Sigmoidal equilibria and eruptive instabilities in laboratory magnetic flux ropes

NASA Astrophysics Data System (ADS)

Myers, C. E.; Yamada, M.; Belova, E.; Ji, H.; Yoo, J.

2013-12-01

The Magnetic Reconnection Experiment (MRX) has recently been modified to study quasi-statically driven line-tied magnetic flux ropes in the context of storage-and-release eruptions in the corona. Detailed in situ magnetic measurements and supporting MHD simulations permit quantitative analysis of the plasma behavior. We find that the behavior of these flux ropes depends strongly on the properties of the applied potential magnetic field arcade. For example, when the arcade is aligned parallel to the flux rope footpoints, force free currents induced in the expanding rope modify the pressure and tension in the arcade, resulting in a confined, quiescent discharge with a saturated kink instability. When the arcade is obliquely aligned to the footpoints, on the other hand, a highly sigmoidal equilibrium forms that can dynamically erupt (see Fig. 1 and Fig. 2). To our knowledge, these storage-and-release eruptions are the first of their kind to be produced in the laboratory. A new 2D magnetic probe array is used to map out the internal structure of the flux ropes during both the storage and the release phases of the discharge. The kink instability and the torus instability are studied as candidate eruptive mechanisms--the latter by varying the vertical gradient of the potential field arcade. We also investigate magnetic reconnection events that accompany the eruptions. The long-term objective of this work is to use internal magnetic measurements of the flux rope structure to better understand the evolution and eruption of comparable structures in the corona. This research is supported by DoE Contract Number DE-AC02-09CH11466 and by the Center for Magnetic Self-Organization (CMSO). Qualitative sketches of flux ropes formed in (1) a parallel potential field arcade; and (2) an oblique potential field arcade. One-dimensional magnetic measurements from (1) a parallel arcade discharge that is confined; and (2) an oblique arcade discharge that erupts.

View of Arcade interior at entrance to Snack House Restaurant. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

View of Arcade interior at entrance to Snack House Restaurant. Note scored plaster detail replicating stone construction joints on brick rearing walls, and detailed plaster relief panels. Various color schemed from panels and cornice details are visible throughout the building and in historic photographs - Post Office Arcade, 2118 First Street, Fort Myers, Lee County, FL

17. Historic American Buildings Survey E. W. Russell, Photographer, May ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

17. Historic American Buildings Survey E. W. Russell, Photographer, May 7, 1936 GENERAL VIEW OF PORTICO (OR ARCADE) LOOKING WEST, 1st FLOOR OF ADMINISTRATION BUILDING - Spring Hill College, Main Building, Old Shell Road, Spring Hill, Mobile County, AL

ARCADE-R2 experiment on board BEXUS 17 stratospheric balloon

NASA Astrophysics Data System (ADS)

Barbetta, Marco; Boesso, Alessandro; Branz, Francesco; Carron, Andrea; Olivieri, Lorenzo; Prendin, Jacopo; Rodeghiero, Gabriele; Sansone, Francesco; Savioli, Livia; Spinello, Fabio; Francesconi, Alessandro

2015-09-01

This paper provides an overview of the ARCADE-R2 experiment, a technology demonstrator that aimed to prove the feasibility of small-scale satellite and/or aircraft systems with automatic (a) attitude determination, (b) control and (c) docking capabilities. The experiment embodies a simplified scenario in which an unmanned vehicle mock-up performs rendezvous and docking operations with a fixed complementary unit. The experiment is composed by a supporting structure, which holds a small vehicle with one translational and one rotational degree of freedom, and its fixed target. The dual system features three main custom subsystems: a relative infrared navigation sensor, an attitude control system based on a reaction wheel and a small-scale docking mechanism. The experiment bus is equipped with pressure and temperature sensors, and wind probes to monitor the external environmental conditions. The experiment flew on board the BEXUS 17 stratospheric balloon on October 10, 2013, where several navigation-control-docking sequences were executed and data on the external pressure, temperature, wind speed and direction were collected, characterizing the atmospheric loads applied to the vehicle. This paper describes the critical components of ARCADE-R2 as well as the main results obtained from the balloon flight.

Direct Observations of Magnetic Flux Rope Formation during a Solar Coronal Mass Ejection

NASA Astrophysics Data System (ADS)

Song, H. Q.; Zhang, J.; Chen, Y.; Cheng, X.

2014-09-01

Coronal mass ejections (CMEs) are the most spectacular eruptive phenomena in the solar atmosphere. It is generally accepted that CMEs are the results of eruptions of magnetic flux ropes (MFRs). However, there is heated debate on whether MFRs exist prior to the eruptions or if they are formed during the eruptions. Several coronal signatures, e.g., filaments, coronal cavities, sigmoid structures, and hot channels (or hot blobs), are proposed as MFRs and observed before the eruption, which support the pre-existing MFR scenario. There is almost no reported observation of MFR formation during the eruption. In this Letter, we present an intriguing observation of a solar eruptive event that occurred on 2013 November 21 with the Atmospheric Imaging Assembly on board the Solar Dynamic Observatory, which shows the formation process of the MFR during the eruption in detail. The process began with the expansion of a low-lying coronal arcade, possibly caused by the flare magnetic reconnection underneath. The newly formed ascending loops from below further pushed the arcade upward, stretching the surrounding magnetic field. The arcade and stretched magnetic field lines then curved in just below the arcade vertex, forming an X-point. The field lines near the X-point continued to approach each other and a second magnetic reconnection was induced. It is this high-lying magnetic reconnection that led to the formation and eruption of a hot blob (~10 MK), presumably an MFR, producing a CME. We suggest that two spatially separated magnetic reconnections occurred in this event, which were responsible for producing the flare and the hot blob (CME).

Direct Observations of Magnetic Flux Rope Formation during a Solar Coronal Mass Ejection

NASA Astrophysics Data System (ADS)

Song, H.; Zhang, J.; Chen, Y.; Cheng, X.

2014-12-01

Coronal mass ejections (CMEs) are the most spectacular eruptive phenomena in the solar atmosphere. It is generally accepted that CMEs are results of eruptions of magnetic flux ropes (MFRs). However, a heated debate is on whether MFRs pre-exist before the eruptions or they are formed during the eruptions. Several coronal signatures, e.g., filaments, coronal cavities, sigmoid structures and hot channels (or hot blobs), are proposed as MFRs and observed before the eruption, which support the pre existing MFR scenario. There is almost no reported observation about MFR formation during the eruption. In this presentation, we present an intriguing observation of a solar eruptive event with the Atmospheric Imaging Assembly on board the Solar Dynamic Observatory, which shows a detailed formation process of the MFR during the eruption. The process started with the expansion of a low lying coronal arcade, possibly caused by the flare magnetic reconnection underneath. The newly-formed ascending loops from below further pushed the arcade upward, stretching the surrounding magnetic field. The arcade and stretched magnetic field lines then curved-in just below the arcade vertex, forming an X-point. The field lines near the X-point continued to approach each other and a second magnetic reconnection was induced. It is this high-lying magnetic reconnection that led to the formation and eruption of a hot blob (~ 10 MK), presumably a MFR, producing a CME. We suggest that two spatially-separated magnetic reconnections occurred in this event, responsible for producing the flare and the hot blob (CME), respectively.

Corrugation Instability of a Coronal Arcade

NASA Astrophysics Data System (ADS)

Klimushkin, D. Y.; Nakariakov, V. M.; Mager, P. N.; Cheremnykh, O. K.

2017-12-01

We analyse the behaviour of linear magnetohydrodynamic perturbations of a coronal arcade modelled by a half-cylinder with an azimuthal magnetic field and non-uniform radial profiles of the plasma pressure, temperature, and the field. Attention is paid to the perturbations with short longitudinal (in the direction along the arcade) wavelengths. The radial structure of the perturbations, either oscillatory or evanescent, is prescribed by the radial profiles of the equilibrium quantities. Conditions for the corrugation instability of the arcade are determined. It is established that the instability growth rate increases with decreases in the longitudinal wavelength and the radial wave number. In the unstable mode, the radial perturbations of the magnetic field are stronger than the longitudinal perturbations, creating an almost circularly corrugated rippling of the arcade in the longitudinal direction. For coronal conditions, the growth time of the instability is shorter than one minute, decreasing with an increase in the temperature. Implications of the developed theory for the dynamics of coronal active regions are discussed.

Blowout Jets: Hinode X-Ray Jets that Don't Fit the Standard Model

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Cirtain, Jonathan W.; Sterling, Alphonse C.; Falconer, David A.

2010-01-01

Nearly half of all H-alpha macrospicules in polar coronal holes appear to be miniature filament eruptions. This suggests that there is a large class of X-ray jets in which the jet-base magnetic arcade undergoes a blowout eruption as in a CME, instead of remaining static as in most solar X-ray jets, the standard jets that fit the model advocated by Shibata. Along with a cartoon depicting the standard model, we present a cartoon depicting the signatures expected of blowout jets in coronal X-ray images. From Hinode/XRT movies and STEREO/EUVI snapshots in polar coronal holes, we present examples of (1) X-ray jets that fit the standard model, and (2) X-ray jets that do not fit the standard model but do have features appropriate for blowout jets. These features are (1) a flare arcade inside the jet-base arcade in addition to the small flare arcade (bright point) outside that standard jets have, (2) a filament of cool (T is approximately 80,000K) plasma that erupts from the core of the jetbase arcade, and (3) an extra jet strand that should not be made by the reconnection for standard jets but could be made by reconnection between the ambient unipolar open field and the opposite-polarity leg of the filament-carrying flux-rope core field of the erupting jet-base arcade. We therefore infer that these non-standard jets are blowout jets, jets made by miniature versions of the sheared-core-arcade eruptions that make CMEs

INFERRING THE MAGNETOHYDRODYNAMIC STRUCTURE OF SOLAR FLARE SUPRA-ARCADE PLASMAS FROM A DATA-ASSIMILATED FIELD TRANSPORT MODEL

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

Scott, Roger B.; McKenzie, David E.; Longcope, Dana W.

2016-03-01

Supra-arcade fans are highly dynamic structures that form in the region above post-reconnection flare arcades. In these features the plasma density and temperature evolve on the scale of a few seconds, despite the much slower dynamics of the underlying arcade. Further, the motion of supra-arcade plasma plumes appears to be inconsistent with the low-beta conditions that are often assumed to exist in the solar corona. In order to understand the nature of these highly debated structures, it is, therefore, important to investigate the interplay of the magnetic field with the plasma. Here we present a technique for inferring the underlying magnetohydrodynamicmore » processes that might lead to the types of motions seen in supra-arcade structures. Taking as a case study the 2011 October 22 event, we begin with extreme-ultraviolet observations and develop a time-dependent velocity field that is consistent with both continuity and local correlation tracking. We then assimilate this velocity field into a simplified magnetohydrodynamic simulation, which deals simultaneously with regions of high and low signal-to-noise ratio, thereby allowing the magnetic field to evolve self-consistently with the fluid. Ultimately, we extract the missing contributions from the momentum equation in order to estimate the relative strength of the various forcing terms. In this way we are able to make estimates of the plasma beta, as well as predict the spectral character and total power of Alfvén waves radiated from the supra-arcade region.« less

Thermodynamics of supra-arcade downflows in solar flares

NASA Astrophysics Data System (ADS)

Chen, Xin; Liu, Rui; Deng, Na; Wang, Haimin

2017-10-01

Context. Supra-arcade downflows (SADs) have been frequently observed during the gradual phase of solar flares near the limb. In coronal emission lines sensitive to flaring plasmas, they appear as tadpole-like dark voids against the diffuse fan-shaped "haze" above, flowing toward the well-defined flare arcade. Aims: We aim to investigate the evolution of SADs' thermal properties, and to shed light on the formation mechanism and physical processes of SADs. Methods: We carefully studied several selected SADs from two flare events and calculated their differential emission measures (DEMs) as well as DEM-weighted temperatures using data obtained by the Atmospheric Imaging Assembly (AIA) onboard the Solar Dynamic Observatory. Results: Our analysis shows that SADs are associated with a substantial decrease in DEM above 4 MK, which is 1-3 orders of magnitude smaller than the surrounding haze as well as the region before or after the passage of SADs, but comparable to the quiet corona. There is no evidence for the presence of the SAD-associated hot plasma (>20 MK) in the AIA data, and this decrease in DEM does not cause any significant change in the DEM distribution as well as the DEM-weighted temperature, which supports this idea that SADs are density depletion. This depression in DEM rapidly recovers in the wake of the SADs studied, generally within a few minutes, suggesting that they are discrete features. In addition, we found that SADs in one event are spatio-temporally associated with the successive formation of post-flare loops along the flare arcade. Movies associated to Figs. A.1 and A.2 are available at http://www.aanda.org

Historic origin of the "Arcade of Struthers".

PubMed

De Jesus, Ramon; Dellon, A Lee

2003-05-01

John Struthers wrote in 1848 and 1854 about sites of compression of the median nerve from axilla to elbow. He is best known for describing the rare median nerve entrapment by a ligament from a supracondylar process extending to the medial humeral epicondyle. In 1973, observation of ulnar nerve entrapment associated with a midshaft humeral fracture and subsequent anatomic dissections led to the creation of the term "Arcade of Struthers." Review of Struthers' original writings fails to identify either the use of word "arcade" or description of ulnar nerve compression. Review of published anatomic dissections identifies variations in the origin of the medial head of the triceps, not described by Struthers, that may cause failure of an anterior transposition of the ulnar nerve. Continued use of the term "Arcade of Struthers" is historically incorrect.

Structures far from the head of comet Kohoutek. II - A discussion of the Swan Cloud of January 11 and of the general morphology of cometary plasma tails

NASA Technical Reports Server (NTRS)

Niedner, M. B., Jr.; Brandt, J. C.

1980-01-01

Photographs show that the 'Swan Cloud' observed in comet Kohoutek on January 11, 1974 was an advanced stage of a plasma tail disconnection event, of which the rejected tail appeared to decelerate as it receded from the head. The event commenced with the development of strong tail ray activity followed by the actual tail disconnection, the merging of the disconnected tail with the new tail to form the Swan and the formation of arcade loops in the space between closing tail rays. The observed morphological sequence is easily understood in the sector boundary model (Niedner et al., 1978), and the arcade loops are proposed to be reconnected flux tubes between oppositely polarized tail rays in the incipient new tail which followed the disconnection

The Flare/CME Connection

NASA Technical Reports Server (NTRS)

Moore, Ron; Falconer, David; Sterling, Alphonse

2008-01-01

We present evidence supporting the view that, while many flares are produced by a confined magnetic explosion that does not produce a CME, every CME is produced by an ejective magnetic explosion that also produces a flare. The evidence is that the observed heliocentric angular width of the full-blown CME plasmoid in the outer corona (at 3 to 20 solar radii) is about that predicted by the standard model for CME production, from the amount of magnetic flux covered by the co-produced flare arcade. In the standard model, sheared and twisted sigmoidal field in the core of an initially closed magnetic arcade erupts. As it erupts, tether-cutting reconnection, starting between the legs of the erupting sigmoid and continuing between the merging stretched legs of the enveloping arcade, simultaneously produces a growing flare arcade and unleashes the erupting sigmoid and arcade to become the low-beta plasmoid (magnetic bubble) that becomes the CME. The flare arcade is the downward product of the reconnection and the CME plasmoid is the upward product. The unleashed, expanding CME plasmoid is propelled into the outer corona and solar wind by its own magnetic field pushing on the surrounding field in the inner and outer corona. This tether-cutting scenario predicts that the amount of magnetic flux in the full-blown CME plasmoid nearly equals that covered by the full-grown flare arcade. This equality predicts (1) the field strength in the flare region from the ratio of the angular width of the CME in the outer corona to angular width of the full-grown flare arcade, and (2) an upper bound on the angular width of the CME in the outer corona from the total magnetic flux in the active region from which the CME explodes. We show that these predictions are fulfilled by observed CMEs. This agreement validates the standard model. The model explains (1) why most CMEs have much greater angular widths than their co-produced flares, and (2) why the radial path of a CME in the outer corona can be laterally far offset from the co-produced flare.

Northwest corner, showing arcade at ground level, and triple leaded ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Northwest corner, showing arcade at ground level, and triple leaded glass windows of bender room high on north elevation. - Stanford University Library, Stanford University, Palo Alto, Santa Clara County, CA

A small-scale eruption leading to a blowout macrospicule jet in an on-disk coronal hole

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

Adams, Mitzi; Sterling, Alphonse C.; Moore, Ronald L.

2014-03-01

We examine the three-dimensional magnetic structure and dynamics of a solar EUV-macrospicule jet that occurred on 2011 February 27 in an on-disk coronal hole. The observations are from the Solar Dynamics Observatory (SDO) Atmospheric Imaging Assembly (AIA) and the SDO Helioseismic and Magnetic Imager (HMI). The observations reveal that in this event, closed-field-carrying cool absorbing plasma, as in an erupting mini-filament, erupted and opened, forming a blowout jet. Contrary to some jet models, there was no substantial recently emerged, closed, bipolar-magnetic field in the base of the jet. Instead, over several hours, flux convergence and cancellation at the polarity inversionmore » line inside an evolved arcade in the base apparently destabilized the entire arcade, including its cool-plasma-carrying core field, to undergo a blowout eruption in the manner of many standard-sized, arcade-blowout eruptions that produce a flare and coronal mass ejection. Internal reconnection made bright 'flare' loops over the polarity inversion line inside the blowing-out arcade field, and external reconnection of the blowing-out arcade field with an ambient open field made longer and dimmer EUV loops on the outside of the blowing-out arcade. That the loops made by the external reconnection were much larger than the loops made by the internal reconnection makes this event a new variety of blowout jet, a variety not recognized in previous observations and models of blowout jets.« less

FLARE-GENERATED SHOCK WAVE PROPAGATION THROUGH SOLAR CORONAL ARCADE LOOPS AND AN ASSOCIATED TYPE II RADIO BURST

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

Kumar, Pankaj; Cho, Kyung-Suk; Innes, D. E., E-mail: pankaj@kasi.re.kr

2016-09-01

This paper presents multiwavelength observations of a flare-generated type II radio burst. The kinematics of the shock derived from the type II burst closely match a fast extreme ultraviolet (EUV) wave seen propagating through coronal arcade loops. The EUV wave was closely associated with an impulsive M1.0 flare without a related coronal mass ejection, and was triggered at one of the footpoints of the arcade loops in active region NOAA 12035. It was initially observed in the 335 Å images from the Atmospheric Image Assembly with a speed of ∼800 km s{sup −1} and it accelerated to ∼1490 km s{supmore » −1} after passing through the arcade loops. A fan–spine magnetic topology was revealed at the flare site. A small, confined filament eruption (∼340 km s{sup −1}) was also observed moving in the opposite direction to the EUV wave. We suggest that breakout reconnection in the fan–spine topology triggered the flare and associated EUV wave that propagated as a fast shock through the arcade loops.« less

The triggering and subsequent development of a solar flare

NASA Technical Reports Server (NTRS)

Vorpahl, J. A.

1975-01-01

High temporal and spatial resolution solar X-ray pictures of a flare at 1827 UT on 5 September 1973 were taken with the S-056 telescope on the Apollo telescope mount. Photographs taken at 9 sec intervals allow detailed information to be obtained about the site of the energy release, as well as about the evolution of the flare itself. Observations suggest that the flare occurred in an entire arcade of loops rather than in any single loop. Sequential brightening of different X-ray features indicates that some excitation moved perpendicular to the magnetic field of the arcade at velocities of 180 to 280 km/sec. The most intense X-ray features were located in places where the magnetic field composing the arcade had a small radius of curvature with horizontal field gradients higher than the surroundings region and where the axis of the arcade changed direction. It was felt that the arcade geometry strongly influenced the propagation of the triggering disturbance, as well as the storage and site of the subsequent deposition of energy. A magnetosonic wave is suggested as the propagating mechanism triggering instabilities that may have existed in the preflare structure.

Delayed Development of Multiple Pancreaticoduodenal Arcade Pseudoaneurysms after Abdominal Trauma.

PubMed

Prosper, Ashley; Saremi, Farhood

2016-10-01

This case report demonstrates development and progressive enlargement of multiple pancreaticoduodenal arcade pseudoaneurysms using computed tomography angiographies over a period of 5 weeks after abdominal trauma. The mechanism of pseudoaneurysm formation, as shown by serial imaging, attributed to preexisting celiac axis stenosis by the median arcuate ligament, posttraumatic celiac artery dissection, and secondary occlusion of proper hepatic artery resulting in elevation of pressure and flow in the pancreaticoduodenal arcade and rupture of small arterial branches. Successful pseudoaneurysm occlusion was achieved through arterial embolization. Published by Elsevier Inc.

An Exploration of Heating Mechanisms in a Supra-arcade Plasma Sheet Formed after a Coronal Mass Ejection

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

Reeves, Katharine K.; Freed, Michael S.; McKenzie, David E.

We perform a detailed analysis of the thermal structure of the region above the post-eruption arcade for a flare that occurred on 2011 October 22. During this event, a sheet of hot plasma is visible above the flare loops in the 131 Å bandpass of the Atmospheric Imaging Assembly (AIA) on the Solar Dynamics Observatory . Supra-arcade downflows (SADs) are observed traveling sunward through the post-eruption plasma sheet. We calculate differential emission measures using the AIA data and derive an emission measure weighted average temperature in the supra-arcade region. In areas where many SADs occur, the temperature of the supra-arcademore » plasma tends to increase, while in areas where no SADs are observed, the temperature tends to decrease. We calculate the plane-of-sky velocities in the supra-arcade plasma and use them to determine the potential heating due to adiabatic compression and viscous heating. Of the 13 SADs studied, 10 have noticeable signatures in both the adiabatic and the viscous terms. The adiabatic heating due to compression of plasma in front of the SADs is on the order of 0.1–0.2 MK/s, which is similar in magnitude to the estimated conductive cooling rate. This result supports the notion that SADs contribute locally to the heating of plasma in the supra-arcade region. We also find that in the region without SADs, the plasma cools at a rate that is slower than the estimated conductive cooling, indicating that additional heating mechanisms may act globally to keep the plasma temperature high.« less

Overlying extreme-ultraviolet arcades preventing eruption of a filament observed by AIA/SDO

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

Chen, Huadong; Ma, Suli; Zhang, Jun, E-mail: hdchen@upc.edu.cn

2013-11-20

Using the multi-wavelength data from the Atmospheric Imaging Assembly/Solar Dynamic Observatory (AIA/SDO) and the Sun Earth Connection Coronal and Heliospheric Investigation/Solar Terrestrial Relations Observatory (SECCHI/STEREO), we report a failed filament eruption in NOAA AR 11339 on 2011 November 3. The eruption was associated with an X1.9 flare, but without any coronal mass ejection (CME), coronal dimming, or extreme ultraviolet (EUV) waves. Some magnetic arcades above the filament were observed distinctly in EUV channels, especially in the AIA 94 Å and 131 Å wavebands, before and during the filament eruption process. Our results show that the overlying arcades expanded along withmore » the ascent of the filament at first until they reached a projected height of about 49 Mm above the Sun's surface, where they stopped. The following filament material was observed to be confined by the stopped EUV arcades and not to escape from the Sun. After the flare, a new filament formed at the low corona where part of the former filament remained before its eruption. These results support that the overlying arcades play an important role in preventing the filament from successfully erupting outward. We also discuss in this paper the EUV emission of the overlying arcades during the flare. It is rare for a failed filament eruption to be associated with an X1.9 class flare, but not with a CME or EUV waves. Therefore, this study also provides valuable insight into the triggering mechanism of the initiation of CMEs and EUV waves.« less

Fetal Topographical Anatomy of the Pancreatic Head and Duodenum with Special Reference to Courses of the Pancreaticoduodenal Arteries

PubMed Central

Jin, Zhe Wu; Cho, Baik Hwan; Kim, Hyoung Tae; Kimura, Wataru; Fujimiya, Mineko; Murakami, Gen

2010-01-01

Purpose The purpose of this study is to provide better understanding as to how the "double" vascular arcades, in contrast to other intestinal marginal vessels, develop along the right margin of the pancreatic head. Materials and Methods In human fetuses between 8-30 weeks, we described the topographical anatomy of the vessels, bile duct, duodenum as well as the ventral and dorsal primordia of the pancreatic head with an aid of pancreatic polypeptide immunohisto-chemistry. Results The contents of the hepatoduodenal ligament crossed the superior side of the pylorus. Moreover, the right hepatic artery originating from the superior mesenteric artery ran along the superior aspect of the pancreatic head. An arterial arcade, corresponding to the posterior pancreaticoduodenal arteries, encircled the superior part of the pancreatic head, whereas another arcade, corresponding to the anterior pancreaticoduodenal arteries, surrounded the inferior part. The dorsal promordium of the pancreas surrounded and/or mixed the ventral primordium at 13-16 weeks. Thus, both arterial arcades were likely to attach to the dorsal primordium. Conclusion The fetal anatomy of the pancreaticoduodenal vascular arcades as well as that of the hepatoduodenal ligament were quite different from adults in topographical relations. Thus, in the stage later than 30 weeks, further rotation of the duodenum along a horizontal axis seemed to be required to move the pylorus posterosuperiorly and to reflect the superior surface of the pancreatic head posteriorly. However, to change the topographical anatomy of the superior and inferior arterial arcades into the final position, re-arrangement of the pancreatic parenchyma might be necessary in the head. PMID:20376893

75. TILE WORKS COURTYARD, NORTH WING ARCADE, FROM WEST, c. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

75. TILE WORKS COURTYARD, NORTH WING ARCADE, FROM WEST, c. 1915. FONTHILL MANUSCRIPTS, SL/BCHS. UNCATALOGED POSTCARD. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

76. TILE WORKS COURTYARD, EAST WING ARCADE, FROM NORTH, c. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

76. TILE WORKS COURTYARD, EAST WING ARCADE, FROM NORTH, c. 1915. FONTHILL MANUSCRIPTS, SL/BCHS. UNCATALOGED POSTCARD. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Quantifying mental foramen position in extant hominoids and Australopithecus: implications for its use in studies of human evolution.

PubMed

Robinson, Chris A; Williams, Frank L

2010-08-01

The location of the mental foramen on the mandibular corpus has figured prominently in debates concerning the taxonomy of fossil hominins and Gorilla gorilla. In this study we quantify the antero/posterior (A/P) position of the mental foramen across great apes, modern humans and Australopithecus. Contrary to most qualitative assessments, we find significant differences between some extant hominoid species in mental foramen A/P position supporting its potential usefulness as a character for taxonomic and phylogenetic analyses of fossil hominoids. Gorilla gorilla, particularly the eastern subspecies, with a comparatively longer dental arcade and fossil and extant hominins with reduced canines and incisors tend to exhibit more anteriorly positioned mental foramina. Conversely, Pan troglodytes exhibits more posteriorly positioned mental foramina. Variation in this character among Gorilla gorilla subspecies supports recent taxonomic assessments that separate eastern and western populations. In all taxa other than Pan troglodytes the A/P position of the mental foramen is positively allometric with respect to dental arcade length. Thus, within each of these species, specimens with longer dental arcades tend to have more posteriorly positioned mental foramina. Those species with greater sexual dimorphism in canine size and dental arcade length (i.e., Gorilla gorilla and Pongo pygmaeus) exhibit more extreme differences between smaller and larger individuals. Moreover, among great apes those individuals with greater anterior convergence of the dental arcade tend to exhibit more posteriorly positioned mental foramina. Dental arcade length, canine crown area and anterior convergence are all significantly associated with mental foramen A/P position, suggesting that these traits may influence taxonomic variation in the A/P position of the mental foramen. (c) 2010 Wiley-Liss, Inc.

13. DETAIL OF THE EAST WING ARCADE WALL. SHOWS REMOVABLE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

13. DETAIL OF THE EAST WING ARCADE WALL. SHOWS REMOVABLE WOODEN WINDOWS, A PERMANENT CONCRETE WINDOW, AND BUILT-IN CONCRETE STORAGE BINS. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Distinguishing Between Supra-Arcade Downflows and Plasmoids

NASA Technical Reports Server (NTRS)

Savage, Sabrina

2015-01-01

Supra-arcade downflows (SADs) and downflowing loops (SADLs), observed as sunward-traveling voids and thin flux tubes in the current sheet region above developing flare arcades, are considered indicators of magnetic reconnection fueling long­-duration solar eruptions. These flows are located in regions of very low signal-­to-noise in the corona where high cadence magnetic field measurements are not yet achievable, making observations difficult to fully interpret with respect to reconnection. Several models have been developed to explain their characteristics and behaviors, but most do not successfully recreate the observations. We will present a variety of downflow observations and provide comparisons to a number of the more prominent models.

Amusement Arcades Help Identify Teen Needs. Research Notes.

ERIC Educational Resources Information Center

Jordan, Debra J.

1995-01-01

Reviews research on youth motivation for visiting amusement arcades and on the relationship among the school achievement, socioeconomic status, and self-esteem of fourth graders. Implications for camp involve providing adolescents with unstructured leisure time with little overt adult supervision and providing early intervention for low-achieving…

Arcade Video Games: Proxemic, Cognitive and Content Analyses.

ERIC Educational Resources Information Center

Braun, Claude M. J.; Giroux, Josette

1989-01-01

A study was designed to determine psychological complexity and reinforcement characteristics of popular arcade video games, including sex differences in game content, clientele social structure, human-to-human interaction contingencies, and value content. Results suggest a need for public control of children's access to the games and the video…

15. EAST WING FROM THE WEST, SHOWING THE COURTYARD ARCADE. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

15. EAST WING FROM THE WEST, SHOWING THE COURTYARD ARCADE. THE CONCRETE MIXER USED TO MIX CONCRETE FOR THE INDIAN HOUSE TOWER IS THE FOREGROUND. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

The Joint Space Operations Center (JSpOC) Mission System (JMS) and the Advanced Research, Collaboration, and Application Development Environment (ARCADE)

NASA Astrophysics Data System (ADS)

Johnson, K.; Kim, R.; Echeverry, J.

The Joint Space Operations Center (JSpOC) is a command and control center focused on executing the Space Control mission of the Joint Functional Component Command for Space (JFCC-SPACE) to ensure freedom of action of United States (US) space assets, while preventing adversary use of space against the US. To accomplish this, the JSpOC tasks a network of space surveillance sensors to collect Space Situational Awareness (SSA) data on resident space objects (RSOs) in near earth and deep space orbits. SSA involves the ingestion of data sources and use of algorithms and tools to build, maintain, and disseminate situational awareness of RSOs in space. On the heels of emergent and complex threats to space assets, the JSpOC's capabilities are limited by legacy systems and CONOPs. The JSpOC Mission System (JMS) aims to consolidate SSA efforts across US agencies, international partners, and commercial partners. The JMS program is intended to deliver a modern service-oriented architecture (SOA) based infrastructure with increased process automation and improved tools to remove the current barriers to JSpOC operations. JMS has been partitioned into several developmental increments. Increment 1, completed and operational in early 2013, and Increment 2, which is expected to be completed in 2016, will replace the legacy Space Defense Operations Center (SPADOC) and Astrodynamics Support Workstation (ASW) capabilities. In 2017 JMS Increment 3 will continue to provide additional SSA and C2 capabilities that will require development of new applications and procedures as well as the exploitation of new data sources. Most importantly, Increment 3 is uniquely postured to evolve the JSpOC into the centralized and authoritative source for all Space Control applications by using its SOA to aggregate information and capabilities from across the community. To achieve this goal, Scitor Corporation has supported the JMS Program Office as it has entered into a partnership with AFRL/RD (Directed Energy) and AFRL/RV (Space Vehicles) to create the Advanced Research, Collaboration, and Application Development Environment (ARCADE). The ARCADE formalizes capability development processes that hitherto have been ad hoc, slow to address the evolving space threat environment, and not easily repeatable. Therefore, the purpose of the ARCADE is to: (1) serve as a centralized testbed for all research and development (R&D) activities related to JMS applications, including algorithm development, data source exposure, service orchestration, and software services, and provide developers reciprocal access to relevant tools and data to accelerate technology development, (2) allow the JMS program to communicate user capability priorities and requirements to developers, (3) facilitate collaboration among developers who otherwise would not collaborate due to organizational, policy, or geographical barriers, and (4) support market research efforts by identifying outstanding performers that are available to shepherd into the formal transition process. Over the last several years Scitor Corporation has provided systems engineering support to the JMS Increment 3 Program Office, and has worked with AFRL/RV and AFRL/RD to create a high performance computing environment and SOA at both unclassified and classified levels that together allow developers to develop applications in an environment similar to the version of JMS currently in use by the JSpOC operators. Currently the ARCADE is operational in an unclassified environment via the High Performance Computing Modernization Program (HPCMP) Portal on DREN. The ARCADE also exists on SECRET and TOP SECRET environments on multiple networks. This presentation will cover the following topics: (1) Scitors role in shaping the ARCADE into its current form, (2) ARCADEs value proposition for potential technology developers, and (3) ARCADEs value proposition for the Government. These topics will be discussed by way of several case studies: a JMS Prototype activity, integration of the Search and Determine Integrated Environment (SADIE) system into the ARCADE, and developer challenge opportunities using the ARCADE. The contents of this presentation will be UNCLASSIFIED.

Thirty Billion Quarters Can't Be Wrong--Or Can They?

ERIC Educational Resources Information Center

Needham, Nancy R.

1982-01-01

Social consequences likely to result from the popularity of video game arcades among teenagers are considered. Views of social theorists are summarized; social and financial problems created by the games are discussed, as are possible advantages, such as development of quicker reflexes. Attempts to regulate arcade hours are noted. (PP)

Some Uses and Gratifications of Arcade Video Game Playing.

ERIC Educational Resources Information Center

Selnow, Gary W.

The question of whether adolescents turn to arcade video games for gratifications similar to those met by television viewing was investigated with 244 children 10 to 14 years old, who were attending a statewide summer sports camp. A questionnaire required subjects to rate the importance of 17 need statements and provide basic demographic…

A prominence eruption driven by flux feeding from chromospheric fibrils

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

Zhang, Quanhao; Liu, Rui; Wang, Yuming

2014-07-10

We present multi-wavelength observations of a prominence eruption originating from a quadrupolar field configuration, in which the prominence was embedded in a side arcade. Within the two-day period prior to its eruption on 2012 October 22, the prominence was perturbed three times by chromospheric fibrils underneath, which rose upward, became brightened, and merged into the prominence, resulting in horizontal flows along the prominence axis, suggesting that the fluxes carried by the fibrils were incorporated into the magnetic field of the prominence. These perturbations caused the prominence to oscillate and to rise faster than before. The absence of intense heating withinmore » the first two hours after the onset of the prominence eruption, which followed an exponential increase in height, indicates that ideal instability played a crucial role. The eruption involved interactions with the other side arcade, leading up to a twin coronal mass ejection, which was accompanied by transient surface brightenings in the central arcade, followed by transient dimmings and brightenings in the two side arcades. We suggest that flux feeding from chromospheric fibrils might be an important mechanism to trigger coronal eruptions.« less

ARCADE 2 Observations of Galactic Radio Emission

NASA Technical Reports Server (NTRS)

Kogut, A.; Fixsen, D. J.; Levin, S. M.; Limon, M.; Lubin, P. M.; Mirel, P.; Seiffert, M.; Singal, J.; Villela, T.; Wollack, E.;

CHAIN RECONNECTIONS OBSERVED IN SYMPATHETIC ERUPTIONS

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

Joshi, Navin Chandra; Magara, Tetsuya; Schmieder, Brigitte

2016-04-01

The nature of various plausible causal links between sympathetic events is still a controversial issue. In this work, we present multiwavelength observations of sympathetic eruptions, associated flares, and coronal mass ejections (CMEs) occurring on 2013 November 17 in two close active regions. Two filaments, i.e., F1 and F2, are observed in between the active regions. Successive magnetic reconnections, caused for different reasons (flux cancellation, shear, and expansion) have been identified during the whole event. The first reconnection occurred during the first eruption via flux cancellation between the sheared arcades overlying filament F2, creating a flux rope and leading to themore » first double-ribbon solar flare. During this phase, we observed the eruption of overlying arcades and coronal loops, which leads to the first CME. The second reconnection is believed to occur between the expanding flux rope of F2 and the overlying arcades of filament F1. We suggest that this reconnection destabilized the equilibrium of filament F1, which further facilitated its eruption. The third stage of reconnection occurred in the wake of the erupting filament F1 between the legs of the overlying arcades. This may create a flux rope and the second double-ribbon flare and a second CME. The fourth reconnection was between the expanding arcades of the erupting filament F1 and the nearby ambient field, which produced the bi-directional plasma flows both upward and downward. Observations and a nonlinear force-free field extrapolation confirm the possibility of reconnection and the causal link between the magnetic systems.« less

Oscillations Excited by Plasmoids Formed During Magnetic Reconnection in a Vertical Gravitationally Stratified Current Sheet

NASA Astrophysics Data System (ADS)

Jelínek, P.; Karlický, M.; Van Doorsselaere, T.; Bárta, M.

2017-10-01

Using the FLASH code, which solves the full set of the 2D non-ideal (resistive) time-dependent magnetohydrodynamic (MHD) equations, we study processes during the magnetic reconnection in a vertical gravitationally stratified current sheet. We show that during these processes, which correspond to processes in solar flares, plasmoids are formed due to the tearing mode instability of the current sheet. These plasmoids move upward or downward along the vertical current sheet and some of them merge into larger plasmoids. We study the density and temperature structure of these plasmoids and their time evolution in detail. We found that during the merging of two plasmoids, the resulting larger plasmoid starts to oscillate with a period largely determined by L/{c}{{A}}, where L is the size of the plasmoid and c A is the Alfvén speed in the lateral parts of the plasmoid. In our model, L/{c}{{A}} evaluates to ˜ 25 {{s}}. Furthermore, the plasmoid moving downward merges with the underlying flare arcade, which causes oscillations of the arcade. In our model, the period of this arcade oscillation is ˜ 35 {{s}}, which also corresponds to L/{c}{{A}}, but here L means the length of the loop and c A is the average Alfvén speed in the loop. We also show that the merging process of the plasmoid with the flare arcade is a complex process as presented by complex density and temperature structures of the oscillating arcade. Moreover, all these processes are associated with magnetoacoustic waves produced by the motion and merging of plasmoids.

Interior detail view, nave arcade, compound column capitals, east aisle ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Interior detail view, nave arcade, compound column capitals, east aisle vaulting, and decorative painting. Note the confessional in the west aisle in the photograph's lower right. (Similar to HABS No. PA-6694-22). - Acts of the Apostles Church in Jesus Christ, 1400-28 North Twenty-eighth Street, northwest corner of North Twenty-eighth & Master Streets, Philadelphia, Philadelphia County, PA

Public Participation and Natural Habitat Preservation Along Arcade Creek, Del Paso Regional Park, Sacramento, California

Treesearch

Timothy J. Vendlinski; Steven N. Talley

1989-01-01

Thirty-six hectares (90 acres) of riparian forest, high terrace oak woodland-savanna, and upland vernal pools were preserved along Arcade Creek in Sacramento, California as a result of citizen involvement in a city-sponsored master plan process for Del Paso Regional Park. Citizens formed an organization and called for a comprehensive Environmental Impact Report to...

A Novel Approach to Resonant Absorption of the Fast Magnetohydrodynamic Eigenmodes of a Coronal Arcade

NASA Astrophysics Data System (ADS)

Hindman, Bradley W.; Jain, Rekha

2018-05-01

The arched field lines forming coronal arcades are often observed to undulate as magnetohydrodynamic waves propagate both across and along the magnetic field. These waves are most likely a combination of resonantly coupled fast magnetoacoustic waves and Alfvén waves. The coupling results in resonant absorption of the fast waves, converting fast wave energy into Alfvén waves. The fast eigenmodes of the arcade have proven difficult to compute or derive analytically, largely because of the mathematical complexity that the coupling introduces. When a traditional spectral decomposition is employed, the discrete spectrum associated with the fast eigenmodes is often subsumed into the continuous Alfvén spectrum. Thus fast eigenmodes become collective modes or quasi-modes. Here we present a spectral decomposition that treats the eigenmodes as having real frequencies but complex wavenumbers. Using this procedure we derive dispersion relations, spatial damping rates, and eigenfunctions for the resonant, fast eigenmodes of the arcade. We demonstrate that resonant absorption introduces a fast mode that would not exist otherwise. This new mode is heavily damped by resonant absorption, travelling only a few wavelengths before losing most of its energy.

ARCADE 2 Measurement of the Absolute Sky Brightness at 3-90 GHz

NASA Technical Reports Server (NTRS)

Fixsen, D. J.; Kogut, A.; Levin, S.; Limon, M.; Mirel, P.; Seiffert, M.; Singal, J.; Wollack, E.; Villela, T.; Wuensche, C. A.

2011-01-01

The ARCADE 2 instrument has measured the absolute temperature of the sky at frequencies 3, 8, 10, 30, and 90 GHz, uSing an open-aperture cryogenic instrument observing al balloon altitudes with no emissive windows between the beam-forming optics and the sky. An external blackbody calibrator provides an in situ reference. Systematic errors were greatly reduced by using differential radiometers and cooling all critical components to physical temperatures approximating the cosmic microwave background (CMB) temperature. A linear model is used to compare the output of each radiometer to a set of thermometers on the instrument. Small correction. are made for the residual emission from the flight train, balloon, atmosphere, and foreground Galactic emission. The ARCADE 2 data alone show an excess radio rise of 54 +/- 6 mK at 3.3 GHz in addition to a CMB temperature of 2.731 +/- 0.004 K. Combining the ARCADE 2 data with data from the literature shows an excess power-law spectrum of T = 24.1 +/- 2.1 (K)(v/v(sub o)(exp -2.599+/-0.036 from 22 MHz to 10 GHz (v(sub 0) = 310 MHz) in addition to a CMB temperature of 2.725 +/- 0.001 K.

Supra Arcade Downflows with XRT Informed by Dipolarization Fronts with THEMIS

NASA Technical Reports Server (NTRS)

Kobelski, Adam; Savage, Sabrina Leah; Malaspina, David

2016-01-01

Magnetic reconnection can rapidly reconfigure the magnetic field of the corona, accelerating plasma through the site of reconnection. Ambiguities due to the nature of remote sensing have complicated the interpretation of observations of the inflowing and outflowing plasma in reconnecting regions. In particular, the interpretation of sunward moving density depletions above flare arcades (known as Supra Arcade Downflows - SADs) is still debated. Hinode/XRT has provided a wealth of observations for SADs and helped inform our current understanding of these structures. SADs have been interpreted as wakes behind newly reconnected and outflowing loops (Supra Arcade Downflowing Loops - SADLs). Models have shown the plausibility of this interpretation, though this interpretation has not yet been fully accepted. We present here observations of newly reconnected outflowing loops observed via in situ instruments in the magnetosphere. These observations, provided by five THEMIS spacecraft, show that around retracting loops (dipolarization fronts in this context) similar dynamic temperature and density structures are found as seen in SADs. We compare data from multiple SADs and dipolarization fronts to show that the observational signatures implied in the corona can be directly observed in similar plasma regimes in the magnetosphere, strongly favoring the interpretation of SADs as wakes behind retracting loops.

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

Toeroek, T.; Aulanier, G.; Schmieder, B.

We address the formation of three-dimensional nullpoint topologies in the solar corona by combining Hinode/X-ray Telescope (XRT) observations of a small dynamic limb event, which occurred beside a non-erupting prominence cavity, with a three-dimensional (3D) zero-beta magnetohydrodynamics (MHD) simulation. To this end, we model the boundary-driven 'kinematic' emergence of a compact, intense, and uniformly twisted flux tube into a potential field arcade that overlies a weakly twisted coronal flux rope. The expansion of the emerging flux in the corona gives rise to the formation of a nullpoint at the interface of the emerging and the pre-existing fields. We unveil amore » two-step reconnection process at the nullpoint that eventually yields the formation of a broad 3D fan-spine configuration above the emerging bipole. The first reconnection involves emerging fields and a set of large-scale arcade field lines. It results in the launch of a torsional MHD wave that propagates along the arcades, and in the formation of a sheared loop system on one side of the emerging flux. The second reconnection occurs between these newly formed loops and remote arcade fields, and yields the formation of a second loop system on the opposite side of the emerging flux. The two loop systems collectively display an anenome pattern that is located below the fan surface. The flux that surrounds the inner spine field line of the nullpoint retains a fraction of the emerged twist, while the remaining twist is evacuated along the reconnected arcades. The nature and timing of the features which occur in the simulation do qualititatively reproduce those observed by XRT in the particular event studied in this paper. Moreover, the two-step reconnection process suggests a new consistent and generic model for the formation of anemone regions in the solar corona.« less

Joint SDO and IRIS Observations of a Novel, Hybrid Prominence-Coronal Rain Complex

NASA Astrophysics Data System (ADS)

Liu, Wei; Antolin, Patrick; Sun, Xudong; Gao, Lijia; Vial, Jean-Claude; Gibson, Sarah; Okamoto, Takenori; Berger, Thomas; Uitenbroek, Han; De Pontieu, Bart

2016-10-01

Solar prominences and coronal rain are intimately related phenomena, both involving cool material at chromospheric temperatures within the hot corona and both playing important roles as part of the return flow of the chromosphere-corona mass cycle. At the same time, they exhibit distinct morphologies and dynamics not yet well understood. Quiescent prominences consist of numerous long-lasting, filamentary downflow threads, while coronal rain is more transient and falls comparably faster along well-defined curved paths. We report here a novel, hybrid prominence-coronal rain complex in an arcade-fan geometry observed by SDO/AIA and IRIS, which provides new insights to the underlying physics of such contrasting behaviors. We found that the supra-arcade fan region hosts a prominence sheet consisting of meandering threads with broad line widths. As the prominence material descends to the arcade, it turns into coronal rain sliding down coronal loops with line widths 2-3 times narrower. This contrast suggests that distinct local plasma and magnetic conditions determine the fate of the cool material, a scenario supported by our magnetic field extrapolations from SDO/HMI. Specifically, the supra-arcade fan (similar to those in solar flares; e.g., McKenzie 2013) is likely situated in a current sheet, where the magnetic field is weak and the plasma-beta could be close to unity, thus favoring turbulent flows like those prominence threads. In contrast, the underlying arcade has a stronger magnetic field and most likely a low-beta environment, such that the material is guided along magnetic field lines to appear as coronal rain. We will discuss the physical implications of these observations beyond prominence and coronal rain.

Coil Embolization of Pancreaticoduodenal Artery Aneurysms Associated with Celiac Artery Stenosis: Report of Three Cases

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

Ikeda, Osamu, E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka

2007-06-15

Aneurysms of the pancreaticoduodenal artery are rare. Degeneration of pancreaticoduodenal arcade vessels due to these aneurysms is associated with celiac artery stenosis or occlusion. Untreated lesions enlarge progressively and may rupture spontaneously. As the location of aneurysms of pancreaticoduodenal arcade vessels renders their surgical extirpation a challenge, we examined whether endovascular techniques offer a treatment alternative. We report on 3 patients with aneurysms of the pancreaticoduodenal arcade vessels and concomitant celiac artery stenosis/occlusion due to compression by the median arcuate ligament or chronic pancreatitis. All patients were treated by percutaneous coil embolization of the aneurysm. The aneurysmal sac was successfullymore » excluded and the native circulation was preserved. Endovascular surgery can be used to treat these aneurysms safely and permits retention of the native circulation.« less

Disruption of coronal magnetic field arcades

NASA Technical Reports Server (NTRS)

Mikic, Zoran; Linker, Jon A.

1994-01-01

The ideal and resistive properties of isolated large-scale coronal magnetic arcades are studied using axisymmetric solutions of the time-dependent magnetohydrodynamic (MHD) equations in spherical geometry. We examine how flares and coronal mass ejections may be initiated by sudden disruptions of the magnetic field. The evolution of coronal arcades in response to applied shearing photospheric flows indicates that disruptive behavior can occur beyond a critical shear. The disruption can be traced to ideal MHD magnetic nonequilibrium. The magnetic field expands outward in a process that opens the field lines and produces a tangential discontinuity in the magnetic field. In the presence of plasma resistivity, the resulting current sheet is the site of rapid reconnection, leading to an impulsive release of magnetic energy, fast flows, and the ejection of a plasmoid. We relate these results to previous studies of force-free fields and to the properties of the open-field configuration. We show that the field lines in an arcade are forced open when the magnetic energy approaches (but is still below) the open-field energy, creating a partially open field in which most of the field lines extend away from the solar surface. Preliminary application of this model to helmet streamers indicates that it is relevant to the initiation of coronal mass ejections.

Shear-induced inflation of coronal magnetic fields

NASA Technical Reports Server (NTRS)

Klimchuk, James A.

1989-01-01

Using numerical models of force-free magnetic fields, the shearing of footprints in arcade geometries leading to an inflation of the coronal magnetic field was examined. For each of the shear profiles considered, all of the field lines become elevated compared with the potential field. This includes cases where the shear is concentrated well away from the arcade axis, such that B(sub z), the component of field parallel to the axis, increases outward to produce an inward B(sub z)squared/8 pi magnetic pressure gradient force. These results contrast with an earlier claim, shown to be incorrect, that field lines can sometimes become depressed as a result of shear. It is conjectured that an inflation of the entire field will always result from the shearing of simple arcade configurations. These results have implications for prominence formation, the interplanetary magnetic flux, and possibly also coronal holes.

Shear-induced inflation of coronal magnetic fields

NASA Technical Reports Server (NTRS)

Klimchuk, James A.

1990-01-01

Using numerical models of force-free magnetic fields, the shearing of footprints in arcade geometries leading to an inflation of the coronal magnetic field was examined. For each of the shear profiles considered, all of the field lines become elevated compared with the potential field. This includes cases where the shear is concentrated well away from the arcade axis, such that B(sub z), the component of field parallel to the axis, increases outward to produce an inward B(sub z) squared/8 pi magnetic pressure gradient force. These results contrast with an earlier claim, shown to be incorrect, that field lines can sometimes become depressed as a result of shear. It is conjectured that an inflation of the entire field will always result from the shearing of simple arcade configurations. These results have implications for prominence formation, the interplanetary magnetic flux, and possibly also coronal holes.

Arcade: A Web-Java Based Framework for Distributed Computing

NASA Technical Reports Server (NTRS)

Chen, Zhikai; Maly, Kurt; Mehrotra, Piyush; Zubair, Mohammad; Bushnell, Dennis M. (Technical Monitor)

2000-01-01

Distributed heterogeneous environments are being increasingly used to execute a variety of large size simulations and computational problems. We are developing Arcade, a web-based environment to design, execute, monitor, and control distributed applications. These targeted applications consist of independent heterogeneous modules which can be executed on a distributed heterogeneous environment. In this paper we describe the overall design of the system and discuss the prototype implementation of the core functionalities required to support such a framework.

Pakistan’s Inter-Services Intelligence Directorate: A State within a State?

DTIC Science & Technology

2008-01-01

Robinson, Bin Laden: Behind the Mask of the Terrorist (New York: Arcade Publishing, 2001), 95. 26 Abbas, 114. 27 Mary Ann Weaver, Pakistan: In the...The Truth Behind the Most Devastating Terror- ist Attack the World Has Ever Seen (New York: Arcade Publishing, 2003), 50. 77 Teresita C. Schaffer...2004), 37. 78 Robert Fisk, The Great War for Civilisation : The Conquest of the Middle East (New York: Knopf, 2005), 862. 79 Peter R. Lavoy

Incidence and distribution of paravascular lamellar holes and their relationship with macular retinoschisis in highly myopic eyes using spectral-domain oct.

PubMed

Vela, José I; Sánchez, Fernando; Díaz-Cascajosa, Jesús; Mingorance, Ester; Andreu, David; Buil, José A

2016-04-01

The purpose of the study is to determine the incidence and distribution of paravascular lamellar holes (PLH) around retinal vessels in highly myopic eyes and their relationship with macular retinoschisis (MR). We examined 306 eyes of 178 patients with high myopia, performing multiple scans of the posterior pole within the retinal vascular arcades using spectral-domain OCT. Type of staphyloma was determined. PLH were divided into three groups: holes only (group 1), holes extending below vessels (group 2), and holes in an area of paravascular retinoschisis (group 3). OCT showed that 96/306 eyes (31.4 %) had PLH mainly along the infero-temporal arcade (39.9 %). Type V and IX staphylomas had a higher proportion of PLH in the infero-temporal arcade than other staphylomas. Group 3 eyes presented higher rates of myopia and staphyloma. MR was detected in 10/27 eyes (37 %) in Group 3, but only in 2/33 eyes (6.1 %) in Group 1. No MR was found in Group 2. PLH are relatively common in highly myopic eyes and mainly distributed in the inferior temporal arcade. Findings from this descriptive study suggest that distribution of PLH might be related to the type of staphyloma. Further studies are needed to evaluate the relevance of PLH in the pathogenesis of MR.

Inside marginal adaptation of crowns by X-ray micro-computed tomography

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

Dos Santos, T. M.; Lima, I.; Lopes, R. T.

The objective of this work was to access dental arcade by using X-ray micro-computed tomography. For this purpose high resolution system was used and three groups were studied: Zirkonzahn CAD-CAM system, IPS e.max Press, and metal ceramic. The three systems assessed in this study showed results of marginal and discrepancy gaps clinically accepted. The great result of 2D and 3D evaluations showed that the used technique is a powerful method to investigate quantitative characteristics of dental arcade. (authors)

The CME Flare Arcade and the Width of the CME in the Outer Corona

NASA Technical Reports Server (NTRS)

Moore, Ron; Falconer, David; Sterling, Alphonse

2008-01-01

Moore, Sterling, & Suess (2007, ApJ, 668, 1221) present evidence that (1) a CME is typically a magnetic bubble, a low-beta gplasmoid with legs h having roughly the 3D shape of a light bulb, and (2) in the outer corona the CME plasmoid is in lateral pressure equilibrium with the ambient magnetic field. They present three CMEs observed by SOHO/LASCO, each from a very different source located near the limb. One of these CMEs came from a compact ejective eruption from a small part of a sunspot active region, another came from a large quiet-region filament eruption, and the third CME, an extremely large and fast one, was produced in tandem with an X20 flare arcade that was centered on a huge delta sunspot. Each of these CMEs had more or less the classic lightbulb silhouette and attained a constant heliocentric angular width in the outer corona. This indicates that the CME plasmoid attained lateral magnetic pressure balance with the ambient radial magnetic field in the outer corona. This lateral pressure balance, together with the standard scenario for CME production by the eruption of a sheared-core magnetic arcade, yields the following simple estimate of the strength B(sub Flare) of the magnetic field in the flare arcade produced together with the CME: B(sub Flare) 1.4(theta CME/theta Flare)sup 2 G, where theta (sub CME) is the heliocentric angular width of the CME plasmoid in the outer corona and theta (sub Flare) is the heliocentric angular width of the full-grown flare arcade. Conversely, theta (sub CME) approximately equal to (R(sub Sun)sup -1(phi(sub Flare)/1.4)sup 1/2 radians, where Flare is the magnetic flux covered by the full-grown flare arcade. In addition to presenting the three CMEs of Moore, Sterling, & Suess (2007) and their agreement with this relation between CME and Flare, we present a further empirical test of this relation. For CMEs that erupt from active regions, the co-produced flare arcade seldom if ever covers the entire active region: if AR is the total magnetic flux of the active region, Flare . AR, and we predict that CME. (R(sub Sun))sup -1(theta AR/1.4)sup 1/2 radians. For a random sample of 31 CMEs that erupted from active regions within 30 of the limb, for each CME we have measured CME from LASCO/C3 and have measured AR from a SOHO/MDI magnetogram of the source active region when it was within 30 of disk center. We find that each CME obeys the above predicted inequality, none having width greater than half of the upper bound given by theta(sub AR). Thus, an active region's magnetic flux content, together with its location on the solar disk, largely determines whether the active region can possibly produce a CME that is wide enough to intercept the Earth.

Observational Signatures of Magnetic Reconnection in the Extended Corona

NASA Technical Reports Server (NTRS)

Savage, Sabrina; West, Matthew J.; Seaton, Daniel B.; Kobelski, Adam

2016-01-01

Observational signatures of reconnection have been studied extensively in the lower corona for decades, successfully providing insight into energy release mechanisms in the region above post-flare arcade loops and below 1.5 solar radii. During large eruptive events, however, energy release continues to occur well beyond the presence of reconnection signatures at these low heights. Supra-Arcade Downflows (SADs) and Supra-Arcade Downflowing Loops (SADLs) are particularly useful measures of continual reconnection in the corona as they may indicate the presence and path of retracting post-reconnection loops. SADs and SADLs have been faintly observed up to 18 hours beyond the passage of coronas mass ejections through the SOHO/LASCO field of view, but a recent event from 2014 October 14 associated with giant arches provides very clear observations of these downflows for days after the initial eruption. We report on this unique event and compare these findings with observational signatures of magnetic reconnection in the extended corona for more typical eruptions.

Observational Signatures of Magnetic Reconnection in the Extended Corona

NASA Technical Reports Server (NTRS)

Savage, Sabrina; West, Matthew J.; Seaton, Danial B.; Kobelski, Adam

2016-01-01

Observational signatures of reconnection have been studied extensively in the lower corona for decades, successfully providing insight into energy release mechanisms in the region above post-flare arcade loops and below 1.5 solar radii. During large eruptive events, however, energy release continues to occur well beyond the presence of reconnection signatures at these low heights. Supra-Arcade Downflows (SADs) and Supra-Arcade Downflowing Loops (SADLs) are particularly useful measures of continual reconnection in the corona as they may indicate the presence and path of retracting post-reconnection loops. SADs and SADLs have been faintly observed up to 18 hours beyond the passage of corona mass ejections through the SOHO/LASCO field of view, but a recent event from 2014 October 14 associated with giant arches provides very clear observations of these downflows for days after the initial eruption. We report on this unique event and compare these findings with observational signatures of magnetic reconnection in the extended corona for more typical eruptions.

Observational Signatures of Magnetic Reconnection in the Extended Corona

NASA Technical Reports Server (NTRS)

Savage, Sabrina; West, Matthew J.; Seaton, Daniel B.; Kobelski, Adam

2017-01-01

Observational signatures of reconnection have been studied extensively in the lower corona for decades, successfully providing insight into energy release mechanisms in the region above post-flare arcade loops and below 1.5 solar radii. During large eruptive events, however, energy release continues to occur well beyond the presence of reconnection signatures at these low heights. Supra-Arcade Downflows (SADs) and Supra-Arcade Downflowing Loops (SADLs) are particularly useful measures of continual reconnection in the corona as they may indicate the presence and path of retracting post-reconnection loops. SADs and SADLs have been faintly observed up to 18 hours beyond the passage of corona mass ejections through the SOHO/LASCO field of view, but a recent event from 2014 October 14 associated with giant arches provides very clear observations of these downflows for days after the initial eruption. We report on this unique event and compare these findings with observational signatures of magnetic reconnection in the extended corona for more typical eruptions.

Why S, Not X, Marks the Spot for CME/Flare Eruptions

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse; Gary, Allen; Cirtain, Jonathan; Falconer, David

2010-01-01

For any major CME/flare eruption: I. The field that erupts is an arcade in which the interior is greatly sheared and twisted. Most of the free magnetic energy to be released: a) Is in the shear and twist of the interior field. b) Is Not due to a big current sheet. The eruption is unleashed by reconnection at a growing current sheet. The current sheet is still little when the reconnection turns on. The unleashed eruption then makes the current sheet much bigger by building it up faster than the reconnection can tear it down. II. Most X-ray jets work the opposite way: a) Tapped free energy is in the field of a pre-jet current sheet. b) Current sheet built by small arcade emerging into ambient field. c) Current sheet still much smaller than the arcade when reconnection turns on and tears it down, producing a jet. III. These rules reflect the low-beta condition in the eruptive magnetic field

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

Fang, X.; Xia, C.; Keppens, R.

We present the first multidimensional, magnetohydrodynamic simulations that capture the initial formation and long-term sustainment of the enigmatic coronal rain phenomenon. We demonstrate how thermal instability can induce a spectacular display of in situ forming blob-like condensations which then start their intimate ballet on top of initially linear force-free arcades. Our magnetic arcades host a chromospheric, transition region, and coronal plasma. Following coronal rain dynamics for over 80 minutes of physical time, we collect enough statistics to quantify blob widths, lengths, velocity distributions, and other characteristics which directly match modern observational knowledge. Our virtual coronal rain displays the deformation ofmore » blobs into V-shaped features, interactions of blobs due to mostly pressure-mediated levitations, and gives the first views of blobs that evaporate in situ or are siphoned over the apex of the background arcade. Our simulations pave the way for systematic surveys of coronal rain showers in true multidimensional settings to connect parameterized heating prescriptions with rain statistics, ultimately allowing us to quantify the coronal heating input.« less

Multidimensional Modeling of Coronal Rain Dynamics

NASA Astrophysics Data System (ADS)

Fang, X.; Xia, C.; Keppens, R.

2013-07-01

We present the first multidimensional, magnetohydrodynamic simulations that capture the initial formation and long-term sustainment of the enigmatic coronal rain phenomenon. We demonstrate how thermal instability can induce a spectacular display of in situ forming blob-like condensations which then start their intimate ballet on top of initially linear force-free arcades. Our magnetic arcades host a chromospheric, transition region, and coronal plasma. Following coronal rain dynamics for over 80 minutes of physical time, we collect enough statistics to quantify blob widths, lengths, velocity distributions, and other characteristics which directly match modern observational knowledge. Our virtual coronal rain displays the deformation of blobs into V-shaped features, interactions of blobs due to mostly pressure-mediated levitations, and gives the first views of blobs that evaporate in situ or are siphoned over the apex of the background arcade. Our simulations pave the way for systematic surveys of coronal rain showers in true multidimensional settings to connect parameterized heating prescriptions with rain statistics, ultimately allowing us to quantify the coronal heating input.

Quantitative Examination of a Large Sample of Supra-Arcade Downflows in Eruptive Solar Flares

NASA Technical Reports Server (NTRS)

Savage, Sabrina L.; McKenzie, David E.

2011-01-01

Sunward-flowing voids above post-coronal mass ejection flare arcades were first discovered using the soft X-ray telescope aboard Yohkoh and have since been observed with TRACE (extreme ultraviolet (EUV)), SOHO/LASCO (white light), SOHO/SUMER (EUV spectra), and Hinode/XRT (soft X-rays). Supra-arcade downflow (SAD) observations suggest that they are the cross-sections of thin flux tubes retracting from a reconnection site high in the corona. Supra-arcade downflowing loops (SADLs) have also been observed under similar circumstances and are theorized to be SADs viewed from a perpendicular angle. Although previous studies have focused on dark flows because they are easier to detect and complementary spectral data analysis reveals their magnetic nature, the signal intensity of the flows actually ranges from dark to bright. This implies that newly reconnected coronal loops can contain a range of hot plasma density. Previous studies have presented detailed SAD observations for a small number of flares. In this paper, we present a substantial SADs and SADLs flare catalog. We have applied semiautomatic detection software to several of these events to detect and track individual downflows thereby providing statistically significant samples of parameters such as velocity, acceleration, area, magnetic flux, shrinkage energy, and reconnection rate. We discuss these measurements (particularly the unexpected result of the speeds being an order of magnitude slower than the assumed Alfven speed), how they were obtained, and potential impact on reconnection models.

Triggering of Solar Magnetic Eruptions on Various Size Scales Alphonse Sterling

NASA Technical Reports Server (NTRS)

Sterling, A.C.

2010-01-01

A solar eruption that produces a coronal mass ejection (CME) together with a flare is driven by the eruption of a closed-loop magnetic arcade that has a sheared-field core. Before eruption, the sheared core envelops a polarity inversion line along which cool filament material may reside. The sheared-core arcade erupts when there is a breakdown in the balance between the confining downward-directed magnetic tension of the overall arcade field and the upward-directed force of the pent-up magnetic pressure of the sheared field in the core of the arcade. What triggers the breakdown in this balance in favor of the upward-directed force is still an unsettled question. We consider several eruption examples, using imaging data from the SoHO, TRACE and Hinode satellites, and other sources, along with information about the magnetic field of the erupting regions. In several cases, observations of large-scale eruptions, where the magnetic neutral line spans few x 10,000 km, are consistent with magnetic flux cancellation being the trigger to the eruption's onset, even though the amount of flux canceled is only few percent of the total magnetic flux of the erupting region. In several other cases, an initial compact (small size-scale) eruption occurs embedded inside of a larger closed magnetic loop system, so that the smaller eruption destabilizes and causes the eruption of the much larger system. In this way, small-scale eruptive events can result in eruption of much larger-scale systems.

Formation, levitation, and stability of prominences in the magnetized solar atmosphere

NASA Technical Reports Server (NTRS)

Drake, J. F.; Mok, Y.; Van Hoven, G.

1993-01-01

The dynamic formation of prominences in the initial magnetothermal equilibrium and their stability to sideward displacements are investigated focusing on the structure of the 2D solar atmosphere in the presence of coronal arcades or loops. A model based on 2D magnetohydrodynamic equations takes into account gravity, compressible flows, heating, radiation, anisotropic thermal conduction, and coupling to a deep chromosphere. It is found that prominences in simple arcades characterized by magnetic field with significant curvature at the apex are unstable to a lateral displacement.

ON THE CAUSE OF SUPRA-ARCADE DOWNFLOWS IN SOLAR FLARES

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

Cassak, P. A.; Shepherd, L. S.; Drake, J. F.

2013-09-20

A model of supra-arcade downflows (SADs), dark low density regions also known as tadpoles that propagate sunward during solar flares, is presented. It is argued that the regions of low density are flow channels carved by sunward-directed outflow jets from reconnection. The solar corona is stratified, so the flare site is populated by a lower density plasma than that in the underlying arcade. As the jets penetrate the arcade, they carve out regions of depleted plasma density which appear as SADs. The present interpretation differs from previous models in that reconnection is localized in space but not in time. Reconnectionmore » is continuous in time to explain why SADs are not filled in from behind as they would if they were caused by isolated descending flux tubes or the wakes behind them due to temporally bursty reconnection. Reconnection is localized in space because outflow jets in standard two-dimensional reconnection models expand in the normal (inflow) direction with distance from the reconnection site, which would not produce thin SADs as seen in observations. On the contrary, outflow jets in spatially localized three-dimensional reconnection with an out-of-plane (guide) magnetic field expand primarily in the out-of-plane direction and remain collimated in the normal direction, which is consistent with observed SADs being thin. Two-dimensional proof-of-principle simulations of reconnection with an out-of-plane (guide) magnetic field confirm the creation of SAD-like depletion regions and the necessity of density stratification. Three-dimensional simulations confirm that localized reconnection remains collimated.« less

RE-INTERPRETATION OF SUPRA-ARCADE DOWNFLOWS IN SOLAR FLARES

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

Savage, Sabrina L.; McKenzie, David E.; Reeves, Katharine K.

Following the eruption of a filament from a flaring active region, sunward-flowing voids are often seen above developing post-eruption arcades. First discovered using the soft X-ray telescope aboard Yohkoh, these supra-arcade downflows (SADs) are now an expected observation of extreme ultra-violet and soft X-ray coronal imagers and spectrographs (e.g, TRACE, SOHO/SUMER, Hinode/XRT, SDO/AIA). Observations made prior to the operation of AIA suggested that these plasma voids (which are seen in contrast to bright, high-temperature plasma associated with current sheets) are the cross-sections of evacuated flux tubes retracting from reconnection sites high in the corona. The high temperature imaging afforded bymore » AIA's 131, 94, and 193 Angstrom-Sign channels coupled with the fast temporal cadence allows for unprecedented scrutiny of the voids. For a flare occurring on 2011 October 22, we provide evidence suggesting that SADs, instead of being the cross-sections of relatively large, evacuated flux tubes, are actually wakes (i.e., trailing regions of low density) created by the retraction of much thinner tubes. This re-interpretation is a significant shift in the fundamental understanding of SADs, as the features once thought to be identifiable as the shrinking loops themselves now appear to be 'side effects' of the passage of the loops through the supra-arcade plasma. In light of the fact that previous measurements have attributed to the shrinking loops characteristics that may instead belong to their wakes, we discuss the implications of this new interpretation on previous parameter estimations and on reconnection theory.« less

ARCADE IMPLOSION CAUSED BY A FILAMENT ERUPTION IN A FLARE

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

Wang, Juntao; Simões, P. J. A.; Fletcher, L.

Coronal implosions—the convergence motion of plasmas and entrained magnetic field in the corona due to a reduction in magnetic pressure—can help to locate and track sites of magnetic energy release or redistribution during solar flares and eruptions. We report here on the analysis of a well-observed implosion in the form of an arcade contraction associated with a filament eruption, during the C3.5 flare SOL2013-06-19T07:29. A sequence of events including the magnetic flux-rope instability and distortion, followed by a filament eruption and arcade implosion, lead us to conclude that the implosion arises from the transfer of magnetic energy from beneath the arcademore » as part of the global magnetic instability, rather than due to local magnetic energy dissipation in the flare. The observed net contraction of the imploding loops, which is found also in nonlinear force-free field extrapolations, reflects a permanent reduction of magnetic energy underneath the arcade. This event shows that, in addition to resulting in the expansion or eruption of an overlying field, flux-rope instability can also simultaneously implode an unopened field due to magnetic energy transfer. It demonstrates the “partial opening of the field” scenario, which is one of the ways in 3D to produce a magnetic eruption without violating the Aly–Sturrock hypothesis. In the framework of this observation, we also propose a unification of three main concepts for active region magnetic evolution, namely the metastable eruption model, the implosion conjecture, and the standard “CSHKP” flare model.« less

ARCADE small-scale docking mechanism for micro-satellites

NASA Astrophysics Data System (ADS)

Boesso, A.; Francesconi, A.

2013-05-01

The development of on-orbit autonomous rendezvous and docking (ARD) capabilities represents a key point for a number of appealing mission scenarios that include activities of on-orbit servicing, automated assembly of modular structures and active debris removal. As of today, especially in the field of micro-satellites ARD, many fundamental technologies are still missing or require further developments and micro-gravity testing. In this framework, the University of Padova, Centre of Studies and Activities for Space (CISAS), developed the Autonomous Rendezvous Control and Docking Experiment (ARCADE), a technology demonstrator intended to fly aboard a BEXUS stratospheric balloon. The goal was to design, build and test, in critical environment conditions, a proximity relative navigation system, a custom-made reaction wheel and a small-size docking mechanism. The ARCADE docking mechanism was designed against a comprehensive set of requirements and it can be classified as small-scale, central, gender mating and unpressurized. The large use of commercial components makes it low-cost and simple to be manufactured. Last, it features a good tolerance to off-nominal docking conditions and a by-design soft docking capability. The final design was extensively verified to be compliant with its requirements by means of numerical simulations and physical testing. In detail, the dynamic behaviour of the mechanism in both nominal and off-nominal conditions was assessed with the multibody dynamics analysis software MD ADAMS 2010 and functional tests were carried out within the fully integrated ARCADE experiment to ensure the docking system efficacy and to highlight possible issues. The most relevant results of the study will be presented and discussed in conclusion to this paper.

Dynamic formation and magnetic support of loop or arcade prominences

NASA Technical Reports Server (NTRS)

Vanhoven, Gerard; Mok, Y.; Drake, J. F.

1992-01-01

The results of model dynamic simulations of the formation and support of a narrow prominence at the apex of a coronal magnetic loop or arcade are described. The condensation process proceeds via an initial radiative cooling and pressure drop, and a secondary siphon flow from the dense chromospheric ends. The antibuoyancy effect as the prominence forms causes a bending of a confining magnetic field, which propagates toward the semirigid ends of the magnetic loop. Thus, a wide magnetic 'hammock' or well (of a normal polarity Kippenhahn-Schlueter type) is formed, which supports the prominence at or near the field apex.

Virtual reconstruction of the Early Pleistocene mandible ATD6-96 from Gran Dolina-TD6-2 (Sierra De Atapuerca, Spain).

PubMed

Bermúdez de Castro, José María; Martín-Francés, Laura; Modesto-Mata, Mario; Martínez de Pinillos, Marina; Martinón-Torres, María; García-Campos, Cecilia; Carretero, José Miguel

2016-04-01

In this report, we present a further study of the late Early Pleistocene ATD6-96 human mandible, recovered from the TD6-2 level of the Gran Dolina cave site (Sierra de Atapuerca, northern Spain) and attributed to Homo antecessor. ATD6-96 consists of a left half of a gracile mandible of an adult individual with the premolars and molars in place that is broken at the level of the lateral incisor-canine septum. The present analysis is based on a virtual reconstruction of the whole mandible by means of computed tomography (CT). We have reconstructed the symphysis using information from a modern human sample, as well as from a wide sample composed of several Homo specimens. This research has allowed us to record new variables with taxonomic and phylogenetic interest. We have estimated the length/width index of the alveolar arcade, as well as the percentage of the arcade length with regard to the total length. The latter confirms that ATD6-96 shares with all African and Asian Homo species a primitive structural pattern, as it was established in previous studies. In constrast, the length/width index of the alveolar arcade in the H. antecessor specimen is close to the mean values of Neandertals and the Atapuerca-Sima de los Huesos hominins. H. antecessor is derived regarding the shape of the mandibular alveolar arcade within the genus Homo and points to an early divergence from contemporaneous African populations. Our results also ratify the affinities of H. antecessor with Neanderthals, although the precise relationship with this lineage needs further research. © 2015 Wiley Periodicals, Inc.

North–south collaboration and capacity development in global health research in low- and middle-income countries – the ARCADE projects

PubMed Central

Atkins, Salla; Marsden, Sophie; Diwan, Vishal; Zwarenstein, Merrick

2016-01-01

Background Research capacity enhancement is needed in low- and middle-income countries (LMICs) for improved health, wellbeing, and health systems’ development. In this article, we discuss two capacity-building projects, the African/Asian Regional Capacity Development (ARCADE) in Health Systems and Services Research (HSSR) and Research on Social Determinants of Health (RSDH), implemented from 2011 to 2015. The two projects focussed on providing courses in HSSR and social determinants of health research, and on developing collaborations between universities, along with capacity in LMIC universities to manage research grant submissions, financing, and reporting. Both face-to-face and sustainable online teaching and learning resources were used in training at higher postgraduate levels (Masters and Doctoral level). Design We collated project meeting and discussion minutes along with project periodic reports and deliverables. We extracted key outcomes from these, reflected on these in discussions, and summarised them for this paper. Results Nearly 55 courses and modules were developed that were delivered to over 920 postgraduate students in Africa, Asia, and Europe. Junior researchers were mentored in presenting, developing, and delivering courses, and in preparing research proposals. In total, 60 collaborative funding proposals were prepared. The consortia also developed institutional capacity in research dissemination and grants management through webinars and workshops. Discussion ARCADE HSSR and ARCADE RSDH were comprehensive programmes, focussing on developing the research skills, knowledge, and capabilities of junior researchers. One of the main strengths of these programmes was the focus on network building amongst the partner institutions, where each partner brought skills, expertise, and diverse work cultures into the consortium. Through these efforts, the projects improved both the capacity of junior researchers and the research environment in Africa, Asia, and Europe. PMID:27725081

Triggering of solar magnetic eruptions on various size scales

NASA Astrophysics Data System (ADS)

Sterling, Alphonse

A solar eruption that produces a coronal mass ejection (CME) together with a flare is driven by the eruption of a closed-loop magnetic arcade that has a sheared-field core. Before eruption, the sheared core envelops a polarity inversion line along which cool filament material may reside. The sheared-core arcade erupts when there is a breakdown in the balance between the confining downward-directed magnetic tension of the overall arcade field and the upward-directed force of the pent-up magnetic pressure of the sheared field in the core of the arcade. What triggers the breakdown in this balance in favor of the upward-directed force is still an unsettled question. We consider several eruption examples, using imaging data from the SoHO, TRACE and Hinode satellites, and other sources, along with information about the magnetic field of the erupting regions. In several cases, observations of large-scale eruptions, where the magnetic neutral line spans ˜ few ×10,000 km, are consistent with magnetic flux cancelation being the trigger to the eruption's onset, even though the amount of flux canceled is only ˜ few percent of the total magnetic flux of the erupting region. In several other cases, an initial compact (small size-scale) eruption occurs embedded inside of a larger closed magnetic loop system, so that the smaller eruption destabilizes and causes the eruption of the much larger system. In this way, small-scale eruptive events can result in eruption of much larger-scale systems. This work was funded by NASA's Science Mission Directorate thought the Living With a Star Targeted Research and Technology Program, the Supporting Research and Program, and the Hinode project.

Formation and Evolution of a Multi-Threaded Prominence

NASA Technical Reports Server (NTRS)

Luna, M.; Karpen, J. T.; DeVore, C. R.

2012-01-01

We investigate the process of formation and subsequent evolution of prominence plasma in a filament channel and its overlying arcade. We construct a three-dimensional time-dependent model of a filament-channel prominence suitable to be compared with observations. We combine this magnetic field structure with one-dimensional independent simulations of many flux tubes. The magnetic structure is a three-dimensional sheared double arcade, and the thermal non-equilibrium process governs the plasma evolution. We have found that the condensations in the corona can be divided into two populations: threads and blobs. Threads are massive condensations that linger in the field line dips. Blobs are ubiquitous small condensations that are produced throughout the filament and overlying arcade magnetic structure, and rapidly fall to the chromosphere. The total prominence mass is in agreement with observations. The threads are the principal contributors to the total mass, whereas the blob contribution is small. The motion of the threads is basically horizontal, while blobs move in all directions along the field. The peak velocities for both populations are comparable, but there is a weak tendency for the velocity to increase with the inclination, and the blobs with motion near vertical have the largest values of the velocity. We have generated synthetic images of the whole structure in an H proxy and in two EUV channels of the AIA instrument aboard SDO. These images show the plasma at cool, warm and hot temperatures. The theoretical differential emission measure of our system agrees very well with observations in the temperature range log T = 4.6-5.7. We conclude that the sheared-arcade magnetic structure and plasma dynamics fit well the abundant observational evidence.

North-south collaboration and capacity development in global health research in low- and middle-income countries - the ARCADE projects.

PubMed

Atkins, Salla; Marsden, Sophie; Diwan, Vishal; Zwarenstein, Merrick

2016-01-01

Research capacity enhancement is needed in low- and middle-income countries (LMICs) for improved health, wellbeing, and health systems' development. In this article, we discuss two capacity-building projects, the African/Asian Regional Capacity Development (ARCADE) in Health Systems and Services Research (HSSR) and Research on Social Determinants of Health (RSDH), implemented from 2011 to 2015. The two projects focussed on providing courses in HSSR and social determinants of health research, and on developing collaborations between universities, along with capacity in LMIC universities to manage research grant submissions, financing, and reporting. Both face-to-face and sustainable online teaching and learning resources were used in training at higher postgraduate levels (Masters and Doctoral level). We collated project meeting and discussion minutes along with project periodic reports and deliverables. We extracted key outcomes from these, reflected on these in discussions, and summarised them for this paper. Nearly 55 courses and modules were developed that were delivered to over 920 postgraduate students in Africa, Asia, and Europe. Junior researchers were mentored in presenting, developing, and delivering courses, and in preparing research proposals. In total, 60 collaborative funding proposals were prepared. The consortia also developed institutional capacity in research dissemination and grants management through webinars and workshops. ARCADE HSSR and ARCADE RSDH were comprehensive programmes, focussing on developing the research skills, knowledge, and capabilities of junior researchers. One of the main strengths of these programmes was the focus on network building amongst the partner institutions, where each partner brought skills, expertise, and diverse work cultures into the consortium. Through these efforts, the projects improved both the capacity of junior researchers and the research environment in Africa, Asia, and Europe.

Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

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

Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara

2013-06-15

Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

Measurement of the cosmic microwave background temperature and Galactic emission at 8.0 and 8.3 GHz with the ARCADE 2 experiment

NASA Astrophysics Data System (ADS)

Singal, Jack Edward

2006-02-01

This work presents a measurement of the radiometric temperature of the Cosmic Microwave Background (CMB) and of the intensity of Galactic emission at 8.1 and 8.3 GHz. These are the science results of the first flight of the ARCADE 2 instrument, on which the author's design, fabrication, and data analysis work forms the basis of this dissertation. ARCADE 2 (Absolute Radiometer for Cosmology, Astrophysics, and Diffuse Emission) is a balloon-borne instrument designed to perform measurements of the radiometric temperatures of the sky at six microwave frequency bands, from 3 to 90 GHz, to milliKelvin precision. ARCADE 2 features a novel cryogenic design and sophisticated radiometry as described herein. During the first flight of the instrument, a mechanical failure allowed for the accumulation of scientifically meaningful data in only one frequency band, and those results are not as well constrained as that from future flights will be. However, the measurement presented here of the radiometric temperature of the CMB is in fact the one of most well constrained below 10 GHz, and the measurement of Galactic free-free and synchrotron emission presented here is a potentially significant confirmation of existing results. The temperature of the CMB at 8.0 and 8.3 GHz is found to be 2.90 × .12 K and 2.77 × .16 K respectively. The level of Galactic synchrotron emission at these frequencies is found to be that which would be expected by naively interpolating the previously available data at other frequencies, and the level of Galactic free-free emission is found to be two-thirds as high, providing an independent confirmation of changes recently announced in the three year Galactic foreground results release from the WMAP satellite. The first section of this work is a comprehensive review of important topics in cosmology, the CMB, and deviations from a blackbody spectrum therein, as well as Galactic microwave emission. The second section describes the ARCADE 2 instrument and instrumental considerations, with some emphasis on design and fabrication contributions by the author. The third section presents the data obtained from the first flight of the instrument, the data analysis as carried out by the author, and the science results.

Magnetic Untwisting in Most Solar X-Ray Jets

NASA Technical Reports Server (NTRS)

Moore, Ronald; Sterling, Alphonse; Falconer, David; Robe, Dominic

2013-01-01

From 54 X-ray jets observed in the polar coronal holes by Hinode's X-Ray Telescope (XRT) during coverage in movies from Solar Dynamic Observatory's Atmospheric Imaging Assembly (AIA) taken in its He II 304 Å band at a cadence of 12 s, we have established a basic characteristic of solar X-ray jets: untwisting motion in the spire. In this presentation, we show the progression of few of these X-ray jets in XRT images and track their untwisting in AIA He II images. From their structure displayed in their XRT movies, 19 jets were evidently standard jets made by interchange reconnection of the magnetic-arcade base with ambient open field, 32 were evidently blowout jets made by blowout eruption of the base arcade, and 3 were of ambiguous form. As was anticipated from the >10,000 km span of the base arcade in most polar X-ray jets and from the disparity of standard jets and blowout jets in their magnetic production, few of the standard X-ray jets (3 of 19) but nearly all of the blowout X-ray jets (29 of 32) carried enough cool (T is approximately 105 K) plasma to be seen in their He II movies. In the 32 X-ray jets that showed a cool component, the He II movies show 10-100 km/s untwisting motions about the axis of the spire in all 3 standard jets and in 26 of the 29 blowout jets. Evidently, the open magnetic field in nearly all blowout X-ray jets and probably in most standard X-ray jets carries transient twist. This twist apparently relaxes by propagating out along the open field as a torsional wave. High-resolution spectrograms and Dopplergrams have shown that most Type-II spicules have torsional motions of 10-30 km/s. Our observation of similar torsional motion in X-ray jets strengthens the case for Type-II spicules being made in the same way as X-ray jets, by blowout eruption of a twisted magnetic arcade in the spicule base and/or by interchange reconnection of the twisted base arcade with the ambient open field. This work was funded by NASA's Heliophysics Division through its LWS TRT Program and its Hinode Project, and by NSF through its Research Experience for Undergraduates Program.

Patchy reconnection in the solar corona

NASA Astrophysics Data System (ADS)

Guidoni, Silvina Esther

2011-05-01

Magnetic reconnection in plasmas, a process characterized by a change in connectivity of field lines that are broken and connected to other ones with different topology, owes its usefulness to its ability to unify a wide range of phenomena within a single universal principle. There are newly observed phenomena in the solar corona that cannot be reconciled with two-dimensional or steady-state standard models of magnetic reconnection. Supra-arcade downflows (SADs) and supra-arcade downflowing loops (SADLs) descending from reconnection regions toward solar post-flare arcades seem to be two different observational signatures of retracting, isolated reconnected flux tubes with irreducible three-dimensional geometries. This dissertation describes work in refining and improving a novel model of patchy reconnection, where only a small bundle of field lines is reconnected across a current sheet (magnetic discontinuity) and forms a reconnected thin flux tube. Traditional models have not been able to explain why some of the observed SADs appear to be hot and relatively devoid of plasma. The present work shows that plasma depletion naturally occurs in flux tubes that are reconnected across nonuniform current sheets and slide trough regions of decreasing magnetic field magnitude. Moreover, through a detailed theoretical analysis of generalized thin flux tube equations, we show that the addition to the model of pressure-driven parallel dynamics, as well as temperature-dependent, anisotropic viscosity and thermal conductivity is essential for self-consistently producing gas-dynamic shocks inside reconnected tubes that heat and compress plasma to observed temperatures and densities. The shock thickness can be as long as the entire tube and heat can be conducted along tube's legs, possibly driving chromospheric evaporation. We developed a computer program that solves numerically the thin flux tube equations that govern the retraction of reconnected tubes. Simulations carried out with this program corroborate our theoretical predictions. A comparison of these simulations with fully three-dimensional magnetohydrodynamic simulations is presented to assess the validity of the thin flux tube model. We also present an observational method based on total emission measure and mean temperature to determine where in the current sheet a tube was reconnected.

Reevaluating the impact of video games.

PubMed

Funk, J B

1993-02-01

The evolution of the video game phenomenon is reviewed and contemporary data are presented. A survey assessing frequency and location of play and game preference was completed by 357 seventh- and eighth-grade students. In this middle-class sample, about two thirds of girls played video games at least one to two hours per week at home, but only 20% played in arcades. About 90% of boys played in the home and about 50% in arcades. Approximately half of preferred games were from one of two categories of violent games, while 2% of preferred games were educational. Parent education about the influence of the media should include recommendations to monitor game playing and influence game selection.

Estimation of Reconnection Flux Using Post-Eruption Arcades and Its Relevance to Magnetic Clouds at 1 AU

NASA Technical Reports Server (NTRS)

Gopalswamy, N.; Yashiro, S.; Akiyama, S.; Xie, H.

2017-01-01

We report on a new method to compute the flare reconnection (RC) flux from post-eruption arcades (PEAs) and the underlying photospheric magnetic fields. In previous works, the RC flux has been computed using the cumulative flare ribbon area. Here we obtain the RC flux as the flux in half of the area underlying the PEA in EUV imaged after the flare maximum. We apply this method to a set of 21 eruptions that originated near the solar disk center in Solar Cycle 23. We find that the RC flux from the arcade method ((Phi)rA) has excellent agreement with the flux from the flare-ribbon method ((Phi)rR) according to (Phi)rA = 1.24((Phi)rR)(sup 0.99). We also find (Phi)rA to be correlated with the poloidal flux ((Phi)P) of the associated magnetic cloud at 1 AU: (Phi)P = 1.20((Phi)rA)(sup 0.85). This relation is nearly identical to that obtained by Qiu et al. (Astrophys. J. 659, 758, 2007) using a set of only 9 eruptions. Our result supports the idea that flare reconnection results in the formation of the flux rope and PEA as a common process.

Temporal regulation of epithelium formation mediated by FoxA, MKLP1, MgcRacGAP, and PAR-6

PubMed Central

Von Stetina, Stephen E.; Liang, Jennifer; Marnellos, Georgios; Mango, Susan E.

2017-01-01

To establish the animal body plan, embryos link the external epidermis to the internal digestive tract. In Caenorhabditis elegans, this linkage is achieved by the arcade cells, which form an epithelial bridge between the foregut and epidermis, but little is known about how development of these three epithelia is coordinated temporally. The arcade cell epithelium is generated after the epidermis and digestive tract epithelia have matured, ensuring that both organs can withstand the mechanical stress of embryo elongation; mistiming of epithelium formation leads to defects in morphogenesis. Using a combination of genetic, bioinformatic, and imaging approaches, we find that temporal regulation of the arcade cell epithelium is mediated by the pioneer transcription factor and master regulator PHA-4/FoxA, followed by the cytoskeletal regulator and kinesin ZEN-4/MKLP1 and the polarity protein PAR-6. We show that PHA-4 directly activates mRNA expression of a broad cohort of epithelial genes, including junctional factor dlg-1. Accumulation of DLG-1 protein is delayed by ZEN-4, acting in concert with its binding partner CYK-4/MgcRacGAP. Our structure–function analysis suggests that nuclear and kinesin functions are dispensable, whereas binding to CYK-4 is essential, for ZEN-4 function in polarity. Finally, PAR-6 is necessary to localize polarity proteins such as DLG-1 within adherens junctions and at the apical surface, thereby generating arcade cell polarity. Our results reveal that the timing of a landmark event during embryonic morphogenesis is mediated by the concerted action of four proteins that delay the formation of an epithelial bridge until the appropriate time. In addition, we find that mammalian FoxA associates with many epithelial genes, suggesting that direct regulation of epithelial identity may be a conserved feature of FoxA factors and a contributor to FoxA function in development and cancer. PMID:28539408

Successes and challenges of north–south partnerships – key lessons from the African/Asian Regional Capacity Development projects

PubMed Central

Färnman, Rosanna; Diwan, Vishal; Zwarenstein, Merrick; Atkins, Salla

2016-01-01

Introduction Increasing efforts are being made globally on capacity building. North–south research partnerships have contributed significantly to enhancing the research capacity in low- and middle-income countries (LMICs) over the past few decades; however, a lack of skilled researchers to inform health policy development persists, particularly in LMICs. The EU FP7 funded African/Asian Regional Capacity Development (ARCADE) projects were multi-partner consortia aimed to develop a new generation of highly trained researchers from universities across the globe, focusing on global health-related subjects: health systems and services research and research on social determinants of health. This article aims to outline the successes, challenges and lessons learned from the life course of the projects, focusing on the key outputs and experiences of developing and implementing these two projects together with sub-Saharan African, Asian and European institution partners. Design Sixteen participants from 12 partner institutions were interviewed. The data were analysed using thematic content analysis, which resulted in four themes and three sub-categories. These data were complemented by a review of project reports. Results The results indicated that the ARCADE projects have been successful in developing and delivering courses, and have reached over 920 postgraduate students. Some partners thought the north–south and south–south partnerships that evolved during the project were the main achievement. However, others found there to be a ‘north–south divide’ in certain aspects. Challenges included technical constraints and quality assurance. Additionally, adapting new teaching and learning methods into current university systems was challenging, combined with not being able to award students with credits for their degrees. Conclusion The ARCADE projects were introduced as an innovative and ambitious project idea, although not designed appropriately for all partner institutions. Some challenges were underestimated from the beginning, and for such future projects, a more structured approach needs to be adopted. ARCADE partners learned that integrating courses into current university systems and awarding students credits are essential. PMID:27725080

Successes and challenges of north-south partnerships - key lessons from the African/Asian Regional Capacity Development projects.

PubMed

Färnman, Rosanna; Diwan, Vishal; Zwarenstein, Merrick; Atkins, Salla

2016-01-01

Increasing efforts are being made globally on capacity building. North-south research partnerships have contributed significantly to enhancing the research capacity in low- and middle-income countries (LMICs) over the past few decades; however, a lack of skilled researchers to inform health policy development persists, particularly in LMICs. The EU FP7 funded African/Asian Regional Capacity Development (ARCADE) projects were multi-partner consortia aimed to develop a new generation of highly trained researchers from universities across the globe, focusing on global health-related subjects: health systems and services research and research on social determinants of health. This article aims to outline the successes, challenges and lessons learned from the life course of the projects, focusing on the key outputs and experiences of developing and implementing these two projects together with sub-Saharan African, Asian and European institution partners. Sixteen participants from 12 partner institutions were interviewed. The data were analysed using thematic content analysis, which resulted in four themes and three sub-categories. These data were complemented by a review of project reports. The results indicated that the ARCADE projects have been successful in developing and delivering courses, and have reached over 920 postgraduate students. Some partners thought the north-south and south-south partnerships that evolved during the project were the main achievement. However, others found there to be a 'north-south divide' in certain aspects. Challenges included technical constraints and quality assurance. Additionally, adapting new teaching and learning methods into current university systems was challenging, combined with not being able to award students with credits for their degrees. The ARCADE projects were introduced as an innovative and ambitious project idea, although not designed appropriately for all partner institutions. Some challenges were underestimated from the beginning, and for such future projects, a more structured approach needs to be adopted. ARCADE partners learned that integrating courses into current university systems and awarding students credits are essential.

Numerical simulations of sheared magnetic lines at the solar null line

NASA Astrophysics Data System (ADS)

Kuźma, B.; Murawski, K.; Solov'ev, A.

2015-05-01

Aims: We perform numerical simulations of sheared magnetic lines at the magnetic null line configuration of two magnetic arcades that are settled in a gravitationally stratified and magnetically confined solar corona. Methods: We developed a general analytical model of a 2.5D solar atmospheric structure. As a particular application of this model, we adopted it for the curved magnetic field lines with an inverted Y shape that compose the null line above two magnetic arcades, which are embedded in the solar atmosphere that is specified by the realistic temperature distribution. The physical system is described by 2.5D magnetohydrodynamic equations that are numerically solved by the FLASH code. Results: The magnetic field line shearing, implemented about 200 km below the transition region, results in Alfvén and magnetoacoustic waves that are able to penetrate solar coronal regions above the magnetic null line. As a result of the coupling of these waves, partial reflection from the transition region and scattering from inhomogeneous regions the Alfvén waves experience fast attenuation on time scales comparable to their wave periods, and the physical system relaxes in time. The attenuation time grows with the large amplitude and characteristic growing time of the shearing. Conclusions: By having chosen a different magnetic flux function, the analytical model we devised can be adopted to derive equilibrium conditions for a diversity of 2.5D magnetic structures in the solar atmosphere. Movie associated to Fig. 5 is available in electronic form at http://www.aanda.org

Distribution Functions of Sizes and Fluxes Determined from Supra-Arcade Downflows

NASA Technical Reports Server (NTRS)

McKenzie, D.; Savage, S.

2011-01-01

The frequency distributions of sizes and fluxes of supra-arcade downflows (SADs) provide information about the process of their creation. For example, a fractal creation process may be expected to yield a power-law distribution of sizes and/or fluxes. We examine 120 cross-sectional areas and magnetic flux estimates found by Savage & McKenzie for SADs, and find that (1) the areas are consistent with a log-normal distribution and (2) the fluxes are consistent with both a log-normal and an exponential distribution. Neither set of measurements is compatible with a power-law distribution nor a normal distribution. As a demonstration of the applicability of these findings to improved understanding of reconnection, we consider a simple SAD growth scenario with minimal assumptions, capable of producing a log-normal distribution.

The Joint Space Operations Center (JSpOC) Mission System (JMS) and the Advanced Research, Collaboration, and Application Development Environment (ARCADE)

NASA Astrophysics Data System (ADS)

Runco, A.; Echeverry, J.; Kim, R.; Sabol, C.; Zetocha, P.; Murray-Krezan, J.

2014-09-01

The JSpOC Mission System is a modern service-oriented architecture (SOA) infrastructure with increased process automation and improved tools to enhance Space Situational Awareness (SSA). The JMS program has already delivered Increment 1 in April 2013 as initial capability to operations. The programs current focus, Increment 2, will be completed by 2016 and replace the legacy Space Defense Operations Center (SPADOC) and Astrodynamics Support Workstation (ASW) capabilities. Post 2016, JMS Increment 3 will continue to provide additional SSA and C2 capabilities that will require development of new applications and procedures as well as the exploitation of new data sources with more agility. In 2012, the JMS Program Office entered into a partnership with AFRL/RD (Directed Energy) and AFRL/RV (Space Vehicles) to create the Advanced Research, Collaboration, and Application Development Environment (ARCADE). The purpose of the ARCADE is to: (1) serve as a centralized testbed for all research and development (R&D) activities related to JMS applications, including algorithm development, data source exposure, service orchestration, and software services, and provide developers reciprocal access to relevant tools and data to accelerate technology development, (2) allow the JMS program to communicate user capability priorities and requirements to developers, (3) provide the JMS program with access to state-of-the-art research, development, and computing capabilities, and (4) support market research efforts by identifying outstanding performers that are available to shepherd into the formal transition process. AFRL/RV and AFRL/RD have created development environments at both unclassified and classified levels that together allow developers to develop applications and work with data sources. The unclassified ARCADE utilizes the Maui high performance computing (HPC) Portal, and can be accessed using a CAC or Kerberos using Yubikey. This environment gives developers a sandbox environment to test and benchmark algorithms and services. The classified environments allow these new applications to be integrated with the JMS SOA and other data sources to help mature the capability to TRL 6.

Irresistably Inviting Arcade Atmosphere. 1974 Award Winning Architecture

ERIC Educational Resources Information Center

American School and University, 1974

1974-01-01

The Student Union on the Sacramento campus of California State University has an interior pedestrian concourse where "activities merchandising" gets students involved and captures the spirit of nonacademic happenings. (Author/MF)

Video game training to improve selective visual attention in older adults

PubMed Central

Belchior, Patrícia; Marsiske, Michael; Sisco, Shannon M.; Yam, Anna; Bavelier, Daphne; Ball, Karlene; Mann, William C.

2013-01-01

The current study investigated the effect of video game training on older adult’s useful field of view performance (the UFOV® test). Fifty-eight older adult participants were randomized to receive practice with the target action game (Medal of Honor), a placebo control arcade game (Tetris), a clinically validated UFOV training program, or into a no contact control group. Examining pretest–posttest change in selective visual attention, the UFOV improved significantly more than the game groups; all three intervention groups improved significantly more than no-contact controls. There was a lack of difference between the two game conditions, differing from findings with younger adults. Discussion considers whether games posing less challenge might still be effective interventions for elders, and whether optimal training dosages should be higher. PMID:24003265

Perioperative Hemodynamic Monitoring of Common Hepatic Artery for Endovascular Embolization of a Pancreaticoduodenal Arcade Aneurysm with Celiac Stenosis

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

Shibata, Eisuke, E-mail: eisuke.shibata1130@gmail.com; Takao, Hidemasa; Amemiya, Shiori

This report describes perioperative hemodynamic monitoring of the common hepatic artery (CHA) during endovascular treatment of a pancreaticoduodenal arcade aneurysm, in a patient with celiac artery stenosis caused by the median arcuate ligament. Pressure monitoring was performed as a safety measure against critical complications such as liver ischemia. As the aneurysm was located in the anterior pancreaticoduodenal artery (APDA) and the posterior pancreaticoduodenal artery (PPDA) was small in caliber, the patient was considered to be at a high risk of liver ischemia. No significant change in pressure was observed in the CHA on balloon occlusion test in the APDA. Immediatelymore » after embolization, the PPDA enlarged and the pressure in the CHA was well maintained. Pressure monitoring appears to improve patient safety during endovascular treatment of visceral aneurysms.« less

SIMULATING THE 'SLIDING DOORS' EFFECT THROUGH MAGNETIC FLUX EMERGENCE

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

MacTaggart, David; Hood, Alan W., E-mail: dm428@st-andrews.ac.u

2010-06-20

Recent Hinode photospheric vector magnetogram observations have shown that the opposite polarities of a long arcade structure move apart and then come together. In addition to this 'sliding doors' effect, orientations of horizontal magnetic fields along the polarity inversion line on the photosphere evolve from a normal-polarity configuration to an inverse one. To explain this behavior, a simple model by Okamoto et al. suggested that it is the result of the emergence of a twisted flux rope. Here, we model this scenario using a three-dimensional megnatohydrodynamic simulation of a twisted flux rope emerging into a pre-existing overlying arcade. We constructmore » magnetograms from the simulation and compare them with the observations. The model produces the two signatures mentioned above. However, the cause of the 'sliding doors' effect differs from the previous model.« less

A need to simplify informed consent documents in cancer clinical trials. A position paper of the ARCAD Group

PubMed Central

Bleiberg, H.; Decoster, G.; de Gramont, A.; Rougier, P.; Sobrero, A.; Benson, A.; Chibaudel, B.; Douillard, J. Y.; Eng, C.; Fuchs, C.; Fujii, M.; Labianca, R.; Larsen, A. K.; Mitchell, E.; Schmoll, H. J.; Sprumont, D.; Zalcberg, J.

2017-01-01

Background In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents. Methods The Aide et Recherche en Cancérologie Digestive (ARCAD) Group, an international scientific committee involving oncologists from all over the world, addressed these issues and developed and uniformly accepted a simplified informed consent documentation for future clinical research. Results A simplified form of informed consent with the leading part of 1200–1800 words containing all of the key information necessary to meet ethical and regulatory requirements and ‘relevant supportive information appendix’ of 2000–3000 words is provided. Conclusions This position paper, on the basis of the ARCAD Group experts discussions, proposes our informed consent model and the rationale for its content. PMID:28453700

Evidence for Two Separate but Interlaced Components of the Chromospheric Magnetic Field

NASA Technical Reports Server (NTRS)

Reardom, K. P.; Wang, Y.-M.; Muglach, K.; Warren, H. P.

2011-01-01

Chromospheric fibrils are generally thought to trace out low-lying, mainly horizontal magnetic elds that fan out from flux concentrations in the photosphere. A high-resolution (approximately 0.1" per pixel) image, taken in the core of the Ca II 854.2 nm line and covering an unusually large area, shows the dark brils within an active region remnant as fine, looplike features that are aligned parallel to each other and have lengths comparable to a supergranular diameter. Comparison with simultaneous line-of-sight magnetograms confirms that the fibrils are centered above intranetwork areas (supergranular cell interiors), with one end rooted just inside the neighboring plage or strong unipolar network but the other endpoint less clearly defined. Focusing on a particular arcade-like structure lying entirely on one side of a lament channel (large-scale polarity inversion), we find that the total amount of positive-polarity flux underlying this "fibril arcade" is approximately 50 times greater than the total amount of negative-polarity flux. Thus, if the brils represent closed loops, they must consist of very weak fields (in terms of total magnetic flux), which are interpenetrated by a more vertical field that contains most of the flux. This surprising result suggests that the fibrils in unipolar regions connect the network to the nearby intranetwork flux, while the bulk of the network flux links to remote regions of the opposite polarity, forming a second, higher canopy above the fibril canopy. The chromospheric field near the edge of the network thus has an interlaced structure resembling that in sunspot penumbrae.

Preliminary Evaluation of the Multipurpose Arcade Combat Simulator (MACS) for the M16, M203, and M72A2

DTIC Science & Technology

1985-06-01

8217 .. = . . - , . . ’ ’ ’- . .’- ’, . -. . ’ -. . . .- . -. .. .. - . . % , -. . REFERENCES * Belier , F. H., Thompson, T. J., &Osborne, A. D. (Draft, 1981). Basic rifle marksmanship

24. Historic American Buildings Survey E. W. Russell, Photographer, May ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

24. Historic American Buildings Survey E. W. Russell, Photographer, May 7, 1936 N. DOOR OPENING ON PORTICO (OR ARCADE) - Spring Hill College, Main Building, Old Shell Road, Spring Hill, Mobile County, AL

A ``perfect'' Late Phase Flare Loop: X-ray And Radio Studies

NASA Astrophysics Data System (ADS)

Bain, Hazel; Fletcher, L.

2009-05-01

We present observations of a GOES X3.1 class flare which occurred on the 24th August 2002. The event was observed by a number of instruments including RHESSI, TRACE and NoRH. This flare is particularly interesting due to its position and orientation on the west limb of the Sun. The flare appears to be perpendicular to the line of sight making it possible to ascertain the geometrical parameters of the post flare arcade loops. We investigate the decay phase of the flare by comparing X-ray and radio observations of the post flare arcade loops with models of soft x-ray and thermal gyrosynchrotron emission to characterise the electron distribution present within the loop. HMB gratefully acknowledges the support of an SPD and STFC studentship. LF gratefully acknowledges the support of an STFC Rolling Grant, and financial support by the European Commission through the SOLAIRE Network (MTRN-CT_2006-035484)

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

Fang, Ke; Linden, Tim, E-mail: kefang@umd.edu, E-mail: linden.70@osu.edu

Radio observations at multiple frequencies have detected a significant isotropic emission component between 22 MHz and 10 GHz, commonly termed the ARCADE-2 Excess. The origin of this radio emission is unknown, as the intensity, spectrum and isotropy of the signal are difficult to model with either traditional astrophysical mechanisms or novel physics such as dark matter annihilation. We posit a new model capable of explaining the key components of the excess radio emission. Specifically, we show that the re-acceleration of non-thermal electrons via turbulence in merging galaxy clusters are capable of explaining the intensity, spectrum, and isotropy of the ARCADE-2more » data. We examine the parameter spaces of cluster re-acceleration, magnetic field, and merger rate, finding that the radio excess can be reproduced assuming reasonable assumptions for each. Finally, we point out that future observations will definitively confirm or rule-out the contribution of cluster mergers to the isotropic radio background.« less

RECURRENT EXPLOSIVE ERUPTIONS AND THE ''SIGMOID-TO-ARCADE'' TRANSFORMATION IN THE SUN DRIVEN BY DYNAMICAL MAGNETIC FLUX EMERGENCE

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

Archontis, V.; Hood, A. W.; Tsinganos, K., E-mail: va11@st-andrews.ac.uk

2014-05-10

We report on three-dimensional MHD simulations of recurrent mini coronal mass ejection (CME)-like eruptions in a small active region (AR), which is formed by the dynamical emergence of a twisted (not kink unstable) flux tube from the solar interior. The eruptions develop as a result of the repeated formation and expulsion of new flux ropes due to continuous emergence and reconnection of sheared field lines along the polarity inversion line of the AR. The acceleration of the eruptions is triggered by tether-cutting reconnection at the current sheet underneath the erupting field. We find that each explosive eruption is followed bymore » reformation of a sigmoidal structure and a subsequent ''sigmoid-to-flare arcade'' transformation in the AR. These results might have implications for recurrent CMEs and eruptive sigmoids/flares observations and theoretical studies.« less

Combined branch retinal vein and artery occlusion in toxoplasmosis.

PubMed

Aggio, Fabio Bom; Novelli, Fernando José de; Rosa, Evandro Luis; Nobrega, Mário Junqueira

2016-01-01

A 22-year-old man complained of low visual acuity and pain in his left eye for five days. His ophthalmological examination revealed 2+ anterior chamber reaction and a white, poorly defined retinal lesion at the proximal portion of the inferotemporal vascular arcade. There were retinal hemorrhages in the inferotemporal region extending to the retinal periphery. In addition, venous dilation, increased tortuosity, and ischemic retinal whitening along the inferotemporal vascular arcade were also observed. A proper systemic work-up was performed, and the patient was diagnosed with ocular toxoplasmosis. He was treated with an anti-toxoplasma medication, and his condition slowly improved. Inferior macular inner and middle retinal atrophy could be observed on optical coherence tomography as a sequela of ischemic injury. To our knowledge, this is the first report of combined retinal branch vein and artery occlusion in toxoplasmosis resulting in a striking and unusual macular appearance.

Energy storage and deposition in a solar flare

NASA Technical Reports Server (NTRS)

Vorpahl, J. A.

1976-01-01

X-ray pictures of a solar flare taken with the S-056 X-ray telescope aboard Skylab are interpreted in terms of flare energy deposition and storage. The close similarity between calculated magnetic-field lines and the overall structure of the X-ray core is shown to suggest that the flare occurred in an entire arcade of loops. It is found that different X-ray features brightened sequentially as the flare evolved, indicating that some triggering disturbance moved from one side to the other in the flare core. A propagation velocity of 180 to 280 km/s is computed, and it is proposed that the geometry of the loop arcade strongly influenced the propagation of the triggering disturbance as well as the storage and site of the subsequent energy deposition. Some possible physical causes for the sequential X-ray brightening are examined, and a magnetosonic wave is suggested as the triggering disturbance. 'Correct' conditions for energy release are considered

Coronal loops and active region structure

NASA Technical Reports Server (NTRS)

Webb, D. F.; Zirin, H.

1981-01-01

Synoptic H-alpha Ca K, magnetograph and Skylab soft X-ray and EUV data were compared for the purpose of identifying the basic coronal magnetic structure of loops in a 'typical' active region and studying its evolution. A complex of activity in July 1973, especially McMath 12417, was emphasized. The principal results are: (1) most of the brightest loops connected the bright f plage to either the sunspot penumbra or to p satellite spots; no non-flaring X-ray loops end in umbrae; (2) short, bright loops had one or both ends in regions of emergent flux, strong field or high field gradients; (3) stable, strongly sheared loop arcades formed over filaments; (4) EFRs were always associated with compact X-ray arcades; and (5) loops connecting to other active regions had their bases in outlying plage of weak field strength in McM 417 where H-alpha fibrils marked the direction of the loops

Temperature evolution of a magnetic flux rope in a failed solar eruption

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

Song, H. Q.; Chen, Y.; Li, B.

2014-03-20

In this paper, we report for the first time the detailed temperature evolution process of the magnetic flux rope in a failed solar eruption. Occurring on 2013 January 05, the flux rope was impulsively accelerated to a speed of ∼400 km s{sup –1} in the first minute, then decelerated and came to a complete stop in two minutes. The failed eruption resulted in a large-size high-lying (∼100 Mm above the surface), high-temperature 'fire ball' sitting in the corona for more than two hours. The time evolution of the thermal structure of the flux rope was revealed through the differential emissionmore » measure analysis technique, which produced temperature maps using observations of the Atmospheric Imaging Assembly on board the Solar Dynamic Observatory. The average temperature of the flux rope steadily increased from ∼5 MK to ∼10 MK during the first nine minutes of the evolution, which was much longer than the rise time (about three minutes) of the associated soft X-ray flare. We suggest that the flux rope is heated by the energy release of the continuing magnetic reconnection, different from the heating of the low-lying flare loops, which is mainly produced by the chromospheric plasma evaporation. The loop arcade overlying the flux rope was pushed up by ∼10 Mm during the attempted eruption. The pattern of the velocity variation of the loop arcade strongly suggests that the failure of the eruption was caused by the strapping effect of the overlying loop arcade.« less

The Relationship Between Exclusions from Gambling Arcades and Accessibility: Evidence from a Newly Introduced Exclusion Program in Hesse, Germany.

PubMed

Strohäker, Tanja; Becker, Tilman

2018-02-28

An exclusion system for gambling arcades has been introduced recently in the state of Hesse. The aim of this paper is to identify significant predictors that are useful in explaining the variation of exclusions between different Hessian communities. Next to socio-demographic factors, we control for three different accessibility variables in two models: the number of electronic gambling machines (EGMs) in model I, and the number of locations and density of gambling machines at a location in model II. We disentangle the association between EGMs and exclusions of model I into a location and a clustering effect. Considering the socio-demographic variables, the explanatory power of our cross-sectional models is rather low. Only the age group of the 30-39 years old and those who are not in a partnership (in model I) yield significant results. As self-exclusion systems reduce availability for the group of vulnerable players, this analysis provides evidence for the assumption that the two groups-pathological gamblers and vulnerable players-seem to have little overlap concerning sociodemographic characteristics. The accessibility variables, on the other hand, turn out to be significantly associated with the number of exclusions. All three of them are statistically significant and their association is positive. The results of model II show that the location effect is more pronounced then the clustering effect of EGMs, i.e. the effect of an additional single-licensed arcade on the number of exclusions is stronger than the increase in the number of license at one location.

A need to simplify informed consent documents in cancer clinical trials. A position paper of the ARCAD Group.

PubMed

Bleiberg, H; Decoster, G; de Gramont, A; Rougier, P; Sobrero, A; Benson, A; Chibaudel, B; Douillard, J Y; Eng, C; Fuchs, C; Fujii, M; Labianca, R; Larsen, A K; Mitchell, E; Schmoll, H J; Sprumont, D; Zalcberg, J

2017-05-01

In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents. The Aide et Recherche en Cancérologie Digestive (ARCAD) Group, an international scientific committee involving oncologists from all over the world, addressed these issues and developed and uniformly accepted a simplified informed consent documentation for future clinical research. A simplified form of informed consent with the leading part of 1200-1800 words containing all of the key information necessary to meet ethical and regulatory requirements and 'relevant supportive information appendix' of 2000-3000 words is provided. This position paper, on the basis of the ARCAD Group experts discussions, proposes our informed consent model and the rationale for its content. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

Observational Evidence of Magnetic Reconnection for Brightenings and Transition Region Arcades in IRIS Observations

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

Zhao, Jie; Li, Hui; Feng, Li

By using a new method of forced-field extrapolation, we study the emerging flux region AR11850 observed by the Interface Region Imaging Spectrograph and Solar Dynamical Observatory . Our results suggest that the bright points (BPs) in this emerging region exhibit responses in lines formed from the upper photosphere to the transition region, which have relatively similar morphologies. They have an oscillation of several minutes according to the Atmospheric Imaging Assembly data at 1600 and 1700 Å. The ratio between the BP intensities measured in 1600 and 1700 Å filtergrams reveals that these BPs are heated differently. Our analysis of themore » Helioseismic and Magnetic Imager vector magnetic field and the corresponding topology in AR11850 indicates that the BPs are located at the polarity inversion line and most of them are related to magnetic reconnection or cancelation. The heating of the BPs might be different due to different magnetic topology. We find that the heating due to the magnetic cancelation would be stronger than the case of bald patch reconnection. The plasma density rather than the magnetic field strength could play a dominant role in this process. Based on physical conditions in the lower atmosphere, our forced-field extrapolation shows consistent results between the bright arcades visible in slit-jaw image 1400 Å and the extrapolated field lines that pass through the bald patches. It provides reliable observational evidence for testing the mechanism of magnetic reconnection for the BPs and arcades in the emerging flux region, as proposed in simulation studies.« less

Trigger of Successive Filament Eruptions Observed by SDO and STEREO

NASA Astrophysics Data System (ADS)

Dhara, Sajal Kumar; Belur, Ravindra; Kumar, Pankaj; Banyal, Ravinder Kumar; Mathew, Shibu K.; Joshi, Bhuwan

2017-10-01

Using multiwavelength observations from the Solar Dynamics Observatory (SDO) and the Solar Terrestrial Relations Observatory (STEREO), we investigate the mechanism of two successive eruptions (F1 and F2) of a filament in active region NOAA 11444 on 27 March 2012. The filament was inverse J-shaped and lay along a quasi-circular polarity inversion line (PIL). The first part of the filament erupted at ˜2{:}30 UT on 27 March 2012 (F1), the second part at around 4:20 UT on the same day (F2). A precursor or preflare brightening was observed below the filament main axis about 30 min before F1. The brightening was followed by a jet-like ejection below the filament, which triggered its eruption. Before the eruption of F2, the filament seemed to be trapped within the overlying arcade loops for almost 1.5 h before it successfully erupted. Interestingly, we observe simultaneously contraction (˜12 km s^{-1}) and expansion (˜20 km s^{-1}) of arcade loops in the active region before F2. Magnetograms obtained with the Helioseismic and Magnetic Imager (HMI) show converging motion of the opposite polarities, which result in flux cancellation near the PIL. We suggest that flux cancellation at the PIL resulted in a jet-like ejection below the filament main axis, which triggered F1, similar to the tether-cutting process. F2 was triggered by removal of the overlying arcade loops via reconnection. Both filament eruptions produced high-speed (˜1000 km s^{-1}) coronal mass ejections.

George E. KidderSmith, photographer, April 1945, Photograph #1101. VIEW OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

George E. Kidder-Smith, photographer, April 1945, Photograph #110-1. VIEW OF BUILDING 23, SOUTH SIDE WITH ARCADE, FACING NORTHWEST - Roosevelt Base, Auditorium-Gymnasium, West Virginia Street between Richardson & Reeves Avenues, Long Beach, Los Angeles County, CA

Playing Videogames: The Electronic Friend.

ERIC Educational Resources Information Center

Selnow, Gary W.

1984-01-01

Concluded that the children in this study (ages 10-14) played video games in arcades for some of the same reasons they watched television: (1) escape; (2) a sense of personal involvement in the action; and (3) a source of or substitute for companionship. (PD)

Software Reviews.

ERIC Educational Resources Information Center

McGrath, Diane, Ed.

1989-01-01

Provides reviews of courseware entitled: "Mystery Matter," which is a series that supplements the basic inquiry process; "Jumping Math Flash," which is an arcade-game program with arithmetic problems; and "Quest for Files: Science Rocks and Minerals The Upper Crust," which is a database program for earth science.…

Pre-schoolers Learn at Home.

ERIC Educational Resources Information Center

Smith, Penny

1985-01-01

Reviews: "ArithMagic (Counting, Addition, Subtraction)" which uses graphics to illustrate/review basic arithmetic concepts; "The Sweet Shop" which uses graphics (and a character called Mr. Jellybean) to teach arithmetic concepts; and "Math Magic," a monster-filled arcade game that teaches addition and subtraction.…

3. WEST SIDE, FROM CORNER OF FIRST STREET AND GOLD ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

3. WEST SIDE, FROM CORNER OF FIRST STREET AND GOLD AVENUE (Original arcade on this side was blocked ca. 1934 to create bar and offices. High wall on left enclosed outdoor bar.) - Alvarado Hotel, First Street, Albuquerque, Bernalillo County, NM

Onset of a Large Ejective Solar Eruption from a Typical Coronal-jet-base Field Configuration

NASA Astrophysics Data System (ADS)

Joshi, Navin Chandra; Sterling, Alphonse C.; Moore, Ronald L.; Magara, Tetsuya; Moon, Yong-Jae

2017-08-01

Utilizing multiwavelength observations and magnetic field data from the Solar Dynamics Observatory (SDO)/Atmospheric Imaging Assembly (AIA), SDO/Helioseismic and Magnetic Imager (HMI), the Geostationary Operational Environmental Satellite (GOES), and RHESSI, we investigate a large-scale ejective solar eruption of 2014 December 18 from active region NOAA 12241. This event produced a distinctive “three-ribbon” flare, having two parallel ribbons corresponding to the ribbons of a standard two-ribbon flare, and a larger-scale third quasi-circular ribbon offset from the other two. There are two components to this eruptive event. First, a flux rope forms above a strong-field polarity inversion line and erupts and grows as the parallel ribbons turn on, grow, and spread apart from that polarity inversion line; this evolution is consistent with the mechanism of tether-cutting reconnection for eruptions. Second, the eruption of the arcade that has the erupting flux rope in its core undergoes magnetic reconnection at the null point of a fan dome that envelops the erupting arcade, resulting in formation of the quasi-circular ribbon; this is consistent with the breakout reconnection mechanism for eruptions. We find that the parallel ribbons begin well before (˜12 minutes) the onset of the circular ribbon, indicating that tether-cutting reconnection (or a non-ideal MHD instability) initiated this event, rather than breakout reconnection. The overall setup for this large-scale eruption (diameter of the circular ribbon ˜105 km) is analogous to that of coronal jets (base size ˜104 km), many of which, according to recent findings, result from eruptions of small-scale “minifilaments.” Thus these findings confirm that eruptions of sheared-core magnetic arcades seated in fan-spine null-point magnetic topology happen on a wide range of size scales on the Sun.

Equilibrium features and eruptive instabilities in laboratory magnetic flux rope plasmas

NASA Astrophysics Data System (ADS)

Myers, Clayton E; Yamada, Masaaki; Belova, Elena V; Ji, Hantao; Yoo, Jongsoo; Fox, William

2014-06-01

One avenue for connecting laboratory and solar plasma studies is to carry out laboratory plasma experiments that serve as a well-diagnosed model for specific solar phenomena. In this paper, we present the latest results from one such laboratory experiment that is designed to address ideal instabilities that drive flux rope eruptions in the solar corona. The experiment, which utilizes the existing Magnetic Reconnection Experiment (MRX) at Princeton Plasma Physics Laboratory, generates a quasi-statically driven line-tied magnetic flux rope in a solar-relevant potential field arcade. The parameters of the potential field arcade (e.g., its magnitude, orientation, and vertical profile) are systematically scanned in order to study their influence on the evolution and possible eruption of the line-tied flux rope. Each flux rope discharge is diagnosed using a combination of fast visible light cameras and an in situ 2D magnetic probe array that measures all three components of the magnetic field over a large cross-section of the plasma. In this paper, we present the first results obtained from this new 2D magnetic probe array. With regard to the flux rope equilibrium, non-potential features such as the formation of a characteristic sigmoid shape and the generation of core toroidal field within the flux rope are studied in detail. With regard to instabilities, the onset and evolution of two key eruptive instabilities—the kink and torus instabilities—are quantitatively assessed as a function of the potential field arcade parameters and the amount of magnetic energy stored in the flux rope.This research is supported by DoE Contract Number DE-AC02-09CH11466 and by the NSF/DoE Center for Magnetic Self-Organization (CMSO).

The Width of a Solar Coronal Mass Ejection and the Source of the Driving Magnetic Explosion

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse C.; Suess, Steven T.

2007-01-01

We show that the strength of the magnetic field in the area covered by the flare arcade following a CME-producing ejective solar eruption can be estimated from the final angular width of the CME in the outer corona and the final angular width of the flare arcade. We assume (1) the flux-rope plasmoid ejected from the flare site becomes the interior of the CME plasmoid, (2) in the outer corona (R greater than 2R(sub Sun)) the CME is roughly a spherical plasmoid with legs shaped like a light bulb, and (3) beyond some height in or below the outer corona the CME plasmoid is in lateral pressure balance with the surrounding magnetic field. The strength of the nearly radial magnetic field in the outer corona is estimated from the radial component of the interplanetary magnetic field measured by Ulysses. We apply this model to three well-observed CMEs that exploded from flare regions of extremely different size and magnetic setting. One of these CMEs is an over-and-out CME that exploded from a laterally far offset compact ejective flare. In each event, the estimated source-region field strength is appropriate for the magnetic setting of the flare. This agreement (1) indicates that CMEs are propelled by the magnetic field of the CME plasmoid pushing against the surrounding magnetic field, (2) supports the magnetic-arch-blowout scenario for over-and-out CMEs, and (3) shows that a CME s final angular width in the outer corona can be estimated from the amount of magnetic flux covered by the source-region flare arcade.

Supra Arcade Downflows in the Earth's Magnetotail

NASA Astrophysics Data System (ADS)

Kobelski, A.; Savage, S. L.; Malaspina, D.

2017-12-01

Pinpointing the location of a single reconnection event in the corona is difficult due to observational constraints, although features directly resulting from this rapid reconfiguration of the field lines can be observed beyond the reconnection site. One set of such features are outflows in the form of post-reconnection loops, which have been linked to observations of supra-arcade downflows (SADs). SADs appear as sunward-traveling, density-depleted regions above flare arcades that develop during long duration eruptions. The limitations of remote sensing methods inherently results in ambiguities regarding the interpretation of SAD formation. Of particular interest is how these features are related to post-reconnection retracting magnetic field lines. In planetary magnetospheres, similar events to solar flares occur in the form of substorms, where reconnection in the anti-sunward tail of the magnetosphere causes field lines to retract toward the planet. Using data from the Time History of Events and Macroscopic Interactions during Substorms (THEMIS), we compare one particular aspect of substorms, dipolarization fronts, to SADs. Dipolarization fronts are observed as rapid but temporary changes in the magnetic field of the magnetotail plasma sheet into a more potential-like dipolar shape. These dipolarization fronts are believed to be retracting post-reconnection field lines. We combine data sets to show that the while the densities and magnetic fields involved vary greatly between the regimes, the plasma βs and Alfvén speeds are similar. These similarities allow direct comparison between the retracting field lines and their accompanying wakes of rarified plasma observed with THEMIS around the Earth to the observed morphological density depletions visible with XRT and AIA on the Sun. These results are an important source of feedback for models of coronal current sheets.

Density Enhancements and Voids Following Patchy Reconnection

NASA Astrophysics Data System (ADS)

Guidoni, S. E.; Longcope, D. W.

2011-04-01

We show, through a simple patchy reconnection model, that retracting reconnected flux tubes may present elongated regions relatively devoid of plasma, as well as long lasting, dense central hot regions. Reconnection is assumed to happen in a small patch across a Syrovatskiiˇ (non-uniform) current sheet (CS) with skewed magnetic fields. The background magnetic pressure has its maximum at the center of the CS plane and decreases toward its edges. The reconnection patch creates two V-shaped reconnected tubes that shorten as they retract in opposite directions, due to magnetic tension. One of them moves upward toward the top edge of the CS, and the other one moves downward toward the top of the underlying arcade. Rotational discontinuities (RDs) propagate along the legs of the tubes and generate parallel supersonic flows that collide at the center of the tube. There, gas-dynamic shocks that compress and heat the plasma are launched outwardly. The descending tube moves through the bottom part of the CS where it expands laterally in response to the decreasing background magnetic pressure. This effect may decrease plasma density by 30%-50% of background levels. This tube will arrive at the top of the arcade that will slow it to a stop. Here, the perpendicular dynamics is halted, but the parallel dynamics continues along its legs; the RDs are shut down, and the gas is rarified to even lower densities. The hot post-shock regions continue evolving, determining a long lasting hot region on top of the arcade. We provide an observational method based on total emission measure and mean temperature that indicates where in the CS the tube has been reconnected.

NON-POTENTIAL FIELDS IN THE QUIET SUN NETWORK: EXTREME-ULTRAVIOLET AND MAGNETIC FOOTPOINT OBSERVATIONS

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

Chesny, D. L.; Oluseyi, H. M.; Orange, N. B.

The quiet Sun (QS) magnetic network is known to contain dynamics which are indicative of non-potential fields. Non-potential magnetic fields forming ''S-shaped'' loop arcades can lead to the breakdown of static activity and have only been observed in high temperature X-ray coronal structures—some of which show eruptive behavior. Thus, analysis of this type of atmospheric structuring has been restricted to large-scale coronal fields. Here we provide the first identification of non-potential loop arcades exclusive to the QS supergranulation network. High-resolution Atmospheric Imaging Assembly data from the Solar Dynamics Observatory have allowed for the first observations of fine-scale ''S-shaped'' loop arcadesmore » spanning the network. We have investigated the magnetic footpoint flux evolution of these arcades from Heliospheric and Magnetic Imager data and find evidence of evolving footpoint flux imbalances accompanying the formation of these non-potential fields. The existence of such non-potentiality confirms that magnetic field dynamics leading to the build up of helicity exist at small scales. QS non-potentiality also suggests a self-similar formation process between the QS network and high temperature corona and the existence of self-organized criticality (SOC) in the form of loop-pair reconnection and helicity dissipation. We argue that this type of behavior could lead to eruptive forms of SOC as seen in active region (AR) and X-ray sigmoids if sufficient free magnetic energy is available. QS magnetic network dynamics may be considered as a coronal proxy at supergranular scales, and events confined to the network can even mimic those in coronal ARs.« less

OSCILLATION OF CURRENT SHEETS IN THE WAKE OF A FLUX ROPE ERUPTION OBSERVED BY THE SOLAR DYNAMICS OBSERVATORY

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

Li, L. P.; Zhang, J.; Su, J. T.

An erupting flux rope (FR) draws its overlying coronal loops upward, causing a coronal mass ejection. The legs of the overlying loops with opposite polarities are driven together. Current sheets (CSs) form, and magnetic reconnection, producing underneath flare arcades, occurs in the CSs. Employing Solar Dynamic Observatory /Atmospheric Imaging Assembly images, we study a FR eruption on 2015 April 23, and for the first time report the oscillation of CSs underneath the erupting FR. The FR is observed in all AIA extreme-ultraviolet passbands, indicating that it has both hot and warm components. Several bright CSs, connecting the erupting FR andmore » the underneath flare arcades, are observed only in hotter AIA channels, e.g., 131 and 94 Å. Using the differential emission measure (EM) analysis, we find that both the temperature and the EM of CSs temporally increase rapidly, reach the peaks, and then decrease slowly. A significant delay between the increases of the temperature and the EM is detected. The temperature, EM, and density spatially decrease along the CSs with increasing heights. For a well-developed CS, the temperature (EM) decreases from 9.6 MK (8 × 10{sup 28} cm{sup −5}) to 6.2 MK (5 × 10{sup 27} cm{sup −5}) in 52 Mm. Along the CSs, dark supra-arcade downflows (SADs) are observed, and one of them separates a CS into two. While flowing sunward, the speeds of the SADs decrease. The CSs oscillate with a period of 11 minutes, an amplitude of 1.5 Mm, and a phase speed of 200 ± 30 km s{sup −1}. One of the oscillations lasts for more than 2 hr. These oscillations represent fast-propagating magnetoacoustic kink waves.« less

Supra Arcade Downflows in the Earth's Magnetotail

NASA Technical Reports Server (NTRS)

Kobelski, Adam; Savage, Sabrina L.; Malaspina, David M.

2017-01-01

Pinpointing the location of a single reconnection event in the corona is difficult due to observational constraints, although features directly resulting from this rapid reconfiguration of the field lines can be observed beyond the reconnection site. One set of such features are outflows in the form of post-reconnection loops, which have been linked to observations of supra-arcade downflows (SADs). SADs appear as sunward-traveling, density-depleted regions above flare arcades that develop during long duration eruptions. The limitations of remote sensing methods inherently results in ambiguities regarding the interpretation of SAD formation. Of particular interest is how these features are related to post-reconnection retracting magnetic field lines. In planetary magnetospheres, similar events to solar flares occur in the form of substorms, where reconnection in the anti-sunward tail of the magnetosphere causes field lines to retract toward the planet. Using data from the Time History of Events and Macroscopic Interactions during Substorms (THEMIS), we compare one particular aspect of substorms, dipolarization fronts, to SADs. Dipolarization fronts are observed as rapid but temporary changes in the magnetic field of the magnetotail plasma sheet into a more potential-like dipolar shape. These dipolarization fronts are believed to be retracting post-reconnection field lines. We combine data sets to show that the while the densities and magnetic fields involved vary greatly between the regimes, the plasma betas and Alfvén speeds are similar. These similarities allow direct comparison between the retracting field lines and their accompanying wakes of rarified plasma observed with THEMIS around the Earth to the observed morphological density depletions visible with XRT and AIA on the Sun. These results are an important source of feedback for models of coronal current sheets.

7. WEST WING, SOUTH ELEVATION. DETAIL SHOWING THE SPANISH GABLE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

7. WEST WING, SOUTH ELEVATION. DETAIL SHOWING THE SPANISH GABLE AND ARCADE. THE COURTYARD AND THE NORTH WING ARE IN THE BACKGROUND. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

1. Historic American Buildings Survey Copied by E. W. Russell, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Historic American Buildings Survey Copied by E. W. Russell, Photographer, August 31, 1936 75TH ANNIVERSARY YEARBOOK (NOT COPYRIGHT) - FRONT OF MAIN BUILDING BEFORE CLOISTER ARCADE WAS ADDED - Spring Hill College, Main Building, Old Shell Road, Spring Hill, Mobile County, AL

Varying self-inductance and energy storage in a sheared force-free arcade. [of coronal loops

NASA Technical Reports Server (NTRS)

Zuccarello, F.; Burm, H.; Kuperus, M.; Raadu, M.; Spicer, D. S.

1987-01-01

An electric circuit analogy is used to model the build-up and storage of magnetic energy in the coronal loops known to exist in the atmosphere of the sun. The present parameterization of magnetic energy storage in an electric circuit analog uses a bulk current I flowing in the circuit and a self-inductance L. Because the self-inductance is determined by the geometry of the magnetic configuration any change in its dimensions will change L. If L is increased, the amount of magnetic energy stored and the rate at which magnetic energy is stored are both increased. One way of increasing L is to shear the magnetic field lines and increase their effective geometrical length. Using the force-free field approximation for a magnetic arcade whose field lines are sheared by photospheric motions, it is demonstrated that the increase of magnetic energy is initially due to the increase of the current intensity I and later mainly due to the increase of the self-inductance.

The solar wind structure that caused a large-scale disturbance of the plasma tail of comet Austin

NASA Technical Reports Server (NTRS)

Kozuka, Yukio; Konno, Ichishiro; Saito, Takao; Numazawa, Shigemi

1992-01-01

The plasma tail of Comet Austin (1989c1) showed remarkable disturbances because of the solar maximum periods and its orbit. Figure 1 shows photographs of Comet Austin taken in Shibata, Japan, on 29 Apr. 1990 UT, during about 20 minutes with the exposure times of 90 to 120 s. There are two main features in the disturbance; one is many bowed structures, which seem to move tailwards; and the other is a large-scale wavy structure. The bowed structures can be interpreted as arcade structures brushing the surface of both sides of the cometary plasma surrounding the nucleus. We identified thirteen structures of the arcades from each of the five photographs and calculated the relation between the distance of each structure from the cometary nucleus, chi, and the velocity, upsilon. The result is shown. This indicates that the velocity of the structures increases with distance. This is consistent with the result obtained from the observation at the Kiso Observatory.

Upper eyelid abscess as a late complication of frontal sinus trauma

PubMed Central

Adriana, Iliescu Daniela; Cornel, Stefan; Mihaela, Timaru Cristina; Speranta, Schmitzer; Algerino, De Simone; Mehdi, Batras; Elena, Zeca Cristina; Bogdan, Maciuceanu-Zarnescu Mircea

2015-01-01

The authors report a case of upper eyelid abscess in a 30 year old male that presented in the ophthalmology department with complains of recurrent eyelid pyosis, hyperaemia and swelling that started 2 months earlier and that did not ease to repeated courses of antibiotic therapy. The reported history of the patient revealed frontal sinus trauma that occurred 5 years before and that required surgical treatment (fixation with titan plaque and screws) with total healing and giving no further complains over the next years. The present cranial CT imaging showed intraorbital fat infiltration with displacement of one orbital arcade screw. Clinical findings showed normal ocular mobility. Antibiotic treatment and screw extraction through eyelid fistula improved the outcome but did not resolve the fistulous communication. Final management involved surgical removal of orbital arcade plaque and remaining screw and excision of fistula tract. The postoperative outcome was very good and the fistula remained closed but left the patient with an upper eyelid retraction which will require oculoplastic surgery in the future. PMID:29450319

The Electronic Game Gambit.

ERIC Educational Resources Information Center

Bing, Jon

1982-01-01

The rapid evolution of today's video games now fills arcades, snack bars, and homes with an array of highly interactive, graphically vivid technical devices. This electronic environment is creating a worldwide communication network. Developments in this area will be beneficial provided that appropriate media policies can be framed. (Author/JN)

10. INDIAN HOUSE TOWER, FROM, THE EAST. ALSO SHOWS THE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

10. INDIAN HOUSE TOWER, FROM, THE EAST. ALSO SHOWS THE BALCONY AND ARCADE OF THE WEST WING. THE TOWER WAS ADDED IN 1916. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Storing free magnetic energy in the solar corona

NASA Astrophysics Data System (ADS)

Vekstein, G.

2016-08-01

This article presents a mini-tutorial aimed at a wide readership not familiar with the field of solar plasma physics. The exposition is centred around the issue of excess/free magnetic energy stored in the solar corona. A general consideration is followed with a particular example of coronal magnetic arcade, where free magnetic energy builds up by photospheric convective flows. In the context of solar physics the major task is to explain how this free energy can be released quickly enough to match what is observed in coronal explosive events such as solar flares. Therefore, in the last section of the paper we discuss briefly a possible role of magnetic reconnection in these processes. This is done in quite simple qualitative physical terms, so that an interested reader can follow it up in more detail with help of the provided references.

An Unofficial Guide to Web-Based Instructional Gaming and Simulation Resources.

ERIC Educational Resources Information Center

Kirk, James J.

Games and digital-based games and simulations are slowly becoming an accepted learning strategy. Public school teachers, college professors, corporate trainers, and military trainers are embracing games as an effective means of motivating learners and teaching complex concepts. Popular games include action games, adventure games,arcade games,…

82. WEST WING. SOUTH ELEVATION. DETAIL SHOWING THE SPANISH GABLE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

82. WEST WING. SOUTH ELEVATION. DETAIL SHOWING THE SPANISH GABLE AND ARCADE. THE COURTYARD AND THE NORTH WING ARE IN THE BACKGROUND. SAME VIEW AS PA-107-7. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Effects of Age and Visual-Motor Skills on Preschool Children's Computer-Game Performance.

ERIC Educational Resources Information Center

Strein, William

1987-01-01

The relationship of both age and visual-motor skills to performance on an arcade-like video game was studied with 16 preschool children. While age was positively related to performance, no significant relationship was found for the visual-motor skills variable. (Author/CB)

Games People Play

ERIC Educational Resources Information Center

VerBruggen, Robert

2012-01-01

Today's video games aren't even a little bit like the ones that came out a few decades ago. Not only has the underlying technology dramatically improved, but the medium has matured remarkably in the years since "Pong" and "Space Invaders." ruled the arcades. The artistic promise of video games has yet to be fulfilled. The current state of the…

77 FR 42211 - Small Business Size Standards: Arts, Entertainment, and Recreation

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

... 16.5 68.3 0.598 5.0 5.0 5.0 $5.0 5.0 7.0 713210 Casinos (except Casino Hotels) 67.0 189.2 54.4 15.9... Theme Parks. 713120 Amusement 7.0 5.0 Arcades. 713210 Casinos (except 7.0 25.5 Casino Hotels). 713290...

76 FR 38651 - Sikes Oil Service; Arcade, Jackson County, GA; Notice of Settlement

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... ENVIRONMENTAL PROTECTION AGENCY [Docket EPA-RO4-SFUND-2011-0557, FRL-9427-7] Sikes Oil Service... settlement for reimbursement of past response costs concerning the Sikes Oil Service Superfund Site located...- SFUND-2011-0557 or Site name Sikes Oil Service Superfund Site by one of the following methods: http...

Teaching Design Patterns through Computer Game Development

ERIC Educational Resources Information Center

Gestwicki, Paul; Sun, Fu-Shing

2008-01-01

We present an approach for teaching design patterns that emphasizes object-orientation and patterns integration. The context of computer game development is used to engage and motivate students, and it is additionally rich with design patterns. A case study is presented based on "EEClone," an arcade-style computer game implemented in Java. Our…

84. INDIAN HOUSE TOWER, FROM THE EAST. ALSO SHOWS THE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

84. INDIAN HOUSE TOWER, FROM THE EAST. ALSO SHOWS THE BALCONY AND ARCADE OF THE WEST WING. THE TOWER WAS ADDED IN 1916. SAME VIEW AS PA-107-10. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Multidimensional Simulations of Filament Channel Structure and Evolution

NASA Astrophysics Data System (ADS)

Karpen, J. T.

2007-10-01

Over the past decade, the NRL Solar Theory group has made steady progress toward formulating a comprehensive model of filament-channel structure and evolution, combining the results of our sheared 3D arcade model for the magnetic field with our thermal nonequilibrium model for the cool, dense material suspended in the corona. We have also discovered that, when a sheared arcade is embedded within the global dipolar field, the resulting stressed filament channel can erupt through the mechanism of magnetic breakout. Our progress has been largely enabled by the development and implementation of state-of-the-art 1D hydrodynamic and 3D magnetohydrodynamic (MHD) codes to simulate the field-aligned plasma thermodynamics and large-scale magnetic-field evolution, respectively. Significant questions remain, however, which could be answered with the advanced observations anticipated from Solar-B. In this review, we summarize what we have learned from our simulations about the magnetic and plasma structure, evolution, and eruption of filament channels, and suggest key observational objectives for Solar-B that will test our filament-channel and CME-initiation models and augment our understanding of the underlying physical processes.

Observations of the Formation, Development, and Structure of a Current Sheet in an Eruptive Solar Flare

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

Seaton, Daniel B.; Darnel, Jonathan M.; Bartz, Allison E., E-mail: daniel.seaton@noaa.gov

2017-02-01

We present Atmospheric Imaging Assembly observations of a structure we interpret as a current sheet associated with an X4.9 flare and coronal mass ejection that occurred on 2014 February 25 in NOAA Active Region 11990. We characterize the properties of the current sheet, finding that the sheet remains on the order of a few thousand kilometers thick for much of the duration of the event and that its temperature generally ranged between 8 and 10 MK. We also note the presence of other phenomena believed to be associated with magnetic reconnection in current sheets, including supra-arcade downflows and shrinking loops.more » We estimate that the rate of reconnection during the event was M{sub A} ≈ 0.004–0.007, a value consistent with model predictions. We conclude with a discussion of the implications of this event for reconnection-based eruption models.« less

Onset of a Large Ejective Solar Eruption from a Typical Coronal-jet-base Field Configuration

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

Joshi, Navin Chandra; Magara, Tetsuya; Moon, Yong-Jae

Utilizing multiwavelength observations and magnetic field data from the Solar Dynamics Observatory ( SDO )/Atmospheric Imaging Assembly (AIA), SDO /Helioseismic and Magnetic Imager (HMI), the Geostationary Operational Environmental Satellite ( GOES ), and RHESSI , we investigate a large-scale ejective solar eruption of 2014 December 18 from active region NOAA 12241. This event produced a distinctive “three-ribbon” flare, having two parallel ribbons corresponding to the ribbons of a standard two-ribbon flare, and a larger-scale third quasi-circular ribbon offset from the other two. There are two components to this eruptive event. First, a flux rope forms above a strong-field polarity inversionmore » line and erupts and grows as the parallel ribbons turn on, grow, and spread apart from that polarity inversion line; this evolution is consistent with the mechanism of tether-cutting reconnection for eruptions. Second, the eruption of the arcade that has the erupting flux rope in its core undergoes magnetic reconnection at the null point of a fan dome that envelops the erupting arcade, resulting in formation of the quasi-circular ribbon; this is consistent with the breakout reconnection mechanism for eruptions. We find that the parallel ribbons begin well before (∼12 minutes) the onset of the circular ribbon, indicating that tether-cutting reconnection (or a non-ideal MHD instability) initiated this event, rather than breakout reconnection. The overall setup for this large-scale eruption (diameter of the circular ribbon ∼10{sup 5} km) is analogous to that of coronal jets (base size ∼10{sup 4} km), many of which, according to recent findings, result from eruptions of small-scale “minifilaments.” Thus these findings confirm that eruptions of sheared-core magnetic arcades seated in fan–spine null-point magnetic topology happen on a wide range of size scales on the Sun.« less

The Width of a Solar Coronal Mass Ejection and the Source of the Driving Magnetic Explosion: A Test of the Standard Scenario for CME Production

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse C.; Suess, Steven T.

2007-01-01

We show that the strength (B(sub F1are)) of the magnetic field in the area covered by the flare arcade following a CME-producing ejective solar eruption can be estimated from the final angular width (Final Theta(sub CME)) of the CME in the outer corona and the final angular width (Theta(sub Flare)) of the flare arcade: B(sub Flare) approx. equals 1.4[(Final Theta(sub CME)/Theta(sub Flare)] (exp 2)G. We assume (1) the flux-rope plasmoid ejected from the flare site becomes the interior of the CME plasmoid; (2) in the outer corona (R > 2 (solar radius)) the CME is roughly a "spherical plasmoid with legs" shaped like a lightbulb; and (3) beyond some height in or below the outer corona the CME plasmoid is in lateral pressure balance with the surrounding magnetic field. The strength of the nearly radial magnetic field in the outer corona is estimated from the radial component of the interplanetary magnetic field measured by Ulysses. We apply this model to three well-observed CMEs that exploded from flare regions of extremely different size and magnetic setting. One of these CMEs was an over-and-out CME, that is, in the outer corona the CME was laterally far offset from the flare-marked source of the driving magnetic explosion. In each event, the estimated source-region field strength is appropriate for the magnetic setting of the flare. This agreement (1) indicates that CMEs are propelled by the magnetic field of the CME plasmoid pushing against the surrounding magnetic field; (2) supports the magnetic-arch-blowout scenario for over-and-out CMEs; and (3) shows that a CME's final angular width in the outer corona can be estimated from the amount of magnetic flux covered by the source-region flare arcade.

piBox: A Platform for Privacy-Preserving Apps

DTIC Science & Technology

2012-10-03

media Arcade/Action! Books! Brain/Puzzles! Business! Cards/Casino! Casual! Comics! Communication! Education ! Entertainment! Finance! Health/Fitness... Lifestyle ! Live Wallpaper! Media/Video! Medical! Music/Audio! News/Magazines! Personalization! Photography! Productivity! Racing! Shopping! Social! Sports...Cells: A virtual mobile smartphone architecture. In SOSP, 2011. [4] Google App Engine. https://developers. google.com/appengine. [5] M. Backes, A. Kate

Mortal Kombat: The Effects of Violent Video Technology on Males' Hostility and Cardiovascular Responding.

ERIC Educational Resources Information Center

Ballard, Mary E.; Wiest, J. Rose

A study examined differences in cardiovascular (CV) reactions and hostility following non-violent play and violent video game play. Subjects were 30 male college undergraduate students. Only male subjects were used because most video games are male oriented, males frequent videogame arcades more often than females, and the gender gap in video game…

A Typology of UK Slot Machine Gamblers: A Longitudinal Observational and Interview Study

ERIC Educational Resources Information Center

Griffiths, Mark D.

2011-01-01

Slot machine gambling is a popular leisure activity worldwide yet there has been very little research into different types of slot machine gamblers. Earlier typologies of slot machine gamblers have only concentrated on adolescents in arcade environments. This study presents a new typology of slot machine players based on over 1000 h of participant…

49. Photograph of an original construction drawing, dated August 1927, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

49. Photograph of an original construction drawing, dated August 1927, in the possession of Facilities Planning Office, Iowa State University, Ames, Iowa. ELEVATIONS & DETAILS CROSS SECTION THROUGH COURTYARD SHOWING WEST ELEVATION OF ARCADE AT EAST SIDE, REAR (EAST) ELEVATION OF BUILDING; SHEET NO. 7 OF 10 - Dairy Industry Building, Iowa State University campus, Ames, Story County, IA

Gaming: Eat Breakfast, Drink Milk, Play Xbox

ERIC Educational Resources Information Center

O'Hanlon, Charlene

2007-01-01

Plagued by one of the most overweight populaces in the country, the state of West Virginia was looking for a solution to its obesity problem that would appeal to the school-age crowd. It turned to Linda Carson, a professor at West Virginia University's School of Physical Education. Carson recalled witnessing kids lining up in an arcade to play a…

"Cracking Open the Natural Teleology": Walter Benjamin, Charles Fourier and the Figure of the Child

ERIC Educational Resources Information Center

Dolbear, Sam; Proctor, Hannah

2016-01-01

The French utopian socialist Charles Fourier is a key figure in Walter Benjamin's "Arcades Project". For Benjamin, one of the most significant aspects of Fourier's utopian vision was its conceptualisation of work as a form of play. According to Fourier it would be possible to build a world around people's inherent desires. In such a…

Adding Instructional Features that Promote Learning in a Game-Like Environment

ERIC Educational Resources Information Center

Mayer, Richard E.; Johnson, Cheryl I.

2010-01-01

Students learned about electrical circuits in an arcade-type game consisting of 10 levels. For example, in one level students saw two circuits consisting of various batteries and resistors connected in series or parallel, and had to indicate which one had a higher rate of moving current. On levels 1-9, all students received a correct tone and had…

Dental arcade arteriovenous fistulas: from diagnosis to treatment with emphasis on the role of endovascular or percutaneous treatment: single centre experience.

PubMed

Saraf, Rashmi; Shrivastava, Manish; Siddhartha, W; Limaye, Uday

2014-10-01

Dental arcade arteriovenous fistula (DA-AVF) are rare. The purpose of this study was to understand the angioarchitecture of these lesions, changing strategies of endovascular treatment and to analyse the best therapeutic option which will allow normal skeletal development especially in children. Retrospective study of all the patients of DA-AVF managed at our centre over the last 16 years. Detailed analysis of the clinical features, the imaging findings, endovascular treatment and angiographic outcomes was done. Total of six patients were treated. 5 were in the mandible and one in the maxilla. Transarterial glue embolization was done in 3 patients and direct puncture of the intraosseous venous pouch in 2. Transarterial Onyx was used in 2 patients through dual lumen balloon catheter. Overall cure was achieved in 5 out of 6 patients (83%). High index of suspicion is required to diagnose it on panoramic radiographs. CT/MR/CTA can lead to early diagnosis. Transarterial Onyx embolization using dual lumen balloon catheter is a promising technique & allows excellent penetration of Onyx into the intraosseous venous pouch. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The Joint Space Operations Center Mission System and the Advanced Research, Collaboration, and Application Development Environment Status Update 2016

NASA Astrophysics Data System (ADS)

Murray-Krezan, Jeremy; Howard, Samantha; Sabol, Chris; Kim, Richard; Echeverry, Juan

2016-05-01

The Joint Space Operations Center (JSpOC) Mission System (JMS) is a service-oriented architecture (SOA) infrastructure with increased process automation and improved tools to enhance Space Situational Awareness (SSA) performed at the US-led JSpOC. The Advanced Research, Collaboration, and Application Development Environment (ARCADE) is a test-bed maintained and operated by the Air Force to (1) serve as a centralized test-bed for all research and development activities related to JMS applications, including algorithm development, data source exposure, service orchestration, and software services, and provide developers reciprocal access to relevant tools and data to accelerate technology development, (2) allow the JMS program to communicate user capability priorities and requirements to developers, (3) provide the JMS program with access to state-of-the-art research, development, and computing capabilities, and (4) support JMS Program Office-led market research efforts by identifying outstanding performers that are available to shepherd into the formal transition process. In this paper we will share with the international remote sensing community some of the recent JMS and ARCADE developments that may contribute to greater SSA at the JSpOC in the future, and share technical areas still in great need.

Triggers and Manifestations of Flare Energy Release in the Low Atmosphere

NASA Astrophysics Data System (ADS)

Kosovichev, A. G.; Sharykin, I. N.; Sadykov, V. M.; Vargas, S.; Zimovets, I. V.

2016-12-01

The main goal is to understand triggers and manifestations of the flare energy release in the lower layers of the solar atmosphere (the photosphere and chromosphere) using high-resolution optical observations and magnetic field measurements. As a case study we present results for an M-class flare. We analyze optical images, HMI Dopplergrams and vector magnetograms, and use Non-Linear Force-Free Field (NLFFF) extrapolation for reconstruction of the magnetic topology. The NLFFF modelling reveals interaction of oppositely directed magnetic flux-tubes in the Polarity Inversion Line (PIL). These two interacting magnetic flux tubes are observed as a compact sheared arcade along the PIL in the high-resolution broad-band continuum images from New Solar Telescope (NST). In the vicinity of the PIL, the NST H-alpha observations reveal formation of a thin three-ribbon structure corresponding to the small-scale photospheric magnetic arcade. Magnetic reconnection is triggered by two interacting magnetic flux tubes with forming current sheet extended along the PIL. Presented observational results evidence in favor of location of the primary energy release site in the dense chromosphere where plasma is partially ionized in the region of strong electric currents concentrated near the polarity inversion line.

XML-Based Visual Specification of Multidisciplinary Applications

NASA Technical Reports Server (NTRS)

Al-Theneyan, Ahmed; Jakatdar, Amol; Mehrotra, Piyush; Zubair, Mohammad

2001-01-01

The advancements in the Internet and Web technologies have fueled a growing interest in developing a web-based distributed computing environment. We have designed and developed Arcade, a web-based environment for designing, executing, monitoring, and controlling distributed heterogeneous applications, which is easy to use and access, portable, and provides support through all phases of the application development and execution. A major focus of the environment is the specification of heterogeneous, multidisciplinary applications. In this paper we focus on the visual and script-based specification interface of Arcade. The web/browser-based visual interface is designed to be intuitive to use and can also be used for visual monitoring during execution. The script specification is based on XML to: (1) make it portable across different frameworks, and (2) make the development of our tools easier by using the existing freely available XML parsers and editors. There is a one-to-one correspondence between the visual and script-based interfaces allowing users to go back and forth between the two. To support this we have developed translators that translate a script-based specification to a visual-based specification, and vice-versa. These translators are integrated with our tools and are transparent to users.

Ultraviolet Properties of Halo Coronal Mass Ejections: Doppler Shifts, Angles, Shocks, and Bulk Morphology

NASA Astrophysics Data System (ADS)

Ciaravella, A.; Raymond, J. C.; Kahler, S. W.

2006-11-01

We present UV spectral information for 22 halo or partial halo CMEs observed by UVCS. The CME fronts show broad line profiles, while the line intensities are comparable to the background corona. The Doppler shifts of the front material are generally small, showing that the motion of gas in the fronts is mostly transverse to the line of sight. This indicates that, at least in halo CMEs, the fronts generally correspond to coronal plasma swept up by a shock or compression wave, rather than plasma carried outward by magnetic loops. This favors an ice cream cone (or a spherical shell) model, as opposed to an expanding arcade of loops. We use the line widths to discriminate between shock heating and bulk expansion. Of 14 cases where we detected the CME front, the line broadening in 7 cases can be attributed to shock heating, while in 3 cases it is the line-of-sight component of the CME expansion. For the CME cores we determine the angles between the motion and the plane of the sky, along with the actual heliocentric distances, in order to provide quantitative estimates of projection effects.

The natural history of splanchnic artery aneurysms and outcomes after operative intervention.

PubMed

Corey, Michael R; Ergul, Emel A; Cambria, Richard P; English, Sean J; Patel, Virendra I; Lancaster, R Todd; Kwolek, Christopher J; Conrad, Mark F

2016-04-01

Splanchnic artery aneurysms (SAAs) are uncommon, and standards for surveillance and intervention are lacking. The goal of this study was to review our 20-year experience with managing SAAs. The Research Patient Data Registry at the Massachusetts General Hospital was queried, and all patients with SAAs identified by axial imaging from 1994 to 2014 were included. Aneurysms were stratified into two cohorts: those that underwent early intervention (<6 months after lesion discovery) and those that received surveillance. Primary study end points included aneurysm growth or rupture during surveillance and patient 30-day morbidity or mortality after aneurysm repair. There were 264 SAAs identified in 250 patients. In 166 patients, 176 SAAs (66.6%) were placed into the surveillance cohort; 38 SAAs (21.6%) did not have subsequent axial imaging and were considered lost to follow-up. Mean aneurysm size in the surveillance cohort at first imaging study was 16.28 mm (8-41 mm), and mean surveillance time was 36.1 months (2-155 months); 126 SAAs (91.3%) remained stable in size over time, and 8 SAAs (5.8%) required intervention for aneurysm growth after a mean of 24 months. There were no ruptures in the surveillance cohort. There were 88 SAAs (33.3%) repaired early. Mean size of SAAs that were repaired early was 31.1 mm (10-140 mm). For intact SAAs, 30-day morbidity and mortality rates after repair were 13% and 3%, respectively. In the early repair cohort, 13 SAAs (14.7%) were ruptured at presentation. The 30-day morbidity and mortality rates after rupture were 54% and 8%, respectively. Five ruptured SAAs (38%) were anatomically located in the pancreaticoduodenal arcade. On univariate analysis, pancreaticoduodenal aneurysms were strongly associated with rupture (P = .0002). Small SAAs (≤25 mm) are not prone to significant expansion and do not require frequent surveillance imaging. Imaging every 3 years for small SAAs is adequate. Aneurysms of the pancreaticoduodenal arcade and gastroduodenal aneurysms are more likely to rupture and therefore warrant a more aggressive interventional approach. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Installation Restoration Program, Stage 3, McClellan Air Force Base. Preliminary Groundwater Operable Unit Remedial Investigation (Hydrogeologic Assessment) Sampling and Analysis Plan

DTIC Science & Technology

1990-02-01

PRESENT C,(8;2) 131o sia &1 OTE MUNICIPAL WATER b9PLY WELLS: ON-BASE CW CITY OSARMENTO AREAS NW NORTHRIDGE WATEtj DISTRICT RW RIO LINDA AW ARCADE WATER...1ASE PRODUCTION WELL ACTIVE BAS PRODUCTION WELL ., CITY WELL T #f CALTRANS WELL . EXTRACTION WELL 0 500 1000 N : SCALL IN FEET If-3. 82

HOW DID A MAJOR CONFINED FLARE OCCUR IN SUPER SOLAR ACTIVE REGION 12192?

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

Jiang, Chaowei; Feng, Xueshang; Wu, S. T.

We study the physical mechanism of a major X-class solar flare that occurred in the super NOAA active region (AR) 12192 using data-driven numerical magnetohydrodynamic (MHD) modeling complemented with observations. With the evolving magnetic fields observed at the solar surface as bottom boundary input, we drive an MHD system to evolve self-consistently in correspondence with the realistic coronal evolution. During a two-day time interval, the modeled coronal field has been slowly stressed by the photospheric field evolution, which gradually created a large-scale coronal current sheet, i.e., a narrow layer with intense current, in the core of the AR. The currentmore » layer was successively enhanced until it became so thin that a tether-cutting reconnection between the sheared magnetic arcades was set in, which led to a flare. The modeled reconnecting field lines and their footpoints match well the observed hot flaring loops and the flare ribbons, respectively, suggesting that the model has successfully “reproduced” the macroscopic magnetic process of the flare. In particular, with simulation, we explained why this event is a confined eruption—the consequence of the reconnection is a shared arcade instead of a newly formed flux rope. We also found a much weaker magnetic implosion effect compared to many other X-class flares.« less

Numerical simulation of solar coronal magnetic fields

NASA Technical Reports Server (NTRS)

Dahlburg, Russell B.; Antiochos, Spiro K.; Zang, T. A.

1990-01-01

Many aspects of solar activity are believed to be due to the stressing of the coronal magnetic field by footpoint motions at the photosphere. The results are presented of a fully spectral numerical simulation which is the first 3-D time dependent simulation of footpoint stressing in a geometry appropriate for the corona. An arcade is considered that is initially current-free and impose a smooth footpoint motion that produces a twist in the field of approx 2 pi. The footprints were fixed and the evolution was followed until the field relaxes to another current-free state. No evidence was seen for any instability, either ideal or resistive and no evidence for current sheet formation. The most striking feature of the evolution is that in response to photospheric motions, the field expands rapidly upward to minimize the stress. The expansion has two important effects. First, it suppresses the development of dips in the field that could support dense, cool material. For the motions assumed, the magnetic field does not develop a geometry suitable for prominence formation. Second, the expansion inhibits ideal instabilities such as kinking. The results indicate that simple stearing of a single arcade is unlikely to lead to solar activity such as flares or prominences. Effects are discussed that might possibly lead to such activity.

MHD SIMULATIONS OF CORONAL SUPRA-ARCADE DOWNFLOWS INCLUDING ANISOTROPIC THERMAL CONDUCTION

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

Zurbriggen, E.; Costa, A.; Schneiter, M.

2016-11-20

Coronal supra-arcade downflows (SADs) are observed as dark trails descending toward hot turbulent-fan-shaped regions. Due to the large temperature values and gradients in these fan regions, the thermal conduction (TC) should be very efficient. While several models have been proposed to explain the triggering and the evolution of SADs, none of these scenarios address a systematic consideration of TC. Thus, we accomplish this task numerically simulating the evolution of SADs within this framework. That is, SADs are conceived as voided (subdense) cavities formed by nonlinear waves triggered by downflowing bursty localized reconnection events in a perturbed hot fan. We generatemore » a properly turbulent fan, obtained by a stirring force that permits control of the energy and vorticity input in the medium where SADs develop. We include anisotropic TC and consider plasma properties consistent with observations. Our aim is to study whether it is possible to prevent SADs from vanishing by thermal diffusion. We find that this will be the case, depending on the turbulence parameters, in particular if the magnetic field lines are able to envelope the voided cavities, thermally isolating them from the hot environment. Velocity shear perturbations that are able to generate instabilities of the Kelvin–Helmholtz type help to produce magnetic islands, extending the lifetime of SADs.« less

OUTFLOWS AND DARK BANDS AT ARCADE-LIKE ACTIVE REGION CORE BOUNDARIES

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

Scott, J. T.; Martens, P. C. H.; Tarr, L.

Observations from the EUV Imaging Spectrometer (EIS) on board Hinode have revealed outflows and non-thermal line broadening in low intensity regions at the edges of active regions (ARs). We use data from Hinode's EIS, Solar Dynamic Observatory's Atmospheric Imaging Assembly and Helioseismic and Magnetic Imager, and the Transition Region and Coronal Explorer instrument to investigate the boundaries of arcade-like AR cores for NOAA ARs 11112, 10978, and 9077. A narrow, low intensity region that is observed at the core's periphery as a dark band shows outflows and increased spectral line broadening. This dark band is found to exist for daysmore » and appears between the bright coronal loop structures of different coronal topologies. We find a case where the dark band region is formed between the magnetic field from emerging flux and the field of the pre-existing flux. A magnetic field extrapolation indicates that this dark band is coincident with the spine lines or magnetic separatrices in the extrapolated field. This occurs over unipolar regions where the brightened coronal field is separated in connectivity and topology. This separation does not appear to be infinitesimal and an initial estimate of the minimum distance of separation is found to be Almost-Equal-To 1.5-3.5 Mm.« less

Interpretation of the Arcade 2 Absolute Sky Brightness Measurement

NASA Technical Reports Server (NTRS)

Seiffert, M.; Fixsen, D. J.; Kogut, A.; Levin, S. M.; Limon, M.; Lubin, P. M.; Mirel, P.; Singal, J.; Villela, T.; Wollack, E.;

Depressed emission between magnetic arcades near a sunspot

NASA Astrophysics Data System (ADS)

Ryabov, B. I.; Shibasaki, K.

The locations of the depressed emission in microwaves, EUV and soft X-rays are compared with each other and with the location of the plasma outflow in the active region (AR) 8535 on the Sun. We found that two open-field regions overlap the regions of depressed emission near the AR's sunspot. These two open-field regions are simulated with the potential-field source-surface (PFSS) model under radial distances of RSS = 1.8 R⊙ and RSS = 2.5 R⊙. Each open-field region is located between the arcades of the loops of the same magnetic polarity. The former open-field region covers the region of the plasma outflow, which is thus useful for the tests on connection to the heliosphere. The utmost microwave depression of the intensity in the ordinary mode (the Very Large Array 15 GHz observations) also overlaps the region of the plasma outflow and thus indicates this outflow. The lasting for eight days depression in soft X-rays and the SOHO EIT 2.84× 10-8 m images are attributed to the evacuation of as hot coronal plasma as T≥ 2× 106 K from the extended in height (``open") magnetic structures. We conclude that the AR 8535 presents the sunspot atmosphere affected by the large-scale magnetic fields.

Great geomagnetic storm of 9 November 1991: Association with a disappearing solar filament

NASA Astrophysics Data System (ADS)

Cliver, E. W.; Balasubramaniam, K. S.; Nitta, N. V.; Li, X.

2009-02-01

We attribute the great geomagnetic storm on 8-10 November 1991 to a large-scale eruption that encompassed the disappearance of a ~25° solar filament in the southern solar hemisphere. The resultant soft X-ray arcade spanned ~90° of solar longitude. The rapid growth of an active region lying at one end of the X-ray arcade appears to have triggered the eruption. This is the largest geomagnetic storm yet associated with the eruption of a quiescent filament. The minimum hourly Dst value of -354 nT on 9 November 1991 compares with a minimum Dst value of -161 nT for the largest 27-day recurrent (coronal hole) storm observed from 1972 to 2005 and the minimum -559 nT value observed during the flare-associated storm of 14 March 1989, the greatest magnetic storm recorded during the space age. Overall, the November 1991 storm ranks 15th on a list of Dst storms from 1905 to 2004, surpassing in intensity such well-known storms as 14 July 1982 (-310 nT) and 15 July 2000 (-317 nT). We used the Cliver et al. and Gopalswamy et al. empirical models of coronal mass ejection propagation in the solar wind to provide consistency checks on the eruption/storm association.

Irreversibility and the Point of No Return in the Evolution of Eruptive Active Regions

NASA Astrophysics Data System (ADS)

Georgoulis, Manolis K.

We combine multiple methods and findings to demonstrate that those eruptive solar active regions that form intense photospheric magnetic polarity inversion lines (PILs) enter a domain of irreversible evolution that will unavoidably force them to erupt at least once, giving rise to a major flare and an associated fast CME. Electric currents, Lorentz forces, free magnetic energy storage, and magnetic helicity, all play major roles in bringing the magnetic configuration on the verge of instability. The inferred irreversibility stems from the conservative properties of magnetic helicity in high magnetic Reynolds-number plasmas. In addition, the long-standing and fiercely debated classification of eruptive magnetic structures into sheared arcades and flux ropes is found to be of relatively little meaning: by means of the evolution above, the simplest possible sheared-arcade structure may gradually evolve into a flux rope susceptible to the helical-kink and the torus instabilities, among other destabilization mechanisms. Research partially supported by the EU Seventh Framework Programme under grant agreement No. PIRG07-GA-2010-268245 and by the European Union Social Fund (ESF) and Greek national funds through the Operational Program "Education and Lifelong Learning" of the National Strategic Reference Framework (NSRF) - Research Funding Program: Thales. Investing in knowledge society through the European Social Fund.

The relationship of metals, bifenthrin, physical habitat metrics, grain size, total organic carbon, dissolved oxygen and conductivity to Hyalella sp. abundance in urban California streams.

PubMed

Hall, Lenwood W; Anderson, Ronald D

2013-01-01

The objectives of this study were to determine the relationship between Hyalella sp. abundance in four urban California streams and the following parameters: (1) 8 bulk metals (As, Cd, Cr, Cu, Pb, Hg, Ni, and Zn) and their associated sediment Threshold Effect Levels (TELs); (2) bifenthrin sediment concentrations; (3) 10 habitat metrics and total score; (4) grain size (% sand, silt and clay); (5) Total Organic Carbon (TOC); (6) dissolved oxygen; and (7) conductivity. California stream data used for this study were collected from Kirker Creek (2006 and 2007), Pleasant Grove Creek (2006, 2007 and 2008), Salinas streams (2009 and 2010) and Arcade Creek (2009 and 2010). Hyalella abundance in the four California streams generally declined when metals concentrations were elevated beyond the TELs. There was also a statistically significant negative relationship between Hyalella abundance and % silt for these 4 California streams as Hyalella were generally not present in silt areas. No statistically significant relationships were reported between Hyalella abundance and metals concentrations, bifenthrin concentrations, habitat metrics, % sand, % clay, TOC, dissolved oxygen and conductivity. The results from this study highlight the complexity of assessing which factors are responsible for determining the abundance of amphipods, such as Hyalella sp., in the natural environment.

Student experiences of participating in five collaborative blended learning courses in Africa and Asia: a survey

PubMed Central

Atkins, Salla; Yan, Weirong; Meragia, Elnta; Mahomed, Hassan; Rosales-Klintz, Senia; Skinner, Donald; Zwarenstein, Merrick

2016-01-01

Background As blended learning (BL; a combination of face-to-face and e-learning methods) becomes more commonplace, it is important to assess whether students find it useful for their studies. ARCADE HSSR and ARCADE RSDH (African Regional Capacity Development for Health Systems and Services Research; Asian Regional Capacity Development for Research on Social Determinants of Health) were unique capacity-building projects, focusing on developing BL in Africa and Asia on issues related to global health. Objective We aimed to evaluate the student experience of participating in any of five ARCADE BL courses implemented collaboratively at institutions from Africa, Asia, and Europe. Design A post-course student survey with 118 students was conducted. The data were collected using email or through an e-learning platform. Data were analysed with SAS, using bivariate and multiple logistic regression. We focused on the associations between various demographic and experience variables and student-reported overall perceptions of the courses. Results In total, 82 students responded to the survey. In bivariate logistic regression, the course a student took [p=0.0067, odds ratio (OR)=0.192; 95% confidence interval (CI): 0.058–0.633], male gender of student (p=0.0474, OR=0.255; 95% CI: 0.066–0.985), not experiencing technical problems (p<0.001, OR=17.286; 95% CI: 4.629–64.554), and reporting the discussion forum as adequate for student needs (p=0.0036, OR=0.165; 95% CI: 0.049–0.555) were found to be associated with a more positive perception of BL, as measured by student rating of the overall helpfulness of the e-learning component to their studies. In contrast, perceiving the assessment as adequate was associated with a worse perception of overall usefulness. In a multiple regression, the course, experiencing no technical problems, and perceiving the discussion as adequate remained significantly associated with a more positively rated perception of the usefulness of the online component of the blended courses. Discussion The results suggest that lack of technical problems and functioning discussion forums are of importance during BL courses focusing on global health-related topics. Through paying attention to these aspects, global health education could be provided using BL approaches to student satisfaction. PMID:27725077

Student experiences of participating in five collaborative blended learning courses in Africa and Asia: a survey.

PubMed

Atkins, Salla; Yan, Weirong; Meragia, Elnta; Mahomed, Hassan; Rosales-Klintz, Senia; Skinner, Donald; Zwarenstein, Merrick

2016-01-01

As blended learning (BL; a combination of face-to-face and e-learning methods) becomes more commonplace, it is important to assess whether students find it useful for their studies. ARCADE HSSR and ARCADE RSDH (African Regional Capacity Development for Health Systems and Services Research; Asian Regional Capacity Development for Research on Social Determinants of Health) were unique capacity-building projects, focusing on developing BL in Africa and Asia on issues related to global health. We aimed to evaluate the student experience of participating in any of five ARCADE BL courses implemented collaboratively at institutions from Africa, Asia, and Europe. A post-course student survey with 118 students was conducted. The data were collected using email or through an e-learning platform. Data were analysed with SAS, using bivariate and multiple logistic regression. We focused on the associations between various demographic and experience variables and student-reported overall perceptions of the courses. In total, 82 students responded to the survey. In bivariate logistic regression, the course a student took [ p =0.0067, odds ratio (OR)=0.192; 95% confidence interval (CI): 0.058-0.633], male gender of student ( p =0.0474, OR=0.255; 95% CI: 0.066-0.985), not experiencing technical problems ( p <0.001, OR=17.286; 95% CI: 4.629-64.554), and reporting the discussion forum as adequate for student needs ( p =0.0036, OR=0.165; 95% CI: 0.049-0.555) were found to be associated with a more positive perception of BL, as measured by student rating of the overall helpfulness of the e-learning component to their studies. In contrast, perceiving the assessment as adequate was associated with a worse perception of overall usefulness. In a multiple regression, the course, experiencing no technical problems, and perceiving the discussion as adequate remained significantly associated with a more positively rated perception of the usefulness of the online component of the blended courses. The results suggest that lack of technical problems and functioning discussion forums are of importance during BL courses focusing on global health-related topics. Through paying attention to these aspects, global health education could be provided using BL approaches to student satisfaction.

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

Takacs, Peter

More than fifty years ago, before either arcades or home video games, visitors waited in line at Brookhaven National Laboratory to play Tennis for Two, an electronic tennis game that is unquestionably a forerunner of the modern video game. Two people played the electronic tennis game with separate controllers that connected to an analog computer and used an oscilloscope for a screen. The game's creator, William Higinbotham, was a physicist who lobbied for nuclear nonproliferation as the first chair of the Federation of American Scientists.

The Width of a CME and the Source of the Driving Magnetic Explosion

NASA Technical Reports Server (NTRS)

Moore, R. L.; Sterling, A. C.; Suess, S. T.

2007-01-01

We show that the strength of the magnetic field in the area covered by the flare arcade following a CME-producing ejective solar eruption can be estimated from the final angular width of the CME in the outer corona and the final angular width of the flare arcade. We assume (1) the flux-rope plasmoid ejected from the flare site becomes the interior of the CME plasmoid, (2) in the outer corona the CME is roughly a "spherical plasmoid with legs" shaped like a light bulb, and (3) beyond some height in or below the outer corona the CME plasmoid is in lateral pressure balance with the surrounding magnetic field. The strength of the nearly radial magnetic field in the outer corona is estimated from the radial component of the interplanetary magnetic field measured by Ulysses. We apply this model to three well-observed CMEs that exploded from flare regions of extremely different size and magnetic setting. In each event, the estimated source-region field strength is appropriate for the magnetic setting of the flare. This agreement indicates via the model that CMEs (1) are propelled by the magnetic field of the CME plasmoid pushing against the surrounding magnetic field, and (2) can explode from flare regions that are laterally far offset from the radial path of the CME in the outer corona.

Observing Formation of Flux Rope by Tether-cutting Reconnection in the Sun

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

Xue, Zhike; Yan, Xiaoli; Yang, Liheng

Tether-cutting reconnection is considered as one mechanism for the formation of a flux rope. It has been proposed for more than 30 years; however, so far, direct observations of it are very rare. In this Letter, we present observations of the formation of a flux rope via tether-cutting reconnection in NOAA AR 11967 on 2014 February 2 by combining observations with the New Vacuum Solar Telescope and the Solar Dynamic Observatory . The tether-cutting reconnection occurs between two sets of highly sheared magnetic arcades. Comprehensive observational evidence of the reconnection is as follows: changes of the connections between the arcades,more » brightenings at the reconnection site, hot outflows, formation of a flux rope, slow-rise motion of the flux rope, and flux cancelation. The outflows are along three directions from the reconnection site to the footpoints with the velocities from 24 ± 1 km s{sup −1} to 69 ± 5 km s{sup −1}. Additionally, it is found that the newly formed flux rope connects far footpoints and has a left-handed twisted structure with many fine threads and a concave-up-shape structure in the middle. All the observations are in agreement with the tether-cutting model and provide evidence that tether-cutting reconnection leads to the formation of the flux rope associated with flux shear flow and cancelation.« less

Dichotomy of X-Ray Jets in Solar Coronal Holes

NASA Astrophysics Data System (ADS)

Robe, D. M.; Moore, R. L.; Falconer, D. A.

2012-12-01

It has been found that there are two different types of X-ray jets observed in the Sun's polar coronal holes: standard jets and blowout jets. A proposed model of this dichotomy is that a standard jet is produced by a burst of reconnection of the ambient magnetic field with the opposite-polarity leg of the base arcade. In contrast, it appears that a blowout jet is produced when the interior of the arcade has so much pent-up free magnetic energy in the form of shear and twist in the interior field that the external reconnection unleashes the interior field to erupt open. In this project, X-ray movies of the polar coronal holes taken by Hinode were searched for X-ray jets. Co-temporal movies taken by the Solar Dynamics Observatory in 304 Å emission from He II, showing solar plasma at temperatures around 80,000 K, were examined for whether the identified blowout jets carry much more He II plasma than the identified standard jets. It was found that though some jets identified as standard from the X-ray movies could be seen in the He II 304 Å movies, the blowout jets carried much more 80,000 K plasma than did most standard jets. This finding supports the proposed model for the morphology and development of the two types of jets.

First Video Game

ScienceCinema

Takacs, Peter

2018-06-21

More than fifty years ago, before either arcades or home video games, visitors waited in line at Brookhaven National Laboratory to play Tennis for Two, an electronic tennis game that is unquestionably a forerunner of the modern video game. Two people played the electronic tennis game with separate controllers that connected to an analog computer and used an oscilloscope for a screen. The game's creator, William Higinbotham, was a physicist who lobbied for nuclear nonproliferation as the first chair of the Federation of American Scientists.

Reconnection Outflows in the Extended Corona and Magnetotail

NASA Astrophysics Data System (ADS)

Savage, Sabrina; Kobelski, Adam

2017-08-01

Observational signatures of reconnection have been studied extensively in the lower corona for decades, successfully providing insight into energy release mechanisms in the region above post-flare arcade loops and below 1.5 solar radii. During large eruptive events, however, energy release continues to occur well beyond the presence of reconnection signatures at these low heights. Supra-arcade downflows (SADs) and downflowing loops (SADLs) are particularly useful measures of continual reconnection in the corona as they may indicate the presence and path of retracting post-reconnection loops. SADs and SADLs have been observed for days beyond the passage of corona mass ejections through the SOHO/LASCO field of view and for nearly a week after an eruption on 14 October 2014. The association of these features with magnetic reconnection increases the significance of understanding their genesis. SADs have been interpreted as wakes behind newly reconnected and outflowing loops (SADLs). Models have shown the plausibility of this interpretation, though this interpretation has not yet been fully accepted. We will present a preliminary study of complementary observations of magnetic reconnection detected via in situ instruments in the magnetosphere. These observations, provided by five THEMIS spacecraft, reveal similar structures and conditions to those related to SADs. We compare data from multiple SADs and dipolarization fronts to test the similarity between these plasma regimes, strongly favoring the interpretation of SADs as instabilities trailing retracting loops. We will also use these observations to strengthen the case for the development of an EUV wide-field coronal imager.

An interpretation of flare-induced and decayless coronal-loop oscillations as interference patterns

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

Hindman, Bradley W.; Jain, Rekha, E-mail: hindman@solarz.colorado.edu

2014-04-01

We present an alternative model of coronal-loop oscillations, which considers that the waves are trapped in a two-dimensional waveguide formed by the entire arcade of field lines. This differs from the standard one-dimensional model which treats the waves as the resonant oscillations of just the visible bundle of field lines. Within the framework of our two-dimensional model, the two types of oscillations that have been observationally identified, flare-induced waves and 'decayless' oscillations, can both be attributed to MHD fast waves. The two components of the signal differ only because of the duration and spatial extent of the source that createsmore » them. The flare-induced waves are generated by strong localized sources of short duration, while the decayless background can be excited by a continuous, stochastic source. Further, the oscillatory signal arising from a localized, short-duration source can be interpreted as a pattern of interference fringes produced by waves that have traveled diverse routes of various pathlengths through the waveguide. The resulting amplitude of the fringes slowly decays in time with an inverse square root dependence. The details of the interference pattern depend on the shape of the arcade and the spatial variation of the Alfvén speed. The rapid decay of this wave component, which has previously been attributed to physical damping mechanisms that remove energy from resonant oscillations, occurs as a natural consequence of the interference process without the need for local dissipation.« less

Flare Ribbons Approach Observed by the Interface Region Imaging Spectrograph and the Solar Dynamics Observatory

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

Li, Ting; Zhang, Jun; Hou, Yijun, E-mail: liting@nao.cas.cn

We report flare ribbons approach (FRA) during a multiple-ribbon M-class flare on 2015 November 4 in NOAA AR 12443, obtained by the Interface Region Imaging Spectrograph and the Solar Dynamics Observatory. The flare consisted of a pair of main ribbons and two pairs of secondary ribbons. The two pairs of secondary ribbons were formed later than the appearance of the main ribbons, with respective time delays of 15 and 19 minutes. The negative-polarity main ribbon spread outward faster than the first secondary ribbon with the same polarity in front of it, and thus the FRA was generated. Just before theirmore » encounter, the main ribbon was darkening drastically and its intensity decreased by about 70% in 2 minutes, implying the suppression of main-phase reconnection that produced two main ribbons. The FRA caused the deflection of the main ribbon to the direction of secondary ribbon with a deflection angle of about 60°. A post-approach arcade was formed about 2 minutes later and the downflows were detected along the new arcade with velocities of 35–40 km s{sup −1}, indicative of the magnetic restructuring during the process of FRA. We suggest that there are three topological domains with footpoints outlined by the three pairs of ribbons. Close proximity of these domains leads to deflection of the ribbons, which is in agreement with the magnetic field topology.« less

Study of Three-dimensional Magnetic Structure and the Successive Eruptive Nature of Active Region 12371

NASA Astrophysics Data System (ADS)

Vemareddy, P.; Demóulin, P.

2018-04-01

We study the magnetic structure of a successively erupting sigmoid in active region 12371 by modeling the quasi-static coronal field evolution with nonlinear force-free field (NLFFF) equilibria. Helioseismic and Magnetic Imager/Solar Dynamic Observatory vector magnetograms are used as input to the NLFFF model. In all eruption events, the modeled structure resembles the observed pre-eruptive coronal sigmoid and the NLFFF core field is a combination of double inverse-J-shaped and inverse-S field lines with dips touching the photosphere. Such field lines are formed by the flux cancellation reconnection of opposite-J field lines at bald-patch locations, which in turn implies the formation of a weakly twisted flux-rope (FR) from large-scale sheared arcade field lines. Later on, this FR undergoes coronal tether-cutting reconnection until a coronal mass ejection is triggered. The modeled structure captured these major features of sigmoid-to-arcade-to-sigmoid transformation, which is reoccuring under continuous photospheric flux motions. Calculations of the field line twist reveal a fractional increase followed by a decrease of the number of pixels having a range of twist. This traces the buildup process of a twisted core field by slow photospheric motions and the relaxation after eruption, respectively. Our study infers that the large eruptivity of this AR is due to a steep decrease of the background coronal field meeting the torus instability criteria at a low height (≈40 Mm) in contrast to noneruptive ARs.

NUMERICAL STUDY ON IN SITU PROMINENCE FORMATION BY RADIATIVE CONDENSATION IN THE SOLAR CORONA

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

Kaneko, T.; Yokoyama, T., E-mail: kaneko@eps.s.u-tokyo.ac.jp

2015-06-10

We propose an in situ formation model for inverse-polarity solar prominences and demonstrate it using self-consistent 2.5 dimensional MHD simulations, including thermal conduction along magnetic fields and optically thin radiative cooling. The model enables us to form cool dense plasma clouds inside a flux rope by radiative condensation, which is regarded as an inverse-polarity prominence. Radiative condensation is triggered by changes in the magnetic topology, i.e., formation of the flux rope from the sheared arcade field, and by thermal imbalance due to the dense plasma trapped inside the flux rope. The flux rope is created by imposing converging and shearingmore » motion on the arcade field. Either when the footpoint motion is in the anti-shearing direction or when heating is proportional to local density, the thermal state inside the flux rope becomes cooling-dominant, leading to radiative condensation. By controlling the temperature of condensation, we investigate the relationship between the temperature and density of prominences and derive a scaling formula for this relationship. This formula suggests that the proposed model reproduces the observed density of prominences, which is 10–100 times larger than the coronal density. Moreover, the time evolution of the extreme ultraviolet emission synthesized by combining our simulation results with the response function of the Solar Dynamics Observatory Atmospheric Imaging Assembly filters agrees with the observed temporal and spatial intensity shift among multi-wavelength extreme ultraviolet emission during in situ condensation.« less

Conditions for the formation of prominences as inferred from optical observations

NASA Technical Reports Server (NTRS)

Martin, Sara F.

1990-01-01

It is suggested that three conditions, if dynamically maintained for a sufficient period of time, will result in the formation of a solar prominence. These conditions are the presence of a coronal arcade that connects the magnetic fields on opposite sides of a prominence; the existence of a long-term (hours to days) converging flow of small patches of opposite-polarity magnetic flux toward a common-polarity inversion zone; and the cancellation of encountered patches of magnetic flux of opposite polarity at a photospheric polarity inversion boundary.

Global Network of Slow Solar Wind

NASA Technical Reports Server (NTRS)

Crooker, N. U.; Antiochos, S. K.; Zhao, X.; Neugebauer, M.

2012-01-01

The streamer belt region surrounding the heliospheric current sheet (HCS) is generally treated as the primary or sole source of the slow solar wind. Synoptic maps of solar wind speed predicted by the Wang-Sheeley-Arge model during selected periods of solar cycle 23, however, show many areas of slow wind displaced from the streamer belt. These areas commonly have the form of an arc that is connected to the streamer belt at both ends. The arcs mark the boundaries between fields emanating from different coronal holes of the same polarity and thus trace the paths of belts of pseudostreamers, i.e., unipolar streamers that form over double arcades and lack current sheets. The arc pattern is consistent with the predicted topological mapping of the narrow open corridor or singular separator line that must connect the holes and, thus, consistent with the separatrix-web model of the slow solar wind. Near solar maximum, pseudostreamer belts stray far from the HCS-associated streamer belt and, together with it, form a global-wide web of slow wind. Recognition of pseudostreamer belts as prominent sources of slow wind provides a new template for understanding solar wind stream structure, especially near solar maximum.

Automated detection of retinal landmarks for the identification of clinically relevant regions in fundus photography

NASA Astrophysics Data System (ADS)

Ometto, Giovanni; Calivá, Francesco; Al-Diri, Bashir; Bek, Toke; Hunter, Andrew

2016-03-01

Automatic, quick and reliable identification of retinal landmarks from fundus photography is key for measurements used in research, diagnosis, screening and treating of common diseases affecting the eyes. This study presents a fast method for the detection of the centre of mass of the vascular arcades, optic nerve head (ONH) and fovea, used in the definition of five clinically relevant areas in use for screening programmes for diabetic retinopathy (DR). Thirty-eight fundus photographs showing 7203 DR lesions were analysed to find the landmarks manually by two retina-experts and automatically by the proposed method. The automatic identification of the ONH and fovea were performed using template matching based on normalised cross correlation. The centre of mass of the arcades was obtained by fitting an ellipse on sample coordinates of the main vessels. The coordinates were obtained by processing the image with hessian filtering followed by shape analyses and finally sampling the results. The regions obtained manually and automatically were used to count the retinal lesions falling within, and to evaluate the method. 92.7% of the lesions were falling within the same regions based on the landmarks selected by the two experts. 91.7% and 89.0% were counted in the same areas identified by the method and the first and second expert respectively. The inter-repeatability of the proposed method and the experts is comparable, while the 100% intra-repeatability makes the algorithm a valuable tool in tasks like analyses in real-time, of large datasets and of intra-patient variability.

Onset of the Magnetic Explosion in Solar Polar Coronal X-Ray Jets

NASA Astrophysics Data System (ADS)

Moore, Ronald L.; Sterling, Alphonse C.; Panesar, Navdeep K.

2018-05-01

We follow up on the Sterling et al. discovery that nearly all polar coronal X-ray jets are made by an explosive eruption of a closed magnetic field carrying a miniature filament in its core. In the same X-ray and EUV movies used by Sterling et al., we examine the onset and growth of the driving magnetic explosion in 15 of the 20 jets that they studied. We find evidence that (1) in a large majority of polar X-ray jets, the runaway internal/tether-cutting reconnection under the erupting minifilament flux rope starts after both the minifilament’s rise and the spire-producing external/breakout reconnection have started; and (2) in a large minority, (a) before the eruption starts, there is a current sheet between the explosive closed field and the ambient open field, and (b) the eruption starts with breakout reconnection at that current sheet. The variety of event sequences in the eruptions supports the idea that the magnetic explosions that make polar X-ray jets work the same way as the much larger magnetic explosions that make a flare and coronal mass ejection (CME). That idea and recent observations indicating that magnetic flux cancellation is the fundamental process that builds the field in and around the pre-jet minifilament and triggers that field’s jet-driving explosion together suggest that flux cancellation inside the magnetic arcade that explodes in a flare/CME eruption is usually the fundamental process that builds the explosive field in the core of the arcade and triggers that field’s explosion.

THE NAKED EMERGENCE OF SOLAR ACTIVE REGIONS OBSERVED WITH SDO/HMI

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

Centeno, Rebecca

We take advantage of the HMI/SDO instrument to study the naked emergence of active regions (ARs) from the first imprints of the magnetic field on the solar surface. To this end, we followed the first 24 hr in the life of two rather isolated ARs that appeared on the surface when they were about to cross the central meridian. We analyze the correlations between Doppler velocities and the orientation of the vector magnetic field, consistent finding that the horizontal fields connecting the main polarities are dragged to the surface by relatively strong upflows and are associated with elongated granulation thatmore » is, on average, brighter than its surroundings. The main magnetic footpoints, on the other hand, are dominated by vertical fields and downflowing plasma. The appearance of moving dipolar features (MDFs, of opposite polarity to that of the AR) in between the main footpoints is a rather common occurrence once the AR reaches a certain size. The buoyancy of the fields is insufficient to lift up the magnetic arcade as a whole. Instead, weighted by the plasma that it carries, the field is pinned down to the photosphere at several places in between the main footpoints, giving life to the MDFs and enabling channels of downflowing plasma. MDF poles tend to drift toward each other, merge and disappear. This is likely to be the signature of a reconnection process in the dipped field lines, which relieves some of the weight allowing the magnetic arcade to finally rise beyond the detection layer of the Helioseismic and Magnetic Imager spectral line.« less

The initiation of coronal mass ejections by newly emerging magnetic flux

NASA Technical Reports Server (NTRS)

Feynman, J.; Martin, S. F.

1995-01-01

We present observational evidence that eruptions of quiescent filaments and associated coronal mass ejections (CMEs) occur as a consequence of the destabilization of large-scale coronal arcades due to interactions between these structures and new and growing active regions. Both statistical and case studies have been carried out. In a case study of a 'bulge' observed by the High-Altitude Observatory Solar Maximum Mission coronagraph, the high-resolution magnetograms from the Big Bear Solar Observatory show newly emerging and rapidly changing flux in the magnetic fields that apparently underlie the bugle. For other case studies and in the statistical work the eruption of major quiescent filaments was taken as a proxy for CME eruption. We have found that two thirds of the quiescent-filament-associated CMEs occurred after substantial amounts of new magnetic flux emerged in the vicinity of the filament. In addition, in a study of all major quiescent filaments and active regions appearing in a 2-month period we found that 17 of the 22 filaments that were associated with new active regions erupted and 26 of the 31 filaments that were not associated with new flux did not erupt. In all cases in which the new flux was oriented favorably for reconnection with the preexisting large-scale coronal arcades; the filament was observed to erupt. The appearance of the new flux in the form of new active regions begins a few days before the eruption and typically is still occurring at the time of the eruption. A CME initiation scenario taking account of these observational results is proposed.

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

Howard, T. A.; DeForest, C. E., E-mail: howard@boulder.swri.edu

We present a data-driven narrative of the launch and early evolution of the magnetic structure that gave rise to the coronal mass ejection (CME) on 2008 December 12. The structure formed on December 7 and launched early on December 12. We interpret this structure as a flux rope based on prelaunch morphology, postlaunch magnetic measurements, and the lack of large-scale magnetic reconnection signatures at launch. We ascribe three separate onset mechanisms to the complete disconnection of the flux rope from the Sun. It took 19 hr for the flux rope to be fully removed from the Sun, by which timemore » the segment that first disconnected was around 40 R {sub ☉} away. This implies that the original flux rope was stretched or broken; we provide evidence for a possible bisection. A transient dark arcade was observed on the Sun that was later obscured by a bright arcade, which we interpret as the strapping field stretching and magnetically reconnecting as it disconnected from the coronal field. We identify three separate structures in coronagraph images to be manifestations of the same original flux rope, and we describe the implications for CME interpretation. We cite the rotation in the central flux rope vector of the magnetic clouds observed in situ by ACE/Wind and STEREO-B as evidence of the kink instability of the eastern segment of the flux rope. Finally, we discuss possible alternative narratives, including multiple prelaunch magnetic structures and the nonflux rope scenario. Our results support the view that, in at least some CMEs, flux rope formation occurs before launch.« less

Culture and Creativity: World of Warcraft Modding in China and the US

NASA Astrophysics Data System (ADS)

Kow, Yong Ming; Nardi, Bonnie

Modding - end-user modification of commercial hardware and software - can be traced back at least to 1961 when Spacewar! was developed by a group of MIT students on a DEC PDP-1. Spacewar! evolved into arcade games including Space Wars produced in 1977 by Cinematronics (Sotamaa 2003). In 1992, players altering Wolfenstein 3-D (1992), a first person shooter game made by id Software, overwrote the graphics and sounds by editing the game files. Learning from this experience, id Software released Doom in 1993 with isolated media files and open source code for players to develop custom maps, images, sounds, and other utilities. Players were able to pass on their modifications to others. By 1996, with the release of Quake, end-user modifications had come to be known as "mods," and modding was an accepted part of the gaming community (Kucklich 2005; Postigo 2008a, b). Since late-2005, we have been studying World of Warcraft (WoW) in which the use of mods is an important aspect of player practice (Nardi and Harris 2006; Nardi et al. 2007). Technically minded players with an interest in extending the game write mods and make them available to players for free download on distribution sites. Most modders work for free, but the distribution sites are commercial enterprises with advertising.

Dental evidence for wild tuber processing among Titicaca Basin foragers 7000 ybp.

PubMed

Watson, James T; Haas, Randall

2017-09-01

The objective of this work is to characterize dental wear in a skeletal sample dating to the Middle/Late Archaic period transition (8,000-6,700 cal. B.P.) from the Lake Titicaca Basin, Peru to better define subsistence behaviors of foragers prior to incipient sedentism and food production. The dental sample consists of 251 teeth from 11 individuals recovered from the site of Soro Mik'aya Patjxa (SMP), the earliest securely dated burial assemblage in the Lake Titicaca Basin and the only burial assemblage in the region from an unequivocal forager context. Occlusal surface wear was quantified according to Smith (1984) and Scott (1979a) to characterize diversity within the site and to facilitate comparison with other foraging groups worldwide. General linear modeling was used to assess observation error and principal axis analysis was used to compare molar wear rates and angles. Teeth were also examined for caries and specialized wear. Occlusal surface attrition is generally heavy across the dental arcade and tends to be flat among posterior teeth. Only one carious lesion was observed. Five of the 11 individuals exhibit lingual surface attrition of the maxillary anterior teeth (LSAMAT). Tooth wear rates, molar wear plane, and caries rates are consistent with terrestrial foraging and a diverse diet. The presence of LSAMAT indicates tuber processing. The results therefore contribute critical new data toward our understanding of forager diet in the Altiplano prior to plant and animal domestication in the south-central Andes. © 2017 Wiley Periodicals, Inc.

Revisiting Absolute Radio Backgrounds in Light of Juno Cruise Data

NASA Astrophysics Data System (ADS)

Chang, Tzu-Ching

Radio backgrounds have played a critical role in recent progress in astronomy and cosmology. Major amongst them, the Cosmic Microwave Background (CMB) is currently our most precise window on the physics of the early universe. Both its near perfect blackbody spectrum and its angular fluctuations led to unique cosmological inferences. Beyond the CMB, radio backgrounds have offered golden insights to Galactic and extragalactic astrophysics. In this proposal, we take note of the recently released "cruise data" collected over five years by the MicroWave Radiometer (MWR) instrument on board the Juno planetary mission to construct new, unprecedented and well-characterized full-sky maps at 6 frequencies ranging from 0.6 to 22 GHz. We propose to generate, validate and release these full-sky maps and investigate their rich and unique astrophysical implications. In particular, we expect the use of Juno data to shed light on the "ARCADE excess" and lead to new insights on Galactic and extragalactic radio signals. Over the past several years, evidence indicating the existence of a significant isotropic radio background has been hinted at by a number of instruments. In 2011, the Absolute Radiometer for Cosmology, Astrophysics and Diffuse Emission (ARCADE 2) collaboration reported measurements of the absolute sky temperature at a number of frequencies between 3 and 90 GHz (Fixsen et al. 2011). While these measurements are dominated by the CMB at frequencies above several GHz, they reveal the presence of significant excess power at the lowest measured frequencies (Seiffert et al. 2011). This conclusion is strengthened by a number of observations at lower frequencies, reported at 22 MHz, 45 MHz, 408 MHz and 1.42 GHz: the emission observed by each of these groups appears to be in significant excess to what can be attributed to Galactic emission, or to unresolved members of known extragalactic radio source populations. In addition, it appears to be anomalously spatially smooth to be extragalactic. Six years after the report of this excess, this situation remains unsettled and has not evolved due to the lack of new observations at these frequencies. For this reason, and for the intrinsic value of the unprecedented full-sky maps, the astrophysics impact of MWR Juno cruise observations will be very important. Our program will be articulated along five projects (labeled P1 to P5), loosely corresponding to research papers: (P1) We will generate well characterized full-sky maps at the Juno MWR six frequencies starting from the timestream data, released in September 2016 on the Planetary Data System (PDS) archive. We will validate these maps using cross-correlations with WMAP and Planck public maps at low frequencies. We will release our maps to the community via the NASA LAMBDA archive. This analysis will set the basis for the following projects. (P2) We will investigate the implication of these new maps for foreground modeling with a focus on CMB foreground separation. This analysis will be performed jointly with now standard WMAP and Planck component separation tools and products. (P3) We will investigate the implication of these new maps for foreground modeling with a focus on radio 21 cm intensity mapping signals, extending in the process current community foreground models. This analysis will be improve our understanding and characterization of radio foregrounds, and guide current and future redshifted 21 cm line mapping experiments. (P4) Using the above maps, we will revisit the ARCADE excess and perform absolute temperature measurement of the extragalactic radio backgrounds at multiple frequencies and angular positions over the sky. (P5) Using the above maps, we will revisit the ARCADE excess and perform absolute temperature measurement of the Galactic radio backgrounds at multiple frequencies and angular positions in the Galactic plane, using multiple other line surveys to guide our interpretation.

Evolution and Activity in the Solar Corona: A Comparison of Coronal and Chromospheric Structures Seen in Soft X-Rays, White Light and H-Alpha Emission

NASA Technical Reports Server (NTRS)

Bagenal, Fran

2001-01-01

The work completed under this project, 'Evolution and Activity in the Solar Corona: A Comparison of Coronal and Chromospheric Structures Seen in Soft X-Rays, White Light and H-Alpha Emission', includes the following presentations: (1) Analysis of H-alpha Observations of High-altitude Coronal Condensations; (2) Multi-spectral Imaging of Coronal Activity; (3) Measurement and Modeling of Soft X-ray Loop Arcades; (4) A Study of the Origin and Dynamics of CMEs; and various poster presentations and thesis dissertations.

Retinal phlebitis associated with autoimmune hemolytic anemia.

PubMed

Chew, Fiona L M; Tajunisah, Iqbal

2009-01-01

To describe a case of retinal phlebitis associated with autoimmune hemolytic anemia. Observational case report. A 44-year-old Indian man diagnosed with autoimmune hemolytic anemia presented with a 1-week history of blurred vision in both eyes. Fundus biomicroscopy revealed bilateral peripheral retinal venous sheathing and cellophane maculopathy. Fundus fluorescent angiogram showed bilateral late leakage from the peripheral venous arcades and submacular fluid accumulation. The retinal phlebitis resolved following a blood transfusion and administration of systemic steroids. Retinopathy associated with autoimmune hemolytic anemia is not well known. This is thought to be the first documentation of retinal phlebitis occurring in this condition.

Multipurpose Arcade Combat Simulator (MACS) Basic Rifle Marksmanship (BRM) Program

DTIC Science & Technology

1989-10-01

that shooters are aiming at the center of mass of each target to the best of their abilities. It then computes the central point of the three-round shot...group, measures the distance between this central point and the actual center of the target, and uses this distance as a constant offset value, which...WAE LIto, SIT 3 CLA HO CHANGE 151100 CM? $111 ,10-Im6%AAG ISE LEST30 IF$ SCREEN OCO ias NEXT 2 syltJ4 NSK L91T1)S Olt ?ILA ,r6 SORDERA COLo0 410 Ltx7 2

Stable gastric pentadecapeptide BPC 157 in the treatment of colitis and ischemia and reperfusion in rats: New insights.

PubMed

Duzel, Antonija; Vlainic, Josipa; Antunovic, Marko; Malekinusic, Dominik; Vrdoljak, Borna; Samara, Mariam; Gojkovic, Slaven; Krezic, Ivan; Vidovic, Tinka; Bilic, Zdenko; Knezevic, Mario; Sever, Marko; Lojo, Nermin; Kokot, Antonio; Kolovrat, Marijan; Drmic, Domagoj; Vukojevic, Jaksa; Kralj, Tamara; Kasnik, Katarina; Siroglavic, Marko; Seiwerth, Sven; Sikiric, Predrag

2017-12-28

To provide new insights in treatment of colitis and ischemia and reperfusion in rats using stable gastric pentadecapeptide BPC 157. Medication [BPC 157, L-NAME, L-arginine (alone/combined), saline] was bath at the blood deprived colon segment. During reperfusion, medication was BPC 157 or saline. We recorded (USB microscope camera) vessel presentation through next 15 min of ischemic colitis (IC-rats) or reperfusion (removed ligations) (IC + RL-rats); oxidative stress as MDA (increased (IC- and IC + RL-rats)) and NO levels (decreased (IC-rats); increased (IC + RL-rats)) in colon tissue. IC + OB-rats [IC-rats had additional colon obstruction (OB)] for 3 d (IC + OB-rats), then received BPC 157 bath. Commonly, in colon segment (25 mm, 2 ligations on left colic artery and vein, 3 arcade vessels within ligated segment), in IC-, IC + RL-, IC + OB-rats, BPC 157 (10 μg/kg) bath (1 mL/rat) increased vessel presentation, inside/outside arcade interconnections quickly reappeared, mucosal folds were preserved and the pale areas were small and markedly reduced. BPC 157 counteracted worsening effects induced by L-NAME (5 mg) and L-arginine (100 mg). MDA- and NO-levels were normal in BPC 157 treated IC-rats and IC + RL-rats. In addition, on day 10, BPC 157-treated IC + OB-rats presented almost completely spared mucosa with very small pale areas and no gross mucosal defects; the treated colon segment was of normal diameter, and only small adhesions were present. BPC 157 is a fundamental treatment that quickly restores blood supply to the ischemically injured area and rapidly activates collaterals. This effect involves the NO system.

Stable gastric pentadecapeptide BPC 157 in the treatment of colitis and ischemia and reperfusion in rats: New insights

PubMed Central

Duzel, Antonija; Vlainic, Josipa; Antunovic, Marko; Malekinusic, Dominik; Vrdoljak, Borna; Samara, Mariam; Gojkovic, Slaven; Krezic, Ivan; Vidovic, Tinka; Bilic, Zdenko; Knezevic, Mario; Sever, Marko; Lojo, Nermin; Kokot, Antonio; Kolovrat, Marijan; Drmic, Domagoj; Vukojevic, Jaksa; Kralj, Tamara; Kasnik, Katarina; Siroglavic, Marko; Seiwerth, Sven; Sikiric, Predrag

2017-01-01

AIM To provide new insights in treatment of colitis and ischemia and reperfusion in rats using stable gastric pentadecapeptide BPC 157. METHODS Medication [BPC 157, L-NAME, L-arginine (alone/combined), saline] was bath at the blood deprived colon segment. During reperfusion, medication was BPC 157 or saline. We recorded (USB microscope camera) vessel presentation through next 15 min of ischemic colitis (IC-rats) or reperfusion (removed ligations) (IC + RL-rats); oxidative stress as MDA (increased (IC- and IC + RL-rats)) and NO levels (decreased (IC-rats); increased (IC + RL-rats)) in colon tissue. IC + OB-rats [IC-rats had additional colon obstruction (OB)] for 3 d (IC + OB-rats), then received BPC 157 bath. RESULTS Commonly, in colon segment (25 mm, 2 ligations on left colic artery and vein, 3 arcade vessels within ligated segment), in IC-, IC + RL-, IC + OB-rats, BPC 157 (10 μg/kg) bath (1 mL/rat) increased vessel presentation, inside/outside arcade interconnections quickly reappeared, mucosal folds were preserved and the pale areas were small and markedly reduced. BPC 157 counteracted worsening effects induced by L-NAME (5 mg) and L-arginine (100 mg). MDA- and NO-levels were normal in BPC 157 treated IC-rats and IC + RL-rats. In addition, on day 10, BPC 157-treated IC + OB-rats presented almost completely spared mucosa with very small pale areas and no gross mucosal defects; the treated colon segment was of normal diameter, and only small adhesions were present. CONCLUSION BPC 157 is a fundamental treatment that quickly restores blood supply to the ischemically injured area and rapidly activates collaterals. This effect involves the NO system. PMID:29358856

THE MAGNETIC SYSTEMS TRIGGERING THE M6.6 CLASS SOLAR FLARE IN NOAA ACTIVE REGION 11158

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

Toriumi, Shin; Iida, Yusuke; Bamba, Yumi

2013-08-20

We report a detailed event analysis of the M6.6 class flare in the active region (AR) NOAA 11158 on 2011 February 13. AR 11158, which consisted of two major emerging bipoles, showed prominent activity including one X- and several M-class flares. In order to investigate the magnetic structures related to the M6.6 event, particularly the formation process of a flare-triggering magnetic region, we analyzed multiple spacecraft observations and numerical results of a flare simulation. We observed that, in the center of this quadrupolar AR, a highly sheared polarity inversion line (PIL) was formed through proper motions of the major magneticmore » elements, which built a sheared coronal arcade lying over the PIL. The observations lend support to the interpretation that the target flare was triggered by a localized magnetic region that had an intrusive structure, namely, a positive polarity penetrating into a negative counterpart. The geometrical relationship between the sheared coronal arcade and the triggering region is consistent with the theoretical flare model based on the previous numerical study. We found that the formation of the trigger region was due to the continuous accumulation of small-scale magnetic patches. A few hours before the flare occurred, the series of emerged/advected patches reconnected with a pre-existing field. Finally, the abrupt flare eruption of the M6.6 event started around 17:30 UT. Our analysis suggests that in the process of triggering flare activity, all magnetic systems on multiple scales are included, not only the entire AR evolution but also the fine magnetic elements.« less

The experiences of lecturers in African, Asian and European universities in preparing and delivering blended health research methods courses: a qualitative study

PubMed Central

Protsiv, Myroslava; Atkins, Salla

2016-01-01

Background Growing demand for Global Health (GH) training and the internationalisation of education requires innovative approaches to training. Blended learning (BL, a form of e-learning combining face-to-face or real-time interaction with computer-assisted learning) is a promising approach for increasing GH research capacity in low- to middle-income countries. Implementing BL, however, requires additional skills and efforts from lecturers. This paper explores lecturers’ views and experiences of delivering BL courses within the context of two north–south collaborative research capacity building projects, ARCADE HSSR and ARCADE RSDH. Design We used a qualitative approach to explore the experiences and perceptions of 11 lecturers involved in designing and delivering BL courses collaboratively across university campuses in four countries (South Africa, Uganda, India and Sweden). Data were collected using interviews in person or via Skype. Inductive qualitative content analysis was used. Results Participants reported that they felt BL increased access to learning opportunities and made training more flexible and convenient for adult learners, which were major motivations to engage in BL. However, despite eagerness to implement and experiment with BL courses, they lacked capacity and support, and found the task time consuming. They needed to make compromises between course objectives and available technological tools, in the context of poor Internet infrastructure. Conclusions BL courses have the potential to build bridges between low- and middle-income contexts and between lecturers and students to meet the demand for GH training. Lecturers were very motivated to try these approaches but encountered obstacles in implementing BL courses. Considerable investments are needed to implement BL and support lecturers in delivering courses. PMID:27725078

The experiences of lecturers in African, Asian and European universities in preparing and delivering blended health research methods courses: a qualitative study.

PubMed

Protsiv, Myroslava; Atkins, Salla

2016-01-01

Growing demand for Global Health (GH) training and the internationalisation of education requires innovative approaches to training. Blended learning (BL, a form of e-learning combining face-to-face or real-time interaction with computer-assisted learning) is a promising approach for increasing GH research capacity in low- to middle-income countries. Implementing BL, however, requires additional skills and efforts from lecturers. This paper explores lecturers' views and experiences of delivering BL courses within the context of two north-south collaborative research capacity building projects, ARCADE HSSR and ARCADE RSDH. We used a qualitative approach to explore the experiences and perceptions of 11 lecturers involved in designing and delivering BL courses collaboratively across university campuses in four countries (South Africa, Uganda, India and Sweden). Data were collected using interviews in person or via Skype. Inductive qualitative content analysis was used. Participants reported that they felt BL increased access to learning opportunities and made training more flexible and convenient for adult learners, which were major motivations to engage in BL. However, despite eagerness to implement and experiment with BL courses, they lacked capacity and support, and found the task time consuming. They needed to make compromises between course objectives and available technological tools, in the context of poor Internet infrastructure. BL courses have the potential to build bridges between low- and middle-income contexts and between lecturers and students to meet the demand for GH training. Lecturers were very motivated to try these approaches but encountered obstacles in implementing BL courses. Considerable investments are needed to implement BL and support lecturers in delivering courses.

Inflows in the Inner White-light Corona: The Closing-down of Flux after Coronal Mass Ejections

NASA Astrophysics Data System (ADS)

Hess, P.; Wang, Y.-M.

2017-11-01

During times of high solar activity, the Solar and Heliospheric Observatory/Large Angle and Spectrometric Coronagraph C2 coronagraph has recorded multitudes of small features moving inward through its 2{--}6 {R}⊙ field of view. These outer-coronal inflows, which are concentrated around the heliospheric current sheet, tend to be poorly correlated with individual coronal mass ejection (CME) events. Using running-difference movies constructed from Solar Terrestrial Relations Observatory/COR1 coronagraph images taken during 2008-2014, we have identified large numbers of inward-moving features at heliocentric distances below 2 {R}⊙ , with the rate increasing with sunspot and CME activity. Most of these inner-coronal inflows are closely associated with CMEs, being observed during and in the days immediately following the eruptions. Here, we describe several examples of the pinching-off of tapered streamer structures in the wake of CMEs. This type of inflow event is characterized by a separation of the flow into incoming and outgoing components connected by a thin spike, which is interpreted as a continually elongating current sheet viewed edge-on; by the prior convergence of narrow rays toward the current sheet; and by a succession of collapsing loops that form a cusp-shaped structure at the base of the current sheet. The re-forming streamer overlies a growing post-eruption arcade that is visible in EUV images. These observations provide support for standard reconnection models for the formation/evolution of flux ropes during solar eruptive events. We suggest that inflow streams that occur over a relatively wide range of position angles result from the pinching-off of loop arcades whose axes are oriented parallel rather than perpendicular to the sky plane.

Onset of the Magnetic Explosion in Solar Polar Coronal X-Ray Jets

NASA Astrophysics Data System (ADS)

Moore, Ronald L.; Sterling, Alphonse C.; Panesar, Navdeep

2017-08-01

We examine the onset of the driving magnetic explosion in 15 random polar coronal X-ray jets. Each eruption is observed in a coronal X-ray movie from Hinode and in a coronal EUV movie from Solar Dynamics Observatory. Contrary to the Sterling et al (2015, Nature, 523, 437) scenario for minifilament eruptions that drive polar coronal jets, these observations indicate: (1) in most polar coronal jets (a) the runaway internal tether-cutting reconnection under the erupting minifilament flux rope starts after the spire-producing breakout reconnection starts, not before it, and (b) aleady at eruption onset, there is a current sheet between the explosive closed magnetic field and ambient open field; and (2) the minifilament-eruption magnetic explosion often starts with the breakout reconnection of the outside of the magnetic arcade that carries the minifilament in its core. On the other hand, the diversity of the observed sequences of occurrence of events in the jet eruptions gives further credence to the Sterlling et al (2015, Nature, 523, 437) idea that the magnetic explosions that make a polar X-ray jet work the same way as the much larger magnetic explosions that make and flare and CME. We point out that this idea, and recent observations indicating that magnetic flux cancelation is the fundamental process that builds the field in and around pre-jet minifilaments and triggers the jet-driving magnetic explosion, together imply that usually flux cancelation inside the arcade that explodes in a flare/CME eruption is the fundamental process that builds the explosive field and triggers the explosion.This work was funded by the Heliophysics Division of NASA's Science Mission Directorate through its Living With a Star Targeted Research and Technology Program, its Heliophsyics Guest Investigators Program, and the Hinode Project.

Development of cyclic shedding teeth from semi-shedding teeth: the inner dental arcade of the stem osteichthyan Lophosteus

NASA Astrophysics Data System (ADS)

Chen, Donglei; Blom, Henning; Sanchez, Sophie; Tafforeau, Paul; Märss, Tiiu; Ahlberg, Per E.

2017-05-01

The numerous cushion-shaped tooth-bearing plates attributed to the stem group osteichthyan Lophosteus superbus, which are argued here to represent an early form of the osteichthyan inner dental arcade, display a previously unknown and presumably primitive mode of tooth shedding by basal hard tissue resorption. They carry regularly spaced, recumbent, gently recurved teeth arranged in transverse tooth files that diverge towards the lingual margin of the cushion. Three-dimensional reconstruction from propagation phase-contrast synchrotron microtomography (PPC-SRµCT) reveals remnants of the first-generation teeth embedded in the basal plate, a feature never previously observed in any taxon. These teeth were shed by semi-basal resorption with the periphery of their bases retained as dentine rings. The rings are highly overlapped, which evidences tooth shedding prior to adding the next first-generation tooth at the growing edge of the plate. The first generation of teeth is thus diachronous. Successor teeth at the same sites underwent cyclical replacing and shedding through basal resorption, producing stacks of buried resorption surfaces separated by bone of attachment. The number and spatial arrangement of resorption surfaces elucidates that basal resorption of replacement teeth had taken place at the older tooth sites before the addition of the youngest first-generation teeth at the lingual margin. Thus, the replacement tooth buds cannot have been generated by a single permanent dental lamina at the lingual edge of the tooth cushion, but must have arisen either from successional dental laminae associated with the individual predecessor teeth, or directly from the dental epithelium of these teeth. The virtual histological dissection of these Late Silurian microfossils broadens our understanding of the development of the gnathostome dental systems and the acquisition of the osteichthyan-type of tooth replacement.

Association of Age With Survival in Patients With Metastatic Colorectal Cancer: Analysis From the ARCAD Clinical Trials Program

PubMed Central

Lieu, Christopher H.; Renfro, Lindsay A.; de Gramont, Aimery; Meyers, Jeffrey P.; Maughan, Timothy S.; Seymour, Matthew T.; Saltz, Leonard; Goldberg, Richard M.; Sargent, Daniel J.; Eckhardt, S. Gail; Eng, Cathy

2014-01-01

Purpose This study addressed whether age is prognostic for overall survival (OS) or progression-free survival (PFS) in patients with metastatic colorectal cancer (mCRC). Patients and Methods A total of 20,023 patients from 24 first-line clinical trials in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were analyzed. Primary age effects and interactions with age, sex, performance status (PS), and metastatic site were modeled using Cox proportional hazards stratified by treatment arm within study. Results Of total patients, 3,051 (15%) were age ≤ 50 years. Age was prognostic for both OS (P < .001) and PFS (P < .001), with U-shaped risk (ie, highest risk was evident in youngest and oldest patients). Relative to patients of middle age, the youngest patients experienced 19% (95% CI, 7% to 33%) increased risk of death and 22% (95% CI, 10% to 35%) increased risk of progression. The oldest patients experienced 42% (95% CI, 31% to 54%) increased risk of death and 15% (95% CI, 7% to 24%) increased risk of progression or death. This relationship was more pronounced in the first year of follow-up. Age remained marginally significant for OS (P = .08) when adjusted for PS, sex, and presence of liver, lung, or peritoneal metastases, and age was significant in an adjusted model for PFS (P = .005). The age effect did not differ by site of metastatic disease, year of enrollment, type of therapy received, or biomarker mutational status. Conclusion Younger and older age are associated with poorer OS and PFS among treated patients with mCRC. Younger and older patients may represent higher-risk populations, and additional studies are warranted. PMID:25002720

Gamification and serious games for personalized health.

PubMed

McCallum, Simon

2012-01-01

Computer games are no longer just a trivial activity played by children in arcades. Social networking and casual gaming have broadened the market for, and acceptance of, games. This has coincided with a realization of their power to engage and motivate players. Good computer games are excellent examples of modern educational theory [1]. The military, health providers, governments, and educators, all use computer games. This paper focuses on Games for Health, discussing the range of areas and approaches to developing these games. We extend a taxonomy for Games for Health, describe a case study on games for dementia sufferers, and finally, present some challenges and research opportunities in this area.

Cytomegalovirus retinitis in a patient with proliferative diabetes retinopathy.

PubMed

Takayama, Kei; Ogawa, Manabu; Mochizuki, Manabu; Takeuchi, Masaru

2013-06-01

To report a case of cytomegalovirus (CMV) retinitis in an immunocompetent patient with proliferative diabetic retinopathy (PDR). Case report. A 69-year-old man presented with a 44-year history of diabetes mellitus and 4 years of PDR. Fundus of left eye could not be visualized because of vitreous hemorrhage. Laboratory tests indicated normal immunological status. Yellowish white retinal exudative lesion and whitening inside vascular arcades were observed during vitrectomy. Multiplex PCR using vitreous sample detected CMV DNA at 4.37 × 10(4) copies/mL. CMV retinitis was diagnosed. If atypical findings of PDR are observed, a multiplex PCR test should be performed for further investigation.

Retrievable Stent-Assisted Coiling Technique Using a Solitaire Stent: Treatment of Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Occlusion.

PubMed

Sanal, Bekir; Nas, Omer Fatih; Hacikurt, Kadir; Hakyemez, Bahattin; Erdogan, Cuneyt

2016-02-01

True aneurysm of pancreaticoduodenal arcade (PDA) is usually accompanied by stenosis or occlusion of celiac trunk (CeT). The up-to-date and first choice treatment modality of PDA aneurysm is the endovascular approach in nearly all cases except few selected ones necessitating surgery. The main approach in endovascular treatment is embolization of the aneurysm by preserving the parent artery. A case with concomitant CeT occlusion and PDA aneurysm was treated with coil embolization by preserving inferior pancreaticoduodenal artery with retrievable Solitaire(®) stent. In our knowledge, this is the first case with PDA aneurysm treated with this technique. © The Author(s) 2016.

Intermittent Reconnection Downflow Enhancements In A Simulated Flux Rope Eruption

NASA Astrophysics Data System (ADS)

Kliem, Bernhard; Linton, M. G.

2009-05-01

Supra-arcade downflows in X-ray and EUV flare emissions and post-eruption inflows in coronagraph data have been interpreted to be signatures of the downward reconnection outflow from a vertical (flare) current sheet. These downflows show an intermittent occurrence pattern, indicating that the reconnection is bursty in time or patchy in space, or both. We present MHD simulations of such reconnection in the realistic configuration of a vertical current sheet formed beneath and driven by an erupting flux rope. The reconnection is found to develop bursty outflows, both upward and downward, with the upward outflows generally showing the stronger variablity. While the reconnection starts early in the rise of the flux rope and its peak upward outflow velocity is closely correlated with the rope's rise velocity, the burstiness develops in a clear fashion only as the rope's height has increased from the initial position by about an order of magnitude, so that the current sheet has reached a sufficient vertical extent. The reconnection downflow shows a series of enhancements, each of them starting at a successively greater height from a newly developed magnetic X line. The plasma temporarily accelerated downward in such an enhancement soon turns into a gradual deceleration and then eventually comes to rest on top of previously accelerated plasma. These findings are consistent with the observations of intermittent downflows.

Range of movement in ray I of manus and pes and the prehensility of the autopodia in the Early Permian to Late Cretaceous non-anomodont Synapsida.

PubMed

Kümmell, Susanna B; Frey, Eberhard

2014-01-01

The mobility of ray I was analysed in seventy-eight Early Permian to Late Cretaceous specimens of non-mammalian Synapsida and one extant mammal. In all non-mammaliamorph Synapsida investigated, ray I formed a digital arcade. The first phalanx was maximally extendable to the zero position in the metapodiophalangeal joint I. Metapodiale I was the functional equivalent to a basal phalanx of digits II-V. In contrast, there was no digital arcade in ray I in Mesozoic Mammaliamorpha. Phalanx 1 I was dorsally extendable and metapodiale I was functionally part of the metapodium. During the propulsion phase, autopodial rotation occurred in the majority of Synapsida with abducted limb posture. Regarding ray I, the reduction of autopodial rotation can be estimated, e.g., from the decrease of lateral rotation and medial abduction of the first phalanx in the metapodiophalangeal joint I. Autopodial rotation was high in Titanophoneus and reduced in derived Cynodontia. In Mammaliamorpha the mobility of the first ray suggests autopodial rolling in an approximately anterior direction. Most non-mammaliamorph Therapsida and probably some Mesozoic Mammaliamorpha had prehensile autopodia with an opposable ray I. In forms with a pronounced relief of the respective joints, ray I could be opposed to 90° against ray III. A strong transverse arch in the row of distalia supported the opposition movement of ray I and resulted in a convergence of the claws of digits II-V just by flexing those digits. A tight articular coherence in the digital joints of digits II-V during strong flexion supported a firm grip capacity. Usually the grip capacity was more pronounced in the manus than in the pes. Prehensile autopodia of carnivorous Therapsida may have been utilized to hold prey while biting, thus helping to avoid fractures of the laterally compressed fangs.

Reconstructed Homo habilis type OH 7 suggests deep-rooted species diversity in early Homo.

PubMed

Spoor, Fred; Gunz, Philipp; Neubauer, Simon; Stelzer, Stefanie; Scott, Nadia; Kwekason, Amandus; Dean, M Christopher

2015-03-05

Besides Homo erectus (sensu lato), the eastern African fossil record of early Homo has been interpreted as representing either a single variable species, Homo habilis, or two species. In the latter case, however, there is no consensus over the respective groupings, and which of the two includes OH 7, the 1.8-million-year-old H. habilis holotype. This partial skull and hand from Olduvai Gorge remains pivotal to evaluating the early evolution of the Homo lineage, and by priority names one or other of the two taxa. However, the distorted preservation of the diagnostically important OH 7 mandible has hindered attempts to compare this specimen with other fossils. Here we present a virtual reconstruction of the OH 7 mandible, and compare it to other early Homo fossils. The reconstructed mandible is remarkably primitive, with a long and narrow dental arcade more similar to Australopithecus afarensis than to the derived parabolic arcades of Homo sapiens or H. erectus. We find that this shape variability is not consistent with a single species of early Homo. Importantly, the jaw morphology of OH 7 is incompatible with fossils assigned to Homo rudolfensis and with the A.L. 666-1 Homo maxilla. The latter is morphologically more derived than OH 7 but 500,000 years older, suggesting that the H. habilis lineage originated before 2.3 million years ago, thus marking deep-rooted species diversity in the genus Homo. We also reconstructed the parietal bones of OH 7 and estimated its endocranial volume. At between 729 and 824 ml it is larger than any previously published value, and emphasizes the near-complete overlap in brain size among species of early Homo. Our results clarify the H. habilis hypodigm, but raise questions about its phylogenetic relationships. Differences between species of early Homo appear to be characterized more by gnathic diversity than by differences in brain size, which was highly variable within all taxa.

New Evidence for the Role of Emerging Flux in a Solar Filament's Slow Rise Preceding its CME-Producing Fast Eruption

NASA Technical Reports Server (NTRS)

Sterling, Alphonse C.; Harra, Louis K.; Moore, Ronald L.

2007-01-01

We observe the eruption of a large-scale (approx.300,000 km) quiet-region solar filament, leading to an Earth-directed "halo" coronal mass ejection (CME). We use coronal imaging data in EUV from the EUV Imaging Telescope (EIT) on the Solar and Heliospheric Observatory (SOHO) satellite, and in soft X-rays (SXRs) from the Soft X-ray Telescope (SXT) on the Yohkoh satellite. We also use spectroscopic data from the Coronal Diagnostic Spectrometer (CDS), magnetic data from the Michelson Doppler Imager (MDI), and white-light coronal data from the Large Angle and Spectrometric Coronagraph Experiment (LASCO), all on SOHO. Initially the filament shows a slow (approx.1 km/s projected against the solar disk) and approximately constant-velocity rise for about 6 hours, before erupting rapidly, reaching a velocity of approx. 8 km/s over the next approx. 25 min. CDS Doppler data show Earth-directed filament velocities ranging from < 20 km/s (the noise limit) during the slow-rise phase, to approx. 100 km/s-1 early in the eruption. Beginning within 10 hours prior to the start of the slow rise, localized new magnetic flux emerged near one end of the filament. Near the start of and during the slow-rise phase, SXR microflaring occurred repeatedly at the flux-emergence site, in conjunction with the development of a fan of SXR illumination of the magnetic arcade over the filament. The SXR microflares, development of the SXR fan, and motion of the slow-rising filament are all consistent with "tether-weakening" reconnection occurring between the newly-emerging flux and the overlying arcade field containing the filament field. The microflares and fan structure are not prominent in EUV, and would not have been detected without the SXR data. Standard "twin dimmings" occur near the location of the filament, and "remote dimmings" and "brightenings" occur further removed from the filament.

Surgical anatomy of penis in exstrophy-epispadias: a study of arrangement of fascial planes and superficial vessels of surgical significance.

PubMed

Kureel, Shiv Narain; Gupta, Archika; Singh, Chandra Shekhar; Kumar, Manoj

2013-10-01

To study the anatomic arrangement of the fascial planes and superficial vessels in relationship to the laid-open urethral plate, glans, corpus spongiosum, and corpora cavernosa in the penis of patients with exstrophy or epispadias. Of 6 patients, 4 had classic exstrophy and 2 had incontinent epispadias. These patients had presented beyond adolescence without previous intervention and were selected for the present study. Using a 1.5-T magnetic resonance imaging scanner and compatible 3-in. surface coil, the epispadiac penises were studied using fast spin echo sequences and contrast-enhanced sequences. In 2 patients, angiography of the superficial vessels was also performed using multidetector row helical computed tomography. The imaging findings were also verified during the subsequent reconstructive surgery. A clear demarcation of the skin, dartos fascia, Buck's fascia, corpora cavernosa, corpus spongiosum, and the intraglanular planes were seen with the course of the blood vessels. The penile dartos received axial pattern vessels from the external pudendal vessels, with collateral branches from the dorsal penile artery as transverse branches at the shaft of the penis and preputial branches at the coronal sulcus. Buck's fascia sleeved the corpora cavernosa, enveloped the neurovascular bundle, and fused with the corpus spongiosum without crossing the midline. Intraglanular extension of Buck's fascia separated the intraglanular vascular arcade from the tip of the corpora. Parallel to the ventral midline, axial pattern vessels to the skin-dartos complex are present, with an additional supply to the prepuce from the terminal penile arteries. These findings can be used for designing the skin coverage. The subfascial plane between the tip of the corpora and the intraglanular vascular arcade and the plane of cleavage between the cavernosa-spongiosum interface can be used for efficient corporal urethral separation. Copyright © 2013 Elsevier Inc. All rights reserved.

The X17.2 flare occurred in NOAA 10486: an example of filament destabilization caused by a domino effect

NASA Astrophysics Data System (ADS)

Zuccarello, F.; Romano, P.; Farnik, F.; Karlicky, M.; Contarino, L.; Battiato, V.; Guglielmino, S. L.; Comparato, M.; Ugarte-Urra, I.

2009-01-01

Context: It is now possible to distinguish between two main models describing the mechanisms responsible for eruptive flares : the standard model, which assumes that most of the energy is released, by magnetic reconnection, in the region hosting the core of a sheared magnetic field, and the breakout model, which assumes reconnection occurs at first in a magnetic arcade overlaying the eruptive features. Aims: We analyze the phenomena observed in NOAA 10486 before and during an X17.2 flare that occurred on 2003 October 28, to study the relationship between the pre-flare and flare phases and determine which model is the most suitable for interpreting this event. Methods: We performed an analysis of multiwavelength data set available for the event using radio data (0.8-4.5 GHz), images in the visible range (WL and Hα), EUV images (1600 and 195 Å), and X-ray data, as well as MDI longitudinal magnetograms. We determined the temporal sequence of events occurring before and during the X17.2 flare and the magnetic field configuration in the linear force-free field approximation. Results: The active region was characterized by a multiple arcade configuration and the X17.2 flare was preceded, by ~2 h, by the partial eruption of one filament. This eruption caused reconnection at null points located in the low atmosphere and a decrease in magnetic tension in the coronal field lines overlaying other filaments present in the active region. As a consequence, these filaments were destabilized and the X17.2 flare occurred. Conclusions: The phenomena observed in NOAA 10486 before and during the X17.2 flare cannot be explained by a simple scenario such as the standard or breakout model, but instead in terms of a so-called domino effect, involving a sequence of destabilizing processes that triggered the flare.

Range of Movement in Ray I of Manus and Pes and the Prehensility of the Autopodia in the Early Permian to Late Cretaceous Non-Anomodont Synapsida

PubMed Central

Kümmell, Susanna B.; Frey, Eberhard

2014-01-01

The mobility of ray I was analysed in seventy-eight Early Permian to Late Cretaceous specimens of non-mammalian Synapsida and one extant mammal. In all non-mammaliamorph Synapsida investigated, ray I formed a digital arcade. The first phalanx was maximally extendable to the zero position in the metapodiophalangeal joint I. Metapodiale I was the functional equivalent to a basal phalanx of digits II–V. In contrast, there was no digital arcade in ray I in Mesozoic Mammaliamorpha. Phalanx 1 I was dorsally extendable and metapodiale I was functionally part of the metapodium. During the propulsion phase, autopodial rotation occurred in the majority of Synapsida with abducted limb posture. Regarding ray I, the reduction of autopodial rotation can be estimated, e.g., from the decrease of lateral rotation and medial abduction of the first phalanx in the metapodiophalangeal joint I. Autopodial rotation was high in Titanophoneus and reduced in derived Cynodontia. In Mammaliamorpha the mobility of the first ray suggests autopodial rolling in an approximately anterior direction. Most non-mammaliamorph Therapsida and probably some Mesozoic Mammaliamorpha had prehensile autopodia with an opposable ray I. In forms with a pronounced relief of the respective joints, ray I could be opposed to 90° against ray III. A strong transverse arch in the row of distalia supported the opposition movement of ray I and resulted in a convergence of the claws of digits II–V just by flexing those digits. A tight articular coherence in the digital joints of digits II–V during strong flexion supported a firm grip capacity. Usually the grip capacity was more pronounced in the manus than in the pes. Prehensile autopodia of carnivorous Therapsida may have been utilized to hold prey while biting, thus helping to avoid fractures of the laterally compressed fangs. PMID:25517726

Standing Kink modes in three-dimensional coronal loops

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

Pascoe, D. J.; De Moortel, I., E-mail: dpascoe@mcs.st-andrews.ac.uk

2014-04-01

So far, the straight flux tube model proposed by Edwin and Roberts is the most commonly used tool in practical coronal seismology, in particular, to infer values of the (coronal) magnetic field from observed, standing kink mode oscillations. In this paper, we compare the period predicted by this basic model with three-dimensional (3D) numerical simulations of standing kink mode oscillations, as the period is a crucial parameter in the seismological inversion to determine the magnetic field. We perform numerical simulations of standing kink modes in both straight and curved 3D coronal loops and consider excitation by internal and external drivers.more » The period of oscillation for the displacement of dense coronal loops is determined by the loop length and the kink speed, in agreement with the estimate based on analytical theory for straight flux tubes. For curved coronal loops embedded in a magnetic arcade and excited by an external driver, a secondary mode with a period determined by the loop length and external Alfvén speed is also present. When a low number of oscillations is considered, these two periods can result in a single, non-resolved (broad) peak in the power spectrum, particularly for low values of the density contrast for which the two periods will be relatively similar. In that case (and for this particular geometry), the presence of this additional mode would lead to ambiguous seismological estimates of the magnetic field strength.« less

Practical Vascular Anatomy in the Preparation of Radioembolization

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

Paprottka, P. M., E-mail: philipp.paprottka@med.uni-muenchen.de; Jakobs, T. F., E-mail: tobias.jakobs@barmherzige-muenchen.de; Reiser, M. F.

2012-06-15

As the incidence of primary and metastatic liver cancer continues to increase, the use of minimally invasive techniques as a treatment option is becoming more common. Radioembolization, a form of intra-arterial brachytherapy, is a technique where particles of glass or resin, impregnated with the isotope {sup 90}yttrium ({sup 90}Y), are infused through a catheter directly into the hepatic arteries. This modality is based on the fact that hepatic malignancies receive their blood supply from the hepatic artery, whereas normal hepatocytes are perfused mostly from the portal circulation, which allows delivery of high doses to the tumor vasculature with relative sparingmore » of normal liver tissue. This has been shown to be effective for both primary and metastatic tumors. A variety of complications may be related to hepatic intra-arterial treatments, especially to the gastroduodenal region. These complications are known to come from inadvertent extrahepatic infusion of {sup 90}Y particles, through arteries originating from the hepatic arterial branches such as the falciform artery, cystic artery, arteries from the pancreaticoduodenal arcade, gastroduodenal artery, or right gastric artery. Surgeons and interventional radiologists rely on accurate imaging and assessment of the hepatic arterial supply. It is important to know the common anatomic variations and technical considerations before radioembolization. We recommend an aggressive occlusion of all the above-mentioned arteries; further, clinicians should watch out for any other aberrant branches, and if in doubt, they ought to be coiled.« less

The differential emission measure of nested hot and cool magnetic loops

NASA Technical Reports Server (NTRS)

Van Hoven, G.; Mok, Y.

1993-01-01

The detailed thermal structure of the magnetized solar transition region, as measured by its differential emission measure (DEM(T)), is poorly known. Building on the fact that the solar surface is strongly magnetized and thereby structured, proposals have been made that envision a significant lower-temperature contribution to the energy balance from (ion) heat flux across an arcade of different temperature loops. In this paper, we describe a self-consistent 2D MHD simulation, which includes the full thermal effects of parallel stability and anisotropic conduction, of a nested-loop model of the thermal and magnetic structure of the transition region. We then demonstrate that the predicted DEM agrees with observations in the conceptually elusive T less than 10 exp 5 K regime.

New Evidence that CMEs are Self-Propelled Magnetic Bubbles

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse C.; Seuss, Steven T.

2007-01-01

We briefly describe the "standard model" for the production of coronal mass ejections (CMEs), and our view of how it works. We then summarize pertinent recent results that we have found from SOHO observations of CMEs and the flares at the sources of these magnetic explosions. These results support our interpretation of the standard model: a CME is basically a self-propelled magnetic bubble, a low-beta plasmoitl, that (1) is built and unleashed by the tether-cutting reconnection that builds and heats the coronal flare arcade, (2) can explode from a flare site that is far from centered under the full-blown CME in the outer corona, and (3) drives itself out into the solar wind by pushing on the surrounding coronal magnetic field.

Clearing out a maze: A model of chemotactic motion in porous media

NASA Astrophysics Data System (ADS)

Schilling, Tanja; Voigtmann, Thomas

2017-12-01

We study the anomalous dynamics of a biased "hungry" (or "greedy") random walk on a percolating cluster. The model mimics chemotaxis in a porous medium: In close resemblance to the 1980s arcade game PAC-MA N ®, the hungry random walker consumes food, which is initially distributed in the maze, and biases its movement towards food-filled sites. We observe that the mean-squared displacement of the process follows a power law with an exponent that is different from previously known exponents describing passive or active microswimmer dynamics. The change in dynamics is well described by a dynamical exponent that depends continuously on the propensity to move towards food. It results in slower differential growth when compared to the unbiased random walk.

Prominence condensation and magnetic levitation in a coronal loop

NASA Technical Reports Server (NTRS)

Van Hoven, G.; Mok, Y.; Drake, J. F.

1992-01-01

The results of a model dynamic simulation of the formation and support of a narrow prominence at the apex of a coronal magnetic loop or arcade are described. The condensation process proceeds via an initial radiative cooling and pressure drop, and a secondary siphon flow from the dense chromospheric ends. The antibuoyancy effect as the prominence forms causes a bending of the confining magnetic field, which propagates toward the semirigid ends of the magnetic loop. Thus, a wide magnetic 'hammock' or well (of the normal-polarity Kippenhahn-Schlueter-type) is formed, which supports the prominence at or near the field apex. The simplicity of this 1.5-dimensional model, with its accompanying diagnostics, elucidates the various contributions to the nonlinear dynamics of prominence condensation and levitation.

Pornography and rape: theory and practice? Evidence from crime data in four countries where pornography is easily available.

PubMed

Kutchinsky, B

1991-01-01

We have looked at the empirical evidence of the well-known feminist dictum: "pornography is the theory--rape is the practice" (Morgan, 1980). While earlier research, notably that generated by the U.S. Commission on Obscenity and Pornography (1970) had found no evidence of a causal link between pornography and rape, a new generation of behavioral scientists have, for more than a decade, made considerable effort to prove such a connection, especially as far as "aggressive pornography" is concerned. The first part of the article examines and discusses the findings of this new research. A number of laboratory experiments have been conducted, much akin to the types of experiments developed by researchers of the effects of nonsexual media violence. As in the latter, a certain degree of increased "aggressiveness" has been found under certain circumstances, but to extrapolate from such laboratory effects to the commission of rape in real life is dubious. Studies of rapists' and nonrapists' immediate sexual reactions to presentations of pornography showed generally greater arousal to non-violent scenes, and no difference can be found in this regard between convicted rapists, nonsexual criminals and noncriminal males. In the second part of the paper an attempt was made to study the necessary precondition for a substantial causal relationship between the availability of pornography, including aggressive pornography, and rape--namely, that obviously increased availability of such material was followed by an increase in cases of reported rape. The development of rape and attempted rape during the period 1964-1984 was studied in four countries: the U.S.A., Denmark, Sweden and West Germany. In all four countries there is clear and undisputed evidence that during this period the availability of various forms of pictorial pornography including violent/dominant varieties (in the form of picture magazines, and films/videos used at home or shown in arcades or cinemas) has developed from extreme scarcity to relative abundance. If (violent) pornography causes rape, this exceptional development in the availability of (violent) pornography should definitely somehow influence the rape statistics. Since, however, the rape figures could not simply be expected to remain steady during the period in question (when it is well known that most other crimes increased considerably), the development of rape rates was compared with that of non-sexual violent offences and nonviolent sexual offences (in so far as available statistics permitted). The results showed that in none of the countries did rape increase more than nonsexual violent crimes. This finding in itself would seem sufficient to discard the hypothesis that pornography causes rape.(ABSTRACT TRUNCATED AT 400 WORDS)

GP Networks as enablers of quality of care: implementing a practice engagement framework in a General Practice Network.

PubMed

Pearce, Christopher; Shearer, Marianne; Gardner, Karina; Kelly, Jill; Xu, Tony Baixian

2012-01-01

This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.

Planning continuity and the actual conditions of shopping malls.

PubMed

Morita, Yoshitsugu; Tahara, Manabu

2004-11-01

The main purpose of this study is to investigate the continuity of the planning of shopping malls in downtown areas of Japan and to look into the tendencies of the current existing malls until today. This paper is a summary of a survey conducted on the actual conditions of current shopping malls and a questionnaire administered to local governments in the survey areas. The results of this study allow us to summarize the reasons for and changes caused by renewal efforts directed toward the streets, public spaces, and urban elements (pavement, bench, streetlight, arcade, sculpture, etc.) in shopping malls. Furthermore, these results also help us to understand the scale of the renewal efforts as well as their timing in relation to when the shopping mall was originally constructed.

Coronal magnetic fields and the solar wind

NASA Technical Reports Server (NTRS)

Newkirk, G., Jr.

1972-01-01

Current information is presented on coronal magnetic fields as they bear on problems of the solar wind. Both steady state fields and coronal transient events are considered. A brief critique is given of the methods of calculating coronal magnetic fields including the potential (current free) models, exact solutions for the solar wind and field interaction, and source surface models. These solutions are compared with the meager quantitative observations which are available at this time. Qualitative comparisons between the shapes of calculated magnetic field lines and the forms visible in the solar corona at several recent eclipses are displayed. These suggest that: (1) coronal streamers develop above extended magnetic arcades which connect unipolar regions of opposite polarity; and (2) loops, arches, and rays in the corona correspond to preferentially filled magnetic tubes in the approximately potential field.

Studies of the astronomical array at the castle in Olsztyn

NASA Astrophysics Data System (ADS)

Szubiakowski, Jacek P.

2014-12-01

The paper describes a mathematical model simulating the operation of the board for Sun observation located in Olsztyn castle. The board was made around 1517, when Nicolaus Copernicus held the office of the property administrator of the Warmian Chapter. The idea of the functioning of the array is adapted to the lighting conditions of the cloister. As an indicator of the instantaneous position of the Sun and the moment of time a ray of sunshine reflected from the mirror mounted horizontally on the windowsill of arcade was used. The paper presents the results of the analysis of the calendar lines as well as the hour lines. The architectural conditions determining the hours of operation of the array in different months and the factors affecting its accuracy has also been examined.

Filament Eruptions, Jets, and Space Weather

NASA Technical Reports Server (NTRS)

Moore, Ronald; Sterling, Alphonse; Robe, Nick; Falconer, David; Cirtain, Jonathan

2013-01-01

Previously, from chromospheric H alpha and coronal X-ray movies of the Sun's polar coronal holes, it was found that nearly all coronal jets (greater than 90%) are one or the other of two roughly equally common different kinds, different in how they erupt: standard jets and blowout jets (Yamauchi et al 2004, Apl, 605, 5ll: Moore et all 2010, Apj, 720, 757). Here, from inspection of SDO/AIA He II 304 A movies of 54 polar x-ray jets observed in Hinode/XRT movies, we report, as Moore et al (2010) anticipated, that (1) most standard x-ray jets (greater than 80%) show no ejected plasma that is cool enough (T is less than or approximately 10(exp 5K) to be seen in the He II 304 A movies; (2) nearly all blownout X-ray jets (greater than 90%) show obvious ejection of such cool plasma; (3) whereas when cool plasma is ejected in standard X-ray jets, it shows no lateral expansion, the cool plasma ejected in blowout X-ray jets shows strong lateral expansion; and (4) in many blowout X-ray jets, the cool plasma ejection displays the erupting-magnetic-rope form of clasic filament eruptions and is thereby seen to be a miniature filament eruption. The XRT movies also showed most blowout X-ray jets to be larger and brighter, and hence to apparently have more energy, than most standard X-ray jets. These observations (1) confirm the dichotomy of coronal jets, (2) agree with the Shibata model for standard jets, and (3) support the conclusion of Moore et al (2010) that in blowout jets the magnetic-arch base of the jet erupts in the manner of the much larger magnetic arcades in which the core field, the field rooted along the arcade's polarity inversion line, is sheared and twisted (sigmoid), often carries a cool-plasma filament, and erupts to blowout the arcade, producing a CME. From Hinode/SOT Ca II movies of the polar limb, Sterling et al (2010, ApJ, 714, L1) found that chromospheric Type-II spicules show a dichotomy of eruption dynamics similar to that found here for the cool-plasma component of coronal X-ray jets. This favors the idea that Type-II spicules are miniature counterparts of coronal X-ray jets. In Moore et al (2011, ApJ, 731, L18), we pointed out that if Type-II spicules are magnetic eruptions that work like coronal X-ray jets, they carry an area-averaged mechanical energy flux of approximately 7x10)(exp 5) erg cm(exp -2) s(exp-1) into the corona in the form of MHD waves and jet outflow, enough to power the heating of the global corona and solar wind. On this basis, from our observations of mini-filament eruptions in blowout X-ray jets, we infer that magnetic explosions of the type that have erupting filaments in them are the main engines of both (1) the steady solar wind and (2) the CMEs that produce the most severe space weather by blasting out through the corona and solar wind, making solar energetic particle storms, and bashing the Earth's magnetosphere. We conclude that in focusing on prominences and filament eruptions, Einar had his eye on the main bet for understanding what powers all space weather, both the extreme and the normal.

The Primordial Inflation Polarization Explorer: Science from Circular Polarization Measurements

NASA Astrophysics Data System (ADS)

Switzer, Eric; Ade, P.; Benford, D. J.; Bennett, C. L.; Chuss, D. T.; Dotson, J. L.; Eimer, J.; Fixsen, D. J.; Halpern, M.; Hinshaw, G. F.; Irwin, K.; Jhabvala, C.; Johnson, B.; Kogut, A. J.; Lazear, J.; Mirel, P.; Moseley, S. H.; Staguhn, J.; Tucker, C. E.; Weston, A.; Wollack, E.

2014-01-01

The Primordial Inflation Polarization Explorer (PIPER) is a balloon-borne CMB polarimeter designed to constrain the B-mode signature of cosmological inflation. Sequential one-day flights from Northern- and Southern- Hemisphere sites will yield maps of Stokes I, Q, U and V at 200, 270, 350 and 600 GHz over 85% of the sky. The full optical path is cooled to 1.5 K by liquid helium in the ARCADE bucket dewar, and a variable-delay polarization modulator (VPM) at the front of the optics modulates the polarization response. Independent Q and U cameras each have two 32x40 Transition Edge Sensor array receivers. In addition to its primary inflationary science goal, PIPER will also measure the circular (Stokes V) polarization to a depth similar to that of the primary linear polarization. The circular polarization has received relatively little attention in large-area surveys, with constraints from the 1980’s and recent results by the Milan Polarimeter. Astrophysical circular polarization is generally tied to the presence of magnetic fields, either in relativistic plasmas or Zeeman splitting of resonances. These effects are thought to be undetectable at PIPER's frequencies and resolution, despite the depth. The expectation of a null result makes the deep Stokes V map a good cross-check for experimental systematics. More fundamentally, the fact that the sky is expected to be dark in Stokes V makes it a sector sensitive to processes such as Lorentz-violating terms in the standard model or magnetic fields in the CMB era.

A homozygous founder missense variant in arylsulfatase G abolishes its enzymatic activity causing atypical Usher syndrome in humans.

PubMed

Khateb, Samer; Kowalewski, Björn; Bedoni, Nicola; Damme, Markus; Pollack, Netta; Saada, Ann; Obolensky, Alexey; Ben-Yosef, Tamar; Gross, Menachem; Dierks, Thomas; Banin, Eyal; Rivolta, Carlo; Sharon, Dror

2018-01-04

PurposeWe aimed to identify the cause of disease in patients suffering from a distinctive, atypical form of Usher syndrome.MethodsWhole-exome and genome sequencing were performed in five patients from three families of Yemenite Jewish origin, suffering from distinctive retinal degeneration phenotype and sensorineural hearing loss. Functional analysis of the wild-type and mutant proteins was performed in human fibrosarcoma cells.ResultsWe identified a homozygous founder missense variant, c.133G>T (p.D45Y) in arylsulfatase G (ARSG). All patients shared a distinctive retinal phenotype with ring-shaped atrophy along the arcades engirdling the fovea, resulting in ring scotoma. In addition, patients developed moderate to severe sensorineural hearing loss. Both vision and hearing loss appeared around the age of 40 years. The identified variant affected a fully conserved amino acid that is part of the catalytic site of the enzyme. Functional analysis of the wild-type and mutant proteins showed no basal activity of p.D45Y.ConclusionHomozygosity for ARSG-p.D45Y in humans leads to protein dysfunction, causing an atypical combination of late-onset Usher syndrome. Although there is no evidence for generalized clinical manifestations of lysosomal storage diseases in this set of patients, we cannot rule out the possibility that mild and late-onset symptoms may appear.GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.227.

Study of the Source Regions of Coronal Mass Ejections Using Yohkoh SXT Data

NASA Technical Reports Server (NTRS)

Webb, David F.; Kahler, Stephen W.

1997-01-01

The scientific objective of the program was to better understand how CMEs (Coronal Mass Ejections) are initiated at the sun by examining structures on the disk which are related to the origins of CMEs. CMEs represent important disruptions of large-scale structures of closed magnetic fields in the corona, and result in significant disturbances of the interplanetary medium and near-Earth space. The program pertained to NASA's objectives of understanding the physics of solar activity and the structured and evolution of the corona, and the results are being applied to understanding CMEs currently being observed by SOHO near the sun and by WIND and Ulysses in the heliosphere. Three general areas of research were pursued in the program. One was to use Yohkoh soft X-ray telescope (SXT) images of eruptive events visible against the solar disk to examine the coronal structures and the boundaries of the large-scale magnetic fields considered to be involved in coronal mass ejections (CMEs). The second area involved a survey and study of SXT X-ray arcade events which exhibit dimming, or the possible depletion of coronal material above and possibly before onset of the bright long-duration event (LDE). Finally, we studied the SXT data during periods when white light CMEs were observed the HAO Mauna Loa K-coronameter and, conversely, we examined the white light data during periods when expanding X-ray loops were observed at the limb.

Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

PubMed Central

Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

2015-01-01

Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from <1.0% of clinical teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve this. PMID:26009536

WestREN: a description of an Irish academic general practice research network

PubMed Central

2010-01-01

Background Primary care research networks have been established internationally since the 1960s to enable diverse practitioners to engage in and develop research and education and implement research evidence. The newly established Western Research and Education Network (WestREN) is one such network consisting of a collaboration between the Discipline of General Practice at NUI Galway and 71 West of Ireland general practices. In September 2009 all member practices were issued with a questionnaire with two objectives: to describe the structure and characteristics of the member practices and to compare the results to the national profile of Irish general practice. Methods A postal survey was used followed by one written and one email reminder. Results A response rate of 73% (52/71) was achieved after two reminders. Half of practices were in a rural location, one quarter located in an urban setting and another quarter in a mixed location. Ninety-four per cent of general practitioners practice from purpose-built or adapted premises with under 6% of practices being attached to the general practitioner's residence. Over 96% of general practitioners use appointment systems with 58% using appointment only. All practices surveyed were computerised, with 80% describing their practices as 'fully computerised'. Almost 60% of general practitioners are coding chronic diagnoses with 20% coding individual consultations. Twenty-five per cent of general practitioners were single-handed with the majority of practices having at least two general practitioners, and a mean number of general practitioners of 2.4. Ninety-two per cent of practices employed a practice nurse with 30% employing more than one nurse. Compared to the national profile, WestREN practices appear somewhat larger, and more likely to be purpose-built and in rural areas. National trends apparent between 1982 and 1992, such as increasing computerisation and practice nurse availability, appear to be continuing. Conclusions WestREN is a new university-affiliated general practice research network in Ireland. Survey of its initial membership confirms WestREN practices to be broadly representative of the national profile and has provided us with valuable information on the current and changing structure of Irish general practice. PMID:20925958

Evidence for the Magnetic Breakout Model in an Equatorial Coronal-Hole Jet

NASA Astrophysics Data System (ADS)

Karpen, Judith T.; Kumar, Pankaj; Antiochos, Spiro K.; Wyper, Peter; DeVore, C. Richard

2017-08-01

We have analyzed an equatorial coronal-hole jet observed by SDO/AIA on 09 January 2014. The source-region magnetic field structure is consistent with the embedded-bipole topology that we identified and modeled previously as a source of coronal jets (Pariat et al. 2009, 2010, 2015, 2016; Karpen et al. 2017; Wyper et al. 2016). Initial brightenings were observed below a small but distinct “mini-filament” about 25 min before jet onset. A bright circular structure, interpreted as magnetic flux rope (MFR), surrounded the mini-filament. The MFR and filament rose together slowly at first, with a speed of ˜15 km s-1. When bright footpoints and loops appeared below, analogous to flare ribbons and arcade, the MFR/mini-filament rose rapidly (˜126 km s-1), and a bright elongated feature interpreted as a current sheet appeared between the MFR and the growing arcade. Multiple plasmoids propagating upward (˜135 km s-1) and downward (˜55 km s-1) were detected in this sheet. The jet was triggered when the rising MFR interacted with the overlying magnetic structure, most likely at a stressed magnetic null distorted into a current sheet. This event thus exhibits clear evidence of “flare” reconnection below the MFR as well as breakout reconnection above it, consistent with the breakout model for a wide range of solar eruptions (Antiochos et al. 1999; Devore & Antiochos 2008; Karpen et al. 2012; Wyper et al. 2017). Breakout reconnection destroyed the MFR and enabled the entrained coronal plasma and mini-filament to escape onto open field lines, producing an untwisting jet. SDO/HMI magnetograms reveal small footpoint motions at the eruption site and its surroundings, but do not show significant flux emergence or cancellation during or 1-2 hours before the eruption. Therefore, the free energy powering this jet most likely originated in magnetic shear concentrated at the polarity inversion line within the embedded bipole - a mini-filament channel - possibly created by helicity condensation (Antiochos 2013; Knizhnik et al. 2015, 2017).This work was supported in part by a grant from the NASA H-SR program and the NASA Postdoctoral Program.

A spatial analysis of the expanding roles of nurses in general practice.

PubMed

Pearce, Christopher; Hall, Sally; Phillips, Christine; Dwan, Kathryn; Yates, Rachael; Sibbald, Bonnie

2012-08-07

Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. This study used a mixed methods, 'rapid appraisal' approach involving observation, photographs, and interviews. Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.

Stakeholder experiences with general practice pharmacist services: a qualitative study.

PubMed

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of general practice pharmacist roles.

Near patient testing in general practice: a review.

PubMed Central

Hilton, S

1990-01-01

Until recently, technological advances in general practice have generally been thought of as the applications of microcomputers in practice organization and record keeping. Advances in miniaturization and versatility of diagnostic technology will have a similarly large impact on the way general practitioners practice medicine in the next decade. This article reviews some of the newer tests that are already available to general practitioners, particularly in diagnostic biochemistry and microbiology. Preliminary evaluative work and research studies in general practice are also described. PMID:2107838

How common is multiple general practice attendance in Australia?

PubMed

Wright, Michael; Hall, Jane; van Gool, Kees; Haas, Marion

2018-05-01

Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances. A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey. Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey

PubMed Central

Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-01-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013–2014 (n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government (‘General Medical Services’ 54.6%; 4337/7949). Few practices were limited companies with locally negotiated ‘Alternative Provider Medical Services’ contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference −3.04, 95% CI −4.15 to −1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (−12.78, 95% CI −15.17 to −10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013–2014. PMID:29096580

Contract and ownership type of general practices and patient experience in England: multilevel analysis of a national cross-sectional survey.

PubMed

Cowling, Thomas E; Laverty, Anthony A; Harris, Matthew J; Watt, Hilary C; Greaves, Felix; Majeed, Azeem

2017-11-01

Objective To examine associations between the contract and ownership type of general practices and patient experience in England. Design Multilevel linear regression analysis of a national cross-sectional patient survey (General Practice Patient Survey). Setting All general practices in England in 2013-2014 ( n = 8017). Participants 903,357 survey respondents aged 18 years or over and registered with a general practice for six months or more (34.3% of 2,631,209 questionnaires sent). Main outcome measures Patient reports of experience across five measures: frequency of consulting a preferred doctor; ability to get a convenient appointment; rating of doctor communication skills; ease of contacting the practice by telephone; and overall experience (measured on four- or five-level interval scales from 0 to 100). Models adjusted for demographic and socioeconomic characteristics of respondents and general practice populations and a random intercept for each general practice. Results Most practices had a centrally negotiated contract with the UK government ('General Medical Services' 54.6%; 4337/7949). Few practices were limited companies with locally negotiated 'Alternative Provider Medical Services' contracts (1.2%; 98/7949); these practices provided worse overall experiences than General Medical Services practices (adjusted mean difference -3.04, 95% CI -4.15 to -1.94). Associations were consistent in direction across outcomes and largest in magnitude for frequency of consulting a preferred doctor (-12.78, 95% CI -15.17 to -10.39). Results were similar for practices owned by large organisations (defined as having ≥20 practices) which were uncommon (2.2%; 176/7949). Conclusions Patients registered to general practices owned by limited companies, including large organisations, reported worse experiences of their care than other patients in 2013-2014.

General practice research: attitudes and involvement of Queensland general practitioners.

PubMed

Askew, Deborah A; Clavarino, Alexandra M; Glasziou, Paul P; Del Mar, Christopher B

2002-07-15

To determine general practitioners' (GPs') attitudes towards and involvement in general practice research. Postal survey and semi-structured interviews conducted from May to September 2001. 467 of 631 GPs in four Queensland Divisions of General Practice responded to the survey (74% response rate); 18 selected GPs were interviewed. Survey - attitudes to research; access to information resources; and involvement in research. Interviews - the need for general practice research; barriers against and factors enabling greater participation in research. 389/463 (84%) GPs, especially younger and more recent graduates, had positive attitudes to research, but only 29% wanted more involvement. 223/462 (48%) were aware they had access to MEDLINE, although presumably all those with Internet access (89%) would have free access via PubMed. Barriers included the general practice environment (especially fee-for-service funding), and the culture of general practice. Enabling factors included academic mentors; opportunities to participate in reputable, established research activities relevant to general practice; and access to information resources. Although Australian general practice has a weak research culture, about a third of GPs would like to increase their involvement in research. However, the research must be perceived as relevant, and structured to minimise the inherent barriers in the environment and culture of general practice.

The development of professional practice standards for Australian general practice nurses.

PubMed

Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

2017-08-01

The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Concurrent mixed methods design. Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. © 2017 John Wiley & Sons Ltd.

Unintended imitation affects success in a competitive game.

PubMed

Naber, Marnix; Vaziri Pashkam, Maryam; Nakayama, Ken

2013-12-10

Imitation typically occurs in social contexts where people interact and have common goals. Here, we show that people are also highly susceptible to imitate each other in a competitive context. Pairs of players performed a competitive and fast-reaching task (a variant of the arcade whac-a-mole game) in which money could be earned if players hit brief-appearing visual targets on a large touchscreen before their opponents. In three separate experiments, we demonstrate that reaction times and movements were highly correlated within pairs of players. Players affected their success by imitating each other, and imitation depended on the visibility of the opponent's behavior. Imitation persisted, despite the competitive and demanding nature of the game, even if this resulted in lower scores and payoffs and even when there was no need to counteract the opponent's actions.

Weighted current sheets supported in normal and inverse configurations - A model for prominence observations

NASA Technical Reports Server (NTRS)

Demoulin, P.; Forbes, T. G.

1992-01-01

A technique which incorporates both photospheric and prominence magnetic field observations is used to analyze the magnetic support of solar prominences in two dimensions. The prominence is modeled by a mass-loaded current sheet which is supported against gravity by magnetic fields from a bipolar source in the photosphere and a massless line current in the corona. It is found that prominence support can be achieved in three different kinds of configurations: an arcade topology with a normal polarity; a helical topology with a normal polarity; and a helical topology with an inverse polarity. In all cases the important parameter is the variation of the horizontal component of the prominence field with height. Adding a line current external to the prominence eliminates the nonsupport problem which plagues virtually all previous prominence models with inverse polarity.

Cat-scratch disease: unusual perivascular chorioretinal lesions.

PubMed

Sahin, Ozlem

2014-01-01

This study is a case report of bilateral perivascular chorioretinal lesions associated with Bartonella henselae. A 37-year-old woman presented with headache and blurred vision in both eyes aggravating occasionally during five years. She was otherwise healthy, with best-corrected visual acuities were 20/20 in both eyes. History of close contact with cats was more than merely eye-catching upon examination of her fundus. In both eyes, fundi were coated with yellow-brown pigmented perivenous chorioretinal lesions along the superotemporal and inferotemporal vascular arcades and their branches. The perivenous lesions were associated with vascular fibrous bands and corresponding changes in vascular calibers. There were no associated intraocular inflammatory signs in both eyes. The serologic tests confirmed the diagnosis of cat-scratch disease. The patient received no treatment, and she was followed for three years without any signs of ocular inflammation.

A case of cat-scratch disease with unusual ophthalmic manifestations.

PubMed

Ghazi, Nicola G; Sams, Waler A

2012-01-01

We report a case of cat-scratch disease with unusual posterior segment manifestations. A 12-year-old healthy male presented with three weeks history of decreased visual acuity in the right eye. A significant history of cat exposure and elevated Bartonella titers were present. A large white-gray vascularized mass extending off the optic disk, an early stellate maculopathy, a plaque of choroiditis, an inferior serous retinal detachment involving the macula were present in the right eye. Sector papillitis and a focal area of chorioretinitis along the superotemporal arcade with associated retinal artery to vein anastomosis were present in the left eye. Bilateral optic nerve head involvement including peripapillary angiomatosis, retinal-retinal anastomosis and plaque choroiditis as ocular complications of cat-scratch disease have not been previously described to our knowledge and make this case noteworthy.

Engaging participants in a complex intervention trial in Australian General Practice

PubMed Central

Perkins, David; Harris, Mark F; Tan, Jocelyn; Christl, Bettina; Taggart, Jane; Fanaian, Mahnaz

2008-01-01

Background The paper examines the key issues experienced in recruiting and retaining practice involvement in a large complex intervention trial in Australian General Practice. Methods Reflective notes made by research staff and telephone interviews with staff from general practices which expressed interest, took part or withdrew from a trial of a complex general practice intervention. Results Recruitment and retention difficulties were due to factors inherent in the demands and context of general practice, the degree of engagement of primary care organisations (Divisions of General Practice), perceived benefits by practices, the design of the trial and the timing and complexity of data collection. Conclusion There needs to be clearer articulation to practices of the benefits of the research to participants and streamlining of the design and processes of data collection and intervention to fit in with their work practices. Ultimately deeper engagement may require additional funding and ongoing participation through practice research networks. Trial Registration Current Controlled Trials ACTRN12605000788673 PMID:18700984

Patient initiated aggression - prevalence and impact for general practice staff.

PubMed

Herath, Pushpani; Forrest, Laura; McRae, Ian; Parker, Rhian

2011-06-01

Patient initiated aggression toward general practice staff can cause distress among staff, however, it is unknown how frequently practice staff experience patient aggression in the workplace. The aim of this study is to determine the national prevalence of patient aggression toward general practice staff. A clustered cross sectional survey involving general practice staff working in Australia. A questionnaire was posted to 1109 general practices nationally and 217 questionnaires were completed and returned (19.6% response rate). It was found that verbal aggression is commonly experienced by practice staff, particularly receptionists, whereas physical aggression is infrequent. Staff working in larger practices experience more verbal aggression and property damage or theft and it was reported that verbal aggression has a greater impact on staff wellbeing than physical aggression. This study provides some national evidence of the prevalence of patient aggression toward general practice staff. This may inform the development of policy and procedures.

The proposed general practice descriptors--will they influence preventive medicine?

PubMed

Moorhead, R G

1989-01-01

The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.

Influences on final year medical students' attitudes to general practice as a career.

PubMed

Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J

2014-03-01

General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

The economic benefit for family/general medicine practices employing physician assistants.

PubMed

Grzybicki, Dana M; Sullivan, Paul J; Oppy, J Miller; Bethke, Anne-Marie; Raab, Stephen S

2002-07-01

To measure the economic benefit of a family/general medicine physician assistant (PA) practice. Qualitative description of a model PA practice in a family/general medicine practice office setting, and comparison of the financial productivity of a PA practice with that of a non-PA (physician-only) practice. The study site was a family/general medicine practice office in southwestern Pennsylvania. The description of PA practice was obtained through direct observation and semistructured interviews during site visits in 1998. Comparison of site practice characteristics with published national statistics was performed to confirm the site's usefulness as a model practice. Data used for PA productivity analyses were obtained from site visits, interviews, office billing records, office appointment logs, and national organizations. The PA in the model practice had a same-task substitution ratio of 0.86 compared with the supervising physician. The PA was economically beneficial for the practice, with a compensation-to-production ratio of 0.36. Compared with a practice employing a full-time physician, the annual financial differential of a practice employing a full-time PA was $52,592. Sensitivity analyses illustrated the economic benefit of a PA practice in a variety of theoretical family/general medicine practice office settings. Family/general medicine PAs are of significant economic benefit to practices that employ them.

[Manual therapy in general practice].

PubMed

Березуцкий, Владимир И

2016-01-01

The article is devoted to manual therapy practice for diagnostics and treatment of vertebrogenic pain syndrome in general practice. Analytical roundup of sources proves medical advantage of implementation of manual therapy basic methods by general practice specialists.

Human resource management in general practice: survey of current practice.

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change. PMID:8855013

The Future of General Surgery: Evolving to Meet a Changing Practice.

PubMed

Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

2016-01-01

Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Integrating counselling into general practice.

PubMed

Stone, L; Blashki, G

2000-03-01

General practice counselling has many significant differences to counselling in other settings. General practitioners have long term relationships with their patients involving physical as well as mental health care. General practitioners are often the first point of contact for distressed patients who may not perceive their problem to have a psychological basis. There are barriers to counselling including time management and cultural expectations of the consultation. To outline a practical biopsychosocial model for counselling in the general practice setting using the knowledge and skills unique to each GP. Theoretical and practical barriers to counselling commonly encountered in general practice are discussed. Assessing the problem in a biopsychosocial format highlights strengths and skills the patient already possesses and involves consideration of physical sensations, emotions, behaviours, key relationships, family, social roles and resources. Counselling in general practice requires flexibility and an ability to adapt available resources to address patient needs in an individually appropriate way.

Vertical Integration in Teaching And Learning (VITAL): an approach to medical education in general practice.

PubMed

Dick, Marie-Louise B; King, David B; Mitchell, Geoffrey K; Kelly, Glynn D; Buckley, John F; Garside, Susan J

2007-07-16

There is increasing demand to provide clinical and teaching experiences in the general practice setting. Vertical integration in teaching and learning, whereby teaching and learning roles are shared across all learner stages, has the potential to decrease time demands and stress on general practitioners, to provide teaching skills and experience to GP registrars, and to improve the learning experience for medical students, and may also help meet the increased demand for teaching in general practice. We consider potential advantages and barriers to vertical integration of teaching in general practice, and provide results of focus group discussions with general practice principals and registrars about vertical integration. We recommend further research into the feasibility of using vertical integration to enhance the capacity to teach medical students in general practice.

Flexible but boring: medical students' perceptions of a career in general practice.

PubMed

Koehler, Nicole; McMenamin, Christine

2016-07-01

Australia will continue to face a general practitioner (GP) shortage unless a significant number of medical students make general practice their chosen career. Perceptions regarding general practice may influence career choices. Thus this study investigated what Australian medical students perceived to be the advantages and disadvantages of pursuing a career in general practice via an anonymous online survey. Fifty-one students indicated general practice to be their first ranked career preference, 200 indicated a career other than general practice, and 106 were undecided. Two-hundred and two students reported having been on a GP placement, whereas 88 students had not. Flexibility, continuity of patient care and work-life balance were the three most common stated advantages to pursuing a career in general practice whereas general practice being boring, poorly paid, and of low prestige were the three most common disadvantages stated. Some disadvantages stated by those with a non-GP preference were not stated by those with a GP preference (e.g. lack of procedural skills, lack of career advancement opportunities). Students with more than 80 h of GP placement experience were more likely to list the advantages of work-life balance and a diversity of problems/illnesses/patients than those with no placement experience but were also more likely to list the disadvantage of low prestige. Negative stereotypes regarding general practice continue to exist which may influence students' career choices.

A qualitative study of the barriers and enablers to fertility-awareness education in general practice.

PubMed

Hampton, Kerry D; Newton, Jennifer M; Parker, Rhian; Mazza, Danielle

2016-07-01

To understand the barriers and enablers to fertility-awareness education in general practice. Most women along with their primary care practitioners - general practitioners and practice nurses - believe that women should be educated about fertility-awareness when first reporting trouble conceiving. To date, no in-depth study has examined the enablers and challenges of this type of education in general practice. A descriptive exploratory qualitative study using deductive content analysis. General practitioners (N = 11) and practice nurses (N = 20) were recruited from general practices in three socioculturally diverse areas in Victoria, Australia. Data were collected through semistructured interviews based on the 12 domains of a theoretical behaviour change framework from April-August 2012. The participants' responses were organized into themes that fall under the framework domains. The biggest barriers to fertility-awareness education in general practice were short consultations and time constraints faced by general practitioners together with a lack of patient educational materials and remuneration to support its delivery. The biggest enablers were a greater use of nurses trained in fertility-awareness in a collaborative team care arrangement with general practitioners. This study has identified several important barriers and enablers to fertility-awareness education in general practice. Translation into practice of our findings is imperative as the first step in establishing a primary care model in fertility-awareness. This would fill an important gap in the primary care of infertile women and build capacity in general practice to reduce infertility through women's enhanced fertility knowledge. © 2016 John Wiley & Sons Ltd.

Enamel hypoplasia in the middle pleistocene hominids from Atapuerca (Spain).

PubMed

Bermúdez de Castro, J M; Pérez, P J

1995-03-01

The prevalence and chronology of enamel hypoplasias were studied in a hominid dental sample from the Sima de los Huesos (SH) Middle Pleistocene site at the Sierra de Atapuerca (Burgos, northern Spain). A total of 89 permanent maxillary teeth, 143 permanent mandibular teeth, and one deciduous lower canine, belonging to a minimum of 29 individuals, were examined. Excluding the antimeres (16 maxillary and 37 mandibular cases) from the sample, the prevalence of hypoplasias in the permanent dentition is 12.8% (23/179), whereas the deciduous tooth also showed an enamel defect. No statistically significant differences were found between both arcades and between the anterior and postcanine teeth for the prevalence of hypoplasias. In both the maxilla and the mandible the highest frequency of enamel hypoplasias was recorded in the canines. Only one tooth (a permanent upper canine) showed two different enamel defects, and most of the hypoplasias were expressed as faint linear horizontal defects. Taking into account the limitations that the incompleteness of virtually all permanent dentitions imposes, we have estimated that the frequency by individual in the SH hominid sample was not greater than 40%. Most of the hypoplasias occurred between birth and 7 years (N = 18, X = 3.5, SD = 1.3). Both the prevalence and severity of the hypoplasias of the SH hominid sample are significantly less than those of a large Neandertal sample. Furthermore, prehistoric hunter-gatherers and historic agricultural and industrial populations exhibit a prevalence of hypoplasias generally higher than that of the SH hominids. Implications for the survival strategies and life quality of the SH hominids are also discussed.

A Statistical Study of Solar Sources of Wide Coronal Mass Ejections in 2011

NASA Astrophysics Data System (ADS)

Akiyama, S.; Yashiro, S.; Gopalswamy, N.; Makela, P. A.; Xie, H.; Olmedo, O. A.

2013-12-01

Solar surface signatures of coronal mass ejections (CMEs) are flares, filament eruptions/disappearances, EUVI waves, dimmings, and post-eruption arcades. After the SDO launch we have an excellent opportunity to investigate the solar sources of CMEs because of the high spatial- and temporal-resolution images from SDO/AIA and multiple views from SOHO, SDO, and STEREO-A/B. We examined the solar sources of all wide CMEs (width ≥ 60°) observed by either SOHO/LASCO or STEREO/SECCHI in 2011. Out of the 597 wide CMEs identified, 322 (54%) were associated with active region flares (FLs) and 164 (27%) with eruptive quiescent prominences (EPs). In 88 cases (15%) only EUV dimmings (DIMs) were observed. For the remaining 23 (4%) CMEs we were not able to identify the solar sources (UNK), i.e. they were stealth CMEs. The average speed and width of the CMEs are, 481 km/s and 115° for FLs, 349 km/s and 90° for EPs, 270 km/s and 78° for DIMs, and 171 km/s and 90° for UNKs, respectively. According to Ma et al. (2010), one third of CMEs observed by STEREO-A/B from 2009 Jan. 1 to Aug. 31 was categorized as stealth CMEs. Our study shows that the rate of stealth CMEs is much smaller for wide CMEs. We also compared the average appearance latitude of CMEs between the stealth and all wide CMEs and found that the stealth CMEs appeared from higher latitude (48°) than the general population (35°). Reference: Ma et al. (2010) ApJ, 722, 289

Specialization and the Current Practices of General Surgeons

PubMed Central

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan.

PubMed

Ie, Kenya; Murata, Akiko; Tahara, Masao; Komiyama, Manabu; Ichikawa, Shuhei; Takemura, Yousuke C; Onishi, Hirotaka

2018-01-01

Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

Truly simultaneous SS-OCT of the anterior and posterior human eye with full anterior chamber and 50° retinal field of views (Conference Presentation)

NASA Astrophysics Data System (ADS)

McNabb, Ryan P.; Viehland, Christian; Keller, Brenton; Vann, Robin R.; Izatt, Joseph A.; Kuo, Anthony N.

2017-02-01

Optical coherence tomography (OCT) has revolutionized clinical observation of the eye and is an indispensable part of the modern ophthalmic practice. Unlike many other ophthalmic imaging techniques, OCT provides three-dimensional information about the imaged eye. However, conventional clinical OCT systems image only the anterior or the posterior eye during a single acquisition. Newer OCT systems have begun to image both during the same acquisition but with compromises such as limited field of view in the posterior eye or requiring rapid switching between the anterior and posterior eye during the scan. We describe here the development and demonstration of an OCT system with truly simultaneous imaging of both the anterior and posterior eye capable of imaging the full anterior chamber width and 50° on the retina (macula, optic nerve, and arcades). The whole eye OCT system was developed using custom optics and optomechanics. Polarization was utilized to separate the imaging channels. We utilized a 200kHz swept-source laser (Axsun Technologies) centered at 1040±50nm of bandwidth. The clock signal generated by the laser was interpolated 4x to generate 5504 samples per laser sweep. With the whole eye OCT system, we simultaneously acquired anterior and posterior segments with repeated B-scans as well as three-dimensional volumes from seven healthy volunteers (other than refractive error). On three of these volunteers, whole eye OCT and partial coherence interferometry (LenStar PCI, Haag-Streit) were used to measure axial eye length. We measured a mean repeatability of ±47µm with whole eye OCT and a mean difference from PCI of -68µm.

Supervision--growing and building a sustainable general practice supervisor system.

PubMed

Thomson, Jennifer S; Anderson, Katrina J; Mara, Paul R; Stevenson, Alexander D

2011-06-06

This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

Video-assisted feedback in general practice internships using German general practitioner's guidelines

PubMed Central

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept. The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out. PMID:23255963

Video-assisted feedback in general practice internships using German general practitioner's guidelines.

PubMed

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.

A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process.

PubMed

Galbraith, Kevin; Ward, Alison; Heneghan, Carl

2017-05-03

Evidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM. We synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice. A simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one's approach towards EBM itself, and to the influences on decision-making; (2) pragmatism - in one's approach to finding and evaluating evidence; and (3) knowledge of the patient - as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work. We have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a strategy for actual practice.

The impact of new forms of large-scale general practice provider collaborations on England's NHS: a systematic review.

PubMed

Pettigrew, Luisa M; Kumpunen, Stephanie; Mays, Nicholas; Rosen, Rebecca; Posaner, Rachel

2018-03-01

Over the past decade, collaboration between general practices in England to form new provider networks and large-scale organisations has been driven largely by grassroots action among GPs. However, it is now being increasingly advocated for by national policymakers. Expectations of what scaling up general practice in England will achieve are significant. To review the evidence of the impact of new forms of large-scale general practice provider collaborations in England. Systematic review. Embase, MEDLINE, Health Management Information Consortium, and Social Sciences Citation Index were searched for studies reporting the impact on clinical processes and outcomes, patient experience, workforce satisfaction, or costs of new forms of provider collaborations between general practices in England. A total of 1782 publications were screened. Five studies met the inclusion criteria and four examined the same general practice networks, limiting generalisability. Substantial financial investment was required to establish the networks and the associated interventions that were targeted at four clinical areas. Quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management. The fifth study of a large-scale multisite general practice organisation showed that it may be better placed to implement safety and quality processes than conventional practices. However, unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care. Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why. © British Journal of General Practice 2018.

Regionalisation of general practice training--are we meeting the needs of rural Australia?

PubMed

Campbell, David G; Greacen, Jane H; Giddings, Patrick H; Skinner, Lesley P

2011-06-06

The concept of "social accountability" has underpinned the development of many medical education programs over the past decade. Success of the regionalisation of the general practice training program in Australia will ultimately be measured by the ability of the program to deliver a sufficient rural general practice workforce to meet the health needs of rural communities. Regionalisation of general practice training in Australia arose from the 1998 recommendations of the Ministerial Review of General Practice Training. The resultant competitive structure adopted by government was not the preferred option of the Review Committee, and may be a negative influence on rural workforce, as the competitive corporate structure of regional training providers has created barriers to meaningful vertical integration. Available data suggest that the regionalised training program is not yet providing a sustainable general practice workforce to rural Australia. The current increase in medical student and general practice training places provides an opportunity to address some of these issues. In particular, it is recommended that changes be made to registrar selection processes, the rural pipeline and vertical integration of training, and training for procedural rural practice. To achieve these goals, perhaps it is time for another comprehensive ministerial review of general practice training in Australia.

The place of knowledge and evidence in the context of Australian general practice nursing.

PubMed

Mills, Jane; Field, John; Cant, Robyn

2009-01-01

The purpose of the study was to ascertain the place of knowledge and evidence in the context of Australian general practice nursing. General practice nursing is a rapidly developing area of specialized nursing in Australia. The provision of primary care services in Australia rests largely with medical general practitioners who employ nurses in a small business model. A statistical research design was used that included a validated instrument: the developing evidence-based practice questionnaire (Gerrish et al. 2007). A total of 1,800 Victorian practice nurses were surveyed with a return of 590 completed questionnaires, equaling a response rate of 33%. Lack of time to access knowledge for practice was a barrier for participants in this study. In-service education and training opportunities were ranked as the number one source of knowledge for general practice nurses. Experiential learning and interactions with clients, peers, medical practitioners, and specialist nurses were also considered very important sources of knowledge. Research journals were ranked much lower than experiential learning and personal interactions. Participants assessed their own skills at sourcing and translating evidence into practice knowledge as low. Younger general practice nurses were more likely than older nurses to assess themselves as competent at using the library and Internet to locate evidence. The predominantly oral culture of nursing needs to be identified and incorporated into methods for disseminating evidence from research findings in order to increase the knowledge base of Australian general practice nurses. Findings from this study will be significant for policy makers and funders of Australian nursing in general practice. The establishment of a career structure for general practice nurses that includes salaried positions for clinical nurse specialists would assist in the translation of evidence into knowledge for utilization at the point of care.

General practitioners’ experiences using cognitive behavioural therapy in general practice: A qualitative study

PubMed Central

Aschim, Bente; Lundevall, Sverre; Martinsen, Egil W.; Frich, Jan C.

2011-01-01

Objective To explore GPs’ experiences using cognitive behavioural therapy (CBT), with a focus on factors that promote or limit the use of CBT in general practice. Design Qualitative study using data from written evaluation reports and focus-group interviews. Setting Norwegian general practice. Subjects GPs who participated in a longitudinal CBT course in the continuous medical education (CME) programme for GPs in Norway, of whom 19 filled in evaluation forms and 15 participated in focus-group interviews. Main outcome measures Experiences with the use of CBT in general practice. Results GPs used CBT mainly in the treatment of patients with anxiety disorders and depression. Factors that promoted the use of CBT in general practice were structured supervision and group counselling, receiving feedback on individual video-recorded consultations, and experiencing that one mastered the therapeutic techniques. Limiting factors were that it took some time before one mastered the techniques, lack of eligible patients, constraints related to attending group supervision during office hours, and the lack of financial incentives to use CBT in general practice. Conclusion Tailored training programmes in CBT for GPs may contribute to more frequent use of CBT in general practice. A formal recognition of CBT in the reimbursement scheme for GPs might counter limiting factors to an increased use of CBT in general practice. PMID:21861599

Improving vaccination cold chain in the general practice setting.

PubMed

Page, Sue L; Earnest, Arul; Birden, Hudson; Deaker, Rachelle; Clark, Chris

2008-10-01

This study compared temperature control in different types of vaccine storing refrigerators in general practice and tested knowledge of general practice staff in vaccine storage requirements. Temperature data loggers were set to serially record the temperature within vaccine refrigerators in 28 general practices, recording at 12 minute intervals over a period of 10 days on each occasion. A survey of vaccine storage knowledge and records of divisions of general practice immunisation contacts were also obtained. There was a significant relationship between type of refrigerator and optimal temperature, with the odds ratio for bar style refrigerator being 0.005 (95% CI: 0.001-0.044) compared to the purpose built vaccine refrigerators. Score on a survey of vaccine storage was also positively associated with optimal storage temperature. General practices that invest in purpose built vaccine refrigerators will achieve standards of vaccine cold chain maintenance significantly more reliably than can be achieved through regular cold chain monitoring and practice supports.

Specialization and the current practices of general surgeons.

PubMed

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for 3 US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and percentage of practice that made up their most common operation were calculated. Correlation was measured between general surgeons' case volume and the number of other specialists in a health service area. There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure constituted no more than 30% of total practice. The most common operations, ranked by the frequency they appeared as general surgeons' top procedure, included cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice composed of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (rho = -0.50; p = 0.005). Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Shared learning in general practice--facilitators and barriers.

PubMed

van de Mortel, Thea; Silberberg, Peter; Ahern, Christine

2013-03-01

Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

Microcirculation of the pancreas. A quantitative study of physiology and changes in pancreatitis.

PubMed

Klar, E; Endrich, B; Messmer, K

1990-02-01

A rabbit model was designed to study the microcirculation of the pancreas with special reference to changes occurring during acute pancreatitis. Intravital microscopy was used in conjunction with video techniques allowing for continuous observation and off-line evaluation of microvessel diameters and blood cell velocities. Based on the microvessel geometry a functional microvascular unit could be defined at the level of the pancreatic lobule consisting of intralobular arteries and veins and an arcade-like preferential pathway framing the capillary network. Experimental acute pancreatitis resulted in immediate leakage of the macromolecular plasma marker (FITC-Dextran 70) from the microvasculature suggesting increased permeability. In contrast to control conditions, pancreatic capillaries were excluded from the circulation during acute pancreatitis starting 30 min after induction with only single capillaries remaining perfused after 3 hours. At the same time, there was constant blood flow through the preferential pathways representing shunt perfusion.

A rare case of toxic optic neuropathy secondary to consumption of neem oil.

PubMed

Suresha, A R; Rajesh, P; Anil Raj, K S; Torgal, Radhika

2014-03-01

A 35-year-old female was referred to our hospital with bilateral loss of vision of two days duration. She gave history of consumption of about 150 ml of neem oil five days back.Examination revealed no perception of light in both eyes. Both pupils were dilated and sluggishly reacting to light. Her fundus examination showed bilateral hyperemic, edematous discs and also edema extending along the superior and inferior temporal vascular arcade. Magnetic resonance imaging (MRI) scan showed bilateral putaminal regions with altered signal, hypointensities in T1-weighted images, hyperintensities on T2-weighted, images and hyperintense on Fluid Attenuation Inversion Recovery (FLAIR) images suggestive of cytotoxic edema due to tissue hypoxia. Her vision improved to 20/200 in both eyes with treatment after two months. This is the first case report of such nature in the literature to the best of our knowledge.

MHD simulations of coronal dark downflows considering thermal conduction

NASA Astrophysics Data System (ADS)

Zurbriggen, E.; Costa, A.; Esquivel, A.; Schneiter, M.; Cécere, M.

2017-10-01

While several scenarios have been proposed to explain supra-arcade downflows (SADs) observed descending through turbulent hot regions, none of them have systematically addressed the consideration of thermal conduction. The SADs are known to be voided cavities. Our model assumes that SADs are triggered by bursty localized reconnection events that produce non-linear waves generating the voided cavity. These subdense cavities are sustained in time because they are hotter than their surrounding medium. Due to the low density and large temperature values of the plasma we expect the thermal conduction to be an important process. Our main aim here is to study if it is possible to generate SADs in the framework of our model considering thermal conduction. We carry on 2D MHD simulations including anisotropic thermal conduction, and find that if the magnetic lines envelope the cavities, they can be isolated from the hot environment and be identified as SADs.

Autopsy Features of Fatal Donkey Attack.

PubMed

Fogel, Lajos; Varga, Gyula; Hubay, Marta; Felszeghy, Endre; Varga, Peter; Byard, Roger W

2018-05-02

Lethal donkey attacks have very rarely been described. The case of a 65-year-old man who was found deceased on a country road with 2 domestic donkeys nearby is, therefore, reported. Examination of the body revealed contusions and lacerations of the face and scalp, a comminuted fracture of the left maxilla, comminuted fracturing of the right radius and ulna and of the left anterior superior iliac spine, a flail chest, and pulmonary contusions. In addition, there were bite marks on the left thigh, right buttock, right axilla/upper arm, and left cheek which corresponded to the dental arcades of the donkeys. Death had resulted from blunt chest trauma due to an attack by 1 or 2 donkeys. Deaths and serious injuries are much more commonly caused by horses; however, this case shows that even domesticated donkeys may also rarely be capable of inflicting significant trauma and so should be approached with circumspection.

Fine-needle aspiration cytology of malignant hemangiopericytoma of the salivary gland: A case report.

PubMed

Shimizu, K; Ogura, S; Kobayashi, T K; Kushima, R; Toyokuni, S; Iwasa, Y; Sakurai, M

1999-12-01

A 79-yr-old woman presented with a 5-yr history of swelling of the left cheek. The fine-needle aspiration (FNA) smear showed a spindle-cell neoplasm with capillaries and benign endothelial cells. The spindle cells possessed pleomorphic, hyperchromatic elongated nuclei and a moderate amount of ill-defined cytoplasm. They also showed papillary arcades surrounded and encased by relatively small ovoid to short spindle cells. Subsequent surgical excision confirmed the presence of malignant hemangiopericytoma (HP). Immunohistochemical studies on the histologic section using vimentin were strongly positive, consistent with HP. To the best of our knowledge, this is the second published report of FNA cellular features of malignant HP of the salivary gland. Besides delineating the FNA cellular features of HP of the salivary gland, the present case illustrates the value of using immunohistochemical approaches. Diagn. Cytopathol. 1999;21:398-401. Copyright 1999 Wiley-Liss, Inc.

Association of X-ray arches with chromospheric neutral lines

NASA Technical Reports Server (NTRS)

Mcintosh, P. S.; Krieger, A. S.; Nolte, J. T.; Vaiana, G.

1976-01-01

Daily maps of magnetic neutral lines derived from H-alpha observations have been superimposed on solar X-ray images for the period from June 15 to 30, 1973. Nearly all X-ray-emitting structures consist of systems of arches covering chromospheric neutral lines. Areas of low emissivity, coronal holes, appear as the areas between arcades of arches. The presence of a coronal hole, therefore, is determined by the spacing between neutral lines and the scale of the arches over those neutral lines. X-ray emissivity on the solar disk extends from neutral lines in proportion to the vertical and horizontal scale of the arches over those neutral lines. Increasing scale of arches corresponds with increasing age of magnetic fields associated with the neutral line. All X-ray filament cavities coincided with neutral lines, but filaments appeared under cavities for only part of their length and for only a fraction of the disk passage.

Theoretical Study on the Mechanics of the Conjunct Gnatoprothetic Devices in the Context of Occlusive Function Rehabilitation

PubMed Central

POPESCU, M.R.; TRANĂ, F.; MANOLEA, H.; RAUTEN, ANE-MARIE; ȘURLIN, PETRA; DRAGOMIR, L.P.

2014-01-01

The partially intercalated edentation offers the practitioner the possibility of the functional rehabilitation of the dental arcades through conjunct gnato-prosthetic devices. The functions of the dento-maxilar device, disturbed by the presence of edentation, require a treatment approach so that, without pre-planning or estimating, the result can lead most of the times to failure in terms of functionality. Clinical evaluation associated with pre- and proprosthetic treatment can also impose, in some situations the evaluation of the dental units involved in prosthetic rehabilitation. The association and implementation of the prosthetic construction in the occlusive-articular ensemble, as well as the counterbalancing of the mastication forces per dental unit and whole interarch system, linked to the distribution of the forces at the level of the pillar teeth and prosthetic construction, represent the goal of this theoretical study. PMID:25729593

Theoretical study on the mechanics of the conjunct gnatoprothetic devices in the context of occlusive function rehabilitation.

PubMed

Popescu, M R; Trană, F; Manolea, H; Rauten, Ane-Marie; Șurlin, Petra; Dragomir, L P

2014-01-01

The partially intercalated edentation offers the practitioner the possibility of the functional rehabilitation of the dental arcades through conjunct gnato-prosthetic devices. The functions of the dento-maxilar device, disturbed by the presence of edentation, require a treatment approach so that, without pre-planning or estimating, the result can lead most of the times to failure in terms of functionality. Clinical evaluation associated with pre- and proprosthetic treatment can also impose, in some situations the evaluation of the dental units involved in prosthetic rehabilitation. The association and implementation of the prosthetic construction in the occlusive-articular ensemble, as well as the counterbalancing of the mastication forces per dental unit and whole interarch system, linked to the distribution of the forces at the level of the pillar teeth and prosthetic construction, represent the goal of this theoretical study.

Innervated boomerang flap for finger pulp reconstruction.

PubMed

Chen, Shao-Liang; Chiou, Tai-Fung

2007-11-01

The boomerang flap originates from the dorsolateral aspect of the proximal phalanx of an adjacent digit and is supplied by the retrograde blood flow through the vascular arcades between the dorsal and palmar digital arteries. To provide sensation of the boomerang flap for finger pulp reconstruction, the dorsal sensory branch of the proper digital nerve and the superficial sensory branch of the corresponding radial or ulnar nerve are included within the skin flap. After transfer of the flap to the injured site, epineural neurorrhaphies are done between the digital nerves of the pulp and the sensory branches of the flap. We used this sensory flap in five patients, with more than 1 year follow-up, and all patients achieved measurable two-points discrimination. The boomerang flap not only preserves the proper palmar digital artery but also provides an extended and innervated skin paddle. It seems to be an alternative choice for one-stage reconstruction of major pulp defect.

The Radio Synchrotron Background: Conference Summary and Report

NASA Astrophysics Data System (ADS)

Singal, J.; Haider, J.; Ajello, M.; Ballantyne, D. R.; Bunn, E.; Condon, J.; Dowell, J.; Fixsen, D.; Fornengo, N.; Harms, B.; Holder, G.; Jones, E.; Kellermann, K.; Kogut, A.; Linden, T.; Monsalve, R.; Mertsch, P.; Murphy, E.; Orlando, E.; Regis, M.; Scott, D.; Vernstrom, T.; Xu, L.

2018-03-01

We summarize the radio synchrotron background workshop that took place 2017 July 19–21 at the University of Richmond. This first scientific meeting dedicated to the topic was convened because current measurements of the diffuse radio monopole reveal a surface brightness that is several times higher than can be straightforwardly explained by known Galactic and extragalactic sources and processes, rendering it by far the least well understood photon background at present. It was the conclusion of a majority of the participants that the radio monopole level is at or near that reported by the ARCADE 2 experiment and inferred from several absolutely calibrated zero-level lower frequency radio measurements, and unanimously agreed that the production of this level of surface brightness, if confirmed, represents a major outstanding question in astrophysics. The workshop reached a consensus on the next priorities for investigations of the radio synchrotron background.

Swept-Source Optical Coherence Tomography Angiography in West Nile Virus Chorioretinitis and Associated Occlusive Retinal Vasculitis.

PubMed

Khairallah, Moncef; Kahloun, Rim; Gargouri, Salma; Jelliti, Bechir; Sellami, Dorra; Ben Yahia, Salim; Feki, Jamel

2017-08-01

A 65-year-old man with diabetes and a history of fever of unknown origin 2 weeks earlier complained of sudden decreased vision in the left eye. The patient was diagnosed with bilateral West Nile virus (WNV) chorioretinitis associated with occlusive retinal vasculitis in the left eye. Swept-source optical coherence tomography angiography (SS-OCTA) of the left eye showed extensive, well-delineated, hypointense non-perfusion areas and perifoveal capillary arcade disruption in the superficial capillary plexus, as well as larger non-perfusion areas, capillary rarefaction, and diffuse capillary network attenuation and disorganization in the deep capillary plexus. OCTA may be a valuable tool for noninvasively assessing occlusive retinal vasculitis associated with WNV infection. It allows an accurate detection and precise delineation of areas of retinal capillary nonperfusion in both the superficial and deep capillary plexuses. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:672-675.]. Copyright 2017, SLACK Incorporated.

Cosmological origin of anomalous radio background

NASA Astrophysics Data System (ADS)

Cline, James M.; Vincent, Aaron C.

2013-02-01

The ARCADE 2 collaboration has reported a significant excess in the isotropic radio background, whose homogeneity cannot be reconciled with clustered sources. This suggests a cosmological origin prior to structure formation. We investigate several potential mechanisms and show that injection of relativistic electrons through late decays of a metastable particle can give rise to the observed excess radio spectrum through synchrotron emission. However, constraints from the cosmic microwave background (CMB) anisotropy, on injection of charged particles and on the primordial magnetic field, present a challenge. The simplest scenario is with a gtrsim9 GeV particle decaying into e+e- at a redshift of z ~ 5, in a magnetic field of ~ 5μG, which exceeds the CMB B-field constraints, unless the field was generated after decoupling. Decays into exotic millicharged particles can alleviate this tension, if they emit synchroton radiation in conjunction with a sufficiently large background magnetic field of a dark U(1)' gauge field.

Is video-game playing a risk factor for pathological gambling in Australian adolescents?

PubMed

Delfabbro, Paul; King, Daniel; Lambos, Chrisi; Puglies, Stan

2009-09-01

Very little research has been conducted to examine the relationship between video-game playing and gambling in adolescence. In this study, 2,669 adolescents aged 13-17 years were surveyed to obtained details of their involvement in gambling and video-game playing as well as a measure of pathological gambling (the DSM-IV-J). The results showed that, the frequency of video game playing was significantly related to pathological gambling, but that the effect size was very small and largely accounted for by the greater popularity of both activities amongst boys. There was some evidence for stronger associations between technologically similar activities, namely arcade video games and an interest in gaming machines, but other factors discussed in the paper may also account for this association. In summary, the findings suggested that playing video-games is unlikely to be a significant risk factor for pathological gambling during adolescence.

Improving communication between health-care professionals and patients with limited English proficiency in the general practice setting.

PubMed

Attard, Melanie; McArthur, Alexa; Riitano, Dagmara; Aromataris, Edoardo; Bollen, Chris; Pearson, Alan

2015-01-01

Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia.

Integrating postgraduate and undergraduate general practice education: qualitative study.

PubMed

O'Regan, Andrew; Culhane, Aidan; Dunne, Colum; Griffin, Michael; McGrath, Deirdre; Meagher, David; O'Dwyer, Pat; Cullen, Walter

2013-05-01

Educational activity in general practice has increased considerably in the past 20 years. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' capacity to fulfil this role. To explore the potential for vertical integration in undergraduate and postgraduate education in general practice, by describing the experience of (and attitudes towards) 'vertical integration in general practice education' among key stakeholder groups. Qualitative study of GPs, practice staff, GPs-in-training and medical students involving focus groups which were thematically analysed. We identified four overarching themes: (1) Important practical features of vertical integration are interaction between learners at different stages, active involvement in clinical teams and interagency collaboration; (2) Vertical integration may benefit GPs/practices, students and patients through improved practice systems, exposure to team-working and multi-morbidity and opportunistic health promotion, respectively; (3) Capacity issues may challenge its implementation; (4) Strategies such as recognising and addressing diverse learner needs and inter-agency collaboration can promote vertical integration. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' teaching capacity. Recognising the diverse educational needs of learners at different stages and collaboration between agencies responsible for the planning and delivery of specialist training and medical degree programmes would appear to be important.

Becoming willing to role model. Reciprocity between new graduate nurses and experienced practice nurses in general practice in New Zealand: a constructivist grounded theory.

PubMed

Hoarea, Karen J; Millsc, Jane; Francis, Karen

2013-01-01

Graduate nurses in general practice became a feature of New Zealand's health care system in 2008 following an expansion of the New Entrant to Practice Programme. General practice in New Zealand comprises general practitioner business owners who employ nursing and administration staff. Practice nurses are an ageing workforce in New Zealand, it is imperative therefore to attract younger nurses into general practice. This paper reports a section of the findings from a constructivist grounded theory study which examines the use of information by practice nurses in New Zealand. Initially data were collected using the ethnographic technique of observation and field notations in one general practice. Theoretical sensitivity to the value of role models was heightened by this first phase of data collection. A total of eleven practice nurses were interviewed from six general practices. One practice nurse agreed to a second interview; five of the interviewees were new graduate nurses and the other six were experienced practice nurses. The grounded theory constructed from this research was reciprocal role modelling which comprises the following three categories, becoming willing, realising potential and becoming a better practitioner. Graduate nurses and experienced practice nurses enter into a relationship of reciprocal role modelling. Becoming willing, the first core category of this grounded theory features three sub-categories: building respectful relationships, proving yourself and discerning decision making which are reported in this paper. Findings from this study may address the reported phenomenon of 'transition shock' of newly graduated nurses in the work place.

Understanding general practice: a conceptual framework developed from case studies in the UK NHS.

PubMed

Checkland, Kath

2007-01-01

General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. Five general practices in England, selected using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and nonparticipant observation, and examination of documents. A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality.

Predictors of a positive attitude of medical students towards general practice - a survey of three Bavarian medical faculties.

PubMed

Schneider, Antonius; Karsch-Völk, Marlies; Rupp, Alica; Fischer, Martin R; Drexler, Hans; Schelling, Jörg; Berberat, Pascal

2013-01-01

Germany is witnessing an increasing shortage of general practitioners (GPs). The aim was to determine predictors of the job-related motivation of medical students of three medical faculties with different institutionalisation of general practice as an academic discipline. Medical students were surveyed with a standardised questionnaire about their attitudes towards general practice and their motivation to work as a GP in different working conditions. Predictors for positive attitudes and motivation were calculated using logistic regression models. 940 (15.2%) out of 6182 medical students from three Bavarian medical faculties participated in an online survey. 585 (62.7%) were female, and the average age was 25.0 (standard deviation 3.7). The average grade of a university-entrance diploma was 1.6 (standard deviation 0.5). 718 (76.4%) could imagine working as a GP. However, they favoured being employed within another organisation and not having their own private practice (65.5% vs. 35.1%). "Presence of a professorship of general practice" was associated with a positive attitude towards general practice (OR 1.57; 95%CI 1.13-2.417). Motivation for working as a GP was associated with "being female" (OR 2.56; 95%CI 1.80-3.56) and "presence of a professorship of general practice" (OR 1.68; 95%CI 1.14-2.46). Having a lower grade for one's university-entrance diploma was associated with a higher preference to work in one's own practice (OR 1.39; 95%CI 1.02-1.90). A high amount of medical students were open-minded towards general practice. However, they favoured employment within an organization over working in their own practice. Institutionalisation of general practice as an academic discipline might be of importance to gain positive attitudes towards general practice and motivate medical students to work as a GP.

Attitudes of newly qualified doctors towards a career in general practice: a qualitative focus group study.

PubMed

Merrett, Alexandra; Jones, Daniel; Sein, Kim; Green, Trish; Macleod, Una

2017-04-01

A key element of the NHS is universal access to a GP. Recently, UK general practice has been described as being in crisis, with training places unfilled and multiple practices reporting vacancies or facing closure. The recruitment of GPs continues to be a key focus for both the Royal College of General Practitioners (RCGP) and the government. To understand the attitudes of newly qualified doctors towards a career in general practice, to appreciate potential reasons for the crisis in GP recruitment, and to recommend ways to improve recruitment. A qualitative study comprising five focus groups with 74 Foundation Year 1 (FY1) doctors from one Yorkshire deanery. Audio recordings were transcribed verbatim and thematic analysis undertaken. Foundation Year 1 doctors' thoughts towards a career in general practice were summarised in four themes: quality of life, job satisfaction, uncertainty surrounding the future of general practice, and the lack of respect for GPs among both doctors and the public. Participants felt that general practice could provide a good work-life balance, fair pay, and job stability. Job satisfaction, with the ability to provide care from the cradle to the grave, and to work within a community, was viewed positively. Uncertainties around future training, skill levels, pay, and workload, together with a perceived stigma experienced in medical schools and hospitals, were viewed as a deterrent to a career in general practice. This study has gathered the opinions of doctors at a critical point in their careers, before they choose a future specialty. Findings highlight areas of concern and potential deterrents to a career in general practice, together with recommendations to address these issues. © British Journal of General Practice 2017.

Satisfaction and comfort with nursing in Australian general practice.

PubMed

2015-01-01

The practice nursing workforce has grown exponentially in recent years. Whilst evidence has shown the important contributions of nurses to general practice service delivery, the consumer perspective of nursing in general practice has received limited attention. Given that acceptability of nurses is influenced by patient satisfaction which can in turn improve both treatment adherence and clinical outcomes, this is an important area for investigation. The primary aim of this study was to evaluate consumer satisfaction with chronic disease management by nurses in general practice (NiGP) and comfort with the tasks undertaken by nurses in general practice. Consumers receiving chronic disease services from nurses in general practice participating in a larger study were recruited to complete a survey. The survey comprised of demographic information, and items related to satisfaction with the nurse encounter (SPN-9) and consumer comfort with nurse roles in general practice (CPN-18). Eighty-one consumers participated in the study. Cronbach's alpha values of the SPN-9 and the CPN-18 were 0.95 and 0.97 respectively. SPN-9 results demonstrated high levels of satisfaction with PN consultations. Bivariate analysis did not show any significant differences within the consumer group relating to satisfaction. However, those who presented for diabetes-related reasons were more likely to report high comfort levels with the nurse encounter compare to those who presented to general practice for other chronic disease conditions (38% versus 14%, p = 0.016). The results of this study demonstrate that consumers are generally satisfied with nursing consultations in general practice related to chronic disease. However, further research evaluating consumer confidence, comfort and satisfaction with nursing care is needed to ensure that nursing services meet consumer needs.

Influence on general practitioners of teaching undergraduates: qualitative study of London general practitioner teachers

PubMed Central

Hartley, Sarah; Macfarlane, Fraser; Gantley, Madeleine; Murray, Elizabeth

1999-01-01

Objective To examine the perceived effect of teaching clinical skills and associated teacher training programmes on general practitioners' morale and clinical practice. Design Qualitative semistructured interview study. Setting General practices throughout north London. Subjects 30 general practitioners who taught clinical skills were asked about the effect of teaching and teacher training on their morale, confidence in clinical and teaching skills, and clinical practice. Results The main theme was a positive effect on morale. Within teacher training this was attributed to developing peer and professional support; improved teaching skills; and revision of clinical knowledge and skills. Within teaching this was attributed to a broadening of horizons; contact with enthusiastic students; increased time with patients; improved clinical practice; improved teaching skills; and an improved image of the practice. Problems with teaching were due to external factors such as lack of time and space and anxieties about adequacy of clinical cover while teaching. Conclusions Teaching clinical skills can have a positive effect on the morale of general practitioner teachers as a result of contact with students and peers, as long as logistic and funding issues are adequately dealt with. Key messagesThe increase in community based teaching of clinical skills requires an increase in the number of general practitioner teachersLittle evidence is available about the effect of teaching of clinical skills and teacher training on general practitioner teachers and practicesGeneral practitioner teachers reported an increase in morale, improvements in clinical skills, and changes in clinical practice and in practice infrastructure as a result of teaching and trainingGeneral practitioner teachers reported problems because of pressure on time, lack of space, problems recruiting patients, and unsupportive practice partnersPositive effects on morale and clinical practice may be important for sustainable teaching and continuing medical education PMID:10541508

Development and psychometric validation of the general practice nurse satisfaction scale.

PubMed

Halcomb, Elizabeth J; Caldwell, Belinda; Salamonson, Yenna; Davidson, Patricia M

2011-09-01

To develop an instrument to assess consumer satisfaction with nursing in general practice to provide feedback to nurses about consumers' perceptions of their performance. Prospective psychometric instrument validation study. A literature review was conducted to generate items for an instrument to measure consumer satisfaction with nursing in general practice. Face and content validity were evaluated by an expert panel, which had extensive experience in general practice nursing and research. Included in the questionnaire battery was the 27-item General Practice Nurse Satisfaction (GPNS) scale, as well as demographic and health status items. This survey was distributed to 739 consumers following intervention administered by a practice nurse in 16 general practices across metropolitan, rural, and regional Australia. Participants had the option of completing the survey online or receiving a hard copy of the survey form at the time of their visit. These data were collected between June and August 2009. Satisfaction data from 739 consumers were collected following their consultation with a general practice nurse. From the initial 27-item GPNS scale, a 21-item instrument was developed. Two factors, "confidence and credibility" and "interpersonal and communication" were extracted using principal axis factoring and varimax rotation. These two factors explained 71.9% of the variance. Cronbach's α was 0.97. The GPNS scale has demonstrated acceptable psychometric properties and can be used both in research and clinical practice for evaluating consumer satisfaction with general practice nurses. Assessing consumer satisfaction is important for developing and evaluating nursing roles. The GPNS scale is a valid and reliable tool that can be utilized to assess consumer satisfaction with general practice nurses and can assist in performance management and improving the quality of nursing services. © 2011 Sigma Theta Tau International.

Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

PubMed

Sturmberg, Joachim P; Martin, Carmel M; Katerndahl, David A

2014-01-01

Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline's philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform.

Systems and Complexity Thinking in the General Practice Literature: An Integrative, Historical Narrative Review

PubMed Central

Sturmberg, Joachim P.; Martin, Carmel M.; Katerndahl, David A.

2014-01-01

PURPOSE Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. METHODS We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. RESULTS General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. CONCLUSIONS This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline’s philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform. PMID:24445105

Guidelines for computer security in general practice.

PubMed

Schattner, Peter; Pleteshner, Catherine; Bhend, Heinz; Brouns, Johan

2007-01-01

As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

General practice registrars' intentions for future practice: implications for rural medical workforce planning.

PubMed

Harding, Catherine; Seal, Alexa; McGirr, Joe; Caton, Tim

2016-11-01

The models of practice that general practice registrars (GPRs) envisage undertaking will affect workforce supply. The aim of this research was to determine practice intentions of current GPRs in a regional general practice training program (Coast City Country General Practice Training). Questionnaires were circulated to 220 GPRs undertaking general practice placements to determine characteristics of ideal practice models and intentions for future practice. Responses were received for 99 participants (45%). Current GPRs intend to work an average of less than eight half-day sessions/week, with male participants intending to work more hours (t(91)=3.528, P=0.001). More than one-third of this regional cohort intends to practice in metropolitan centres. Proximity to family and friends was the most important factor influencing the choice of practice location. Men ranked remuneration for work as more important (t (88)=-4.280, P<0.001) and women ranked the ability to work part-time higher (t(94)=3.697, P<0.001). Fee-for-service payment alone, or in combination with capitation, was the preferred payment system. Only 22% of Australian medical graduates intend to own their own practice compared with 52% of international medical graduates (χ 2 (1)=8.498, P=0.004). Future general practitioners (GPs) intend to work fewer hours than current GPs. Assumptions about lifestyle factors, practice models and possible professional roles should be carefully evaluated when developing strategies to recruit GPs and GPRs into rural practice.

Refugee experiences of general practice in countries of resettlement: a literature review.

PubMed

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-03-01

Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams.

PubMed

Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine

2015-01-01

In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Changes in pathology test ordering by early career general practitioners: a longitudinal study.

PubMed

Magin, Parker J; Tapley, Amanda; Morgan, Simon; Henderson, Kim; Holliday, Elizabeth G; Davey, Andrew R; Ball, Jean; Catzikiris, Nigel F; Mulquiney, Katie J; van Driel, Mieke L

2017-07-17

To assess the number of pathology tests ordered by general practice registrars during their first 18-24 months of clinical general practice. Longitudinal analysis of ten rounds of data collection (2010-2014) for the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multicentre, cohort study of general practice registrars in Australia. The principal analysis employed negative binomial regression in a generalised estimating equations framework (to account for repeated measures on registrars).Setting, participants: General practice registrars in training posts with five of 17 general practice regional training providers in five Australian states. The registrar participation rate was 96.4%. Number of pathology tests requested per consultation. The time unit for analysis was the registrar training term (the 6-month full-time equivalent component of clinical training); registrars contributed data for up to four training terms. 876 registrars contributed data for 114 584 consultations. The number of pathology tests requested increased by 11% (95% CI, 8-15%; P < 0.001) per training term. Contrary to expectations, pathology test ordering by general practice registrars increased significantly during their first 2 years of clinical practice. This causes concerns about overtesting. As established general practitioners order fewer tests than registrars, test ordering may peak during late vocational training and early career practice. Registrars need support during this difficult period in the development of their clinical practice patterns.

Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

PubMed

Stol, Daphne M; Hollander, Monika; Nielen, Markus M J; Badenbroek, Ilse F; Schellevis, François G; de Wit, Niek J

2018-03-01

Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. Observational study. Dutch primary care. General practices. Organizational characteristics. General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points   There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.   • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.   • Implementation of selective CMD prevention programs including easily accessible services for lifestyle support should be the focus of attention.   • Policy makers, health insurance companies and healthcare professionals share the responsibility to realize structural funding for selective CMD prevention.

["General Practice is a great job anyway" - a qualitative study with vocational trainees].

PubMed

Steinhäuser, Jost; Paulus, Jan; Roos, Marco; Peters-Klimm, Frank; Ledig, Thomas; Szecsenyi, Joachim; Joos, Stefanie

2011-01-01

Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany. A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner. The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession. Copyright © 2010. Published by Elsevier GmbH.

Datasets collected in general practice: an international comparison using the example of obesity.

PubMed

Sturgiss, Elizabeth; van Boven, Kees

2018-06-04

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

Increasing medical student interest in general practice in New Zealand: where to from here?

PubMed

Poole, Phillippa; Bourke, David; Shulruf, Boaz

2010-05-28

To meet increasing health demands, increasing the proportion of local graduates entering general practice is imperative. Students entering or exiting The University of Auckland's medical programme from 2006 to 2008 were invited to complete a tracking project survey. Levels of interest in general practice were determined along with characteristics associated with a greater or lesser interest in this career. 712 students replied--a response rate of 80%. At entry, 40% of students had a strong interest in a career in general practice, and at exit, 29% (P =0.003). A quarter at each time point had no interest. The proportion of domestic students born outside NZ or Australia was 160/376 (42.5%). There were significantly higher levels of interest in general practice among females, students born in NZ, and those from outside Auckland--especially rural origin. Flexibility in career was more important to students with a strong interest in general practice than those with no interest. Auckland medical students have levels of interest in general practice comparable with international data. Increasing this interest further may require admission of a greater proportion of students from those groups with higher interest levels, greater emphasis on the positive aspects of general practice, and on GPs as equals to other specialists.

Private or salaried practice: how do young general practitioners make their career choice? A qualitative study.

PubMed

Kinouani, Shérazade; Boukhors, Gary; Luaces, Baptiste; Durieux, William; Cadwallader, Jean-Sébastien; Aubin-Auger, Isabelle; Gay, Bernard

2016-09-01

Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners. A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently. Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice. National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

Integrating patient empowerment as an essential characteristic of the discipline of general practice/family medicine.

PubMed

Mola, Ernesto; De Bonis, Judith A; Giancane, Raffaele

2008-01-01

Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline. The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline. The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline. General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities. "Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.

16 CFR 0.11 - Office of the General Counsel.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Office of the General Counsel. 0.11 Section 0.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.11 Office of the General Counsel. The General Counsel is the Commission's chief law officer...

Doctors' attitudes and confidence towards providing nutrition care in practice: Comparison of New Zealand medical students, general practice registrars and general practitioners.

PubMed

Crowley, Jennifer; Ball, Lauren; Han, Dug Yeo; McGill, Anne-Thea; Arroll, Bruce; Leveritt, Michael; Wall, Clare

2015-09-01

Improvements in individuals' nutrition behaviour can improve risk factors and outcomes associated with lifestyle-related chronic diseases. This study describes and compares New Zealand medical students, general practice registrars and general practitioners' (GPs') attitudes towards incorporating nutrition care into practice, and self-perceived skills in providing nutrition care. A total of 183 New Zealand medical students, 51 general practice registrars and 57 GPs completed a 60-item questionnaire investigating attitudes towards incorporating nutrition care into practice and self-perceived skills in providing nutrition care. Items were scored using a 5-point Likert scale. Factor analysis was conducted to group questionnaire items and a generalised linear model compared differences between medical students, general practice registrars and GPs. All groups indicated that incorporating nutrition care into practice is important. GPs displayed more positive attitudes than students towards incorporating nutrition in routine care (p<0.0001) and performing nutrition recommendations (p<0.0001). General practice registrars were more positive than students towards performing nutrition recommendations (p=0.004), specified practices (p=0.037), and eliciting behaviour change (p=0.024). All groups displayed moderate confidence towards providing nutrition care. GPs were more confident than students in areas relating to wellness and disease (p<0.0001); macronutrients (p=0.030); micronutrients (p=0.010); and women, infants and children (p<0.0001). New Zealand medical students, general practice registrars and GPs have positive attitudes and moderate confidence towards incorporating nutrition care into practice. It is possible that GPs' experience providing nutrition care contributes to greater confidence. Strategies to facilitate medical students developing confidence in providing nutrition care are warranted.

Undergraduate teaching in UK general practice: a geographical snapshot.

PubMed

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-06-01

Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. National survey of all medical schools in the UK. All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK's health departments. All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum-maximum) of 142 (17-385) practices per school. The median (minimum-maximum) distance between a school and a teaching practice was 28 km (0-1421 km), 41 (0:00-23:26) minutes' travel by car and 1 hour 12 (0:00-17:29) minutes' travel by public transport. All teaching practices were accessible by public transport in one school and 90-99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. © British Journal of General Practice 2014.

What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study

PubMed Central

Dunham, Annette H; Dunbar, James A; Johnson, Julie K; Fuller, Jeff; Morgan, Mark; Ford, Dale

2018-01-01

Objectives To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Design Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Setting Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Participants Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Results Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Conclusions Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision. PMID:29643162

Intermittent Flare Energy Release: A Signature of Contracting Magnetic Islands from Reconnection?

NASA Astrophysics Data System (ADS)

Guidoni, S. E.; Karpen, J. T.; DeVore, C.

2013-12-01

Many flares show short-lived enhancements of emission that protrude above their smooth underlying emission. These spikes have been observed over a vast energy spectrum, from radio to hard x-rays. In hard X-rays, for example, their duration ranges from 0.2 to 2 s, with the majority occurring during the flare impulsive phase (Cheng 2012). In most cases, this intermittent energy release is situated at the footpoints of flare arcades where ionized particles, previously accelerated to high energies at coronal heights, are decelerated by the dense solar surface. It is not yet understood what mechanisms accelerate ionized particles to the energies required to produce the observed emission spikes. Drake et al. (2006) proposed a kinetic mechanism for accelerating electrons from contracting magnetic islands that form as reconnection proceeds, analogous to the energy gain of a ball bouncing between converging walls. They estimated that multi-island regions of macroscopic dimensions might account for the required acceleration rates in flares, but at this time it is impractical to simulate large-scale systems in kinetic models. On the other hand, our recent high-resolution MHD simulations of a breakout eruptive flare (Karpen et al. 2012) allow us to resolve in detail the generation and evolution of macroscopic magnetic islands in a flare current sheet. Incorporating a rigorous kinetic model into our global simulations is not feasible at present. However, we intend to breach the gap between kinetic and fluid models by characterizing the contractions of islands as they move away from the main reconnection site, to determine their plausibility as candidates for the observed bursts of radiation. With our null-tracking capabilities, we follow the creation and evolution of the X- and O-type (island) nulls that result from spatially and temporally localized reconnection. Different regimes of current-sheet reconnection (slow/fast), island sizes, rates of island coalescence, and rates of reconnection between islands and arcades may help to explain the variety of energy and time scales exhibited by flare emission spikes. This research was supported, in part, by NASA's SR&T program and by an appointment to the NASA Postdoctoral Program at the Goddard Space Flight Center administered by Oak Ridge Associated Universities through a contract with NASA.

Over-and-Out Coronal Mass Ejections: Blowouts of Magnetic Arches by Ejective Flares in One Foot

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Sterling, Alphonse C.

2006-01-01

Streamer puffs from compact ejective flares in the foot of an outer loop of the magnetic arcade under a streamer were recently identified as a new variety of coronal mass ejection (CME) (Bemporad, Sterling, Moore, & Poletto 2006, ApJ Letters, in press). In the reported examples, the compact flares produced only weak to moderate soft X-ray bursts having peak intensities no stronger than GOES class C3. Here, we present two examples of this type of CME in which the compact flare in the flank of the steamer base is much stronger (one M-class, the other X-class in GOES X-rays) and the resulting streamer puff is wider and brighter than in the discovery examples. Coronal dimming observed in SOHOBIT Fe XII images in the launching of each of these two CMEs M e r supports the view that these CMEs are produced by a high loop of the steamer arcade being blown out by magnetoplasma ejecta exploding up the leg of the loop from the flare. In addition, we present evidence that this same type of CME occurs on larger scales than in the above examples. We examine a sequence of flare eruptions seated on the north side of AR 8210 as it rotated across the southern hemisphere in late April and early May 1998. Each flare occurs in synchrony with the launching of a large CME centered on the equator. Coronal dimming in EIT Fe XII images shows the trans-equatorial footprints of these CMEs extending north from the flare site. The set of flare-with-CME events includes the trans-equatorial loop eruptions reported by Khan & Hudson (1998, GRL, 27, 1083). Our observations indicate that these CMEs were not driven by the self-eruption of the transequatorial loops, but that these loops were part of a trans-equatorial magnetic arch that was blown open by ejecta from the flares on the north side of AR 8210. Thus, a relatively compact ejective flare can be the driver of a CME that is much larger in lateral extent than the flare and is laterally far offset from the flare. It has previously been thought that such spatial disparities between the flare and the CME prohibited the flare explosion from being the driver of the CME (e.g., Kahler 1992, ARA&A, 30, 113).

The Core Competencies for General Orthopaedic Surgeons.

PubMed

Kellam, James F; Archibald, Douglas; Barber, James W; Christian, Eugene P; D'Ascoli, Richard J; Haynes, Richard J; Hecht, Suzanne S; Hurwitz, Shepard R; Kellam, James F; McLaren, Alexander C; Peabody, Terrance D; Southworth, Stephen R; Strauss, Robert W; Wadey, Veronica M R

2017-01-18

With the changing delivery of orthopaedic surgical care, there is a need to define the knowledge and competencies that are expected of an orthopaedist providing general and/or acute orthopaedic care. This article provides a proposal for the knowledge and competencies needed for an orthopaedist to practice general and/or acute care orthopaedic surgery. Using the modified Delphi method, the General Orthopaedic Competency Task Force consisting of stakeholders associated with general orthopaedic practice has proposed the core knowledge and competencies that should be maintained by orthopaedists who practice emergency and general orthopaedic surgery. For relevancy to clinical practice, 2 basic sets of competencies were established. The assessment competencies pertain to the general knowledge needed to evaluate, investigate, and determine an overall management plan. The management competencies are generally procedural in nature and are divided into 2 groups. For the Management 1 group, the orthopaedist should be competent to provide definitive care including assessment, investigation, initial or emergency care, operative or nonoperative care, and follow-up. For the Management 2 group, the orthopaedist should be competent to assess, investigate, and commence timely non-emergency or emergency care and then either transfer the patient to the appropriate subspecialist's care or provide definitive care based on the urgency of care, exceptional practice circumstance, or individual's higher training. This may include some higher-level procedures usually performed by a subspecialist, but are consistent with one's practice based on experience, practice environment, and/or specialty interest. These competencies are the first step in defining the practice of general orthopaedic surgery including acute orthopaedic care. Further validation and discussion among educators, general orthopaedic surgeons, and subspecialists will ensure that these are relevant to clinical practice. These competencies provide many stakeholders, including orthopaedic educators and orthopaedists, with what may be the minimum knowledge and competencies necessary to deliver acute and general orthopaedic care. This document is the first step in defining a practice-based standard for training programs and certification groups.

Business plans--tips from the toolkit 6.

PubMed

Steer, Neville

2010-07-01

General practice is a business. Most practices can stay afloat by having appointments, billing patients, managing the administration processes and working long hours. What distinguishes the high performance organisation from the average organisation is a business plan. This article examines how to create a simple business plan that can be applied to the general practice setting and is drawn from material contained in The Royal Australian College of General Practitioners' 'General practice management toolkit'.

Leadership and management skills of general practice nurses: experience or education?

PubMed

Lau, Rosalind; Cross, Wendy; Moss, Cheryle; Campbell, Annie; De Castro, Magali; Oxley, Victoria

2014-12-01

A key finding of this qualitative exploratory descriptive study into advanced nursing for general practice nurses (Australian setting) revealed that participants viewed leadership and management as best learnt 'apprenticeship' style on the job by years of experience. Participants (48) comprised of general practice nurses, practice managers and general practitioners from metropolitan Melbourne were interviewed. Other findings demonstrated that the participants generally had limited awareness that postgraduate education can assist in the development of leadership and management in advanced nursing practice. The participants lacked clarity about professional competencies and generally did not connect these to leadership and management. Professional bodies need to take the opportunity to promote awareness of the national competency standards. All three groups of participants expressed hopes about the future provision of professional development opportunities and support by the Medicare Local for leadership and management aspirations within advanced practice nursing.

Spot-checks to measure general hygiene practice.

PubMed

Sonego, Ina L; Mosler, Hans-Joachim

2016-01-01

A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers' cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.

A framework for developing rural academic general practices: a qualitative case study in rural Victoria.

PubMed

Brown, J B; Morrison, Tracy; Bryant, Melanie; Kassell, Lisa; Nestel, Debra

2015-01-01

There is increasing pressure for Australian rural general practices to engage in educational delivery as a means of addressing workforce issues and accommodating substantial increases in learners. For practices that have now developed a strong focus on education, there is the challenge to complement this by engaging in research activity. This study develops a rural academic general practice framework to assist rural practices in developing both comprehensive educational activity and a strong research focus thus moving towards functioning as mature academic units. A case study research design was used with the unit of analysis at the level of the rural general practice. Purposively sampled practices were recruited and individual interviews conducted with staff (supervisors, practice managers, nurses), learners (medical students, interns and registrars) and patients. Three practices hosted 'multi-level learners', two practices hosted one learner group and one had no learners. Forty-four individual interviews were conducted with staff, learners and patients. Audio recordings were transcribed for thematic analysis. After initial inductive coding, deductive analysis was undertaken with reference to recent literature and the expertise of the research team resulting in the rural academic general practice framework. Three key themes emerged with embedded subthemes. For the first theme, organisational considerations, subthemes were values/vision/culture, patient population and clinical services, staffing, physical infrastructure/equipment, funding streams and governance. For the second theme, educational considerations, subthemes were processes, clinical supervision, educational networks and learner presence. Third, for research considerations, there were the subthemes of attitude to research and research activity. The framework maps the development of a rural academic practice across these themes in four progressive stages: beginning, emerging, consolidating and established. The data enabled a framework to be constructed to map rural general practice activity with respect to activity characteristic of an academic general practice. The framework offers guidance to practices seeking to transition towards becoming a mature academic practice. The framework also offers guidance to educational institutions and funding bodies to support the development of academic activity in rural general practices. The strengths and limitations of the study design are outlined.

Health sciences libraries’ subscriptions to journals: expectations of general practice departments and collection-based analysis

PubMed Central

Barreau, David; Bouton, Céline; Renard, Vincent; Fournier, Jean-Pascal

2018-01-01

Objective The aims of this study were to (i) assess the expectations of general practice departments regarding health sciences libraries’ subscriptions to journals and (ii) describe the current general practice journal collections of health sciences libraries. Methods A cross-sectional survey was distributed electronically to the thirty-five university general practice departments in France. General practice departments were asked to list ten journals to which they expected access via the subscriptions of their health sciences libraries. A ranked reference list of journals was then developed. Access to these journals was assessed through a survey sent to all health sciences libraries in France. Adequacy ratios (access/need) were calculated for each journal. Results All general practice departments completed the survey. The total reference list included 44 journals. This list was heterogeneous in terms of indexation/impact factor, language of publication, and scope (e.g., patient care, research, or medical education). Among the first 10 journals listed, La Revue Prescrire (96.6%), La Revue du Praticien–Médecine Générale (90.9%), the British Medical Journal (85.0%), Pédagogie Médicale (70.0%), Exercer (69.7%), and the Cochrane Database of Systematic Reviews (62.5%) had the highest adequacy ratios, whereas Family Practice (4.2%), the British Journal of General Practice (16.7%), Médecine (29.4%), and the European Journal of General Practice (33.3%) had the lowest adequacy ratios. Conclusions General practice departments have heterogeneous expectations in terms of health sciences libraries’ subscriptions to journals. It is important for librarians to understand the heterogeneity of these expectations, as well as local priorities, so that journal access meets users’ needs. PMID:29632446

Influences on students’ career decisions concerning general practice: a focus group study

PubMed Central

Nicholson, Sandra; Hastings, Adrian Michael; McKinley, Robert Kee

2016-01-01

Background Despite concerns about recruitment to UK general practice, there has been no concerted educational intervention to address them. Aim To better understand how medical students’ perceptions of their experiences of their undergraduate curriculum may affect choosing general practice as a career. Design and setting Qualitative study comprising focus groups of a total of 58 students from a range of medical schools across the UK. Method A range of UK medical schools students were invited by email to participate in focus groups and return a questionnaire detailing their current career choice to facilitate sampling students with varied career preferences. Students late in their studies were sampled as they were likely to be considering future careers. Focus group discussions were audiotaped, transcribed, and anonymised for both school and participant, then thematically analysed. Perceived differences in medical school culture, curriculum philosophy, design, and intent were explored. Results Six focus groups (58 students) were convened. Some student participants’ career aspirations were strongly shaped by family and home, but clinical placements remained important in confirming or refuting these choices. High-quality general practice attachments are a powerful attractor to general practice and, when they reflect authentic clinical practice, promote general practice careers. GP tutors can be powerful, positive role models. Students’ comments revealed conflicting understandings about general practice. Conclusion Attracting rather than coercing students to general practice is likely to be more effective at changing their career choices. Early, high-quality, ongoing and, authentic clinical exposure promotes general practice and combats negative stereotyping. It is recommended that increasing opportunities to help students understand what it means to be a ‘good GP’ and how this can be achieved are created. PMID:27578812

Validation of an instrument to measure inter-organisational linkages in general practice.

PubMed

Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

2007-12-03

Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high quality clinical linkages in general practice.

Engaging Musical Practices: A Sourcebook for Middle School General Music

ERIC Educational Resources Information Center

Burton, Suzanne L., Ed.

2012-01-01

Middle school general music may be a student's last encounter with school music. A practical book with accessible pedagogical resources on middle school general music is needed for methods courses and music practitioners' use. The book "Engaging Musical Practices: A Sourcebook for Middle School General Music" presents numerous ways to engage…

General surgery graduates may be ill prepared to enter rural or community surgical practice.

PubMed

Gillman, Lawrence M; Vergis, Ashley

2013-06-01

Rural/community surgery presents unique challenges to general surgeons. Not only are they required to perform "classic" general surgery procedures, but they are also often expected to be competent in other surgical disciplines. Final-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. Sixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. More than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

Quantifying the proportion of general practice and low-acuity patients in the emergency department.

PubMed

Nagree, Yusuf; Camarda, Vanessa J; Fatovich, Daniel M; Cameron, Peter A; Dey, Ian; Gosbell, Andrew D; McCarthy, Sally M; Mountain, David

2013-06-17

To accurately estimate the proportion of patients presenting to the emergency department (ED) who may have been suitable to be seen in general practice. Using data sourced from the Emergency Department Information Systems for the calendar 2013s 2009 to 2011 at three major tertiary hospitals in Perth, Western Australia, we compared four methods for calculating general practice-type patients. These were the validated Sprivulis method, the widely used Australasian College for Emergency Medicine method, a discharge diagnosis method developed by the Tasmanian Department of Human and Health Services, and the Australian Institute of Health and Welfare (AIHW) method. General practice-type patient attendances to EDs, estimated using the four methods. All methods except the AIHW method showed that 10%-12% of patients attending tertiary EDs in Perth may have been suitable for general practice. These attendances comprised 3%-5% of total ED length of stay. The AIHW method produced different results (general practice-type patients accounted for about 25% of attendances, comprising 10%-11% of total ED length of stay). General practice-type patient attendances were not evenly distributed across the week, with proportionally more patients presenting during weekday daytime (08:00-17:00) and proportionally fewer overnight (00:00-08:00). This suggests that it is not a lack of general practitioners that drives patients to the ED, as weekday working hours are the time of greatest GP availability. The estimated proportion of general practice-type patients attending the EDs of Perth's major hospitals is 10%-12%, and this accounts for < 5% of the total ED length of stay. The AIHW methodology overestimates the actual proportion of general practice-type patient attendances.

Clinical accuracy of point-of-care urine culture in general practice.

PubMed

Holm, Anne; Cordoba, Gloria; Sørensen, Tina Møller; Jessen, Lisbeth Rem; Frimodt-Møller, Niels; Siersma, Volkert; Bjerrum, Lars

2017-06-01

To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. Prospective diagnostic accuracy study comparing two index tests (Flexicult™ SSI-Urinary Kit or ID Flexicult™) with a reference standard (urine culture performed in the microbiological department). General practice in the Copenhagen area patients. Adult female patients consulting their general practitioner with suspected uncomplicated, symptomatic UTI. (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply in boric acid used for transportation for the reference standard. (4) Accuracy based on expert reading of photographs of POC urine cultures performed in general practice. Standard culture performed in the microbiological department was used as reference standard for all four measures. Twenty general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71-0.80), SEN 0.88 (CI: 0.83-0.92) and SPE 0.55 (CI: 0.46-0.64). The two POC tests produced similar results individually. Overall agreement with enterococci excluded was 0.82 (0.77-0.86) and agreement between expert readings of photographs and reference results was 0.81 (CI: 0.76-0.85). POC culture used in general practice has high SEN but low SPE. Low SPE could be due to both misinterpretation in general practice and an imperfect reference standard. Registration number: ClinicalTrials.gov NCT02323087.

How do Australian patients rate their general practitioner? A descriptive study using the General Practice Assessment Questionnaire.

PubMed

Potiriadis, Maria; Chondros, Patty; Gilchrist, Gail; Hegarty, Kelsey; Blashki, Grant; Gunn, Jane M

2008-08-18

To report patient responses to the General Practice Assessment Questionnaire (GPAQ) as a measure of satisfaction with health care received from Australian general practitioners. A clustered cross-sectional study involving general practice patients from 30 randomly selected general practices in Victoria. Between January and December 2005, a screening survey, including a postal version of the GPAQ, was mailed to 17 780 eligible patients. Scores on the six GPAQ items. We analysed data from 7130 patients who completed the screening survey and fulfilled our eligibility criteria. Levels of patient satisfaction with general practice care were generally high: mean GPAQ scores ranged from 68.6 (95% CI, 66.1-71.0) for satisfaction with access to the practice to 84.0 (95% CI, 82.2-85.4) for satisfaction with communication. Intracluster correlations for the GPAQ items ranged from 0.016 for overall satisfaction with the practice to 0.163 for satisfaction with access to the practice. Compared with national benchmarks in the United Kingdom, the GPs and practices participating in our study were rated higher on all six GPAQ items. Multivariable mixed effects linear regression showed that patients who were older, rated their health more highly, visited their GP more frequently and saw the same GP each time tended to express greater satisfaction with their care. Generally patients reported high levels of satisfaction with GP care. Greater satisfaction with care was associated with older patients, good health, more frequent contact with the GP, and seeing the one GP consistently.

Students learning medicine in general practice in Canada and Australia.

PubMed

Strasser, Roger

2016-01-01

Over the past 20 years, there has been increasing focus on general practice and the role of general practitioners (GPs) in undergraduate medical education. This article explores the experiences in Australia and Canada of students learning medicine in the general practice setting, drawing on general practice and medical education literature in both countries and beyond. In Canada and Australia, there is substantial and growing evidence that students learning medicine in general practice has positive value for all involved, including the students, patients, wider community, academic institutions and GPs. The space, time and financial aspects of GP-based medical education require further study. Nevertheless, there is considerable potential to develop and implement a national plan for GP-based medical education with targeted government investment and commitment from academic institutions.

Job satisfaction of practice assistants in general practice in Germany: an observational study.

PubMed

Goetz, Katja; Campbell, Stephen; Broge, Bjoern; Brodowski, Marc; Steinhaeuser, Jost; Wensing, Michel; Szecsenyi, Joachim

2013-08-01

Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions. To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction, staff characteristics and culture in general practice organizations. The study was based on data from the European Practice Assessment accreditation scheme for general practices and used an observational design. The study population consisted of 1158 practice assistants from 345 general practices across Germany. Job satisfaction was measured with the 10-item Warr-Cook-Wall questionnaire. Organizational culture was evaluated with four items. A linear regression analysis was performed in which each of the job satisfaction items was handled as dependent variable. Out of 1716 staff member questionnaires handed out to practice assistants, 1158 questionnaires were completed (response rate: 67.5%). Practice assistants were most satisfied with their colleagues and least satisfied with their income. Higher job satisfaction was associated with issues of organizational culture, particularly a good working atmosphere, opportunities to suggest and influence areas for improvement and clear responsibilities within the practice team. Prioritizing initiatives to maintain high levels of, or to improve the job satisfaction of practice assistants, is important for recruitment and retention. It will also help to improve working conditions for both practice assistants and GPs and create an environment to provide better quality care.

General practice registrars' views on maternity care in general practice in New Zealand.

PubMed

Preston, Hanna; Jaye, Chrystal; Miller, Dawn L

2015-12-01

The number of general practitioners (GPs) providing maternity care in New Zealand has declined dramatically since legislative changes of the 1990s. The Ministry of Health wants GPs to provide maternity care again. To investigate New Zealand general practice registrars' perspectives on GPs' role in maternity care; specifically, whether maternity services should be provided by GPs, registrars' preparedness to provide such services, and training opportunities available or required to achieve this. An anonymous online questionnaire was distributed to all registrars enrolled in The Royal New Zealand College of General Practitioners' (RNZCGP's) General Practice Education Programme (GPEP) in 2012, via their online learning platform OWL. 165 of the 643 general practice registrars responded (25.7% response rate). Most (95%) believe that GPs interested and trained in maternity care should consider providing antenatal, postnatal or shared care with midwives, and 95% believe women should be able to access maternity care from their general practice. When practising as a GP, 90% would consider providing antenatal and postnatal care, 47.3% shared care, and 4.3% full pregnancy care. Professional factors including training and adequate funding were most important when considering providing maternity care as a GP. Ninety-five percent of general practice registrars who responded to our survey believe that GPs should provide some maternity services, and about 90% would consider providing maternity care in their future practice. Addressing professional issues of training, support and funding are essential if more GPs are to participate in maternity care in New Zealand.

Does responsibility drive learning? Lessons from intern rotations in general practice.

PubMed

Cantillon, Peter; Macdermott, Maeve

2008-01-01

The intern (or pre-registration) year has been criticised in the past for its emphasis on service delivery at the expense of educational achievement. It is hoped that new approaches to early postgraduate training such as the foundation programmes in the UK, will make clinical education more structured and effective. Intern placements in non-traditional settings such as general practice have been shown in the past to improve the quality of learning. Little is known however about which features of the general practice learning environment contribute most to the perception of improved learning. This aim of this study was to examine the learning environment in general practice from the perspective of interns, (the learners), to determine the factors that contribute most to motivating effective learning in a general practice setting. This study used a qualitative case study approach to explore the effects of two different learning environments, (general practice and hospital) on learner motivation amongst a small group of interns. We found that the biggest difference between the hospital and general practice learning environments was the increased individual responsibility for patient care experienced by interns in general practice. Greater responsibility was associated with greater motivation for learning. Increased intern responsibility for patient care does appear to motivate learning. More work needs to be done on providing interns in hospital posts with greater patient responsibility within an effective supervisory structure.

Understanding general practice: a conceptual framework developed from case studies in the UK NHS

PubMed Central

Checkland, Kath

2007-01-01

Background General practice in the UK is undergoing a period of rapid and profound change. Traditionally, research into the effects of change on general practice has tended to regard GPs as individuals or as members of a professional group. To understand the impact of change, general practices should also be considered as organisations. Aim To use the organisational studies literature to build a conceptual framework of general practice organisations, and to test and develop this empirically using case studies of change in practice. This study used the implementation of National Service Frameworks (NSFs) and the new General Medical Services (GMS) contract as incidents of change. Design of study In-depth, qualitative case studies. The design was iterative: each case study was followed by a review of the theoretical ideas. The final conceptual framework was the result of the dynamic interplay between theory and empirical evidence. Setting Five general practices in England, selected using purposeful sampling. Method Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results A conceptual framework was developed that can be used to understand how and why practices respond to change. This framework enabled understanding of observed reactions to the introduction of NSFs and the new GMS contract. Important factors for generating responses to change included the story that the practice members told about their practice, beliefs about what counted as legitimate work, the role played by the manager, and previous experiences of change. Conclusion Viewing general practices as small organisations has generated insights into factors that influence responses to change. Change tends to occur from the bottom up and is determined by beliefs about organisational reality. The conceptual framework suggests some questions that can be asked of practices to explain this internal reality. PMID:17244426

New Record Folder for Use in General Practice

PubMed Central

Hawkey, J. K.; Loudon, I. S. L.; Greenhalgh, G. P.; Bungay, G. T.

1971-01-01

A new concept for filing medical records in general practice is described, based on an A4-size folder; in experimental use in 40 practices doctors were generally in favour of the new system. ImagesFIG. 1FIG. 2 PMID:5134567

47 CFR 76.1001 - Unfair practices generally.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Competitive Access to Cable Programming § 76.1001 Unfair practices generally. (a) Unfair practices generally. No cable operator, satellite cable programming vendor in which a cable operator has an attributable interest, or satellite broadcast programming vendor...

47 CFR 76.1001 - Unfair practices generally.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Competitive Access to Cable Programming § 76.1001 Unfair practices generally. (a) Unfair practices generally. No cable operator, satellite cable programming vendor in which a cable operator has an attributable interest, or satellite broadcast programming vendor...

Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations.

PubMed

Taylor, Robyn; McKinlay, Eileen; Morris, Caroline

2017-03-01

INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders' views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

45 CFR 50.5 - Waivers for the delivery of health care service.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Primary care physicians are defined as: physicians practicing general internal medicine, pediatrics... practice, general pediatrics, obstetrics/gynecology, general internal medicine, or general psychiatry; and...

45 CFR 50.5 - Waivers for the delivery of health care service.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Primary care physicians are defined as: physicians practicing general internal medicine, pediatrics... practice, general pediatrics, obstetrics/gynecology, general internal medicine, or general psychiatry; and...

What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study.

PubMed

Dunham, Annette H; Dunbar, James A; Johnson, Julie K; Fuller, Jeff; Morgan, Mark; Ford, Dale

2018-04-10

To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Development of a pharmacological curriculum for general practice: Identifying and prescribing orally administered pharmacological substances with relevance for general practice].

PubMed

Straßner, Cornelia; Kaufmann-Kolle, Petra; Flum, Elisabeth; Schwill, Simon; Brandt, Bettina; Steinhäuser, Jost

2017-05-01

General practitioners (GPs) are among the specialists who prescribe the highest number of medication. Therefore the improvement of pharmacological competencies is an important part of the GP specialist training. The self-concept of general practice stating that GPs are the first contact persons for all health problems makes it challenging to define and acquire competencies for specialist training. While the "Competence-based Curriculum" developed by the German College of General Practitioners and Family Physicians defines diagnoses, reasons for counselling and competencies which are essential for general practice, a similar orientation guide is lacking for the pharmacological field. The aim of this study is to define and characterize pharmacological substances which every GP should know so well that he or she is able to conduct counselling and monitoring. We analysed private and public health insurance prescriptions of all general practices participating in the CONTENT project in the period from 2009 to 2014. The analysis was limited to substances with oral application which were prescribed at least once by at least 25 % (n = 11) of the practices. While the 100 most frequent prescriptions were included due to their frequency, less frequently prescribed substances were assessed concerning their relevance for general practice in a rating procedure. The substances included were classified by diagnoses and reasons for counselling. We analysed 1,912,896 prescriptions from 44 practices and 112,535 patients on the basis of the Anatomical Therapeutic Chemical (ATC) classification system. After applying the inclusion criteria, 453 substances were left, 302 of which were considered relevant for general practice and could be assigned to 45 diagnoses / reasons for counselling. The result of this study could be considered a working draft for a pharmacological curriculum for general practice, which may complement the "Competence-based Curriculum" in the medium term. Copyright © 2017. Published by Elsevier GmbH.

A survey of statistics in three UK general practice journal

PubMed Central

Rigby, Alan S; Armstrong, Gillian K; Campbell, Michael J; Summerton, Nick

2004-01-01

Background Many medical specialities have reviewed the statistical content of their journals. To our knowledge this has not been done in general practice. Given the main role of a general practitioner as a diagnostician we thought it would be of interest to see whether the statistical methods reported reflect the diagnostic process. Methods Hand search of three UK journals of general practice namely the British Medical Journal (general practice section), British Journal of General Practice and Family Practice over a one-year period (1 January to 31 December 2000). Results A wide variety of statistical techniques were used. The most common methods included t-tests and Chi-squared tests. There were few articles reporting likelihood ratios and other useful diagnostic methods. There was evidence that the journals with the more thorough statistical review process reported a more complex and wider variety of statistical techniques. Conclusions The BMJ had a wider range and greater diversity of statistical methods than the other two journals. However, in all three journals there was a dearth of papers reflecting the diagnostic process. Across all three journals there were relatively few papers describing randomised controlled trials thus recognising the difficulty of implementing this design in general practice. PMID:15596014

Allergen-specific immunotherapy prescription patterns in veterinary practice: a US population-based cohort study.

PubMed

Tater, Kathy Chu; Cole, William Elliott; Pion, Paul David

2017-08-01

Poor adherence to continuing allergen-specific immunotherapy treatment (ASIT) may be an issue in veterinary medicine. No studies describe how allergen tests are used in general veterinary practice, including the percentage of patients that receive ASIT after allergen testing. Assess veterinary ASIT patterns in United States general practices. Dogs (n = 2,557) and 121 cats allergen-tested at 177 hospitals (173 general practice and four specialty practices) in 44 states. Invoiced service descriptions of allergen tests and ASIT orders were retrieved from an aggregated database of veterinary practices. In general practice, 42% (992 of 2,360) of patients did not begin ASIT after allergen testing. ASIT was not refilled for 29% (398 of 1,368) of patients after the initial order. ASIT was initiated and refilled more often in dogs (56.6%, 71.4%, respectively) than cats (38%, 67.4%). Specialty practice patients had the highest ASIT initiation (94.4%) and refill (92.7%) percentages in comparison to general practices (P < 0.001). Size, age, geographical region and type of practice were associated with whether dogs were started on ASIT. Geographical region was also associated with refilling a prescription for ASIT, which was considered to be evidence of adherence to continuing treatment. Almost one third of clients failed to continue ASIT beyond the initial order, which is a much shorter duration of therapy than the 12 months recommended for determining ASIT efficacy. A large number of general practice patients did not begin ASIT after allergen testing, likely due to differences in how clinicians in general and dermatology practices use allergen tests. © 2017 ESVD and ACVD.

Financial costs for teaching in rural and urban Australian general practices: is there a difference?

PubMed

Laurence, Caroline O; Coombs, Maryanne; Bell, Janice; Black, Linda

2014-04-01

To determine if the financial costs of teaching GP registrars differs between rural and urban practices. Cost-benefit analysis of teaching activities in private GP for GP vocational training. Data were obtained from a survey of general practitioners in South Australia and Western Australia. General practitioners and practices teaching in association with the Adelaide to Outback General Practice Training Program or the Western Australian General Practice Training. Net financial effect per week per practice. At all the training levels, rural practices experienced a financial loss for teaching GP registrars, while urban practices made a small financial gain. The differences in net benefit between rural and urban teaching practices was significant at the GPT2/PRRT2 (-$515 per week 95% CI -$1578, -$266) and GPT3/PRRT3 training levels (-$396 per week, 95% CI (-$2568, -$175). The variables contributing greatest to the difference were the higher infrastructure costs for a rural practice and higher income to the practice from the GP registrars in urban practices. There were significant differences in the financial costs and benefits for a teaching rural practice compared with an urban teaching practice. With infrastructure costs which include accommodation, being a key contributor to the difference found, it might be time to review the level of incentives paid to practices in this area. If not addressed, this cost difference might be a disincentive for rural practices to participate in teaching. © 2014 National Rural Health Alliance Inc.

16 CFR 1025.41 - General rules.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false General rules. 1025.41 Section 1025.41 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL RULES OF PRACTICE FOR ADJUDICATIVE... to the convenience of the parties, shall continue without suspension until concluded, except in...

Ad Hoc Supervision of General Practice Registrars as a "Community of Practice": Analysis, Interpretation and Re-Presentation

ERIC Educational Resources Information Center

Clement, T.; Brown, J.; Morrison, J.; Nestel, D.

2016-01-01

General practice registrars in Australia undertake most of their vocational training in accredited general practices. They typically see patients alone from the start of their community-based training and are expected to seek timely ad hoc support from their supervisor. Such ad hoc encounters are a mechanism for ensuring patient safety, but also…

Involving migrants in the development of guidelines for communication in cross-cultural general practice consultations: a participatory learning and action research project

PubMed Central

O'Reilly-de Brún, Mary; MacFarlane, Anne; de Brún, Tomas; Okonkwo, Ekaterina; Bonsenge Bokanga, Jean Samuel; Manuela De Almeida Silva, Maria; Ogbebor, Florence; Mierzejewska, Aga; Nnadi, Lovina; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; van Weel, Chris

2015-01-01

Objective The aim of this research was to involve migrants and other key stakeholders in a participatory dialogue to develop a guideline for enhancing communication in cross-cultural general practice consultations. In this paper, we focus on findings about the use of formal versus informal interpreters because dialogues about these issues emerged as central to the identification of recommendations for best practice. Design This qualitative case study involved a Participatory Learning and Action (PLA) research methodology. Participants The sample comprised 80 stakeholders: 51 from migrant communities; 15 general practitioners (GPs) and general practice staff; 7 established migrants as peer researchers; 5 formal, trained interpreters; and 2 service planners from the national health authority. Setting Galway, Ireland. Results There was 100% consensus across stakeholder groups that while informal interpreters have uses for migrants and general practice staff, they are not considered acceptable as best practice. There was also 100% consensus that formal interpreters who are trained and working as per a professional code of practice are acceptable as best practice. Conclusions Policymakers and service planners need to work in partnership with service providers and migrants to progress the implementation of professional, trained interpreters as a routine way of working in general practice. PMID:26391628

A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No. 32.

PubMed

Park, Sophie; Khan, Nada F; Hampshire, Mandy; Knox, Richard; Malpass, Alice; Thomas, James; Anagnostelis, Betsy; Newman, Mark; Bower, Peter; Rosenthal, Joe; Murray, Elizabeth; Iliffe, Steve; Heneghan, Carl; Band, Amanda; Georgieva, Zoya

2015-05-06

General practice is increasingly used as a learning environment in undergraduate medical education in the UK. The aim of this project was to identify, summarise and synthesise research about undergraduate medical education in general practice in the UK. We systematically identified studies of undergraduate medical education within a general practice setting in the UK from 1990 onwards. All papers were summarised in a descriptive report and categorised into two in-depth syntheses: a quantitative and a qualitative in-depth review. 169 papers were identified, representing research from 26 UK medical schools. The in-depth review of quantitative papers (n = 7) showed that medical students learned clinical skills as well or better in general practice settings. Students receive more teaching, and clerk and examine more patients in the general practice setting than in hospital. Patient satisfaction and enablement are similar whether a student is present or not in a consultation, however, patients experience lower relational empathy. Two main thematic groups emerged from the qualitative in-depth review (n = 10): the interpersonal interactions within the teaching consultation and the socio-cultural spaces of learning which shape these interactions. The GP has a role as a broker of the interactions between patients and students. General practice is a socio-cultural and developmental learning space for students, who need to negotiate the competing cultures between hospital and general practice. Lastly, patients are transient members of the learning community, and their role requires careful facilitation. General practice is as good, if not better, than hospital delivery of teaching of clinical skills. Our meta-ethnography has produced rich understandings of the complex relationships shaping possibilities for student and patient active participation in learning.

Program logic: a framework for health program design and evaluation - the Pap nurse in general practice program.

PubMed

Hallinan, Christine M

2010-01-01

In this paper, program logic will be used to 'map out' the planning, development and evaluation of the general practice Pap nurse program in the Australian general practice arena. The incorporation of program logic into the evaluative process supports a greater appreciation of the theoretical assumptions and external influences that underpin general practice Pap nurse activity. The creation of a program logic model is a conscious strategy that results an explicit understanding of the challenges ahead, the resources available and time frames for outcomes. Program logic also enables a recognition that all players in the general practice arena need to be acknowledged by policy makers, bureaucrats and program designers when addressing through policy, issues relating to equity and accessibility of health initiatives. Logic modelling allows decision makers to consider the complexities of causal associations when developing health care proposals and programs. It enables the Pap nurse in general practice program to be represented diagrammatically by linking outcomes (short, medium and long term) with both the program activities and program assumptions. The research methodology used in the evaluation of the Pap nurse in general practice program includes a descriptive study design and the incorporation of program logic, with a retrospective analysis of Australian data from 2001 to 2009. For the purposes of gaining both empirical and contextual data for this paper, a data set analysis and literature review was performed. The application of program logic as an evaluative tool for analysis of the Pap PN incentive program facilitates a greater understanding of complex general practice activity triggers, and also allows this greater understanding to be incorporated into policy to facilitate Pap PN activity, increase general practice cervical smear and ultimately decrease burden of disease.

Medical students' attitudes towards general practice and factors affecting career choice: a questionnaire study

PubMed Central

Garnham, Laura

2014-01-01

Background The current issue of general practice recruitment is a significant challenge and concern. In order to address this, it is vital to understand medical students' attitudes towards general practice and what influences their choice of intended career. Method We used a questionnaire study to examine these attitudes across all years at Imperial College Medical School and to understand what a group of London medical students' current intended career choices were. Results We found that only 13% of students ranked general practice as their first choice career despite having a generally realistic and positive attitude towards the speciality. They highlighted that the main influence on future career choice was interest in the specific speciality and that lifestyle factors did not seem to be so important. Conclusion Exposure to general practice, primary care research and student GP societies might play some part in increasing interest, but more work is needed to understand why students are rejecting general practice and what we can do collectively to attract students into choosing a career in primary care. PMID:25949732

The new era of postgraduate certified general practice training in Japan.

PubMed

Takamura, Akiteru

2016-09-01

This paper describes the background to, and the recent evolution of general practice as a recognised medical specialism in Japan (2015), and the evolution of a system of training to support this development. We, the general practitioners (GPs) in Japan have not been recognised as one body of medical specialists and have been training in our own way. A new certified training system will commence in 2018, authorised by a new third organisation, the Japanese Medical Specialty Board. An effective educational system has been developed for medical graduates that have a career intention in general practice that is distinct from other basic medical fields, but collaborates with them. A challenge exists to provide clarity to the Japanese population about what the specialty of general practice is, and what professionals in general practice can do for them. Japan currently has approximately 500 certified GPs and it is unclear at present what numbers will eventually be required. This paper reviews some of the challenges facing the development of general practice from the perspective of the Japan Primary Care Association.

GP wellbeing and general practice issues.

PubMed

Murfett, Amanda; Charman, Denise

2006-09-01

Studies of general practitioner wellbeing have demonstrated remarkably consistent findings. However, the implications for day-to-day general practice have been unclear. This study was based on a survey comprising items extracted from transcripts of interviews with GPs and designed to link general practice issues with self reported wellbeing. 480 GP Australian Family Physician (AFP) subscribers (2.18% response rate); aged 26-81 years (mean 45.5 years); 273 (56.9%) men and 199 (43.1%) women. A survey insert in AFP September 2003 with questions about wellbeing, demographic details and 27 items about general practice issues. Almost 15% reported poor/very poor wellbeing, 47% reported good wellbeing and 38% reported very good/excellent wellbeing. Poor wellbeing was associated with being single, divorced or widowed, and reports of being alone in an adversarial context and more negative reactions to patients. Excellent or very good wellbeing was associated with being coupled and reports of general practice as a vocation. Targeted wellbeing strategies advocating social support may ameliorate the stress of general practice, especially for those GPs who are single.

Kinematic and Energetic Properties of the 2012 March 12 Polar Coronal Mass Ejection

NASA Technical Reports Server (NTRS)

Gopalswamy, N.; Yashiro, Seiji; Akiyama, S.

2015-01-01

We report on the energetics of the 2012 March 12 polar coronal mass ejection (CME) originating from a southern latitude of approximately 60deg. The polar CME is similar to low-latitude (LL) CMEs in almost all respects: three-part morphology; post-eruption arcade (PEA), CME, and filament kinematics; CME mass and kinetic energy; and the relative thermal energy content of the PEA. From polarized brightness images, we estimate the CME mass, which is close to the average mass of LL CMEs. The CME kinetic energy (3.3 × 10(sup 30) erg) is also typical of the general population of CMEs. From photospheric magnetograms, we estimate the free energy (1.8 × 10(sup 31) erg) in the polar crown source region, which we find is sufficient to power the CME and the PEA. About 19% of the free energy went into the CME kinetic energy. We compute the thermal energy content of the PEA (2.3 × 10(sup 29) erg) and find it to be a small fraction (6.8%) of the CME kinetic energy. This fraction is remarkably similar to that in active region CMEs associated with major flares. We also show that the 2012 March 12 is one among scores of polar CMEs observed during the maximum phase of cycle 24. The cycle 24 polar crown prominence eruptions have the same rate of association with CMEs as those from LLs. This investigation supports the view that all CMEs are magnetically propelled from closed field regions, irrespective of their location on the Sun (polar crown filament regions, quiescent filament regions, or active regions).

False Windows - Yesterday and Today

NASA Astrophysics Data System (ADS)

Niewitecki, Stefan

2017-10-01

The article is concerned with a very interesting aspect of architectural design, namely, a contradiction between the building functions and the necessity of giving the building a desired external appearance. One of the possibilities of reconciling this contradiction is using pseudo windows that are visible on the elevation and generally have the form of a black painted recess accompanied by frames and sashes and often single glazing. Of course, there are no windows or openings in the corresponding places in the walls inside the building. The article discusses the differences between false windows and blind widows (German: blende), also known as blank windows, which, in fact, are shallow recesses in the wall having the external appearance of an arcade or a window and which had already been used in Gothic architecture mostly for aesthetic reasons and sometimes to reduce the load of the wall. Moreover, the article describes various false windows that appeared later than blind windows because they did not appear until the 17th century. Contemporary false windows are also discussed and it is shown that contrary to the common belief they are widely used. In his research, the author not only used the Internet data but also carried out his own in situ exploration. The false windows constitute very interesting albeit rare elements of the architectural design of buildings. They have been used successfully for a few hundred years. It might seem that they should have been discarded by now but this has not happened. Quite contrary, since the second half of the 20th century there has been a rapid development of glass curtain walls that serve a similar function in contemporary buildings as the false windows once did, only in a more extensive way.

THE POSSIBLE ROLE OF CORONAL STREAMERS AS MAGNETICALLY CLOSED STRUCTURES IN SHOCK-INDUCED ENERGETIC ELECTRONS AND METRIC TYPE II RADIO BURSTS

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

Kong, Xiangliang; Chen, Yao; Feng, Shiwei

2015-01-10

Two solar type II radio bursts, separated by ∼24 hr in time, are examined together. Both events are associated with coronal mass ejections (CMEs) erupting from the same active region (NOAA 11176) beneath a well-observed helmet streamer. We find that the type II emissions in both events ended once the CME/shock fronts passed the white-light streamer tip, which is presumably the magnetic cusp of the streamer. This leads us to conjecture that the closed magnetic arcades of the streamer may play a role in electron acceleration and type II excitation at coronal shocks. To examine such a conjecture, we conduct a test-particle simulationmore » for electron dynamics within a large-scale partially closed streamer magnetic configuration swept by a coronal shock. We find that the closed field lines play the role of an electron trap via which the electrons are sent back to the shock front multiple times and therefore accelerated to high energies by the shock. Electrons with an initial energy of 300 eV can be accelerated to tens of keV concentrating at the loop apex close to the shock front with a counter-streaming distribution at most locations. These electrons are energetic enough to excite Langmuir waves and radio bursts. Considering the fact that most solar eruptions originate from closed field regions, we suggest that the scenario may be important for the generation of more metric type IIs. This study also provides an explanation of the general ending frequencies of metric type IIs at or above 20-30 MHz and the disconnection issue between metric and interplanetary type IIs.« less

KINEMATIC AND ENERGETIC PROPERTIES OF THE 2012 MARCH 12 POLAR CORONAL MASS EJECTION

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

Gopalswamy, N.; Yashiro, S.; Akiyama, S., E-mail: nat.gopalswamy@nasa.gov

2015-08-10

We report on the energetics of the 2012 March 12 polar coronal mass ejection (CME) originating from a southern latitude of ∼60°. The polar CME is similar to low-latitude (LL) CMEs in almost all respects: three-part morphology; post-eruption arcade (PEA), CME, and filament kinematics; CME mass and kinetic energy; and the relative thermal energy content of the PEA. From polarized brightness images, we estimate the CME mass, which is close to the average mass of LL CMEs. The CME kinetic energy (3.3 × 10{sup 30} erg) is also typical of the general population of CMEs. From photospheric magnetograms, we estimatemore » the free energy (1.8 × 10{sup 31} erg) in the polar crown source region, which we find is sufficient to power the CME and the PEA. About 19% of the free energy went into the CME kinetic energy. We compute the thermal energy content of the PEA (2.3 × 10{sup 29} erg) and find it to be a small fraction (6.8%) of the CME kinetic energy. This fraction is remarkably similar to that in active region CMEs associated with major flares. We also show that the 2012 March 12 is one among scores of polar CMEs observed during the maximum phase of cycle 24. The cycle 24 polar crown prominence eruptions have the same rate of association with CMEs as those from LLs. This investigation supports the view that all CMEs are magnetically propelled from closed field regions, irrespective of their location on the Sun (polar crown filament regions, quiescent filament regions, or active regions)« less

MICROWAVE IMAGING OF A HOT FLUX ROPE STRUCTURE DURING THE PRE-IMPULSIVE STAGE OF AN ERUPTIVE M7.7 SOLAR FLARE

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

Wu, Zhao; Chen, Yao; Song, Hongqiang

Corona structures and processes during the pre-impulsive stage of solar eruption are crucial to understanding the physics leading to the subsequent explosive energy release. Here we present the first microwave imaging study of a hot flux rope structure during the pre-impulsive stage of an eruptive M7.7 solar flare, with the Nobeyama Radioheliograph at 17 GHz. The flux rope is also observed by the SDO/AIA in its hot passbands of 94 and 131 Å. In the microwave data, it is revealed as an overall arcade-like structure consisting of several intensity enhancements bridged by generally weak emissions, with brightness temperatures (T{sub B})more » varying from ∼10,000 K to ∼20,000 K. Locations of microwave intensity enhancements along the structure remain relatively fixed at certain specific parts of the flux rope, indicating that the distribution of emitting electrons is affected by the large-scale magnetic configuration of the twisted flux rope. Wavelet analysis shows a pronounced 2 minute period of the microwave T{sub B} variation during the pre-impulsive stage of interest. The period agrees well with that reported for AIA sunward-contracting loops and upward ejective plasmoids (suggested to be reconnection outflows). This suggests that both periodicities are controlled by the same reconnection process that takes place intermittently at a 2 minute timescale. We infer that at least a part of the emission is excited by non-thermal energetic electrons via the gyro-synchrotron mechanism. The study demonstrates the potential of microwave imaging in exploring the flux rope magnetic geometry and relevant reconnection process during the onset of solar eruption.« less

PLASMA JETS AND ERUPTIONS IN SOLAR CORONAL HOLES: A THREE-DIMENSIONAL FLUX EMERGENCE EXPERIMENT

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

Moreno-Insertis, F.; Galsgaard, K.

2013-07-01

A three-dimensional (3D) numerical experiment of the launching of a hot and fast coronal jet followed by several violent eruptions is analyzed in detail. These events are initiated through the emergence of a magnetic flux rope from the solar interior into a coronal hole. We explore the evolution of the emerging magnetically dominated plasma dome surmounted by a current sheet and the ensuing pattern of reconnection. A hot and fast coronal jet with inverted-Y shape is produced that shows properties comparable to those frequently observed with EUV and X-ray detectors. We analyze its 3D shape, its inhomogeneous internal structure, andmore » its rise and decay phases, lasting for some 15-20 minutes each. Particular attention is devoted to the field line connectivities and the reconnection pattern. We also study the cool and high-density volume that appears to encircle the emerged dome. The decay of the jet is followed by a violent phase with a total of five eruptions. The first of them seems to follow the general pattern of tether-cutting reconnection in a sheared arcade, although modified by the field topology created by the preceding reconnection evolution. The two following eruptions take place near and above the strong-field concentrations at the surface. They show a twisted, {Omega}-loop-like rope expanding in height, with twist being turned into writhe, thus hinting at a kink instability (perhaps combined with a torus instability) as the cause of the eruption. The succession of a main jet ejection and a number of violent eruptions that resemble mini-CMEs and their physical properties suggest that this experiment may provide a model for the blowout jets recently proposed in the literature.« less

Roles, risks, and responsibilities in maternity care: trainees' beliefs and the effects of practice obstetric training.

PubMed Central

Smith, L. F.

1992-01-01

OBJECTIVES--To document the content of practice obstetric vocational training, the beliefs of general practitioner trainees about the roles of midwives and general practitioners in maternity care, and the risks of providing such care; and to ascertain if undergoing such training affects their beliefs. DESIGN--Confidential postal questionnaire survey. SUBJECTS--Random one in four sample of all general practitioner trainees in the United Kingdom on vocational training schemes or in training practices in autumn 1990. MAIN OUTCOME MEASURES--Beliefs scored on seven point Likert scales and characteristics of trainer and training practice. RESULTS--Of 1019 trainees sent questionnaires, 765 (75.1% response rate) replied; 638 (83.3%) had done some part of their practice year. Of their trainers, 224 (35.1%) provided full obstetric care. 749 (99%) and 364 (48%) trainees believed that midwives and general practitioners respectively have an important role in normal labour; 681 (91.7%) trainees believed that general practice intrapartum care is a high risk "specialty." Those trainees whose trainers provide full obstetric care were significantly more likely to believe that both midwives and general practitioners have an important role in abnormal labour and to see the provision of intrapartum care as an incentive to join a practice. CONCLUSION--In this series most general practitioner trainees believed that both midwives and general practitioners have important roles in maternity care. Exposure of trainees to the provision of full obstetric care while in their training practice resulted in a more positive attitude towards the provision of such care by general practitioners. PMID:1628091

Cheques and challenges: business performance in New Zealand general practice.

PubMed

Greatbanks, Richard; Doolan-Noble, Fiona; McKenna, Alex

2017-09-01

INTRODUCTION New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors. AIM To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice. METHODS For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data. RESULTS All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand. DISCUSSION As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of 'super practices' based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between high-quality, safe patient care and the maintenance of a sustainable business.

Refugee experiences of general practice in countries of resettlement: a literature review

PubMed Central

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-01-01

Background Refugees and asylum seekers often struggle to use general practice services in resettlement countries. Aim To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Design and setting Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Method Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker’s personal experiences of general practice services were identified, coded, and analysed. Results From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor–patient relationships, and problems with the cultural acceptability of medical care. Conclusion The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. PMID:25733438

Near patient testing in general practice: attitudes of general practitioners and practice nurses, and quality assurance procedures carried out.

PubMed Central

Hilton, S; Rink, E; Fletcher, J; Sibbald, B; Freeling, P; Szczepura, A; Davies, C; Stilwell, J

1994-01-01

BACKGROUND. The evaluation of near patient testing in British general practice has largely been confined to studies examining individual tests or comparing equipment. AIM. This study set out to determine the attitudes of practice staff to near patient testing, and the extent to which staff undertook quality assessment. METHOD. Four types of near patient testing machines were introduced into 12 general practices in two regions of England, south west Thames and west Midlands. General practitioner and practice nurse attitudes to near patient testing were assessed by semi-structured interview before and six months after the introduction of the machines. The extent to which routine quality assurance procedures were carried out within the surgery and as part of local and national schemes was examined. RESULTS. Although 80% of general practitioners anticipated changing patient management with near patient testing, only two fifths reported having done so after six months. Nurses generally were enthusiastic at the outset, although one third were unhappy about incorporating near patient testing into their work schedules. Time pressure was the most important factor restricting uptake of near patient testing. Nurses performed quality control regularly but complete local external quality assurance procedures were established in only half the practices. All the practices participated in a national scheme for cholesterol assays. CONCLUSION. General practitioners in this study did not find near patient testing a very useful addition to their resources. Pressure on nurses' time was the most frequently reported limitation. PMID:7748669

The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation.

PubMed

Henderson, Emily J; Rubin, Greg P

2013-05-01

To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. General practitioners' views, experiences and usage of the system. Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.

Going for gold: the health promoting general practice.

PubMed

Watson, Michael

2008-01-01

The World Health Organization's Ottawa Charter for Health Promotion has been influential in guiding the development of 'settings' based health promotion. Over the past decade, settings such as schools have flourished and there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention. This paper discusses: the significance of this setting for health promotion; how a health promoting general practice can be created; effective health promotion approaches; the nursing contribution; and some challenges that need to be resolved. In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community. The health promoting general practice is the gold standard for health promotion. Settings that have developed have had the support of local, national and European networks. Similar assistance and advocacy will be needed in general practice. This paper recommends that a series of rigorously evaluated, high-quality pilot sites need to be established to identify and address potential difficulties, and to ensure that this innovative approach yields tangible health benefits for local communities. It also suggests that government support is critical to the future development of health promoting general practices. This will be needed both directly and in relation to the capacity and resourcing of public health in general.

Models of clinical reasoning with a focus on general practice: A critical review.

PubMed

Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat

2017-10-01

Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

Management of venous leg ulcers in general practice - a practical guideline.

PubMed

Sinha, Sankar; Sreedharan, Sadhishaan

2014-09-01

Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. To produce a short practical guideline incorporating the TIME concept and A2BC2D approach to help general practitioners and their practice nurses in delivering evidence-based initial care to patients with chronic venous leg ulcers. Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge.

Laboratory-supported influenza surveillance in Victorian sentinel general practices.

PubMed

Kelly, H; Murphy, A; Leong, W; Leydon, J; Tresise, P; Gerrard, M; Chibo, D; Birch, C; Andrews, R; Catton, M

2000-12-01

Laboratory-supported influenza surveillance is important as part of pandemic preparedness, for identifying and isolating candidate vaccine strains, for supporting trials of anti-influenza drugs and for refining the influenza surveillance case definition in practice. This study describes the implementation of laboratory-supported influenza surveillance in Victorian sentinel general practices and provides an estimate of the proportion of patients with an influenza-like illness proven to have influenza. During 1998 and 1999, 25 sentinel general practices contributed clinical surveillance data and 16 metropolitan practices participated in laboratory surveillance. Serological, virus-antigen detection, virus culture and multiplex polymerase chain reaction procedures were used to establish the diagnosis of influenza. Two laboratories at major teaching hospitals in Melbourne provided additional data on influenza virus identification. General practice sentinel surveillance and laboratory identification of influenza provided similar data on the pattern of influenza in the community between May and September. The clinical suspicion of influenza was confirmed in 49 to 54 per cent of cases seen in general practice.

16 CFR 24.1 - Deception (general).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Deception (general). 24.1 Section 24.1 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR SELECT LEATHER AND IMITATION LEATHER PRODUCTS § 24.1 Deception (general). It is unfair or deceptive to misrepresent, directly...

General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland.

PubMed

McLean, Gary; Guthrie, Bruce; Mercer, Stewart W; Watt, Graham C M

2015-12-01

Universal access to health care, as provided in the NHS, does not ensure that patients' needs are met. To explore the relationships between multimorbidity, general practice funding, and workload by deprivation in a national healthcare system. Cross-sectional study using routine data from 956 general practices in Scotland. Estimated numbers of patients with multimorbidity, estimated numbers of consultations per 1000 patients, and payments to practices per patient are presented and analysed by deprivation decile at practice level. Levels of multimorbidity rose with practice deprivation. Practices in the most deprived decile had 38% more patients with multimorbidity compared with the least deprived (222.8 per 1000 patients versus 161.1; P<0.001) and over 120% more patients with combined mental-physical multimorbidity (113.0 per 1000 patients versus 51.5; P<0.001). Practices in the most deprived decile had 20% more consultations per annum compared with the least deprived (4616 versus 3846, P<0.001). There was no association between total practice funding and deprivation (Spearman ρ -0.09; P = 0.03). Although consultation rates increased with deprivation, the social gradients in multimorbidity were much steeper. There was no association between consultation rates and levels of funding. No evidence was found that general practice funding matches clinical need, as estimated by different definitions of multimorbidity. Consultation rates provide only a partial estimate of the work involved in addressing clinical needs and are poorly related to the prevalence of multimorbidity. In these circumstances, general practice is unlikely to mitigate health inequalities and may increase them. © British Journal of General Practice 2015.

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on.

PubMed

Halcomb, Elizabeth J; Salamonson, Yenna; Davidson, Patricia M; Kaur, Rajneesh; Young, Samantha Am

2014-03-25

Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. In the nascence of the expansion of the role of nurses in Australian general practice (2003-2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009-2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses' role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses' role in general practice was slightly decreased over time. This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce.

Postgraduate training for general practice in the United Kingdom.

PubMed

Eisenberg, J M

1979-04-01

Although the role of general practice is well established in the United Kingdom's National Health Service, formal postgraduate training for primary care practice is a recent development. Trainees may enter three-year programs of coordinated inpatient and outpatient training or may select a series of independent posts. Programs have been developed to train general practitioners as teachers, and innovative courses have been established. Nevertheless, there is a curious emphasis on inpatient experiences, especially since British general practitioners seldom treat patients in the hospital. In their outpatient experiences trainees are provided with little variety in their instructors, practice settings, and medical problems. The demands on this already strained system will soon be increased due to recent legislation requiring postgraduate training for all new general practitioners. With a better understanding of training for primary care in the National Health Service, those planning American primary care training may avoid the problems and incorporate the attributes of British training for general practice.

When and why do doctors decide to become general practitioners? Implications for recruitment into UK general practice specialty training.

PubMed

Irish, Bill; Lake, Jonathan

2011-01-01

All applicants to round 1 of national recruitment into the general practice specialty recruitment process were surveyed as to the reasons for, and the timing of their career choices. Most applicants reported decision making after completing undergraduate training citing variety, continuity of care and work-life balance as their main drivers for a career in general practice. Applicants were statistically more likely to have undertaken a Foundation placement in general practice than their peers on a Foundation programme. Reasons for choice of deanery were largely related to location and social ties, rather than to the educational 'reputation' of its programmes.

Getting the most out of your practice--the Practice Health Atlas and business modelling opportunities.

PubMed

Del Fante, Peter; Allan, Don; Babidge, Elizabeth

2006-01-01

The Practice Health Atlas (PHA) is a decision support tool for general practice, designed by the Adelaide Western Division of General Practice (AWDGP). This article describes the features of the PHA and its potential role in enhancing health care. In developing the PHA, the AWDGP utilises a range of software tools and consults with a practice to understand its clinical data management approach. The PHA comprises three sections: epidemiology, business and clinical modelling systems, access to services. The objectives include developing a professional culture around quality health data and synthesis of aggregated de-identified general practice data at both practice and divisional level (and beyond) to assist with local health needs assessment, planning, and funding. Evaluation occurs through group feedback sessions and from the general practitioners and staff. It has demonstrated its potential to fulfill the objectives in outcome areas such as data quality and management, team based care, pro-active practice population health care, and business systems development, thereby contributing to improved patient health outcomes.

16 CFR 20.1 - Deception generally.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Deception generally. 20.1 Section 20.1 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR THE REBUILT, RECONDITIONED AND OTHER USED AUTOMOBILE PARTS INDUSTRY § 20.1 Deception generally. (a) It is unfair or deceptive...

16 CFR 20.1 - Deception generally.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Deception generally. 20.1 Section 20.1 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR THE REBUILT, RECONDITIONED AND OTHER USED AUTOMOBILE PARTS INDUSTRY § 20.1 Deception generally. (a) It is unfair or deceptive...

16 CFR 20.1 - Deception generally.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Deception generally. 20.1 Section 20.1 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR THE REBUILT, RECONDITIONED AND OTHER USED AUTOMOBILE PARTS INDUSTRY § 20.1 Deception generally. (a) It is unfair or deceptive...

16 CFR 20.1 - Deception generally.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Deception generally. 20.1 Section 20.1 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR THE REBUILT, RECONDITIONED AND OTHER USED AUTOMOBILE PARTS INDUSTRY § 20.1 Deception generally. (a) It is unfair or deceptive...

16 CFR 20.1 - Deception generally.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Deception generally. 20.1 Section 20.1 Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR THE REBUILT, RECONDITIONED AND OTHER USED AUTOMOBILE PARTS INDUSTRY § 20.1 Deception generally. (a) It is unfair or deceptive...

A qualitative study of patient experiences of Type 2 Diabetes care delivered comparatively by General Practice Nurses and Medical Practitioners.

PubMed

Boyle, Eileen; Saunders, Rosemary; Drury, Vicki

2016-07-01

To explore patient experiences of type 2 diabetes mellitus care delivered by general practice nurses in collaboration with the general practitioner. Australian general practice nurses are expanding their role in multidisciplinary type 2 diabetes care with limited research on patient perceptions of care provision within this collaborative model. Qualitative interpretive. Purposeful sampling was used to invite the patients (n = 10). Data were collected from semi-structured face-to-face interviews. Braun and Clarke's () inductive coding thematic analysis process was used to interpret the data. All participants experienced their General Practice Nurse consultation as a clinical assessment for their General Practitioner. While they appreciated the extra time with the General Practice Nurse, they were unsure of the purpose of the consultation beyond clinical assessment. They described the ongoing challenge of living with T2DM and identified a need for additional information and advice. The results suggest that the model of general practice nurse type 2 diabetes care has an important role to play in the delivery of effective ongoing care of patients. However, this role requires further development to ensure that it is understood by the patients as a role that not only conducts clinical assessments but also provides relevant education and self-management support as part of a collaborative approach to care delivery with General Practitioners. The findings are relevant to primary health care clinicians providing diabetes care to inform more relevant supportive care by general practice nurses. © 2016 John Wiley & Sons Ltd.

Management in general practice: the challenge of the new General Medical Services contract.

PubMed

Checkland, Kath

2004-10-01

Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role.

Management in general practice: the challenge of the new General Medical Services contract

PubMed Central

Checkland, Kath

2004-01-01

Background: Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. Aim: To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. Design of study: In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Setting: Three general practices in England, chosen using purposeful sampling. Method: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results: Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. Conclusion: The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role. PMID:15469672

Tools to overcome potential barriers to chlamydia screening in general practice: Qualitative evaluation of the implementation of a complex intervention.

PubMed

Ricketts, Ellie J; Francischetto, Elaine O'Connell; Wallace, Louise M; Hogan, Angela; McNulty, Cliodna A M

2016-03-22

Chlamydia trachomatis remains a significant public health problem. We used a complex intervention, with general practice staff, consisting of practice based workshops, posters, computer prompts and testing feedback and feedback to increase routine chlamydia screening tests in under 25 year olds in South West England. We aimed to evaluate how intervention components were received by staff and to understand what determined their implementation into ongoing practice. We used face-to-face and telephone individual interviews with 29 general practice staff analysed thematically within a Normalisation Process Theory Framework which explores: 1. Coherence (if participants understand the purpose of the intervention); 2. Cognitive participation (engagement with and implementation of the intervention); 3. Collective action (work actually undertaken that drives the intervention forwards); 4. Reflexive monitoring (assessment of the impact of the intervention). Our results showed coherence as all staff including receptionists understood the purpose of the training was to make them aware of the value of chlamydia screening tests and how to increase this in their general practice. The training was described by nearly all staff as being of high quality and responsible for creating a shared understanding between staff of how to undertake routine chlamydia screening. Cognitive participation in many general practice staff teams was demonstrated through their engagement by meeting after the training to discuss implementation, which confirmed the role of each staff member and the use of materials. However several participants still felt unable to discuss chlamydia in many consultations or described sexual health as low priority among colleagues. National targets were considered so high for some general practice staff that they didn't engage with the screening intervention. Collective action work undertaken to drive the intervention included use of computer prompts which helped staff remember to make the offer, testing rate feedback and having a designated lead. Ensuring patients collected samples when still in the general practice was not attained in most general practices. Reflexive monitoring showed positive feedback from patients and other staff about the value of screening, and feedback about the general practices testing rates helped sustain activity. A complex intervention including interactive workshops, materials to help implementation and feedback can help chlamydia screening testing increase in general practices.

Pre- and postdoctoral dental education compared to practice patterns in special care dentistry.

PubMed

Subar, Paul; Chávez, Elisa M; Miles, Jeffrey; Wong, Allen; Glassman, Paul; Labarre, Eugene

2012-12-01

There has been limited research into the impact of predoctoral experiences and postdoctoral general dentistry residencies on the practice patterns of dentists in the care of patients with special or complex needs. This study was undertaken to determine if educational experiences with special populations had a relationship to practice patterns after graduation or residency. University of the Pacific alumni who graduated between 1997 and 2007 were surveyed regarding their pre- and postdoctoral dental education and their practice patterns for the care of patients categorized as medically compromised, frail elders, and developmentally disabled. Definitions for each patient category were provided. Alumni were asked about their practice setting and postdoctoral education. Thirty-one percent (n=526) of those surveyed responded. Regression analyses showed respondents not in private practice were more likely to have completed a postdoctoral general dentistry program (Advanced Education in General Dentistry or General Practice Residency) after dental school compared to respondents in private practice (p<0.001). Across all age groups, respondents not in private practice treated significantly more patients with developmental disabilities than those in private practice (p<0.001). Respondents not in private practice treated more medically compromised patients younger than age sixty-five compared to respondents in private practice (p<0.01). Interestingly, those in private practice treated significantly more patients over sixty-five who were also classified as medically compromised (p<0.05). Pacific alumni who completed postdoctoral training in general dentistry were found to practice more often in non-private practice settings. Alumni in non-private practice settings reported treating a higher percentage of medically compromised patients below age sixty-five than their counterparts in a typical private practice. The pre- and postdoctoral experiences of treating special needs populations appear to have a relationship to graduates' practice setting and patient population.

Conditions for research in general practice. Can the Dutch and British experiences be applied to other countries, for example Spain?

PubMed

van der Zee, Jouke; Kroneman, Madelon; Bolíbar, Bonaventura

2003-06-01

The aim of this study is to identify conditions for research as part of professional development in general practice. Based on the work of Andrew Abbott, who studied the dynamics of professional development, five conditions were identified. These are: the creation of associations among professionals; control of work; the establishment of specialised education; the development of professional knowledge; and the creation of organised structures for professional work. Two countries with a well-established research tradition in general practice (the UK and the Netherlands) and one country where GP research development is still limited (Spain) were evaluated on the basis of these conditions. The conditions identified as favourable were as follows: the existence of a scientific association; a peer-reviewed journal; a defined population resulting in a population denominator for practices; a gatekeeping system; chairs and departments of general practice at universities; the integration of education centres and research centres; GPs working in group practices or health centres; a certain degree of independence from the Ministry of Health; and financial support for practicing GPs to conduct research activities. We showed that most conditions for the successful scientific progress of general practice in Spain are present. However there is still a gap between academia and general practice and a lack of research organisation and support.

An evaluation of general practice websites in the UK.

PubMed

Howitt, Alistair; Clement, Sarah; de Lusignan, Simon; Thiru, Krish; Goodwin, Daryl; Wells, Sally

2002-10-01

General practice websites are an emerging phenomenon, but there have been few critical evaluations of their content. Previously developed rating instruments to assess medical websites have been criticized for failing to report their reliability and validity. The purpose of this study was to develop a rating instrument for assessing UK general practice websites, and then to evaluate them critically. The STaRNet Website Assessment Tool (SWAT) was developed listing criteria that general practice websites may meet, which was then used to evaluate a random sample of websites drawn from an electronic database. A second assessor rated a subsample of the sites to assess the tool's inter-rater reliability. The setting was an information technology group of a general practice research network using a random sample of 108 websites identified from the database. The main outcome measures were identification of rating criteria and frequency counts from the website rating instrument. Ninety (93.3%) sites were accessible, of which 84 were UK general practice websites. Criteria most frequently met were those describing the scope of the website and their functionality. Apart from e-mail to practices, criteria related to electronic communication were rarely met. Criteria relating to the quality of information were least often met. Inter-rater reliability kappa values for the items in the tool ranged from -0.06 to 1.0 (mean 0.59). Values were >0.6 for 15 out of 25 criteria assessed in 40 sites which were rated by two assessors. General practice websites offer a wide range of information. They are technically satisfactory, but do not exploit fully the potential for electronic doctor-patient communication. The quality of information they provide is poor. The instrument may be developed as a template for general practices producing or revising their own websites.

Pre-registration house officer rotations incorporating general practice: does the order of rotation matter?

PubMed

Williams, C; Cantillon, P; Cochrane, M

2001-06-01

In relation to pre-registration house officer (PRHO) rotations incorporating general practice, previous research has recommended that where possible, no PRHO should undertake general practice as the first placement, because of the difficulties encountered. It was recognized that logistically, this could make such schemes almost unworkable. Within the context of a larger qualitative evaluation comparing how 24 PRHOs learned in hospital and general practice settings, the issue of rotation order was explored. In-depth semistructured interviews were conducted with the 12 PRHOs who were involved in general practice rotations. They were interviewed at the beginning and end of the PRHO year, and following their return to hospital work after the general practice placement. Each rotation order had both advantages and disadvantages, with no particular rotation order being obviously better or worse for the PRHOs involved. This small qualitative evaluation has highlighted a number of advantages and disadvantages specific to each rotation order, and makes some practical recommendations to help alleviate the problems encountered. It is important that future evaluations of similar schemes consider this issue, as there are conflicting reports about the significance of the rotation order.

Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

2007-08-01

Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

Changing hearts and minds: examining student nurses' experiences and perceptions of a general practice placement through a 'community of practice' lens.

PubMed

Lewis, Robin; Kelly, Shona

2018-04-05

The recent UK Government paper 'Five year forward view' describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students' perceptions of general practice as a placement and a potential career option post-graduation. Data were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout. Using the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: 'Myths and misunderstandings' outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a 'good' placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. 'Changing hearts and minds' referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students' perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation. The CoP that is emerging through the ATPS placements appear to be gradually changing the socio-cultural landscape within general practice by enabling student nurses to experience the reality of life in general practice nursing, and to view the GPN role as a viable career option upon graduation.

Patients' evaluations of European general practice--revisited after 11 years.

PubMed

Petek, Davorina; Künzi, Beat; Kersnik, Janko; Szecsenyi, Joachim; Wensing, Michel

2011-12-01

In the last decade many things have changed in healthcare systems, primary care practices and populations. To describe evaluations of general practice care by patients with a chronic illness in 2009 and compare these with a previous study done in 1998. A descriptive analysis of patients' evaluations, using data from the European practice assessment Cardio study on cardiovascular patients in eight European countries in 2009. We compared these evaluations with a subgroup of patients with self-defined chronic illness from the study in 1998, using a linear regression model. Patients' evaluation of general practice using the EUROPEP questionnaire. The EUROPEP is a 23-item validated measure of patient evaluations of general practice care. In 2009, 7472 patients from 251 practices participated in the study with an overall response rate of 49.6%. The percentage of patients with positive evaluations (good/excellent) was 80% or higher for all items, except for the waiting time. More positive evaluations were found in older patients, patients with a longer attachment to the practice, patients with a higher self-evaluation of their health, patients with fewer mental health problems and less pain/discomfort. The comparison between 1998 and 2009 showed no overall trends for all countries combined. Whereas English patients became fairly more positive about general practice in 2009, German patients became slightly less positive, although still more positive than English patients. Overall, the patients' evaluations of general practice were very positive in family practice care in the years 1998 and 2009. The trends over the years need to be carefully interpreted over time.

Cross-sectional multicentre study on the cohort of all the French junior lecturers in general practice.

PubMed

Barais, Marie; Laporte, Catherine; Schuers, Matthieu; Saint-Lary, Olivier; Frappé, Paul; Dibao-Dina, Clarisse; Darmon, David; Bouchez, Tiphanie; Gelly, Julien

2018-12-01

General practice became an academic discipline quite recently in many western countries. In France, junior lecturer work is specified in a three-part mandate: medical work in general practice, teaching in the university, and research. Since 2007, 130 junior lecturers have been appointed in general practice. The aim of the creation of junior lecturer status was to align general practice with other specialties and to develop research and education in primary care. To describe the healthcare, teaching and research undertaken by junior lecturers in general practice, practising in October 2014. A cross-sectional multicentre study using an online self-administered questionnaire on the cohort composed of all the junior lecturers in general practice with open questions and the qualitative analysis of written verbatim accounts. Of the 95 junior lecturers practising at the date of the study, 75 (79%) responded; average age 32 years; gender ratio (F/M) 2.4:1. They spent five, two and three half-days per week respectively in healthcare, teaching and research. The healthcare activity was predominantly carried out in the community (73%). Thirty-nine per cent worked as part of a multi-professional team taking on 50 consultations per week. Most of the educational work involved lecturing and mentoring students specializing in general practice (median 86 hours per year). Research output increased during the fellowship. Research topics were varied and relevant to the disciplinary field. During the fellowship, the balancing, and even the reinforcement, of healthcare and research contributions were accompanied by a significant investment in educational provision.

Variation in formulary adherence in general practice over time (2003-2007).

PubMed

van Dijk, Liset; de Jong, Judith D; Westert, Gert P; de Bakker, Dinny H

2011-12-01

To study trends and variation in adherence to the main national formulary for the 20 most prevalent health problems in Dutch general practice over a 5-year period (2003-07). Routine electronic medical records from a pool of 115 representative general practices were linked to the main national formulary. Analyses included over 2 million prescriptions for 246 391 patients. The outcome variable was whether or not the prescribed medication was congruent with recommendations in the national formulary. Trends and variation were analysed using three-level multilevel logistic regression analyses (general practice, patient, and prescription). The percentage of formulary adherent prescriptions for the 20 most prevalent health problems was 73-76% between 2003 and 2007. The percentage varied considerably between guidelines. Lowest adherence rates were found for acute bronchitis and acute upper respiratory infection. Interpractice variation was constant over time. General practice information networks are useful for monitoring general patterns of formulary on a year-to-year basis. Formulary adherence is stable over time but varies across diagnoses, patients and general practices. In the past decade, efforts have been made to increase the level of formulary adherent prescribing. These general efforts managed to stabilize (variation in) adherence in a field where many other initiatives (e.g. by pharmaceutical companies) are undertaken to influence prescribing behaviour.

Promoting leadership and management in Australian general practice nursing: what will it take?

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Patterson, Elizabeth

2008-10-01

This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.

Assessment of training capacity in New Zealand general practices: a stocktake in the lower North Island and South Island.

PubMed

Murton, Samantha A; Pullon, Susan Rh

2017-09-22

General practices are providing clinically-based training for rapidly increasing numbers of medical (and other health professional) trainees. This study investigated capacity and intention of general practices to additionally teach junior doctors (now required to undertake community-based attachments by the New Zealand Medical Council) alongside current trainees in their service. A web-based/telephone survey of all general practices was developed and administered November 2015-April 2016. In the Otago study region (lower North Island, South Island), 463 currently operating practices were identified. (A companion Auckland-based study concurrently investigated the upper North Island.) Of the 280/463 (60%) responding practices, 93% (261/280) were currently taking health professional trainees, with 86% (241/280) taking at least one type of medical trainee. Practices indicate that 14% fewer of them will take undergraduate medical students than previously (199 practices down to 162), but more would take junior doctors (42 up to 79) and GP registrars (129 practices up to 142). Most practices in these regions already contribute to teaching. Practices indicated limitations in accommodating continued increases in numbers of trainees in the current poorly coordinated system. Improved support and training for practices is needed to enable practices to take more trainees of multiple types per practice, both concurrently and sequentially.

Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines.

PubMed

Barton, Christopher; Proudfoot, Judith; Amoroso, Cheryl; Ramsay, Emmae; Holton, Christine; Bubner, Tanya; Harris, Mark; Beilby, Justin

2009-06-01

We investigated the quality of primary care asthma management in a sample of Australian general practices. 247 general practitioners (GPs) from 97 practices completed a structured interview about management of asthma, diabetes and hypertension/heart disease. A further structured interview with the senior practice principal and practice manager was used to collect information about practice capacity for chronic disease management. Just under half of GPs (47%) had access to an asthma register and the majority (76%) had access to spirometry in their practice. In terms of routine management of asthma, 12% of GPs reported using spirometry routinely, 13% routinely reviewed written asthma action plans, 27% routinely provided education about trigger factors, 30% routinely reviewed inhaler technique, 24% routinely assessed asthma severity, and 29% routinely assessed physical activity. Practice characteristics such as practice size (p=1.0) and locality (rural/metropolitan) (p=0.7) did not predict quality of asthma management nor did indicators of practice capacity including Business maturity, IT/IM maturity, Multidisciplinary teamwork, and Clinical linkages. Gaps remain in the provision of evidence-based care for patients with asthma in general practice. Markers of practice capacity measured here were not associated with guideline-based respiratory care within practices.

Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: views of general practitioners and practice nurses.

PubMed

Halcomb, Elizabeth J; Furler, John S; Hermiz, Oshana S; Blackberry, Irene D; Smith, Julie P; Richmond, Robyn L; Zwar, Nicholas A

2015-08-01

Support in primary care can assist smokers to quit successfully, but there are barriers to general practitioners (GPs) providing this support routinely. Practice nurses (PNs) may be able to effectively take on this role. The aim of this study was to perform a process evaluation of a PN-led smoking cessation intervention being tested in a randomized controlled trial in Australian general practice. Process evaluation was conducted by means of semi-structured telephone interviews with GPs and PNs allocated in the intervention arm (Quit with PN) of the Quit in General Practice trial. Interviews focussed on nurse training, content and implementation of the intervention. Twenty-two PNs and 15 GPs participated in the interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified. The Quit with PN intervention was acceptable to participating PNs and GPs. Issues to be addressed in the planning and wider implementation of future trials of nurse-led intervention in general practice include providing ongoing mentoring support, integration into practice management systems and strategies to promote greater collaboration in GPs and PN teams in general practice. The ongoing feasibility of the intervention was impacted by the funding model supporting PN employment and the competing demands on the PNs time. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Towards vertical integration in general practice education: literature review and discussion paper.

PubMed

O'Regan, A; Culhane, A; Dunne, C; Griffin, M; Meagher, D; McGrath, D; O'Dwyer, P; Cullen, W

2013-09-01

Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

GP obstetricians' views of the model of maternity care in New Zealand.

PubMed

Miller, Dawn L; Mason, Zara; Jaye, Chrystal

2013-02-01

The Lead Maternity Carer (LMC) model of maternity care, and independent midwifery practice, was introduced to New Zealand in the 1990s. The LMC midwife or general practitioner obstetrician (GPO) has clinical and budgetary responsibility for women's primary maternity care. To determine views of practising GPOs and former GPOs about the LMC model of care, its impact on maternity care in general practice, and future of maternity care in general practice. 10 GPOs and 13 former GPOs were interviewed: one focus group (n = 3), 20 semi-structured interviews. The qualitative data analysis program ATLAS.ti assisted thematic analysis. Participants thought the LMC model isolates the LMC - particularly concerning during intrapartum care, in rural practice, and covering 24-hour call; Is not compatible with or adequately funded for GP participation; Excludes the GP from caring for their pregnant patients. Participants would like a flexible, locally adaptable, adequately funded maternity model, supporting shared care. Some thought work-life balance and low GPO numbers could deter future GPs from maternity practice. Others felt with political will, support of universities, and Royal New Zealand College of General Practice and Royal Australian and New Zealand College of Obstetrics and Gynaecology, GPs could become more involved in maternity care again. Participants thought the LMC model isolates maternity practitioners, is incompatible with general practice and causes loss of continuity of general practice care. They support provision of maternity care in general practice; however, for more GPs to become involved, the LMC model needs review. © 2013 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Immunising Children in Primary Care in the UK--What Are the Concerns of Principal Immunisers?

ERIC Educational Resources Information Center

Maconachie, Moira; Lewendon, Gill

2004-01-01

Objective: To determine the levels of concern about risks associated with childhood immunisations among principal immunisers in general practice. Design: Self-administered postal questionnaire survey. Setting: South & West Devon Health Authority. Participants: Eighty-eight/102 general practices: 78 practice nurses, 7 general practitioners, 3…

The contribution of demographic and morbidity factors to self-reported visit frequency of patients: a cross-sectional study of general practice patients in Australia

PubMed Central

Knox, Stephanie A; Britt, Helena

2004-01-01

Background Understanding the factors that affect patients' utilisation of health services is important for health service provision and effective patient management. This study aimed to investigate the specific morbidity and demographic factors related to the frequency with which general practice patients visit a general practitioner/family physician (GP) in Australia. Methods A sub-study was undertaken as part of an ongoing national study of general practice activity in Australia. A cluster sample of 10,755 general practice patients were surveyed through a random sample of 379 general practitioners. The patient reported the number of times he/she had visited a general practitioner in the previous twelve months. The GP recorded all the patient's major health problems, including those managed at the current consultation. Results Patients reported an average of 8.8 visits to a general practitioner per year. After adjusting for other patient demographics and number of health problems, concession health care card holders made on average 2.6 more visits per year to a general practitioner than did non-card holders (p < .001). After adjustment, patients from remote/very remote locations made 2.3 fewer visits per year than patients from locations where services were highly accessible (p < .001). After adjustment for patient demographics, patients with diagnosed anxiety made on average 2.7 more visits per year (p = 0.003), those with diagnosed depression 2.2 more visits than average (p < .0001), and those with back problems 2.4 more visits (p = 0.009) than patients without the respective disorders. Conclusions Anxiety, back pain and depression are associated with greater patient demand for general practice services than other health problems. The effect of sociodemographic factors on patient utilisation of general practice services is complex. Equity of access to general practice services remains an issue for patients from remote areas, while concession health care card holders are attending general practice more frequently than other patients relative to their number of health problems. PMID:15318948

HIV and measures to control infection in general practice.

PubMed Central

Foy, C; Gallagher, M; Rhodes, T; Setters, J; Philips, P; Donaldson, C; Bond, J; Moore, M; Naji, S

1990-01-01

OBJECTIVE--To assess the impact of HIV on procedures to control infection in general practices. DESIGN--A postal questionnaire survey. SETTING--General practices throughout Britain. SUBJECTS--5359 General practitioners, 3429 (63.9%) of whom returned the questionnaire. MAIN OUTCOME MEASURE--Response to questionnaire on knowledge about HIV and policies for controlling infection. RESULTS--Most doctors (2018) had started to wear gloves when taking blood. Almost half (1510) had not resheathed needles previously but a further 776 had adopted this policy because of HIV. Over half of the doctors did not know or were unsure about the risk of infection from needlestick injuries, and 1759 had no practice policy for controlling infection. CONCLUSIONS--Many doctors are uncertain about measures to control infection in general practice. More information and advice are needed to help doctors develop policies to protect patients and staff. PMID:2344517

Making the links between domestic violence and child safeguarding: an evidence-based pilot training for general practice.

PubMed

Szilassy, Eszter; Drinkwater, Jess; Hester, Marianne; Larkins, Cath; Stanley, Nicky; Turner, William; Feder, Gene

2017-11-01

We describe the development of an evidence-based training intervention on domestic violence and child safeguarding for general practice teams. We aimed - in the context of a pilot study - to improve knowledge, skills, attitudes and self-efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two-stage consensus process with a multi-professional stakeholder group. Data were collected between January and December 2013. This paper reports key research findings and their implications for practice and policy; describes how the research findings informed the training development and outlines the principal features of the training intervention. We found lack of cohesion and co-ordination in the approach to domestic violence and child safeguarding. General practice clinicians have insufficient understanding of multi-agency work, a limited competence in gauging thresholds for child protection referral to children's services and little understanding of outcomes for children. While prioritising children's safety, they are more inclined to engage directly with abusive parents than with affected children. Our research reveals uncertainty and confusion surrounding the recording of domestic violence cases in families' medical records. These findings informed the design of the RESPONDS training, which was developed in 2014 to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children. We conclude that general practice clinicians need more support in managing the complexity of this area of practice. We need to integrate and further evaluate responses to the needs of children exposed to domestic violence into general practice-based domestic violence training. © 2016 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Association between general practice characteristics and use of out-of-hours GP cooperatives.

PubMed

Smits, Marleen; Peters, Yvonne; Broers, Sanne; Keizer, Ellen; Wensing, Michel; Giesen, Paul

2015-05-01

The use of out-of-hours healthcare services for non-urgent health problems is believed to be related to the organisation of daytime primary care but insight into underlying mechanisms is limited. Our objective was to examine the association between daytime general practice characteristics and the use of out-of-hours care GP cooperatives. A cross-sectional observational study in 100 general practices in the Netherlands, connected to five GP cooperatives. In each GP cooperative, we took a purposeful sample of the 10 general practices with the highest use of out-of-hours care and the 10 practices with the lowest use. Practice and population characteristics were obtained by questionnaires, interviews, data extraction from patient registration systems and telephone accessibility measurements. To examine which aspects of practice organisation were associated with patients' use of out-of-hours care, we performed logistic regression analyses (low versus high out-of-hours care use), correcting for population characteristics. The mean out-of-hours care use in the high use group of general practices was 1.8 times higher than in the low use group. Day time primary care practices with more young children and foreigners in their patient populations and with a shorter distance to the GP cooperative had higher out-of-hours primary care use. In addition, longer telephone waiting times and lower personal availability for palliative patients in daily practice were associated with higher use of out-of-hours care. Moreover, out-of-hours care use was higher when practices performed more diagnostic tests and therapeutic procedures and had more assistant employment hours per 1000 patients. Several other aspects of practice management showed some non-significant trends: high utilising general practices tended to have longer waiting times for non-urgent appointments, lower availability of a telephone consulting hour, lower availability for consultations after 5 p.m., and less frequent holiday openings. Besides patient population characteristics, organisational characteristics of general practices are associated with lower use of out-of-hours care. Improving accessibility and availability of day time primary day care might be a potential effective way to improve the efficient use of out-of-hours care services.

Putting principals back into practice: an evaluation of a re-entry course for vocationally trained doctors.

PubMed Central

Baker, M; Williams, J; Petchey, R

1997-01-01

BACKGROUND: Current recruitment difficulties in general practice have sharpened the interest of the profession in non-principals. No re-entry course for general practice has previously been run in the UK. AIM: To design and evaluate a re-entry course for general practice. METHOD: A re-entry course was developed to help doctors return to general practice as principals. A telephone interview was carried out with each delegate prior to their attendance on the course and was repeated one month and six months after the course to measure any change in career intentions and the perceived benefit of attending the course. RESULTS: Six months after the course, 11 out of 14 delegates had taken positive steps to return to general practice or had increased their time commitment to medicine. This contrasts with only one of the control group having made any steps to change career. CONCLUSION: The course was evaluated and found to be beneficial, particularly in terms of increasing the confidence of the delegates. PMID:9463984

A critical incident study of general practice trainees in their basic general practice term.

PubMed

Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Epidemiology of Patient Harms in New Zealand: Protocol of a General Practice Records Review Study

PubMed Central

Leitch, Sharon; Wallis, Katharine A; Eggleton, Kyle S; Cunningham, Wayne K; Williamson, Martyn I; Lillis, Steven; McMenamin, Andrew W; Tilyard, Murray W; Reith, David M; Samaranayaka, Ari; Hall, Jason E

2017-01-01

Background Knowing where and why harm occurs in general practice will assist patients, doctors, and others in making informed decisions about the risks and benefits of treatment options. Research to date has been unable to verify the safety of primary health care and epidemiological research about patient harms in general practice is now a top priority for advancing health systems safety. Objective We aim to study the incidence, distribution, severity, and preventability of the harms patients experience due to their health care, from the whole-of-health-system lens afforded by electronic general practice patient records. Methods “Harm” is defined as disease, injury, disability, suffering, and death, arising from the health system. The study design is a stratified, 2-level cluster, retrospective records review study. Both general practices and patients will be randomly selected so that the study’s results will apply nationally, after weighting. Stratification by practice size and rurality will allow comparisons between 6 study groups (large, medium-sized, small; urban and rural practices). Records of equal numbers of patients from each study group will be included in the study because there may be systematic differences in patient harms in different types of practices. Eight general practitioner investigators will review 3 years of electronic general practice health records (consultation notes, prescriptions, investigations, referrals, and summaries of hospital care) from 9000 patients registered in 60 general practices. Double-blinded reviews will check the concordance of reviewers’ assessments. Study data will comprise demographic data of all 9000 patients and reviewers’ assessments of whether patients experienced harm arising from health care. Where patient harm is identified, their types, preventability, severity, and outcomes will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 18.0. Results We have recruited practices and collected electronic records from 9078 patients. Reviews of these records are under way. The study is expected to be completed in August 2017. Conclusions The design of this complex study is presented with discussion on data collection methods, sampling weights, power analysis, and statistical approach. This study will show the epidemiology of patient harms recorded in general practice records for all of New Zealand and will show whether this epidemiology differs by rural location and clinic size. PMID:28119276

Meningococcal vaccination in primary care amongst adolescents in North West England: an ecological study investigating associations with general practice characteristics.

PubMed

Blagden, Sarah; Hungerford, Daniel; Limmer, Mark

2018-01-27

In 2015 the meningococcal ACWY (MenACWY) vaccination was introduced amongst adolescents in England following increased incidence and mortality associated with meningococcal group W. MenACWY vaccination uptake data for 17-18 years old and students delivered in primary care were obtained for 20 National Health Service clinical commissioning groups (CCGs) via the ImmForm vaccination system. Data on general practice characteristics, encompassing demographics and patient satisfaction variables, were extracted from the National General Practice Profiles resource. Univariable analysis of the associations between practice characteristics and vaccination was performed, followed by multivariable negative binomial regression. Data were utilized from 587 general practices, accounting for ~8% of all general practices in England. MenACWY vaccination uptake varied from 20.8% to 46.8% across the CCGs evaluated. Upon multivariable regression, vaccination uptake increased with increasing percentage of patients from ethnic minorities, increasing percentage of patients aged 15-24 years, increasing percentage of patients that would recommend their practice and total Quality and Outcomes Framework achievement for the practice. Conversely, vaccination uptake decreased with increasing deprivation. This study has identified several factors independently associated with MenACWY vaccination in primary care. These findings will enable a targeted approach to improve general practice-level vaccination uptake. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Undergraduate teaching in UK general practice: a geographical snapshot

PubMed Central

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-01-01

Background Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. Aim To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. Design and setting National survey of all medical schools in the UK. Method All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK’s health departments. Results All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum–maximum) of 142 (17–385) practices per school. The median (minimum–maximum) distance between a school and a teaching practice was 28 km (0–1421 km), 41 (0:00–23:26) minutes’ travel by car and 1 hour 12 (0:00–17:29) minutes’ travel by public transport. All teaching practices were accessible by public transport in one school and 90–99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. Conclusion The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. PMID:24868071

MHD simulations of homologous and cannibalistic coronal mass ejections

NASA Astrophysics Data System (ADS)

Fan, Yuhong; Chatterjee, Piyali

2014-06-01

We present magneto-hydrodynamic simulations of the development of a homologous sequence of coronal mass ejections (CMEs) and demonstrate their so-called cannibalistic behavior. These CMEs originate from the repeated formations and partial eruptions of kink unstable flux ropes as a result of the continued emergence of a twisted flux rope across the lower boundary into a pre-existing coronal potential arcade field. The simulations show that a CME erupting into the open magnetic field created by a preceding CME has a higher speed, and therefore tends to be cannibalistic, catching up and merging with the preceding one into a single fast CME. All the CMEs attained speeds of about 1000 km/s as they exit the domain. The reformation of a twisted flux rope after each CME eruption during the sustained flux emergence can naturally explain the X-ray observations of repeated reformations of sigmoids and “sigmoid-under-cusp” configurations at a low-coronal source of homologous CMEs.

NASA Sponsors Antelope Valley’s Inaugural FIRST Robotics Competition

NASA Image and Video Library

2018-06-18

The Antelope Valley hosted its inaugural FIRST Robotics Competition (FRC) on April 6-7, 2018, in the gymnasium of Eastside High School in Lancaster, California. The regional competition “Aerospace Valley Regional” serves as a championship-qualifying robotics competition and is sponsored by NASA, Lockheed, Northrup, Boeing and several other local organizations. An estimated 500 to 700 high-school students on 35 teams from around the world, competed in the regional’s 2018 season challenge, “FIRST POWER UP.” The "FIRST POWER UP" game pairs two alliances of video game characters with their human operators as they work to defeat a "boss" to escape an arcade game where they are trapped inside. Each match begins with a 15-second autonomous period in which robots operate only on pre-programmed instructions. During this period, robots work to earn points according to the game's rules. During the remaining two minutes and 15 seconds, student drivers’ control robots to earn points.

[Polypoidal choroidal vasculopathy with spontaneous regression of subfoveal changes--case report].

PubMed

Lachowicz, Ewelina; Kubasik-Kładna, Katarzyna; Mozolewska-Piotrowska, Katarzyna; Karczewicz, Danuta

2012-01-01

To report a patient with polypoidal choroidal vasculopathy (PCV) with spontaneous regression of subfoveal changes during follow-up. The seventy six years old men was referred to the treatment of exudative type of age related macular degeneration (AMD) in the RE. The routine ophthalmological examination, the optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) were performed. Decreasing of visual acuity of the RE and abnormal result of the Amsler test, hemorrhagic and exudative changes near inferior-temporalis vascular arcade were observed. Intraretinal fluid in the OCT was noted. FA revealed parapapillaris changes suggesting CNV. ICGA showed the presence of branching vascular network extending from choroidal vasculature (BVN) and polypoidal and aneurysmal vascular terminal lesion (PL) localized under retinal pigment epithelium (RPE). Based on the results PCV was diagnosed and the patient was referred to laserotherapy. Due to the regression of the eye fundus changes during the period of observation, confirmed by control OCT and FA the treatment was not implemented.

Reconnection–Condensation Model for Solar Prominence Formation

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

Kaneko, Takafumi; Yokoyama, Takaaki, E-mail: kaneko@isee.nagoya-u.ac.jp

We propose a reconnection–condensation model in which topological change in a coronal magnetic field via reconnection triggers radiative condensation, thereby resulting in prominence formation. Previous observational studies have suggested that reconnection at a polarity inversion line of a coronal arcade field creates a flux rope that can sustain a prominence; however, they did not explain the origin of cool dense plasmas of prominences. Using three-dimensional magnetohydrodynamic simulations, including anisotropic nonlinear thermal conduction and optically thin radiative cooling, we demonstrate that reconnection can lead not only to flux rope formation but also to radiative condensation under a certain condition. In ourmore » model, this condition is described by the Field length, which is defined as the scale length for thermal balance between radiative cooling and thermal conduction. This critical condition depends weakly on the artificial background heating. The extreme ultraviolet emissions synthesized with our simulation results have good agreement with observational signatures reported in previous studies.« less

‘Research clinics’: online journal clubs between south and north for student mentoring

PubMed Central

Atkins, Salla; Varshney, Dinansha; Meragia, Elnta; Zwarenstein, Merrick; Diwan, Vishal

2016-01-01

Background Capacity development in health research is high on the agenda of many low- and middle-income countries. Objective The ARCADE projects, funded by the EU, have been working in Africa and Asia since 2011 in order to build postgraduate students’ health research capacity. In this short communication, we describe one initiative in these projects, that of research clinics – online journal clubs connecting southern and northern students and experts. Design We describe the implementation of these research clinics together with student and participant experiences. Results From 2012 to 2015, a total of seven journal clubs were presented by students and junior researchers on topics related to global health. Sessions were connected through web conferencing, connecting experts and students from different countries. Conclusions The research clinics succeeded in engaging young researchers across the globe and connecting them with global experts. The contacts and suggestions made were appreciated by students. This format has potential to contribute toward research capacity building in low- and middle-income countries. PMID:27725079

COMPLEX FLARE DYNAMICS INITIATED BY A FILAMENT–FILAMENT INTERACTION

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

Zhu, Chunming; McAteer, R. T. James; Liu, Rui

2015-11-01

We report on an eruption involving a relatively rare filament–filament interaction on 2013 June 21, observed by SDO and STEREO-B. The two filaments were separated in height with a “double-decker” configuration. The eruption of the lower filament began simultaneously with a descent of the upper filament, resulting in a convergence and direct interaction of the two filaments. The interaction was accompanied by the heating of surrounding plasma and an apparent crossing of a loop-like structure through the upper filament. The subsequent coalescence of the filaments drove a bright front ahead of the erupting structures. The whole process was associated withmore » a C3.0 flare followed immediately by an M2.9 flare. Shrinking loops and descending dark voids were observed during the M2.9 flare at different locations above a C-shaped flare arcade as part of the energy release, giving us unique insight into the flare dynamics.« less

The growth of filaments by the condensation of coronal arches

NASA Technical Reports Server (NTRS)

Davis, J. M.; Krieger, A. S.

1982-01-01

A model of filament formation based on the condensation of coronal arches is described. The condensation results from initiating the radiative instability within an arch by superimposing a transient energy supply upon the steady state heating mechanism. The transient energy supply increases the density within the arch so that when it is removed the radiative losses are sufficient to lead to cooling below the minimum in the power loss curve. Times from the initial formation of the condensation to its temperature stabilization as a cool filament have been calculated for various initial conditions. They lie in the range 10,000-100,000 s with the majority of the time spent above a temperature of 1 x 10 to the 6th K. Under the assumption that the condensation of a single arch forms an element of the filament, a complete filament requires the condensation of an arcade of loops. Using experimentally derived parameters, filament densities of 10 to the 11th to 10 to the 12th per cu cm can be obtained.

Synchrotron Spectral Curvature from 22 MHZ to 23 GHZ

NASA Technical Reports Server (NTRS)

Kogut, Alan J.

2012-01-01

We combine surveys of the radio sky at frequencies 22 MHz to 1.4 GHz with data from the ARCADE-2 instrument at frequencies 3 GHz to 10 GHz to characterize the frequency spectrum of diffuse synchrotron emission in the Galaxy. The radio spectrum steepens with frequency from 22 MHz to 10 GHz. The projected spectral index at 23 GHz derived from the low-frequency data agrees well with independent measurements using only data at frequencies 23 GHz and above. Comparing the spectral index at 23 GHz to the value from previously published analyses allows extension of the model to higher frequencies. The combined data are consistent with a power-law index beta = -2.64 +/-= 0.03 at 0.31 GHz, steepening by an amount of Delta-beta = 0.07 every octave in frequency. Comparison of the radio data to models including the cosmic-ray energy spectrum suggests that any break in the synchrotron spectrum must occur at frequencies above 23 GHz.

X-Ray Flare Oscillations Track Plasma Sloshing along Star-disk Magnetic Tubes in the Orion Star-forming Region

NASA Astrophysics Data System (ADS)

Reale, Fabio; Lopez-Santiago, Javier; Flaccomio, Ettore; Petralia, Antonino; Sciortino, Salvatore

2018-03-01

Pulsing X-ray emission tracks the plasma “echo” traveling in an extremely long magnetic tube that flares in an Orion pre-main sequence (PMS) star. On the Sun, flares last from minutes to a few hours and the longest-lasting ones typically involve arcades of closed magnetic tubes. Long-lasting X-ray flares are observed in PMS stars. Large-amplitude (∼20%), long-period (∼3 hr) pulsations are detected in the light curve of day-long flares observed by the Advanced CCD Imaging Spectrometer on-board Chandra from PMS stars in the Orion cluster. Detailed hydrodynamic modeling of two flares observed on V772 Ori and OW Ori shows that these pulsations may track the sloshing of plasma along a single long magnetic tube, triggered by a sufficiently short (∼1 hr) heat pulse. These magnetic tubes are ≥20 solar radii long, enough to connect the star with the surrounding disk.

Witnessing magnetic twist with high-resolution observation from the 1.6-m New Solar Telescope

PubMed Central

Wang, Haimin; Cao, Wenda; Liu, Chang; Xu, Yan; Liu, Rui; Zeng, Zhicheng; Chae, Jongchul; Ji, Haisheng

2015-01-01

Magnetic flux ropes are highly twisted, current-carrying magnetic fields. They are crucial for the instability of plasma involved in solar eruptions, which may lead to adverse space weather effects. Here we present observations of a flaring using the highest resolution chromospheric images from the 1.6-m New Solar Telescope at Big Bear Solar Observatory, supplemented by a magnetic field extrapolation model. A set of loops initially appear to peel off from an overall inverse S-shaped flux bundle, and then develop into a multi-stranded twisted flux rope, producing a two-ribbon flare. We show evidence that the flux rope is embedded in sheared arcades and becomes unstable following the enhancement of its twists. The subsequent motion of the flux rope is confined due to the strong strapping effect of the overlying field. These results provide a first opportunity to witness the detailed structure and evolution of flux ropes in the low solar atmosphere. PMID:25919706

Effects of playing video games on pain response during a cold pressor task.

PubMed

Raudenbush, Bryan; Koon, Jerrod; Cessna, Trevor; McCombs, Kristin

2009-04-01

Two studies assessed whether playing video games would significantly distract participants from painful stimulation via a cold pressor test. In Study 1, participants (8 men, 22 women, M age = 18.5 yr., SD = 1.3) in an action-oriented game condition tolerated pain for a longer time period and reported lower pain intensity ratings than those in a nonaction-oriented game or a nongame control condition. No differences were found on scores of aggressiveness, competitiveness, or prior video game experience, suggesting that these factors play little role. In Study 2, participants (14 men, 13 women, M age = 19.7 yr., SD = 1.3) engaged in six video game conditions (action, fighting, puzzle, sports, arcade, and boxing) and a nongame control condition. Video game play produced an increase in pulse, which was greatest during the action, fighting, sports, and boxing games. Pain tolerance was greatest during the sports and fighting games. Thus, certain games produce greater distraction, which may have implications for the medical field as an adjunct to pain management.

Macrospicule Jets in On-Disk Coronal Holes

NASA Technical Reports Server (NTRS)

Adams, M. L.; Sterling, A. C.; Moore, R. L.

2014-01-01

We examine the magnetic structure and dynamics of multiple jets found in coronal holes close to or on disk center. All data are from the Atmospheric Imaging Assembly (AIA) and the Helioseismic and Magnetic Imager (HMI) of the Solar Dynamics Observatory (SDO). We report on observations of six jets in an equatorial coronal hole spanning 2011 February 27 and 28. We show the evolution of these jets in AIA 193 A, examine the magnetic field configuration, and postulate the probable trigger mechanism of these events. We recently reported on another jet in the same coronal hole on 2011 February 27, approximately 13:04 Universal Time (Adams et al 2014, Astrophysical Journal, 783: 11); this jet is a previously-unrecognized variety of blowout jet. In this variety, the reconnection bright point is not made by interchange reconnection of initially-closed erupting field in the base of the jet with ambient open field. Instead, there is a miniature filament-eruption flare arcade made by internal reconnection of the legs of the erupting field.

VERTICAL KINK OSCILLATION OF A MAGNETIC FLUX ROPE STRUCTURE IN THE SOLAR CORONA

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

Kim, S.; Cho, K.-S.; Nakariakov, V. M., E-mail: sjkim@kasi.re.kr

2014-12-20

Vertical transverse oscillations of a coronal magnetic rope, observed simultaneously in the 171 Å and 304 Å bandpasses of the Atmospheric Imaging Assembly on board the Solar Dynamics Observatory (SDO), are detected. The oscillation period is about 700 s and the displacement amplitude is about 1 Mm. The oscillation amplitude remains constant during the observation. Simultaneous observation of the rope in the bandpasses corresponding to the coronal and chromospheric temperatures suggests that it has a multi-thermal structure. Oscillatory patterns in 171 Å and 304 Å are coherent, which indicates that the observed kink oscillation is collective, in which the ropemore » moves as a single entity. We interpret the oscillation as a fundamental standing vertically polarized kink mode of the rope, while the interpretation in terms of a perpendicular fast wave could not be entirely ruled out. In addition, the arcade situated above the rope and seen in the 171 Å bandpass shows an oscillatory motion with the period of about 1000 s.« less

Data-driven magnetohydrodynamic modelling of a flux-emerging active region leading to solar eruption

PubMed Central

Jiang, Chaowei; Wu, S. T.; Feng, Xuesheng; Hu, Qiang

2016-01-01

Solar eruptions are well-recognized as major drivers of space weather but what causes them remains an open question. Here we show how an eruption is initiated in a non-potential magnetic flux-emerging region using magnetohydrodynamic modelling driven directly by solar magnetograms. Our model simulates the coronal magnetic field following a long-duration quasi-static evolution to its fast eruption. The field morphology resembles a set of extreme ultraviolet images for the whole process. Study of the magnetic field suggests that in this event, the key transition from the pre-eruptive to eruptive state is due to the establishment of a positive feedback between the upward expansion of internal stressed magnetic arcades of new emergence and an external magnetic reconnection which triggers the eruption. Such a nearly realistic simulation of a solar eruption from origin to onset can provide important insight into its cause, and also has the potential for improving space weather modelling. PMID:27181846

Control Points in School Business Management, Presenting General Observations, Specific Control Points, and a Series of Checkpoints for the Practicing School Business Administrator.

ERIC Educational Resources Information Center

Association of School Business Officials, Chicago, IL.

This revised outline of a 1962 address contains general guidelines considered still useful for practicing school business administrators. Introductory "general observations" and a preamble give advice about good personal qualities, policy and planning practices, and relations with school boards, community, staff, and fellow professional…

Models of clinical reasoning with a focus on general practice: A critical review

PubMed Central

YAZDANI, SHAHRAM; HOSSEINZADEH, MOHAMMAD; HOSSEINI, FAKHROLSADAT

2017-01-01

Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed. PMID:28979912

Locum doctors in general practice: motivation and experiences.

PubMed Central

McKevitt, C; Morgan, M; Hudson, M

1999-01-01

BACKGROUND: There is evidence of dissatisfaction with locum doctors' performance, but little is known about doctors who work as locums in general practice or about their experiences of this work. AIM: To describe the motivations and experiences of doctors providing locum cover in general practices. METHOD: A postal questionnaire survey distributed to locums through organizations such as locum groups, commercial agencies, and general practices. RESULTS: Questionnaires were returned by 111 doctors currently working as locums in general practice. Four main reasons for working as a locum GP were: as a short-term option while between posts, to gain experience of different practices before commitment to one practice, to balance work and family or other commitments, to continue part-time work after retirement. One-quarter of responders intended to continue working as a locum indefinitely. The drawbacks of locum work included frustration with low status, lack of security, and difficulty accessing structured training and education. CONCLUSION: Locum doctors in general practice are a heterogeneous group that includes those who have chosen this type of work. The doctors who intend to continue as locums indefinitely represent a useful resource in primary care whose ability to provide short-term cover could be maximized. The need to control the quality of 'freelance' doctors should not overshadow the need to control the quality of their working environments. PMID:10621983

What makes a good GP? An empirical perspective on virtue in general practice

PubMed Central

Braunack-Mayer, A

2005-01-01

This paper takes a virtuist approach to medical ethics to explore, from an empirical angle, ideas about settled ways of living a good life. Qualitative research methods were used to analyse the ways in which a group of 15 general practitioners (GPs) articulated notions of good doctoring and the virtues in their work. I argue that the GPs, whose talk is analysed here, defined good general practice in terms of the ideals of accessibility, comprehensiveness, and continuity. They regarded these ideals significant both for the way they dealt with morally problematic situations and for how they conducted their professional lives more generally. In addition, I argue that the GPs who articulated these ideals most clearly were able to, in part, because they shared the experience of working in rural areas. This experience helped them to develop an understanding of the nature of general practice that their urban colleagues were less able to draw on. In that sense, the structural and organisational framework of general practice in rural areas provided the context for their understanding of ideals in general practice. PMID:15681671

Readiness for organisational change among general practice staff.

PubMed

Christl, B; Harris, M F; Jayasinghe, U W; Proudfoot, J; Taggart, J; Tan, J

2010-10-01

Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. To explore general practice staff readiness for organisational change and its association with staff and practices characteristics. This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires. 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; p<0.001), full-time employment (vs part-time; B=0.175, 95% CI 0.06 to 0.29; p<0.01) and lower job satisfaction (B=-0.277, 95% CI -0.40 to -0.15; p<0.001). The results suggest that different approaches are needed to facilitate change which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

Assessing the work of medical audit advisory groups in promoting audit in general practice.

PubMed

Baker, R; Hearnshaw, H; Cooper, A; Cheater, F; Robertson, N

1995-12-01

Objectives--To determine the role of medical audit advisory groups in audit activities in general practice. Design--Postal questionnaire survey. Subjects--All 104 advisory groups in England and Wales in 1994. Main measures--Monitoring audit: the methods used to classify audits, the methods used by the advisory group to collect data on audits from general practices, the proportion of practices undertaking audit. Directing and coordinating audits: topics and number of practices participating in multipractice audits. Results--The response rate was 86-5%. In 1993-4, 54% of the advisory groups used the Oxfordshire or Kirklees methods for classifying audits, or modifications of them. 99% of the advisory groups collected data on audit activities at least once between 1991-2 and 1993-4. Visits, questionnaires, and other methods were used to collect information from all or samples of practices in each of the advisory group's areas. Some advisory groups used different methods in different years. In 1991-2, 57% of all practices participated in some audit, in 1992-3, 78%, and in 1993-4, 86%. 428 multipractice audits were identified. The most popular topic was diabetes. Conclusions--Advisory groups have been active in monitoring audit in general practice. However, the methods used to classify and collect information about audits in general practices varied widely. The number of practices undertaking audit increased between 1991-2 and 1993 1. The large number of multipractice audits supports the view that the advisory groups have directed and coordinated audit activities. This example of a national audit programme for general practice may be helpful in other countries in which the introduction of quality assurance is being considered.

The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on

PubMed Central

2014-01-01

Background Nursing in Australian general practice has grown rapidly over the last decade in response to government initiatives to strengthen primary care. There are limited data about how this expansion has impacted on the nursing role, scope of practice and workforce characteristics. This study aimed to describe the current demographic and employment characteristics of Australian nurses working in general practice and explore trends in their role over time. Methods In the nascence of the expansion of the role of nurses in Australian general practice (2003–2004) a national survey was undertaken to describe nurse demographics, clinical roles and competencies. This survey was repeated in 2009–2010 and comparative analysis of the datasets undertaken to explore workforce changes over time. Results Two hundred eighty four nurses employed in general practice completed the first survey (2003/04) and 235 completed the second survey (2009/10). Significantly more participants in Study 2 were undertaking follow-up of pathology results, physical assessment and disease specific health education. There was also a statistically significant increase in the participants who felt that further education/training would augment their confidence in all clinical tasks (p < 0.001). Whilst the impact of legal implications as a barrier to the nurses’ role in general practice decreased between the two time points, more participants perceived lack of space, job descriptions, confidence to negotiate with general practitioners and personal desire to enhance their role as barriers. Access to education and training as a facilitator to nursing role expansion increased between the two studies. The level of optimism of participants for the future of the nurses’ role in general practice was slightly decreased over time. Conclusions This study has identified that some of the structural barriers to nursing in Australian general practice have been addressed over time. However, it also identifies continuing barriers that impact practice nurse role development. Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce. PMID:24666420

The Role of Food Parenting Skills and the Home Food Environment in Children's Weight Gain and Obesity.

PubMed

Gerards, S M P L; Kremers, S P J

2015-03-01

This paper presents an overview to provide readers with an update on the literature about the relation between parental influences (general parenting and food parenting practices) and children's weight-related outcomes. It first summarizes the evidence regarding the role of food parenting practices in shaping and maintaining children's nutritional and weight status. It then describes empirical evidence on the relation between general parenting and children's weight status. This evidence is less convincing, possibly because general parenting has a different, more distal role in influencing child behavior than parenting practices. General parenting may moderate the impact of food parenting practices on children's nutrition behaviors. Finally, we discuss studies on interventions targeting childhood overweight and obesity. There is no consensus on the optimal intervention targets (i.e., general parenting and/or food parenting practices). Based on the overview, we offer suggestions for future research.

A nurse-led model of chronic disease management in general practice: Patients' perspectives.

PubMed

Young, Jacqueline; Eley, Diann; Patterson, Elizabeth; Turner, Catherine

2016-12-01

Evidence suggests that current models of chronic disease management within general practice are not effective in meeting the needs of the community. The objective of this article is to examine patients' perceptions of a nurse-led collaborative model of care trialled in three general practices in Australia. This article reports on the second phase of a mixed-methods study in which semi-structured interviews with purposively selected patients were conducted to elicit information about their perceptions of nurse-led care. Three themes emerged from the data - time, ambiance and dimensions of the nurse role. The results suggest that general practice nurses had a positive impact on patients' ability to manage their chronic disease. This infers that there is scope for general practice nurses to expand their role in chronic disease management to assist patients to better self-manage their chronic diseases.

21 CFR 225.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 225.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS General Provisions § 225.1 Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act...

21 CFR 210.1 - Status of current good manufacturing practice regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Status of current good manufacturing practice... SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PROCESSING, PACKING, OR HOLDING OF DRUGS; GENERAL § 210.1 Status of current good manufacturing practice regulations...

21 CFR 226.1 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 226.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR TYPE A MEDICATED ARTICLES General Provisions § 226.1 Current good manufacturing practice. (a) The criteria in §§ 226.10 through 226.115, inclusive...

Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines' implementation.

PubMed

Cullen, Walter; Stanley, June; Langton, Deirdre; Kelly, Yvonne; Staines, Anthony; Bury, Gerard

2006-11-01

Hepatitis C is a common infection among injecting drug users and has important implications for general practice. Although several clinical guidelines concerning the infection have been published, their effectiveness has yet to be tested. To assess the effectiveness of a general practice-based complex intervention to support the implementation of clinical guidelines for hepatitis C management among current or former drug users attending general practice. Cluster randomised controlled trial. General practices in the Eastern Regional Health Authority area of Ireland. Twenty-six practices were randomly allocated within strata to receive the intervention under study or to provide care as usual for a period of 6 months. There was screening for patients attending general practice for methadone maintenance treatment for hepatitis C and referral of anti-HCV antibody positive patients to a specialist hepatology department for assessment. At study completion, patients in the intervention group were significantly more likely to have been screened for hepatitis C than those in the control group, odds ratio adjusted for clustering 3.76 (95% confidence interval [CI] = 1.3 to 11.3) and this association remained significant after adjusting for other potentially confounding variables, using multiple logistic regression, with the odds ratio adjusted for clustering 4.53 (95% CI = 1.39 to 14.78). Although anti-HCV antibody positive patients in the intervention group were more likely to have been referred to a hepatology clinic, this was not statistically significant (P = 0.06). General practice has an important role in the care of people at risk of hepatitis C and when appropriately supported can effectively implement current best practice.

Patient and professional attitudes towards research in general practice: the RepR qualitative study.

PubMed

Cadwallader, Jean-Sébastien; Lebeau, Jean-Pierre; Lasserre, Evelyne; Letrilliart, Laurent

2014-07-21

Since the 1990s, professional institutions worldwide have emphasised the need to develop research in general practice to improve the health of the population. The recent creation of professorships in general practice in French Universities should foster research in this field. Our aim was to explore the views of patients and relevant professionals on research in general practice. Qualitative study, using the grounded theory approach according to Strauss and Corbin, conducted in 2010 in three French regions. Nine focus groups were run to data saturation, and included 57 participants in four different categories: patients, non-academic GPs, academic GPs, academics in other disciplines. Most of the participants in the four categories described research in general practice as specific to the population managed and relevant for health care. They considered that its grounding in day-to-day practice enabled pragmatic approaches. The influence of the pharmaceutical industry, rivalries between university disciplines and a possible gap between research and practice were considered as pitfalls. The barriers identified were representations of the medical researcher as a "laboratory worker", the lack of awareness of any research in the discipline, and lack of time and training. While the views of patients and non-academic GPs are mostly focused on professional issues and the views of academics other than GPs on technical issues, academic GPs are in a position to play a role of interface between the universities and general practices. Although the role of GPs in research is perceived differently by the various protagonists, research in general practice has an undisputed legitimacy in France. Solutions for overcoming the identified barriers include research networks with appropriate resources and training and scientifically sound collaborative research projects, as already implemented in leading countries.

Public and private funding of general practice services for children and adolescents in New Zealand.

PubMed

Dovey, Susan; Tilyard, Murray; Cunningham, Wayne; Williamson, Martyn

2011-11-01

To measure public and private funding of general practice services for New Zealand children. Computerized records from 111 general practices provided private payments for 118,905 general practice services to children aged 6-17 years. Government subsidies and public insurance payments provided public funding amounts for seven services. Overall and for each service we estimated the ratio of public:private payments (RPPP). 64.0% of annual expenditure was public, 36.0% private, (RPPP=1:0.56). General medical consultations were 67.2% of services (RPPP=1:0.57); 15.3% were injury-related (RPPP=1:0.36); 5.2% were prescribing services (all private); 4.9% were immunizations (RPPP=1:0.12); 2.9% were nursing (RPPP=1:1.33); 4.4% were administration (all private); and 0.1% were for maternity care (RPPP=1:0.007). Before capitation funding, public and private funding levels for general medical consultations were similar (RPPP=1:0.93) but after capitation public payments more than doubled (RPPP=1:0.40). There is a complex of pattern of public and private payments for general practice services for children and adolescents in New Zealand. Both funding sources are critical. Capitation funding changed the balance substantially but did not remove ongoing reliance on private funding to support general practice care for children. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Work of female rural doctors.

PubMed

Wainer, Jo

2004-04-01

To identify the impact of family life on the ways women practice rural medicine and the changes needed to attract women to rural practice. Census of women rural doctors in Victoria in 2000, using a self-completed postal survey. General and specialist practice. Two hundred and seventy-one female general practitioners and 31 female specialists practising in Rural, Remote and Metropolitan Area Classifications 3-7. General practitioners are those doctors with a primary medical degree and without additional specialist qualifications. Interaction of hours and type of work with family responsibilities. Generalist and specialist women rural doctors carry the main responsibility for family care. This is reflected in the number of hours they work in clinical and non-clinical professional practice, availability for on-call and hospital work, and preference for the responsibilities of practice partnership or the flexibility of salaried positions. Most of the doctors had established a satisfactory balance between work and family responsibilities, although a substantial number were overworked in order to provide an income for their families or meet the needs of their communities. Thirty-six percent of female rural general practitioners and 56% of female rural specialists preferred to work fewer hours. Female general practitioners with responsibility for children were more than twice as likely as female general practitioners without children to be in a salaried position and less likely to be a practice partner. The changes needed to attract and retain women in rural practice include a place for everyone in the doctor's family, flexible practice structures, mentoring by women doctors and financial and personal recognition. Women make up less than a quarter of the rural general practice workforce and an even smaller percentage of the specialist rural medical workforce. As a result their experiences are not well articulated in research on rural medical practice and their needs are not well represented in policies and programs for rural doctors. The incoming cohort of rural general practitioners has a majority of women and it is essential that the practice styles and needs of women doctors are understood in order to attract and retain women in rural medicine. This survey identifies some of the effects of family responsibilities on the work practices of female rural doctors and the changes needed to the structure of rural practice to include the way women work.

GPs' views of health policy changes: a qualitative 'netnography' study of UK general practice online magazine commentary.

PubMed

Elvey, Rebecca; Voorhees, Jennifer; Bailey, Simon; Burns, Taylor; Hodgson, Damian

2018-06-01

Shifts in health policy since 2010 have brought major structural changes to the English NHS, with government stating intentions to increase GPs' autonomy and improve access to care. Meanwhile, GPs' levels of job satisfaction are low, while stress levels are high. PulseToday is a popular UK general practice online magazine that provides a key discussion forum on news relevant to general practice. To analyse readers' reactions to news stories about health policy changes published in an online general practice magazine. A qualitative 'netnography' was undertaken of readers' comments to PulseToday. METHOD: A sample of readers' comments on articles published in PulseToday was collated and subjected to thematic analysis. Around 300 comments on articles published between January 2012 and March 2016 were included in the analysis, using 'access to care' as a tracer theme. Concern about the demand and strain on general practice was perhaps to be expected. However, analysis revealed various dimensions to this concern: GPs' underlying feelings about their work and place in the NHS; constraints to GPs' control of their own working practices; a perceived loss of respect for the role of GP; and disappointment with representative bodies and GP leadership. This study shows a complex mix of resistance and resignation in general practice about the changing character of GPs' roles. This ambivalence deserves further attention because it could potentially shape responses to further change in primary care in ways that are as yet unknown. © British Journal of General Practice 2018.

Assessment of publication output in the field of general practice and family medicine and by general practitioners and general practice institutions.

PubMed

Jelercic, Stasa; Lingard, Heide; Spiegel, Wolfgang; Pichlhöfer, Otto; Maier, Manfred

2010-10-01

The discipline of family medicine (FM) lacks a comprehensive methodology, which can be applied as a standard for assessing overall research output in both the field of FM and by general practitioners (GPs)/general practice institutions. It was the aim of this study to develop a sensitive search strategy for assessing publication output in the field of FM independent of the author's profession or affiliation and by GPs/general practice institutions independent of their field of scientific interest. Literature searches limited to the year 2005 were conducted in PubMed and ISI Web of Sciences (ISI WoS). In PubMed, all relevant MeSH terms were used. Search terms possibly contained in the author's affiliations have been collected. In ISI WoS, the same entry terms including their abbreviations and plural forms were applied. The final queries were validated by manual review and matching results with selected FM journals. A comprehensive list of combined search terms could be defined. For the field of general practice/FM more publications could be retrieved in PubMed. Almost twice as many publications by GPs/general practice institutions could be retrieved in ISI WoS, where--in contrast to PubMed--the affiliation is documented for all authors. To quantitatively assess publication output in the field of FM, PubMed was identified as the preferable database. To assess publication output by GPs/general practice institutions, the ISI WoS is recommended as the preferable database. Apparently, the ISI WoS is more suitable to compare the research productivity of different countries, authors or institutions.

Getting governance right for a sustainable regionalised business model.

PubMed

Laurence, Caroline O; Black, Linda E; Rowe, Mark; Pearce, Rod

2011-06-06

The 1998 Ministerial Review of General Practice Training identified several areas for improvement that led to major changes in the provision of general practice training, including the establishment of General Practice Education and Training (GPET) and the regionalisation of training. The regionalised training business model has been in place for nearly 10 years, and several key organisations have been involved in its evolution, including the Australian Government, speciality colleges, GPET and regionalised training providers. Both the college-focused and regionalised-focused models have had some successes. These include recognition and support of general practice as a vocational specialty, increased numbers of junior doctors undertaking placements in general practice, and increased numbers of registrars training in rural areas. This period has also seen changes in the governance and decision-making processes with creation of a new framework that is inclusive of all the key players in the new regionalised training system. The future holds challenges for the regionalised training business model as the general practice education and training landscape becomes more complex. The framework in the current model will provide a base to help meet these challenges and allow for further sustainable expansion.

Mentoring medical students in your general practice.

PubMed

Fraser, John

2016-05-01

Mentoring medical students in general practices is becoming more common in Australia due to formalised scholarship programs and informal approaches by students. This paper defines mentoring in Australian general practice. Practical suggestions are made on how to structure a mentorship program in your practice. Mentoring differs from leadership and teaching. It is a long-term relationship between a student and an experienced general practitioner. Avoiding summative assessment in mentorship is important to its success. Mentoring is about forming a safe place to confidentially discuss personal and professional issues between a mentor and student. This is based on defining roles and mutual trust. At the same time, students crave formative feedback. Unfortunately, present feedback models are based on teaching principles that can blur the differences between assessor, teacher and mentor. Mentorship can provide students with orientation and learning experiences so that they are prepared for practice as an intern.

General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements.

PubMed

Kelly, Martina; Bennett, Deirdre; O'Flynn, Siun

2012-01-01

The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?

Views of practice managers and general practitioners on implementing NHS Health Checks.

PubMed

Krska, Janet; du Plessis, Ruth; Chellaswamy, Hannah

2016-03-01

As part of an evaluation of a contract with general practices to deliver the national NHS Health Checks programme in Sefton, North West England, we surveyed general practitioners (GPs) and practice managers (PMs) in all 55 practices. The contract required practices to identify individuals from their practice registers with potentially high cardiovascular disease risk, and provide annual reviews. Responses were obtained from 43/178 GPs and 40/55 PMs representing 56 and 73% of practices, respectively. There was variation in many aspects of implementation. Time and software were viewed as barriers to implementation, the increased nurse workload impacted on other services and payments were insufficient to cover costs. The main enabler for successful implementation was IT support. Fewer than half the respondents viewed the programme as beneficial to their practice. Findings have been used to address many issues raised. Practices need more support from commissioners to help implement NHS Health Checks.

Segmenting a general practitioner market to improve recruitment outcomes.

PubMed

Hemphill, Elizabeth; Kulik, Carol T

2011-05-01

Recruitment is an ongoing challenge in the health industry with general practitioner (GP) shortages in many areas beyond rural and Indigenous communities. This paper suggests a marketing solution that identifies different segments of the GP market for recruitment strategy development. In February 2008, 96 GPs in Australia responded to a mail questionnaire (of which 85 questionnaires were useable). A total of 350 GPs were sent the questionnaire. Respondents considered small sets of attributes in the decision to accept a new job at a general practice and selected the most and least important attribute from each set. We identified latent class clusters (cohorts) of GPs from the most-least important data. Three cohorts were found in the GP market, distinguishing practitioners who emphasised job, family or practice attributes in their decision to join a practice. Few significant demographic differences exist between the cohorts. A segmented GP market suggests two alternative recruitment strategies. One option is for general practices to target members of a single cohort (family-, job-, or practice-focussed GPs). The other option is for general practices to diversify their recruitment strategies to target all three cohorts (family-, job- and practice-focussed GPs). A single brand (practice) can have multiple advertising strategies with each strategy involving advertising activities targeting a particular consumer segment.

Shaping the future medical workforce: take care with selection tools.

PubMed

Poole, Phillippa; Shulruf, Boaz

2013-12-01

Medical school selection is a first step in developing a general practice workforce. To determine the relationship between medical school selection scores and intention to pursue a career in general practice. A longitudinal cohort study of students selected in 2006 and 2007 for The University of Auckland medical programme, who completed an exit survey on career intentions. Students are ranked for selection into year 2 of a six-year programme by combining grade point average from prior university achievement (60%), interview (25%) and Undergraduate Medicine and Health Sciences Admission Test (UMAT) scores (15%). The main outcome measure was level of interest in general practice at exit. Logistic regression assessed whether any demographic variables or admission scores predicted a 'strong' interest in general practice. None of interview scores, grade point average, age, gender, or entry pathway predicted a 'strong' interest in general practice. Only UMAT scores differentiated between those with a 'strong' interest versus those with 'some' or 'no' interest, but in an inverse fashion. The best predictor of a 'strong' interest in general practice was a low UMAT score of between 45 and 55 on all three UMAT sections (OR 3.37, p=0.020). Yet, the academic scores at entry of students with these UMAT scores were not lower than those of their classmates. Setting inappropriately high cut-points for medical school selection may exclude applicants with a propensity for general practice. These findings support the use of a wider lens through which to view medical school selection tools.

The importance of social support for people with type 2 diabetes - a qualitative study with general practitioners, practice nurses and patients.

PubMed

Goetz, Katja; Szecsenyi, Joachim; Campbell, Stephen; Rosemann, Thomas; Rueter, Gernot; Raum, Elke; Brenner, Herrmann; Miksch, Antje

2012-01-01

Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner's, practice nurse's and people with type 2 diabetes' views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support. Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9). All data were audio-recorded, fully transcribed and thematically analysed using qualitative content analysis by Mayring. All participants emphasized the importance of the concept of social support and its impacts on well-being of people with type 2 diabetes. Social support is perceived helpful for people with diabetes in order to improve diabetes control and give support for changes in lifestyle habits (physical activity and dietary changes). General practitioners identified a lack of information about facilities in the community like sports or self-help groups. Practice nurses emphasized that they need more training, such as in dietary counselling. Social support given by general practitioners and practice nurses plays a crucial role for people with type 2 diabetes and is an additional component of social care. However there is a need for an increased awareness by general practitioners and practice nurses about the influence social support could have on the individual's diabetes management.

Norfolk general practice: a comparison of rural and urban doctors

PubMed Central

Fearn, Richard M.G.

1988-01-01

A postal questionnaire was sent to all Norfolk practitioners, allowing a comparison to be made between rural general practice and urban practice in Norwich and Great Yarmouth. However, when Norfolk town and country doctors were compared, little difference was found in their personal or practice characteristics. In respect of their workload rural doctors, as expected, carried out more procedures overall but, somewhat surprisingly, did not make more home visits. Both sets of doctors had similar views on their present and future role in general practice. When Norfolk doctors collectively were compared with general practitioners nationally their service appeared to be of a high standard. The only uncertainty surrounded the effects of the greater clustering of Norfolk surgeries, together with the levels of home visiting and their attendant effects on patient accessibility. PMID:3255815

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What is current good manufacturing practice for... HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION TOMOGRAPHY DRUGS (Eff. 12-12-2011) General Provisions § 212.2 What is current good manufacturing practice for...

29 CFR 780.146 - Importance of relationship of the practice to farming generally.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 3 2014-07-01 2014-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not intended...

29 CFR 780.146 - Importance of relationship of the practice to farming generally.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 3 2013-07-01 2013-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not intended...

29 CFR 780.146 - Importance of relationship of the practice to farming generally.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not intended...

29 CFR 780.146 - Importance of relationship of the practice to farming generally.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 3 2012-07-01 2012-07-01 false Importance of relationship of the practice to farming... in Conjunction Withâ the Farming Operations § 780.146 Importance of relationship of the practice to farming generally. The inclusion of incidental practices in the definition of agriculture was not intended...

Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

PubMed Central

Whitford, David L; Hickey, Anne; Horgan, Frances; O'Sullivan, Bernadette; McGee, Hannah; O'Neill, Desmond

2009-01-01

Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care. PMID:19402908

iPhone ECG screening by practice nurses and receptionists for atrial fibrillation in general practice: the GP-SEARCH qualitative pilot study.

PubMed

Orchard, Jessica; Freedman, Saul Benedict; Lowres, Nicole; Peiris, David; Neubeck, Lis

2014-05-01

Atrial fibrillation (AF) is often asymptomatic and substantially increases stroke risk. A single-lead iPhone electrocardiograph (iECG) with a validated AF algorithm could make systematic AF screening feasible in general practice. A qualitative screening pilot study was conducted in three practices. Receptionists and practice nurses screened patients aged ≥65 years using an iECG (transmitted to a secure website) and general practitioner (GP) review was then provided during the patient's consultation. Fourteen semi-structured interviews with GPs, nurses, receptionists and patients were audio-recorded, transcribed and analysed thematically. Eighty-eight patients (51% male; mean age 74.8 ± 8.8 years) were screened: 17 patients (19%) were in AF (all previously diagnosed). The iECG was well accepted by GPs, nurses and patients. Receptionists were reluctant, whereas nurses were confident in using the device, explaining and providing screening. AF screening in general practice is feasible. A promising model is likely to be one delivered by a practice nurse, but depends on relevant contextual factors for each practice.

Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease.

PubMed

Walters, Julia A E; Courtney-Pratt, Helen; Cameron-Tucker, Helen; Nelson, Mark; Robinson, Andrew; Scott, Jenn; Turner, Paul; Walters, E Haydn; Wood-Baker, Richard

2012-01-01

The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

Improving access for patients – a practice manager questionnaire

PubMed Central

Meade, James G; Brown, James S

2006-01-01

Background The administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting. Methods A four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB) in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire. Results There was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256) had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006), urban practices (p < 0.001) and those with above average patient list sizes (p < 0.001). Receptionists had not received training in patient appointment management in a quarter of practices. Practices with smaller list sizes were more likely than larger ones to utilise nurses in seeing extra patients (p = 0.007) or to undertake triage procedures (p = 0.062). Conclusion The findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study. PMID:16784530

Evidence for Gradual External Reconnection Before Explosive Eruption of a Solar Filament

NASA Technical Reports Server (NTRS)

Sterling, Alphonse C.; Moore, Ronald L.

2004-01-01

We observe a slowly evolving quiet-region solar eruption of 1999 April 18, using extreme-ultraviolet (EUV) images from the EUV Imaging Telescope (EIT) on the Solar and Heliospheric Observatory (SOHO) and soft X-ray images from the Soft X-ray Telescope (SXT) on Yohkoh. Using difference images, in which an early image is subtracted from later images, we examine dimmings and brightenings in the region for evidence of the eruption mechanism. A filament rose slowly at about 1 km/s for 6 hours before being rapidly ejected at about 16 km/s leaving flare brightenings and postflare loops in its wake. Magnetograms from the Michelson Doppler Imager (MDI) on SOHO show that the eruption occurred in a large quadrupolar magnetic region with the filament located on the neutral line of the quadrupole s central inner lobe between the inner two of the four polarity domains. In step with the slow rise, subtle EIT dimmings commence and gradually increase over the two polarity domains on one side of the filament, i.e., in some of the loops of one of the two sidelobes of the quadrupole. Concurrently, soft X-ray brightenings gradually increase in both sidelobes. Both of these effects suggest heating in the sidelobe magnetic arcades. which gradually increase over several hours before the fast eruption. Also, during the slow pre- eruption phase, SXT dimmings gradually increase in the feet and legs of the central lobe, indicating expansion of the central-lobe magnetic arcade enveloping the filament. During the rapid ejection. these dimmings rapidly grow in darkness and in area, especially in the ends of the sigmoid field that erupts with the filament. and flare brightenings begin underneath the fast-moving but still low-altitude filament. We consider two models for explaining the eruption: "breakout. which says that reconnection occurs high above the filament prior to eruption, and tether cutting, which says that the eruption is unleashed by reconnection beneath the filament. The pre-eruption evolution is consistent with gradual breakout that led to (and perhaps caused) the fast eruption. Tether-cutting reconnection below the filament begins early in the rapid ejection. but our data are not complete enough to determine whether this reconnection began early enough to be the cause of the fast-phase onset. Thus, our observations are consistent with gradual breakout reconnection causing the long slow rise of the filament, but allow the cause of the sudden onset of the explosive fast phase to be either a jump in the breakout reconnection rate or the onset of runaway tether-cutting reconnection. or both.

40 CFR 49.131 - General rule for open burning.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false General rule for open burning. 49.131... General Rules for Application to Indian Reservations in Epa Region 10 § 49.131 General rule for open... eliminate open burning disposal practices where alternative methods are feasible and practicable, to...

40 CFR 49.131 - General rule for open burning.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 1 2012-07-01 2012-07-01 false General rule for open burning. 49.131... General Rules for Application to Indian Reservations in Epa Region 10 § 49.131 General rule for open... eliminate open burning disposal practices where alternative methods are feasible and practicable, to...

40 CFR 49.131 - General rule for open burning.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false General rule for open burning. 49.131... General Rules for Application to Indian Reservations in Epa Region 10 § 49.131 General rule for open... eliminate open burning disposal practices where alternative methods are feasible and practicable, to...

Using educational outreach and a financial incentive to increase general practices’ contribution to chlamydia screening in South-East London 2003–2011

PubMed Central

2012-01-01

Background The London Boroughs of Lambeth and Southwark have high levels of sexually transmitted infections including Chlamydia trachomatis. Modelling studies suggest that reductions in the prevalence of chlamydia infection will require a high level of population screening coverage and positivity among those screened. General practice has a potentially important role to play in delivering these levels of coverage since large numbers (up to 60%) of young people visit their general practice every year but previous work suggests that there are barriers to delivering screening in this setting. The aim of this study was to evaluate an intervention to increase chlamydia screening in general practice within Primary Care Trusts (PCTs) of Lambeth and Southwark, a strategy combining financial incentives and supportive practice visits to raise awareness and solve problems. Methods Data on age, gender, venue and chlamydia result for tests on under 25 s in Lambeth from 2003–11 was obtained from the National Chlamydia Screening Programme. We analysed the number and percentage of tests generated in general practice, and looked at the number of practices screening more than 10% of their practice cohort of 15–24 year olds, male/female ratio and positivity rates across other screening venues. We also looked at practices screening less than 10% and studied change over time. We compared data from Lambeth and Southwark with London and England. We also studied features of the level and type of educational and financial incentive interventions employed. Results Chlamydia tests performed in general practice increased from 23 tests in 2003–4 to 4813 tests in 2010–11 in Lambeth. In Southwark they increased from 5 tests in 2003/04 to 4321 in 2010/11. In 2011, 44.6% of tests came from GPs in Lambeth and 46% from GP’s in Southwark. In Lambeth 62.7% of practices tested more than 10% of their cohort and in Southwark this was 55.8%. In Lambeth, postivity rate in 2010/11 was 5.8% in men and 6.0% in women. In Southwark positivity rate was 3.9% in men and 5.3% in women. In 2003/04 13% tests in general practice (Lambeth) were from men, this increased to 25% in 2010/11. In Southwark this increased from 20% in 2003/04 to 27.6% in 2010/11. We compared the results with London and national data and showed significant differences between GP testing in Lambeth and Southwark, and GP testing in London and the rest of England. Conclusions General practices can be important potential providers of chlamydia tests. With a combination of sustained support, financial incentives and feedback on performance, general practice may be able to test a large percentage of 15–24 year olds. General practice is also a potentially important provider of chlamydia tests to young men. PMID:22984897

Patterns of Alcohol and Other Drug Use Associated with Major Depression among Gay Men Attending General Practices in Australia

ERIC Educational Resources Information Center

Holt, Martin; Bryant, Joanne; Newman, Christy E.; Paquette, Dana M.; Mao, Limin; Kidd, Michael R.; Saltman, Deborah C.; Kippax, Susan C.

2012-01-01

Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social,…

Systematic use of closed-circuit television in a general practice teaching unit

PubMed Central

Irwin, W. George; Perrott, Jon S.

1981-01-01

We describe use of closed-circuit television in teaching general practice consulting skills in a new central teaching unit of a department of general practice. We explain how the system works, present a simple analysis of student performance in communicating with real and simulated patients and discuss the value of teaching from the consultation with closed-circuit television and video. PMID:7328539

Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

PubMed

Jacobs, Jac J W M; Jacobs, Jan P A M; van Sonderen, Eric; van der Molen, Thys; Sanderman, Robbert

2015-05-06

Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

Variations in the organization and delivery of the 'NHS health check' in primary care.

PubMed

Nicholas, Jennifer M; Burgess, Caroline; Dodhia, Hiten; Miller, Jane; Fuller, Frances; Cajeat, Eric; Gulliford, Martin C

2013-03-01

To evaluate the organization of the new cardiovascular risk assessment programme, NHS Health Checks, in general practices. All 99 general practices in two inner London boroughs were invited to participate in a cross-sectional survey by completing an online questionnaire. Data were analysed for 66/99 (67%) eligible practices. Training attended for delivering the Health Check included measurement methods (43%), delivering risk information (65%) and advising on lifestyle change (62%). The Framingham risk score was used by 66% of practices, the QRisk score by 12% and both by 8%. Advice given to patients identified as high risk was 'usually' brief at 26% of practices, advice was given verbally at 92% of practices, in written form at 74% and through interactive visual materials at 29%. Statins were 'usually' prescribed to high-risk patients by 34% of practices and antihypertensive drugs by 22%. The follow-up of high-risk patients was by means of a register with regular recall at 51% of general practices. There is considerable diversity in general practices' implementation of the NHS Health Check. A formal quality assurance process may be required in order to optimize the implementation of the NHS cardiovascular risk assessment programme.

A survey to assess the provision of conscious sedation by general dental practitioners in the Republic of Ireland.

PubMed

Fisher, Veronica; Stassen, Leo F A; Nunn, June

2011-01-01

To quantify and qualify how conscious sedation was used in general dental practice before the introduction of formal sedation teaching in the Republic of Ireland. 1. To determine the extent of use of oral, inhalational and intravenous sedation; 2. to determine the training and experience of general dental practitioners providing conscious sedation; 3. to determine the perceived barriers to the practice of conscious sedation; and, 4. to gauge the level of interest in a postgraduate course in conscious sedation. Postal questionnaire sent to one general practitioner in seven, selected randomly from the General Dental Council register, in 2007. Seventy six percent of respondents agreed that the provision of conscious sedation in general dental practice is important. However, the current provision of inhalation and intravenous sedation by respondents is low in comparison to provision in the UK. The main barrier to the use of conscious sedation in general dental practice appears to be lack of availability of training. The data from this study indicated the need for postgraduate training in conscious sedation in Ireland and a need for increased awareness of the Dental Council Code of Practice on sedation.

Attitudes to the public release of comparative information on the quality of general practice care: qualitative study.

PubMed

Marshall, Martin N; Hiscock, Julia; Sibbald, Bonnie

2002-11-30

To examine the attitudes of service users, general practitioners, and clinical governance leads based in primary care trusts to the public dissemination of comparative reports on quality of care in general practice, to guide the policy and practice of public disclosure of information in primary care. Qualitative focus group study using mock quality report cards as prompts for discussion. 12 focus groups held in an urban area in north west England and a semirural area in the south of England. 35 service users, 24 general practitioners, and 18 clinical governance leads. There was general support for the principle of publishing comparative information, but all three stakeholder groups expressed concerns about the practical implications. Attitudes were strongly influenced by experience of comparative reports from other sectors-for example, school league tables. Service users distrusted what they saw as the political motivation driving the initiative, expressed a desire to "protect" their practices from political and managerial interference, and were uneasy about practices being encouraged to compete against each other. General practitioners focused on the unfairness of drawing comparisons from current data and the risks of "gaming" the results. Clinical governance leads thought that public disclosure would damage their developmental approach to implementing clinical governance. The initial negative response to the quality reports seemed to diminish on reflection. Despite support for the principle of greater openness, the planned publication of information about quality of care in general practice is likely to face considerable opposition, not only from professional groups but also from the public. A greater understanding of the practical implications of public reporting is required before the potential benefits can be realised.

General practice integration in Australia. Primary health services provider and consumer perceptions of barriers and solutions.

PubMed

Appleby, N J; Dunt, D; Southern, D M; Young, D

1999-08-01

To identify practical examples of barriers and possible solutions to improve general practice integration with other health service providers. Twelve focus groups, including one conducted by teleconference, were held across Australia with GPs and non GP primary health service providers between May and September, 1996. Focus groups were embedded within concept mapping sessions, which were used to conceptually explore the meaning of integration in general practice. Data coding, organising and analysis were based on the techniques documented by Huberman and Miles. Barriers to integration were perceived to be principally due to the role and territory disputes between the different levels of government and their services, the manner in which the GP's role is currently defined, and the system of GP remuneration. Suggestions on ways to improve integration involved two types of strategies. The first involves initiatives implemented 'top down' through major government reform to service structures, including the expansion of the role of divisions of general practice, and structural changes to the GP remuneration systems. The second type of strategy suggested involves initiatives implemented from the 'bottom up' involving services such as hospitals (e.g. additional GP liaison positions) and the use of information technology to link services and share appropriate patient data. The findings support the need for further research and evaluation of initiatives aimed at achieving general practice integration at a systems level. There is little evidence to suggest which types of initiatives improve integration. However, general practice has been placed in the centre of the health care debate and is likely to remain central to the success of such initiatives. Clarification of the future role and authority of general practice will therefore be required if such integrative strategies are to be successful at a wider health system level.

Why do general practitioners from France choose to work in London practices? A qualitative study.

PubMed

Ballard, Karen D; Robinson, Susan I; Laurence, Priscilla B

2004-10-01

Growing concerns about the ability to maintain and increase the general practitioner (GP) workforce has led to active recruitment of GPs from overseas. However, little is known about why these GPs choose to leave their countries and come to work in London. To investigate the motivations and expectations of French GPs migrating to work in general practices in London. A qualitative study using semi-structured interviews. General practice induction programme in southeast London. Individual interviews with 31 French GPs, who attended an induction programme for international recruits, were taped, transcribed, and analysed using a categorical approach. Three factors led to the process of migration: instigating factors, creating the stimulus for migration; activating factors, based on the perception that English general practice offered greater opportunities; and facilitating factors, which make migration possible. Particular emphasis was placed on personal and professional instigating factors, with a desire for new cultural experiences and a widespread discontent surrounding the infrastructure of French general practice, playing crucial roles in the stimulus to migrate. Ease of travel and a paid induction programme facilitated the move to their chosen destination. French GPs' decisions were part of a process of migration influenced by a series of integrated factors. Consideration of these factors will not only enhance recruitment to English general practice, but will also facilitate foreign GPs' transition to work in the National Health Service (NHS) and, ultimately, maximise their retention.

Whither British general practice after the 2004 GMS contract? Stories and realities of change in four UK general practices.

PubMed

Huby, Guro; Guthrie, Bruce; Grant, Suzanne; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw

2008-01-01

The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact? The article is based on comparative in-depth case studies of four UK practices. There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision-making became concentrated in fewer hands. Formally or informally constituted "elite" multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant "story" each practice constructed about its unique ethos and style. The "stories" also failed to detect negative consequences to the practice flowing from its adaptation to the contract. The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.

Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

PubMed

Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

2003-12-01

Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

32 CFR 776.11 - Outside part-time practice of law.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Outside part-time practice of law. 776.11... ADVOCATE GENERAL General § 776.11 Outside part-time practice of law. A covered USG attorney's primary.... Covered USG attorneys who wish to engage in the part-time, outside practice of law must first obtain...

32 CFR 776.11 - Outside part-time practice of law.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Outside part-time practice of law. 776.11... ADVOCATE GENERAL General § 776.11 Outside part-time practice of law. A covered USG attorney's primary.... Covered USG attorneys who wish to engage in the part-time, outside practice of law must first obtain...

Supporting families of parents with mental illness in general practice.

PubMed

Baulderstone, Michaela J; Morgan, Bradley S; Fudge, Elizabeth A

2013-08-05

The general-practice setting provides a unique opportunity to positively influence the impact of mental illness on individuals and families. Intervention can begin from the moment an individual seeks professional help. Using a family-focused approach, and supporting parents to develop practical strategies to promote resilience in their children, can aid parents' recovery and promote the optimal emotional wellbeing of their children. We suggest a family-orientated therapeutic approach relevant to the general-practice setting, with particular consideration of the value of communicating with children according to the child's stage of emotional development.

Small business, cash budgets and general practice.

PubMed

Jackson, A R

1991-01-01

In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

"Is general surgery still relevant to the subspecialised trainee?" A 10 year comparison of general versus specialty surgical practice.

PubMed

Fleming, C A; Khan, Z; Andrews, E J; Fulton, G J; Redmond, H P; Corrigan, M A

2015-02-01

The splintering of general surgery into subspecialties in the past decade has brought into question the relevance of a continued emphasis on traditional general surgical training. With the majority of trainees now expressing a preference to subspecialise early, this study sought to identify if the requirement for proficiency in managing general surgical conditions has reduced over the past decade through comparison of general and specialty surgical admissions at a tertiary referral center. A cross-sectional review of all surgical admissions at Cork University Hospital was performed at three individual time points: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Categorisation of admissions into specialty relevant or general surgery was made using International guidelines. 11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the 10-year period. While growth in overall service provision was seen, the practice of general versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002 to 2012 (p = 0.87). General surgery was mostly practiced in the emergency setting (84 % of all emergency admissions in 2012) with only 28 % elective admissions for general surgery. A reduction in length of stay was seen in both elective (3.62-2.58 bed days, p = 0.342) & emergency admissions (7.36-5.65, p = 0.026). General surgical emergency work continues to constitute a major part of the specialists practice. These results emphasize the importance of general surgical training even for those trainees committed to sub-specialisation.

Quality improvement activities associated with organisational capacity in general practice.

PubMed

Amoroso, Cheryl; Proudfoot, Judy; Bubner, Tanya; Swan, Edward; Espinel, Paola; Barton, Christopher; Beilby, Justin; Harris, Mark

2007-01-01

Clinical audit is recognised worldwide as a useful tool for quality improvement. A feedback report profiling capacity for chronic disease care was sent to 97 general practices. These practices were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general practices. From the data in their feedback report, 37 (65%) of the 57 practices recognised the area most in need of improvement. This was most likely where the need related to clinical practice or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 practices (46%) developed an action plan related to their recognised area for improvement, and 22 (39%) practices implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. The clinical audit process offered participating GPs and practices an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the practice's capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.

Promoting chlamydia screening with posters and leaflets in general practice--a qualitative study.

PubMed

Freeman, Elaine; Howell-Jones, Rebecca; Oliver, Isabel; Randall, Sarah; Ford-Young, William; Beckwith, Philippa; McNulty, Cliodna

2009-10-12

General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.

Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

PubMed Central

Freeman, Elaine; Howell-Jones, Rebecca; Oliver, Isabel; Randall, Sarah; Ford-Young, William; Beckwith, Philippa; McNulty, Cliodna

2009-01-01

Background General practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening. Methods Twenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach. Results Although two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets. Conclusion The NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice. PMID:19821964

The role of counsellors in general practice. A qualitative study.

PubMed Central

Sibbald, B.; Addington-Hall, J.; Brenneman, D.; Obe, P. F.

1996-01-01

Counselling services in general practice are now widespread but little is known about their nature or role. We therefore carried out in-depth telephone interviews with a representative sample of 72 general practitioners and 60 of their counsellors who had participated in a previous national survey of counselling services in England and Wales. Our aim was to gain greater insight into the functioning of these services in order to determine the most appropriate focus for future research and development. Interviews were semi-structured and focused on service initiation and duration; counsellors' background and training; working arrangements including sources of funding; types of clients; communication between general practitioners and counsellors; perceived advantages and disadvantages to general practitioners, counsellors, and clients; goals, barriers, and proposed changes. Approximately two thirds of counsellors were employed by district health authorities and attached to practices. One third were employed by the practice with the financial assistance of family health services authorities. Practice-employed counsellors appeared a relatively new service innovation whose growth was facilitated by the general practitioner contract of 1991. Practice-employed counsellors were preferred to practice-attached staff in that general practitioners had greater control over the selection of counsellors and their working arrangements. Problems with interprofessional communication were noted in relation to counsellors' wishes to maintain patient confidentiality by not exchanging information about patients with general practitioners. Counsellors received referrals principally from general practitioners and occasionally from other primary health care staff. Self-referral by patients was rare. The problems for which patients were most commonly referred were: stress/anxiety, relationship problems, depression, and bereavement. The principal therapeutic styles were Rogerian counselling, behavioural therapy, and psychodynamic psychotherapy. A quarter described their style as 'eclectic'. Individual, not group, therapy was the norm. Sessions were usually 50 minutes in duration. However, waiting list times, the frequency of sessions, and overall duration of therapy varied enormously. Overall 28% of counsellors held no formal qualification in counselling or in any of the psychotherapies. Counsellors and general practitioners were generally satisfied with the service and identified a wide range of benefits with few disadvantages. The principal problem was said to be that demand exceeded capacity and the principal change proposed was expansion of the service. The findings provide the most comprehensive account to date of the present state and likely future direction of counselling services in general practice and point to the need to: 1. Evaluate the cost-effectiveness of counselling in the management of common psychiatric disorders such as anxiety and depression 2. Establish a national policy for the training and accreditation of counsellors working in general practice settings 3. Educate general practitioners about the organization and role of counselling services with particular attention to interprofessional communication and the maintenance of patient confidentiality. PMID:9080766

Public attitudes to the storage of blood left over from routine general practice tests and its use in research.

PubMed

Treweek, Shaun; Doney, Alex; Leiman, David

2009-01-01

There is increasing international interest in DNA biobanks but relatively little evidence concerning appropriate recruitment methods for these repositories of genetic information linked to patient-specific phenotypic data. To this end, our study aimed to investigate the attitudes of members of the public recruited through general practices to the donation and storage of blood left over from routine clinical tests in general practice. A questionnaire was mailed to 2600 individuals randomly selected from two general practice patient lists in Dundee, Scotland. Using a 7-point Likert scale, respondents rated their attitudes toward DNA biobanks in general, and procurement of blood samples specifically. Overall, 841 (34%) of 2471 delivered questionnaires were returned. Compared with patients on the practice lists, respondents were older and more likely to be women. A majority of respondents (61%) were unequivocally positive about storing blood left over from routine tests. Despite general support for this collection method, when asked about open-ended consent, respondents expressed concern about future uses. Respondents' increasing age and level of deprivation had significant adverse effects on attitudes towards making leftover routine biological samples available for research (P = 0.013 and P = 0.034, respectively). The study had three main limitations: there was a low response rate (34%) such that respondents were not entirely respresentative of the survey population; some respondents had difficulty with the questionnaire; and the study was somewhat underpowered for some comparisons. Despite its limitations, this first survey of a general practice population suggests that the majority would be willing to consider giving open-ended consent for the use of blood left over from routine clinical tests in general practice to be stored and used later for medical research.

Are "part-time" general practitioners workforce idlers or committed professionals?

PubMed

Dwan, Kathryn M; Douglas, Kirsty A; Forrest, Laura E

2014-09-19

The traditional view of general practice holds that only general practitioners (GPs) in full-time clinical practice can provide quality patient care. Nevertheless, increasing numbers of GPs are choosing to work sessionally, that is, ostensibly "part-time". There are concerns about the health workforce's ability to meet demand and also fears that patient care may be compromised. We sought answers to a) what activities do GPs undertake when not consulting patients, b) why do they choose to work sessionally, and c) does sessional general practice reflect a lack of commitment to patients and the profession? Semi-structured interviews were conducted with GPs who worked sessionally, (i.e. six or fewer sessions a week in clinical general practice, where a session comprises four consecutive hours of patient care). These data were analysed qualitatively and saturation was reached. The majority of participants were in full-time paid employment, while part-time in clinical general practice. They reported that consultations increasingly required the management of patients with complex, chronic conditions who also required psychological management. Coupled with unrealistic patient expectations, these factors led GPs to be concerned about maintaining the quality patient care they considered professionally desirable. Many diversified their work activities to ensure that they retained their professional standards. "Part-time" general practice is a misnomer that masks the contribution these GPs make as part of the health workforce. Sessional practice more accurately describes the nature of our participants' clinical work. Their choice of sessional work is a professional response to the increasing demands within the consultation. It enables GPs to maintain their commitment to quality patient care and their profession, while attenuating the challenges of demanding consultations. Sessional general practitioners demonstrate strong commitment to their patients and the profession.

42 CFR 417.106 - Quality assurance program; Availability, accessibility, and continuity of basic and supplemental...

Code of Federal Regulations, 2012 CFR

2012-10-01

... emergency care service, if the number of providers of that basic health service who will provide the service... includes general practice, family practice, general internal medicine, general pediatrics, and general... after-hours services. (Medically necessary emergency services must be available 24 hours a day, 7 days a...

42 CFR 417.106 - Quality assurance program; Availability, accessibility, and continuity of basic and supplemental...

Code of Federal Regulations, 2014 CFR

2014-10-01

... emergency care service, if the number of providers of that basic health service who will provide the service... includes general practice, family practice, general internal medicine, general pediatrics, and general... after-hours services. (Medically necessary emergency services must be available 24 hours a day, 7 days a...

42 CFR 417.106 - Quality assurance program; Availability, accessibility, and continuity of basic and supplemental...

Code of Federal Regulations, 2013 CFR

2013-10-01

... emergency care service, if the number of providers of that basic health service who will provide the service... includes general practice, family practice, general internal medicine, general pediatrics, and general... after-hours services. (Medically necessary emergency services must be available 24 hours a day, 7 days a...

Determining the Evolution and Propagation of CME Flux Ropes from the Sun to Earth

NASA Astrophysics Data System (ADS)

Palmerio, E.; Kilpua, E.; Mierla, M.; Rodriguez, L.; Isavnin, A.; Zhukov, A.

2017-12-01

Coronal mass ejections (CMEs) are the main drivers of space weather phenomena at the Earth. They form in the solar atmosphere as helical magnetic field structures known as flux ropes. The key parameter that defines the ability of a CME to drive geomagnetic storms is the North-South magnetic field component. One of the most significant problems in current long-term space weather forecasts is that there is no practical method to measure the magnetic structure of CMEs routinely in the corona. The magnetic structure of erupting flux ropes can however be inferred based on the properties of the CME's source region characteristics, e.g.filament details, coronal EUV arcades, X-ray/EUV sigmoids, taking into account nearby coronal and photospheric features. These proxies are useful for reconstructing the "instrinsic flux rope type" at the time of the eruption. However, the knowledge of the flux rope's magnetic structure at the Sun does not always imply a successful prediction of the magnetic structure at the Earth. This is because CMEs can change their orientation due to deflections, rotations, and deformations. We present here examples of CMEs for which we have determined their magnetic structure when launched from the Sun by using a synthesis of indirect proxies based on multiwavelength remote-sensing observations. When compared to their in situ counterparts, these CMEs present a different magnetic configuration, implying a high amount of rotation of their central axis during their propagation. We study the early evolution of these CMEs both on the solar disk and in coronagraph images though different techniques, e.g. forward modelling and tie-pointing technique. When possible, we study the CME structure in situ at other planets. We aim at determining where the rotation occurs and the rate of rotation during the CME evolution from the Sun to Earth, and possibly estimating the causes of such a high amount of rotation.

Prescribing Data in General Practice Demonstration (PDGPD) project--a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension.

PubMed

Williamson, Margaret; Cardona-Morrell, Magnolia; Elliott, Jeffrey D; Reeve, James F; Stocks, Nigel P; Emery, Jon; Mackson, Judith M; Gunn, Jane M

2012-08-23

Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner's drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a "control" for the other two groups.De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870.

Prescribing Data in General Practice Demonstration (PDGPD) project - a cluster randomised controlled trial of a quality improvement intervention to achieve better prescribing for chronic heart failure and hypertension

PubMed Central

2012-01-01

Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting. Currently, there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1) hypertension (HT) and 2) chronic heart failure (CHF). The objectives of this study were to improve general practitioner’s drug treatment management of these patients through feedback on their own prescribing and small group discussions with peers and a trained group facilitator. The impact evaluation includes quantitative assessment of prescribing changes at 6, 9, 12 and 18 months after the intervention. Methods A pragmatic multi site cluster RCT began recruiting practices in October 2009 to evaluate the effects of a multi-faceted quality improvement (QI) intervention on prescribing practice among Australian general practitioners (GP) in relation to patients with CHF and HT. General practices were recruited nationally through General Practice Networks across Australia. Participating practices were randomly allocated to one of three groups: two groups received the QI intervention (the prescribing indicator feedback reports and small group discussion) with each group undertaking the clinical topics (CHF and HT) in reverse order to the other. The third group was waitlisted to receive the intervention 6 months later and acted as a “control” for the other two groups. De-identified data on practice, doctor and patient characteristics and their treatment for CHF and HT are extracted at six-monthly intervals before and after the intervention. Post-test comparisons will be conducted between the intervention and control arms using intention to treat analysis and models that account for clustering of practices in a Network and clustering of patients within practices and GPs. Discussion This paper describes the study protocol for a project that will contribute to the development of acceptable and sustainable methods to promote QI activities within routine general practice, enhance prescribing practices and improve patient outcomes in the context of CHF and HT. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), Trial # 320870. PMID:22913571

A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol

PubMed Central

2012-01-01

Background Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. Design A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. Discussion This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. Trial registration ACTRN12610000592044\\ PMID:22958678

Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices

PubMed Central

Butler, Chris C; Dunstan, Frank; Heginbothom, Margaret; Mason, Brendan; Roberts, Zoë; Hillier, Sharon; Howe, Robin; Palmer, Stephen; Howard, Anthony

2007-01-01

Background GPs are urged to prescribe antibiotics less frequently, despite lack of evidence linking reduced antibiotic prescribing with reductions in resistance at a local level. Aim To investigate associations between changes in antibiotic dispensing and changes in antibiotic resistance at general-practice level. Design of study Seven-year study of dispensed antibiotics and antibiotic resistance in coliform isolates from urine samples routinely submitted from general practice. Setting General practices in Wales. Method Multilevel modelling of trends in resistance to ampicillin and trimethoprim, and changes in practice total antibiotic dispensing and amoxicillin and trimethoprim dispensing. Results The primary analysis included data on 164 225 coliform isolates from urine samples submitted from 240 general practices over the 7-year study period. These practices served a population of 1.7 million patients. The quartile of practices that had the greatest decrease in total antibiotic dispensing demonstrated a 5.2% reduction in ampicillin resistance over the 7-year period with changes of 0.4%, 2.4%, and −0.3% in the other three quartiles. There was a statistically significant overall decrease in ampicillin resistance of 1.03% (95% confidence interval [CI] = 0.37 to 1.67%) per decrease of 50 amoxicillin items dispensed per 1000 patients per annum. There were also significant reductions in trimethoprim resistance in the two quartiles of practices that reduced total antibiotic dispensing most compared with those that reduced it least, with an overall decrease in trimethoprim resistance of 1.08% (95% CI = 0.065 to 2.10%) per decrease of 20 trimethoprim items dispensed per 1000 patients per annum. Main findings were confirmed by secondary analyses of 256 370 isolates from 527 practices that contributed data at some point during the study period. Conclusion Reducing antibiotic dispensing at general-practice level is associated with reduced local antibiotic resistance. These findings should further encourage clinicians and patients to use antibiotics conservatively. PMID:17925135

Promoting Mental Health and Preventing Mental Illness in General Practice.

PubMed

Thomas, Steve; Jenkins, Rachel; Burch, Tony; Calamos Nasir, Laura; Fisher, Brian; Giotaki, Gina; Gnani, Shamini; Hertel, Lise; Marks, Marina; Mathers, Nigel; Millington-Sanders, Catherine; Morris, David; Ruprah-Shah, Baljeet; Stange, Kurt; Thomas, Paul; White, Robert; Wright, Fiona

2016-01-01

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.

Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study

PubMed Central

Russell, Rachel; Scott, Emma; Owen, Katherine

2017-01-01

Objectives General practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans. Design Online questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach. Setting and participants Doctors approaching the end of 3-year GP vocational training in the West Midlands, England. Results 178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers. The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work–life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media. Conclusion This study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level. PMID:28819069

Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study.

PubMed

Dale, Jeremy; Russell, Rachel; Scott, Emma; Owen, Katherine

2017-08-17

General practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans. Online questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach. Doctors approaching the end of 3-year GP vocational training in the West Midlands, England. 178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers.The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work-life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media. This study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Following the funding trail: Financing, nurses and teamwork in Australian general practice

PubMed Central

2011-01-01

Background Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate. Methods This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies. Results Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice. Conclusions Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice. PMID:21329506