[The work of the intensive care nurse: a study on the social representations structure].

PubMed

Silva, Iranete Almeida Sousa; da Cruz, Enêde Andrade

2008-09-01

This study aims at characterizing the social representations of the nurse in the intensive care unit (ICU) by identifying the central core and the peripheral system. It was carried out in five ICUs from both public and philanthropic teaching, research and assistance hospitals in Salvador (Bahia, Brazil). Data were gathered from ninety nurses by means of free evocation from the phrase: nurse's work in an ICU and then processed with the EVOC software. Analysis was performed by building a four-digit chart based on the structural approach to the theory of social representations. Results point out stress, responsibility, integral care and gratification as the core elements. The peripheral system comprised personal and professional attitudes deemed necessary to perform the work. Therefore, it could be concluded that stress and responsible work are relieved by the gratifying feeling of providing integral care, which demands a range of personal and professional attitudes.

The Process and Impact of Stakeholder Engagement in Developing a Pediatric Intensive Care Unit Communication and Decision-Making Intervention.

PubMed

Michelson, Kelly N; Frader, Joel; Sorce, Lauren; Clayman, Marla L; Persell, Stephen D; Fragen, Patricia; Ciolino, Jody D; Campbell, Laura C; Arenson, Melanie; Aniciete, Danica Y; Brown, Melanie L; Ali, Farah N; White, Douglas

2016-12-01

Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.

The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations

PubMed Central

Hawthorne, Margaret; LaNoue, Marianna; Brenner, Jeffrey

2016-01-01

Abstract In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of “authentic healing relationships” in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core elements of the authentic healing relationship—security, genuineness, and continuity—a relationship that is linked to patient motivation and active health management. Although not readily found in the traditional health care delivery system, these authentic healing relationships present significant implications for addressing the persistent health-related needs of patients with frequent hospitalizations. (Population Health Management 2016;19:248–256) PMID:26565379

Trauma-informed juvenile justice systems: A systematic review of definitions and core components.

PubMed

Branson, Christopher Edward; Baetz, Carly Lyn; Horwitz, Sarah McCue; Hoagwood, Kimberly Eaton

2017-11-01

The U.S. Department of Justice has called for the creation of trauma-informed juvenile justice systems in order to combat the negative impact of trauma on youth offenders and frontline staff. Definitions of trauma-informed care have been proposed for various service systems, yet there is not currently a widely accepted definition for juvenile justice. The current systematic review examined published definitions of a trauma-informed juvenile justice system in an effort to identify the most commonly named core elements and specific interventions or policies. A systematic literature search was conducted in 10 databases to identify publications that defined trauma-informed care or recommended specific practices or policies for the juvenile justice system. We reviewed 950 unique records, of which 10 met criteria for inclusion. The 10 publications included 71 different recommended interventions or policies that reflected 10 core domains of trauma-informed practice. We found 8 specific practice or policy recommendations with relative consensus, including staff training on trauma and trauma-specific treatment, while most recommendations were included in 2 or less definitions. The extant literature offers relative consensus around the core domains of a trauma-informed juvenile justice system, but much less agreement on the specific practices and policies. A logical next step is a review of the empirical research to determine which practices or policies produce positive impacts on outcomes for youth, staff, and the broader agency environment, which will help refine the core definitional elements that comprise a unified theory of trauma-informed practice for juvenile justice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Person-Centredness and Fundamentals of Care - Dancing with Beauty Rather than Fighting Ugliness.

PubMed

McCormack, Brendan

2016-01-01

The fundamentals of care have re-emerged as an important consideration in nursing following a period when these role elements were predominantly "delegated tasks" delivered by other (usually unregistered/unregulated) members of the health and social care team. Contemporary critiques of nursing highlight the technical focus of nursing at the expense of its caring function. Person-centred nursing theory offers a way of reinstating the value of fundamental care as a core part of providing holistic nursing to persons as well as highlighting the importance of the nursing role in coordinating healthcare services in ways that are consistent with a person's beliefs and values. This paper argues that a focus on person-centredness enables the core function of nurses as providers and coordinators of holistic person-centred fundamental care to be revalued. It highlights the importance of nurses being clear about "what matters" in caring practices and suggests that nurses adopting a person-centred approach can achieve effective care coordination through the lens of the fundamentals of care. In reading this paper, a greater understanding of person-centredness in the context of the fundamentals of care can be achieved. Copyright © 2016 Longwoods Publishing.

ElemeNT: a computational tool for detecting core promoter elements.

PubMed

Sloutskin, Anna; Danino, Yehuda M; Orenstein, Yaron; Zehavi, Yonathan; Doniger, Tirza; Shamir, Ron; Juven-Gershon, Tamar

2015-01-01

Core promoter elements play a pivotal role in the transcriptional output, yet they are often detected manually within sequences of interest. Here, we present 2 contributions to the detection and curation of core promoter elements within given sequences. First, the Elements Navigation Tool (ElemeNT) is a user-friendly web-based, interactive tool for prediction and display of putative core promoter elements and their biologically-relevant combinations. Second, the CORE database summarizes ElemeNT-predicted core promoter elements near CAGE and RNA-seq-defined Drosophila melanogaster transcription start sites (TSSs). ElemeNT's predictions are based on biologically-functional core promoter elements, and can be used to infer core promoter compositions. ElemeNT does not assume prior knowledge of the actual TSS position, and can therefore assist in annotation of any given sequence. These resources, freely accessible at http://lifefaculty.biu.ac.il/gershon-tamar/index.php/resources, facilitate the identification of core promoter elements as active contributors to gene expression.

Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting

PubMed Central

Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.

2016-01-01

Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058

What's love got to do with it? Investigating consumer commitment in health care.

PubMed

Kemp, Elyria; Poole, Sonja Martin

2017-01-01

Building relationships with patients to create patient-centered care is critical to the success of health care organizations. A core element in relationships is commitment. Commitment may be based on affect and emotions, perceived costs, and even obligation. This research proposes that three types of commitment-affective, continuance, and normative commitment-differentially impact consumer purchase loyalty, attitudinal loyalty, and advocacy for a health care provider. To examine the impact of commitment type on consumer relationships, exploratory data were garnered and surveys were administered. Findings are discussed and implications for health care marketing managers in developing successful relationships with consumers are delineated.

Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems.

PubMed

2014-05-01

Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care. Copyright © 2014 by the American Academy of Pediatrics.

A tactile sensing element based on a hetero-core optical fiber for force measurement and texture detection

NASA Astrophysics Data System (ADS)

Yamazaki, Hiroshi; Koyama, Yuya; Watanabe, Kazuhiro

2014-05-01

Tactile sensing technology can measure a given property of an object through physical contact between a sensing element and the object. Various tactile sensing techniques have been developed for several applications such as intelligent robots, tactile interface, medical support and nursing care support. A desirable tactile sensing element for supporting human daily life can be embedded in the soft material with high sensitivity and accuracy in order to prevent from damaging to human or object physically. This report describes a new tactile sensing element. Hetero-core optical fibers have high sensitivity of macro-bending at local sensor portion and temperature independency, including advantages of optical fiber itself; thin size, light weight, flexible transmission line, and immunity to electro-magnetic interference. The proposed tactile sensing element could detect textures of touched objects through the optical loss caused by the force applied to the sensing element. The characteristics of the sensing element have been evaluated, in which the sensing element has the monotonic and non-linear sensitivity against the normal force ranged from 0 to 5 N with lower accuracy than 0.25 dB. Additionally, texture detection have been successfully demonstrated in which small surface figures of 0.1 mm in height were detected with spatial resolution of 0.4 mm.

Communication elements supporting patient safety in psychiatric inpatient care.

PubMed

Kanerva, A; Kivinen, T; Lammintakanen, J

2015-06-01

Communication is important for safe and quality health care. The study provides needed insight on the communication elements that support patient safety from the psychiatric care view. Fluent information transfer between the health care professionals and care units is important for care planning and maintaining practices. Information should be documented and implemented accordingly. Communication should happen in an open communication culture that enables discussion, the opportunity to have debriefing discussions and the entire staff can feel they are heard. For effective communication, it is also important that staff are active themselves in information collecting about the essential information needed in patient care. In mental health nursing, it is important to pay attention to all elements of communication and to develop processes concerning communication in multidisciplinary teams and across unit boundaries. The study aims to describe which communication elements support patient safety in psychiatric inpatient care from the viewpoint of the nursing staff. Communication is an essential part of care and one of the core competencies of the psychiatric care. It enables safe and quality patient care. Errors in health care are often connected with poor communication. The study brings needed insight from the psychiatric care view to the topic. The data were gathered from semi-structured interviews in which 26 nurses were asked to describe the elements that constitute patient safety in psychiatric inpatient care. The data were analysed inductively from the viewpoint of communication. The descriptions connected with communication formed a main category of communication elements that support patient safety; this main category was made up of three subcategories: fluent information transfer, open communication culture and being active in information collecting. Fluent information transfer consists of the practical implementation of communication; open communication culture is connected with the cultural issues of communication; and being active in information collecting is related to a nurse's personal working style, which affects communication. It is important to pay attention to all the three areas and use this knowledge in developing patient safety practices and strategies where communication aspect and culture are noted and developed. In mental health nursing, it is important to develop processes concerning communication in multidisciplinary teams and across unit boundaries. © 2015 John Wiley & Sons Ltd.

Replication in Practice: Lessons from Five Lead Agencies

ERIC Educational Resources Information Center

McGonigel, Mary

2005-01-01

This article describes the replication efforts of five programs funded by the Pritzker Early Childhood Foundation and determines what methods are key to replication success. Before replication can take place, the lead agency must have substantial evidence of its effectiveness and know its core elements. It must also think carefully about how its…

[Ethical issues in the practice of advance directives, living wills, and self-determination in end of life care].

PubMed

Fang, Hui-Feng; Jhing, Huei-Yu; Lin, Chia-Chin

2009-02-01

The Hospice-Palliative Care Act, enacted in Taiwan in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination is a core element of human dignity. Advance directive documents include a living will, and durable power of attorney for healthcare. This article reviews current issues and ethical dilemmas with regard to advance directives. Patients, family members, and clinicians may require better education on the Hospice-Palliative Care Act in order to respect more appropriately patient end of life medical care wishes.

The Working Alliance Between Patients With Bipolar Disorder and the Nurse: Helpful and Obstructive Elements During a Depressive Episode From the Patients' Perspective.

PubMed

Stegink, Eva E; van der Voort, Trijntje Y G Nienke; van der Hooft, Truus; Kupka, Ralph W; Goossens, Peter J J; Beekman, Aartjan T F; van Meijel, Berno

2015-10-01

Despite treatment, many patients with bipolar disorder experience impaired functioning and a decreased quality of life. Optimal collaboration between patient and mental health care providers could enhance treatment outcomes. The goal of this qualitative study, performed in a trial investigating the effect of collaborative care, was to gain more insight in patients' experiences regarding the helpful and obstructive elements of the working alliance between the patient recovering from a depressive episode and their nurse. Three core themes underpinned the nurses' support during recovery: a safe and supportive environment, assistance in clarifying thoughts and feelings, and support in undertaking physical activities. Copyright © 2015 Elsevier Inc. All rights reserved.

Dignity realization of patients with stroke in hospital care: A grounded theory.

PubMed

Rannikko, Sunna; Stolt, Minna; Suhonen, Riitta; Leino-Kilpi, Helena

2017-01-01

Dignity is seen as an important but complex concept in the healthcare context. In this context, the discussion of dignity includes concepts of other ethical principles such as autonomy and privacy. Patients consider dignity to cover individuality, patient's feelings, communication, and the behavior of healthcare personnel. However, there is a lack of knowledge concerning the realization of patients' dignity in hospital care and the focus of the study is therefore on the realization of dignity of the vulnerable group of patients with stroke. The aim of the study was to create a theoretical construct to describe the dignity realization of patients with stroke in hospital care. Research design and participants: Patients with stroke (n = 16) were interviewed in 2015 using a semi-structured interview containing open questions concerning dignity. The data were analyzed using constant comparison of Grounded Theory. Ethical considerations: Ethical approval for the research was obtained from the Ethics Committee of the University. The permission for the research was given by the hospital. Informed consent was obtained from participants. The "Theory of Dignity Realization of Patients with Stroke in Hospital Care" consists of a core category including generic elements of the new situation and dignity realization types. The core category was identified as "Dignity in a new situation" and the generic elements as health history, life history, individuality and stroke. Dignity of patients with stroke is realized through specific types of realization: person-related dignity type, control-related dignity type, independence-related dignity type, social-related dignity type, and care-related dignity type. The theory has similar elements with the previous literature but the whole construct is new. The theory reveals possible special characteristics in dignity realization of patients with stroke. For healthcare personnel, the theory provides a frame for a better understanding and recognition of how dignity of patients with stroke is realized.

The Fundamentals of Care Framework as a Point-of-Care Nursing Theory.

PubMed

Kitson, Alison L

Nursing theories have attempted to shape the everyday practice of clinical nurses and patient care. However, many theories-because of their level of abstraction and distance from everyday caring activity-have failed to help nurses undertake the routine practical aspects of nursing care in a theoretically informed way. The purpose of the paper is to present a point-of-care theoretical framework, called the fundamentals of care (FOC) framework, which explains, guides, and potentially predicts the quality of care nurses provide to patients, their carers, and family members. The theoretical framework is presented: person-centered fundamental care (PCFC)-the outcome for the patient and the nurse and the goal of the FOC framework are achieved through the active management of the practice process, which involves the nurse and the patient working together to integrate three core dimensions: establishing the nurse-patient relationship, integrating the FOC into the patient's care plan, and ensuring that the setting or context where care is transacted and coordinated is conducive to achieving PCFC outcomes. Each dimension has multiple elements and subelements, which require unique assessment for each nurse-patient encounter. The FOC framework is presented along with two scenarios to demonstrate its usefulness. The dimensions, elements, and subelements are described, and next steps in the development are articulated.

Using the Repertory Grid Technique to Examine Trainee Clinical Psychologists' Construal of Their Personal and Professional Development.

PubMed

Hill, Katy; Wittkowski, Anja; Hodgkinson, Emma; Bell, Richard; Hare, Dougal J

2016-09-01

The repertory grid technique was used to explore how 26 third-year trainee clinical psychologists construed their personal and professional selves over the course of training and into the future. Each trainee completed a demographic questionnaire and a repertory grid with 10 elements: four 'personal self' elements, four 'professional self' elements and two 'qualified clinical psychologist' elements. They then rated the 10 elements on 10 bipolar constructs of their choosing. Trainees' personal and professional selves were construed to be similar to each other. Trainees had low self-esteem and reported currently feeling anxious, stressed, unsettled and lacking an appropriate work-life balance. These difficulties were attributed to the demands of training and were expected to resolve once training was completed with future selves being construed as similar to ideal selves. Suggestions for future research with improved methodology are made, and the implications of the findings for trainees, training providers and employers of newly qualified clinical psychologists are given. The overall implication being that stress in training is normative and the profession has a duty to normalize this and ensure that self-care and personal development are recognized as core competencies of the clinical psychologist for the benefit of its members and their clients. Copyright © 2015 John Wiley & Sons, Ltd. Clinical psychology trainees experience training as demanding and stressful, which negatively impacts on their personal and professional self-image and self-esteem. However, they are optimistic that they will become more like their ideal self in the future. Stress in clinical training (and beyond) is normative, and thus, personal development and self-care should be recognized as clinical psychologist's core competencies. Copyright © 2015 John Wiley & Sons, Ltd.

Improving performance on core processes of care.

PubMed

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

Do emergency nurses have enough emotional intelligence?

PubMed

Codier, Estelle; Codier, David

2015-06-01

A significant body of research suggests there is a correlation between measured emotional intelligence (EI) abilities and performance in nursing. The four critical elements of EI, namely the abilities to identify emotions correctly in self and others, using emotions to support reasoning, understanding emotions and managing emotions, apply to emergency care settings and are important for safe patient care, teamwork, retention and burnout prevention. This article describes 'emotional labour' and the importance of EI abilities for emergency nurses, and suggests that such abilities should be considered core competencies for the profession.

ACO model should encourage efficient care delivery.

PubMed

Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M

2015-09-01

The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance. Copyright © 2015 Elsevier Inc. All rights reserved.

On track for success: an innovative behavioral science curriculum model.

PubMed

Freedy, John R; Carek, Peter J; Dickerson, Lori M; Mallin, Robert M

2013-01-01

This article describes the behavioral science curriculum currently in place at the Trident/MUSC Family Medicine Residency Program. The Trident/MUSC Program is a 10-10-10 community-based, university-affiliated program in Charleston, South Carolina. Over the years, the Trident/MUSC residency program has graduated over 400 Family Medicine physicians. The current behavioral science curriculum consists of both required core elements (didactic lectures, clinical observation, Balint groups, and Resident Grand Rounds) as well as optional elements (longitudinal patient care experiences, elective rotations, behavioral science editorial experience, and scholars project with a behavioral science focus). All Trident/MUSC residents complete core behavioral science curriculum elements and are free to participate in none, some, or all of the optional behavioral science curriculum elements. This flexibility allows resident physicians to tailor the educational program in a manner to meet individual educational needs. The behavioral science curriculum is based upon faculty interpretation of existing "best practice" guidelines (Residency Review Committee-Family Medicine and AAFP). This article provides sufficient curriculum detail to allow the interested reader the opportunity to adapt elements of the behavioral science curriculum to other residency training programs. While this behavioral science track system is currently in an early stage of implementation, the article discusses track advantages as well as future plans to evaluate various aspects of this innovative educational approach.

How unique is continuity of care? A review of continuity and related concepts.

PubMed

Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; van den Bosch, Wil J H M

2012-06-01

The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management. We identified and reviewed articles including a definition of one of these concepts by performing an extensive literature search in PubMed. In addition, we checked the definition of these concepts in the Oxford English Dictionary. Definitions of continuity, coordination, integration, patient-centred care and case management vary over time. These concepts show both great entanglement and also demonstrate differences. Three major common themes could be identified within these concepts: personal relationship between patient and care provider, communication between providers and cooperation between providers. Most definitions of the concepts are formulated from the patient's perspective. The identified themes appear to be core elements of care to patients. Thus, it may be valuable to develop an instrument to measure these three common themes universally. In the patient-centred medical home, such an instrument might turn out to be an important quality measure, which will enable researchers and policy makers to compare care settings and practices and to evaluate new care interventions from the patient perspective.

Integration of Palliative Care in Chronic Critical Illness Management

PubMed Central

Nelson, Judith E; Hope, Aluko A

2016-01-01

Palliative care is an essential component of comprehensive care for all patients with chronic critical illness, including those receiving restorative or life-sustaining therapies. Core elements include alleviation of symptom distress, communication about care goals, alignment of treatment with the patient’s values and preferences, transitional planning, and family support. Here we address strategies for assessment and management of symptoms, including pain, dyspnea, and depression, and for assisting patients to communicate while endotracheally intubated. We also discuss approaches to optimize communication among clinicians, patients, and families about care goals. Challenges for supporting families and planning for transitions between care settings are identified, while the value of interdisciplinary input is emphasized. We review “consultative” and “integrative” models for integrating palliative care and restorative critical care. Finally, we highlight key ethical issues that arise in the care of chronically critically ill patients and their families. PMID:22663973

Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach.

PubMed

Pulcini, C; Binda, F; Lamkang, A S; Trett, A; Charani, E; Goff, D A; Harbarth, S; Hinrichsen, S L; Levy-Hara, G; Mendelson, M; Nathwani, D; Gunturu, R; Singh, S; Srinivasan, A; Thamlikitkul, V; Thursky, K; Vlieghe, E; Wertheim, H; Zeng, M; Gandra, S; Laxminarayan, R

2018-04-03

With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability. A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires. The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased. This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.

Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review.

PubMed

Sfantou, Danae F; Laliotis, Aggelos; Patelarou, Athina E; Sifaki-Pistolla, Dimitra; Matalliotakis, Michail; Patelarou, Evridiki

2017-10-14

Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004-2015. The research question that guided this review was posed as: "Is there any relationship between leadership style in healthcare settings and quality of care?" Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals.

Nurse leaders as managers of ethically sustainable caring cultures.

PubMed

Salmela, Susanne; Koskinen, Camilla; Eriksson, Katie

2017-04-01

The aim of this study was to identify the distinctive foundations of the care culture and how nurse leaders (NL) can manage and strengthen these in a quest for ethically sustainable caring cultures. Sustainability presupposes an ethical leadership, a management of the good care and a well-educated staff, but research on NLs as managers of ethically sustainable caring cultures is not available. The study has a quantitative design with elements of a qualitative research approach. Data were collected through a web-based questionnaire sent to staff at eight selected units at a hospital in western Finland during September 2013; the reply rate was 32%. The data material was comprised of opinion questions, the ranking of values and two open-ended questions on lodestars in care and ethical principles in care work. NLs manage a care culture that rests on a solid foundation, where staff are co-creators of an ethically sustainable caring culture that includes good traditions for the praxis of care. NLs as managers are therefore responsible for realizing and passing on ethically sustainable caring cultures and creating prerequisites for staff's growth and development. The basis of good care, patient safety and sustainability is comprised of ethics with a respectful and dignified care that is evidence-based and economically stable. Through their management NLs have a responsibility to nurture and protect the core of caring and create contextual, professional and cultural prerequisites to maintain the core and art of caring as well as care staff's ethical and professional competence. © 2016 John Wiley & Sons Ltd.

Joining Dental Ceramic Layers With Glass

PubMed Central

Saied, MA; Lloyd, IK; Haller, WK; Lawn, BR

2011-01-01

Objective Test the hypothesis that glass-bonding of free-form veneer and core ceramic layers can produce robust interfaces, chemically durable and aesthetic in appearance and, above all, resistant to delamination. Methods Layers of independently produced porcelains (NobelRondo™ Press porcelain, Nobel BioCare AB and Sagkura Interaction porcelain, Elephant Dental) and matching alumina or zirconia core ceramics (Procera alumina, Nobel BioCare AB, BioZyram yttria stabilized tetragonal zirconia polycrystal, Cyrtina Dental) were joined with designed glasses, tailored to match thermal expansion coefficients of the components and free of toxic elements. Scanning electron microprobe analysis was used to characterize the chemistry of the joined interfaces, specifically to confirm interdiffusion of ions. Vickers indentations were used to drive controlled corner cracks into the glass interlayers to evaluate the toughness of the interfaces. Results The glass-bonded interfaces were found to have robust integrity relative to interfaces fused without glass, or those fused with a resin-based adhesive. Significance The structural integrity of the interfaces between porcelain veneers and alumina or zirconia cores is a critical factor in the longevity of all-ceramic dental crowns and fixed dental prostheses. PMID:21802131

Launching forward: The integration of behavioral health in primary care as a key strategy for promoting young child wellness.

PubMed

Oppenheim, Jennifer; Stewart, Whitney; Zoubak, Ekaterina; Donato, Ingrid; Huang, Larke; Hudock, William

2016-03-01

In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) created a national grant program, Project LAUNCH (Linking Actions for Unmet Needs in Children's Health), to improve behavioral health and developmental outcomes for young children through the incorporation of prevention and wellness promotion practices in key early childhood settings. Project LAUNCH supports states, tribal nations, and territories to improve coordination across early childhood systems and implement 5 core strategies of prevention and promotion. This article focuses on the lessons learned from 1 of the 5 core strategies: integration of behavioral health into primary care for young children. This paper analyzes the experiences of a sample of Project LAUNCH grantees, describing 10 common elements of integration approaches and exploring some of the challenges of promoting health and preventing social, emotional, and behavioral problems at a population level. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Registry Assessment of Peripheral Interventional Devices (RAPID)　- Registry Assessment of Peripheral Interventional Devices Core Data Elements.

PubMed

Jones, W Schuyler; Krucoff, Mitchell W; Morales, Pablo; Wilgus, Rebecca W; Heath, Anne H; Williams, Mary F; Tcheng, James E; Marinac-Dabic, J Danica; Malone, Misti L; Reed, Terrie L; Fukaya, Rie; Lookstein, Robert; Handa, Nobuhiro; Aronow, Herbert D; Bertges, Daniel J; Jaff, Michael R; Tsai, Thomas T; Smale, Joshua A; Zaugg, Margo J; Thatcher, Robert J; Cronenwett, Jack L; Nc, Durham; Md, Silver Spring; Japan, Tokyo; Ny, New York; Ri, Providence; Vt, Burlington; Mass, Newton; Colo, Denver; Ariz, Tempe; Calif, Santa Clara; Minn, Minneapolis; Nh, Lebanon

2018-01-25

The current state of evaluating patients with peripheral artery disease and more specifically of evaluating medical devices used for peripheral vascular intervention (PVI) remains challenging because of the heterogeneity of the disease process, the multiple physician specialties that perform PVI, the multitude of devices available to treat peripheral artery disease, and the lack of consensus about the best treatment approaches. Because PVI core data elements are not standardized across clinical care, clinical trials, and registries, aggregation of data across different data sources and physician specialties is currently not feasible.Methods and Results:Under the auspices of the U.S. Food and Drug Administration's Medical Device Epidemiology Network initiative-and its PASSION (Predictable and Sustainable Implementation of the National Registries) program, in conjunction with other efforts to align clinical data standards-the Registry Assessment of Peripheral Interventional Devices (RAPID) workgroup was convened. RAPID is a collaborative, multidisciplinary effort to develop a consensus lexicon and to promote interoperability across clinical care, clinical trials, and national and international registries of PVI. The current manuscript presents the initial work from RAPID to standardize clinical data elements and definitions, to establish a framework within electronic health records and health information technology procedural reporting systems, and to implement an informatics-based approach to promote the conduct of pragmatic clinical trials and registry efforts in PVI. Ultimately, we hope this work will facilitate and improve device evaluation and surveillance for patients, clinicians, health outcomes researchers, industry, policymakers, and regulators.

Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions.

PubMed

Fukui, Sadaaki; Matthias, Marianne S; Salyers, Michelle P

2015-01-01

Shared decision-making (SDM) is imperative to person-centered care, yet little is known about what aspects of SDM are targeted during psychiatric visits. This secondary data analysis (191 psychiatric visits with 11 providers, coded with a validated SDM coding system) revealed two factors (scientific and preference-based discussions) underlying SDM communication. Preference-based discussion occurred less. Both provider and consumer initiation of SDM elements and decision complexity were associated with greater discussions in both factors, but were more strongly associated with scientific discussion. Longer visit length correlated with only scientific discussion. Providers' understanding of core domains could facilitate engaging consumers in SDM.

Experiences of family carers of older people with mental health problems in the acute general hospital: a qualitative study.

PubMed

Clissett, Philip; Porock, Davina; Harwood, Rowan H; Gladman, John R F

2013-12-01

To explore the experiences of family carers of people with cognitive impairment during admission to hospital. Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with family members. Qualitative interview study. Semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had co-morbid cognitive impairment. Interviews conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. The findings elaborate a core problem, 'disruption from normal routine' and a core process, 'gaining or giving a sense of control to cope with disruption'. Family carers responded to disruption proactively by trying to make sense of the situation and attempting to gain control for themselves or the patient. They tried to stay informed, communicate with staff about the patient and plan for the future. The interaction of the core problem and the core process resulted in outcomes where family members either valued the support of hospital staff and services or were highly critical of the care provided. Family carers are not passive in the face of the disruption of hospitalization and respond both by trying to involve themselves in the care and support of their relative and by trying to work in partnership with members of staff. Nurses need to foster this relationship conscientiously. © 2013 John Wiley & Sons Ltd.

[Health care of refugees in 2015 - Evaluation of an ambulance for refugees in a Cologne emergency accommodation (Cologne Model)].

PubMed

Borgschulte, H S; Bunte, A; Neuhann, F; Weber, L T; Wiesmüller, G A

2016-12-01

Access to medical care is a core element in the care of refugees and asylum seekers, and should therefore be guaranteed in a barrier-free way. In practice, there are usually numerous access barriers and the first contact with the German Health Care System takes place in form of a statutory examination to exclude infectious diseases. In addition to the introduction of health insurance cards for refugees, an offer of medical consultation for several hours a week in the municipal emergency accommodations provides an opportunity for low threshold access to primary care and a bridging function to the integration into the regular health care system. This offer is independent of the obligatory initial examination according to § 62 Asylum Law (AsylG) 1. The evaluation of the first year of such a health care center is presented. © Georg Thieme Verlag KG Stuttgart · New York.

Multiple age components in individual molybdenite grains

USGS Publications Warehouse

Aleinikoff, John N.; Creaser, Robert A.; Lowers, Heather; Magee, Charles W.; Grauch, Richard I.

2012-01-01

Re–Os geochronology of fractions composed of unsized, coarse, and fine molybdenite from a pod of unusual monazite–xenotime gneiss within a granulite facies paragneiss, Hudson Highlands, NY, yielded dates of 950.5 ± 2.5, 953.8 ± 2.6, and 941.2 ± 2.6 Ma, respectively. These dates are not recorded by co-existing zircon, monazite, or xenotime. SEM–BSE imagery of thin sections and separated grains reveals that most molybdenite grains are composed of core and rim plates that are approximately perpendicular. Rim material invaded cores, forming irregular contacts, probably reflecting dissolution/reprecipitation. EPMA and LA-ICP-MS analyses show that cores and rims have different trace element concentrations (for example, cores are relatively enriched in W). On the basis of inclusions of zircon with metamorphic overgrowths, we conclude that molybdenite cores and rims formed after high-grade regional metamorphism. The discovery of cores and rims in individual molybdenite grains is analogous to multi-component U-Pb geochronometers such as zircon, monazite, and titanite; thus, molybdenite should be carefully examined before dating to ensure that the requirement of age homogeneity is fulfilled.

Influence of peak oral temperatures on veneer–core interface stress state

PubMed Central

Marrelli, Massimo; Pujia, Antonella; Apicella, Davide; Sansalone, Salvatore; Tatullo, Marco

2015-01-01

Abstract Objective: There is a growing interest for the use of Y-TZP zirconia as core material in veneered all-ceramic prostheses. The objective of this study was to evaluate the influence of CET on the stress distribution of a porcelain layered to zirconia core single crowns by finite elements analysis. Material and methods: CET of eight different porcelains was considered during the analysis. Results: Results of this study indicated that the mismatch in CET between the veneering porcelain and the Y-TZP zirconia core has to be minimum (0.5–1 μm/mK) so as to decrease the growing of residual stresses which could bring chipping. Conclusions: The stress state due to temperature variation should be carefully taken into consideration while studying the effect of mechanical load on zirconia core crown by FEA. The interfacial stress state can be increased by temperature variation up to 20% with respect to the relative failure parameter (interface strength in this case). This means that stress due to mechanical load combined to temperature variation-induced stress can lead porcelain veneer–zirconia core interfaces to failure. PMID:28642897

The Wisconsin immunization registry experience: comparing real-time and batched file submissions from health care providers.

PubMed

Schauer, Stephanie L; Maerz, Thomas R; Verdon, Matthew J; Hopfensperger, Daniel J; Davis, Jeffrey P

2014-06-01

The Wisconsin Immunization Registry is a confidential, web-based system used since 1999 as a centralized repository of immunization information for Wisconsin residents. Provide evidence based on Registry experiences with electronic data exchange, comparing the benefits and drawbacks of using the Health Level 7 standard, including the option for real time data exchange vs the flat file method. For data regarding vaccinations received by children aged 4 months through 6 years with Wisconsin addresses that were submitted to the Registry during 2010 and 2011, data timeliness (days from vaccine administration to date information was received) and completeness (percentage of records received that include core data elements for electronic storage) were compared by file submission method. Data submitted using Health Level 7 were substantially more timely than data submitted using the flat file method. Additionally, data submitted using Health Level 7 were substantially more complete for each of the core elements compared to flat file submission. Health care organizations that submit electronic data to immunization information systems should be aware that the technical decision to use the Health Level 7 format, particularly if real-time data exchange is employed, can result in more timely and accurate data. This will assist clinicians in adhering to the Advisory Committee on Immunization Practices schedule and reducing over-immunization.

Importance of Leadership Style towards Quality of Care Measures in Healthcare Settings: A Systematic Review

PubMed Central

Sfantou, Danae F.; Patelarou, Athina E.; Sifaki- Pistolla, Dimitra; Patelarou, Evridiki

2017-01-01

Effective leadership of healthcare professionals is critical for strengthening quality and integration of care. This study aimed to assess whether there exist an association between different leadership styles and healthcare quality measures. The search was performed in the Medline (National Library of Medicine, PubMed interface) and EMBASE databases for the time period 2004–2015. The research question that guided this review was posed as: “Is there any relationship between leadership style in healthcare settings and quality of care?” Eighteen articles were found relevant to our research question. Leadership styles were found to be strongly correlated with quality care and associated measures. Leadership was considered a core element for a well-coordinated and integrated provision of care, both from the patients and healthcare professionals. PMID:29036901

Addressing Social Determinants Of Health Through Medical-Legal Partnerships.

PubMed

Regenstein, Marsha; Trott, Jennifer; Williamson, Alanna; Theiss, Joanna

2018-03-01

The US health care system needs effective tools to address complex social and environmental issues that perpetuate health inequities, such as food insecurity, education and employment barriers, and substandard housing conditions. The medical-legal partnership is a collaborative intervention that embeds civil legal aid professionals in health care settings to address seemingly intractable social problems that contribute to poor health outcomes and health disparities. More than three hundred health care organizations are home to medical-legal partnerships. This article draws upon national survey data and field research to identify three models of the medical-legal partnership that health care organizations have adopted and the core elements of infrastructure that they share. Financing and commitment from health care organizations are key considerations for sustaining and scaling up the medical-legal partnership as a health equity intervention.

[Process orientation as a tool of strategic approaches to corporate governance and integrated management systems].

PubMed

Sens, Brigitte

2010-01-01

The concept of general process orientation as an instrument of organisation development is the core principle of quality management philosophy, i.e. the learning organisation. Accordingly, prestigious quality awards and certification systems focus on process configuration and continual improvement. In German health care organisations, particularly in hospitals, this general process orientation has not been widely implemented yet - despite enormous change dynamics and the requirements of both quality and economic efficiency of health care processes. But based on a consistent process architecture that considers key processes as well as management and support processes, the strategy of excellent health service provision including quality, safety and transparency can be realised in daily operative work. The core elements of quality (e.g., evidence-based medicine), patient safety and risk management, environmental management, health and safety at work can be embedded in daily health care processes as an integrated management system (the "all in one system" principle). Sustainable advantages and benefits for patients, staff, and the organisation will result: stable, high-quality, efficient, and indicator-based health care processes. Hospitals with their broad variety of complex health care procedures should now exploit the full potential of total process orientation. Copyright © 2010. Published by Elsevier GmbH.

Towards a duty of care for biodiversity.

PubMed

Earl, G; Curtis, A; Allan, C

2010-04-01

The decline in biodiversity is a worldwide phenomenon, with current rates of species extinction more dramatic than any previously recorded. Habitat loss has been identified as the major cause of biodiversity decline. In this article we suggest that a statutory duty of care would complement the current mix of policy options for biodiversity conservation. Obstacles hindering the introduction of a statutory duty of care include linguistic ambiguity about the terms 'duty of care' and 'stewardship' and how they are applied in a natural resource management context, and the absence of a mechanism to guide its implementation. Drawing on international literature and key informant interviews we have articulated characteristics of duty of care to reduce linguistic ambiguity, and developed a framework for implementing a duty of care for biodiversity at the regional scale. The framework draws on key elements of the common law 'duty of care', the concepts of 'taking reasonable care' and 'avoiding foreseeable harm', in its logic. Core elements of the framework include desired outcomes for biodiversity, supported by current recommended practices. The focus on outcomes provides opportunities for the development of innovative management practices. The framework incorporates multiple pathways for the redress of non-compliance including tiered negative sanctions, and positive measures to encourage compliance. Importantly, the framework addresses the need for change and adaptation that is a necessary part of biodiversity management.

Experimental constraints on light elements in the Earth’s outer core

PubMed Central

Zhang, Youjun; Sekine, Toshimori; He, Hongliang; Yu, Yin; Liu, Fusheng; Zhang, Mingjian

2016-01-01

Earth’s outer core is liquid and dominantly composed of iron and nickel (~5–10 wt%). Its density, however, is ~8% lower than that of liquid iron, and requires the presence of a significant amount of light element(s). A good way to specify the light element(s) is a direct comparison of density and sound velocity measurements between seismological data and those of possible candidate compositions at the core conditions. We report the sound velocity measurements of a model core composition in the Fe-Ni-Si system at the outer core conditions by shock-wave experiments. Combining with the previous studies, we found that the best estimate for the outer core’s light elements is ~6 wt% Si, ~2 wt% S, and possible ~1–2.5 wt% O. This composition satisfies the requirements imposed by seismology, geochemistry, and some models of the early core formation. This finding may help us to further constrain the thermal structure of the Earth and the models of Earth’s core formation. PMID:26932596

Iranian staff nurses' views of their productivity and human resource factors improving and impeding it: a qualitative study

PubMed Central

Nayeri, Nahid Dehghan; Nazari, Ali Akbar; Salsali, Mahvash; Ahmadi, Fazlollah

2005-01-01

Background Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses' perceptions and experiences of productivity and human resource factors improving or impeding it. Method A qualitative approach was used to obtain rich data; open, semi-structured interviews were also conducted. The sampling was based on the maximum variant approach; data analysis was carried out by content analysis, with the constant comparative method. Results Participants indicated that human resources issues are the most important factor in promoting or impeding their productivity. They suggested that the factors influencing effectiveness of human resource elements include: systematic evaluation of staff numbers; a sound selection process based on verifiable criteria; provision of an adequate staffing level throughout the year; full involvement of the ward sister in the process of admitting patients; and sound communication within the care team. Paying attention to these factors creates a suitable background for improved productivity and decreases negative impacts of human resource shortages, whereas ignoring or interfering with them would result in lowering of nurses' productivity. Conclusion Participants maintained that satisfactory human resources can improve nurses' productivity and the quality of care they provide; thereby fulfilling the core objective of the health care system. PMID:16212672

Management of the high-order mode content in large (40 microm) core photonic bandgap Bragg fiber laser.

PubMed

Gaponov, D A; Février, S; Devautour, M; Roy, P; Likhachev, M E; Aleshkina, S S; Salganskii, M Y; Yashkov, M V; Guryanov, A N

2010-07-01

Very large-mode-area Yb(3+)-doped single-mode photonic bandgap (PBG) Bragg fiber oscillators are considered. The transverse hole-burning effect is numerically modeled, which helps properly design the PBG cladding and the Yb(3+)-doped region for the high-order mode content to be carefully controlled. A ratio of the Yb(3+)-doped region diameter to the overall core diameter of 40% allows for single-mode emission, even for small spool diameters of 15 cm. Such a fiber was manufactured and subsequently used as the core element of a cw oscillator. Very good beam quality parameter M(2)=1.12 and slope efficiency of 80% were measured. Insensitivity to bending, exemplified by the absence of temporal drift of the beam, was demonstrated for curvature diameter as small as 15 cm.

Identification of both copy number variation-type and constant-type core elements in a large segmental duplication region of the mouse genome

PubMed Central

2013-01-01

Background Copy number variation (CNV), an important source of diversity in genomic structure, is frequently found in clusters called CNV regions (CNVRs). CNVRs are strongly associated with segmental duplications (SDs), but the composition of these complex repetitive structures remains unclear. Results We conducted self-comparative-plot analysis of all mouse chromosomes using the high-speed and large-scale-homology search algorithm SHEAP. For eight chromosomes, we identified various types of large SD as tartan-checked patterns within the self-comparative plots. A complex arrangement of diagonal split lines in the self-comparative-plots indicated the presence of large homologous repetitive sequences. We focused on one SD on chromosome 13 (SD13M), and developed SHEPHERD, a stepwise ab initio method, to extract longer repetitive elements and to characterize repetitive structures in this region. Analysis using SHEPHERD showed the existence of 60 core elements, which were expected to be the basic units that form SDs within the repetitive structure of SD13M. The demonstration that sequences homologous to the core elements (>70% homology) covered approximately 90% of the SD13M region indicated that our method can characterize the repetitive structure of SD13M effectively. Core elements were composed largely of fragmented repeats of a previously identified type, such as long interspersed nuclear elements (LINEs), together with partial genic regions. Comparative genome hybridization array analysis showed that whereas 42 core elements were components of CNVR that varied among mouse strains, 8 did not vary among strains (constant type), and the status of the others could not be determined. The CNV-type core elements contained significantly larger proportions of long terminal repeat (LTR) types of retrotransposon than the constant-type core elements, which had no CNV. The higher divergence rates observed in the CNV-type core elements than in the constant type indicate that the CNV-type core elements have a longer evolutionary history than constant-type core elements in SD13M. Conclusions Our methodology for the identification of repetitive core sequences simplifies characterization of the structures of large SDs and detailed analysis of CNV. The results of detailed structural and quantitative analyses in this study might help to elucidate the biological role of one of the SDs on chromosome 13. PMID:23834397

Core-Mantle Partitioning of Volatile Elements and the Origin of Volatile Elements in Earth and Moon

NASA Technical Reports Server (NTRS)

Righter, K.; Pando, K.; Danielson, L.; Nickodem, K.

2014-01-01

Depletions of siderophile elements in mantles have placed constraints on the conditions on core segregation and differentiation in bodies such as Earth, Earth's Moon, Mars, and asteroid 4 Vesta. Among the siderophile elements there are a sub-set that are also volatile (volatile siderophile elements or VSE; Ga, Ge, In, As, Sb, Sn, Bi, Zn, Cu, Cd), and thus can help to constrain the origin of volatile elements in these bodies, and in particular the Earth and Moon. One of the fundamental observations of the geochemistry of the Moon is the overall depletion of volatile elements relative to the Earth, but a satisfactory explanation has remained elusive. Hypotheses for Earth include addition during accretion and core formation and mobilized into the metallic core, multiple stage origin, or addition after the core formed. Any explanation for volatile elements in the Earth's mantle must also be linked to an explanation of these elements in the lunar mantle. New metal-silicate partitioning data will be applied to the origin of volatile elements in both the Earth and Moon, and will evaluate theories for exogenous versus endogenous origin of volatile elements.

HIV Stigma, Retention in Care, and Adherence Among Older Black Women Living With HIV.

PubMed

Sangaramoorthy, Thurka; Jamison, Amelia M; Dyer, Typhanye V

Stigma is recognized as a barrier to the prevention, care, and treatment of HIV, including engagement in the HIV care continuum. HIV stigma in older Black women may be compounded by preexisting social inequities based on gender, age, and race. Using semi-structured interviews and survey questionnaires, we explore experiences of HIV stigma, retention in care, and antiretroviral therapy (ART) adherence in 35 older Black women with HIV from Prince George's County, Maryland. Study findings indicated that older Black women experienced high levels of HIV stigma, retention in care, and ART adherence. Findings suggest that experiences of HIV stigma were intensified for older Black women due to multiple stigmatized social positions. Participants also reported experiences of marginalization in health care that hindered retention in care and ART adherence. Interventions aimed at improving HIV prevention, care, and treatment outcomes should incorporate HIV stigma reduction strategies as core elements. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Data Set for Pathology Reporting of Cutaneous Invasive Melanoma

PubMed Central

Judge, Meagan J.; Evans, Alan; Frishberg, David P.; Prieto, Victor G.; Thompson, John F.; Trotter, Martin J.; Walsh, Maureen Y.; Walsh, Noreen M.G.; Ellis, David W.

2013-01-01

An accurate and complete pathology report is critical for the optimal management of cutaneous melanoma patients. Protocols for the pathologic reporting of melanoma have been independently developed by the Royal College of Pathologists of Australasia (RCPA), Royal College of Pathologists (United Kingdom) (RCPath), and College of American Pathologists (CAP). In this study, data sets, checklists, and structured reporting protocols for pathologic examination and reporting of cutaneous melanoma were analyzed by an international panel of melanoma pathologists and clinicians with the aim of developing a common, internationally agreed upon, evidence-based data set. The International Collaboration on Cancer Reporting cutaneous melanoma expert review panel analyzed the existing RCPA, RCPath, and CAP data sets to develop a protocol containing “required” (mandatory/core) and “recommended” (nonmandatory/noncore) elements. Required elements were defined as those that had agreed evidentiary support at National Health and Medical Research Council level III-2 level of evidence or above and that were unanimously agreed upon by the review panel to be essential for the clinical management, staging, or assessment of the prognosis of melanoma or fundamental for pathologic diagnosis. Recommended elements were those considered to be clinically important and recommended for good practice but with lesser degrees of supportive evidence. Sixteen core/required data elements for cutaneous melanoma pathology reports were defined (with an additional 4 core/required elements for specimens received with lymph nodes). Eighteen additional data elements with a lesser level of evidentiary support were included in the recommended data set. Consensus response values (permitted responses) were formulated for each data item. Development and agreement of this evidence-based protocol at an international level was accomplished in a timely and efficient manner, and the processes described herein may facilitate the development of protocols for other tumor types. Widespread utilization of an internationally agreed upon, structured pathology data set for melanoma will lead not only to improved patient management but is a prerequisite for research and for international benchmarking in health care. PMID:24061524

REACTOR UNLOADING

DOEpatents

Leverett, M.C.

1958-02-18

This patent is related to gas cooled reactors wherein the fuel elements are disposed in vertical channels extending through the reactor core, the cooling gas passing through the channels from the bottom to the top of the core. The invention is a means for unloading the fuel elements from the core and comprises dump values in the form of flat cars mounted on wheels at the bottom of the core structure which support vertical stacks of fuel elements. When the flat cars are moved, either manually or automatically, for normal unloading purposes, or due to a rapid rise in the reproduction ratio within the core, the fuel elements are permtted to fall by gravity out of the core structure thereby reducing the reproduction ratio or stopping the reaction as desired.

Core-Mantle Partitioning of Volatile Siderophile Elements and the Origin of Volatile Elements in the Earth

NASA Technical Reports Server (NTRS)

Nickodem, K.; Righter, K.; Danielson, L.; Pando, K.; Lee, C.

2012-01-01

There are currently several hypotheses on the origin of volatile siderophile elements in the Earth. One hypothesis is that they were added during Earth s accretion and core formation and mobilized into the metallic core [1], others claim multiple stage origin [2], while some hypothesize that volatiles were added after the core already formed [3]. Several volatile siderophile elements are depleted in Earth s mantle relative to the chondrites, something which continues to puzzle many scientists. This depletion is likely due to a combination of volatility and core formation. The Earth s core is composed of Fe and some lighter constituents, although the abundances of these lighter elements are unknown [4]. Si is one of these potential light elements [5] although few studies have analyzed the effect of Si on metal-silicate partitioning, in particular the volatile elements. As, In, Ge, and Sb are trace volatile siderophile elements which are depleted in the mantle but have yet to be extensively studied. The metal-silicate partition coefficients of these elements will be measured to determine the effect of Si. Partition coefficients depend on temperature, pressure, oxygen fugacity, and metal and silicate composition and can constrain the concentrations of volatile, siderophile elements found in the mantle. Reported here are the results from 13 experiments examining the partitioning of As, In, Ge, and Sb between metallic and silicate liquid. These experiments will examine the effect of temperature, and metal-composition (i.e., Si content) on these elements in or-der to gain a greater understanding of the core-mantle separation which occurred during the Earth s early stages. The data can then be applied to the origin of volatile elements in the Earth.

Sulfur in Earth's Mantle and Its Behavior During Core Formation

NASA Technical Reports Server (NTRS)

Chabot, Nancy L.; Righter,Kevin

2006-01-01

The density of Earth's outer core requires that about 5-10% of the outer core be composed of elements lighter than Fe-Ni; proposed choices for the "light element" component of Earth's core include H, C, O, Si, S, and combinations of these elements [e.g. 1]. Though samples of Earth's core are not available, mantle samples contain elemental signatures left behind from the formation of Earth's core. The abundances of siderophile (metal-loving) elements in Earth's mantle have been used to gain insight into the early accretion and differentiation history of Earth, the process by which the core and mantle formed, and the composition of the core [e.g. 2-4]. Similarly, the abundance of potential light elements in Earth's mantle could also provide constraints on Earth's evolution and core composition. The S abundance in Earth's mantle is 250 ( 50) ppm [5]. It has been suggested that 250 ppm S is too high to be due to equilibrium core formation in a high pressure, high temperature magma ocean on early Earth and that the addition of S to the mantle from the subsequent accretion of a late veneer is consequently required [6]. However, this earlier work of Li and Agee [6] did not parameterize the metalsilicate partitioning behavior of S as a function of thermodynamic variables, limiting the different pressure and temperature conditions during core formation that could be explored. Here, the question of explaining the mantle abundance of S is revisited, through parameterizing existing metal-silicate partitioning data for S and applying the parameterization to core formation in Earth.

Effect of heat treatment on interfacial and mechanical properties of A6022/A7075/A6022 roll-bonded multi-layer Al alloy sheets

NASA Astrophysics Data System (ADS)

Cha, Joon-Hyeon; Kim, Su-Hyeon; Lee, Yun-Soo; Kim, Hyoung-Wook; Choi, Yoon Suk

2016-09-01

Multi-layered Al alloy sheets can exhibit unique properties by the combination of properties of component materials. A poor corrosion resistance of high strength Al alloys can be complemented by having a protective surface with corrosion resistant Al alloys. Here, a special care should be taken regarding the heat treatment of multi-layered Al alloy sheets because dissimilar Al alloys may exhibit unexpected interfacial reactions upon heat treatment. In the present study, A6022/A7075/A6022 sheets were fabricated by a cold roll-bonding process, and the effect of the heat treatment on the microstructure and mechanical properties was examined. The solution treatment gave rise to the diffusion of Zn, Mg, Cu and Si elements across the core/clad interface. In particular, the pronounced diffusion of Zn, which is a major alloying element (for solid-solution strengthening) of the A7075 core, resulted in a gradual hardness change across the core/clad interface. Mg2Si precipitates and the precipitate free zone were also formed near the interface after the heat treatment. The heat-treated sheet showed high strengths and reasonable elongation without apparent deformation misfit or interfacial delamination during the tensile deformation. The high strength of the sheet was mainly due to the T4 and T6 heat treatment of the A7075 core.

Research on the equivalence between digital core and rock physics models

NASA Astrophysics Data System (ADS)

Yin, Xingyao; Zheng, Ying; Zong, Zhaoyun

2017-06-01

In this paper, we calculate the elastic modulus of 3D digital cores using the finite element method, systematically study the equivalence between the digital core model and various rock physics models, and carefully analyze the conditions of the equivalence relationships. The influences of the pore aspect ratio and consolidation coefficient on the equivalence relationships are also further refined. Theoretical analysis indicates that the finite element simulation based on the digital core is equivalent to the boundary theory and Gassmann model. For pure sandstones, effective medium theory models (SCA and DEM) and the digital core models are equivalent in cases when the pore aspect ratio is within a certain range, and dry frame models (Nur and Pride model) and the digital core model are equivalent in cases when the consolidation coefficient is a specific value. According to the equivalence relationships, the comparison of the elastic modulus results of the effective medium theory and digital rock physics is an effective approach for predicting the pore aspect ratio. Furthermore, the traditional digital core models with two components (pores and matrix) are extended to multiple minerals to more precisely characterize the features and mineral compositions of rocks in underground reservoirs. This paper studies the effects of shale content on the elastic modulus in shaly sandstones. When structural shale is present in the sandstone, the elastic modulus of the digital cores are in a reasonable agreement with the DEM model. However, when dispersed shale is present in the sandstone, the Hill model cannot describe the changes in the stiffness of the pore space precisely. Digital rock physics describes the rock features such as pore aspect ratio, consolidation coefficient and rock stiffness. Therefore, digital core technology can, to some extent, replace the theoretical rock physics models because the results are more accurate than those of the theoretical models.

Assisting allied health in performance evaluation: a systematic review.

PubMed

Lizarondo, Lucylynn; Grimmer, Karen; Kumar, Saravana

2014-11-14

Performance evaluation raises several challenges to allied health practitioners and there is no agreed approach to measuring or monitoring allied health service performance. The aim of this review was to examine the literature on performance evaluation in healthcare to assist in the establishment of a framework that can guide the measurement and evaluation of allied health clinical service performance. This review determined the core elements of a performance evaluation system, tools for evaluating performance, and barriers to the implementation of performance evaluation. A systematic review of the literature was undertaken. Five electronic databases were used to search for relevant articles: MEDLINE, Embase, CINAHL, PsychInfo, and Academic Search Premier. Articles which focussed on any allied health performance evaluation or those which examined performance in health care in general were considered in the review. Content analysis was used to synthesise the findings from individual articles. A total of 37 articles were included in the review. The literature suggests there are core elements involved in performance evaluation which include prioritising clinical areas for measurement, setting goals, selecting performance measures, identifying sources of feedback, undertaking performance measurement, and reporting the results to relevant stakeholders. The literature describes performance evaluation as multi-dimensional, requiring information or data from more than one perspective to provide a rich assessment of performance. A range of tools or instruments are available to capture various perspectives and gather a comprehensive picture of health care quality. Every allied health care delivery system has different performance needs and will therefore require different approaches. However, there are core processes that can be used as a framework to evaluate allied health performance. A careful examination of barriers to performance evaluation and subsequent tailoring of strategies to overcome these barriers should be undertaken to achieve the aims of performance evaluation. The findings of this review should inform the development of a standardised framework that can be used to measure and evaluate allied health performance. Future research should explore the utility and overall impact of such framework in allied health service delivery.

Registry Assessment of Peripheral Interventional Devices (RAPID): Registry assessment of peripheral interventional devices core data elements.

PubMed

Jones, W Schuyler; Krucoff, Mitchell W; Morales, Pablo; Wilgus, Rebecca W; Heath, Anne H; Williams, Mary F; Tcheng, James E; Marinac-Dabic, J Danica; Malone, Misti L; Reed, Terrie L; Fukaya, Rie; Lookstein, Robert A; Handa, Nobuhiro; Aronow, Herbert D; Bertges, Daniel J; Jaff, Michael R; Tsai, Thomas T; Smale, Joshua A; Zaugg, Margo J; Thatcher, Robert J; Cronenwett, Jack L

2018-02-01

The current state of evaluating patients with peripheral artery disease and more specifically of evaluating medical devices used for peripheral vascular intervention (PVI) remains challenging because of the heterogeneity of the disease process, the multiple physician specialties that perform PVI, the multitude of devices available to treat peripheral artery disease, and the lack of consensus about the best treatment approaches. Because PVI core data elements are not standardized across clinical care, clinical trials, and registries, aggregation of data across different data sources and physician specialties is currently not feasible. Under the auspices of the U.S. Food and Drug Administration's Medical Device Epidemiology Network initiative-and its PASSION (Predictable and Sustainable Implementation of the National Registries) program, in conjunction with other efforts to align clinical data standards-the Registry Assessment of Peripheral Interventional Devices (RAPID) workgroup was convened. RAPID is a collaborative, multidisciplinary effort to develop a consensus lexicon and to promote interoperability across clinical care, clinical trials, and national and international registries of PVI. The current manuscript presents the initial work from RAPID to standardize clinical data elements and definitions, to establish a framework within electronic health records and health information technology procedural reporting systems, and to implement an informatics-based approach to promote the conduct of pragmatic clinical trials and registry efforts in PVI. Ultimately, we hope this work will facilitate and improve device evaluation and surveillance for patients, clinicians, health outcomes researchers, industry, policymakers, and regulators. Copyright © 2017 Society for Vascular Surgery. All rights reserved.

What Are the Core Elements of Your Curriculum?

ERIC Educational Resources Information Center

Exchange: The Early Childhood Leaders' Magazine Since 1978, 2009

2009-01-01

Several administrators discuss the core elements of their curriculum. These core elements are: (1) Child-centered; (2) Play; (3) Problem solving; (4) Respect; (5)Creativity; (6) Community; (7) Independence; (8) Curiosity; (9) Love of learning; (10) Relationship; (11) Cooperation; (12) Self-confidence; (13) Language; (14) Joy; (15) Nature; Natural…

Core attitudes of professionals in palliative care: a qualitative study.

PubMed

Simon, Steffen T; Ramsenthaler, Christina; Bausewein, Claudia; Krischke, Norbert; Geiss, Gerlinde

2009-08-01

Self-awareness of one's own reactions towards patients and their relatives is of paramount importance for all professionals in palliative care. 'Core attitude' describes the way in which a person perceives himself and the world, and forms the basis for his actions and thoughts. The aim of this study is to explore what core attitude means for palliative care professionals and whether there is a specific core attitude in palliative care. Qualitative study with 10 face-to-face in-depth interviews with experts in palliative care (nurses, physicians, social workers, psychologists, chaplain) in Germany. Core attitude in palliative care can be best described with the following three domains: 1) personal characteristics; 2) experience of care; and 3) competence in care. Authenticity is the most important characteristic of professionals, along with honesty and mindfulness. Core attitude primarily becomes apparent in the relationship with the patient. Perception and listening are key competences. The experts emphasized the universality of the core attitude in the care of ill people. They stressed the importance and relevance of teaching core attitudes in palliative care education. In the field of palliative care, core attitude consists predominately of authenticity, manifests itself in relationships, and requires a high degree of perceptiveness.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association.

PubMed

Riegel, Barbara; Moser, Debra K; Buck, Harleah G; Dickson, Victoria Vaughan; Dunbar, Sandra B; Lee, Christopher S; Lennie, Terry A; Lindenfeld, JoAnn; Mitchell, Judith E; Treat-Jacobson, Diane J; Webber, David E

2017-08-31

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

CAM-SE: A scalable spectral element dynamical core for the Community Atmosphere Model.

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

Dennis, John; Edwards, Jim; Evans, Kate J

2012-01-01

The Community Atmosphere Model (CAM) version 5 includes a spectral element dynamical core option from NCAR's High-Order Method Modeling Environment. It is a continuous Galerkin spectral finite element method designed for fully unstructured quadrilateral meshes. The current configurations in CAM are based on the cubed-sphere grid. The main motivation for including a spectral element dynamical core is to improve the scalability of CAM by allowing quasi-uniform grids for the sphere that do not require polar filters. In addition, the approach provides other state-of-the-art capabilities such as improved conservation properties. Spectral elements are used for the horizontal discretization, while most othermore » aspects of the dynamical core are a hybrid of well tested techniques from CAM's finite volume and global spectral dynamical core options. Here we first give a overview of the spectral element dynamical core as used in CAM. We then give scalability and performance results from CAM running with three different dynamical core options within the Community Earth System Model, using a pre-industrial time-slice configuration. We focus on high resolution simulations of 1/4 degree, 1/8 degree, and T340 spectral truncation.« less

METHOD AND APPARATUS FOR CONTROLLING NEUTRON DENSITY

DOEpatents

Wigner, E.P.; Young, G.J.; Weinberg, A.M.

1961-06-27

A neutronic reactor comprising a moderator containing uniformly sized and spaced channels and uniformly dimensioned fuel elements is patented. The fuel elements have a fissionable core and an aluminum jacket. The cores and the jackets of the fuel elements in the central channels of the reactor are respectively thinner and thicker than the cores and jackets of the fuel elements in the remainder of the reactor, producing a flattened flux.

Nuclear reactor composite fuel assembly

DOEpatents

Burgess, Donn M.; Marr, Duane R.; Cappiello, Michael W.; Omberg, Ronald P.

1980-01-01

A core and composite fuel assembly for a liquid-cooled breeder nuclear reactor including a plurality of elongated coextending driver and breeder fuel elements arranged to form a generally polygonal bundle within a thin-walled duct. The breeder elements are larger in cross section than the driver elements, and each breeder element is laterally bounded by a number of the driver elements. Each driver element further includes structure for spacing the driver elements from adjacent fuel elements and, where adjacent, the thin-walled duct. A core made up of the fuel elements can advantageously include fissile fuel of only one enrichment, while varying the effective enrichment of any given assembly or core region, merely by varying the relative number and size of the driver and breeder elements.

Local, regional and national interoperability in hospital-level systems architecture.

PubMed

Mykkänen, J; Korpela, M; Ripatti, S; Rannanheimo, J; Sorri, J

2007-01-01

Interoperability of applications in health care is faced with various needs by patients, health professionals, organizations and policy makers. A combination of existing and new applications is a necessity. Hospitals are in a position to drive many integration solutions, but need approaches which combine local, regional and national requirements and initiatives with open standards to support flexible processes and applications on a local hospital level. We discuss systems architecture of hospitals in relation to various processes and applications, and highlight current challenges and prospects using a service-oriented architecture approach. We also illustrate these aspects with examples from Finnish hospitals. A set of main services and elements of service-oriented architectures for health care facilities are identified, with medium-term focus which acknowledges existing systems as a core part of service-oriented solutions. The services and elements are grouped according to functional and interoperability cohesion. A transition towards service-oriented architecture in health care must acknowledge existing health information systems and promote the specification of central processes and software services locally and across organizations. Software industry best practices such as SOA must be combined with health care knowledge to respond to central challenges such as continuous change in health care. A service-oriented approach cannot entirely rely on common standards and frameworks but it must be locally adapted and complemented.

42 CFR 457.1140 - Program specific review process: Core elements of review.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Program specific review process: Core elements of review. 457.1140 Section 457.1140 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... review process: Core elements of review. In adopting the procedures for review of matters described in...

42 CFR 457.1140 - Program specific review process: Core elements of review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Program specific review process: Core elements of review. 457.1140 Section 457.1140 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... review process: Core elements of review. In adopting the procedures for review of matters described in...

34 CFR 200.26 - Core elements of a schoolwide program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Core elements of a schoolwide program. 200.26 Section 200.26 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND... Improving Basic Programs Operated by Local Educational Agencies Schoolwide Programs § 200.26 Core elements...

Can the ministry collaborate to form the "next generation" of sponsors?

PubMed

Stanley, Teresa

2007-01-01

In looking to the future of sponsored ministry of Catholic institutions, the formation of future sponsors--both religious and lay alike--is an important issue. As this ministry continues to evolve, and sponsoring groups determine how best to prepare new sponsors, might it not be time to think about how to pool the ministry's collective wisdom on formation? Sponsors act not only in the name of the health care institution (or other ministry) but on behalf of the faith community engaged in continuing the compassionate healing ministry of Jesus. In Catholic ministry, and particularly health care ministry, sponsors carry out their responsibilities through a multiplicity of organizational relationships. Just as structures differ, so too do criteria that guide who will be called to join a sponsoring group. There are several core elements that are incorporated in the majority of sponsor competency sets. Elements identified by a committee of ministry members, and reviewed by hundreds of sponsors and other ministry leaders are: mission oriented, animated, theologically grounded, collaborative, church related, and accountable. If one is looking at the potential for convening dialogues about possible areas of collaboration in formation, these core elements, with examples of how they are lived out, may offer an outline of areas new sponsors might need to learn more about for their personal and professional development. Our Catholic health ministry depends on leaders who can create and steward organizational cultures that incarnate Jesus' healing. The possibilities for collaboration in the formation of future sponsors are endless, but there are challenges. If you are a member of a sponsor body/council/corporate member in Catholic health care, and are interested in nominating potential persons to take part in a representative group that would discuss possibilities for collaboration in sponsor formation, please go to www.chausa.org/sponsorformation and complete all sections of the nomination form.

Geisinger's Retail Innovation Journey.

PubMed

Prince, Denise B; Graf, Thomas

2015-01-01

In 2003, Geisinger Health System formed a new group, Geisinger Ventures (GV), to accelerate the growth of new lines of business that were extensions of the core mission of the organization. Careworks, the convenient care clinic line of business, began in early 2006 as one of the early components of the GV portfolio. Over the past nine years, Geisinger has tested several retail and walk-in models, including in-store clinics, separate retail sites, and models colocated with primary care practices and emergency departments. Each site and model presents different benefits and challenges with respect to patient care, marketing, staffing, and clinical integration. With the implementation of healthcare reform and a decision to participate in Medicaid'managed care, Geisinger's strategic need for convenient care options has intensified, and new models, including e-visits and telemedicine specialty consultations, are being actively explored. Geisinger's view is that healthcare is rapidly changing, being affected by demographic shifts, diagnostic and treatment options, payment changes, and communication technologies. Healthcare delivery must flex to adjust to these and other trends, and retail clinics are part of that response. Careful examination of the critical elements necessary for optimal care (including wellness, prevention, and management of chronic disease and severe multimorbid disease) and then matching those elements to the optimal mode and site of care will lead to a streamlined healthcare system. The historical--and still most prevalent--methodology of traditional office, emergency department, and inpatient care options are not ideal for all patients' care needs in the twenty-first century. A thoughtful, deliberate extension of those options will be necessary. Rather than simply adding a static retail or virtual offering, medical professionals should develop a process to continually assess patients, technology, payment, and disease changes so that they are constantly adding exciting new options to the clinical delivery model. The ability to assess and respond to the changes that these varied inputs drive will be the most important element of success for the future.

NUCLEAR REACTOR CORE

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

Bell, F.R.

1963-02-01

A nuclear reactor core composed of a number of identical elements of solid moderator material fitted together was designed. Each moderator element is apertured to provide channels for fuel and coolant. The elements have an external shape which permits them to be stacked in layers with similar elements, with the surfaces of adjacent elements fitting and in contact with each other. The cross section of the element is of a general hexagonal shape with identations and protrusions, so that the elements can be fitted together. The described core should not be liable to fracture under transverse loading. Specific arrangements ofmore » moderator elements and fuel and coolant apertures are described. (M.P.G.)« less

Pharmacist provision of primary health care: a modified Delphi validation of pharmacists' competencies.

PubMed

Kennie-Kaulbach, Natalie; Farrell, Barbara; Ward, Natalie; Johnston, Sharon; Gubbels, Ashley; Eguale, Tewodros; Dolovich, Lisa; Jorgenson, Derek; Waite, Nancy; Winslade, Nancy

2012-03-28

Pharmacists have expanded their roles and responsibilities as a result of primary health care reform. There is currently no consensus on the core competencies for pharmacists working in these evolving practices. The aim of this study was to develop and validate competencies for pharmacists' effective performance in these roles, and in so doing, document the perceived contribution of pharmacists providing collaborative primary health care services. Using a modified Delphi process including assessing perception of the frequency and criticality of performing tasks, we validated competencies important to primary health care pharmacists practising across Canada. Ten key informants contributed to competency drafting; thirty-three expert pharmacists replied to a second round survey. The final primary health care pharmacist competencies consisted of 34 elements and 153 sub-elements organized in seven CanMeds-based domains. Highest importance rankings were allocated to the domains of care provider and professional, followed by communicator and collaborator, with the lower importance rankings relatively equally distributed across the manager, advocate and scholar domains. Expert pharmacists working in primary health care estimated their most important responsibilities to be related to direct patient care. Competencies that underlie and are required for successful fulfillment of these patient care responsibilities, such as those related to communication, collaboration and professionalism were also highly ranked. These ranked competencies can be used to help pharmacists understand their potential roles in these evolving practices, to help other health care professionals learn about pharmacists' contributions to primary health care, to establish standards and performance indicators, and to prioritize supports and education to maximize effectiveness in this role.

Pharmacist provision of primary health care: a modified Delphi validation of pharmacists' competencies

PubMed Central

2012-01-01

Background Pharmacists have expanded their roles and responsibilities as a result of primary health care reform. There is currently no consensus on the core competencies for pharmacists working in these evolving practices. The aim of this study was to develop and validate competencies for pharmacists' effective performance in these roles, and in so doing, document the perceived contribution of pharmacists providing collaborative primary health care services. Methods Using a modified Delphi process including assessing perception of the frequency and criticality of performing tasks, we validated competencies important to primary health care pharmacists practising across Canada. Results Ten key informants contributed to competency drafting; thirty-three expert pharmacists replied to a second round survey. The final primary health care pharmacist competencies consisted of 34 elements and 153 sub-elements organized in seven CanMeds-based domains. Highest importance rankings were allocated to the domains of care provider and professional, followed by communicator and collaborator, with the lower importance rankings relatively equally distributed across the manager, advocate and scholar domains. Conclusions Expert pharmacists working in primary health care estimated their most important responsibilities to be related to direct patient care. Competencies that underlie and are required for successful fulfillment of these patient care responsibilities, such as those related to communication, collaboration and professionalism were also highly ranked. These ranked competencies can be used to help pharmacists understand their potential roles in these evolving practices, to help other health care professionals learn about pharmacists' contributions to primary health care, to establish standards and performance indicators, and to prioritize supports and education to maximize effectiveness in this role. PMID:22455482

Insights into Mercury's interior structure from geodesy measurements

NASA Astrophysics Data System (ADS)

Rivoldini, A.; Van Hoolst, T.; Trinh, A.

2013-09-01

The measurements of the gravitational field of Mercury by MESSENGER [1] and improved measurements of the spin state of Mercury [2] provide important constraints on the interior structure of Mercury. In particular, these data give strong constraints on the radius and density of Mercury's core and on the core's concentration of sulfur if sulfur is the only light element in the core [3]. Although sulfur is ubiquitously invoked as being the principal candidate light element in terrestrial planet's cores its abundance in the core depends on the redox conditions during planetary formation. MESSENGER data from remote sensing of Mercury's surface [4] indicate a high abundance of sulfur and confirm the low abundance in FeO supporting the hypotheses that Mercury formed under reducing conditions [5]. Therefore, substantial amounts of other light elements like for instance silicon could be present together with sulfur inside Mercury's core. Unlike sulfur, which does almost not partition into solid iron under Mercury's core pressure and temperature conditions, silicon partitions virtually equally between solid and liquid iron. Thus, if silicon is the only light element inside the core, the density jump at the inner-core outer-core boundary is significantly smaller if compared to an Fe - FeS core. If both silicon and sulfur are present inside Mercury's core then as a consequence of a large immiscibility region in liquid Fe - Si - S at Mercury's core conditions and for specific concentrations of light elements [6] a thin layer much enriched in sulfur and depleted in silicon could form at the top of the core. In this study we analyze interior structure models with silicon as the only light element in the core and with both silicon and sulfur in the core. Compared to models with Fe - FeS both settings have different mass distributions within their cores and will likely deform differently due to different elastic properties. Consequently their libration and tides will be different. Here we will use the measured 88 day libration amplitude and polar moment of inertia of Mercury in order to constrain the interior structure of both settings and calculate their tides.

The centrality of the nurse-patient relationship: A Scandinavian perspective.

PubMed

Uhrenfeldt, Lisbeth; Sørensen, Erik Elgaard; Bahnsen, Iben Bøgh; Pedersen, Preben Ulrich

2018-04-06

To address aspects of importance in the nurse-patient relationship, as conceptualised within the Scandinavian healthcare context. An experiment in Beth Israel Hospital uncovered a set of core values (ontology) that were wiped away by stronger forces. Despite this, some of the ideas impacted the development of nursing thought and values in the Scandinavian countries, partly because they connected with deeper social values and also because investment was being put into explicitly identifying and understanding the core elements of nursing (ontology) and how to provide evidence that they found were important (epistemology). From that beginning and through the work of key thought leaders, Scandinavian nursing is ready to embark on a new phase, which could be helped by the Fundamentals of Care framework. This discursive position study offers insights from a public healthcare setting, influenced by values such as equal rights to equal care and/or cure. This study presents two complementing perspectives: an ontological and an epistemological, on establishing caring relationships. There are different pathways to follow in building person-oriented care; however, the nursing approach is both ontologically and epistemologically grounded and based on dialogue. Patients meet different nurses, the meeting may be short and, routine actions may be on the agenda. However, nurses must engage with patients' experiences and knowledge, in order to add to patients' present and future well-being with their person-oriented care. © 2018 John Wiley & Sons Ltd.

Metal-silicate partitioning and the light element in the core (Invited)

NASA Astrophysics Data System (ADS)

Wood, B. J.; Wade, J.; Tuff, J.

2009-12-01

Most attempts to constrain the concentrations of “light” elements in the Earth’s core rely either on cosmochemical arguments or on arguments based on the densities and equations of state of Fe-alloys containing the element of concern. Despite its utility, the latter approach yields a wide range of permissible compositions and hence weak constraints. The major problem with the cosmochemical approach is that the abundances in the bulk Earth of all the candidate “light” elements- H, C, O, Si and S are highly uncertain because of their volatile behavior during planetary accretion. In contrast, refractory elements appear to be in approximately CI chondritic relative abundances in the Earth. This leads to the potential for using the partitioning of refractory siderophile elements between the mantle and core to constrain the concentrations of light elements in the core. Recent experimental metal-silicate partitioning data, coupled with mantle abundances of refractory siderophile elements (e.g. Wade and Wood, EPSL v.236, 78—95,2005; Kegler et. al. EPSL v.268, 28-40,2008) have shown that the core segregated from the mantle under high pressure conditions (~40 GPa). If a wide range of elements, from very siderophile, (e.g. Mo) through moderately (Ni, Co, W) to weakly siderophile (V, Cr, Nb, Si) are considered, the Earth also appears to have become more oxidized during accretion. Metal-silicate partitioning of some elements is also sensitive to the light element content of the metal. For example, Nb and W partitioning depend strongly on carbon, Mo on silicon and Cr on sulfur. Given the measured mantle abundances of the refractory elements, these observations enable the Si and C contents of the core to be constrained at ~5% and <2% respectively while partitioning is consistent with a cosmochemically-estimated S content of ~2%.

Patient participation in nursing care: towards a concept clarification from a nurse perspective.

PubMed

Sahlsten, Monika J M; Larsson, Inga E; Sjöström, Björn; Lindencrona, Catharina S C; Plos, Kaety A E

2007-04-01

The aim of this study was to investigate the meanings of the concept of patient participation in nursing care from a nurse perspective. Participation is essential and increases patients' motivation and satisfaction with received care. Studies of patient participation in nursing care are not congruent regarding definition, elements and processes. This lack of clarity is amplified by several terms used; patient/client/consumer involvement or collaboration, partnership and influence. Despite the fact that several nursing theories have emphasized the importance of patient participation, an empirically grounded theory has yet to be published. Seven focus group interviews were held with nurses providing inpatient physical care at five hospitals in West Sweden. The focus groups consisted of Registered Swedish nurses (n = 31) who described the meaning and implementation of patient participation in nursing care. A Grounded Theory approach has been applied to tape-recorded data. Constant comparative analysis was used and saturation was achieved. Mutuality in negotiation emerged as the core category for explaining nurses' perspectives on patient participation in nursing care. It is characterized by four interrelated sub-core categories: interpersonal procedure, therapeutic approach, focus on resources and opportunities for influence. Mutuality in negotiation constitutes the dynamic nurse-patient interaction process. The study clarifies that patient participation can be explained as an interactional process identified as mutuality in negotiation based on four components. The results are important and can be used in nursing practice and education. Application in a clinical context means nursing care organized to include all the components presented. The results can also be used in quality assurance to improve and evaluate patient participation.

Common data elements for substance use disorders in electronic health records: the NIDA Clinical Trials Network experience.

PubMed

Ghitza, Udi E; Gore-Langton, Robert E; Lindblad, Robert; Shide, David; Subramaniam, Geetha; Tai, Betty

2013-01-01

Electronic health records (EHRs) are essential in improving quality and enhancing efficiency of health-care delivery. By 2015, medical care receiving service reimbursement from US Centers for Medicare and Medicaid Services (CMS) must show 'meaningful use' of EHRs. Substance use disorders (SUD) are grossly under-detected and under-treated in current US medical care settings. Hence, an urgent need exists for improved identification of and clinical intervention for SUD in medical settings. The National Institute on Drug Abuse Clinical Trials Network (NIDA CTN) has leveraged its infrastructure and expertise and brought relevant stakeholders together to develop consensus on brief screening and initial assessment tools for SUD in general medical settings, with the objective of incorporation into US EHRs. Stakeholders were identified and queried for input and consensus on validated screening and assessment for SUD in general medical settings to develop common data elements to serve as shared resources for EHRs on screening, brief intervention and referral to treatment (SBIRT), with the intent of supporting interoperability and data exchange in a developing Nationwide Health Information Network. Through consensus of input from stakeholders, a validated screening and brief assessment instrument, supported by Clinical Decision Support tools, was chosen to be used at out-patient general medical settings. The creation and adoption of a core set of validated common data elements and the inclusion of such consensus-based data elements for general medical settings will enable the integration of SUD treatment within mainstream health care, and support the adoption and 'meaningful use' of the US Office of the National Coordinator for Health Information Technology (ONC)-certified EHRs, as well as CMS reimbursement. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.

A volatile rich Earth's core?

NASA Astrophysics Data System (ADS)

Morard, G.; Antonangeli, D.; Andrault, D.; Nakajima, Y.

2017-12-01

The composition of the Earth's core is still an open question. Although mostly composed of iron, it contains impurities that lower its density and melting point with respect to pure Fe. Knowledge of the nature and abundance of light elements (O, S, Si, C or H) in the core has major implications for establishing the bulk composition of the Earth and for building the model of Earth's differentiation. Geochemical models of the Earth's formation point out that its building blocks were depleted in volatile elements compared to the chondritic abundance, therefore light elements such as S, H or C cannot be the major elements alloyed with iron in the Earth's core. However, such models should be compatible with the comparison of seismic properties of the Earth's core and physical properties of iron alloys under extreme conditions, such as sound velocity or density of solid and liquid. The present work will discuss the recent progress for compositional model issued from studies of phase diagrams and elastic properties of iron alloys under core conditions and highlight the compatibility of volatile elements with observed properties of the Earth's core, in potential contradiction with models derived from metal-silicate partitioning experiments.

Developing a patient-led electronic feedback system for quality and safety within Renal PatientView.

PubMed

Giles, Sally J; Reynolds, Caroline; Heyhoe, Jane; Armitage, Gerry

2017-03-01

It is increasingly acknowledged that patients can provide direct feedback about the quality and safety of their care through patient reporting systems. The aim of this study was to explore the feasibility of patients, healthcare professionals and researchers working in partnership to develop a patient-led quality and safety feedback system within an existing electronic health record (EHR), known as Renal PatientView (RPV). Phase 1 (inception) involved focus groups (n = 9) and phase 2 (requirements) involved cognitive walkthroughs (n = 34) and 1:1 qualitative interviews (n = 34) with patients and healthcare professionals. A Joint Services Expert Panel (JSP) was convened to review the findings from phase 1 and agree the core principles and components of the system prototype. Phase 1 data were analysed using a thematic approach. Data from phase 1 were used to inform the design of the initial system prototype. Phase 2 data were analysed using the components of heuristic evaluation, resulting in a list of core principles and components for the final system prototype. Phase 1 identified four main barriers and facilitators to patients feeding back on quality and safety concerns. In phase 2, the JSP agreed that the system should be based on seven core principles and components. Stakeholders were able to work together to identify core principles and components for an electronic patient quality and safety feedback system in renal services. Tensions arose due to competing priorities, particularly around anonymity and feedback. Careful consideration should be given to the feasibility of integrating a novel element with differing priorities into an established system with existing functions and objectives. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Experiments on Lunar Core Composition: Phase Equilibrium Analysis of A Multi-Element (Fe-Ni-S-C) System

NASA Technical Reports Server (NTRS)

Go, B. M.; Righter, K.; Danielson, L.; Pando, K.

2015-01-01

Previous geochemical and geophysical experiments have proposed the presence of a small, metallic lunar core, but its composition is still being investigated. Knowledge of core composition can have a significant effect on understanding the thermal history of the Moon, the conditions surrounding the liquid-solid or liquid-liquid field, and siderophile element partitioning between mantle and core. However, experiments on complex bulk core compositions are very limited. One limitation comes from numerous studies that have only considered two or three element systems such as Fe-S or Fe-C, which do not supply a comprehensive understanding for complex systems such as Fe-Ni-S-Si-C. Recent geophysical data suggests the presence of up to 6% lighter elements. Reassessments of Apollo seismological analyses and samples have also shown the need to acquire more data for a broader range of pressures, temperatures, and compositions. This study considers a complex multi-element system (Fe-Ni-S-C) for a relevant pressure and temperature range to the Moon's core conditions.

Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions

PubMed Central

2012-01-01

Background In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities. Methods Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care. Results The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions. Conclusions The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model. PMID:22889290

Major and trace elements in Mahogany zone oil shale in two cores from the Green River Formation, piceance basin, Colorado

USGS Publications Warehouse

Tuttle, M.L.; Dean, W.E.; Parduhn, N.L.

1983-01-01

The Parachute Creek Member of the lacustrine Green River Formation contains thick sequences of rich oil-shale. The richest sequence and the richest oil-shale bed occurring in the member are called the Mahogany zone and the Mahogany bed, respectively, and were deposited in ancient Lake Uinta. The name "Mahogany" is derived from the red-brown color imparted to the rock by its rich-kerogen content. Geochemical abundance and distribution of eight major and 18 trace elements were determined in the Mahogany zone sampled from two cores, U. S. Geological Survey core hole CR-2 and U. S. Bureau of Mines core hole O1-A (Figure 1). The oil shale from core hole CR-2 was deposited nearer the margin of Lake Uinta than oil shale from core hole O1-A. The major- and trace-element chemistry of the Mahogany zone from each of these two cores is compared using elemental abundances and Q-mode factor modeling. The results of chemical analyses of 44 CR-2 Mahogany samples and 76 O1-A Mahogany samples are summarized in Figure 2. The average geochemical abundances for shale (1) and black shale (2) are also plotted on Figure 2 for comparison. The elemental abundances in the samples from the two cores are similar for the majority of elements. Differences at the 95% probability level are higher concentrations of Ca, Cu, La, Ni, Sc and Zr in the samples from core hole CR-2 compared to samples from core hole O1-A and higher concentrations of As and Sr in samples from core hole O1-A compared to samples from core hole CR-2. These differences presumably reflect slight differences in depositional conditions or source material at the two sites. The Mahogany oil shale from the two cores has lower concentrations of most trace metals and higher concentrations of carbonate-related elements (Ca, Mg, Sr and Na) compared to the average shale and black shale. During deposition of the Mahogany oil shale, large quantities of carbonates were precipitated resulting in the enrichment of carbonate-related elements and dilution of most trace elements as pointed out in several previous studies. Q-mode factor modeling is a statistical method used to group samples on the basis of compositional similarities. Factor end-member samples are chosen by the model. All other sample compositions are represented by varying proportions of the factor end-members and grouped as to their highest proportion. The compositional similarities defined by the Q-mode model are helpful in understanding processes controlling multi-element distributions. The models for each core are essentially identical. A four-factor model explains 70% of the variance in the CR-2 data and 64% of the O1-A data (the average correlation coefficients are 0. 84 and 0. 80, respectively). Increasing the number of factors above 4 results in the addition of unique instead of common factors. Table I groups the elements based on high factor-loading scores (the amount of influence each element has in defining the model factors). Similar elemental associations are found in both cores. Elemental abundances are plotted as a function of core depth using a five-point weighted moving average of the original data to smooth the curve (Figure 3 and 4). The plots are grouped according to the four factors defined by the Q-mode models and show similar distributions for elements within the same factor. Factor 1 samples are rich in most trace metals. High oil yield and the presence of illite characterize the end-member samples for this factor (3, 4) suggesting that adsorption of metals onto clay particles or organic matter is controlling the distribution of the metals. Precipitation of some metals as sulfides is possible (5). Factor 2 samples are high in elements commonly associated with minerals of detrital or volcanogenic origin. Altered tuff beds and lenses are prevalent within the Mahogany zone. The CR-2 end-member samples for this factor contain analcime (3) which is an alteration product within the tuff beds of the Green River Formation. Th

HIGH TEMPERATURE, HIGH POWER HETEROGENEOUS NUCLEAR REACTOR

DOEpatents

Hammond, R.P.; Wykoff, W.R.; Busey, H.M.

1960-06-14

A heterogeneous nuclear reactor is designed comprising a stationary housing and a rotatable annular core being supported for rotation about a vertical axis in the housing, the core containing a plurality of radial fuel- element supporting channels, the cylindrical empty space along the axis of the core providing a central plenum for the disposal of spent fuel elements, the core cross section outer periphery being vertically gradated in radius one end from the other to provide a coolant duct between the core and the housing, and means for inserting fresh fuel elements in the supporting channels under pressure and while the reactor is in operation.

Properties of iron alloys under the Earth's core conditions

NASA Astrophysics Data System (ADS)

Morard, Guillaume; Andrault, Denis; Antonangeli, Daniele; Bouchet, Johann

2014-05-01

The Earth's core is constituted of iron and nickel alloyed with lighter elements. In view of their affinity with the metallic phase, their relative high abundance in the solar system and their moderate volatility, a list of potential light elements have been established, including sulfur, silicon and oxygen. We will review the effects of these elements on different aspects of Fe-X high pressure phase diagrams under Earth's core conditions, such as melting temperature depression, solid-liquid partitioning during crystallization, and crystalline structure of the solid phases. Once extrapolated to the inner-outer core boundary, these petrological properties can be used to constrain the Earth's core properties.

Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital.

PubMed

Sepucha, Karen R; Simmons, Leigh H; Barry, Michael J; Edgman-Levitan, Susan; Licurse, Adam M; Chaguturu, Sreekanth K

2016-04-01

Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions. We profile two different implementation initiatives that increased the use of patient decision aids at the hospital's eighteen adult primary care practices, and we summarize key elements of the shared decision making program. Project HOPE—The People-to-People Health Foundation, Inc.

CORE-SINEs: eukaryotic short interspersed retroposing elements with common sequence motifs.

PubMed

Gilbert, N; Labuda, D

1999-03-16

A 65-bp "core" sequence is dispersed in hundreds of thousands copies in the human genome. This sequence was found to constitute the central segment of a group of short interspersed elements (SINEs), referred to as mammalian-wide interspersed repeats, that proliferated before the radiation of placental mammals. Here, we propose that the core identifies an ancient tRNA-like SINE element, which survived in different lineages such as mammals, reptiles, birds, and fish, as well as mollusks, presumably for >550 million years. This element gave rise to a number of sequence families (CORE-SINEs), including mammalian-wide interspersed repeats, whose distinct 3' ends are shared with different families of long interspersed elements (LINEs). The evolutionary success of the generic CORE-SINE element can be related to the recruitment of the internal promoter from highly transcribed host RNA as well as to its capacity to adapt to changing retropositional opportunities by sequence exchange with actively amplifying LINEs. It reinforces the notion that the very existence of SINEs depends on the cohabitation with both LINEs and the host genome.

The role of the multidisciplinary health care team in the management of patients with Marfan syndrome

PubMed Central

von Kodolitsch, Yskert; Rybczynski, Meike; Vogler, Marina; Mir, Thomas S; Schüler, Helke; Kutsche, Kerstin; Rosenberger, Georg; Detter, Christian; Bernhardt, Alexander M; Larena-Avellaneda, Axel; Kölbel, Tilo; Debus, E Sebastian; Schroeder, Malte; Linke, Stephan J; Fuisting, Bettina; Napp, Barbara; Kammal, Anna Lena; Püschel, Klaus; Bannas, Peter; Hoffmann, Boris A; Gessler, Nele; Vahle-Hinz, Eva; Kahl-Nieke, Bärbel; Thomalla, Götz; Weiler-Normann, Christina; Ohm, Gunda; Neumann, Stefan; Benninghoven, Dieter; Blankenberg, Stefan; Pyeritz, Reed E

2016-01-01

Marfan syndrome (MFS) is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary health care team at the Hamburg Marfan center gives a personal account of his or her contribution in the management of patients with MFS. The authors show how, with the support of health care managers, key team members organize themselves in an organizational structure to create a common meaning, to maximize therapeutic success for patients with MFS. First, we show how the initiative and collaboration of patient representatives, scientists, and physicians resulted in the foundation of Marfan centers, initially in the US and later in Germany, and how and why such centers evolved over time. Then, we elucidate the three main structural elements; a team of coordinators, core disciplines, and auxiliary disciplines of health care. Moreover, we explain how a multidisciplinary health care team integrates into many other health care structures of a university medical center, including external quality assurance; quality management system; clinical risk management; center for rare diseases; aorta center; health care teams for pregnancy, for neonates, and for rehabilitation; and in structures for patient centeredness. We provide accounts of medical goals and standards for each core discipline, including pediatricians, pediatric cardiologists, cardiologists, human geneticists, heart surgeons, vascular surgeons, vascular interventionists, orthopedic surgeons, ophthalmologists, and nurses; and of auxiliary disciplines including forensic pathologists, radiologists, rhythmologists, pulmonologists, sleep specialists, orthodontists, dentists, neurologists, obstetric surgeons, psychiatrist/psychologist, and rehabilitation specialists. We conclude that a multidisciplinary health care team is a means to maximize therapeutic success. PMID:27843325

What does the Development of the European Core Curriculum for Cardiovascular Nurses Mean for Australia?

PubMed

Neubeck, Lis; Lin, Stella Hsi-Man; Ferry, Cate; Gallagher, Robyn

2016-04-01

A core curriculum for the continuing professional development of nurses has recently been published by the Council on Cardiovascular Nursing and Allied Professions of the European Society of Cardiology. This core curriculum was envisaged to bridge the educational gap between qualification as a nurse and an advance practice role. In addition, the shared elements and international consensus on core themes creates a strong pathway for nursing career development that is directly relevant to Australia. Education programs for nurses in Australia must meet the mandatory standards of the Australian Nursing and Midwifery Accreditation Council (ANMAC), but without a national core curriculum, there can be considerable variation in the content of such courses. The core curriculum is developed to be adapted locally, allowing the addition of nationally relevant competencies, for example, culturally appropriate care of Aboriginal and Torres Strait Islander individuals. Two existing specialist resources could be utilised to deliver a tailored cardiovascular core curriculum; the Heart Education Assessment and Rehabilitation Toolkit (HEART) online (www.heartonline.org.au) and HeartOne (www.heartone.com.au). Both resources could be further enhanced by incorporating the core curriculum. The release of the European core curriculum should be viewed as a call to action for Australia to develop a core curriculum for cardiovascular nurses. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Enhancing the role of case managers with specialty populations: development and evaluation of a palliative care education program.

PubMed

Howell, Doris; Prestwich, Catherine; Laughlin, Emmy; Giga, Nasreen

2004-01-01

Palliative home care is an important component of the care system for patients at the end of life and case management is considered an essential element of the Canadian home care system. Case managers play a critical role in allocating resources, thus influencing the costs and the viability of palliative home care. Case management education programs focused on care coordination with specialty palliative care populations are nonexistent. An education program targeted at improving the knowledge and skills of case managers in allocating resources to palliative care populations was developed and pilot-tested in a metropolitan Canadian city home care program. Core curriculum was based on an initial learning needs assessment and used case-based problem solving to enhance case-management skills. An improvement in knowledge was noted on posttests and case managers described increased comfort and confidence in their role as case managers to this patient population. Home care organizations caring for palliative care populations must ensure case managers are prepared for case management roles with specialty populations if the home is to be rendered an appropriate and viable care setting for patients at the end of life.

MEANS FOR COOLING REACTORS

DOEpatents

Wheeler, J.A.

1957-11-01

A design of a reactor is presented in which the fuel elements may be immersed in a liquid coolant when desired without the necessity of removing them from the reactor structure. The fuel elements, containing the fissionable material are in plate form and are disposed within spaced slots in a moderator material, such as graphite to form the core. Adjacent the core is a tank containing the liquid coolant. The fuel elements are mounted in spaced relationship on a rotatable shaft which is located between the core and the tank so that by rotation of the shaft the fuel elements may be either inserted in the slots in the core to sustain a chain reaction or immersed in the coolant.

A Finite Element Analysis for Predicting the Residual Compressive Strength of Impact-Damaged Sandwich Panels

NASA Technical Reports Server (NTRS)

Ratcliffe, James G.; Jackson, Wade C.

2008-01-01

A simple analysis method has been developed for predicting the residual compressive strength of impact-damaged sandwich panels. The method is tailored for honeycomb core-based sandwich specimens that exhibit an indentation growth failure mode under axial compressive loading, which is driven largely by the crushing behavior of the core material. The analysis method is in the form of a finite element model, where the impact-damaged facesheet is represented using shell elements and the core material is represented using spring elements, aligned in the thickness direction of the core. The nonlinear crush response of the core material used in the analysis is based on data from flatwise compression tests. A comparison with a previous analysis method and some experimental data shows good agreement with results from this new approach.

A Finite Element Analysis for Predicting the Residual Compression Strength of Impact-Damaged Sandwich Panels

NASA Technical Reports Server (NTRS)

Ratcliffe, James G.; Jackson, Wade C.

2008-01-01

A simple analysis method has been developed for predicting the residual compression strength of impact-damaged sandwich panels. The method is tailored for honeycomb core-based sandwich specimens that exhibit an indentation growth failure mode under axial compression loading, which is driven largely by the crushing behavior of the core material. The analysis method is in the form of a finite element model, where the impact-damaged facesheet is represented using shell elements and the core material is represented using spring elements, aligned in the thickness direction of the core. The nonlinear crush response of the core material used in the analysis is based on data from flatwise compression tests. A comparison with a previous analysis method and some experimental data shows good agreement with results from this new approach.

TRANSFER FROM PEDIATRIC TO ADULT ENDOCRINOLOGY.

PubMed

Jones, Marybeth R; Robbins, Brett W; Augustine, Marilyn; Doyle, Jackie; Mack-Fogg, Jean; Jones, Heather; White, Patience H

2017-07-01

Adult and pediatric endocrinologists share responsibility for the transition of youth with type 1 diabetes from pediatric to adult healthcare. This study aimed to increase successful transfers to adult care in subspecialty practices by establishing a systematic health care transition (HCT) process. Providers from the adult and pediatric endocrinology divisions at the University of Rochester Medical Center met monthly to customize and integrate the Six Core Elements (6CEs) of HCT into clinical workflows. Young adult patients with type 1 diabetes having an outpatient visit during a 34-month pre-post intervention period were eligible (N = 371). Retrospective chart review was performed on patients receiving referrals to adult endocrinology (n = 75) to obtain (1) the proportion of patients explicitly tracked during transfer from the pediatric to adult endocrinology practice, (2) the providers' documentation of the use of the 6CEs, and (3) the patients' diabetes control and healthcare utilization during the transition period. The percent of eligible patients with type 1 diabetes who were explicitly tracked in their transfer more than doubled compared to baseline (11% vs. 27% of eligible patients; P<.01). Pediatric providers started to use transition readiness assessments and create medical summaries, and adult providers increased closed-loop communication with pediatric providers after a patient's first adult visit. Glycemic control and healthcare utilization remained stable. Successful implementation of the 6CEs into pediatric and adult subspecialty practices can result in improvements of planned transfers of pediatric patients with type 1 diabetes to adult subspecialty providers. 6CEs = six core elements; AYA = adolescent and young adult; DKA = diabetic ketoacidosis; ED = emergency department; HbA1c = hemoglobin A1c; HCT = health care transition.

How transformational learning promotes caring, consultation and creativity, and ultimately contributes to sustainable development: Lessons from the Partnership for Education and Research about Responsible Living (PERL) network

NASA Astrophysics Data System (ADS)

Thoresen, Victoria Wyszynski

2017-12-01

Oases of learning which are transformative and lead to significant behavioural change can be found around the globe. Transformational learning has helped learners not only to understand what they have been taught but also to re-conceptualise and re-apply this understanding to their daily lives. Unfortunately, as many global reports indicate, inspirational transformational learning approaches for sustainable development are rare and have yet to become the norm - despite calls for such approaches by several outstanding educators and organisations. This article examines three learning approaches developed by the network of the Partnership for Education and Research about Responsible Living (PERL). These approaches are structured around core elements of transformative learning for sustainable development, yet focus particularly on the ability to care, consult with others and be creative. They seem to depend on the learners' ability to articulate their perceptions of sustainable development in relation to their own values and to identify how these are actualised in their daily life. Together with other core elements of transformative learning, an almost magical (not precisely measurable) synergy then emerges. The intensity of this synergy appears to be directly related to the individual learner's understanding of the contradictions, interlinkages and interdependencies of modern society. The impact of this synergy seems to be concurrent with the extent to which the learner engages in a continual learning process with those with whom he/she has contact. The findings of this study suggest that mainstreaming transformational learning for sustainable development in ways that release the "magic synergy of creative caring" can result in the emergence of individuals who are willing and able to move from "business as usual" towards more socially just, economically equitable, and environmentally sensitive behaviour.

The effect of acidified sample storage time on the determination of trace element concentration in ice cores by ICP-SFMS

NASA Astrophysics Data System (ADS)

Uglietti, C.; Gabrielli, P.; Lutton, A.; Olesik, J.; Thompson, L. G.

2012-12-01

Trace elements in micro-particles entrapped in ice cores are a valuable proxy of past climate and environmental variations. Inductively coupled plasma sector field mass spectrometry (ICP-SFMS) is generally recognized as a sensitive and accurate technique for the quantification of ultra-trace element concentrations in ice cores. Usually, ICP-SFMS analyses of ice core samples are performed by melting and acidifying aliquots. Acidification is important to transfer trace elements from particles into solution by partial and/or complete dissolution. Only elements in solution and in sufficiently small particles will be vaporized and converted to elemental ions in the plasma for detection by ICP-SFMS. However, experimental results indicate that differences in acidified sample storage time at room temperature may lead to the recovery of different trace element fractions. Moreover, different lithologies of the relatively abundant crustal material entrapped in the ice matrix could also influence the fraction of trace elements that are converted into elemental ions in the plasma. These factors might affect the determination of trace elements concentrations in ice core samples and hamper the comparison of results obtained from ice cores from different locations and/or epochs. In order to monitor the transfer of elements from particles into solution in acidified melted ice core samples during storage, a test was performed on sections from nine ice cores retrieved from low latitude drilling sites around the world. When compared to ice cores from polar regions, these samples are characterized by a relative high content of micro-particles that may leach trace elements into solution differently. Of the nine ice cores, five are from the Tibetan Plateau (Dasuopu, Guliya, Naimonanyi, Puruogangri and Dunde), two from the Andes (Quelccaya and Huascaran), one from Africa (Kilimanjaro) and one from the Eastern Alps (Ortles). These samples were decontaminated by triple rinsing, melted and stored in pre-cleaned low-density polyethylene bottles, and kept frozen until acidification (2% v/v ultra-pure HNO3). Determination of twenty trace elements (Ag, Al, As, Bi, Cd, Co, Cr, Cu, Fe, Mn, Mo, Pb, Rb, Sb, Sn, Ti, Tl, U, V, and Zn) was repeated at different times after acidification using the same aliquot. Analyses show a mean increase of 40-50% in trace element concentration in all the samples during the first 15 days of storage after acidification, except Al, Fe, V and Cr, which show a larger increase (90-100%). After 15 days the trace element concentrations reach generally stable values (with small increases within measurement uncertainty), except for the Naimonanyi and Kilimanjaro samples which continue to increase. In contrast, Ag concentration decreases after one week, likely due to its low stability in the acidified solution that may depend on the Cl- concentration. We froze the samples 43 days after the acidification. After two weeks the samples were melted and re-analyzed by ICP-SFMS in two different laboratories as an inter-calibration exercise. The results show a good correspondence between the measured concentrations determined by the two instruments and a consistent additional increase of 20-30% of measured trace element concentrations in almost all samples.

Towards a Duty of Care for Biodiversity

NASA Astrophysics Data System (ADS)

Earl, G.; Curtis, A.; Allan, C.

2010-04-01

The decline in biodiversity is a worldwide phenomenon, with current rates of species extinction more dramatic than any previously recorded. Habitat loss has been identified as the major cause of biodiversity decline. In this article we suggest that a statutory duty of care would complement the current mix of policy options for biodiversity conservation. Obstacles hindering the introduction of a statutory duty of care include linguistic ambiguity about the terms ‘duty of care’ and ‘stewardship’ and how they are applied in a natural resource management context, and the absence of a mechanism to guide its implementation. Drawing on international literature and key informant interviews we have articulated characteristics of duty of care to reduce linguistic ambiguity, and developed a framework for implementing a duty of care for biodiversity at the regional scale. The framework draws on key elements of the common law ‘duty of care’, the concepts of ‘taking reasonable care’ and ‘avoiding foreseeable harm’, in its logic. Core elements of the framework include desired outcomes for biodiversity, supported by current recommended practices. The focus on outcomes provides opportunities for the development of innovative management practices. The framework incorporates multiple pathways for the redress of non-compliance including tiered negative sanctions, and positive measures to encourage compliance. Importantly, the framework addresses the need for change and adaptation that is a necessary part of biodiversity management.

Fuel handling system for a nuclear reactor

DOEpatents

Saiveau, James G.; Kann, William J.; Burelbach, James P.

1986-01-01

A pool type nuclear fission reactor has a core, with a plurality of core elements and a redan which confines coolant as a hot pool at a first end of the core separated from a cold pool at a second end of the core by the redan. A fuel handling system for use with such reactors comprises a core element storage basket located outside of the redan in the cold pool. An access passage is formed in the redan with a gate for opening and closing the passage to maintain the temperature differential between the hot pool and the cold pool. A mechanism is provided for opening and closing the gate. A lifting arm is also provided for manipulating the fuel core elements through the access passage between the storage basket and the core when the redan gate is open.

Fuel handling system for a nuclear reactor

DOEpatents

Saiveau, James G.; Kann, William J.; Burelbach, James P.

1986-12-02

A pool type nuclear fission reactor has a core, with a plurality of core elements and a redan which confines coolant as a hot pool at a first end of the core separated from a cold pool at a second end of the core by the redan. A fuel handling system for use with such reactors comprises a core element storage basket located outside of the redan in the cold pool. An access passage is formed in the redan with a gate for opening and closing the passage to maintain the temperature differential between the hot pool and the cold pool. A mechanism is provided for opening and closing the gate. A lifting arm is also provided for manipulating the fuel core elements through the access passage between the storage basket and the core when the redan gate is open.

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

Blanchard, I.; Badro, J.; Siebert, J.

We present gallium concentration (normalized to CI chondrites) in the mantle is at the same level as that of lithophile elements with similar volatility, implying that there must be little to no gallium in Earth's core. Metal-silicate partitioning experiments, however, have shown that gallium is a moderately siderophile element and should be therefore depleted in the mantle by core formation. Moreover, gallium concentrations in the mantle (4 ppm) are too high to be only brought by the late veneer; and neither pressure, nor temperature, nor silicate composition has a large enough effect on gallium partitioning to make it lithophile. Wemore » therefore systematically investigated the effect of core composition (light element content) on the partitioning of gallium by carrying out metal–silicate partitioning experiments in a piston–cylinder press at 2 GPa between 1673 K and 2073 K. Four light elements (Si, O, S, C) were considered, and their effect was found to be sufficiently strong to make gallium lithophile. The partitioning of gallium was then modeled and parameterized as a function of pressure, temperature, redox and core composition. A continuous core formation model was used to track the evolution of gallium partitioning during core formation, for various magma ocean depths, geotherms, core light element contents, and magma ocean composition (redox) during accretion. The only model for which the final gallium concentration in the silicate Earth matched the observed value is the one involving a light-element rich core equilibrating in a FeO-rich deep magma ocean (>1300 km) with a final pressure of at least 50 GPa. More specifically, the incorporation of S and C in the core provided successful models only for concentrations that lie far beyond their allowable cosmochemical or geophysical limits, whereas realistic O and Si amounts (less than 5 wt.%) in the core provided successful models for magma oceans deeper that 1300 km. In conclusion, these results offer a strong argument for an O- and Si-rich core, formed in a deep terrestrial magma ocean, along with oxidizing conditions.« less

Suppression of grp78 core promoter element-mediated stress induction by the dbpA and dbpB (YB-1) cold shock domain proteins.

PubMed Central

Li, W W; Hsiung, Y; Wong, V; Galvin, K; Zhou, Y; Shi, Y; Lee, A S

1997-01-01

The highly conserved grp78 core promoter element plays an important role in the induction of grp78 under diverse stress signals. Previous studies have established a functional region in the 3' half of the core (stress-inducible change region [SICR]) which exhibits stress-inducible changes in stressed nuclei. The human transcription factor YY1 is shown to bind the SICR and transactivate the core element under stress conditions. Here we report that expression library screening with the core element has identified two new core binding proteins, YB-1 and dbpA. Both proteins belong to the Y-box family of proteins characterized by an evolutionarily conserved DNA binding motif, the cold shock domain (CSD). In contrast to YY1, which binds only double-stranded SICR, the Y-box/CSD proteins much prefer the lower strand of the SICR. The Y-box proteins can repress the inducibility of the grp78 core element mediated by treatment of cells with A23187, thapsigargin, and tunicamycin. In gel shift assays, YY1 binding to the core element is inhibited by either YB-1 or dbpA. A yeast interaction trap screen using LexA-YY1 as a bait and a HeLa cell cDNA-acid patch fusion library identified YB-1 as a YY1-interacting protein. In cotransfection experiments, the Y-box proteins antagonize the YY1-mediated enhancement of transcription directed by the grp78 core in stressed cells. Thus, the CSD proteins may be part of the stress signal transduction mechanism in the mammalian system. PMID:8972186

Distilling Common History and Practice Elements to Inform Dissemination: Hanf-Model BPT Programs as an Example

PubMed Central

Kaehler, Laura A.; Jacobs, Mary; Jones, Deborah J.

2016-01-01

There is a shift in evidence-based practice toward an understanding of the treatment elements that characterize empirically-supported interventions in general and the core components of specific approaches in particular. The evidence-base for Behavioral Parent Training (BPT), the standard of care for early-onset disruptive behavior disorders (Oppositional Defiant Disorder and Conduct Disorder), which frequently co-occur with Attention Deficit Hyperactivity Disorder, is well-established; yet, an ahistorical, program-specific lens tells little regarding how leaders, including Constance Hanf at the University of Oregon, shaped the common practice elements of contemporary evidence-based BPT. Accordingly, this review summarizes the formative work of Hanf, as well as the core elements, evolution, and extensions of her work, represented in Community Parent Education (COPE; Cunningham, Bremner, & Boyle, 1995; Cunningham, Bremner, Secord, & Harrison, 2009), Defiant Children (DC; Barkley 1987; Barkley, 2013), Helping the Noncompliant Child (HNC; Forehand & McMahon, 1981; McMahon & Forehand, 2003), Parent-Child Interaction Therapy (PCIT; Eyberg, & Robinson, 1982; Eyberg, 1988; Eyberg & Funderburk, 2011), and the Incredible Years (IY; Webster-Stratton, 1981; 1982; 2008). Our goal is not to provide an exhaustive review of the evidence-base for the Hanf-Model programs; rather, our intention is to provide a template of sorts from which agencies and clinicians can make informed choices about how and why they are using one program versus another, as well as how to make inform flexible use one program or combination of practice elements across programs, to best meet the needs of child clients and their families. Clinical implications and directions for future work are discussed. PMID:27389606

The development of integrated diabetes care in the Netherlands: a multiplayer self-assessment analysis.

PubMed

Zonneveld, Nick; Vat, Lidewij E; Vlek, Hans; Minkman, Mirella M N

2017-03-21

Since recent years Dutch diabetes care has increasingly focused on improving the quality of care by introducing the concept of care groups (in Dutch: 'zorggroepen'), care pathways and improving cooperation with involved care professionals and patients. This study examined how participating actors in care groups assess the development of their diabetes services and the differences and similarities between different stakeholder groups. A self-evaluation study was performed within 36 diabetes care groups in the Netherlands. A web-based self-assessment instrument, based on the Development Model for Integrated Care (DMIC), was used to collect data among stakeholders of each care group. The DMIC defines nine clusters of integrated care and four phases of development. Statistical analysis was used to analyze the data. Respondents indicated that the diabetes care groups work together in well-organized multidisciplinary teams and there is clarity about one another's expertise, roles and tasks. The care groups can still develop on elements related to the management and monitoring of performance, quality of care and patient-centeredness. The results show differences (p < 0.01) between three stakeholders groups in how they assess their integrated care services; (1) core players, (2) managers/directors/coordinators and (3) players at a distance. Managers, directors and coordinators assessed more implemented integrated care activities than the other two stakeholder groups. This stakeholder group also placed their care groups in a further phase of development. Players at a distance assessed significantly less present elements and assessed their care group as less developed. The results show a significant difference between stakeholder groups in the assessment of diabetes care practices. This reflects that the professional disciplines and the roles of stakeholders influence the way they asses the development of their integrated care setting, or that certain stakeholder groups could be less involved or informed.

Composition of the low seismic velocity E' layer at the top of Earth's core

NASA Astrophysics Data System (ADS)

Badro, J.; Brodholt, J. P.

2017-12-01

Evidence for a layer (E') at the top of the outer core has been available since the '90s and while different studies suggest slightly different velocity contrasts and thicknesses, the common observation is that the layer has lower velocities than the bulk outer core (PREM). Although there are no direct measurements on the density of this layer, dynamic stability requires it to be less dense than the bulk outer core under those same pressure and temperature conditions. Using ab initio simulations on Fe-Ni-S-C-O-Si liquids we constrain the origin and composition of the low-velocity layer E' at the top of Earth's outer core. We find that increasing the concentration of any light-element always increases velocity and so a low-velocity and low-density layer (for stability) cannot be made by simply increasing light element concentration. This rules out barodiffusion or upwards sedimentation of a light phase for its origin. However, exchanging elements can—depending on the elements exchanged—produce such a layer. We evaluate three possibilities. Firstly, crystallization of a light phase from a core containing more than one light element may make such a layer, but only if the crystalizing phase is very Fe-rich, which is at odds with available phase diagrams at CMB conditions. Secondly, the E' layer may result from incomplete mixing of an early Earth core with a late impactor, depending on the light element compositions of the impactor and Earth's core, but such a primordial stratification is neither supported by dynamical models of the core nor thermodynamic models of core merger after the giant impact. The last and most plausible scenario is core-mantle chemical interaction; using thermodynamic models for metal-silicate partitioning of silicon and oxygen at CMB conditions, we show that a reaction between the core and an FeO-rich basal magma ocean can enrich the core in oxygen while depleting it in silicon, in relative amounts that produce a light and slow layer consistent with seismological observations.

The Pasamonte unequilibrated eucrite: Pyroxene REE systematic and major-, minor-, and trace-element zoning. [Abstract only

NASA Technical Reports Server (NTRS)

Pun, A.; Papike, J. J.

1994-01-01

We are evaluating the trace-element concentrations in the pyroxenes of Pasamonte. Pasamonte is a characteristic member of the main group eucrites, and has recently been redescribed as a polymict eucrite. Our Pasamonte sample contained eucritic clasts with textures ranging from subophitic to moderately coarse-grained. This study concentrates on pyroxenes from an unequilibrated, coarse-grained eucrite clast. Major-, minor-, and trace-element analyses were measured for zoned pyroxenes in the eucritic clast of Pasamonte. The major- and minor-element zoning traverses were measured using the JEOL 733 electron probe with an Oxford-Link imaging/analysis system. Complemenatry trace elements were then measured for the core and rim of each of the grains by SIMS. The trace elements analyzed consisted of eight REE, Sr, Y, and Zr. These analyses were performed on a Cameca 4f ion probe. The results of the CI chondrite normalized (average CI trace-element analyses for several grains and the major- and minor-element zoning patterns from a single pyroxene grain are given. The Eu abundance in the cores of the pyroxenes represents the detection limit and therefore the (-Eu) anomaly is a minimum. Major- and minor-element patterns are typical for igneous zoning. Pyroxene cores are Mg enriched, whereas the rims are enriched in Fe and Ca. Also, Ti and Mn are found to increase, while Cr and Al generally decrease in core-to-rim traverses. The cores of the pyroxenes are more depleted in the Rare Earth Elements (REE) than the rims. Using the minor- and trace-element concentrations of bulk Pasamonte and the minor- and trace-element concentrations from the cores of the pyroxenes in Pasamonte measured in this study, we calculated partition coefficients between pyroxene and melt. This calculation assumes that bulk Pasamonte is representative of a melt composition.

The Fuzziness of Giant Planets’ Cores

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

Helled, Ravit; Stevenson, David

2017-05-01

Giant planets are thought to have cores in their deep interiors, and the division into a heavy-element core and hydrogen–helium envelope is applied in both formation and structure models. We show that the primordial internal structure depends on the planetary growth rate, in particular, the ratio of heavy elements accretion to gas accretion. For a wide range of likely conditions, this ratio is in one-to-one correspondence with the resulting post-accretion profile of heavy elements within the planet. This flux ratio depends sensitively on the assumed solid-surface density in the surrounding nebula. We suggest that giant planets’ cores might not bemore » distinct from the envelope and includes some hydrogen and helium, and the deep interior can have a gradual heavy-element structure. Accordingly, Jupiter’s core may not be well defined. Accurate measurements of Jupiter’s gravitational field by Juno could put constraints on Jupiter’s core mass. However, as we suggest here, the definition of Jupiter’s core is complex, and the core’s physical properties (mass, density) depend on the actual definition of the core and on the planet’s growth history.« less

Perspectives on family health, happiness and harmony (3H) among Hong Kong Chinese people: a qualitative study.

PubMed

Lam, W W T; Fielding, R; McDowell, I; Johnston, J; Chan, Sophia; Leung, G M; Lam, T H

2012-10-01

Family harmony, an important Confucian ideal in Chinese society is believed to determine family happiness and therefore health, but is this accurate? This is a qualitative study of 41 Hong Kong Chinese family members. Individual recorded interviews were thematically analysed describing perceived interactions between harmony, happiness and health. Family harmony comprised four components: communication, mutual respect, lack of conflict and family time [notably 'Gou tong' (in Cantonese )-opportunity and willingness to spend time together-requiring good interpersonal communication, emphasized by female respondents]. Lack of conflict was emphasized, while diverse values, parenting styles and financial difficulties were common causes of conflict. Respect required reciprocity. Family happiness comprised four elements: family harmony, an important pre-requisite; mutual caring and supportive orientation; sense of security emphasizing financial security in middle-class versus sense of togetherness in lower social class groups and contentment. Healthy families were harmonious; 'typical' (children/two-parent/two-grandparent); happy; caring and respectful, with individual health and healthy behaviours. Family harmony, happiness and health are interrelated and built on a communicative, respectful, caring and contented set of attitudes, in particular allowing for family time. Harmony is apparently a core element of good family functioning.

Chemical evolution of the Earth: Equilibrium or disequilibrium process?

NASA Technical Reports Server (NTRS)

Sato, M.

1985-01-01

To explain the apparent chemical incompatibility of the Earth's core and mantle or the disequilibrium process, various core forming mechanisms have been proposed, i.e., rapid disequilibrium sinking of molten iron, an oxidized core or protocore materials, and meteorite contamination of the upper mantle after separation from the core. Adopting concepts used in steady state thermodynamics, a method is devised for evaluating how elements should distribute stable in the Earth's interior for the present gradients of temperature, pressure, and gravitational acceleration. Thermochemical modeling gives useful insights into the nature of chemical evolution of the Earth without overly speculative assumptions. Further work must be done to reconcile siderophile elements, rare gases, and possible light elements in the outer core.

[From anthropocentrism to ecocentrism: educating for ecological care in health].

PubMed

Backes, Marli Terezinha Stein; Backes, Dirce Stein; Drago, Lívia Crespo; Koerich, Magda Santos; Erdmann, Alacoque Lorenzini

2011-06-01

The focus of the paper is the meaning of ecological care as understood by students and educators and how this issue is addressed in programs in the fields of health sciences and health care in a federal public institution in southern Brazil. Our goal is to discuss the central category. The methodology adopted was Grounded Theory. Ten interviews were carried out among two sample groups between September, 2008, and April, 2009. The results led to the design of the theory: considering ecological care as broad and complex phenomenon, and the core category: the ecological care that results from relations, interactions and associations within the global environment. We concluded that rejecting anthropocentrism is not enough for the survival of all forms of life in the planet. This survival demands educating for ecocentrism and for systemic-functional interactivity and adaptability. We must go beyond speeches and world conferences and redo the web of interdependence of all beings and elements of nature.

Grain-size distribution and selected major and trace element concentrations in bed-sediment cores from the Lower Granite Reservoir and Snake and Clearwater Rivers, eastern Washington and northern Idaho, 2010

USGS Publications Warehouse

Braun, Christopher L.; Wilson, Jennifer T.; Van Metre, Peter C.; Weakland, Rhonda J.; Fosness, Ryan L.; Williams, Marshall L.

2012-01-01

Fifty subsamples from 15 cores were analyzed for major and trace elements. Concentrations of trace elements were low, with respect to sediment quality guidelines, in most cores. Typically, major and trace element concentrations were lower in the subsamples collected from the Snake River compared to those collected from the Clearwater River, the confluence of the Snake and Clearwater Rivers, and Lower Granite Reservoir. Generally, lower concentrations of major and trace elements were associated with coarser sediments (larger than 0.0625 millimeter) and higher concentrations of major and trace elements were associated with finer sediments (smaller than 0.0625 millimeter).

Effect of Silicon on Activity Coefficients of Siderophile Elements (P, Au, Pd, As, Ge, Sb, and In) in Liquid Fe, with Application to Core Formation

NASA Technical Reports Server (NTRS)

Righter, K.; Pando, K.; Danielson, L. R.; Humayun, M.; Righter, M.; Lapen, T.; Boujibar, A.

2016-01-01

Earth's core contains approximately 10 percent light elements that are likely a combination of S, C, Si, and O, with Si possibly being the most abundant. Si dissolved into Fe liquids can have a large effect on the magnitude of the activity coefficient of siderophile elements (SE) in Fe liquids, and thus the partitioning behavior of those elements between core and mantle. The effect of Si can be small such as for Ni and Co, or large such as for Mo, Ge, Sb, As. The effect of Si on many siderophile elements is unknown yet could be an important, and as yet unquantified, influence on the core-mantle partitioning of SE. Here we report new experiments designed to quantify the effect of Si on the partitioning of P, Au, Pd, and many other SE between metal and silicate melt. The results will be applied to Earth, for which we have excellent constraints on the mantle siderophile element concentrations.

Barium and calcium analyses in sediment cores using µ-XRF core scanners

NASA Astrophysics Data System (ADS)

Acar, Dursun; Çaǧatay, Namık; Genç, S. Can; Eriş, K. Kadir; Sarı, Erol; Uçarkus, Gülsen

2017-04-01

Barium and Ca are used as proxies for organic productivity in paleooceanographic studies. With its heavy atomic weight (137.33 u), barium is easily detectable in small concentrations (several ppm levels) in marine sediments using XRF methods, including the analysis by µ-XRF core scanners. Calcium has an intermediate atomic weight (40.078 u) but is a major element in the earth's crust and in sediments and sedimentary rocks, and hence it is easily detectable by µ-XRF techniques. Normally, µ-XRF elemental analysis of cores are carried out using split half cores or 1-2 cm thich u-channels with an original moisture. Sediment cores show variation in different water content (and porosity) along their length. This in turn results in variation in the XRF counts of the elements and causes error in the elemental concentrations. We tried µ-XRF elemental analysis of split half cores, subsampled as 1 cm thick u-channels with original moisture and 0.3 mm-thin film slices of the core with original wet sample and after air drying with humidity protector mylar film. We found considerable increase in counts of most elements, and in particular for Ba and Ca, when we used 0.3 mm thin film, dried slice. In the case of Ba, the counts increased about three times that of the analysis made with wet and 1 cm thick u-channels. The higher Ba and Ca counts are mainly due to the possible precipitation of Ba as barite and Ca as gypsum from oxidation of Fe-sulphides and the evaporation of pore waters. The secondary barite and gypsum precipitation would be especially serious in unoxic sediment units, such as sapropels, with considerable Fe-sulphides and bio-barite.It is therefore suggested that reseachers should be cautious of such secondary precipitation on core surfaces when analyzing cores that have long been exposed to the atmospheric conditions.

Composition of the core from gallium metal–silicate partitioning experiments

DOE PAGES

Blanchard, I.; Badro, J.; Siebert, J.; ...

2015-07-24

We present gallium concentration (normalized to CI chondrites) in the mantle is at the same level as that of lithophile elements with similar volatility, implying that there must be little to no gallium in Earth's core. Metal-silicate partitioning experiments, however, have shown that gallium is a moderately siderophile element and should be therefore depleted in the mantle by core formation. Moreover, gallium concentrations in the mantle (4 ppm) are too high to be only brought by the late veneer; and neither pressure, nor temperature, nor silicate composition has a large enough effect on gallium partitioning to make it lithophile. Wemore » therefore systematically investigated the effect of core composition (light element content) on the partitioning of gallium by carrying out metal–silicate partitioning experiments in a piston–cylinder press at 2 GPa between 1673 K and 2073 K. Four light elements (Si, O, S, C) were considered, and their effect was found to be sufficiently strong to make gallium lithophile. The partitioning of gallium was then modeled and parameterized as a function of pressure, temperature, redox and core composition. A continuous core formation model was used to track the evolution of gallium partitioning during core formation, for various magma ocean depths, geotherms, core light element contents, and magma ocean composition (redox) during accretion. The only model for which the final gallium concentration in the silicate Earth matched the observed value is the one involving a light-element rich core equilibrating in a FeO-rich deep magma ocean (>1300 km) with a final pressure of at least 50 GPa. More specifically, the incorporation of S and C in the core provided successful models only for concentrations that lie far beyond their allowable cosmochemical or geophysical limits, whereas realistic O and Si amounts (less than 5 wt.%) in the core provided successful models for magma oceans deeper that 1300 km. In conclusion, these results offer a strong argument for an O- and Si-rich core, formed in a deep terrestrial magma ocean, along with oxidizing conditions.« less

Rallying the troops: a four-step guide to preparing a residency program for short-term weather emergencies.

PubMed

Chow, Grant V; Hayashi, Jennifer; Hirsch, Glenn A; Christmas, Colleen

2011-04-01

Weather emergencies present a multifaceted challenge to residents and residency programs. Both the individual trainee and program may be pushed to the limits of physical and mental strain, potentially jeopardizing core competencies of patient care and professionalism. Although daunting, the task of preparing for these events should be a methodical process integrated into every residency training program. The core elements of emergency preparation with regard to inpatient services include identifying and staffing critical positions, motivating residents to consider the needs of the group over those of the individual, providing for basic needs, and planning activities in order to preserve team morale and facilitate recovery. The authors outline a four-step process in preparing a residency program for an anticipated short-term weather emergency. An example worksheet for emergency planning is included. With adequate preparation, residency training programs can maintain the highest levels of patient care, professionalism, and esprit de corps during weather emergencies. When managed effectively, emergencies may present an opportunity for professional growth and a sense of unity for those involved.

Training tomorrow's clinicians today--managed care essentials: a process for curriculum development.

PubMed

Colenda, C C; Wadland, W; Hayes, O; Anderson, W; Priester, F; Pearson, R; Keefe, C; Fleck, L

2000-05-01

To develop a managed care curriculum for primary care residents. This article outlines a 4-stage curriculum development process focusing on concepts of managed care organization and finance. The stages consist of: (1) identifying the curriculum development work group and framing the scope of the curriculum, (2) identifying stakeholder buy-in and expectations, (3) choosing curricular topics and delivery mechanisms, and (4) outlining the evaluation process. Key elements of building a curriculum development team, content objectives of the curriculum, the rationale for using problem-based learning, and finally, lessons learned from the partnership among the stakeholders are reviewed. The curriculum was delivered to an entering group of postgraduate-year 1 primary care residents. Attitudes among residents toward managed care remained relatively negative and stable over the yearlong curriculum, especially over issues relating to finance, quality of care, control and autonomy of practitioners, time spent with patients, and managed care's impact on the doctor-patient relationship. Residents' baseline knowledge of core concepts about managed care organization and finance improved during the year that the curriculum was delivered. Satisfaction with a problem-based learning approach was high. Problem-based learning, using real-life clinical examples, is a successful approach to resident instruction about managed care.

Interfacial characterization of ceramic core materials with veneering porcelain for all-ceramic bi-layered restorative systems.

PubMed

Tagmatarchis, Alexander; Tripodakis, Aris-Petros; Filippatos, Gerasimos; Zinelis, Spiros; Eliades, George

2014-01-01

The aim of the study was to characterize the elemental distribution at the interface between all-ceramic core and veneering porcelain materials. Three groups of all-ceramic cores were selected: A) Glass-ceramics (Cergo, IPS Empress, IPS Empress 2, e-max Press, Finesse); B) Glass-infiltrated ceramics (Celay Alumina, Celay Zirconia) and C) Densely sintered ceramics (Cercon, Procera Alumina, ZirCAD, Noritake Zirconia). The cores were combined with compatible veneering porcelains and three flat square test specimens were produced for each system. The core-veneer interfaces were examined by scanning electron microscopy and energy dispersive x-ray microanalysis. The glass-ceramic systems showed interfacial zones reach in Si and O, with the presence of K, Ca, Al in core and Ca, Ce, Na, Mg or Al in veneer material, depending on the system tested. IPS Empress and IPS Empress 2 demonstrated distinct transitional phases at the core-veneer interface. In the glassinfiltrated systems, intermixing of core (Ce, La) with veneer (Na, Si) elements occurred, whereas an abrupt drop of the core-veneer elemental concentration was documented at the interfaces of all densely sintered ceramics. The results of the study provided no evidence of elemental interdiffusion at the core-veneer interfaces in densely sintered ceramics, which implies lack of primary chemical bonding. For the glass-containing systems (glassceramics and glass-infiltrated ceramics) interdiffusion of the glass-phase seems to play a critical role in establishing a primary bonding condition between ceramic core and veneering porcelain.

Identification of the core sequence elements in Penaeus stylirostris densovirus promoters

USDA-ARS?s Scientific Manuscript database

This manuscript describes the role of different core elements in the transcriptional activity of promoters in a marine parvovirus, Penaeus stylirostris densovirus (PstDNV) that infects shrimp. Although comprehensive information on the role of different elements in the promoters of several animal par...

Muslim Middle Eastern clients' reflections on their relationship with their occupational therapists in mental health care.

PubMed

Pooremamali, Parvin; Eklund, Mona; Östman, Margareta; Persson, Dennis

2012-07-01

Persons with a Middle Eastern background represent a minority in Sweden which has significantly increased in size over recent years. The purpose of the present study was to explore the elements that shape the experiences and perceptions of clients with a Middle Eastern background living by Muslim norms who received occupational therapy in mental health care at the time of participating in the study. The study included interviews with 11 clients who received occupational therapy in mental health care. Data collection and analysis were carried out in accordance with the grounded theory approach. One core category, desiring a union, described the clients' desire for an alliance with the therapists that encompassed the realities and truths embedded in their values, preferences, world-views, and belief systems, as well as a wish to reconstruct their abilities to function and perform daily life tasks within their cultural contexts. The core category included sub-categories: desiring relationship, desiring affiliation, and desiring affirmation as well as some related components. The overall findings showed a tentative model in which the notion of mahram affinity was embedded. The results demonstrated that the clients' views regarding desiring a union had their support in collectivistic world-views that often clash with those of the therapists.

Core formation in the Moon: The mystery of the excess depletion of Mo, W and P

NASA Technical Reports Server (NTRS)

Newsom, H. E.; Maehr, S. A.

1993-01-01

We have evaluated siderophile element depletion models for the Moon in light of our improved statistical treatment of siderophile element abundance data and new information on the physics of core formation. If core formation occurred in the Moon at the large degrees of partial melting necessary for metal segregation, according to recent estimates, then a significant inconsistency (not seen in the eucrite parent body) exists in the depletion of the incompatible siderophile elements Mo, W, and P, compared to other siderophile elements in the Moon. The siderophile data, with the exception of Mo, are most consistent with terrestrial initial siderophile abundances and segregation of a very small core in the Moon. Our improved abundance estimates and possible explanations for these discrepancies are discussed.

The effect of melt composition on metal-silicate partitioning of siderophile elements and constraints on core formation in the angrite parent body

NASA Astrophysics Data System (ADS)

Steenstra, E. S.; Sitabi, A. B.; Lin, Y. H.; Rai, N.; Knibbe, J. S.; Berndt, J.; Matveev, S.; van Westrenen, W.

2017-09-01

We present 275 new metal-silicate partition coefficients for P, S, V, Cr, Mn, Co, Ni, Ge, Mo, and W obtained at moderate P (1.5 GPa) and high T (1683-1883 K). We investigate the effect of silicate melt composition using four end member silicate melt compositions. We identify possible silicate melt dependencies of the metal-silicate partitioning of lower valence elements Ni, Ge and V, elements that are usually assumed to remain unaffected by changes in silicate melt composition. Results for the other elements are consistent with the dependence of their metal-silicate partition coefficients on the individual major oxide components of the silicate melt composition suggested by recently reported parameterizations and theoretical considerations. Using multiple linear regression, we parameterize compiled metal-silicate partitioning results including our new data and report revised expressions that predict their metal-silicate partitioning behavior as a function of P-T-X-fO2. We apply these results to constrain the conditions that prevailed during core formation in the angrite parent body (APB). Our results suggest the siderophile element depletions in angrite meteorites are consistent with a CV bulk composition and constrain APB core formation to have occurred at mildly reducing conditions of 1.4 ± 0.5 log units below the iron-wüstite buffer (ΔIW), corresponding to a APB core mass of 18 ± 11%. The core mass range is constrained to 21 ± 8 mass% if light elements (S and/or C) are assumed to reside in the APB core. Incorporation of light elements in the APB core does not yield significantly different redox states for APB core-mantle differentiation. The inferred redox state is in excellent agreement with independent fO2 estimates recorded by pyroxene and olivine in angrites.

Identification of water-quality trends using sediment cores from Dillon Reservoir, Summit County, Colorado

USGS Publications Warehouse

Greve, Adrienne I.; Spahr, Norman E.; Van Metre, Peter C.; Wilson, Jennifer T.

2001-01-01

Since the construction of Dillon Reservoir, in Summit County, Colorado, in 1963, its drainage area has been the site of rapid urban development and the continued influence of historical mining. In an effort to assess changes in water quality within the drainage area, sediment cores were collected from Dillon Reservoir in 1997. The sediment cores were analyzed for pesticides, polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), and trace elements. Pesticides, PCBs, and PAHs were used to determine the effects of urban development, and trace elements were used to identify mining contributions. Water-quality and streambed-sediment samples, collected at the mouth of three streams that drain into Dillon Reservoir, were analyzed for trace elements. Of the 14 pesticides and 3 PCBs for which the sediment samples were analyzed, only 2 pesticides were detected. Low amounts of dichloro-diphenyldichloroethylene (DDE) and dichloro-diphenyldichloroethane (DDD), metabolites of dichlorodiphenyltrichloroethane (DDT), were found at core depths of 5 centimeters and below 15 centimeters in a core collected near the dam. The longest core, which was collected near the dam, spanned the entire sedimentation history of the reservoir. Concentrations of total combustion PAH and the ratio of fluoranthene to pyrene in the core sample decreased with core depth and increased over time. This relation is likely due to growth in residential and tourist populations in the region. Comparisons between core samples gathered in each arm of the reservoir showed the highest PAH concentrations were found in the Tenmile Creek arm, the only arm that has an urban area on its shores, the town of Frisco. All PAH concentrations, except the pyrene concentration in one segment in the core near the dam and acenaphthylene concentrations in the tops of three cores taken in the reservoir arms, were below Canadian interim freshwater sediment-quality guidelines. Concentrations of arsenic, cadmium, chromium, copper, lead, and zinc in sediment samples from Dillon Reservoir exceeded the Canadian interim freshwater sediment-quality guidelines. Copper, iron, lithium, nickel, scandium, titanium, and vanadium concentrations in sediment samples decreased over time. Other elements, while no trend was evident, displayed concentration spikes in the down-core profiles, indicating loads entering the reservoir may have been larger than they were in 1997. The highest concentrations of copper, lead, manganese, mercury, and zinc were detected during the late 1970's and early 1980's. Elevated concentrations of trace elements in sediment in Dillon Reservoir likely resulted from historical mining in the drainage area. The downward trend identified for copper, iron, lithium, nickel, scandium, titanium, and vanadium may be due in part to restoration efforts in mining-affected areas and a decrease in active mining in the Dillon Reservoir watershed. Although many trace-element core-sediment concentrations exceeded the Canadian probable effect level for freshwater lakes, under current limnological conditions, the high core-sediment concentrations do not adversely affect water quality in Dillon Reservoir. The trace-element concentrations in the reservoir water column meet the standards established by the Colorado Water Quality Control Commission. Although many trace-element core-sediment concentrations exceeded the Canadian probable effect level for freshwater lakes, under current limnological conditions, the high core-sediment concentrations do not adversely affect water quality in Dillon Reservoir. The trace-element concentrations in the reservoir water column meet the standards established by the Colorado Water Quality Control Commission.

Mercury's core evolution

NASA Astrophysics Data System (ADS)

Deproost, Marie-Hélène; Rivoldini, Attilio; Van Hoolst, Tim

2016-10-01

Remote sensing data of Mercury's surface by MESSENGER indicate that Mercury formed under reducing conditions. As a consequence, silicon is likely the main light element in the core together with a possible small fraction of sulfur. Compared to sulfur, which does almost not partition into solid iron at Mercury's core conditions and strongly decreases the melting temperature, silicon partitions almost equally well between solid and liquid iron and is not very effective at reducing the melting temperature of iron. Silicon as the major light element constituent instead of sulfur therefore implies a significantly higher core liquidus temperature and a decrease in the vigor of compositional convection generated by the release of light elements upon inner core formation.Due to the immiscibility in liquid Fe-Si-S at low pressure (below 15 GPa), the core might also not be homogeneous and consist of an inner S-poor Fe-Si core below a thinner Si-poor Fe-S layer. Here, we study the consequences of a silicon-rich core and the effect of the blanketing Fe-S layer on the thermal evolution of Mercury's core and on the generation of a magnetic field.

Core Formation Process and Light Elements in the Planetary Core

NASA Astrophysics Data System (ADS)

Ohtani, E.; Sakairi, T.; Watanabe, K.; Kamada, S.; Sakamaki, T.; Hirao, N.

2015-12-01

Si, O, and S are major candidates for light elements in the planetary core. In the early stage of the planetary formation, the core formation started by percolation of the metallic liquid though silicate matrix because Fe-S-O and Fe-S-Si eutectic temperatures are significantly lower than the solidus of the silicates. Therefore, in the early stage of accretion of the planets, the eutectic liquid with S enrichment was formed and separated into the core by percolation. The major light element in the core at this stage will be sulfur. The internal pressure and temperature increased with the growth of the planets, and the metal component depleted in S was molten. The metallic melt contained both Si and O at high pressure in the deep magma ocean in the later stage. Thus, the core contains S, Si, and O in this stage of core formation. Partitioning experiments between solid and liquid metals indicate that S is partitioned into the liquid metal, whereas O is weakly into the liquid. Partitioning of Si changes with the metallic iron phases, i.e., fcc iron-alloy coexisting with the metallic liquid below 30 GPa is depleted in Si. Whereas hcp-Fe alloy above 30 GPa coexisting with the liquid favors Si. This contrast of Si partitioning provides remarkable difference in compositions of the solid inner core and liquid outer core among different terrestrial planets. Our melting experiments of the Fe-S-Si and Fe-O-S systems at high pressure indicate the core-adiabats in small planets, Mercury and Mars, are greater than the slope of the solidus and liquidus curves of these systems. Thus, in these planets, the core crystallized at the top of the liquid core and 'snowing core' formation occurred during crystallization. The solid inner core is depleted in both Si and S whereas the liquid outer core is relatively enriched in Si and S in these planets. On the other hand, the core adiabats in large planets, Earth and Venus, are smaller than the solidus and liquidus curves of the systems. The inner core of these planets crystallized at the center of the core and it has the relatively Si rich inner core and the S enriched outer core. Based on melting and solid-liquid partitioning, the equation of state, and sound velocity of iron-light element alloys, we examined the plausible distribution of light elements in the liquid outer and solid inner cores of the terrestrial planets.

Trace element fluxes during the last 100 years in sediment near a nuclear power plant

NASA Astrophysics Data System (ADS)

Bojórquez-Sánchez, S.; Marmolejo-Rodríguez, A. J.; Ruiz-Fernández, A. C.; Sánchez-González, A.; Sánchez-Cabeza, J. A.; Bojórquez-Leyva, H.; Pérez-Bernal, L. H.

2017-11-01

The Salada coastal lagoon is located in Veracruz (Mexico) near the Laguna Verde Nuclear Power Plant (LVNPP). Currently, the lagoon receives the cooling waters used in the LVNPP. To evaluate the fluxes and mobilization of trace elements due to human activities in the area, two sediment cores from the coastal flood plains of Salada Lagoon were analysed. Cores were collected using PVC tubes. Sediments cores were analysed every centimetre for dating (210Pb by alpha detector) and trace metal analysis using ICP-Mass Spectrometry. The dating of both sediment cores covers the period from 1900 to 2013, which includes the construction of the LVNPP (1970's). The Normalized Enrichment Factor shows enrichment of Ag, As and Cr in both sediment cores. These enrichments correspond to the extent of mining activity (which reached a maximum in the 1900's) and to the geological setting of the coastal zone. The profiles of the element fluxes in both sediment cores reflected the construction and operation of the LVNPP; however, the elements content did not show evidence of pollution coming from the LVNPP.

Designing and delivering facilitated storytelling interventions for chronic disease self-management: a scoping review.

PubMed

Gucciardi, Enza; Jean-Pierre, Nicole; Karam, Grace; Sidani, Souraya

2016-07-11

Little is known about how to develop and deliver storytelling as an intervention to support those managing chronic illnesses. This scoping review aims to describe the core elements of storytelling interventions in order to help facilitate its implementation. A scoping review was conducted in seven databases for articles published up to May 2014 to identify interventions that describe in detail how storytelling was used to support people in disease self-management interventions. Ten articles met all inclusion criteria. Core elements consistently observed across the storytelling interventions were: reflection and interactive meaning-making of experiences; principles of informality and spontaneity; non-directional and non-hierarchical facilitation; development of group norms and conduct to create a community among participants; and both an individual and collective role for participants. Differences were also observed across interventions, such as: the conceptual frameworks that directed the design of the intervention; the type and training of facilitators; intervention duration; and how session topics were selected and stories delivered. Furthermore, evaluation of the intervention and outcome assessment varied greatly across studies. The use of storytelling can be a novel intervention to enhance chronic disease self-management. The core elements identified in the review inform the development of the intervention to be more patient-centred by guiding participants to take ownership of and lead the intervention, which differs significantly from traditional support groups. Storytelling has the potential to provide patients with a more active role in their health care by identifying their specific needs as well as gaps in knowledge and skills, while allowing them to form strong bonds with peers who share similar disease-related experiences. However, measures of impact differed across interventions given the variation in chronic conditions. Our findings can guide future development and implementations of storytelling interventions.

Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care

PubMed Central

2012-01-01

Background Pregnant women in Canada have traditionally received prenatal care individually from their physicians, with some women attending prenatal education classes. Group prenatal care is a departure from these practices providing a forum for women to experience medical care and child birth education simultaneously and in a group setting. Although other qualitative studies have described the experience of group prenatal care, this is the first which sought to understand the central meaning or core of the experience. The purpose of this study was to understand the central meaning of the experience of group prenatal care for women who participated in CenteringPregnancy through a maternity clinic in Calgary, Canada. Methods The study used a phenomenological approach. Twelve women participated postpartum in a one-on-one interview and/or a group validation session between June 2009 and July 2010. Results Six themes emerged: (1) "getting more in one place at one time"; (2) "feeling supported"; (3) "learning and gaining meaningful information"; (4) "not feeling alone in the experience"; (5) "connecting"; and (6) "actively participating and taking on ownership of care". These themes contributed to the core phenomenon of women "getting more than they realized they needed". The active sharing among those in the group allowed women to have both their known and subconscious needs met. Conclusions Women's experience of group prenatal care reflected strong elements of social support in that women had different types of needs met and felt supported. The findings also broadened the understanding of some aspects of social support beyond current theories. In a contemporary North American society, the results of this study indicate that women gain from group prenatal care in terms of empowerment, efficiency, social support and education in ways not routinely available through individual care. This model of care could play a key role in addressing women's needs and improving health outcomes. PMID:22436393

Core competencies of the entrepreneurial leader in health care organizations.

PubMed

Guo, Kristina L

2009-01-01

The purpose of this article is to discuss core competencies that entrepreneurial health care leaders should acquire to ensure the survival and growth of US health care organizations. Three overlapping areas of core competencies are described: (1) health care system and environment competencies, (2) organization competencies, and (3) interpersonal competencies. This study offers insight into the relationship between leaders and entrepreneurship in health care organizations and establishes the foundation for more in-depth studies on leadership competencies in health care settings. The approach for identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations, so that through the understanding and practice of these 3 areas of core competencies, they can enhance their entrepreneurial leadership skills to become more effective health care entrepreneurial leaders. This study can also be used as a tool by health care organizations to better understand leadership performance, and competencies can be used to further the organization's strategic vision and for individual improvement purposes.

Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice

PubMed Central

Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven

2009-01-01

Title Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Aim This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Background Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Data sources Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Conclusion Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes. PMID:19686402

Four-terminal circuit element with photonic core

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

Sampayan, Stephen

A four-terminal circuit element is described that includes a photonic core inside of the circuit element that uses a wide bandgap semiconductor material that exhibits photoconductivity and allows current flow through the material in response to the light that is incident on the wide bandgap material. The four-terminal circuit element can be configured based on various hardware structures using a single piece or multiple pieces or layers of a wide bandgap semiconductor material to achieve various designed electrical properties such as high switching voltages by using the photoconductive feature beyond the breakdown voltages of semiconductor devices or circuits operated basedmore » on electrical bias or control designs. The photonic core aspect of the four-terminal circuit element provides unique features that enable versatile circuit applications to either replace the semiconductor transistor-based circuit elements or semiconductor diode-based circuit elements.« less

Siderophile Element Constraints on the Conditions of Core Formation in Mars

NASA Technical Reports Server (NTRS)

Righter, K.; Humayun, M.

2012-01-01

Siderophile element concentrations in planetary basalts and mantle samples have been used to estimate conditions of core formation for many years and have included applications to Earth, Moon, Mars and asteroid 4 Vesta [1]. For Earth, we have samples of mantle and a diverse collection of mantle melts which have provided a mature understanding of the how to reconstruct the concentration of siderophile elements in mantle materials, from only concentrations in surficial basalt (e.g., [2]). This approach has led to the consensus views that Earth underwent an early magma ocean stage to pressures of 40-50 GPa (e.g., [3,4]), Moon melted extensively and formed a small (approx. 2 mass %) metallic core [5], and 4 Vesta contains a metallic core that is approximately 18 mass % [6,7]. Based on new data from newly found meteorites, robotic spacecraft, and experimental partitioning studies, [8] showed that eight siderophile elements (Ni, Co, Mo, W, Ga, P, V and Cr) are consistent with equilibration of a 20 mass% S-rich metallic core with the mantle at pressures of 14 +/- 3 GPa. We aim to test this rather simple scenario with additional analyses of meteorites for a wide range of siderophile elements, and application of new experimental data for the volatile siderophile and highly siderophile elements.

[Gender representations in nursing student and client relations: contributions to the learning process].

PubMed

Muroya, Renata de Lima; Auad, Daniela; Brêtas, José Roberto da Silva

2011-01-01

The purpose of the study was to identity, to know, and to improve the knowledge about the relationships of gender among the students and the clients in the practice of nursing care. That was a qualitative study, based in the theory of social representation and analyzed concerning the gender theoretical references. Concerning the data base made, based in the technique of Central Core Theory. The results were organized in a "tree". Two main thematic ways were arisen as second interest elements: "The triad equality/difference/inequality in the nursing care" and "The lack of knowledge: a gap in the learning process". The results have showed a students' difficulty in the process to take care a patient who has a different gender of theirs; showed a speech based in the perception of the gender differences and in the belief of heterosexuality presumed.

Sound velocity of iron-light element compounds and the chemical structure of the inner core

NASA Astrophysics Data System (ADS)

Ohtani, E.; Sakamaki, T.; Fukui, H.; Tanaka, R.; Shibazaki, Y.; Kamada, S.; Sakairi, T.; Takahashi, S.; Tsutsui, S.; Baron, A. Q. R.

2016-12-01

The light elements in the core could constrain the conditions of accretion, subsequent magma ocean, and core formation stages of the Earth. There are several studies for sound velocity measurements of the iron-light elements alloys. However, the measurements are not enough to constrain the light element abundance in the core tightly at present due to inter-laboratory inconsistencies using different methods which are originated from the difficulties to make such measurements under the extreme conditions. We measured the sound velocity of iron alloy compounds at high pressure and temperature relevant to the Earth's core using double-sided laser heating of a DAC combined with inelastic X-ray scattering at SPring-8. We measured the compressional velocity of hcp-Fe up to 166 GPa and 3000 K, and derived a clear temperature dependence of the Birch's law for hcp-Fe. We measured the compressional velocity of Fe0.89Si0.11 alloy and Fe3C at high pressure and temperature, and we could not detect temperature dependency in Birch's law in these compounds. Additionally, we measured the sound velocity of Fe3S, Fe0.83Ni0.09Si0.08 alloy, and FeH at high pressure. Combining our new data set which showed remarkable differences from previous data on the sound velocity, we present a model of the chemical structure of the inner core. The outer core composition was also estimated based on partitioning behaviors of these light elements between solid and liquid iron alloys under the core conditions.

CORE-SINEs: Eukaryotic short interspersed retroposing elements with common sequence motifs

PubMed Central

Gilbert, Nicolas; Labuda, Damian

1999-01-01

A 65-bp “core” sequence is dispersed in hundreds of thousands copies in the human genome. This sequence was found to constitute the central segment of a group of short interspersed elements (SINEs), referred to as mammalian-wide interspersed repeats, that proliferated before the radiation of placental mammals. Here, we propose that the core identifies an ancient tRNA-like SINE element, which survived in different lineages such as mammals, reptiles, birds, and fish, as well as mollusks, presumably for >550 million years. This element gave rise to a number of sequence families (CORE-SINEs), including mammalian-wide interspersed repeats, whose distinct 3′ ends are shared with different families of long interspersed elements (LINEs). The evolutionary success of the generic CORE-SINE element can be related to the recruitment of the internal promoter from highly transcribed host RNA as well as to its capacity to adapt to changing retropositional opportunities by sequence exchange with actively amplifying LINEs. It reinforces the notion that the very existence of SINEs depends on the cohabitation with both LINEs and the host genome. PMID:10077603

MCNP-model for the OAEP Thai Research Reactor

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

Gallmeier, F.X.; Tang, J.S.; Primm, R.T. III

An MCNP input was prepared for the Thai Research Reactor, making extensive use of the MCNP geometry`s lattice feature that allows a flexible and easy rearrangement of the core components and the adjustment of the control elements. The geometry was checked for overdefined or undefined zones by two-dimensional plots of cuts through the core configuration with the MCNP geometry plotting capabilities, and by a three-dimensional view of the core configuration with the SABRINA code. Cross sections were defined for a hypothetical core of 67 standard fuel elements and 38 low-enriched uranium fuel elements--all filled with fresh fuel. Three test calculationsmore » were performed with the MCNP4B-code to obtain the multiplication factor for the cases with control elements fully inserted, fully withdrawn, and at a working position.« less

Theoretical and experimental investigation of architected core materials incorporating negative stiffness elements

NASA Astrophysics Data System (ADS)

Chang, Chia-Ming; Keefe, Andrew; Carter, William B.; Henry, Christopher P.; McKnight, Geoff P.

2014-04-01

Structural assemblies incorporating negative stiffness elements have been shown to provide both tunable damping properties and simultaneous high stiffness and damping over prescribed displacement regions. In this paper we explore the design space for negative stiffness based assemblies using analytical modeling combined with finite element analysis. A simplified spring model demonstrates the effects of element stiffness, geometry, and preloads on the damping and stiffness performance. Simplified analytical models were validated for realistic structural implementations through finite element analysis. A series of complementary experiments was conducted to compare with modeling and determine the effects of each element on the system response. The measured damping performance follows the theoretical predictions obtained by analytical modeling. We applied these concepts to a novel sandwich core structure that exhibited combined stiffness and damping properties 8 times greater than existing foam core technologies.

RNA connectivity requirements between conserved elements in the core of the yeast telomerase RNP

PubMed Central

Mefford, Melissa A; Rafiq, Qundeel; Zappulla, David C

2013-01-01

Telomerase is a specialized chromosome end-replicating enzyme required for genome duplication in many eukaryotes. An RNA and reverse transcriptase protein subunit comprise its enzymatic core. Telomerase is evolving rapidly, particularly its RNA component. Nevertheless, nearly all telomerase RNAs, including those of H. sapiens and S. cerevisiae, share four conserved structural elements: a core-enclosing helix (CEH), template-boundary element, template, and pseudoknot, in this order along the RNA. It is not clear how these elements coordinate telomerase activity. We find that although rearranging the order of the four conserved elements in the yeast telomerase RNA subunit, TLC1, disrupts activity, the RNA ends can be moved between the template and pseudoknot in vitro and in vivo. However, the ends disrupt activity when inserted between the other structured elements, defining an Area of Required Connectivity (ARC). Within the ARC, we find that only the junction nucleotides between the pseudoknot and CEH are essential. Integrating all of our findings provides a basic map of functional connections in the core of the yeast telomerase RNP and a framework to understand conserved element coordination in telomerase mechanism. PMID:24129512

Electrical and thermal conductivity of Fe-C alloy at high pressure: implications for effects of carbon on the geodynamo of the Earth's core

NASA Astrophysics Data System (ADS)

Zhang, C.; Lin, J. F.; Liu, Y.; Feng, S.; Jin, C.; Yoshino, T.

2017-12-01

Thermal conductivity of iron alloy in the Earth's core plays a crucial role in constraining the energetics of the geodynamo and the thermal evolution of the planet. Studies on the thermal conductivity of iron reveal the importance of the effects of light elements and high temperature. Carbon has been proposed to be a candidate light element in Earth's core for its meteoritic abundance and high-pressure velocity-density profiles of iron carbides (e.g., Fe7C3). In this study, we employed four-probe van der Pauw method in a diamond anvil cell to measure the electrical resistivity of pure iron, iron carbon alloy, and iron carbides at high pressures. These studies were complimented with synchrotron X-ray diffraction and focused ion beam (FIB) analyses. Our results show significant changes in the electrical conductivity of these iron-carbon alloys that are consistent previous reports with structural and electronic transitions at high pressures, indicating that these transitions should be taken into account in evaluating the electrical and thermal conductivity at high pressure. To apply our results to understand the thermal conduction in the Earth's core, we have compared our results with literature values for the electrical and thermal conductivity of iron alloyed with light elements (C, Si) at high pressures. These comparisons permit the validity of the Wiedemann-Franz law and Matthiessen's rule for the effects of light elements on the thermal conductivity of the Earth's core. We found that an addition of a light element such as carbon has an strong effect on the reducing the thermal conductivity of Earth's core, but the magnitude of the alloying effect strongly depends on the identity of the light element and the crystal and electronic structures. Based on our results and literature values, we have modelled the electrical and thermal conductivity of iron-carbon alloy at Earth's core pressure-temperature conditions to the effects on the heat flux in the Earth's core. In this presentation, we will address how carbon as a potential light element in the Earth's core can significantly affect our view of the heat flux across the core-mantle boundary and geodynamo of our planet.

HerzMobil Tirol network: rationale for and design of a collaborative heart failure disease management program in Austria.

PubMed

Von der Heidt, Andreas; Ammenwerth, Elske; Bauer, Karl; Fetz, Bettina; Fluckinger, Thomas; Gassner, Andrea; Grander, Willhelm; Gritsch, Walter; Haffner, Immaculata; Henle-Talirz, Gudrun; Hoschek, Stefan; Huter, Stephan; Kastner, Peter; Krestan, Susanne; Kufner, Peter; Modre-Osprian, Robert; Noebl, Josef; Radi, Momen; Raffeiner, Clemens; Welte, Stefan; Wiseman, Andreas; Poelzl, Gerhard

2014-11-01

Heart failure (HF) is approaching epidemic proportions worldwide and is the leading cause of hospitalization in the elderly population. High rates of readmission contribute substantially to excessive health care costs and highlight the fragmented nature of care available to HF patients. Disease management programs (DMPs) have been implemented to improve health outcomes, patient satisfaction, and quality of life, and to reduce health care costs. Telemonitoring systems appear to be effective in the vulnerable phase after discharge from hospital to prevent early readmissions. DMPs that emphasize comprehensive patient education and guideline-adjusted therapy have shown great promise to result in beneficial long-term effects. It can be speculated that combining core elements of the aforementioned programs may substantially improve long-term cost-effectiveness of patient management.We introduce a collaborative post-discharge HF disease management program (HerzMobil Tirol network) that incorporates physician-controlled telemonitoring and nurse-led care in a multidisciplinary network approach.

Towards an organization with a memory: exploring the organizational generation of adverse events in health care.

PubMed

Smith, Denis; Toft, Brian

2005-05-01

The role of organizational factors in the generation of adverse events, and the manner in which such factors can also inhibit an organization's abilities to learn, have become important agenda items within health care. The government report 'An organization with a memory' highlighted many of the problems facing health care and suggested changes that need to be made if the sector is to learn effective lessons and prevent adverse events from occurring. This paper seeks to examine some of these organizational factors in more detail and suggests issues that managers need to consider as part of their wider strategies for the prevention and management of risk. The paper sets out five core elements that are held to be importance in shaping the manner in which the potential for risk is incubated within organizations. Although the paper focuses its attention on health care, the points made have validity across the public sector and into private sector organizations.

Effect of Silicon on Activity Coefficients of Platinum in Liquid Fe-Si, With Application to Core Formation

NASA Technical Reports Server (NTRS)

Righter, K.; Pando, K.; Danielson, L. R.; Humayun, M.

2017-01-01

Earth's core contains approximately 10% of a light element that is likely a combination of S, C, Si, and O, with Si possibly being the most abundant light element. Si dissolved into Fe liquids can have a large effect on the magnitude of the activity coefficient of siderophile elements (SE) in Fe liquids, and thus the partitioning behavior of those elements between core and mantle. The effect of Si can be small such as for Ni and Co, or large such as for Mo, Ge, Sb, As. The effect of Si on many siderophile elements is unknown yet could be an important, and as yet unquantified, influence on the core-mantle partitioning of SE. Here we report new experiments designed to quantify the effect of Si on the partitioning of Pt (with Re and Ru in progress or planned) between metal and silicate melt. The results will be applied to Earth, for which we have excellent constraints on the mantle Pt concentrations.

Geochemical stratigraphy of two regolith cores from the Central Highlands of the moon

NASA Technical Reports Server (NTRS)

Korotev, R. L.

1991-01-01

High-resolution concentration profiles are presented for 20-22 chemical elements in the under 1-mm grain-size fractions of 60001-7 and 60009/10. Emphasis is placed on the stratigraphic features of the cores, and the fresh results are compared with those of previous petrographic and geochemical studies. For elements associated with major mineral phases, the variations in concentration in both cores exceed that observed in some 40 samples of surface and trench soils. Most of the variation in lithophile element concentrations at depths of 18 to 21 cm results from the mixing of two components - oil that is relatively mafic and rich in incompatible trace elements (ITEs), and coarse-grained anorthosite. The linearity of mixing lines on two-element concentration plots argues that the relative abundances of these various subcomponents are sufficiently uniform from sample to sample and from region to region in the core that the mixture behaves effectively as a single component. Soils at depths of 52-55 cm exhibit very low concentrations of ITEs.

Influence of precipitating light elements on stable stratification below the core/mantle boundary

NASA Astrophysics Data System (ADS)

O'Rourke, J. G.; Stevenson, D. J.

2017-12-01

Stable stratification below the core/mantle boundary is often invoked to explain anomalously low seismic velocities in this region. Diffusion of light elements like oxygen or, more slowly, silicon could create a stabilizing chemical gradient in the outermost core. Heat flow less than that conducted along the adiabatic gradient may also produce thermal stratification. However, reconciling either origin with the apparent longevity (>3.45 billion years) of Earth's magnetic field remains difficult. Sub-isentropic heat flow would not drive a dynamo by thermal convection before the nucleation of the inner core, which likely occurred less than one billion years ago and did not instantly change the heat flow. Moreover, an oxygen-enriched layer below the core/mantle boundary—the source of thermal buoyancy—could establish double-diffusive convection where motion in the bulk fluid is suppressed below a slowly advancing interface. Here we present new models that explain both stable stratification and a long-lived dynamo by considering ongoing precipitation of magnesium oxide and/or silicon dioxide from the core. Lithophile elements may partition into iron alloys under extreme pressure and temperature during Earth's formation, especially after giant impacts. Modest core/mantle heat flow then drives compositional convection—regardless of thermal conductivity—since their solubility is strongly temperature-dependent. Our models begin with bulk abundances for the mantle and core determined by the redox conditions during accretion. We then track equilibration between the core and a primordial basal magma ocean followed by downward diffusion of light elements. Precipitation begins at a depth that is most sensitive to temperature and oxygen abundance and then creates feedbacks with the radial thermal and chemical profiles. Successful models feature a stable layer with low seismic velocity (which mandates multi-component evolution since a single light element typically increases seismic velocity) growing to its present-day size while allowing enough precipitation to drive compositional convection below. Crucially, this modeling offers unique constrains on Earth's accretion and the light element composition of the core compared to degenerate estimates derived from bulk density and seismic measurements.

Statistical Constraints from Siderophile Elements on Earth's Accretion, Differentiation, and Initial Core Stratification

NASA Astrophysics Data System (ADS)

O'Rourke, J. G.; Stevenson, D. J.

2015-12-01

Abundances of siderophile elements in the primitive mantle constrain the conditions of Earth's core/mantle differentiation. Core growth occurred as Earth accreted from collisions between planetesimals and larger embryos of unknown original provenance, so geochemistry is directly related to the overall dynamics of Solar System formation. Recent studies claim that only certain conditions of equilibration (pressure, temperature, and oxygen fugacity) during core formation can reproduce the available data. Typical analyses, however, only consider the effects of varying a few out of tens of free parameters in continuous core formation models. Here we describe the Markov chain Monte Carlo method, which simultaneously incorporates the large uncertainties on Earth's composition and the parameterizations that describe elemental partitioning between metal and silicate. This Bayesian technique is vastly more computationally efficient than a simple grid search and is well suited to models of planetary accretion that involve a plethora of variables. In contrast to previous work, we find that analyses of siderophile elements alone cannot yield a unique scenario for Earth's accretion. Our models predict a wide range of possible light element contents for the core, encompassing all combinations permitted by seismology and mineral physics. Specifically, we are agnostic between silicon and oxygen as the dominant light element, and the addition of carbon or sulfur is also permissible but not well constrained. Redox conditions may have remained roughly constant during Earth's accretion or relatively oxygen-rich material could have been incorporated before reduced embryos. Pressures and temperatures of equilibration, likewise, may only increase slowly throughout accretion. Therefore, we do not necessarily expect a thick (>500 km), compositionally stratified layer that is stable against convection to develop at the top of the core of Earth (or, by analogy, Venus). A thinner stable layer might inhibit the initialization of the dynamo.

Polished Downhole Transducer Having Improved Signal Coupling

DOEpatents

Hall, David R.; Fox, Joe

2006-03-28

Apparatus and methods to improve signal coupling in downhole inductive transmission elements to reduce the dispersion of magnetic energy at the tool joints and to provide consistent impedance and contact between transmission elements located along the drill string. A transmission element for transmitting information between downhole tools is disclosed in one embodiment of the invention as including an annular core constructed of a magnetically conductive material. The annular core forms an open channel around its circumference and is configured to form a closed channel by mating with a corresponding annular core along an annular mating surface. The mating surface is polished to provide improved magnetic coupling with the corresponding annular core. An annular conductor is disposed within the open channel.

Comparative study of representations of professional autonomy produced by first and last-period undergraduate nursing students 1

PubMed Central

dos Santos, Érick Igor; Gomes, Antonio Marcos Tosoli; Marques, Sergio Corrêa; Ramos, Raquel de Souza; da Silva, Aline Cerqueira Santos Santana; de Oliveira, Francimar Tinoco

2017-01-01

ABSTRACT Objective: to compare the social representations of professional nurse autonomy produced by first and last-period undergraduate nursing students. Method: qualitative, descriptive and exploratory study, based on the structural approach of social representations, the Central Core Theory, carried out with 171 students from three federal public universities, using the free association technique on the object “professional nurse autonomy”. The data were submitted to EVOC 2005 software and to similarity analysis. Results: care was the central core of the representational structure identified among the students of the first period. Among last-period students, knowledge stood out as a core element. The term responsibility was identified as common to both central cores. Conclusion: regarding professional autonomy, the results point to an overlapping process of the reified and consensual universes during the undergraduate course. However, responsibility, inherent in the profession, remains cross-sectional. For the first period students, autonomy is resignified in a practical and attitudinal way, whereas for the last period students, the knowledge acquired stimulates them to assign meaning to professional autonomy with a cognitive and attitudinal representation. The data can support the use of innovative teaching practices in nursing undergraduate courses.

Siderophile Volatile Element Partitioning during Core Formation.

NASA Astrophysics Data System (ADS)

Loroch, D. C.; Hackler, S.; Rohrbach, A.; Klemme, S.

2017-12-01

Since the nineteen sixties it is known, that the Earth's mantle is depleted relative to CI chondrite in numerous elements as a result of accretion and core-mantle differentiation. Additionally, if we take the chondritic composition as the initial solar nebular element abundances, the Earth lacks 85 % of K and up to 98 % of other volatiles. However one potentially very important group of elements has received considerably less attention in this context and these elements are the siderophile but volatile elements (SVEs). SVEs perhaps provide important information regarding the timing of volatile delivery to Earth. Especially for the SVEs the partitioning between metal melt and silicate melt (Dmetal/silicate) at core formation conditions is poorly constrained, never the less they are very important for most of the core formation models. This study is producing new metal-silicate partitioning data for a wide range of SVEs (S, Se, Te, Tl, Ag, As, Au, Cd, Bi, Pb, Sn, Cu, Ge, Zn, In and Ga) with a focus on the P, T and fO2dependencies. The initial hypothesis that we are aiming to test uses the accretion of major portions of volatile elements while the core formation was still active. The key points of this study are: - What are the effects of P, T and fO2 on SVE metal-silicate partioning? - What is the effect of compositional complexity on SVE metal-silicate partioning? - How can SVE's D-values fit into current models of core formation? The partitioning experiments will be performed using a Walker type multi anvil apparatus in a pressure range between 10 and 20 GPa and temperatures of 1700 up to 2100 °C. To determine the Dmetal/silicate values we are using a field emission high-resolution JEOL JXA-8530F EPMA for major elements and a Photon Machines Analyte G2 Excimer laser (193 nm) ablation system coupled to a Thermo Fisher Element 2 single-collector ICP-MS (LA-ICP-MS) for the trace elements. We recently finished the first sets of experiments and can provide the corresponding datasets. Based on the general understanding of Dmetal/silicate values we expect to depend on the composition, in this particular case this means a variation in sulfur and carbon content of the core composition, and also a change of the redox conditions. The major goal however is to derive a model of core formation on Earth that includes and also explains the SVEs.

The HTA core model: a novel method for producing and reporting health technology assessments.

PubMed

Lampe, Kristian; Mäkelä, Marjukka; Garrido, Marcial Velasco; Anttila, Heidi; Autti-Rämö, Ilona; Hicks, Nicholas J; Hofmann, Björn; Koivisto, Juha; Kunz, Regina; Kärki, Pia; Malmivaara, Antti; Meiesaar, Kersti; Reiman-Möttönen, Päivi; Norderhaug, Inger; Pasternack, Iris; Ruano-Ravina, Alberto; Räsänen, Pirjo; Saalasti-Koskinen, Ulla; Saarni, Samuli I; Walin, Laura; Kristensen, Finn Børlum

2009-12-01

The aim of this study was to develop and test a generic framework to enable international collaboration for producing and sharing results of health technology assessments (HTAs). Ten international teams constructed the HTA Core Model, dividing information contained in a comprehensive HTA into standardized pieces, the assessment elements. Each element contains a generic issue that is translated into practical research questions while performing an assessment. Elements were described in detail in element cards. Two pilot assessments, designated as Core HTAs were also produced. The Model and Core HTAs were both validated. Guidance on the use of the HTA Core Model was compiled into a Handbook. The HTA Core Model considers health technologies through nine domains. Two applications of the Model were developed, one for medical and surgical interventions and another for diagnostic technologies. Two Core HTAs were produced in parallel with developing the model, providing the first real-life testing of the Model and input for further development. The results of formal validation and public feedback were primarily positive. Development needs were also identified and considered. An online Handbook is available. The HTA Core Model is a novel approach to HTA. It enables effective international production and sharing of HTA results in a structured format. The face validity of the Model was confirmed during the project, but further testing and refining are needed to ensure optimal usefulness and user-friendliness. Core HTAs are intended to serve as a basis for local HTA reports. Core HTAs do not contain recommendations on technology use.

MODERATOR ELEMENTS FOR UNIFORM POWER NUCLEAR REACTOR

DOEpatents

Balent, R.

1963-03-12

This patent describes a method of obtaining a flatter flux and more uniform power generation across the core of a nuclear reactor. The method comprises using moderator elements having differing moderating strength. The elements have an increasing amount of the better moderating material as a function of radial and/or axial distance from the reactor core center. (AEC)

A new method for geochemical characterization of atmospheric mineral dust from polar ice cores: preliminary results from Talos Dome ice core (East Antarctica, Pacific-Ross Sea sector)

NASA Astrophysics Data System (ADS)

Baccolo, Giovanni; Delmonte, Barbara; Clemenza, Massimiliano; Previtali, Ezio; Maggi, Valter

2015-04-01

Assessing the elemental composition of atmospheric dust entrapped in polar ice cores is important for the identification of the potential dust sources and thus for the reconstruction of past atmospheric circulation, at local, regional and global scale. Accurate determination of major and trace elements in the insoluble fraction of dust extracted from ice cores is also useful to better understand some geochemical and biogeochemical mechanisms which are linked with the climate system. The extremely reduced concentration of dust in polar ice (typical Antarctic concentrations during interglacials are in the range of 10 ppb), the limited availability of such samples and the high risk of contamination make these analyses a challenge. A new method based on low background Instrumental Neutron Activation Analysis (INAA) was specifically developed for this kind of samples. The method allows the determination of the concentration of up to 35 elements in extremely reduced dust samples (20-30 μg). These elements span from major to trace and ultra-trace elements. Preliminary results from TALDICE (TALos Dome Ice CorE, East Antarctica, Pacific-Ross Sea Sector) ice core are presented along with results from potential source areas in Victoria Land. A set of 5 samples from Talos Dome, corresponding to the last termination, MIS3, MIS4 and MIS6 were prepared and analyzed by INAA.

Insights into Mercury's interior structure from geodesy measurements and global contraction

NASA Astrophysics Data System (ADS)

Rivoldini, A.; Van Hoolst, T.

2014-04-01

The measurements of the gravitational field of Mercury by MESSENGER [6] and improved measurements of the spin state of Mercury [3] provide important insights on its interior structure. In particular, these data give strong constraints on the radius and density of Mercury's core [5, 2]. However, present geodesy data do not provide strong constraints on the radius of the inner core. The data allow for models with a fully molten liquid core to models which have an inner core radius that is smaller than about 1760km [5], if it is assumed that sulfur is the only light element in the core. Models without an inner core are, however, at odds with the observed internally generated magnetic field of Mercury since Mercury's dynamo cannot operate by secular cooling alone at present. The present radius of the inner core depends mainly on Mercury's thermal state and light elements inside the core. Because of the secular cooling of the planet,the temperature inside the core drops below the liquidus temperature of the core material somewhere in the core and leads to the formation of an inner core and to the global contraction of the planet. The amount of contraction depends on the temperature decrease, on the thermal expansion of the materials inside the planet, and on the volume of crystallized liquid core alloy. In this study we use geodesy data, the recent estimate about the radial contraction of Mercury [1], and thermo-chemical evolution calculations in order to improve our knowledge about Mercury's inner core radius and thermal state. Since data from remote sensing of Mercury's surface [4] indicate that Mercury formed under reducing conditions we consider models that have sulfur and silicon as light elements inside their core. Unlike sulfur, which does almost not partition into solid iron under Mercury's core pressure and temperature conditions, silicon partitions virtually equally between solid and liquid iron. As a consequence, the density difference between the liquid and the crystallized material is smaller than for sulfur as only light element inside the core and therefore, for a given inner core radius the contraction of the planet is likely smaller.

Plastic deformation of FeSi at high pressures: implications for planetary cores

NASA Astrophysics Data System (ADS)

Kupenko, Ilya; Merkel, Sébastien; Achorner, Melissa; Plückthun, Christian; Liermann, Hanns-Peter; Sanchez-Valle, Carmen

2017-04-01

The cores of terrestrial planets is mostly comprised of a Fe-Ni alloy, but it should additionally contain some light element(s) in order to explain the observed core density. Silicon has long been considered as a likely candidate because of geochemical and cosmochemical arguments: the Mg/Si and Fe/Si ratios of the Earth does not match those of the chondrites. Since silicon preferentially partition into iron-nickel metal, having 'missing' silicon in the core would solve this problem. Moreover, the evidence of present (e.g. Mercury) or ancient (e.g. Mars) magnetic fields on the terrestrial planets is a good indicator of (at least partially) liquid cores. The estimated temperature profiles of these planets, however, lay below iron melting curve. The addition of light elements in their metal cores could allow reducing their core-alloy melting temperature and, hence, the generation of a magnetic field. Although the effect of light elements on the stability and elasticity of Fe-Ni alloys has been widely investigated, their effect on the plasticity of core materials remains largely unknown. Yet, this information is crucial for understanding how planetary cores deform. Here we investigate the plastic deformation of ɛ-FeSi up to 50 GPa at room temperature employing a technique of radial x-ray diffraction in diamond anvil cells. Stoichiometric FeSi endmember is a good first-order approximation of the Fe-FeSi system and a good starting material to develop new experimental perspectives. In this work, we focused on the low-pressure polymorph of FeSi that would be the stable phase in the cores of small terrestrial planets. We will present the analysis of measured data and discuss their potential application to constrain plastic deformation in planetary cores.

The lunar core and the origin of the moon

NASA Astrophysics Data System (ADS)

Newsom, H. E.

1984-05-01

The results of recent analyses of concentrations of refractory siderophile elements molybdenum and rhenium in lunar rock samples suggest that most siderophile elements in lunar crustal rocks and mare basalts are significantly less concentrated than in the earth's mantle and much less than in chondrite meteorites. The depletion of siderophile elements in the samples implies the existence of a metal core, and the amount of metal in the core is directly related to the conditions under which segregation occurs. The consequences of the data are discussed in terms of three theoretical models of lunar evolution: a terrestrial origin model; a terrestrial origin model which takes metal segregation into account; and an independent origin model. It is shown that less metal is needed for a terrestrial origin because the earth's mantle was already partially depleted in siderophile elements due to the formation of the earth core.

NEUTRONIC REACTOR FUEL ELEMENT AND CORE SYSTEM

DOEpatents

Moore, W.T.

1958-09-01

This patent relates to neutronic reactors and in particular to an improved fuel element and a novel reactor core system for facilitating removal of contaminating fission products, as they are fermed, from association with the flssionable fuel, so as to mitigate the interferent effects of such fission products during reactor operation. The fuel elements are comprised of tubular members impervious to fluid and contatning on their interior surfaces a thin layer of fissionable material providing a central void. The core structure is comprised of a plurality of the tubular fuel elements arranged in parallel and a closed manifold connected to their ends. In the reactor the core structure is dispersed in a water moderator and coolant within a pressure vessel, and a means connected to said manifuld is provided for withdrawing and disposing of mobile fission product contamination from the interior of the feel tubes and manifold.

Simulation on reactor TRIGA Puspati core kinetics fueled with thorium (Th) based fuel element

NASA Astrophysics Data System (ADS)

Mohammed, Abdul Aziz; Pauzi, Anas Muhamad; Rahman, Shaik Mohmmed Haikhal Abdul; Zin, Muhamad Rawi Muhammad; Jamro, Rafhayudi; Idris, Faridah Mohamad

2016-01-01

In confronting global energy requirement and the search for better technologies, there is a real case for widening the range of potential variations in the design of nuclear power plants. Smaller and simpler reactors are attractive, provided they can meet safety and security standards and non-proliferation issues. On fuel cycle aspect, thorium fuel cycles produce much less plutonium and other radioactive transuranic elements than uranium fuel cycles. Although not fissile itself, Th-232 will absorb slow neutrons to produce uranium-233 (233U), which is fissile. By introducing Thorium, the numbers of highly enriched uranium fuel element can be reduced while maintaining the core neutronic performance. This paper describes the core kinetic of a small research reactor core like TRIGA fueled with a Th filled fuel element matrix using a general purpose Monte Carlo N-Particle (MCNP) code.

Simulation on reactor TRIGA Puspati core kinetics fueled with thorium (Th) based fuel element

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

Mohammed, Abdul Aziz, E-mail: azizM@uniten.edu.my; Rahman, Shaik Mohmmed Haikhal Abdul; Pauzi, Anas Muhamad, E-mail: anas@uniten.edu.my

2016-01-22

In confronting global energy requirement and the search for better technologies, there is a real case for widening the range of potential variations in the design of nuclear power plants. Smaller and simpler reactors are attractive, provided they can meet safety and security standards and non-proliferation issues. On fuel cycle aspect, thorium fuel cycles produce much less plutonium and other radioactive transuranic elements than uranium fuel cycles. Although not fissile itself, Th-232 will absorb slow neutrons to produce uranium-233 ({sup 233}U), which is fissile. By introducing Thorium, the numbers of highly enriched uranium fuel element can be reduced while maintainingmore » the core neutronic performance. This paper describes the core kinetic of a small research reactor core like TRIGA fueled with a Th filled fuel element matrix using a general purpose Monte Carlo N-Particle (MCNP) code.« less

Constraints on the coupled thermal evolution of the Earth's core and mantle, the age of the inner core, and the origin of the 186Os/188Os “core signal” in plume-derived lavas

NASA Astrophysics Data System (ADS)

Lassiter, J. C.

2006-10-01

The possibility that some mantle plumes may carry a geochemical signature of core/mantle interaction has rightly generated considerable interest and attention in recent years. Correlated 186Os- 187Os enrichments in some plume-derived lavas (Hawaii, Gorgona, Kostomuksha) have been interpreted as deriving from an outer core with elevated Pt/Os and Re/Os ratios due to the solidification of the Earth's inner core (c.f., [A.D. Brandon, R.J. Walker, The debate over core-mantle interaction, Earth Planet. Sci. Lett. 232 (2005) 211-225.] and references therein). Conclusive identification of a "core signal" in plume-derived lavas would profoundly influence our understanding of mantle convection and evolution. This paper reevaluates the Os-isotope evidence for core/mantle interaction by examining other geochemical constraints on core/mantle interaction, geophysical constraints on the thermal evolution of the outer core, and geochemical and cosmochemical constraints on the abundance of heat-producing elements in the core. Additional study of metal/silicate and sulfide/silicate partitioning of K, Pb, and other trace elements is needed to more tightly constrain the likely starting composition of the Earth's core. However, available data suggest that the observed 186Os enrichments in Hawaiian and other plume-derived lavas are unlikely to derive from core/mantle interaction. 1) Core/mantle interaction sufficient to produce the observed 186Os enrichments would likely have significant effects on other tracers such as Pb- and W-isotopes that are not observed. 2) Significant partitioning of K or other heat-producing elements into the core would produce a "core depletion" pattern in the Silicate Earth very different from that observed. 3) In the absence of heat-producing elements in the core, core/mantle heat flow of ˜ 6-15 TW estimated from several independent geophysical constraints suggests an inner core age (< ˜ 2.5 Ga) too young for the outer core to have developed a significant 186Os enrichment. Core/mantle thermal and chemical interaction remains an important problem that warrants future research. However, Os-isotopes may have only limited utility in this area due to the relatively young age of the Earth's inner core.

Building a Consensus on Community Health Workers’ Scope of Practice: Lessons From New York

PubMed Central

Matos, Sergio; Hicks, April L.; Campbell, Ayanna; Moore, Addison; Diaz, Diurka

2012-01-01

Objectives. We evaluated efforts in New York to build a consensus between community health workers (CHWs) and employers on CHWs’ scope of practice, training standards, and certification procedures. Methods. We conducted multiple-choice surveys in 2008 and 2010 with 226 CHWs and 44 employers. We compared CHWs’ and employers’ recommendations regarding 28 scope of practice elements. The participatory ranking method was used to identify consensus scope of practice recommendations. Results. There was consensus on 5 scope of practice elements: outreach and community organizing, case management and care coordination, home visits, health education and coaching, and system navigation. For each element, 3 to 4 essential skills were identified, giving a total of 27 skills. These included all skills recommended in national CHW studies, along with 3 unique to New York: computer skills, participatory research methods, and time management. Conclusions. CHWs and employers in New York were in consensus on CHWs’ scope of practice on virtually all of the detailed core competency skills. The CHW scope of practice recommendations of these groups can help other states refine their scope of practice elements. PMID:22897548

[A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients].

PubMed

Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu

2015-12-01

Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

Intrinsic Aniostropic Anelasticity of Hcp Iron Due to Light Element Solute Atoms

NASA Astrophysics Data System (ADS)

Redfern, S. A. T.

2014-12-01

Earth's inner core is elastically anisotropic, with seismology showing faster wave propagation along the polar axis compared to the equatorial plane. Some inner core studies report anisotropic seismic attenuation. Attenuation of body-waves has, previously, been postulated to be due to scattering by anisotropic microstructure, but recent normal mode studies also show strong anisotropic attenuation (Mäkinen et al. 2014). This suggests that the anisotropic attenuation is a result of the intrinsic (and anisotropic) anelastic properties of the solid iron alloy forming Earth's inner core. Here, I consider the origins of inner core anisotropic attenuation. Possibilities include grain boundary relaxation, dislocation bowing/glide, or point defect (alloying element) relaxations. The inner core is an almost perfect environment for near-equilibrium crystallisation, with very low temperature gradients across the inner core, low gravity, and slow crystallisation rates. It is assumed that grain sizes may be of the order of hundreds of metres. This implies vanishingly small volumes of grain boundary, and insignificant grain boundary relaxation. The very high homologous temperature and the absence of obvious deviatoric stress, also leads one to conclude that dislocation densities are low. On the other hand, estimates for light element concentrations are of the order of a few % with O, S, Si, C and H at various times being suggested as candidate elements. Light element solutes in hcp metals contribute to intrinsic anelastic attenuation if they occur in sufficient concentrations to pair and form elastic dipoles. Switching of dipoles under the stress of a passing seismic wave will result in anelastic mechanical loss. Such attenuation has been measured in hcp metals in the lab, and is anisotropic due to the intrinsic elastic anisotropy of the host lattice. Such solute pair relaxations result in a "Zener effect", which is suggested here to be responsible for observed anisotropic seismic attenuation. Zener relaxation magnitude scales with solute concentrationand is consistent with around 5% loght element. Variations in attenuation are expected in a core with spatially varying concentrations of light element, and attenuation tomography of the inner core could, therefore, be employed to map chemical heterogeneity.

Sediment and water chemistry of the San Juan River and Escalante River deltas of Lake Powell, Utah, 2010-2011

USGS Publications Warehouse

Hornewer, Nancy J.

2014-01-01

Recent studies have documented the presence of trace elements, organic compounds including polycyclic aromatic hydrocarbons, and radionuclides in sediment from the Colorado River delta and from sediment in some side canyons in Lake Powell, Utah and Arizona. The fate of many of these contaminants is of significant concern to the resource managers of the National Park Service Glen Canyon National Recreation Area because of potential health impacts to humans and aquatic and terrestrial species. In 2010, the U.S. Geological Survey began a sediment-core sampling and analysis program in the San Juan River and Escalante River deltas in Lake Powell, Utah, to help the National Park Service further document the presence or absence of contaminants in deltaic sediment. Three sediment cores were collected from the San Juan River delta in August 2010 and three sediment cores and an additional replicate core were collected from the Escalante River delta in September 2011. Sediment from the cores was subsampled and composited for analysis of major and trace elements. Fifty-five major and trace elements were analyzed in 116 subsamples and 7 composited samples for the San Juan River delta cores, and in 75 subsamples and 9 composited samples for the Escalante River delta cores. Six composited sediment samples from the San Juan River delta cores and eight from the Escalante River delta cores also were analyzed for 55 low-level organochlorine pesticides and polychlorinated biphenyls, 61 polycyclic aromatic hydrocarbon compounds, gross alpha and gross beta radionuclides, and sediment-particle size. Additionally, water samples were collected from the sediment-water interface overlying each of the three cores collected from the San Juan River and Escalante River deltas. Each water sample was analyzed for 57 major and trace elements. Most of the major and trace elements analyzed were detected at concentrations greater than reporting levels for the sediment-core subsamples and composited samples. Low-level organochlorine pesticides and polychlorinated biphenyls were not detected in any of the samples. Only one polycyclic aromatic hydrocarbon compound was detected at a concentration greater than the reporting level for one San Juan composited sample. Gross alpha and gross beta radionuclides were detected at concentrations greater than reporting levels for all samples. Most of the major and trace elements analyzed were detected at concentrations greater than reporting levels for water samples.

A volatile-rich Earth's core inferred from melting temperature of core materials

NASA Astrophysics Data System (ADS)

Morard, G.; Andrault, D.; Antonangeli, D.; Nakajima, Y.; Auzende, A. L.; Boulard, E.; Clark, A. N.; Lord, O. T.; Cervera, S.; Siebert, J.; Garbarino, G.; Svitlyk, V.; Mezouar, M.

2016-12-01

Planetary cores are mainly constituted of iron and nickel, alloyed with lighter elements (Si, O, C, S or H). Understanding how these elements affect the physical and chemical properties of solid and liquid iron provides stringent constraints on the composition of the Earth's core. In particular, melting curves of iron alloys are key parameter to establish the temperature profile in the Earth's core, and to asses the potential occurrence of partial melting at the Core-Mantle Boundary. Core formation models based on metal-silicate equilibration suggest that Si and O are the major light element components1-4, while the abundance of other elements such as S, C and H is constrained by arguments based on their volatility during planetary accretion5,6. Each compositional model implies a specific thermal state for the core, due to the different effect that light elements have on the melting behaviour of Fe. We recently measured melting temperatures in Fe-C and Fe-O systems at high pressures, which complete the data sets available both for pure Fe7 and other binary alloys8. Compositional models with an O- and Si-rich outer core are suggested to be compatible with seismological constraints on density and sound velocity9. However, their crystallization temperatures of 3650-4050 K at the CMB pressure of 136 GPa are very close to, if not higher than the melting temperature of the silicate mantle and yet mantle melting above the CMB is not a ubiquitous feature. This observation requires significant amounts of volatile elements (S, C or H) in the outer core to further reduce the crystallisation temperature of the core alloy below that of the lower mantle. References 1. Wood, B. J., et al Nature 441, 825-833 (2006). 2. Siebert, J., et al Science 339, 1194-7 (2013). 3. Corgne, A., et al Earth Planet. Sc. Lett. 288, 108-114 (2009). 4. Fischer, R. a. et al. Geochim. Cosmochim. Acta 167, 177-194 (2015). 5. Dreibus, G. & Palme, H. Geochim. Cosmochim. Acta 60, 1125-1130 (1995). 6. McDonough, W. F. Treatise in Geochemistry 2, 547-568 (2003). 7. Anzellini, S., et al Science 340, 464-6 (2013). 8. Morard, G. et al. Phys. Chem. Miner. 38, 767-776 (2011). 9. Badro, J., et al Proc. Natl. Acad. Sci. U. S. A. 111, 7542-5 (2014).

P4 medicine: how systems medicine will transform the healthcare sector and society

PubMed Central

Glusman, Gustavo; Brogaard, Kristin; Price, Nathan D; Hood, Leroy

2014-01-01

Ten years ago, the proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was regarded as highly speculative. Today, the core elements of that vision are widely accepted and have been articulated in a series of recent reports by the US Institute of Medicine. Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual’s unique health experience of both health and disease at the molecular, cellular and organ levels. This information will make disease care radically more cost effective by personalizing care to each person’s unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions. Working together in digitally powered familial and affinity networks, consumers will be able to reduce the incidence of the complex chronic diseases that currently account for 75% of disease-care costs in the USA. PMID:25342952

Defining the system of care concept and philosophy: to update or not to update?

PubMed

Stroul, Beth A; Blau, Gary M

2010-02-01

This commentary considers the task of updating the system of care concept and philosophy within its historical context, reviewing the original intent of the definition and clarifying misconceptions about its meaning. The authors identify the aspects of the concept and philosophy that should be updated based on the latest thinking, experience, and data, such as incorporating applicability to a broader range of populations, increasing the emphasis on the core values, specifying desired outcomes, and adding accountability as a critical element. An updated definition and values and principles are proposed, and the importance of always presenting the definition along with the accompanying specification of the philosophy is emphasized in order to increase its utility in assisting the field to move from theory to practice.

Comparison of biomechanical function at ideal and varied surgical placement for two lumbar artificial disc implant designs: mobile-core versus fixed-core.

PubMed

Moumene, Missoum; Geisler, Fred H

2007-08-01

Finite element model. To estimate the effect of lumbar mobile-core and fixed-core artificial disc design and placement on the loading of the facet joints, and stresses on the polyethylene core. Although both mobile-core and fixed-core lumbar artificial disc designs have been used clinically, the effect of their design and the effect of placement within the disc space on the structural element loading, and in particular the facets and the implant itself, have not been investigated. A 3D nonlinear finite element model of an intact ligamentous L4-L5 motion segment was developed and validated in all 6 df based on previous experiments conducted on human cadavers. Facet loading of a mobile-core TDR and a fixed-core TDR were estimated with 4 different prosthesis placements for 3 different ranges of motion. Placing the mobile-core TDR anywhere within the disc space reduced facet loading by more than 50%, while the fixed-core TDR increased facet loading by more than 10% when compared with the intact disc in axial rotation. For central (ideal) placement, the mobile- and fixed-core implants were subjected to compressive stresses on the order of 3 MPa and 24 MPa, respectively. The mobile-core stresses were not affected by implant placement, while the fixed-core stresses increased by up to 40%. A mobile-core artificial disc design is less sensitive to placement, and unloads the facet joints, compared with a fixed-core design. The decreased core stress may result in a reduced potential for wear in a mobile-core prosthesis compared with a fixed-core prosthesis, which may increase the functional longevity of the device.

Rare earth element compositions of core sediments from the shelf of the South Sea, Korea: Their controls and origins

NASA Astrophysics Data System (ADS)

Jung, Hoi-Soo; Lim, Dhongil; Choi, Jin-Yong; Yoo, Hae-Soo; Rho, Kyung-Chan; Lee, Hyun-Bok

2012-10-01

Rare earth elements (REEs) of bulk sediments and heavy mineral samples of core sediments from the South Sea shelf, Korea, were analyzed to determine the constraints on REE concentrations and distribution patterns as well as to investigate their potential applicability for discriminating sediment provenance. Bulk sediment REEs showed large variation in concentrations and distribution patterns primarily due to grain size and carbonate dilution effects, as well as due to an abundance of heavy minerals. In the fine sandy sediments (cores EZ02-15 and 19), in particular, heavy minerals (primarily monazite and titanite/sphene) largely influenced REE compositions. Upper continental crust-normalized REE patterns of these sand-dominated sediments are characterized by enriched light REEs (LREEs), because of inclusion of heavy minerals with very high concentrations in LREEs. Notably, such a strong LREE enrichment is also observed in Korean river sediments. So, a great care must be taken when using the REE concentrations and distribution patterns of sandy and coarse silty shelf sediments as a proxy for discriminating sediment provenance. In the fine-grained muddy sediments with low heavy mineral abundance, in contrast, REE fractionation ratios and their UCC-normalized patterns seem to be reliable proxies for assessing sediment provenance. The resultant sediment origin suggested a long lateral transportation of some fine-grained Chinese river sediments (probably the Changjiang River) to the South Sea of Korea across the shelf of the northern East China Sea.

The influence of carbon, sulfur, and silicon on trace element partitioning in iron alloys

NASA Astrophysics Data System (ADS)

Han, J.; Van Orman, J. A.; Crispin, K. L.; Ash, R. D.

2014-12-01

Non-metallic light elements are important constituents of planetary cores and have a strong influence on the partitioning behavior of trace elements. Planetary cores may contain a wide range of non-metallic light elements, including H, N, S, P, Si, and C. Under highly reducing conditions, such as those that are thought to have pertained during the formation of Mercury's core, Si and C, in addition to sulfur, may be particularly important constituents. Each of these elements may strongly effect and have a different impact on the partitioning behavior of trace elements but their combined effects on trace element partitioning have not been quantified. We investigated the partitioning behavior of more than 25 siderophile trace elements within the Fe-S-C-Si system with varying concentrations of C, S, and Si. The experiments were performed under pressures varying from 1 atm to 2 GPa and temperatures ranging from 1200˚C to 1450˚C. All experiments produced immiscible liquids, one enriched in Si and C, and the other predominantly FeS. We found some highly siderophile elements including Os, Ru, Ir, and Re are much more enriched in Fe-Si-C phase than in Fe-S phase, whereas other trace elements like V, Co, Ag, Hf, and Pb are enriched in S-rich phase. However, not all the trace elements enriched in Fe-Si-C phase are repelled by sulfur. Elements like Re and Ru could have different partitioning trends if sulfur concentration in S-rich phase rises. The partitioning behavior of these trace elements could enhance our understanding of the differentiation of Mercury's core under oxygen-poor conditions.

MERCHANT MARINE SHIP REACTOR

DOEpatents

Mumm, J.F.; North, D.C. Jr.; Rock, H.R.; Geston, D.K.

1961-05-01

A nuclear reactor is described for use in a merchant marine ship. The reactor is of pressurized light water cooled and moderated design in which three passes of the water through the core in successive regions of low, intermediate, and high heat generation and downflow in a fuel region are made. The foregoing design makes a compact reactor construction with extended core life. The core has an egg-crate lattice containing the fuel elements confined between a lower flow baffle and upper grid plate, with the latter serving also as part of a turn- around manifold from which the entire coolant is distributed into the outer fuel elements for the second pass through the core. The inner fuel elements are cooled in the third pass.

Merchant Marine Ship Reactor

DOEpatents

Sankovich, M. F.; Mumm, J. F.; North, Jr, D. C.; Rock, H. R.; Gestson, D. K.

1961-05-01

A nuclear reactor for use in a merchant marine ship is described. The reactor is of pressurized, light water cooled and moderated design in which three passes of the water through the core in successive regions of low, intermediate, and high heat generation and downflow in a fuel region are made. The design makes a compact reactor construction with extended core life. The core has an egg-crate lattice containing the fuel elements that are confined between a lower flow baffle and upper grid plate, with the latter serving also as part of a turn- around manifold from which the entire coolant is distributed into the outer fuel elements for the second pass through the core. The inner fuel elements are cooled in the third pass. (AEC)

Effect of light elements on the sound velocities in solid iron: Implications for the composition of Earth's core

NASA Astrophysics Data System (ADS)

Badro, James; Fiquet, Guillaume; Guyot, François; Gregoryanz, Eugene; Occelli, Florent; Antonangeli, Daniele; d'Astuto, Matteo

2007-02-01

We measured compressional sound velocities in light element alloys of iron (FeO, FeSi, FeS, and FeS2) at high-pressure by inelastic X-ray scattering. This dataset provides new mineralogical constraints on the composition of Earth's core, and completes the previous sets formed by the pressure-density systematics for these compounds. Based on the combination of these datasets and their comparison with radial seismic models, we propose an average composition model of the Earth's core. We show that the incorporation of small amounts of silicon or oxygen is compatible with geophysical observations and geochemical abundances. The effect of nickel on the calculated light element contents is shown to be negligible. The preferred core model derived from our measurements is an inner core which contains 2.3 wt.% silicon and traces of oxygen, and an outer core containing 2.8 wt.% silicon and around 5.3 wt.% oxygen.

FUEL-BREEDER FUEL ELEMENT FOR NUCLEAR REACTOR

DOEpatents

Abbott, W.E.; Balent, R.

1958-09-16

A fuel element design to facilitate breeding reactor fuel is described. The fuel element is comprised of a coatainer, a central core of fertile material in the container, a first bonding material surrounding the core, a sheet of fissionable material immediately surrounding the first bonding material, and a second bonding material surrounding the fissionable material and being in coniact with said container.

Core-Mantle Partitioning of Volatile Elements and the Origin of Volatile Elements in Earth and Moon

NASA Technical Reports Server (NTRS)

Righter, Kevin; Pando, K.; Danielson, L.; Nickodem, K.

2014-01-01

Depletions of volatile siderophile elements (VSE; Ga, Ge, In, As, Sb, Sn, Bi, Zn, Cu, Cd) in mantles of Earth and Moon, constrain the origin of volatile elements in these bodies, and the overall depletion of volatile elements in Moon relative to Earth. A satisfactory explanation has remained elusive [1,2]. We examine the depletions of VSE in Earth and Moon and quantify the amount of depletion due to core formation and volatility of potential building blocks. We calculate the composition of the Earth's PUM during continuous accretion scenarios with constant and variable fO2. Results suggest that the VSE can be explained by a rather simple scenario of continuous accretion leading to a high PT metal-silicate equilibrium scenario that establishes the siderophile element content of Earth's PUM near the end of accretion [3]. Core formation models for the Moon explain most VSE, but calculated contents of In, Sn, and Zn (all with Tc < 750 K) are all still too high after core formation, and must therefore require an additional process to explain the depletions in the lunar mantle. We discuss possible processes including magmatic degassing, evaporation, condensation, and vapor-liquid fractionation in the lunar disk.

FEDAL SYSTEM OPERATION DURING STATION START-UP. Test Results (T-643734). Core I, Seed 2. Section I

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

None

An investigation was conducted to determine if any failed blanket fuel elements exist in core locations previously found to have high levels of delayed neutron emitter activity. Data from Fedal System monitors indicate that J5 may have a failed blanket element, there is no evidence of failure at core location F7. (J.R.D.)

Origins of anisotropic seismic attenuation of the inner core - intrinsic anelasticity of hcp iron alloy

NASA Astrophysics Data System (ADS)

Redfern, Simon

2015-04-01

Earth's inner core is elastically anisotropic, with seismology showing faster wave propagation along the polar axis compared to the equatorial plane. Some inner core studies report anisotropic seismic attenuation. Attenuation of body-waves has, previously, been postulated to be due to scattering by anisotropic microstructure, but recent normal mode studies also show strong anisotropic attenuation (Mäkinen et al. 2014). This suggests that the anisotropic attenuation is a result of the intrinsic (and anisotropic) anelastic properties of the solid iron alloy forming Earth's inner core. Here, I consider the origins of inner core anisotropic attenuation. Possibilities include grain boundary relaxation, dislocation bowing/glide, or point defect (alloying element) relaxations. The inner core is an almost perfect environment for near-equilibrium crystallisation, with very low temperature gradients across the inner core, low gravity, and slow crystallisation rates. It is assumed that grain sizes may be of the order of hundreds of metres. This implies vanishingly small volumes of grain boundary, and insignificant grain boundary relaxation. The very high homologous temperature and the absence of obvious deviatoric stress, also leads one to conclude that dislocation densities are low. On the other hand, estimates for light element concentrations are of the order of a few % with O, S, Si, C and H at various times being suggested as candidate elements. Light element solutes in hcp metals contribute to intrinsic anelastic attenuation if they occur in sufficient concentrations to pair and form elastic dipoles. Switching of dipoles under the stress of a passing seismic wave will result in anelastic mechanical loss. Such attenuation has been measured in hcp metals in the lab, and is anisotropic due to the intrinsic elastic anisotropy of the host lattice. Such solute pair relaxations result in a "Zener effect", which is suggested here to be responsible for observed anisotropic seismic attenuation. Zener relaxation magnitude scales with solute concentration and is consistent with around 5% light element. Variations in attenuation are expected in a core with spatially varying concentrations of light element, and attenuation tomography of the inner core could, therefore, be employed to map chemical heterogeneity.

Thermal-Hydraulic Transient Analysis of a Packed Particle Bed Reactor Fuel Element

DTIC Science & Technology

1990-06-01

long fuel elements, arranged to form a core , were analyzed for an up-power transient from 0 MWt to approximately 18 MWt. The simple model significantly...VARIATIONS IN FUEL ELEMENT GEOMETRY ............. 60 4.4 VARIATIONS IN THE MANNER OF TRANSIENT CONTROL ..... 62 4.5 CORE REPRESENTATION BY MULTIPLE FUEL ...the HTGR , however, the PBR packs small fuel particles between inner and outer retention elements, designated as frits. The PBR is appropriate for a

CALANDRIA TYPE SODIUM GRAPHITE REACTOR

DOEpatents

Peterson, R.M.; Mahlmeister, J.E.; Vaughn, N.E.; Sanders, W.J.; Williams, A.C.

1964-02-11

A sodium graphite power reactor in which the unclad graphite moderator and fuel elements are contained within a core tank is described. The core tank is submersed in sodium within the reactor vessel. Extending longitudinally through the core thnk are process tubes with fuel elements positioned therein. A bellows sealing means allows axial expansion and construction of the tubes. Within the core tank, a leakage plenum is located below the graphite, and above the graphite is a gas space. A vent line regulates the gas pressure in the space, and another line removes sodium from the plenum. The sodium coolant flows from the lower reactor vessel through the annular space between the fuel elements and process tubes and out into the reactor vessel space above the core tank. From there, the heated coolant is drawn off through an outlet line and sent to the heat exchange. (AEC)

Effective delayed neutron fraction and prompt neutron lifetime of Tehran research reactor mixed-core.

PubMed

Lashkari, A; Khalafi, H; Kazeminejad, H

2013-05-01

In this work, kinetic parameters of Tehran research reactor (TRR) mixed cores have been calculated. The mixed core configurations are made by replacement of the low enriched uranium control fuel elements with highly enriched uranium control fuel elements in the reference core. The MTR_PC package, a nuclear reactor analysis tool, is used to perform the analysis. Simulations were carried out to compute effective delayed neutron fraction and prompt neutron lifetime. Calculation of kinetic parameters is necessary for reactivity and power excursion transient analysis. The results of this research show that effective delayed neutron fraction decreases and prompt neutron lifetime increases with the fuels burn-up. Also, by increasing the number of highly enriched uranium control fuel elements in the reference core, the prompt neutron lifetime increases, but effective delayed neutron fraction does not show any considerable change.

Effective delayed neutron fraction and prompt neutron lifetime of Tehran research reactor mixed-core

PubMed Central

Lashkari, A.; Khalafi, H.; Kazeminejad, H.

2013-01-01

In this work, kinetic parameters of Tehran research reactor (TRR) mixed cores have been calculated. The mixed core configurations are made by replacement of the low enriched uranium control fuel elements with highly enriched uranium control fuel elements in the reference core. The MTR_PC package, a nuclear reactor analysis tool, is used to perform the analysis. Simulations were carried out to compute effective delayed neutron fraction and prompt neutron lifetime. Calculation of kinetic parameters is necessary for reactivity and power excursion transient analysis. The results of this research show that effective delayed neutron fraction decreases and prompt neutron lifetime increases with the fuels burn-up. Also, by increasing the number of highly enriched uranium control fuel elements in the reference core, the prompt neutron lifetime increases, but effective delayed neutron fraction does not show any considerable change. PMID:24976672

Explicit Instruction Elements in Core Reading Programs

ERIC Educational Resources Information Center

Child, Angela R.

2012-01-01

Classroom teachers are provided instructional recommendations for teaching reading from their adopted core reading programs (CRPs). Explicit instruction elements or what is also called instructional moves, including direct explanation, modeling, guided practice, independent practice, discussion, feedback, and monitoring, were examined within CRP…

Nursing and justice as a basic human need.

PubMed

Johnstone, Megan-Jane

2011-01-01

This paper explores the idea that justice is a basic human need akin to those famously depicted in Maslow's hierarchy of human needs and, as such, warrants recognition as a core element in representative ideas about nursing. Early nurse theorists positioned the principles and practice of nursing as having their origins in 'universal human needs'. The principle of deriving nursing care from human needs was thought to provide a guide not only for promoting health, but for preventing disease and illness. The nursing profession has had a longstanding commitment to social justice as a core professional value and ideal, obligating nurses to address the social conditions that undermine people's health. The idea of justice as a universal human need per se and its possible relationship to people's health outcomes has, however, not been considered. One reason for this is that justice in nursing discourse has more commonly been associated with law and ethics, and the legal and ethical responsibilities of nurses in relation to individualized patient care and, more recently, changing systems of care to improve health and health outcomes. Although this association is not incorrect, it is incomplete. A key aim of this paper is to redress this oversight and to encourage a broader conceptualization of justice as necessary for human survival, health and development, not merely as a professional value, or legal or ethical principle for guiding human conduct. © 2010 Blackwell Publishing Ltd.

Vertical distribution of trace-element concentrations and occurrence of metallurgical slag particles in accumulated bed sediments of Lake Roosevelt, Washington, September 2002

USGS Publications Warehouse

Cox, S.E.; Bell, P.R.; Lowther, J.S.; Van Metre, P.C.

2005-01-01

Sediment cores were collected from six locations in Lake Roosevelt to determine the vertical distributions of trace-element concentrations in the accumulated sediments of Lake Roosevelt. Elevated concentrations of arsenic, cadmium, copper, lead, mercury, and zinc occurred throughout much of the accumulated sediments. Concentrations varied greatly within the sediment core profiles, often covering a range of 5 to 10 fold. Trace-element concentrations typically were largest below the surficial sediments in the lower one-half of each profile, with generally decreasing concentrations from the 1964 horizon to the surface of the core. The trace-element profiles reflect changes in historical discharges of trace elements to the Columbia River by an upstream smelter. All samples analyzed exceeded clean-up guidelines adopted by the Confederated Tribes of the Colville Reservation for cadmium, lead, and zinc and more than 70 percent of the samples exceeded cleanup guidelines for mercury, arsenic, and copper. Although 100 percent of the samples exceeded sediment guidelines for cadmium, lead, and zinc, surficial concentrations of arsenic, copper, and mercury in some cores were less than the sediment-quality guidelines. With the exception of copper, the trace-element profiles of the five cores collected along the pre-reservoir Columbia River channel typically showed trends of decreasing concentrations in sediments deposited after the 1964 time horizon. The decreasing concentrations of trace elements in the upper half of cores from along the pre-reservoir Columbia River showed a pattern of decreasing concentrations similar to reductions in trace-element loading in liquid effluent from an upstream smelter. Except for arsenic, trace-element concentrations typically were smaller at downstream reservoir locations along the pre-reservoir Columbia River. Trace-element concentration in sediments from the Spokane Arm of the reservoir showed distinct differences compared to the similarities observed in cores from along the pre-reservoir Columbia River. Particles of slag, which have physical and chemical characteristics of slag discharged to the Columbia River by a lead-zinc smelter upstream of the reservoir at Trail, British Columbia, were found in sediments of Lake Roosevelt. Slag particles are more common in the upstream reaches of the reservoir. The chemical composition of the interior matrix of slag collected from Lake Roosevelt closely approximated the reported elemental concentrations of fresh smelter slag, although evidence of slag weathering was observed. Exfoliation flakes were observed on the surface of weathered slag particles isolated from the core sediments. The concentrations of zinc on the exposed surface of slag grains were smaller than concentrations on interior surfaces. Weathering rinds also were observed in the cross section of weathered slag grains, indicating that the glassy slag material was undergoing hydration and chemical weathering. Trace elements observed in accumulated sediments in the middle and lower reaches of the reservoir are more likely due to the input from liquid effluent discharges compared to slag discharges from the upstream smelter.

Improving quality of care through routine, successful implementation of evidence-based practice at the bedside: an organizational case study protocol using the Pettigrew and Whipp model of strategic change

PubMed Central

2007-01-01

Background Evidence-based practice (EBP) is an expected approach to improving the quality of patient care and service delivery in health care systems internationally that is yet to be realized. Given the current evidence-practice gap, numerous authors describe barriers to achieving EBP. One recurrently identified barrier is the setting or context of practice, which is likewise cited as a potential part of the solution to the gap. The purpose of this study is to identify key contextual elements and related strategic processes in organizations that find and use evidence at multiple levels, in an ongoing, integrated fashion, in contrast to those that do not. Methods The core theoretical framework for this multi-method explanatory case study is Pettigrew and Whipp's Content, Context, and Process model of strategic change. This framework focuses data collection on three entities: the Why of strategic change, the What of strategic change, and the How of strategic change, in this case related to implementation and normalization of EBP. The data collection plan, designed to capture relevant organizational context and related outcomes, focuses on eight interrelated factors said to characterize a receptive context. Selective, purposive sampling will provide contrasting results between two cases (departments of nursing) and three embedded units in each. Data collection methods will include quantitative tools (e.g., regarding culture) and qualitative approaches including focus groups, interviews, and documents review (e.g., regarding integration and “success”) relevant to the EBP initiative. Discussion This study should provide information regarding contextual elements and related strategic processes key to successful implementation and sustainability of EBP, specifically in terms of a pervasive pattern in an acute care hospital-based health care setting. Additionally, this study will identify key contextual elements that differentiate successful implementation and sustainability of EBP efforts, both within varying levels of a hospital-based clinical setting and across similar hospital settings interested in EBP. PMID:17266756

The influence of linear elements on plant species diversity of Mediterranean rural landscapes: assessment of different indices and statistical approaches.

PubMed

García del Barrio, J M; Ortega, M; Vázquez De la Cueva, A; Elena-Rosselló, R

2006-08-01

This paper mainly aims to study the linear element influence on the estimation of vascular plant species diversity in five Mediterranean landscapes modeled as land cover patch mosaics. These landscapes have several core habitats and a different set of linear elements--habitat edges or ecotones, roads or railways, rivers, streams and hedgerows on farm land--whose plant composition were examined. Secondly, it aims to check plant diversity estimation in Mediterranean landscapes using parametric and non-parametric procedures, with two indices: Species richness and Shannon index. Land cover types and landscape linear elements were identified from aerial photographs. Their spatial information was processed using GIS techniques. Field plots were selected using a stratified sampling design according to relieve and tree density of each habitat type. A 50x20 m2 multi-scale sampling plot was designed for the core habitats and across the main landscape linear elements. Richness and diversity of plant species were estimated by comparing the observed field data to ICE (Incidence-based Coverage Estimator) and ACE (Abundance-based Coverage Estimator) non-parametric estimators. The species density, percentage of unique species, and alpha diversity per plot were significantly higher (p < 0.05) in linear elements than in core habitats. ICE estimate of number of species was 32% higher than of ACE estimate, which did not differ significantly from the observed values. Accumulated species richness in core habitats together with linear elements, were significantly higher than those recorded only in the core habitats in all the landscapes. Conversely, Shannon diversity index did not show significant differences.

Implementation of a Preventive Services Bundle in Academic Pediatric Primary Care Centers.

PubMed

Samaan, Zeina Marcho; Brown, Courtney M; Morehous, John; Perkins, Alison A; Kahn, Robert S; Mansour, Mona E

2016-03-01

Previous studies have documented poor rates of delivery of preventive services, 1 of the core services provided in the primary care medical home setting. We aimed to increase the reliability of delivering a bundle of preventive services to patients 0 to 14 months of age from 58% of patient visits to 95% of visits. The bundle includes administration of routine vaccinations, offering influenza vaccination, completed lead screening, completed developmental screening tool, screening for maternal depression and food insecurity, and documentation of gestational age. The setting was 3 academic pediatric primary care clinics that serve 31,000 patients (>90% Medicaid). Quality improvement methodology was used and key driver diagram was determined. Patient "Ideal Visit Flow" and the Responsible, Accountable, Support, Consulted, and Informed Matrix were developed to drive accountability for components of the ideal flow. Plan, Do, Study, Act cycles were used to develop successful interventions. The percent of patients seen who received all bundle elements for which they were eligible was plotted weekly on a run chart, and statistical process control methods were used to determine a significant change in performance. The preintervention percentage of patient visits ages 0 to 14 months receiving all preventive service bundle elements was 58%. The postintervention percentage is 92%. Innovative redesign led to improvement in percentage of patients age 0 to 14 months who received the entire preventive services bundle. Key elements for success were multidisciplinary site-specific teams, redesigned visit flow, effective communication, and resources for data and project management. Copyright © 2016 by the American Academy of Pediatrics.

COMSKIL Communication Training in Oncology-Adaptation to German Cancer Care Settings.

PubMed

Hartung, Tim J; Kissane, David; Mehnert, Anja

2018-01-01

Medical communication is a skill which can be learned and taught and which can substantially improve treatment outcomes, especially if patients' communication preferences are taken into account. Here, we give an overview of communication training research and outline the COMSKIL program as a state-of-the-art communication skills training in oncology. COMSKIL has a solid theoretical foundation and teaches core elements of medical communication in up to ten fully operationalized modules. These address typical situations ranging from breaking bad news to responding to difficult emotions, shared decision-making, and communicating via interpreters.

78 FR 27468 - Order of Suspension of Trading in the Matter of CoreCare Systems, Inc., Forticell Bioscience, Inc...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] Order of Suspension of Trading in the Matter of CoreCare Systems, Inc., Forticell Bioscience, Inc., Michelex Corporation, and Rx for Africa, Inc... accurate information concerning the securities of CoreCare Systems, Inc. because it has not filed any...

Domain atrophy creates rare cases of functional partial protein domains.

PubMed

Prakash, Ananth; Bateman, Alex

2015-04-30

Protein domains display a range of structural diversity, with numerous additions and deletions of secondary structural elements between related domains. We have observed a small number of cases of surprising large-scale deletions of core elements of structural domains. We propose a new concept called domain atrophy, where protein domains lose a significant number of core structural elements. Here, we implement a new pipeline to systematically identify new cases of domain atrophy across all known protein sequences. The output of this pipeline was carefully checked by hand, which filtered out partial domain instances that were unlikely to represent true domain atrophy due to misannotations or un-annotated sequence fragments. We identify 75 cases of domain atrophy, of which eight cases are found in a three-dimensional protein structure and 67 cases have been inferred based on mapping to a known homologous structure. Domains with structural variations include ancient folds such as the TIM-barrel and Rossmann folds. Most of these domains are observed to show structural loss that does not affect their functional sites. Our analysis has significantly increased the known cases of domain atrophy. We discuss specific instances of domain atrophy and see that there has often been a compensatory mechanism that helps to maintain the stability of the partial domain. Our study indicates that although domain atrophy is an extremely rare phenomenon, protein domains under certain circumstances can tolerate extreme mutations giving rise to partial, but functional, domains.

Validation of the Polish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care in patients with advanced cancer.

PubMed

Leppert, Wojciech; Majkowicz, Mikolaj

2013-05-01

Limited data exist on the validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care in advanced cancer patients. To adapt the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care to the Polish clinical setting and to evaluate its psychometric properties in advanced cancer patients. Two quality-of-life measurements were performed at baseline and after 7 days. The concurrent validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care was established by the Pearson correlation coefficients with the modified Edmonton Symptom Assessment System, the Karnofsky Performance Status and the Brief Pain Inventory - Short Form. Reliability was assessed using Cronbach's alpha coefficients and the Spearman correlation coefficients of the baseline and of the second measurement of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care items. A total of 160 consecutive patients in one academic palliative medicine centre were included. A total of 129 patients completed the study. The concurrent validity revealed significant correlations of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care pain scale with the Brief Pain Inventory - Short Form, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care symptom items with the modified Edmonton Symptom Assessment System and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care functional scales with the Karnofsky Performance Status scores. High Cronbach's alpha and standardised Cronbach's alpha values were found in the case of both functional (range: 0.830-0.925; 0.830-0.932) and symptom scales (range: 0.784-0.940; 0.794-0.941) of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care, respectively. The Spearman correlation coefficients between the first and the second measurements were significant (p < 0.0001) for all European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care items. Polish version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 15 - Palliative Care is a valid and reliable tool recommended for quality-of-life assessment and monitoring in advanced cancer patients.

Health care ethics consultation: an update on core competencies and emerging standards from the American Society For Bioethics and Humanities' core competencies update task force.

PubMed

Tarzian, Anita J

2013-01-01

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report.

Use of a Standardized Patient Exercise to Assess Core Competencies During Fellowship Training

PubMed Central

Barry, Curtis T.; Avissar, Uri; Asebrook, Maureen; Sostok, Michael A.; Sherman, Kenneth E.; Zucker, Stephen D.

2010-01-01

Background The Accreditation Council for Graduate Medical Education requires fellows in many specialties to demonstrate attainment of 6 core competencies, yet relatively few validated assessment tools currently exist. We present our initial experience with the design and implementation of a standardized patient (SP) exercise during gastroenterology fellowship that facilitates appraisal of all core clinical competencies. Methods Fellows evaluated an SP trained to portray an individual referred for evaluation of abnormal liver tests. The encounters were independently graded by the SP and a faculty preceptor for patient care, professionalism, and interpersonal and communication skills using quantitative checklist tools. Trainees' consultation notes were scored using predefined key elements (medical knowledge) and subjected to a coding audit (systems-based practice). Practice-based learning and improvement was addressed via verbal feedback from the SP and self-assessment of the videotaped encounter. Results Six trainees completed the exercise. Second-year fellows received significantly higher scores in medical knowledge (55.0 ± 4.2 [standard deviation], P  =  .05) and patient care skills (19.5 ± 0.7, P  =  .04) by a faculty evaluator as compared with first-year trainees (46.2 ± 2.3 and 14.7 ± 1.5, respectively). Scores correlated by Spearman rank (0.82, P  =  .03) with the results of the Gastroenterology Training Examination. Ratings of the fellows by the SP did not differ by level of training, nor did they correlate with faculty scores. Fellows viewed the exercise favorably, with most indicating they would alter their practice based on the experience. Conclusions An SP exercise is an efficient and effective tool for assessing core clinical competencies during fellowship training. PMID:21975896

Melting of Fe-Si-O alloys: the Fate of Coexisting Si and O in the Core

NASA Astrophysics Data System (ADS)

Arveson, S. M.; Lee, K. K. M.

2017-12-01

The light element budget of Earth's core plays an integral role in sustaining outer core convection, which powers the geodynamo. Many experiments have been performed on binary iron compounds, but the results do not robustly agree with seismological observations and geochemical constraints. Earth's core is almost certainly made up of multiple light elements, so the future of core composition studies lies in ternary (or higher order) systems in order to examine interactions between light elements. We perform melting experiments on Fe-Si-O alloys in a laser-heated diamond-anvil cell to 80 GPa and 4000 K. Using 2D multi- wavelength imaging radiometry together with textural and chemical analysis of quenched samples, we measure the high-pressure melting curves and determine partitioning of light elements between the melt and the coexisting solid. Quenched samples are analyzed both in map view and in cross section using scanning electron microscopy (SEM) and electron microprobe analysis (EPMA) to examine the 3D melt structure and composition. Partitioning of light elements between molten and solid alloys dictates (1) the density contrast at the ICB, which drives compositional convection in the outer core and (2) the temperature of the CMB, an integral parameter for understanding the deep Earth. Our experiments suggest silicon and oxygen do not simply coexist in the melt and instead show complex solubility based on temperature. Additionally, we do not find evidence of crystallization of SiO2 at low oxygen content as was recently reported.11 Hirose, K., et al., Crystallization of silicon dioxide and compositional evolution of the Earth's core. Nature, 2017. 543(7643): p. 99-102.

Exploring Implementation and Fidelity of Evidence-Based Behavioral Interventions for HIV Prevention: Lessons Learned From the Focus on Kids Diffusion Case Study

PubMed Central

Galbraith, Jennifer S.; Stanton, Bonita; Boekeloo, Bradley; King, Winifred; Desmond, Sharon; Howard, Donna; Black, Maureen M.; Carey, James W.

2014-01-01

Evidence-based interventions (EBIs) are used in public health to prevent HIV infection among youth and other groups. EBIs include core elements, features that are thought to be responsible for the efficacy of interventions. The authors evaluate experiences of organizations that adopted an HIV-prevention EBI, Focus on Kids (FOK), and their fidelity to the intervention’s eight core elements. A cross-sectional telephone survey was administered to 34 staff members from organizations that had previously implemented FOK. Questions assessed how the organization adhered to, adapted, dropped, or altered the intervention. None of the organizations implemented all eight core elements. This study underscores the importance for HIV intervention researchers to clearly identify and describe core elements. More effort is needed to reflect the constraints practitioners face in nonresearch settings. To ensure intervention effectiveness, additional research and technical assistance are needed to help organizations implement HIV prevention EBIs with fidelity. PMID:18445739

Paediatric nurses' perceptions and practices of family-centred care in Saudi hospitals: A mixed methods study.

PubMed

Alabdulaziz, Hawa; Moss, Cheryle; Copnell, Beverley

2017-04-01

Family-centred care is widely accepted as the underlying philosophy of paediatric nursing. Studies of family-centred care have mainly been conducted in western countries and little is known of its practice in other contexts. No studies have been undertaken in the Middle East. To explore family-centred care in the Saudi context from the perspectives of paediatric nurses. A mixed methodology was utilised with an explanatory sequential design. In the quantitative phase a convenience sample of 234 nurses from six hospitals in Jeddah, Saudi Arabia completed the Family Centred Care Questionnaire. The qualitative phase took place in one hospital and involved 140h of non-participant observation of paediatric nurses' practice. A convenience sample of 14 nurses was involved. Additionally, 10 face-to-face semi-structured interviews were conducted with key staff members. A purposeful sample of 10 nurses was involved. The findings from both phases were integrated in the final analysis. The survey results indicated that participants identified most elements of family-centred care as necessary for its practice. They were less likely to incorporate them into their practice (p<0.001, paired t-tests, all subscales). These findings were supported by the observation data, which revealed that, while several elements of family-centred care were frequently practised, others were implemented either inconsistently or not at all. Findings from the interview data indicated that participants had limited and superficial understanding of what family-centred care means as a model of care; rather, they worked with the elements as a set of core tasks. In the current study, there were similarities between what has been found in the Saudi context and findings from other studies using the same tool in western contexts. There is general agreement regarding the differences between theory and practice. Nurses do believe and acknowledge the importance of family-centred care; however, they struggle with practising this model in their everyday work. In the current study, many factors contributed to this issue, including language barriers, communication issues, cultural issues and hospital policies. Western concepts of family-centred care appear to be accepted by paediatric nurses in Saudi Arabia. However, full adoption of family-centred care in keeping with western values is likely not to be appropriate or successful in the Saudi context where both nurses and families have a non-western culture. The western model of family-centred care requires cultural modification and further development to fit Saudi and Middle Eastern cultures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Optimized Lentiviral Vector Design Improves Titer and Transgene Expression of Vectors Containing the Chicken β-Globin Locus HS4 Insulator Element

PubMed Central

Hanawa, Hideki; Yamamoto, Motoko; Zhao, Huifen; Shimada, Takashi; Persons, Derek A

2009-01-01

Hematopoietic cell gene therapy using retroviral vectors has achieved success in clinical trials. However, safety issues regarding vector insertional mutagenesis have emerged. In two different trials, vector insertion resulted in the transcriptional activation of proto-oncogenes. One strategy for potentially diminishing vector insertional mutagenesis is through the use of self-inactivating lentiviral vectors containing the 1.2-kb insulator element derived from the chicken β-globin locus. However, use of this element can dramatically decrease both vector titer and transgene expression, thereby compromising its practical use. Here, we studied lentiviral vectors containing either the full-length 1.2-kb insulator or the smaller 0.25-kb core element in both orientations in the partially deleted long-terminal repeat. We show that use of the 0.25-kb core insulator rescued vector titer by alleviating a postentry block to reverse transcription associated with the 1.2-kb element. In addition, in an orientation-dependent manner, the 0.25-kb core element significantly increased transgene expression from an internal promoter due to improved transcriptional termination. This element also demonstrated barrier activity, reducing variability of expression due to position effects. As it is known that the 0.25-kb core insulator has enhancer-blocking activity, this particular insulated lentiviral vector design may be useful for clinical application. PMID:19223867

Summative clinical competency assessment: A survey of ultrasound practitioners' views.

PubMed

Harrison, Gill

2015-02-01

Clinical competency and the assessment of core skills is a crucial element of any programme leading to an award with a clinical skills component. This has become a more prominent feature of current reports on quality health care provision. This project aimed to determine ultrasound practitioners' opinions about how best to assess clinical competency. An on-line questionnaire was sent to contacts from the Consortium for the Accreditation of Sonographic Education and details distributed at the British Medical Ultrasound Society conference in 2011. One hundred and sixteen responses were received from a range of clinical staff with an interest in ultrasound assessment. The majority of respondents suggested that competency assessments should take place in the clinical departments with or without an element of assessment at the education centre. Moderation was an important area highlighted by respondents, with 84% of respondents suggesting that two assessors were required and 66% of those stating some element of external moderation should be included. The findings suggest that respondents' preference is for some clinical competency assessments to take place on routine lists within the clinical department, assessed by two people one of which would be an external assessor. In view of recent reports relating to training and assessment of health care professionals, the ultrasound profession needs to begin the debate about how best to assess clinical competence and ensure appropriate first post-competency of anyone undertaking ultrasound examinations.

Summative clinical competency assessment: A survey of ultrasound practitioners’ views

PubMed Central

2014-01-01

Clinical competency and the assessment of core skills is a crucial element of any programme leading to an award with a clinical skills component. This has become a more prominent feature of current reports on quality health care provision. This project aimed to determine ultrasound practitioners’ opinions about how best to assess clinical competency. An on-line questionnaire was sent to contacts from the Consortium for the Accreditation of Sonographic Education and details distributed at the British Medical Ultrasound Society conference in 2011. One hundred and sixteen responses were received from a range of clinical staff with an interest in ultrasound assessment. The majority of respondents suggested that competency assessments should take place in the clinical departments with or without an element of assessment at the education centre. Moderation was an important area highlighted by respondents, with 84% of respondents suggesting that two assessors were required and 66% of those stating some element of external moderation should be included. The findings suggest that respondents’ preference is for some clinical competency assessments to take place on routine lists within the clinical department, assessed by two people one of which would be an external assessor. In view of recent reports relating to training and assessment of health care professionals, the ultrasound profession needs to begin the debate about how best to assess clinical competence and ensure appropriate first post-competency of anyone undertaking ultrasound examinations. PMID:27433232

Thermo-Physics Technical Note No. 60: thermal analysis of SNAP 10A reactor core during atmospheric reentry and resulting core disintegration and fuel element separation

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

Mouradian, E.M.

1966-02-16

A thermal analysis is carried out to determine the temperature distribution throughout a SNAP 10A reactor core, particularly in the vicinity of the grid plates, during atmospheric reentry. The transient temperatue distribution of the grid plate indicates when sufficient melting occurs so that fuel elements are free to be released and continue their descent individually.

Thermionic nuclear reactor with internal heat distribution and multiple duct cooling

DOEpatents

Fisher, C.R.; Perry, L.W. Jr.

1975-11-01

A Thermionic Nuclear Reactor is described having multiple ribbon-like coolant ducts passing through the core, intertwined among the thermionic fuel elements to provide independent cooling paths. Heat pipes are disposed in the core between and adjacent to the thermionic fuel elements and the ribbon ducting, for the purpose of more uniformly distributing the heat of fission among the thermionic fuel elements and the ducts.

FUEL ELEMENTS FOR THERMAL-FISSION NUCLEAR REACTORS

DOEpatents

Flint, O.

1961-01-10

Fuel elements for thermal-fission nuclear reactors are described. The fuel element is comprised of a core of alumina, a film of a metal of the class consisting of copper, silver, and nickel on the outer face of the core, and a coating of an oxide of a metal isotope of the class consisting of Un/sup 235/, U/ sup 233/, and Pu/sup 239/ on the metal f ilm.

Integrated specialty service readiness in health reform: connections in haemophilia comprehensive care.

PubMed

Pritchard, A M; Page, D

2008-05-01

The World Health Organization (WHO) has identified primary healthcare reform as a global priority whereby innovative practice changes are directed at improving health. This transformation to health reform in haemophilia service requires clarification of comprehensive care to reflect the WHO definition of health and key elements of primary healthcare reform. While comprehensive care supports effective healthcare delivery, comprehensive care must also be regarded beyond immediate patient management to reflect the broader system purpose in the care continuum with institutions, community agencies and government. Furthermore, health reform may be facilitated through integrated service delivery (ISD). ISD in specialty haemophilia care has the potential to reduce repetition of assessments, enhance care plan communication between providers and families, provide 24-h access to care, improve information availability regarding care quality and outcomes, consolidate access for multiple healthcare encounters and facilitate family self-efficacy and autonomy [1]. Three core aspects of ISD have been distinguished: clinical integration, information management and technology and vertical integration in local communities [2]. Selected examples taken from Canadian haemophilia comprehensive care illustrate how practice innovations are bridged with a broader system level approach and may support initiatives in other contexts. These innovations are thought to indicate readiness regarding ISD. Reflecting on the existing capacity of haemophilia comprehensive care teams will assist providers to connect and direct their existing strengths towards ISD and health reform.

Normalizing XRF-scanner data: A cautionary note on the interpretation of high-resolution records from organic-rich lakes

NASA Astrophysics Data System (ADS)

Löwemark, L.; Chen, H.-F.; Yang, T.-N.; Kylander, M.; Yu, E.-F.; Hsu, Y.-W.; Lee, T.-Q.; Song, S.-R.; Jarvis, S.

2011-04-01

X-ray fluorescence (XRF) scanning of unlithified, untreated sediment cores is becoming an increasingly common method used to obtain paleoproxy data from lake records. XRF-scanning is fast and delivers high-resolution records of relative variations in the elemental composition of the sediment. However, lake sediments display extreme variations in their organic matter content, which can vary from just a few percent to well over 50%. As XRF scanners are largely insensitive to organic material in the sediment, increasing levels of organic material effectively dilute those components that can be measured, such as the lithogenic material (the closed-sum effect). Consequently, in sediments with large variations in organic material, the measured variations in an element will to a large extent mirror the changes in organic material. It is therefore necessary to normalize the elements in the lithogenic component of the sediment against a conservative element to allow changes in the input of the elements to be addressed. In this study we show that Al, which is the lightest element that can be measured using the Itrax XRF-scanner, can be used to effectively normalize the elements of the lithogenic fraction of the sediment against variations in organic content. We also show that care must be taken when choosing resolution and exposure time to ensure optimal output from the measurements.

IMPROVEMENTS RELATING TO NUCLEAR REACTOR CORE

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

Bell, F.R.

1963-03-01

A nuclear reactor core composed of a number of stacked horizontal layers is described. Each layer is made up of elements of moderator material of equal height and of generally hexagonal cross-section. Each element has holes containing nuclear fuel and separate ones for coolant. (C.E.S.)

A Numerical Study on the Edgewise Compression Strength of Sandwich Structures with Facesheet-Core Disbonds

NASA Technical Reports Server (NTRS)

Bergan, Andrew C.

2017-01-01

Damage tolerant design approaches require determination of critical damage modes and flaw sizes in order to establish nondestructive evaluation detection requirements. A finite element model is developed to assess the effect of circular facesheet-core disbonds on the strength of sandwich specimens subjected to edgewise compressive loads for the purpose of predicting the critical flaw size for a variety of design parameters. Postbuckling analyses are conducted in which an initial imperfection is seeded using results from a linear buckling analysis. Both the virtual crack closure technique (VCCT) and cohesive elements are considered for modeling disbond growth. Predictions from analyses using the VCCT and analyses using cohesive elements are in good correlation. A series of parametric analyses are conducted to investigate the effect of core thickness and material, facesheet layup, facesheet-core interface properties, and curvature on the criticality of facesheet-core disbonds of various sizes. The results from these analyses provide a basis for determining the critical flaw size for facesheet-core disbonds subjected to edgewise compression loads and, therefore, nondestructive evaluation flaw detection requirements for this configuration.

Finite element simulation of core inspection in helicopter rotor blades using guided waves.

PubMed

Chakrapani, Sunil Kishore; Barnard, Daniel; Dayal, Vinay

2015-09-01

This paper extends the work presented earlier on inspection of helicopter rotor blades using guided Lamb modes by focusing on inspecting the spar-core bond. In particular, this research focuses on structures which employ high stiffness, high density core materials. Wave propagation in such structures deviate from the generic Lamb wave propagation in sandwich panels. To understand the various mode conversions, finite element models of a generalized helicopter rotor blade were created and subjected to transient analysis using a commercial finite element code; ANSYS. Numerical simulations showed that a Lamb wave excited in the spar section of the blade gets converted into Rayleigh wave which travels across the spar-core section and mode converts back into Lamb wave. Dispersion of Rayleigh waves in multi-layered half-space was also explored. Damage was modeled in the form of a notch in the core section to simulate a cracked core, and delamination was modeled between the spar and core material to simulate spar-core disbond. Mode conversions under these damaged conditions were examined numerically. The numerical models help in assessing the difficulty of using nondestructive evaluation for complex structures and also highlight the physics behind the mode conversions which occur at various discontinuities. Copyright © 2015 Elsevier B.V. All rights reserved.

Asthma Self-Management Goals, Beliefs and Behaviors of Urban African American Adolescents Prior to Transitioning to Adult Health Care.

PubMed

Gibson-Scipio, Wanda; Gourdin, Dustin; Krouse, Helene J

2015-01-01

Adolescence is a unique time of development incorporating a transition from child centered to adult centered health care. This transition period can be particularly challenging for individuals with a chronic disease such as asthma. Inadequate transition planning during adolescence may place an already vulnerable population such as African American adolescents with known health disparities in asthma prevalence, morbidity and mortality at risk for a continuation of poor health outcomes across the lifespan. Central to transition planning for these youth is the core element of developing and prioritizing goals. The purpose of this qualitative study was to explore the asthma self-management goals, beliefs and behaviors of urban African American adolescents prior to transitioning from pediatric to adult health care. A focus group composed of 13 African American adolescents with asthma ages 14-18 years from an urban population was conducted. Responses from transcripts and field notes were reviewed using an iterative process to best characterize asthma self-management goals and beliefs that emerged. Four core themes were identified: 1) medication self-management, 2) social support, 3) independence vs. interdependence, and 4) self-advocacy. Medication self-management included subthemes of rescue medications, controller medications and medication avoidance. The social support theme included three subthemes: peer support, caregiver support and healthcare provider support. Findings suggest that adolescents with asthma form both short term and long term goals. Their goals indicated a need for guided support to facilitate a successful health care transition. Copyright © 2015 Elsevier Inc. All rights reserved.

Accessing health care in a rural area: an evaluation of a voluntary medical transport scheme in the English Midlands.

PubMed

Sherwood, K B; Lewis, G J

2000-12-01

In recent years notions of self-help and voluntarism have emerged as key elements in the delivery of services in rural England. This paper explores these themes by reference to 'Rural Wheels', a voluntary medical transport scheme in rural Northamptonshire, introduced to overcome the closure of branch surgeries and to provide access to a new medical centre. By focusing upon the organisation and operations of the scheme, the paper highlights the important role it plays in the welfare of rural residents, particularly elderly women. Yet, because effectively it is run by a small core group, the paper raises questions not just about the viability of this scheme but also about the increasing commitment of central government to the voluntary sector as a means of delivering health care to rural people.

Development of the Competency Assessment Tool-Mental Health, an instrument to assess core competencies for mental health care workers.

PubMed

Clasen, Carla; Meyer, Cheryl; Brun, Carl; Mase, William; Cauley, Kate

2003-01-01

As the focus on accountability in health care increases, there has been a corresponding emphasis on establishing core competencies for health care workers. This article discusses the development of an instrument to establish core competencies for workers in inpatient mental health settings. Twenty-six competencies were identified and rated by mental health care personnel on two subscales: the importance of the competency and how much behavioral health care workers could benefit from training on the competency. The reliability of the scale and its contributions to the training, retention and recruitment of direct care workers for behavioral health are discussed.

Laurentide Ice Sheet Meltwater Geochemistry During the MIS 3 Warm Phase from Single-Shell Trace Element and Isotope Measurements

NASA Astrophysics Data System (ADS)

Branson, O.; Vetter, L.; Fehrenbacher, J. S.; Spero, H. J.

2016-12-01

The geochemical variability between individual foraminifera within single core intervals records both palaeo-oecanographic conditions and ecology. Within the biological context of foraminiferal species, this population variability may be interpreted to provide unparalleled paleoenvironmental information. For example, coupled trace element and stable isotope analyses of single O. universa offer a powerful tool for reconstructing the δ18O of Laurentide Ice Sheet (LIS) meltwater, by calculating the intercept between temperature-corrected δ18O water and Ba/Ca salinity estimates (Vetter et al., in review). This offers valuable insights into the dynamics of ice sheet melting at the end of the last glacial maximum. Here we apply similar coupled single-shell laser ablation (LA-ICP-MS) and isotope ratio mass spectrometry (IRMS) techniques to explore the δ18O of Laurentide meltwater during H4 and bracketing intervals. The application of these methods to down-core samples requires the development of robust LA-ICP-MS data processing techniques to identify primary signals within Ba contaminated samples, and careful consideration of palaeo Ba/Ca-salinity relationships. Our analyses offer a significant advance in systematic LA-ICP-MS data processing methods, offer constraints on the variability of riverine Ba fluxes, and ultimately provide δ18O estimates of LIS meltwater during H4.

Correlation consistent valence basis sets for use with the Stuttgart-Dresden-Bonn relativistic effective core potentials: The atoms Ga-Kr and In-Xe

NASA Astrophysics Data System (ADS)

Martin, Jan M. L.; Sundermann, Andreas

2001-02-01

We propose large-core correlation-consistent (cc) pseudopotential basis sets for the heavy p-block elements Ga-Kr and In-Xe. The basis sets are of cc-pVTZ and cc-pVQZ quality, and have been optimized for use with the large-core (valence-electrons only) Stuttgart-Dresden-Bonn (SDB) relativistic pseudopotentials. Validation calculations on a variety of third-row and fourth-row diatomics suggest them to be comparable in quality to the all-electron cc-pVTZ and cc-pVQZ basis sets for lighter elements. Especially the SDB-cc-pVQZ basis set in conjunction with a core polarization potential (CPP) yields excellent agreement with experiment for compounds of the later heavy p-block elements. For accurate calculations on Ga (and, to a lesser extent, Ge) compounds, explicit treatment of 13 valence electrons appears to be desirable, while it seems inevitable for In compounds. For Ga and Ge, we propose correlation consistent basis sets extended for (3d) correlation. For accurate calculations on organometallic complexes of interest to homogenous catalysis, we recommend a combination of the standard cc-pVTZ basis set for first- and second-row elements, the presently derived SDB-cc-pVTZ basis set for heavier p-block elements, and for transition metals, the small-core [6s5p3d] Stuttgart-Dresden basis set-relativistic effective core potential combination supplemented by (2f1g) functions with exponents given in the Appendix to the present paper.

Using the core curriculum on childhood trauma to strengthen clinical knowledge in evidence-based practitioners.

PubMed

Layne, Christopher M; Strand, Virginia; Popescu, Marciana; Kaplow, Julie B; Abramovitz, Robert; Stuber, Margaret; Amaya-Jackson, Lisa; Ross, Leslie; Pynoos, Robert S

2014-01-01

The high prevalence of trauma exposure in mental health service-seeking populations, combined with advances in evidence-based practice, competency-based training, common-elements research, and adult learning make this an opportune time to train the mental health workforce in trauma competencies. The Core Curriculum on Childhood Trauma (CCCT) utilizes a five-tiered conceptual framework (comprising Empirical Evidence, Core Trauma Concepts, Intervention Objectives, Practice Elements, and Skills), coupled with problem-based learning, to build foundational trauma knowledge and clinical reasoning skills. We present findings from three studies: Study 1 found that social work graduate students' participation in a CCCT course (N = 1,031) was linked to significant pre-post increases in self-reported confidence in applying core trauma concepts to their clinical work. Study 2 found significant pre-post increases in self-reported conceptual readiness (N = 576) and field readiness (N = 303) among social work graduate students participating in a "Gold Standard Plus" educational model that integrated classroom instruction in core trauma concepts, training in evidence-based trauma treatment (EBTT), and implementation of that EBTT in a supervised field placement. Students ranked the core concepts course as an equivalent or greater contributor to field readiness compared to standard EBTT training. Study 3 used qualitative methods to "distill" common elements (35 intervention objectives, 59 practice elements) from 26 manualized trauma interventions. The CCCT is a promising tool for educating "next-generation" evidence-based practitioners who possess competencies needed to implement modularized, individually tailored trauma interventions by strengthening clinical knowledge, clinical reasoning, and familiarity with common elements.

Platinum Partitioning at Low Oxygen Fugacity: Implications for Core Formation Processes

NASA Technical Reports Server (NTRS)

Medard, E.; Martin, A. M.; Righter, K.; Lanziroti, A.; Newville, M.

2016-01-01

Highly siderophile elements (HSE = Au, Re, and the Pt-group elements) are tracers of silicate / metal interactions during planetary processes. Since most core-formation models involve some state of equilibrium between liquid silicate and liquid metal, understanding the partioning of highly siderophile elements (HSE) between silicate and metallic melts is a key issue for models of core / mantle equilibria and for core formation scenarios. However, partitioning models for HSE are still inaccurate due to the lack of sufficient experimental constraints to describe the variations of partitioning with key variable like temperature, pressure, and oxygen fugacity. In this abstract, we describe a self-consistent set of experiments aimed at determining the valence of platinum, one of the HSE, in silicate melts. This is a key information required to parameterize the evolution of platinum partitioning with oxygen fugacity.

Understanding the complexity of redesigning care around the clinical microsystem.

PubMed

Barach, P; Johnson, J K

2006-12-01

The microsystem is an organizing design construct in which social systems cut across traditional discipline boundaries. Because of its interdisciplinary focus, the clinical microsystem provides a conceptual and practical framework for simplifying complex organizations that deliver care. It also provides an important opportunity for organizational learning. Process mapping and microworld simulation may be especially useful for redesigning care around the microsystem concept. Process mapping, in which the core processes of the microsystem are delineated and assessed from the perspective of how the individual interacts with the system, is an important element of the continuous learning cycle of the microsystem and the healthcare organization. Microworld simulations are interactive computer based models that can be used as an experimental platform to test basic questions about decision making misperceptions, cause-effect inferences, and learning within the clinical microsystem. Together these tools offer the user and organization the ability to understand the complexity of healthcare systems and to facilitate the redesign of optimal outcomes.

Smart telemedicine support for continuous glucose monitoring: the embryo of a future global agent for diabetes care.

PubMed

Rigla, Mercedes

2011-01-01

Although current systems for continuous glucose monitoring (CGM) are the result of progressive technological improvement, and although a beneficial effect on glucose control has been demonstrated, few patients are using them. Something similar has happened to telemedicine (TM); in spite of the long-term experience, which began in the early 1980s, no TM system has been widely adopted, and presential visits are still almost the only way diabetologists and patients communicate. The hypothesis developed in this article is that neither CGM nor TM will ever be routinely implemented separately, and their consideration as essential elements for standard diabetes care will one day come from their integration as parts of a telemedical monitoring platform. This platform, which should include artificial intelligence for giving decision support to patients and physicians, will represent the core of a more complex global agent for diabetes care, which will provide control algorithms and risk analysis among other essential functions. © 2010 Diabetes Technology Society.

Genome-wide computational prediction and analysis of core promoter elements across plant monocots and dicots

USDA-ARS?s Scientific Manuscript database

Transcription initiation, essential to gene expression regulation, involves recruitment of basal transcription factors to the core promoter elements (CPEs). The distribution of currently known CPEs across plant genomes is largely unknown. This is the first large scale genome-wide report on the compu...

Clinical wisdom: the essential foundation of "good" nursing care.

PubMed

Haggerty, Lois A; Grace, Pamela

2008-01-01

Clinical wisdom, an essential foundation of nursing care that provides for the "good" of individual patients while taking into account the common good, is a concept that is difficult to define and comprehend. However, understanding what constitutes clinical wisdom is essential for the education of the types of nurses who are most likely to provide leadership that is consistent with the goals of nursing as outlined in the 2005 Code of Ethics for Nurses of the International Council of Nurses and the 2001 Code of Ethics for Nurses With Interpretive Statements of the American Nurses Association. The three key elements of wisdom, derived from the psychology and philosophy literature, are (1) balancing and providing for the good of another and the common good, (2) the use of intellect and affect in problem solving, and (3) the demonstration of experience-based tacit knowing in problematic situations. We conceptualized clinical wisdom as a more specific variant of general wisdom by examining how the core elements described can be linked to wisdom for nursing practice. In doing so, the nature of clinical wisdom is clarified and strategies are suggested to assist nurse educators in developing wise nurses.

Siderophile and chalcophile element abundances in oceanic basalts, Pb isotope evolution and growth of the earth's core

NASA Technical Reports Server (NTRS)

Newsom, H. E.; White, W. M.; Jochum, K. P.; Hofmann, A. W.

1986-01-01

The hypothesis that the mantle Pb isotope ratios reflect continued extraction of Pb into the earth's core over geologic time is evaluated by studying the depeletion of chalcophile and siderophile elements in the mantle. Oceanic basalt samples are analyzed in order to determine the Pb, Sr, and Nd isotropic compositions and the abundances of siderophile and chalcophile elements and incompatible lithophile elements. The data reveal that there is no systematic variation of siderophile or chalcophile element abundances relative to abundances of lithophile elements and the Pb/Ce ratio of the mantle is constant. It is suggested that the crust formation involves nonmagmatic and magmatic processes.

Self-care Concept Analysis in Cancer Patients: An Evolutionary Concept Analysis.

PubMed

Hasanpour-Dehkordi, Ali

2016-01-01

Self-care is a frequently used concept in both the theory and the clinical practice of nursing and is considered an element of nursing theory by Orem. The aim of this paper is to identify the core attributes of the self-care concept in cancer patients. We used Rodgers' evolutionary method of concept analysis. The articles published in English language from 1980 to 2015 on nursing and non-nursing disciplines were analyzed. Finally, 85 articles, an MSc thesis, and a PhD thesis were selected, examined, and analyzed in-depth. Two experts checked the process of analysis and monitored and reviewed the articles. The analysis showed that self-care concept is determined by four attributes of education, interaction, self-control, and self-reliance. Three types of antecedents in the present study were client-related (self-efficacy, self-esteem), system-related (adequate sources, social networks, and cultural factors), and healthcare professionals-related (participation). The self-care concept has considerably evolved among patients with chronic diseases, particularly cancer, over the past 35 years, and nurses have managed to enhance their knowledge about self-care remarkably for the clients so that the nurses in healthcare teams have become highly efficient and able to assume the responsibility for self-care teams.

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

PubMed

McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

2013-01-01

We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

Self-care Concept Analysis in Cancer Patients: An Evolutionary Concept Analysis

PubMed Central

Hasanpour-Dehkordi, Ali

2016-01-01

Background: Self-care is a frequently used concept in both the theory and the clinical practice of nursing and is considered an element of nursing theory by Orem. The aim of this paper is to identify the core attributes of the self-care concept in cancer patients. Materials and Methods: We used Rodgers’ evolutionary method of concept analysis. The articles published in English language from 1980 to 2015 on nursing and non-nursing disciplines were analyzed. Finally, 85 articles, an MSc thesis, and a PhD thesis were selected, examined, and analyzed in-depth. Two experts checked the process of analysis and monitored and reviewed the articles. Results: The analysis showed that self-care concept is determined by four attributes of education, interaction, self-control, and self-reliance. Three types of antecedents in the present study were client-related (self-efficacy, self-esteem), system-related (adequate sources, social networks, and cultural factors), and healthcare professionals-related (participation). Conclusion: The self-care concept has considerably evolved among patients with chronic diseases, particularly cancer, over the past 35 years, and nurses have managed to enhance their knowledge about self-care remarkably for the clients so that the nurses in healthcare teams have become highly efficient and able to assume the responsibility for self-care teams. PMID:27803559

Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

PubMed

McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

2014-01-01

We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

Constraints on Earth’s inner core composition inferred from measurements of the sound velocity of hcp-iron in extreme conditions

PubMed Central

Sakamaki, Tatsuya; Ohtani, Eiji; Fukui, Hiroshi; Kamada, Seiji; Takahashi, Suguru; Sakairi, Takanori; Takahata, Akihiro; Sakai, Takeshi; Tsutsui, Satoshi; Ishikawa, Daisuke; Shiraishi, Rei; Seto, Yusuke; Tsuchiya, Taku; Baron, Alfred Q. R.

2016-01-01

Hexagonal close-packed iron (hcp-Fe) is a main component of Earth’s inner core. The difference in density between hcp-Fe and the inner core in the Preliminary Reference Earth Model (PREM) shows a density deficit, which implies an existence of light elements in the core. Sound velocities then provide an important constraint on the amount and kind of light elements in the core. Although seismological observations provide density–sound velocity data of Earth’s core, there are few measurements in controlled laboratory conditions for comparison. We report the compressional sound velocity (VP) of hcp-Fe up to 163 GPa and 3000 K using inelastic x-ray scattering from a laser-heated sample in a diamond anvil cell. We propose a new high-temperature Birch’s law for hcp-Fe, which gives us the VP of pure hcp-Fe up to core conditions. We find that Earth’s inner core has a 4 to 5% smaller density and a 4 to 10% smaller VP than hcp-Fe. Our results demonstrate that components other than Fe in Earth’s core are required to explain Earth’s core density and velocity deficits compared to hcp-Fe. Assuming that the temperature effects on iron alloys are the same as those on hcp-Fe, we narrow down light elements in the inner core in terms of the velocity deficit. Hydrogen is a good candidate; thus, Earth’s core may be a hidden hydrogen reservoir. Silicon and sulfur are also possible candidates and could show good agreement with PREM if we consider the presence of some melt in the inner core, anelasticity, and/or a premelting effect. PMID:26933678

FUEL ELEMENTS FOR NUCLEAR REACTORS

DOEpatents

Blainey, A.; Lloyd, H.

1961-07-11

A method of sheathing a tubular fuel element for a nuclear reactor is described. A low melting metal core member is centered in a die, a layer of a powdered sheathing substance is placed on the bottom of the die, the tubular fuel element is inserted in the die, the space between the tubular fuel element and the die walls and core member is filled with the same powdered sheathing substance, a layer of the same substance is placed over the fissile material, and the charge within the die is subjected to pressure in the direction of the axis of the fuel element at the sintering temperature of the protective substance.

[Is there an essence of caring? A core of Nursing? Criticism of Katie Erikssons' "Vårdandets ide"].

PubMed

Nielsen, G; Larsen, B

1989-01-01

In her book "Vårdandets Ide" the Finnish nurse, Katie Eriksson puts forward the thesis, that all kind af caring activities do have a common core. To establish this thesis professor Eriksson introduces the Aristotelian notion of an essence: Different kinds of caring activities do have a common set of essential properties constituting the act of caring. In this article we submit a thesis to the contrary: There may exist no set of essential properties common to all kind of caring activities: The belief is induced in us, that there may exist some common core to all caring activities, because the same term, namely "caring", is being used as a general term to cover a wide field of very different kinds of activities. Instead of the traditional Aristotelian craving for generality issuing in the notion of an essence, we suggest the use of the more modern Wittgensteinian concept of a family resemblance: There may be no common core but a set of family resemblances among the different kinds of caring activities. Instead of an abstract philosophical search for the common core of caring activities, we propose nurses to look at the actual use of the term "to care", thereby circumscribing the subject matter of caring. It goes without saying, that this article contains a good deal of philosophical arguments including, of course, an introduction to some basic Aristotelian notions, fundamental distinctions in the theory of definition, and finally the Wittgensteinian concept of family resemblance.

EVALUATION OF THE HTA CORE MODEL FOR NATIONAL HEALTH TECHNOLOGY ASSESSMENT REPORTS: COMPARATIVE STUDY AND EXPERIENCES FROM EUROPEAN COUNTRIES.

PubMed

Kõrge, Kristina; Berndt, Nadine; Hohmann, Juergen; Romano, Florence; Hiligsmann, Mickael

2017-01-01

The health technology assessment (HTA) Core Model® is a tool for defining and standardizing the elements of HTA analyses within several domains for producing structured reports. This study explored the parallels between the Core Model and a national HTA report. Experiences from various European HTA agencies were also investigated to determine the Core Model's adaptability to national reports. A comparison between a national report on Genetic Counseling, produced by the Cellule d'expertise médicale Luxembourg, and the Core Model was performed to identify parallels in terms of relevant and comparable assessment elements (AEs). Semi-structured interviews with five representatives from European HTA agencies were performed to assess their user experiences with the Core Model. The comparative study revealed that 50 percent of the total number (n = 144) of AEs in the Core Model were relevant for the national report. Of these 144 AEs from the Core Model, 34 (24 percent) were covered in the national report. Some AEs were covered only partly. The interviewees emphasized flexibility in using the Core Model and stated that the most important aspects to be evaluated include characteristics of the disease and technology, clinical effectiveness, economic aspects, and safety. In the present study, the national report covered an acceptable number of AEs of the Core Model. These results need to be interpreted with caution because only one comparison was performed. The Core Model can be used in a flexible manner, applying only those elements that are relevant from the perspective of the technology assessment and specific country context.

International exchange program: findings from Taiwanese graduate nursing students.

PubMed

Shieh, Carol

2004-01-01

This study explored Taiwanese graduate nursing students' transcultural experiences in the United States during an international exchange program. A qualitative method with content analysis was used to analyze journal entries on perceptions of American culture, American nursing, and reflections on personal and professional growth written by nine graduate nursing students from Taiwan. The mean age of the participants was 32 (range, 29-45). Taiwanese nursing students perceived American culture as full of hospitality and patriotism, valuing human rights and social welfare, and favoring direct and expressive affection. American nursing was viewed as a combination of independence, confidence, autonomy, and knowledge, with caring being the core element, fostered by an environment conducive to patient care. In personal and professional growth, three themes surfaced: reinforcement of holistic care, nursing without borders, and lifelong learning and changing. American culture and nursing were perceived by Taiwanese students as a paradigm of Western culture valuing individual rights, autonomy, and independence. A caring and supportive patient care environment was a positive perception of American nursing; it was the desired practice standard that was lacking in these students' homeland. Overall, the exchange program was thought by these students to foster their personal and professional growth.

Advanced access: reducing waiting and delays in primary care.

PubMed

Murray, Mark; Berwick, Donald M

2003-02-26

Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support.

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

PubMed

Hunter, Andrew; Devane, Declan; Houghton, Catherine; Grealish, Annmarie; Tully, Agnes; Smith, Valerie

2017-09-25

Recent policy and service provision recommends a woman-centred approach to maternity care. Midwife-led models of care are seen as one important strategy for enhancing women's choice; a core element of woman-centred care. In the Republic of Ireland, an obstetric consultant-led, midwife-managed service model currently predominates and there is limited exploration of the concept of women centred care from the perspectives of those directly involved; that is, women, midwives, general practitioners and obstetricians. This study considers women's and clinicians' views, experiences and perspectives of woman-centred maternity care in Ireland. A descriptive qualitative design. Participants (n = 31) were purposively sampled from two geographically distinct maternity units. Interviews were face-to-face or over the telephone, one-to-one or focus groups. A thematic analysis of the interview data was performed. Five major themes representing women's and clinicians' views, experiences and perspectives of women-centred care emerged from the data. These were Protecting Normality, Education and Decision Making, Continuity, Empowerment for Women-Centred Care and Building Capacity for Women-Centred Care. Within these major themes, sub-themes emerged that reflect key elements of women-centred care. These were respect, partnership in decision making, information sharing, educational impact, continuity of service, staff continuity and availability, genuine choice, promoting women's autonomy, individualized care, staff competency and practice organization. Women centred-care, as perceived by participants in this study, is not routinely provided in Ireland and women subscribe to the dominant culture that views safety as paramount. Women-centred care can best be facilitated through continuity of carer and in particular through midwife led models of care; however, there is potential to provide women-centred care within existing labour wards in terms of consistency of care, education of women, common approaches to care across professions and women's choice. To achieve this, however, future research is required to better understand the role of midwife-led care within existing labour ward settings. While a positive view of women-centred care was found; there is still a difference in approach and imbalance of power between the professions. More research is required to consider how these differences impact care provision and how they might be overcome.

Pm-1 Reactor Core Final Design Report

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

Bagley, R. O.; Cox, F. H.; Carnasale, A.

1962-01-01

The PM-1 water cooled and moderated core contains 741 highly enriched stainless steel cermet tubular fuel elements and 90 lumped B stainless steel burnable poison elements, and it is controlled by 6 Y-shaped europium titanate movable control rods. The core has a lifetime of 1.95 years when operated at its design power level of 9.37 mw of thermal energy. The control of the core is designed so that there is a positive shutdown margin at all times with either one rod stuck completely out or the core or with two rods stuck in the operating condition. The core power ismore » removed by 2125 gpm of pressurized water at an average temperature of 463 deg F and pressure of 1300 psia. In reactors of this type, the core is stable with a negative temperature coefficient of approximately 2.5 x 10/sup -4/ DELTA K/K/ deg F.« less

FUEL ELEMENT CONSTRUCTION

DOEpatents

Zumwalt, L.R.

1961-08-01

Fuel elements having a solid core of fissionable material encased in a cladding material are described. A conversion material is provided within the cladding to react with the fission products to form stable, relatively non- volatile compounds thereby minimizing the migration of the fission products into the coolant. The conversion material is preferably a metallic fluoride, such as lead difluoride, and may be in the form of a coating on the fuel core or interior of the cladding, or dispersed within the fuel core. (AEC)

Radiation collimator and systems incorporating same

DOEpatents

Norman, Daren R [Idaho Falls, ID; Yoon, Woo Y [Idaho Falls, ID; Jones, James L [Idaho Falls, ID; Haskell, Kevin J [Idaho Falls, ID; Bennett, Brion D [Idaho Falls, ID; Tschaggeny, Charles W [Woods Cross, UT; Jones, Warren F [Idaho Falls, ID

2011-09-13

A collimator including a housing having disposed therein a shield element surrounding a converter core in which a photon beam is generated from electrons emanating from a linear accelerator. A beam channeler longitudinally adjacent the shield element has a beam aperture therethrough coaxially aligned with, and of the same diameter as, an exit bore of the converter core. A larger entry bore in the converter core is coaxial with, and longitudinally separated from, the exit bore thereof. Systems incorporating the collimator are also disclosed.

High Entropy Alloys: A Current Evaluation of Founding Ideas and Core Effects and Exploring Nonlinear Alloys (Postprint)

DTIC Science & Technology

2017-08-29

contain IM phases when using TEM diffraction.1,2 High -Entropy Alloys: A Current Evaluation of Founding Ideas and Core Effects and Exploring ‘‘Nonlinear...obvious outsider. Specifically, an alloy with a high Tm need not contain only elements with high Tm, and it can include one or two elements of moderate or...AFRL-RX-WP-JA-2017-0383 HIGH ENTROPY ALLOYS: A CURRENT EVALUATION OF FOUNDING IDEAS AND CORE EFFECTS AND EXPLORING "NONLINEAR ALLOYS

What Do We Mean by 'Community Resilience'? A Systematic Literature Review of How It Is Defined in the Literature.

PubMed

Patel, Sonny S; Rogers, M Brooke; Amlôt, Richard; Rubin, G James

2017-02-01

Government, industry and charitable organisations have an increasing focus on programs intended to support community resilience to disasters. But has consensus been reached as to what defines 'community resilience' and what its core characteristics are? We undertook a systematic literature review of definitions of community resilience related to disasters. We conducted an inductive thematic analysis of the definitions and descriptions that we identified, in order to determine the proposed characteristics of community resilience prior to, during and after a disaster. We identified 80 relevant papers. There was no evidence of a common, agreed definition of community resilience. In spite of this, evidence was found of nine core elements of community resilience that were common among the definitions. The core elements were: local knowledge, community networks and relationships, communication, health, governance and leadership, resources, economic investment, preparedness, and mental outlook. Within these core elements, we identified 19 sub-elements linked to community resilience. Our findings show that community resilience remains an amorphous concept that is understood and applied differently by different research groups. Yet in spite of the differences in conception and application, there are well-understood elements that are widely proposed as important for a resilient community. A focus on these individual elements may be more productive than attempting to define and study community resilience as a distinct concept.

What Do We Mean by 'Community Resilience'? A Systematic Literature Review of How It Is Defined in the Literature

PubMed Central

Patel, Sonny S.; Rogers, M. Brooke; Amlôt, Richard; Rubin, G. James

2017-01-01

Background: Government, industry and charitable organisations have an increasing focus on programs intended to support community resilience to disasters. But has consensus been reached as to what defines 'community resilience' and what its core characteristics are? Methods: We undertook a systematic literature review of definitions of community resilience related to disasters. We conducted an inductive thematic analysis of the definitions and descriptions that we identified, in order to determine the proposed characteristics of community resilience prior to, during and after a disaster. Results: We identified 80 relevant papers. There was no evidence of a common, agreed definition of community resilience. In spite of this, evidence was found of nine core elements of community resilience that were common among the definitions. The core elements were: local knowledge, community networks and relationships, communication, health, governance and leadership, resources, economic investment, preparedness, and mental outlook. Within these core elements, we identified 19 sub-elements linked to community resilience. Conclusion: Our findings show that community resilience remains an amorphous concept that is understood and applied differently by different research groups. Yet in spite of the differences in conception and application, there are well-understood elements that are widely proposed as important for a resilient community. A focus on these individual elements may be more productive than attempting to define and study community resilience as a distinct concept. PMID:29188132

Defining core elements and outstanding practice in Nutritional Science through collaborative benchmarking.

PubMed

Samman, Samir; McCarthur, Jennifer O; Peat, Mary

2006-01-01

Benchmarking has been adopted by educational institutions as a potentially sensitive tool for improving learning and teaching. To date there has been limited application of benchmarking methodology in the Discipline of Nutritional Science. The aim of this survey was to define core elements and outstanding practice in Nutritional Science through collaborative benchmarking. Questionnaires that aimed to establish proposed core elements for Nutritional Science, and inquired about definitions of " good" and " outstanding" practice were posted to named representatives at eight Australian universities. Seven respondents identified core elements that included knowledge of nutrient metabolism and requirement, food production and processing, modern biomedical techniques that could be applied to understanding nutrition, and social and environmental issues as related to Nutritional Science. Four of the eight institutions who agreed to participate in the present survey identified the integration of teaching with research as an indicator of outstanding practice. Nutritional Science is a rapidly evolving discipline. Further and more comprehensive surveys are required to consolidate and update the definition of the discipline, and to identify the optimal way of teaching it. Global ideas and specific regional requirements also need to be considered.

A New Innovative Spherical Cermet Nuclear Fuel Element to Achieve an Ultra-Long Core Life for use in Grid-Appropriate LWRs

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

Senor, David J.; Painter, Chad L.; Geelhood, Ken J.

2007-12-01

Spherical cermet fuel elements are proposed for use in the Atoms For Peace Reactor (AFPR-100) concept. AFPR-100 is a small-scale, inherently safe, proliferation-resistant reactor that would be ideal for deployment to nations with emerging economies that decide to select nuclear power for the generation of carbon-free electricity. The basic concept of the AFPR core is a water-cooled fixed particle bed, randomly packed with spherical fuel elements. The flow of coolant within the particle bed is at such a low rate that the bed does not fluidize. This report summarizes an approach to fuel fabrication, results associated with fuel performance modeling,more » core neutronics and thermal hydraulics analyses demonstrating a ~20 year core life, and a conclusion that the proliferation resistance of the AFPR reactor concept is high.« less

Effect of Silicon on the Activity Coefficient of Rhenium in Fe-Si Liquids: Implications for HSE and Os Isotopes in Planetary Mantles

NASA Technical Reports Server (NTRS)

Righter, K.; Pando, K.; Yang, S.; Humayun, M.

2018-01-01

Metallic cores contain light alloying elements that can be a combination of S, C, Si, and O, all of which have important chemical and physical influences. For Earth, Si may be the most abundant light element in the core. Si dissolved into Fe liquids can have a large effect on the magnitude of the activity coefficient of siderophile elements (SE), and thus the partitioning behavior of those elements between core and mantle. The effect of Si on the highly siderophile elements is only beginning to be studied and the effects on Au, Pd and Pt are significant. Here we report new experiments designed to quantify the effect of Si on the partitioning of Re between metal and silicate melt. A solid understanding of Re partitioning is required for a complete understanding of the Re-Os isotopic systems. The results will be applied to understanding the HSEs and Os isotopic data for planetary mantles, and especially Earth.

Sensitivities of Earth's core and mantle compositions to accretion and differentiation processes

NASA Astrophysics Data System (ADS)

Fischer, Rebecca A.; Campbell, Andrew J.; Ciesla, Fred J.

2017-01-01

The Earth and other terrestrial planets formed through the accretion of smaller bodies, with their core and mantle compositions primarily set by metal-silicate interactions during accretion. The conditions of these interactions are poorly understood, but could provide insight into the mechanisms of planetary core formation and the composition of Earth's core. Here we present modeling of Earth's core formation, combining results of 100 N-body accretion simulations with high pressure-temperature metal-silicate partitioning experiments. We explored how various aspects of accretion and core formation influence the resulting core and mantle chemistry: depth of equilibration, amounts of metal and silicate that equilibrate, initial distribution of oxidation states in the disk, temperature distribution in the planet, and target:impactor ratio of equilibrating silicate. Virtually all sets of model parameters that are able to reproduce the Earth's mantle composition result in at least several weight percent of both silicon and oxygen in the core, with more silicon than oxygen. This implies that the core's light element budget may be dominated by these elements, and is consistent with ≤1-2 wt% of other light elements. Reproducing geochemical and geophysical constraints requires that Earth formed from reduced materials that equilibrated at temperatures near or slightly above the mantle liquidus during accretion. The results indicate a strong tradeoff between the compositional effects of the depth of equilibration and the amounts of metal and silicate that equilibrate, so these aspects should be targeted in future studies aiming to better understand core formation conditions. Over the range of allowed parameter space, core and mantle compositions are most sensitive to these factors as well as stochastic variations in what the planet accreted as a function of time, so tighter constraints on these parameters will lead to an improved understanding of Earth's core composition.

Activation of HIV-1 pre-mRNA 3' processing in vitro requires both an upstream element and TAR.

PubMed Central

Gilmartin, G M; Fleming, E S; Oetjen, J

1992-01-01

The architecture of the human immunodeficiency virus type 1 (HIV-1) genome presents an intriguing dilemma for the 3' processing of viral transcripts--to disregard a canonical 'core' poly(A) site processing signal present at the 5' end of the transcript and yet to utilize efficiently an identical signal that resides at the 3' end of the message. The choice of processing sites in HIV-1 appears to be influenced by two factors: (i) proximity to the cap site, and (ii) sequences upstream of the core poly(A) site. We now demonstrate that an in vivo-defined upstream element that resides within the U3 region, 76 nucleotides upstream of the AAUAAA hexamer, acts specifically to enhance 3' processing at the HIV-1 core poly(A) site in vitro. We furthermore show that efficient in vitro 3' processing requires the RNA stem-loop structure of TAR, which serves to juxtapose spatially the upstream element and the core poly(A) site. An analysis of the stability of 3' processing complexes formed at the HIV-1 poly(A) site in vitro suggests that the upstream element may function by increasing processing complex stability at the core poly(A) site. Images PMID:1425577

The Earth's Core: How Does It Work? Perspectives in Science. Number 1.

ERIC Educational Resources Information Center

Carnegie Institution of Washington, Washington, DC.

Various research studies designed to enhance knowledge about the earth's core are discussed. Areas addressed include: (1) the discovery of the earth's core; (2) experimental approaches used in studying the earth's core (including shock-wave experiments and experiments at high static pressures), the search for the core's light elements, the…

Integrating Child Health Information Systems

PubMed Central

Hinman, Alan R.; Eichwald, John; Linzer, Deborah; Saarlas, Kristin N.

2005-01-01

The Health Resources and Services Administration and All Kids Count (a national technical assistance center fostering development of integrated child health information systems) have been working together to foster development of integrated child health information systems. Activities have included: identification of key elements for successful integration of systems; development of principles and core functions for the systems; a survey of state and local integration efforts; and a conference to develop a common vision for child health information systems to meet medical care and public health needs. We provide 1 state (Utah) as an example that is well on the way to development of integrated child health information systems. PMID:16195524

Multidisciplinary management of chronic heart failure: principles and future trends.

PubMed

Davidson, Patricia M; Newton, Phillip J; Tankumpuan, Thitipong; Paull, G; Dennison-Himmelfarb, Cheryl

2015-10-01

Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF. Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management. Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention. Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

Core Competencies for Early Care and Education Professionals in Kansas and Missouri: What Professionals Who Work with Young Children and Families Need To Know and Are Able To Do To Provide Quality Early Care and Education.

ERIC Educational Resources Information Center

Metropolitan Council on Child Care, Kansas City, MO.

This guide details the core competencies for early care and education professionals in Kansas and Missouri. The guide's introduction provides background information about what core competencies are, why they are important, and how they can be used by practitioners, directors, trainers, higher education faculty, agencies, and professional…

The elemental abundances (with uncertainties) of the most Earth-like planet

NASA Astrophysics Data System (ADS)

Wang, Haiyang S.; Lineweaver, Charles H.; Ireland, Trevor R.

2018-01-01

To first order, the Earth as well as other rocky planets in the Solar System and rocky exoplanets orbiting other stars, are refractory pieces of the stellar nebula out of which they formed. To estimate the chemical composition of rocky exoplanets based on their stellar hosts' elemental abundances, we need a better understanding of the devolatilization that produced the Earth. To quantify the chemical relationships between the Earth, the Sun and other bodies in the Solar System, the elemental abundances of the bulk Earth are required. The key to comparing Earth's composition with those of other objects is to have a determination of the bulk composition with an appropriate estimate of uncertainties. Here we present concordance estimates (with uncertainties) of the elemental abundances of the bulk Earth, which can be used in such studies. First we compile, combine and renormalize a large set of heterogeneous literature values of the primitive mantle (PM) and of the core. We then integrate standard radial density profiles of the Earth and renormalize them to the current best estimate for the mass of the Earth. Using estimates of the uncertainties in i) the density profiles, ii) the core-mantle boundary and iii) the inner core boundary, we employ standard error propagation to obtain a core mass fraction of 32.5 ± 0.3 wt%. Our bulk Earth abundances are the weighted sum of our concordance core abundances and concordance PM abundances. Unlike previous efforts, the uncertainty on the core mass fraction is propagated to the uncertainties on the bulk Earth elemental abundances. Our concordance estimates for the abundances of Mg, Sn, Br, B, Cd and Be are significantly lower than previous estimates of the bulk Earth. Our concordance estimates for the abundances of Na, K, Cl, Zn, Sr, F, Ga, Rb, Nb, Gd, Ta, He, Ar, and Kr are significantly higher. The uncertainties on our elemental abundances usefully calibrate the unresolved discrepancies between standard Earth models under various geochemical and geophysical assumptions.

Experimental constraints on Earth's core formation

NASA Astrophysics Data System (ADS)

Bouhifd, Mohamed Ali

2017-04-01

The Earth contains a Fe-rich metallic core that segregated from the primitive silicate mantle very early in its 4.5 billion year history. One major consequence of this segregation is the depletion of the Earth's mantle from the siderophile elements "high core affinity" relative to primitive solar system abundances. The way in which siderophile elements partition between metal and silicate depends strongly on pressure (P), temperature (T), oxygen fugacity (fO2) and chemical compositions of both metal and silicate phases. In the present presentation, I will discuss the experimental results of metal-silicate partitioning of Ni and Co that show a marked change with increasing pressure (e.g. Bouhifd and Jephcoat, 2011; Siebert et al., 2012; Fischer et al., 2015 for the most recent studies). This behavior coincides with a change in the coordination of silicon (in a basaltic melt composition) from 4-fold coordination under ambient conditions to 6-fold coordination at about 35 GPa, indicating that melt compressibility may controls siderophile-element partitioning (Sanloup et al., 2013). I will also discuss the impact of Earth's core formation on "lithophile" elements such as Sm, Nd, Ta and Nb (e.g. Bouhifd et al. 2015; Cartier et al., 2014), as well as the impact of sulphur on the behavior of various elements during core formation (e.g. Boujibar et al., 2014; Wohlers and Wood, 2015). By combining the metal-silicate partitioning data from siderophile, lithophile and chalcophile elements I will present and discuss the most plausible conditions for Earth's core formation. References Bouhifd and Jephcoat (2011) EPSL, 307, 341-348. Bouhifd et al. (2015) EPSL 413, 158-166. Boujibar et al. (2014) EPSL 391, 42-54. Cartier et al. (2014) Nature Geoscience, 7, 573-576. Fischer et al. (2015) GCA 167, 177-194. Sanloup et al. (2013) Nature, 503, 104-107. Siebert et al. (2012) EPSL 321-322, 189-197. Wohlers and Wood (2015) Nature 520, 337-340.

COOLED NEUTRONIC REACTOR

DOEpatents

Binner, C.R.; Wilkie, C.B.

1958-03-18

This patent relates to a design for a reactor of the type in which a fluid coolant is flowed through the active portion of the reactor. This design provides for the cooling of the shielding material as well as the reactor core by the same fluid coolant. The core structure is a solid moderator having coolant channels in which are disposed the fuel elements in rod or slug form. The coolant fluid enters the chamber in the shield, in which the core is located, passes over the inner surface of said chamber, enters the core structure at the center, passes through the coolant channels over the fuel elements and out through exhaust ducts.

The elastic properties of hcp-Fe alloys under the conditions of the Earth's inner core

NASA Astrophysics Data System (ADS)

Li, Yunguo; Vočadlo, Lidunka; Brodholt, John P.

2018-07-01

Geophysical and cosmochemical constraints suggest the inner-core is mainly composed of iron with a few percent of light elements. However, despite extensive studies over many years, no single alloying light-element has been found that is able to simultaneously match the observed inner-core density and both seismic velocities. This has motivated a number of suggestions of other mechanism to lower velocities, such as anelasticity or premelting. However, an unexplored possibility is that a combination of two or more light-elements might produce the desired reduction in velocities and densities of the inner core. In order to test this, we use ab initio molecular dynamics calculations to map the elastic property space of hcp-Fe alloyed with S, Si and C at 360 GPa up to the melting temperature. Based on a mixing solid solution model together with direct simulations on the ternaries, we found a number of compositions which are able to match the observed properties of the inner core. This is the first time that the density, VP, Vs and the Poisson's ratio of the inner core have been matched directly with an hcp-Fe alloy.

Limits on the Core Mass of Jupiter

NASA Astrophysics Data System (ADS)

Stevenson, D. J.

2015-12-01

The core is here defined as the central concentration of elements heavier than hydrogen and helium (it need not be solid and it need not be purely heavy elements and it will not have a sharp boundary). Its determination is a major goal of the Juno mission (2016-17) and it will be difficult to determine because it is expected to be only a few percent of the total mass. It has long been known that there is no prospect of determining the nature of this core (e.g., its density) from gravity measurements, even though the mass can be estimated. By consideration of simple models that are nonetheless faithful to the essential physics, it is further shown that should the core be contaminated with light elements (hydrogen and helium) then the gravity data can tell us the core mass as defined (with some caveats about the fuzziness of its boundary) but not the total mass within some small radius (which could include any light elements mixed in). This is both good and bad news: Good in that the core is thought to be diagnostic of the conditions under which the planet formed but bad in that the admixture also tells us more about both formation process and core erosion. Further, a linear perturbation theory has been developed that provides an easy approximate way of determining how errors in the equation of state (EOS) propagate into errors in the estimated core mass or envelope enrichment in heavies in models that nonetheless satisfy all observables. This theory does not require detailed models of the planet but provides an integral mapping from changes in the EOS into approximate changes in radius at fixed mass, and low degree gravity (or moment of inertia, MOI). This procedure also shows that there exist perturbations that leave the radius, mass and MOI unchanged but cause a change in J2, though in practice the non-uniqueness of structure by this consideration (~0.2% or less in MOI for example) is less than the non-uniqueness arising from likely EOS uncertainties (~1% in total mass, potentially 30% in core mass). Although the likely independent determination of MOI from precession is expected to help in the modeling procedure, the uncertainty in EOS and in the distribution of heavy elements (and resulting non-adiabaticity) will necessarily introduce ambiguity into the determination of core mass.

Some Lessons Learned From 15 Years of Engaging Undergraduates in Space Physics Research

NASA Astrophysics Data System (ADS)

Lopez, R. E.; Bruntz, R. J.

2016-12-01

Over the past 15 years, the Lopez research group has provided about 10 undergraduates each year with opportunities to enagage in space physics research. In this presentation I will discuss and describe three critical factors to the success of the group. First of these is the use of near-peer mentoring structure that entends from undergradutes who have just joined the group up through postdocs and the lead professor. Second is the empahasis we place on science communication, which includes professional development of presentation skills and attending regional or national scientific meetings. Third is the careful selection of research projects that can be carried out successfully by undergraduates with the proper support and scaffolding. While other elements do contribute to the success of the group (such as the use of a group-wide wiki as a resource center and lab notebook), these three elements are at the core of what we do, and all senior group members (Ph.D. graduates and Postdocs) gain an understanding of these elements that they have been able to apply in their own settings once they move on.

Biomechanical Evaluation of a Tooth Restored with High Performance Polymer PEKK Post-Core System: A 3D Finite Element Analysis.

PubMed

Lee, Ki-Sun; Shin, Joo-Hee; Kim, Jong-Eun; Kim, Jee-Hwan; Lee, Won-Chang; Shin, Sang-Wan; Lee, Jeong-Yol

2017-01-01

The aim of this study was to evaluate the biomechanical behavior and long-term safety of high performance polymer PEKK as an intraradicular dental post-core material through comparative finite element analysis (FEA) with other conventional post-core materials. A 3D FEA model of a maxillary central incisor was constructed. A cyclic loading force of 50 N was applied at an angle of 45° to the longitudinal axis of the tooth at the palatal surface of the crown. For comparison with traditionally used post-core materials, three materials (gold, fiberglass, and PEKK) were simulated to determine their post-core properties. PEKK, with a lower elastic modulus than root dentin, showed comparably high failure resistance and a more favorable stress distribution than conventional post-core material. However, the PEKK post-core system showed a higher probability of debonding and crown failure under long-term cyclic loading than the metal or fiberglass post-core systems.

Biomechanical Evaluation of a Tooth Restored with High Performance Polymer PEKK Post-Core System: A 3D Finite Element Analysis

PubMed Central

Shin, Joo-Hee; Kim, Jong-Eun; Kim, Jee-Hwan; Lee, Won-Chang; Shin, Sang-Wan

2017-01-01

The aim of this study was to evaluate the biomechanical behavior and long-term safety of high performance polymer PEKK as an intraradicular dental post-core material through comparative finite element analysis (FEA) with other conventional post-core materials. A 3D FEA model of a maxillary central incisor was constructed. A cyclic loading force of 50 N was applied at an angle of 45° to the longitudinal axis of the tooth at the palatal surface of the crown. For comparison with traditionally used post-core materials, three materials (gold, fiberglass, and PEKK) were simulated to determine their post-core properties. PEKK, with a lower elastic modulus than root dentin, showed comparably high failure resistance and a more favorable stress distribution than conventional post-core material. However, the PEKK post-core system showed a higher probability of debonding and crown failure under long-term cyclic loading than the metal or fiberglass post-core systems. PMID:28386547

Hypervelocity Impact Behaviour of CFRP-A1/HC Sandwich Panel: Finite-Element Studies

NASA Astrophysics Data System (ADS)

Phadnis, Vaibhav A.; Roy, Anish; Silberschmidt, Vadim V.

2014-06-01

The mechanical response of CFRP-Al/HC (carbon fibre- reinforced/epoxy composite face sheets with Al honeycomb core) sandwich panels to hyper-velocity impact ( 1 km/s) is studied using a finite-element model developed in ABAQUS/Explicit. The intraply damage of CFRP face sheets is analysed by the means of a user-defined material model (VUMAT) employing a combination of Hashin and Puck criteria and delamination is modelled using cohesive-zone elements. The damage of Al/HC core is assessed on the basis of a Johnson-Cook dynamic failure model while its hydrodynamic response is captured using the Mie- Gruneisen equation of state. The results obtained with the developed finite-element model showed a reasonable correlation to experimental damage patterns. The surface peeling of both face sheets was evident, with a significant delamination around the impact location accompanied by crushing of HC core.

Finite element analysis of hypervelocity impact behaviour of CFRP-Al/HC sandwich panel

NASA Astrophysics Data System (ADS)

Phadnis, Vaibhav A.; Silberschmidt, Vadim V.

2015-09-01

The mechanical response of CFRP-Al/HC (carbon fibre-reinforced/epoxy composite face sheets with Al honeycomb core) sandwich panels to hyper-velocity impact (up to 1 km/s) is studied using a finite-element model developed in ABAQUS/Explicit. The intraply damage of CFRP face sheets is analysed by mean of a user-defined material model (VUMAT) employing a combination of Hashin and Puck criteria, delamination modelled using cohesive-zone elements. The damaged Al/HC core is assessed on the basis of a Johnson Cook dynamic failure model while its hydrodynamic response is captured using the Mie-Gruneisen equation of state. The results obtained with the developed finite-element model showed a reasonable correlation to experimental damage patterns. The surface peeling of both face sheets was evident, with a significant delamination around the impact location accompanied by crushing HC core.

Consensus statement on an updated core communication curriculum for UK undergraduate medical education.

PubMed

Noble, Lorraine M; Scott-Smith, Wesley; O'Neill, Bernadette; Salisbury, Helen

2018-04-22

Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine. The consensus was developed through an iterative consultation process with the communication leads who represent their medical schools on the UK Council of Clinical Communication in Undergraduate Medical Education. The updated curriculum defines the underpinning values, core components and skills required within the context of contemporary medical care. It incorporates the evolving relational issues associated with the more prominent role of the patient in the consultation, reflected through legal precedent and changing societal expectations. The impact on clinical communication of the increased focus on patient safety, the professional duty of candour and digital medicine are discussed. Changes in the way medicine is practised should lead rapidly to adjustments to the content of curricula. The updated curriculum provides a model of best practice to help medical schools develop their teaching and argue for resources. Copyright © 2018 Elsevier B.V. All rights reserved.

Constraints on the Properties of the Moon's Outer Core from High-Pressure Sound Velocity Measurements on Fe-S Liquids

NASA Astrophysics Data System (ADS)

Jing, Z.; Wang, Y.; Kono, Y.; Yu, T.; Sakamaki, T.; Park, C.; Rivers, M. L.; Sutton, S. R.; Shen, G.

2013-12-01

Geophysical observations based on lunar seismology and laser ranging strongly suggest that the Moon's iron core is partially molten. Similar to Earth and other terrestrial planets, light elements, such as sulfur, silicon, carbon, and oxygen, are likely present in the lunar core. Determining the light element concentration in the outer core is of vital importance to the understanding of the structure, dynamics, and chemical evolution of the Moon, as well as the enigmatic history of the lunar dynamo. Among the candidate elements, sulfur is the preferred major light element in the lunar outer due to its high abundance in the parent bodies of iron meteorites, its high solubility in liquid Fe at the lunar core pressure (~5 GPa), and its strong effects on reducing the density, velocity, and freezing temperature of the core. In this study, we conducted in-situ sound velocity measurements on liquid samples of four different compositions, including pure Fe, Fe-10wt%S, Fe-20wt%S, and Fe-27wt%S, at pressure and temperature conditions up to 8 GPa and 1973 K (encompassing the entire lunar depth range), using the Kawai-type multi-anvil device at the GSECARS beamline 13-ID-D and the Paris-Edinburgh cell at HPCAT beamline 16-BM-B. Our results show that the velocity of Fe-rich liquids increases upon compression, decreases with increasing sulfur content, and is nearly independent of temperature. Compared to the seismic velocity of the outer core, our velocity data constrain the sulfur content at 4×2 wt%, indicating a significantly denser (6.4×0.4 g/cm3) and hotter (1860×60 K) outer core than previously estimated. A new lunar structure model incorporating available geophysical observations points to a smaller core radius. Our model also suggests a top-down solidification scenario for the evolution of the lunar core. Such an 'iron snow' process may have been an important mechanism for the growth of the inner core.

Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

PubMed

Ginsburg, Paul B

2012-09-01

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

DUBLIN CORE

EPA Science Inventory

The Dublin Core is a metadata element set intended to facilitate discovery of electronic resources. It was originally conceived for author-generated descriptions of Web resources, and the Dublin Core has attracted broad ranging international and interdisciplinary support. The cha...

A motivational counseling approach to improving heart failure self-care: mechanisms of effectiveness.

PubMed

Riegel, Barbara; Dickson, Victoria V; Hoke, Linda; McMahon, Janet P; Reis, Brendali F; Sayers, Steven

2006-01-01

Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging. Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 +/- 1.5 home visits (median 3, mode 3, range 1-6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness. Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources). An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.

Progress on core outcome sets for critical care research.

PubMed

Blackwood, Bronagh; Marshall, John; Rose, Louise

2015-10-01

Appropriate selection and definition of outcome measures are essential for clinical trials to be maximally informative. Core outcome sets (an agreed, standardized collection of outcomes measured and reported in all trials for a specific clinical area) were developed due to established inconsistencies in trial outcome selection. This review discusses the rationale for, and methods of, core outcome set development, as well as current initiatives in critical care. Recent systematic reviews of reported outcomes and measurement instruments relevant to the critically ill highlight inconsistencies in outcome selection, definition, and measurement, thus establishing the need for core outcome sets. Current critical care initiatives include development of core outcome sets for trials aimed at reducing mechanical ventilation duration; rehabilitation following critical illness; long-term outcomes in acute respiratory failure; and epidemic and pandemic studies of severe acute respiratory infection. Development and utilization of core outcome sets for studies relevant to the critically ill is in its infancy compared to other specialties. Notwithstanding, core outcome set development frameworks and guidelines are available, several sets are in various stages of development, and there is strong support from international investigator-led collaborations including the International Forum for Acute Care Trialists.

Core Clinical Data Elements for Cancer Genomic Repositories: A Multi-stakeholder Consensus.

PubMed

Conley, Robert B; Dickson, Dane; Zenklusen, Jean Claude; Al Naber, Jennifer; Messner, Donna A; Atasoy, Ajlan; Chaihorsky, Lena; Collyar, Deborah; Compton, Carolyn; Ferguson, Martin; Khozin, Sean; Klein, Roger D; Kotte, Sri; Kurzrock, Razelle; Lin, C Jimmy; Liu, Frank; Marino, Ingrid; McDonough, Robert; McNeal, Amy; Miller, Vincent; Schilsky, Richard L; Wang, Lisa I

2017-11-16

The Center for Medical Technology Policy and the Molecular Evidence Development Consortium gathered a diverse group of more than 50 stakeholders to develop consensus on a core set of data elements and values essential to understanding the clinical utility of molecularly targeted therapies in oncology. Copyright © 2017 Elsevier Inc. All rights reserved.

Core data elements tracking elder sexual abuse.

PubMed

Hanrahan, Nancy P; Burgess, Ann W; Gerolamo, Angela M

2005-05-01

Sexual abuse in the older adult population is an understudied vector of violent crimes with significant physical and psychological consequences for victims and families. Research requires a theoretical framework that delineates core elements using a standardized instrument. To develop a conceptual framework and identify core data elements specific to the older adult population, clinical, administrative, and criminal experts were consulted using a nominal group method to revise an existing sexual assault instrument. The revised instrument could be used to establish a national database of elder sexual abuse. The database could become a standard reference to guide the detection, assessment, and prosecution of elder sexual abuse crimes as well as build a base from which policy makers could plan and evaluate interventions that targeted risk factors.

Iron-magnesium alloy in the Earth's Core

NASA Astrophysics Data System (ADS)

Dubrovinskaia, N.; Dubrovinsky, L.; Abrikosov, I.

2005-12-01

Composition of the Earth's outer core is a geochemical parameter crucial for understanding the evolution and current dynamics of our planet. Since it was recognized that the liquid metallic outer core is about 10% less dense than pure iron, different elements lighter than iron, including Si, S, O, C, and H, were proposed as major or at least significantly abundant in Earth's core. However, combination of experimental results with theoretical and geochemical considerations shows that it is unlikely that any one of these elements can account for the density deficit on its own. In series of experiments in a multianvil apparatus and in electrically- and laser-heated diamond anvil cells, we demonstrate that high pressure promotes solubility of magnesium in iron and at megabar pressure range more than 10 at% of Mg can dissolve in Fe. At pressures above 95 to 100 GPa, molten iron reacts with periclase MgO forming an iron-magnesium alloy and iron oxide. Our observations suggest that magnesium can be an important light element in Earth's outer core, but it cannot account for the seismologically determined density deficit on its own.

Modelling of Equilibrium Between Mantle and Core: Refractory, Volatile, and Highly Siderophile Elements

NASA Technical Reports Server (NTRS)

Righter, K.; Danielson, L.; Pando, K.; Shofner, G.; Lee, C. -T.

2013-01-01

Siderophile elements have been used to constrain conditions of core formation and differentiation for the Earth, Mars and other differentiated bodies [1]. Recent models for the Earth have concluded that the mantle and core did not fully equilibrate and the siderophile element contents of the mantle can only be explained under conditions where the oxygen fugacity changes from low to high during accretion and the mantle and core do not fully equilibrate [2,3]. However these conclusions go against several physical and chemical constraints. First, calculations suggest that even with the composition of accreting material changing from reduced to oxidized over time, the fO2 defined by metal-silicate equilibrium does not change substantially, only by approximately 1 logfO2 unit [4]. An increase of more than 2 logfO2 units in mantle oxidation are required in models of [2,3]. Secondly, calculations also show that metallic impacting material will become deformed and sheared during accretion to a large body, such that it becomes emulsified to a fine scale that allows equilibrium at nearly all conditions except for possibly the length scale for giant impacts [5] (contrary to conclusions of [6]). Using new data for D(Mo) metal/silicate at high pressures, together with updated partitioning expressions for many other elements, we will show that metal-silicate equilibrium across a long span of Earth s accretion history may explain the concentrations of many siderophile elements in Earth's mantle. The modeling includes refractory elements Ni, Co, Mo, and W, as well as highly siderophile elements Au, Pd and Pt, and volatile elements Cd, In, Bi, Sb, Ge and As.

Geochemical Comparison of Four Cores from the Manson Impact Structure

NASA Technical Reports Server (NTRS)

Korotev, Randy L.; Rockow, Kaylynn M.; Jolliff, Bradley L.; Haskin, Larry A.; McCarville, Peter; Crossey, Laura J.

1996-01-01

Concentrations of 33 elements were determined in relatively unaltered, matrix-rich samples of impact breccia at approximately 3-m-depth intervals in the M-1 core from the Manson impact structure, Iowa. In addition, 46 matrix-rich samples from visibly altered regions of the M-7, M-8, and M-10 cores were studied, along with 42 small clasts from all four cores. Major element compositions were determined for a subset of impact breccias from the M-1 core, including matrix-rich impact-melt breccia. Major- and trace-element compositions were also determined for a suite of likely target rocks. In the M-1 core, different breccia units identified from lithologic examination of cores are compositionally distinct. There is a sharp compositional discontinuity at the boundary between the Keweenawan-shale-clast breccia and the underlying unit of impact-melt breccia (IMB) for most elements, suggesting minimal physical mixing between the two units during emplacement. Samples from the 40-m-thick IMB (M-1) are all similar to each other in composition, although there are slight increases in concentration with depth for those elements that have high concentrations in the underlying fragmental-matrix suevite breccia (SB) (e.g., Na, Ca, Fe, Sc), presumably as a result of greater clast proportions at the bottom margin of the unit of impact-melt breccia. The high degree of compositional similarity we observe in the impact-melt breccias supports the interpretation that the matrix of this unit represents impact melt. That our analyses show such compositional similarity results in part from our technique for sampling these breccias: for each sample we analyzed a few small fragments (total mass: approximately 200 mg) selected to be relatively free of large clasts and visible signs of alteration instead of subsamples of powders prepared from a large mass of breccia. The mean composition of the matrix-rich part of impact-melt breccia from the M-1 core can be modeled as a mixture of approximately 35% shale and siltstone (Proterozoic "Red Clastics"), 23% granite, 40% hornblende-biotite gneiss, and a small component (less than 2%) of mafic-dike rocks.

Thermal breeder fuel enrichment zoning

DOEpatents

Capossela, Harry J.; Dwyer, Joseph R.; Luce, Robert G.; McCoy, Daniel F.; Merriman, Floyd C.

1992-01-01

A method and apparatus for improving the performance of a thermal breeder reactor having regions of higher than average moderator concentration are disclosed. The fuel modules of the reactor core contain at least two different types of fuel elements, a high enrichment fuel element and a low enrichment fuel element. The two types of fuel elements are arranged in the fuel module with the low enrichment fuel elements located between the high moderator regions and the high enrichment fuel elements. Preferably, shim rods made of a fertile material are provided in selective regions for controlling the reactivity of the reactor by movement of the shim rods into and out of the reactor core. The moderation of neutrons adjacent the high enrichment fuel elements is preferably minimized as by reducing the spacing of the high enrichment fuel elements and/or using a moderator having a reduced moderating effect.

Model depicting aspects of audit and feedback that impact physicians' acceptance of clinical performance feedback.

PubMed

Payne, Velma L; Hysong, Sylvia J

2016-07-13

Audit and feedback (A&F) is a strategy that has been used in various disciplines for performance and quality improvement. There is limited research regarding medical professionals' acceptance of clinical-performance feedback and whether feedback impacts clinical practice. The objectives of our research were to (1) investigate aspects of A&F that impact physicians' acceptance of performance feedback; (2) determine actions physicians take when receiving feedback; and (3) determine if feedback impacts physicians' patient-management behavior. In this qualitative study, we employed grounded theory methods to perform a secondary analysis of semi-structured interviews with 12 VA primary care physicians. We analyzed a subset of interview questions from the primary study, which aimed to determine how providers of high, low and moderately performing VA medical centers use performance feedback to maintain and improve quality of care, and determine perceived utility of performance feedback. Based on the themes emergent from our analysis and their observed relationships, we developed a model depicting aspects of the A&F process that impact feedback acceptance and physicians' patient-management behavior. The model is comprised of three core components - Reaction, Action and Impact - and depicts elements associated with feedback recipients' reaction to feedback, action taken when feedback is received, and physicians modifying their patient-management behavior. Feedback characteristics, the environment, external locus-of-control components, core values, emotion and the assessment process induce or deter reaction, action and impact. Feedback characteristics (content and timeliness), and the procedural justice of the assessment process (unjust penalties) impact feedback acceptance. External locus-of-control elements (financial incentives, competition), the environment (patient volume, time constraints) and emotion impact patient-management behavior. Receiving feedback generated intense emotion within physicians. The underlying source of the emotion was the assessment process, not the feedback. The emotional response impacted acceptance, impelled action or inaction, and impacted patient-management behavior. Emotion intensity was associated with type of action taken (defensive, proactive, retroactive). Feedback acceptance and impact have as much to do with the performance assessment process as it does the feedback. In order to enhance feedback acceptance and the impact of feedback, developers of clinical performance systems and feedback interventions should consider multiple design elements.

Consensus development of core competencies in intensive and critical care medicine training in China.

PubMed

Hu, Xiaoyun; Xi, Xiuming; Ma, Penglin; Qiu, Haibo; Yu, Kaijiang; Tang, Yaoqing; Qian, Chuanyun; Fang, Qiang; Wang, Yushan; Yu, Xiangyou; Xu, Yuan; Du, Bin

2016-10-16

The aim of this study is to develop consensus on core competencies required for postgraduate training in intensive care medicine. We used a combination of a modified Delphi method and a nominal group technique to create and modify the list of core competencies to ensure maximum consensus. Ideas were generated modified from Competency Based Training in Intensive Care Medicine in Europe collaboration (CoBaTrICE) core competencies. An online survey invited healthcare professionals, educators, and trainees to rate and comment on these competencies. The output from the online survey was edited and then reviewed by a nominal group of 13 intensive care professionals to identify each competence for importance. The resulting list was then recirculated in the nominal group for iterative rating. The online survey yielded a list of 199 competencies for nominal group reviewing. After five rounds of rating, 129 competencies entered the final set defined as core competencies. We have generated a set of core competencies using a consensus technique which can serve as an indicator for training program development.

Engaging Frontline Staff in Central Line-Associated Bloodstream Infection Prevention Practice in the Wake of Superstorm Sandy.

PubMed

Rosenberg, Rebecca E; Devins, Lea; Geraghty, Gail; Bock, Steven; Dugan, Christina A; Transou, Marjorie; Phillips, Michael; Lighter-Fisher, Jennifer

2015-10-01

Central venous catheters are crucial devices in the care of hospitalized children, both in and out of critical care units, but the concomitant risk of central line-associated bloodstream infection (CLABSI) affects 15,000 Americans annually. In 2012, CLABSI rates varied among units from 6.8/1,000 to 1.0/1,000 in a 109-bed children's service within NYU Langone Medical Center (NYULMC; New York City), a 1,069-bed tertiary care academic medical center. In response to variation in central line-related practices and infection prevention rates, a CLABSI Prevention Core Team began an effort to standardize central venous catheter (CVC) care across all pediatric units (ICU and non-ICU). Momentum in this quality improvement (QI) work was interrupted when Superstorm Sandy shuttered the flagship hospital, but the relatively decreased clinical load provided a "downtime" opportunity to address CLABSI prevention. The first phase of the collaborative effort, Booster 1, Planning/Initial Phase: Development of a Pediatric Central Venous Catheter Working Group, was followed by Booster 2, Maintenance/Sustaining Phase: Transitioning for Sustainability and Adopting Model for Improvement. Data in the subsequent 21 months after the temporary closure of the facility (January 2013-September 2014) showed an increase in maintenance bundle reliability. The inpatient CLABSI rate for patients<18 years decreased from an annual rate of 2.7/1,000 line days (2012) to 0.6/1,000 line days (2013) to 0.5/1,000 line days as of August 2014. There was a decrease in pediatric CLABSI events and no significant change in line days. Key elements contributing to initial success with evolving QI capacity and resources were likely multi-factorial, including staff and leadership engagement, culture change, consistent guidelines, and accountability by individuals and by our multidisciplinary core team.

A federated semantic metadata registry framework for enabling interoperability across clinical research and care domains.

PubMed

Sinaci, A Anil; Laleci Erturkmen, Gokce B

2013-10-01

In order to enable secondary use of Electronic Health Records (EHRs) by bridging the interoperability gap between clinical care and research domains, in this paper, a unified methodology and the supporting framework is introduced which brings together the power of metadata registries (MDR) and semantic web technologies. We introduce a federated semantic metadata registry framework by extending the ISO/IEC 11179 standard, and enable integration of data element registries through Linked Open Data (LOD) principles where each Common Data Element (CDE) can be uniquely referenced, queried and processed to enable the syntactic and semantic interoperability. Each CDE and their components are maintained as LOD resources enabling semantic links with other CDEs, terminology systems and with implementation dependent content models; hence facilitating semantic search, much effective reuse and semantic interoperability across different application domains. There are several important efforts addressing the semantic interoperability in healthcare domain such as IHE DEX profile proposal, CDISC SHARE and CDISC2RDF. Our architecture complements these by providing a framework to interlink existing data element registries and repositories for multiplying their potential for semantic interoperability to a greater extent. Open source implementation of the federated semantic MDR framework presented in this paper is the core of the semantic interoperability layer of the SALUS project which enables the execution of the post marketing safety analysis studies on top of existing EHR systems. Copyright © 2013 Elsevier Inc. All rights reserved.

The radiative decays of excited states of transition elements located inside and near core-shell nanoparticles

NASA Astrophysics Data System (ADS)

Pukhov, Konstantin K.

2017-12-01

Here we discuss the radiative decays of excited states of transition elements located inside and outside of the subwavelength core-shell nanoparticles embedded in dielectric medium. Based on the quantum mechanics and quantum electrodynamics, the general analytical expressions are derived for the probability of the spontaneous transitions in the luminescent centers (emitter) inside and outside the subwavelength core-shell nanoparticle. Obtained expressions holds for arbitrary orientation of the dipole moment and the principal axes of the quadrupole moment of the emitter with respect to the radius-vector r connecting the center of the emitter with the center of the nanoparticle. They have simple form and show how the spontaneous emission in core-shell NPs can be controlled and engineered due to the dependence of the emission rates on core-shell sizes, radius-vector r and permittivities of the surrounding medium, shell, and core.

New Medicine for the U.S. Health Care System: Training Physicians for Structural Interventions.

PubMed

Hansen, Helena; Metzl, Jonathan M

2017-03-01

Structural competency provides a language and theoretical framework to promote institutional-level interventions by clinical practitioners working with community organizations, non-health-sector institutions, and policy makers. The special collection of articles on structural competency in this issue of Academic Medicine addresses the need to move from theory to an appraisal of core educational interventions that operationalize the goals of and foster structural competency. In this Commentary, the authors review the role of clinical practitioners in enhancing population-level health outcomes through collaborations with professionals in fields outside medicine, including the social sciences and law. They describe the core elements of structural competency in preclinical and clinical education, as illustrated by the articles of this special collection: perceiving the structural causes of patients' disease, envisioning structural interventions, and cultivating alliances with non-health-sector agencies that can implement structural interventions. Finally, the authors argue that preparing trainees to form partnerships will empower them to influence the social determinants of their patients' health and reduce health inequalities.

Practices and Policies of Clinical Exome Sequencing Providers: Analysis and Implications

PubMed Central

Jamal, Seema M.; Yu, Joon-Ho; Chong, Jessica X.; Dent, Karin M.; Conta, Jessie H.; Tabor, Holly K.; Bamshad, Michael J.

2013-01-01

Exome and whole genome sequencing (ES/WGS) offer potential advantages over traditional approaches to diagnostic genetic testing. Consequently, use of ES/WGS in clinical settings is rapidly becoming commonplace. Yet there are myriad moral, ethical, and perhaps legal implications attached to the use of ES and health care professionals and institutions will need to consider these implications in the context of the varied practices and policies of ES service providers. We developed “core elements” of content and procedures for informed consent, data sharing, and results management and a quantitative scale to assess the extent to which research protocols met the standards established by these core elements. We then used these tools to evaluate the practices and policies of each of the 6 U.S. CLIA-certified labs offering clinical ES. Approaches toward informed consent, data sharing, and results return vary widely among ES providers as do the overall potential merits and disadvantages of each, and more importantly, the balance between the two. PMID:23610049

Refining a definition of reflection for the being as well as doing the work of a physician.

PubMed

Wald, Hedy S

2015-04-21

Reflection is core to professional competency and supports the active, constructive process of professional identity formation. Medical educators thus grapple with operationalizing and effectively integrating reflection as a foundational construct within health care professions education and practice. Core elements of reflection including role of emotions and awareness of self, other and situation, do not appear within various working definitions of reflection. This observation as well as noted recent shift in medical education toward emphasis on the "being" as well as "doing the work" of a physician led to the author's proposed refining of Sandars' reflection definition and expansion of Nguyen et al.'s reflection model. A refined reflection definition is offered for a more inclusionary approach. A caveat regarding potential for expected reflective learning outcomes (given reflection as a process) is provided and the integral role of mentor-enhanced reflection is discussed. Reflection as a continuum is highlighted and exemplified within Wald et al.'s REFLECT rubric and Nguyen et al.'s reflection model.

Testing a laser-induced breakdown spectroscopy technique on the Arctic sediments

NASA Astrophysics Data System (ADS)

Han, D.; Nam, S. I.

2017-12-01

Physical and geochemical investigations coupled with the Laser-induced Breakdown Spectroscopy (LIBS) were performed on three surface sediment cores (ARA03B/24BOX, ARA02B/01(A)MUC, ARA02B/02MUC and ARA02B/03(A)MUC) recovered from the western Arctic Ocean (Chukchi Sea) during IBRV ARON expeditions in 2012. The LIBS technique was applied to carry out elemental chemical analysis of the Arctic sediments and compared with that measured by ITRAX X-ray fuorescence (XRF) core scanning. LIBS and XRF have shown similar elemental composition within each sediment core. In this study, mineral composition (XRD), grain size distribution and organic carbon content as well as elemental composition (LIBS) were all considered to understand paleoenvironmental changes (ocean circulation, sea-ice drift, iceberg discharge, and etc.) recorded in the Arctic Holocene sediment. Quantitative LIBS analysis shows a gradually varying distribution of the elements along the sampled core and clear separation between the cores. The cores are geochemically characterized by elevated Mn profile. The gradient of mineral composition and grain sizes among the cores shows regional distribution and variation in sedimentary condition due to geological distance between East Siberian and North America. The present study reveals that a LIBS technique can be employed for in-situ sediment analyses for the Arctic Ocean. Furthermore, LIBS does not require costly equipment, trained operators, and complicated sample pre-treatment processes compared to Atomic absorption spectroscopy (AAS) and inductively coupled plasma emission spectroscopy (ICP), and also known to show relatively high levels of sensitivity, precision, and distinction than XRF analysis, scanning electron microscopy-energy dispersive spectrometry (SEM-EDS), and electron probe X-ray microanalysis (EPMA).

Nucleoporins as components of the nuclear pore complex core structure and Tpr as the architectural element of the nuclear basket.

PubMed

Krull, Sandra; Thyberg, Johan; Björkroth, Birgitta; Rackwitz, Hans-Richard; Cordes, Volker C

2004-09-01

The vertebrate nuclear pore complex (NPC) is a macromolecular assembly of protein subcomplexes forming a structure of eightfold radial symmetry. The NPC core consists of globular subunits sandwiched between two coaxial ring-like structures of which the ring facing the nuclear interior is capped by a fibrous structure called the nuclear basket. By postembedding immunoelectron microscopy, we have mapped the positions of several human NPC proteins relative to the NPC core and its associated basket, including Nup93, Nup96, Nup98, Nup107, Nup153, Nup205, and the coiled coil-dominated 267-kDa protein Tpr. To further assess their contributions to NPC and basket architecture, the genes encoding Nup93, Nup96, Nup107, and Nup205 were posttranscriptionally silenced by RNA interference (RNAi) in HeLa cells, complementing recent RNAi experiments on Nup153 and Tpr. We show that Nup96 and Nup107 are core elements of the NPC proper that are essential for NPC assembly and docking of Nup153 and Tpr to the NPC. Nup93 and Nup205 are other NPC core elements that are important for long-term maintenance of NPCs but initially dispensable for the anchoring of Nup153 and Tpr. Immunogold-labeling for Nup98 also results in preferential labeling of NPC core regions, whereas Nup153 is shown to bind via its amino-terminal domain to the nuclear coaxial ring linking the NPC core structures and Tpr. The position of Tpr in turn is shown to coincide with that of the nuclear basket, with different Tpr protein domains corresponding to distinct basket segments. We propose a model in which Tpr constitutes the central architectural element that forms the scaffold of the nuclear basket.

Creating value-focused healthcare delivery systems: Part three--Core competencies.

PubMed

Beveridge, R N

1997-01-01

Value is created through the delivery of high-quality, cost--effective healthcare services. The ability to create value from the providers' perspective is facilitated through the development and implementation of essential, customer-focused core competencies. These core competencies include customer relationship management, payer/provider relationship management, disease management, outcomes management, financial/cost management, and information management. Customer relationship management is the foundation upon which all core competencies must be built. All of the core competencies must focus on the needs of the customers, both internal and external. Structuring all processes involved in the core competencies from the perspective of the customer will ensure that value is created throughout the system. Payer/provider relationship management will become a crucial pillar for healthcare providers in the future. As more vertical integration among providers occurs, the management of the relationships among providers and with payers will become more important. Many of the integration strategies being implemented across the country involve the integration of hospitals, physicians, and payers to form accountable health plans. The relationships must be organized to form "win/win" situations, where all parties are focused on a shared vision of creating value and none of the parties benefits at the expense of the others. Disease management in creating value requires that we begin examining the disease process along the entire continuum. Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. Only through managing the full continuum of health will value be created throughout the healthcare delivery system. Outcomes management ensures that the outcomes are the highest quality at a cost-effective price. Outcomes must not only be compared to best practices, but to what is possible. Providers must constantly strive to enhance the quality of the services. Financial/cost management ensures that care is cost-effective and that a marginal profit is maintained to allow continued investment in new technology and continuing medical education to enhance the quality of care and lifestyles for all stakeholders. Information management is the binding element, or keystone, in providing value-focused care. Through the collection, storing, transfer, manipulation, sorting, and reporting of data, more effective decision-making can occur. Integrated MIS allows information to be generated about the cost-effectiveness of treatment regimens, employee productivity, physician cost-effectiveness, supply utilization, and clinical outcomes, as well as patient information to be readily available throughout the healthcare system. Having this information available will allow providers to become more cost-effective in the delivery of care, which results in perceived higher value for the services. Customers demand value. Value is created by meeting the needs and demands of the customers through the delivery of cost-effective, high-quality healthcare services that are easily accessible and meet with high patient satisfaction. Providers who can demonstrate their ability to provide the services in this manner will create a competitive advantage in the marketplace and will be perceived as the value provider of choice by loyal customers.

Improving collaboration between primary care and mental health services.

PubMed

Kates, Nick; Arroll, Bruce; Currie, Elizabeth; Hanlon, Charlotte; Gask, Linda; Klasen, Henrikje; Meadows, Graham; Rukundo, Godfrey; Sunderji, Nadiya; Ruud, Torleif; Williams, Mark

2018-06-20

Previous guidelines and planning documents have identified the key role primary care providers play in delivering mental health care, including the recommendation from the WHO that meeting the mental health needs of the population in many low and middle income countries will only be achieved through greater integration of mental health services within general medical settings. This position paper aims to build upon this work and present a global framework for enhancing mental health care delivered within primary care. This paper synthesizes previous guidelines, empirical data from the literature and experiences of the authors in varied clinical settings to identify core principles and the key elements of successful collaboration, and organizes these into practical guidelines that can be adapted to any setting. The paper proposes a three-step approach. The first is mental health services that any primary care provider can deliver with or without the presence of a mental health professional. Second is practical ways that effective collaboration can enhance this care. The third looks at wider system changes required to support these new roles and how better collaboration can lead to new responses to respond to challenges facing all mental health systems. This simple framework can be applied in any jurisdiction or country to enhance the detection, treatment, and prevention of mental health problems, reinforcing the role of the primary care provider in delivering care and showing how collaborative care can lead to better outcomes for people with mental health and addiction problems.

Constraining Mercury's interior structure with geodesy data and its present thermal state

NASA Astrophysics Data System (ADS)

Rivoldini, Attilio; Van Hoolst, Tim; Noack, Lena

2015-04-01

Recent measurements of Mercury's spin state and gravitational field supplemented by the assumption that the planet's core is made of iron and sulfur give strong constraints on its interior structure. In particular, they allow a precise determination of Mercury's core size and average mantle density. Present geodesy data do, however, almost not constrain the size of the inner core. Interior structure models with a fully molten liquid core as well as models with an inner core almost as large as the core agree with the observations. Additionally, the observed internally generated magnetic field of Mercury does not preclude the absence of an inner core, since remelting of iron snow inside the core could produce a sufficient buoyancy flux to drive magnetic field generation by compositional convection. Although sulfur is ubiquitously invoked as being the principal candidate light element in terrestrial planet's cores its abundance in the core depends on the redox conditions during planetary formation. Remote sensing data of Mercury's surface by MESSENGER indicate that Mercury formed under reducing conditions. As a consequence, substantial amounts of other light elements like for example silicon and carbon could be present together with sulfur inside Mercury's core. Compared to sulfur, which does almost not partition into solid iron at Mercury's core conditions, silicon partitions almost equally well between solid and liquid iron whereas a few percent of carbon can partition into solid iron. Therefore, compared to a pure iron-sulfur core, if silicon and carbon are present in the core the density jump at the inner-core outer-core boundary could be smaller and induce a large enough change in the inner-core flattening to alter Mercury's libration amplitude. Moreover, the presence of carbon together with sulfur further reduces the core solidus temperature, potentially delaying the onset of inner core formation. Finally, if both silicon and sulfur are present in sufficient quantities a thin layer much enriched in sulfur and depleted in silicon could form at the top of the core as a consequence of a large immiscibility region in liquid Fe-S-Si at Mercury's core conditions. The present radius of an inner core depends mainly on Mercury's thermal state and concentration of light elements inside the core. Because of the secular cooling of the planet, at a time in Mercury's evolution the temperature inside the core drops below the core liquidus temperature somewhere in the core, which can lead to the formation of an inner core and to the global contraction of the planet. The amount of contraction depends mainly on the temperature decrease, on the thermal expansion of the materials inside the planet, on the volume of crystallized iron-rich core liquid, and on the volume of crystallized crust. In this study we use geodesy data (88 day libration amplitude, polar moment of inertia, and tidal Love number), the recent estimate about the radial contraction of Mercury, and thermo-chemical evolution calculations taking into account the formation of the crust, a growing inner core, and modeling the formation of iron-rich snow in the core in order to improve our knowledge about Mercury's inner core radius and thermal state. Since data from remote sensing of Mercury's surface indicate that Mercury formed under reducing conditions we consider models that have sulfur, silicon, and carbon as light elements inside their core.

Probing Core Processes in the Earth and Small Bodies Using Paleomagnetism

NASA Astrophysics Data System (ADS)

Fu, R. R.; Weiss, B. P.; Lima, E. A.; Glenn, D. R.; Kehayias, P.; Walsworth, R. L.

2015-12-01

Convective motion in the cores of differentiated metal-silicate bodies may sustain a global dynamo magnetic field. Progressive crystallization in a dynamo-generating core is expected to play a central role in determining the observable properties of the hosted magnetic field. Importantly, the release of light elements and latent heat during core crystallization is a key source of entropy for sustaining core convection. Therefore, the persistence and intensity of a dynamo magnetic field depend directly on the extent and style of core crystallization. We present and discuss paleomagnetic data from the Earth and asteroid-sized bodies to characterize internally generated magnetic fields during the early histories of these objects. In the case of the Earth, recent and ongoing paleomagnetic experiments of zircons from the Jack Hills of Australia can potentially constrain the existence and intensity of the geodynamo before 3.5 Ga. If robust, such measurements hold strong implications for the energy budget of the Earth's early core and the dynamics of the early mantle. We will discuss both recently published and preliminary results and assess carefully the challenges and uncertainties of paleomagnetic experimentation on ancient zircon samples. In the case of small bodies, several classes of meteorites record ancient magnetic fields likely produced by core dynamos on their parent bodies. Data from the CV carbonaceous chondrites and pallasites indicate that dynamos in planetesimal-sized bodies persisted for a broad range of timescales between ~10 My and >100 My. Meanwhile, measurements of the angrite group of achondrites show that their earliest-forming members crystallized in an almost non-magnetic environment, suggesting a delayed onset of the planetesimal dynamo until several My after initial differentiation. We will discuss the possible causes for this observed diversity of small body dynamo properties, including the role of core crystallization and the distribution of short-lived radioisotopes.

How core nursing textbooks inform holistic spiritual care.

PubMed

2016-08-01

National and international health and nursing guidelines recommend that staff attend to patients' spiritual and religious needs, which suggests that spiritual care is an important aspect of holistic care. However, many nurses lack knowledge of the subject, and it is unclear whether core textbooks provide the information they need.

Seismic Wave Velocity in Earth's Shallow Core

NASA Astrophysics Data System (ADS)

Alexandrakis, C.; Eaton, D. W.

2008-12-01

Studies of the outer core indicate that it is composed of liquid Fe and Ni alloyed with a ~10% fraction of light elements such as O, S or Si. Recently, unusual features, such as sediment accumulation, immiscible fluid layers or stagnant convection, have been predicted in the shallow core region. Secular cooling and compositional buoyancy drive vigorous convection that sustains the geodynamo, although critical details of light-element composition and thermal regime remain uncertain. Seismic velocity models can provide important constraints on the light element composition, however global reference models, such as Preliminary Reference Earth Model (PREM), IASP91 and AK135 vary significantly in the 200 km below the core-mantle boundary. Past studies of the outermost core velocity structure have been hampered by traveltime uncertainties due to lowermost mantle heterogeneities. The recently published Empirical Transfer Function (ETF) method has been shown to reduce the uncertainty using a waveform stacking approach to improve global observations of SmKS teleseismic waves. Here, we apply the ETF method to achieve a precise top-of-core velocity measurement of 8.05 ± 0.03 km/s. This new model accords well with PREM. Since PREM is based on the adiabatic form of the Adams-Williamson equation, it assumes a well mixed (i.e. homogeneous) composition. This result suggests a lack of heterogeneity in the outermost core due to layering or stagnant convection.

Equation of State of Fe3C and Implications for the Carbon Content of Earth's Core

NASA Astrophysics Data System (ADS)

Davis, A.; Brauser, N.; Thompson, E. C.; Chidester, B.; Greenberg, E.; Prakapenka, V. B.; Campbell, A.

2017-12-01

Carbon is a common component in protoplanetary cores, as represented by iron meteorites. Therefore, along with silicon, oxygen, and other light elements, it is likely to be an alloying component with iron in Earth's core. Previous studies of the densities of iron carbides have not reached the combined pressure and temperature conditions relevant to Earth's core. To better understand the geophysical implications of carbon addition to Earth's core, we report P-V-T measurements of Fe3C to pressures and temperatures exceeding 110 GPa and 2500 K, using synchrotron X-ray diffraction in a laser heated diamond anvil cell. Fitting these measurements to an equation of state and assuming 1.5% density change upon melting and a 4000 K core-mantle boundary temperature, we report a value of 6 wt% carbon necessary to match the PREM density in the outer core. This value should be considered an upper bound due to the likely presence of other light elements.

Out-of-Core Streamline Visualization on Large Unstructured Meshes

NASA Technical Reports Server (NTRS)

Ueng, Shyh-Kuang; Sikorski, K.; Ma, Kwan-Liu

1997-01-01

It's advantageous for computational scientists to have the capability to perform interactive visualization on their desktop workstations. For data on large unstructured meshes, this capability is not generally available. In particular, particle tracing on unstructured grids can result in a high percentage of non-contiguous memory accesses and therefore may perform very poorly with virtual memory paging schemes. The alternative of visualizing a lower resolution of the data degrades the original high-resolution calculations. This paper presents an out-of-core approach for interactive streamline construction on large unstructured tetrahedral meshes containing millions of elements. The out-of-core algorithm uses an octree to partition and restructure the raw data into subsets stored into disk files for fast data retrieval. A memory management policy tailored to the streamline calculations is used such that during the streamline construction only a very small amount of data are brought into the main memory on demand. By carefully scheduling computation and data fetching, the overhead of reading data from the disk is significantly reduced and good memory performance results. This out-of-core algorithm makes possible interactive streamline visualization of large unstructured-grid data sets on a single mid-range workstation with relatively low main-memory capacity: 5-20 megabytes. Our test results also show that this approach is much more efficient than relying on virtual memory and operating system's paging algorithms.

Computer-assisted self interviewing in sexual health clinics.

PubMed

Fairley, Christopher K; Sze, Jun Kit; Vodstrcil, Lenka A; Chen, Marcus Y

2010-11-01

This review describes the published information on what constitutes the elements of a core sexual history and the use of computer-assisted self interviewing (CASI) within sexually transmitted disease clinics. We searched OVID Medline from 1990 to February 2010 using the terms "computer assisted interviewing" and "sex," and to identify published articles on a core sexual history, we used the term "core sexual history." Since 1990, 3 published articles used a combination of expert consensus, formal clinician surveys, and the Delphi technique to decide on what questions form a core sexual health history. Sexual health histories from 4 countries mostly ask about the sex of the partners, the number of partners (although the time period varies), the types of sex (oral, anal, and vaginal) and condom use, pregnancy intent, and contraceptive methods. Five published studies in the United States, Australia, and the United Kingdom compared CASI with in person interviews in sexually transmitted disease clinics. In general, CASI identified higher risk behavior more commonly than clinician interviews, although there were substantial differences between studies. CASI was found to be highly acceptable and individuals felt it allowed more honest reporting. Currently, there are insufficient data to determine whether CASI results in differences in sexually transmitted infection testing, diagnosis, or treatment or if CASI improves the quality of sexual health care or its efficiency. The potential public health advantages of the widespread use of CASI are discussed.

High energy overcurrent protective device

DOEpatents

Praeg, Walter F.

1982-01-01

Electrical loads connected to capacitance elements in high voltage direct current systems are protected from damage by capacitance discharge overcurrents by connecting between the capacitance element and the load, a longitudinal inductor comprising a bifilar winding wound about a magnetic core, which forms an incomplete magnetic circuit. A diode is connected across a portion of the bifilar winding which conducts a unidirectional current only. Energy discharged from the capacitance element is stored in the inductor and then dissipated in an L-R circuit including the diode and the coil winding. Multiple high voltage circuits having capacitance elements may be connected to loads through bifilar windings all wound about the aforementioned magnetic core.

Analysis of Moderately Siderophile Elements in Angrites: Implications for Core Formation of the Angrite Parent Body

NASA Technical Reports Server (NTRS)

Righter, K.; Shirai, N.; Irving, A.J.

2009-01-01

Angrites are an enigmatic group of achondrites, that constitute the largest group of basalts not affiliated with the Moon, Mars or Vesta (HEDs). Chemically, angrites are exceptionally refractory element- enriched (e.g., Al, Ca) and volatile element-depleted (e.g., Na and K) achondrites. Highly volatile siderophile and chalcophile elements (Zn, Ge and Se) may be less depleted than alkalis and Ga taken to imply a fractionation of plagiophile elements. Core formation on the angrite parent body (APB) is not well understood due to the dearth of moderately siderophile element (Ga, Ge, Mo, Sb, W) data for angrites, with the exception of Ni and Co [2]. In particular, there are no data for Mo abundances of angrites, while Sb and W abundances are reported for only 3 angrites, and have not always been determined on the same sample. The recent increase in angrite numbers (13) has greatly increased our knowledge of the compositional diversity of the angrite parent body (APB). In this study, we report new Co, Ni, Ga, Mo, Sb and W abundances for angrites by laser ablation inductively coupled plasma mass spectrometry (ICP-MS) in order to place constraints on core formation of the APB.

A three-dimensional nonlinear Timoshenko beam based on the core-congruential formulation

NASA Technical Reports Server (NTRS)

Crivelli, Luis A.; Felippa, Carlos A.

1992-01-01

A three-dimensional, geometrically nonlinear two-node Timoshenkoo beam element based on the total Larangrian description is derived. The element behavior is assumed to be linear elastic, but no restrictions are placed on magnitude of finite rotations. The resulting element has twelve degrees of freedom: six translational components and six rotational-vector components. The formulation uses the Green-Lagrange strains and second Piola-Kirchhoff stresses as energy-conjugate variables and accounts for the bending-stretching and bending-torsional coupling effects without special provisions. The core-congruential formulation (CCF) is used to derived the discrete equations in a staged manner. Core equations involving the internal force vector and tangent stiffness matrix are developed at the particle level. A sequence of matrix transformations carries these equations to beam cross-sections and finally to the element nodal degrees of freedom. The choice of finite rotation measure is made in the next-to-last transformation stage, and the choice of over-the-element interpolation in the last one. The tangent stiffness matrix is found to retain symmetry if the rotational vector is chosen to measure finite rotations. An extensive set of numerical examples is presented to test and validate the present element.

Magnesium Content of the Core: an Experimental Study

NASA Astrophysics Data System (ADS)

Fiquet, G.; Badro, J.; Auzende, A.; Siebert, J.; Gregoryanz, E.; Guignot, N.

2006-12-01

There is still a considerable debate about which light element among sulfur, silicon, oxygen, carbon or hydrogen should be in the core [Poirier, Phys. Earth Planet. Int., 85, 319, 1994]. The nature and distribution of these elements is a standing problem of prime importance, since it controls the freezing point depression at the inner core boundary. In addition to these candidates, new elements have been recently proposed as iron alloying constituants for the core, such as magnesium [Dubrovinskaia et al., Phys. Rev. Lett., 95, 245502, 2005]. We present series of experiments carried out on hot-pressed samples of iron and periclase in a laser-heated diamond-anvil cell, combined with in situ X-ray diffraction analysis and ATEM examination of recovered samples. We show that even at megabar pressures the amount of magnesium released in iron from the equilibrium with magnesium oxide is marginal. This finding is at odds with the 10 at% of magnesium found by Dubrovinskaia et al. [2005] in an iron alloy made from the reaction between iron and a metallic magnesium foil. Our observations suggest that magnesium is unlikely to be an important light element in the Earth's core. In addition, we provide structural data for iron to 130 GPa in excess of 3000 K with reliable pressure and temperature measurements, which enable us to propose a new thermal equation of state for iron at megabar pressures.

Study of Core Competency Elements and Factors Affecting Performance Efficiency of Government Teachers in Northeastern Thailand

ERIC Educational Resources Information Center

Chansirisira, Pacharawit

2012-01-01

The research aimed to investigate the core competency elements and the factors affecting the performance efficiency of the civil service teachers in the northeastern region, Thailand. The research procedure consisted of two steps. In the first step, the data were collected using a questionnaire with the reliability (Cronbach's Alpha) of 0.90. The…

Drill core major, trace and rare earth element anlayses from wells RN-17B and RN-30, Reykjanes, Iceland

DOE Data Explorer

Andrew Fowler

2015-04-01

Analytical results for X-ray fluorescence (XRF) and inductively coupled plasma mass spectrometry (ICP-MS) measurement of major, trace and rare earth elements in drill core from geothermal wells in Reykjanes, Iceland. Total Fe was analyzed as FeO, therefore is not included under the Fe2O3 column.

FUEL ELEMENT FOR NUCLEAR REACTORS

DOEpatents

Dickson, J.J.

1963-09-24

A method is described whereby fuel tubes or pins are cut, loaded with fuel pellets and a heat transfer medium, sealed at each end with slotted fittings, and assembled into a rectangular tube bundle to form a fuel element. The tubes comprising the fuel element are laterally connected between their ends by clips and tabs to form a linear group of spaced parallel tubes, which receive their vertical support by resting on a grid. The advantages of this method are that it permits elimination of structural material (e.g., fuel-element cans) within the reactor core, and removal of at least one fuel pin from an element and replacement thereof so that a burnable poison may be utilized during the core lifetime. (AEC)

Experimental and computational studies on the femoral fracture risk for advanced core decompression.

PubMed

Tran, T N; Warwas, S; Haversath, M; Classen, T; Hohn, H P; Jäger, M; Kowalczyk, W; Landgraeber, S

2014-04-01

Two questions are often addressed by orthopedists relating to core decompression procedure: 1) Is the core decompression procedure associated with a considerable lack of structural support of the bone? and 2) Is there an optimal region for the surgical entrance point for which the fracture risk would be lowest? As bioresorbable bone substitutes become more and more common and core decompression has been described in combination with them, the current study takes this into account. Finite element model of a femur treated by core decompression with bone substitute was simulated and analyzed. In-vitro compression testing of femora was used to confirm finite element results. The results showed that for core decompression with standard drilling in combination with artificial bone substitute refilling, daily activities (normal walking and walking downstairs) are not risky for femoral fracture. The femoral fracture risk increased successively when the entrance point is located further distal. The critical value of the deviation of the entrance point to a more distal part is about 20mm. The study findings demonstrate that optimal entrance point should locate on the proximal subtrochanteric region in order to reduce the subtrochanteric fracture risk. Furthermore the consistent results of finite element and in-vitro testing imply that the simulations are sufficient. Copyright © 2014 Elsevier Ltd. All rights reserved.

Post-Buckling Analysis of Curved Honeycomb Sandwich Panels Containing Interfacial Disbonds

NASA Technical Reports Server (NTRS)

Pineda, Evan J.; Bednarcyk, Brett A.; Krivanek, Thomas K.

2016-01-01

A numerical study on the effect of facesheet-core disbonds on the post-buckling response of curved honeycomb sandwich panels is presented herein. This work was conducted as part of the development of a damage tolerance plan for the next-generation Space Launch System heavy lift launch vehicle payload fairing. As such, the study utilized full-scale fairing barrel segments as the structure of interest. The panels were composed of carbon fiber reinforced polymer facesheets and aluminum honeycomb core. The panels were analyzed numerically using the finite element method incorporating geometric nonlinearity. In a predetermined circular region, facesheet and core nodes were detached to simulate a disbond, between the outer mold line facesheet and honeycomb core, induced via low-speed impact. Surface-to-surface contact in the disbonded region was invoked to prevent interpenetration of the facesheet and core elements and obtain realistic stresses in the core. The diameter of this disbonded region was varied and the effect of the size of the disbond on the post-buckling response was observed. Significant changes in the slope of the edge load-deflection response were used to determine the onset of global buckling and corresponding buckling load. Finally, several studies were conducted to determine the sensitivity of the numerical predictions to refinement in the finite element mesh.

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator.

PubMed

Hendy, Jane; Chrysanthaki, Theopisti; Barlow, James; Knapp, Martin; Rogers, Anne; Sanders, Caroline; Bower, Peter; Bowen, Robert; Fitzpatrick, Ray; Bardsley, Martin; Newman, Stanton

2012-11-15

To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Case-studies of three sites forming the UK Department of Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.

Development and validation of the Medical Home Care Coordination Survey for assessing care coordination in the primary care setting from the patient and provider perspectives.

PubMed

Zlateva, Ianita; Anderson, Daren; Coman, Emil; Khatri, Khushbu; Tian, Terrence; Fifield, Judith

2015-06-07

Community health centers are increasingly embracing the Patient Centered Medical Home (PCMH) model to improve quality, access to care, and patient experience while reducing healthcare costs. Care coordination (CC) is an important element of the PCMH model, but implementation and measurability of CC remains a problem within the outpatient setting. Assessing CC is an integral component of quality monitoring in health care systems. This study developed and validated the Medical Home Care Coordination Survey (MHCCS), to fill the gap in assessing CC in primary care from the perspectives of patients and their primary healthcare teams. We conducted a review of relevant literature and existing care coordination instruments identified by bibliographic search and contact with experts. After identifying all care coordination domains that could be assessed by primary healthcare team members and patients, we developed a conceptual model. Potentially appropriate items from existing published CC measures, along with newly developed items, were matched to each domain for inclusion. A modified Delphi approach was used to establish content validity. Primary survey data was collected from 232 patients with care transition and/or complex chronic illness needs from the Community Health Center, Inc. and from 164 staff members from 12 community health centers across the country via mail, phone and online survey. The MHCCS was validated for internal consistency, reliability, discriminant and convergent validity. This study was conducted at the Community Health Center, Inc. from January 15, 2012 to July 15, 2014. The 13-item MHCCS - Patient and the 32-item MHCCS - Healthcare Team were developed and validated. Exploratory Structural Equation Modeling was used to test the hypothesized domain structure. Four CC domains were confirmed from the patient group and eight were confirmed from the primary healthcare team group. All domains had high reliability (Cronbach's α scores were above 0.8). Patients experience the ultimate output of care coordination services, but primary healthcare staff members are best primed to perceive many of the structural elements of care coordination. The proactive measurement and monitoring of the core domains from both perspectives provides a richer body of information for the continuous improvement of care coordination services. The MHCCS shows promise as a valid and reliable assessment of these CC efforts.

Geriatric core competencies for family medicine curriculum and enhanced skills: care of elderly.

PubMed

Charles, Lesley; Triscott, Jean A C; Dobbs, Bonnie M; McKay, Rhianne

2014-06-01

There is a growing mandate for Family Medicine residency programs to directly assess residents' clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit.

Hyper Text Mark-up Language and Dublin Core metadata element set usage in websites of Iranian State Universities' libraries.

PubMed

Zare-Farashbandi, Firoozeh; Ramezan-Shirazi, Mahtab; Ashrafi-Rizi, Hasan; Nouri, Rasool

2014-01-01

Recent progress in providing innovative solutions in the organization of electronic resources and research in this area shows a global trend in the use of new strategies such as metadata to facilitate description, place for, organization and retrieval of resources in the web environment. In this context, library metadata standards have a special place; therefore, the purpose of the present study has been a comparative study on the Central Libraries' Websites of Iran State Universities for Hyper Text Mark-up Language (HTML) and Dublin Core metadata elements usage in 2011. The method of this study is applied-descriptive and data collection tool is the check lists created by the researchers. Statistical community includes 98 websites of the Iranian State Universities of the Ministry of Health and Medical Education and Ministry of Science, Research and Technology and method of sampling is the census. Information was collected through observation and direct visits to websites and data analysis was prepared by Microsoft Excel software, 2011. The results of this study indicate that none of the websites use Dublin Core (DC) metadata and that only a few of them have used overlaps elements between HTML meta tags and Dublin Core (DC) elements. The percentage of overlaps of DC elements centralization in the Ministry of Health were 56% for both description and keywords and, in the Ministry of Science, were 45% for the keywords and 39% for the description. But, HTML meta tags have moderate presence in both Ministries, as the most-used elements were keywords and description (56%) and the least-used elements were date and formatter (0%). It was observed that the Ministry of Health and Ministry of Science follows the same path for using Dublin Core standard on their websites in the future. Because Central Library Websites are an example of scientific web pages, special attention in designing them can help the researchers to achieve faster and more accurate information resources. Therefore, the influence of librarians' ideas on the awareness of web designers and developers will be important for using metadata elements as general, and specifically for applying such standards.

Hyper Text Mark-up Language and Dublin Core metadata element set usage in websites of Iranian State Universities’ libraries

PubMed Central

Zare-Farashbandi, Firoozeh; Ramezan-Shirazi, Mahtab; Ashrafi-Rizi, Hasan; Nouri, Rasool

2014-01-01

Introduction: Recent progress in providing innovative solutions in the organization of electronic resources and research in this area shows a global trend in the use of new strategies such as metadata to facilitate description, place for, organization and retrieval of resources in the web environment. In this context, library metadata standards have a special place; therefore, the purpose of the present study has been a comparative study on the Central Libraries’ Websites of Iran State Universities for Hyper Text Mark-up Language (HTML) and Dublin Core metadata elements usage in 2011. Materials and Methods: The method of this study is applied-descriptive and data collection tool is the check lists created by the researchers. Statistical community includes 98 websites of the Iranian State Universities of the Ministry of Health and Medical Education and Ministry of Science, Research and Technology and method of sampling is the census. Information was collected through observation and direct visits to websites and data analysis was prepared by Microsoft Excel software, 2011. Results: The results of this study indicate that none of the websites use Dublin Core (DC) metadata and that only a few of them have used overlaps elements between HTML meta tags and Dublin Core (DC) elements. The percentage of overlaps of DC elements centralization in the Ministry of Health were 56% for both description and keywords and, in the Ministry of Science, were 45% for the keywords and 39% for the description. But, HTML meta tags have moderate presence in both Ministries, as the most-used elements were keywords and description (56%) and the least-used elements were date and formatter (0%). Conclusion: It was observed that the Ministry of Health and Ministry of Science follows the same path for using Dublin Core standard on their websites in the future. Because Central Library Websites are an example of scientific web pages, special attention in designing them can help the researchers to achieve faster and more accurate information resources. Therefore, the influence of librarians’ ideas on the awareness of web designers and developers will be important for using metadata elements as general, and specifically for applying such standards. PMID:24741646

From spouse to caregiver and back: a grounded theory study of post-intensive care unit spousal caregiving.

PubMed

Ågård, Anne Sophie; Egerod, Ingrid; Tønnesen, Else; Lomborg, Kirsten

2015-08-01

To explore the challenges and caring activities of spouses of intensive care unit survivors during the first year of patient recovery. Every year, millions of people globally are discharged from an intensive care unit after critical illness to continue treatment, care and rehabilitation in general hospital wards, rehabilitation facilities and at home. Consequently, millions of spouses become informal caregivers. Little is known, however, about the concrete challenges spouses face in post-intensive care unit everyday life. Explorative, qualitative grounded theory study. Participants were spouses of intensive care unit survivors. The study was undertaken in Denmark in 2009-2010. Data consisted of 35 semi-structured dyad interviews at 3 and 12 months post-intensive care unit discharge, two group interviews with patients and two with spouses. 'Shifting their role from spouse to caregiver and back' was identified as the core category of the study. The role shifts progressed in a dynamic process involving four elements: (1) committing to caregiving; (2) acquiring caregiving skills; (3) negotiating level of caregiving and (4) gradually leaving the caregiver role. Post-ICU caregiving comprised five patient dimensions: observing, assisting, coaching, advocating and managing activities. Spouses play a vital and multifaceted role in post-intensive care unit recovery. The findings can inform healthcare professionals in their efforts to prepare intensive care unit patients' families for the time following intensive care unit and hospital discharge. Hospital staff, rehabilitation experts and primary care professionals must acknowledge spouses' important contribution from intensive care unit admission throughout recovery. © 2015 John Wiley & Sons Ltd.

Interaction between two cis-acting elements, ABRE and DRE, in ABA-dependent expression of Arabidopsis rd29A gene in response to dehydration and high-salinity stresses.

PubMed

Narusaka, Yoshihiro; Nakashima, Kazuo; Shinwari, Zabta K; Sakuma, Yoh; Furihata, Takashi; Abe, Hiroshi; Narusaka, Mari; Shinozaki, Kazuo; Yamaguchi-Shinozaki, Kazuko

2003-04-01

Many abiotic stress-inducible genes contain two cis-acting elements, namely a dehydration-responsive element (DRE; TACCGACAT) and an ABA-responsive element (ABRE; ACGTGG/TC), in their promoter regions. We precisely analyzed the 120 bp promoter region (-174 to -55) of the Arabidopsis rd29A gene whose expression is induced by dehydration, high-salinity, low-temperature, and abscisic acid (ABA) treatments and whose 120 bp promoter region contains the DRE, DRE/CRT-core motif (A/GCCGAC), and ABRE sequences. Deletion and base substitution analyses of this region showed that the DRE-core motif functions as DRE and that the DRE/DRE-core motif could be a coupling element of ABRE. Gel mobility shift assays revealed that DRE-binding proteins (DREB1s/CBFs and DREB2s) bind to both DRE and the DRE-core motif and that ABRE-binding proteins (AREBs/ABFs) bind to ABRE in the 120 bp promoter region. In addition, transactivation experiments using Arabidopsis leaf protoplasts showed that DREBs and AREBs cumulatively transactivate the expression of a GUS reporter gene fused to the 120 bp promoter region of rd29A. These results indicate that DRE and ABRE are interdependent in the ABA-responsive expression of the rd29A gene in response to ABA in Arabidopsis.

Organizational readiness for knowledge translation in chronic care: a Delphi study.

PubMed

Attieh, Randa; Gagnon, Marie-Pierre; Estabrooks, Carole A; Légaré, France; Ouimet, Mathieu; Vazquez, Patricia; Nuño, Roberto

2014-11-08

Health-care organizations need to be ready prior to implement evidence-based interventions. In this study, we sought to achieve consensus on a framework to assess the readiness of health-care organizations to implement evidence-based interventions in the context of chronic care. We conducted a web-based modified Delphi study between March and May 2013. We contacted 76 potentially eligible international experts working in the fields of organizational readiness (OR), knowledge translation (KT), and chronic care to comment upon the 76 elements resulting from our proposed conceptual map. This conceptual map was based on a systematic review of the existing frameworks of Organizational Readiness for Change (ORC) in health-care. We developed a conceptual map that proposed a set of core concepts and their associated 17 dimensions and 59 sub-dimensions. Experts rated their agreement concerning the applicability and importance of ORC elements on a 5-point Likert scale, where 1 indicates total disagreement and 5 indicates total agreement. Two rounds were needed to get a consensus from the experts. Consensus was a priori defined as strong (≥75%) or moderate (60-74%). Simple descriptive statistics was used. In total, 14 participants completed the first round and 10 completed the two rounds. Panel members reached consensus on the applicability and importance of 6 out of 17 dimensions and 28 out of 59 sub-dimensions to assess OR for KT in the context of chronic care. A strong level of consensus (≥75%) was attained on the Organizational contextual factors, Leadership/participation, Organizational support, and Motivation dimensions. The Organizational climate for change and Change content dimensions reached a moderate consensus (60-74%). Experts also reached consensus on 28 out of 59 sub-dimensions to assess OR for KT. Twenty-one sub-dimensions reached a strong consensus (≥75%) and seven a moderate consensus (60-74%). This study results provided the most important and applicable dimensions and sub-dimensions for assessing OR-KT in the context of chronic care. They can be used to guide the design of an assessment tool to improve knowledge translation in the field of chronic care.

10 CFR 55.41 - Written examination: Operators.

Code of Federal Regulations, 2011 CFR

2011-01-01

... coefficients, and poison effects. (2) General design features of the core, including core structure, fuel elements, control rods, core instrumentation, and coolant flow. (3) Mechanical components and design... changes, and operating limitations and reasons for these operating characteristics. (6) Design, components...

10 CFR 55.41 - Written examination: Operators.

Code of Federal Regulations, 2010 CFR

2010-01-01

... coefficients, and poison effects. (2) General design features of the core, including core structure, fuel elements, control rods, core instrumentation, and coolant flow. (3) Mechanical components and design... changes, and operating limitations and reasons for these operating characteristics. (6) Design, components...

10 CFR 55.41 - Written examination: Operators.

Code of Federal Regulations, 2012 CFR

2012-01-01

... coefficients, and poison effects. (2) General design features of the core, including core structure, fuel elements, control rods, core instrumentation, and coolant flow. (3) Mechanical components and design... changes, and operating limitations and reasons for these operating characteristics. (6) Design, components...

The Combined Strength of Thermodynamics and Comparative Planetology: Application of Activity Models to Core Formation in Terrestrial Bodies

NASA Technical Reports Server (NTRS)

Righter, K.; Pando, K. M.; Danielson, L. R.

2015-01-01

Recent models for accretion of terrestrial bodies involve metal-silicate equilibrium as the metallic core formed during growth. Most elements considered are either refractory or well studied elements for which effects of pressure, temperature, oxygen fugacity, and metallic liquid composition are well known. There are a large number of elements that are both siderophile and volatile, whose fate in such models is unknown, largely due to a lack of data at comparable conditions and com-positions (FeNi core with light elements such as S, C, Si, and O). We have focused on Ge, In, As, Sb and determined the effect of Si and C on metal-silicate partitioning, and developed a thermo-dynamic model that allows application of these new data to a wide range of planetary bodies. New experiments: We have previously carried out experiments with FeSi metallic liquid at C-saturated conditions at 1600 and 1800 C [4]. In a new series of experiments we investigate the effect of Si in carbon-free systems at 1600 C for comparison. Experiments were carried out at 1 GPa in MgO capsules using the same basaltic starting composition as in previous studies. The MgO capsule reacts with the silicate melt to form more MgO-rich liquids that have 22-26 wt% MgO. Experimental met-als and silicates were analyzed using a combination of electron microprobe analysis and laser ablation ICP-MS. Results: The new results can be interpreted by considering Ge as an example, in the simple exchange equilibrium Fe + GeO = FeO + Ge, where the equilibrium constant Kd can be examined as a function of Si content of the metal. The slope of lnKd vs. (1-XSi) for this new series allows derivation of the epsilon interaction parameter for each of these four elements and Si (both C-saturated and C-free).All four elements have positive epsilon values, indicating that Si causes a decrease in the partition coefficients; values are 6.6, 6.5, 27.8 and 25.2 for In, Ge, As, and Sb, respectively, at 1 GPa and 1600 C. As an example of how large the effect of Si can be, these epsilon values correspond to activity coefficients (gamma) for As of 0.01 when XSi = 0, and up to gamma = 23 when XSi = 0.2. Combining these new results with previous determinations [5,6] of epsilon parameters for S and C for these elements allows us calculate activity of Ge, In, As, and Sb in Fe-Ni-Si-S-C-O metallic liquids. We apply this new model to sever-al terrestrial bodies such as Earth (Si-rich core), Mars (S-rich core), Moon (S-, C-, and Si-poor core), and Vesta, and examine the resulting core and mantle concentrations of these elements. Mantle concentrations of these four elements are well explained for Earth and Mars in models that call for mid-mantle equilibration between Si-bearing and S-bearing FeNi cores, respectively. Modeling results for the Moon and Vesta will also be presented.

The Common Core of a Child Care Center. Child Care Facility Design.

ERIC Educational Resources Information Center

Moore, Gary T.

1997-01-01

Examines the notion of an early childhood education center organized as a series of houses around a common core of shared facilities. Discusses examples of child-care centers in Sweden and explores ideas that can promote functional facilities. Suggestions include ideas about physical-motor activities areas, administration offices, centralized…

Critical elements of culturally competent communication in the medical encounter: a review and model.

PubMed

Teal, Cayla R; Street, Richard L

2009-02-01

Increasing the cultural competence of physicians is one means of responding to demographic changes in the USA, as well as reducing health disparities. However, in spite of the development and implementation of cultural competence training programs, little is known about the ways cultural competence manifests itself in medical encounters. This paper will present a model of culturally competent communication that offers a framework of studying cultural competence 'in action.' First, we describe four critical elements of culturally competent communication in the medical encounter--communication repertoire, situational awareness, adaptability, and knowledge about core cultural issues. We present a model of culturally competent physician communication that integrates existing frameworks for cultural competence in patient care with models of effective patient-centered communication. The culturally competent communication model includes five communication skills that are depicted as elements of a set in which acquisition of more skills corresponds to increasing complexity and culturally competent communication. The culturally competent communication model utilizes each of the four critical elements to fully develop each skill and apply increasingly sophisticated, contextually appropriate communication behaviors to engage with culturally different patients in complex interactions. It is designed to foster maximum physician sensitivity to cultural variation in patients as the foundation of physician-communication competence in interacting with patients.

Nuclear reactor

DOEpatents

Thomson, Wallace B.

2004-03-16

A nuclear reactor comprising a cylindrical pressure vessel, an elongated annular core centrally disposed within and spaced from the pressure vessel, and a plurality of ducts disposed longitudinally of the pressure vessel about the periphery thereof, said core comprising an annular active portion, an annular reflector just inside the active portion, and an annular reflector just outside the active a portion, said annular active portion comprising rectangular slab, porous fuel elements radially disposed around the inner reflector and extending the length of the active portion, wedge-shaped, porous moderator elements disposed adjacent one face of each fuel element and extending the length of the fuel element, the fuel and moderator elements being oriented so that the fuel elements face each other and the moderator elements do likewise, adjacent moderator elements being spaced to provide air inlet channels, and adjacent fuel elements being spaced to provide air outlet channels which communicate with the interior of the peripheral ducts, and means for introducing air into the air inlet channels which passes through the porous moderator elements and porous fuel elements to the outlet channel.

Critical Care Organizations: Building and Integrating Academic Programs.

PubMed

Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir

2018-04-01

Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical care programs to transition to integrated Critical Care Organizations within academic medical centers and provide recommendations and resources to facilitate this transition and foster Critical Care Organization effectiveness and future success.

[Human resources for health in Ecuador's new model of care].

PubMed

Espinosa, Verónica; de la Torre, Daniel; Acuña, Cecilia; Cadena, Cristina

2017-06-08

Describe strategies implemented by Ecuador's Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012-2015. A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform's objectives. Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

A Life Participation Approach to Primary Progressive Aphasia Intervention.

PubMed

Rogalski, Emily J; Khayum, Becky

2018-07-01

Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by deficits in spoken and written word retrieval, word usage, and/or word comprehension. Currently, there are no effective treatments to reverse or halt the underlying disease process; however, speech-language therapy may be helpful. The Communication Bridge Care Model was developed to address the unique communication and quality of life needs of individuals living with PPA. The core elements include person-centered care with dyadic instruction for disease education, and counseling, along with tailored levels of impairment- and compensatory-based communication strategy training. Our multicomponent approach incorporates guidance from the Life Participation Approach for Aphasia, including client-directed assessment and interventions that aim to maximize functional communication and participation in desired life activities. The direct and indirect use of technology is integrated into our tailored model of care to facilitate achievement of the client's functional goals. Here, we describe how to practically apply the Communication Bridge Care Model across treatment settings, including case examples from the Communication Bridge research study. This approach to care provides an opportunity to maximize communication effectiveness and quality of life for individuals living with PPA throughout the course of disease. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Radiated Sound Power from a Curved Honeycomb Panel

NASA Technical Reports Server (NTRS)

Robinson, Jay H.; Buehrle, Ralph D.; Klos, Jacob; Grosveld, Ferdinand W.

2003-01-01

The validation of finite element and boundary element model for the vibro-acoustic response of a curved honeycomb core composite aircraft panel is completed. The finite element and boundary element models were previously validated separately. This validation process was hampered significantly by the method in which the panel was installed in the test facility. The fixture used was made primarily of fiberboard and the panel was held in a groove in the fiberboard by a compression fitting made of plastic tubing. The validated model is intended to be used to evaluate noise reduction concepts from both an experimental and analytic basis simultaneously. An initial parametric study of the influence of core thickness on the radiated sound power from this panel, using this numerical model was subsequently conducted. This study was significantly influenced by the presence of strong boundary condition effects but indicated that the radiated sound power from this panel was insensitive to core thickness primarily due to the offsetting effects of added mass and added stiffness in the frequency range investigated.

Nuclear fuel elements having a composite cladding

DOEpatents

Gordon, Gerald M.; Cowan, II, Robert L.; Davies, John H.

1983-09-20

An improved nuclear fuel element is disclosed for use in the core of nuclear reactors. The improved nuclear fuel element has a composite cladding of an outer portion forming a substrate having on the inside surface a metal layer selected from the group consisting of copper, nickel, iron and alloys of the foregoing with a gap between the composite cladding and the core of nuclear fuel. The nuclear fuel element comprises a container of the elongated composite cladding, a central core of a body of nuclear fuel material disposed in and partially filling the container and forming an internal cavity in the container, an enclosure integrally secured and sealed at each end of said container and a nuclear fuel material retaining means positioned in the cavity. The metal layer of the composite cladding prevents perforations or failures in the cladding substrate from stress corrosion cracking or from fuel pellet-cladding interaction or both. The substrate of the composite cladding is selected from conventional cladding materials and preferably is a zirconium alloy.

Potassium-bearing Iron-Nickel Sulfides in Nature and High-Pressure Experiments: Geochemical Consequences of Potassium in the Earth's Core

NASA Technical Reports Server (NTRS)

Keshav, S.; Corgne, A.; McDonough, W. F.; Fei, Y.

2005-01-01

Introduction: Potassium (K) as a large ion lithophile element has dominantly been concentrated in the Earth s crust and the mantle through differentiation, and in the form of K-40 contributes to the planet s heat budget. However, whether or not K also enters core-forming phases, has been debated for over three decades. Arguments favoring entry of K in the core are based on: (1) K-sulfide (with Fe, Ni, Cu, Na, and Cl; djerfisherite) found in highly reduced enstatite chondrites (or aubrites, enstatite achondrites); (2) demonstration that K, owing to an s-d electronic switch at high-pressure, exhibits transition- element like character, (3) solubility of measurable K in Fe-Ni-S liquids at high pressure, temperature conditions, and (4) models of cooling of the core that seem to require, besides convection, some form of radioactivity, and thus lending support to the experimental work. In this contribution, we assess the effect of sequestering K in the core, as it is perhaps an element that is a key to reconciling geochemistry, paleomagnetism, accretion, and thermal evolution models for the planet.

Fast elemental screening of soil and sediment profiles using small-spot energy-dispersive X-ray fluorescence: application to mining sediments geochemistry.

PubMed

Gonzalez-Fernandez, Oscar; Queralt, Ignacio

2010-09-01

Elemental analysis of different sediment cores originating from the Cartagena-La Union mining district in Spain was carried out by means of a programmable small-spot energy-dispersive X-ray fluorescence (EDXRF) spectrometer to study the distribution of heavy metals along soil profiles. Cores were obtained from upstream sediments of a mining creek, from the lowland sedimentation plain, and from a mining landfill dump (tailings pile). A programmable two-dimensional (2D) stage and a focal spot resolution of 600 μm allow us to obtain complete core mapping. Geochemical results were verified using a more powerful wavelength-dispersion X-ray fluorescence (WDXRF) technique. The data obtained was processed in order to study the statistical correlations within the elemental compositions. The results obtained allow us to observe the differential in-depth distribution of heavy metals among the sampled zones. Dump site cores exhibit a homogeneous distribution of heavy metals, whereas the alluvial plain core shows accumulation of heavy metals in the upper part. This approach can be useful for the fast screening of heavy metals in depositional environments around mining sites.

SLS Test Stand Site Selection

NASA Technical Reports Server (NTRS)

Crowe, Kathryn; Williams, Michael

2015-01-01

Test site selection is a critical element of the design, development and production of a new system. With the advent of the new Space Launch System (SLS), the National Aeronautics and Space Administration (NASA) had a number of test site selection decisions that needed to be made early enough in the Program to support the planned Launch Readiness Date (LRD). This case study focuses on decisions that needed to be made in 2011 and 2012 in preparation for the April 2013 DPMC decision about where to execute the Main Propulsion Test that is commonly referred to as "Green Run." Those decisions relied upon cooperative analysis between the Program, the Test Lab and Center Operations. The SLS is a human spaceflight vehicle designed to carry a crew farther into space than humans have previously flown. The vehicle consists of four parts: the crew capsule, the upper stage, the core stage, and the first stage solid rocket boosters. The crew capsule carries the astronauts, while the upper stage, the core stage, and solid rocket boosters provide thrust for the vehicle. In other words, the stages provide the "lift" part of the lift vehicle. In conjunction with the solid rocket boosters, the core stage provides the initial "get-off-the-ground" thrust to the vehicle. The ignition of the four core stage engines and two solid rocket boosters is the first step in the launch portion of the mission. The solid rocket boosters burn out after about 2 minutes of flight, and are then jettisoned. The core stage provides thrust until the vehicle reaches a specific altitude and speed, at which point the core stage is shut off and jettisoned, and the upper stage provides vehicle thrust for subsequent mission trajectories. The integrated core stage primarily consists of a liquid oxygen tank, a liquid hydrogen tank, and the four core stage engines. For the SLS program, four RS-25 engines were selected as the four core stage engines. The RS-25 engine is the same engine that was used for Space Shuttle. The test plan for the integrated core stage was broken down into several segments: Component testing, system level testing, and element level testing. In this context, components are items such as valves, controllers, sensors, etc. Systems are items such as an entire engine, a tank, or the outer stage body. The core stage itself is considered to be an element. The rocket engines are also considered an element. At the program level, it was decided to perform a single green run test on the integrated core stage prior to shipment of it to Kennedy Space Center (KSC) for use in the EM-1 test flight of the SLS vehicle. A green run test is the first live fire of the new integrated core stage and engine elements - without boosters of course. The SLS Program had to decide where to perform SLS green run testing.

METHOD AND APPARATUS FOR IMPROVING PERFORMANCE OF A FAST REACTOR

DOEpatents

Koch, L.J.

1959-01-20

A specific arrangement of the fertile material and fissionable material in the active portion of a fast reactor to achieve improvement in performance and to effectively lower the operating temperatures in the center of the reactor is described. According to this invention a group of fuel elements containing fissionable material are assembled to form a hollow fuel core. Elements containing a fertile material, such as depleted uranium, are inserted into the interior of the fuel core to form a central blanket. Additional elemenis of fertile material are arranged about the fuel core to form outer blankets which in tunn are surrounded by a reflector. This arrangement of fuel core and blankets results in substantial flattening of the flux pattern.

Automating the generation of finite element dynamical cores with Firedrake

NASA Astrophysics Data System (ADS)

Ham, David; Mitchell, Lawrence; Homolya, Miklós; Luporini, Fabio; Gibson, Thomas; Kelly, Paul; Cotter, Colin; Lange, Michael; Kramer, Stephan; Shipton, Jemma; Yamazaki, Hiroe; Paganini, Alberto; Kärnä, Tuomas

2017-04-01

The development of a dynamical core is an increasingly complex software engineering undertaking. As the equations become more complete, the discretisations more sophisticated and the hardware acquires ever more fine-grained parallelism and deeper memory hierarchies, the problem of building, testing and modifying dynamical cores becomes increasingly complex. Here we present Firedrake, a code generation system for the finite element method with specialist features designed to support the creation of geoscientific models. Using Firedrake, the dynamical core developer writes the partial differential equations in weak form in a high level mathematical notation. Appropriate function spaces are chosen and time stepping loops written at the same high level. When the programme is run, Firedrake generates high performance C code for the resulting numerics which are executed in parallel. Models in Firedrake typically take a tiny fraction of the lines of code required by traditional hand-coding techniques. They support more sophisticated numerics than are easily achieved by hand, and the resulting code is frequently higher performance. Critically, debugging, modifying and extending a model written in Firedrake is vastly easier than by traditional methods due to the small, highly mathematical code base. Firedrake supports a wide range of key features for dynamical core creation: A vast range of discretisations, including both continuous and discontinuous spaces and mimetic (C-grid-like) elements which optimally represent force balances in geophysical flows. High aspect ratio layered meshes suitable for ocean and atmosphere domains. Curved elements for high accuracy representations of the sphere. Support for non-finite element operators, such as parametrisations. Access to PETSc, a world-leading library of programmable linear and nonlinear solvers. High performance adjoint models generated automatically by symbolically reasoning about the forward model. This poster will present the key features of the Firedrake system, as well as those of Gusto, an atmospheric dynamical core, and Thetis, a coastal ocean model, both of which are written in Firedrake.

Patient perspectives of an individualized diabetes care management plan

PubMed Central

Saucier, Ashley N.; Ansa, Benjamin; Coffin, Janis; Akhtar, Mariam; Miller, Andre; Mahoney, Holly; Hodo, Denise M.; Duffie, Carla; Fontenot, Brittney; Andrews, Holly E.; Smith, Selina A.

2017-01-01

Purpose This cross sectional study examines patients’ knowledge, attitudes and beliefs about a diabetic care management plan (DCMP) that was developed to provide patient education on diabetes guidelines and display individual diabetic core measures. Secondary objectives included a comparison of diabetic core measures [hemoglobin A1C (HbA1C), systolic and diastolic blood pressure (SBP, DBP), low-density lipoprotein (LDL) and urine microalbumin (Um)] before and after DCMP implementation. We hypothesize this tool will contribute to patients’ awareness of current disease status, diabetes knowledge and diabetic core value improvement over time. Methods A consecutive sample of 102 adult patients with diabetes mellitus type 2 in a primary care setting participated. Patients’ perspectives on the care plan and knowledge about diabetes was collected via survey after care plan implementation. A comparison of selected diabetic core measures was conducted at baseline and post-DCMP. Descriptive statistics summarized survey response and diabetic core measures. A repeated measures ANOVA was used to assess change in diabetic core measures over time. Results Participants understood the DCMP (96%), found it important because it explained their laboratory results and medications (89%) and believed it would help them to have better diabetic control (99%). There was a significant interaction between time and being at goal pre-DCMP for HbA1c, SBP and LDL. Patients not at goal pre-DCMP for the above measures decreased significantly over time (P = <0.01 for HbA1c, SBP and LDL). Participants at goal for all diabetic core measures increased pre- to post-DCMP from 13% to 20% (P = 0.28). Conclusion Patients perceived the diabetic care management plan favorably and their diabetic core measurements improved over time. This simple and reproducible self-management intervention can enhance self-management in a patient population with diabetes mellitus type 2. PMID:28835847

Isolation and functional characterization of TIF-IB, a factor that confers promoter specificity to mouse RNA polymerase I.

PubMed

Schnapp, A; Clos, J; Hädelt, W; Schreck, R; Cvekl, A; Grummt, I

1990-03-25

The murine ribosomal gene promoter contains two cis-acting control elements which operate in concert to promote efficient and accurate transcription initiation by RNA polymerase I. The start site proximal core element which is indispensable for promoter recognition by RNA polymerase I (pol I) encompasses sequences from position -39 to -1. An upstream control element (UCE) which is located between nucleotides -142 and -112 stimulates the efficiency of transcription initiation both in vivo and in vitro. Here we report the isolation and functional characterization of a specific rDNA binding protein, the transcription initiation factor TIF-IB, which specifically interacts with the core region of the mouse ribosomal RNA gene promoter. Highly purified TIF-IB complements transcriptional activity in the presence of two other essential initiation factors TIF-IA and TIF-IC. We demonstrate that the binding efficiency of purified TIF-IB to the core promoter is strongly enhanced by the presence in cis of the UCE. This positive effect of upstream sequences on TIF-IB binding is observed throughout the purification procedure suggesting that the synergistic action of the two distant promoter elements is not mediated by a protein different from TIF-IB. Increasing the distance between both control elements still facilitates stable factor binding but eliminates transcriptional activation. The results demonstrate that TIF-IB binding to the rDNA promoter is an essential early step in the assembly of a functional transcription initiation complex. The subsequent interaction of TIF-IB with other auxiliary transcription initiation factors, however, requires the correct spacing between the UCE and the core promoter element.

High-pressure melting experiments on Fe-Si alloys and implications for silicon as a light element in the core

NASA Astrophysics Data System (ADS)

Ozawa, Haruka; Hirose, Kei; Yonemitsu, Kyoko; Ohishi, Yasuo

2016-12-01

We carried out melting experiments on Fe-Si alloys to 127 GPa in a laser-heated diamond-anvil cell (DAC). On the basis of textural and chemical characterizations of samples recovered from a DAC, a change in eutectic liquid composition in the Fe-FeSi binary system was examined with increasing pressure. The chemical compositions of coexisting liquid and solid phases were quantitatively determined with field-emission-type electron microprobes. The results demonstrate that silicon content in the eutectic liquid decreases with increasing pressure to less than 1.5 ± 0.1 wt.% Si at 127 GPa. If silicon is a single light element in the core, 4.5 to 12 wt.% Si is required in the outer core in order to account for its density deficit from pure iron. However, such a liquid core, whose composition is on the Si-rich side of the eutectic point, crystallizes less dense solid, CsCl (B2)-type phase at the inner core boundary (ICB). Our data also show that the difference in silicon concentration between coexisting solid and liquid is too small to account for the observed density contrast across the ICB. These indicate that silicon cannot be the sole light element in the core. Previous geochemical and cosmochemical arguments, however, strongly require ∼6 wt.% Si in the core. It is possible that the Earth's core originally included ∼6 wt.% Si but then became depleted in silicon by crystallizing SiO2 or MgSiO3.

A Comprehensive Plan for the Long-Term Calibration and Validation of Oceanic Biogeochemical Satellite Data

NASA Technical Reports Server (NTRS)

Hooker, Stanford B.; McClain, Charles R.; Mannino, Antonio

2007-01-01

The primary objective of this planning document is to establish a long-term capability and validating oceanic biogeochemical satellite data. It is a pragmatic solution to a practical problem based primarily o the lessons learned from prior satellite missions. All of the plan's elements are seen to be interdependent, so a horizontal organizational scheme is anticipated wherein the overall leadership comes from the NASA Ocean Biology and Biogeochemistry (OBB) Program Manager and the entire enterprise is split into two components of equal sature: calibration and validation plus satellite data processing. The detailed elements of the activity are based on the basic tasks of the two main components plus the current objectives of the Carbon Cycle and Ecosystems Roadmap. The former is distinguished by an internal core set of responsibilities and the latter is facilitated through an external connecting-core ring of competed or contracted activities. The core elements for the calibration and validation component include a) publish protocols and performance metrics; b) verify uncertainty budgets; c) manage the development and evaluation of instrumentation; and d) coordinate international partnerships. The core elements for the satellite data processing component are e) process and reprocess multisensor data; f) acquire, distribute, and archive data products; and g) implement new data products. Both components have shared responsibilities for initializing and temporally monitoring satellite calibration. Connecting-core elements include (but are not restricted to) atmospheric correction and characterization, standards and traceability, instrument and analysis round robins, field campaigns and vicarious calibration sites, in situ database, bio-optical algorithm (and product) validation, satellite characterization and vicarious calibration, and image processing software. The plan also includes an accountability process, creating a Calibration and Validation Team (to help manage the activity), and a discussion of issues associated with the plan's scientific focus.

Core element characterization of Rhodococcus promoters and development of a promoter-RBS mini-pool with different activity levels for efficient gene expression.

PubMed

Jiao, Song; Yu, Huimin; Shen, Zhongyao

2018-09-25

To satisfy the urgent demand for promoter engineering that can accurately regulate the metabolic circuits and expression of specific genes in the Rhodococcus microbial platform, a promoter-ribosome binding site (RBS) coupled mini-pool with fine-tuning of different activity levels was successfully established. Transcriptome analyses of R. ruber TH revealed several representative promoters with different activity levels, e.g., Pami, Pcs, Pnh, P50sl36, PcbiM, PgroE and Pniami. β-Galactosidase (LacZ) reporter measurement demonstrated that different gene expression levels could be obtained with these natural promoters combined with an optimal RBS of ami. Further use of these promoters to overexpress the nitrile hydratase (NHase) gene with RBSami in R. ruber THdAdN produced different expression levels consistent with the transcription analyses. The -35 and -10 core elements of different promoters were further analyzed, and the conserved sequences were revealed to be TTGNNN and (T/C)GNNA(A/C)AAT. By mutating the core elements of the strong promoters, Pnh and Pami, into the above consensus sequence, two even stronger promoters, PnhM and PamiM, were obtained with 2.2-fold and 7.7-fold improvements in transcription, respectively. Integrating several strategies, including transcriptome promoter screening, -35 and -10 core element identification, core element point-mutation, RBS optimization and diverse reporter verification, a fine-tuning promoter-RBS combination mini-pool with different activity levels in Rhodococcus strains was successfully established. This development is significant for broad applications of the Rhodococcus genus as a microbial platform. Copyright © 2018 Elsevier B.V. All rights reserved.

Tools and techniques for developing tephra stratigraphies in lake cores: A case study from the basaltic Auckland Volcanic Field, New Zealand

NASA Astrophysics Data System (ADS)

Hopkins, Jenni L.; Millet, Marc-Alban; Timm, Christian; Wilson, Colin J. N.; Leonard, Graham S.; Palin, J. Michael; Neil, Helen

2015-09-01

Probabilistic hazard forecasting for a volcanic region relies on understanding and reconstructing the eruptive record (derived potentially from proximal as well as distal volcanoes). Tephrostratigraphy is commonly used as a reconstructive tool by cross-correlating tephra deposits to create a stratigraphic framework that can be used to assess magnitude-frequency relationships for eruptive histories. When applied to widespread rhyolitic deposits, tephra identifications and correlations have been successful; however, the identification and correlation of basaltic tephras are more problematic. Here, using tephras in drill cores from six maars in the Auckland Volcanic Field (AVF), New Zealand, we show how X-ray density scanning coupled with magnetic susceptibility analysis can be used to accurately and reliably identify basaltic glass shard-bearing horizons in lacustrine sediments and which, when combined with the major and trace element signatures of the tephras, can be used to distinguish primary from reworked layers. After reliably identifying primary vs. reworked basaltic horizons within the cores, we detail an improved method for cross-core correlation based on stratigraphy and geochemical fingerprinting. We present major and trace element data for individual glass shards from 57 separate basaltic horizons identified within the cores. Our results suggest that in cases where major element compositions (SiO2, CaO, Al2O3, FeO, MgO) do not provide unambiguous correlations, trace elements (e.g. La, Gd, Yb, Zr, Nb, Nd) and trace element ratios (e.g. [La/Yb]N, [Gd/Yb]N, [Zr/Yb]N) are successful in improving the compositional distinction between the AVF basaltic tephra horizons, thereby allowing an improved eruptive history of the AVF to be reconstructed.

Engagement and Education

PubMed Central

Tosh, Pritish K.; Hick, John L.; Hanfling, Dan; Geiling, James; Reed, Mary Jane; Uyeki, Timothy M.; Shah, Umair A.; Fagbuyi, Daniel B.; Skippen, Peter; Dichter, Jeffrey R.; Kissoon, Niranjan; Christian, Michael D.; Upperman, Jeffrey S.; Christian, Michael D.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Rubinson, Lewis; Amundson, Dennis; Anderson, Michael R.; Balk, Robert; Barfield, Wanda D.; Bartz, Martha; Benditt, Josh; Beninati, William; Berkowitz, Kenneth A.; Daugherty Biddison, Lee; Braner, Dana; Branson, Richard D; Burkle, Frederick M.; Cairns, Bruce A.; Carr, Brendan G.; Courtney, Brooke; DeDecker, Lisa D.; De Jong, Marla J.; Dominguez-Cherit, Guillermo; Dries, David; Einav, Sharon; Erstad, Brian L.; Etienne, Mill; Fagbuyi, Daniel B.; Fang, Ray; Feldman, Henry; Garzon, Hernando; Geiling, James; Gomersall, Charles D.; Grissom, Colin K.; Hanfling, Dan; Hick, John L.; Hodge, James G.; Hupert, Nathaniel; Ingbar, David; Kanter, Robert K.; King, Mary A.; Kuhnley, Robert N.; Lawler, James; Leung, Sharon; Levy, Deborah A.; Lim, Matthew L.; Livinski, Alicia; Luyckx, Valerie; Marcozzi, David; Medina, Justine; Miramontes, David A.; Mutter, Ryan; Niven, Alexander S.; Penn, Matthew S.; Pepe, Paul E.; Powell, Tia; Prezant, David; Reed, Mary Jane; Rich, Preston; Rodriquez, Dario; Roxland, Beth E.; Sarani, Babak; Shah, Umair A.; Skippen, Peter; Sprung, Charles L.; Subbarao, Italo; Talmor, Daniel; Toner, Eric S.; Tosh, Pritish K.; Upperman, Jeffrey S.; Uyeki, Timothy M.; Weireter, Leonard J.; West, T. Eoin; Wilgis, John; Ornelas, Joe; McBride, Deborah; Reid, David; Baez, Amado; Baldisseri, Marie; Blumenstock, James S.; Cooper, Art; Ellender, Tim; Helminiak, Clare; Jimenez, Edgar; Krug, Steve; Lamana, Joe; Masur, Henry; Mathivha, L. Rudo; Osterholm, Michael T.; Reynolds, H. Neal; Sandrock, Christian; Sprecher, Armand; Tillyard, Andrew; White, Douglas; Wise, Robert; Yeskey, Kevin

2014-01-01

BACKGROUND: Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. CONCLUSIONS: The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians. PMID:25144161

Quelccaya Ice Core Evidence of Widespread Atmospheric Pollution from Colonial Metallurgy after the Spanish Conquest of South America (1532 AD)

NASA Astrophysics Data System (ADS)

Gabrielli, P.; Uglietti, C.; Cooke, C. A.; Thompson, L. G.

2014-12-01

A few ice core records recovered from remote arctic regions suggest a widespread impact of toxic trace elements (Pb, Cu, Sb, As and Bi) to the North Hemisphere atmosphere prior to the onset of the Industrial Revolution (1780s-1830s). In the Southern Hemisphere, evidence for preindustrial trace element emissions are, to date, limited to sediment cores recovered from lakes located within the immediate airshed of major metallurgical centers of South America. Thus it remains unresolved whether they could have had a larger scale impact. Here, we present an annually resolved ice core record of anthropogenic trace element deposition from the remote drilling site of the Quelccaya Ice Cap (Peru) that spans 793-1989 AD. During the pre-Inca period (i.e., prior to ~1450 AD) the deposition of trace elements was dominated by the fallout of aeolian dust from the deglaciated margins of the ice cap and of ash from occasional volcanic eruptions. In contrast, the ice core record indicates a clear anthropogenic signal emerging after the onset of large scale colonial mining and metallurgy (1532-1820 AD), ~300 years prior to the Industrial Revolution during the last part of the Little Ice Age. This shift was coincidental with a major technological transition for silver extraction (1572 AD), from lead-based smelting to mercury amalgamation, that initiated a major increase in ore mining and milling that likely resulted in an increase of metallic dust emissions. While atmospheric trace element deposition resulting from colonial metallurgy was certainly much larger than during the pre-Colonial period, trace element fallout during the Colonial era was still several factors lower than during the 20th century, when the construction of the trans-Andean railway and highways promoted a widespread societal and industrial development of South America.

Finite Element Modeling of the Buckling Response of Sandwich Panels

NASA Technical Reports Server (NTRS)

Rose, Cheryl A.; Moore, David F.; Knight, Norman F., Jr.; Rankin, Charles C.

2002-01-01

A comparative study of different modeling approaches for predicting sandwich panel buckling response is described. The study considers sandwich panels with anisotropic face sheets and a very thick core. Results from conventional analytical solutions for sandwich panel overall buckling and face-sheet-wrinkling type modes are compared with solutions obtained using different finite element modeling approaches. Finite element solutions are obtained using layered shell element models, with and without transverse shear flexibility, layered shell/solid element models, with shell elements for the face sheets and solid elements for the core, and sandwich models using a recently developed specialty sandwich element. Convergence characteristics of the shell/solid and sandwich element modeling approaches with respect to in-plane and through-the-thickness discretization, are demonstrated. Results of the study indicate that the specialty sandwich element provides an accurate and effective modeling approach for predicting both overall and localized sandwich panel buckling response. Furthermore, results indicate that anisotropy of the face sheets, along with the ratio of principle elastic moduli, affect the buckling response and these effects may not be represented accurately by analytical solutions. Modeling recommendations are also provided.

NEUTRONIC REACTOR

DOEpatents

Hurwitz, H. Jr.; Brooks, H.; Mannal, C.; Payne, J.H.; Luebke, E.A.

1959-03-24

A reactor of the heterogeneous, liquid cooled type is described. This reactor is comprised of a central region of a plurality of vertically disposed elongated tubes surrounded by a region of moderator material. The central region is comprised of a central core surrounded by a reflector region which is surrounded by a fast neutron absorber region, which in turn is surrounded by a slow neutron absorber region. Liquid sodium is used as the primary coolant and circulates through the core which contains the fuel elements. Control of the reactor is accomplished by varying the ability of the reflector region to reflect neutrons back into the core of the reactor. For this purpose the reflector is comprised of moderator and control elements having varying effects on reactivity, the control elements being arranged and actuated by groups to give regulation, shim, and safety control.

X-ray Fluorescence Core Scanning of Oman Drilling Project Holes BT1B and GT3A Cores on D/V CHIKYU

NASA Astrophysics Data System (ADS)

Johnson, K. T. M.; Kelemen, P. B.; Michibayashi, K.; Greenberger, R. N.; Koepke, J.; Beinlich, A.; Morishita, T.; Jesus, A. P. M.; Lefay, R.

2017-12-01

The JEOL JSX-3600CA1 energy dispersive X-ray fluorescence core logger (XRF-CL) on the D/V Chikyu provides quantitative element concentrations of scanned cores. Scans of selected intervals are made on an x-y grid with point spacing of 5 mm. Element concentrations for Si, Al, Ti, Ca, Mg, Mn, Fe, Na, K, Cr, Ni, S and Zn are collected for each point on the grid. Accuracy of element concentrations provided by the instrument software is improved by applying empirical correction algorithms. Element concentrations were collected for 9,289 points from twenty-seven core intervals in Hole BT1B (basal thrust) and for 6,389 points from forty core intervals in Hole GT3A (sheeted dike-gabbro transition) of the Oman Drilling Project on the D/V Chikyu XRF-CL during Leg 2 of the Oman Drilling Project in August-September, 2017. The geochemical data are used for evaluating downhole compositional details associated with lithological changes, unit contacts and mineralogical variations and are particularly informative when plotted as concentration contour maps or downhole concentration diagrams. On Leg 2 additional core scans were made with X-ray Computed Tomography (X-ray CT) and infrared images from the visible-shortwave infrared imaging spectroscopy (IR) systems on board. XRF-CL, X-ray CT and IR imaging plots used together provide detailed information on rock compositions, textures and mineralogy that assist naked eye visual observations. Examples of some uses of XRF-CL geochemical maps and downhole data are shown. XRF-CL and IR scans of listvenite clearly show zones of magnesite, dolomite and the Cr-rich mica, fuchsite that are subdued in visual observation, and these scans can be used to calculate variations in proportions of these minerals in Hole BT1B cores. In Hole GT3A XRF-CL data can be used to distinguish compositional changes in different generations of sheeted dikes and gabbros and when combined with visual observations of intrusive relationships the detailed geochemical information can be used to infer temporal changes in parental magma compositions. Secondary sulfide mineralization and epidote-rich hydrothermal alteration zones in sheeted dikes and gabbros are clearly highlighted on element maps of S, Fe, Ca, Al, and Zn.

Maker Cultures and the Prospects for Technological Action.

PubMed

Nascimento, Susana; Pólvora, Alexandre

2018-06-01

Supported by easier and cheaper access to tools and expanding communities, maker cultures are pointing towards the ideas of (almost) everyone designing, creating, producing and distributing renewed, new and improved products, machines, things or artefacts. A careful analysis of the assumptions and challenges of maker cultures emphasizes the relevance of what may be called technological action, that is, active and critical interventions regarding the purposes and applications of technologies within ordinary lives, thus countering the deterministic trends of current directions of technology. In such transformative potential, we will explore a set of elements what is and could be technological action through snapshots of maker cultures based on the empirical research conducted in three particular contexts: the Fab Lab Network, Maker Media core outputs and initiatives such as Maker Faires, and the Open Source Hardware Association (OSHWA). Elements such as control and empowerment through material engagement, openness and sharing, and social, cultural, political and ethical values of the common good in topics such as diversity, sustainability and transparency, are critically analysed.

Compositional and mineralogical zoning by inward crystallization of mafic magma: evidence from the Guwoon hornblende gabbro-diorite Complex, Hwacheon, Korea.

NASA Astrophysics Data System (ADS)

Park, Y.-R.; Kim, G.-Y.

2009-04-01

The small body, ca. 1.3 by 1.6km, of a hot-air ballon shape hornblende gabbro - diorite Complex, in Gowoonri, Hwacheon, Korea consists of marginal diorite and central hornblende gabbro. The volumetrically dominant hornblende gabbro in the core of the Complex shows a zoned distribution with three layers distinguished by different dominant mafic mineral phases. From the margin toward the core of the hornblende gabbro body, the domintant mafic minerals change from amphibole phenocryst of nearly rounded shape in cross section with pyroxene pseudomorph through prismatic shape of amphibole to polycrystalline biotite aggregates. Systematic variations in geochemical characteristics among three distinct zones of hornblende gabbro body are also observed. From the outer zone toward the core, major oxides such as MnO, MgO, and CaO show a decreasing tendency, whereas total FeO/(total FeO + MgO) value shows an increasing tendency. Concentrations of trace elements also show systematic variations. Where incompatible elements such as Ba and Th increase, compatible elements like Cr and Sc decrease from the margin toward the core. The zonal distribution divided by change in dominant mafic mineral phase from pyroxene through amphibole to biotite, and systematic compositional changes in both major and trace elements from the outer zone toward the core of the hornblende gabbro body suggest that an inward crystallization mechanism played a major role in the formation of the hornblende gabbro in Guwoonri, Hwacheon, Korea.

Zirconia-based dental crown to support a removable partial denture: a three-dimensional finite element analysis using contact elements and micro-CT data.

PubMed

Rocha, Eduardo Passos; Anchieta, Rodolfo Bruniera; de Almeida, Erika Oliveira; Freitas, Amilcar Chagas; Martini, Ana Paula; Sotto-Maior, Bruno Sales; Luersen, Marco Antonio; Ko, Ching Chang

2015-01-01

Veneer fracture is the most common complication in zirconia-based restorations. The aim of this study was to evaluate the mechanical behavior of a zirconia-based crown in a lower canine tooth supporting removable partial denture (RPD) prosthesis, varying the bond quality of the veneer/coping interface. Microtomography (μCT) data of an extracted left lower canine were used to build the finite element model (M) varying the core material (gold core - MAu; zirconia core - MZi) and the quality of the veneer/core interface (complete bonded - MZi; incomplete bonded - MZi-NL). The incomplete bonding condition was only applied for zirconia coping by using contact elements (Target/Contact) with 0.3 frictional coefficients. Stress fields were obtained using Ansys Workbench 10.0. The loading condition (L = 1 N) was vertically applied at the base of the RPD prosthesis metallic support towards the dental apex. Maximum principal (σmax) and von Mises equivalent (σvM) stresses were obtained. The σmax (MPa) for the bonded condition was similar between gold and zirconia cores (MAu, 0.42; MZi, 0.40). The incomplete bonded condition (MZi-NL) raised σmax in the veneer up to 800% (3.23 MPa) in contrast to the bonded condition. The peak of σvM increased up to 270% in the MZi-NL. The incomplete bond condition increasing the stress in the veneer/zirconia interface.

Low-loss single-mode hollow-core fiber with anisotropic anti-resonant elements.

PubMed

Habib, Md Selim; Bang, Ole; Bache, Morten

2016-04-18

A hollow-core fiber using anisotropic anti-resonant tubes in the cladding is proposed for low loss and effectively single-mode guidance. We show that the loss performance and higher-order mode suppression is significantly improved by using symmetrically distributed anisotropic anti-resonant tubes in the cladding, elongated in the radial direction, when compared to using isotropic, i.e. circular, anti-resonant tubes. The effective single-mode guidance of the proposed fiber is achieved by enhancing the coupling between the cladding modes and higher-order-core modes by suitably engineering the anisotropic anti-resonant elements. With a silica-based fiber design aimed at 1.06 µm, we show that the loss extinction ratio between the higher-order core modes and the fundamental core mode can be more than 1000 in the range 1.0-1.65 µm, while the leakage loss of the fundamental core mode is below 15 dB/km in the same range.

Finite Element Development and Specifications of a Patched, Recessed Nomex Core Honeycomb Panel for Increased Sound Transmission Loss

NASA Technical Reports Server (NTRS)

Grosveld, Ferdinand W.

2007-01-01

This informal report summarizes the development and the design specifications of a recessed nomex core honeycomb panel in fulfillment of the deliverable in Task Order 13RBE, Revision 10, Subtask 17. The honeycomb panel, with 0.020-inch thick aluminum face sheets, has 0.016-inch thick aluminum patches applied to twenty-five, 6 by 6 inch, quarter inch thick recessed cores. A 10 dB higher transmission loss over the frequency range 250 - 1000 Hz was predicted by a MSC/NASTRAN finite element model when compared with the transmission loss of the base nomex core honeycomb panel. The static displacement, due to a unit force applied at either the core or recessed core area, was of the same order of magnitude as the static displacement of the base honeycomb panel when exposed to the same unit force. The mass of the new honeycomb design is 5.1% more than the base honeycomb panel. A physical model was constructed and is being tested.

Hydrodynamic metamaterials: Microfabricated arrays to steer, refract, and focus streams of biomaterials

PubMed Central

Morton, Keith J.; Loutherback, Kevin; Inglis, David W.; Tsui, Ophelia K.; Sturm, James C.; Chou, Stephen Y.; Austin, Robert H.

2008-01-01

We show that it is possible to direct particles entrained in a fluid along trajectories much like rays of light in classical optics. A microstructured, asymmetric post array forms the core hydrodynamic element and is used as a building block to construct microfluidic metamaterials and to demonstrate refractive, focusing, and dispersive pathways for flowing beads and cells. The core element is based on the concept of deterministic lateral displacement where particles choose different paths through the asymmetric array based on their size: Particles larger than a critical size are displaced laterally at each row by a post and move along the asymmetric axis at an angle to the flow, while smaller particles move along streamline paths. We create compound elements with complex particle handling modes by tiling this core element using multiple transformation operations; we show that particle trajectories can be bent at an interface between two elements and that particles can be focused into hydrodynamic jets by using a single inlet port. Although particles propagate through these elements in a way that strongly resembles light rays propagating through optical elements, there are unique differences in the paths of our particles as compared with photons. The unusual aspects of these modular, microfluidic metamaterials form a rich design toolkit for mixing, separating, and analyzing cells and functional beads on-chip. PMID:18495920

Three-dimensional discrete element method simulation of core disking

NASA Astrophysics Data System (ADS)

Wu, Shunchuan; Wu, Haoyan; Kemeny, John

2018-04-01

The phenomenon of core disking is commonly seen in deep drilling of highly stressed regions in the Earth's crust. Given its close relationship with the in situ stress state, the presence and features of core disking can be used to interpret the stresses when traditional in situ stress measuring techniques are not available. The core disking process was simulated in this paper using the three-dimensional discrete element method software PFC3D (particle flow code). In particular, PFC3D is used to examine the evolution of fracture initiation, propagation and coalescence associated with core disking under various stress states. In this paper, four unresolved problems concerning core disking are investigated with a series of numerical simulations. These simulations also provide some verification of existing results by other researchers: (1) Core disking occurs when the maximum principal stress is about 6.5 times the tensile strength. (2) For most stress situations, core disking occurs from the outer surface, except for the thrust faulting stress regime, where the fractures were found to initiate from the inner part. (3) The anisotropy of the two horizontal principal stresses has an effect on the core disking morphology. (4) The thickness of core disk has a positive relationship with radial stress and a negative relationship with axial stresses.

Geriatric Core Competencies for Family Medicine Curriculum and Enhanced Skills: Care of Elderly

PubMed Central

Charles, Lesley; Triscott, Jean A.C.; Dobbs, Bonnie M.; McKay, Rhianne

2014-01-01

Background There is a growing mandate for Family Medicine residency programs to directly assess residents’ clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Methods Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Results Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Conclusions Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit. PMID:24883163

Eigenvalue equation and core-mode cutoff of weakly guiding tapered fiber as three layer optical waveguide and used as biochemical sensor.

PubMed

Linslal, C L; Mohan, P M S; Halder, A; Gangopadhyay, T K

2012-06-01

The core-mode cutoff plays a major role in evanescent field absorption based sensors. A method has been proposed to calculate the core-mode cutoff by solving the eigenvalue equations of a weakly guiding three layer optical waveguide graphically. The variation of normalized waveguide parameter (V) is also calculated with different wavelengths at core-mode cutoff. At the first step, theoretical analysis of tapered fiber parameters has been performed for core-mode cutoff. The taper angle of an adiabatic tapered fiber is also analyzed using the length-scale criterion. Secondly, single-mode tapered fiber has been developed to make a precision sensor element suitable for chemical detection. Finally, the sensor element has been used to detect absorption peak of ethylenediamine. Results are presented in which an absorption peak at 1540 nm is observed.

The lunar core can be a major reservoir for volatile elements S, Se, Te and Sb.

PubMed

Steenstra, Edgar S; Lin, Yanhao; Dankers, Dian; Rai, Nachiketa; Berndt, Jasper; Matveev, Sergei; van Westrenen, Wim

2017-11-06

The Moon bears a striking compositional and isotopic resemblance to the bulk silicate Earth (BSE) for many elements, but is considered highly depleted in many volatile elements compared to BSE due to high-temperature volatile loss from Moon-forming materials in the Moon-forming giant impact and/or due to evaporative loss during subsequent magmatism on the Moon. Here, we use high-pressure metal-silicate partitioning experiments to show that the observed low concentrations of volatile elements sulfur (S), selenium (Se), tellurium (Te), and antimony (Sb) in the silicate Moon can instead reflect core-mantle equilibration in a largely to fully molten Moon. When incorporating the core as a reservoir for these elements, their bulk Moon concentrations are similar to those in the present-day bulk silicate Earth. This suggests that Moon formation was not accompanied by major loss of S, Se, Te, Sb from Moon-forming materials, consistent with recent indications from lunar carbon and S isotopic compositions of primitive lunar materials. This is in marked contrast with the losses of other volatile elements (e.g., K, Zn) during the Moon-forming event. This discrepancy may be related to distinctly different cosmochemical behavior of S, Se, Te and Sb within the proto-lunar disk, which is as of yet virtually unconstrained.

Turnover Intentions of Employees With Informal Eldercare Responsibilities: The Role of Core Self-Evaluations and Supervisor Support.

PubMed

Greaves, Claire E; Parker, Stacey L; Zacher, Hannes; Jimmieson, Nerina L

2015-12-01

As longevity increases, so does the need for care of older relatives by working family members. This research examined the interactive effect of core self-evaluations and supervisor support on turnover intentions in two samples of employees with informal caregiving responsibilities. Data were obtained from 57 employees from Australia (Study 1) and 66 employees from the United States and India (Study 2). Results of Study 1 revealed a resource compensation effect, that is, an inverse relationship between core self-evaluations and turnover intentions when supervisor care support was low. Results of Study 2 extended these findings by demonstrating resource boosting effects. Specifically, there was an inverse relationship between core self-evaluations and subsequent turnover intentions for those with high supervisor work and care support. In addition, employees' satisfaction and emotional exhaustion from their work mediated the inverse relationship between core self-evaluations and subsequent turnover intentions when supervisor work support and care support were high. Overall, these findings highlight the importance of employee- and supervisor-focused intervention strategies in organizations to support informal caregivers. © The Author(s) 2016.

What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families

PubMed Central

You, John J.; Dodek, Peter; Lamontagne, Francois; Downar, James; Sinuff, Tasnim; Jiang, Xuran; Day, Andrew G.; Heyland, Daren K.

2014-01-01

Background: The guideline-recommended elements to include in discussions about goals of care with patients with serious illness are mostly based on expert opinion. We sought to identify which elements are most important to patients and their families. Methods: We used a cross-sectional study design involving patients from 9 Canadian hospitals. We asked older adult patients with serious illness and their family members about the occurrence and importance of 11 guideline-recommended elements of goals-of-care discussions. In addition, we assessed concordance between prescribed goals of care and patient preferences, and we measured patient satisfaction with goals-of-care discussions using the Canadian Health Care Evaluation Project (CANHELP) questionnaire. Results: Our study participants included 233 patients (mean age 81.2 yr) and 205 family members (mean age 60.2 yr). Participants reported that clinical teams had addressed individual elements of goals-of-care discussions infrequently (range 1.4%–31.7%). Patients and family members identified the same 5 elements as being the most important to address: preferences for care in the event of life-threatening illness, values, prognosis, fears or concerns, and questions about goals of care. Addressing more elements was associated with both greater concordance between patients’ preferences and prescribed goals of care, and greater patient satisfaction. Interpretation: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting. PMID:25367427

Core formation and core composition from coupled geochemical and geophysical constraints

DOE PAGES

Badro, James; Brodholt, John P.; Piet, Helene; ...

2015-09-21

The formation of Earth’s core left behind geophysical and geochemical signatures in both the core and mantle that remain to this day. Seismology requires that the core be lighter than pure iron and therefore must contain light elements, and the geochemistry of mantle-derived rocks reveals extensive siderophile element depletion and fractionation. Both features are inherited from metal–silicate differentiation in primitive Earth and depend upon the nature of physiochemical conditions that prevailed during core formation. To date, core formation models have only attempted to address the evolution of core and mantle compositional signatures separately, rather than seeking a joint solution. Heremore » we combine experimental petrology, geochemistry, mineral physics and seismology to constrain a range of core formation conditions that satisfy both constraints. We find that core formation occurred in a hot (liquidus) yet moderately deep magma ocean not exceeding 1,800 km depth, under redox conditions more oxidized than present-day Earth. This new scenario, at odds with the current belief that core formation occurred under reducing conditions, proposes that Earth’s magma ocean started oxidized and has become reduced through time, by oxygen incorporation into the core. As a result, this core formation model produces a core that contains 2.7–5% oxygen along with 2–3.6% silicon, with densities and velocities in accord with radial seismic models, and leaves behind a silicate mantle that matches the observed mantle abundances of nickel, cobalt, chromium, and vanadium.« less

Core formation and core composition from coupled geochemical and geophysical constraints

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

Badro, James; Brodholt, John P.; Piet, Helene

The formation of Earth’s core left behind geophysical and geochemical signatures in both the core and mantle that remain to this day. Seismology requires that the core be lighter than pure iron and therefore must contain light elements, and the geochemistry of mantle-derived rocks reveals extensive siderophile element depletion and fractionation. Both features are inherited from metal–silicate differentiation in primitive Earth and depend upon the nature of physiochemical conditions that prevailed during core formation. To date, core formation models have only attempted to address the evolution of core and mantle compositional signatures separately, rather than seeking a joint solution. Heremore » we combine experimental petrology, geochemistry, mineral physics and seismology to constrain a range of core formation conditions that satisfy both constraints. We find that core formation occurred in a hot (liquidus) yet moderately deep magma ocean not exceeding 1,800 km depth, under redox conditions more oxidized than present-day Earth. This new scenario, at odds with the current belief that core formation occurred under reducing conditions, proposes that Earth’s magma ocean started oxidized and has become reduced through time, by oxygen incorporation into the core. As a result, this core formation model produces a core that contains 2.7–5% oxygen along with 2–3.6% silicon, with densities and velocities in accord with radial seismic models, and leaves behind a silicate mantle that matches the observed mantle abundances of nickel, cobalt, chromium, and vanadium.« less

Provenance and depositional history of continental slope sediments in the Southwestern Gulf of Mexico unraveled by geochemical analysis

NASA Astrophysics Data System (ADS)

Armstrong-Altrin, John S.; Machain-Castillo, María Luisa; Rosales-Hoz, Leticia; Carranza-Edwards, Arturo; Sanchez-Cabeza, Joan-Albert; Ruíz-Fernández, Ana Carolina

2015-03-01

The aim of this work is to constrain the provenance and depositional history of continental slope sediments in the Southwestern Gulf of Mexico (~1089-1785 m water depth). To achieve this, 10 piston sediment cores (~5-5.5 m long) were studied for mineralogy, major, trace and rare earth element geochemistry. Samples were analyzed at three core sections, i.e. upper (0-1 cm), middle (30-31 cm) and lower (~300-391 cm). The textural study reveals that the core sediments are characterized by silt and clay fractions. Radiocarbon dating of sediments for the cores at different levels indicated a maximum of ~28,000 year BP. Sediments were classified as shale. The chemical index of alteration (CIA) values for the upper, middle, and lower sections revealed moderate weathering in the source region. The index of chemical maturity (ICV) and SiO2/Al2O3 ratio indicated low compositional maturity for the core sediments. A statistically significant correlation observed between total rare earth elements (∑REE) versus Al2O3 and Zr indicated that REE are mainly housed in detrital minerals. The North American Shale Composite (NASC) normalized REE patterns, trace element concentrations such as Cr, Ni and V, and the comparison of REE concentrations in sediments and source rocks indicated that the study area received sediments from rocks intermediate between felsic and mafic composition. The enrichment factor (EF) results indicated that the Cd and Zn contents of the upper section sediments were influenced by an anthropogenic source. The trace element ratios and authigenic U content of the core sediments indicated the existence of an oxic depositional environment.

The development of individuation in autism

PubMed Central

O'Hearn, Kirsten; Franconeri, Steven; Wright, Catherine; Minshew, Nancy; Luna, Beatriz

2012-01-01

Evidence suggests that people with autism use holistic information differently than typical adults. The current studies examine this possibility by investigating how core visual processes that contribute to holistic processing – individuation and element grouping – develop in participants with autism and typically developing (TD) participants matched for age, IQ and gender. Individuation refers to the ability to `see' up to 4 elements simultaneously; grouping these elements can change the number of elements that are rapidly apprehended. We examined these core processes using two well-established paradigms, rapid enumeration and multiple object tracking (MOT). In both tasks, a performance limit of about 4 elements in adulthood is thought to reflect individuation capacity. Participants with autism has a smaller individuation capacity than TD controls, regardless of whether they were enumerating static elements or tracking moving ones. To manipulate holistic information and individuation performance, we grouped the elements into a design or had elements move together. Participants with autism were affected to a similar degree as TD participants by the holistic information, whether the manipulation helped or hurt performance, consistent with evidence that some types of gestalt/grouping information are processed typically in autism. There was substantial development in autism from childhood to adolescence, but not from adolescence to adulthood, a pattern distinct from TD participants. These results provide important information about core visual processes in autism, as well as insight into the architecture of vision (e.g., individuation appears distinct from visual strengths in autism, such as visual search, despite similarities). PMID:22963232

NASA Stennis Space Center Integrated System Health Management Test Bed and Development Capabilities

NASA Technical Reports Server (NTRS)

Figueroa, Fernando; Holland, Randy; Coote, David

2006-01-01

Integrated System Health Management (ISHM) is a capability that focuses on determining the condition (health) of every element in a complex System (detect anomalies, diagnose causes, prognosis of future anomalies), and provide data, information, and knowledge (DIaK)-not just data-to control systems for safe and effective operation. This capability is currently done by large teams of people, primarily from ground, but needs to be embedded on-board systems to a higher degree to enable NASA's new Exploration Mission (long term travel and stay in space), while increasing safety and decreasing life cycle costs of spacecraft (vehicles; platforms; bases or outposts; and ground test, launch, and processing operations). The topics related to this capability include: 1) ISHM Related News Articles; 2) ISHM Vision For Exploration; 3) Layers Representing How ISHM is Currently Performed; 4) ISHM Testbeds & Prototypes at NASA SSC; 5) ISHM Functional Capability Level (FCL); 6) ISHM Functional Capability Level (FCL) and Technology Readiness Level (TRL); 7) Core Elements: Capabilities Needed; 8) Core Elements; 9) Open Systems Architecture for Condition-Based Maintenance (OSA-CBM); 10) Core Elements: Architecture, taxonomy, and ontology (ATO) for DIaK management; 11) Core Elements: ATO for DIaK Management; 12) ISHM Architecture Physical Implementation; 13) Core Elements: Standards; 14) Systematic Implementation; 15) Sketch of Work Phasing; 16) Interrelationship Between Traditional Avionics Systems, Time Critical ISHM and Advanced ISHM; 17) Testbeds and On-Board ISHM; 18) Testbed Requirements: RETS AND ISS; 19) Sustainable Development and Validation Process; 20) Development of on-board ISHM; 21) Taxonomy/Ontology of Object Oriented Implementation; 22) ISHM Capability on the E1 Test Stand Hydraulic System; 23) Define Relationships to Embed Intelligence; 24) Intelligent Elements Physical and Virtual; 25) ISHM Testbeds and Prototypes at SSC Current Implementations; 26) Trailer-Mounted RETS; 27) Modeling and Simulation; 28) Summary ISHM Testbed Environments; 29) Data Mining - ARC; 30) Transitioning ISHM to Support NASA Missions; 31) Feature Detection Routines; 32) Sample Features Detected in SSC Test Stand Data; and 33) Health Assessment Database (DIaK Repository).

Temperature Profile in Fuel and Tie-Tubes for Nuclear Thermal Propulsion Systems

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

Vishal Patel

A finite element method to calculate temperature profiles in heterogeneous geometries of tie-tube moderated LEU nuclear thermal propulsion systems and HEU designs with tie-tubes is developed and implemented in MATLAB. This new method is compared to previous methods to demonstrate shortcomings in those methods. Typical methods to analyze peak fuel centerline temperature in hexagonal geometries rely on spatial homogenization to derive an analytical expression. These methods are not applicable to cores with tie-tube elements because conduction to tie-tubes cannot be accurately modeled with the homogenized models. The fuel centerline temperature directly impacts safety and performance so it must be predictedmore » carefully. The temperature profile in tie-tubes is also important when high temperatures are expected in the fuel because conduction to the tie-tubes may cause melting in tie-tubes, which may set maximum allowable performance. Estimations of maximum tie-tube temperature can be found from equivalent tube methods, however this method tends to be approximate and overly conservative. A finite element model of heat conduction on a unit cell can model spatial dependence and non-linear conductivity for fuel and tie-tube systems allowing for higher design fidelity of Nuclear Thermal Propulsion.« less

The power of collective ambition.

PubMed

Ready, Douglas A; Truelove, Emily

2011-12-01

In the past few years, some companies have not just weathered the economic storm: They've emerged stronger than ever. How did such players as Four Seasons, Sephora, and Standard Chartered Bank defy conventional logic? Instead of pursuing a single ambition, such as profits, employees defined a collective ambition. As a result, those organizations deepened their engagement with employees and other stakeholders and became sustainably profitable. Purpose, a company's reason for existence, is the central element of collective ambition. The other elements--vision, targets and milestones, strategic and operational priorities, brand promise, core values, and leader behaviors--must be aligned to serve the company's purpose. Articulating the elements of collective ambition can give everyone in the organization a better sense of the company's purpose and how they can contribute to it. Purpose does not have to be about saving the world; providing excellent entertainment or banking services is just as meaningful a purpose as improving health care in emerging economies--as long as it is an authentic representation of why the company exists. To shape and then achieve a collective ambition, companies must strengthen their organizational glue (the collaborative engagement that creates a unified culture) and grease (the disciplined execution that enterprisewide change initiatives require).

Real-time haptic cutting of high-resolution soft tissues.

PubMed

Wu, Jun; Westermann, Rüdiger; Dick, Christian

2014-01-01

We present our systematic efforts in advancing the computational performance of physically accurate soft tissue cutting simulation, which is at the core of surgery simulators in general. We demonstrate a real-time performance of 15 simulation frames per second for haptic soft tissue cutting of a deformable body at an effective resolution of 170,000 finite elements. This is achieved by the following innovative components: (1) a linked octree discretization of the deformable body, which allows for fast and robust topological modifications of the simulation domain, (2) a composite finite element formulation, which thoroughly reduces the number of simulation degrees of freedom and thus enables to carefully balance simulation performance and accuracy, (3) a highly efficient geometric multigrid solver for solving the linear systems of equations arising from implicit time integration, (4) an efficient collision detection algorithm that effectively exploits the composition structure, and (5) a stable haptic rendering algorithm for computing the feedback forces. Considering that our method increases the finite element resolution for physically accurate real-time soft tissue cutting simulation by an order of magnitude, our technique has a high potential to significantly advance the realism of surgery simulators.

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

Kwon, Deug-Nam; Park, Mi-Ryung; Park, Jong-Yi

Highlights: {yields} The sequences of -604 to -84 bp of the pUPII promoter contained the region of a putative negative cis-regulatory element. {yields} The core promoter was located in the 5F-1. {yields} Transcription factor HNF4 can directly bind in the pUPII core promoter region, which plays a critical role in controlling promoter activity. {yields} These features of the pUPII promoter are fundamental to development of a target-specific vector. -- Abstract: Uroplakin II (UPII) is a one of the integral membrane proteins synthesized as a major differentiation product of mammalian urothelium. UPII gene expression is bladder specific and differentiation dependent, butmore » little is known about its transcription response elements and molecular mechanism. To identify the cis-regulatory elements in the pig UPII (pUPII) gene promoter region, we constructed pUPII 5' upstream region deletion mutants and demonstrated that each of the deletion mutants participates in controlling the expression of the pUPII gene in human bladder carcinoma RT4 cells. We also identified a new core promoter region and putative negative cis-regulatory element within a minimal promoter region. In addition, we showed that hepatocyte nuclear factor 4 (HNF4) can directly bind in the pUPII core promoter (5F-1) region, which plays a critical role in controlling promoter activity. Transient cotransfection experiments showed that HNF4 positively regulates pUPII gene promoter activity. Thus, the binding element and its binding protein, HNF4 transcription factor, may be involved in the mechanism that specifically regulates pUPII gene transcription.« less

High Pressure and Temperature Core Formation as an Alternative to the "Late Veneer" Hypothesis

NASA Technical Reports Server (NTRS)

Righter, Kevin; Pando, K.; Humayun, M.; Danielson, L.

2011-01-01

The highly siderophile elements (HSE; Re, Au and the Platinum Group Elements - Pd Pt, Rh, Ru, Ir, Os) are commonly utilized to constrain accretion processes in terrestrial differentiated bodies due to their affinity for FeNi metal [1]. These eight elements exhibit highly siderophile behavior, but nonetheless have highly diverse metal-silicate partition coefficients [2]. Therefore the near chondritic relative concentrations of HSEs in the terrestrial and lunar mantles, as well as some other bodies, are attributed to late accretion rather than core formation [1]. Evaluation of competing theories, such as high pressure metal-silicate partitioning or magma ocean hypotheses has been hindered by a lack of relevant partitioning data for this group of eight elements. In particular, systematic studies isolating the effect of one variable (e.g. temperature or melt compositions) are lacking. Here we undertake new experiments on all eight elements, using Fe metal and FeO-bearing silicate melts at fixed pressure, but variable temperatures. These experiments, as well as some additional planned experiments should allow partition coefficients to be more accurately calculated or estimated at the PT conditions and compositions at which core formation is thought to have occurred.

Analysis of Accidents at the Pakistan Research Reactor-1 Using Proposed Mixed-Fuel (HEU and LEU) Core

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

Bokhari, Ishtiaq H.

2004-12-15

The Pakistan Research Reactor-1 (PARR-1) was converted from highly enriched uranium (HEU) to low-enriched uranium (LEU) fuel in 1991. The reactor is running successfully, with an upgraded power level of 10 MW. To save money on the purchase of costly fresh LEU fuel elements, the use of less burnt HEU spent fuel elements along with the present LEU fuel elements is being considered. The proposal calls for the HEU fuel elements to be placed near the thermal column to gain the required excess reactivity. In the present study the safety analysis of a proposed mixed-fuel core has been carried outmore » at a calculated steady-state power level of 9.8 MW. Standard computer codes and correlations were employed to compute various parameters. Initiating events in reactivity-induced accidents involve various modes of reactivity insertion, namely, start-up accident, accidental drop of a fuel element on the core, flooding of a beam tube with water, and removal of an in-pile experiment during reactor operation. For each of these transients, time histories of reactor power, energy released, temperature, and reactivity were determined.« less

The hidden competencies of healthcare: why self-esteem, accountability, and professionalism may affect hospital customer satisfaction scores.

PubMed

Decker, P J

1999-01-01

Data from 103 for-profit, nonprofit, and government-owned hospitals, spread across about half of the United States clearly show that there are common elements and several core competencies in all hospitals, some probably driven by JCAHO accreditation standards, but others coming from universal experience stemming from the changes in healthcare. The common competencies that are not, in my opinion, driven directly by the JCAHO standards include professionalism, accountability, self-esteem, customer service/focus, communication, information management/using data in decision making, and teamwork. There are several possible connections among the core competencies that suggest that the effects of accountability and possibly self-esteem on such outcomes as patient satisfaction and quality of care should be the subject of more research in healthcare settings. There are, however, several possible interventions to increase the core competency base of any hospital, which can be applied without this research. Executives and managers who attempt to measure and change these common competencies through selection, assessment, organizational system change, or reward and compensation systems will change the competence base of their workforce in critical areas needed in the future healthcare economy. Using a competence model incorporating these competencies may change the culture of the organization toward that which will be needed for survival in the twenty-first century.

Psychosocial care for children with haemophilia and their parents in the Netherlands.

PubMed

Limperg, P F; Haverman, L; Beijlevelt, M; van der Pot, M; Zaal, G; de Boer, W A; Fijnvandraat, K; Peters, M; Grootenhuis, M A

2017-05-01

Children growing up with haemophilia are at greater risk for psychosocial problems than their healthy peers. Providing psychosocial care to children with haemophilia and their families is indispensable, since psychosocial factors can have a significant impact on health and health-related quality of life (HRQOL). Our aim was to give a description of psychosocial care provided by the multidisciplinary team of the Hemophilia Comprehensive Care Centre (HCCC) at the Emma Children's Hospital in Amsterdam, the Netherlands. With this overview, other caregivers and hospitals can benefit in organizing their psychosocial care for children with haemophilia. The focus of the psychosocial care provided by the multidisciplinary team is on preventing psychosocial problems and medical-related stress, and supporting and equipping the child with haemophilia and its parents with as many skills as possible to lead an independent life with a high HRQOL. Core elements of the psychosocial care are therefore monitoring and screening of HRQOL (e.g. in daily clinical practice via www.hetklikt.nu), psychoeducation (haemophilia camp, haemophilia school, disease-specific activities, meetings for girls, parent meetings), practical help (Emma at Work, an employment agency for adolescents and young adults; Educational Facility and school visits), psychosocial interventions (the On Track group intervention and the Haemophilia Coping and Perception Test) and individual care (psychological counselling and referrals). By providing this overview of psychosocial support offered and by sharing this knowledge, psychosocial care can become more structured and consistent between HCCCs around the world. Potentially, processes and outcomes of care can be improved. © 2017 John Wiley & Sons Ltd.

Geochemical data for core and bottom-sediment samples collected in 2007 from Grand Lake O' the Cherokees, northeast Oklahoma

USGS Publications Warehouse

Fey, David L.; Becker, Mark F.; Smith, Kathleen S.

2010-01-01

Grand Lake O' the Cherokees is a large reservoir in northeast Oklahoma, below the confluence of the Neosho and Spring Rivers, both of which drain the Tri-State Mining District to the north. The Tri-State district covers an area of 1,200 mi2 (3,100 km2) and comprises Mississippi Valley-type lead-zinc deposits. A result of 120 years of mining activity is an estimated 75 million tons of processed mine tailings (chat) remaining in the district. Concerns of sediment quality and the possibility of human exposure to cadmium and lead through eating fish have led to several studies of the sediments in the Tri-State district. In order to record the transport and deposition of metals from the Tri-State district by the Spring and Neosho Rivers into Grand Lake O' the Cherokees, the U.S. Geological Survey collected 11 sediment cores and 15 bottom-sediment samples in September 2007. Subsamples from five selected cores and the bottom-sediment samples were analyzed for major and trace elements and forms of carbon. The sediment samples collected from the sediment-water interface had larger average concentrations of zinc, cadmium, and lead than local background. The core collected from the Spring River had the largest concentrations of mining-related elements. A core collected just south of Twin Bridges State Park, at the confluence of the Spring and Neosho Rivers, showed a mixing zone with more mining-related elements coming from the Spring River side. The element zinc showed the most definitive patterns in graphs depicting concentration-versus-depth profiles. A core collected from the main body of the reservoir showed affected sediment down to a depth of 85 cm (33 in). This core and two others appear to have penetrated to below mining-affected sediment.

Fish scales in sediments from off Callao, central Peru

NASA Astrophysics Data System (ADS)

Díaz-Ochoa, J. A.; Lange, C. B.; Pantoja, S.; De Lange, G. J.; Gutiérrez, D.; Muñoz, P.; Salamanca, M.

2009-07-01

We study fish scales as a proxy of fish abundance and preservation biases together with phosphorus from fish remains (P fish) in a sediment core retrieved off Callao, Peru (12°1'S, 77°42'W; water depth=179 m; core length=52 cm). We interpret our results as a function of changing redox conditions based on ratios of redox-sensitive trace elements (Cu/Al, Mo/Al, Ni/Al, Zn/Al, V/Al), terrigenous indicators (Fe in clays, Ti, Al), and biogenic proxies (CaCO 3, biogenic opal, total nitrogen, organic carbon, barite Ba). The core covers roughly 700 years of deposition, based on 210Pb activities extrapolated downcore and 14C dating at selected intervals. Our fish-scale record is dominated by anchovy ( Engraulis ringens) scales followed by hake ( Merluccius gayii) scales. The core presented an abrupt lithological change at 17 cm (corresponding to the early 19th century). Above that depth, it was laminated and was more organic-rich (10-15% organic carbon) than below, where the core was partly laminated and less organic-rich (<10%). The lithological shift coincides with abrupt changes in dry bulk density and in the contents of terrigenous and redox-sensitive trace elements, biogenic proxies, and fish scales. The remarkable increase in redox-sensitive trace elements in the upper 17 cm of the core suggests more reducing conditions when compared with deeper and older horizons, and is interpreted as an intensification of the oxygen minimum zone off Peru beginning in the early 19th century. Higher fish-scale contents and higher P fish/P total ratios were also observed within the upper 17 cm of the core. The behavior of biogenic proxies and redox-sensitive trace elements was similar; more reduced conditions corresponded to higher contents of CaCO 3, C org, total nitrogen and fish scales, suggesting that these proxies might convey an important preservation signal.

The Drosophila Translational Control Element (TCE) Is Required for High-Level Transcription of Many Genes That Are Specifically Expressed in Testes

PubMed Central

Anderson, Ashley K.; Ohler, Uwe; Wassarman, David A.

2012-01-01

To investigate the importance of core promoter elements for tissue-specific transcription of RNA polymerase II genes, we examined testis-specific transcription in Drosophila melanogaster. Bioinformatic analyses of core promoter sequences from 190 genes that are specifically expressed in testes identified a 10 bp A/T-rich motif that is identical to the translational control element (TCE). The TCE functions in the 5′ untranslated region of Mst(3)CGP mRNAs to repress translation, and it also functions in a heterologous gene to regulate transcription. We found that among genes with focused initiation patterns, the TCE is significantly enriched in core promoters of genes that are specifically expressed in testes but not in core promoters of genes that are specifically expressed in other tissues. The TCE is variably located in core promoters and is conserved in melanogaster subgroup species, but conservation dramatically drops in more distant species. In transgenic flies, short (300–400 bp) genomic regions containing a TCE directed testis-specific transcription of a reporter gene. Mutation of the TCE significantly reduced but did not abolish reporter gene transcription indicating that the TCE is important but not essential for transcription activation. Finally, mutation of testis-specific TFIID (tTFIID) subunits significantly reduced the transcription of a subset of endogenous TCE-containing but not TCE-lacking genes, suggesting that tTFIID activity is limited to TCE-containing genes but that tTFIID is not an obligatory regulator of TCE-containing genes. Thus, the TCE is a core promoter element in a subset of genes that are specifically expressed in testes. Furthermore, the TCE regulates transcription in the context of short genomic regions, from variable locations in the core promoter, and both dependently and independently of tTFIID. These findings set the stage for determining the mechanism by which the TCE regulates testis-specific transcription and understanding the dual role of the TCE in translational and transcriptional regulation. PMID:22984601

The Drosophila Translational Control Element (TCE) is required for high-level transcription of many genes that are specifically expressed in testes.

PubMed

Katzenberger, Rebeccah J; Rach, Elizabeth A; Anderson, Ashley K; Ohler, Uwe; Wassarman, David A

2012-01-01

To investigate the importance of core promoter elements for tissue-specific transcription of RNA polymerase II genes, we examined testis-specific transcription in Drosophila melanogaster. Bioinformatic analyses of core promoter sequences from 190 genes that are specifically expressed in testes identified a 10 bp A/T-rich motif that is identical to the translational control element (TCE). The TCE functions in the 5' untranslated region of Mst(3)CGP mRNAs to repress translation, and it also functions in a heterologous gene to regulate transcription. We found that among genes with focused initiation patterns, the TCE is significantly enriched in core promoters of genes that are specifically expressed in testes but not in core promoters of genes that are specifically expressed in other tissues. The TCE is variably located in core promoters and is conserved in melanogaster subgroup species, but conservation dramatically drops in more distant species. In transgenic flies, short (300-400 bp) genomic regions containing a TCE directed testis-specific transcription of a reporter gene. Mutation of the TCE significantly reduced but did not abolish reporter gene transcription indicating that the TCE is important but not essential for transcription activation. Finally, mutation of testis-specific TFIID (tTFIID) subunits significantly reduced the transcription of a subset of endogenous TCE-containing but not TCE-lacking genes, suggesting that tTFIID activity is limited to TCE-containing genes but that tTFIID is not an obligatory regulator of TCE-containing genes. Thus, the TCE is a core promoter element in a subset of genes that are specifically expressed in testes. Furthermore, the TCE regulates transcription in the context of short genomic regions, from variable locations in the core promoter, and both dependently and independently of tTFIID. These findings set the stage for determining the mechanism by which the TCE regulates testis-specific transcription and understanding the dual role of the TCE in translational and transcriptional regulation.

CHAP-2 heat-transfer analysis of the Fort St. Vrain reactor core

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

Kotas, J.F.; Stroh, K.R.

1983-01-01

The Los Alamos National Laboratory is developing the Composite High-Temperature Gas-Cooled Reactor Analysis Program (CHAP) to provide advanced best-estimate predictions of postulated accidents in gas-cooled reactor plants. The CHAP-2 reactor-core model uses the finite-element method to initialize a two-dimensional temperature map of the Fort St. Vrain (FSV) core and its top and bottom reflectors. The code generates a finite-element mesh, initializes noding and boundary conditions, and solves the nonlinear Laplace heat equation using temperature-dependent thermal conductivities, variable coolant-channel-convection heat-transfer coefficients, and specified internal fuel and moderator heat-generation rates. This paper discusses this method and analyzes an FSV reactor-core accident thatmore » simulates a control-rod withdrawal at full power.« less

What Aspects of Personal Care Are Most Important to Patients Undergoing Radiation Therapy for Prostate Cancer?

PubMed

Foley, Kimberley A; Feldman-Stewart, Deb; Groome, Patti A; Brundage, Michael D; McArdle, Siobhan; Wallace, David; Peng, Yingwei; Mackillop, William J

2016-02-01

The overall quality of patient care is a function of the quality of both its technical and its nontechnical components. The purpose of this study was to identify the elements of nontechnical (personal) care that are most important to patients undergoing radiation therapy for prostate cancer. We reviewed the literature and interviewed patients and health professionals to identify elements of personal care pertinent to patients undergoing radiation therapy for prostate cancer. We identified 143 individual elements relating to 10 aspects of personal care. Patients undergoing radical radiation therapy for prostate cancer completed a self-administered questionnaire in which they rated the importance of each element. The overall importance of each element was measured by the percentage of respondents who rated it as "very important." The importance of each aspect of personal care was measured by the mean importance of its elements. One hundred eight patients completed the questionnaire. The percentage of patients who rated each element "very important" ranged from 7% to 95% (mean 61%). The mean importance rating of the elements of each aspect of care varied significantly: "perceived competence of caregivers," 80%; "empathy and respectfulness of caregivers," 67%; "adequacy of information sharing," 67%; "patient centeredness," 59%; "accessibility of caregivers," 57%; "continuity of care," 51%; "privacy," 51%; "convenience," 45%; "comprehensiveness of services," 44%; and "treatment environment," 30% (P<.0001). Neither age nor education was associated with importance ratings, but the patient's health status was associated with the rating of some elements of care. Many different elements of personal care are important to patients undergoing radiation therapy for prostate cancer, but the 3 aspects of care that most believe are most important are these: the perceived competence of their caregivers, the empathy and respectfulness of their caregivers, and the adequacy of information sharing. Copyright © 2016 Elsevier Inc. All rights reserved.

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

PubMed

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H; Nolan, Jerry P

2015-11-01

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. Copyright © 2014 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier Ireland Ltd.. All rights reserved.

Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

PubMed

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Huei-Ming Ma, Matthew; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Eng Hock Ong, Marcus; Travers, Andrew H; Nolan, Jerry P

2015-09-29

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. © 2014 by the American Heart Association, Inc., and European Resuscitation Council.

Web 2.0 systems supporting childhood chronic disease management: a pattern language representation of a general architecture.

PubMed

Timpka, Toomas; Eriksson, Henrik; Ludvigsson, Johnny; Ekberg, Joakim; Nordfeldt, Sam; Hanberger, Lena

2008-11-28

Chronic disease management is a global health concern. By the time they reach adolescence, 10-15% of all children live with a chronic disease. The role of educational interventions in facilitating adaptation to chronic disease is receiving growing recognition, and current care policies advocate greater involvement of patients in self-care. Web 2.0 is an umbrella term for new collaborative Internet services characterized by user participation in developing and managing content. Key elements include Really Simple Syndication (RSS) to rapidly disseminate awareness of new information; weblogs (blogs) to describe new trends, wikis to share knowledge, and podcasts to make information available on personal media players. This study addresses the potential to develop Web 2.0 services for young persons with a chronic disease. It is acknowledged that the management of childhood chronic disease is based on interplay between initiatives and resources on the part of patients, relatives, and health care professionals, and where the balance shifts over time to the patients and their families. Participatory action research was used to stepwise define a design specification in the form of a pattern language. Support for children diagnosed with diabetes Type 1 was used as the example area. Each individual design pattern was determined graphically using card sorting methods, and textually in the form Title, Context, Problem, Solution, Examples and References. Application references were included at the lowest level in the graphical overview in the pattern language but not specified in detail in the textual descriptions. The design patterns are divided into functional and non-functional design elements, and formulated at the levels of organizational, system, and application design. The design elements specify access to materials for development of the competences needed for chronic disease management in specific community settings, endorsement of self-learning through online peer-to-peer communication, and systematic accreditation and evaluation of materials and processes. The use of design patterns allows representing the core design elements of a Web 2.0 system upon which an 'ecological' development of content respecting these constraints can be built. Future research should include evaluations of Web 2.0 systems implemented according to the architecture in practice settings.

Siderophile Element Partitioning between Cohenite and Liquid in Fe-Ni-S-C System and Implications for Geochemistry of Planetary Cores and Mantles

NASA Astrophysics Data System (ADS)

Buono, A. S.; Dasgupta, R.; Walker, D.

2011-12-01

Secular cooling of terrestrial planets is known to cause crystallization of a solid inner core from metallic liquid core. Fractionation of light and siderophile elements is important during such crystallization for evolution of outer core and possible core-mantle interaction. Thus far studies focused on a pure Fe inner core in simple binary systems but the effects of possible formation of a carbide inner core component on siderophile element partitioning in a multi-component system has yet to be looked at in detail. We investigated the effects of pressure and S content on partition coefficients (D) between cohenite and liquid in the Fe-Ni-S-C system. Multi-anvil experiments were performed at 3 and 6 GPa at 1150 °C, in an Fe-rich mix containing a constant C and Ni to which S contents of 0, 5, and 14 wt.% were added. All the mixes were doped with W, Re, Os, Pt, and Co. Samples were imaged and analyzed for Fe, Ni, S, and C using an EPMA. Fe, Ni, and trace elements were analyzed using a LA-ICP-MS. All the experiments produced cohenite and Fe-Ni-C±S liquid. Compared to solid-Fe/melt Ds [1-2], cohenite/melt Ds are lower for all elements except W. The light element (S+C) content of the liquid is the dominant controlling factor in siderophile element partitioning between cohenite and liquid as it is between crystalline Fe and liquid. In the cohenite-metallic melt experiments, D Ni decreases as S+C increases. Ni is excluded from the crystallizing solid if the solid is cohenite. We also find that in the Fe-Ni-S-C system, cohenite is stabilized to higher P than in the Fe-S-C system [3-5]. Similar to the Fe-metallic liquid systems the non-metal avoidance model [6] is applicable to the Fe3C-metallic liquid system studied here. Our study has implications for both the cores of smaller planets and the mantles of larger planets. If inner core forms a cohenite layer we would predict that depletions in the outer core will be less than they might be for Fe metal crystallization. For the mantle of the earth, which is thought to become Fe-Ni metal-saturated as shallow as 250 km, the sub-system Fe-Ni + C + S becomes relevant and Fe-Ni carbide rather than metallic Fe-Ni alloy may become the crystalline phase of interest. Our study implies that because the partition coefficients between cohenite and Fe-C-S melts are significantly lower than those between Fe-metal and S-rich liquid, in the presence of cohenite and Fe-C-S melt in the mantle, the mantle budget of Ni, Co, and Pt may be dominated by Fe-C-S liquid. W, Re, and Os will also be slightly enriched in C-rich Fe-Ni liquid over cohenite if the metal sub-system of interest is S-free. [1] Chabot et al., GCA 70, 1322-1335, 2006 [2] Chabot et al., GCA 72, 4146-4158, 2008 [3] Chabot et al., Meteorit. Planet. Sci. 42, 1735-1750, 2007 [4] Stewart et al., EPSL 284, 302-309, 2009 [5] Van Orman et al., EPSL 274, 250-257, 2008 [6] Jones, J.H., Malvin, D.J., Metall Mater Trans B 21, 697-706, 1990

Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care.

PubMed

O'Donnell, Allison N; Williams, Mark; Kilbourne, Amy M

2013-12-01

The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the Neonatal Intensive Care Unit. Part A: Background and Rationale. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN.

PubMed

Milette, Isabelle; Martel, Marie-Josée; Ribeiro da Silva, Margarida; Coughlin McNeil, Mary

2017-06-01

The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.

The dynamics of health care reform--learning from a complex adaptive systems theoretical perspective.

PubMed

Sturmberg, Joachim P; Martin, Carmel M

2010-10-01

Health services demonstrate key features of complex adaptive systems (CAS), they are dynamic and unfold in unpredictable ways, and unfolding events are often unique. To better understand the complex adaptive nature of health systems around a core attractor we propose the metaphor of the health care vortex. We also suggest that in an ideal health care system the core attractor would be personal health attainment. Health care reforms around the world offer an opportunity to analyse health system change from a complex adaptive perspective. At large health care reforms have been pursued disregarding the complex adaptive nature of the health system. The paper details some recent reforms and outlines how to understand their strategies and outcomes, and what could be learnt for future efforts, utilising CAS principles. Current health systems show the inherent properties of a CAS driven by a core attractor of disease and cost containment. We content that more meaningful health systems reform requires the delicate task of shifting the core attractor from disease and cost containment towards health attainment.

Superconductor cable

DOEpatents

Allais, Arnaud [Hannover, DE; Schmidt, Frank [Langenhagen, DE

2009-12-15

A superconductor cable includes a superconductive cable core (1) and a cryostat (2) enclosing the same. The cable core (1) has a superconductive conductor (3), an insulation (4) surrounding the same and a shielding (5) surrounding the insulation (4). A layer (3b) of a dielectric or semiconducting material is applied to a central element (3a) formed from a normally conducting material as a strand or tube and a layer (3c) of at least one wire or strip of superconductive material is placed helically on top. The central element (3a) and the layer (3c) are connected to each other in an electrically conducting manner at the ends of the cable core (1).

NEUTRONIC REACTOR

DOEpatents

Metcalf, H.E.

1957-10-01

A reactor of the type which preferably uses plutonium as the fuel and a liquid moderator, preferably ordinary water, and which produces steam within the reactor core due to the heat of the chain reaction is described. In the reactor shown the fuel elements are essentially in the form of trays and are ventically stacked in spaced relationship. The water moderator is continuously supplied to the trays to maintain a constant level on the upper surfaces of the fuel element as it is continually evaporated by the heat. The steam passes out through the spaces between the fuel elements and is drawn off at the top of the core. The fuel elements are clad in aluminum to prevent deterioration thereof with consequent contamimation of the water.

A New Model for General Education in Associate's Degree Programs: Developing and Teaching a Core Across the Curriculum.

ERIC Educational Resources Information Center

Altieri, Guy; Cygnar, Patricia Marvelli

1997-01-01

Describes how faculty and administrators at Washtenaw Community College (WCC) strengthened general education requirements by identifying 24 core learning elements and incorporating them into existing classes. Provides advice for other colleges undergoing core curriculum revision. (17 citations) (YKH)

12 CFR 567.5 - Components of capital.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Requirements § 567.5 Components of capital. (a) Core Capital. (1) The following elements, 3 less the amount of any deductions pursuant to paragraph (a)(2) of this section, comprise a savings association' s core... includable in core capital. (iii) Minority interests in the equity accounts of the subsidiaries that are...

Vocational Education and Connecticut's Common Core of Learning.

ERIC Educational Resources Information Center

Connecticut State Dept. of Education, Hartford. Div. of Vocational, Technical, and Adult Education.

The Connecticut State Board of Education policy known as the Common Core of Learning, outlines the skill, knowledge and attitudinal attainments expected of the state's secondary school graduates. This guide identifies the common core elements that can and should be reinforced through the vocational education curriculum. Information on the common…

Liquid Iron Alloys with Hydrogen at Outer Core Conditions by First Principles

NASA Astrophysics Data System (ADS)

Umemoto, K.; Hirose, K.

2015-12-01

Since the density of the outer core deduced from seismic data is about 10% lower than that of pure iron at core pressures and temperatures (P-T), it is widely believed that the outer core includes one or more light elements. Although intensive experimental and theoretical studies have been performed so far, the light element in the core has not yet been identified. Comparison of the density and sound velocity of liquid iron alloys with observations, such as the PREM, is a promising way to determine the species and quantity of light alloying component(s) in the outer core. Here we report the results of a first-principles molecular dynamics study on liquid iron alloyed with hydrogen, one of candidates of the light elements. Hydrogen had been much less studied than other candidates. However, hydrogen has been known to reduce the melting temperature of Fe-H solid [1]. Furthermore, very recently, Nomura et al. argued that the outer core may include 24 at.% H in order to be molten under relatively low temperature (< 3600 K) [2]. Since then hydrogen has attracted strong interests. We clarify the effects of hydrogen on density and sound velocity of liquid iron alloys under outer core P-T conditions. It is shown that ~1 wt% hydrogen can reproduce PREM density and sound velocity simultaneously very well. In addition, we show the presence of hydrogen rather reduces Gruneisen parameters. It indicates that, if hydrogen exists in the outer core, temperature profile of the outer core could be changed considerably from one estimated so far. [1] Sakamaki, K., E. Takahashi, Y. Nakajima, Y. Nishihara, K. Funakoshi, T. Suzuki, and Y. Fukai, Phys. Earth Planet. Inter., 174, 192-201 (2009). [2] Nomura, R., K. Hirose, K. Uesugi, Y. Ohishi, A. Tsuchiyama, A. Miyake, and Y. Ueno, Science 31, 522-525 (2014).

The Metabolic Core and Catalytic Switches Are Fundamental Elements in the Self-Regulation of the Systemic Metabolic Structure of Cells

PubMed Central

De la Fuente, Ildefonso M.; Cortes, Jesus M.; Perez-Pinilla, Martin B.; Ruiz-Rodriguez, Vicente; Veguillas, Juan

2011-01-01

Background Experimental observations and numerical studies with dissipative metabolic networks have shown that cellular enzymatic activity self-organizes spontaneously leading to the emergence of a metabolic core formed by a set of enzymatic reactions which are always active under all environmental conditions, while the rest of catalytic processes are only intermittently active. The reactions of the metabolic core are essential for biomass formation and to assure optimal metabolic performance. The on-off catalytic reactions and the metabolic core are essential elements of a Systemic Metabolic Structure which seems to be a key feature common to all cellular organisms. Methodology/Principal Findings In order to investigate the functional importance of the metabolic core we have studied different catalytic patterns of a dissipative metabolic network under different external conditions. The emerging biochemical data have been analysed using information-based dynamic tools, such as Pearson's correlation and Transfer Entropy (which measures effective functionality). Our results show that a functional structure of effective connectivity emerges which is dynamical and characterized by significant variations of bio-molecular information flows. Conclusions/Significance We have quantified essential aspects of the metabolic core functionality. The always active enzymatic reactions form a hub –with a high degree of effective connectivity- exhibiting a wide range of functional information values being able to act either as a source or as a sink of bio-molecular causal interactions. Likewise, we have found that the metabolic core is an essential part of an emergent functional structure characterized by catalytic modules and metabolic switches which allow critical transitions in enzymatic activity. Both, the metabolic core and the catalytic switches in which also intermittently-active enzymes are involved seem to be fundamental elements in the self-regulation of the Systemic Metabolic Structure. PMID:22125607

AFRL’s ALREST Physics-Based Combustion Stability Program

DTIC Science & Technology

2012-11-08

enduring challenge because of the inherent complexities in the physics of multiphase turbulent flames. The present paper provides the Air Force...Combustor F i d e l i t y URANS LES Steady RANS HLES Current SOA Capability with 2000 cores Capability at Program End in 2015 (2,000 cores+GPUs) Capability...Unlimited ALREST Validation Cases “Final Exam ” Hydrogen Stable Single Element (PSU) Stable Single Element Methane (Singla) Supercritical Non

Geochemical Constraints on Core Formation in the Earth

NASA Technical Reports Server (NTRS)

Jones, John H.; Drake, Michael J.

1986-01-01

New experimental data on the partitioning of siderophile and chalcophile elements among metallic and silicate phases may be used to constrain hypotheses of core formation in the Earth. Three current hypotheses can explain gross features of mantle geochemistry, but none predicts siderophile and chalcophile element abundances to within a factor of two of observed values. Either our understanding of metal-silicate interactions and/or our understanding of the early Earth requires revision.

Femtosecond laser processing of optical fibres for novel sensor development

NASA Astrophysics Data System (ADS)

Kalli, Kyriacos; Theodosiou, Antreas; Ioannou, Andreas; Lacraz, Amedee

2017-04-01

We present results of recent research where we have utilized a femtosecond laser to micro-structure silica and polymer optical fibres in order to realize versatile optical components such as diffractive optical elements on the fibre end face, the inscription of integrated waveguide circuits in the fibre cladding and novel optical fibre sensors designs based on Bragg gratings in the core. A major hurdle in tailoring or modifying the properties of optical fibres is the development of an inscription method that can prove to be a flexible and reliable process that is generally applicable to all optical fibre types; this requires careful matching of the laser parameters and optics in order to examine the spatial limits of direct laser writing, whether the application is structuring at the surface of the optical fibre or inscription in the core and cladding of the fibre. We demonstrate a variety of optical components such as two-dimensional grating structures, Bessel, Airy and vortex beam generators; moreover, optical bridging waveguides inscribed in the cladding of single-mode fibre as a means to selectively couple light from single-core to multi-core optical fibres, and demonstrate a grating based sensor; finally, we have developed a novel femtosecond laser inscription method for the precise inscription of tailored Bragg grating sensors in silica and polymer optical fibres. We also show that this novel fibre Bragg grating inscription technique can be used to modify and add versatility to an existing, encapsulated optical fibre pressure sensor.

Glued Joint Behavior of Ribs for Wood-Based Composite Plates

NASA Astrophysics Data System (ADS)

Frolovs, G.; Rocens, K.; Sliseris, J.

2015-11-01

This article presents experimental investigations of composite sandwich plywood plates with cell type core and their connections between skin layers of birch plywood and a core of straight and curved plywood honeycomb-type ribs. This shape of core ribs provides several improvements for these plates in the manufacturing process as well as improves the mechanical properties of plywood plates. This specific form of ribs allows simplifying the manufacturing of these plates although it should be detailed and improved. The most typical cases (series of specimens) were compared to the results obtained from FEM (ANSYS) simulations. All thicknesses of elements are chosen according to plywood supplier assortment. Standard birch plywood (Riga Ply) plates were used - three layer plywood was chosen for skin elements (Surfaces) and three or five layer plywood was chosen for edge elements. Different bond pressures were taken to compare their influence on joint strength and stiffness.

Developments in the Gung Ho dynamical core

NASA Astrophysics Data System (ADS)

Melvin, Thomas

2017-04-01

Gung Ho is the new dynamical core being developed for the next generation Met Office weather and climate model, suitable for meeting the exascale challenge on emerging computer architectures. It builds upon the earlier collaborative project between the Met Office, NERC and STFC Daresbury of the same name to investigate suitable numerical methods for dynamical cores. A mixed-finite element approach is used, where different finite element spaces are used to represent various fields. This method provides a number of beneficial improvements over the current model, such a compatibility and inherent conservation on quasi-uniform unstructured meshes, whilst maintaining the accuracy and good dispersion properties of the staggered grid currently used. Furthermore, the mixed finite element approach allows a large degree of flexibility in the type of mesh, order of approximation and discretisation, providing a simple way to test alternative options to obtain the best model possible.

Palliative care for respiratory disease: An education model of care.

PubMed

Bowman, Brynn; Meier, Diane E

2018-02-01

That palliative care improves quality of life for seriously ill patients and their families is well known - but how can healthcare providers ensure that the palliative needs of all patients are being assessed and addressed? A growing number of curricula in core palliative care practices have been developed to ensure that clinicians from all specialties and disciplines have the necessary training to manage pain and symptoms and discuss care goals with patients and families. Through broad-based training in core palliative care skills, combined with referral to specialty palliative care for high-need patients, providers can improve quality of life for their patients with respiratory disease.

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator

PubMed Central

2012-01-01

Background To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Methods Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. Results The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. Conclusions The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised. PMID:23153014

In-situ Density and Thermal Expansion Measurements of Fe and Fe-S Alloying Liquids Under Planetary Core Conditions

NASA Astrophysics Data System (ADS)

Jing, Z.; Chantel, J.; Yu, T.; Sakamaki, T.; Wang, Y.

2015-12-01

Liquid iron is likely the dominant constituent in the cores of terrestrial planets and icy satellites such as Earth, Mars, Mercury, the Moon, Ganymede, and Io. Suggested by geophysical and geochemical observations, light elements such as S, C, Si, etc., are likely present in planetary cores. These light elements can significantly reduce the density and melting temperature of the Fe cores, and hence their abundances are crucial to our understanding of the structure and thermal history of planetary cores, as well as the generation of intrinsic magnetic fields. Knowledge on the density of Fe-light element alloying liquids at high pressures is critical to place constraints on the composition of planetary cores. However, density data on liquid Fe-light element alloys at core pressures are very limited in pressure and composition and are sometimes controversial. In this study, we extend the density dataset for Fe-rich liquids by measuring the density of Fe, Fe-10wt%S, Fe-20wt%S, Fe-27wt%S, and FeS liquids using the X-ray absorption technique in a DIA-type multianvil apparatus up to 7 GPa and 2173 K. An ion chamber (1D-detector) and a CCD camera (2D-detector) were used to measure intensities of transmitted monochromatic X-rays through molten samples, with the photon energy optimized at 40 keV. The densities were then determined from the Beer-Lambert law using the mass absorption coefficients, calibrated by solid standards using X-ray diffraction. At each pressure, density measurements were conducted at a range of temperatures above the liquidus of the samples, enabling the determination of thermal expansion. Combined with our previous results on the sound velocity of Fe and Fe-S liquids at high pressures (Jing et al., 2014, Earth Planet. Sci. Lett. 396, 78-87), these data provide tight constraints on the equation of state and thermodynamic properties such as the adiabatic temperature gradient for Fe-S liquids. We will discuss these results with implications to planetary cores.

Toward Connecting Core-Collapse Supernova Theory with Observations: Nucleosynthetic Yields and Distribution of Elements in a 15 M⊙ Blue Supergiant Progenitor with SN 1987A Energetics

NASA Astrophysics Data System (ADS)

Plewa, Tomasz; Handy, Timothy; Odrzywolek, Andrzej

2014-09-01

We compute and discuss the process of nucleosynthesis in a series of core-collapse explosion models of a 15 solar mass, blue supergiant progenitor. We obtain nucleosynthetic yields and study the evolution of the chemical element distribution from the moment of core bounce until young supernova remnant phase. Our models show how the process of energy deposition due to radioactive decay modifies the dynamics and the core ejecta structure on small and intermediate scales. The results are compared against observations of young supernova remnants including Cas A and the recent data obtained for SN 1987A. We compute and discuss the process of nucleosynthesis in a series of core-collapse explosion models of a 15 solar mass, blue supergiant progenitor. We obtain nucleosynthetic yields and study the evolution of the chemical element distribution from the moment of core bounce until young supernova remnant phase. Our models show how the process of energy deposition due to radioactive decay modifies the dynamics and the core ejecta structure on small and intermediate scales. The results are compared against observations of young supernova remnants including Cas A and the recent data obtained for SN 1987A. The work has been supported by the NSF grant AST-1109113 and DOE grant DE-FG52-09NA29548. This research used resources of the National Energy Research Scientific Computing Center, which is supported by the U.S. DoE under Contract No. DE-AC02-05CH11231.

Elastic properties and phase transitions of Fe7C3 and new constraints on the light element budget of the Earth's inner core

NASA Astrophysics Data System (ADS)

Prescher, C.; Bykova, E.; Kupenko, I.; Glazyrin, K.; Kantor, A.; McCammon, C. A.; Mookherjee, M.; Miyajima, N.; Cerantola, V.; Nakajima, Y.; Prakapenka, V.; Rüffer, R.; Chumakov, A.; Dubrovinsky, L. S.

2013-12-01

The Earth's inner core consists mainly of iron (or iron-nickel alloy) with some amount of light element(s) whereby their nature remains controversial. Seismological data suggest that the material forming Earth's inner core (pressures over 330 GPa and temperatures above 5000 K) has an enigmatically high Poisson's ratio ~0.44, while iron or it alloys with Si, S, O, or H expected to have at appropriate thermodynamic conditions Poisson's ratio well below 0.39. We will present an experimental study on a new high pressure variant in the iron carbide system. We have synthesized and solved structure of high-pressure orthorhombic phase of o-Fe7C3, and investigated its stability and behavior at pressures over 180 GPa and temperatures above 3500 K by means of different methods including single crystal X-ray diffraction, Mössbauer spectroscopy, and nuclear resonance scattering. O-Fe7C3 is structurally stable to at least outer core conditions and demonstrates magnetic or electronic transitions at ~18 GPa and ~70 GPa. The high pressure phase of o-Fe7C3 above 70 GPa exhibits anomalous elastic properties. When extrapolated to the conditions of the Earth's inner core it shows shear wave velocities and Poisson's ratios close to the values inferred by seismological models. Our results not only support earlier works suggesting that carbon may be an important component of Earth's core, but shows that it may drastically change iron's elastic properties, thus explaining anomalous Earth's inner core elastic properties.

Crustal forensics in arc magmas

NASA Astrophysics Data System (ADS)

Davidson, Jon P.; Hora, John M.; Garrison, Jennifer M.; Dungan, Michael A.

2005-01-01

The geochemical characteristics of continental crust are present in nearly all arc magmas. These characteristics may reflect a specific source process, such as fluid fluxing, common to both arc magmas and the continental crust, and/or may reflect the incorporation of continental crust into arc magmas either at source via subducted sediment, or via contamination during differentiation. Resolving the relative mass contributions of juvenile, mantle-derived material, versus that derived from pre-existing crust of the upper plate, and providing these estimates on an element-by-element basis, is important because: (1) we want to constrain crustal growth rates; (2) we want to quantitatively track element cycling at convergent margins; and (3) we want to determine the origin of economically important elements and compounds. Traditional geochemical approaches for determining the contributions of various components to arc magmas are particularly successful when applied on a comparative basis. Studies of suites from multiple magmatic systems along arcs, for which differentiation effects can be individually constrained, can be used to extrapolate to potential source compositions. In the Lesser Antilles Arc, for example, differentiation trends from individual volcanoes are consistent with open-system evolution. However, such trends do not project back to a common primitive magma composition, suggesting that differentiation modifies magmas that were derived from distinct mantle sources. We propose that such approaches should now be complemented by petrographically constrained mineral-scale isotope and trace element analysis to unravel the contributing components to arc magmas. This innovative approach can: (1) better constrain true end-member compositions by returning wider ranges in geochemical compositions among constituent minerals than is found in whole rocks; (2) better determine magmatic evolution processes from core-rim isotopic or trace element profiles from the phases contained in magmas; and (3) constrain rates of differentiation by applying diffusion-controlled timescales to element profiles. An example from Nguaruhoe Volcano, New Zealand, underscores the importance of such a microsampling approach, showing that mineral isotopic compositions encompass wide ranges, that whole-rock isotopic compositions are consequently simply element-weighted averages of the heterogeneous crystal cargo, and that open-system evolution is proved by core-rim variations in Sr isotope ratios. Nguaruhoe is just one of many systems examined through microanalytical approaches. The overwhelming conclusion of these studies is that crystal cargoes are not truly phenocrystic, but are inherited from various sources. The implication of this realization is that the interpretation of whole-rock isotopic data, including the currently popular U-series, needs careful evaluation in the context of petrographic observations.

Core formation in the shergottite parent body and comparison with the earth

NASA Technical Reports Server (NTRS)

Treiman, Allan H.; Jones, John H.; Drake, Michael J.

1987-01-01

Abundances of elements in shergottite, nakhlite, and Chassigny meteorites which originated on a single planet, the shergottite parent body (SPB), were examined with the aim of elucidating the chemical conditions of metal separation and core formation in the SPB and of testing present models of planetary core formation. Using partition coefficients and the SPB mantle composition determined in earlier studies, the abundances of Ag, Au, Co, Ga, Mo, Ni, P, Re, S, and W were modeled, with free parameters being oxygen fugacity, proportion of solid metal formed, proportion of metallic liquid formed, and proportion of silicate that is molten. It is shown that the abundances of all elements (except Mo) could be reproduced using models with these four free parameters. In contrast to the SPB, an equivalent model used to predict element abundances in the earth's mantle was shown by Jones and Drake (1986) to be inadequate; there is at present no hypothesis capable of quantitatively reproducing the elemental abundances of the earth's mantle. The contrast suggests that these two terrestrial planets (assuming that the SPB is Mars) may have accreted or differentiated differently.

Primary care nursing role and care coordination: an observational study of nursing work in a community health center.

PubMed

Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret

2012-05-31

Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.

Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the NICU. Part B: Recommendations and Justification. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN.

PubMed

Milette, Isabelle; Martel, Marie-Josée; da Silva, Margarida Ribeiro; Coughlin McNeil, Mary

2017-06-01

The use of age-appropriate care as an organized framework for care delivery in the NICU is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the NICU. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for healthcare professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of these core measures require a strong framework for institutional operationalization presented in these guidelines. Part B will present the recommendations and justification of each steps behind the present guidelines to facilitate their implementation.

Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions.

PubMed

Solberg, Hilde Strøm; Steinsbekk, Aslak; Solbjør, Marit; Granbo, Randi; Garåsen, Helge

2014-11-08

Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users' and health professionals' perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients' every-day life situations. The user informants' perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring approach should be applied in the development of the health professionals' competence in practice. The effect of a self-management support programme based on the core characteristics found in this study needs to be evaluated.

Engagement and education: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

PubMed

Devereaux, Asha V; Tosh, Pritish K; Hick, John L; Hanfling, Dan; Geiling, James; Reed, Mary Jane; Uyeki, Timothy M; Shah, Umair A; Fagbuyi, Daniel B; Skippen, Peter; Dichter, Jeffrey R; Kissoon, Niranjan; Christian, Michael D; Upperman, Jeffrey S

2014-10-01

Engagement and education of ICU clinicians in disaster preparedness is fragmented by time constraints and institutional barriers and frequently occurs during a disaster. We reviewed the existing literature from 2007 to April 2013 and expert opinions about clinician engagement and education for critical care during a pandemic or disaster and offer suggestions for integrating ICU clinicians into planning and response. The suggestions in this article are important for all of those involved in a pandemic or large-scale disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. A systematic literature review was performed and suggestions formulated according to the American College of Chest Physicians (CHEST) Consensus Statement development methodology. We assessed articles, documents, reports, and gray literature reported since 2007. Following expert-informed sorting and review of the literature, key priority areas and questions were developed. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Twenty-three suggestions were formulated based on literature-informed consensus opinion. These suggestions are grouped according to the following thematic elements: (1) situational awareness, (2) clinician roles and responsibilities, (3) education, and (4) community engagement. Together, these four elements are considered to form the basis for effective ICU clinician engagement for mass critical care. The optimal engagement of the ICU clinical team in caring for large numbers of critically ill patients due to a pandemic or disaster will require a departure from the routine independent systems operating in hospitals. An effective response will require robust information systems; coordination among clinicians, hospitals, and governmental organizations; pre-event engagement of relevant stakeholders; and standardized core competencies for the education and training of critical care clinicians.

A comparison of human elements and nonhuman elements in private health care settings: customers' perceptions and expectations.

PubMed

Mohd Suki, Norazah; Chwee Lian, Jennifer Chiam; Suki, Norbayah Mohd

2009-01-01

In today's highly competitive health care environment, many private health care settings are now looking into customer service indicators to learn customers' perceptions and determine whether they are meeting customers' expectations in order to ensure that their customers are satisfied with the services. This research paper aims to investigate whether the human elements were more important than the nonhuman elements in private health care settings. We used the internationally renowned SERVQUAL five-dimension model plus three additional dimensions-courtesy, communication, and understanding of customers of the human element-when evaluating health care services. A total of 191 respondents from three private health care settings in the Klang Valley region of Malaysia were investigated. Descriptive statistics were calculated by the Statistical Package for Social Sciences (SPSS) computer program, version 15. Interestingly, the results suggested that customers nowadays have very high expectations especially when it comes to the treatment they are receiving. Overall, the research indicated that the human elements were more important than the nonhuman element in private health care settings. Hospital management should look further to improve on areas that have been highlighted. Implications for management practice and directions for future research are discussed.

Initial experiences in embedding core competency education in entry-level surgery residents through a nonclinical rotation.

PubMed

Kahol, Kanav; Huston, Carrie; Hamann, Jessica; Ferrara, John J

2011-03-01

Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers. Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors. We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation. By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas. Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.

The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System

PubMed Central

Kurahashi, Allison M; Stinson, Jennifer N; van Wyk, Margaret; Luca, Stephanie; Jamieson, Trevor; Weinstein, Peter; Cafazzo, Joseph A; Lokuge, Bhadra; Cohen, Eyal; Rapoport, Adam

2018-01-01

Background Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system’s uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective This study aimed to report end users’ perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results Participants enjoyed testing Loop and were able to use the core functions—composing, posting, and reading messages—with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. PMID:29317386

Vertical distribution of potentially toxic elements in sediments impacted by intertidal geothermal hot springs (Bahia Concepcion, Gulf of California)

NASA Astrophysics Data System (ADS)

Leal-Acosta, M. L.; Shumilin, E.

2016-12-01

The intertidal geothermal hot springs (GHS) in Bahia Concepcion, Gulf of California are the source of potentially toxic elements to the adjacent marine environment surrounded by mangroves trees. The anoxic sediments enriched in organic carbon accumulate As, Hg and other heavy metals that can be bioavailable for the biota. To know the vertical distribution of these elements the geochemistry of a short sediment core was carried out. It was collected in June, 2010 in the mangrove area near to GHS (1 m) during a low tide, pushing manually a polypropylene tube into the sediments. The extracted sediment core was cut with plastic knife on 1 cm thick sub-samples, stored in plastic bags and transported on ice to the laboratory. The major and trace elements contents were determinate by ICP-MS after total digestion with stronger acids (HClO4-HNO3-HCl-HF). Certificate reference materials were used for the quality control of the method obtaining good recoveries for most of the elements (80-105%). The sediment core had high maximum contents of CaCO3 (70%) and total organic carbon (12%). The concentration of Hg along the core ranges from 650 to 74300 mg kg-1 and had more than three orders of magnitude above the reference values of 40 mg kg-1 for the Upper Continental Crust (UCC)1. In contrast, As ranges from 12 to 258 mg kg-1 resulting in more than one order of magnitude respect to UCC1 (1.7 mg kg-1). Similar pattern result for Mn, Cu, Pb, and Zn with the maximum values of 3200 mg kg-1, 42 mg kg-1, 12.4 mg kg-1, 71 mg kg-1 respectively that coincide with the maximum for As at the same core depth (4 cm). The Ca, Li, Co, Sb, U, and Mg also show high contents in comparison with the UCC1reference values. The maximum contents of Mo and Cd coincide with maximum concentration of sulfur (2%) at 6 to 8 cm. The enrichment factor calculated using Al as normalizing element showed Cd (7-280), As (26-329) and Hg (23-1196) as highly enriched mainly in the first centimeters of the sediment core. 1 Wedephol (1995)

Analytical performance of a versatile laboratory microscopic X-ray fluorescence system for metal uptake studies on argillaceous rocks

NASA Astrophysics Data System (ADS)

Gergely, Felicián; Osán, János; Szabó, B. Katalin; Török, Szabina

2016-02-01

Laboratory-scale microscopic X-ray fluorescence (micro-XRF) plays an increasingly important role in various fields where multielemental investigations of samples are indispensable. In case of geological samples, the reasonable detection limits (LOD) and spatial resolutions are necessary to identify the trace element content in microcrystalline level. The present study focuses on the analytical performance of a versatile laboratory-scale micro-XRF system with various options of X-ray sources and detectors to find the optimal experimental configuration in terms of sensitivities and LOD for selected elements in loaded petrographic thin sections. The method was tested for sorption studies involving thin sections prepared from cores of Boda Claystone Formation, which is a potential site for a high-level radioactive waste repository. Loaded ions in the sorption measurements were Cs(I) and Ni(II) chemically representing fission and corrosion products. Based on the collected elemental maps, the correlation between the elements representative of main rock components and the selected loaded ion was studied. For the elements of interest, Cs(I) and Ni(II) low-power iMOXS source with polycapillary and silicon drift detector was found to be the best configuration to reach the optimal LOD values. Laboratory micro-XRF was excellent to identify the responsible key minerals for the uptake of Cs(I). In case of nickel, careful corrections were needed because of the relatively high Ca content of the rock samples. The results were compared to synchrotron radiation micro-XRF.

HFSE systematics of rutile-bearing eclogites: New insights into subduction zone processes and implications for the earth’s HFSE budget

NASA Astrophysics Data System (ADS)

Schmidt, Alexander; Weyer, Stefan; John, Timm; Brey, Gerhard P.

2009-01-01

The depleted mantle and the continental crust are generally thought to balance the budget of refractory and lithophile elements of the Bulk Silicate Earth (BSE), resulting in complementary trace element patterns. However, the two high field strength elements (HFSE) niobium and tantalum appear to contradict this mass balance. All reservoirs of the silicate Earth exhibit subchondritic Nb/Ta ratios, possibly as a result of Nb depletion. In this study a series of nineteen orogenic MORB-type eclogites from different localities was analyzed to determine their HFSE concentrations and to contribute to the question of whether subducted oceanic crust could form a hidden reservoir to account for the mass imbalance of Nb/Ta between BSE and the chondritic reservoir. Concentrations of HFSE were analyzed with isotope dilution (ID) techniques. Additionally, LA-ICPMS analyses of clinopyroxene, garnet and rutile have been performed. Rutile is by far the major host for Nb and Ta in all analyzed eclogites. However, many rutiles revealed zoning in Nb/Ta ratios, with cores being higher than rims. Accordingly, in situ analyses of rutiles have to be evaluated carefully and rutile cores do not necessarily reflect a bulk rock Nb and Ta composition, although over 90% of these elements reside in rutile. The HFSE concentration data in bulk rocks show that the orogenic eclogites have subchondritic Nb/Ta ratios and near chondritic Zr/Hf ratios. The investigated eclogites show neither enrichment of Nb compared to similarly incompatible elements (e.g. La), nor fractionation of Nb/Ta ratios relative to MOR-basalts, the likely precursor of these rocks. This indicates that during the conversion of the oceanic crust to eclogites in most cases, (1) HFSE and REE have similar mobility on average, possibly because both element groups remain in the down going slab, and (2) no significant fractionation of Nb/Ta occurs in subducted oceanic crust. With an average Nb/Ta ratio of 14.2 ± 1.4 (2s.e.), the investigated eclogites cannot balance the differences between BSE and chondrite. Additionally, as their average Nb/Ta is indistinguishable from the Nb/Ta of MORB, they are also an unlikely candidate to balance the potentially small differences in Nb/Ta between the continental crust and the mantle.

Lithium Zoning in Kīlauea Olivine: Growth vs. Diffusion?

NASA Astrophysics Data System (ADS)

Shea, T.; Lynn, K. J.; Garcia, M. O.; Costa Rodriguez, F.

2016-12-01

Lithium is a fast-diffusing element with the potential to characterize magmatic processes that occur on timescales of hours to days [1]. However, Li diffusion in olivine is complex. Experimental studies show that it can diffuse via two paths: a `fast' interstitial mechanism and a `slow' vacancy mechanism [1]. Charge balancing relationships with other incompatible trace elements may also play a role in Li diffusion [2]. A detailed study of lithium zoning in natural olivine was undertaken to better understand how Li is correlated with other trace elements and determine if Li diffusion profiles can be used to extract meaningful timescales of magmatic processes. Olivine crystals from the Keanakāko`i explosive period at Kīlauea Volcano (HI) were used in this study because (a) the lavas and tephra generally contain phenocrysts of only olivine in a rapidly quenched glass, which avoid complications of multi-phase systems and post-eruptive diffusion; (b) we previously constrained the magmatic histories of these crystals using major and minor elements; and (c) at concentrations (e.g. 1-10 ppm) and temperatures (e.g. 1150-1250 °C) typical of Kīlauea basalts, Li diffusion is probably dominated by the vacancy mechanism [1]. Euhedral crystals were carefully oriented and mounted on either the a- or b- crystallographic axes (c-axis is always within the plane of section) and polished to the crystal core. High precision LA-ICP-MS analyses of Li (2σ = 0.08 ppm), Na, Al, P, and Cr complement EPMA profiles of Si, Mg, Fe, Ni, and Ca (200 nA current). Core-to-rim transects were collected along two axes (c and a or b) to identify potential diffusion anisotropy effects for Li and other elements. Li zoning is correlated with Na, indicative of a growth signature (also observed for Al, P, and Cr), or is decoupled from incompatible trace elements and have profiles that indicate diffusive re-equilibration. Modeling of Li diffusion profiles yields timescales of hours to days, which probably represent the final stages of magma transport from crustal magma reservoirs and allow ascent rates to be estimated. [1] Dohmen et al. (2010), Geochimica et Cosmochimica Acta, 74, 274-292. [2] Spandler and O'Neill (2010), Contributions to Mineralogy and Petrology, 159, 791-818.

Bioturbating animals control the mobility of redox-sensitive trace elements in organic-rich mudstone

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

Harazim, Dario; McIlroy, Duncan; Edwards, Nicholas P.

Bioturbating animals modify the original mineralogy, porosity, organic content, and fabric of mud, thus affecting the burial diagenetic pathways of potential hydrocarbon source, seal, and reservoir rocks. High-sensitivity, synchrotron rapid scanning X-ray fluorescence elemental mapping reveals that producers of phycosiphoniform burrows systematically partition redox-sensitive trace elements (i.e., Fe, V, Cr, Mn, Co, Ni, Cu, and As) in fine-grained siliciclastic rocks. Systematic differences in organic carbon content (total organic carbon >1.5 wt%) and quality (Δ 13C org~0.6‰) are measured between the burrow core and host sediment. The relative enrichment of redox-sensitive elements in the burrow core does not correlate with significantmore » neo-formation of early diagenetic pyrite (via trace metal pyritization), but is best explained by physical concentration of clay- and silt-sized components. A measured loss (~–15%) of the large-ionic-radius elements Sr and Ba from both burrow halo and core is most likely associated with the release of Sr and Ba to pore waters during biological ( in vivo) weathering of silt- to clay-sized lithic components and feldspar. In conclusion, this newly documented effect has significant potential to inform the interpretation of geochemical proxy and rock property data, particularly from shales, where elemental analyses are commonly employed to predict reservoir quality and support paleoenvironmental analysis.« less

Bioturbating animals control the mobility of redox-sensitive trace elements in organic-rich mudstone

DOE PAGES

Harazim, Dario; McIlroy, Duncan; Edwards, Nicholas P.; ...

2015-10-07

Bioturbating animals modify the original mineralogy, porosity, organic content, and fabric of mud, thus affecting the burial diagenetic pathways of potential hydrocarbon source, seal, and reservoir rocks. High-sensitivity, synchrotron rapid scanning X-ray fluorescence elemental mapping reveals that producers of phycosiphoniform burrows systematically partition redox-sensitive trace elements (i.e., Fe, V, Cr, Mn, Co, Ni, Cu, and As) in fine-grained siliciclastic rocks. Systematic differences in organic carbon content (total organic carbon >1.5 wt%) and quality (Δ 13C org~0.6‰) are measured between the burrow core and host sediment. The relative enrichment of redox-sensitive elements in the burrow core does not correlate with significantmore » neo-formation of early diagenetic pyrite (via trace metal pyritization), but is best explained by physical concentration of clay- and silt-sized components. A measured loss (~–15%) of the large-ionic-radius elements Sr and Ba from both burrow halo and core is most likely associated with the release of Sr and Ba to pore waters during biological ( in vivo) weathering of silt- to clay-sized lithic components and feldspar. In conclusion, this newly documented effect has significant potential to inform the interpretation of geochemical proxy and rock property data, particularly from shales, where elemental analyses are commonly employed to predict reservoir quality and support paleoenvironmental analysis.« less

Health Professionals' Views of Informatics Education

PubMed Central

Staggers, Nancy; Gassert, Carole A.; Skiba, Diane J.

2000-01-01

Health care leaders emphasize the need to include information technology and informatics concepts in formal education programs, yet integration of informatics into health educational programs has progressed slowly. The AMIA 1999 Spring Congress was held to address informatics educational issues across health professions, including the educational needs in the various health professions, goals for health informatics education, and implementation strategies to achieve these goals. This paper presents the results from AMIA work groups focused on informatics education for non-informatics health professionals. In the categories of informatics needs, goals, and strategies, conference attendees suggested elements in these areas: educational responsibilities for faculty and students, organizational responsibilities, core computer skills and informatics knowledge, how to learn informatics skills, and resources required to implement educational strategies. PMID:11062228

Highly siderophile elements were stripped from Earth’s mantle by iron sulfide segregation

NASA Astrophysics Data System (ADS)

Rubie, David C.; Laurenz, Vera; Jacobson, Seth A.; Morbidelli, Alessandro; Palme, Herbert; Vogel, Antje K.; Frost, Daniel J.

2016-09-01

Highly siderophile elements (HSEs) are strongly depleted in the bulk silicate Earth (BSE) but are present in near-chondritic relative abundances. The conventional explanation is that the HSEs were stripped from the mantle by the segregation of metal during core formation but were added back in near-chondritic proportions by late accretion, after core formation had ceased. Here we show that metal-silicate equilibration and segregation during Earth’s core formation actually increased HSE mantle concentrations because HSE partition coefficients are relatively low at the high pressures of core formation within Earth. The pervasive exsolution and segregation of iron sulfide liquid from silicate liquid (the “Hadean matte”) stripped magma oceans of HSEs during cooling and crystallization, before late accretion, and resulted in slightly suprachondritic palladium/iridium and ruthenium/iridium ratios.

Spatial and seasonal variations of elemental composition in Mt. Everest (Qomolangma) snow/firn

NASA Astrophysics Data System (ADS)

Kang, Shichang; Zhang, Qianggong; Kaspari, Susan; Qin, Dahe; Cong, Zhiyuan; Ren, Jiawen; Mayewski, Paul A.

In May 2005, a total of 14 surface snow (0-10 cm) samples were collected along the climbing route from the advanced base camp to the summit (6500-8844 m a.s.l.) on the northern slope of Mt. Everest (Qomolangma). A 108 m firn/ice core was retrieved from the col of the East Rongbuk Glacier (28.03°N, 86.96°E, 6518 m a.s.l.) on the north eastern saddle of Mt. Everest in September 2002. Surface snow and the upper 3.5 m firn samples from the core were analyzed for major and trace elements by inductively coupled plasma mass spectroscopy (ICP-MS). Measurements show that crustal elements dominated both surface snow and the firn core, suggesting that Everest snow chemistry is mainly influenced by crustal aerosols from local rock or prevalent spring dust storms over southern/central Asia. There are no clear trends for element variations with elevation due to local crustal aerosol inputs or redistribution of surface snow by strong winds during the spring. Seasonal variability in snow/firn elements show that high elemental concentrations occur during the non-monsoon season and low values during the monsoon season. Ca, Cr, Cs, and Sr display the most distinct seasonal variations. Elemental concentrations (especially for heavy metals) at Mt. Everest are comparable with polar sites, generally lower than in suburban areas, and far lower than in large cities. This indicates that anthropogenic activities and heavy metal pollution have little effect on the Mt. Everest atmospheric environment. Everest firn core REE concentrations are the first reported in the region and seem to be comparable with those measured in modern and Last Glacial Maximum snow/ice samples from Greenland and Antarctica, and with precipitation samples from Japan and the East China Sea. This suggests that REE concentrations measured at Everest are representative of the background atmospheric environment.

Calculated power distribution of a thermionic, beryllium oxide reflected, fast-spectrum reactor

NASA Technical Reports Server (NTRS)

Mayo, W.; Lantz, E.

1973-01-01

A procedure is developed and used to calculate the detailed power distribution in the fuel elements next to a beryllium oxide reflector of a fast-spectrum, thermionic reactor. The results of the calculations show that, although the average power density in these outer fuel elements is not far from the core average, the power density at the very edge of the fuel closest to the beryllium oxide is about 1.8 times the core avearge.

Mechatronic Materials and Systems. Design and Demonstration of High Aughtority Shape Morphing Structures

DTIC Science & Technology

2005-09-01

thermal expansion of these truss elements. One side of the structure is fully clamped, while the other is free to displace. As in prior assessments [6...levels, by using the finite element package ABAQUS . To simulate the complete system, the core and the Kagome face members are modeled using linear...code ABAQUS . To simulate the complete actuation system, the core and Kagome members are modeled using linear Timoshenko-type beams, while the solid

High Pressure/Temperature Metal Silicate Partitioning of Tungsten

NASA Technical Reports Server (NTRS)

Shofner, G. A.; Danielson, L.; Righter, K.; Campbell, A. J.

2010-01-01

The behavior of chemical elements during metal/silicate segregation and their resulting distribution in Earth's mantle and core provide insight into core formation processes. Experimental determination of partition coefficients allows calculations of element distributions that can be compared to accepted values of element abundances in the silicate (mantle) and metallic (core) portions of the Earth. Tungsten (W) is a moderately siderophile element and thus preferentially partitions into metal versus silicate under many planetary conditions. The partitioning behavior has been shown to vary with temperature, silicate composition, oxygen fugacity, and pressure. Most of the previous work on W partitioning has been conducted at 1-bar conditions or at relatively low pressures, i.e. <10 GPa, and in two cases at or near 20 GPa. According to those data, the stronger influences on the distribution coefficient of W are temperature, composition, and oxygen fugacity with a relatively slight influence in pressure. Predictions based on extrapolation of existing data and parameterizations suggest an increased pressured dependence on metal/ silicate partitioning of W at higher pressures 5. However, the dependence on pressure is not as well constrained as T, fO2, and silicate composition. This poses a problem because proposed equilibration pressures for core formation range from 27 to 50 GPa, falling well outside the experimental range, therefore requiring exptrapolation of a parametereized model. Higher pressure data are needed to improve our understanding of W partitioning at these more extreme conditions.

Total Precipitable Water

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

None

2012-01-01

The simulation was performed on 64K cores of Intrepid, running at 0.25 simulated-years-per-day and taking 25 million core-hours. This is the first simulation using both the CAM5 physics and the highly scalable spectral element dynamical core. The animation of Total Precipitable Water clearly shows hurricanes developing in the Atlantic and Pacific.

How Should the Graduate Economics Core Be Changed?

ERIC Educational Resources Information Center

Abito, Jose Miguel; Borovickova, Katarina; Golden, Hays; Goldin, Jacob; Masten, Matthew A.; Morin, Miguel; Poirier, Alexandre; Pons, Vincent; Romem, Israel; Williams, Tyler; Yoon, Chamna

2011-01-01

The authors present suggestions by graduate students from a range of economics departments for improving the first-year core sequence in economics. The students identified a number of elements that should be added to the core: more training in building microeconomic models, a discussion of the methodological foundations of model-building, more…

Design of a Modular E-Core Flux Concentrating Axial Flux Machine: Preprint

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

Husain, Tausif; Sozer, Yilmaz; Husain, Iqbal

2015-08-24

In this paper a novel E-Core axial flux machine is proposed. The machine has a double-stator, single-rotor configuration with flux-concentrating ferrite magnets and pole windings across each leg of an E-Core stator. E-Core stators with the proposed flux-concentrating rotor arrangement result in better magnet utilization and higher torque density. The machine also has a modular structure facilitating simpler construction. This paper presents a single-phase and a three-phase version of the E-Core machine. Case studies for a 1.1-kW, 400-rpm machine for both the single-phase and three-phase axial flux machines are presented. The results are verified through 3D finite element analysis. facilitatingmore » simpler construction. This paper presents a single-phase and a three-phase version of the E-Core machine. Case studies for a 1.1-kW, 400-rpm machine for both the single-phase and three-phase axial flux machines are presented. The results are verified through 3D finite element analysis.« less

Is It Rational to Pursue Zero Suicides Among Patients in Health Care?

PubMed

Mokkenstorm, Jan K; Kerkhof, Ad J F M; Smit, Johannes H; Beekman, Aartjan T F

2017-10-26

Suicide prevention is a major health care responsibility in need of new perspectives. This study reviews Zero Suicide, an emerging approach to suicide prevention that embraces the aspirational goal of zero suicides among patients treated in health care systems or organizations. Zero Suicide is gaining international momentum while at the same time evoking objections and concerns. Fundamental to Zero Suicide is a multilevel system view on suicide prevention, with three core elements: a direct approach to suicidal behaviors; continual improvement of the quality and safety of care processes; and an organizational commitment to the aspirational goal of zero suicides. The rationale and evidence for these components are clarified and discussed against the backdrop of concerns and objections that focus on possible undesired consequences of the pursuit of zero suicide, in particular for clinicians and for those who are bereaved by suicide. It is concluded that it is rational to pursue zero suicides as an aspirational goal, provided the journey toward zero suicides is undertaken in a systemic and sustained manner, in a way that professionals feel supported, empowered, and protected against blame and inappropriate guilt. © 2017 The Authors. Suicide and Life-Threatening Behavior published by Wiley Periodicals, Inc. on behalf of American Association of Suicidology.

Health Care. Georgia Core Standards for Occupational Clusters.

ERIC Educational Resources Information Center

Georgia Univ., Athens. Dept. of Occupational Studies.

This document lists core standards and occupational knowledge and skills that have been identified/validated by industry as necessary to all Georgia students in secondary-level health care occupations programs. First, foundation skills are grouped as follows: basic skills (reading, writing, arithmetic/mathematics, listening, speaking); thinking…

Chemical composition of Earth's core

NASA Astrophysics Data System (ADS)

Saxena, S.

2017-12-01

Many planetary scientists accept that the condensed planetesimals in the solar nebula eventually led to accretion of the earth. The details of the process have not been worked out. From the metallurgical experience, it is assumed that Earth's core may have formed by density differentiation with iron sinking to the core and the slag forming the mantle. This would be a post-accretionary process with temperature developing with self-compression. The problem with this hypothesis was recognized some time ago in that the seismic density profile of the core does not match the density of iron and requires the addition of a light element. Many elements such as Si, O, C and s have been proposed as diluents to decrease the density of a purely iron core. How and when this will be accomplished is still under discussion. Since the planetesimals (or condensates) formed in a well stirred nebula, it may be argued that a variety of condensed solids and fluids may have accreted and compressed without differentiation and the core does not necessarily contain mainly the differentiated iron. It is a matter of accumulating the condensate composition that would result in a density of 12 to 13 g/cm3 in the inner core. Therefore, we need a thermodynamic database that extends to 6000 K over the pressure range of ambient to 360 GPa. The development of such a database is currently in progress. It is a database with multicomponent solutions (C-Fe-Ni-S-Si) and all the major elements in the solar gas. Thermodynamic calculations using a preliminary dataset reveal that the solid species condensed at a temperature of 650 K and a pressure of 0.001 bar pressure, when self-compressed to various pressures and temperatures, yield densities that are appropriate for the mantle and core. Depending on H2/O of the escaping fluid, the formation of hydrous minerals, carbides, carbonates and iron melts with significant other elements have been found. Earth's core may have formed from solar condensate materials representing a range of solids avaeraging the seismic density of 13 kg/m3. Such material does not have to be Fe-Ni alloy but could be many different solids and a multielement alloy. Appropriate PVT equations of state have been used in arriving at this conclusion.

Self-management education interventions for patients with cancer: a systematic review.

PubMed

Howell, Doris; Harth, Tamara; Brown, Judy; Bennett, Cathy; Boyko, Susan

2017-04-01

This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments. Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'. Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review. Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.

Sulfide in the core and the composition of the silicate Earth

NASA Astrophysics Data System (ADS)

Burton, K. W.

2015-12-01

The chemical composition of the Earth is traditionally explained in terms of evolution from a solar-like composition, similar to that found in primitive 'chondritic' meteorites. It now appears, however, that the silicate Earth is not 'chondritic', but depleted in incompatible elements, including refractory lithophile and heat-producing elements. Either Earth lost material during planet-building due to collisional erosion or else internal differentiation processes produced a hidden reservoir deep in the early Earth. Sulfide in the core may provide a reservoir capable of balancing the composition of the silicate Earth. Recent experimental work suggests that the core contains a significant proportion of sulfide, added during the final stages of accretion and new data suggests that at high pressures sulfide can incorporate a substantial amount of refractory lithophile and heat-producing elements [1]. Pioneering work using the short-lived 146Sm-142Nd system strongly suggests that Earth's silicate mantle is non-chondritic [e.g. 2]. The drawback of such radiogenic isotope systems is that it is not possible to distinguish the fractionation of Sm/Nd that occurs during silicate melting from that occurring during the segregation of a sulfide-melt to form the core. Neodymium stable isotopes have the potential to provide just such a tracer of sulfide segregation, because there is a significant contrast in bonding environment between sulfide and silicate, where heavy isotopes should be preferentially incorporated into high force-constant bonds involving REE3+ (i.e. the silicate mantle). Preliminary data indicate that mantle rocks do indeed possess heavier 146Nd/144Nd values than chondritic meteorites, consistent with the removal of light Nd into sulfide in the core, driving the residual mantle to heavy values. Overall, our isotope and elemental data indicate that the rare earths and other incompatible elements are substantially incorporated into sulfide. While Nd Stable isotope data for chondritic meteorites and mantle rocks, are consistent with the segregation of sulfide to the core. [1] Wohlers &Wood, Nature 520, 337 (2015) [2] Boyet & Carlson, Science 309, 576 (2005)

Resorptive depressions on a horn core of Late Pleistocene (MIS 3) Bison priscus (Bovidae, Mammalia) from northeastern Germany.

PubMed

Kierdorf, Uwe; Meng, Stefan; Kahlke, Ralf-Dietrich

2016-12-01

This report describes an isolated right horn core of a fossil steppe bison (Bison priscus) recovered from Late Pleistocene deposits near Langsdorf in the federal state of Mecklenburg-Vorpommern (Germany). AMS radiocarbon dating provided an age of 45353±2894cal yr BP for the specimen. The horn core, which by morphological criteria belonged to a female, has two depressions in its basal portion that differ in size, shape, and depth. While depressions are known from horn cores of domestic cattle, sheep, and goats, this is the first case reported from a wild bovid. Formation of the depressions on the steppe bison's horn core likely was caused by localized bone resorption during periods of increased demand for mineral elements that could not be met by dietary uptake. Such situations may have occurred in relation to pregnancy and/or lactation. Pronounced bone resorption as a means to mobilize skeletally stored mineral elements was observed in other mammals, too. Since horn cores are recovered frequently among skeletal remains of fossil bison, a systematic inspection of fossil collections for similar horn core depressions is encouraged. Copyright © 2016 Elsevier Inc. All rights reserved.

IMPROVEMENTS IN OR RELATING TO NUCLEAR REACTORS

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

Dennis, W.E.; Lindley, P.A.

1958-05-01

A unique feature of the GEC Hunterston power station is the use of what the firm call the 'replaceable channel fuel element' and the patent covers the idea. The actual metallic element is generally simlar to those used in other power stations--a uranium bar sheathed in a helically-finned can--but it is supported inside a sleeve of graphite or other material. The composite elements are stacked inside channels through the core and are charged and discharged as complete units. The advantages claimed are: the core channels are protected against mechanical abrasion during fuelling operation, the moderator is protected against chemical attackmore » and mass transfer from the coolant, and if there is a burst slug it is only the sleeve which is contaminated. The sleeve also takes all the weight, thus elements are unlformly stressed. Working on this idea, the specification covers several variants, including the use of plate-type elements.« less

Analysis of a cis-Acting Element Involved in Regulation by Estrogen of Human Angiotensinogen Gene Expression.

PubMed

Zhao, Yan-Yan; Sun, Kai-Lai; Ashok, Kumar

1998-01-01

The work was aimed to identify the estrogen responsive element in the human angiotensinogen gene. The nucleotide sequence between the transcription initiation site and TATA box in angiotensinogen gene promoter was found to be strongly homologous with the consensus estrogen responsive element. This sequence was confirmed as the estrogen responsive element (HAG ERE) by electrophoretic mobility shift assay. The recombinant expression vectors were constructed in which chloramphenicol acetyltransferase (CAT) reporter gene was driven by angiotensinogen core promoter with HAG ERE of by TK core promoter with multiplied HAG ERE, and were used in cotransfection with the human estrogen receptor expression vector into HepG(2) cells; CAT assays showed an increase of the CAT activity on 17beta-estradiol treatment in those transfectants. These results suggest that the human angiotensinogen gene is transcriptionally up-regulated by estrogen through the estrogen responsive element near TATA box of the promoter.

German diabetes disease management programs are appropriate for restructuring care according to the chronic care model: an evaluation with the patient assessment of chronic illness care instrument.

PubMed

Szecsenyi, Joachim; Rosemann, Thomas; Joos, Stefanie; Peters-Klimm, Frank; Miksch, Antje

2008-06-01

With the introduction of diabetes disease management programs (DMPs) in Germany, there is a necessity to evaluate whether patients receive care that is congruent to the Chronic Care Model (CCM) and evidence-based behavioral counseling. We examined differences as perceived and experienced by patients with type 2 diabetes between those enrolled in a DMP compared with patients receiving usual care in two federal states of Germany. A random, heterogeneous sample of 3,546 patients (59.3% female) received a mailed questionnaire from their regional health fund, including the German version of the Patient Assessment of Chonic Illness Care (PACIC) instrument, which had additional items for behavioral advice (5A). Two weeks later, a general reminder was sent out. A total of 1,532 questionnaires were returned (response rate 42.2%), and valid data could be obtained for 1,399 patients. Mean age of responders was 70.3 years, of which 53.6% were female. Overall, patients enrolled in a DMP scored significantly higher (3.21 of a possible 5) than patients not enrolled in a DMP (2.86) (P < 0.001). Significant differences in the same direction were found on all five subscales of the PACIC. For the 5A scales, similar differences were found for all five subscales plus the sum score (P < 0.001; mean for DMP = 3.08, mean for non-DMP = 2.78). DMPs, as currently established in primary care in Germany, may impact provided care significantly. The changes in daily practice that have been induced by the DMPs are recognized by patients as care that is more structured and that to a larger extent reflects the core elements of the CCM and evidence-based counseling compared with usual care.

Detailed clinical models: a review.

PubMed

Goossen, William; Goossen-Baremans, Anneke; van der Zel, Michael

2010-12-01

Due to the increasing use of electronic patient records and other health care information technology, we see an increase in requests to utilize these data. A highly level of standardization is required during the gathering of these data in the clinical context in order to use it for analyses. Detailed Clinical Models (DCM) have been created toward this purpose and several initiatives have been implemented in various parts of the world to create standardized models. This paper presents a review of DCM. Two types of analyses are presented; one comparing DCM against health care information architectures and a second bottom up approach from concept analysis to representation. In addition core parts of the draft ISO standard 13972 on DCM are used such as clinician involvement, data element specification, modeling, meta information, and repository and governance. SIX INITIATIVES WERE SELECTED: Intermountain Healthcare, 13606/OpenEHR Archetypes, Clinical Templates, Clinical Contents Models, Health Level 7 templates, and Dutch Detailed Clinical Models. Each model selected was reviewed for their overall development, involvement of clinicians, use of data types, code bindings, expressing semantics, modeling, meta information, use of repository and governance. Using both a top down and bottom up approach to comparison reveals many commonalties and differences between initiatives. Important differences include the use of or lack of a reference model and expressiveness of models. Applying clinical data element standards facilitates the use of conceptual DCM models in different technical representations.

Narratives of Natural Recovery: Youth Experience of Social Inclusion through Green Care

PubMed Central

Kogstad, Ragnfrid Eline; Agdal, Rita; Hopfenbeck, Mark Steven

2014-01-01

The aim of this study has been to investigate the effects of Green Care services for youth in vulnerable situations risking social exclusion. Green Care enterprises represent alternative arenas in which people can work with animals, agriculture and other tasks related to nature. We interviewed nine persons, aged 17–27, working in three different places, two or more times over a two-year period. We looked at essential beneficial factors in order to better understand how the “green” element could add to more traditional recovery factors. We found that the youth described core success factors corresponding to well-known recovery factors such as recognition, supportive relationships, motivation, meaning, positive coping, self-esteem, confidence and hope. The effective factors can be described as: (a) The leader’s ability to create a good group atmosphere, (b) the varied tasks which allow step-wise increases in self-efficacy, and (c) experiences with animals and in nature that provide comfort for youth who lack trust in people and need safe situations to recover a positive sense of self. We followed a process in which several persons gradually regained self-respect and the motivation for further education or a job outside the Green Care enterprise. The study illustrates that Green Care can be an important supplement in helping people back to a satisfying life and meaningful roles in society. PMID:24914641

Narratives of natural recovery: youth experience of social inclusion through green care.

PubMed

Kogstad, Ragnfrid Eline; Agdal, Rita; Hopfenbeck, Mark Steven

2014-06-06

The aim of this study has been to investigate the effects of Green Care services for youth in vulnerable situations risking social exclusion. Green Care enterprises represent alternative arenas in which people can work with animals, agriculture and other tasks related to nature. We interviewed nine persons, aged 17-27, working in three different places, two or more times over a two-year period. We looked at essential beneficial factors in order to better understand how the "green" element could add to more traditional recovery factors. We found that the youth described core success factors corresponding to well-known recovery factors such as recognition, supportive relationships, motivation, meaning, positive coping, self-esteem, confidence and hope. The effective factors can be described as: (a) The leader's ability to create a good group atmosphere, (b) the varied tasks which allow step-wise increases in self-efficacy, and (c) experiences with animals and in nature that provide comfort for youth who lack trust in people and need safe situations to recover a positive sense of self. We followed a process in which several persons gradually regained self-respect and the motivation for further education or a job outside the Green Care enterprise. The study illustrates that Green Care can be an important supplement in helping people back to a satisfying life and meaningful roles in society.

The next frontier: Bringing collaborative care to scale.

PubMed

Levkovich, Natalie

2015-12-01

In my position as CEO of the Health Federation of Philadelphia (HFP), I am acutely aware of the effort required to implement practice transformation, including fully integrated behavioral health (IBH) and primary care. We integrate knowledge of our marketplace, best practices from the field, and the wisdom of our providers to achieve our practice goals. We have found this to be a key to the success of our advocacy, efficient replication, and rapid regional spread of IBH. Even when payment models, the other driving barrier to IBH, catch up and reflect a better fit with the demands of efficiently integrated, whole-person, teambased care, the challenges resulting from lack of implementation support will still exist. That's where the Collaborative Family Healthcare Association (CFHA) comes in. CFHA can be that centralized and reliable structure to help guide the planning and application of the essential core elements of integrated care: aligned systems, metrics and operations; patient and family centered approaches; workforce competencies; and strategies for stakeholder engagement. In spite of its influence, integrity, and accomplishments, CFHA is still a "too-well-kept secret." By embracing a focused approach, strategic partnerships, clear communication of our unique strengths and capabilities, and the collective might that exists within our own CFHA family, CFHA can grow and thrive and continue to lead the field of collaborative family health care. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

What Aspects of Personal Care Are Most Important to Patients Undergoing Radiation Therapy for Prostate Cancer?

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

Foley, Kimberley A.; Department of Public Health Sciences, Queen's University, Kingston, Ontario; Feldman-Stewart, Deb

Purpose/Objective: The overall quality of patient care is a function of the quality of both its technical and its nontechnical components. The purpose of this study was to identify the elements of nontechnical (personal) care that are most important to patients undergoing radiation therapy for prostate cancer. Methods and Materials: We reviewed the literature and interviewed patients and health professionals to identify elements of personal care pertinent to patients undergoing radiation therapy for prostate cancer. We identified 143 individual elements relating to 10 aspects of personal care. Patients undergoing radical radiation therapy for prostate cancer completed a self-administered questionnaire inmore » which they rated the importance of each element. The overall importance of each element was measured by the percentage of respondents who rated it as “very important.” The importance of each aspect of personal care was measured by the mean importance of its elements. Results: One hundred eight patients completed the questionnaire. The percentage of patients who rated each element “very important” ranged from 7% to 95% (mean 61%). The mean importance rating of the elements of each aspect of care varied significantly: “perceived competence of caregivers,” 80%; “empathy and respectfulness of caregivers,” 67%; “adequacy of information sharing,” 67%; “patient centeredness,” 59%; “accessibility of caregivers,” 57%; “continuity of care,” 51%; “privacy,” 51%; “convenience,” 45%; “comprehensiveness of services,” 44%; and “treatment environment,” 30% (P<.0001). Neither age nor education was associated with importance ratings, but the patient's health status was associated with the rating of some elements of care. Conclusions: Many different elements of personal care are important to patients undergoing radiation therapy for prostate cancer, but the 3 aspects of care that most believe are most important are these: the perceived competence of their caregivers, the empathy and respectfulness of their caregivers, and the adequacy of information sharing.« less

A coupled/uncoupled deformation and fatigue damage algorithm utilizing the finite element method

NASA Technical Reports Server (NTRS)

Wilt, Thomas E.; Arnold, Steven M.

1994-01-01

A fatigue damage computational algorithm utilizing a multiaxial, isothermal, continuum based fatigue damage model for unidirectional metal matrix composites has been implemented into the commercial finite element code MARC using MARC user subroutines. Damage is introduced into the finite element solution through the concept of effective stress which fully couples the fatigue damage calculations with the finite element deformation solution. An axisymmetric stress analysis was performed on a circumferentially reinforced ring, wherein both the matrix cladding and the composite core were assumed to behave elastic-perfectly plastic. The composite core behavior was represented using Hill's anisotropic continuum based plasticity model, and similarly, the matrix cladding was represented by an isotropic plasticity model. Results are presented in the form of S-N curves and damage distribution plots.

Two-Dimensional Diffusion Theory Analysis of Reactivity Effects of a Fuel-Plate-Removal Experiment

NASA Technical Reports Server (NTRS)

Gotsky, Edward R.; Cusick, James P.; Bogart, Donald

1959-01-01

Two-dimensional two-group diffusion calculations were performed on the NASA reactor simulator in order to evaluate the reactivity effects of fuel plates removed successively from the center experimental fuel element of a seven- by three-element core loading at the Oak Ridge Bulk Shielding Facility. The reactivity calculations were performed by two methods: In the first, the slowing-down properties of the experimental fuel element were represented by its infinite media parameters; and, in the second, the finite size of the experimental fuel element was recognized, and the slowing-down properties of the surrounding core were attributed to this small region. The latter calculation method agreed very well with the experimented reactivity effects; the former method underestimated the experimental reactivity effects.

Evaluation of HFIR LEU Fuel Using the COMSOL Multiphysics Platform

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

Primm, Trent; Ruggles, Arthur; Freels, James D

2009-03-01

A finite element computational approach to simulation of the High Flux Isotope Reactor (HFIR) Core Thermal-Fluid behavior is developed. These models were developed to facilitate design of a low enriched core for the HFIR, which will have different axial and radial flux profiles from the current HEU core and thus will require fuel and poison load optimization. This report outlines a stepwise implementation of this modeling approach using the commercial finite element code, COMSOL, with initial assessment of fuel, poison and clad conduction modeling capability, followed by assessment of mating of the fuel conduction models to a one dimensional fluidmore » model typical of legacy simulation techniques for the HFIR core. The model is then extended to fully couple 2-dimensional conduction in the fuel to a 2-dimensional thermo-fluid model of the coolant for a HFIR core cooling sub-channel with additional assessment of simulation outcomes. Finally, 3-dimensional simulations of a fuel plate and cooling channel are presented.« less

Melting-induced stratification above the Earth's inner core due to convective translation.

PubMed

Alboussière, Thierry; Deguen, Renaud; Melzani, Mickaël

2010-08-05

In addition to its global North-South anisotropy, there are two other enigmatic seismological observations related to the Earth's inner core: asymmetry between its eastern and western hemispheres and the presence of a layer of reduced seismic velocity at the base of the outer core. This 250-km-thick layer has been interpreted as a stably stratified region of reduced composition in light elements. Here we show that this layer can be generated by simultaneous crystallization and melting at the surface of the inner core, and that a translational mode of thermal convection in the inner core can produce enough melting and crystallization on each hemisphere respectively for the dense layer to develop. The dynamical model we propose introduces a clear asymmetry between a melting and a crystallizing hemisphere which forms a basis for also explaining the East-West asymmetry. The present translation rate is found to be typically 100 million years for the inner core to be entirely renewed, which is one to two orders of magnitude faster than the growth rate of the inner core's radius. The resulting strong asymmetry of buoyancy flux caused by light elements is anticipated to have an impact on the dynamics of the outer core and on the geodynamo.

The influence of health policy and market factors on the hospital safety net.

PubMed

Bazzoli, Gloria J; Lindrooth, Richard C; Kang, Ray; Hasnain-Wynia, Romana

2006-08-01

To examine how the financial pressures resulting from the Balanced Budget Act (BBA) of 1997 interacted with private sector pressures to affect indigent care provision. American Hospital Association Annual Survey, Area Resource File, InterStudy Health Maintenance Organization files, Current Population Survey, and Bureau of Primary Health Care data. We distinguished core and voluntary safety net hospitals in our analysis. Core safety net hospitals provide a large share of uncompensated care in their markets and have large indigent care patient mix. Voluntary safety net hospitals provide substantial indigent care but less so than core hospitals. We examined the effect of financial pressure in the initial year of the 1997 BBA on uncompensated care for three hospital groups. Data for 1996-2000 were analyzed using approaches that control for hospital and market heterogeneity. All urban U.S. general acute care hospitals with complete data for at least 2 years between 1996 and 2000, which totaled 1,693 institutions. Core safety net hospitals reduced their uncompensated care in response to Medicaid financial pressure. Voluntary safety net hospitals also responded in this way but only when faced with the combined forces of Medicaid and private sector payment pressures. Nonsafety net hospitals did not exhibit similar responses. Our results are consistent with theories of hospital behavior when institutions face reductions in payment. They raise concern given continuing state budget crises plus the focus of recent federal deficit reduction legislation intended to cut Medicaid expenditures.

New insights into trace element wet deposition in the Himalayas: amounts, seasonal patterns, and implications.

PubMed

Cong, Zhiyuan; Kang, Shichang; Zhang, Yulan; Gao, Shaopeng; Wang, Zhongyan; Liu, Bin; Wan, Xin

2015-02-01

Our research provides the first complete year-long dataset of wet deposition of trace elements in the high Himalayas based on a total of 42 wet deposition events on the northern slope of Mt. Qomolangma (Everest). Except for typical crustal elements (Al, Fe, and Mn), the concentration level of most trace elements (Sc, V, Cr, Co, Ni, Cu, Zn, As, Mo, Cd, Sn, Cs, Pb, Bi, and U) are generally comparable to those preserved in snow pits and ice cores from the nearby East Rongbuk Glacier. Cadmium was the element most affected by anthropogenic emissions. No pronounced seasonal variations are observed for most trace elements despite different transport pathways. In our study, the composition of wet precipitation reflects a regional background condition and is not clearly related to specific source regions. For the trace element record from ice cores and snow pits in the Himalayas, it could be deduced that the pronounced seasonal patterns were caused by the dry deposition of trace elements (aerosols) during their long exposure to the atmosphere after precipitation events. Our findings are of value for the understanding of the trace element deposition mechanisms in the Himalayas.

Development of a longitudinal integrated clerkship at an academic medical center.

PubMed

Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia

2011-04-04

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

Putting policy into practice? Poverty and people with serious mental illness.

PubMed

Wilton, Robert

2004-01-01

This paper addresses the effects of chronic poverty on people with serious mental illness. More specifically, we are concerned with the extent to which welfare restructuring, by deepening the poverty facing people with serious mental illness, undermines the expressed intent of mental health policy to improve the quality of life (QOL) of this population. The province of Ontario in Canada forms the setting for the study. The paper first examines recent trends in mental health care and social assistance policy in Ontario. While income support is consistently recognized as a core element of mental health care, welfare restructuring has led to a significant decline in the real value of income supports received by people with serious mental illness. The paper then examines the implications of this trend for the QOL of residential care facility tenants in Hamilton, Ontario. Here, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysis of the broader transformation of the welfare state in Ontario. Interview data suggest that tenants experience chronic poverty that has a deleterious impact on multiple life domains including basic needs, family, social relations, leisure and self-esteem. Implications for research and policy are discussed.

Development of a longitudinal integrated clerkship at an academic medical center

PubMed Central

Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E.; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J.; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia

2011-01-01

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center. PMID:21475642

Promoting a Culture of Safety as a Patient Safety Strategy

PubMed Central

Weaver, Sallie J.; Lubomksi, Lisa H.; Wilson, Renee F.; Pfoh, Elizabeth R.; Martinez, Kathryn A.; Dy, Sydney M.

2015-01-01

Developing a culture of safety is a core element of many efforts to improve patient safety and care quality. This systematic review identifies and assesses interventions used to promote safety culture or climate in acute care settings. The authors searched MEDLINE, CINAHL, PsycINFO, Cochrane, and EMBASE to identify relevant English-language studies published from January 2000 to October 2012. They selected studies that targeted health care workers practicing in inpatient settings and included data about change in patient safety culture or climate after a targeted intervention. Two raters independently screened 3679 abstracts (which yielded 33 eligible studies in 35 articles), extracted study data, and rated study quality and strength of evidence. Eight studies included executive walk rounds or interdisciplinary rounds; 8 evaluated multicomponent, unit-based interventions; and 20 included team training or communication initiatives. Twenty-nine studies reported some improvement in safety culture or patient outcomes, but measured outcomes were highly heterogeneous. Strength of evidence was low, and most studies were pre–post evaluations of low to moderate quality. Within these limits, evidence suggests that interventions can improve perceptions of safety culture and potentially reduce patient harm. PMID:23460092

Evaluating Community Health Advisor (CHA) Core Competencies: The CHA Core Competency Retrospective Pretest/Posttest (CCCRP).

PubMed

Story, Lachel; To, Yen M

2016-05-01

Health care and academic systems are increasingly collaborating with community health advisors (CHAs) to provide culturally relevant health interventions that promote sustained community transformation. Little attention has been placed on CHA training evaluation, including core competency attainment. This study identified common CHA core competencies, generated a theoretically based measure of those competencies, and explored psychometric properties of that measure. A concept synthesis revealed five CHA core competencies (leadership, translation, guidance, advocacy, and caring). The CHA Core Competency Retrospective Pretest/Posttest (CCCRP) resulted from that synthesis, which was administered using multiple approaches to individuals who previously received CHA training (N= 142). Exploratory factor analyses revealed a two-factor structure underlying the posttraining data, and Cronbach's alpha indicated high internal consistency. This study suggested some CHA core competencies might be more interrelated than previously thought, and two major competencies exist rather than five and supported the CCCRP's use to evaluate core competency attainment resulting from training. © The Author(s) 2014.

Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

PubMed

Baggett, Margarita; Batcheller, Joyce; Blouin, Ann Scott; Behrens, Elizabeth; Bradley, Carol; Brown, Mary J; Brown, Diane Storer; Bolton, Linda Burnes; Borromeo, Annabelle R; Burtson, Paige; Caramanica, Laura; Caspers, Barbara A; Chow, Marilyn; Christopher, Mary Ann; Clarke, Sean P; Delucas, Christine; Dent, Robert L; Disser, Tony; Eliopoulos, Charlotte; Everett, Linda Q; Garcia, Amy; Glassman, Kimberly; Goodwin, Susan; Haagenson, Deb; Harper, Ellen; Harris, Kathy; Hoying, Cheryl L; Hughes-Rease, Marsha; Kelly, Lesly; Kiger, Anna J; Kobs-Abbott, Ann; Krueger, Janelle; Larson, Jackie; March, Connie; Martin, Deborah Maust; Mazyck, Donna; Meenan, Penny; McGaffigan, Patricia; Myers, Karen K; Nell, Kate; Newcomer, Britta; Cathy, Rick; O'Rourke, Maria; Rosa, Billy; Rose, Robert; Rudisill, Pamela; Sanford, Kathy; Simpson, Roy L; Snowden, Tami; Strickland, Bob; Strohecker, Sharon; Weems, Roger B; Welton, John; Weston, Marla; Valentine, Nancy M; Vento, Laura; Yendro, Susan

2014-01-01

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

Results of chemical and isotopic analyses of sediment and water from alluvium of the Canadian River near a closed municipal landfill, Norman, Oklahoma

USGS Publications Warehouse

Breit, George N.; Tuttle, Michele L.W.; Cozzarelli, Isabelle M.; Christenson, Scott C.; Jaeschke, Jeanne B.; Fey, David L.; Berry, Cyrus J.

2005-01-01

Results of physical and chemical analyses of sediment and water collected near a closed municipal landfill at Norman, Oklahoma are presented in this report. Sediment analyses are from 40 samples obtained by freeze-shoe coring at 5 sites, and 14 shallow (depth <1.3 m) sediment samples. The sediment was analyzed to determine grain size, the abundance of extractable iron species and the abundances and isotopic compositions of forms of sulfur. Water samples included pore water from the freeze-shoe core, ground water, and surface water. Pore water from 23 intervals of the core was collected and analyzed for major and trace dissolved species. Thirteen ground-water samples obtained from wells within a few meters of the freeze-shoe core sites and one from the landfill were analyzed for major and trace elements as well as the sulfur and oxygen isotope composition of dissolved sulfate. Samples of surface water were collected at 10 sites along the Canadian River from New Mexico to central Oklahoma. These river-water samples were analyzed for major elements, trace elements, and the isotopic composition of dissolved sulfate.

Anionic Pt in Silicate Melts at Low Oxygen Fugacity: Speciation, Partitioning and Implications for Core Formation Processes on Asteroids

NASA Technical Reports Server (NTRS)

Medard, E.; Martin, A. M.; Righter, K.; Malouta, A.; Lee, C.-T.

2017-01-01

Most siderophile element concentrations in planetary mantles can be explained by metal/ silicate equilibration at high temperature and pressure during core formation. Highly siderophile elements (HSE = Au, Re, and the Pt-group elements), however, usually have higher mantle abundances than predicted by partitioning models, suggesting that their concentrations have been set by late accretion of material that did not equilibrate with the core. The partitioning of HSE at the low oxygen fugacities relevant for core formation is however poorly constrained due to the lack of sufficient experimental constraints to describe the variations of partitioning with key variables like temperature, pressure, and oxygen fugacity. To better understand the relative roles of metal/silicate partitioning and late accretion, we performed a self-consistent set of experiments that parameterizes the influence of oxygen fugacity, temperature and melt composition on the partitioning of Pt, one of the HSE, between metal and silicate melts. The major outcome of this project is the fact that Pt dissolves in an anionic form in silicate melts, causing a dependence of partitioning on oxygen fugacity opposite to that reported in previous studies.

Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative

PubMed Central

McPherson, Christopher; Lee, Brian R.; Terrill, Cindy; Hersh, Adam L.; Gerber, Jeffrey S.; Kronman, Matthew P.; Newland, Jason G.

2018-01-01

In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention’s (CDC) seven core elements of a successful ASP within a large subset of US Children’s Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources. PMID:29370071

Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative.

PubMed

McPherson, Christopher; Lee, Brian R; Terrill, Cindy; Hersh, Adam L; Gerber, Jeffrey S; Kronman, Matthew P; Newland, Jason G

2018-01-25

In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention's (CDC) seven core elements of a successful ASP within a large subset of US Children's Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources.

Elemental concentration variations in Plio-Pleistocene sediments from ODP Site 1143 (southern South China Sea) obtained by XRF analyses

NASA Astrophysics Data System (ADS)

Tian, J.; Xie, X.; Jin, H.; Wang, P.; Jian, Z.

2009-12-01

Energy dispersive X-ray fluorescence (XRF) scanning technology provides the most accurate and most economic analytical methods for the determination of major and minor elements of the deep-sea sediment ranging from sodium (11) to uranium (92). Scanning on the smooth core surface by XRF Core scanner is reliable and non-destructive to the sediment, requiring little or no time to prepare the core. This method overcomes the drawback of the traditional analytical method by ICP-AES or ICP-MS which requires long time for sample preparation. Thus, it makes it viable to reconstruct long and high-resolution elemental time series from sediment cores. We have performed relatively elemental concentration analyses on the deep sea sediment cores from ODP site 1143 (southern SCS) down to 190.77 mcd (meters composite depth) by XRF core scanner. The depth resolution of the scanning is 1 cm, equivalent to a time resolution of ~250 years. The age model is based on tuning the benthic foraminiferal d18O at Site 1143 to obliquity and precession (Tian et al., 2002) which indicates that the 190.77 meters long sediment spans the past 5 Myr. We compared the records between 99.5 and 136.46 mcd with the elemental records from the same site obtained by Philips PW 2400 X-ray spectrometer (Wehausen et al., online publication). Comparison reveals, regardless of the absolute changes of the elements, that the elemental records (Si, Ti, Al, Fe, Mn, Ca, K, P, Ba, Rb, Sr) obtained by two methods are nearly the same. Results show that the relative concentration variations of the productivity related elements such as Ba and Ca display distinctive glacial-interglacial cycles for the past 5 Myr. These productivity cycles recorded show one-on-one relationship with the glacial-interglacial cycles of the global ice volume change recorded in the benthic foraminiferal d18O. The glacial-interglacial cycles in productivity and global ice volume changes are consistent with each other not only in amplitude but also in secular variations. The benthic d18O implies the final formation of the northern hemisphere glaciation between ~2.5 Ma and ~3.3 Ma, as indicated by gradually increased values of d18O. During this period, both Ba and Ca show gradually increased values of relative concentration, indicating increased productivity which was probably caused by intensified East Asia summer monsoon. The close relationship of the productivity related elemental variations with benthic foraminiferal d18O reveals that the Plio-Pleistocene variations of the East Asian monsoon have been greatly dominated by global ice volume change. Although the elements related to terrigenous detrital matter composition of site 1143 such as Ti, Fe, As, Co and Ni display distinct glacial-interglacial cycles for the past 5 Myr, they display different patterns in secular variation with that of the benthic foraminiferal d18O. The mismatch indicates that besides northern hemisphere glaciation other multiple processes including changes in provenance and weathering intensity caused by monsoonal climate variability and sea level fluctuations could have affected the terrigenous detrital matter composition of site 1143.

Investigating the Microscopic Location of Trace Elements in High-Alpine Glacier Ice

NASA Astrophysics Data System (ADS)

Avak, Sven Erik; Birrer, Mario; Laurent, Oscar; Guillong, Marcel; Wälle, Markus; Jenk, Theo Manuel; Bartels-Rausch, Thorsten; Schwikowski, Margit; Eichler, Anja

2017-04-01

Past changes in atmospheric pollution can be reconstructed from high-alpine ice core trace element records (Schwikowski et al., 2004). Percolation of meltwater alters the information originally stored in these environmental archives. Eichler et al. (2001) suggested that the preservation of major ions with respect to meltwater percolation depends on their location in the crystal ice lattice, i.e. grain boundaries versus grain interiors. Other studies have also focused on the effect of meltwater on organic pollutant concentrations as well as on stable isotope profiles in ice cores, whereas no information exists about trace elements. Here, we investigate for the first time the effect of the microscopic location of anthropogenic, dust and volcanic related trace elements on the behavior during meltwater percolation by using two different approaches. On the one hand we assess the microscopic location of trace elements indirectly by analyzing trace element concentrations in a high-alpine ice core, which has been shown to be affected by an inflow of meltwater, using discrete inductively coupled plasma mass spectrometry (ICP-MS). Impurities located at grain boundaries are prone to be removed by meltwater and tend to be depleted in the affected section of the record whereas those incorporated into the ice interior are preserved and not disturbed in the record. In the second approach we work towards a direct quantification of differences in concentrations of trace elements between ice grain boundaries and grain interiors in samples both from unaffected and affected sections of this ice core. Therefore we use cryocell laser ablation (LA) ICP-MS, which is the method of choice for the direct in situ chemical analysis of trace elements at a sub-millimeter resolution in glacier ice (Reinhardt et al., 2001, Della Lunga et al., 2014, Sneed et al., 2015). We will present first results of both approaches with regard to the evaluation of the potential of trace elements as environmental proxies in glaciers partially affected by melting. References Della Lunga, D., Müller, W., Rasmussen, S. O. & Svensson, A. 2014: Location of cation impurities in NGRIP deep ice revealed by cryo-cell UV-laser-ablation ICPMS, Journal of Glaciology, 60, 970-988. Eichler, A., Schwikowski, M., Gäggeler, H. W. 2001: Meltwater-induced relocation of chemical species in Alpine firn, Tellus B, 53, 192-203. Reinhardt, H., Kriews, M., Miller, H., Schrems, O., Lüdke, C., Hoffmann, E. & Skole, J. 2001: Laser ablation inductively coupled plasma mass spectrometry: a new tool for trace element analysis in ice cores, Fresenius' Journal of Analytical Chemistry, 370, 629-636. Schwikowski, M., Barbante, C., Doering, T., Gäggeler, H. W., Boutron, C., Schotterer, U., Tobler, L., van de Velde, K., Ferrari, C., Cozzi, G., Rosman, K., Cescon, P. 2004: Post-17th-Century Changes of European Lead Emissions Recorded in High-Altitude Alpine Snow and Ice, Environmental Science & Technology, 38, 957-964. Sneed, S. B., Mayewski, P. A., Sayre, W. G., Handley, M. J., Kurbatov, A. V., Taylor, K. C., Bohleber, P., Wagenbach, D., Erhardt, T. & Spaulding, N. E. 2015: New LA-ICP-MS cryocell and calibration technique for sub-millimeter analysis of ice cores, Journal of Glaciology, 61, 233-242.

Collecting, preparing, crossdating, and measuring tree increment cores

USGS Publications Warehouse

Phipps, R.L.

1985-01-01

Techniques for collecting and handling increment tree cores are described. Procedures include those for cleaning and caring for increment borers, extracting the sample from a tree, core surfacing, crossdating, and measuring. (USGS)

United States Air Force Graduate Student Summer Support Program (1987). Program Technical Report. Volume 1.

DTIC Science & Technology

1987-12-01

developed for a large percentage of the participants in the Summer Faculty Research Program in 1979-1983 period through an AFOSR Minigrant Program . On 1...Analysis of a Bimodal Nuclear Rocket Core by Dav,, C. Carpenter ABSTRACT The framework for a general purpose finite element analysis code was developed ...to study the 2-D temperature distribution in a hot-channel S hexagonal fuel element in the core of a bimodal nuclear’ rocket. Prelim- inary thermal

Nuclear reactor fuel element

DOEpatents

Johnson, Carl E.; Crouthamel, Carl E.

1980-01-01

A nuclear reactor fuel element is described which has an outer cladding, a central core of fissionable or mixed fissionable and fertile fuel material and a layer of oxygen gettering material on the inner surface of the cladding. The gettering material reacts with oxygen released by the fissionable material during irradiation of the core thereby preventing the oxygen from reacting with and corroding the cladding. Also described is an improved method for coating the inner surface of the cladding with a layer of gettering material.

Submarine landslide identified in DLW3102 core of the northern continental slope, South China Sea

NASA Astrophysics Data System (ADS)

Xu, Yuanqin; Liu, Lejun; Zhou, Hang; Huang, Baoqi; Li, Ping; Ma, Xiudong; Dong, Feiyin

2018-02-01

In this paper, we take DLW3101 core obtained at the top of the canyon (no landslide area) and DLW3102 core obtained at the bottom of the canyon (landslide area) on the northern continental slope of the South China Sea as research objects. The chronostratigraphic framework of the DLW3101 core and elemental strata of the DLW3101 core and the DLW3102 core since MIS5 are established by analyzing oxygen isotope, calcium carbonate content, and X-Ray Fluorescence (XRF) scanning elements. On the basis of the information obtained by analyzing the sedimentary structure and chemical elements in the landslide deposition, we found that the DLW3102 core shows four layers of submarine landslides, and each landslide layer is characterized by high Si, K, Ti, and Fe contents, thereby indicating terrigenous clastic sources. L1 (2.15-2.44 m) occurred in MIS2, which is a slump sedimentary layer with a small sliding distance and scale. L2 (15.48-16.00 m) occurred in MIS5 and is a debris flow-deposited layer with a scale and sliding distance that are greater than those of L1. L3 (19.00-20.90 m) occurred in MIS5; its upper part (19.00-20.00 m) is a debris flow-deposited layer, and its lower part (20.00-20.90 m) is a sliding deposition layer. The landslide scale of L3 is large. L4 (22.93-24.27 m) occurred in MIS5; its upper part (22.93-23.50 m) is a turbid sedimentary layer, and its lower part (23.50-24.27 m) is a slump sedimentary layer. The landslide scale of L4 is large.

An Ice Core Melter System for Continuous Major and Trace Chemical Analyses of a New Mt. Logan Summit Ice Core

NASA Astrophysics Data System (ADS)

Osterberg, E. C.; Handley, M. J.; Sneed, S. D.; Mayewski, P. A.; Kreutz, K. J.; Fisher, D. A.

2004-12-01

The ice core melter system at the University of Maine Climate Change Institute has been recently modified and updated to allow high-resolution (<1-2 cm ice/sample), continuous and coregistered sampling of ice cores, most notably the 2001 Mt. Logan summit ice core (187 m to bedrock), for analyses of 34 trace elements (Sr, Cd, Sb, Cs, Ba, Pb, Bi, U, As, Al, S, Ca, Ti, V, Cr, Mn, Fe, Co, Cu, Zn, REE suite) by inductively coupled plasma mass spectrometry (ICP-MS), 8 major ions (Na+, Ca2+, Mg2+, K+, Cl-, SO42-, NO3-, MSA) by ion chromatography (IC), stable water isotopes (δ 18O, δ D, d) and volcanic tephra. The UMaine continuous melter (UMCoM) system is housed in a dedicated clean room with HEPA filtered air. Standard clean room procedures are employed during melting. A Wagenbach-style continuous melter system has been modified to include a pure Nickel melthead that can be easily dismantled for thorough cleaning. The system allows melting of both ice and firn without wicking of the meltwater into unmelted core. Contrary to ice core melter systems in which the meltwater is directly channeled to online instruments for continuous flow analyses, the UMCoM system collects discrete samples for each chemical analysis under ultraclean conditions. Meltwater from the pristine innermost section of the ice core is split between one fraction collector that accumulates ICP-MS samples in acid pre-cleaned polypropylene vials under a class-100 HEPA clean bench, and a second fraction collector that accumulates IC samples. A third fraction collector accumulates isotope and tephra samples from the potentially contaminated outer portion of the core. This method is advantageous because an archive of each sample remains for subsequent analyses (including trace element isotope ratios), and ICP-MS analytes are scanned for longer intervals and in replicate. Method detection limits, calculated from de-ionized water blanks passed through the entire UMCoM system, are below 10% of average Mt. Logan values. A strong correlation (R2>0.9) between Ca and S concentrations measured on different fractions of the same sample by IC and ICP-MS validates sample coregistration. Preliminary analyses of data from the 2001 Mt. Logan summit ice core confirm subannual resolution sampling and annual scale variability of major and trace elements. Accumulation rate models and isotope data suggest that annual resolution will be possible to 1000-2000 y.b.p., with multi-annual to centennial resolution for the remainder of the Holocene and possibly including the last deglaciation. Dust proxy elements, including REEs, strongly co-vary in time-series and reveal concentration ratio fluctuations interpreted as source region changes. Volcanic eruptions are characterized by elevated concentrations of S, SO42-, Cu, Sb, Zn and other trace elements. Concentrations of potential anthropogenic contaminants are also discussed.

Towards accessible integrated palliative care: Perspectives of leaders from seven European countries on facilitators, barriers and recommendations for improvement.

PubMed

den Herder-van der Eerden, Marlieke; Ewert, Benjamin; Hodiamont, Farina; Hesse, Michaela; Hasselaar, Jeroen; Radbruch, Lukas

2017-01-01

Literature suggests that integrated palliative care (IPC) increases the quality of care for palliative patients at lower costs. However, knowledge on models encompassing all integration levels for successfully implementing IPC is scarce. The purpose of this paper is to describe the experiences of IPC leaders in seven European countries regarding core elements, facilitators and barriers of IPC implementation and provides recommendations for future policy and practice. A qualitative interview study was conducted between December 2013 and May 2014. In total, 34 IPC leaders in primary and secondary palliative care or public health in Belgium, Germany, Hungary, Ireland, the Netherlands, Spain and the UK were interviewed. Transcripts were analysed using thematic data analysis. IPC implementation efforts involved a multidisciplinary team approach and cross-sectional coordination. Informal professional relationships, basic medical education and general awareness were regarded as facilitators of IPC. Identified barriers included lack of knowledge about when to start palliative care, lack of collaboration and financial structures. Recommendations for improvement included access, patient-centeredness, coordination and cooperation, financing and ICT systems. Although IPC is becoming more common, action has been uneven at different levels. IPC implementation largely remains provisional and informal due to the lack of standardised treatment pathways, legal frameworks and financial incentives to support multilevel integration. In order to make IPC more accessible, palliative care education as well as legal and financial support within national healthcare systems needs to be enhanced.

Cognitive-behavioural treatment for weight loss in primary care: a prospective study.

PubMed

Eichler, Klaus; Zoller, Marco; Steurer, Johann; Bachmann, Lucas M

2007-09-08

Cognitive-behavioural treatment (CBT) is effective for weight loss in obese patients, but such programmes are difficult to implement in primary care. We assessed whether implementation of a community-based CBT weight loss programme for adults in routine care is feasible and prospectively assessed patient outcome. The weight loss programme was provided by a network of Swiss general practitioners in cooperation with a community centre for health education. We chose a five-step strategy focusing on structure of care rather than primarily addressing individual physician behaviour. A multidisciplinary core group of trained CBT instructors acted as the central element of the programme. Overweight and obese adults from the community (BMI >25 kg/m2) were included. We used a patient perspective to report the impact on delivery of care and assessed weight change of consecutive participants prospectively with a follow-up of 12 months. Twenty-eight courses, with 16 group meetings each, were initiated over a period of 3 years. 44 of 110 network physicians referred patients to the programme. 147 of 191 study participants were monitored for one year (attrition rate: 23%). Median weight loss after 12 months for 147 completers was 4 kg (IQR: 1-7 kg; intention-to-treat analysis for 191 participants: 2 kg, IQR: 0-5 kg). The programme produced a clinically meaningful weight loss in our participants, with a relatively low attrition rate. Implementation of an easily accessible CBT programme for weight loss in daily routine primary care is feasible.

How to evaluate population management? Transforming the Care Continuum Alliance population health guide toward a broadly applicable analytical framework.

PubMed

Struijs, Jeroen N; Drewes, Hanneke W; Heijink, Richard; Baan, Caroline A

2015-04-01

Many countries face the persistent twin challenge of providing high-quality care while keeping health systems affordable and accessible. As a result, the interest for more efficient strategies to stimulate population health is increasing. A possible successful strategy is population management (PM). PM strives to address health needs for the population at-risk and the chronically ill at all points along the health continuum by integrating services across health care, prevention, social care and welfare. The Care Continuum Alliance (CCA) population health guide, which recently changed their name in Population Health Alliance (PHA) provides a useful instrument for implementing and evaluating such innovative approaches. This framework is developed for PM specifically and describes the core elements of the PM-concept on the basis of six subsequent interrelated steps. The aim of this article is to transform the CCA framework into an analytical framework. Quantitative methods are refined and we operationalized a set of indicators to measure the impact of PM in terms of the Triple Aim (population health, quality of care and cost per capita). Additionally, we added a qualitative part to gain insight into the implementation process of PM. This resulted in a broadly applicable analytical framework based on a mixed-methods approach. In the coming years, the analytical framework will be applied within the Dutch Monitor Population Management to derive transferable 'lessons learned' and to methodologically underpin the concept of PM. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Melting Experiments in the Fe-FeSi System at High Pressure

NASA Astrophysics Data System (ADS)

Ozawa, H.; Hirose, K.

2013-12-01

The principal light element in the Earth's core must reproduce the density jump at the inner core boundary (ICB). Silicon is thought to be a plausible light element in the core, and the melting phase relations in Fe-FeSi binary system at the ICB pressure are of great importance. Theoretical calculations on the Fe-FeSi binary system suggested that the difference in Si content between the outer core and the inner core would be too small to satisfy the observed density jump at the ICB [Alfè et al., 2002 EPSL], which requires other light elements in addition to silicon. Here we experimentally examined partitioning of silicon between liquid and solid iron up to 97 GPa. High pressure and temperature conditions were generated in a laser-heated diamond-anvil cell. Chemical compositions of co-existing quenched liquid and solid Fe-Si alloys were determined with a field-emission-type electron probe micro-analyzer. We used Fe-Si alloy containing 9 wt% Si as a starting material. Chemical analyses on the recovered samples from 39 and 49 GPa demonstrated the coexistence of quenched Si-depleted liquid and Si-enriched solid. In contrast, silicon partitions preferentially into liquid metal at 97 GPa, suggesting the starting composition (Fe-9wt% Si) lies on the iron-rich part of the eutectic. These results indicate the eutectic composition shifts toward FeSi between 49 and 97 GPa.

LA-ICP-MS trace element mapping: insights into the crystallisation history of a metamorphic garnet population

NASA Astrophysics Data System (ADS)

George, Freya; Gaidies, Fred

2017-04-01

In comparison to our understanding of major element zoning, relatively little is known about the incorporation of trace elements into metamorphic garnet. Given their extremely slow diffusivities and sensitivity to changing mineral assemblages, the analysis of the distribution of trace elements in garnet has the potential to yield a wealth of information pertaining to interfacial attachment mechanisms during garnet crystallisation, the mobility of trace elements in both garnet and the matrix, and trace element geochronology. Due to advances in the spatial resolution and analytical precision of modern microbeam techniques, small-scale trace element variations can increasingly be documented and used to inform models of metamorphic crystallisation. Laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) in particular, can be used to rapidly quantify a wide range of elemental masses as a series of laser rasters, producing large volumes of spatially constrained trace element data. In this study, we present LA-ICP-MS maps of trace element concentrations from numerous centrally-sectioned garnets representative of the crystal size-distribution of a single sample's population. The study sample originates from the garnet-grade Barrovian zone of the Lesser Himalayan Sequence in Sikkim, northeast India, and has been shown to have crystallised garnet within a single assemblage between 515 ˚C and 565˚C, with no evidence for accessory phase reaction over the duration of garnet growth. Previous models have indicated that the duration of garnet crystallisation was extremely rapid (<1 Myr), with negligible diffusional homogenisation of major divalent cations. Consequently, the trace element record likely documents the primary zonation generated during garnet growth. In spite of straightforward (i.e. concentrically-zoned) major element garnet zonation, trace elements maps are characterised by significant complexity and variability. Y and the heavy rare earth elements are strongly enriched in crystal cores, where there is overprinting of the observed internal fabric, and exhibit numerous concentric annuli towards crystal rims. Conversely, the medium rare earth elements (e.g. Gd, Eu and Sm) exhibit bowl-shaped zoning from core to rim, with no annuli, and core and rim compositions of the medium rare earth elements are the same throughout the population within crystals of differing size. Cr exhibits pronounced spiral zoning, and the average Cr content increases towards garnet rims. In all cases, spirals are centered on the geometric core of the crystals. These LA-ICP-MS maps highlight the complexity of garnet growth over a single prograde event, and indicate that there is still much to be learnt from the analysis of garnet using ever-improving analytical methods. We explore the potential causes of the variations in the distribution of trace elements in garnet, and assess how these zoning patterns may be used to refine our understanding of the intricacies of garnet crystallisation and the spatial and temporal degree of trace element equilibration during metamorphism.

[Finite element analysis of the maxillary central incisor with crown lengthening surgery and post-core restoration in management of crown-root fracture].

PubMed

Zhen, Min; Hu, Wen-jie; Rong, Qi-guo

2015-12-18

To construct the finite element models of maxillary central incisor and the simulations with crown lengthening surgery and post-core restoration in management of different crown-root fracture types, to investigate the stress intensity and distributions of these models mentioned above, and to analyze the indications of crown lengthening from the point of view of mechanics. An extracted maxillary central incisor and alveolar bone plaster model were scanned by Micro-CT and dental impression scanner (3shape D700) respectively. Then the 3D finite element models of the maxillary central incisor and 9 simulations with crown lengthening surgery and post-core restoration were constructed by Mimics 10.0, Geomagic studio 9.0 and ANSYS 14.0 software. The oblique static force (100 N) was applied to the palatal surface (the junctional area of the incisal 1/3 and middle 1/3), at 45 degrees to the longitudinal axis, then the von Mises stress of dentin, periodontal ligament, alveolar bone, post and core, as well as the periodontal ligament area, were calculated. A total of 10 high-precision three-dimensional finite element models of maxillary central incisor were established. The von Mises stress of models: post>dentin>alveolar bone>core>periodontal ligament, and the von Mises stress increased linearly with the augmentation of fracture degree (besides the core). The periodontal ligament area of the crown lengthening was reduced by 12% to 33%. The von Mises stress of periodontal ligament of the B2L2c, B2L3c, B3L1c, B3L2c, B3L3c models exceeded their threshold limit value, respectively. The maxillary central incisors with the labial fracture greater than three-quarter crown length and the palatal fracture deeper than 1 mm below the alveolar crest are not the ideal indications of the crown lengthening surgery.

Chondritic Mn/Na ratio and limited post-nebular volatile loss of the Earth

NASA Astrophysics Data System (ADS)

Siebert, Julien; Sossi, Paolo A.; Blanchard, Ingrid; Mahan, Brandon; Badro, James; Moynier, Frédéric

2018-03-01

The depletion pattern of volatile elements on Earth and other differentiated terrestrial bodies provides a unique insight as to the nature and origin of planetary building blocks. The processes responsible for the depletion of volatile elements range from the early incomplete condensation in the solar nebula to the late de-volatilization induced by heating and impacting during planetary accretion after the dispersion of the H2-rich nebular gas. Furthermore, as many volatile elements are also siderophile (metal-loving), it is often difficult to deconvolve the effect of volatility from core formation. With the notable exception of the Earth, all the differentiated terrestrial bodies for which we have samples have non-chondritic Mn/Na ratios, taken as a signature of post-nebular volatilization. The bulk silicate Earth (BSE) is unique in that its Mn/Na ratio is chondritic, which points to a nebular origin for the depletion; unless the Mn/Na in the BSE is not that of the bulk Earth (BE), and has been affected by core formation through the partitioning of Mn in Earth's core. Here we quantify the metal-silicate partitioning behavior of Mn at deep magma ocean pressure and temperature conditions directly applicable to core formation. The experiments show that Mn becomes more siderophile with increasing pressure and temperature. Modeling the partitioning of Mn during core formation by combining our results with previous data at lower P-T conditions, we show that the core likely contains a significant fraction (20 to 35%) of Earth's Mn budget. However, we show that the derived Mn/Na value of the bulk Earth still lies on the volatile-depleted end of a trend defined by chondritic meteorites in a Mn/Na vs Mn/Mg plot, which tend to higher Mn/Na with increasing volatile depletion. This suggests that the material that formed the Earth recorded similar chemical fractionation processes for moderately volatile elements as chondrites in the solar nebula, and experienced limited post nebular volatilization.

Anthropogenic versus natural control on trace element and Sr-Nd-Pb isotope stratigraphy in peat sediments of southeast Florida (USA), ˜1500 AD to present

NASA Astrophysics Data System (ADS)

Kamenov, George D.; Brenner, Mark; Tucker, Jaimie L.

2009-06-01

Analysis of a well-dated peat core from Blue Cypress Marsh (BCM) provides a detailed record of natural and anthropogenic factors that controlled the geochemical cycles of a number of trace elements in Florida over the last five centuries. The trace elements were divided into "natural" and "anthropogenic" groups using concentration trends from the bottom to the top of the core. The "natural" group includes Li, Sc, Cr, Co, Ga, Ge, Zr, Nb, Cs, Ba, Hf, Y, Ta, Th, and REE (Rare Earth Elements). These elements show similar concentrations throughout the core, indicating that changes in human activities after European arrival in the "New World" did not affect their geochemical cycles. The "anthropogenic" group includes Pb, Cu, Zn, V, Sb, Sn, Bi, and Cd. Upcore enrichment of these elements indicates enhancement by anthropogenic activities. From the early 1500s to present, fluxes of the "anthropogenic" metals to the marsh increased significantly, with modern accumulation rates several-fold (e.g., V) to hundreds of times (e.g., Zn) greater than pre-colonial rates. The dominant input mechanism for trace elements from both groups to the marsh has been atmospheric deposition. Atmospheric input of a number of the elements, including the anthropogenic metals, was dominated by local sources during the last century. For several elements, long-distant transport may be important. For instance, REE and Nd isotopes provide evidence for long-range atmospheric transport dominated by Saharan dust. The greatest increase in flux of the "anthropogenic" metals occurred during the 20th century and was caused by changes in the chemical composition of atmospheric deposition entering the marsh. Increased atmospheric inputs were a consequence of several anthropogenic activities, including fossil fuel combustion (coal and oil), agricultural activities, and quarrying and mining operations. Pb and V exhibit similar trends, with peak accumulation rates in 1970. The principal anthropogenic source of V is oil combustion. The decline in V accumulation after 1970 in the BCM peat corresponds to the introduction of low-sulfur fuels and the change from heavy to distilled oils since the 1970s. After the 1920s, Pb distribution in the peat follows closely the history of alkyl lead consumption in the US, which peaked in the 1970s. Pb isotopes support this inference and furthermore, record changes in the ore sources used to produce leaded gasoline. Idaho ores dominated the peat Pb isotope record until the 1960s, followed by Pb from Mississippi Valley Type deposits from the 1960s to the 1980s. Enhanced fluxes of Cu, Zn, Cd, Sn, Sb, Bi, and to some extent Ni during the last century are likely also related to fossil fuel combustion. Local agricultural activities may also have influenced the geochemical cycles of Cu and Zn. The peat record shows enhanced U accumulation during the last century, possibly related to phosphate mining in western Florida. Sr isotopes in the peat core also reflect anthropogenic influence. The 87Sr/ 86Sr ratio decreases from natural background values in the basal part of the core to lower values in the upper part of the core. The Sr isotope shift is probably related to quarrying operations in Florida, and marks the first time an anthropogenic signal has been detected using the Sr isotope record in a peat core.

Detailed history of atmospheric trace elements from the Quelccaya ice core (Southern Peru) during the last 1200 years

NASA Astrophysics Data System (ADS)

Uglietti, C.; Gabrielli, P.; Thompson, L. G.

2013-12-01

The recent increase in trace element concentrations, for example Cr, Cu, Zn, Ag, Pb, Bi, and U, in polar snow and ice has provided compelling evidence of a hemispheric change in atmospheric composition since the nineteenth century. This change has been concomitant with the expansion of the Industrial Revolution and points towards an anthropogenic source of trace elements in the atmosphere. There are very few low latitude trace element ice core records and these are believed to be sensitive to perturbations of regional significance. To date, these records have not been used to document a preindustrial anthropogenic impact on atmospheric composition at low latitudes. Ice cores retrieved from the tropical Andes are particularly interesting because they have the potential to reveal detailed information about the evolution and environmental consequences of mineral exploitation related to the Pre Inca Civilizations, the Inca Empire (1438-1533 AD) and the subsequent Spanish invasion and dominance (1532-1833 AD). The chemical record preserved in the ice of the Quelccaya ice cap (southern Peruvian Andes) offers the exceptional opportunity to geochemically constrain the composition of the tropical atmosphere at high resolution over the last ~1200 years. Quantification of twenty trace elements (Ag, Al, As, Bi, Cd, Co, Cr, Cu, Fe, Mn, Mo, Pb, Rb, Sb, Sn, Ti, Tl, U, V, and Zn) was performed by ICP-SFMS over 105 m of the Quelccaya North Dome core (5600 m asl, 128.57 m) by analyzing 2450 samples. This provides the first atmospheric trace element record in South America spanning continuously and at high resolution for the time period between 1990 and 790 AD. Ag, As, Bi, Cd, Cr, Co, Cu, Mn, Mo, Sb, Sn, Pb and Zn show increases in concentration and crustal enrichment factor starting at different times between 1450 and 1550 AD, in concomitance with the expansions of the Inca Empire and, subsequently, the Spanish Empire well before the inception of the Industrial Revolution. This indicates that there have been additional anthropogenic sources that have impacted the South American atmosphere during the past ~550 years. Furthermore, As, Bi and Pb record shows, the two most significant increases have occurred in the 20th century, one beginning in ~1905 AD and peaking in the 1920s and the second beginning in ~1955 AD and peaking in the 1970s. Comparison with other trace element records from Greenland and Antarctica reveals concomitant peaks of different amplitude in Pb concentration and crustal enrichment factor, possibly pointing to an unexpected larger than regional scale significance for the Quelccaya ice core record during the last century. In conclusion, the Quelccaya ice core indicates that societal and industrial development influenced the atmospheric composition in South America, from different large scale sources, during the last ~550 years. This is the first time that a low latitude ice core record has been used to reconstruct pre-industrial anthropogenic forcing on the atmosphere.

Mercury content of Illinois soils

USGS Publications Warehouse

Dreher, G.B.; Follmer, L.R.

2004-01-01

For a survey of Illinois soils, 101 cores had been collected and analyzed to determine the current and background elemental compositions of Illinois soils. Mercury and other elements were determined in six samples per core, including a surface sample from each core. The mean mercury content in the surface samples was 33 ?? 20 ??g/kg soil, and the background content was 20 ?? 9 ??g/kg. The most probable sources of mercury in these soils were the parent material, and wet and dry deposition of Hg0 and Hg2+ derived from coal-burning power plants, other industrial plants, and medical and municipal waste incinerators. Mercury-bearing sewage sludge or other fertilizers applied to agricultural fields could have been the local sources of mercury. Although the mercury content correlated with organic carbon content or clay content in individual cores, when all the data were considered, there was no strong correlation between mercury and either the organic carbon or the clay-size content.

A conceptual framework of clinical nursing care in intensive care.

PubMed

da Silva, Rafael Celestino; Ferreira, Márcia de Assunção; Apostolidis, Thémistoklis; Brandão, Marcos Antônio Gomes

2015-01-01

to propose a conceptual framework for clinical nursing care in intensive care. descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.

The competencies required by professional hospice palliative care spiritual care providers.

PubMed

Cooper, Dan; Aherne, Michael; Pereira, José

2010-07-01

The Canadian Hospice Palliative Care Association (2002) identifies spiritual care of the dying and their families as a core service for Hospice Palliative Care programs. Yet, until the Spiritual Care Development Initiative of the Canadian Pallium Project, there was no published literature indicating systematic profiling of occupationally relevant core competencies or competency-based training programs specific to this specialized field of practice. This article describes a Canadian Community of Practice process to develop an occupational analysis-based competency profile for the Professional Hospice Palliative Care Spiritual Care Provider utilizing a modified Developing a Curriculum (DACUM) methodology. Competency profiles are important contributions to the development of curricula to train care providers who are recognized by other professions and by institutions as possessing the requisite theoretical and clinical expertise, particularly in academic tertiary care settings.

Gap analysis: a method to assess core competency development in the curriculum.

PubMed

Fater, Kerry H

2013-01-01

To determine the extent to which safety and quality improvement core competency development occurs in an undergraduate nursing program. Rapid change and increased complexity of health care environments demands that health care professionals are adequately prepared to provide high quality, safe care. A gap analysis compared the present state of competency development to a desirable (ideal) state. The core competencies, Nurse of the Future Nursing Core Competencies, reflect the ideal state and represent minimal expectations for entry into practice from pre-licensure programs. Findings from the gap analysis suggest significant strengths in numerous competency domains, deficiencies in two competency domains, and areas of redundancy in the curriculum. Gap analysis provides valuable data to direct curriculum revision. Opportunities for competency development were identified, and strategies were created jointly with the practice partner, thereby enhancing relevant knowledge, attitudes, and skills nurses need for clinical practice currently and in the future.

DNA sequence analysis of ARS elements from chromosome III of Saccharomyces cerevisiae: identification of a new conserved sequence.

PubMed Central

Palzkill, T G; Oliver, S G; Newlon, C S

1986-01-01

Four fragments of Saccharomyces cerevisiae chromosome III DNA which carry ARS elements have been sequenced. Each fragment contains multiple copies of sequences that have at least 10 out of 11 bases of homology to a previously reported 11 bp core consensus sequence. A survey of these new ARS sequences and previously reported sequences revealed the presence of an additional 11 bp conserved element located on the 3' side of the T-rich strand of the core consensus. Subcloning analysis as well as deletion and transposon insertion mutagenesis of ARS fragments support a role for 3' conserved sequence in promoting ARS activity. PMID:3529036

Trace-element analyses of core samples from the 1967-1988 drillings of Kilauea Iki lava lake, Hawaii

USGS Publications Warehouse

Helz, Rosalind Tuthill

2012-01-01

This report presents previously unpublished analyses of trace elements in drill core samples from Kilauea Iki lava lake and from the 1959 eruption that fed the lava lake. The two types of data presented were obtained by instrumental neutron-activation analysis (INAA) and energy-dispersive X-ray fluorescence analysis (EDXRF). The analyses were performed in U.S. Geological Survey (USGS) laboratories from 1989 to 1994. This report contains 93 INAA analyses on 84 samples and 68 EDXRF analyses on 68 samples. The purpose of the study was to document trace-element variation during chemical differentiation, especially during the closed-system differentiation of Kilauea Iki lava lake.

Platinum group elements in a 3.5 Ga nickel-iron occurrence - Possible evidence of a deep mantle origin

NASA Technical Reports Server (NTRS)

Tredoux, Marian; Hart, Rodger J.; Lindsay, Nicholas M.; De Wit, Maarten J.; Armstrong, Richard A.

1989-01-01

This paper reports the results of new field observations and the geochemical analyses for the area of the Bon Accord (BA) (the Kaapvaal craton, South Africa) Ni-Fe deposit, with particular consideration given to the trace element, platinum-group element, and isotopic (Pb, Nd, and Os) compositions. On the basis of these data, an interpretation of BA is suggested, according to which the BA deposit is a siderophile-rich heterogeneity remaining in the deep mantle after a process of incomplete core formation. The implications of such a model for the study of core-mantle segregation and the geochemistry of the lowermost mantle are discussed.

Methods for making radially anisotropic thin-film magnetic torroidal cores

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

Qiu, Jizheng; Sullivan, Charles R.

2017-05-23

A method of forming a radially anisotropic toroidal magnetic core includes providing apparatus having a first magnet for providing a radial magnetic field extending across a cavity from an axial spindle to a surrounding second magnetic element, placing a substrate in the cavity, the substrate having a hole fitting around the head of the spindle; and sputter-depositing a film of ferromagnetic material onto the substrate. In an embodiment, the spindle is magnetically coupled to a first pole of the first magnet, the second magnetic element is coupled to a second pole of the first magnet, and a thermally conductive, nonmagnetic,more » insert separates the spindle and the second magnetic element.« less

The Sun is a plasma diffuser that sorts atoms by mass

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

Manuel, O., E-mail: omatumr@yahoo.com; Kamat, S. A.; Mozina, M.

2006-11-15

The Sun is a plasma diffuser that selectively moves light elements like H and He and the lighter isotopes of each element to its surface. The Sun formed on the collapsed core of a supernova (SN) and is composed mostly of elements made near the SN core (Fe, O, Ni, Si, and S), like the rocky planets and ordinary meteorites. Neutron emission from the central neutron star triggers a series of reactions that generate solar luminosity, solar neutrinos, solar mass fractionation, and an outpouring of hydrogen in the solar wind. Mass fractionation seems to have operated in the parent starmore » and likely occurs in other stars as well.« less

Assessment of trauma quality improvement activities at public hospitals in Thailand.

PubMed

Fuangworawong, Phuphit; LaGrone, Lacey N; Chadbunchachai, Witaya; Sornsrivichai, Vorasith; Mock, Charles N; Vavilala, Monica S

2016-09-01

Given the current exceptional burden of injury in Thailand, the proven efficacy of quality improvement programs, and the current scarcity of national-level information on trauma quality improvement program (TQIP) implementation in Thailand, we aimed to examine the use of TQIPs and barriers to TQIP adoption in Thai public trauma centers. We distributed a survey to 110 public hospitals which are designated to provide trauma care in Thailand. The survey assessed the presence or absence of the four core elements of the World Health Organization (WHO) recommended TQIPs (morbidity and mortality (M&M) conferences, preventable death panels, trauma registries, and audit filters), and provider perception of barriers and priorities in TQIP implementation. Responses were received from 80 (72%) respondents. Seventy-two (90%) reported having a trauma registry and seventy (88%) respondents reported use of audit filters. Seventy (88%) respondents reported conducting regular M&M conferences, and 45 (56%) respondents reported the presence of preventable death panels. Thirty-eight (48%) respondents reported presence of all four elements of WHO TQIPs. The most commonly reported barriers to implementing TQIPs were lack of interest (55; 68%) and lack of time (39; 48%)to implement TQIPs. Audit filters were reported by only 25 (31%) of respondents and optimization of audit filters was the most frequently identified next-step in further development of TQIP. Just under half of responding Thai public trauma centers reported implementation of all four elements of the WHO recommended TQIPs. Priority strategies to facilitate TQIP maturation in Thailand should address staff motivation, provision of staff time for TQIP development, and optimization of audit filter use to monitor quality of care. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Monitoring arrangement for vented nuclear fuel elements

DOEpatents

Campana, Robert J.

1981-01-01

In a nuclear fuel reactor core, fuel elements are arranged in a closely packed hexagonal configuration, each fuel element having diametrically opposed vents permitting 180.degree. rotation of the fuel elements to counteract bowing. A grid plate engages the fuel elements and forms passages for communicating sets of three, four or six individual vents with respective monitor lines in order to communicate vented radioactive gases from the fuel elements to suitable monitor means in a manner readily permitting detection of leakage in individual fuel elements.

Technical Elements, Demonstration Projects, and Fiscal Models in Medicaid Managed Care for People with Developmental Disabilities.

ERIC Educational Resources Information Center

Kastner, Theodore A.; Walsh, Kevin K.; Criscione, Teri

1997-01-01

Presents a general model of the structure and functioning of managed care and describes elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to people with developmental disabilities. Managed care demonstration projects and a hypothetical…

Elements for an Ontology of Care in the Field of Artificial Intelligence.

PubMed

González Aguña, Alexandra; Fernández Batalla, Marta; Cercas Duque, Adriana; Herrero Jaén, Sara; Monsalvo San Macario, Enrique; Jiménez Rodríguez, Ma Lourdes; Santamaría García, José Ma; Ramírez Sánchez, Sylvia Claudine; Vialart Vidal, Niurka; Condor Camara, Daniel Flavio

2018-01-01

An ontology of care is a formal, explicit specification of a shared conceptualization. Constructing an ontology is a process that requires four elements: knowledge object, subject that knows, knowledge operation and result. These elements configure theframework to generate ontologies that can be used in Artificial Intelligence systems for care.

Health Care Assistant Core. Instructor Manual.

ERIC Educational Resources Information Center

Feilner, Veronica; Robling, Jeannine

This document contains the core curriculum for a basic high school course for health care assistants. It is designed as a 1-semester course of study, after which students can take a course in an emphasis area, such as veterinary, nursing, pharmacology, or physical therapy, in which they learn skills for specific entry-level jobs. The curriculum…

Social Work and Interprofessional Education in Health Care: A Call for Continued Leadership

ERIC Educational Resources Information Center

Jones, Barbara; Phillips, Farya

2016-01-01

A report from the Interprofessional Education Collaborative and another from the Institute of Medicine cite working as part of interdisciplinary teams as a core proficiency area for improving health care. This article discusses the core competencies of interprofessional education and the essential role for social workers as leaders and…

NEUTRONIC REACTOR CORE

DOEpatents

Thomson, W.B.; Corbin, A. Jr.

1961-07-18

An improved core for a gas-cooled power reactor which admits gas coolant at high temperatures while affording strong integral supporting structure and efficient moderation of neutrons is described. The multiplicities of fuel elements constituting the critical amassment of fissionable material are supported and confined by a matrix of metallic structure which is interspersed therebetween. Thermal insulation is interposed between substantially all of the metallic matrix and the fuel elements; the insulation then defines the principal conduit system for conducting the coolant gas in heat-transfer relationship with the fuel elements. The metallic matrix itseif comprises a system of ducts through which an externally-cooled hydrogeneous liquid, such as water, is circulated to serve as the principal neutron moderant for the core and conjointly as the principal coolant for the insulated metallic structure. In this way, use of substantially neutron transparent metals, such as aluminum, becomes possible for the supporting structure, despite the high temperatures of the proximate gas. The Aircraft Nuclear Propulsion program's "R-1" reactor design is a preferred embodiment.

Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process.

PubMed

Bunch, K J; Allin, B; Jolly, M; Hardie, T; Knight, M

2018-05-16

To develop a core metric set to monitor the quality of maternity care. Delphi process followed by a face-to-face consensus meeting. English maternity units. Three representative expert panels: service designers, providers and users. Maternity care metrics judged important by participants. Participants were asked to complete a two-phase Delphi process, scoring metrics from existing local maternity dashboards. A consensus meeting discussed the results and re-scored the metrics. In all, 125 distinct metrics across six domains were identified from existing dashboards. Following the consensus meeting, 14 metrics met the inclusion criteria for the final core set: smoking rate at booking; rate of birth without intervention; caesarean section delivery rate in Robson group 1 women; caesarean section delivery rate in Robson group 2 women; caesarean section delivery rate in Robson group 5 women; third- and fourth-degree tear rate among women delivering vaginally; rate of postpartum haemorrhage of ≥1500 ml; rate of successful vaginal birth after a single previous caesarean section; smoking rate at delivery; proportion of babies born at term with an Apgar score <7 at 5 minutes; proportion of babies born at term admitted to the neonatal intensive care unit; proportion of babies readmitted to hospital at <30 days of age; breastfeeding initiation rate; and breastfeeding rate at 6-8 weeks. Core outcome set methodology can be used to incorporate the views of key stakeholders in developing a core metric set to monitor the quality of care in maternity units, thus enabling improvement. Achieving consensus on core metrics for monitoring the quality of maternity care. © 2018 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Fracture-induced flow and liquid metal transport during core formation

NASA Astrophysics Data System (ADS)

Jones, V.; Petford, N.; Rushmer, T.; Wertheim, D.

2008-12-01

The most important event in the early history of the earth was the separation of its iron-rich core. Core formation induced profound chemical fractionations and extracted into the core most of Earth's iron and siderophile elements (Ni, Co, Au, Pt, W, Re), leaving the silicate crust and mantle with strong depletions of these elements relative to primitive planetary material. Recent measurements of radiogenic 182W anomalies in the silicate Earth, Mars and differentiated meteorites imply that planetesimals segregated metallic cores within a few Myr of the origin of the solar system. Various models have been put forward to explain the physical nature of the segregation mechanism (Fe-diapirs, 'raining' through a magma ocean), and more recently melt flow via fractures. In this contribution we present the initial results of a numerical study into Fe segregation in a deforming silicate matrix that captures the temperature-dependent effect of liquid metal viscosity on the transport rate. Flow is driven by pressure gradients associated with impact deformation in a growing planetesimal and the fracture geometry is constrained by experimental data on naturally deformed H6 chondrite. Early results suggest that under dynamic conditions, fracture-driven melt flow can in principle be extremely rapid, leading to a significant draining of the Fe-liquid metal and siderophile trace element component on a timescale of hours to days. Fluid transport in planetesimals where deformation is the driving force provides an attractive and simple way of segregating Fe from host silicate as both precursor and primary agent of core formation

Acquiring Sediment and Element Compositional Changes Based on a Diffuse Reflectance Spectrophotometry Technology from Cores Offshore Southwestern Taiwan

NASA Astrophysics Data System (ADS)

Pan, H. J.; Chen, M. T.

2014-12-01

Heavy summer monsoon rainfall along with typhoon-induced extreme precipitation cause frequent geological hazards that often threaten the human's safety and property in Taiwan. These geological hazards can be triggered by both natural factors, and/or have become deteriorated by perturbations from more and more human activities ever since few thousand years ago. However, due to the limit of instrumental records for observing long-term environmental changes in Taiwan, few evidence exist for distinguishing the human-induced impacts from natural climate change. Here we report a study on a high quality marine sediment core (MD103264) which were retrieved from the high sedimentation rate area from offshore southwestern Taiwan and present evidence for the long-term climate and possibly human-induced environmental changes since the last glacial. We are using the VIS-NIR Diffuse Reflectance Spectrophotometry (DRS) methods to study the cores. Interpreting the VIS-NIR reflectance spectra through the VARIMAX-rotation, principle component analysis (VPCA) helps conducting rapid and inexpensive measurements for acquiring high-resolution biogenic component, clay, and iron oxide mineral compositional data from the cores. We are also using X-Ray Fluorescence (XRF) analysis, which is also useful in determining the element compositional changes in the core. Our studies aim toward understanding the sediment and element compositional changes that reflect the patterns of changes in precipitation and soil erosion on land since the last glacial to the Holocene, during which the human activities (deforestation, agriculture, and land uses change) may have increased drastically. We will report and interpret the preliminary results of the optical analyses of the core.

Probing the Structure near the Top of the Earth's Outer Core Using SmKS Traveltimes

NASA Astrophysics Data System (ADS)

Tang, V. C.; Zhao, L.; Hung, S.

2013-12-01

The Earth's solid inner core is composed of heavy Fe and Ni with a fraction of light elements such as O, S, Si. These light elements were expelled from the inner core during its formation and rise up through the outer core as the result of buoyancy, but their existence is still a mystery. Some authors have presented seismological evidence for lowered wave speed beneath the core-mantle boundary (CMB) relative to PREM, suggesting light elements there, but counter argument also exists. In this study, we use traveltime measurements from recorded and modeled SmKS waves to investigate the effect of the velocity under the CMB on the differential traveltimes between SKKS and S3KS waves (TS3KS-TSKKS). Due to the long propagation distance and interference with neighboring phases, the arrival times of SKKS and S3KS waves are difficult to define accurately in the records. Therefore in our analysis we measure both the observed and model-predicted differential traveltime TS3KS-TSKKS by cross-correlating the waveform of Hilbert-transformed S3KS with that of SKKS. We use synthetic seismograms calculated by the Direct-Solution Method (DSM) in a suite of 1D models with different structural profiles under the CMB to examine the existence of a zone of lowered velocity at the top of the outer core. We are conducting a systematic investigation using waveforms available at IRIS from globally distributed large deep earthquakes. Results from events we have processed so far indicate that the velocity under the CMB is slightly slower than that in PREM.

PROCESS FOR JACKETING A CORE

DOEpatents

Last, G.A.

1960-07-19

A process is given for enclosing the uranium core of a nuclear fuel element by placing the core in an aluminum cup and closing the open end of the cup over the core. As the metal of the cup is brought together in a weld over the center of the end of the core, it is extruded inwardly as internal projection into a central recess in the core and outwardly as an external projection. Thus oxide inclusions in the weld of the cup are spread out into the internal and external projections and do not interfere with the integrity of the weld.

STARS: A general-purpose finite element computer program for analysis of engineering structures

NASA Technical Reports Server (NTRS)

Gupta, K. K.

1984-01-01

STARS (Structural Analysis Routines) is primarily an interactive, graphics-oriented, finite-element computer program for analyzing the static, stability, free vibration, and dynamic responses of damped and undamped structures, including rotating systems. The element library consists of one-dimensional (1-D) line elements, two-dimensional (2-D) triangular and quadrilateral shell elements, and three-dimensional (3-D) tetrahedral and hexahedral solid elements. These elements enable the solution of structural problems that include truss, beam, space frame, plane, plate, shell, and solid structures, or any combination thereof. Zero, finite, and interdependent deflection boundary conditions can be implemented by the program. The associated dynamic response analysis capability provides for initial deformation and velocity inputs, whereas the transient excitation may be either forces or accelerations. An effective in-core or out-of-core solution strategy is automatically employed by the program, depending on the size of the problem. Data input may be at random within a data set, and the program offers certain automatic data-generation features. Input data are formatted as an optimal combination of free and fixed formats. Interactive graphics capabilities enable convenient display of nodal deformations, mode shapes, and element stresses.

Low-Cost Label-Free Biosensing Bimetallic Cellulose Strip with SILAR-Synthesized Silver Core-Gold Shell Nanoparticle Structures.

PubMed

Kim, Wansun; Lee, Jae-Chul; Lee, Gi-Ja; Park, Hun-Kuk; Lee, Anbok; Choi, Samjin

2017-06-20

We introduce a label-free biosensing cellulose strip sensor with surface-enhanced Raman spectroscopy (SERS)-encoded bimetallic core@shell nanoparticles. Bimetallic nanoparticles consisting of a synthesis of core Ag nanoparticles (AgNP) and a synthesis of shell gold nanoparticles (AuNPs) were fabricated on a cellulose substrate by two-stage successive ionic layer absorption and reaction (SILAR) techniques. The bimetallic nanoparticle-enhanced localized surface plasmon resonance (LSPR) effects were theoretically verified by computational calculations with finite element models of optimized bimetallic nanoparticles interacting with an incident laser source. Well-dispersed raspberry-like bimetallic nanoparticles with highly polycrystalline structure were confirmed through X-ray and electron analyses despite ionic reaction synthesis. The stability against silver oxidation and high sensitivity with superior SERS enhancement factor (EF) of the low-cost SERS-encoded cellulose strip, which achieved 3.98 × 10 8 SERS-EF, 6.1%-RSD reproducibility, and <10%-degraded sustainability, implicated the possibility of practical applications in high analytical screening methods, such as single-molecule detection. The remarkable sensitivity and selectivity of this bimetallic biosensing strip in determining aquatic toxicities for prohibited drugs, such as aniline, sodium azide, and malachite green, as well as monitoring the breast cancer progression for urine, confirmed its potential as a low-cost label-free point-of-care test chip for the early diagnosis of human diseases.

Cross-cultural psychiatric residency training: the Oregon experience.

PubMed

Boehnlein, James K; Leung, Paul K; Kinzie, John David

2008-01-01

The purpose of this article is to describe the goals and structure of cross-cultural psychiatric training at Oregon Health and Science University (OHSU). This training in core knowledge, skills, and attitudes of cultural psychiatry over the past three decades has included medical students, residents, and fellows, along with allied mental health personnel. The curriculum includes both didactic sessions devoted to core topics in the field and varied clinical experiences in community settings and the Intercultural Psychiatric Program under the supervision of experienced academic faculty. The authors review the central elements of the training experiences and include a detailed description of the core clinical settings and experiences. At the conclusion of their clinical experiences, trainees have specialized cross-cultural psychiatric knowledge and skills, including treatment of refugees and immigrants, sociocultural variables that influence the assessment and treatment of a wide range of psychiatric conditions, and comfort with cultural dynamics that influence both the doctor/patient relationship and collaboration with a wide range of mental health professionals. Because of rapid demographic changes in the U.S. population, providing cross-cultural training for students, residents, and fellows is an essential foundation for the education of the next generation of clinicians and health care leaders. OHSU has provided a long-term model for this training in a busy clinical and academic setting that places an emphasis on multidisciplinary and multicultural collaboration.

Siderophile Element Partitioning between Sulfide- and Silicate melts.

NASA Astrophysics Data System (ADS)

Hackler, S.; Rohrbach, A.; Loroch, D. C.; Klemme, S.; Berndt, J.

2017-12-01

Different theories concerning the formation of the Earth are debated. Either Earth accreted mostly `dry' or volatile elements were delivered late after core formation was largely inactive [1, 2], or volatile rich material was accreted during the main stages of accretion and core formation [3, 4, 5]. The partitioning behavior of siderophile volatile elements (SVE; S, Se, Te, Tl, Ag, Au, Cd, Bi, Pb, Sn, Cu, Ge, and In) may provide first order constraints whether these element concentrations in Earth's mantle were established before or after core-mantle differentiation or perhaps during both periods by multi stage core formation [6]. A special interest is laid into chalcophile element behavior with respective to the possible formation and segregation of a hadean matte [7]. To examine the influence of sulfur on SVE partitioning between metal-silicate melts, we performed experiments simulating a magma ocean stage evolving from sulfur poor- (low fO2) to more oxidizing sulfur rich- (Fe, Ni)-S melts ( 20 wt% S) towards the end of accretion. We carried out partitioning experiments under various P-T-fO2 conditions with a Bristol type end loaded piston cylinder apparatus (<3 GPa) and a 1000 t walker-type multi-anvil press (3-20 GPa). Our results will be presented at the meeting. References: [1] Albarède F. (2009) Nature, 461, 1227-1233. [2] Ballhaus C. et al. (2013) EPSL, 362, 237-245. [3] Fischer-Gödde M. and Kleine T. (2017) Nature, 541, 525 527. [4] Wade J. and Wood B. J. (2005) EPSL, 236, 78-95. [5] Rubie D. et al. (2016) Science, 253, 1141-1144. [6] Rubie D. et al. (2011) EPSL, 301, 31-42. [7] O'Neill H. St. C. (1991) GCA, 55, 1159-1172.

Analytical Results for 42 Fluvial Tailings Cores and 7 Stream Sediment Samples from High Ore Creek, Northern Jefferson County, Montana

USGS Publications Warehouse

Fey, David L.; Church, Stan E.

1998-01-01

Metal-mining related wastes in the Boulder River basin study area in northern Jefferson County, Montana have been implicated in their detrimental effects on water quality with regard to acid-generation and toxic-metal solubility. Sediments, fluvial tailings and water from High Ore Creek have been identified as significant contributors to water quality degradation of the Boulder River below Basin, Montana. A study of 42 fluvial tailings cores and 7 stream sediments from High Ore Creek was undertaken to determine the concentrations of environmentally sensitive elements (i.e. Ag, As, Cd, Cu, Pb, Zn) present in these materials, and the mineral phases containing those elements. Two sites of fluvial deposition of mine-waste contaminated sediment on upper High Ore Creek were sampled using a one-inch soil probe. Forty-two core samples were taken producing 247 subsamples. The samples were analyzed by ICP-AES (inductively coupled-plasma atomic emission spectroscopy) using a total mixed-acid digestion. Results of the core analyses show that the elements described above are present at very high concentrations (to 22,000 ppm As, to 460 ppm Ag, to 900 ppm Cd, 4,300 ppm Cu, 46,000ppm Pb, and 50,000 ppm Zn). Seven stream-sediment samples were also analyzed by ICP-AES for total element content and for leachable element content. Results show that the sediment of High Ore Creek has elevated levels of ore-related metals throughout its length, down to the confluence with the Boulder River, and that the metals are, to a significant degree, contained in the leachable phase, namely the hydrous amorphous iron- and manganese-hydroxide coatings on detrital sediment particles.

Models of the Earth's Core.

PubMed

Stevenson, D J

1981-11-06

Combined inferences from seismology, high-pressure experiment and theory, geomagnetism, fluid dynamics, and current views of terrestrial planetary evolution lead to models of the earth's core with the following properties. Core formation was contemporaneous with earth accretion; the core is not in chemical equilibrium with the mantle; the outer core is a fluid iron alloy containing significant quantities of lighter elements and is probably almost adiabatic and compositionally uniform; the more iron-rich inner solid core is a consequence of partial freezing of the outer core, and the energy release from this process sustains the earth's magnetic field; and the thermodynamic properties of the core are well constrained by the application of liquid-state theory to seismic and laboratory data.

The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

PubMed Central

2011-01-01

Background Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Methods Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. Results The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. Conclusions Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices. PMID:21801428

The implementation of integrated care: the empirical validation of the Development Model for Integrated care.

PubMed

Minkman, Mirella M N; Vermeulen, Robbert P; Ahaus, Kees T B; Huijsman, Robbert

2011-07-30

Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices.

A Mercury-like component of early Earth yields uranium in the core and high mantle (142)Nd.

PubMed

Wohlers, Anke; Wood, Bernard J

2015-04-16

Recent (142)Nd isotope data indicate that the silicate Earth (its crust plus the mantle) has a samarium to neodymium elemental ratio (Sm/Nd) that is greater than that of the supposed chondritic building blocks of the planet. This elevated Sm/Nd has been ascribed either to a 'hidden' reservoir in the Earth or to loss of an early-formed terrestrial crust by impact ablation. Since removal of crust by ablation would also remove the heat-producing elements--potassium, uranium and thorium--such removal would make it extremely difficult to balance terrestrial heat production with the observed heat flow. In the 'hidden' reservoir alternative, a complementary low-Sm/Nd layer is usually considered to reside unobserved in the silicate lower mantle. We have previously shown, however, that the core is a likely reservoir for some lithophile elements such as niobium. We therefore address the question of whether core formation could have fractionated Nd from Sm and also acted as a sink for heat-producing elements. We show here that addition of a reduced Mercury-like body (or, alternatively, an enstatite-chondrite-like body) rich in sulfur to the early Earth would generate a superchondritic Sm/Nd in the mantle and an (142)Nd/(144)Nd anomaly of approximately +14 parts per million relative to chondrite. In addition, the sulfur-rich core would partition uranium strongly and thorium slightly, supplying a substantial part of the 'missing' heat source for the geodynamo.

A Mercury-like component of early Earth yields uranium in the core and high mantle 142Nd

NASA Astrophysics Data System (ADS)

Wohlers, Anke; Wood, Bernard J.

2015-04-01

Recent 142Nd isotope data indicate that the silicate Earth (its crust plus the mantle) has a samarium to neodymium elemental ratio (Sm/Nd) that is greater than that of the supposed chondritic building blocks of the planet. This elevated Sm/Nd has been ascribed either to a `hidden' reservoir in the Earth or to loss of an early-formed terrestrial crust by impact ablation. Since removal of crust by ablation would also remove the heat-producing elements--potassium, uranium and thorium--such removal would make it extremely difficult to balance terrestrial heat production with the observed heat flow. In the `hidden' reservoir alternative, a complementary low-Sm/Nd layer is usually considered to reside unobserved in the silicate lower mantle. We have previously shown, however, that the core is a likely reservoir for some lithophile elements such as niobium. We therefore address the question of whether core formation could have fractionated Nd from Sm and also acted as a sink for heat-producing elements. We show here that addition of a reduced Mercury-like body (or, alternatively, an enstatite-chondrite-like body) rich in sulfur to the early Earth would generate a superchondritic Sm/Nd in the mantle and an 142Nd/144Nd anomaly of approximately +14 parts per million relative to chondrite. In addition, the sulfur-rich core would partition uranium strongly and thorium slightly, supplying a substantial part of the `missing' heat source for the geodynamo.

The tolerance to exchanges of the Watson–Crick base pair in the hammerhead ribozyme core is determined by surrounding elements

PubMed Central

Przybilski, Rita; Hammann, Christian

2007-01-01

Tertiary interacting elements are important features of functional RNA molecules, for example, in all small nucleolytic ribozymes. The recent crystal structure of a tertiary stabilized type I hammerhead ribozyme revealed a conventional Watson–Crick base pair in the catalytic core, formed between nucleotides C3 and G8. We show that any Watson–Crick base pair between these positions retains cleavage competence in two type III ribozymes. In the Arabidopsis thaliana sequence, only moderate differences in cleavage rates are observed for the different base pairs, while the peach latent mosaic viroid (PLMVd) ribozyme exhibits a preference for a pyrimidine at position 3 and a purine at position 8. To understand these differences, we created a series of chimeric ribozymes in which we swapped sequence elements that surround the catalytic core. The kinetic characterization of the resulting ribozymes revealed that the tertiary interacting loop sequences of the PLMVd ribozyme are sufficient to induce the preference for Y3–R8 base pairs in the A. thaliana hammerhead ribozyme. In contrast to this, only when the entire stem–loops I and II of the A. thaliana sequences are grafted on the PLMVd ribozyme is any Watson–Crick base pair similarly tolerated. The data provide evidence for a complex interplay of secondary and tertiary structure elements that lead, mediated by long-range effects, to an individual modulation of the local structure in the catalytic core of different hammerhead ribozymes. PMID:17666711

The Influence of Health Policy and Market Factors on the Hospital Safety Net

PubMed Central

Bazzoli, Gloria J; Lindrooth, Richard C; Kang, R ay; Hasnain-Wynia, R omana

2006-01-01

Objective To examine how the financial pressures resulting from the Balanced Budget Act (BBA) of 1997 interacted with private sector pressures to affect indigent care provision. Data Sources/Study Setting American Hospital Association Annual Survey, Area Resource File, InterStudy Health Maintenance Organization files, Current Population Survey, and Bureau of Primary Health Care data. Study Design We distinguished core and voluntary safety net hospitals in our analysis. Core safety net hospitals provide a large share of uncompensated care in their markets and have large indigent care patient mix. Voluntary safety net hospitals provide substantial indigent care but less so than core hospitals. We examined the effect of financial pressure in the initial year of the 1997 BBA on uncompensated care for three hospital groups. Data for 1996–2000 were analyzed using approaches that control for hospital and market heterogeneity. Data Collection/Extraction Methods All urban U.S. general acute care hospitals with complete data for at least 2 years between 1996 and 2000, which totaled 1,693 institutions. Principal Findings Core safety net hospitals reduced their uncompensated care in response to Medicaid financial pressure. Voluntary safety net hospitals also responded in this way but only when faced with the combined forces of Medicaid and private sector payment pressures. Nonsafety net hospitals did not exhibit similar responses. Conclusions Our results are consistent with theories of hospital behavior when institutions face reductions in payment. They raise concern given continuing state budget crises plus the focus of recent federal deficit reduction legislation intended to cut Medicaid expenditures. PMID:16899001