revealed that the patient had developed and been treated for paracoccidioidomycosis 10 years earlier. A biopsy was performed and microscopic examination revealed microabscesses, collections of macrophages organized into granulomas, multinucleated giant cells and Paracoccidioides brasiliensis. The patient was treated with Itraconazole and, the oral lesions disappeared within 3 months. Persistent follow-up examination in patients with a history of paracoccidioidomycosis is essential in the management of this disease.
Adult-onset Still's disease initially thought to be an odontogenic infection: A case report.

PubMed

Hino, Shunsuke; Nakamura, Satoshi; Kaneko, Takahiro; Horie, Norio; Shimoyama, Tetsuo

2018-06-01

To present a case of Adult-onset Still's disease (AOSD) initially suspected to be odontogenic inflammation. Adult-onset Still's disease is a rare, complex autoinflammatory disease and a known cause of fever of unknown origin. The patient had both a fever and dental pain. Following meticulous examination, the patient was diagnosed with AOSD. Clinicians should keep in mind that a patient such as AOSD may visit their clinics. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Characterization of Metarhizium viride Mycosis in Veiled Chameleons (Chamaeleo calyptratus), Panther Chameleons (Furcifer pardalis), and Inland Bearded Dragons (Pogona vitticeps).

PubMed

Schmidt, Volker; Klasen, Linus; Schneider, Juliane; Hübel, Jens; Pees, Michael

2017-03-01

Metarhizium viride has been associated with fatal systemic mycoses in chameleons, but subsequent data on mycoses caused by this fungus in reptiles are lacking. The aim of this investigation was therefore to obtain information on the presence of M. viride in reptiles kept as pets in captivity and its association with clinical signs and pathological findings as well as improvement of diagnostic procedures. Beside 18S ribosomal DNA (rDNA) (small subunit [SSU]) and internal transcribed spacer region 1 (ITS-1), a fragment of the large subunit (LSU) of 28S rDNA, including domain 1 (D1) and D2, was sequenced for the identification of the fungus and phylogenetic analysis. Cultural isolation and histopathological examinations as well as the pattern of antifungal drug resistance, determined by using agar diffusion testing, were additionally used for comparison of the isolates. In total, 20 isolates from eight inland bearded dragons ( Pogona vitticeps ), six veiled chameleons ( Chamaeleo calyptratus ), and six panther chameleons ( Furcifer pardalis ) were examined. Most of the lizards suffered from fungal glossitis, stomatitis, and pharyngitis or died due to visceral mycosis. Treatment with different antifungal drugs according to resistance patterns in all three different lizard species was unsuccessful. Sequence analysis resulted in four different genotypes of M. viride based on differences in the LSU fragment, whereas the SSU and ITS-1 were identical in all isolates. Sequence analysis of the SSU fragment revealed the first presentation of a valid large fragment of the SSU of M. viride According to statistical analysis, genotypes did not correlate with differences in pathogenicity, antifungal susceptibility, or species specificity. Copyright © 2017 American Society for Microbiology.
Characterization of Metarhizium viride Mycosis in Veiled Chameleons (Chamaeleo calyptratus), Panther Chameleons (Furcifer pardalis), and Inland Bearded Dragons (Pogona vitticeps)

PubMed Central

Klasen, Linus; Schneider, Juliane; Hübel, Jens; Pees, Michael

2016-01-01

ABSTRACT Metarhizium viride has been associated with fatal systemic mycoses in chameleons, but subsequent data on mycoses caused by this fungus in reptiles are lacking. The aim of this investigation was therefore to obtain information on the presence of M. viride in reptiles kept as pets in captivity and its association with clinical signs and pathological findings as well as improvement of diagnostic procedures. Beside 18S ribosomal DNA (rDNA) (small subunit [SSU]) and internal transcribed spacer region 1 (ITS-1), a fragment of the large subunit (LSU) of 28S rDNA, including domain 1 (D1) and D2, was sequenced for the identification of the fungus and phylogenetic analysis. Cultural isolation and histopathological examinations as well as the pattern of antifungal drug resistance, determined by using agar diffusion testing, were additionally used for comparison of the isolates. In total, 20 isolates from eight inland bearded dragons (Pogona vitticeps), six veiled chameleons (Chamaeleo calyptratus), and six panther chameleons (Furcifer pardalis) were examined. Most of the lizards suffered from fungal glossitis, stomatitis, and pharyngitis or died due to visceral mycosis. Treatment with different antifungal drugs according to resistance patterns in all three different lizard species was unsuccessful. Sequence analysis resulted in four different genotypes of M. viride based on differences in the LSU fragment, whereas the SSU and ITS-1 were identical in all isolates. Sequence analysis of the SSU fragment revealed the first presentation of a valid large fragment of the SSU of M. viride. According to statistical analysis, genotypes did not correlate with differences in pathogenicity, antifungal susceptibility, or species specificity. PMID:28003420
Unusual presentation of obscure Meckel diverticulum treated with robot-assisted diverticulectomy: A case report.

PubMed

Pandey, Sagar; Fan, Miao; Xu, Zhe; Yan, Chaogui; Zhu, Junfeng; Li, Xiuhong

2016-10-01

Meckel diverticulum (MD) is the most common congenital abnormality of gastrointestinal tract. Tough believed to occur in 2% of population, most of them remain veiled because majority are clinically asymptomatic and remain obscure in radiological examination. A 26-year-old male with episodic black colored stool since last 10 years. Tough symptomatic, diagnosis of pathological lesion, and the bleeding site could not be established with any of the sophisticated diagnostic technique. After 10 years, it was finally diagnosed as MD with careful observation of bowel loops on computed tomography enterography (CTE) where remnant of vitelline vessel and hyper-enhancing nodule are seen along the wall of diverticular loop. The patient underwent robot assisted laparoscopic surgery with excision of diverticular loop. To the best of our knowledge, this robot-assistant Meckel diverculectomy is probably the first reported surgical procedure in PubMed. Follow-up for 3 month showed no complication or recurrence. Every case is unique and we must be aware and remain alert in tracing the possible morphological variation of the case. Here, we present one unique but rare feature of MD, which helped us in making diagnosis.
Case report of narcolepsy in a six-year-old child initially misdiagnosed as atypical epilepsy.

PubMed

Zhou, Jinquan; Zhang, Xi; Dong, Zaiwen

2014-08-01

This report describes a case of first-onset narcolepsy in a six-year-old female that was misdiagnosed as atypical epilepsy and other diagnoses at eight different hospitals over a period of 10 months before the correct diagnosis was made. The diagnosis of narcolepsy is more difficult in children because very few of them experience all four cardinal symptoms of narcolepsy - paroxysmal sleep, cataplexy, hypnagogic hallucination, and sleep paralysis - and they often have a more prolonged onset and diverse symptoms. To decrease the time lag between initial presentation and accurate diagnosis, we recommend that in all cases in which children report excessive sleep of unknown etiology - regardless of the associated symptoms - that sleep monitoring and sleep latency tests be conducted to rule out the possibility of narcolepsy. The case highlights the wide variety of presentations of uncommon psychiatric conditions, particularly in children, and the need for clinicians to be aware of the atypical presentations of these conditions when collecting medical histories.
Evaluation of the Effectiveness of an Initiative to Develop Leadership among Women in Africa: A Case Study

ERIC Educational Resources Information Center

Wakahiu, Jane M.

2011-01-01

This qualitative case study assesses the impact of a three-year Hilton Foundation-supported, Sisters Leadership Development Initiative (SLDI) in five African nations. The goal was to evaluate the SLDI program for increasing leadership capacities of 340 women in Kenya, Uganda, Tanzania, Ghana and Nigeria. The purpose of this study was to determine…
Deterministic physical systems under uncertain initial conditions: the case of maximum entropy applied to projectile motion

NASA Astrophysics Data System (ADS)

Montecinos, Alejandra; Davis, Sergio; Peralta, Joaquín

2018-07-01

The kinematics and dynamics of deterministic physical systems have been a foundation of our understanding of the world since Galileo and Newton. For real systems, however, uncertainty is largely present via external forces such as friction or lack of precise knowledge about the initial conditions of the system. In this work we focus on the latter case and describe the use of inference methodologies in solving the statistical properties of classical systems subject to uncertain initial conditions. In particular we describe the application of the formalism of maximum entropy (MaxEnt) inference to the problem of projectile motion, given information about the average horizontal range over many realizations. By using MaxEnt we can invert the problem and use the provided information on the average range to reduce the original uncertainty in the initial conditions. Also, additional insight into the initial condition's probabilities, and the projectile path distribution itself, can be achieved based on the value of the average horizontal range. The wide applicability of this procedure, as well as its ease of use, reveals a useful tool with which to revisit a large number of physics problems, from classrooms to frontier research.
Extensive intramuscular manifestation of sarcoidosis with initially missed diagnosis and delayed therapy: a case report.

PubMed

Meyer, Niklaus; Sutter, Reto; Schirp, Udo; Gutzeit, Andreas

2017-08-24

Sarcoidosis is a multisystemic granulomatous disorder, which in nearly all cases involves the lungs and other organs. Isolated forms of sarcoidosis within the muscles, but without lung involvement, are extremely rare and can lead to delayed or even false diagnosis. A 52-year-old white, Swiss man presented with painful arm cramps and a history of symptoms over the previous 3 years. In the initial clinical investigation, our patient also showed edema in both legs without any other complaints. After performing an magnetic resonance imaging scan of his extremities and a positron emission tomography/computed tomography scan, diffuse myositis was described. The subsequent muscle biopsy provided the surprising diagnosis of muscle sarcoidosis, without involvement of the lungs or any other organ. After starting therapy with glucocorticoids, his symptoms improved immediately. Sarcoidosis is a common disorder, which in most cases affects the lungs. In this case report an isolated sarcoidosis is described without lung involvement, but with involvement of the muscles of the extremities and the trunk. Reported cases of sarcoidosis only involving skeletal muscle and without lung involvement are extremely rare. Radiologists should consider this presentation of sarcoidosis to avoid delayed diagnosis and therapy.
Initiation of movement and energy expenditure in children with developmental delay: a case-control study.

PubMed

Chen, Chiao-Nan Joyce; Hwang, Ai-Wen; Lin, Shang-Ying; Lin, Yu-Chieh

2014-10-01

Lower levels of physical activity in children with developmental delay (DD) usually are attributed to higher energy costs. However, there is no evidence that children with DD spend more energy on daily physical activities, such as walking. The aim of this study was to compare energy costs during walking and movement initiation times in children with DD and children with typical development (TD) and matched for age. This was a case-control study. Children who were 3 and 5 years old and had DD (n=12) or TD (n=12) participated in the study. Measurements included ranges of motion in the lower extremities, physiological costs of walking, and movement initiation times. A task designed to evaluate the initiation of movement (the "go play with the toy" task) was used to examine the reaction times for children's goal-directed walking. The physiological costs of walking were similar in the 2 groups; however, children with DD walked at a lower speed than children with TD. Importantly, children with DD took more time to initiate goal-directed walking. The nature of the study design limited causal inference from the results. Children who were 3 to 5 years old and had DD had delays in goal-directed movement that may not have been attributable to motor impairments. The findings suggest that therapists should evaluate the movement initiation ability of 3- to 5-year-old children with DD as part of the design of an overall intervention plan. © 2014 American Physical Therapy Association.
[Usefulness of stratigraphy and computerized tomography in the initial staging of osteosarcoma of the extremities. Retrospective study of 217 cases].

PubMed

Pelotti, P; Ciminari, R; Bacci, G; Avella, M; Briccoli, A

1988-01-01

The value of stratigraphy and pulmonary CT in the initial work-up of osteosarcoma of the extremities is assessed with reference to 217 patients encountered in the Bone Tumour Centre of Rizzoli Orthopaedic Institute in May 1983-May 1986. Stratigraphy revealed lung metastases not identified by standard radiography in 4 patients (1.8%), while CT revealed metastases not identified by either standard X-rays or stratigraphy in a further 6 cases (2.7%). It is concluded that the increase in the percentage of cures (about 30%) reported in the last 10 years in osteosarcoma cases given adjuvant chemotherapy cannot be explained by any difference in initial selection due to the use of these techniques that were not adopted in the historical series.
The Exceptional Responders Initiative: Welcoming More Cases

Cancer.gov

The initiative is studying tissue, clinical, and genomic data from patients with cancer who have had dramatic and long-lasting responses to standard and experimental treatments that were not seen in similar patients who received the same treatment.
Severe pulmonary hypertension as the initial manifestation of systemic lupus erythematosus: a case report and review of the literature.

PubMed

Prete, M; Fatone, M C; Vacca, A; Racanelli, V; Perosa, F

2014-01-01

Severe pulmonary arterial hypertension (PAH) is rarely observed as the initial manifestation of systemic lupus erythematosus (SLE), and the diagnosis is often delayed. Here we present the case of a 32-year-old woman with severe PAH as the initial manifestation of SLE, who was successfully treated with mycophenolate mofetil and cyclosporine. This case offered the opportunity to critically review the epidemiology data, predictive markers, and pathogenic pathways of SLE-associated PAH (SLE-PAH) in relation to the currently available therapeutic options and to the main clinical trials of the last 10 years focused on the treatment of SLE-PAH. Mycophenolate mofetil and cyclosporine - currently used in the maintenance phase of the disease in certain clinical settings - should be considered, as an alternative to cyclophosphamide, in future clinical trials aimed at evaluating the most effective treatment of SLE-PAH at presentation.
Severe vitamin D deficiency in Arab-American women living in Dearborn, Michigan.

PubMed

Hobbs, Raymond D; Habib, Zeina; Alromaihi, Dalal; Idi, Leila; Parikh, Nayana; Blocki, Frank; Rao, D Sudhaker

2009-01-01

To determine the prevalence and degree of 25-hydroxyvitamin D deficiency in a group of Arab-American women in the largest, most-concentrated Arab-American settlement in the United States and to search for correlations with dress, diet, and use of vitamin D-fortified foods and vitamin supplements. In this cross-sectional study, Arab-American women, 18 years and older, who attended an ethnic market on April 7 or 14, 2007, were recruited. Participants were interviewed by bilingual English- and Arabic-speaking investigators using a semi-structured interview to assess dress; demographic variables; medical history; medication use; clinical symptoms associated with vitamin D deficiency (eg, joint or bone pain, muscle weakness); and dietary intake of vitamin D from fortified orange juice, milk, and vitamin supplementation. Blood samples were drawn to measure concentrations of serum calcium, creatinine, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D. Participants were initially divided into 2 groups based on whether the woman was veiled and further subdivided into 3 groups on the basis of vitamin D intake from supplemented food sources (milk or vitamin D-fortified orange juice) and vitamin pills: unveiled, veiled and taking supplements, and veiled and taking no supplements. Eighty-seven women participated. Serum 25-hydroxyvitamin D levels were uniformly low, with the highest levels in the unveiled group (median [interquartile range]) (8.5 ng/mL [5.75-13.5 ng/mL]) followed by the veiled, supplemented group (7 ng/mL [4-11.5 ng/mL]) and the veiled, unsupplemented group (4 ng/mL [2-6.8 ng/mL]). 25-Hydroxyvitamin D levels were lower in women with less experience in the United States and in those with less education. Vitamin D-fortified orange juice consumption had a greater positive predictive effect on serum 25-hydroxyvitamin D levels than either milk or vitamin pills and may possibly serve as a surrogate marker for vitamin D awareness. Vitamin D
Case report of narcolepsy in a six-year-old child initially misdiagnosed as atypical epilepsy

PubMed Central

ZHOU, Jinquan; ZHANG, Xi; DONG, Zaiwen

2014-01-01

Summary This report describes a case of first-onset narcolepsy in a six-year-old female that was misdiagnosed as atypical epilepsy and other diagnoses at eight different hospitals over a period of 10 months before the correct diagnosis was made. The diagnosis of narcolepsy is more difficult in children because very few of them experience all four cardinal symptoms of narcolepsy – paroxysmal sleep, cataplexy, hypnagogic hallucination, and sleep paralysis – and they often have a more prolonged onset and diverse symptoms. To decrease the time lag between initial presentation and accurate diagnosis, we recommend that in all cases in which children report excessive sleep of unknown etiology – regardless of the associated symptoms – that sleep monitoring and sleep latency tests be conducted to rule out the possibility of narcolepsy. The case highlights the wide variety of presentations of uncommon psychiatric conditions, particularly in children, and the need for clinicians to be aware of the atypical presentations of these conditions when collecting medical histories. PMID:25317010
Atmospheric chemical reactions of alternatives of polybrominated diphenyl ethers initiated by OH: A case study on triphenyl phosphate.

PubMed

Yu, Qi; Xie, Hong-Bin; Chen, Jingwen

2016-11-15

Many studies have been performed to evaluate the environmental risk caused by alternative flame retardants (AFRs) of polybrominated diphenyl ethers due to their ubiquitous occurrence in the environment. However, as an indispensable component of the environmental risk assessment, the information on atmospheric fate of AFRs is limited although some AFRs have been frequently and highly detected in the atmosphere. Here, a combined quantum chemical method and kinetics modeling were used to investigate atmospheric transformation mechanism and kinetics of AFRs initiated by OH in the presence of O2, taking triphenyl phosphate (TPhP) as a case. Results show that the pathway involving initial OH addition to phenyl of TPhP to form TPhP-OH adduct, and subsequent reaction of the TPhP-OH adduct with O2 to finally form phenol phosphate, is the most favorable for the titled reaction. The calculated overall reaction rate constant is 1.6×10(-12)cm(3) molecule(-1)s(-1), translating 7.6days atmospheric lifetime of TPhP. This clarifies that gaseous TPhP has atmospheric persistence. In addition, it was found that ice surface, as a case of ubiquitous water in the atmosphere, has little effect on the kinetics of the rate-determining step in the OH-initiated TPhP reaction. Copyright © 2016 Elsevier B.V. All rights reserved.
The FIDELIS initiative: innovative strategies for increased case finding.

PubMed

Hinderaker, S G; Rusen, I D; Chiang, C-Y; Yan, L; Heldal, E; Enarson, D A

2011-01-01

Low-income, high tuberculosis (TB) burden countries. To compare case finding of new smear-positive pulmonary TB patients in projects funded to apply innovative approaches. Prospective application of innovative approaches to case finding within routine services to determine the numbers of additional cases detected and the cost per additional case detected, according to the type of approach applied. Between 2003 and 2007, 51 FIDELIS projects were implemented in 18 countries; 273,239 cases were reported, of which 85,267 were additional to the number reported in the previous year. The median cost per additional case was US$103. The interventions employed were: 1) social mobilisation and information, education and communication; 2) engagement of the private sector; 3) innovative approaches for microscopy services; 4) enhanced or semi-active case finding; 5) health systems strengthening; and 6) use of incentives. None of these was significantly more likely to detect additional cases or to have a lower cost per additional case than any of the others. While there was a substantial increase in cases detected, at a moderate cost per additional case, we were unable to show that any single intervention had an advantage over the others.
The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought.

PubMed

Wilkinson, Thomas; Sculpher, Mark J; Claxton, Karl; Revill, Paul; Briggs, Andrew; Cairns, John A; Teerawattananon, Yot; Asfaw, Elias; Lopert, Ruth; Culyer, Anthony J; Walker, Damian G

2016-12-01

Policymakers in high-, low-, and middle-income countries alike face challenging choices about resource allocation in health. Economic evaluation can be useful in providing decision makers with the best evidence of the anticipated benefits of new investments, as well as their expected opportunity costs-the benefits forgone of the options not chosen. To guide the decisions of health systems effectively, it is important that the methods of economic evaluation are founded on clear principles, are applied systematically, and are appropriate to the decision problems they seek to inform. The Bill and Melinda Gates Foundation, a major funder of economic evaluations of health technologies in low- and middle-income countries (LMICs), commissioned a "reference case" through the International Decision Support Initiative (iDSI) to guide future evaluations, and improve both the consistency and usefulness to decision makers. The iDSI Reference Case draws on previous insights from the World Health Organization, the US Panel on Cost-Effectiveness in Health Care, and the UK National Institute for Health and Care Excellence. Comprising 11 key principles, each accompanied by methodological specifications and reporting standards, the iDSI Reference Case also serves as a means of identifying priorities for methods research, and can be used as a framework for capacity building and technical assistance in LMICs. The iDSI Reference Case is an aid to thought, not a substitute for it, and should not be followed slavishly without regard to context, culture, or history. This article presents the iDSI Reference Case and discusses the rationale, approach, components, and application in LMICs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Initial experience of subcutaneous implantable cardioverter defibrillators in Singapore: a case series and review of the literature

PubMed Central

Lim, Tien Siang Eric; Tan, Boon Yew; Ho, Kah Leng; Lim, Chuh Yih Paul; Teo, Wee Siong; Ching, Chi-Keong

2015-01-01

Transvenous implantable cardioverter defibrillators are a type of implantable cardiac device. They are effective at reducing total and arrhythmic mortality in patients at risk of sudden cardiac death. Subcutaneous implantable cardioverter defibrillators (S-ICDs) are a new alternative that avoids the disadvantages of transvenous lead placement. In this case series, we report on the initial feasibility and safety of S-ICD implantation in Singapore. PMID:26512151
Initial experience of subcutaneous implantable cardioverter defibrillators in Singapore: a case series and review of the literature.

PubMed

Lim, Tien Siang Eric; Tan, Boon Yew; Ho, Kah Leng; Lim, Chuh Yih Paul; Teo, Wee Siong; Ching, Chi-Keong

2015-10-01

Transvenous implantable cardioverter defibrillators are a type of implantable cardiac device. They are effective at reducing total and arrhythmic mortality in patients at risk of sudden cardiac death. Subcutaneous implantable cardioverter defibrillators (S-ICDs) are a new alternative that avoids the disadvantages of transvenous lead placement. In this case series, we report on the initial feasibility and safety of S-ICD implantation in Singapore.
A Typology of Knowledge Collaboration: A Case Study of an Initiative to Accelerate the Internationalization of Finnish Cleantech Entrepreneurship

ERIC Educational Resources Information Center

Vauterin, Johanna Julia; Virkki-Hatakka, Terhi

2016-01-01

A critical understanding of how knowledge collaboration may work in various configurations is a prerequisite in shedding light on how effective knowledge collaboration affects opportunities for business growth. This article presents a case analysis of a knowledge collaboration initiative between a university and other knowledge organizations. The…
Effect of initial conditions on combustion generated loads

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tieszen, S.R.

1991-01-01

This analytical study examines the effect of initial thermodynamic conditions on the loads generated by the combustion of homogeneous hydrogen-air-steam mixtures. The effect of initial temperature, pressure, hydrogen concentration, and steam concentration is evaluated for two cases, (1) constant volume and (2) constant initial pressure. For each case, the Adiabatic, Isochoric, Complete Combustion (AICC), Chapman-Jouguet (CJ), and normally reflected CJ pressures are calculated for a range of hydrogen and steam concentrations representative of the entire flammable regime. For detonation loads, pressure profiles and time-histories are also evaluated in one-dimensional Cartesian geometry. The results show that to a first approximation, themore » AICC and CJ pressures are directly proportional to the initial density. Increasing the hydrogen concentration up to stoichiometric concentrations significantly increases the AICC, CJ, and reflected CJ pressures. For the constant volume case, the AICC, CJ, and reflected CJ pressures increase with increasing hydrogen concentration on the rich side of stoichiometric concentrations. For the constant initial pressure case, the AICC, CJ and reflected CJ pressures decrease with increasing hydrogen concentration on the rich side of stoichiometric values. The addition of steam decreases the AICC, CJ and reflected CJ pressures for the constant initial pressure case, but increases them for the constant volume case. For detonations, the pressure time-histories can be normalized with the AICC pressure and the reverberation time for Cartesian geometry. 35 refs., 16 figs.« less

An Exploratory Multiple-Case Study of the Experiences of Participants in Self-Initiated Peer Support Groups among School Leaders

ERIC Educational Resources Information Center

House, Collette R.

2016-01-01

School leaders commonly face issues of loneliness, isolation, burnout, and depression. The purpose of this qualitative multiple-case study was to explore self-initiated peer support group participation for professional impact and personal impact on school leaders facing issues of loneliness, isolation, stress, and burnout. This study provides an…
The role of initial coherence and path materials in the dynamics of three rock avalanche case histories

USGS Publications Warehouse

Aaron, Jordan; McDougall, Scott; Moore, Jeffrey R.; Coe, Jeffrey A.; Hungr, Oldrich

2017-01-01

BackgroundRock avalanches are flow-like landslides that can travel at extremely rapid velocities and impact surprisingly large areas. The mechanisms that lead to the unexpected mobility of these flows are unknown and debated. Mechanisms proposed in the literature can be broadly classified into those that rely on intrinsic characteristics of the rock avalanche material, and those that rely on extrinsic factors such as path material. In this work a calibration-based numerical model is used to back-analyze three rock avalanche case histories. The results of these back-analyses are then used to infer factors that govern rock avalanche motionResultsOur study has revealed two key insights that must be considered when analyzing rock avalanches. Results from two of the case histories demonstrate the importance of accounting for the initially coherent phase of rock avalanche motion. Additionally, the back-analyzed basal resistance parameters, as well as the best-fit rheology, are different for each case history. This suggests that the governing mechanisms controlling rock avalanche motion are unlikely to be intrinsic. The back-analyzed strength parameters correspond well to those that would be expected by considering the path material that the rock avalanches overran.ConclusionOur results show that accurate simulation of rock avalanche motion must account for the initially coherent phase of movement, and that the mechanisms governing rock avalanche motion are unlikely to be intrinsic to the failed material. Interaction of rock avalanche debris with path materials is the likely mechanism that governs the motion of many rock avalanches.
Evaluation of the Pilot Program of the Truancy Case Management Partnership Initiative in the District of Columbia, 2011-12

ERIC Educational Resources Information Center

Liberman, Akiva; Cahill, Meagan

2012-01-01

This evaluation of the Case Management Partnership Initiative (CPMI) found that the program successfully linked high-need families with services designed to prevent truancy. The truancy prevention program, implemented at Anacostia and Ballou High Schools in 2011-2012, links chronically truant ninth graders and their families to social services and…
Predictors of provider- initiated HIV testing and counseling refusal by outpatient department clients in Wolaita zone, Southern Ethiopia: a case control study.

PubMed

Facha, Wolde; Kassahun, Wondewosen; Workicho, Abdulhalik

2016-08-12

Despite different strategies designed to rapidly identify HIV infected individuals, majority of HIV-infected people are unaware of their sero-status in developing countries. The objective of this study was to assess predictors of provider-initiated HIV testing and counseling (PITC) refusal by outpatient department (OPD) clients in Wolaita zone, Southern Ethiopia. Facility based unmatched case control study was conducted on outpatient department clients in randomly selected seven health facilities in Wolaita zone, Southern Ethiopia in February 2012. A total of 291 participants (97 cases and 194 controls) were included in our study. Cases were patients who refused HIV test while controls were patients who tested for HIV after provider-initiated HIV testing and counseling (PITC) recommendation by outpatient department (OPD) clinicians. We used both quantitative and qualitative methods of data collection. Pretested interviewer administered questionnaires were used to collect quantitative data by trained nurses, and in-depth interview with 14 OPD clinicians was conducted by principal investigator to supplement quantitative findings. Bivariate and multivariate analyses were done to identify independent predictors of provider-initiated HIV testing and counseling refusal by OPD clients. Study participants who had stigmatizing attitude [AOR = 6.09, (95 % CI: 1.70, 21.76)], who had perceived risk for HIV infection [AOR = 5.23, (95 % CI: 2.22, 12.32)], who did not perceive the benefits of provider-initiated HIV testing and counseling [AOR = 4.64, (95 % CI: 1.79, 12.01)], who did not get minimum recommended pretest information from their providers [AOR = 2.98, (95 % CI: 1.06, 8.35)], who ever not heard of provider-initiated HIV testing and counseling service [AOR = 2.41, (95 % CI: 1.14, 5.09)], and who were from urban area [AOR = 2.40, (95 % CI = 1.26, 4.57)] were more likely to refuse provider-initiated HIV testing and counseling service than
Introduction of a new Rotavirus vaccine: Initial results of uptake and impact on laboratory confirmed cases in Anglia and Essex, United Kingdom, July 2015.

PubMed

Inns, Thomas; Trindall, Amy; Dunling-Hall, Sara; Shankar, Ananda Giri

2016-04-02

Rotavirus gastroenteritis accounts for an estimated 130,000 GP consultations and 13,000 hospitalisations for children under 5 y old each year in England and Wales. In July 2013, an oral live attenuated rotavirus vaccine (Rotarix®) was introduced into the UK infant immunisation program as a 2 dose schedule at 2 and 3 months of age. We collected vaccination uptake from October 2013 to March 2015 and laboratory confirmed cases data on children under the age of 5 y from 1 January 2004 to 31 May 2015. The vaccine uptake rates and laboratory confirmed cases were compared to provide evidence of the impact of this vaccination program. Vaccine uptake rates were available from sentinel data with between 91-98% of GP practices in Anglia and Essex providing data every month. These data showed from February 2014 to March 2015 between 90-92% of infants received the recommended 2 doses of Rotarix® each month. The numbers of rotavirus cases reported by laboratories decreased on average by 82% in the post vaccination seasons. The mean number of cases reported in weeks 1-22 for 2004-2013 in Anglia and Essex was 1,318. For the same period in 2014, 256 cases were reported and initial data for 2015 report 226 cases. In the first 5 months 2014 the greatest reduction in cases (89%) was seen in those under 1 yr (who would have been directly affected by vaccination) with case numbers falling to 59 from a mean 537 cases in the equivalent period for 2004-2013. Initially data suggests a 92% reduction in 2015 compared to the same pre-vaccination periods. For those aged 1 to <5 y who would not have been vaccinated, a reduction of 75% was also evident in 2014 and 77% in 2015, suggesting indirect protection in this group. In conclusion, initial results following the introduction of the Rotavirus vaccine clearly indicates a very good uptake of the vaccine and a significant reduction in the numbers of laboratory confirmed cases.
Introduction of a new Rotavirus vaccine: Initial results of uptake and impact on laboratory confirmed cases in Anglia and Essex, United Kingdom, July 2015

PubMed Central

Inns, Thomas; Trindall, Amy; Dunling-Hall, Sara; Shankar, Ananda Giri

2016-01-01

abstract Rotavirus gastroenteritis accounts for an estimated 130,000 GP consultations and 13,000 hospitalisations for children under 5 y old each year in England and Wales. In July 2013, an oral live attenuated rotavirus vaccine (Rotarix®) was introduced into the UK infant immunisation program as a 2 dose schedule at 2 and 3 months of age. We collected vaccination uptake from October 2013 to March 2015 and laboratory confirmed cases data on children under the age of 5 y from 1 January 2004 to 31 May 2015. The vaccine uptake rates and laboratory confirmed cases were compared to provide evidence of the impact of this vaccination program. Vaccine uptake rates were available from sentinel data with between 91–98% of GP practices in Anglia and Essex providing data every month. These data showed from February 2014 to March 2015 between 90–92% of infants received the recommended 2 doses of Rotarix® each month. The numbers of rotavirus cases reported by laboratories decreased on average by 82% in the post vaccination seasons. The mean number of cases reported in weeks 1–22 for 2004–2013 in Anglia and Essex was 1,318. For the same period in 2014, 256 cases were reported and initial data for 2015 report 226 cases. In the first 5 months 2014 the greatest reduction in cases (89%) was seen in those under 1 yr (who would have been directly affected by vaccination) with case numbers falling to 59 from a mean 537 cases in the equivalent period for 2004–2013. Initially data suggests a 92% reduction in 2015 compared to the same pre-vaccination periods. For those aged 1 to <5 y who would not have been vaccinated, a reduction of 75% was also evident in 2014 and 77% in 2015, suggesting indirect protection in this group. In conclusion, initial results following the introduction of the Rotavirus vaccine clearly indicates a very good uptake of the vaccine and a significant reduction in the numbers of laboratory confirmed cases. PMID:26618660
Fire prevention in Delaware: a case study of fire and life safety initiatives.

PubMed

Frattaroli, Shannon; Gielen, Andrea C; Piver-Renna, Jennifer; Pollack, Keshia M; Ta, Van M

2011-01-01

Injuries resulting from residential house fires are a significant public health issue. The fire service is engaged in fire prevention activities aimed at preventing fire-related morbidity and mortality. The fire service in Delaware is regarded by some leaders in the field as a model for fire and life safety education (FLSE). We identified 3 questions to guide this research. What is the culture and context of fire prevention in Delaware? What prevention programs and policies constitute Delaware's fire prevention efforts? What can be learned from select model programs regarding their impact, sustainability, strengths, limitations, and general applicability? A discussion of the lessons learned from Delaware's experience with FLSE initiatives concludes the article. We used a single case study design and collected and analyzed data from in-depth interviews, documents, and participant observation notes to address the research questions. Data were collected in Delaware. Interviewees included a purposeful sample of members of the Delaware fire service. Descriptions of the context in which fire prevention occurs, the initiatives underway, and the factors associated with successfully supporting fire prevention in the state. Data from 16 key informant interviews, relevant documents, and direct observations of FLSE events revealed a fire service rooted in tradition, dedication, and community. A compilation of state and local FLSE initiatives illustrates the diversity of FLSE in Delaware. Thematic analysis of the data emphasize the importance of a strategic, comprehensive, and coordinated approach to realizing success in Delaware's approach to FLSE. The fire service is an important part of the public health infrastructure. While their role as first responders is evident, their contributions to prevention are also significant. This research suggests ways to support fire service prevention efforts and more fully integrate their FLSE work into the public health infrastructure.
Primary Sjögren syndrome that initially presented with repeated hypergammaglobulinemic purpura after prolonged sitting: A case report.

PubMed

Zhou, Zhihua; Jiang, Weiqiang; Wang, Ming; Liu, Yongyuan; Zhang, Wei; Huang, Manping; Liang, Donghui

2017-12-01

Purpura is a common dermatologic manifestation in Sjögren syndrome (SS). When a patient presents with sicca symptoms, the diagnosis of SS is not difficult. Here, we reported a case of a 52-year-old Chinese woman who initially presented with nonpalpable purpura on both lower extremities, and these lesions had developed soon after prolonged sitting. In the past 2 years, she had repeated cutaneous nonpalpable purpura 4 times. She had no sicca symptoms, dry eyes, or dry mouth. Combining the laboratory findings, Schirmer test, and labial gland biopsy, primary SS was confirmed. The patient was placed on a trial of hydroxychloroquine (200 mg once daily). The purpura on both lower extremities had faded at the sixth day after onset and at the third day after hydroxychloroquine treatment. These case was not easy to diagnosis primary SS because she had no sicca symptoms. A patient with primary SS who initially presented with recurrent purpura associated with prolonged sitting. Prolonged sitting had been a possible aggravating factor for the cutaneous purpura of this patient with primary SS. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.
The Vertical Linear Fractional Initialization Problem

NASA Technical Reports Server (NTRS)

Lorenzo, Carl F.; Hartley, Tom T.

1999-01-01

This paper presents a solution to the initialization problem for a system of linear fractional-order differential equations. The scalar problem is considered first, and solutions are obtained both generally and for a specific initialization. Next the vector fractional order differential equation is considered. In this case, the solution is obtained in the form of matrix F-functions. Some control implications of the vector case are discussed. The suggested method of problem solution is shown via an example.
Dry mouth as an initial sign of food-borne botulism: a case report and review of the literature.

PubMed

Manfredi, Maddalena; Scoditti, Umberto; Angelini, Monica; de Giampaulis, Piero; Borrini, Bianca Maria; Macaluso, Guido Maria; Pavesi, Giovanni; Vescovi, Paolo

2011-04-01

Botulism is a rare neuroparalytic disease caused by a potent neurotoxin produced by Clostridium botulinum. There are different clinical types of botulism. Early diagnosis of the condition is essential for effective treatment. We report a case of food-borne botulism in identical twins characterized by severe initial oral involvement and a review of the literature about the condition. Copyright © 2011 Mosby, Inc. All rights reserved.
Bilineal Extramedullary Blast Crisis as an Initial Presentation of Chronic Myeloid Leukemia: A Case Report and Literature Review

PubMed Central

Gao, Xiaoning; Li, Jie; Wang, Lili; Lin, Ji; Jin, Hongshi; Xu, Yihan; Wang, Nan; Zhao, Yu; Liu, Daihong; Yu, Li; Wang, Quanshun

2016-01-01

Patient: Male, 49 Final Diagnosis: T-lymphoid/myeloid bilineal blastic transformation of CML Symptoms: Rapidly enlarging mass in left neck Medication: — Clinical Procedure: Biopsy of the left submandibular lymph nodes Specialty: Hematology Objective: Rare co-existance of disease or pathology Background: Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder characterized by the Philadelphia chromosome generated by the reciprocal translocation t(9: 22)(q34;q11). CML is usually diagnosed in the chronic phase. Blast crisis represents an advanced phase of CML. Extramedullary blast crisis as the initial presentation of CML with bone marrow remaining in chronic phase is an unusual event. Further, extramedullary blast crisis with T lymphoid/myeloid bilineal phenotype as an initial presentation for CML is extremely unusual. Case Report: Here, we report the case of a 49-year-old male with rapidly enlarged submandibular lymph nodes. Biopsy specimen from the nodes revealed a characteristic appearance with morphologically and immunohistochemically distinct myeloblasts and T lymphoblasts co-localized in 2 adjacent regions, accompanied by chronic phase of the disease in bone marrow. The presence of the BCR/ABL1 fusion gene within both cellular populations in this case confirmed the extramedullary disease represented a localized T lymphoid/myeloid bilineal blastic transformation of CML. After 3 courses of combined chemotherapy plus tyrosine kinase inhibitor treatment, the mass was completely regressed with a 3-log decrease in BCR/ABL1 transcript from baseline. Five months after the diagnosis, the patient showed diminished vision, hand tremors, and weakness of lower extremities. Flow cytometric immunophenotyping of cerebrospinal fluid revealed the presence of myeloid blasts. An isolated central nervous system relapse of leukemia was identified. Following high-dose systemic and intrathecal chemotherapy, the patient continued to do well. Conclusions: The
Cerebral and subdural abscess with spatio-temporal multiplicity 12 years after initial craniotomy for acute subdural hematoma. Case report.

PubMed

Wakui, Daisuke; Nagashima, Goro; Takada, Tatsuro; Ueda, Toshihiro; Itoh, Hidemichi; Tanaka, Yuichiro; Hashimoto, Takuo

2012-01-01

A 34-year-old man presented with a case of subdural empyema and cerebral abscess that developed 12 years after initial neurosurgical intervention for a traffic accident in 1998. Under a diagnosis of acute subdural hematoma and cerebral contusion, several neurosurgical procedures were performed at another hospital, including hematoma removal by craniotomy, external decompression, duraplasty, and cranioplasty. The patient experienced an epileptic seizure, and was referred to our hospital in March 2010. Magnetic resonance imaging revealed a cerebral abscess extending to the subdural space just under the previous surgical field. Surgical intervention was refused and antimicrobial treatment was initiated, but proved ineffective. Surgical removal of artificial dura and cranium with subdural empyema, and resection of a cerebral abscess were performed on May 12, 2010. No organism was recovered from the surgical samples. Meropenem and vancomycin were selected as perioperative antimicrobial agents. No recurrence of infection has been observed. Postneurosurgical subdural empyema and cerebral abscess are recently emerging problems. Infections of neurosurgical sites containing implanted materials occur in 6% of cases, usually within several months of the surgery. Subdural empyema and cerebral abscess developing 12 years after neurosurgical interventions are extremely rare. The long-term clinical course suggests less pathogenic organisms as a cause of infection, and further investigations to develop appropriate antimicrobial selection and adequate duration of antimicrobial administration for these cases are needed.
Lupus pneumonitis as the initial presentation of systemic lupus erythematosus: case series from a single institution.

PubMed

Wan, S A; Teh, C L; Jobli, A T

2016-11-01

Objective The aim of this study was to examine the clinical features, treatment and outcome of systemic lupus erythematosus (SLE) patients in our centre who presented with lupus pneumonitis as the initial manifestation. Methods We performed a retrospective review of all patients who presented with lupus pneumonitis during the initial SLE manifestation from March 2006 to March 2015. Results There were a total of five patients in our study who presented with fever and cough as the main clinical features. All patients had pulmonary infiltrates on chest radiographs. High-resolution computed tomography, which was performed in two patients, showed ground glass opacities with patchy consolidations bilaterally. All patients received high-dose steroids, 80% received intravenous cyclophosphamide and 60% received intravenous immunoglobulin. Two patients died from severe lupus pneumonitis within 2 weeks of admission despite treatment with ventilation, steroids, cyclophosphamide and intravenous immunoglobulin. Conclusions Acute lupus pneumonitis is an uncommon presentation of SLE. Mortality in this case series is 40%.
A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit.

PubMed

Pearse, Bronwyn Louise; Rickard, Claire M; Keogh, Samantha; Lin Fung, Yoke

2018-03-09

Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost. Given the success of the initiative, we sought to answer the question; "How and why was the process of implementing a bleeding management quality initiative in the cardiac surgery unit successful, and sustainable?" A retrospective explanatory case study design was chosen to explore the quality initiative. Analysis of the evidence was reviewed through phases of the 'Knowledgeto Action' planned change model. Data was derived from: (1) document analysis, (2) direct observation of the local environment, (3) clinical narratives from interviews, and analysed with a triangulation approach. The study period extended from 10/2011 to 6/2013. Results demonstrated the complexity of changing practice, as well as the significant amount of dedicated time and effort required to support individual, department and system wide change. Results suggest that while many clinicians were aware of the potential to apply improved practice, numerous barriers and challenges needed to be overcome to implement change across multiple disciplines and departments. The key successful components of the QI were revealed through the case study analysis as: (1) an appropriately skilled project manager to facilitate the implementation process; (2) tools to support changes in workflow and decision making including a bleeding management treatment algorithm with POCCTs; (3) strong clinical leadership from the multidisciplinary team and; (4) the evolution of the project
Two black hole initial data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leski, Szymon

2005-06-15

The Misner initial data are a standard example of time-symmetric initial data with two apparent horizons. Compact formulae describing such data are presented in the cases of equal or nonequal masses (i.e. isometric or nonisometric horizons). The interaction energy in the 'Schwarzschild + test-particle' limit of the Misner data is analyzed.
Exploring Leadership in Schools-Based iPad Initiatives: A Case Study

ERIC Educational Resources Information Center

Harrold, Richard

2017-01-01

The world's first school-based one-to-one iPad initiative was implemented in a British school in 2010. Every year since, more iPad initiatives have been implemented in British schools, with school leaders citing various reasons for introducing them. However, results of iPad initiatives have not always matched expectations. British schools are also…
Counter-intuitive plasma vitamin D and zinc status in HIV-1-infected adults with persistent low-level viraemia after treatment initiation: a pilot case-control study.

PubMed

Melliez, H; Duhamel, A; Robineau, O; Bocket, L; Kim, I; Sauser, E; Loiseleur, F; Viget, N; Pasquet, A; Senneville, E; Seguy, D

2017-11-01

Determinants of persistent low-level viraemia [PLLV, a viral load (VL) of between 50 and 500 copies/mL] have not been elucidated. In a case-control study, we evaluated the influence of micronutrients on PLLV in a population of 454 HIV-1 adults having initiated antiretroviral therapy (ART) between January 2007 and December 2011. Plasma levels of retinol (vitamin A), 25-OH vitamin D 2 + D 3 , vitamin E and zinc were measured at ART initiation in cases (PLLV after 6 months of ART) and in controls (VL <50 copies/mL after 6 months). Cases and controls were matched for the CD4 cell count (±50/mm 3 ) and ethnic origin. Intergroup differences in demographic, biological and treatment parameters and sunshine intensity at ART initiation were adjusted using a propensity score. A receiver operating characteristic (ROC) curve was used to assess intergroup differences in plasma micronutrient levels. Thirty-three of the 454 patients (7.3%) displayed PLLV (median VL: 92 copies/mL). Patients were predominantly male (89%), Caucasian (64%) and CDC stage C (25%). The median age was 38 years, the median initial VL was 5.2 log 10 copies/mL and the median CD4 count was 74/mm 3 . The 22 cases and matched controls were balanced in these respects, and had similar vitamin A/E levels. Two cases (9%) and 9 controls (41%) had a vitamin D level <10.3 ng/mL (p = 0.0015), and 2 cases (9%) and 10 controls (48%) had a zinc level <74.6 μg/dL (p = 0.04). Our results support in vitro studies suggesting that vitamin D favours HIV-1 replication and that HIV-1 is zinc-dependent. Wide-scale, prospective studies are required.
Gravity wave initiated convection

NASA Astrophysics Data System (ADS)

Hung, R. J.

1990-09-01

The vertical velocity of convection initiated by gravity waves was investigated. In one particular case, the convective motion-initiated and supported by the gravity wave-induced activity (excluding contributions made by other mechanisms) reached its maximum value about one hour before the production of the funnel clouds. In another case, both rawinsonde and geosynchronous satellite imagery were used to study the life cycles of severe convective storms. Cloud modelling with input sounding data and rapid-scan imagery from GOES were used to investigate storm cloud formation, development and dissipation in terms of growth and collapse of cloud tops, as well as, the life cycles of the penetration of overshooting turrets above the tropopause. The results based on these two approaches are presented and discussed.
The role of transnational mobility in the local spread of mosquito-borne disease: Measuring the determinants of spatial-temporal lags of imported dengue cases initiating indigenous epidemics in Taiwan

NASA Astrophysics Data System (ADS)

Wen, Tzai-Hung

2014-05-01

Dengue fever is one of the world's most widely spread mosquito-borne diseases. International travelers who acquire dengue infection are important routes for virus transmission from one country to another one. Previous studies have shown that imported dengue cases are able to initiate indigenous epidemics when appropriate weather conditions are present. However, the spatial-temporal associations between imported cases and indigenous epidemics in areas with different social-economic conditions are still unclear. This study investigated determinants of spatial-temporal lags of imported dengue cases who initiated indigenous epidemics from 2003 to 2012 in Taiwan. The quantile regression is used to explore the associations between spatial-temporal lags of imported cases and social-economic indicators with geographic heterogeneity. Our results indicated that imported cases in April and May have statistically significant contribution to initiate indigenous epidemics. Areas with high population density and low average income have significant risk of being imported virus from other areas. However, the areas with imported cases are not significant transmission risk. The results imply that imported cases reported in early summer may be an early-warning indicator of indigenous epidemics. Local demographic and economic conditions, rather than imported cases, may determine the areas with the risk of indigenous epidemics.
The use of international service learning initiatives for global health education: case studies from Rwanda and Mexico.

PubMed

Plumb, Ellen; Roe, Kathleen; Plumb, James; Sepe, Priscilla; Soin, Komal; Ramirez, Aragon; Baganizi, Edmond; Simmons, Rob; Khubchandani, Jagdish

2013-05-01

Global health education and health promotion have the potential to engage students, scholars, and practitioners in ways that go beyond the classroom teaching routine. This engagement in global communities, can range from reflection on continuing deep-seated questions about human rights and civic responsibility to the use of health education and promotion-related theoretical, intellectual, and practical skills. In the arena of global health education and promotion, these skills also range from leadership and advocacy to decision making, critical and creative thinking, teamwork, and problem solving. In recent times, there has been a growing interest in cross-cultural collaborations and educational initiatives to improve stakeholder's understanding of global health principles and practices, to enrich the experiences of health professionals, and to improve the lives of those who are disenfranchised and live across borders. In this article of Health Promotion Practice, we highlight two unique cases of cross-national collaborations and provide a glimpse of the various shapes and forms taken by cross-cultural educational initiatives for global health education and promotion. We summarize the history, philosophy, and current working practices relevant to these collaborations, keeping in view the global health domains, competencies, and activities. In addition, we also compare the key components and activities of these two case studies from Rwanda and Mexico, wherein communities in these two countries collaborated with academic institutions and health professionals in the United States.

[Secondary Splenic Rupture after Initially Inconspicuous CAT Scan].

PubMed

Prokop, A; Koll, S; Chmielnicki, M

2016-04-01

Splenic injuries occur in 1-5 % of blunt abdominal trauma cases. After initial haemorrhagic compression, secondary delayed spleen rupture can occur with a latency of one day to a month or longer. Mortality is then up to 15 %. The spleen injury is almost always recognisable on CT or ultrasound. In one case from our clinic, secondary splenic rupture occurred in a patient after discharge from hospitalisation, even though the initial CT and ultrasound were unremarkable. The patient survived, and underwent emergent splenectomy 8 days after the trauma. An expert review of the case identified no errors in treatment. No case of secondary splenic rupture after initially unremarkable diagnostic studies and clinical course has previously been published. Secondary splenic rupture has a high mortality rate. Patients should be advised of potential complications after hospital discharge, and should return to the hospital immediately in case of symptoms. Georg Thieme Verlag KG Stuttgart · New York.
Intradural pathology and pathophysiology associated with Chiari I malformation in children and adults with and without syringomyelia.

PubMed

Dlouhy, Brian J; Dawson, Jeffrey D; Menezes, Arnold H

2017-12-01

obstructing the foramen of Magendie (21.1%), intertonsillar and tonsil to CMJ arachnoid adhesions (85.3%), vermian posterior inferior cerebellar artery branches obstructing the foramen of Magendie (43.1%), and arachnoid veils or webs obstructing or occluding the foramen of Magendie (52.3%). Arachnoid veils varied in type and were observed in 59.5% of patients with CM-I who had syringomyelia, which was significantly greater than the 33.3% of patients with CM-I without syringomyelia who had an arachnoid veil (p = 0.018). The presence of CM-I with an arachnoid veil had 3.22 times the odds (p = 0.013, 95% CI 1.29-8.07, by multivariate logistic regression) of being associated with syringomyelia, adjusting for tonsillar herniation. The inferior descent of the fourth ventricle and CMJ occurred with a greater degree of tonsillar herniation (p < 0.001) and correlated with a cervicomedullary kink or buckle on preoperative MRI. CONCLUSIONS Intradural pathology associated with CM-I with or without syringomyelia exists in many forms, is more prevalent than previously recognized in patients of all ages, and may play a role in the pathophysiology of CM-I tonsillar herniation. Arachnoid veils appear to partially obstruct CSF flow, are significantly more prevalent in cases of CM-I with syringomyelia, and therefore may play a role in the pathophysiology of CM-I-associated syringomyelia.
Peer-Delivered Linkage Case Management and Same-Day ART Initiation for Men and Young Persons with HIV Infection - Eswatini, 2015-2017.

PubMed

MacKellar, Duncan; Williams, Daniel; Bhembe, Bonsile; Dlamini, Makhosazana; Byrd, Johnita; Dube, Lenhle; Mazibuko, Sikhathele; Ao, Trong; Pathmanathan, Ishani; Auld, Andrew F; Faura, Pamela; Lukhele, Nomthandazo; Ryan, Caroline

2018-06-15

To achieve epidemic control of human immunodeficiency virus (HIV) infection, sub-Saharan African countries are striving to diagnose 90% of HIV infections, initiate and retain 90% of HIV-diagnosed persons on antiretroviral therapy (ART), and achieve viral load suppression* for 90% of ART recipients (90-90-90) (1). In Eswatini (formerly Swaziland), the country with the world's highest estimated HIV prevalence (27.2%), achieving 90-90-90 depends upon improving access to early ART for men and young adults with HIV infection, two groups with low ART coverage (1-3). Although community-based strategies test many men and young adults with HIV infection in Eswatini, fewer than one third of all persons who test positive in community settings enroll in HIV care within 6 months of diagnosis after receiving standard referral services (4,5). To evaluate the effectiveness of peer-delivered linkage case management † in improving early ART initiation for persons with HIV infection diagnosed in community settings in Eswatini, CDC analyzed data on 651 participants in CommLink, a community-based, mobile HIV-testing, point-of-diagnosis HIV care, and peer-delivered linkage case management demonstration project, and found that after diagnosis, 635 (98%) enrolled in care within a median of 5 days (interquartile range [IQR] = 2-8 days), and 541 (83%) initiated ART within a median of 6 days (IQR = 2-14 days), including 402 (74%) on the day of their first clinic visit (same-day ART). After expanding ART eligibility to all persons with HIV infection on October 1, 2016, 96% of 225 CommLink clients initiated ART, including 87% at their first clinic visit. Compared with women and adult clients aged ≥30 years, similar high proportions of men and persons aged 15-29 years enrolled in HIV care and received same-day ART. To help achieve 90-90-90 by 2020, the United States President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the national scale-up of CommLink in Eswatini and
A Case Study of Mentoring Relationships between Faculty Ambassadors and First Generation Hispanic Students in a First-Year Initiative Program

ERIC Educational Resources Information Center

Swafford, Clark Elliott

2017-01-01

This qualitative case study sought understanding of unique mentoring relationships of six faculty ambassadors and nine Hispanic first-generation students (HFGS) as part of a first-year initiative program. The single site was a career college in Texas, Taylor College. There were three research questions to guide inquiry comprised of six faculty…
Iatrogenic sexual dysfunction and the protective withholding of information: in whose best interest?

PubMed

Higgins, A; Barker, P; Begley, C M

2006-08-01

In recent years a growing body of evidence has highlighted the impact of neuroleptics and antidepressants on sexual function. Research from a service user's perspective suggested that service users are dissatisfied with the information that they received on drugs, and would like more education, in particular, on the side effects of medication that impact on sexual function. This paper reports some of the findings of a grounded theory study that explored how psychiatric nurses responded to issues of sexuality in practice. Emphasis within the paper is given to how nursing staff addressed the side effects of drugs that impact on sexual function. Findings suggested that nurse addressed the issue of prescribed medication and sexual function in practice, using a 'Veiling Sexualities Cycle', which had three subcategories: 'Hanging the Veil', 'Lifting the Veil' and 'Re-veiling'. In the light of contemporary mental health policy, findings from the study are discussed and recommendations for practice and education made.
ICT integration in mathematics initial teacher training and its impact on visualization: the case of GeoGebra

NASA Astrophysics Data System (ADS)

Dockendorff, Monika; Solar, Horacio

2018-01-01

This case study investigates the impact of the integration of information and communications technology (ICT) in mathematics visualization skills and initial teacher education programmes. It reports on the influence GeoGebra dynamic software use has on promoting mathematical learning at secondary school and on its impact on teachers' conceptions about teaching and learning mathematics. This paper describes how GeoGebra-based dynamic applets - designed and used in an exploratory manner - promote mathematical processes such as conjectures. It also refers to the changes prospective teachers experience regarding the relevance visual dynamic representations acquire in teaching mathematics. This study observes a shift in school routines when incorporating technology into the mathematics classroom. Visualization appears as a basic competence associated to key mathematical processes. Implications of an early integration of ICT in mathematics initial teacher training and its impact on developing technological pedagogical content knowledge (TPCK) are drawn.
The Spectral Variability of the T Tauri Star DF Tauri

NASA Astrophysics Data System (ADS)

Johns-Krull, Christopher M.; Basri, Gibor

1997-01-01

We analyze 117 echelle spectra of the T Tauri star DF Tau, concentrating on variations in the optical continuum veiling and the strong emission lines. Although this star was the inspiration for the original suggestion of magnetospheric accretion in T Tauri stars (TTSs), this hypothesis is only partially supported in our data. We find that variations in the Ca II infrared triplet lines correlate with the veiling variations; there is some evidence that the broad component of the He I line does, too. The narrow component of He I is shown to arise at the stellar surface, but it correlates with the broad component. There is a surprising lack of periodicity in the lines, and it does not occur where expected when seen. The correlation between continuum veiling and the line components expected to be most related to the veiling is poor. There is a great deal of variability in all the lines and line components; a snapshot spectrum is a poor way to characterize the star as a whole. The total Balmer line fluxes are poorly correlated with the veiling, unlike previous results on a large sample of TTSs. Redshifted absorption components are found in the weaker lines but are not common. The strength of the blueshifted absorption feature in Hα is correlated with the veiling, but changes in it perhaps occur before veiling changes by about one day. This time delay supports the idea that the wind originates at some distance from the stellar surface and is related to accretion. Spherically symmetric wind models are unable to reproduce well the relative absorption levels on the blue side of the Hα and Hβ lines simultaneously. Hα does not display the asymmetries expected of magnetospheric accretion, but it is sometimes suggestive of azimuthally asymmetric corotating structures. The line wings indicate that the formation region of the Hα line is dominated by high turbulence. Hβ does show more of the asymmetry expected of magnetospheric accretion. Based on observations obtained at the
Partnership in Knowledge Creation: Lessons Learned from a Researcher-Policy Actor Partnership to Co-Produce a Rapid Appraisal Case Study of South Australia's Social Inclusion Initiative

ERIC Educational Resources Information Center

Newman, Lareen; Biedrzycki, Kate; Patterson, Jan; Baum, Fran

2011-01-01

This paper describes a partnership between researchers and policy actors that was developed within a short timeframe to produce a rapid appraisal case study of a government policy initiative--South Australia's "Social Inclusion Initiative"--for the Social Exclusion Knowledge Network of the international Commission on Social Determinants…
Carpal spasm in a girl as initial presentation of celiac disease: a case report.

PubMed

Ramosaj-Morina, Atifete; Keka-Sylaj, A; Hasbahta, V; Baloku-Zejnullahu, A; Azemi, M; Zunec, R

2017-09-04

Celiac disease is an immune-mediated disorder elicited by ingestion of gluten in genetically susceptible persons. This disorder is characterized by specific histological changes of the small intestine mucosa resulting in malabsorption. This case was written up as it was an unusual and dramatic presentation of celiac disease. We report the case of a 3-year-old Albanian girl who presented at our clinic with carpal spasms and hand paresthesia. A physical examination at admission revealed a relatively good general condition and body weight of 10.5 kg (10 percentile). Carpal spasms and paresthesias of her extremities were present. Neuromuscular irritability was demonstrated by positive Chvostek and Trousseau signs. Blood tests showed severe hypocalcemia with a total serum calcium of 1.2 mmol/L (normal range 2.12 to 2.55 mmol/L), ionized calcium of 0.87 (normal range 1.11 to 1.30 mmol/L), and 24-hour urine calcium excretion of 9.16 mmol (normal range female <6.2 mmol/day). Among other tests, screening for celiac disease was performed: antigliadin immunoglobulin A, anti-tissue transglutaminase, and anti-endomysial immunoglobulin A antibodies were positive. A duodenal biopsy revealed lymphocyte infiltration, crypt hyperplasia, and villous atrophy compatible with celiac disease grade IIIb according to the Marsh classification. Following the diagnosis of celiac disease, human leukocyte antigen typing was performed, giving a definite diagnosis of celiac disease. She was started on a gluten-free diet. Due to failure to follow a gluten-free diet, episodes of carpal spasms appeared again. Unfortunately, at the age of 7 years she presents with delayed psychophysical development. Although hypocalcemia is a common finding in celiac disease, hypocalcemic carpal spasm is a rare initial manifestation of the disease. Therefore, the possibility of celiac disease should be considered in patients with repeated carpal spasms that seem unduly difficult to treat. This should be
Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature

PubMed Central

2012-01-01

Background The development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI).Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) as a cause of liver disease in patients initiating HAART, which could also cause jaundice. Case presentations We report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART) for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa. All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) in the other four. In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated – in addition to epithelioid histiocytes and Langhans giant cells – neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response. Conclusion In this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be useful to clinicians in low
The United States Army War College: A Focus on Tomorrow’s Army

DTIC Science & Technology

1992-04-08

solutions? MEAN = 3 .6 VEW~ WELL’ a WELL: 4 22 000QU’e 2 42 0.0 12.0 24.0 26.0 46.0 60.0 PPCNTAGE 54 OUESTION 12: How veil does USAWC prepare senior...QUESTION 13: How veil does USAWC prepare senior officers to succeed in jobs of broad scope and responsibility? MEAN - 3.8 VERY WELL’ 5 WELL: 4 47.9...critically? MEAN m 3.e VERfy WELL: 5 WELL: 4 3 FAIR 2 POORILY 2 . 0.0 12.0 24.0 36. 4.0 60.0 PeRCENTAGL 56 OUESTION 18: How veil does USAWC prepare senior
Lack of pre-antiretroviral care and competition from traditional healers, crucial risk factors for very late initiation of antiretroviral therapy for HIV--a case-control study from eastern Uganda.

PubMed

Muhamadi, Lubega; Tumwesigye, Nazarius Mbona; Kadobera, Daniel; Marrone, Gaetano; Wabwire-Mangen, Fred; Pariyo, George; Peterson, Stefan; Ekström, Anna Mia

2011-01-01

Although WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/[µ]L, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4<50 cells/[µ]L. This study seeks to establish crucial risk factors for very late ART initiation in eastern Uganda. All adult HIV-infected clients on ART in Iganga who enrolled between 2005 and 2009 were eligible for this case-control study. Clients who started ART at CD4 cell count of <50 cells/[µ]L (very late initiators) were classified as cases and 50-200 cells/[µ]L (late initiators) as control subjects. A total of 152 cases and 202 controls were interviewed. Multivariate analyses were performed to calculate adjusted odds ratios and 95% confidence intervals. Reported health system-related factors associated with very late ART initiation were stock-outs of antiretroviral drugs stock-outs (affecting 70% of the cases and none of the controls), competition from traditional/spiritual healers (AOR 7.8, 95 CI% 3.7-16.4), and lack of pre-ARV care (AOR 4.6, 95% CI: 2.3-9.3). Men were 60% more likely and subsistence farmers six times more likely (AOR 6.3, 95% CI: 3.1-13.0) to initiate ART very late. Lack of family support tripled the risk of initiating ART very late (AOR 3.3, 95% CI: 1.6-6.6). Policy makers should prevent ARV stock-outs though effective ARV procurement and supply chain management. New HIV clients should seek pre-ARV care for routine monitoring and determination of ART eligibility. ART services should be more affordable, accessible and user-friendly to make them more attractive than traditional healers.
Managing Dualities in Planned Change Initiatives

ERIC Educational Resources Information Center

Barge, J. Kevin; Lee, Michael; Maddux, Kristy; Nabring, Richard; Townsend, Bryan

2008-01-01

Dualities play an important role in creating the conditions for change and managing planned change initiatives. Building on Seo, Putnam, and Bartunek's (2003) work, this study focuses on the dualities associated with managing change processes. A case study of a planned change process called the Circle of Prosperity Initiative, a multi-stakeholder…
A Case of Community-Acquired Pneumonia Due to Legionella pneumophila Serogroup 9 Wherein Initial Treatment with Single-Dose Oral Azithromycin Appeared Useful.

PubMed

Ito, Akihiro; Ishida, Tadashi; Tachibana, Hiromasa; Ito, Yuhei; Takaiwa, Takuya; Fujii, Hiroyuki; Hashimoto, Toru; Nakajima, Hiroshi; Amemura-Maekawa, Junko

2017-11-22

Legionella species are important causative pathogens for severe community-acquired pneumonia (CAP). Most cases of Legionella pneumonia are due to Legionella pneumophila serogroup 1, and CAP due to L. pneumophila serogroup 9 is rare. A fourth case of CAP due to L. pneumophila serogroup 9 has been reported, and initial treatment using single-dose oral azithromycin appeared useful. Azithromycin or fluoroquinolone injection is usually recommended for the treatment of Legionella pneumonia, and no previous reports have shown the effectiveness of single-dose oral azithromycin. This case report is therefore valuable from the perspective of possible treatment for mild to moderate Legionella pneumonia using single-dose oral azithromycin.
Examining Initial Sleep Onset in Primary Insomnia: A Case-Control Study Using 4-Second Epochs

PubMed Central

Moul, Douglas E.; Germain, Anne; Cashmere, J. David; Quigley, Michael; Miewald, Jean M.; Buysse, Daniel J.

2007-01-01

Study Objectives: To explore the sleep onset process in primary insomnia patients, new rules for scoring 4-second epochs were implemented to score sleep and artifacts during initial sleep onset. Conventional scorings in 20-second and 60-second epochs were also obtained. Methods: The start of the initial 60-second epoch of stage 1 was used to define “time zero” (t0). Sleep onset periods from 11 patients and 11 individually age- and sex-matched controls spanned from 5 minutes before t0 through 29 minutes after t0. Using the new rules, the periods were scored blind to group assignment. This t0 time-referenced the data analysis to one plausible midpoint in the sleep onset process. In parallel, latencies were time-referenced from good night time. Results: Reliability in scoring sleep and artifacts was adequate (kappa = 0.68 & 0.63, respectively, p <0.001). Group differences in sleep latencies were marginal in 60-second and 20-second scoring but significant with a definition of 4-second sleep latency. Patients had more 4-second epochs scored as awake (Mantel-Haenszel χ2 = 271, d.f. = 1, p <0.001) and containing artifact (M-H χ2 = 143, p <0.001). Patients took longer to achieve 30 continuous 4-second epochs of NREM sleep (Breslow χ2 = 4.03, d.f. = 1, p = 0.045) after t0. Patients accumulated sleep more slowly with all 3 scoring rules after t0. A slower rate of accumulating sleep after t0 was detected only with the 4-second scoring (p = 0.047). Conclusions: Evidence was present for momentary state-switching instabilities in the patients during the initial sleep onset process. Using rules for scoring small epochs may reveal such instabilities more readily than traditional scoring methods. Citation: Moul DE; Germain A; Cashmere D; Quigley M; Miewald JM; Buysse DJ. Examining initial sleep onset in primary insomnia: a case-control study using 4-second epochs. J Clin Sleep Med 2007;3(5):479-488. PMID:17803011
Lifting the Veil: A Realist Critique of Sistema's Upwardly Mobile Path

ERIC Educational Resources Information Center

Logan, Owen

2016-01-01

El Sistema sits somewhere between a social project and a classical music initiative. However, its promise of delivering upward mobility has not been sufficiently examined as a structural phenomenon which dovetails with critical policy issues in taxation, educational provision, human rights, and welfare. This article argues that Sistema-style…
Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale

PubMed Central

Steele, Catriona M.; Namasivayam-MacDonald, Ashwini M.; Guida, Brittany T.; Cichero, Julie A.; Duivestein, Janice; MRSc; Hanson, Ben; Lam, Peter; Riquelme, Luis F.

2018-01-01

Objective To assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. Design Participants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. Setting Web-based survey. Participants Respondents (NZ170) from 29 countries. Interventions Not applicable. Main Outcome Measures Consensual validity (percent agreement and Kendall t), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). Results The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (>70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. Conclusions This initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional
Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale.

PubMed

Steele, Catriona M; Namasivayam-MacDonald, Ashwini M; Guida, Brittany T; Cichero, Julie A; Duivestein, Janice; Hanson, Ben; Lam, Peter; Riquelme, Luis F

2018-05-01

To assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. Participants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. Web-based survey. Respondents (N=170) from 29 countries. Not applicable. Consensual validity (percent agreement and Kendall τ), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (>70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. This initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians
Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause? A population-based case-control study.

PubMed

Carrasquilla, Germán D; Berglund, Anita; Gigante, Bruna; Landgren, Britt-Marie; de Faire, Ulf; Hallqvist, Johan; Leander, Karin

2015-06-01

This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk. This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression. Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48). Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.
[Nineteen cases of school-aged children with degenerative or metabolic neurological disorders initially presenting with learning difficulty and/or behavior disturbance].

PubMed

Honzawa, Shiho; Sugai, Kenji; Akaike, Hiroto; Nakayama, Tojo; Fujikawa, Yoshinao; Komaki, Hirofumi; Nakagawa, Eiji; Sasaki, Masayuki

2012-07-01

We reported 19 cases of school-aged children. They were initially judged to have learning difficulty or school maladaptation because of attention deficits, hyperactive behaviors or poor school performance, followed by the diagnosis such as degenerative or metabolic neurological diseases. The patients consisted of 4 cases of adrenoleukodystrophy, 5 cases of dentatorubral-pallidoluysian atrophy, 3 cases of Sanfilippo syndrome, 3 cases of subacute sclerosing panencephalitis, and each one case of juvenile Gaucher disease, juvenile Huntington disease, juvenile metachromatic leukodystrophy and Leigh disease. They had markedly poor school performance, and/or abnormal behaviors, followed by seizures, character disorders or psychomotor regression. The diagnostic clues included brain CT scan and/or MRI, peculiar facial appearance and notable family histories. When the children were indicated to have learning difficulty or maladjustment to school life, we should make deliberate differential diagnoses before concluding that they have a learning disorder and/or attention-deficit/hyperactivity disorder. Instead they should be recommended to visit child neurologists, when they present with any problems as aforesaid.

Evaluating a Tacit Knowledge Sharing Initiative: A Case Study

ERIC Educational Resources Information Center

Gubbins, Claire; Corrigan, Siobhan; Garavan, Thomas N.; O'Connor, Christy; Leahy, Damien; Long, David; Murphy, Eamonn

2012-01-01

Purpose: This paper aims to present a case study illustrating the issues involved in the tacit knowledge conversion process and to determine whether such conversion delivers value to the organisation in terms of business value and return on investment (ROI). Design/methodology/approach: A single-case multiple baseline participants experimental…
Dynamics of an Overdriven Nitromethane Initiation System

NASA Astrophysics Data System (ADS)

Hároz, E. H.; Rae, P. J.; Armstrong, C. L.; Baca, E. V.; Campbell, C.; Gunderson, J. A.; Holmes, M.; Lopez-Pulliam, I.; Vaughan, L. D.; Dickson, P. M.

2017-06-01

For upcoming large-scale HE experiments, an initiation system is needed to ensure uniform and simultaneous burn. To that end, we developed an initiation system based on nitromethane. Initial, small-scale tests characterized the response of the nitromethane in the proposed cylindrical initiator geometry, indicating robust detonation under a variety of conditions such as a plane wave lenses & cylinders of PBX 9501 into a flyer plate or direct-drive. Detonation velocity, as measured by piezoelectric pin time-of-arrival measurements along the length and at bottom of vessel, shows an overdriven response. All cases show a detonation velocity faster than the literature value of 7.3 km s-1 for nitromethane, with the fastest velocity occurring for the 8-detonator, 8'' cylinder case with a velocity = 7.7 km s-1. Streak camera imaging characterized the curvature of the shock front as it arrived at the bottom of the vessel via spark gap. A final test of the initiator system looked at the expansion of the initiator vessel walls via PDV, showing velocities up to 3.5 km s-1. Finally, our initiator was placed inside a secondary vessel containing 1000 lbs of nitromethane. High-speed photography & pin data indicate complete symmetrical burn of the secondary nitromethane.
Tablet Technology in Teacher Preparation: A Case Study--The Nook Initiative

ERIC Educational Resources Information Center

Jordan, Hope; Hunter, Elizabeth; Douglas, Maegan; Wighting, Mervyn

2015-01-01

Regent University's Special Education and Reading Specialist Programs introduced the Nook Initiative fall 2013. This paper discusses the implementation, the need for integrated tablet technology in teacher preparation, initial outcomes of the study, and offers suggestions for practice. A second tablet pilot program introducing the iPad mini in the…
Factors associated with late ANC initiation among pregnant women in select public health centers of Addis Ababa, Ethiopia: unmatched case-control study design.

PubMed

Gebrekidan, Kahasse; Worku, Alemayehu

2017-01-01

Although Ethiopia has shown remarkable achievements in reducing maternal mortality in the last 10 years, the prevalence of late antenatal care (ANC) initiation is still high in the country. The primary purpose of this study was to identify the factors related to late ANC initiation among pregnant women in selected public health centers in Addis Ababa, Ethiopia. A total of 402 pregnant women (cases=134, controls=268) were recruited using multistage sampling. The design selected for the study was unmatched case-control. EpiData version 3.02 and SPSS version 20.0 were used for data entry and statistical analysis, respectively. Binary logistic regression model was used to model the odds of late ANC initiation. The odds of attending ANC late were significantly higher for mothers with a monthly household income of $8.50 to start the ANC service (AOR=3.04; 95% CI: 1.98, 4.67). Low educational level, low income of the household, unplanned pregnancy, stay for <5 years in Addis Ababa, not getting advice from health extension workers or local TV/radio and higher cost associated with initiation of the first ANC service were the main predictors of late ANC initiation. Therefore, any intervention which would need to improve early ANC initiation should focus on economic empowerment of women, and tailored health education for migrant women should be strengthened.
5 CFR 1201.111 - Initial decision by judge.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Initial decision by judge. 1201.111... PRACTICES AND PROCEDURES Procedures for Appellate Cases Final Decisions § 1201.111 Initial decision by judge. (a) The judge will prepare an initial decision after the record closes, and will serve that decision...
Institutional initiatives in professional scientific ethics: three case studies

NASA Astrophysics Data System (ADS)

Nickless, Edmund; Bilham, Nic

2015-04-01

Learned and professional scientific bodies can play a vital role in promoting ethical behaviours, giving practical substance to theoretical consideration of geoethical principles and complementing the efforts of individual scientists and practitioners to behave in a professional and ethical manner. Institutions may do this through mandatory professional codes of conduct, by developing guidelines and initiatives to codify and stimulate the uptake of best practice, and through wider initiatives to engender a culture conducive to such behaviours. This presentation will outline three current institutional initiatives which directly or indirectly address scientific ethics: i. The UK Science Council's Declaration on Diversity, Equality and Inclusion. ii. Development and promulgation of the American Geosciences Institute's (AGI) Guidelines for Ethical Professional Conduct. iii. The American Geophysical Union's (AGU) Scientific Code of Conduct and Professional Ethics. The focus of the Science Council and its member bodies (including the Geological Society of London) on diversity is of central importance when considering ethical behaviours in science. First, improving equality and diversity in the science workforce is at the heart of ethical practice, as well as being essential to meeting current and future skills needs. Second, in addition to demographic diversity (whether in terms of gender, race, economic status, sexuality or gender identity, etc), an important dimension of diversity in science is to allow space for a plurality of scientific views, and to nurture dissenting voices - essential both to the development of scientific knowledge and to its effective communication to non-technical audiences.
Global Health Initiatives and aid effectiveness: insights from a Ugandan case study

PubMed Central

2011-01-01

Background The emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade. This paper seeks to examine in depth the behaviour of two prominent GHIs in the early stages of their operation in Uganda as well as the responses of the government. Methods The study adopted a qualitative and case study approach to investigate the governance of aid transactions in Uganda. Data sources included documentary review, in-depth and semi-structured interviews and observation of meetings. Agency theory guided the conceptual framework of the study. Results The Ugandan government had a stated preference for donor funding to be channelled through the general or sectoral budgets. Despite this preference, two large GHIs opted to allocate resources and deliver activities through projects with a disease-specific approach. The mixed motives of contributor country governments, recipient country governments and GHI executives produced incentive regimes in conflict between different aid mechanisms. Conclusion Notwithstanding attempts to align and harmonize donor activities, the interests and motives of the various actors (GHIs and different parts of the government) undermine such efforts. PMID:21726431
Nephrogenic diabetes insipidus in initial stage of acute lymphoblastic leukemia and relapse after haploidentical hematopoietic stem-cell transplantation: A case report.

PubMed

Li, Dezhi; Liu, Qian; Feng, Zhifang; Zhang, Qi; Feng, Saran

2018-06-01

Nephrogenic diabetes insipidus (NDI) rarely presents in the initial stage of acute lymphoblastic leukemia (ALL) and relapse due to renal infiltration is also rare. A 19-year-old man presented with weakness, polydipsia, and polyuria for 1 month. NDI was diagnosed with insignificant response to a water deprivation test after stimulation with vasopressin injection. Bone marrow examination combined with immunophenotypic analysis, cerebrospinal cytology, and abdominal ultrasonography confirmed the diagnoses of precursor B cell ALL with renal infiltration. The patient accepted standardized combination chemotherapy and ultimately had sustained remission, and his polydipsia and polyuria disappeared after 3 days of treatment. The ALL relapsed 1 year later and he received haploidentical stem cell transplantation (haplo-SCT) from his father. One year later, he again developed NDI, with bilateral renal enlargement because of extramedullary relapse, leading to subsequent death. This case demonstrates unusual early renal involvement in ALL presenting with initial NDI. Interestingly, the NDI returned with the relapse of renal infiltration 1 year after haplo-SCT. This case suggests that NDI was probably secondary to renal leukemic infiltration.
Factors influencing voting results of local transportation funding initiatives with a substantial rail transit component : case studies of ballot measures in eleven communities

DOT National Transportation Integrated Search

2001-10-01

This publication is a follow-up study to MTI publication 00-01, Why Campaigns for Local Transportation Funding Initiatives Succeed or Fail: An Analysis of Four Communities and National Data.The earlier publication was case studies of four local ballo...
Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study

PubMed Central

Dunnigan, Matthew G; Pollock, Allyson M

2003-01-01

Objectives To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Design Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Main outcome measures Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. Results By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). Conclusion The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1. What is already known on this topicThe full business cases for the 15 first wave private finance initiative (PFI) hospitals in England
Isolator fragmentation and explosive initiation tests

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dickson, Peter; Rae, Philip John; Foley, Timothy J.

2016-09-19

Three tests were conducted to evaluate the effects of firing an isolator in proximity to a barrier or explosive charge. The tests with explosive were conducted without a barrier, on the basis that since any barrier will reduce the shock transmitted to the explosive, bare explosive represents the worst-case from an inadvertent initiation perspective. No reaction was observed. The shock caused by the impact of a representative plastic material on both bare and cased PBX 9501 is calculated in the worst-case, 1-D limit, and the known shock response of the HE is used to estimate minimum run-to-detonation lengths. The estimatesmore » demonstrate that even 1-D impacts would not be of concern and that, accordingly, the divergent shocks due to isolator fragment impact are of no concern as initiating stimuli.« less
Isolator fragmentation and explosive initiation tests

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dickson, Peter; Rae, Philip John; Foley, Timothy J.

2015-09-30

Three tests were conducted to evaluate the effects of firing an isolator in proximity to a barrier or explosive charge. The tests with explosive were conducted without barrier, on the basis that since any barrier will reduce the shock transmitted to the explosive, bare explosive represents the worst-case from an inadvertent initiation perspective. No reaction was observed. The shock caused by the impact of a representative plastic material on both bare and cased PBX9501 is calculated in the worst-case, 1-D limit, and the known shock response of the HE is used to estimate minimum run-to-detonation lengths. The estimates demonstrate thatmore » even 1-D impacts would not be of concern and that, accordingly, the divergent shocks due to isolator fragment impact are of no concern as initiating stimuli.« less
Initial Multidisciplinary Design and Analysis Framework

NASA Technical Reports Server (NTRS)

Ozoroski, L. P.; Geiselhart, K. A.; Padula, S. L.; Li, W.; Olson, E. D.; Campbell, R. L.; Shields, E. W.; Berton, J. J.; Gray, J. S.; Jones, S. M.;

2010-01-01

Within the Supersonics (SUP) Project of the Fundamental Aeronautics Program (FAP), an initial multidisciplinary design & analysis framework has been developed. A set of low- and intermediate-fidelity discipline design and analysis codes were integrated within a multidisciplinary design and analysis framework and demonstrated on two challenging test cases. The first test case demonstrates an initial capability to design for low boom and performance. The second test case demonstrates rapid assessment of a well-characterized design. The current system has been shown to greatly increase the design and analysis speed and capability, and many future areas for development were identified. This work has established a state-of-the-art capability for immediate use by supersonic concept designers and systems analysts at NASA, while also providing a strong base to build upon for future releases as more multifidelity capabilities are developed and integrated.

Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

PubMed Central

Cho, Bo Ra; Han, Jae Won; Kim, Tae Hyun; Han, Ae Ra; Hur, Sung Eun; Lee, Sung Ki

2017-01-01

Objective Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. Methods We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. Results SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m2, respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. Conclusion Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery. PMID:28217669
The Historical Supernovae in the Pre-historic Southwest: Veil Supernova Circa 3000 B.C. and 185, 393, 1006, 1054, 1181 and 1572 A.D.

NASA Astrophysics Data System (ADS)

Bradford, Suzan

2008-09-01

After 3 years of personally-funded research in predominantly Ancestral Puebloan, Chacoan, and Mimbres areas in New Mexico and Utah, this author has developed plausible evidence or intriguing examples of what may be ancient recordings by astute sky-watcher eye-witnesses (or of oral tradition re-tellings finally committed to stone and pottery designs) of the same historical supernovae recorded by humankind in Old World texts and words: the Veil supernova (redated to about 3000 B.C.) and the supernovae of 185, 393, 1006, 1054, 1181 and 1572 A.D. These recordings are in an ancient, holistic Visual Symbols Language which a school child might learn with a little diligence. And, as such, these graphic-art, representational images (of more than "a point of light") and simple celestial-entity symbols are arrayed next to their identifying constellations_oftentimes evoked as descriptive cracks and holes in the natural rock where a glyphist felt the earth mirrored the sky-vault locations overhead. To underline the objective and proto-scientific nature of the supernova observations (along with early great-comet sightings), these are sometimes accompanied by days-visible counter motifs (double-rakes, line rays and centipede legs) which agree to the day with some of the naked-eye visibility records and extrapolations from the Old World histories and records with which we are more familiar. A simple reason we have not generally identified sites like the author's examples before is that the ancient holistic glyphists utilized the cracks and textures in the rocky outcrops where they wrote: the very evidence we tend to have blind spots towards in our confidence with flat 2-dimensional means of communication such as paper, books, screens, canvases, etc. We have not lived as closely and intimately with potential informational media such as stony outcrops and fired pottery vessels (and sherds) which outlast the millennia even so.
A case of moderate liver enzyme elevation after acute acetaminophen overdose despite undetectable acetaminophen level and normal initial liver enzymes.

PubMed

Bebarta, Vikhyat S; Shiner, Drew C; Varney, Shawn M

2014-01-01

Liver function test (LFT) increase is an early sign of acetaminophen (APAP) toxicity. Typically, when an acute overdose patient is evaluated and has an initial undetectable APAP level and normal liver enzymes, the patient is not treated with N-acetylcysteine, and liver enzymes are not expected to increase later. We report a case of moderate LFT increase despite normal LFTs and an undetectable APAP level after delayed presentation of an APAP ingestion. A 22-year-old male with no medical history ingested 15-25 hydrocodone/APAP tablets (5 mg/500 mg). His suicide note and his bunkmate corroborated the overdose time. He arrived at the emergency department 16 hours after ingestion. At that time, his APAP level was <10 μg/mL, and his liver enzymes were normal [aspartate transaminase (AST) 31 U/L and alanine transaminase (ALT) 34 U/L]. Twenty-nine hours after ingestion, the psychiatry team obtained LFTs (AST 45, ALT 61). He had persistent nausea and diffuse abdominal pain. On repeat analysis, the APAP level at 36 hours was found to be <10 μg/mL, AST 150, and ALT 204. After 2 more days of increasing LFTs and persistent abdominal pain and nausea, the toxicology department was consulted, the patient was transferred to the medicine department, and intravenous N-acetylcysteine was started 66 hours after ingestion. He was treated for 16 hours and had a significant decline in LFTs and symptom resolution. His prothrombin time, bilirubin, lactate, creatinine, and mental status were normal throughout the admission. Other cases of LFT increase were excluded. Our case report illustrates that a moderate increase in liver transaminase may occur despite an initial undetectable APAP level and normal transaminases after a delayed presentation. In our case, no serious clinical effects were reported.
[Refusal of initiation of dialysis by elderly patients with chronic renal failure].

PubMed

Fujimaki, Hiroshi; Kasuya, Yutaka; Kawaguchi, Sachiko; Hara, Shino; Koga, Shiro; Takahashi, Tadao; Mizuno, Shoichi

2005-07-01

Refusal of dialysis is not uncommon in elderly patients with chronic renal failure. In this study, we retrospectively inspected our dealings with patients who refused our offer to initiate dialysis. In addition, we discussed how to grasp the meaning of this phenomenon. We treated 152 patients with advanced chronic renal failure aged 60 years and over at Tokyo Metropolitan Geriatric Hospital. The patients fulfilling the following two criteria were considered to be refusal cases. The first criterion was that an acceptance of the initiation of dialysis could not be obtained in spite of repeated counseling. The second criterion was that a definite outcome was precipitated by the development of severe uremic symptoms. In every refusal case, clinical characteristics and household members were surveyed. Verbal expressions of the reasons for refusal were retrieved from medical charts. The outcome was also studied. The two criteria were fulfilled in 7 cases. The male/female ratio was 5:2. The age was 78 +/- 7 years (mean +/- standard deviation). All but one cases were ambulatory, and all cases had normal cognitive function. Four cases were married, and the other cases had lost their partners. The number of household members was 3.9 +/- 1.8. We speculated that every case could maintain a good quality of life even after the initiation of dialysis. Representative expressions of the reasons for refusal were "I have already lived fully" and "I would prefer to accept death rather than dialysis". The outcome was urgent initiation of dialysis (five cases) and death (two cases). The time between initial counseling and the outcome was 115 +/- 37 days. Accepting or refusing dialysis therapy is a selection related to life or death. We must make an effort to obtain consent to initiating dialysis if patients are assessed as suitable for dialysis.
Gynecomastia as the initial manifestation of hyperthyroidism.

PubMed

Gordon, D L; Brown, J L; Emanuele, N V; Hall, L

1997-01-01

To present two new cases of gynecomastia as the initial manifestation of hyperthyroidism. We describe detailed case reports of two men with breast enlargement who were found to have hyperthyroidism, and we review the related literature. Two men sought medical assistance because of unilateral tender gynecomastia. In one of these patients, thyroid, gonadal, and prostate examinations showed normal findings at the time of initial assessment, and symptoms of hyperthyroidism developed later. In our other patient with gynecomastia, other symptoms of hyperthyroidism--for example, nervousness, irritability, palpitations, and fatigue--had been present for a prolonged period but had been considered "normal" by the patient. In both patients, the hyperthyroidism was treated with radioiodine. Breast pain disappeared in both patients, and breast enlargement disappeared in one patient and was decreased in the other patient after euthyroidism was achieved. Review of the literature disclosed only two similar cases. Because of the rarity of gynecomastia as the initial symptom of hyperthyroidism, we believe that thyroid function tests are not indicated in the workup of patients whose major complaint is gynecomastia.
10 CFR 710.22 - Initial decision process.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) The Manager shall make an initial decision as to the individual's access authorization eligibility... Officer refers the individual's case to the Manager in accordance with § 710.25(e) or § 710.26(b). (b..., the Manager's initial decision as to the individual's access authorization eligibility shall be made...
An instrumental case study examining the introduction and dissemination of the Baby Friendly Health Initiative in Australia: Participants' perspectives.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2018-06-01

Australia experiences high breastfeeding initiation but low duration rates. UNICEF introduced the global breastfeeding strategy, the Baby-Friendly Hospital Initiative, to Australia in 1992, transferring governance to the Australian College of Midwives (ACM) in 1995. In 2017 23% of facilities were registered as 'baby-friendly' accredited. To examine the introduction and dissemination of the Baby-friendly Hospital Initiative into the Australian national setting. An instrumental case study was conducted containing two components: analysis of historical documents pertaining to the Initiative and participant's interviews, reported here. A purposive sampling strategy identified 14 participants from UNICEF, ACM, maternity and community health services, the Australian government and volunteer organisations who took part in in-depth interviews. Thematic analysis explored participants' perceptions of factors influencing the uptake and future of the since renamed Baby Friendly Health Initiative (BFHI) and accreditation programme, BFHI Australia. Two broad categories, enablers and barriers, guided the interviews and analysis. Participants revealed a positive perception of the BFHI whilst identifying that its interpretation and expansion in Australia had been negatively influenced by intangible government support and suboptimal capacity building. BFHI's advocacy agenda competed with BFHI Australia's need for financial viability. Widespread stakeholder collaboration and tangible political endorsement was seen as a way to move the strategy forward. Dissemination of BFHI Australia is hampered by multi-level systems issues. Prioritisation, stakeholder collaboration and adequate resourcing of the BFHI is required to create a supportive and enabling environment for Australian women to determine and practice their preferred infant feeding method. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Perceptions of Female Muslim Students Who Veil: Campus Religious Climate

ERIC Educational Resources Information Center

Seggie, Fatma Nevra; Sanford, Gretchen

2010-01-01

This article is based on a small qualitative case study that examined the perceptions of undergraduate Muslim American and Muslim international female students regarding the campus religious climate in a predominantly Christian four-year research university. Specifically, it seeks to understand the opportunities and challenges of female Muslim…
Piercing the veil: ethical issues in ethnographic research.

PubMed

Schrag, Brian

2009-06-01

It is not unusual for researchers in ethnography (and sometimes Institutional Review Boards) to assume that research of "public" behavior is morally unproblematic. I examine an historical case of ethnographic research and the sustained moral outrage to the research expressed by the subjects of that research. I suggest that the moral outrage was legitimate and articulate some of the ethical issues underlying that outrage. I argue that morally problematic Ethnographic research of public behavior can derive from research practice that includes a tendency to collapse the distinction between harm and moral wrong, a failure to take account of recent work on ethical issues in privacy; failure to appreciate the deception involved in ethnographers' failure to reveal their role as researchers to subjects and finally a failure to appropriately weigh the moral significance of issues of invasion of privacy and inflicted insight in both the research process and subsequent publication of research.
Lifting the veil.

PubMed

Sorrel, Amy Lynn

2014-07-01

As governments and employers look for ways to curb growing health care costs, and as patients bear a higher share of their medical bills, policymakers in Texas and beyond increasingly target physicians in their efforts to unveil health care prices. They couch such "price transparency" as a way to help patients make more informed health care decisions. But Texas Medical Association's Board of Trustees member Gary W. Floyd, MD, of Fort Worth, cautions that for a complex health care payment system, coupled with individual patients' complex needs, coming up with a so-called "sticker price" is not as simple as it seems.
Enhancing Infant Mental Health Using a Capacity-Building Model: A Case Study of a Process Evaluation of the "Ready, Steady, Grow" Initiative

ERIC Educational Resources Information Center

O'Farrelly, Christine; Guerin, Suzanne; Victory, Gerard

2017-01-01

Infant mental health (IMH) is best promoted through a continuum of services underpinned by strong service capacity. However, service providers often lack fundamental IMH knowledge and skills. Using the Ready, Steady, Grow (RSG) initiative as a case study of a capacity-building model (P., Hawe, L., King, M., Noort, C., Jordens, & B., Llyod,…
Oligo kernels for datamining on biological sequences: a case study on prokaryotic translation initiation sites

PubMed Central

Meinicke, Peter; Tech, Maike; Morgenstern, Burkhard; Merkl, Rainer

2004-01-01

Background Kernel-based learning algorithms are among the most advanced machine learning methods and have been successfully applied to a variety of sequence classification tasks within the field of bioinformatics. Conventional kernels utilized so far do not provide an easy interpretation of the learnt representations in terms of positional and compositional variability of the underlying biological signals. Results We propose a kernel-based approach to datamining on biological sequences. With our method it is possible to model and analyze positional variability of oligomers of any length in a natural way. On one hand this is achieved by mapping the sequences to an intuitive but high-dimensional feature space, well-suited for interpretation of the learnt models. On the other hand, by means of the kernel trick we can provide a general learning algorithm for that high-dimensional representation because all required statistics can be computed without performing an explicit feature space mapping of the sequences. By introducing a kernel parameter that controls the degree of position-dependency, our feature space representation can be tailored to the characteristics of the biological problem at hand. A regularized learning scheme enables application even to biological problems for which only small sets of example sequences are available. Our approach includes a visualization method for transparent representation of characteristic sequence features. Thereby importance of features can be measured in terms of discriminative strength with respect to classification of the underlying sequences. To demonstrate and validate our concept on a biochemically well-defined case, we analyze E. coli translation initiation sites in order to show that we can find biologically relevant signals. For that case, our results clearly show that the Shine-Dalgarno sequence is the most important signal upstream a start codon. The variability in position and composition we found for that signal is
Cost effectiveness of the Oregon quitline "free patch initiative".

PubMed

Fellows, Jeffrey L; Bush, Terry; McAfee, Tim; Dickerson, John

2007-12-01

We estimated the cost effectiveness of the Oregon tobacco quitline's "free patch initiative" compared to the pre-initiative programme. Using quitline utilisation and cost data from the state, intervention providers and patients, we estimated annual programme use and costs for media promotions and intervention services. We also estimated annual quitline registration calls and the number of quitters and life years saved for the pre-initiative and free patch initiative programmes. Service utilisation and 30-day abstinence at six months were obtained from 959 quitline callers. We compared the cost effectiveness of the free patch initiative (media and intervention costs) to the pre-initiative service offered to insured and uninsured callers. We conducted sensitivity analyses on key programme costs and outcomes by estimating a best case and worst case scenario for each intervention strategy. Compared to the pre-intervention programme, the free patch initiative doubled registered calls, increased quitting fourfold and reduced total costs per quit by $2688. We estimated annual paid media costs were $215 per registered tobacco user for the pre-initiative programme and less than $4 per caller during the free patch initiative. Compared to the pre-initiative programme, incremental quitline promotion and intervention costs for the free patch initiative were $86 (range $22-$353) per life year saved. Compared to the pre-initiative programme, the free patch initiative was a highly cost effective strategy for increasing quitting in the population.
A Relationship Marketing Approach to Academic Initiative Planning: A Case in Point

ERIC Educational Resources Information Center

Mobley, Mary F.; Basciano, Peter

2012-01-01

Many higher education initiatives are dependent upon the development of multiple relationships across academic and support functions. The probability of achieving superior initiative outcomes rests, in part, on the construction of an infrastructure that supports the goals, strategies, tactics, and ongoing mission of a defined project. Through…
Case Report: Dermoscopic features of oral lichen planus - the evolution of mucoscopy.

PubMed

Sonthalia, Sidharth; Varma, Sangeeta; Jha, Abhijeet Kumar; Jakhar, Deepak; Kaliyadan, Feroze

2018-01-01

Dermoscopy, a non-invasive technique for cutaneous diagnosis is being increasingly studied in various disorders of the skin, nails and scalp. However, it has been under-utilized for the diagnosis and characterization of mucosal disorders. The dermoscopic characterization of cutaneous lichen planus and its variants has been well documented with Wickham's striae constituting the hallmark of the condition. However, the dermoscopic features of oral lichen planus with hand-held or videodermoscopy remain to be elucidated. We present the case of a young adult man who presented with asymptomatic white lacy lesions over a bluish-black background over the tongue, patchy hyperpigmentation of the buccal mucosae and gingivae, and longitudinal melanonychia involving some nails. History of intake of any drugs preceding the lesions, smoking, chewing of betel nut and dental implants was negative. Family history was non-contributory. There were no cutaneous lesions suggestive of lichen planus. Mucoscopy (dermoscopy of the mucosa, oral in this case) and onychoscopy were done followed by biopsy from the tongue that confirmed the diagnosis of lichen planus. Oral mucoscopy of the tongue revealed a tri-colored pattern with structureless veil-like grey-white areas (modified Wickham's striae), well-demarcated red glossy erosions, and violaceous-to-brown clods. Additionally, vascular pattern of dotted and linear to curved vessels along the borders of leukoplakia-like areas and erosions were observed. Onychoscopy confirmed lichen planus-associated melanonychia. Dermoscopy also proved useful in conveniently ruling out other disorders typified by mucosal and nail pigmentation such as Laugier Hunziker syndrome and drug-induced changes. Although direct oral microscopy has been used in defining features of oral lichen planus, to the best of our knowledge this case is the first report on mucoscopy or dermoscopy of oral lichen planus.
Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study.

PubMed

Dunnigan, Matthew G; Pollock, Allyson M

2003-04-26

To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1.
Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression

PubMed Central

Son, Seong; Lee, Sang Gu; Kim, Eun Young; Park, Chan Woo; Kim, Woo Kyung

2013-01-01

Objective The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. Methods Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors. Results No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG. Conclusion A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging. PMID:24278650
"In the Middle of Difficulty Lies Opportunity"--Using a Case Study to Identify Critical Success Factors Contributing to the Initiation of International Collaborative Projects

ERIC Educational Resources Information Center

Johnson, Ian M.

2005-01-01

This paper identifies factors that contribute to the successful initiation of international collaborative projects intended to support the development of education for librarianship and information sciences. It discusses the widespread failure to analyse the Critical Success Factors in international collaborative projects and proposes a case study…
ColorChecker at the beach: dangers of sunburn and glare

NASA Astrophysics Data System (ADS)

McCann, John

2014-01-01

In High-Dynamic-Range (HDR) imaging, optical veiling glare sets the limits of accurate scene information recorded by a camera. But, what happens at the beach? Here we have a Low-Dynamic-Range (LDR) scene with maximal glare. Can we calibrate a camera at the beach and not be burnt? We know that we need sunscreen and sunglasses, but what about our cameras? The effect of veiling glare is scene-dependent. When we compare RAW camera digits with spotmeter measurements we find significant differences. As well, these differences vary, depending on where we aim the camera. When we calibrate our camera at the beach we get data that is valid for only that part of that scene. Camera veiling glare is an issue in LDR scenes in uniform illumination with a shaded lens.
75 FR 39494 - Initiation of Five-Year (“Sunset”) Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-09

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the...), we are initiating the Sunset Review of the following antidumping duty orders: DOC Case No. ITC Case... case number listed for Carboxymethylcellulose from Sweden was incorrect. The case number listed above...
20 CFR 404.969 - Appeals Council initiates review.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Appeals Council initiates review. 404.969... and Decisions Appeals Council Review § 404.969 Appeals Council initiates review. (a) General. Anytime..., the Appeals Council may decide on its own motion to review the action that was taken in your case. We...
20 CFR 416.1469 - Appeals Council initiates review.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Appeals Council initiates review. 416.1469... Determinations and Decisions Appeals Council Review § 416.1469 Appeals Council initiates review. (a) General... section, the Appeals Council may decide on its own motion to review the action that was taken in your case...
Student-Led Campus Climate Change Initiatives in Canada

ERIC Educational Resources Information Center

Helferty, Anjali; Clarke, Amelia

2009-01-01

Purpose: The purpose of this paper is to provide a comprehensive list of student-led, campus-based climate change initiatives, and offers details on many specific cases. The paper also documents the roles students have played and considers the larger youth engagement implications. Many of these initiatives can be replicated elsewhere, thereby…
Preparing Teachers for Diversity: The Role of Initial Teacher Education. Annex 2 To the Final Report to DG Education, Youth, Sport and Culture of the European Commission. Case Study Summaries

ERIC Educational Resources Information Center

European Commission, 2017

2017-01-01

"Preparing Teachers for Diversity: The Role of Initial Teacher Education. Annex 2 To the Final Report to DG Education, Youth, Sport and Culture of the European Commission. Case Study Summaries" is designed as a companion document to the final report "Preparing Teachers for Diversity: The Role of Initial Teacher Education. Final…
16 CFR 3.52 - Appeal from initial decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Appeal from initial decision. 3.52 Section 3.52 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE RULES OF PRACTICE FOR ADJUDICATIVE PROCEEDINGS Decision § 3.52 Appeal from initial decision. (a) Automatic review of cases in which the Commission sough...
Myalgias or non-specific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency.

PubMed

Badsha, Humeira; Daher, Mirna; Ooi Kong, Kok

2009-08-01

The aim of our study was to determine the prevalence of vitamin D deficiency (<20 ng/dl) among patients with fibromyalgia or muscle pain in a musculoskeletal clinic in the United Arab Emirates. Consecutive patients who were diagnosed with fibromyalgia and/or non-specific musculoskeletal pain (ICD-9 729.1) were screened for vitamin D deficiency. Patients were seen at follow-up after treatment with vitamin D was given. Improvement was assessed by a simple questionnaire. Patients (139) with muscle pain were seen in 2007. Average age was 40 +/- year; 95% were female; 69 (49%) were Arab, of whom 92% were veiled; 43 (30%) Indian of whom 11% were veiled; 23 (16%) were Caucasian; and four were East Asian (3%) and all wore western clothes. One hundred three (74%) of these patients had a low vitamin D level. Vitamin D deficiency was most common among Arab patients (86%) and Indo-Pakistani (87%) and least common among the Caucasians (8%) and was equally prevalent among veiled and non-veiled patients. Treatment resulted in clinical improvement in 90% of patients. Non-specific muscle pains among Arab and Indian-Pakistani populations may indicate vitamin D deficiency, and prompt treatment can result in resolution of symptoms.
Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative

PubMed Central

Everett, Beverly; McGinnis, Matthew; Beresky, Amy; Cane, Rudolph C.; Cooper, Tasha; Davda, Rajesh K.; Farmer, Donna; John, Stella M.; Sollars, Denise L.; Rausch, John F.

2017-01-01

Purpose of Study: Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5. Primary Practice Settings: A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012. Methodology and Sample: Claims data were analyzed to compare 3,861 beneficiaries randomized to receive condition-focused case management with 3,859 controls, with follow-up through July 2013. After using an algorithm to identify beneficiaries at highest risk of progression, a case management team implemented, among those assigned to the intervention, an evidence-based assessment tool, provided education and follow-up, engaged nephrologists and other providers, and conducted weekly rounds. Primary outcome measures were hospital admissions, emergency department visits, nephrologist visits, dialysis, arteriovenous (AV) fistula creation, and total medical costs. Analysis of variance techniques were used to test group differences. Results: As compared with controls, intervention beneficiaries were 12% more likely to have fistula creation (p = .004). Intervention beneficiaries were observed to have savings of $199 per member per month (PMPM), F = 23.05, p = .04. This difference equated to 6% lower total medical costs in the intervention group. Savings observed were derived half from improved in-network utilization and half from reduced hospital costs. Implications for Case Management Practice: The observed 12% increased rate of creation of AV fistulas and $199 (6%) decrease in PMPM cost between the intervention and control groups corresponded to a savings of more than $18 million in 2015 U.S. dollars (USD). On the basis

Acute Psychosis after Recent Isoniazid Initiation

PubMed Central

Sukhija, Gagandeep; Singh, Harpreet

2015-01-01

Isoniazid as part of Directly Observed Treatment-Short course (DOTS) regimen is universally used. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset of symptoms remains highly variable. We describe a case of 54-year-old female on anti-tubercular therapy with onset of psychosis within three days of Isoniazid initiation characterised by agitation, loosening of association, echolalia with spontaneous remission after drug stoppage. This case highlights the importance of remaining vigilant and considering isoniazid as possible causative agent for psychosis even within days of its intiation and avoiding delay in management. PMID:26266198
The Florida State Initial Teacher Certification Test: A Case Study.

ERIC Educational Resources Information Center

Dorn, Charles M.

1989-01-01

Describes the development of the art certification examination which was designed for the Florida State Initial Teacher Certification Test. Discusses problems of subjectivity, content, and question format. Suggests criteria which can guide the development of viable college art education programs that can adequately prepare teachers in the areas of…
Acromegaly and gigantism in the medical literature. Case descriptions in the era before and the early years after the initial publication of Pierre Marie (1886).

PubMed

de Herder, Wouter W

2009-01-01

In 1886 Pierre Marie used the term "acromegaly" for the first time and gave a full description of the characteristic clinical picture. However several others had already given clear clinical descriptions before him and sometimes had given the disease other names. After 1886, it gradually became clear that pituitary enlargement (caused by a pituitary adenoma) was the cause and not the consequence of acromegaly, as initially thought. Pituitary adenomas could be found in the great majority of cases. It also became clear that acromegaly and gigantism were the same disease but occurring at different stages of life and not different diseases as initially thought. At the end of the 19th and beginning of the 20th century most information was derived from case descriptions and post-mortem examinations of patients with acromegaly or (famous) patients with gigantism. The stage was set for further research into the pathogenesis, diagnosis and therapy of acromegaly and gigantism.
Corporate social responsibility initiatives addressing social exclusion in Bangladesh.

PubMed

Werner, Wendy J

2009-08-01

The private sector is often seen as a driver of exclusionary processes rather than a partner in improving the health and welfare of socially-excluded populations. However, private-sector initiatives and partnerships- collectively labelled corporate social responsibility (CSR) initiatives-may be able to positively impact social status, earning potential, and access to services and resources for socially-excluded populations. This paper presents case studies of CSR projects in Bangladesh that are designed to reduce social exclusion among marginalized populations and explores whether CSR initiatives can increase economic and social capabilities to reduce exclusion. The examples provide snapshots of projects that (a) increase job-skills and employment opportunities for women, disabled women, and rehabilitated drug-users and (b) provide healthcare services to female workers and their communities. The CSR case studies cover a limited number of people but characteristics and practices replicable and scaleable across different industries, countries, and populations are identified. Common success factors from the case studies form the basis for recommendations to design and implement more CSR initiatives targeting socially-excluded groups. The analysis found that CSR has potential for positive and lasting impact on developing countries, especifically on socially-excluded populations. However, there is a need for additional monitoring and critical evaluation.
Vitamin A and D Deficiencies Associated With Incident Tuberculosis in HIV-Infected Patients Initiating Antiretroviral Therapy in Multinational Case-Cohort Study.

PubMed

Tenforde, Mark W; Yadav, Ashish; Dowdy, David W; Gupte, Nikhil; Shivakoti, Rupak; Yang, Wei-Teng; Mwelase, Noluthando; Kanyama, Cecilia; Pillay, Sandy; Samaneka, Wadzanai; Santos, Breno; Poongulali, Selvamuthu; Tripathy, Srikanth; Riviere, Cynthia; Berendes, Sima; Lama, Javier R; Cardoso, Sandra W; Sugandhavesa, Patcharaphan; Christian, Parul; Semba, Richard D; Campbell, Thomas B; Gupta, Amita

2017-07-01

Numerous micronutrients have immunomodulatory roles that may influence risk of tuberculosis (TB), but the association between baseline micronutrient deficiencies and incident TB after antiretroviral therapy (ART) initiation in HIV-infected individuals is not well characterized. We conducted a case-cohort study (n = 332) within a randomized trial comparing 3 ART regimens in 1571 HIV treatment-naive adults from 9 countries. A subcohort of 30 patients was randomly selected from each country (n = 270). Cases (n = 77; main cohort = 62, random subcohort = 15) included patients diagnosed with TB by 96 weeks post-ART initiation. We determined pretreatment concentrations of vitamin A, carotenoids, vitamin B6, vitamin B12, vitamin D, vitamin E, and selenium. We measured associations between pretreatment micronutrient deficiencies and incident TB using Breslow-weighted Cox regression models. Median pretreatment CD4 T-cell count was 170 cells/mm; 47.3% were women; and 53.6% Black. In multivariable models after adjusting for age, sex, country, treatment arm, previous TB, baseline CD4 count, HIV viral load, body mass index, and C-reactive protein, pretreatment deficiency in vitamin A (adjusted hazard ratio, aHR 5.33, 95% confidence interval, CI: 1.54 to 18.43) and vitamin D (aHR 3.66, 95% CI: 1.16 to 11.51) were associated with TB post-ART. In a diverse cohort of HIV-infected adults from predominantly low- and middle-income countries, deficiencies in vitamin A and vitamin D at ART initiation were independently associated with increased risk of incident TB in the ensuing 96 weeks. Vitamin A and D may be important modifiable risk factors for TB in high-risk HIV-infected patients starting ART in resource-limited highly-TB-endemic settings.
Abriendo Caminos Para La Educacion: A Case Study of a Parent Outreach Initiative Building on the Knowledge, Skills, and Resources of the Latina/o Community

ERIC Educational Resources Information Center

Fernandez, Graciela

2010-01-01

Informed by research studies that demonstrate a positive relationship between parent engagement and student academic attainment, state and national parent outreach initiatives have aimed to bridge the gap between Latina/o parents and schools. Such was the case with the Latina/o Family, School and Community "Avanzando" Project, which…
76 FR 31588 - Initiation of Five-Year (“Sunset”) Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-01

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the...), we are initiating the Sunset Review of the following antidumping duty orders: DOC case no. ITC case...
77 FR 32527 - Initiation of Five-Year (“Sunset”) Review

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2012-06-01

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the... initiating the Sunset Review of the following antidumping duty order: DOC Case No. ITC Case No. Country...
77 FR 53867 - Initiation of Five-Year (“Sunset”) Review

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78 FR 13862 - Initiation of Five-Year (“Sunset”) Review

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2013-03-01

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the... initiating a Sunset Review of the following antidumping duty order: Department DOC Case No. ITC Case No...
75 FR 53664 - Initiation of Five-Year (“Sunset”) Review

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...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the...), we are initiating the Sunset Review of the following antidumping duty orders: DOC Case No. ITC Case...
76 FR 24459 - Initiation of Five-Year (“Sunset”) Review

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2011-05-02

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the...), we are initiating the Sunset Review of the following antidumping duty orders: DOC case No. ITC case...
77 FR 19643 - Initiation of Five-Year (“Sunset”) Review

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76 FR 67412 - Initiation of Five-Year (“Sunset”) Review

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2011-11-01

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77 FR 4995 - Initiation of Five-Year (“Sunset”) Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-01

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the...), we are initiating the Sunset Review of the following antidumping duty orders: DOC case No. ITC case...
Marginal Structural Models for Case-Cohort Study Designs to Estimate the Association of Antiretroviral Therapy Initiation With Incident AIDS or Death

PubMed Central

Cole, Stephen R.; Hudgens, Michael G.; Tien, Phyllis C.; Anastos, Kathryn; Kingsley, Lawrence; Chmiel, Joan S.; Jacobson, Lisa P.

2012-01-01

To estimate the association of antiretroviral therapy initiation with incident acquired immunodeficiency syndrome (AIDS) or death while accounting for time-varying confounding in a cost-efficient manner, the authors combined a case-cohort study design with inverse probability-weighted estimation of a marginal structural Cox proportional hazards model. A total of 950 adults who were positive for human immunodeficiency virus type 1 were followed in 2 US cohort studies between 1995 and 2007. In the full cohort, 211 AIDS cases or deaths occurred during 4,456 person-years. In an illustrative 20% random subcohort of 190 participants, 41 AIDS cases or deaths occurred during 861 person-years. Accounting for measured confounders and determinants of dropout by inverse probability weighting, the full cohort hazard ratio was 0.41 (95% confidence interval: 0.26, 0.65) and the case-cohort hazard ratio was 0.47 (95% confidence interval: 0.26, 0.83). Standard multivariable-adjusted hazard ratios were closer to the null, regardless of study design. The precision lost with the case-cohort design was modest given the cost savings. Results from Monte Carlo simulations demonstrated that the proposed approach yields approximately unbiased estimates of the hazard ratio with appropriate confidence interval coverage. Marginal structural model analysis of case-cohort study designs provides a cost-efficient design coupled with an accurate analytic method for research settings in which there is time-varying confounding. PMID:22302074
Robustness of inflation to inhomogeneous initial conditions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clough, Katy; Lim, Eugene A.; DiNunno, Brandon S.

We consider the effects of inhomogeneous initial conditions in both the scalar field profile and the extrinsic curvature on different inflationary models. In particular, we compare the robustness of small field inflation to that of large field inflation, using numerical simulations with Einstein gravity in 3+1 dimensions. We find that small field inflation can fail in the presence of subdominant gradient energies, suggesting that it is much less robust to inhomogeneities than large field inflation, which withstands dominant gradient energies. However, we also show that small field inflation can be successful even if some regions of spacetime start out inmore » the region of the potential that does not support inflation. In the large field case, we confirm previous results that inflation is robust if the inflaton occupies the inflationary part of the potential. Furthermore, we show that increasing initial scalar gradients will not form sufficiently massive inflation-ending black holes if the initial hypersurface is approximately flat. Finally, we consider the large field case with a varying extrinsic curvature K , such that some regions are initially collapsing. We find that this may again lead to local black holes, but overall the spacetime remains inflationary if the spacetime is open, which confirms previous theoretical studies.« less
Robustness of inflation to inhomogeneous initial conditions

NASA Astrophysics Data System (ADS)

Clough, Katy; Lim, Eugene A.; DiNunno, Brandon S.; Fischler, Willy; Flauger, Raphael; Paban, Sonia

2017-09-01

We consider the effects of inhomogeneous initial conditions in both the scalar field profile and the extrinsic curvature on different inflationary models. In particular, we compare the robustness of small field inflation to that of large field inflation, using numerical simulations with Einstein gravity in 3+1 dimensions. We find that small field inflation can fail in the presence of subdominant gradient energies, suggesting that it is much less robust to inhomogeneities than large field inflation, which withstands dominant gradient energies. However, we also show that small field inflation can be successful even if some regions of spacetime start out in the region of the potential that does not support inflation. In the large field case, we confirm previous results that inflation is robust if the inflaton occupies the inflationary part of the potential. Furthermore, we show that increasing initial scalar gradients will not form sufficiently massive inflation-ending black holes if the initial hypersurface is approximately flat. Finally, we consider the large field case with a varying extrinsic curvature K, such that some regions are initially collapsing. We find that this may again lead to local black holes, but overall the spacetime remains inflationary if the spacetime is open, which confirms previous theoretical studies.
The Influence of Information Ecology on E-Commerce Initiatives.

ERIC Educational Resources Information Center

Detlor, Brian

2001-01-01

Explores the influence of an organization's information ecology, or internal information environment, on a firm's electronic commerce initiatives and plans. Reports results from a case study investigation on the adoption and use of an e-commerce initiative, a corporate portal, by participants at a large Canadian company. (Author/LRW)
Massachusetts Expanded Learning Time (ELT) Initiative. Case Studies 2010-2011

ERIC Educational Resources Information Center

Caven, Meghan; Checkoway, Amy; Fisman, Lianne; Gamse, Beth; Fountain, Alyssa Rulf

2012-01-01

The Massachusetts Expanded Learning Time (ELT) initiative was launched in 2005, and it provides grants to selected schools across multiple districts to increase instructional time by at least 300 hours per academic year. Participating schools receive an additional $1,300 per student to lengthen the day and/or year. Schools are expected to use the…

Overview of Medicaid capitation and case-management initiatives

PubMed Central

Freund, Deborah A.; Neuschler, Edward

1986-01-01

Case-management programs have grown in number and in acceptance in the Medicaid program since 1981. In this article, we review their structure and incentives as well as what is known about their impact on cost and use. These programs also have been difficult to implement, posing myriad management challenges for prepaid program managers and State administrators. We highlight the problems in the following areas: eligibility, enrollment, rate setting, and management information systems. PMID:10311923
CMV sinusitis as the initial manifestation of AIDS.

PubMed

Jütte, A; Fätkenheuer, G; Hell, K; Salzberger, B

2000-03-01

Cytomegalovirus (CMV) disease is a typical late-stage complication of AIDS. Only six cases of CMV sinusitis have been reported in the literature. This is the first case of CMV sinusitis leading to the diagnosis of HIV and CMV retinitis. Diseases of the sinonasal tract may represent an initial manifestation of HIV or AIDS.
Causes of unplanned hemodialysis initiation.

PubMed

Gomis Couto, A; Teruel Briones, J L; Fernández Lucas, M; Rivera Gorrin, M; Rodríguez Mendiola, N; Jiménez Álvaro, S; Quereda Rodríguez-Navarro, C

2011-01-01

Half of patients starting chronic hemodialysis used a transient vascular catheter as a vascular access (unplanned initiation). An objective of the Quality Management Group of the Spanish Society of Nephrology is to achieve that 80% of the patients starting hemodialysis do it with an arteriovenous fistula. We want to review the causes of non-planned hemodialysis nowadays. In 2010, 43 patients had started chronic hemodialysis in the Hospital Ramón y Cajal in Madrid (Spain). Mean age was 61 years, 79% were men, the most frequent cause of chronic renal disease was the diabetes (23%) and Charlson Comorbidity Index was 6.3 ± 2.6. The unplanned hemodialysis occurred in 20 patients (47%), without any differences with the 23 patients who began planned hemodialysis, in none of the clinical or demographic parameters analyzed. The main cause of unplanned hemodialysis was the acute exacerbation of chronic kidney disease stage 3 or 4, previously stable, secondary to an unforeseeable intercurrent process (8 patients, 40% of the cases). One patient began after a non-recovery acute renal failure and in other 6 patients, the reason of unplanned hemodialysis initiation was not attributable to the operation Health System (in 3 cases unknown kidney chronic disease and in the other 3 cases it was patient´s responsibility). Only in 5 cases (25%), the cause could be corrigible. Most causes of unplanned hemodialysis does not come from the healthcare organization and therefore not easy to resolve it. Consequently, the objective of the Quality Group will be difficult to be achieved.
Viewing health care through a semiotic veil of signs.

PubMed

Elwood, Thomas W

2012-01-01

An old joke goes as follows. A patient is admitted to an emergency room and, while lying there, overhears a conversation about his case by a group of health professionals. One asks, "Should we treat him or should we let him live." Fear of the unknown upon entering the health care arena is an important element in life for many patients. Apart from a sense of anxiety that may result from the appearance of a suspicious lump or stomach pain, patients bring a host of important attributes to the health care setting. Depending on the degree of similarity, or lack thereof, between patients and providers on factors such as age, gender, and race/ethnicity, their interaction might be more of a social collision than a satisfactory encounter. This chapter touches upon certain elements that have the potential to influence the quality of their interaction.
The Dynamics of Initiative in Communication Networks.

PubMed

Mollgaard, Anders; Mathiesen, Joachim

2016-01-01

Human social interaction is often intermittent. Two acquainted persons can have extended periods without social interaction punctuated by periods of repeated interaction. In this case, the repeated interaction can be characterized by a seed initiative by either of the persons and a number of follow-up interactions. The tendency to initiate social interaction plays an important role in the formation of social networks and is in general not symmetric between persons. In this paper, we study the dynamics of initiative by analysing and modeling a detailed call and text message network sampled from a group of 700 individuals. We show that in an average relationship between two individuals, one part is almost twice as likely to initiate communication compared to the other part. The asymmetry has social consequences and ultimately might lead to the discontinuation of a relationship. We explain the observed asymmetry by a positive feedback mechanism where individuals already taking initiative are more likely to take initiative in the future. In general, people with many initiatives receive attention from a broader spectrum of friends than people with few initiatives. Lastly, we compare the likelihood of taking initiative with the basic personality traits of the five factor model.
A case study: the initiative to improve RN scheduling at Hamilton Health Sciences.

PubMed

Wallace, Laurel-Anne; Pierson, Sharon

2008-01-01

In 2003, Hamilton Health Sciences embarked on an initiative to improve and standardize nursing schedules and scheduling practices. The scheduling project was one of several initiatives undertaken by a corporate-wide Nursing Resource Group established to enhance the work environment and patient care and to ensure appropriate utilization of nursing resources across the organization's five hospitals. This article focuses on major activities undertaken in the scheduling initiative. The step-by-step approach described, plus examples of the scheduling resources developed and samples of extended-tour schedules, will all provide insight, potential strategies and practical help for nursing administrators, human resources (HR) personnel and others interested in improving nurse scheduling.
Perceived Utility of the RE-AIM Framework for Health Promotion/Disease Prevention Initiatives for Older Adults: A Case Study from the U.S. Evidence-Based Disease Prevention Initiative.

PubMed

Ory, Marcia G; Altpeter, Mary; Belza, Basia; Helduser, Janet; Zhang, Chen; Smith, Matthew Lee

2014-01-01

Dissemination and implementation (D&I) frameworks are increasingly being promoted in public health research. However, less is known about their uptake in the field, especially for diverse sets of programs. Limited questionnaires exist to assess the ways that frameworks can be utilized in program planning and evaluation. We present a case study from the United States that describes the implementation of the RE-AIM framework by state aging services providers and public health partners and a questionnaire that can be used to assess the utility of such frameworks in practice. An online questionnaire was developed to capture community perspectives about the utility of the RE-AIM framework. Distributed to project leads in 27 funded states in an evidence-based disease prevention initiative for older adults, 40 key stakeholders responded representing a 100% state-participation rate among the 27 funded states. Findings suggest that there is perceived utility in using the RE-AIM framework when evaluating grand-scale initiatives for older adults. The RE-AIM framework was seen as useful for planning, implementation, and evaluation with relevance for evaluators, providers, community leaders, and policy makers. Yet, the uptake was not universal, and some respondents reported difficulties in use, especially adopting the framework as a whole. This questionnaire can serve as the basis to assess ways the RE-AIM framework can be utilized by practitioners in state-wide D&I efforts. Maximal benefit can be derived from examining the assessment of RE-AIM-related knowledge and confidence as part of a continual quality assurance process. We recommend such an assessment be performed before the implementation of new funding initiatives and throughout their course to assess RE-AIM uptake and to identify areas for technical assistance.
Perceived Utility of the RE-AIM Framework for Health Promotion/Disease Prevention Initiatives for Older Adults: A Case Study from the U.S. Evidence-Based Disease Prevention Initiative

PubMed Central

Ory, Marcia G.; Altpeter, Mary; Belza, Basia; Helduser, Janet; Zhang, Chen; Smith, Matthew Lee

2015-01-01

Dissemination and implementation (D&I) frameworks are increasingly being promoted in public health research. However, less is known about their uptake in the field, especially for diverse sets of programs. Limited questionnaires exist to assess the ways that frameworks can be utilized in program planning and evaluation. We present a case study from the United States that describes the implementation of the RE-AIM framework by state aging services providers and public health partners and a questionnaire that can be used to assess the utility of such frameworks in practice. An online questionnaire was developed to capture community perspectives about the utility of the RE-AIM framework. Distributed to project leads in 27 funded states in an evidence-based disease prevention initiative for older adults, 40 key stakeholders responded representing a 100% state-participation rate among the 27 funded states. Findings suggest that there is perceived utility in using the RE-AIM framework when evaluating grand-scale initiatives for older adults. The RE-AIM framework was seen as useful for planning, implementation, and evaluation with relevance for evaluators, providers, community leaders, and policy makers. Yet, the uptake was not universal, and some respondents reported difficulties in use, especially adopting the framework as a whole. This questionnaire can serve as the basis to assess ways the RE-AIM framework can be utilized by practitioners in state-wide D&I efforts. Maximal benefit can be derived from examining the assessment of RE-AIM-related knowledge and confidence as part of a continual quality assurance process. We recommend such an assessment be performed before the implementation of new funding initiatives and throughout their course to assess RE-AIM uptake and to identify areas for technical assistance. PMID:25964897
Full-Thickness Macular Hole Formation in the Postoperative Period After Initial Vitrectomy for Rhegmatogenous Retinal Detachment.

PubMed

Takashina, Hirotsugu; Watanabe, Akira; Tsuneoka, Hiroshi

2017-01-01

To evaluate full-thickness macular hole (MH) formation in the postoperative period after initial vitrectomy for rhegmatogenous retinal detachment (rRD). We retrospectively reviewed the medical records of 4 consecutive eyes that required additional vitrectomy for full-thickness MH between April 2013 and March 2016 after undergoing an initial vitrectomy for rRD. Epiretinal membrane (ERM) was identified by preoperative optical coherence tomography or intraoperative dye staining in each case. Photocoagulation of retinal breaks prior to initial vitrectomy was performed in Cases 1, 2, and 3 (4-16 days), with yttrium-aluminum-garnet capsulotomy after cataract extraction also performed prior to the retinal break formation in Case 3. At the initial vitrectomy, there was a superior retinal break which crossed the equator in Case 2, and an intentional hole was created in Cases 1 and 4. The mean interval from the initial vitrectomy until MH formation was 27.5 ± 15.8 months. As with Case 2, the intervals in Cases 1 and 4, in which an intentional hole was created, were clearly shorter than in those in Case 3. Finally, MH closure was achieved after an additional vitrectomy (removal of the internal limiting membrane with ERM and gas tamponade) and best-corrected visual acuity improved in each case. ERM was identified in the cases examined in our study. The presence of an intentional hole might shorten the interval of MH formation after vitrectomy for rRD.
Pisgah Lava Cave Communication Test: Science Case Study for the Networked Constellations Initiative

NASA Technical Reports Server (NTRS)

Belov, K.; Ellison, D.; Fraeman, A.

2017-01-01

As part of the science case study for the Networked Constellations initiative, a team of JPL scientists explore the possibility of a mission to study the lava caves on Mars. Natural caves on Mars and the Moon present a unique opportunity to learn about the planetary geology and to provide a shelter for human explorers. Due to power and communication challenges, a network of assets has significant advantages over a single asset sent inside a cave. However, communication between the assets and the data downlink present significant difficulties due to the presence of rough walls, boulders, and other obstacles with unknown dielectric constant inside a typical cave, disturbing the propagation of the radio waves. A detailed study is needed to establish the limitations of the current communication technologies and to develop requirements for the new communication technology applicable to the cave environment. On May 4 of 2017, Konstantin Belov, Doug Ellison, and Abby Fraeman visited a lava cave in Pisgah, CA. The purpose of the visit was to build a 3D map of the cave, which could be used to create a model of radio wave propagation, and to conduct a series of communication tests using off-the-shelf equipment to verify the in-cave communication challenges. This experiment should be considered as a simple 'proof of concept' and is the subject of this report.
Impact of inhomogeneity on SH-type wave propagation in an initially stressed composite structure

NASA Astrophysics Data System (ADS)

Saha, S.; Chattopadhyay, A.; Singh, A. K.

2018-02-01

The present analysis has been made on the influence of distinct form of inhomogeneity in a composite structure comprised of double superficial layers lying over a half-space, on the phase velocity of SH-type wave propagating through it. Propagation of SH-type wave in the said structure has been examined in four distinct cases of inhomogeneity viz. when inhomogeneity in double superficial layer is due to exponential variation in density only (Case I); when inhomogeneity in double superficial layers is due to exponential variation in rigidity only (Case II); when inhomogeneity in double superficial layer is due to exponential variation in rigidity, density and initial stress (Case III) and when inhomogeneity in double superficial layer is due to linear variation in rigidity, density and initial stress (Case IV). Closed-form expression of dispersion relation has been accomplished for all four aforementioned cases through extensive application of Debye asymptotic analysis. Deduced dispersion relations for all the cases are found in well-agreement to the classical Love-wave equation. Numerical computation has been carried out to graphically demonstrate the effect of inhomogeneity parameters, initial stress parameters as well as width ratio associated with double superficial layers in the composite structure for each of the four aforesaid cases on dispersion curve. Meticulous examination of distinct cases of inhomogeneity and initial stress in context of considered problem has been carried out with detailed analysis in a comparative approach.
"Do-It-Ourselves Science": Case Studies of Volunteer-Initiated Citizen Science Involvement

NASA Astrophysics Data System (ADS)

Raddick, Jordan; Bracey, G.; Gay, P. L.

2009-05-01

Galaxy Zoo is a citizen science website in which members of the public volunteer to classify galaxies, thereby helping astronomers conduct publishable research into galaxy morphologies and environments. Although the site was originally created to answer a few specific questions, some members of the community - both scientists and volunteers - have spontaneously developed an interest in a wider variety of questions. Volunteers have pursued answers to these questions with guidance from professional astronomers; in completing these projects, volunteers have independently used some of the same data viewing and analysis tools that professional astronomers use, and have even developed their own online tools. They have created their own research questions and their own plans for data analysis, and are planning to write scientific papers with the results to be submitted to peer-reviewed scientific journals. Volunteers have identified a number of such projects. These volunteer-initiated projects have extended the scientific reach of Galaxy Zoo, while also giving volunteers first-hand experience with the process of science. We are interested in the process by which volunteers become interested in volunteer-initiated projects, and what tasks they participate in, both initially and as their involvement increases. What motivates a volunteer to become involved in a volunteer-initiated project? How does his or her motivation change with further involvement? We are conducting a program of qualitative education research into these questions, using as data sources the posts that volunteers have made to the Galaxy Zoo forum and transcripts of interviews with volunteers.
Research at the Crossroads: How Intellectual Initiatives across Disciplines Evolve

ERIC Educational Resources Information Center

Frost, Susan H.; Jean, Paul M.; Teodorescu, Daniel; Brown, Amy B.

2004-01-01

How do intellectual initiatives across disciplines evolve? This qualitative case study of 11 interdisciplinary research initiatives at Emory University identifies key factors in their development: the passionate commitments of scholarly leaders, the presence of strong collegial networks, access to timely and multiple resources, flexible practices,…
High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

PubMed

Doshi, Jalpa A; Li, Pengxiang; Huo, Hairong; Pettit, Amy R; Kumar, Rishab; Weiss, Brenda M; Huntington, Scott F

2016-03-01

Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet, no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Oral tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. A retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. TKI initiation rates and time to initiation were compared between fee-for-service non-LIS Part D patients newly diagnosed with CML and their LIS counterparts who faced nominal cost sharing of ≤ $5. The first 30-day TKI fill "straddled" benefit phases, for a mean out-of-pocket cost of $2600 or more for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs 66.9%; P < .001) and those initiating a TKI took twice as long to fill it (mean = 50.9 vs 23.7 days; P < .001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics confirmed descriptive findings (hazard ratio, 0.59; 95% CI, 0.45-0.76). Extensive sensitivity analyses confirmed the robustness of our findings. High cost sharing was associated with reduced and/or delayed initiation of TKIs. We discuss policy strategies to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.
Initiation devices, initiation systems including initiation devices and related methods

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daniels, Michael A.; Condit, Reston A.; Rasmussen, Nikki

Initiation devices may include at least one substrate, an initiation element positioned on a first side of the at least one substrate, and a spark gap electrically coupled to the initiation element and positioned on a second side of the at least one substrate. Initiation devices may include a plurality of substrates where at least one substrate of the plurality of substrates is electrically connected to at least one adjacent substrate of the plurality of substrates with at least one via extending through the at least one substrate. Initiation systems may include such initiation devices. Methods of igniting energetic materialsmore » include passing a current through a spark gap formed on at least one substrate of the initiation device, passing the current through at least one via formed through the at least one substrate, and passing the current through an explosive bridge wire of the initiation device.« less
Barriers to Student Mobilization and Service at Institutions of Higher Education: A Greenbuilding Initiative Case Study on a Historic, Urban Campus in Charleston, South Carolina, USA

ERIC Educational Resources Information Center

Zimmerman, Katherine S.; Halfacre-Hitchcock, Angela

2006-01-01

Purpose: To identify some of the barriers to mobilizing students of higher education in sustainable initiatives, in order to enhance project success on campuses. Design/methodology/approach: Uses a case study of a model green building retrofit on the College of Charleston campus in Charleston, South Carolina, USA. Several constraints already…
Carpal tunnel syndrome: Investigating the sensitivity of initial-diagnosis with electro-diagnostic tests in 600 cases and associated risk factors especially manual milking.

PubMed

Tunç, Abdulkadir; Güngen, Belma Doğan

2017-01-01

Electro-diagnostic studies are the most reliable methods in diagnosis of carpal tunnel syndrome (CTS). Although there are many risk factors associated with CTS, there are a limited number of studies in the literature indicating that manual milking, which is frequently seen in Turkey, is a risk factor for CTS. The purpose of this study was to evaluate demographic findings of cases referred due to initial diagnosis of CTS as well as aetiological data especially manual milking and to investigate the sensitivity of initial diagnosis of CTS. Six hundred patients, who were referred to our electromyography laboratory due to initial diagnosis of CTS, were included. Demographic findings, duration of complaints, existence of diabetes mellitus, and manual milking histories of all patients were recorded. Sensitivity of initial diagnosis was investigated based on electro-diagnostic test results. According to electro-diagnostic test results, 289 of the patients were diagnosed with CTS (48.17%). 110 (18.3%) of 600 patients had a history of manual milking. In 94 of this group (85.4%), CTS was detected. Statistically significant correlation was found between CTS and age, female gender, duration of complaints, obesity and manual milking. This study confirms that manual milking is an important risk factor for CTS in addition to female gender, age, symptom duration and obesity. The fact that sensitivity of initial diagnosis of CTS was found to be low according to electro-diagnostic test results indicates importance of detailed clinical evaluation.
Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda.

PubMed

English, Lacey; Miller, James S; Mbusa, Rapheal; Matte, Michael; Kenney, Jessica; Bwambale, Shem; Ntaro, Moses; Patel, Palka; Mulogo, Edgar; Stone, Geren S

2016-04-29

In Uganda, over half of under-five child mortality is attributed to three infectious diseases: malaria, pneumonia and diarrhoea. Integrated community case management (iCCM) trains village health workers (VHWs) to provide in-home diagnosis and treatment of these common childhood illnesses. For severely ill children, iCCM relies on a functioning referral system to ensure timely treatment at a health facility. However, referral completion rates vary widely among iCCM programmes and are difficult to monitor. The Bugoye Integrated Community Case Management Initiative (BIMI) is an iCCM programme operating in Bugoye sub-county, Uganda. This case study describes BIMI's experience with monitoring referral completion at Bugoye Health Centre III (BHC), and outlines improvements to be made within iCCM referral systems. This study triangulated multiple data sources to evaluate the strengths and gaps in the BIMI referral system. Three quantitative data sources were reviewed: (1) VHW report of referred patients, (2) referral forms found at BHC, and (3) BHC patient records. These data sources were collated and triangulated from January-December 2014. The goal was to determine if patients were completing their referrals and if referrals were adequately documented using routine data sources. From January-December 2014, there were 268 patients referred to BHC, as documented by VHWs. However, only 52 of these patients had referral forms stored at BHC. Of the 52 referral forms found, 22 of these patients were also found in BHC register books recorded by clinic staff. Thus, the study found a mismatch between VHW reports of patient referrals and the referral visits documented at BHC. This discrepancy may indicate several gaps: (1) referred patients may not be completing their referral, (2) referral forms may be getting lost at BHC, and, (3) referred patients may be going to other health facilities or drug shops, rather than BHC, for their referral. This study demonstrates the challenges
Delayed Temporal Lobe Hemorrhage After Initiation of Acyclovir in an Immunocompetent Patient with Herpes Simplex Virus-2 Encephalitis: A Case Report.

PubMed

Mueller, Kyle; Ryan, Joshua E; Tai, Alex; Armonda, Rocco A

2017-01-15

Herpes simplex virus (HSV) is the most common cause of non-epidemic, sporadic, acute focal encephalitis in the United States. Inflammation of the vasculature makes them friable and susceptible to hemorrhage. Massive hemorrhage, though rare, can present in a delayed fashion after initiation of acyclovir and often requires surgical intervention. We report a unique case of delayed temporal lobe hemorrhage after initiation of acyclovir in an immunocompetent patient, specifically for its presentation, virology, and surgical management. A 40-year-old left-handed Caucasian female with chronic headaches, along with a 20-pack-year smoking history, presented to an outside facility with one week of diffuse, generalized headache, fever, nausea, and vomiting. Initial cranial imaging was negative for hemorrhage. Cerebrospinal fluid (CSF) studies showed a lymphocytic pleocytosis with elevated protein, along with polymerase chain reaction (PCR) positive staining for HSV, establishing the diagnosis of HSV-2 encephalitis, which is less common in adults. Acyclovir was initiated and one week later while still hospitalized, the patient developed acute altered mental status with cranial imaging showing a large right temporal lobe hemorrhage with significant midline shift. She was transferred to our facility for surgical intervention. Computed tomography angiography (CTA) was negative for any underlying vascular lesion. She was taken to the operating room for a decompressive unilateral (right) hemicraniectomy and temporal lobectomy. She had no postoperative complications and completed a three-week course of acyclovir. She was discharged to acute rehab with plans to return at a later date for cranioplasty. Intracerebral hemorrhage is an uncommon, although possible sequela, of herpes encephalitis. Despite initiation of early antiviral therapy, close monitoring is warranted, given the pathophysiology of the vasculature. Any decline in the neurological exam and/or increasing symptomatology
Clinicopathological correlates in HIV seropositive tuberculosis cases presenting with jaundice after initiating antiretroviral therapy with a structured review of the literature.

PubMed

Barr, David A; Ramdial, Pravistadevi K

2012-10-14

The development of jaundice after initiation of HAART in HIV-TB co-infected patients is a challenging presentation in resource constrained settings, and is often attributed to drug induced liver injury (DILI).Some investigators have described hepatic tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) as a cause of liver disease in patients initiating HAART, which could also cause jaundice. We report the clinical and histopathological features of five HIV-TB co-infected patients presenting with a syndrome of jaundice, tender hepatomegaly, bile canalicular enzyme rise and return of constitutional symptoms within 8 weeks of initiation of highly active antiretroviral therapy (HAART) for advanced HIV infection at a rural clinic in KwaZulu Natal, South Africa.All five patients had been diagnosed with tuberculosis infection prior to HAART initiation and were on antituberculous medication at time of developing jaundice. There was evidence of multiple aetiologies of liver injury in all patients. However, based on clinical course and pathological findings, predominant hepatic injury was thought to be drug induced in one case and hepatic tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) in the other four.In these later 4 patients, liver biopsy findings included necrotising and non-necrotising granulomatous inflammation in the lobules and portal tracts. The granulomas demonstrated - in addition to epithelioid histiocytes and Langhans giant cells - neutrophils, plasma cells and large numbers of lymphocytes, which are not features of a conventional untreated tuberculous response. In this high TB prevalent, low resource setting, TB-IRIS may be an important cause of jaundice post-HAART initiation. Clinicopathological correlation is essential for optimal diagnosis. Further multi-organ based histopathological studies in the context of immune reconstitution would be useful to clinicians in low resource settings dealing with this challenging

Case management.

PubMed

Woodward, Judy; Rice, Eve

2015-03-01

Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.
A physician-led initiative to improve clinical documentation results in improved health care documentation, case mix index, and increased contribution margin.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Durgin, Jonathan M; Doucet, Danielle R; Simons, Jessica P; Durocher, Dawn M; Flahive, Julie M; Schanzer, Andres

2018-05-04

Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin. A physician-led coding initiative to educate physicians on the documentation of comorbidities and conditions was initiated with concurrent chart review sessions with coding specialists for 3 months, and then as needed, after the creation of a vascular surgery documentation guide. Clinical documentation and billing for all carotid endarterectomy (CEA) and open infrainguinal procedures (OIPs) performed between January 2013 and July 2016 were stratified into precoding and postcoding initiative groups. Age, duration of stay, direct costs, actual reimbursements, contribution margin (CM), CMI, rate of complication or comorbidity, major complication or comorbidity, severity of illness, and risk of mortality assigned to each discharge were abstracted. Data were compared over time by standardizing Centers for Medicare and Medicaid Services (CMS) values for each diagnosis related group and using a CMS base rate reimbursement. Among 458 CEA admissions, postcoding initiative CEA patients (n = 253) had a significantly higher CMI (1.36 vs 1.25; P = .03), CM ($7859 vs $6650; P = .048), and CMS base rate reimbursement ($8955 vs $8258; P = .03) than precoding initiative CEA patients (n = 205). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (43% vs
Piezoelectrically Initiated Pyrotechnic Igniter

NASA Technical Reports Server (NTRS)

Quince, Asia; Dutton, Maureen; Hicks, Robert; Burnham, Karen

2013-01-01

This innovation consists of a pyrotechnic initiator and piezoelectric initiation system. The device will be capable of being initiated mechanically; resisting initiation by EMF, RF, and EMI (electromagnetic field, radio frequency, and electromagnetic interference, respectively); and initiating in water environments and space environments. Current devices of this nature are initiated by the mechanical action of a firing pin against a primer. Primers historically are prone to failure. These failures are commonly known as misfires or hang-fires. In many cases, the primer shows the dent where the firing pin struck the primer, but the primer failed to fire. In devices such as "T" handles, which are commonly used to initiate the blowout of canopies, loss of function of the device may result in loss of crew. In devices such as flares or smoke generators, failure can result in failure to spot a downed pilot. The piezoelectrically initiated ignition system consists of a pyrotechnic device that plugs into a mechanical system (activator), which on activation, generates a high-voltage spark. The activator, when released, will strike a stack of electrically linked piezo crystals, generating a high-voltage, low-amperage current that is then conducted to the pyro-initiator. Within the initiator, an electrode releases a spark that passes through a pyrotechnic first-fire mixture, causing it to combust. The combustion of the first-fire initiates a primary pyrotechnic or explosive powder. If used in a "T" handle, the primary would ramp the speed of burn up to the speed of sound, generating a shock wave that would cause a high explosive to go "high order." In a flare or smoke generator, the secondary would produce the heat necessary to ignite the pyrotechnic mixture. The piezo activator subsystem is redundant in that a second stack of crystals would be struck at the same time with the same activation force, doubling the probability of a first strike spark generation. If the first
Intellectual Initiatives at a Research University: Origins, Evolutions, and Challenges.

ERIC Educational Resources Information Center

Frost, Susan H.; Jean, Paul M.; Teodorescu, Daniel; Brown, Amy B.

This qualitative case study explored the origins, evolutions, and challenges of 12 cross-disciplinary intellectual initiatives at 1 research university. Researchers conducted open-ended interviews with leaders of the 12 initiatives and used program literature to support the data gathered from the interviews. The study found that key factors such…
Reducing maternal mortality from ruptured uterus--the Sokoto initiative.

PubMed

Ahmed, Y; Shehu, C E; Nwobodo, E I; Ekele, B A

2004-06-01

Uterine rupture is the most common cause of maternal mortality in our institution. Case fatality for the year 2001 was 47%. Health care including emergency obstetric care (EmOC) is not free, hence, delays in receiving care could occur in patients with limited resources. The objectives of the study were to promote access to emergency obstetric care through a loan scheme for indigent patients with ruptured uterus and determine the success or otherwise of the scheme. The scheme was initiated in January 2002, with the sum of thirty eight Thousand Naira (about 300 US dollars) by consultant obstetricians in the department. Funds were released to the patient only after assessment of her financial capability to enable her get emergency surgical packs. All that was required was a promise to pay back the loan before discharge. Following resuscitation, surgery was performed by one of the consultants. Eighteen cases of ruptured uterus have been managed. Treatment was initiated within 30 minutes of admission. Admission-laparotomy interval averaged 3.5 hours (+/-1.2). There were two maternal deaths, giving a case fatality of 11% (2/ 18). The case fatality from a previous study from the same centre was 38% (16/42). There was a significant difference in case fatality between the two studies (P<0.05; confidence limits are-0.328 and -0.211). Of the seventeen patients that benefited from the scheme, 16 repaid the loan before discharge (94% loan recovery). Only one patient defaulted with five thousand Naira (40 US dollars). A loan scheme for indigent patients with ruptured uterus that enabled them receive emergency obstetric care reduced case fatality. Loan recovery was good. In our quest to reduce maternal mortality in low-income countries without health insurance policies, there might be a need to extend similar initiative to other obstetric emergencies.
18 CFR 4.20 - Initial statement.

Code of Federal Regulations, 2014 CFR

2014-04-01

... PROJECT COSTS Determination of Cost of Constructed Projects not Subject to Section 23(a) of the Act § 4.20 Initial statement. (a) Notification of Commission. In all cases where licenses are issued for projects... letter shall also include a statement to the effect that actual legitimate original cost, or if not known...
18 CFR 4.20 - Initial statement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROJECT COSTS Determination of Cost of Constructed Projects not Subject to Section 23(a) of the Act § 4.20 Initial statement. (a) Notification of Commission. In all cases where licenses are issued for projects... letter shall also include a statement to the effect that actual legitimate original cost, or if not known...
18 CFR 4.20 - Initial statement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... PROJECT COSTS Determination of Cost of Constructed Projects not Subject to Section 23(a) of the Act § 4.20 Initial statement. (a) Notification of Commission. In all cases where licenses are issued for projects... letter shall also include a statement to the effect that actual legitimate original cost, or if not known...
18 CFR 4.20 - Initial statement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... PROJECT COSTS Determination of Cost of Constructed Projects not Subject to Section 23(a) of the Act § 4.20 Initial statement. (a) Notification of Commission. In all cases where licenses are issued for projects... letter shall also include a statement to the effect that actual legitimate original cost, or if not known...
18 CFR 4.20 - Initial statement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... PROJECT COSTS Determination of Cost of Constructed Projects not Subject to Section 23(a) of the Act § 4.20 Initial statement. (a) Notification of Commission. In all cases where licenses are issued for projects... letter shall also include a statement to the effect that actual legitimate original cost, or if not known...
Conformally flat black hole initial data with one cylindrical end

NASA Astrophysics Data System (ADS)

Gabach Clément, María E.

2010-06-01

We give a complete analytical proof of the existence and uniqueness of extreme-like black hole initial data for Einstein equations, which possess a cylindrical end, analogous to extreme Kerr, extreme Reissner-Nördstrom and extreme Bowen-York's initial data. This extends and refines a previous result (Dain and Clement 2009 Class. Quantum Grav. 26 035020) to a general case of conformally flat, maximal initial data with angular momentum, linear momentum and matter.
Exploring the Case for a Global Alliance for Medical Diagnostics Initiative

PubMed Central

Mugambi, Melissa L.; Palamountain, Kara M.; Gallarda, Jim; Drain, Paul K.

2017-01-01

In recent years, the private and public sectors have increased investments in medical diagnostics for low- and middle-income countries (LMICs). Despite these investments, numerous barriers prevent the adoption of existing diagnostics and discourage the development and introduction of new diagnostics in LMICs. In the late 1990s, the global vaccine community had similar challenges, as vaccine coverage rates stagnated and the introduction of new vaccines was viewed as a distraction to delivering existing vaccines. To address these challenges, the international community came together and formed the Global Alliance for Vaccines Initiative (GAVI). Sixteen years after the formation of GAVI, we see evidence of a healthier global vaccine landscape. We discuss how GAVI’s four guiding principles (product, health systems strengthening, financing and market shaping) might apply to the advancement of medical diagnostics in LMICs. We present arguments for the international community and existing organizations to establish a Global Alliance for Medical Diagnostics Initiative (GAMDI). PMID:28134750
Supporting knowledge translation through collaborative translational research initiatives: ‘Bridging’ versus ‘blurring’ boundary-spanning approaches in the UK CLAHRC initiative

PubMed Central

Evans, Sarah; Scarbrough, Harry

2014-01-01

Recent policy initiatives in the UK and internationally have sought to promote knowledge translation between the ‘producers’ and ‘users’ of research. Within this paper we explore how boundary-spanning interventions used within such initiatives can support knowledge translation between diverse groups. Using qualitative data from a 3-year research study conducted from January 2010 to December 2012 of two case-sites drawn from the CLAHRC initiative in the UK, we distinguish two different approaches to supporting knowledge translation; a ‘bridging’ approach that involves designated roles, discrete events and activities to span the boundaries between communities, and a ‘blurring’ approach that de-emphasises the boundaries between groups, enabling a more continuous process of knowledge translation as part of day-to-day work-practices. In this paper, we identify and differentiate these boundary-spanning approaches and describe how they emerged from the context defined by the wider CLAHRC networks. This highlights the need to develop a more contextualised analysis of the boundary-spanning that underpins knowledge translation processes, relating this to the distinctive features of a particular case. PMID:24561773
Initiation of Long-Wave Instability of Vortex Pairs at Cruise Altitudes

NASA Technical Reports Server (NTRS)

Rossow, Vernon J.

2011-01-01

Previous studies have usually attributed the initiation of the long-wave instability of a vortex pair to turbulence in the atmosphere or in the wake of the aircraft. The purpose here is to show by use of observations and photographs of condensation trails shed by aircraft at cruise altitudes that another initiating mechanism is not only possible but is usually the mechanism that initiates the long-wave instability at cruise altitudes. The alternate initiating mechanism comes about when engine thrust is robust enough to form an array of circumferential vortices around each jet-engine-exhaust stream. In those cases, initiation begins when the vortex sheet shed by the wing has rolled up into a vortex pair and descended to the vicinity of the inside bottom of the combined shear-layer vortex arrays. It is the in-and-out (up and down) velocity field between sequential circumferential vortices near the bottom of the array that then impresses disturbance waves on the lift-generated vortex pair that initiate the long-wave instability. A time adjustment to the Crow and Bate estimate for vortex linking is then derived for cases when thrust-based linking occurs.
Full-field initialized decadal predictions with the MPI earth system model: an initial shock in the North Atlantic

NASA Astrophysics Data System (ADS)

Kröger, Jürgen; Pohlmann, Holger; Sienz, Frank; Marotzke, Jochem; Baehr, Johanna; Köhl, Armin; Modali, Kameswarrao; Polkova, Iuliia; Stammer, Detlef; Vamborg, Freja S. E.; Müller, Wolfgang A.

2017-12-01

Our decadal climate prediction system, which is based on the Max-Planck-Institute Earth System Model, is initialized from a coupled assimilation run that utilizes nudging to selected state parameters from reanalyses. We apply full-field nudging in the atmosphere and either full-field or anomaly nudging in the ocean. Full fields from two different ocean reanalyses are considered. This comparison of initialization strategies focuses on the North Atlantic Subpolar Gyre (SPG) region, where the transition from anomaly to full-field nudging reveals large differences in prediction skill for sea surface temperature and ocean heat content (OHC). We show that nudging of temperature and salinity in the ocean modifies OHC and also induces changes in mass and heat transports associated with the ocean flow. In the SPG region, the assimilated OHC signal resembles well OHC from observations, regardless of using full fields or anomalies. The resulting ocean transport, on the other hand, reveals considerable differences between full-field and anomaly nudging. In all assimilation runs, ocean heat transport together with net heat exchange at the surface does not correspond to OHC tendencies, the SPG heat budget is not closed. Discrepancies in the budget in the cases of full-field nudging exceed those in the case of anomaly nudging by a factor of 2-3. The nudging-induced changes in ocean transport continue to be present in the free running hindcasts for up to 5 years, a clear expression of memory in our coupled system. In hindcast mode, on annual to inter-annual scales, ocean heat transport is the dominant driver of SPG OHC. Thus, we ascribe a significant reduction in OHC prediction skill when using full-field instead of anomaly initialization to an initialization shock resulting from the poor initialization of the ocean flow.
Corporate Social Responsibility Initiatives Addressing Social Exclusion in Bangladesh

PubMed Central

2009-01-01

The private sector is often seen as a driver of exclusionary processes rather than a partner in improving the health and welfare of socially-excluded populations. However, private-sector initiatives and partnerships—collectively labelled corporate social responsibility (CSR) initiatives—may be able to positively impact social status, earning potential, and access to services and resources for socially-excluded populations. This paper presents case studies of CSR projects in Bangladesh that are designed to reduce social exclusion among marginalized populations and explores whether CSR initiatives can increase economic and social capabilities to reduce exclusion. The examples provide snapshots of projects that (a) increase job-skills and employment opportunities for women, disabled women, and rehabilitated drug-users and (b) provide healthcare services to female workers and their communities. The CSR case studies cover a limited number of people but characteristics and practices replicable and scaleable across different industries, countries, and populations are identified. Common success factors from the case studies form the basis for recommendations to design and implement more CSR initiatives targeting socially-excluded groups. The analysis found that CSR has potential for positive and lasting impact on developing countries, especifically on socially-excluded populations. However, there is a need for additional monitoring and critical evaluation. PMID:19761088
How Health in All Policies are developed and implemented in a developing country? A case study of a HiAP initiative in Iran.

PubMed

Khayatzadeh-Mahani, Akram; Sedoghi, Zeynab; Mehrolhassani, Mohammad Hossein; Yazdi-Feyzabadi, Vahid

2016-12-01

Population health is influenced by many factors beyond the control of health system which should be addressed by other sectors through inter-sectoral collaboration (ISC). Countries have adopted diverse initiatives to operationalize ISC for health such as establishment of Councils of Health and Food Security (CHFSs) and development of provincial Health Master Plans (HMPs) in Iran. The literature, however, provides meager information on how these initiatives have been moved into the top policy agenda, how and by whom they have been formulated and what factors enable or inhibit their implementation. In addressing these knowledge gaps, we employed a qualitative case study approach, incorporating mixed methods: in-depth interviews and a textual analysis of policy documents. Iran founded the Supreme Council of Health and Food Security (SCHFS) at national level in 2006 followed by provincial and district CHFSs to ensure political commitment to ISC for health and Health in All Policies (HiAPs). In 2009, the SCHFS mandated all provincial CHFSs across the country to develop provincial HMP to operationalize the HiAP approach and Kerman was among the first provinces which responded to this call. We selected Kerman province HMP as a case study to investigate the research questions raised in this study. The study revealed two types of leverage, which played crucial role in agenda setting, policy formulation and implementation of HMP including politics (political commitment) and policy entrepreneurs. The multiple streams model was found to be informative for thinking about different stages of a policy cycle including agenda setting, policy formulation and policy implementation. It was also found to be a useful framework in analyzing HiAP initiatives as these policies do not smoothly and readily reach the policy agenda. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
77 FR 59897 - Initiation of Five-Year (“Sunset”) Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

... 20, 1998) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues....218(c), we are initiating Sunset Reviews of the following antidumping duty orders: DOC Case No. ITC Case No. Country Product Department contact A-570-868 731-TA-932 China Folding Metal Tables Jennifer...
Treatment Effect Heterogeneity in a Science Professional Development Initiative: The Case for School Capacity

ERIC Educational Resources Information Center

Bruch, Sarah; Grigg, Jeffrey; Hanselman, Paul

2010-01-01

This study focuses on how the treatment effects of a teacher professional development initiative in science differed by school capacity. In other words, the authors are primarily concerned with treatment effect heterogeneity. As such, this paper complements ongoing evaluation of the average treatment effects of the initiative over time. The…
Disks, Winds, and Veiling Curtains: Dissecting the Ultraviolet Spectrum of the Dwarf Nova Z Camelopardalis in Outburst

NASA Astrophysics Data System (ADS)

Knigge, Christian; Long, Knox S.; Blair, William P.; Wade, Richard A.

1997-02-01

-ionization lines in Z Cam's spectrum in terms of a simple, kinematic description of a rotating, biconical accretion disk wind. Adopting the picture of such an outflow that has recently been proposed for another cataclysmic variable, UX UMa, we find that acceptable fits to the data can be obtained. The relative mean ionization fractions we derive for the ionic species included in our wind modeling appear to be consistent with photoionization by a radiation field with T ~ 1.2 × 105 K. This temperature is within the range that has recently been inferred for Z Cam's soft X-ray component from ROSAT data and similar to the boundary layer temperature that has been derived on the basis of Extreme-Ultraviolet Explorer (EUVE) observations for the dwarf nova U Gem in outburst. An important feature of our adopted outflow model is the existence of a vertically extended, dense, slow-moving ``transition region'' between the disk photosphere and the fast-moving wind. Using a static LTE slab to crudely model this region, we find many of the absorption features in Z Cam's line spectrum that we have not modeled with our Monte Carlo code. The physical conditions expected in the extended disk atmosphere--ne ~ 1012 cm-3, NH ~ 1022 cm-2, and T ~= few × 104 K--are similar to those in the ``Fe II curtain'' that has been found to veil the white dwarf in the dwarf nova OY Car in quiescence. Based on observations obtained with the Hopkins Ultraviolet Telescope as part of the Astro-2 mission.

Neither Saints nor Sinners: Initial Reporting of the "Progressive" Case.

ERIC Educational Resources Information Center

Swain, Bruce M.

1980-01-01

Examines the circumstances of the 1979 "Progressive" case, in which the federal government quashed an article about hydrogen bomb production. Notes reportorial lapses that prevented a full and balanced account of the situation. (RL)
Student Initiatives and Missed Learning Opportunities in an IRF Sequence: A Single Case Analysis

ERIC Educational Resources Information Center

Li, Houxiang

2013-01-01

Most conversation analysis (CA) studies of the initiation-response-feedback (IRF; Sinclair & Coulthard, 1975) sequence have focused on teacher actions in the feedback move. In this article, I use CA to analyze student initiatives (Waring, 2011) within an IRF sequence in one excerpt from a Chinese as a foreign language class. The excerpt…
77 FR 39218 - Initiation of Five-Year (“Sunset”) Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the....218(c), we are initiating the Sunset Review of the following antidumping duty orders: DOC Case No. ITC Case No. Country Product Department contact A-357-812 731-TA-892 Argentina Honey (2nd Review...
77 FR 12562 - Initiation of Five-Year (“Sunset”) Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... 20, 1998) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues....218(c), we are initiating the Sunset Review of the following antidumping duty order: DOC case No. ITC case No. Country Product Department contact A-570-904 731-TA-1103 China Activated Carbon Jennifer Moats...
Legionnaire's disease surveillance programme (initial survey analysis).

PubMed

O'Neill, K

1990-08-01

In Australia, approximately 150 cases of Legionnaire's Disease are reported annually. Untreated, the mortality rate is estimated at 20%. Australia's largest Legionnaire's Disease epidemic broke out in Wollongong (New South Wales) back in 1987, where some 45 cases required hospitalization and 10 of these died. Local Health Authorities have been advised to conduct initial surveys of their particular municipalities to locate all known water cooling towers and evaporative condensers to establish maintenance standards on such units to overcome possible future outbreaks of this disease with significant mortality.
Case Studies Behavior Modification.

ERIC Educational Resources Information Center

Wark, David M.

The case histories of five students enrolled in a university course in how to study are reported. The students ranged in age from 18 to 35, included two males and three females, and varied in school experience from no college in one case and some college in two cases to college degrees in two cases. Students were initially taught to chart their…
SCC Initiation Behavior of Alloy 182 in PWR Primary Water

DOE Office of Scientific and Technical Information (OSTI.GOV)

Toloczko, Mychailo B.; Zhai, Ziqing; Bruemmer, Stephen M.

SCC initiation behavior of 15% cold forged specimens cut from four different alloy 182 weldments was investigated in 360°C simulated PWR primary water under constant load at the yield stress using direct current potential drop to perform in-situ monitoring of SCC initiation time. Within each weldment, one or more specimens underwent SCC initiation within 24 hours of reaching full load while some specimens had much longer initiation times, in a few cases exceeding 2500 hours. Detailed examinations were conducted on these specimens with a focus on different microstructural features such as preexisting defects, grain orientation and second phases, highlighting anmore » important role of microstructure in crack initiation of alloy 182.« less
Developing a smoke free household initiative: an Indonesian case study.

PubMed

Nichter, Mimi; Nichter, Mark; Padmawati, Retna Siwi; Ng, Nawi

2010-01-01

Little research has focused on women's exposure to secondhand smoke (SHS) in LMICs, local perceptions of SHS risk to women and children, and women's attempts to limit exposure to tobacco smoke in their households. This paper describes a community based survey in Indonesia that investigated these issues as one step in a movement to initiate community wide household smoking bans. The survey found high levels of exposure to SHS, high levels of awareness among both women and men that SHS placed women and children at risk for illness, a very low percentage of households having indoor smoking rules, great interest on the part of women to participate in a communitywide ban, and a promising level of male smoker agreement to comply with such a ban. Women expressed a low sense of self efficacy in individually getting their husbands to quit smoking in their homes, but a strong sense of collective efficacy that husbands might agree to a well-publicized and agreed-upon community household smoking ban. Men and women expressed concern about the social risk of asking guests not to smoke in their homes without a communitywide ban and visible displays communicating their participation in this movement. The smoke free initiative described requires the participation of doctors in community education programs, and is attempting to introduce household smoking bans as a way of turning tobacco control into a family health and not just a smokers' health issue.
Atypical Initial Presentation of Painful Muscle Cramps in a Patient with Amyotrophic Lateral Sclerosis: A Case Report and Brief Review of the Literature.

PubMed

Kuzel, Aaron R; Lodhi, Muhammad Uzair; Syed, Intekhab Askari; Rahim, Mustafa

2017-11-10

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized clinically by progressive muscle weakness that can occur proximally or distally in either the upper or lower extremities. It includes both upper motor neuron signs (spasticity, hyperreflexia, clonus, and Babinski sign) and lower motor neuron signs (atrophy, weakness, and muscle fasciculation). Initial presentation of progressively painful muscle cramps should lead the physician to screen for other signs of amyotrophic lateral sclerosis. We report the case of a 51-year-old male, who presented with dull muscle cramps in the right upper shoulder and arm. After a careful history and physical exam, it was found that patient had both upper and lower motor neuron signs; therefore, a diagnosis of amyotrophic lateral sclerosis was made. Amyotrophic lateral sclerosis should strongly be considered in the differential diagnosis of patients presenting with an atypical initial presentation of progressively painful muscle cramps.
76 FR 74775 - Initiation of Five-Year (“Sunset”) Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-01

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the....218(c), we are initiating the Sunset Review of the following antidumping duty orders: DOC case No. ITC case No. Country Product Department contact A-570-862 731-TA-891 China Foundry Coke (2nd Review...
Thermodynamic Behavior in Decaying Compressible Turbulence with Initially Dominant Temperature Fluctuations

NASA Astrophysics Data System (ADS)

Cai, X. D.; O'Brien, Edward E.; Ladeinde, Foluso

1996-11-01

Direct numerical simulation of decaying, isotropic, compressible turbulence in three dimensions is used to examine the behavior of fluctuations in density, temperature, and pressure when the initial conditions include temperature fluctuations larger than pressure fluctuations. The numerical procedure is described elsewhere (Ladeinde, F. et al.,) Phys. Fluids 7(11), pp. 2848 (1995), the initial turbulence Mach number range is subsonic, 0.3 to 0.7, and, following Ghosh and Matthaeus(Ghosh, S. and Matthaeus, W. H. Phys. Fluids A, pp. 148 (1991)), the initial compressible turbulence is characterized as a: mostly solenoidal, b: random, or c: longitudinal. These cases represent, respectively, ratios of initial kinetic energy in the compressible modes to total initial kinetic energy, say \\chi_0, which are either a: very small, b: about 0.6, or c: near unity. Thermodynamic scalings at the lowest values of initial Mach number and \\chi0 follow the predictions of Zank and Matthaeus (Zank, G. P. and Matthaeus, W. H. Phys. Fluids A(3), pp. 69 (1991)), but not otherwise. The relationship between \\chi, Mach number, and compressible pressure predicted by Sarkar et al.(Sarkar, S. et al.,) J. Fluid Mech. 227, pp. 473 (1991) applies, on average, to all cases computed.
The Open Water Data Initiative: Water information for a thirsty nation

USGS Publications Warehouse

Rea, Alan; Clark, Edward; Adams, Angela; Samuels, William B.

2015-01-01

Initial efforts of the Open Water Data Initiative have focused on three use cases covering flooding, drought, and contaminant spill response, with a goal of identifying critical water data resources and making them more accessible. Significant progress has been made in the past year, although much remains to be done.
Building Perinatal Case Manager Capacity Using Quality Improvement.

PubMed

Fitzgerald, Elaine

2015-01-01

Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.
10 CFR 710.22 - Initial decision process.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) The Manager shall make an initial decision as to the individual's access authorization eligibility... Officer refers the individual's case to the Manager in accordance with § 710.25(e) or § 710.26(b). (b) Unless an extension of time is granted by the Director, Office of Personnel Security, DOE Headquarters...
10 CFR 710.22 - Initial decision process.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) The Manager shall make an initial decision as to the individual's access authorization eligibility... Administrative Judge refers the individual's case to the Manager in accordance with § 710.25(e) or § 710.26(b). (b) Unless an extension of time is granted by the Director, Office of Personnel Security, DOE...
10 CFR 710.22 - Initial decision process.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) The Manager shall make an initial decision as to the individual's access authorization eligibility... Officer refers the individual's case to the Manager in accordance with § 710.25(e) or § 710.26(b). (b) Unless an extension of time is granted by the Director, Office of Personnel Security, DOE Headquarters...
10 CFR 710.22 - Initial decision process.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) The Manager shall make an initial decision as to the individual's access authorization eligibility... Officer refers the individual's case to the Manager in accordance with § 710.25(e) or § 710.26(b). (b) Unless an extension of time is granted by the Director, Office of Personnel Security, DOE Headquarters...
Logistic regression trees for initial selection of interesting loci in case-control studies

PubMed Central

Nickolov, Radoslav Z; Milanov, Valentin B

2007-01-01

Modern genetic epidemiology faces the challenge of dealing with hundreds of thousands of genetic markers. The selection of a small initial subset of interesting markers for further investigation can greatly facilitate genetic studies. In this contribution we suggest the use of a logistic regression tree algorithm known as logistic tree with unbiased selection. Using the simulated data provided for Genetic Analysis Workshop 15, we show how this algorithm, with incorporation of multifactor dimensionality reduction method, can reduce an initial large pool of markers to a small set that includes the interesting markers with high probability. PMID:18466557
Improving Initiation and Tracking of Research Projects at an Academic Health Center: A Case Study.

PubMed

Schmidt, Susanne; Goros, Martin; Parsons, Helen M; Saygin, Can; Wan, Hung-Da; Shireman, Paula K; Gelfond, Jonathan A L

2017-09-01

Research service cores at academic health centers are important in driving translational advancements. Specifically, biostatistics and research design units provide services and training in data analytics, biostatistics, and study design. However, the increasing demand and complexity of assigning appropriate personnel to time-sensitive projects strains existing resources, potentially decreasing productivity and increasing costs. Improving processes for project initiation, assigning appropriate personnel, and tracking time-sensitive projects can eliminate bottlenecks and utilize resources more efficiently. In this case study, we describe our application of lean six sigma principles to our biostatistics unit to establish a systematic continual process improvement cycle for intake, allocation, and tracking of research design and data analysis projects. The define, measure, analyze, improve, and control methodology was used to guide the process improvement. Our goal was to assess and improve the efficiency and effectiveness of operations by objectively measuring outcomes, automating processes, and reducing bottlenecks. As a result, we developed a web-based dashboard application to capture, track, categorize, streamline, and automate project flow. Our workflow system resulted in improved transparency, efficiency, and workload allocation. Using the dashboard application, we reduced the average study intake time from 18 to 6 days, a 66.7% reduction over 12 months (January to December 2015).
Detection of skeletal muscle metastases on initial staging of lung cancer: a retrospective case series.

PubMed

Bocchino, Marialuisa; Valente, Tullio; Somma, Francesco; de Rosa, Ilaria; Bifulco, Marco; Rea, Gaetano

2014-03-01

Estimation of skeletal muscle metastases (SMMs) at the time of diagnosis and/or initial staging of lung cancer. Retrospective evaluation of clinical charts and imaging data suggestive of SMMs of patients with histology-proved lung cancer over a 5-year period. SMMs were identified in 46 out of 1,754 patients. Single and multiple (62.9% of cases) SMMs were detected by total body multi-detector computed tomography (MDCT). They were associated with poorly differentiated (43%) and advanced adenocarcinomas (52%) without clinically relevant symptoms and/or signs. Psoas and buttock muscles were most frequently involved (33.3%). MDCT findings consisted of well-defined homogeneously hyperdense oval masses (31%), lesions with ring-like enhancement and central hypoattenuation (68%), or large abscess-like necrotic lesions (24%). Sonography revealed well-defined hypoechoic masses (41.6%), ill-defined hypoechoic lesions (33.3%), or anechoic areas with a necrotic centre (25%). Positron emission tomography revealed that all SMMs were metabolically active. SMMs are uncommon but not negligible in lung cancer, with an estimated prevalence of 2.62% in our series. Although histology remains the recommended method, use of high-performance imaging techniques and increased clinical suspicion may improve their early detection. Efforts addressing their effect on the natural history of lung cancer are needed.

Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign.

PubMed

Zhang, Lu; Haga, Nobuhiro; Ogawa, Soichiro; Matsuoka, Kanako; Koguchi, Tomoyuki; Akaihata, Hidenori; Hata, Junya; Kataoka, Masao; Ishibashi, Kei; Kojima, Yoshiyuki

2017-11-01

Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment. © 2017 The Japanese Urological Association.
Integration of DNA barcoding for the initial recordings of Lessepsian fishes: a case study of the Indo-Pacific slender ponyfish Equulites elongatus.

PubMed

Sakinan, S; Karahan, A; Ok, M

2017-03-01

In this study, the DNA barcode of a regional Lessepsian sighting of the slender ponyfish Equulites elongatus is integrated with morphometric and meristic descriptors as a case study to address further identification problems in the Mediterranean Sea. The study also aims to contribute to the regional mitochondrial cytochrome oxidase I information pool, to support other potential uses. The initial sighting of E. elongatus from the north-eastern Mediterranean coast of Turkey is provided from a trawl survey on 3 June 2015, where 76 specimens were captured during a 15 min tow. © 2016 The Fisheries Society of the British Isles.
21 CFR 7.46 - Firm-initiated recall.

Code of Federal Regulations, 2010 CFR

2010-04-01

... action, e.g., seizure. In such cases, the firm will be asked to provide the Food and Drug Administration... requested a recall. The firm's action also is considered a firm-initiated recall and is subject to... but where it is apparent, e.g., because of complaints or adverse reactions regarding the product, that...
Arp2/3 complex–dependent actin networks constrain myosin II function in driving retrograde actin flow

PubMed Central

Yang, Qing; Zhang, Xiao-Feng; Pollard, Thomas D.

2012-01-01

The Arp2/3 complex nucleates actin filaments to generate networks at the leading edge of motile cells. Nonmuscle myosin II produces contractile forces involved in driving actin network translocation. We inhibited the Arp2/3 complex and/or myosin II with small molecules to investigate their respective functions in neuronal growth cone actin dynamics. Inhibition of the Arp2/3 complex with CK666 reduced barbed end actin assembly site density at the leading edge, disrupted actin veils, and resulted in veil retraction. Strikingly, retrograde actin flow rates increased with Arp2/3 complex inhibition; however, when myosin II activity was blocked, Arp2/3 complex inhibition now resulted in slowing of retrograde actin flow and veils no longer retracted. Retrograde flow rate increases induced by Arp2/3 complex inhibition were independent of Rho kinase activity. These results provide evidence that, although the Arp2/3 complex and myosin II are spatially segregated, actin networks assembled by the Arp2/3 complex can restrict myosin II–dependent contractility with consequent effects on growth cone motility. PMID:22711700
Entanglement Evolution of Jaynes-Cummings Model in Resonance Case and Non-resonance Case

NASA Astrophysics Data System (ADS)

Cheng, Jing; Chen, Xi; Shan, Chuan-Jia

2018-06-01

We investigate the entanglement evolution of a two-level atom and a quantized single model electromagnetic filed in the resonance and non-resonance cases. The effects of the initial state, detuning degree, photon number on the entanglement are shown in detail. The results show that the atom-cavity entanglement state appears with periodicity. The increasing of the photon number can make the period of quantum entanglement be shorter. In the non-resonant case, if we choose the suitable initial state the entanglement of atom-cavity can be 1.0
Brown tumours of the tibia and second metacarpal bone in a woman with severe vitamin D deficiency.

PubMed

Al-Sharafi, Butheinah A; Al-Imad, Shafiq A; Shamshair, Amani M; Al-Faqeeh, Derhim H

2015-08-03

Brown tumours caused by vitamin D deficiency are rare. Most cases are caused by primary hyperparathyroidism, and are rarely caused by secondary hyperparathyroidism in cases of renal failure. We present a case of Brown tumours of the tibia and second metacarpal bone in a 50-year-old woman who had a low dietary intake of vitamin D and had worn a veil for most of her adult life. The Brown tumours were caused by vitamin D deficiency and secondary hyperparathyroidism. The patient improved on treatment with vitamin D3 and calcium supplements. This is a rare case and the first, to our knowledge, with a Brown tumour of the tibia caused by vitamin D deficiency due to decreased dietary intake and decreased exposure to sunlight. The course of treatment and investigations of the patient are described. 2015 BMJ Publishing Group Ltd.
Segmentation of Vowel-Initial Words Is Facilitated by Function Words

ERIC Educational Resources Information Center

Kim, Yun Jung; Sundara, Megha

2015-01-01

Within the first year of life, infants learn to segment words from fluent speech. Previous research has shown that infants at 0;7·5 can segment consonant-initial words, yet the ability to segment vowel-initial words does not emerge until the age of 1;1-1;4 (0;11 in some restricted cases). In five experiments, we show that infants aged 0;11 but not…
Cancer initiatives in developing countries.

PubMed

Mellstedt, H

2006-06-01

The coming decades will bring dramatic increases in morbidity and mortality from cancer in the developing world. The burden of cancer is increasing globally, with an expected 20 million new cases per year in 2020, half of which will be in low- and middle-income countries. Despite an already overwhelming burden of health problems, developing countries must somehow address this cancer pandemic and their alarming share of cancer illness. Many large-scale and innovative worldwide initiatives have been launched in the fight against cancer. These programs represent colossal efforts to expand resources for health education among people and healthcare workers in developing countries and to increase awareness of cancer prevention. Many novel evidence-based and culturally-relevant programs are being implemented for screening and early prevention of common cancers. Several key initiatives are supporting clinical research, guideline development, oncology training, and appropriate technology transfer, such as access to electronic medical literature. Treatment programs are expanding access and quality of radiologic and pharmacologic therapies for cancer. These initiatives represent an unprecedented level of and cooperation among international agencies, governmental and nongovernmental organizations, international foundations, scientific societies, local institutions, and industry. This review examines the scope of need in response to the increasing burden of cancer in the developing world and major initiatives that have been created to respond to these needs.
Building Perinatal Case Manager Capacity Using Quality Improvement

PubMed Central

Fitzgerald, Elaine

2015-01-01

ABSTRACT Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum. PMID:26937160
Risk factors for Kaposi's sarcoma in human immunodeficiency virus patients after initiation of antiretroviral therapy: A nested case-control study in Kenya.

PubMed

Lupia, Rodgers; Wabuyia, Peter B; Otiato, Peter; Fang, Chi-Tai; Tsai, Feng-Jen

2017-12-01

This study aimed to evaluate the association between highly active antiretroviral therapy (HAART) adherence and development of Kaposi's sarcoma (KS) in human immunodeficiency virus (HIV)/AIDS patients. We conducted a retrospective nested case-control study of 165 participants (33 cases and 132 controls) receiving HAART care at Maseno Hospital, Kenya, from January 2005 to October 2013. Cases were HIV-positive adults with KS, who were matched with controls in a ratio of 1:4 based on age (±5 years of each case), sex, and KS diagnosis date. Perfect adherence to HAART was assessed on every clinic visit by patients' self-reporting and pill counts. Chi-square tests were performed to compare socioeconomic and clinical statuses between cases and controls. A conditional logistic regression was used to assess the effects of perfect adherence to HAART, the latest CD4 count, education level, distance to health-care facility, initial World Health Organization stage, and number of regular sexual partners on the development of KS. Only 63.6% participants reported perfect adherence, and the control group had a significantly higher percentage of perfect adherence (75.0%) than did cases (18.2%). After adjustment for potential imbalances in the baseline and clinical characteristics, patients with imperfect HAART adherence had 20-times greater risk of developing KS than patients with perfect HAART adherence [hazard ratios: 21.0, 95% confidence interval: 4.2-105.1]. Patients with low latest CD4 count (≤350 cells/mm 3 ) had a seven-times greater risk of developing KS than did their counterparts (HRs: 7.1, 95% CI: 1.4-36.2). Imperfect HAART adherence and low latest CD4 count are significantly associated with KS development. Copyright © 2015. Published by Elsevier B.V.
Development and growth of fruit bodies and crops of the button mushroom, Agaricus bisporus.

PubMed

Straatsma, Gerben; Sonnenberg, Anton S M; van Griensven, Leo J L D

2013-10-01

We studied the appearance of fruit body primordia, the growth of individual fruit bodies and the development of the consecutive flushes of the crop. Relative growth, measured as cap expansion, was not constant. It started extremely rapidly, and slowed down to an exponential rate with diameter doubling of 1.7 d until fruit bodies showed maturation by veil breaking. Initially many outgrowing primordia were arrested, indicating nutritional competition. After reaching 10 mm diameter, no growth arrest occurred; all growing individuals, whether relatively large or small, showed an exponential increase of both cap diameter and biomass, until veil breaking. Biomass doubled in 0.8 d. Exponential growth indicates the absence of competition. Apparently there exist differential nutritional requirements for early growth and for later, continuing growth. Flushing was studied applying different picking sizes. An ordinary flushing pattern occurred at an immature picking size of 8 mm diameter (picking mushrooms once a day with a diameter above 8 mm). The smallest picking size yielded the highest number of mushrooms picked, confirming the competition and arrested growth of outgrowing primordia: competition seems less if outgrowing primordia are removed early. The flush duration (i.e. between the first and last picking moments) was not affected by picking size. At small picking size, the subsequent flushes were not fully separated in time but overlapped. Within 2 d after picking the first individuals of the first flush, primordia for the second flush started outgrowth. Our work supports the view that the acquisition of nutrients by the mycelium is demand rather than supply driven. For formation and early outgrowth of primordia, indications were found for an alternation of local and global control, at least in the casing layer. All these data combined, we postulate that flushing is the consequence of the depletion of some unknown specific nutrition required by outgrowing
Consistent Initial Conditions for the DNS of Compressible Turbulence

NASA Technical Reports Server (NTRS)

Ristorcelli, J. R.; Blaisdell, G. A.

1996-01-01

Relationships between diverse thermodynamic quantities appropriate to weakly compressible turbulence are derived. It is shown that for turbulence of a finite turbulent Mach number there is a finite element of compressibility. A methodology for generating initial conditions for the fluctuating pressure, density and dilatational velocity is given which is consistent with finite Mach number effects. Use of these initial conditions gives rise to a smooth development of the flow, in contrast to cases in which these fields are specified arbitrarily or set to zero. Comparisons of the effect of different types of initial conditions are made using direct numerical simulation of decaying isotropic turbulence.
Evaluating ballot initiative support for legalised marijuana: The case of Washington.

PubMed

Collingwood, Loren; O'Brien, Ben Gonzalez; Dreier, Sarah

2018-03-11

In 2012, Washington and Colorado became the first U.S. states to legalise recreational marijuana. By 2016, eight states and the District of Columbia had legalised recreational marijuana, with more expected to consider it in 2018. Despite this trend, little academic research explains what drives ballot-initiative vote choice on marijuana legalisation. This paper uses a pre-election random sample voter survey to examine the individual characteristics that correlated with Washington voters' support for legal recreational marijuana. We find that voting on marijuana ballot initiatives largely reflects public opinion about marijuana and is particularly shaped voters' political ideology, party affiliation, religious affiliation and practice, and education. Notably, we find that those reporting experiences (i.e., someone they know) with the criminal justice system are more supportive of legalisation than those who do not. We conclude that marijuana legalisation voting behavior generally aligns with public opinion on the issue. However, one key aspect of Washington's legalisation campaign-the criminal injustices of marijuana illegality-helped shape Washington state voting behavior. Further research is needed to examine if, when, and in what contexts criminal justice campaign themes are likely to strengthen or undermine future states' marijuana legalisation efforts. Copyright © 2018 Elsevier B.V. All rights reserved.
Biogenic isoprene emissions driven by regional weather predictions using different initialization methods: case studies during the SEAC4RS and DISCOVER-AQ airborne campaigns

NASA Astrophysics Data System (ADS)

Huang, Min; Carmichael, Gregory R.; Crawford, James H.; Wisthaler, Armin; Zhan, Xiwu; Hain, Christopher R.; Lee, Pius; Guenther, Alex B.

2017-08-01

Land and atmospheric initial conditions of the Weather Research and Forecasting (WRF) model are often interpolated from a different model output. We perform case studies during NASA's SEAC4RS and DISCOVER-AQ Houston airborne campaigns, demonstrating that using land initial conditions directly downscaled from a coarser resolution dataset led to significant positive biases in the coupled NASA-Unified WRF (NUWRF, version 7) surface and near-surface air temperature and planetary boundary layer height (PBLH) around the Missouri Ozarks and Houston, Texas, as well as poorly partitioned latent and sensible heat fluxes. Replacing land initial conditions with the output from a long-term offline Land Information System (LIS) simulation can effectively reduce the positive biases in NUWRF surface air temperature by ˜ 2 °C. We also show that the LIS land initialization can modify surface air temperature errors almost 10 times as effectively as applying a different atmospheric initialization method. The LIS-NUWRF-based isoprene emission calculations by the Model of Emissions of Gases and Aerosols from Nature (MEGAN, version 2.1) are at least 20 % lower than those computed using the coarser resolution data-initialized NUWRF run, and are closer to aircraft-observation-derived emissions. Higher resolution MEGAN calculations are prone to amplified discrepancies with aircraft-observation-derived emissions on small scales. This is possibly a result of some limitations of MEGAN's parameterization and uncertainty in its inputs on small scales, as well as the representation error and the neglect of horizontal transport in deriving emissions from aircraft data. This study emphasizes the importance of proper land initialization to the coupled atmospheric weather modeling and the follow-on emission modeling. We anticipate it to also be critical to accurately representing other processes included in air quality modeling and chemical data assimilation. Having more confidence in the weather
Water management practices used by Fayetteville shale gas producers.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Veil, J. A.

2011-06-03

Water issues continue to play an important role in producing natural gas from shale formations. This report examines water issues relating to shale gas production in the Fayetteville Shale. In particular, the report focuses on how gas producers obtain water supplies used for drilling and hydraulically fracturing wells, how that water is transported to the well sites and stored, and how the wastewater from the wells (flowback and produced water) is managed. Last year, Argonne National Laboratory made a similar evaluation of water issues in the Marcellus Shale (Veil 2010). Gas production in the Marcellus Shale involves at least threemore » states, many oil and gas operators, and multiple wastewater management options. Consequently, Veil (2010) provided extensive information on water. This current study is less complicated for several reasons: (1) gas production in the Fayetteville Shale is somewhat more mature and stable than production in the Marcellus Shale; (2) the Fayetteville Shale underlies a single state (Arkansas); (3) there are only a few gas producers that operate the large majority of the wells in the Fayetteville Shale; (4) much of the water management information relating to the Marcellus Shale also applies to the Fayetteville Shale, therefore, it can be referenced from Veil (2010) rather than being recreated here; and (5) the author has previously published a report on the Fayetteville Shale (Veil 2007) and has helped to develop an informational website on the Fayetteville Shale (Argonne and University of Arkansas 2008), both of these sources, which are relevant to the subject of this report, are cited as references.« less
Cases as Shared Inquiry: A Dialogical Model of Teacher Preparation.

ERIC Educational Resources Information Center

Harrington, Helen L.; Garrison, James W.

1992-01-01

A dialogical model is proposed for connecting theory to practice in teacher education by conceiving of cases from case-based pedagogy as problems that initiate shared inquiry. Cases with genuine cognitive and axiological content can initiate self-directed, student-centered inquiry while building democratic dialogical communities. (SLD)
Manipulation of three-dimensional Richtmyer-Meshkov instability by initial interfacial principal curvatures

NASA Astrophysics Data System (ADS)

Guan, Ben; Zhai, Zhigang; Si, Ting; Lu, Xiyun; Luo, Xisheng

2017-03-01

The characteristics of three-dimensional (3D) Richtmyer-Meshkov instability (RMI) in the early stages are studied numerically. By designing 3D interfaces that initially possess various identical and opposite principal curvature combinations, the growth rate of perturbations can be effectively manipulated. The weighted essentially nonoscillatory scheme and the level set method combined with the real ghost fluid method are used to simulate the flow. The results indicate that the interface development and the shock propagation in 3D cases are much more complicated than those in 2D case, and the evolution of 3D interfaces is heavily dependent on the initial interfacial principal curvatures. The 3D structure of wave patterns induces high pressure zones in the flow field, and the pressure oscillations change the local instabilities of interfaces. In the linear stages, the perturbation growth rate follows regularity as the interfacial principal curvatures vary, which is further predicted by the stability theory of 2D and 3D interfaces. It is also found that hysteresis effects exist at the onset of the linear stages in the 3D case for the same initial perturbations as the 2D case, resulting in different evolutions of 3D RMI in the nonlinear stages.
Persistence of initial conditions in continental scale air quality ...

EPA Pesticide Factsheets

This study investigates the effect of initial conditions (IC) for pollutant concentrations in the atmosphere and soil on simulated air quality for two continental-scale Community Multiscale Air Quality (CMAQ) model applications. One of these applications was performed for springtime and the second for summertime. Results show that a spin-up period of ten days commonly used in regional-scale applications may not be sufficient to reduce the effects of initial conditions to less than 1% of seasonally-averaged surface ozone concentrations everywhere while 20 days were found to be sufficient for the entire domain for the spring case and almost the entire domain for the summer case. For the summer case, differences were found to persist longer aloft due to circulation of air masses and even a spin-up period of 30 days was not sufficient to reduce the effects of ICs to less than 1% of seasonally-averaged layer 34 ozone concentrations over the southwestern portion of the modeling domain. Analysis of the effect of soil initial conditions for the CMAQ bidirectional NH3 exchange model shows that during springtime they can have an important effect on simulated inorganic aerosols concentrations for time periods of one month or longer. The effects are less pronounced during other seasons. The results, while specific to the modeling domain and time periods simulated here, suggest that modeling protocols need to be scrutinized for a given application and that it cannot be assum
Different types of pausing modes during transcription initiation.

PubMed

Lerner, Eitan; Ingargiola, Antonino; Lee, Jookyung J; Borukhov, Sergei; Michalet, Xavier; Weiss, Shimon

2017-08-08

In many cases, initiation is rate limiting to transcription. This due in part to the multiple cycles of abortive transcription that delay promoter escape and the transition from initiation to elongation. Pausing of transcription in initiation can further delay promoter escape. The previously hypothesized pausing in initiation was confirmed by two recent studies from Duchi et al. 1 and from Lerner, Chung et al. 2 In both studies, pausing is attributed to a lack of forward translocation of the nascent transcript during initiation. However, the two works report on different pausing mechanisms. Duchi et al. report on pausing that occurs during initiation predominantly on-pathway of transcript synthesis. Lerner, Chung et al. report on pausing during initiation as a result of RNAP backtracking, which is off-pathway to transcript synthesis. Here, we discuss these studies, together with additional experimental results from single-molecule FRET focusing on a specific distance within the transcription bubble. We show that the results of these studies are complementary to each other and are consistent with a model involving two types of pauses in initiation: a short-lived pause that occurs in the translocation of a 6-mer nascent transcript and a long-lived pause that occurs as a result of 1-2 nucleotide backtracking of a 7-mer transcript.
Holistic Initiatives for Enhancing Graduate Employability in Zimbabwe

ERIC Educational Resources Information Center

Garwe, Evelyn Chiyevo

2014-01-01

The objective of the study was to document initiatives for enhancing graduate employability and building successful future careers for students. The author used the case of Zimbabwe to explore interventions by higher education institutions, government, industry and commerce as well as professional bodies. The methodology involved a mix of…

Severely Crusted Cheilitis as an Initial Presentation of Systemic Lupus Erythematosus.

PubMed

Chan, Wai Man Mandy; Pang, Shiu Ming; Ng, See Ket

2017-01-01

Lupus erythematosus (LE) is an autoimmune disease which may initially present solely with lip lesions. Due to a wide spectrum of presentation, these features may initially be misdiagnosed as other oral diseases such as lichen planus, erythema multiforme (EM), and actinic cheilitis, leading to a delay in diagnosis and treatment. We discuss a case of severely crusted cheilitis which was initially diagnosed as EM, with subsequent development of subacute cutaneous LE, and progression to systemic LE. We will discuss the clinical and histological features of lupus cheilitis.
Corticobasal degeneration initially developing motor versus non-motor symptoms: a comparative clinicopathological study.

PubMed

Ikeda, Chikako; Yokota, Osamu; Nagao, Shigeto; Ishizu, Hideki; Morisada, Yumi; Terada, Seishi; Nakashima, Yoshihiko; Akiyama, Haruhiko; Uchitomi, Yosuke

2014-09-01

Clinical presentations of pathologically confirmed corticobasal degeneration (CBD) vary, and the heterogeneity makes its clinical diagnosis difficult, especially when a patient lacks any motor disturbance in the early stage. We compared clinical and pathological features of four pathologically confirmed CBD cases that initially developed non-motor symptoms, including behavioural and psychiatric symptoms but without motor disturbance (CBD-NM), and five CBD cases that initially developed parkinsonism and/or falls (CBD-M). The age range at death for the CBD-NM and CBD-M subjects (58-85 years vs 45-67 years) and the range of disease duration (2-18 years vs 2-6 years) did not significantly differ between the groups. Prominent symptoms in the early stage of CBD-NM cases included self-centred behaviours such as frontotemporal dementia (n = 1), apathy with and without auditory hallucination (n = 2), and aggressive behaviours with delusion and visual hallucination (n = 1). Among the four CBD-NM cases, only one developed asymmetric motor disturbance, and two could walk without support throughout the course. Final clinical diagnoses of the CBD-NM cases were frontotemporal dementia (n = 2), senile psychosis with delirium (n = 1), and schizophrenia (n = 1). Neuronal loss was significantly less severe in the subthalamic nucleus and substantia nigra in the CBD-NM cases than in the CBD-M cases. The severity of tau pathology in all regions examined was comparable in the two groups. CBD cases that initially develop psychiatric and behavioural changes without motor symptoms may have less severe degenerative changes in the subthalamic nucleus and substantia nigra, and some CBD cases can lack motor disturbance not only in the early stage but also in the last stage of the course. © 2014 The Authors. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.
Initiatives supporting evidence informed health system policymaking in Cameroon and Uganda: a comparative historical case study.

PubMed

Ongolo-Zogo, Pierre; Lavis, John N; Tomson, Goran; Sewankambo, Nelson K

2014-11-29

There is a scarcity of empirical data on institutions devoted to knowledge brokerage and their influence in Africa. Our objective was to describe two pioneering Knowledge Translation Platforms (KTPs) supporting evidence informed health system policymaking (EIHSP) in Cameroon and Uganda since 2006. This comparative historical case study of Evidence Informed Policy Network (EVIPNet) Cameroon and Regional East African Community Health Policy Initiative (REACH-PI) Uganda using multiple methods comprised (i) a descriptive documentary analysis for a narrative historical account, (ii) an interpretive documentary analysis of the context, profiles, activities and outputs inventories and (iii) an evaluative survey of stakeholders exposed to evidence briefs produced and policy dialogues organized by the KTPs. Both initiatives benefited from the technical and scientific support from the global EVIPNet resource group. EVIPNet Cameroon secretariat operates with a multidisciplinary group of part-time researchers in a teaching hospital closely linked to the ministry of health. REACH-PI Uganda secretariat operates with a smaller team of full time staff in a public university. Financial resources were mobilized from external donors to scale up capacity building, knowledge management, and linkage and exchange activities. Between 2008 and 2012, twelve evidence briefs were produced in Cameroon and three in Uganda. In 2012, six rapid evidence syntheses in response to stakeholders' urgent needs were produced in Cameroon against 73 in Uganda between 2010 and 2012. Ten policy dialogues (seven in Cameroon and three in Uganda) informed by pre-circulated evidence briefs were well received. Both KTPs contributed to developing and testing new resources and tools for EIHSP. A network of local and global experts has created new spaces for evidence informed deliberations on priority health policy issues related to MDGs. This descriptive historical account of two KTPs housed in government
Computational Study of the Richtmyer-Meshkov Instability with a Complex Initial Condition

NASA Astrophysics Data System (ADS)

McFarland, Jacob; Reilly, David; Greenough, Jeffrey; Ranjan, Devesh

2014-11-01

Results are presented for a computational study of the Richtmyer-Meshkov instability with a complex initial condition. This study covers experiments which will be conducted at the newly-built inclined shock tube facility at the Georgia Institute of Technology. The complex initial condition employed consists of an underlying inclined interface perturbation with a broadband spectrum of modes superimposed. A three-dimensional staggered mesh arbitrary Lagrange Eulerian (ALE) hydrodynamics code developed at Lawerence Livermore National Laboratory called ARES was used to obtain both qualitative and quantitative results. Qualitative results are discussed using time series of density plots from which mixing width may be extracted. Quantitative results are also discussed using vorticity fields, circulation components, and energy spectra. The inclined interface case is compared to the complex interface case in order to study the effect of initial conditions on shocked, variable-density flows.
The start of lightning: Evidence of bidirectional lightning initiation.

PubMed

Montanyà, Joan; van der Velde, Oscar; Williams, Earle R

2015-10-16

Lightning flashes are known to initiate in regions of strong electric fields inside thunderstorms, between layers of positively and negatively charged precipitation particles. For that reason, lightning inception is typically hidden from sight of camera systems used in research. Other technology such as lightning mapping systems based on radio waves can typically detect only some aspects of the lightning initiation process and subsequent development of positive and negative leaders. We report here a serendipitous recording of bidirectional lightning initiation in virgin air under the cloud base at ~11,000 images per second, and the differences in characteristics of opposite polarity leader sections during the earliest stages of the discharge. This case reveals natural lightning initiation, propagation and a return stroke as in negative cloud-to-ground flashes, upon connection to another lightning channel - without any masking by cloud.
The Young Visual Binary Database

NASA Astrophysics Data System (ADS)

Prato, Lisa A.; Avilez, Ian; Allen, Thomas; Zoonematkermani, Saeid; Biddle, Lauren; Muzzio, Ryan; Wittal, Matthew; Schaefer, Gail; Simon, Michal

2017-01-01

We have obtained adaptive optics imaging and high-resolution H-band and in some cases K-band spectra of each component in close to 100 young multiple systems in the nearby star forming regions of Taurus, Ophiuchus, TW Hya, and Orion. The binary separations for the pairs in our sample range from 30 mas to 3 arcseconds. The imaging and most of our spectra were obtained with instruments behind adaptive optics systems in order to resolve even the closest companions. We are in the process of determining fundamental stellar and circumstellar properties, such as effective temperature, Vsin(i), veiling, and radial velocity, for each component in the entire sample. The beta version of our database includes systems in the Taurus region and provides plots, downloadable ascii spectra, and values of the stellar and circumstellar properties for both stars in each system. This resource is openly available to the community at http://jumar.lowell.edu/BinaryStars/. In this poster we describe initial results from our analysis of the survey data. Support for this research was provided in part by NSF award AST-1313399 and by NASA Keck KPDA funding.
Development of a military competency checklist for case management.

PubMed

Stanton, Marietta P; Swanson, Carol; Baker, Rebecca D

2005-01-01

This presentation will discuss the design, implementation, and evaluation of a competency-based checklist in military nursing network. The checklist was initiated to help assess case manager competency where background and preparation for the case manager role were quite diverse. The checklist assisted initially with the assessment of learning needs; later, it served as a self-assessment for case managers to determine their areas for improvement. Finally, the assessment was used not only to verify competency by the case management supervisor, but also to establish systemwide quality in case management.
The Impact of Heterogeneous Thresholds on Social Contagion with Multiple Initiators

PubMed Central

Karampourniotis, Panagiotis D.; Sreenivasan, Sameet; Szymanski, Boleslaw K.; Korniss, Gyorgy

2015-01-01

The threshold model is a simple but classic model of contagion spreading in complex social systems. To capture the complex nature of social influencing we investigate numerically and analytically the transition in the behavior of threshold-limited cascades in the presence of multiple initiators as the distribution of thresholds is varied between the two extreme cases of identical thresholds and a uniform distribution. We accomplish this by employing a truncated normal distribution of the nodes’ thresholds and observe a non-monotonic change in the cascade size as we vary the standard deviation. Further, for a sufficiently large spread in the threshold distribution, the tipping-point behavior of the social influencing process disappears and is replaced by a smooth crossover governed by the size of initiator set. We demonstrate that for a given size of the initiator set, there is a specific variance of the threshold distribution for which an opinion spreads optimally. Furthermore, in the case of synthetic graphs we show that the spread asymptotically becomes independent of the system size, and that global cascades can arise just by the addition of a single node to the initiator set. PMID:26571486
Analysis of the Climate Change Technology Initiative

EIA Publications

1999-01-01

Analysis of the impact of specific policies on the reduction of carbon emissions and their impact on U.S. energy use and prices in the 2008-2012 time frame. Also, analyzes the impact of the President's Climate Change Technology Initiative, as defined for the 2000 budget, on reducing carbon emissions from the levels forecast in the Annual Energy Outlook 1999 reference case.
77 FR 45589 - Initiation of Five-Year (“Sunset”) Review and Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

...) and 70 FR 62061 (October 28, 2005). Guidance on methodological or analytical issues relevant to the... Modification, 77 FR 8101 (February 14, 2012). Correction of Case Number From Previous Sunset Review Initiation... Department case number for the antidumping duty order on steel concrete reinforcing bars from Latvia. The...
Recalled Initiation and Duration of Maternal Breastfeeding Among Children with and Without ADHD in a Well Characterized Case-Control Sample.

PubMed

Stadler, Diane D; Musser, Erica D; Holton, Kathleen F; Shannon, Jackilen; Nigg, Joel T

2016-02-01

Early environmental influences are increasingly of interest in understanding ADHD as a neurodevelopmental condition, particularly in light of recognition that gene by environment interplay are likely involved in this condition. Breastfeeding duration predicts cognitive development, as well as development of brain white matter connectivity, in areas similar to those seen in ADHD. Prior studies show an association between breastfeeding and ADHD but without adequate evaluation of ADHD. A case control cohort of 474 children aged 7-13 years was examined, 291 with well characterized ADHD (71.5 % male) and the rest typically developing controls (51.9 % male). Mothers retrospectively reported on breast feeding initiation and duration. Initiation of breastfeeding was not associated with child ADHD, but shorter duration of breastfeeding was associated with child ADHD with a medium effect size (d = 0.40, p < 0.05); this effect held after covarying a broad set of potential confounders, including child oppositional defiant and conduct problems and including maternal and paternal ADHD symptoms. Effects were replicated across both parent and teacher ratings of child ADHD symptoms. Shorter duration of breastfeeding is among several risk factors in early life associated with future ADHD, or else longer duration is protective. The direction of this effect is unknown, however. It may be that some children are more difficult to breastfeed or that breastfeeding provides nutrients or other benefits that reduce future chance of ADHD.
Complete atrioventricular block as initial manifestation of systemic lupus erythematosus.

PubMed

Arce-Salinas, C A; Carmona-Escamilla, M A; Rodríguez-García, F

2009-01-01

Only a few cases of complete atrioventricular block (AVB) in adult lupus patients have been previously described, but only one as the initial manifestation. A 19-year-old woman who presented with seizures and loss of consciousness, was diagnosed with complete ABV and underwent pacemaker placement. Over the next weeks she developed serositis, joint, cutaneous, and renal involvement; positive antinuclear antibodies and high anti-SSA/Ro titers. This is the second case with AVB as a feature of SLE at onset. A review of previous complete AVB cases of adult SLE patients is presented.
Family Literacy Legislation and Initiatives in Eleven States.

ERIC Educational Resources Information Center

Peyton, Tony

This report focuses on 11 states' efforts to develop state-funded family literacy initiatives either through legislation or other actions. An introduction defines family literacy. Part I includes in-depth case studies on seven states that have either passed or attempted to pass state family literacy legislation. For each state (Kentucky,…
Driver-initiated distractions: examining strategic adaptation for in-vehicle task initiation.

PubMed

Horrey, William J; Lesch, Mary F

2009-01-01

Today, drivers are faced with many in-vehicle activities that are potentially distracting. In many cases, they are not passive recipients of these tasks; rather, drivers decide whether or not (or how) to perform them. In this study, we examined whether drivers, given knowledge of the upcoming road demands, would strategically delay performing in-vehicle activities until demands were reduced. Twenty drivers drove an instrumented van around a closed track that was divided into sections of varying demands and difficulty. Drivers were asked to perform one of four in-vehicle tasks (e.g., phone conversation; read a text message; find an address; pick up an object on the floor); however, they were free to decide when to initiate these tasks, provided they finish them before a given deadline. Although drivers were fully aware of the relative demands of the road, they did not tend to strategically postpone tasks--a finding that was consistent across the different tasks (p >.05). Rather, drivers tended to initiate tasks regardless of the current driving conditions. This strategy frequently led to driving errors. Given the control that drivers have over many in-vehicle distractions, interventions that focus on strategic decisions and planning may have merit.
Parent-Child Communication and Marijuana Initiation: Evidence Using Discrete-Time Survival Analysis

PubMed Central

Nonnemaker, James M.; Silber-Ashley, Olivia; Farrelly, Matthew C.; Dench, Daniel

2012-01-01

This study supplements existing literature on the relationship between parent-child communication and adolescent drug use by exploring whether parental and/or adolescent recall of specific drug-related conversations differentially impact youth's likelihood of initiating marijuana use. Using discrete-time survival analysis, we estimated the hazard of marijuana initiation using a logit model to obtain an estimate of the relative risk of initiation. Our results suggest that parent-child communication about drug use is either not protective (no effect) or—in the case of youth reports of communication—potentially harmful (leading to increased likelihood of marijuana initiation). PMID:22958867
A Social Contract for University-Industry Collaboration: A Case of Project-Based Learning Environment

NASA Astrophysics Data System (ADS)

Vartiainen, Tero

This study determines a social contract for a form of university-industry collaboration to a project-based learning environment in close collaboration with industry. The author's previous studies on moral conflicts in a project-based learning (PjBL) environment and his 5-year engagement in the PjBL environment are used as background knowledge, and John Rawls' veil of ignorance is used as a method in the contract formulation. Fair and impartial treatment of actors is strived for with the contract which constitutes of sets of obligations for each party, students, clients, and university (instructors) in the chosen project course. With the contract fair and impartial treatment of actors is strived for and the most dilemmatic moral conflicts are tried to be avoided. The forming of the social contract is evaluated, and implications for research and collaborations in practice are offered.
Plasma Discharge Initiation of Explosives in Rock Blasting Application: A Case Study

NASA Astrophysics Data System (ADS)

Jae-Ou, Chae; Young-Jun, Jeong; V, M. Shmelev; A, A. Denicaev; V, M. Poutchkov; V, Ravi

2006-07-01

A plasma discharge initiation system for the explosive volumetric combustion charge was designed, investigated and developed for practical application. Laboratory scale experiments were carried out before conducting the large scale field tests. The resultant explosions gave rise to less noise, insignificant seismic vibrations and good specific explosive consumption for rock blasting. Importantly, the technique was found to be safe and environmentally friendly.
Persistence of initial conditions in continental scale air quality simulations

NASA Astrophysics Data System (ADS)

Hogrefe, Christian; Roselle, Shawn J.; Bash, Jesse O.

2017-07-01

This study investigates the effect of initial conditions (IC) for pollutant concentrations in the atmosphere and soil on simulated air quality for two continental-scale Community Multiscale Air Quality (CMAQ) model applications. One of these applications was performed for springtime and the second for summertime. Results show that a spin-up period of ten days commonly used in regional-scale applications may not be sufficient to reduce the effects of initial conditions to less than 1% of seasonally-averaged surface ozone concentrations everywhere while 20 days were found to be sufficient for the entire domain for the spring case and almost the entire domain for the summer case. For the summer case, differences were found to persist longer aloft due to circulation of air masses and even a spin-up period of 30 days was not sufficient to reduce the effects of ICs to less than 1% of seasonally-averaged layer 34 ozone concentrations over the southwestern portion of the modeling domain. Analysis of the effect of soil initial conditions for the CMAQ bidirectional NH3 exchange model shows that during springtime they can have an important effect on simulated inorganic aerosols concentrations for time periods of one month or longer. The effects are less pronounced during other seasons. The results, while specific to the modeling domain and time periods simulated here, suggest that modeling protocols need to be scrutinized for a given application and that it cannot be assumed that commonly-used spin-up periods are necessarily sufficient to reduce the effects of initial conditions on model results to an acceptable level. What constitutes an acceptable level of difference cannot be generalized and will depend on the particular application, time period and species of interest. Moreover, as the application of air quality models is being expanded to cover larger geographical domains and as these models are increasingly being coupled with other modeling systems to better represent
The CAST Initiative in Guam: A Model of Effective Teachers Teaching Teachers

ERIC Educational Resources Information Center

Zuercher, Deborah K.; Kessler, Cristy; Yoshioka, Jon

2011-01-01

The CAST (content area specialized training) model of professional development enables sustainable teacher leadership and is responsive to the need for culturally relevant educational practices. The purpose of this paper is to share the background, methods, findings and recommendations of a case study on the CAST initiative in Guam. The case study…
The case against one-shot testing for initial dental licensure.

PubMed

Chambers, David W; Dugoni, Arthur A; Paisley, Ian

2004-03-01

High-stakes testing are expected to meet standards for cost-effectiveness, fairness, transparency, high reliability, and high validity. It is questionable whether initial licensure examinations in dentistry meet such standards. Decades of piecemeal adjustments in the system have resulted in limited improvement. The essential flaw in the system is reliance on a one-shot sample of a small segment of the skills, understanding, and supporting values needed for today's professional practice of dentistry. The "snapshot" approach to testing produces inherently substandard levels of reliability and validity. A three-step alternative is proposed: boards should (1) define the competencies required of beginning practitioners, (2) establish the psychometric standards needed to make defensible judgments about candidates, and (3) base licensure decisions only on portfolios of evidence that test for defined competencies at established levels of quality.

Initiation Phenomena in Pulsed Chemical Lasers

DTIC Science & Technology

1978-10-01

2-3 4 Normalized Cavity llumination Contours.............. 2-5 5 Case B ....... * . . .. ... . ...... . . . .. .. . ... . 2-6 6 Nonuniformity in...improvement in illumination uniformity were obtained. Figure 6 shows the decrease in initiation nonuniformity with increasing numbers of lamps in the...Flow10 Entry and Exit < 6 4 2 10 14 18 22 26 30 34 Number of Lamps 1.0 1.4 1.8 2.2 2.6 3.0 3.4 Cavity Width/Cavity Height Figure 6. Nonuniformity in
Correcting the initialization of models with fractional derivatives via history-dependent conditions

NASA Astrophysics Data System (ADS)

Du, Maolin; Wang, Zaihua

2016-04-01

Fractional differential equations are more and more used in modeling memory (history-dependent, non-local, or hereditary) phenomena. Conventional initial values of fractional differential equations are defined at a point, while recent works define initial conditions over histories. We prove that the conventional initialization of fractional differential equations with a Riemann-Liouville derivative is wrong with a simple counter-example. The initial values were assumed to be arbitrarily given for a typical fractional differential equation, but we find one of these values can only be zero. We show that fractional differential equations are of infinite dimensions, and the initial conditions, initial histories, are defined as functions over intervals. We obtain the equivalent integral equation for Caputo case. With a simple fractional model of materials, we illustrate that the recovery behavior is correct with the initial creep history, but is wrong with initial values at the starting point of the recovery. We demonstrate the application of initial history by solving a forced fractional Lorenz system numerically.
Piercing the veil: the marginalization of midwives in the United States.

PubMed

Goodman, Steffie

2007-08-01

This paper investigates the marginalization of certified nurse-midwives (CNMs) in the US. This marginalization occurs despite ample evidence demonstrating that a midwifery model delivers high-quality cost-effective care. Currently midwives attend only 7% of births, compared to 50-75% of births in other developed countries. Given the escalating costs of health care and relatively poor maternal and child health indicators in comparison with other developed countries, these findings are disturbing. This paper investigates this paradox through a qualitative case study of two prestigious but declining midwifery services in a large US city. Fifty-two multi-sited in-depth interviews were conducted along with an analysis of relevant archival sources. It was found that institutions successfully altered maternity care and diminished midwifery services without accountability for their actions. These findings illuminate the larger political-economic forces that shape the marginalization of midwifery in the US.
Multipoint propagators for non-Gaussian initial conditions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bernardeau, Francis; Sefusatti, Emiliano; Crocce, Martin

2010-10-15

We show here how renormalized perturbation theory calculations applied to the quasilinear growth of the large-scale structure can be carried on in presence of primordial non-Gaussian (PNG) initial conditions. It is explicitly demonstrated that the series reordering scheme proposed in Bernardeau, Crocce, and Scoccimarro [Phys. Rev. D 78, 103521 (2008)] is preserved for non-Gaussian initial conditions. This scheme applies to the power spectrum and higher-order spectra and is based on a reorganization of the contributing terms into the sum of products of multipoint propagators. In case of PNG, new contributing terms appear, the importance of which is discussed in themore » context of current PNG models. The properties of the building blocks of such resummation schemes, the multipoint propagators, are then investigated. It is first remarked that their expressions are left unchanged at one-loop order irrespective of statistical properties of the initial field. We furthermore show that the high-momentum limit of each of these propagators can be explicitly computed even for arbitrary initial conditions. They are found to be damped by an exponential cutoff whose expression is directly related to the moment generating function of the one-dimensional displacement field. This extends what had been established for multipoint propagators for Gaussian initial conditions. Numerical forms of the cutoff are shown for the so-called local model of PNG.« less
Dropout revisited: patient- and therapist-initiated discontinuation of psychotherapy as a function of organizational instability.

PubMed

Werbart, Andrzej; Andersson, Håkan; Sandell, Rolf

2014-01-01

To explore the association between the stability or instability of services' organizational structure and patient- and therapist-initiated discontinuation of therapy in routine mental health. Three groups, comprising altogether 750 cases in routine mental health care in eight different clinics, were included: cases with patient-initiated discontinuation, therapist-initiated discontinuation, and patients remaining in treatment. Multilevel multinomial regression was used to estimate three models: An initial, unconditional intercept-only model, another one including patient variables, and a final model with significant patient and therapist variables including the organizational stability of the therapists' clinic. High between-therapist variability was noted. Odds ratios and significance tests indicated a strong association of organizational instability with patient-initiated premature termination in particular. The question of how organizational factors influence the treatment results needs further research. Future studies have to be designed in ways that permit clinically meaningful subdivision of the patients' and the therapists' decisions for premature termination.
Case 1; An Initial Study of Contingencies Applicable to Special Education.

ERIC Educational Resources Information Center

Cohen, Harold C.; And Others

The first CASE (Contingencies Applicable to Special Education) project, conducted from February to October 1965 with student inmates at the National Training School for Boys (NTSB), used environmental planning concepts and behavioral learning principles to restructure a basic education curriculum in terms of individual performance requirements,…
Student-Initiated Use of Technology--Friend and Foe

ERIC Educational Resources Information Center

Wiklund, Matilda; Andersson, Annika

2018-01-01

A multitude of different technologies are used in school today. Some are provided by the school and others are brought by the individual teacher or student. In addition, different applications are available. In this study the focus is on student-initiated uses of technology and how it conditions learning. Based on a case study with surveys,…
Diversity initiatives in academic psychiatry: applying cultural competence.

PubMed

Lim, Russell F; Luo, John S; Suo, Shannon; Hales, Robert E

2008-01-01

This article describes the process of change in an academic department of psychiatry that has led to the development of a diversity initiative in teaching, research, recruitment, and services. The authors performed a literature review of diversity initiatives using PubMed. The authors then wrote a case study of the development of a diversity initiative at UC Davis. Some articles on diversity initiatives were found, but none that detailed the administrative process, funding, or sustainability of such initiatives. In 1999, the UC Davis Department of Psychiatry and Behavioral Sciences recognized the importance of issues of diversity and established the Diversity Advisory Committee, a group of department faculty and residents that explores and addresses the diversity needs of the department. In our observations, there are at least three requirements for a successful diversity initiative: a diverse patient population, a "critical mass" of interested faculty, and support of the administration. With these three factors in place, the Diversity Advisory Committee produced four Continuing Medical Education symposia focused on diversity topics, developed a 4-year cultural psychiatry curriculum and a 4-year religion and spirituality curriculum within the residency, and supported nine residents who received awards from the APA's Minority Fellowships in 8 years. Future plans include department-wide and medical school faculty-wide diversity training, educational research, and a postgraduate fellowship in cultural psychiatry. This article shows that a diversity initiative can be undertaken with interested minority and nonminority faculty, administrative support, and a diverse patient population. The authors hope this article will provide assistance to other academic departments in developing diversity initiatives.
Optical veiling, disk accretion, and the evolution of T Tauri stars

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hartmann, L.W.; Kenyon, S.J.

1990-01-01

High-resolution spectra of 31 K7-M1 T Tauri stars (TTs) in the Taurus-Auriga molecular cloud demonstrate that most of these objects exhibit substantial excess emission at 5200 A. Extrapolations of these data consistent with low-resolution spectrophotometry indicate that the extra emission is comparable to the stellar luminosity in many cases. If this continuum emission arises in the boundary layers of accreting disks, more than about 30 percent of all TTs may be accreting material at a rate which is sufficiently rapid to alter their evolution from standard Hayashi tracks. It is estimated that roughly 10 percent of the final stellar massmore » is accreted in the TT phase. This amount of material is comparable to the minimum gravitationally unstable disk mass estimated by Larson and it is speculated that the TT phase represents the final stages of disk accretion driven by gravitational instabilities. 40 refs.« less
Lupus Panniculitis as an Initial Manifestation of Systemic Lupus Erythematosus: A Case Report.

PubMed

Zhao, Yu-Kun; Wang, Fang; Chen, Wen-Na; Xu, Rui; Wang, Zhuo; Jiang, Yuan-Wen; Luo, Di-Qing; Han, Jian-De

2016-04-01

Lupus erythematosus panniculitis (LEP) is a variant of chronic cutaneous lupus erythematosus (CCLE). Reported cases of LEP lesions before the diagnosis of systemic lupus erythematosus (SLE) were very rare; only 9 cases have been reported, to the best of our knowledge. We now describe the case of a 19-year-old male patient, with an overall review of the English literature. In the earliest stage of the present case, nodules and ulcers involved his left leg and face, with no other accompanied symptoms. The skin lesions disappeared after treatment with methylprednisolone, 16 mg/d for 1 month. Seven months after discontinuing methylprednisolone, the cutaneous nodules and ulcers on his back recurred and were accompanied by fever, hair loss, and polyarthritis. Blood tests revealed leucopenia, positive antinuclear antibody and Smith antibody, and proteinuria. Histopathological findings were most consistent with LEP. This was followed sequentially by the diagnosis of SLE. The patient improved again after treatment with methylprednisolone and cyclophosphamide.Patients with LEP should have regular follow-ups because the development of SLE is possible. Early diagnosis and proper treatment is pivotal to improve the prognosis of such patients.
Parent-child communication and marijuana initiation: evidence using discrete-time survival analysis.

PubMed

Nonnemaker, James M; Silber-Ashley, Olivia; Farrelly, Matthew C; Dench, Daniel

2012-12-01

This study supplements existing literature on the relationship between parent-child communication and adolescent drug use by exploring whether parental and/or adolescent recall of specific drug-related conversations differentially impact youth's likelihood of initiating marijuana use. Using discrete-time survival analysis, we estimated the hazard of marijuana initiation using a logit model to obtain an estimate of the relative risk of initiation. Our results suggest that parent-child communication about drug use is either not protective (no effect) or - in the case of youth reports of communication - potentially harmful (leading to increased likelihood of marijuana initiation). Copyright © 2012 Elsevier Ltd. All rights reserved.
Free vibration of rectangular plates with a small initial curvature

NASA Technical Reports Server (NTRS)

Adeniji-Fashola, A. A.; Oyediran, A. A.

1988-01-01

The method of matched asymptotic expansions is used to solve the transverse free vibration of a slightly curved, thin rectangular plate. Analytical results for natural frequencies and mode shapes are presented in the limit when the dimensionless bending rigidity, epsilon, is small compared with in-plane forces. Results for different boundary conditions are obtained when the initial deflection is: (1) a polynomial in both directions, and (2) the product of a polynomial and a trigonometric function, and arbitrary. For the arbitrary initial deflection case, the Fourier series technique is used to define the initial deflection. The results obtained show that the natural frequencies of vibration of slightly curved plates are coincident with those of perfectly flat, prestressed rectangular plates. However, the eigenmodes are very different from those of initially flat prestressed rectangular plates. The total deflection is found to be the sum of the initial deflection, the deflection resulting from the solution of the flat plate problem, and the deflection resulting from the static problem.
The initial rise method extended to multiple trapping levels in thermoluminescent materials.

PubMed

Furetta, C; Guzmán, S; Ruiz, B; Cruz-Zaragoza, E

2011-02-01

The well known Initial Rise Method (IR) is commonly used to determine the activation energy when only one glow peak is presented and analysed in the phosphor materials. However, when the glow peak is more complex, a wide peak and some holders appear in the structure. The application of the Initial Rise Method is not valid because multiple trapping levels are considered and then the thermoluminescent analysis becomes difficult to perform. This paper shows the case of a complex glow curve structure as an example and shows that the calculation is also possible using the IR method. The aim of the paper is to extend the well known Initial Rise Method (IR) to the case of multiple trapping levels. The IR method is applied to minerals extracted from Nopal cactus and Oregano spices because the thermoluminescent glow curve's shape suggests a trap distribution instead of a single trapping level. Copyright © 2010 Elsevier Ltd. All rights reserved.
Remote Sensing based multi-temporal observation of North Korea mining activities : A case study of Rakyeon mine

NASA Astrophysics Data System (ADS)

Lim, J. H.; Yu, J.; Koh, S. M.; Lee, G.

2017-12-01

Mining is a major industrial business of North Korea accounting for significant portion of an export for North Korean economy. However, due to its veiled political system, details of mining activities of North Korea is rarely known. This study investigated mining activities of Rakyeon Au-Ag mine, North Korea based on remote sensing based multi-temporal observation. To monitor the mining activities, CORONA data acquired in 1960s and 1970s, SPOT and Landsat data acquired in 1980s and 1990s and KOMPSAT-2 data acquired in 2010s are utilized. The results show that mining activities of Rakyeon mine continuously carried out for the observation period expanding tailing areas of the mine. However, its expanding rate varies between the period related to North Korea's economic and political situations.
Unemployment and initiation of psychotropic medication: a case-crossover study of 2 348 552 Norwegian employees.

PubMed

Kaspersen, Silje L; Pape, Kristine; Ose, Solveig O; Gunnell, David; Bjørngaard, Johan Håkon

2016-11-01

The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss, to detect the period of greatest risk. The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A case-crossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions. Purchases of all psychotropic drugs increased 1-3 months before job loss. Antidepressants had the highest estimate in the month before job loss (OR 2.68, 95% CIs 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in men. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close-to-baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations. Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
A benchmark initiative on mantle convection with melting and melt segregation

NASA Astrophysics Data System (ADS)

Schmeling, Harro; Dohmen, Janik; Wallner, Herbert; Noack, Lena; Tosi, Nicola; Plesa, Ana-Catalina; Maurice, Maxime

2015-04-01

In recent years a number of mantle convection models have been developed which include partial melting within the asthenosphere, estimation of melt volumes, as well as melt extraction with and without redistribution at the surface or within the lithosphere. All these approaches use various simplifying modelling assumptions whose effects on the dynamics of convection including the feedback on melting have not been explored in sufficient detail. To better assess the significance of such assumptions and to provide test cases for the modelling community we initiate a benchmark comparison. In the initial phase of this endeavor we focus on the usefulness of the definitions of the test cases keeping the physics as sound as possible. The reference model is taken from the mantle convection benchmark, case 1b (Blanckenbach et al., 1989), assuming a square box with free slip boundary conditions, the Boussinesq approximation, constant viscosity and a Rayleigh number of 1e5. Melting is modelled assuming a simplified binary solid solution with linearly depth dependent solidus and liquidus temperatures, as well as a solidus temperature depending linearly on depletion. Starting from a plume free initial temperature condition (to avoid melting at the onset time) three cases are investigated: Case 1 includes melting, but without thermal or dynamic feedback on the convection flow. This case provides a total melt generation rate (qm) in a steady state. Case 2 includes batch melting, melt buoyancy (melt Rayleigh number Rm), depletion buoyancy and latent heat, but no melt percolation. Output quantities are the Nusselt number (Nu), root mean square velocity (vrms) and qm approaching a statistical steady state. Case 3 includes two-phase flow, i.e. melt percolation, assuming a constant shear and bulk viscosity of the matrix and various melt retention numbers (Rt). These cases should be carried out using the Compaction Boussinseq Approximation (Schmeling, 2000) or the full compaction
Image quality degradation by light-scattering processes in high-performance display devices for medical imaging

NASA Astrophysics Data System (ADS)

Badano, Aldo

1999-11-01

This thesis addresses the characterization of light scattering processes that degrade image quality in high performance electronic display devices for digital radiography. Using novel experimental and computational tools, we study the lateral diffusion of light in emissive display devices that causes extensive veiling glare and significant reduction of the physical contrast. In addition, we examine the deleterious effects of ambient light reflections that affect the contrast of low luminance regions, and superimpose unwanted structured signal. The analysis begins by introducing the performance limitations of the human visual system to define high fidelity requirements. It is noted that current devices severely suffer from image quality degradation due to optical transport processes. To model the veiling glare and reflectance characteristics of display devices, we introduce a Monte Carlo light transport simulation code, DETECT-II, that tracks individual photons through multiple scattering events. The simulation accounts for the photon polarization state at each scattering event, and provides descriptions for rough surfaces and thin film coatings. A new experimental method to measure veiling glare is described next, based on a conic collimated probe that minimizes contamination from bright areas. The measured veiling glare ratio is taken to be the luminance in the surrounding bright field divided by the luminance in the dark circle. We show that veiling glare ratios in the order of a few hundreds can be measured with an uncertainty of a few percent. The veiling glare response function is obtained by measuring the small spot contrast ratio of test patterns having varying dark spot radius. Using DETECT-II, we then estimate the ring response functions for a high performance medical imaging monitor of current design, and compare the predictions of the model with the experimentally measured response function. The data presented in this thesis demonstrate that although
Impact of Targeted Programs on Health Systems: A Case Study of the Polio Eradication Initiative

PubMed Central

Loevinsohn, Benjamin; Aylward, Bruce; Steinglass, Robert; Ogden, Ellyn; Goodman, Tracey; Melgaard, Bjorn

2002-01-01

The results of 2 large field studies on the impact of the polio eradication initiative on health systems and 3 supplementary reports were presented at a December 1999 meeting convened by the World Health Organization. All of these studies concluded that positive synergies exist between polio eradication and health systems but that these synergies have not been vigorously exploited. The eradication of polio has probably improved health systems worldwide by broadening distribution of vitamin A supplements, improving cooperation among enterovirus laboratories, and facilitating linkages between health workers and their communities. The results of these studies also show that eliminating polio did not cause a diminution of funding for immunization against other illnesses. Relatively little is known about the opportunity costs of polio eradication. Improved planning in disease eradication initiatives can minimize disruptions in the delivery of other services. Future initiatives should include indicators and baseline data for monitoring effects on health systems development. PMID:11772750
30 CFR 250.1608 - Well casing and cementing.

Code of Federal Regulations, 2012 CFR

2012-07-01

... rock casing, (iv) Bobtail cap rock casing (required when the cap rock casing does not penetrate into the cap rock), (v) Second cap rock casing (brine wells), and (vi) Production liner. (2) The lessee... lessee shall initiate remedial action as approved by the District Manager. For cap rock casing, the test...
30 CFR 250.1608 - Well casing and cementing.

Code of Federal Regulations, 2013 CFR

2013-07-01

... rock casing, (iv) Bobtail cap rock casing (required when the cap rock casing does not penetrate into the cap rock), (v) Second cap rock casing (brine wells), and (vi) Production liner. (2) The lessee... lessee shall initiate remedial action as approved by the District Manager. For cap rock casing, the test...

30 CFR 250.1608 - Well casing and cementing.

Code of Federal Regulations, 2014 CFR

2014-07-01

... rock casing, (iv) Bobtail cap rock casing (required when the cap rock casing does not penetrate into the cap rock), (v) Second cap rock casing (brine wells), and (vi) Production liner. (2) The lessee... lessee shall initiate remedial action as approved by the District Manager. For cap rock casing, the test...
Using technology to enhance the quality of home health care: three case studies of health information technology initiatives at the visiting nurse service of New York.

PubMed

Russell, David; Rosenfeld, Peri; Ames, Sylvia; Rosati, Robert J

2010-01-01

There is a growing recognition among health services researchers and policy makers that Health Information Technology (HIT) has the potential to address challenging issues that face patients and providers of healthcare. The Visiting Nurse Service of New York (VNSNY), a large not-for-profit home healthcare agency, has integrated technology applications into the service delivery model of several programs. Case studies, including the development and implementation, of three informatics initiatives at VNSNY are presented on: (1) Quality Scorecards that utilize process, outcomes, cost, and satisfaction measures to assess performance among clinical staff and programs; (2) a tool to identify patients at risk of being hospitalized, and (3) a predictive model that identifies patients who are eligible for physical rehabilitation services. Following a description of these initiatives, we discuss their impact on quality and process indicators, as well as the opportunities and challenges to implementation. © 2010 National Association for Healthcare Quality.
Student-Initiated Use of Facebook for Learning Online Journalism

ERIC Educational Resources Information Center

Song, Yang

2017-01-01

This article presents a case study of student-initiated use of Facebook Groups in doing a team project for an online journalism course. Drawing upon the concept of affinity space and a theoretical taxonomy of asynchronous online discussion, the present study triangulates classroom observation, semi-structured student interviews, and microanalysis…
Resilience of antagonistic networks with regard to the effects of initial failures and degree-degree correlations

NASA Astrophysics Data System (ADS)

Watanabe, Shunsuke; Kabashima, Yoshiyuki

2016-09-01

In this study we investigate the resilience of duplex networked layers α and β coupled with antagonistic interlinks, each layer of which inhibits its counterpart at the microscopic level, changing the following factors: whether the influence of the initial failures in α remains [quenched (case Q )] or not [free (case F )]; the effect of intralayer degree-degree correlations in each layer and interlayer degree-degree correlations; and the type of the initial failures, such as random failures or targeted attacks (TAs). We illustrate that the percolation processes repeat in both cases Q and F , although only in case F are nodes that initially failed reactivated. To analytically evaluate the resilience of each layer, we develop a methodology based on the cavity method for deriving the size of a giant component (GC). Strong hysteresis, which is ignored in the standard cavity analysis, is observed in the repetition of the percolation processes particularly in case F . To handle this, we heuristically modify interlayer messages for macroscopic analysis, the utility of which is verified by numerical experiments. The percolation transition in each layer is continuous in both cases Q and F . We also analyze the influences of degree-degree correlations on the robustness of layer α , in particular for the case of TAs. The analysis indicates that the critical fraction of initial failures that makes the GC size in layer α vanish depends only on its intralayer degree-degree correlations. Although our model is defined in a somewhat abstract manner, it may have relevance to ecological systems that are composed of endangered species (layer α ) and invaders (layer β ), the former of which are damaged by the latter whereas the latter are exterminated in the areas where the former are active.
The Wisconsin Early Childhood Obesity Prevention Initiative: An Example of Statewide Collective Impact.

PubMed

Meinen, Amy; Hilgendorf, Amy; Korth, Amy L; Christens, Brian D; Breuer, Catherine; Joyner, Hilary; Polzin, Molle; Adams, Alexandra; Wolfe, Daithi; Braun, Abbe; Hoiting, Jill; Paulson, Jeanette; Cullen, Bridget; Stader, Kelli

2016-11-01

The Wisconsin Early Childhood Obesity Prevention Initiative (Initiative), established in 2007, seeks to address and prevent obesity in the early care and education system through nutrition and physical activity environmental and policy changes. The collaborative includes professionals from 3 state of Wisconsin Departments, the University of Wisconsin-Extension, the University of Wisconsin-Madison, and public health and early care and education organizations. This paper explores the efforts of the Initiative to advance our understanding of collective impact in practice and its value to health promotion efforts. Evaluators conducted a mixed methods case study to evaluate the application of collective impact principles by the Initiative. This included a survey of Initiative partners, review of archival documents, and qualitative interviews with Initiative leaders. Initiative partners noted progress in establishing the conditions for collective impact. Archival documents and interviews describe both formal and informal practices that helped set a common agenda, align and coordinate partner activities, and promote communication among Initiative leaders. Results also detail the important current and potential roles of “backbone” staff from healthTIDE to support the Initiative. Additionally, results suggest particularly challenging aspects of the Initiative’s impact model related to shared measurement and broader stakeholder communication. While the Initiative is still setting in place the conditions for collective impact, it has achieved significant policy, systems, and environment changes since its formation. Inclusion of nutrition and physical activity criteria in the state’s quality rating improvement system for child care centers is one of its outcomes. This case study offers several important insights about the application of collective impact in health promotion efforts, particularly in relation to the transition from previous collaborative activities, the
Phrenic Nerve Palsy as Initial Presentation of Large Retrosternal Goitre.

PubMed

Hakeem, Arsheed Hussain; Hakeem, Imtiyaz Hussain; Wani, Fozia Jeelani

2016-12-01

Unilateral phrenic nerve palsy as initial presentation of the retrosternal goitre is extremely rare event. This is a case report of a 57-year-old woman with history of cough and breathlessness of 3 months duration, unaware of the thyroid mass. She had large cervico-mediastinal goiter and chest radiograph revealed raised left sided hemidiaphragm. Chest CT scan did not reveal any lung parenchymal or mediastinal pathology. The patient underwent a total thyroidectomy through a cervical approach. The final pathology was in favor of multinodular goitre. Even after 1 year of follow up, phrenic nerve palsy did not improve indicating permanent damage. Phrenic nerve palsy as initial presentation of the retrosternal goitre is unusual event. This case is reported not only because of the rare nature of presentation, but also to make clinicians aware of the entity so that early intervention may prevent attendant morbidity.
Small Island States Green Energy Initiative. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khattak, Nasir

1999-10-15

This report covers the activities carried out during a one year period from 7/15/99 to 7/15/00 as part of the Small Islands Green Energy Initiative. The three activities were: 1) Energy Ministerial conference in the Caribbean; 2) Training session on renewable energy for utility engineers; and 3) Case studies compilation on renewable energy in the Caribbean.
Rigidity of outermost MOTS: the initial data version

NASA Astrophysics Data System (ADS)

Galloway, Gregory J.

2018-03-01

In the paper Commun Anal Geom 16(1):217-229, 2008, a rigidity result was obtained for outermost marginally outer trapped surfaces (MOTSs) that do not admit metrics of positive scalar curvature. This allowed one to treat the "borderline case" in the author's work with R. Schoen concerning the topology of higher dimensional black holes (Commun Math Phys 266(2):571-576, 2006). The proof of this rigidity result involved bending the initial data manifold in the vicinity of the MOTS within the ambient spacetime. In this note we show how to circumvent this step, and thereby obtain a pure initial data version of this rigidity result and its consequence concerning the topology of black holes.
Initiating Smokeless Tobacco Use across Reproductive Stages.

PubMed

Begum, Shahina; Schensul, Jean J; Nair, Saritha; Donta, Balaiah

2015-01-01

The use of smokeless tobacco (SLT) among women is increasing in India, especially among those with limited education and resources. Preventing the initiation of SLT among women is critical since it has known negative consequences for oral and reproductive health. Most research on tobacco initiation in India focuses on adolescents. This paper addresses the unrecognized issues of post marital initiation among women of reproductive age, highlighting the importance of reproductive stages in women's tobacco initiation. The objective is to examine the correlates of SLT initiation among low income women in Mumbai from pre-marriage through early marriage, first pregnancy and beyond, using case examples to illustrate initiation during each of these stages. In 2011-2012, cross-sectional community level survey data were collected from a representative sample of 409 daily SLT-using married women aged 18-40 years in a low income community in Mumbai. Information on socio-demographics, initiation by reproductive stage, types of tobacco use, childhood exposure to tobacco, learning to use, and initiation influences and reasons were collected through a researcher-administered survey. Univariate and bivariate analysis assessed factors influencing initiation of SLT use by reproductive stage. In addition 42 narratives of tobacco use were collected from a purposive sample of pregnant and non-pregnant married women addressing the same questions in detail. Narratives were transcribed, translated, and coded for key concepts including initiation of tobacco use. Thirty-two percent of women initiated SLT use before marriage, 44% initiated after marriage but before pregnancy, 18.1% initiated during their first pregnancy and the remainder started after their first pregnancy. Mean age of marriage among women in this study was 16 years. Younger women (i.e. age at time of the interview of less than 30 years) were 0.47 [95% CI (0.32, 0.87)] percent less likely to initiate after marriage than women
Working smarter on cold cases: identifying factors associated with successful cold case investigations.

PubMed

Davis, Robert C; Jensen, Carl J; Burgette, Lane; Burnett, Kathryn

2014-03-01

Cold case squads have garnered much attention; however, they have yet to undergo significant empirical scrutiny. In the present study, the authors interviewed investigators and reviewed 189 solved and unsolved cold cases in Washington, D.C., to determine whether there are factors that can predict cold case solvability. In the interviews, new information from witnesses or information from new witnesses was cited as the most prevalent reason for case clearance. The case reviews determined that there were factors in each of the following domains that predicted whether cases would be solved during cold case investigations: Crime Context, Initial Investigation Results, Basis for Opening Cold Case, and Cold Case Investigator Actions. The results suggest that it is possible to prioritize cold case work based on the likelihood of investigations leading to clearances. © 2014 American Academy of Forensic Sciences.
Recurrence of Phaeochromocytoma and Abdominal Paraganglioma After Initial Surgical Intervention.

PubMed

Johnston, Philip C; Mullan, Karen R; Atkinson, A Brew; Eatock, Fiona C; Wallace, Helen; Gray, Moyra; Hunter, Steven J

2015-05-01

Clinical and biochemical follow up after surgery for phaeochromocytoma is essential with long term studies demonstrating recurrence frequencies between 6% and 23%. To examine the characteristics and frequency of tumour recurrence in a regional endocrine referral centre, in patients with surgical resection of phaeochromocytoma (P) and abdominal paraganglioma (AP). We identified a cohort of 52 consecutive patients who attended our Regional Endocrinology & Diabetes Centre and retrospectively reviewed their clinical, biochemical and radiological data (between 2002 and 2013). After confirmation of early post-operative remission by negative biochemical testing, tumour recurrence was defined by demonstration of catecholamine excess with confirmatory imaging. Phaeochromocytoma was confirmed histologically in all cases (43:P, 9:AP, mean-age:53 years). Open adrenalectomy was performed in 20 cases and laparoscopically in 32. Hereditary phaeochromocytoma was confirmed by genetic analysis in 12 (23%) patients. Median follow up time from initial surgery was 47 months, (range: 12 - 296 months), 49 patients had no evidence of tumour recurrence at latest follow-up. Three patients (6%) demonstrated tumour development, one in a patient with VHL which occurred in a contralateral adrenal gland, one sporadic case had local recurrence, and an adrenal tumour occurred in a patient with a SDHB gene mutation who had a previous bladder tumour. After initial surgery, the tumours occurred at 8.6, 12.0 and 17.7 years respectively. In this study tumour development occurred in 6% of patients. Although tumour rates were low, careful and sustained clinical and biochemical follow up is advocated, as new tumour development or recurrence may occur long after the initial surgery is performed.
Trajectory of cartilage loss within 4 years of knee replacement--a nested case-control study from the osteoarthritis initiative.

PubMed

Eckstein, F; Boudreau, R M; Wang, Z; Hannon, M J; Wirth, W; Cotofana, S; Guermazi, A; Roemer, F; Nevitt, M; John, M R; Ladel, C; Sharma, L; Hunter, D J; Kwoh, C K

2014-10-01

Knee replacement (KR) represents a clinically important endpoint of knee osteoarthritis (KOA). Here we examine the 4-year trajectory of femoro-tibial cartilage thickness loss prior to KR vs non-replaced controls. A nested case-control study was performed in Osteoarthritis Initiative (OAI) participants: Cases with KR between 12 and 60 month (M) follow-up were each matched with one control (without KR through 60M) by age, sex, and baseline radiographic stage. Femoro-tibial cartilage thickness was measured quantitatively using magnetic resonance imaging (MRI) at the annual visit prior to KR occurrence (T0), and at 1-4 years prior to T0 (T-1 to T-4). Cartilage loss between cases and controls was compared using paired t-tests and conditional logistic regression. One hundred and eighty-nine knees of 164 OAI participants [55% women; age 64 ± 8.7; body mass index (BMI) 29 ± 4.5] had KR and longitudinal cartilage data. Comparison of annualized slopes of change across all time points revealed greater loss in the central medial tibia (primary outcome) in KRs than in controls [94 ± 137 vs 55 ± 104 μm; P = 0.0017 (paired t); odds ratio (OR) 1.36 (95% confidence interval (CI): 1.08-1.70)]. The discrimination was stronger for T-2 → T0 [OR 1.61 (1.33-1.95), n = 127] than for T-1 → T0, and was not statistically significant for intervals prior to T-2 [i.e., T-4 → T-2, OR 0.97 (0.67-1.41), n = 60]. Results were similar for total medial femoro-tibial cartilage loss (secondary outcome), and when adjusting for pain and BMI. In knees with subsequent replacement, cartilage loss accelerates in the 2 years, and particularly in the year prior to surgery, compared with controls. Whether slowing this cartilage loss can delay KR remains to be determined. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
State Initiatives on Industry-Based Skill Standards and Credentials.

ERIC Educational Resources Information Center

Ganzglass, Evelyn; Simon, Martin

A study examined state initiatives for industry-based skill standards and credentials. Officials in 19 states were interviewed, case studies of programs in 3 states (Georgia, Pennsylvania, and Texas) were conducted, and focus group discussions were held with 25 individuals. State skill standards were generally found to be tied to broader efforts…
Enhancing science teaching in an elementary school: A case study of a school-initiated Teacher Professional Development Program

NASA Astrophysics Data System (ADS)

Brooks, Clare M.

1998-12-01

This naturalistic case study documents a year long Teacher Professional Development Program (TPDP) initiated by an elementary school staff in British Columbia. The TPDP was designed to enable the teachers to meet their objective of making science instruction more frequent, more active, and more student-centered in all classrooms in the school. This case study addresses two research questions: (1) What attributes of the Teacher Professional Development Program supported the school's "objective" for improved science instruction? (2) How did the outcomes of the Teacher Professional Development Program relate to the achievement of the school's educational objective? The site for the research was a kindergarten--Grade 7 school. A university professor and the researcher were invited to visit the school on a bi-weekly basis during one school year (1993--94) to facilitate a series of science workshops involving the entire teaching staff and to provide classroom support to teachers. Teachers were offered university course credit for their participation. This case study draws on qualitative data including: audio recordings of planning/debriefing sessions, workshop discussions, and interviews with participants; field notes and written observations; a survey of teachers' opinions about the TPDP; and documents relating to the school accreditation process in 1994--95. The results of the study show that teachers, administrators, and parents were satisfied that the school's objective for science instruction was met, and that the TPDP contributed significantly to this outcome. The study identifies TPDP attributes which supported the school's objective with reference to the teachers and their context, the planning process, and the organizational context, that is, the school. This study contributes to our understanding of teacher professional development by examining an alternative to more common approaches to elementary teacher science inservice in British Columbia, which are
Autopsy-confirmed hippocampal-sparing Alzheimer's disease with delusional jealousy as initial manifestation.

PubMed

Fujishiro, Hiroshige; Iritani, Shuji; Hattori, Miho; Sekiguchi, Hirotaka; Matsunaga, Shinji; Habuchi, Chikako; Torii, Youta; Umeda, Kentaro; Ozaki, Norio; Yoshida, Mari; Fujita, Kiyoshi

2015-09-01

Alzheimer's disease (AD) is clinically characterized by gradual onset over years with worsening of cognition. The initial and most prominent cognitive deficit is commonly memory dysfunction. However, a subset of AD cases has less hippocampal atrophy than would be expected relative to the predominance of cortical atrophy. These hippocampal-sparing cases have distinctive clinical features, including the presence of focal cortical clinical syndromes. Given that previous studies have indicated that severe hippocampal atrophy corresponds to prominent loss of episodic memory, it is likely that memory impairment is initially absent in hippocampal-sparing AD cases. Here, we report on a patient with an 8-year history of delusional jealousy with insidious onset who was clinically diagnosed as possible AD and pathologically confirmed to have AD with relatively preserved neurons in the hippocampus. This patient had delusional jealousy with a long pre-dementia stage, which initially was characterized by lack of memory impairment. Head magnetic resonance imaging findings showed preserved hippocampal volume with bilateral enlarged ventricles and mild-to-moderate cortical atrophy. Head single-photon emission computed tomography revealed severely decreased regional cerebral blood flow in the right temporal lobe. The resolution of the delusion was attributed to pharmacotherapy by an acetylcholinesterase inhibitor, suggesting that the occurrence of delusional jealousy was due to the disease process of AD. Although the neural basis of delusional jealousy remains unclear, this hippocampal-sparing AD case may be classified as an atypical presentation of AD. © 2015 The Authors. Psychogeriatrics © 2015 Japanese Psychogeriatric Society.
Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report.

PubMed

Soghaier, Mohammed A; Hagar, Ahmed; Abbas, Mohammed A; Elmangory, Mutasim M; Eltahir, Khalid M; Sall, Amadou A

2013-10-01

Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. The field investigation confirmed the outbreak and identified its cause to be YF. National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
32 CFR 644.70 - Closing of cases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Closing of cases. 644.70 Section 644.70 National... HANDBOOK Acquisition Procurement of Title Evidence, Title Clearance, and Closings § 644.70 Closing of cases. (a) Closing and Settlement Officers. Payment and closing of cases will be initiated immediately upon...
Mesoscale Simulation Data for Initializing Fast-Time Wake Transport and Decay Models

NASA Technical Reports Server (NTRS)

Ahmad, Nashat N.; Proctor, Fred H.; Vanvalkenburg, Randal L.; Pruis, Mathew J.; LimonDuparcmeur, Fanny M.

2012-01-01

The fast-time wake transport and decay models require vertical profiles of crosswinds, potential temperature and the eddy dissipation rate as initial conditions. These inputs are normally obtained from various field sensors. In case of data-denied scenarios or operational use, these initial conditions can be provided by mesoscale model simulations. In this study, the vertical profiles of potential temperature from a mesoscale model were used as initial conditions for the fast-time wake models. The mesoscale model simulations were compared against available observations and the wake model predictions were compared with the Lidar measurements from three wake vortex field experiments.
Initial Results of Hypofractionated Carbon Ion Radiotherapy for Cholangiocarcinoma.

PubMed

Abe, Takanori; Shibuya, Kei; Koyama, Yoshinori; Okamoto, Masahiko; Kiyohara, Hiroki; Katoh, Hiroyuki; Shimada, Hirohumi; Kuwano, Hiroyuki; Ohno, Tatsuya; Nakano, Takashi

2016-06-01

To report initial results of hypofractionated carbon ion radiotherapy (C-ion RT) for cholangiocarcinoma. Data regarding seven patients with cholangiocarcinoma treated by C-ion RT were analyzed. Prescribed doses were 52.8 Gy [relative biological effectiveness (RBE)] or 60.0 Gy (RBE) in four fractions for intrahepatic cases and 12 fractions for hilar hepatic/close to gastro-intestinal tract cases. Local control and overall survival were evaluated and toxicity was graded using Common Terminology Criteria for Adverse Events, version 4.0. The median follow-up period was 16 months. There were two patients with stage I cancer, one with stage II, one with stage III, and three with stage IVA. Local control was achieved in five out of seven patients (71%) and survival was maintained in six out of seven patients (86%). There were no occurrences of acute or late toxicity of grade 3 or higher. Initial results show that hypofractionated C-ion RT appears to be tolerated and effective for cholangiocarcinoma. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
Summary of semi-initiative and initiative control automobile engine vibration

NASA Astrophysics Data System (ADS)

Qu, Wei; Qu, Zhou

2009-07-01

Engine vibration accounts for around 55% of automobile vibration, separating the engine vibration from transmitting to automobile to the utmost extent is significant for improving NVH performance. Semi-initiative and initiative control of engine vibration is one of the hot spots of technical research in domestic and foreign automobile industry, especially luxury automobiles which adopt this technology to improve amenity and competitiveness. This article refers to a large amount of domestic and foreign related materials, fully introduces the research status of semi-initiative and initiative control suspension of engine vibration suspension and many kinds of structural style, and provides control policy and method of semi-initiative and initiative control suspension system. Compare and analyze the structural style of semi-initiative and initiative control and merits and demerits of current structures of semi-initiative and initiative control of mechanic electrorheological, magnetorheological, electromagnetic actuator, piezoelectric ceramics, electrostriction material, pneumatic actuator etc. Models of power assembly mounting system was classified.Calculation example indicated that reasonable selection of engine mounting system parameters is useful to reduce engine vibration transmission and to increase ride comfort. Finally we brought forward semi-initiative and initiative suspension which might be applied for automobiles, and which has a promising future.

A rare pleural mucinous cystadenocarcinoma mimicking loculated empyema initially: A case report

PubMed Central

Moon, Sung Min; Seon, Hyun Ju; Choi, Yoo-Duk; Song, Sang-Yun

2013-01-01

We report a case of pleural mucinous cystadenocarcinoma which was mistaken to be a loculated empyema on chest CT. To the best of our knowledge, this entity has never been previously reported in literature. PMID:24604931
Thrombosed Aneurysm of the Posterior Inferior Cerebellar Artery and Lateral Medullary Ischemia as the Initial Presentation of Polyarteritis Nodosa: Case Report and Literature Review.

PubMed

Boukobza, Monique; Dossier, Antoine; Laissy, Jean-Pierre

2018-03-27

A 27-year-old woman with a previously undiagnosed polyarteritis nodosa (PAN) developed lateral medullary stroke related to a thrombosed posterior inferior cerebellar artery (PICA)-origin aneurysm. A concurrent thrombosis of the PICA was identified on high-resolution 3-dimensional CUBE T1 magnetic resonance imaging sequence at 3 T. Body computed tomography angiography, magnetic resonance imaging-magnetic resonance angiography, and digital angiography revealed multiple tiny aneurysms of the visceral arteries and bilateral kidney infarcts. On the basis of these findings and of laboratory data, the patient was diagnosed as having PAN. Intracranial aneurysms (IAs) are extremely rare in PAN and usually manifest as subarachnoid or cerebral hemorrhage. Ischemic manifestation of small thrombosed IA is a rare occurrence. This case highlights (1) an uncommon complication in patients with PAN (16 other cases of IAs in patients with PAN found in the literature), (2) an unusual initial presentation of PAN, and (3) a thrombosed PICA-origin aneurysm responsible for an ischemic stroke and for secondary thrombosis of the parent vessel. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Motives for cosmetic procedures in Saudi women.

PubMed

Al-Natour, Sahar H

2014-01-01

The media-fuelled obsession with beauty in modern society has led more women to seek elective cosmetic procedures to meet the portrayed ideals of beauty in different cultures. This study gives insights into incentives and desires to undergo cosmetic procedures in a conservative society with strict religious practices where women are veiled. Questionnaire data were obtained from 509 Saudi women who responded to a survey distributed randomly to a sample of Saudi women aged 17 to 72 years. At least 1 elective cosmetic procedure was performed in 42% of the women, of whom 77.8% wore a veil. Another 33% considered having a procedure. The motives for seeking a cosmetic procedure were to improve self-esteem in 83.7%, attract a husband in 63.3%, or prevent a husband from seeking another wife in 36.2%. The decision to seek a procedure was affected by the media, with high peer influence. Motivation for elective cosmetic procedures in Saudi women is influenced by a combination of emotional and cultural factors, level of education, marital status, and religious beliefs. The veil is not an impediment for seeking such procedures. The limitation of the study was missing data analysis as some items in the questionnaire were completed inaccurately or left unanswered.
Openness initiative

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duncan, S.S.

1995-12-31

Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need tomore » make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.« less
State-Based Case Studies of Assessment Initiatives in Undergraduate Education: Chronology of Critical Points.

ERIC Educational Resources Information Center

Boyer, Carol M.; Ewell, Peter T.

The Education Commission of the States (ECS) together with the American Association for Higher Education recently conducted five case studies of state-based approaches to assessment in undergraduate education in Colorado, Missouri, New Jersey, South Dakota, and Virginia. The case studies, in turn, are part of the Missouri Governor John Ashcroft's…
National Enforcement Initiative: Preventing Animal Waste from Contaminating Surface and Ground Water

EPA Pesticide Factsheets

This page describes EPA's goal in preventing animal waste from contaminating surface and ground Water. It is an EPA National Enforcement Initiative. Both enforcement cases, and a map of enforcement actions are provided.
Wind laws for shockless initialization. [numerical forecasting model

NASA Technical Reports Server (NTRS)

Ghil, M.; Shkoller, B.

1976-01-01

A system of diagnostic equations for the velocity field, or wind laws, was derived for each of a number of models of large-scale atmospheric flow. The derivation in each case is mathematically exact and does not involve any physical assumptions not already present in the prognostic equations, such as nondivergence or vanishing of derivatives of the divergence. Therefore, initial states computed by solving these diagnostic equations should be compatible with the type of motion described by the prognostic equations of the model and should not generate initialization shocks when inserted into the model. Numerical solutions of the diagnostic system corresponding to a barotropic model are exhibited. Some problems concerning the possibility of implementing such a system in operational numerical weather prediction are discussed.
Clinical indications for high-field 1.5 T intraoperative magnetic resonance imaging and neuro-navigation for neurosurgical procedures. Review of initial 100 cases.

PubMed

Maesawa, Satoshi; Fujii, Masazumi; Nakahara, Norimoto; Watanabe, Tadashi; Saito, Kiyoshi; Kajita, Yasukazu; Nagatani, Tetsuya; Wakabayashi, Toshihiko; Yoshida, Jun

2009-08-01

Initial experiences are reviewed in an integrated operation theater equipped with an intraoperative high-field (1.5 T) magnetic resonance (MR) imager and neuro-navigation (BrainSUITE), to evaluate the indications and limitations. One hundred consecutive cases were treated, consisting of 38 gliomas, 49 other tumors, 11 cerebrovascular diseases, and 2 functional diseases. The feasibility and usefulness of the integrated theater were evaluated for individual diseases, focusing on whether intraoperative images (including diffusion tensor imaging) affected the surgical strategy. The extent of resection and outcomes in each histological category of brain tumors were examined. Intraoperative high-field MR imaging frequently affected or modified the surgical strategy in the glioma group (27/38 cases, 71.1%), but less in the other tumor group (13/49 cases, 26.5%). The surgical strategy was not modified in cerebrovascular or functional diseases, but the success of procedures and the absence of complications could be confirmed. In glioma surgery, subtotal or greater resection was achieved in 22 of the 31 patients (71%) excluding biopsies, and intraoperative images revealed tumor remnants resulting in the extension of resection in 21 of the 22 patients (95.4%), the highest rate of extension among all types of pathologies. The integrated neuro-navigation improved workflow. The best indication for intraoperative high-field MR imaging and integrated neuro-navigation is brain tumors, especially gliomas, and is supplementary in assuring quality in surgery for cerebrovascular or functional diseases. Immediate quality assurance is provided in several types of neurosurgical procedures.
Portal hypertension as the initial manifestation of POEMS syndrome: a case report.

PubMed

Wu, Lina; Li, Yue; Yao, Fang; Lu, Chongmei; Li, Jian; Zhou, Weixun; Qian, Jiaming

2017-01-01

Portal hypertension has a broad differential diagnosis. POEMS syndrome is an uncommon cause of it. POEMS syndrome is a rare disease involving multiple organs. In differential diagnosis of portal hypertension, POEMS syndrome should be considered especially when other symptoms such as numbness, organomegaly, endocrine alteration and skin changes also present, as it is highlighted by our case. We report a 46-year-old Chinese male, a teacher, presenting with portal hypertension. Electromyography revealed peripheral neuropathy. Immunofixation showed monoclonal immunoglobulin A lambda protein. The diagnosis of POEMS syndrome was established. After treatment of lenalidomide combined with dexamethasone over 2 years, the patient achieved a considerable improvement. This case highlights the manifestation of portal hypertension in POEMS syndrome. Lenalidomide with or without dexamethasone is effective for portal hypertension due to POEMS syndrome, though esophageal and gastric varices seems not reversible so easily.
Rates of initial acceptance of PAP masks and outcomes of mask switching.

PubMed

Bachour, Adel; Vitikainen, Pirjo; Maasilta, Paula

2016-05-01

Recently, we noticed a considerable development in alleviating problems related to positive airway pressure (PAP) masks. In this study, we report on the initial PAP mask acceptance rates and the effects of mask switching on mask-related symptoms. We prospectively collected all cases of mask switching in our sleep unit for a period of 14 months. At the time of the study, we used ResMed™ CPAP devices and masks. Mask switching was defined as replacing a mask used for at least 1 day with another type of mask. Changing to a different size but keeping the same type of mask did not count as mask switching. Switching outcomes were considered failed if the initial problem persisted or reappeared during the year that followed switching. Our patient pool was 2768. We recorded 343 cases of mask switching among 267 patients. Of the 566 patients who began new PAP therapy, 108 (39 women) had switched masks, yielding an initial mask acceptance rate of 81 %. The reason for switching was poor-fit/uncomfortable mask in 39 %, leak-related in 30 %, outdated model in 25 %, and nasal stuffiness in 6 % of cases; mask switching resolved these problems in 61 %. Mask switching occurred significantly (p = 0.037) more often in women and in new PAP users. The odds ratio for abandoning PAP therapy within 1 year after mask switching was 7.2 times higher (interval 4.7-11.1) than not switching masks. The initial PAP mask acceptance rate was high. Patients who switched their masks are at greater risk for abandoning PAP therapy.
Local initiatives to access emergency obstetric and neonatal care in Burkina Faso.

PubMed

Yaméogo, Wambi M E; Ouédraogo, Talatou M; Kouanda, Seni

2016-11-01

To describe the various local initiatives to access emergency obstetric and neonatal care in Burkina Faso. An existing framework was used to review the three processes for local initiatives: emergence, formulation, and implementation. Multiple case studies were conducted, followed by literature review and semi-structured interviews with key informants. Sixteen districts had implemented local initiatives, including cost sharing, free care for women and children, and free care for delivery and cesareans. Most districts (n=10) had implemented the cost-sharing intervention. These initiatives were initiated by local actors as well as nongovernmental organizations. The profile of those involved led to different ways of handling the emergence and formulation processes. At implementation, these initiatives faced many issues including late payment of contributions, low involvement of local governments, and equity in participation. There are some issues in the implementation and sustainability of the local initiatives. Although many initiatives exist, these are unable to fully address the financial barriers to care. However, these initiatives highlight context-based financial barriers that must be taken into account to accelerate universal access to health care. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Numerical investigation of contact stresses for fretting fatigue damage initiation

NASA Astrophysics Data System (ADS)

Bhatti, N. A.; Abdel Wahab, M.

2017-05-01

Fretting fatigue phenomena occurs due to interaction between contacting bodies under application of cyclic and normal loads. In addition to environmental conditions and material properties, the response at the contact interface highly depends on the combination of applied loads. High stress concentration is present at the contact interface, which can start the damage nucleation process. At the culmination of nucleation process several micro cracks are initiated, ultimately leading to the structural failure. In this study, effect of ratio of tangential to normal load on contact stresses, slip amplitude and damage initiation is studied using finite element analysis. The results are evaluated for Ruiz parameter as it involves the slip amplitude which in an important factor in fretting fatigue conditions. It is observed that tangential to normal load ratio influences the stick zone size and damage initiation life. Furthermore, it is observed that tensile stress is the most important factor that drives the damage initiation to failure for the cases where failure occurs predominantly in mode I manner.
Correlates of sexual initiation among European adolescents.

PubMed

Gambadauro, Pietro; Carli, Vladimir; Hadlaczky, Gergö; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Banzer, Raphaela; Bobes, Julio; Brunner, Romuald; Cosman, Doina; Farkas, Luca; Haring, Christian; Hoven, Christina W; Kaess, Michael; Kahn, Jean Pierre; McMahon, Elaine; Postuvan, Vita; Sisask, Merike; Värnik, Airi; Zadravec Sedivy, Nusa; Wasserman, Danuta

2018-01-01

Sexuality is a physiological component of adolescent development, though early initiation is associated with reproductive health risk. This study aimed at identifying correlates and predictors of sexual initiation in a large multinational cohort of European adolescents. A questionnaire addressing socio-demographics, behaviours, mental health and sexual activity, was delivered to 11,110 adolescents recruited from 168 randomly selected schools in 10 European countries between 2009 and 2011. A follow-up questionnaire was delivered after 12 months. The longitudinal association of baseline risk behaviors, psychological attributes and contextual vulnerabilities, with sexual initiation during follow-up was evaluated through simple and multivariable age/sex stratified logistic regression. Multinomial logistic regression measured the association between predictors and sexual initiation with or without coexisting reproductive risk factors, such as multiple partners or infrequent condom use. Baseline sexual experience was reported by 19.2% of 10,757 respondents (median age 15; IQR 14-15; females 59.6%). This was significantly more frequent among pupils older than 15 (41%) and males (20.8%). Of 7,111 pupils without previous experience who were available at follow-up (response rate 81.8%), 17% reported sexual initiation, without differences between females and males. Baseline smoking (age/sex adjusted odds ratio [aOR] 3.63), alcohol use (aOR 2.95), illegal drugs use (aOR 2.72), and poor sleep (aOR 1.71) predicted sexual initiation. Stratified analyses showed a particularly strong association in case of younger and female pupils, and, among girls, when initiation was reported together with multiple partners and/or infrequent condom use. Externalizing (i.e. conduct and hyperactivity) symptoms independently predicted sexual initiation. Internalizing difficulties (i.e. emotional and peer problems) were negatively associated with early and risky sexual initiation among boys
Effects of eddy initial conditions on nonlinear forcing of planetary scale waves by amplifying baroclinic eddies

NASA Technical Reports Server (NTRS)

Young, Richard E.

1986-01-01

The previous study of Young and Villere concerning growth of planetary scale waves forced by wave-wave interactions of amplifying intermediate scale baroclinic eddies is extended to investigate effects of different eddy initial conditions. A global, spectral, primitive equation model is used for the calculations. For every set of eddy initial conditions considered, growth rates of planetary modes are considerably greater than growth rates computed from linear instability theory for a fixed zonally independent basic state. However, values of growth rates ranged over a factor of 3 depending on the particular set of eddy initial conditions used. Nonlinear forcing of planetary modes via wave-wave coupling becomes more important than baroclinic growth on the basic state at small values of the intermediate-scale modal amplitudes. The relative importance of direct transfer of kinetic energy from intermediate scales of motion to a planetary mode, compared to baroclinic conversion of available potential energy to kinetic energy within that planetary mode, depends on the individual case. In all cases, however, the transfer of either kinetic or available potential energy to the planetary modes was accomplished principally by wave-wave transfer from intermediate scale eddies, rather than from the zonally averaged state. The zonal wavenumber 2 planetary mode was prominent in all solutions, even in those for which eddy initial conditions were such that a different planetary mode was selectively forced at the start. General characteristics of the structural evolution of the planetary wave components of total heat and momentum flux, and modal structures themselves, were relatively insensitive to variations in eddy initial conditions, even though quantitative details varied from case to case.
National Enforcement Initiative: Keeping Industrial Pollutants Out of the Nation’s Waters

EPA Pesticide Factsheets

This page describes EPA's enforcement activities on water pollution from raw sewage and contaminated stormwater. This is one of EPA's National Enforcement Initiatives. Both enforcement cases, and a map of enforcement actions are provided.
Recurrence of Phaeochromocytoma and Abdominal Paraganglioma After Initial Surgical Intervention

PubMed Central

Mullan, Karen R; Atkinson, A Brew; Eatock, Fiona C; Wallace, Helen; Gray, Moyra; Hunter, Steven J

2015-01-01

Background Clinical and biochemical follow up after surgery for phaeochromocytoma is essential with long term studies demonstrating recurrence frequencies between 6% and 23%. Aim To examine the characteristics and frequency of tumour recurrence in a regional endocrine referral centre, in patients with surgical resection of phaeochromocytoma (P) and abdominal paraganglioma (AP). Methods We identified a cohort of 52 consecutive patients who attended our Regional Endocrinology & Diabetes Centre and retrospectively reviewed their clinical, biochemical and radiological data (between 2002 and 2013). After confirmation of early post-operative remission by negative biochemical testing, tumour recurrence was defined by demonstration of catecholamine excess with confirmatory imaging. Results Phaeochromocytoma was confirmed histologically in all cases (43:P, 9:AP, mean-age:53years). Open adrenalectomy was performed in 20 cases and laparoscopically in 32. Hereditary phaeochromocytoma was confirmed by genetic analysis in 12 (23%) patients. Median follow up time from initial surgery was 47 months, (range: 12 - 296 months), 49 patients had no evidence of tumour recurrence at latest follow-up. Three patients (6%) demonstrated tumour development, one in a patient with VHL which occurred in a contralateral adrenal gland, one sporadic case had local recurrence, and an adrenal tumour occurred in a patient with a SDHB gene mutation who had a previous bladder tumour. After initial surgery, the tumours occurred at 8.6, 12.0 and 17.7 years respectively. Conclusion In this study tumour development occurred in 6% of patients. Although tumour rates were low, careful and sustained clinical and biochemical follow up is advocated, as new tumour development or recurrence may occur long after the initial surgery is performed. PMID:26170485
Framing Innovation: The Impact of the Superintendent's Technology Infrastructure Decisions on the Acceptance of Large-Scale Technology Initiatives

ERIC Educational Resources Information Center

Arnold, Erik P.

2014-01-01

A multiple-case qualitative study of five school districts that had implemented various large-scale technology initiatives was conducted to describe what superintendents do to gain acceptance of those initiatives. The large-scale technology initiatives in the five participating districts included 1:1 District-Provided Device laptop and tablet…
Environmental initiative prioritization with a Delphi approach: a case study.

PubMed

Gokhale, A A

2001-08-01

India is fast finding its place in the industrialized world and that is beginning to raise its environmental consciousness. The Delphi technique was used to prioritize specific needs and articulate a sustainable urban improvement strategy for the city of Mumbai (formerly Bombay). The Delphi technique is a means of achieving consensual validity among raters by providing them feedback regarding other raters' responses. Mumbai has several indigenous environmental groups that were tapped for activists and leaders; the study was conducted using ten environmentalists. In the initial phases the responses resulted in a range of possible program alternatives. The last two stages helped to seek out information that generated a consensus on the part of the respondent group. Statistical analysis methods included a hierarchical cluster analysis, mean, median, mode, and percent of agreement calculations using SPSS software. The face-to-face discussion in phase 4 clarified some issues and helped the group as a whole to outline the strategy for putting in place the essential elements of a framework to improve the quality of life in an urban environment.
Does the private finance initiative promote innovation in health care? The case of the British National Health Service.

PubMed

Petratos, Pythagoras

2005-12-01

The Private Finance Initiative (PFI) is a specific example of health care privatization within the British National Health Service. In this essay, I critically assess the ways in which various Private Finance Initiatives have increased health care efficiency and effectiveness, as well as encouraged medical innovation. Indeed, as the analysis will demonstrate, significant empirical evidence supports the conclusion that Private Finance Initiatives are a driving force of innovation within the British Health Care System.
Acute psychosis as an initial manifestation of hypothyroidism: a case report.

PubMed

Ueno, Shinichi; Tsuboi, Satoko; Fujimaki, Motoki; Eguchi, Hiroto; Machida, Yutaka; Hattori, Nobutaka; Miwa, Hideto

2015-11-17

Hypothyroidism is one of the most important causes of treatable dementia, and psychosis occasionally associated with it is known as myxedema madness. We report a case of a 90-year-old patient who developed myxedema madness acutely without overt clinical symptoms and signs suggestive of hypothyroidism. A 90-year-old Japanese man, a general practitioner, was admitted to our emergency room because of acute-onset lethargy, delusions, and hallucinations. He had been actively working until 3 days before the admission. Upon admission, his general physical examination was unremarkable. However, a blood investigation showed the presence of hypothyroidism, and computed tomography revealed pleural effusion and ascites. Electroencephalography revealed diffuse slow waves with a decrease of α-wave activity. A single-photon emission computed tomography scan revealed a decrease of cerebral blood flow in both frontal lobes. The patient was soon treated with thyroid hormone replacement therapy. Following normalization of his thyroid function, both pleural effusion and ascites diminished and his electroencephalographic activity improved simultaneously; however, he did not recover from his psychosis. Myxedema madness should be kept in mind in the differential diagnosis of acute psychosis in elderly patients, particularly the oldest patients as in our case, because manifestations of hypothyroidism often may be indistinguishable from the aging process.

Application of Artificial Thunderstorm Cells for the Investigation of Lightning Initiation Problems between a Thundercloud and the Ground

NASA Astrophysics Data System (ADS)

Temnikov, A. G.; Chernensky, L. L.; Orlov, A. V.; Lysov, N. Y.; Zhuravkova, D. S.; Belova, O. S.; Gerastenok, T. K.

2017-12-01

The results of the experimental application of artificial thunderstorm cells of negative and positive polarities for the investigation of the lightning initiation problems between the thundercloud and the ground using model hydrometeor arrays are presented. Possible options of the initiation and development of a discharge between the charged cloud and the ground in the presence of model hydrometeors are established. It is experimentally shown that groups of large hydrometeors of various shapes significantly increase the probability of channel discharge initiation between the artificial thunderstorm cell and the ground, especially in the case of positive polarity of the cloud. The authors assume that large hail arrays in the thundercloud can initiate the preliminary breakdown stage in the lower part of the thundercloud or initiate and stimulate the propagation of positive lightning from its upper part. A significant effect of the shape of model hydrometeors and the way they are grouped on the processes of initiation and stimulation of the channel discharge propagation in the artificial thunderstorm cell of negative or positive polarity-ground gap is experimentally established. It is found that, in the case of negative polarity of a charged cloud, the group of conductive cylindrical hydrometeors connected by a dielectric string more effectively initiates the channel discharge between the artificial thunderstorm cell and the ground. In the case of positive polarity of the artificial thunderstorm cell, the best effect of the channel discharge initiation is achieved for model hydrometeors grouped together by the dielectric tape. The obtained results can be used in the development of the method for the directed artificial lightning initiation between the thundercloud and the ground.
Relativistic initial conditions for N-body simulations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fidler, Christian; Tram, Thomas; Crittenden, Robert

2017-06-01

Initial conditions for (Newtonian) cosmological N-body simulations are usually set by re-scaling the present-day power spectrum obtained from linear (relativistic) Boltzmann codes to the desired initial redshift of the simulation. This back-scaling method can account for the effect of inhomogeneous residual thermal radiation at early times, which is absent in the Newtonian simulations. We analyse this procedure from a fully relativistic perspective, employing the recently-proposed Newtonian motion gauge framework. We find that N-body simulations for ΛCDM cosmology starting from back-scaled initial conditions can be self-consistently embedded in a relativistic space-time with first-order metric potentials calculated using a linear Boltzmann code.more » This space-time coincides with a simple ''N-body gauge'' for z < 50 for all observable modes. Care must be taken, however, when simulating non-standard cosmologies. As an example, we analyse the back-scaling method in a cosmology with decaying dark matter, and show that metric perturbations become large at early times in the back-scaling approach, indicating a breakdown of the perturbative description. We suggest a suitable ''forwards approach' for such cases.« less
Semiclassical modelling of finite-pulse effects on non-adiabatic photodynamics via initial condition filtering: The predissociation of NaI as a test case

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martínez-Mesa, Aliezer; Institut für Chemie, Universität Potsdam, Karl-Liebknecht-Strasse 24-25, D-14476 Potsdam-Golm; Saalfrank, Peter

2015-05-21

Femtosecond-laser pulse driven non-adiabatic spectroscopy and dynamics in molecular and condensed phase systems continue to be a challenge for theoretical modelling. One of the main obstacles is the “curse of dimensionality” encountered in non-adiabatic, exact wavepacket propagation. A possible route towards treating complex molecular systems is via semiclassical surface-hopping schemes, in particular if they account not only for non-adiabatic post-excitation dynamics but also for the initial optical excitation. One such approach, based on initial condition filtering, will be put forward in what follows. As a simple test case which can be compared with exact wavepacket dynamics, we investigate the influencemore » of the different parameters determining the shape of a laser pulse (e.g., its finite width and a possible chirp) on the predissociation dynamics of a NaI molecule, upon photoexcitation of the A(0{sup +}) state. The finite-pulse effects are mapped into the initial conditions for semiclassical surface-hopping simulations. The simulated surface-hopping diabatic populations are in qualitative agreement with the quantum mechanical results, especially concerning the subpicosend photoinduced dynamics, the main deviations being the relative delay of the non-adiabatic transitions in the semiclassical picture. Likewise, these differences in the time-dependent electronic populations calculated via the semiclassical and the quantum methods are found to have a mild influence on the overall probability density distribution. As a result, the branching ratios between the bound and the dissociative reaction channels and the time-evolution of the molecular wavepacket predicted by the semiclassical method agree with those computed using quantum wavepacket propagation. Implications for more challenging molecular systems are given.« less
Herbal hepatotoxicity: suspected cases assessed for alternative causes.

PubMed

Teschke, Rolf; Schulze, Johannes; Schwarzenboeck, Alexander; Eickhoff, Axel; Frenzel, Christian

2013-09-01

Alternative explanations are common in suspected drug-induced liver injury (DILI) and account for up to 47.1% of analyzed cases. This raised the question of whether a similar frequency may prevail in cases of assumed herb-induced liver injury (HILI). We searched the Medline database for the following terms: herbs, herbal drugs, herbal dietary supplements, hepatotoxic herbs, herbal hepatotoxicity, and herb-induced liver injury. Additional terms specifically addressed single herbs and herbal products: black cohosh, Greater Celandine, green tea, Herbalife products, Hydroxycut, kava, and Pelargonium sidoides. We retrieved 23 published case series and regulatory assessments related to hepatotoxicity by herbs and herbal dietary supplements with alternative causes. The 23 publications comprised 573 cases of initially suspected HILI; alternative causes were evident in 278/573 cases (48.5%). Among them were hepatitis by various viruses (9.7%), autoimmune diseases (10.4%), nonalcoholic and alcoholic liver diseases (5.4%), liver injury by comedication (DILI and other HILI) (43.9%), and liver involvement in infectious diseases (4.7%). Biliary and pancreatic diseases were frequent alternative diagnoses (11.5%), raising therapeutic problems if specific treatment is withheld; pre-existing liver diseases including cirrhosis (9.7%) were additional confounding variables. Other diagnoses were rare, but possibly relevant for the individual patient. In 573 cases of initially assumed HILI, 48.5% showed alternative causes unrelated to the initially incriminated herb, herbal drug, or herbal dietary supplement, calling for thorough clinical evaluations and appropriate causality assessments in future cases of suspected HILI.
Use of a business case model for organizational change.

PubMed

Shirey, Maria R

2011-01-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses the concept of a business case and introduces a 3-phase business case model for organizational change.
Dermoscopic Clues for Diagnosing Melanomas That Resemble Seborrheic Keratosis

PubMed Central

Segura, Sonia; Aguilera, Paula; Scalvenzi, Massimiliano; Longo, Caterina; Barreiro, Alicia; Broganelli, Paolo; Cavicchini, Stefano; Llambrich, Alex; Zaballos, Pedro; Thomas, Luc; Malvehy, Josep; Puig, Susana; Zalaudek, Iris

2017-01-01

Importance Melanomas that clinically mimic seborrheic keratosis (SK) can delay diagnosis and adequate treatment. However, little is known about the value of dermoscopy in recognizing these difficult-to-diagnose melanomas. Objective To describe the dermoscopic features of SK-like melanomas to understand their clinical morphology. Design, Setting, and Participants This observational retrospective study used 134 clinical and dermoscopic images of histopathologically proven melanomas in 134 patients treated in 9 skin cancer centers in Spain, France, Italy, and Austria. Without knowledge that the definite diagnosis for all the lesions was melanoma, 2 dermoscopy-trained observers evaluated the clinical descriptions and 48 dermoscopic features (including all melanocytic and nonmelanocytic criteria) of all 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the 7-point checklist score were assessed. Images of the lesions and patient data were collected from July 15, 2013, through July 31, 2014. Main Outcomes and Measures Frequencies of specific morphologic patterns of (clinically and dermoscopically) SK-like melanomas, patient demographics, and interobserver agreement of criteria were evaluated. Results Of the 134 cases collected from 72 men and 61 women, all of whom were white and who had a mean (SD) age of 55.6 (17.5) years, 110 (82.1%) revealed dermoscopic features suggestive of melanoma, including pigment network (74 [55.2%]), blue-white veil (72 [53.7%]), globules and dots (68 [50.7%]), pseudopods or streaks (47 [35.1%]), and blue-black sign (43 [32.3%]). The remaining 24 cases (17.9%) were considered likely SKs, even by dermoscopy. Overall, lesions showed a scaly and hyperkeratotic surface (45 [33.6%]), yellowish keratin (42 [31.3%]), comedo-like openings (41 [30.5%]), and milia-like cysts (30 [22.4%]). The entire sample achieved a mean (SD) total dermoscopy score of 4.7 (1.6) and a 7-point checklist score of 4.4 (2
The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative

PubMed Central

2013-01-01

Patient-reported outcomes (PROs) play an increasingly important role in clinical practice and research. Modern psychometric methods such as item response theory (IRT) enable the creation of item banks that support fixed-length forms as well as computerized adaptive testing (CAT), often resulting in improved measurement precision and responsiveness. Here we describe and discuss the case for developing an international core set of PROs building from the US PROMIS® network. PROMIS is a U.S.-based cooperative group of research sites and centers of excellence convened to develop and standardize PRO measures across studies and settings. If extended to a global collaboration, PROMIS has the potential to transform PRO measurement by creating a shared, unifying terminology and metric for reporting of common symptoms and functional life domains. Extending a common set of standardized PRO measures to the international community offers great potential for improving patient-centered research, clinical trials reporting, population monitoring, and health care worldwide. Benefits of such standardization include the possibility of: international syntheses (such as meta-analyses) of research findings; international population monitoring and policy development; health services administrators and planners access to relevant information on the populations they serve; better assessment and monitoring of patients by providers; and improved shared decision making. The goal of the current PROMIS International initiative is to ensure that item banks are translated and culturally adapted for use in adults and children in as many countries as possible. The process includes 3 key steps: translation/cultural adaptation, calibration, and validation. A universal translation, an approach focusing on commonalities, rather than differences across versions developed in regions or countries speaking the same language, is proposed to ensure conceptual equivalence for all items. International item
The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative.

PubMed

Alonso, Jordi; Bartlett, Susan J; Rose, Matthias; Aaronson, Neil K; Chaplin, John E; Efficace, Fabio; Leplège, Alain; Lu, Aiping; Tulsky, David S; Raat, Hein; Ravens-Sieberer, Ulrike; Revicki, Dennis; Terwee, Caroline B; Valderas, Jose M; Cella, David; Forrest, Christopher B

2013-12-20

Patient-reported outcomes (PROs) play an increasingly important role in clinical practice and research. Modern psychometric methods such as item response theory (IRT) enable the creation of item banks that support fixed-length forms as well as computerized adaptive testing (CAT), often resulting in improved measurement precision and responsiveness. Here we describe and discuss the case for developing an international core set of PROs building from the US PROMIS® network.PROMIS is a U.S.-based cooperative group of research sites and centers of excellence convened to develop and standardize PRO measures across studies and settings. If extended to a global collaboration, PROMIS has the potential to transform PRO measurement by creating a shared, unifying terminology and metric for reporting of common symptoms and functional life domains. Extending a common set of standardized PRO measures to the international community offers great potential for improving patient-centered research, clinical trials reporting, population monitoring, and health care worldwide. Benefits of such standardization include the possibility of: international syntheses (such as meta-analyses) of research findings; international population monitoring and policy development; health services administrators and planners access to relevant information on the populations they serve; better assessment and monitoring of patients by providers; and improved shared decision making.The goal of the current PROMIS International initiative is to ensure that item banks are translated and culturally adapted for use in adults and children in as many countries as possible. The process includes 3 key steps: translation/cultural adaptation, calibration, and validation. A universal translation, an approach focusing on commonalities, rather than differences across versions developed in regions or countries speaking the same language, is proposed to ensure conceptual equivalence for all items. International item
Lightning Initiation Forecasting: An Operational Dual-Polarimetric Radar Technique

NASA Technical Reports Server (NTRS)

Woodard, Crystal J.; Carey, L. D.; Petersen, W. A.; Roeder, W. P.

2011-01-01

The objective of this NASA MSFC and NOAA CSTAR funded study is to develop and test operational forecast algorithms for the prediction of lightning initiation utilizing the C-band dual-polarimetric radar, UAHuntsville's Advanced Radar for Meteorological and Operational Research (ARMOR). Although there is a rich research history of radar signatures associated with lightning initiation, few studies have utilized dual-polarimetric radar signatures (e.g., Z(sub dr) columns) and capabilities (e.g., fuzzy-logic particle identification [PID] of precipitation ice) in an operational algorithm for first flash forecasting. The specific goal of this study is to develop and test polarimetric techniques that enhance the performance of current operational radar reflectivity based first flash algorithms. Improving lightning watch and warning performance will positively impact personnel safety in both work and leisure environments. Advanced warnings can provide space shuttle launch managers time to respond appropriately to secure equipment and personnel, while they can also provide appropriate warnings for spectators and players of leisure sporting events to seek safe shelter. Through the analysis of eight case dates, consisting of 35 pulse-type thunderstorms and 20 non-thunderstorm case studies, lightning initiation forecast techniques were developed and tested. The hypothesis is that the additional dual-polarimetric information could potentially reduce false alarms while maintaining high probability of detection and increasing lead-time for the prediction of the first lightning flash relative to reflectivity-only based techniques. To test the hypothesis, various physically-based techniques using polarimetric variables and/or PID categories, which are strongly correlated to initial storm electrification (e.g., large precipitation ice production via drop freezing), were benchmarked against the operational reflectivity-only based approaches to find the best compromise between
Hypervelocity Impact Initiation of Explosive Transfer Lines

NASA Technical Reports Server (NTRS)

Bjorkman, Michael D.; Christiansen, Eric L.

2012-01-01

The Gemini, Apollo and Space Shuttle spacecraft utilized explosive transfer lines (ETL) in a number of applications. In each case the ETL was located behind substantial structure and the risk of impact initiation by micrometeoroids and orbital debris was negligible. A current NASA program is considering an ETL to synchronize the actuation of pyrobolts to release 12 capture latches in a contingency. The space constraints require placing the ETL 50 mm below the 1 mm thick 2024-T72 Whipple shield. The proximity of the ETL to the thin shield prompted analysts at NASA to perform a scoping analysis with a finite-difference hydrocode to calculate impact parameters that would initiate the ETL. The results suggest testing is required and a 12 shot test program with surplused Shuttle ETL is scheduled for February 2012 at the NASA White Sands Test Facility. Explosive initiation models are essential to the analysis and one exists in the CTH library for HNS I, but not the HNS II used in the Shuttle 2.5 gr/ft rigid shielded mild detonating cord (SMDC). HNS II is less sensitive than HNS I so it is anticipated that these results using the HNS I model are conservative. Until the hypervelocity impact test results are available, the only check on the analysis was comparison with the Shuttle qualification test result that a 22 long bullet would not initiate the SMDC. This result was reproduced by the hydrocode simulation. Simulations of the direct impact of a 7 km/s aluminum ball, impacting at 0 degree angle of incidence, onto the SMDC resulted in a 1.5 mm diameter ball initiating the SMDC and 1.0 mm ball failing to initiate it. Where one 1.0 mm ball could not initiate the SMDC, a cluster of six 1.0 mm diameter aluminum balls striking simultaneously could. Thus the impact parameters that will result in initiating SMDC located behind a Whipple shield will depend on how well the shield fragments the projectile and spreads the fragments. An end-to-end simulation of the impact of an
Problematizing Diversity Initiatives: Japanese American Youth Identities and the Politics of Representation with/in School Spaces

ERIC Educational Resources Information Center

Endo, Rachel

2014-01-01

This article reports on a case study that investigated how six Japanese American youth interpreted the effectiveness and relevance of extra-curricular diversity initiatives at their Midwestern middle and secondary public schools. These initiatives were intended to raise cultural awareness, but ultimately promoted cultural fetishism and racially…
Initial Development and Validation of the Youth Internalizing Problems Screener

ERIC Educational Resources Information Center

Renshaw, Tyler L.; Cook, Clayton R.

2018-01-01

The present studies report on the initial development and validation of the Youth Internalizing Problems Screener (YIPS), which is a 10-item self-report rating scale for assessing general internalizing problems and identifying depression and anxiety caseness within the context of school mental health screening. Results from Study 1 (N = 177)…
Experienced physicians benefit from analyzing initial diagnostic hypotheses

PubMed Central

Bass, Adam; Geddes, Colin; Wright, Bruce; Coderre, Sylvain; Rikers, Remy; McLaughlin, Kevin

2013-01-01

Background Most incorrect diagnoses involve at least one cognitive error, of which premature closure is the most prevalent. While metacognitive strategies can mitigate premature closure in inexperienced learners, these are rarely studied in experienced physicians. Our objective here was to evaluate the effect of analytic information processing on diagnostic performance of nephrologists and nephrology residents. Methods We asked nine nephrologists and six nephrology residents at the University of Calgary and Glasgow University to diagnose ten nephrology cases. We provided presenting features along with contextual information, after which we asked for an initial diagnosis. We then primed participants to use either hypothetico-deductive reasoning or scheme-inductive reasoning to analyze the remaining case data and generate a final diagnosis. Results After analyzing initial hypotheses, both nephrologists and residents improved the accuracy of final diagnoses (31.1% vs. 65.6%, p < 0.001, and 40.0% vs. 70.0%, p < 0.001, respectively). We found a significant interaction between experience and analytic processing strategy (p = 0.02): nephrology residents had significantly increased odds of diagnostic success when using scheme-inductive reasoning (odds ratio [95% confidence interval] 5.69 [1.59, 20.33], p = 0.07), whereas the performance of experienced nephrologists did not differ between strategies (odds ratio 0.57 [0.23, 1.39], p = 0.20). Discussion Experienced nephrologists and nephrology residents can improve their performance by analyzing initial diagnostic hypotheses. The explanation of the interaction between experience and the effect of different reasoning strategies is unclear, but may relate to preferences in reasoning strategy, or the changes in knowledge structure with experience. PMID:26451203
A family with Wagner syndrome with uveitis and a new versican mutation.

PubMed

Rothschild, Pierre-Raphaël; Brézin, Antoine P; Nedelec, Brigitte; Burin des Roziers, Cyril; Ghiotti, Tiffany; Orhant, Lucie; Boimard, Mathieu; Valleix, Sophie

2013-01-01

To report the clinical and molecular findings of a kindred with Wagner syndrome (WS) revealed by intraocular inflammatory features. Eight available family members underwent complete ophthalmologic examination, including laser flare cell meter measurements. Collagen, type II, alpha 1, versican (VCAN), frizzled family receptor 4, low density lipoprotein receptor-related protein 5, tetraspanin 12, and Norrie disease (pseudoglioma) genes were screened with direct sequencing. The index case was initially referred for unexplained severe and chronic postoperative bilateral uveitis following a standard cataract surgery procedure. Clinical examination of the proband revealed an optically empty vitreous with avascular vitreous strands and veils, features highly suggestive of WS. The systematic familial ophthalmologic examination identified three additional unsuspected affected family members who also presented with the WS phenotype, including uveitis for one of them. We identified a novel c.4004-6T>A nucleotide substitution at the acceptor splice site of intron 7 of the VCAN gene that segregated with the disease phenotype. We present a family with WS with typical WS features and intraocular inflammatory manifestations associated with a novel splice site VCAN mutation. Beyond the structural role in the retinal-vitreous architecture, versican is also emerging as a pivotal mediator of the inflammatory response, supporting uveitis predisposition as a clinical manifestation of WS.
Controlling Chaos Via Knowledge of Initial Condition for a Curved Structure

NASA Technical Reports Server (NTRS)

Maestrello, L.

2000-01-01

Nonlinear response of a flexible curved panel exhibiting bifurcation to fully developed chaos is demonstrated along with the sensitivity to small perturbation from the initial conditions. The response is determined from the measured time series at two fixed points. The panel is forced by an external nonharmonic multifrequency and monofrequency sound field. Using a low power time-continuous feedback control, carefully tuned at each initial condition, produces large long-term effects on the dynamics toward taming chaos. Without the knowledge of the initial conditions, control may be achieved by destructive interference. In this case, the control power is proportional to the loading power. Calculation of the correlation dimension and the estimation of positive Lyapunov exponents, in practice, are the proof of chaotic response.
"I'll Take Care of the Flowers!" Researching Agency through Initiatives across Different Learning Environments

ERIC Educational Resources Information Center

Kangas, Marjaana; Kopisto, Kaisa; Löfman, Krista; Salo, Laura; Krokfors, Leena

2017-01-01

This case study examined how the agency of a fifth-grade pupil appeared across different learning environments in the primary school context. In this study, agency is defined as the initiatives taken by an individual in interactive situations. The research question is: how does a pupil's agency manifest and vary through taking initiatives across…
The changing image of the hero in Hindi films.

PubMed

Kavi, A R

2000-01-01

Beneath the surface of the Bollywood cinema is a percolating gay culture trying to break free, waiting for the moment to emerge from subtext into text. For now, in what we might now call a period of transition, the Bollywood hero has been (particularly in the past three decades) the focus of increased homoeroticization, with his body becoming a spectacle at every turn. Unfortunately, what has facilitated this is a veiled (and sometimes not-so-veiled) form of misogyny, in which the heroine's role is minimized such that, rather than another filmic character falling in love with the hero, the audience itself is invited to see the macho (and perhaps narcissistic) hero as unattached and therefore available for homoerotic desire.
A Case of Sporadic Creutzfeldt-Jakob Disease Presenting as Conversion Disorder.

PubMed

Yegya-Raman, Nikhil; Aziz, Rehan; Schneider, Daniel; Tobia, Anthony; Leitch, Megan; Nwobi, Onyi

2017-01-01

Background . Creutzfeldt-Jakob disease is a rare disorder of the central nervous system. Its initial diagnosis may be obscured by its variable presentation. This case report illustrates the complexity of diagnosing this disease early in the clinical course, especially when the initial symptoms may be psychiatric. It offers a brief review of the literature and reinforces a role for consultation psychiatry services. Methods . PUBMED/MEDLINE was searched using the terms "Creutzfeldt-Jakob disease", "psychiatric symptoms", "conversion disorder", "somatic symptom disorder", "functional movement disorder", and "functional neurologic disorder". Case . The patient was a 64-year-old woman with no prior psychiatric history who was initially diagnosed with conversion disorder and unspecified anxiety disorder but soon thereafter was discovered to have Creutzfeldt-Jakob disease. Discussion . This case highlights the central role of psychiatric symptoms in early presentations of Creutzfeldt-Jakob disease. Still, few other cases in the literature report functional neurological symptoms as an initial sign. The consultation psychiatrist must remain alert to changing clinical symptoms, especially with uncharacteristic disease presentations.
Predictors of refusal of provider initiated HIV testing among clients visiting adult outpatient departments in Jimma town, Oromia Region, Ethiopia: unmatched case control study

PubMed Central

Lemu, Yohannes Kebede; Koricha, Zewdie Birhanu; Gebretsadik, Lakew Abebe; Roro, Ameyu Godesso

2012-01-01

Background Currently, provider-initiated human immunodeficiency virus (HIV) testing (PIHT) in health facilities is one of the strategies to advance HIV testing and related services. However, many HIV infected clients are missing the opportunities. This study intends to identify predictors of refusal of PIHT among clients visiting adult outpatient departments (OPDs) in Jimma town. Methods An unmatched case control study was conducted among 296 clients: 149 cases refusing HIV testing and 147 controls accepting HIV testing. The study recruited clients from OPDs of four public health facilities between March 6 and April 8, 2011 using consecutive sampling. The study instrument was adapted mainly considering health belief model (HBM). Jimma University ethical committee reviewed the study protocol. Data were collected by face-to-face interview and analyzed using SPSS Statistics (IBM Corporation, Somers, NY) software, version 16.0. Data were subjected to factor and reliability analysis. For prediction analysis, the study used logistic regression and odds ratio (OR) with 95% confidence interval (CI). To see the effects among HBM constructs, the study used standardized beta (β) coefficients at P < 0.05. Results The study findings showed adjusted protective effects on refusal of PIHT for residence outside study town [adjusted OR (AOR) (95% CI) = 0.41 (0.22–0.79)] and higher scores of perceived benefit of early testing [AOR (95% CI)] = 0.86 (0.69–0.99)], self efficacy to live with HIV [AOR (95% CI) = 0.79 (0.66–0.93)], nondisclosure agreement [AOR (95% CI) = 0.74 (0.58–0.93)], perceived explicitness of opt-out right during initiation [AOR (95% CI) = 0.74 (0.56–0.98)] and clients’ perceptions of selective initiation of HIV suspected [AOR (95% CI) = 0.54 (0.41–0.73)]. On the other hand, report of recent testing [AOR (95% CI) = 3.82 (1.71–8.55)] and perceived unpreparedness for testing [AOR (95% CI) = 1.86 (1.57–2.21)] aggravated refusal of PIHT. Exposure to
The initial zones of the atrioventricular node: really neglected anatomical features of potential clinical significance?

PubMed

Kozłowski, D; Kozłowska, M; Kosiński, A; Woźniak, P; Piwko, G; Kamiński, R; Grzybiak, M; Poland, G Raczak

2007-11-01

The constant evolution of medical knowledge and accompanying development of diagnostic and treatment possibilities for arrhythmias and conduction disturbances has reawakened interest in the structure and function of the conduction system of the human heart, especially in the region of the atrioventricular (AV) junction and within the junction itself. Of the large number of studies dealing with the AV junction few focus on the initial zones of the AV node. These were described for the first time by Tawara in 1906. Similarly, Anderson et al. distinguished two origins of the AV node, the left one running towards the basis of the mitral valve and the right one leading towards the tricuspid valve. The differences in length and scale could be the result of the adoption of different reference points. The study was carried out on the material of 50 human hearts, of both sexes and ranging in age from 22 to 93, which were fixed in 10% formalin and 98% ethanol solution. The tissue obtained was fixed in the 10% formalin solution and, after being sunk in the paraffin, was cut into layers of about 10 mum thick. According to the age of the hearts, every 10(th) or 6(th) section was stained by the Masson-Goldner method. The preparations were examined under a LEICA 2000 and BIOLAR 2 microscope at magnifications of 2x to 400x. Each of the 50 examined hearts contained the atrioventricular node and its initial parts. We observed that the initial zone of the AV node is created by an assembly of cells typical for a conduction system that can create three groups that are initially independent of each other and are always arranged around the AV nodal artery. In all the hearts examined we found at least two initial parts of the node: the superior and inferior. These two groups were present in 45 hearts (90%). In the last 5 cases (10%) there was also a middle group. No cases were found either with a single initial group or without any initial groups. In the sections examined the superior

Case of Mycobacterium tuberculosis meningitis: Gram staining as a useful initial diagnostic clue for tuberculous meningitis.

PubMed

Kawakami, Sayoko; Kawamura, Yasuyosi; Nishiyama, Kyouhei; Hatanaka, Hiroki; Fujisaki, Ryuichi; Ono, Yasuo; Miyazawa, Yukihisa; Nishiya, Hajime

2012-12-01

A 32-year-old man was admitted to our hospital because of fever, headache, and loss of consciousness. Four days before admission, he had had difficulty speaking. On the day of admission, his colleague had found him to be unconscious and lying on his back. He was admitted to our hospital. The temperature at the eardrum was 35.2°C. Neurologic evaluation was negative. Computed tomography (CT) scan of the brain showed slight ventricular enlargement bilaterally. An X-ray film of the chest showed no abnormality. On the second hospital day, neck stiffness was noted. The cerebrospinal fluid (CSF) contained 870 white cells/μl, most of which were neutrophils; the glucose level in the CSF was 10 mg/dl, and the protein level was 140 mg/dl. Stained smears of the CSF, including Gram staining and India-ink preparations, disclosed no microorganisms. Capsular antigen tests for several bacteria were negative. Antimicrobial agents were started. However, by changing the microscope focus slightly while viewing Gram stains of the CSF, we could see brightened and Gram-positive bacilli that had been phagocytosed by neutrophils. This finding suggested the presence of Mycobacterium tuberculosis. Ziehl-Neelsen staining of the CSF and gastric juice revealed anti-acid bacilli. Polymerase chain reaction for M. tuberculosis in the gastric juice was positive. This case showed that Gram staining could be useful as an initial adjunct for the diagnosis of tuberculous meningitis, particularly when the CSF shows predominantly neutrocytic pleocytosis, but no other evidence of bacterial meningitis.
Current Fluctuations in One Dimensional Diffusive Systems with a Step Initial Density Profile

NASA Astrophysics Data System (ADS)

Derrida, Bernard; Gerschenfeld, Antoine

2009-12-01

We show how to apply the macroscopic fluctuation theory (MFT) of Bertini, De Sole, Gabrielli, Jona-Lasinio, and Landim to study the current fluctuations of diffusive systems with a step initial condition. We argue that one has to distinguish between two ways of averaging (the annealed and the quenched cases) depending on whether we let the initial condition fluctuate or not. Although the initial condition is not a steady state, the distribution of the current satisfies a symmetry very reminiscent of the fluctuation theorem. We show how the equations of the MFT can be solved in the case of non-interacting particles. The symmetry of these equations can be used to deduce the distribution of the current for several other models, from its knowledge (Derrida and Gerschenfeld in J. Stat. Phys. 136, 1-15, 2009) for the symmetric simple exclusion process. In the range where the integrated current Qt˜sqrt{t} , we show that the non-Gaussian decay exp [- Q {/t 3}/ t] of the distribution of Q t is generic.
Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation.

PubMed

Manuel, Valdano; Pedro, Gertrudes Maria; Cordeiro, Lemuel Bornelli; de Miranda, Sandra Maria da Rocha Neto

2016-01-01

Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
The Plus 50 Initiative Evaluation: Initiative Impact

ERIC Educational Resources Information Center

American Association of Community Colleges (NJ1), 2012

2012-01-01

The American Association of Community Colleges (AACC), with funding from The Atlantic Philanthropies, created the Plus 50 Initiative (2008-2012). This initiative was designed to build the capacity of community colleges nationwide to develop programming that engages the plus 50 learner. This report contains: (1) An overview of the Plus 50…
Loxoprofen-induced interstitial pneumonia: a case report.

PubMed

Kato, Motoyasu; Sasaki, Shinichi; Sekimoto, Yasuhito; Arano, Naoko; Jo, Hitomi; Suina, Kentaro; Kuriyama, Sachiko; Muraki, Keiko; Nagashima, Osamu; Yoshioka, Yasuko; Tominaga, Shigeru; Takahashi, Kazuhisa

2016-05-25

Loxoprofen is a nonsteroidal anti-inflammatory drug used in the treatment of many diseases. However, there are no case reports about loxoprofen-induced pneumonia. We have encountered a rare case of loxoprofen-induced pneumonia. We report the case of a 71-year-old Japanese woman who was initially treated with loxoprofen for fever. She was admitted to our hospital because of worsening of her symptoms, including fever and dyspnea. Her symptoms improved after treatment with ceftriaxone. Seven days after admission, she again developed high fever. She was again treated with loxoprofen and levofloxacin. However, acute respiratory failure developed after initiation of loxoprofen treatment. Chest computed tomography showed peribronchovascular consolidation. She was diagnosed with loxoprofen-induced pneumonia for which she was administered steroids. After treatment, her dyspnea and radiological findings improved. The findings in this case report reveal an association between treatment with a nonsteroidal anti-inflammatory drug and pneumonia. This rare case was diagnosed after accidental retreatment with loxoprofen. This is the first report of loxoprofen-induced pneumonia.
Correlates of sexual initiation among European adolescents

PubMed Central

Carli, Vladimir; Hadlaczky, Gergö; Sarchiapone, Marco; Apter, Alan; Balazs, Judit; Banzer, Raphaela; Bobes, Julio; Brunner, Romuald; Cosman, Doina; Farkas, Luca; Haring, Christian; Hoven, Christina W.; Kaess, Michael; Kahn, Jean Pierre; McMahon, Elaine; Postuvan, Vita; Sisask, Merike; Värnik, Airi; Zadravec Sedivy, Nusa; Wasserman, Danuta

2018-01-01

Background Sexuality is a physiological component of adolescent development, though early initiation is associated with reproductive health risk. This study aimed at identifying correlates and predictors of sexual initiation in a large multinational cohort of European adolescents. Methods A questionnaire addressing socio-demographics, behaviours, mental health and sexual activity, was delivered to 11,110 adolescents recruited from 168 randomly selected schools in 10 European countries between 2009 and 2011. A follow-up questionnaire was delivered after 12 months. The longitudinal association of baseline risk behaviors, psychological attributes and contextual vulnerabilities, with sexual initiation during follow-up was evaluated through simple and multivariable age/sex stratified logistic regression. Multinomial logistic regression measured the association between predictors and sexual initiation with or without coexisting reproductive risk factors, such as multiple partners or infrequent condom use. Results Baseline sexual experience was reported by 19.2% of 10,757 respondents (median age 15; IQR 14–15; females 59.6%). This was significantly more frequent among pupils older than 15 (41%) and males (20.8%). Of 7,111 pupils without previous experience who were available at follow-up (response rate 81.8%), 17% reported sexual initiation, without differences between females and males. Baseline smoking (age/sex adjusted odds ratio [aOR] 3.63), alcohol use (aOR 2.95), illegal drugs use (aOR 2.72), and poor sleep (aOR 1.71) predicted sexual initiation. Stratified analyses showed a particularly strong association in case of younger and female pupils, and, among girls, when initiation was reported together with multiple partners and/or infrequent condom use. Externalizing (i.e. conduct and hyperactivity) symptoms independently predicted sexual initiation. Internalizing difficulties (i.e. emotional and peer problems) were negatively associated with early and risky sexual
The Charter School Initiative as a Case of Back to the Future

ERIC Educational Resources Information Center

Anderson, Amy L.

2005-01-01

In this article, the author explores the impact of contemporary economic, social and political shifts on the organization, curriculum and instruction of one charter school using the case of Forth Academy. Forth Academy is a charter school operated by a private company that uses market-based and consumer-driven methods to advance a particular…
Transvaginal Laparoscopic Appendectomy Simultaneously with Vaginal Hysterectomy: Initial Experience of 10 Cases

PubMed Central

Tian, Yu; Wu, Shuo-Dong; Chen, Ying-Han; Wang, Dan-Bo

2014-01-01

Background Natural orifice transluminal endoscopic surgery (NOTES) involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform surgical interventions. The vagina is the most widely used approach to NOTES. We report the utilization of the vaginal opening at the time of vaginal hysterectomy as a natural orifice for laparoscopic appendectomy. Material/Methods We reviewed cases of 10 patients with chronic appendicitis who underwent transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy. A laparoscopic approach was established after removal of the uterus, and the appendix was removed transvaginally. Among the 10 cases, 5 were conducted under gasless laparoscopy by using a simple abdominal wall-lifting instrument. Results All procedures were performed successfully without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 21 minutes to 34 minutes. All patients were discharged less than 4 days after surgery, without external scars. Conclusions Transvaginal appendectomy with rigid laparoscopic instruments following vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes. PMID:25300522
Bochdalek hernia presenting with initial local fat infiltration of the thoracic cavity in a leukemic child.

PubMed

Kang, Zhen; Min, Xiangde; Wang, Liang

2017-03-01

Local fat infiltration of the thoracic cavity is a rare initial presentation of Bochdalek hernia. We report a case of Bochdalek hernia in a child with leukemia that demonstrated initial local fat infiltration of the thoracic cavity on computed tomography scan and progressed to an obvious diaphragmatic hernia on subsequent follow-up. We suggest that initial local fat infiltration of the thoracic cavity on computed tomography scan may indicate a potential diaphragmatic hernia.
Collaborative leadership and the implementation of community-based fall prevention initiatives: a multiple case study of public health practice within community groups.

PubMed

Markle-Reid, Maureen; Dykeman, Cathy; Ploeg, Jenny; Kelly Stradiotto, Caralyn; Andrews, Angela; Bonomo, Susan; Orr-Shaw, Sarah; Salker, Niyati

2017-02-16

Falls among community-dwelling older adults are a serious public health concern. While evidence-based fall prevention strategies are available, their effective implementation requires broad cross-sector coordination that is beyond the capacity of any single institution or organization. Community groups comprised of diverse stakeholders that include public health, care providers from the public and private sectors and citizen volunteers are working to deliver locally-based fall prevention. These groups are examples of collective impact and are important venues for public health professionals (PHPs) to deliver their mandate to work collaboratively towards achieving improved health outcomes. This study explores the process of community-based group work directed towards fall prevention, and it focuses particular attention on the collaborative leadership practices of PHPs, in order to advance understanding of the competencies required for collective impact. Four community groups, located in Ontario, Canada, were studied using an exploratory, retrospective, multiple case study design. The criteria for inclusion were presence of a PHP, a diverse membership and the completion of an initiative that fit within the scope of the World Health Organization Fall Prevention Model. Data were collected using interviews (n = 26), focus groups (n = 4), and documents. Cross-case synthesis was conducted by a collaborative team of researchers. The community groups differed by membership, the role of the PHP and the type of fall prevention initiatives. Seven practice themes emerged: (1) tailoring to address context; (2) making connections; (3) enabling communication; (4) shaping a vision; (5) skill-building to mobilize and take action; (6) orchestrating people and projects; and (7) contributing information and experience. The value of recognized leadership competencies was underscored and the vital role of institutional supports was highlighted. To align stakeholders working
Self-Regulation Initiatives: Guidelines for Colleges and Universities. Numbers 1-3.

ERIC Educational Resources Information Center

American Council on Education, Washington, DC.

Three policy statements on self-regulation initiatives for colleges and universities were developed by the American Council on Education with support, in some cases, from other organizations. Policy statement number one concerns policy guidelines for refund of student charges. The guidelines summarize elements of fair and equitable policy in…
Management of traumatic macular holes: case report.

PubMed

Brasil, Oswaldo Ferreira Moura; Brasil, Oswaldo Moura

2008-01-01

Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.
Creating targeted initial populations for genetic product searches in heterogeneous markets

NASA Astrophysics Data System (ADS)

Foster, Garrett; Turner, Callaway; Ferguson, Scott; Donndelinger, Joseph

2014-12-01

Genetic searches often use randomly generated initial populations to maximize diversity and enable a thorough sampling of the design space. While many of these initial configurations perform poorly, the trade-off between population diversity and solution quality is typically acceptable for small-scale problems. Navigating complex design spaces, however, often requires computationally intelligent approaches that improve solution quality. This article draws on research advances in market-based product design and heuristic optimization to strategically construct 'targeted' initial populations. Targeted initial designs are created using respondent-level part-worths estimated from discrete choice models. These designs are then integrated into a traditional genetic search. Two case study problems of differing complexity are presented to illustrate the benefits of this approach. In both problems, targeted populations lead to computational savings and product configurations with improved market share of preferences. Future research efforts to tailor this approach and extend it towards multiple objectives are also discussed.
Incompressible limit of the degenerate quantum compressible Navier-Stokes equations with general initial data

NASA Astrophysics Data System (ADS)

Kwon, Young-Sam; Li, Fucai

2018-03-01

In this paper we study the incompressible limit of the degenerate quantum compressible Navier-Stokes equations in a periodic domain T3 and the whole space R3 with general initial data. In the periodic case, by applying the refined relative entropy method and carrying out the detailed analysis on the oscillations of velocity, we prove rigorously that the gradient part of the weak solutions (velocity) of the degenerate quantum compressible Navier-Stokes equations converge to the strong solution of the incompressible Navier-Stokes equations. Our results improve considerably the ones obtained by Yang, Ju and Yang [25] where only the well-prepared initial data case is considered. While for the whole space case, thanks to the Strichartz's estimates of linear wave equations, we can obtain the convergence of the weak solutions of the degenerate quantum compressible Navier-Stokes equations to the strong solution of the incompressible Navier-Stokes/Euler equations with a linear damping term. Moreover, the convergence rates are also given.
Models of symbiotic stars

NASA Technical Reports Server (NTRS)

Friedjung, Michael

1993-01-01

One of the most important features of symbiotic stars is the coexistence of a cool spectral component that is apparently very similar to the spectrum of a cool giant, with at least one hot continuum, and emission lines from very different stages of ionization. The cool component dominates the infrared spectrum of S-type symbiotics; it tends to be veiled in this wavelength range by what appears to be excess emission in D-type symbiotics, this excess usually being attributed to circumstellar dust. The hot continuum (or continua) dominates the ultraviolet. X-rays have sometimes also been observed. Another important feature of symbiotic stars that needs to be explained is the variability. Different forms occur, some variability being periodic. This type of variability can, in a few cases, strongly suggest the presence of eclipses of a binary system. One of the most characteristic forms of variability is that characterizing the active phases. This basic form of variation is traditionally associated in the optical with the veiling of the cool spectrum and the disappearance of high-ionization emission lines, the latter progressively appearing (in classical cases, reappearing) later. Such spectral changes recall those of novae, but spectroscopic signatures of the high-ejection velocities observed for novae are not usually detected in symbiotic stars. However, the light curves of the 'symbiotic nova' subclass recall those of novae. We may also mention in this connection that radio observations (or, in a few cases, optical observations) of nebulae indicate ejection from symbiotic stars, with deviations from spherical symmetry. We shall give a historical overview of the proposed models for symbiotic stars and make a critical analysis in the light of the observations of symbiotic stars. We describe the empirical approach to models and use the observational data to diagnose the physical conditions in the symbiotics stars. Finally, we compare the results of this empirical
Pulmonary Embolism as the Initial Presentation of Testicular Carcinoma

PubMed Central

Berber, Ilhami; Erkurt, Mehmet Ali; Ulutas, Ozkan; Ediz, Caner; Nizam, Ilknur; Kırıcı Berber, Nurcan; Unlu, Serkan; Koroglu, Reyhan; Koroglu, Mustafa; Akpolat, Nusret

2013-01-01

Objective. The risk of pulmonary embolism is well recognized as showing an increase in oncological patients. We report a case presenting with pulmonary embolism initially, which was then diagnosed with testicular cancer. Clinical Presentation and Intervention. A 25-year-old man was admitted to the emergency department with a complaint of dyspnoea. Thoracic tomography, lung ventilation/perfusion scintigraphy, and an increased D-dimer level revealed pulmonary embolism. For the aetiology of pulmonary embolism, a left orchiectomy was performed and the patient was diagnosed with a germinal cell tumour of the testicle. Conclusion. In this paper, we present a patient for whom pulmonary embolism was the initial presentation, and a germinal cell tumour was diagnosed later during the search for the aetiology. PMID:24383024
Deterministic estimation of hydrological thresholds for shallow landslide initiation and slope stability models: case study from the Somma-Vesuvius area of southern Italy

USGS Publications Warehouse

Baum, Rex L.; Godt, Jonathan W.; De Vita, P.; Napolitano, E.

2012-01-01

Rainfall-induced debris flows involving ash-fall pyroclastic deposits that cover steep mountain slopes surrounding the Somma-Vesuvius volcano are natural events and a source of risk for urban settlements located at footslopes in the area. This paper describes experimental methods and modelling results of shallow landslides that occurred on 5–6 May 1998 in selected areas of the Sarno Mountain Range. Stratigraphical surveys carried out in initiation areas show that ash-fall pyroclastic deposits are discontinuously distributed along slopes, with total thicknesses that vary from a maximum value on slopes inclined less than 30° to near zero thickness on slopes inclined greater than 50°. This distribution of cover thickness influences the stratigraphical setting and leads to downward thinning and the pinching out of pyroclastic horizons. Three engineering geological settings were identified, in which most of the initial landslides that triggered debris flows occurred in May 1998 can be classified as (1) knickpoints, characterised by a downward progressive thinning of the pyroclastic mantle; (2) rocky scarps that abruptly interrupt the pyroclastic mantle; and (3) road cuts in the pyroclastic mantle that occur in a critical range of slope angle. Detailed topographic and stratigraphical surveys coupled with field and laboratory tests were conducted to define geometric, hydraulic and mechanical features of pyroclastic soil horizons in the source areas and to carry out hydrological numerical modelling of hillslopes under different rainfall conditions. The slope stability for three representative cases was calculated considering the real sliding surface of the initial landslides and the pore pressures during the infiltration process. The hydrological modelling of hillslopes demonstrated localised increase of pore pressure, up to saturation, where pyroclastic horizons with higher hydraulic conductivity pinch out and the thickness of pyroclastic mantle reduces or is
Provision of pandemic disease information by health sciences librarians: a multisite comparative case series.

PubMed

Featherstone, Robin M; Boldt, R Gabriel; Torabi, Nazi; Konrad, Shauna-Lee

2012-04-01

The research provides an understanding of pandemic information needs and informs professional development initiatives for librarians in disaster medicine. Utilizing a multisite, comparative case series design, the researchers conducted semi-structured interviews and examined supplementary materials in the form of organizational documents, correspondence, and websites to create a complete picture of each case. The rigor of the case series was ensured through data and investigator triangulation. Interview transcripts were coded using NVivo to identify common themes and points of comparison. Comparison of the four cases revealed a distinct difference between "client-initiated" and "librarian-initiated" provision of pandemic information. Librarian-initiated projects utilized social software to "push" information, whereas client-initiated projects operated within patron-determined parameters to deliver information. Health care administrators were identified as a key audience for pandemic information, and news agencies were utilized as essential information sources. Librarians' skills at evaluating available information proved crucial for selecting best-quality evidence to support administrative decision making. Qualitative analysis resulted in increased understanding of pandemic information needs and identified best practices for disseminating information during periods of high organizational stress caused by an influx of new cases of an unknown infectious disease.
[Lupus enteritis as initial manifestation of systemic lupus erythematosus. Report of one case].

PubMed

Barrera O, Manuel; Barrera M, Rodrigo; de la Rivera V, Matías; Vela U, Javier; Mönckeberg F, Gustavo

2017-10-01

Although gastrointestinal symptoms are not rare in Systemic lupus erythematosus, enteritis is an atypical manifestation of the disease. We report a 54 year-old woman who presented acute symptoms of diarrhea, fever and abdominal pain, receiving empiric antibiotic therapy for bacterial enteritis with no response. Computed tomography showed diffuse small intestine inflammation and serositis. Antinuclear antibodies, anti-Ro and anti-La were positive on blood tests. A lupic enteropathy was diagnosed and steroid treatment was initiated, with subsequent clinical improvement.
Brown tumors of the anterior skull base as the initial manifestation of true normocalcemic primary hyperparathyroidism: report of three cases and review of the literature.

PubMed

Khalatbari, Mahmoud Reza; Hamidi, Mehrdokht; Moharamzad, Yashar; Setayesh, Ali; Amirjamshidi, Abbas

2013-01-01

Brown tumor is a bone lesion secondary to hyperparathyroidism of various etiologies. Skeletal involvement in primary hyperparathyroidism secondary to parathyroid adenoma is very uncommon and brown tumor has become extremely a rare clinical entity. Hyperparathyroidism is usually associated with high levels of serum calcium. Brown tumor as the only and initial symptom of normocalcemic primary hyperparathyroidism is extremely rare. Moreover, involvement of the skull base and the orbit is exceedingly rare. The authors would report three cases of brown tumor of the anterior skull base that were associated with true normocalcemic primary hyperparathyroidism. Clinical manifestations, neuroimaging findings, pathological findings, diagnosis and treatment of the patients are discussed and the relevant literature is reviewed.

Case Studies of UMTA Private Sector Initiative Projects in Syracuse, Central New Jersey, and Atlanta

DOT National Transportation Integrated Search

1987-12-01

This report documents the results of three grants awarded in 1983 by the Urban Mass Transportation Administration for Section 8 Private Sector Initiative projects. The grants were intended to encourage cooperative public and private planning for the ...
The relationship between three-dimensional knee MRI bone shape and total knee replacement—a case control study: data from the Osteoarthritis Initiative

PubMed Central

Barr, Andrew J.; Dube, Bright; Hensor, Elizabeth M. A.; Kingsbury, Sarah R.; Peat, George; Bowes, Mike A.; Sharples, Linda D.

2016-01-01

Objective. There is growing understanding of the importance of bone in OA. Our aim was to determine the relationship between 3D MRI bone shape and total knee replacement (TKR). Methods. A nested case-control study within the Osteoarthritis Initiative cohort identified case knees with confirmed TKR for OA and controls that were matched using propensity scores. Active appearance modelling quantification of the bone shape of all knee bones identified vectors between knees having or not having OA. Vectors were scaled such that −1 and +1 represented the mean non-OA and mean OA shapes. Results. Compared to controls (n = 310), TKR cases (n = 310) had a more positive mean baseline 3D bone shape vector, indicating more advanced structural OA, for the femur [mean 0.98 vs −0.11; difference (95% CI) 1.10 (0.88, 1.31)], tibia [mean 0.86 vs −0.07; difference (95% CI) 0.94 (0.72, 1.16)] and patella [mean 0.95 vs 0.03; difference (95% CI) 0.92 (0.65, 1.20)]. Odds ratios (95% CI) for TKR per normalized unit of 3D bone shape vector for the femur, tibia and patella were: 1.85 (1.59, 2.16), 1.64 (1.42, 1.89) and 1.36 (1.22, 1.50), respectively, all P < 0.001. After including Kellgren–Lawrence grade in a multivariable analysis, only the femur 3D shape vector remained significantly associated with TKR [odds ratio 1.24 (1.02, 1.51)]. Conclusion. 3D bone shape was associated with the endpoint of this study, TKR, with femoral shape being most associated. This study contributes to the validation of quantitative MRI bone biomarkers for OA structure-modification trials. PMID:27185958
Cost-effectiveness analysis of initial treatment strategies for mild-to-moderate Clostridium difficile infection in hospitalized patients.

PubMed

Ford, Diana C; Schroeder, Mary C; Ince, Dilek; Ernst, Erika J

2018-06-14

The cost-effectiveness of initial treatment strategies for mild-to-moderate Clostridium difficile infection (CDI) in hospitalized patients was evaluated. Decision-analytic models were constructed to compare initial treatment with metronidazole, vancomycin, and fidaxomicin. The primary model included 1 recurrence, and the secondary model included up to 3 recurrences. Model variables were extracted from published literature with costs based on a healthcare system perspective. The primary outcome was the incremental cost-effective ratio (ICER) between initial treatment strategies. In the primary model, the overall percentage of patients cured was 94.23%, 95.19%, and 96.53% with metronidazole, vancomycin, and fidaxomicin, respectively. Expected costs per case were $1,553.01, $1,306.62, and $5,095.70, respectively. In both models, vancomycin was more effective and less costly than metronidazole, resulting in negative ICERs. The ICERs for fidaxomicin compared with those for metronidazole and vancomycin in the primary model were $1,540.23 and $2,828.69 per 1% gain in cure, respectively. Using these models, a hospital currently treating initial episodes of mild-to-moderate CDI with metronidazole could expect to save $246.39-$388.37 per case treated by using vancomycin for initial therapy. A decision-analytic model revealed vancomycin to be cost-effective, compared with metronidazole, for treatment of initial episodes of mild-to-moderate CDI in adult inpatients. From the hospital perspective, initial treatment with vancomycin resulted in a higher probability of cure and a lower probability of colectomy, recurrence, persistent recurrence, and cost per case treated, compared with metronidazole. Use of fidaxomicin was associated with an increased probability of cure compared with metronidazole and vancomycin, but at a substantially increased cost. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Stability of semidiscrete approximations for hyperbolic initial-boundary-value problems: Stationary modes

NASA Technical Reports Server (NTRS)

Warming, Robert F.; Beam, Richard M.

1988-01-01

Spatially discrete difference approximations for hyperbolic initial-boundary-value problems (IBVPs) require numerical boundary conditions in addition to the analytical boundary conditions specified for the differential equations. Improper treatment of a numerical boundary condition can cause instability of the discrete IBVP even though the approximation is stable for the pure initial-value or Cauchy problem. In the discrete IBVP stability literature there exists a small class of discrete approximations called borderline cases. For nondissipative approximations, borderline cases are unstable according to the theory of the Gustafsson, Kreiss, and Sundstrom (GKS) but they may be Lax-Richtmyer stable or unstable in the L sub 2 norm on a finite domain. It is shown that borderline approximation can be characterized by the presence of a stationary mode for the finite-domain problem. A stationary mode has the property that it does not decay with time and a nontrivial stationary mode leads to algebraic growth of the solution norm with mesh refinement. An analytical condition is given which makes it easy to detect a stationary mode; several examples of numerical boundary conditions are investigated corresponding to borderline cases.
The value of case reports in human teratology.

PubMed

Goldberg, J D; Golbus, M S

1986-03-01

Birth defects caused by human teratogens are an important and potentially preventable cause of perinatal morbidity and mortality. Case reports provide an initial suggestion that a specific agent may be a human teratogen and provide the basis for further study. This review discusses the importance of case reports in human teratology and provides guidance in evaluating new case reports.
Agreement between the results of meta-analyses from case reports and from clinical studies regarding the efficacy of laronidase therapy in patients with mucopolysaccharidosis type I who initiated enzyme replacement therapy in adult age: An example of case reports meta-analyses as an useful tool for evidence-based medicine in rare diseases.

PubMed

Sampayo-Cordero, Miguel; Miguel-Huguet, Bernat; Pardo-Mateos, Almudena; Moltó-Abad, Marc; Muñoz-Delgado, Cecilia; Pérez-López, Jordi

2018-02-01

Case reports might have a prominent role in the rare diseases field, due to the small number of patients affected by one such disease. A previous systematic review regarding the efficacy of laronidase therapy in patients with mucopolysaccharidosis type I (MPS-I) who initiated enzyme replacement therapy (ERT) in adult age has been published. The review included a meta-analysis of 19 clinical studies and the description of eleven case reports. It was of interest to perform a meta-analysis of those case reports to explore the role of such meta-analyses as a tool for evidence-based medicine in rare diseases. The study included all case reports with standard treatment regimen. Primary analysis was the percentage of case reports showing an improvement in a specific outcome. Only when that percentage was statistically higher than 5%, the improvement was confirmed as such. The outcomes that accomplished this criterion were ranked and compared to the GRADE criteria obtained by those same outcomes in the previous meta-analysis of clinical studies. There were three outcomes that had a significant improvement: Urine glycosaminoglycans, liver volume and 6-minute walking test. Positive and negative predictive values, sensitivity and specificity for the results of the meta-analysis of case reports as compared to that of clinical studies were 100%, 88.9%, 75% and 100%, respectively. Accordingly, absolute (Rho=0.82, 95%CI: 0.47 to 0.95) and relative agreement (Kappa=0.79, 95%CI: 0.593 to 0.99) between the number of case reports with improvement in a specific outcome and the GRADE evidence score for that outcome were good. Sensitivity analysis showed that agreement between the meta-analysis of case reports and that of the clinical studies were good only when using a strong confirmatory strategy for outcome improvement in case reports. We found an agreement between the results of meta-analyses from case reports and from clinical studies in the efficacy of laronidase therapy in
Posterior retroperitoneoscopic adrenalectomy: outcomes and lessons learned from initial 50 cases.

PubMed

Cabalag, Miguel S; Mann, G Bruce; Gorelik, Alexandra; Miller, Julie A

2015-06-01

Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative approach to minimally invasive adrenalectomy, potentially offering less pain and faster recovery compared with laparoscopic transperitoneal adrenalectomy (LA). The authors have recently changed from LA to PRA in suitable patients and audited their first 50 cases. Data were prospectively collected for 50 consecutive PRAs performed by the same surgeon. Patient demographics, tumour characteristics, analgesia use, operative and preparation time, length of stay, and complications were recorded. Fifty adrenalectomies were performed in 49 patients. The median (range) age was 58.5 years (30-83) and the majority of patients were female (n = 33, 66.0%). The median (interquartile range (IQR)) preparation time was 35.5 (28.5-50.0) and median operation time was 70.5 (54-85) min, which decreased during the study period. After a learning curve of 15 cases, median operative time reached 61 min. PRA patients required minimal post-operative analgesia, with a median (IQR) of 0 (0-5) mg of intravenous morphine equivalent used. The median (IQR) length of stay was 1 (1-1) day, with 8 (16.0%) same-day discharges. There were four complications: one blood pressure lability from a phaeochromocytoma, one reintubation, one self-limited bleed and one temporary subcostal neuropraxia. There were no conversions to open surgery or deaths. Our results support previously published findings that PRA is a safe procedure, with a relatively short learning curve, resulting in minimal post-operative analgesia use and short length of hospital stay. © 2014 Royal Australasian College of Surgeons.
Genome-wide association analysis of secondary imaging phenotypes from the Alzheimer's disease neuroimaging initiative study.

PubMed

Zhu, Wensheng; Yuan, Ying; Zhang, Jingwen; Zhou, Fan; Knickmeyer, Rebecca C; Zhu, Hongtu

2017-02-01

The aim of this paper is to systematically evaluate a biased sampling issue associated with genome-wide association analysis (GWAS) of imaging phenotypes for most imaging genetic studies, including the Alzheimer's Disease Neuroimaging Initiative (ADNI). Specifically, the original sampling scheme of these imaging genetic studies is primarily the retrospective case-control design, whereas most existing statistical analyses of these studies ignore such sampling scheme by directly correlating imaging phenotypes (called the secondary traits) with genotype. Although it has been well documented in genetic epidemiology that ignoring the case-control sampling scheme can produce highly biased estimates, and subsequently lead to misleading results and suspicious associations, such findings are not well documented in imaging genetics. We use extensive simulations and a large-scale imaging genetic data analysis of the Alzheimer's Disease Neuroimaging Initiative (ADNI) data to evaluate the effects of the case-control sampling scheme on GWAS results based on some standard statistical methods, such as linear regression methods, while comparing it with several advanced statistical methods that appropriately adjust for the case-control sampling scheme. Copyright © 2016 Elsevier Inc. All rights reserved.
OMC Compressor Case

NASA Technical Reports Server (NTRS)

Humphrey, W. Donald

1997-01-01

This report summarizes efforts expended in the development of an all-composite compressor case. Two pre-production units have been built, one utilizing V-CAP and one utilizing AFR-700B resin systems. Both units have been rig tested at elevated temperatures well above design limit loads. This report discusses the manufacturing processes, test results, and Finite Element Analysis performed. The V-CAP unit was funded by NASA-Lewis Research Center in 1994 under contract number NAS3- 27442 for Development of an All-Composite OMC Compressor Case. This contract was followed by an Air Force study in 1996 to build and identical unit using the AFR-700B resin system in place of the V-CAP system. The second compressor case was funded under U.S. Air Force contract F33615-93-D-5326, Advanced Materials for Aerospace Structures Special Studies (AMAS3), Delivery Order 0021 entitled "Advanced Polymeric Composite Materials and Structures Technology for Advanced High Temperature Gas Turbine Engines.' Initial studies using the V-CAP resin system were undertaken in 1993 under a NASA Lewis contract (NAS3-26829). A first prototype unit was developed in a joint program between Textron-Lycoming (now Allied Signal) and Brunswick (now Lincoln Composites). This unit included composite end closures using low density, high temperature molded end closures. The units was similar in size and shape to a titanium case currently used on the PT-21 0 engine and was funded as part of the integrated High Performance Turbine Engine Technology (EHPTET) initiative of DOD and NASA.
The Robustness of Designs for Trials with Nested Data against Incorrect Initial Intracluster Correlation Coefficient Estimates

ERIC Educational Resources Information Center

Korendijk, Elly J. H.; Moerbeek, Mirjam; Maas, Cora J. M.

2010-01-01

In the case of trials with nested data, the optimal allocation of units depends on the budget, the costs, and the intracluster correlation coefficient. In general, the intracluster correlation coefficient is unknown in advance and an initial guess has to be made based on published values or subject matter knowledge. This initial estimate is likely…
Expanding malaria diagnosis and treatment in Lao PDR: lessons learned from a public-private mix initiative.

PubMed

Simmalavong, Nouannipha; Phommixay, Sengkham; Kongmanivong, Phoudaliphone; Sichanthongthip, Odai; Hongvangthong, Bouasy; Gopinath, Deyer; Sintasath, David M

2017-11-13

As in other countries of the Greater Mekong Sub-region (GMS), the private health sector constitutes a significant avenue where malaria services are provided and presents a unique opportunity for public-private collaboration. In September 2008, a public-private mix (PPM) strategy was launched initially in four northern and southern provinces in Lao PDR to increase access to rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT), improve quality of care, and collect routine malaria data from the private sector. Throughout the process, key stakeholders were involved in the planning, monitoring and supervision of project sites. Following an initial assessment in 2009, the PPM initiative expanded to an additional 14 district sites to a total of 245 private pharmacies and 16 clinics covering 8 provinces and 22 districts. By June 2016, a total of 317 pharmacies, 30 clinics in 32 districts of the 8 provinces were participating in the PPM network and reported monthly malaria case data. This descriptive study documented the process of initiating and maintaining the PPM network in Lao PDR. Epidemiological data reported through the routine surveillance system from January 2009 to June 2016 were analyzed to illustrate the contribution of case reporting from the private sector. A total of 2,301,676 malaria tests were performed in the PPM districts, which included all the PPM pharmacies and clinics (176,224, 7.7%), proportion of patients tested from 14,102 (4.6%) in 2009 to 29,554 (10.4%) in 2015. Over the same period of 90 months, a total of 246,091 positive cases (10.7%) were detected in PPM pharmacies and clinics (33,565; 13.6%), in the same districts as the PPM sites. The results suggest that the PPM sites contributed to a significant increasing proportion of patients positive for malaria from 1687 (7.4%) in 2009 to 5697 (15.8%) in 2015. Ensuring adequate and timely supplies of RDTs and ACT to PPM sites is critical. Frequent refresher training is
Initialized Fractional Calculus

NASA Technical Reports Server (NTRS)

Lorenzo, Carl F.; Hartley, Tom T.

2000-01-01

This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.
Global Health Initiatives of the International Oncology Community.

PubMed

Al-Sukhun, Sana; de Lima Lopes, Gilberto; Gospodarowicz, Mary; Ginsburg, Ophira; Yu, Peter Paul

2017-01-01

Cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries (LMICs), where 60% of the world's total new cases are diagnosed. The challenge for effective control of cancer is multifaceted. It mandates integration of effective cancer prevention, encouraging early detection, and utilization of resource-adapted therapeutic and supportive interventions. In the resource-constrained setting, it becomes challenging to deliver each service optimally, and efficient allocation of resources is the best way to improve the outcome. This concept was translated into action through development of resource-stratified guidelines, pioneered by the Breast Health Global Initiative (BHGI), and later adopted by most oncology societies in an attempt to help physicians deliver the best possible care in a limited-resource setting. Improving outcome entails collaboration between key stakeholders, including the pharmaceutical industry, local and national health authorities, the World Health Organization (WHO), and other nonprofit, patient-oriented organizations. Therefore, we started to observe global health initiatives-led by ASCO, the Union for International Cancer Control (UICC), and the WHO-to address these challenges at the international level. This article discusses some of these initiatives.
A Case Study of "Empathetic Teaching Artistry"

ERIC Educational Resources Information Center

Risner, Doug

2014-01-01

This case study is one of twenty cases derived from Anderson and Risner's international study of teaching artists in dance, and theatre, which investigated participants' (n=172) artistic and academic preparation in dance, and theatre, initial entry into the teaching artist field, rewards, challenges, and obstacles in participants' work, artists'…
Creating an In-School Pastoral System for Student Teachers in School-Based Initial Teacher Education

ERIC Educational Resources Information Center

Philpott, Carey

2015-01-01

Recent developments in initial teacher education (ITE) have produced a number of school-centred models. These mean that student teachers may now spend more of their time in schools than has historically been the case. In some of these models, student teachers are more clearly part of the school as an institution than might be the case in more…
Pulmonary tularaemia: all that looks like cancer is not necessarily cancer - case report of four consecutive cases.

PubMed

Fachinger, Patrick; Tini, Gabrielo Mauro; Grobholz, Rainer; Gambazzi, Franco; Fankhauser, Hans; Irani, Sarosh

2015-03-26

Pulmonary tularaemia is a very rare disease with only a small number of cases described in the literature. So far, to our knowledge, there exists no case report of pulmonary tularaemia where PET-CT scans and follow up CT scans are available. We present four consecutive cases of pulmonary tularaemia. All patients suffered from non-specific symptoms. All patients were referred to our institution with strong suspicions of malignancy, particularly lung cancer. Diagnosis of tularaemia was made by typical findings in the aspirate of EBUS guided fine needle aspiration (necrosis, epithelioid cell aggregation) and surgical biopsy respectively, and a positive serology. In three of the four cases, the diagnosis was confirmed by positive PCR results of the tissue. PET-CT scans obtained in all four cases were indistinguishable from lesions typically seen in patients suffering from lung cancer. One of the four patients suffered from recurrence of the disease after antibiotic treatment; also this patient finally recovered after initiation of a second antibiotic regimen. One case became asymptomatic spontaneously, but this patient still received an antibiotic treatment. In one case, a follow up CT scan was unchanged compared to the initial PET-CT scan; in all other cases, the lesions disappeared almost completely. Symptoms of patients suffering from pulmonary tularaemia are non-specific and can be of prolonged character. PET-CT scans in these cases are indistinguishable from lung cancer. The diagnosis can be established when typical findings in EBUS guided fine needle aspirates or surgical biopsies are found in combination with a positive serology. In most cases the lesions disappear in follow up CT scans after clinically successful treatment.
14 CFR 399.62 - Target dates in hearing cases.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Target dates in hearing cases. 399.62... Target dates in hearing cases. (a) Applicability. This section applies to initial and recommended.... (b) Issuance of target dates. In cases to which this section applies, the Board or the administrative...
14 CFR 399.62 - Target dates in hearing cases.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Target dates in hearing cases. 399.62... Target dates in hearing cases. (a) Applicability. This section applies to initial and recommended.... (b) Issuance of target dates. In cases to which this section applies, the Board or the administrative...
14 CFR 399.62 - Target dates in hearing cases.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Target dates in hearing cases. 399.62... Target dates in hearing cases. (a) Applicability. This section applies to initial and recommended.... (b) Issuance of target dates. In cases to which this section applies, the Board or the administrative...
14 CFR 399.62 - Target dates in hearing cases.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Target dates in hearing cases. 399.62... Target dates in hearing cases. (a) Applicability. This section applies to initial and recommended.... (b) Issuance of target dates. In cases to which this section applies, the Board or the administrative...

14 CFR 399.62 - Target dates in hearing cases.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Target dates in hearing cases. 399.62... Target dates in hearing cases. (a) Applicability. This section applies to initial and recommended.... (b) Issuance of target dates. In cases to which this section applies, the Board or the administrative...
The Bring Your Own Technology Initiative: An Examination of Teachers' Adoption

ERIC Educational Resources Information Center

Cardoza, Yanet; Tunks, Jeanne

2014-01-01

This case study explored teachers' concerns, use, and actual practices in their adoption of the Bring Your Own Technology (BYOT) initiative. Participants were 12 secondary teachers in a private school setting. The Concerns-Based Adoption Model tools provided data: Stages of Concern Questionnaire (SoCQ), Levels of Use interview, and the Innovation…
Acute methaemoglobinaemia initially treated as organophosphate poisoning leading to atropine toxicity.

PubMed

Kakhandki, Srinivas; Yahya, Mohammed; Praveen, Mudalgi

2012-07-01

A case of unknown compound poisoning is presented. It was initially treated as organophosphate poisoning with lack of response. A timely diagnosis of acute methaemoglobinaemia and iatrogenic atropine toxicity was made based on clinical evaluation. Treatment of methaemoglobinaemia using oral methylene blue and of atropine toxicity with supportive measures could save the patient.
[Nutritional therapy in acute pancreatitis: a practical guide for the initial enteral nutritional support.].

PubMed

Gutiérrez-Salmeán, G; Peláez-Luna, M

2010-01-01

Nutritional support is a cornerstone in acute pancreatitis (AP) treatment, which is a catabolic state that can result in patient's nutritional depletion. First step in the management of AP is to asses its severity. Despite mild AP cases usually do not require nutritional support severe cases benefit from its early initiation. Total enteral nutrition (TEN) decreases the frequency of complications and is the preferred nutrition modality in AP. Availability of nutrition specialists is often limited and usually the primary care physician decides when and how to start nutritional support in AP. To perform a systematic review about nutritional support in AP and create a TEN guide to aid the non nutrition specialist involved in the treatment of AP patients. The search for eligible studies was carried out using the Pub Med and the National Library of Medicine electronic data bases. Controlled clinical trials, treatment guidelines and systematic review articles were selected. It is recommended to initiate nutritional support in AP cases that will be without oral intake longer than a week and TEN is the election modality. We created a TEN guide explaining how to choose and initiate TEN in AP. Early TEN improves AP prognosis and is the nutritional modality of choice in every AP patients that will remain without oral intake longer than a week.
Spectroscopic Detection of a Stellar-like Photosphere in an Accreting Protostar

NASA Technical Reports Server (NTRS)

Greene, Thomas P.; Lada, Charles J.; DeVincenzi, Donald L. (Technical Monitor)

2002-01-01

We present high-resolution (R is approximately equal to 18,000), high signal-to-noise 2 micron spectra of two luminous, X-ray flaring Class I protostars in the rho Ophiuchi cloud acquired with the NIRSPEC (near infrared spectrograph) of the Keck II telescope. We present the first spectrum of a highly veiled, strongly accreting protostar which shows photospheric absorption features and demonstrates the stellar nature of its central core. We find the spectrum of the luminous (L (sub bol) = 10 solar luminosity) protostellar source, YLW 15, to be stellar-like with numerous atomic and molecular absorption features, indicative of a K5 IV/V spectral type and a continuum veiling r(sub k) = 3.0. Its derived stellar luminosity (3 stellar luminosity) and stellar radius (3.1 solar radius) are consistent with those of a 0.5 solar mass pre-main-sequence star. However, 70% of its bolometric luminosity is due to mass accretion, whose rate we estimate to be 1.7 x 10(exp -6) solar masses yr(exp -1). We determine that excess infrared emission produced by the circumstellar accretion disk, the inner infalling envelope, and accretion shocks at the surface of the stellar core of YLW 15 all contribute significantly to its near-IR (infrared) continuum veiling. Its rotational velocity v sin i = 50 km s(exp -1) is comparable to those of flat-spectrum protostars but considerably higher than those of classical T Tauri stars in the rho Oph cloud. The protostar may be magnetically coupled to its circumstellar disk at a radius of 2 - 3 R(sub *). It is also plausible that this protostar can shed over half its angular momentum and evolve into a more slowly rotating classical T Tauri star by remaining coupled to its circumstellar disk (at increasing radius) as its accretion rate drops by an order of magnitude during the rapid transition between the Class I and Class II phases of evolution. The spectrum of WL 6 does not show any photospheric absorption features, and we estimate that its continuum
Initial experience with laparoscopic sleeve gastrectomy by a novice bariatric team in an established bariatric center--a review of literature and initial results.

PubMed

Dey, Ashish; Mittal, Tarun; Malik, Vinod K

2013-04-01

Laparoscopic sleeve gastrectomy (LSG) is a highly successful approach to morbid obesity with low incidence of complications. The literature suggests a learning curve of 50-100 cases for attaining proficiency and reducing the complication rates for laparoscopic bariatric surgery. The aims of this paper were to review the literature of initial cases by bariatric surgeons worldwide and to report the experience of initial 50 cases of LSG by a novice bariatric team in a single center. The objective was to evaluate the outcomes for laparoscopic bariatric surgery in the first 50 patients by a novice team of bariatric surgeons in an already established bariatric surgery program with short-term follow-up. All surgeries were done by a new bariatric team who underwent laparoscopic fellowship training under a bariatric team with an experience of over 600 bariatric procedures. Fifty consecutive patients from March 2010 to January 2012 were offered LSG and followed up for a minimum of 6 months. Weight loss and comorbidity resolution were tabulated and assessed. Mean preoperative and postoperative BMIs were 46.6 and 35.7 kg/m2, respectively. There were no life threatening postoperative complications or mortality. The median percent excess weight loss was 50.3% at the end of 6 months. Comorbidity resolution values were 96% for obstructive sleep apnea, 89% for diabetes mellitus, and 87% for joint pains, among the most common comorbidities. LSG is effective in achieving weight loss and in improving comorbidities with minimal complications even at the hands of novice bariatric surgeons with good laparoscopic skills and adequate bariatric training.
On crack initiation in notched, cross-plied polymer matrix composites

NASA Astrophysics Data System (ADS)

Yang, Q. D.; Schesser, D.; Niess, M.; Wright, P.; Mavrogordato, M. N.; Sinclair, I.; Spearing, S. M.; Cox, B. N.

2015-05-01

The physics of crack initiation in a polymer matrix composite are investigated by varying the modeling choices made in simulations and comparing the resulting predictions with high-resolution in situ images of cracks. Experimental data were acquired using synchrotron-radiation computed tomography (SRCT) at a resolution on the order of 1 μm, which provides detailed measurement of the location, shape, and size of small cracks, as well as the crack opening and shear displacements. These data prove sufficient to discriminate among competing physical descriptions of crack initiation. Simulations are executed with a high-fidelity formulation, the augmented finite element method (A-FEM), which permits consideration of coupled damage mechanisms, including both discrete cracks and fine-scale continuum damage. The discrete cracks are assumed to be nonlinear fracture events, governed by reasonably general mixed-mode cohesive laws. Crack initiation is described in terms of strength parameters within the cohesive laws, so that the cohesive law provides a unified model for crack initiation and growth. Whereas the cracks investigated are typically 1 mm or less in length, the fine-scale continuum damage refers to irreversible matrix deformation occurring over gauge lengths extending down to the fiber diameter (0.007 mm). We find that the location and far-field stress for crack initiation are predicted accurately only if the variations of local stress within plies and in the presence of stress concentrators (notches, etc.) are explicitly computed and used in initiation criteria; stress redistribution due to matrix nonlinearity that occurs prior to crack initiation is accounted for; and a mixed-mode criterion is used for crack initiation. If these factors are not all considered, which is the case for commonly used failure criteria, predictions of the location and far-field stress for initiation are not accurate.
Dengue Virus Type 4 Phylogenetics in Brazil 2011: Looking beyond the Veil

PubMed Central

de Souza, Renato Pereira; Rocco, Iray M.; Maeda, Adriana Y.; Spenassatto, Carine; Bisordi, Ivani; Suzuki, Akemi; Silveira, Vivian R.; Silva, Sarai J. S.; Azevedo, Roberta M.; Tolentino, Fernanda M.; Assis, Jaqueline C.; Bassi, Margarida G.; Dambrós, Bibiana P.; Tumioto, Gabriela L.; Gregianini, Tatiana S.; Souza, Luiza Terezinha M.; Timenetsky, Maria do Carmo S. T.; Santos, Cecília L. S.

2011-01-01

Dengue Fever and Dengue Hemorrhagic Fever are diseases affecting approximately 100 million people/year and are a major concern in developing countries. In the present study, the phylogenetic relationship of six strains of the first autochthonous cases of DENV-4 infection occurred in Sao Paulo State, Parana State and Rio Grande do Sul State, Brazil, 2011 were studied. Nucleotide sequences of the envelope gene were determined and compared with sequences representative of the genotypes I, II, III and Sylvatic for DEN4 retrieved from GenBank. We employed a Bayesian phylogenetic approach to reconstruct the phylogenetic relationships of Brazilian DENV-4 and we estimated evolutionary rates and dates of divergence for DENV-4 found in Brazil in 2011. All samples sequenced in this study were located in Genotype II. The studied strains are monophyletic and our data suggest that they have been evolving separately for at least 4 to 6 years. Our data suggest that the virus might have been present in the region for some time, without being noticed by Health Surveillance Services due to a low level of circulation and a higher prevalence of DENV-1 and DENV- 2. PMID:22216365
Electron-transfer reactions in cyanine borate ion pairs: photopolymerization initiators sensitive to visible light

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chatterjee, S.; Gottschalk, P.; Davis, P.D.

1988-03-30

Photoinitiation of polymerization is a process of immense practical, economic, and theoretical importance. In typical examples the polymerization of an acrylate or styrene-derived monomer is initiated by irradiation of a sensitizer with ultraviolet light. The excited state of the sensitizer may dissociate directly to form active free radicals as in the case of the benzoin ethers, or it may first undergo a bimolecular electron-transfer reaction whose products initiate polymerization as is the case in the benzophenone-dimethylaniline system. Efforts to extend the range of useful photoinitiators of free-radical polymerization to the visible region of the spectrum have heretofore met with onlymore » modest success. These special initiators typically are sensitive only to blue light or suffer from thermal instability and have low quantum efficiencies. The authors report herein the discovery that triphenylalkylborate salts of cyanine dyes (Chart I) are photoinitiators of free-radical polymerization whose sensitivity throughout the entire visible spectral region is the result of a novel intra-ion-pair electron-transfer reaction.« less
Fluoroscopic guide wire manipulation of malfunctioning peritoneal dialysis catheters initially placed by interventional radiologists.

PubMed

Kwon, Young Ho; Kwon, Se Hwan; Oh, Joo Hyeong; Jeong, Kyung Hwan; Lee, Tae Won

2014-06-01

To assess the efficacy of fluoroscopic guide wire manipulation in patients with malfunctioning peritoneal dialysis (PD) catheters that were initially placed by interventional radiologists under fluoroscopic guidance. From January 2002 to April 2012, 52 patients (mean age, 52.8 y ± 2.10s; range, 12-79 y) with malfunctioning PD catheters in whom fluoroscopic guide wire manipulation was performed were retrospectively reviewed. Technical success, clinical success, and complications were evaluated. Technical success was defined as fluoroscopically verified, successful catheter repositioning and adequate dialysate drainage after the procedure. Clinical success was defined as maintenance of PD catheter function for at least 30 days after the manipulation. During the study period, 72 manipulations (68 initial manipulations and 4 remanipulations) for malfunctioning PD catheters were done. The technical success rate was 74% (50 of 68) for initial manipulations and 75% (3 of 4) for remanipulations. The overall clinical success rate was 47% (32 of 68) for initial manipulations and 0% (0 of 4) for remanipulations. The primary causes of catheter malfunction were extraluminal obstruction by omental wrapping or adhesions in 43 of 68 cases (63.2%) and catheter malposition in 25 of 68 (36.8%) cases. There were no procedure-related major complications. Fluoroscopic guide wire manipulation in patients with malfunctioning PD catheters initially placed by interventional radiologists is a simple procedure, an effective way of prolonging PD catheter life, and a recommended procedure before invasive surgical procedures. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.
Myotonic Dystrophy Initially Presenting as Tachycardiomyopathy Successful Catheter Ablation of Atrial Flutter

PubMed Central

Asbach, S.; Gutleben, K. J.; Dahlem, P.; Brachmann, J.; Nölker, G.

2010-01-01

Myotonic dystrophy is a genetic muscular disease that is frequently associated with cardiac arrhythmias. Bradyarrhythmias, such as sinus bradycardia and atrioventricular block, are more common than tachyarrhythmias. Rarely, previously undiagnosed patients with myotonic dystrophy initially present with a tachyarrhythmia. We describe the case of a 14-year-old boy, who was admitted to the hospital with clinical signs and symptoms of decompensated heart failure and severely reduced left ventricular function. Electrocardiography showed common-type atrial flutter with 2 : 1 conduction resulting in a heart rate of 160 bpm. Initiation of medical therapy for heart failure as well as electrical cardioversion led to a marked clinical improvement. Catheter ablation of atrial flutter was performed to prevent future cardiac decompensations and to prevent development of tachymyopathy. Left ventricular function normalized during followup. Genetic analysis confirmed the clinical suspicion of myotonic dystrophy as known in other family members in this case. PMID:20871860
Introduction: the Interdisciplinary Nursing Quality Research Initiative.

PubMed

Naylor, Mary D; Lustig, Adam; Kelley, Heather J; Volpe, Ellen M; Melichar, Lori; Pauly, Mark V

2013-04-01

The Robert Wood Johnson Foundation launched the Interdisciplinary Nursing Quality Research Initiative (INQRI) program in 2005 to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality. This special edition of Medical Care provides an overview of the program's strategy, goals, and impact, highlighting cross-cutting issues addressed by the initiative. INQRI's leadership and select grantees discuss the implications of a collection of studies on the following: advances in the science of nursing's contribution to quality, measurement of quality, interdisciplinary collaboration, implementation methodology, dissemination and translation of findings, and the business case for nursing. A comprehensive review of the scholarly literature published in 2004 and 2009 found that the evidence linking nursing to quality of care has grown. The second paper discusses INQRI's work on measurement of quality of care, revealing the need for additional comprehensive measures. The third paper examines INQRI's focus on interdisciplinary collaboration, finding that it can enhance methodological approaches and result in substantive changes in health delivery systems. The fourth paper presents methodological challenges faced in health care implementation, emphasizing the need for standardized terms and research designs. The fifth paper addresses INQRI's commitment to translating research into practice, illustrating dissemination strategies and lessons learned. The final paper discusses how the INQRI program has contributed to the current evidence regarding the business case for nursing. This supplement describes the accomplishments of the INQRI program, discusses current issues in research design and implementation, and places INQRI research within the larger context regarding advances in nursing science.
A protocol for the retina surgeon's safe initial intravitreal injections.

PubMed

Frenkel, Ronald E P; Haji, Shamim A; La, Melvin; Frenkel, Max P C; Reyes, Angela

2010-11-10

To determine the safety of a surgeon's initial consecutive intravitreal injections using a specific protocol and to review the complications that may be attributed to the injection procedure. A retrospective chart review. Fifty-nine patients (30 females, 29 males) received intravitreal injections of pegaptanib, bevacizumab, or ranibizumab as part of their treatment for neovascular age-related macular degeneration. The average patient age was 80 years. Twenty-two patients were diagnosed with or suspected of having glaucoma. Each patient received an average of 5.8 injections. The charts of 59 patients who received a total of 345 intravitreal injections (104 pegaptanib, 74 bevacizumab, 167 ranibizumab) were reviewed. All injections were performed in an office-based setting. Povidone-iodine, topical antibiotics, and eye speculum were used as part of the pre injection procedure. Vision and intraocular pressure were evaluated immediately following each injection. Incidence of post injection complications, including but not limited to endophthalmitis, retinal detachment, traumatic cataract, and vitreous hemorrhage. There were no cases of endophthalmitis, toxic reactions, traumatic cataracts, retinal detachment, or vitreous hemorrhage. There was one case each of lid swelling, transient floaters, retinal pigment epithelial tear, corneal edema, and corneal abrasion. There were five cases of transient no light perception following pegaptanib injections. The incidence of serious complications was very low for the intravitreal injections given. A surgeon's initial intravitreal injections may be performed with a very high degree of safety using this protocol.
Using causal loop diagrams for the initialization of stakeholder engagement in soil salinity management in agricultural watersheds in developing countries: a case study in the Rechna Doab watershed, Pakistan.

PubMed

Inam, Azhar; Adamowski, Jan; Halbe, Johannes; Prasher, Shiv

2015-04-01

Over the course of the last twenty years, participatory modeling has increasingly been advocated as an integral component of integrated, adaptive, and collaborative water resources management. However, issues of high cost, time, and expertise are significant hurdles to the widespread adoption of participatory modeling in many developing countries. In this study, a step-wise method to initialize the involvement of key stakeholders in the development of qualitative system dynamics models (i.e. causal loop diagrams) is presented. The proposed approach is designed to overcome the challenges of low expertise, time and financial resources that have hampered previous participatory modeling efforts in developing countries. The methodological framework was applied in a case study of soil salinity management in the Rechna Doab region of Pakistan, with a focus on the application of qualitative modeling through stakeholder-built causal loop diagrams to address soil salinity problems in the basin. Individual causal loop diagrams were developed by key stakeholder groups, following which an overall group causal loop diagram of the entire system was built based on the individual causal loop diagrams to form a holistic qualitative model of the whole system. The case study demonstrates the usefulness of the proposed approach, based on using causal loop diagrams in initiating stakeholder involvement in the participatory model building process. In addition, the results point to social-economic aspects of soil salinity that have not been considered by other modeling studies to date. Copyright © 2015 Elsevier Ltd. All rights reserved.
The Logistics of Implementing a Field-Based Comprehensive School Reform Initiative

ERIC Educational Resources Information Center

Reeves, Dawn E.

2014-01-01

This research is a qualitative, reflective case study regarding a cohort in the form of a district-university partnership between the Oak Park Schools in Oak Park, Michigan and the College of Education at Western Michigan University in Kalamazoo, Michigan. The initiators of the program envisioned a more successful urban school district by offering…
Case reports: alopecia universalis: hair growth following initiation of simvastatin and ezetimibe therapy.

PubMed

Robins, Douglas N

2007-09-01

Alopecia areata is an organ specific autoimmune disease in which hair is lost in various patterns. Its most extreme form, alopecia universalis, is the total loss of all scalp and body hair. This form of the condition is very resistant to treatment and spontaneous remission is quite rare. The following is a case of a 54-year-old male with longstanding alopecia universalis who began to grow dense hair on his scalp as well as patchy hair growth on his face, pubic and axillary areas one month after starting a course of simvastatin 40 mg and ezetimibe 10 mg daily prescribed for his hyperlipidemia. For 2 years prior to starting the combination drug, he had taken simvastatin 40 mg alone without evidence of any hair growth. The combination of simvastatin and ezetimibe has previously demonstrated synergistic immunomodulatory effects, which most likely accounts for the clinical response in this case.
Initial data for high-compactness black hole-neutron star binaries

NASA Astrophysics Data System (ADS)

Henriksson, Katherine; Foucart, François; Kidder, Lawrence E.; Teukolsky, Saul A.

2016-05-01

For highly compact neutron stars, constructing numerical initial data for black hole-neutron star binary evolutions is very difficult. We describe improvements to an earlier method that enable it to handle these more challenging cases. These improvements were found by invoking a general relaxation principle that may be helpful in improving robustness in other initial data solvers. We examine the case of a 6:1 mass ratio system in inspiral close to merger, where the star is governed by a polytropic {{Γ }}=2, an SLy, or an LS220 equation of state (EOS). In particular, we are able to obtain a solution with a realistic LS220 EOS for a star with compactness 0.26 and mass 1.98 M ⊙, which is representative of the highest reliably determined neutron star masses. For the SLy EOS, we can obtain solutions with a comparable compactness of 0.25, while for a family of polytropic equations of state, we obtain solutions with compactness up to 0.21, the largest compactness that is stable in this family. These compactness values are significantly higher than any previously published results.
National Enforcement Initiative: Keeping Raw Sewage and Contaminated Stormwater Out of Our Nation's Waters

EPA Pesticide Factsheets

This page describes EPA's enforcement activities on water pollution from raw sewage and contaminated stormwater. This is one of EPA's National Enforcement Initiatives. Both enforcement cases, and a map of enforcement actions are provided.
Patterns of initial management of node-negative breast cancer in two Canadian provinces

PubMed Central

Goel, V; Olivotto, I; Hislop, T G; Sawka, C; Coldman, A; Holowaty, E J

1997-01-01

OBJECTIVE: To describe the patterns of initial management of node-negative breast cancer in Ontario and British Columbia and to compare the characteristics of the patients and tumours and of the physicians and hospitals involved in management. DESIGN: Retrospective, population-based, cohort study. PARTICIPANTS: All 942 newly diagnosed cases of node-negative breast cancer in 1991 in British Columbia and a random sample of 938 newly diagnosed cases in Ontario in the same year. OUTCOME MEASURES: Number and proportion of patients with newly diagnosed node-negative breast cancer who received breast-conserving surgery (BCS) or mastectomy and who received radiation therapy after BCS. RESULTS: BCS was used in 413 cases (43.8%) in British Columbia and in 634 cases (67.6%) in Ontario (p < 0.001). After BCS, radiation therapy was received by 378 patients (91.5% of those who had undergone BCS) in British Columbia and 479 patients (75.6% of those who had undergone BCS) in Ontario (p < 0.001). In both provinces, lower patient age, smaller tumour size, a noncentral unifocal tumour, absence of extensive ductal carcinoma in situ and initial surgery by a surgeon with an academic affiliation were associated with greater use of BCS. Lower patient age and larger tumour size were associated with greater use of radiation therapy after BCS in both provinces. CONCLUSION: Patient, tumour and physician factors are associated with the choice of initial management of breast cancer in these two Canadian provinces. However, the differences in management between the two provinces are only partly explained by these factors. Other possible explanations, such as the presence of provincial guidelines, differences in the organization of the health care system or differences in patient preference, require further research. PMID:9006561
Short initial length quench on CICC of ITER TF coils

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nicollet, S.; Ciazynski, D.; Duchateau, J.-L.

Previous quench studies performed for the International Thermonuclear Experimental Reactor (ITER) Toroidal Field (TF) Coils have led to identify two extreme families of quench: first 'severe' quenches over long initial lengths in high magnetic field, and second smooth quenches over short initial lengths in low field region. Detailed analyses and results on smooth quench propagation and detectability on one TF Cable In Conduit Conductor (CICC) with a lower propagation velocity are presented here. The influence of the initial quench energy is shown and results of computations with either a Fast Discharge (FD) of the magnet or without (failure of themore » voltage quench detection system) are reported. The influence of the central spiral of the conductor on the propagation velocity is also detailed. In the cases of a regularly triggered FD, the hot spot temperature criterion of 150 K (with helium and jacket) is fulfilled for an initial quench length of 1 m, whereas this criterion is exceed (Tmax ≈ 200 K) for an extremely short length of 5 cm. These analyses were carried out using both the Supermagnet(trade mark, serif) and Venecia codes and the comparisons of the results are also discussed.« less

Recognition and treatment of Alzheimer's disease: a case-based review.

PubMed

Marseille, Dana M; Silverman, Daniel H S

2006-01-01

Early recognition and treatment initiation are pivotal in managing Alzheimer's disease (AD). Once a diagnosis of AD is made, a treatment plan is developed and should include treatment initiation with cholinesterase inhibitors (ChEIs) to improve cognition, management of comorbid conditions, and treat behavioral symptoms. Caregiver compliance is integral to AD treatment success. The purpose of this report is to present two real case studies of "suspected" AD or related dementia and stress the significance of early and accurate diagnosis in disease management. In case 1, a caregiver reports gradual but progressive loss of memory, and the patient himself complains of memory impairment. Neuroimaging analysis confirms "typical " AD. In case 2, initiation of ChEI therapy is followed by substantial clinical improvement in the face of a complex medical picture, and neuroimaging revealing more neurodegenerative changes than could be accounted for by "pure" AD.
Hemichorea-hemiballismus as an initial manifestation in a Moroccan patient with acquired immunodeficiency syndrome and toxoplasma infection: a case report and review of the literature

PubMed Central

Rabhi, Samira; Amrani, Kawthar; Maaroufi, Mustapha; Khammar, Zineb; Khibri, Hajar; Ouazzani, Maha; Berrady, Rhizlane; Tizniti, Siham; Messouak, Ouafae; Belahsen, Faouzy; Bono, Wafaa

2011-01-01

Neurologic signs and symptoms may represent the initial presentation of AIDS in 10-30% of patients. Movement disorders may be the result of direct central nervous system infection by human immunodeficiency virus (HIV) or the result of opportunistic infections. We report the case of a 59 years old woman who had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection revealing HIV infection. Movement disorders, headache and nausea were resolved after two weeks of antitoxoplasmic treatment. Brain MRI control showed a marked resolution of cerebral lesion. Occurrence of hemichorea-ballismus in patient without familial history of movement disorders suggests a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Early recognition is important since it is a treatable entity. PMID:22187591
Hemichorea-hemiballismus as an initial manifestation in a Moroccan patient with acquired immunodeficiency syndrome and toxoplasma infection: a case report and review of the literature.

PubMed

Rabhi, Samira; Amrani, Kawthar; Maaroufi, Mustapha; Khammar, Zineb; Khibri, Hajar; Ouazzani, Maha; Berrady, Rhizlane; Tizniti, Siham; Messouak, Ouafae; Belahsen, Faouzy; Bono, Wafaa

2011-01-01

Neurologic signs and symptoms may represent the initial presentation of AIDS in 10-30% of patients. Movement disorders may be the result of direct central nervous system infection by human immunodeficiency virus (HIV) or the result of opportunistic infections. We report the case of a 59 years old woman who had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection revealing HIV infection. Movement disorders, headache and nausea were resolved after two weeks of antitoxoplasmic treatment. Brain MRI control showed a marked resolution of cerebral lesion. Occurrence of hemichorea-ballismus in patient without familial history of movement disorders suggests a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Early recognition is important since it is a treatable entity.
[Clinical analysis of 16 cases frontal, ethmoid sinus cyst with eye symptoms as initial amount].

PubMed

Zhao, Ying; Sun, Yijun; Yang, Lihui; Jia, Wenxue; Wang, Lijun

2013-11-01

To investigate the diagnosis of frontal, ethmoid sinus cyst with eye symptoms as initial amount,and the curative effect of nasal endoscopic operation. To retrospectively analyze clinical data of sixteen patients with frontal, ethmoid sinus cyst from February 2006 to March 2008. Diagnostic accordance rate of paranasal sinus MRI and CT examination In 16 patients is 100%. Fourteen patients' ocular symptoms disappeared after nasal endoscope operation treatment, two of them improved. None of them recurrened after the fol low-up 3-6 years up to now, all the patients had satisfactory curative effect. Paranasal sinuses and or bital cavity have close relationship , patients with sinus lesions always firstly visit Ophthalmology doctor. The results of MRI and CT examination are of great value for diagnosis. Patients with frontal, ethmoid sinus cyst with eye symptoms as initial amount should be early diagnosed. The treatment of nasal endoscope operation is safe, effective and is worth of firstly chosen.
Development of the community midwifery education initiative and its influence on women's health and empowerment in Afghanistan: a case study.

PubMed

Speakman, Elizabeth M; Shafi, Ahmad; Sondorp, Egbert; Atta, Nooria; Howard, Natasha

2014-09-15

Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants--particularly in rural areas--hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005. This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson's policy triangle framework. The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society. CME is considered by stakeholders to be a positive model for promoting women's education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan.
Reduction of initial shock in decadal predictions using a new initialization strategy

NASA Astrophysics Data System (ADS)

He, Yujun; Wang, Bin

2017-04-01

Initial shock is a well-known problem occurring in the early years of a decadal prediction when assimilating full-field observations into a coupled model, which directly affects the prediction skill. For the purpose to alleviate this problem, we propose a novel full-field initialization method based on dimension-reduced projection four-dimensional variational data assimilation (DRP-4DVar). Different from the available solution strategies including anomaly assimilation and bias correction, it substantially reduces the initial shock through generating more consistent initial conditions for the coupled model, which, along with the model trajectory in one-month windows, best fit the monthly mean analysis data of oceanic temperature and salinity. We evaluate the performance of initialized hindcast experiments according to three proposed indices to measure the intensity of the initial shock. The results indicate that this strategy can obviously reduce the initial shock in decadal predictions by FGOALS-g2 (the Flexible Global Ocean-Atmosphere-Land System model, Grid-point Version 2) compared with the commonly-used nudging full-field initialization for the same model as well as the different full-field initialization strategies for other CMIP5 (the fifth phase of the Coupled Model Intercomparison Project) models whose decadal prediction results are available. It is also comparable to or even better than the anomaly initialization methods. Better hindcasts of global mean surface air temperature anomaly are obtained due to the reduction of initial shock by the new initialization scheme.
A debate on the certainty of etiology in a case of syncope.

PubMed

Dan, Anca Rodica; Daha, Ioana; Buzea, C A; Dan, G A

2013-01-01

We present the case of a 47-year-old woman with reccurent syncope. The investigations for establishing the etiology of syncope were extended over 4 years and multiple possible mecahisms for the syncope were identified. Even if the guidelines mention a good diagnostic yield for history and initial evaluation, for some selected cases the initial diagnostic supposition should be revised.
Examining the Role of Leadership in an Undergraduate Biology Institutional Reform Initiative

ERIC Educational Resources Information Center

Matz, Rebecca L.; Jardeleza, Sarah E.

2016-01-01

Undergraduate science, technology, engineering, and mathematics (STEM) education reform continues to be a national priority. We studied a reform process in undergraduate biology at a research-intensive university to explore what leadership issues arose in implementation of the initiative when characterized with a descriptive case study method. The…
Utilization of VAS satellite data in the initialization of an oceanic cyclogenesis simulation

NASA Technical Reports Server (NTRS)

Douglas, Sharon G.; Warner, Thomas T.

1987-01-01

A series of experiments was performed to test various methods of incorporating Visible Infrared Spin Scan Radiometer Atmospheric Sounder (VAS)-sounding data into the initial conditions of the Penn State University/National Center for Atmospheric mesoscale model. The VAS data for this ocean-cyclogenesis case consist of 110 irregularly distributed temperature and humidity soundings located over the North Pacific Ocean and apply at approximately 1200 GMT November 10, 1981. Various methods of utilizing VAS data in the initial condition of a mesoscale model were evaluated.
Utilization of VAS satellite data in the initialization of an oceanic-cyclogenesis simulation

NASA Technical Reports Server (NTRS)

Douglas, Sharon G.; Warner, Thomas T.

1986-01-01

A series of experiments was performed to test various method of incorporating Visible Infrared Spin Scan Radiometer Atmospheric Sounder (VAS)-sounding data into the initial conditions of the Penn State University/National Center for Atmospheric mesoscale model. The VAS data for this ocean-cyclogenesis case consist of 110 irregularly distributed temperature and humidity soundings located over the North Pacific Ocean and apply at approximately 1200 GMT 10 November 1981. Various methods of utilizing VAS data in the initial condition of a mesoscale model were evaluated.
LSD Flashbacks - The Appearance of New Visual Imagery Not Experienced During Initial Intoxication: Two Case Reports.

PubMed

G Lerner, Arturo; Goodman, Craig; Rudinski, Dmitri; Lev-Ran, Shaul

2014-01-01

A side effect associated with the use of synthetic hallucinogens such as lysergic acid diethylamide-(LSD) is the partial or total recurrence of perceptual disturbances which previously appeared during intoxication, despite absence of recent use. These are commonly referred to as "flashbacks" or Hallucinogen Persisting Perception Disorder (HPPD). Here we present two cases of patients with a prior history of LSD use who turned to psychiatric consultation following brief episodes of HPPD. Surprisingly, in both cases new visual imagery appeared during episodes of flashbacks which was not experienced during primary LSD use. Both subjects reported the ability to discern between LSD-associated visual disturbances and new visual imagery. This phenomenon did not cause functional impairment and in both cases caused gradual concern due to its persistence. Both patients refused medical treatment and continued psychiatric follow-up. At one year follow-up both patients reported almost complete spontaneous remission. To the best of our knowledge these are the first reported cases of LSD-related benign flashbacks in which new imagery is experienced. Reasons for this reversible and apparently harmless side effect are proposed. Conclusions from case reports should be taken with caution.
The quality of metabolic pathway resources depends on initial enzymatic function assignments: a case for maize

DOE PAGES

Walsh, Jesse R.; Schaeffer, Mary L.; Zhang, Peifen; ...

2016-11-29

As metabolic pathway resources become more commonly available, researchers have unprecedented access to information about their organism of interest. Despite efforts to ensure consistency between various resources, information content and quality can vary widely. Two maize metabolic pathway resources for the B73 inbred line, CornCyc 4.0 and MaizeCyc 2.2, are based on the same gene model set and were developed using Pathway Tools software. These resources differ in their initial enzymatic function assignments and in the extent of manual curation. Here, we present an in-depth comparison between CornCyc and MaizeCyc to demonstrate the effect of initial computational enzymatic function assignmentsmore » on the quality and content of metabolic pathway resources.« less
The quality of metabolic pathway resources depends on initial enzymatic function assignments: a case for maize

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walsh, Jesse R.; Schaeffer, Mary L.; Zhang, Peifen

As metabolic pathway resources become more commonly available, researchers have unprecedented access to information about their organism of interest. Despite efforts to ensure consistency between various resources, information content and quality can vary widely. Two maize metabolic pathway resources for the B73 inbred line, CornCyc 4.0 and MaizeCyc 2.2, are based on the same gene model set and were developed using Pathway Tools software. These resources differ in their initial enzymatic function assignments and in the extent of manual curation. Here, we present an in-depth comparison between CornCyc and MaizeCyc to demonstrate the effect of initial computational enzymatic function assignmentsmore » on the quality and content of metabolic pathway resources.« less
Case and Administrative Support Tools

EPA Pesticide Factsheets

Case and Administrative Support Tools (CAST) is the secure portion of the Office of General Counsel (OGC) Dashboard business process automation tool used to help reduce office administrative labor costs while increasing employee effectiveness. CAST supports business functions which rely on and store Privacy Act sensitive data (PII). Specific business processes included in CAST (and respective PII) are: -Civil Rights Cast Tracking (name, partial medical history, summary of case, and case correspondance). -Employment Law Case Tracking (name, summary of case). -Federal Tort Claims Act Incident Tracking (name, summary of incidents). -Ethics Program Support Tools and Tracking (name, partial financial history). -Summer Honors Application Tracking (name, home address, telephone number, employment history). -Workforce Flexibility Initiative Support Tools (name, alternative workplace phone number). -Resource and Personnel Management Support Tools (name, partial employment and financial history).
Initial resident refractive surgical experience: outcomes of PRK and LASIK for myopia.

PubMed

Wagoner, Michael D; Wickard, Joseph C; Wandling, George R; Milder, Lisa C; Rauen, Matthew P; Kitzmann, Anna S; Sutphin, John E; Goins, Kenneth M

2011-03-01

To evaluate and compare the outcome of initial resident surgical experience with photorefractive keratectomy (PRK) and LASIK. Retrospective review of all cases performed with the VISX Star S4 platform (Abbott Medical Optics) between July 1, 2003 and June 30, 2007. Inclusion criteria were spherical equivalent of -0.50 to -10.00 diopters (D), refractive astigmatic error of ≤3.00 D, intention to provide full distance correction, and minimum 3-month postoperative follow-up after initial ablation or retreatment (if performed). A total of 153 cases performed by 20 different residents met the inclusion criteria; 38 eyes underwent PRK and 115 eyes had LASIK. After initial treatment, mean Snellen uncorrected distance visual acuity (UDVA) after PRK was 20/17.3 and after LASIK was 20/19.5. Photorefractive keratectomy was associated with a significantly better approximation between preoperative corrected distance visual acuity (CDVA) and postoperative UDVA (ΔlogMAR 0.009 vs 0.091; P=.004) and a greater percentage of eyes that achieved UDVA of 20/20 or better (94.7% vs 78.3%; P=.02) or 20/30 or better (100% vs 87.8%; P=.02). There was a higher prevalence of retreatment in eyes that underwent LASIK (7.0% vs 0%; P=.20). One (0.9%) eye lost 2 lines of CDVA after LASIK. Supervised refractive surgery residents can achieve excellent visual outcomes in patients operated during their initial refractive experience. Photorefractive keratectomy was associated with better visual outcome than LASIK. Copyright 2011, SLACK Incorporated.
Lumbosacral Radiculoplexopathy as the Initial Presentation of Lymphoma: A Report of 4 Cases.

PubMed

Marquardt, Robert J; Li, Yuebing

2018-06-01

To evaluate the clinical, laboratory, and radiological features of 4 cases of biopsy-proven lymphomatous lumbosacral radiculoplexopathy. Retrospective chart review. All patients suffered from diffuse large B-cell lymphoma. A mean diagnostic delay of 10 months was encountered. Presenting symptoms in all 4 patients included back pain, radicular leg pain, and leg weakness, similar to spondylotic radiculopathy. Electrodiagnostic study showed axon loss radiculoplexopathy and magnetic resonance imaging of the lumbar spine or pelvis demonstrated nerve or nerve root enhancement. Increased uptake by lumbosacral roots/plexus on fluorodeoxyglucose-positron emission tomography aided diagnosis in 3 cases. Cytology was positive in 1 of 10 cerebrospinal fluid samples. Combined chemotherapy and radiation treatment led to clinicoradiological improvement, with residual neurological symptoms in all patients. Lymphomatous lumbosacral radiculoplexopathy should be considered in patients with progressive lumbosacral radicular symptoms. Magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography, but not cerebrospinal fluid, are helpful in achieving early diagnosis. Treatment responses seem favorable.
Description and evaluation of an initiative to develop advanced practice nurses in mainland China.

PubMed

Wong, Frances Kam Yuet; Peng, Gangyi; Kan, Eva C; Li, Yajie; Lau, Ada T; Zhang, Liying; Leung, Annie F; Liu, Xueqin; Leung, Vilna O; Chen, Weiju; Li, Ming

2010-05-01

This paper describes an initiative to develop Advanced Practice Nurses (APNs) in mainland China and evaluation of the outcomes of the described programme. The pioneer project was an APN postgraduate programme involving 38 students conducted in Guangzhou, China during 2004-2005. Data related to curriculum content and process, student performance, self-reported competence and programme effects were collected. Quantitative data such as demographic data, student performance were analysed using descriptive statistics and the pre and post self-reported practice of competence was compared using chi-square test. Qualitative data such as case reports and interviews were examined using thematic analyses. Reflective journals and case studies revealed the attributes of APNs in managing clinical cases at advanced level, applying theory into practice and exercising evidence-based practice. The relatively modest self-reported practice of competence suggested that the graduates were novice APNs and needed continued development after the completion of the programme. This study reports the experience of an initiative in China and suggests a useful curriculum framework for educating APNs. Copyright 2009 Elsevier Ltd. All rights reserved.
Comparing U.S. Army suicide cases to a control sample: initial data and methodological lessons.

PubMed

Alexander, Cynthia L; Reger, Mark A; Smolenski, Derek J; Fullerton, Nicole R

2014-10-01

Identification of risk and protective factors for suicide is a priority for the United States military, especially in light of the recent steady increase in military suicide rates. The Department of Defense Suicide Event Report contains comprehensive data on suicides for active duty military personnel, but no analogous control data is available to permit identification of factors that differentially determine suicide risk. This proof-of-concept study was conducted to determine the feasibility of collecting such control data. The study employed a prospective case-control design in which control cases were randomly selected from a large Army installation at a rate of four control participants for every qualifying Army suicide. Although 111 Army suicides were confirmed during the study period, just 27 control soldiers completed the study. Despite the small control sample, preliminary analyses comparing suicide cases to controls identified several factors more frequently reported for suicide cases, including recent failed intimate relationships, outpatient mental health history, mood disorder diagnosis, substance abuse history, and prior self-injury. No deployment-related risk factors were found. These data are consistent with existing literature and form a foundation for larger control studies. Methodological lessons learned regarding study design and recruitment are discussed to inform future studies. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.
Northern peatland initiation lagged abrupt increases in deglacial atmospheric CH4

PubMed Central

Reyes, Alberto V.; Cooke, Colin A.

2011-01-01

Peatlands are a key component of the global carbon cycle. Chronologies of peatland initiation are typically based on compiled basal peat radiocarbon (14C) dates and frequency histograms of binned calibrated age ranges. However, such compilations are problematic because poor quality 14C dates are commonly included and because frequency histograms of binned age ranges introduce chronological artefacts that bias the record of peatland initiation. Using a published compilation of 274 basal 14C dates from Alaska as a case study, we show that nearly half the 14C dates are inappropriate for reconstructing peatland initiation, and that the temporal structure of peatland initiation is sensitive to sampling biases and treatment of calibrated 14C dates. We present revised chronologies of peatland initiation for Alaska and the circumpolar Arctic based on summed probability distributions of calibrated 14C dates. These revised chronologies reveal that northern peatland initiation lagged abrupt increases in atmospheric CH4 concentration at the start of the Bølling–Allerød interstadial (Termination 1A) and the end of the Younger Dryas chronozone (Termination 1B), suggesting that northern peatlands were not the primary drivers of the rapid increases in atmospheric CH4. Our results demonstrate that subtle methodological changes in the synthesis of basal 14C ages lead to substantially different interpretations of temporal trends in peatland initiation, with direct implications for the role of peatlands in the global carbon cycle. PMID:21368146
Northern peatland initiation lagged abrupt increases in deglacial atmospheric CH4.

PubMed

Reyes, Alberto V; Cooke, Colin A

2011-03-22

Peatlands are a key component of the global carbon cycle. Chronologies of peatland initiation are typically based on compiled basal peat radiocarbon (14C) dates and frequency histograms of binned calibrated age ranges. However, such compilations are problematic because poor quality 14C dates are commonly included and because frequency histograms of binned age ranges introduce chronological artefacts that bias the record of peatland initiation. Using a published compilation of 274 basal 14C dates from Alaska as a case study, we show that nearly half the 14C dates are inappropriate for reconstructing peatland initiation, and that the temporal structure of peatland initiation is sensitive to sampling biases and treatment of calibrated 14C dates. We present revised chronologies of peatland initiation for Alaska and the circumpolar Arctic based on summed probability distributions of calibrated 14C dates. These revised chronologies reveal that northern peatland initiation lagged abrupt increases in atmospheric CH4 concentration at the start of the Bølling-Allerød interstadial (Termination 1A) and the end of the Younger Dryas chronozone (Termination 1B), suggesting that northern peatlands were not the primary drivers of the rapid increases in atmospheric CH4. Our results demonstrate that subtle methodological changes in the synthesis of basal 14C ages lead to substantially different interpretations of temporal trends in peatland initiation, with direct implications for the role of peatlands in the global carbon cycle.

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