Sample records for imported cases represent

  1. Adjustment Following Disability: Representative Case Studies.

    ERIC Educational Resources Information Center

    Heinemann, Allen W.; Shontz, Franklin C.

    1984-01-01

    Examined adjustment following physical disability using the representative case method with two persons with quadriplegia. Results highlighted the importance of previously established coping styles as well as the role of the environment in adjustment. Willingness to mourn aided in later growth. (JAC)

  2. Determining the relative importance of figures in journal articles to find representative images

    NASA Astrophysics Data System (ADS)

    Müller, Henning; Foncubierta-Rodríguez, Antonio; Lin, Chang; Eggel, Ivan

    2013-03-01

    When physicians are searching for articles in the medical literature, images of the articles can help determining relevance of the article content for a specific information need. The visual image representation can be an advantage in effectiveness (quality of found articles) and also in efficiency (speed of determining relevance or irrelevance) as many articles can likely be excluded much quicker by looking at a few representative images. In domains such as medical information retrieval, allowing to determine relevance quickly and accurately is an important criterion. This becomes even more important when small interfaces are used as it is frequently the case on mobile phones and tablets to access scientific data whenever information needs arise. In scientific articles many figures are used and particularly in the biomedical literature only a subset may be relevant for determining the relevance of a specific article to an information need. In many cases clinical images can be seen as more important for visual appearance than graphs or histograms that require looking at the context for interpretation. To get a clearer idea of image relevance in articles, a user test with a physician was performed who classified images of biomedical research articles into categories of importance that can subsequently be used to evaluate algorithms that automatically select images as representative examples. The manual sorting of images of 50 journal articles of BioMedCentral with each containing more than 8 figures by importance also allows to derive several rules that determine how to choose images and how to develop algorithms for choosing the most representative images of specific texts. This article describes the user tests and can be a first important step to evaluate automatic tools to select representative images for representing articles and potentially also images in other contexts, for example when representing patient records or other medical concepts when selecting

  3. [Dysfunctional workplace organization and mobbing. 4 representative cases].

    PubMed

    Albini, Elisa; Benedetti, Laura; Giordano, S; Punzi, Silvia; Cassitto, Maria Grazia

    2003-01-01

    Stress and psychological harassment at work are increasing worldwide, according to International Agencies (European Community, NIOSH) and to most authors. To describe typical working situations responsible for distress and mobbing, with the aim of early diagnosis and effectiveness of therapy and rehabilitation. Four cases are reported as representative of dysfunctional organization producing distress and pathology or inducing mobbing behavior or mobbing without clear organization responsibilities. In all cases dysfunctional organization appeared to have played a significant role even though not always a direct one. Also, common characteristics were highlighted in the three cases where mobbing was recognized.

  4. 77 FR 56714 - Agency Information Collection (Statement of Accredited Representative in Appealed Case...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-13

    ... Representative in Appealed Case, VA Form 646. OMB Control Number: 2900-0042. Type of Review: Extension of a... (Statement of Accredited Representative in Appealed Case) Activities Under OMB Review AGENCY: Board of Veterans' Appeals, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In compliance with the...

  5. Imported brucellosis: A case series and literature review.

    PubMed

    Norman, Francesca F; Monge-Maillo, Begoña; Chamorro-Tojeiro, Sandra; Pérez-Molina, Jose-Antonio; López-Vélez, Rogelio

    2016-01-01

    Brucellosis is one of the main neglected zoonotic diseases. Several factors may contribute to the epidemiology of brucellosis. Imported cases, mainly in travellers but also in recently arrived immigrants, and cases associated with imported products, appear to be infrequently reported. Cases of brucellosis diagnosed at a referral unit for imported diseases in Europe were described and a review of the literature on imported cases and cases associated with contaminated imported products was performed. Most imported cases were associated with traditional risk factors such as travel/consumption of unpasteurized dairy products in endemic countries. Cases associated with importation of food products or infected animals also occurred. Although a lower disease incidence of brucellosis has been reported in developed countries, a higher incidence may still occur in specific populations, as illustrated by cases in Hispanic patients in the USA and in Turkish immigrants in Germany. Imported brucellosis appears to present with similar protean manifestations and both classical and infrequent modes of acquisition are described, leading on occasions to mis-diagnoses and diagnostic delays. Importation of Brucella spp. especially into non-endemic areas, or areas which have achieved recent control of both animal and human brucellosis, may have public health repercussions and timely recognition is essential. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Changing epidemiology of melioidosis? A case of acute pulmonary melioidosis with fatal outcome imported from Brazil.

    PubMed Central

    Aardema, H.; Luijnenburg, E. M.; Salm, E. F.; Bijlmer, H. A.; Visser, C. E.; Van't Wout, J. W.

    2005-01-01

    Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It is endemic in South East Asia and tropical regions of Northern Australia. Sporadic cases have been described elsewhere. In this article we present a case of acute pulmonary melioidosis with fatal outcome imported from Brazil. The most common pathogen causing severe community-acquired pneumonia in Brazil is Streptococcus pneumoniae. Other possible pathogens include Legionella spp., Mycoplasma pneumonia, Gram-negative rods and viruses. There are few reports of melioidosis in the Americas. This article represents the second known human case of melioidosis from Brazil. Recognition of melioidosis as a possible cause of severe pneumonia, even if a patient has not been travelling in a highly endemic area, is important because of the therapeutic consequences. The epidemiology of melioidosis will be reviewed. PMID:16181507

  7. [Notified cases of imported transmisssible infections in the Czech Republic].

    PubMed

    Dlhý, J; Benes, C

    2007-02-01

    Based on analysis of epidemiological characteristics, to determine trends in the incidence of imported transmissible diseases in the Czech Republic and to draw attention to the epidemiological significance of international tourism and migration. In cooperation with the National Reference Centre for Epidemiological Data Analysis, National Institute of Public Health Prague, the nationwide Epidat information system databases from 1993 to 2005 were analyzed using software Epi Info version 6.04d. Between 1993 and 2005, altogether 12,091 cases of transmissible diseases were imported into the Czech Republic from 168 countries in the world. The notified annual incidence of imported infections ranges from 206 to 1,714 cases. The highest percentage of cases was imported by Czech tourists (50.7 %) while 40 % of the notified cases were imported into the Czech Republic by foreigners. The period 1998-2004 for which the data on Czech tourism to other countries are available is characterized by increase in the absolute number of imported cases while the relative incidence of imported cases per 100,000 population traveling to other countries shows a downward trend. The highest numbers of cases were imported from Viet Nam (1,258 cases), Slovakia (1,155 cases) and India (786 cases). When considering Czech tourism to other countries for which the corresponding data are available, the highest rates of imported diseases in 1998-2004 were linked to the travels to Tunisia (1.18 imported cases per 1,000 tours), Bulgaria (0.69 per 1,000 tours) and Turkey (0.65 per 1,000 tours). The leading diagnosis of imported cases was salmonellosis (22%), followed by campylobacteriosis (10%) and trichuriasis (8%). Analysis of the Epidat information system databases for reporting transmissible diseases enables assessment of trends in imported infections in the Czech Republic as a point of departure for estimation of health risk from tourism and migration.

  8. Neuropsychologist Experts and Civil Capacity Evaluations: Representative Cases.

    PubMed

    Kaufmann, Paul M

    2016-09-01

    Clinical neuropsychologists accept more forensic referrals now and spend more time in forensic consulting than ever before. Recent surveys show weekly hours devoted to forensic consulting increased 97% in the past decade. During the same time period, the number of board certified neuropsychologists more than doubled. Under recently published Specialty Guidelines for Forensic Psychology, clinical neuropsychologists practice forensic psychology when applying scientific, technical, or specialized knowledge of neuropsychology to the law to assist in addressing legal, contractual, or administrative matters. Among those increasingly varied forensic referrals, clinical neuropsychologists are conducting more civil competency and capacity evaluations. Representative cases from three jurisdictions demonstrate how neuropsychologists provide expertize in matters involving testamentary capacity, contractual capacity, business judgments, and job capacity. Case presentations illustrate some of the strengths and weaknesses of neuropsychological evaluation of civil capacities. The article concludes with a "battle of experts" case involving five neuropsychologists with opposing opinions recently heard in a Federal Appellate court. Implications for neuropschology training and forensic competencies are considered. In offering quality services to the legal profession, neuropsychologists support the truth-seeking function of the judiciary, promote justice, protect the profession, and serve public policy. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. 7 CFR 1212.12 - Importer-Handler Representative.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HONEY PACKERS AND IMPORTERS RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER Honey Packers... importer and first handler, who must import at least 75 percent of the honey they market in the United...

  10. 77 FR 39346 - Proposed Information Collection (Statement of Accredited Representative in Appealed Case, VA Form...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-02

    ... in Appealed Case, VA Form 646. OMB Control Number: 2900-0042. Type of Review: Extension of a... (Statement of Accredited Representative in Appealed Case, VA Form 646) Activity: Comment Request AGENCY: The Board of Veterans' Appeals (BVA), Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Board of...

  11. Predicting Local Dengue Transmission in Guangzhou, China, through the Influence of Imported Cases, Mosquito Density and Climate Variability

    PubMed Central

    Sang, Shaowei; Yin, Wenwu; Bi, Peng; Zhang, Honglong; Wang, Chenggang; Liu, Xiaobo; Chen, Bin; Yang, Weizhong; Liu, Qiyong

    2014-01-01

    Introduction Each year there are approximately 390 million dengue infections worldwide. Weather variables have a significant impact on the transmission of Dengue Fever (DF), a mosquito borne viral disease. DF in mainland China is characterized as an imported disease. Hence it is necessary to explore the roles of imported cases, mosquito density and climate variability in dengue transmission in China. The study was to identify the relationship between dengue occurrence and possible risk factors and to develop a predicting model for dengue’s control and prevention purpose. Methodology and Principal Findings Three traditional suburbs and one district with an international airport in Guangzhou city were selected as the study areas. Autocorrelation and cross-correlation analysis were used to perform univariate analysis to identify possible risk factors, with relevant lagged effects, associated with local dengue cases. Principal component analysis (PCA) was applied to extract principal components and PCA score was used to represent the original variables to reduce multi-collinearity. Combining the univariate analysis and prior knowledge, time-series Poisson regression analysis was conducted to quantify the relationship between weather variables, Breteau Index, imported DF cases and the local dengue transmission in Guangzhou, China. The goodness-of-fit of the constructed model was determined by pseudo-R2, Akaike information criterion (AIC) and residual test. There were a total of 707 notified local DF cases from March 2006 to December 2012, with a seasonal distribution from August to November. There were a total of 65 notified imported DF cases from 20 countries, with forty-six cases (70.8%) imported from Southeast Asia. The model showed that local DF cases were positively associated with mosquito density, imported cases, temperature, precipitation, vapour pressure and minimum relative humidity, whilst being negatively associated with air pressure, with different time

  12. Predicting local dengue transmission in Guangzhou, China, through the influence of imported cases, mosquito density and climate variability.

    PubMed

    Sang, Shaowei; Yin, Wenwu; Bi, Peng; Zhang, Honglong; Wang, Chenggang; Liu, Xiaobo; Chen, Bin; Yang, Weizhong; Liu, Qiyong

    2014-01-01

    Each year there are approximately 390 million dengue infections worldwide. Weather variables have a significant impact on the transmission of Dengue Fever (DF), a mosquito borne viral disease. DF in mainland China is characterized as an imported disease. Hence it is necessary to explore the roles of imported cases, mosquito density and climate variability in dengue transmission in China. The study was to identify the relationship between dengue occurrence and possible risk factors and to develop a predicting model for dengue's control and prevention purpose. Three traditional suburbs and one district with an international airport in Guangzhou city were selected as the study areas. Autocorrelation and cross-correlation analysis were used to perform univariate analysis to identify possible risk factors, with relevant lagged effects, associated with local dengue cases. Principal component analysis (PCA) was applied to extract principal components and PCA score was used to represent the original variables to reduce multi-collinearity. Combining the univariate analysis and prior knowledge, time-series Poisson regression analysis was conducted to quantify the relationship between weather variables, Breteau Index, imported DF cases and the local dengue transmission in Guangzhou, China. The goodness-of-fit of the constructed model was determined by pseudo-R2, Akaike information criterion (AIC) and residual test. There were a total of 707 notified local DF cases from March 2006 to December 2012, with a seasonal distribution from August to November. There were a total of 65 notified imported DF cases from 20 countries, with forty-six cases (70.8%) imported from Southeast Asia. The model showed that local DF cases were positively associated with mosquito density, imported cases, temperature, precipitation, vapour pressure and minimum relative humidity, whilst being negatively associated with air pressure, with different time lags. Imported DF cases and mosquito density play a

  13. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept.

    PubMed

    Larson, Christopher M; Kelly, Bryan T; Stone, Rebecca M

    2011-12-01

    Femoroacetabular impingement is typically described as occurring due to a conflict between the femoral head-neck junction and acetabular rim. A prior case report described an open decompression of the anterior inferior iliac spine (AIIS) due to impingement against the proximal femur. AIIS impingement may be developmental or the result of a prior AIIS avulsion or pelvic osteotomy. We describe 3 representative cases with minimum 1-year follow-up treated with an arthroscopic AIIS decompression. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. The effect of improving task representativeness on capturing nurses’ risk assessment judgements: a comparison of written case simulations and physical simulations

    PubMed Central

    2013-01-01

    Background The validity of studies describing clinicians’ judgements based on their responses to paper cases is questionable, because - commonly used - paper case simulations only partly reflect real clinical environments. In this study we test whether paper case simulations evoke similar risk assessment judgements to the more realistic simulated patients used in high fidelity physical simulations. Methods 97 nurses (34 experienced nurses and 63 student nurses) made dichotomous assessments of risk of acute deterioration on the same 25 simulated scenarios in both paper case and physical simulation settings. Scenarios were generated from real patient cases. Measures of judgement ‘ecology’ were derived from the same case records. The relationship between nurses’ judgements, actual patient outcomes (i.e. ecological criteria), and patient characteristics were described using the methodology of judgement analysis. Logistic regression models were constructed to calculate Lens Model Equation parameters. Parameters were then compared between the modeled paper-case and physical-simulation judgements. Results Participants had significantly less achievement (ra) judging physical simulations than when judging paper cases. They used less modelable knowledge (G) with physical simulations than with paper cases, while retaining similar cognitive control and consistency on repeated patients. Respiration rate, the most important cue for predicting patient risk in the ecological model, was weighted most heavily by participants. Conclusions To the extent that accuracy in judgement analysis studies is a function of task representativeness, improving task representativeness via high fidelity physical simulations resulted in lower judgement performance in risk assessments amongst nurses when compared to paper case simulations. Lens Model statistics could prove useful when comparing different options for the design of simulations used in clinical judgement analysis. The approach

  15. Imported human rabies cases worldwide, 1990-2012.

    PubMed

    Carrara, Philippe; Parola, Phillipe; Brouqui, Phillipe; Gautret, Philippe

    2013-01-01

    Sixty cases of human rabies in international travelers were reviewed from 1990-2012. A significant proportion of the cases were observed in migrants or their descendants when emigrating from their country of origin or after a trip to visit friends and relatives or for other reasons (43.3%). The cases were not necessarily associated with long-term travel or expatriation to endemic countries; moreover, cases were observed in travelers after short trips of two weeks or less. A predominance of male patients was observed (75.0%). The proportion of children was low (11.7%). Cases from India and Philippines were frequent (16 cases/60). In a significant proportion of cases (51.1%), diagnosis was challenging, with multiple missed diagnoses and transfers from ward to ward before the final diagnosis of rabies. Among the 28 patients whose confirmed diagnosis was obtained ante-mortem, the mean time between hospitalization and diagnosis was 7.7 days (median time: 6.0 days, range 2-30) including four cases with a diagnosis delayed by 15 or more days. In five cases, a patient traveled through one or more countries before ultimately being hospitalized. Three factors played a role in delaying the diagnosis of rabies in a number of cases: (i) a low index of suspicion for rabies in countries where the disease has been eradicated for a long time or is now rare, (ii) a negative history of animal bites or exposure to rabies, and (iii) atypical clinical presentation of the disease. Clinical symptomatology of rabies is complex and commonly confuses physicians. Furthermore, failure in diagnosing imported cases in more developed countries is most likely related to the lack of medical familiarity with even the typical clinical features of the disease.

  16. 7 CFR 1212.12 - Importer-Handler Representative.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ....12 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HONEY PACKERS AND IMPORTERS RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER Honey Packers...

  17. Benten v. Kessler: the RU 486 import case.

    PubMed

    Pine, R N

    1992-01-01

    On July 1, 1992, the case of Benten v. Kessler was filed in the US District Court in New York. The case arose out of an attempt by abortion rights activist Lawrence Lader to call public attention to the US Food and Drug Administration's (FDA) ban on importation of the abortifacient drug mifepristone known as RU-486. The ban expresses the anti abortion stance of the Reagan and Bush administrations and creates a hostile climate for the development of new drugs related to reproductive health and reproductive choice. Plaintiffs in the Benten case sought public accountability by the FDA for its adoption of a ban of a safe and effective drug for unwanted pregnancy. Although the case did not succeed in retrieving the confiscated RU-486 pills for Leona Benten, in its opinion issued on July 14, 1992, the New York district court judge concluded that the import ban did not appear to be based on concern with the safety or effectiveness of RU-486, describing the FDA's process of adopting the import ban as a sink of illegality. On July 17, 1992, 7 Justices of the Supreme Court, with justices Blackmun and Stevens dissenting, joined in a per curiam opinion denying the application and foreclosing further personal relief for Leona Benten. This was the best result possible short of an all out victory for Leona Benten. The Court ruled against plaintiffs in their argument that notice and comment were required, but left entirely open plaintiffs' claims that the import ban is arbitrary and capricious under the Administrative Procedure Act and that the ban is unconstitutional in that it unduly burdens the right to terminate pregnancy. This backdrop creates a healthy skepticism about the prospects for the introduction of RU-486 into the US in the near future as well as about the fairness of government processes in areas of concern to women. Public health considerations, not politics, should determine access to health care.

  18. Spatiotemporal analysis of indigenous and imported dengue fever cases in Guangdong province, China.

    PubMed

    Li, Zhongjie; Yin, Wenwu; Clements, Archie; Williams, Gail; Lai, Shengjie; Zhou, Hang; Zhao, Dan; Guo, Yansha; Zhang, Yonghui; Wang, Jinfeng; Hu, Wenbiao; Yang, Weizhong

    2012-06-12

    Dengue fever has been a major public health concern in China since it re-emerged in Guangdong province in 1978. This study aimed to explore spatiotemporal characteristics of dengue fever cases for both indigenous and imported cases during recent years in Guangdong province, so as to identify high-risk areas of the province and thereby help plan resource allocation for dengue interventions. Notifiable cases of dengue fever were collected from all 123 counties of Guangdong province from 2005 to 2010. Descriptive temporal and spatial analysis were conducted, including plotting of seasonal distribution of cases, and creating choropleth maps of cumulative incidence by county. The space-time scan statistic was used to determine space-time clusters of dengue fever cases at the county level, and a geographical information system was used to visualize the location of the clusters. Analysis were stratified by imported and indigenous origin. 1658 dengue fever cases were recorded in Guangdong province during the study period, including 94 imported cases and 1564 indigenous cases. Both imported and indigenous cases occurred more frequently in autumn. The areas affected by the indigenous and imported cases presented a geographically expanding trend over the study period. The results showed that the most likely cluster of imported cases (relative risk = 7.52, p < 0.001) and indigenous cases (relative risk = 153.56, p < 0.001) occurred in the Pearl River Delta Area; while a secondary cluster of indigenous cases occurred in one district of the Chao Shan Area (relative risk = 471.25, p < 0.001). This study demonstrated that the geographic range of imported and indigenous dengue fever cases has expanded over recent years, and cases were significantly clustered in two heavily urbanised areas of Guangdong province. This provides the foundation for further investigation of risk factors and interventions in these high-risk areas.

  19. Controlling imported malaria cases in the United States of America.

    PubMed

    Dembele, Bassidy; Yakubu, Abdul-Aziz

    2017-02-01

    We extend the mathematical malaria epidemic model framework of Dembele et al. and use it to ``capture" the 2013 Centers for Disease Control and Prevention (CDC) reported data on the 2011 number of imported malaria cases in the USA. Furthermore, we use our ``fitted" malaria models for the top 20 countries of malaria acquisition by USA residents to study the impact of protecting USA residents from malaria infection when they travel to malaria endemic areas, the impact of protecting residents of malaria endemic regions from mosquito bites and the impact of killing mosquitoes in those endemic areas on the CDC number of imported malaria cases in USA. To significantly reduce the number of imported malaria cases in USA, for each top 20 country of malaria acquisition by USA travelers, we compute the optimal proportion of USA international travelers that must be protected against malaria infection and the optimal proportion of mosquitoes that must be killed.

  20. [Cases diagnosis of imported malaria in Jiangsu province, 2014-2016].

    PubMed

    Cao, Y Y; Wang, W M; Zhou, H Y; Zhu, G D; Xu, S; Gu, Y P; Zhang, C; Liu, Y B; Cao, J

    2018-02-10

    Objective: To understand the situation related to health seeking and diagnosis of imported malaria and to provide practical measures for malaria elimination in Jiangsu province. Methods: Data on imported malaria cases in Jiangsu province was retrieved in CISDCP from 2014 to 2016. Relevant information on health seeking behavior, diagnosis and treatment of the disease was gathered. Results: A total of 1 068 imported cases were reported in Jiangsu province from 2014 to 2016. Except for one malaria case that was caused by blood transfusion, the rest patients were all recognized as 'imported'. Majority of the cases were migrant laborers working in African countries. The accurate rates on the diagnosis of ovale, vivax and quartan malaria and mixed infection were relatively low, as 79.3% (107/135), 29.5% (18/61), 52.9% (18/34) and 0.0% (0/2) at the primary health care settings, respectively. Rate of seeking health care on the same day of onset was more in 2015 than in 2014 and 2016 ( χ (2)=18.6, P =0.001). While only 65.4% (699/1 068) of the patients were diagnosed correctly at the primary health care settings. There appeared no statistical difference in the 3-year-study period ( χ (2)=5.4, P =0.246). Capacity on 'correct diagnosis' seemed stronger at the CDC than at the hospital levels ( χ (2)=13.2, P =0.000; χ (2)=5.4, P =0.020). Totally, 72.7% (32/44) of the severe falciparum malaria cases did not immediately seek for health care when the symptoms started. Conclusions: Migrant workers returning from the high endemic malaria areas seemed to have poor awareness in seeking health care services. Capability on correct diagnosis for malaria at the primary health care settings remained unsatisfactory and staff from these settings needs to receive adequate training.

  1. First Imported Case of Zika Virus Infection into Korea.

    PubMed

    Jang, Hee-Chang; Park, Wan Beom; Kim, Uh Jin; Chun, June Young; Choi, Su-Jin; Choe, Pyoeng Gyun; Jung, Sook-In; Jee, Youngmee; Kim, Nam-Joong; Choi, Eun Hwa; Oh, Myoung-Don

    2016-07-01

    Since Zika virus has been spreading rapidly in the Americas from 2015, the outbreak of Zika virus infection becomes a global health emergency because it can cause neurological complications and adverse fetal outcome including microcephaly. Here, we report clinical manifestations and virus isolation findings from a case of Zika virus infection imported from Brazil. The patient, 43-year-old Korean man, developed fever, myalgia, eyeball pain, and maculopapular rash, but not neurological manifestations. Zika virus was isolated from his semen, and reverse-transcriptase PCR was positive for the virus in the blood, urine, and saliva on the 7th day of the illness but was negative on the 21st day. He recovered spontaneously without any neurological complications. He is the first case of Zika virus infection in Korea imported from Brazil.

  2. Plasmodium ovale infection in Malaysia: first imported case

    PubMed Central

    2010-01-01

    Background Plasmodium ovale infection is rarely reported in Malaysia. This is the first imported case of P. ovale infection in Malaysia which was initially misdiagnosed as Plasmodium vivax. Methods Peripheral blood sample was first examined by Giemsa-stained microscopy examination and further confirmed using a patented in-house multiplex PCR followed by sequencing. Results and Discussion Initial results from peripheral blood smear examination diagnosed P. vivax infection. However further analysis using a patented in-house multiplex PCR followed by sequencing confirmed the presence of P. ovale. Given that Anopheles maculatus and Anopheles dirus, vectors of P. ovale are found in Malaysia, this finding has significant implication on Malaysia's public health sector. Conclusions The current finding should serve as an alert to epidemiologists, clinicians and laboratory technicians in the possibility of finding P. ovale in Malaysia. P. ovale should be considered in the differential diagnosis of imported malaria cases in Malaysia due to the exponential increase in the number of visitors from P. ovale endemic regions and the long latent period of P. ovale. It is also timely that conventional diagnosis of malaria via microscopy should be coupled with more advanced molecular tools for effective diagnosis. PMID:20929588

  3. Plasmodium ovale infection in Malaysia: first imported case.

    PubMed

    Lim, Yvonne A L; Mahmud, Rohela; Chew, Ching Hoong; T, Thiruventhiran; Chua, Kek Heng

    2010-10-08

    Plasmodium ovale infection is rarely reported in Malaysia. This is the first imported case of P. ovale infection in Malaysia which was initially misdiagnosed as Plasmodium vivax. Peripheral blood sample was first examined by Giemsa-stained microscopy examination and further confirmed using a patented in-house multiplex PCR followed by sequencing. Initial results from peripheral blood smear examination diagnosed P. vivax infection. However further analysis using a patented in-house multiplex PCR followed by sequencing confirmed the presence of P. ovale. Given that Anopheles maculatus and Anopheles dirus, vectors of P. ovale are found in Malaysia, this finding has significant implication on Malaysia's public health sector. The current finding should serve as an alert to epidemiologists, clinicians and laboratory technicians in the possibility of finding P. ovale in Malaysia. P. ovale should be considered in the differential diagnosis of imported malaria cases in Malaysia due to the exponential increase in the number of visitors from P. ovale endemic regions and the long latent period of P. ovale. It is also timely that conventional diagnosis of malaria via microscopy should be coupled with more advanced molecular tools for effective diagnosis.

  4. Prescription opioid abuse based on representative postmortem toxicology.

    PubMed

    Häkkinen, Margareeta; Vuori, Erkki; Ojanperä, Ilkka

    2014-12-01

    Opioids are important medications for pain and opioid maintenance treatment. Increasing use and abuse of prescription opioids has, however, caused worldwide concern. Our aim was to estimate the ratio between prescription opioid abuse and total use, based on representative postmortem toxicology. Our material included all the medico-legally examined deaths in Finland during 2010-2011 involving positive findings involving buprenorphine, codeine, fentanyl, methadone, oxycodone, or tramadol. We studied drug abuse by age group, with "abuse" meaning licit opioids used illicitly as narcotics. Drug-abuse history, drug injecting, or laboratory findings of illicit drugs defined an abuser case. We then compared abuser cases and other opioid-related cases between the opioids with the number of fatal poisonings, accidents, suicides, alcohol findings, concomitant opioid use, and median postmortem blood opioid concentrations. Opioid findings numbered 2499 in 2088 cases. Drug abuse involved 545 opioid-positive cases, which in Finland represented 0.5% of those deceased. The proportion of abuser cases among all opioid-related cases for buprenorphine was 85.5%, for methadone 82.4%, for tramadol 29.4%, for codeine 16.3%, for fentanyl 14.5%, and for oxycodone 6.9%. Abuse in age-groups >60 was rare. Concomitant other opioid findings were more frequent in abuser- than in other cases for codeine, oxycodone, and tramadol, whereas alcohol findings were more frequent in buprenorphine, codeine, and fentanyl abuse. Buprenorphine and methadone were most often related to drug abuse. Every other opioid studied involved some abuse, and especially tramadol. Abuse and fatal poisonings were concentrated in men aged 20-49. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. The importance of perinatal autopsy. Review of the literature and series of cases.

    PubMed

    Şorop-Florea, Maria; Ciurea, Raluca Niculina; Ioana, Mihai; Stepan, Alex Emilian; Stoica, George Alin; Tănase, Florentina; Comănescu, Maria Cristina; Novac, Marius Bogdan; Drăgan, Ioana; Pătru, Ciprian LaurenŢiu; Drăguşin, Roxana Cristina; Zorilă, George Lucian; Cărbunaru, Ovidiu Marian; Oprescu, NuŢi Daniela; Ceauşu, Iuliana; Vlădăreanu, Simona; Tudorache, Ştefania; Iliescu, Dominic Gabriel

    2017-01-01

    Perinatal autopsy remains the gold-standard procedure used to establish the fetal, neonatal or infant abnormalities. Progressively, perinatal pathology has become a specialized field with important roles of audit for fetal prenatal diagnostic tools, in parents counseling regarding future pregnancies, in scientific research, for epidemiology of congenital abnormalities and teaching. The differences between prenatal ultrasound and autopsy reports represent a strong argument for the autopsy examination following termination of pregnancy. The reasons for such discrepancies are related to the ultrasonographic or pathological examination conditions, the type of the anomalies, the expertise and availability of the operators. Several facts led to an undesirable increase of refusals from parents to consent to a conventional invasive autopsy: the centralization of pathology services, the poor counseling provided by non-experts in fetal medicine and the clinicians' over-appreciation of the importance of the ultrasound diagnostic investigation. Although non-invasive alternatives have been tested with promising results, conventional autopsy remains the gold standard technique for the prenatal diagnosis audit. We report and analyze several cases of prenatally diagnosed malformed fetuses with different particularities that underline the necessity of perinatal autopsy. We discuss the antenatal findings and management and post-mortem autopsies in the respective pregnancies.

  6. [Phineas Gage, 'Tan' and the importance of case reports].

    PubMed

    Rosselli, D

    The original descriptions of the frontal lobe injury of Phineas Gage (1848) and the slowly growing tumor of 'Tan', Broca's famous patient (1861), are examples of how a simple case report can teach important lessons, some of them still discussed a century and a half later. In this article, the original sources of both of these seminal cases, in Boston and Paris, have been reviewed and are briefly summarized. The lessons learned from them in the effort to localize brain functions are explained and set in the context of modern evidence-based medicine.

  7. Case Report: Severe Imported Influenza Infections Developed during Travel in Reunion Island.

    PubMed

    Allyn, Jérôme; Brottet, Elise; Antok, Emmanuel; Dangers, Laurence; Persichini, Romain; Coolen-Allou, Nathalie; Roquebert, Bénédicte; Allou, Nicolas; Vandroux, David

    2017-12-01

    We report two cases of severe influenza infection imported by tourist patients from their country of origin and developed during travel. While studies have reported cases of influenza infections acquired during travel, here we examine two cases of severe influenza infection contracted in the country of origin that led to diagnosis and therapeutic problems in the destination country. No international recommendation exists concerning influenza vaccination before travel, and few countries recommend it for all travelers. Our study suggests that travel should be canceled when infectious signs are observed before departure. Influenza is a very common infection that is often benign, but sometimes very severe. The most severe cases include shock, acute respiratory distress syndrome (ARDS), myocarditis, rhabdomyolysis, and multiple organ failure. Management can require exceptional therapies, such as extracorporeal membrane oxygenation. A number of studies have focused on influenza infection in travelers. Cases of influenza acquired during travel have been reported in this literature, but no study has examined cases of influenza imported from the country of origin and developed while abroad. The latter situation may lead to 1) diagnostic problems during the nonepidemic season or in places where diagnostic techniques are lacking and 2) therapeutic difficulties resulting from the unavailability of techniques for the management of severe influenza infection in tourist areas. Here, we report two cases of extremely severe influenza infection imported by tourists from their country of origin and developed during travel.

  8. Preparing for imported Ebola cases in Israel, 2014 to 2015.

    PubMed

    Brosh-Nissimov, Tal; Poles, Lion; Kassirer, Micha; Singer, Roee; Kaliner, Ehud; Shriki, Dikla Dahan; Anis, Emilia; Fogel, Itay; Engelhard, Dan; Grotto, Itamar

    2015-01-01

    During the current outbreak of Ebola virus disease (EVD) in West Africa, preventing exportation of the disease posed many challenges for economically more developed countries. In Israel, although the risk of importing single cases was assumed to be low, the implications of local transmission were great. This article describes the EVD preparedness plan of the Israeli Ministry of Health. Key elements were a sensitive case definition, designation of a single treatment centre for suspected and confirmed cases, construction of a mobile unit using customised negative-pressure tents and a vigorous national training programme. There were no patients with EVD in Israel, but a few suspected cases were assessed. The Israeli plan may provide a template for emergency infectious disease response in other geographically small countries.

  9. [Case of imported scrub typhus contracted in Myanmar].

    PubMed

    Matsumura, Yasufumi; Shimizu, Tsunehiro

    2009-05-01

    Scrub typhus is widespread in rural south and southeastern Asia and the western Pacific. The scrub typhus incidence is the highest among vector-borne diseases in Japan, but imported cases are extremely rare. A 49-year-old man admitted for persistent fever, headache, and rash after returning from Myanmar had been exposed to mosquito and tick bites while doing a 12-day forest inventory in Myanmar. On admission, he had a generalized maculopapular rash but no apparent eschars characteristic of scrub typhus. Blood examination and abdominal ultrasonography showed elevated liver enzymes, thrombocytopenia, and hepatosplenomegaly. Repeated blood smears and blood cultures were negative for malaria infection and bacteremia. Dengue fever was denied by both PCR and serology. The patient deteriorated on the ninth day and suffered complications of rhabdomyolysis, pneumonia, and enteritis. Based on a tentative diagnosis of typhoid fever or rickettiosis, we administratered ceftriaxone and minocycline, which dramatically reduced clinical signs and symptoms. After discharge on day 19, immunofluorescence assay showed significantly increased antibodies for Orienta tsutsugamushi serotype Gilliam, first discovered in Myanmar. All serological results were negative for other rickettioses, leptospirosis and Q fever. Given the many travelers from Japan visiting endemic scrub typhus areas, we must recognize cases of imported scrub typhus among those travelers with fever and rash returning from endemic areas.

  10. Spatial and temporal patterns of imported malaria cases and local transmission in Trinidad.

    PubMed

    Chadee, D D; Kitron, U

    1999-10-01

    Over a 30-year period (1968-1997) 213 malaria cases in Trinidad were investigated by the Trinidad and Tobago Ministry of Health. Using a global positional system and a geographic information system, we mapped the precise location of all reported malaria cases, and associated them with breeding habitats of anopheline vectors. The majority of the cases (138, 63%) were individual imported cases around the big port cities. Plasmodium falciparum was the most common parasite, and Africa the most common source of imported cases. Two clusters of cases occurred: an introduced P. vivax outbreak associated with Anopheles aquasalis in 1990-1991, and an autochtonous focus of P. malariae associated with An. bellator and An. homunculus in 1994-1995. Application of a space-time statistic showed a significant clustering of P. malariae cases, and, to a lesser extent of P. vivax cases, but not of P. falciparum cases. Based on potential for occurrence of local transmission, we are developing risk maps to determine surveillance priorities, outbreak potential, and necessary degree and spatial range of control activities following case detections.

  11. Origin of malaria cases: a 7-year audit of global trends in indigenous and imported cases in relation to malaria elimination.

    PubMed

    Velarde-Rodríguez, Mar; Van den Bergh, Rafael; Fergus, Cristin; Casellas, Aina; Sanz, Sergi; Cibulskis, Richard; Ramsay, Andrew R; Bissell, Karen; Zachariah, Rony

    2015-01-01

    Countries in the different stages of pre-elimination, elimination, and prevention of reintroduction are required to report the number of indigenous and imported malaria cases to the World Health Organization (WHO). However, these data have not been systematically analysed at the global level. For the period 2007 to 2013, we aimed to report on 1) the proportion of countries providing data on the origin of malaria cases and 2) the origin of malaria cases in countries classified as being in the stages of pre-elimination, elimination and prevention of reintroduction. An observational study using annual data reported through routine health information systems to the WHO Global Malaria Programme between 2007 and 2013. For all countries classified as being in pre-elimination, elimination, and prevention of reintroduction in the year 2013, there has been a substantial decrease in the total number of indigenous malaria cases, from more than 15,000 cases reported in 2007 to less than 4,000 cases reported in 2013. However, the total number of imported malaria cases has increased over that time period, from 5,600 imported cases in 2007 to approximately 6,800 in 2013. Vigilant monitoring of the numbers of imported and indigenous malaria cases at national and global levels as well as appropriate strategies to target these cases will be critical to achieve malaria eradication.

  12. Origin of malaria cases: a 7-year audit of global trends in indigenous and imported cases in relation to malaria elimination

    PubMed Central

    Velarde-Rodríguez, Mar; Van den Bergh, Rafael; Fergus, Cristin; Casellas, Aina; Sanz, Sergi; Cibulskis, Richard; Ramsay, Andrew R.; Bissell, Karen; Zachariah, Rony

    2015-01-01

    Background Countries in the different stages of pre-elimination, elimination, and prevention of reintroduction are required to report the number of indigenous and imported malaria cases to the World Health Organization (WHO). However, these data have not been systematically analysed at the global level. Objective For the period 2007 to 2013, we aimed to report on 1) the proportion of countries providing data on the origin of malaria cases and 2) the origin of malaria cases in countries classified as being in the stages of pre-elimination, elimination and prevention of reintroduction. Design An observational study using annual data reported through routine health information systems to the WHO Global Malaria Programme between 2007 and 2013. Results For all countries classified as being in pre-elimination, elimination, and prevention of reintroduction in the year 2013, there has been a substantial decrease in the total number of indigenous malaria cases, from more than 15,000 cases reported in 2007 to less than 4,000 cases reported in 2013. However, the total number of imported malaria cases has increased over that time period, from 5,600 imported cases in 2007 to approximately 6,800 in 2013. Conclusions Vigilant monitoring of the numbers of imported and indigenous malaria cases at national and global levels as well as appropriate strategies to target these cases will be critical to achieve malaria eradication. PMID:26449205

  13. 7 CFR 1212.22 - Qualified national organization representing importer interests.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... AGRICULTURE HONEY PACKERS AND IMPORTERS RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER Honey Packers and Importers Research, Promotion, Consumer Education, and Industry Information Order...

  14. 7 CFR 1212.22 - Qualified national organization representing importer interests.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HONEY PACKERS AND IMPORTERS RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER Honey Packers and Importers Research, Promotion, Consumer Education, and Industry Information Order...

  15. Sleepiness and Motor Vehicle Crashes in a Representative Sample of Portuguese Drivers: The Importance of Epidemiological Representative Surveys.

    PubMed

    Gonçalves, M; Peralta, A R; Monteiro Ferreira, J; Guilleminault, Christian

    2015-01-01

    Sleepiness is considered to be a leading cause of crashes. Despite the huge amount of information collected in questionnaire studies, only some are based on representative samples of the population. Specifics of the populations studied hinder the generalization of these previous findings. For the Portuguese population, data from sleep-related car crashes/near misses and sleepiness while driving are missing. The objective of this study is to determine the prevalence of near-miss and nonfatal motor vehicle crashes related to sleepiness in a representative sample of Portuguese drivers. Structured phone interviews regarding sleepiness and sleep-related crashes and near misses, driving habits, demographic data, and sleep quality were conducted using the Pittsburgh Sleep Quality Index and sleep apnea risk using the Berlin questionnaire. A multivariate regression analysis was used to determine the associations with sleepy driving (feeling sleepy or falling asleep while driving) and sleep-related near misses and crashes. Nine hundred subjects, representing the Portuguese population of drivers, were included; 3.1% acknowledged falling asleep while driving during the previous year and 0.67% recalled sleepiness-related crashes. Higher education, driving more than 15,000 km/year, driving more frequently between 12:00 a.m. and 6 a.m., fewer years of having a driver's license, less total sleep time per night, and higher scores on the Epworth Sleepiness Scale (ESS) were all independently associated with sleepy driving. Sleepiness-related crashes and near misses were associated only with falling asleep at the wheel in the previous year. Sleep-related crashes occurred more frequently in drivers who had also had sleep-related near misses. Portugal has lower self-reported sleepiness at the wheel and sleep-related near misses than most other countries where epidemiological data are available. Different population characteristics and cultural, social, and road safety specificities may

  16. Molecular characterization of misidentified Plasmodium ovale imported cases in Singapore.

    PubMed

    Chavatte, Jean-Marc; Tan, Sarah Bee Hui; Snounou, Georges; Lin, Raymond Tzer Pin Valentine

    2015-11-14

    Plasmodium ovale, considered the rarest of the malaria parasites of humans, consists of two morphologically identical but genetically distinct sympatric species, Plasmodium ovale curtisi and Plasmodium ovale wallikeri. These parasites resemble morphologically to Plasmodium vivax with which they also share a tertian periodicity and the ability to cause relapses, making them easily misidentified as P. vivax. Plasmodium ovale infections are rarely reported, but given the likelihood of misidentification, their prevalence might be underestimated. Morphological and molecular analysis of confirmed malaria cases admitted in Singapore in 2012-2014 detected nine imported P. ovale cases that had been misidentified as P. vivax. Since P. ovale had not been previously officially reported in Singapore, a retrospective analysis of available, frozen, archival blood samples was performed and returned two additional misidentified P. ovale cases in 2003 and 2006. These eleven P. ovale samples were characterized with respect to seven molecular markers (ssrRNA, Potra, Porbp2, Pog3p, dhfr-ts, cytb, cox1) used in recent studies to distinguish between the two sympatric species, and to a further three genes (tufa, clpC and asl). The morphological features of P. ovale and the differential diagnosis with P. vivax were reviewed and illustrated by microphotographs. The genetic dimorphism between P. ovale curtisi and P. ovale wallikeri was assessed by ten molecular markers distributed across the three genomes of the parasite (Genbank KP050361-KP050470). The data obtained for seven of these markers were compared with those published and confirmed that both P. ovale species were present. This dimorphism was also confirmed for the first time on: (1) two genes from the apicoplast genome (tufA and clpC genes); and, (2) the asl gene that was used for phylogenetic analyses of other Plasmodium species, and that was found to harbour the highest number of dimorphic loci between the two P. ovale species

  17. Imported Case of Lassa Fever in Sweden With Encephalopathy and Sensorineural Hearing Deficit.

    PubMed

    Grahn, Anna; Bråve, Andreas; Lagging, Martin; Dotevall, Leif; Ekqvist, David; Hammarström, Helena; Karlberg, Helen; Lagerqvist, Nina; Sansone, Martina; Tegnell, Anders; Ulleryd, Peter; Studahl, Marie

    2016-10-01

    We describe an imported case of Lassa fever with both encephalopathy and bilateral sensorineural hearing deficit. Absence of fever during hospitalization, initially nonspecific symptoms, and onset of hearing deficit in a late stage of disease probably contributed to delayed diagnosis (14 days after admittance to hospital). The pathogenesis of neurological manifestations of Lassa fever is poorly understood and no specific treatment was given. A total of 118 personnel had close contact with the patient, but no secondary cases occurred. This case highlights the importance of considering Lassa fever as a differential diagnosis in patients with recent travel to endemic areas.

  18. School Leadership and Administration: Important Concepts, Case Studies and Simulations

    ERIC Educational Resources Information Center

    Gorton, Richard; Alston, Judy; Snowden, Petra

    2006-01-01

    This text helps prospective and experienced principals, administrators, and supervisors increase their knowledge and skills through concepts, case-studies, and simulations. This book contains the following two parts and fifteen chapters. Part I presents important theoretical concepts and research findings that can improve educators'…

  19. Four Cases of Autochthonous Dengue Infection in Japan and 46 Imported Cases: Characteristics of Japanese Dengue.

    PubMed

    Yoshimura, Yukihiro; Sakamoto, Yohei; Amano, Yuichiro; Nakaharai, Kazuhiko; Yaita, Kenichiro; Hoshina, Tokio; Kurai, Hanako; Usuku, Shuzo; Tachikawa, Natsuo

    2015-01-01

    A dengue outbreak occurred in Japan 2014. We investigated the characteristics of dengue infection among Japanese. We investigated the medical charts retrospectively. Patients The study participants are patients who came to our clinic between 2008 and 2014. We investigated 4 domestic cases and 46 imported cases of Japanese with laboratory confirmation of dengue. Major symptoms were fever (100%), rash (86%), fatigue (84%), headache (81%), joint pain (66%), muscle pain (49%), and bleeding (6%). A late rash that appeared near the time of fever resolution was observed in 37 cases (74%). A total of 38/43 (88%) cases had low WBC count (<3,500 /μL) during the febrile period, 42/48 (88%) cases had a low platelet (PLT) count (<130×10(3)/μL), and 44/50 (88%) cases had a C-reactive protein (CRP) <2.0 mg/dL. Patients with a high fever, late rash, fever-associated leukopenia, low PLT count, low CRP, and elevated aminotransferases are generally suspected of having a dengue infection.

  20. Recent activities of the Seismology Division Early Career Representative(s)

    NASA Astrophysics Data System (ADS)

    Agius, Matthew; Van Noten, Koen; Ermert, Laura; Mai, P. Martin; Krawczyk, CharLotte

    2016-04-01

    The European Geosciences Union is a bottom-up-organisation, in which its members are represented by their respective scientific divisions, committees and council. In recent years, EGU has embarked on a mission to reach out for its numerous 'younger' members by giving awards to outstanding young scientists and the setting up of Early Career Scientists (ECS) representatives. The division representative's role is to engage in discussions that concern students and early career scientists. Several meetings between all the division representatives are held throughout the year to discuss ideas and Union-wide issues. One important impact ECS representatives have had on EGU is the increased number of short courses and workshops run by ECS during the annual General Assembly. Another important contribution of ECS representatives was redefining 'Young Scientist' to 'Early Career Scientist', which avoids discrimination due to age. Since 2014, the Seismology Division has its own ECS representative. In an effort to more effectively reach out for young seismologists, a blog and a social media page dedicated to seismology have been set up online. With this dedicated blog, we'd like to give more depth to the average browsing experience by enabling young researchers to explore various seismology topics in one place while making the field more exciting and accessible to the broader community. These pages are used to promote the latest research especially of young seismologists and to share interesting seismo-news. Over the months the pages proved to be popular, with hundreds of views every week and an increased number of followers. An online survey was conducted to learn more about the activities and needs of early career seismologists. We present the results from this survey, and the work that has been carried out over the last two years, including detail of what has been achieved so far, and what we would like the ECS representation for Seismology to achieve. Young seismologists are

  1. Imported melioidosis in Japan: a review of cases.

    PubMed

    Hadano, Yoshiro

    2018-01-01

    Fourteen cases of reported melioidosis in Japan were reviewed. The mean age was 52.4 years (33-69 years), and all patients were male. All of the presumed exposures originated in Southeast Asia. The most common underlying disease was diabetes mellitus, including those patients with impaired glucose tolerance (n=8). As for mode of onset, 13 patients had acute infections and one had chronic infection. Of these 14 patients, the most common infection site on admission was lung (n=8), followed by bone (n=5), skin (n=4), gastrointestinal abscess formation (n=3), urinary tract (n=3), aorta (n=2), mediastinal lymph node swelling (n=1), and central nervous system (n=1). Bacteremia was observed in nine patients, and Burkholderia pseudomallei isolates were mostly susceptible to ceftazidime and carbapenem. Overall mortality was 14.3%. Melioidosis is a rare infection in Japan, with all known cases to date having been imported from Southeast Asia. Diabetes was a common risk factor.

  2. [Clinical analysis of two cases of imported children Zika virus infection in China].

    PubMed

    Zheng, C G; Xu, Y; Jiang, H Q; Yin, Y X; Zhang, J H; Zhu, W J; Liang, X J; Chen, M X; Ye, J W; Tan, L M; Luo, D; Gong, S T

    2016-05-01

    To analyze the clinical characteristics, outcome and diagnosis of two cases of imported children Zika virus infection in China. A retrospective analysis was performed on clinical characteristics, treatment and outcome of two cases of imported children with Zika virus infection in February 2016 in Enping People's Hospital of Guangdong. Two cases of children with imported Zika virus infection resided in an affected area of Venezuela, 8-year-old girl and her 6 year-old brother. The main findings on physical examination included the following manifestations: fever, rash, and conjunctivitis. The rash was first limited to the abdomen, but extended to the torso, neck and face, and faded after 3-4 d. The total number of white blood cells was not high and liver function was normal. The diagnosis of two cases of Zika virus infection was confirmed by the expert group of Guangdong Provincial Center for Disease Control and Prevention, according to the epidemiological history, clinical manifestations and Zika virus nucleic acid detection results.Treatment of Zika virus infection involves supportive care. Two Zika virus infection children had a relatively benign outcome. At present, Zika virus infection in children is an imported disease in China. No specific therapy is available for this disease. Information on long-term outcomes among infants and children with Zika virus disease is limited, routine pediatric care is advised for these infants and children.

  3. Importance of mycological confirmation of clinically suspected cases of tinea corporis, tinea pedis and tinea cruris.

    PubMed

    Omar, Abeer Aly

    2004-01-01

    Tinea corporis, tinea cruris, and tinea pedis are of the most prevalent dermatophytoses. Several conditions that mimic dermatophytoses and atypical and steroid modified forms of the disease usually present difficulties in diagnosis. Hence, the present investigation aimed at studying these conditions on mycological basis. The study included 163 cases clinically diagnosed as having tinea corporis, tinea pedis or tinea cruris. Specimens were taken by skin scraping. Samples were cultured on Sabouraud's dextrose agar and examined microscopically. The results revealed that, only 90.8% of cases were mycologically proven (positive by one or both methods). Most of tinea corporis, tinea pedis and tinea cruris cases (68.9%, 79.1%& 83.9% respectively) were diagnosed by both methods (P>0.05). For cases of tinea corporis and tinea cruris, males were more than females (51.4%, 48.6% and 58.1%, 41.9% respectively) while females exceeded males (72.1%, 27.9% respectively) in cases with tinea pedis (P<0.05). Trichophyton rubrum (T. rubrum) was the most common isolate in all the studied conditions, represented 64.9% in tinea corporis, 53.4 %, for tinea pedis and 64.6% for tinea cruris. T. mentagrophytes var. interdigitale was mostly isolated from cases of tinea pedis (23.3%). The majority of T. violaceum was isolated from cases of tinea corporis (12.2%). The main isolation of E. floccosum was from cases of tinea cruris (16.1%) Microsporum canis (M. canis) was only isolated from one case (1.4%) of tinea corporis while Candida albicans (C. albicans) alone (9.3%) or with T. rubrum (7.0%) was isolated only from cases of interdigital tinea pedis. (P<0.05). The majority of cases of tinea corporis, tinea pedis and tinea cruris had chronic lesions (78.4%, 76.7% and 54.8% respectively) (P<0.05) and received prior therapy for the condition (79.7%, 76.7% and 58.1% respectively, (P>0.05). In conclusion, early accurate diagnosis (on mycological basis) is an important tool to control and reduce the

  4. Comparison of autochthonous and imported cases of hepatitis A or hepatitis E.

    PubMed

    Hartl, J; Kreuels, B; Polywka, S; Addo, M; Luethgehetmann, M; Dandri, M; Dammermann, W; Sterneck, M; Lohse, A W; Pischke, S

    2015-07-01

    Hepatitis A and hepatitis E are not limited to tropical countries but are also present in industrialized countries. Both infections share similar clinical features. There is no comparative study evaluating the clinical parameters of autochthonous and imported hepatitis A virus and hepatitis E virus infections. The aim of this study was to determine differences between autochthonous and imported hepatitis A virus (HAV) and hepatitis E virus (HEV) infections. Medical charts of all patients at our center with acute HAV and HEV infections were analyzed retrospectively (n = 50, study period 01/2009 - 08/2013). Peak bilirubin (median 8.6 vs. 4.4 mg/dL, p = 0.008) and ALT levels (median 2998 vs. 1666 IU/mL, p = 0.04) were higher in patients with hepatitis A compared to hepatitis E. In comparison to autochthones hepatitis E cases, patients with imported infections had significantly higher peak values for AST, ALT, bilirubin and INR (p = 0.009, p = 0.002, p = 0.04 and p = 0.049, respectively). In HAV infection, AST levels tended to be higher in imported infections (p = 0.08). (i) It is not possible to differentiate certainly between acute HAV and HEV infections by clinical or biochemical parameters, however, HAV infections might be associated with more cholestasis and higher ALT values. (ii) Imported HEV infections are associated with higher transaminases, INR and bilirubin levels compared to autochthonous cases and (iii) imported HAV infections tend to be associated with higher transaminases in comparison to autochthonous cases. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Imported Lassa fever: a report of 2 cases in Ghana.

    PubMed

    Kyei, Nicholas N A; Abilba, Mark M; Kwawu, Foster K; Agbenohevi, Prince G; Bonney, Joseph H K; Agbemaple, Thomas K; Nimo-Paintsil, Shirley C; Ampofo, William; Ohene, Sally-Ann; Nyarko, Edward O

    2015-05-29

    Lassa fever is a potentially fatal acute viral illness caused by Lassa virus which is carried by rodents and is endemic in some West African countries. Importation of emerging infections such as Lassa fever, Ebola Virus Disease and other viral hemorrhagic fevers into non endemic regions is a growing threat particularly as international travel and commitments in resolving conflicts in endemic countries in the West Africa sub-region continue. We report the first two recorded imported cases of Lassa fever among Ghanaian Peace keepers in rural Liberia, who became ill while on Peace keeping mission. They were subsequently evacuated to the UN level IV hospital in Accra, where their illnesses were laboratory confirmed. One of the patients recovered with ribavirin treatment and supportive therapy. No secondary clinical cases occurred in Ghana. Healthcare providers at all levels of care should thus have a high index of suspicion for these infectious diseases and adopt standard infection control measures when treating patients in endemic regions or returning travelers from an endemic region with a febrile illness even of a known etiology.

  6. [Imported histoplasmosis in Navarra: presentation of four cases].

    PubMed

    Navascués, Ana; Rodríguez, Irene; Repáraz, Jesús; Salvo, Soledad; Gil-Setas, Alberto; Martínez Peñuela, José María

    2011-01-01

    Histoplasmosis is a fungal infection caused by the dimorphic fungi Histoplasma capsulatum. Its incidence in Spain has increased in recent years, mainly due to the increased presence of immigrants from Latin America and increased travel to the continent for tourism and cooperation. Our aim was to review the clinical characteristics of cases of histoplasmosis diagnosed in our hospital during the last six years. We diagnosed 4 cases from 4 patients from South America, 3 of whom were HIV positive and 1 diagnosed with dermatomyositis was treated with immunosuppressive drugs. The laboratory diagnosis was carried out by histological and microbiological study, by culture and specific PCR directly on the sample. As it is an imported infection there needs to be a high level of suspicion and a detailed history taken to get a diagnosis. This infection requires a differential diagnosis between febrile syndrome in immunosuppressed patients, both HIV positive and immunosuppressive therapy, which originate from endemic areas, or who have a history of staying in them. Copyright © 2010 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  7. A cluster of measles linked to an imported case, Finland, 2017.

    PubMed

    Seppälä, Elina; Zöldi, Viktor; Vuorinen, Sakari; Murtopuro, Satu; Elonsalo, Ulpu; van Beek, Janko; Haveri, Anu; Kontio, Mia; Savolainen-Kopra, Carita; Puumalainen, Taneli; Sane, Jussi

    2017-08-17

    One imported and five secondary cases of measles were detected in Finland between June and August 2017. The measles sequences available for five laboratory-confirmed cases were identical and belonged to serotype D8. The large number of potentially exposed Finnish and foreign individuals called for close cooperation of national and international public health authorities and other stakeholders. Raising awareness among healthcare providers and ensuring universally high vaccination coverage is crucial to prevent future clusters and outbreaks. This article is copyright of The Authors, 2017.

  8. Measures to control an imported case of canine rabies in France.

    PubMed

    2006-01-01

    France has been free from terrestrial rabies since 2001. On 21 August 2004, a female dog aged 4 months died in Gironde (south-west France), after experiencing clinical symptoms suggestive of rabies for 3 days. On 26 August, a diagnosis of rabies was confirmed by the Pasteur Institute. This paper describes the measures that were taken to manage the risks to human and animal health, and analyses the alert raised in France as a result of this imported case of rabies, the third such case in 2004.

  9. Successful public health response to four cases of imported measles in Panama.

    PubMed

    Sosa, Nestor; Guerra, Ilka; Abrego, Leyda; Cisneros, Julio; Castillo, Juan; Nieto-Guevara, Javier; Gálvez, Carlos; Moltó, Yadira; Smith, Rebecca E; Pascale, Juan Miguel

    2012-08-21

    In Panama, the last endemic cases of measles occurred in 1995. In this paper, we report four cases of imported measles in three girls and one boy after they returned from a trip to Poland and Israel between 28 April and 11 May 2011. The etiologic diagnosis of the four cases was confirmed by detection of IgM antibodies against measles virus and positive polymerase chain reaction using measles-specific primers. All cases had genotype D4 with close genetic similarity to virus reported from Poland. Public health interventions included isolation of the cases in their homes and an extensive search for and vaccination of contacts of the four cases, regardless of their vaccination status. A nationwide vaccination campaign was also implemented after the first case was identified. A total of 70,950 measles vaccine doses were administered in Panama in the two months following the identification of these cases. In addition, 94,179 persons were confirmed to have their immunization schedule up-to-date and did not receive the vaccine. No secondary cases were detected in Panama in the following six months.

  10. Representing vision and blindness.

    PubMed

    Ray, Patrick L; Cox, Alexander P; Jensen, Mark; Allen, Travis; Duncan, William; Diehl, Alexander D

    2016-01-01

    There have been relatively few attempts to represent vision or blindness ontologically. This is unsurprising as the related phenomena of sight and blindness are difficult to represent ontologically for a variety of reasons. Blindness has escaped ontological capture at least in part because: blindness or the employment of the term 'blindness' seems to vary from context to context, blindness can present in a myriad of types and degrees, and there is no precedent for representing complex phenomena such as blindness. We explore current attempts to represent vision or blindness, and show how these attempts fail at representing subtypes of blindness (viz., color blindness, flash blindness, and inattentional blindness). We examine the results found through a review of current attempts and identify where they have failed. By analyzing our test cases of different types of blindness along with the strengths and weaknesses of previous attempts, we have identified the general features of blindness and vision. We propose an ontological solution to represent vision and blindness, which capitalizes on resources afforded to one who utilizes the Basic Formal Ontology as an upper-level ontology. The solution we propose here involves specifying the trigger conditions of a disposition as well as the processes that realize that disposition. Once these are specified we can characterize vision as a function that is realized by certain (in this case) biological processes under a range of triggering conditions. When the range of conditions under which the processes can be realized are reduced beyond a certain threshold, we are able to say that blindness is present. We characterize vision as a function that is realized as a seeing process and blindness as a reduction in the conditions under which the sight function is realized. This solution is desirable because it leverages current features of a major upper-level ontology, accurately captures the phenomenon of blindness, and can be

  11. Public Health Response to Imported Case of Poliomyelitis, Australia, 2007

    PubMed Central

    Lester, Rosemary; Moran, Rodney; Brown, Lynne; Meagher, Julian; Roberts, Jason A.; Thorley, Bruce R.

    2009-01-01

    Australia, along with 36 other countries in the Western Pacific Region, was declared free of poliomyelitis by the World Health Organization in October 2000. Yet, the persistence of wild poliovirus in the 4 remaining polio-endemic countries—Afghanistan, India, Nigeria, and Pakistan—poses a risk for its importation into all countries declared polio free. We describe the public health response and outcomes resulting from the importation of a wild poliovirus infection in Melbourne, Australia, in July 2007. This response, based on an assessment of the risk for transmission, included offering vaccination with inactivated polio vaccine to the contacts and placing the index patient in isolation and the household contacts in quarantine until consecutive fecal specimens were negative for poliovirus by culture. The experience gained from the polio importation event in Australia may assist other polio-free countries to prepare for, and respond to, a similar event. No secondary clinical cases resulted from this importation. PMID:19891859

  12. Arthropods of medicoveterinary importance in zoos.

    PubMed

    Adler, Peter H; Tuten, Holly C; Nelder, Mark P

    2011-01-01

    Zoos present a unique assemblage of arthropods, captive vertebrates, free-roaming wildlife, humans, and plants, each with its own biota of symbiotic organisms. Arthropods of medicoveterinary importance are well represented in zoos, and an ample literature documents their influence in these animal-rich environments. Mosquitoes are of greatest significance because of the animal and human pathogens they transmit, followed by ectoparasites, many of which are exotic and present health risks to captive and native animals. Biting flies, cockroaches, filth flies, and triatomid bugs represent additional concerns. Integrated management programs for arthropods in zoos are commonplace. Zoos can play a role in biosurveillance, serving as an advanced guard for detecting exotic arthropods and vector-borne diseases. We provide the first review of arthropods of medicoveterinary importance in zoos. A case is made for the value of collaborations between entomologists and zoo personnel as a means of enhancing research and public education while safeguarding the health of captive animals and the public.

  13. A methodology to estimate representativeness of LAI station observation for validation: a case study with Chinese Ecosystem Research Network (CERN) in situ data

    NASA Astrophysics Data System (ADS)

    Xu, Baodong; Li, Jing; Liu, Qinhuo; Zeng, Yelu; Yin, Gaofei

    2014-11-01

    Leaf Area Index (LAI) is known as a key vegetation biophysical variable. To effectively use remote sensing LAI products in various disciplines, it is critical to understand the accuracy of them. The common method for the validation of LAI products is firstly establish the empirical relationship between the field data and high-resolution imagery, to derive LAI maps, then aggregate high-resolution LAI maps to match moderate-resolution LAI products. This method is just suited for the small region, and its frequencies of measurement are limited. Therefore, the continuous observing LAI datasets from ground station network are important for the validation of multi-temporal LAI products. However, due to the scale mismatch between the point observation in the ground station and the pixel observation, the direct comparison will bring the scale error. Thus it is needed to evaluate the representativeness of ground station measurement within pixel scale of products for the reasonable validation. In this paper, a case study with Chinese Ecosystem Research Network (CERN) in situ data was taken to introduce a methodology to estimate representativeness of LAI station observation for validating LAI products. We first analyzed the indicators to evaluate the observation representativeness, and then graded the station measurement data. Finally, the LAI measurement data which can represent the pixel scale was used to validate the MODIS, GLASS and GEOV1 LAI products. The result shows that the best agreement is reached between the GLASS and GEOV1, while the lowest uncertainty is achieved by GEOV1 followed by GLASS and MODIS. We conclude that the ground station measurement data can validate multi-temporal LAI products objectively based on the evaluation indicators of station observation representativeness, which can also improve the reliability for the validation of remote sensing products.

  14. Malaria in paradise: characterization of imported cases in Gran Canaria Island (1993-2006).

    PubMed

    Espinosa-Vega, Elizabeth; Martín-Sánchez, Antonio Manuel; Elcuaz-Romano, Rosa; Hernández-Febles, Melisa; Molina-Cabrillana, Jesús; Pérez-Arellano, Jose Luis

    2011-01-01

    Spain obtained the official certificate of malaria eradication in 1964. However, imported malaria cases have been increasing during the last few decades in this country. This study aims to describe the clinical and epidemiological features of patients diagnosed with malaria on Gran Canaria Island. A retrospective study was conducted based on case review of all patients diagnosed with malaria microbiologically confirmed from 1993 to 2006, at the three referral teaching hospitals on Gran Canaria Island. One hundred eighty-four episodes in 181 patients were diagnosed, 170 of them were analyzed. Most of them (82%) were travelers. Nearly 15% (14.7%) declared having had some chemoprophylaxis, but only half of them completed the treatment. Twenty cases (10.9%) were diagnosed who had just arrived as immigrants, mainly children. Malaria was acquired in Africa by 94.7% of the cases and Plasmodium falciparum was responsible for the majority of the cases (84.1%). Clinical and epidemiological differences were observed among different groups of patients formed by their origin and travel purposes. At least one indicator of severe malaria was established in 22.9% of the cases. However, global mortality was 3.8%. Malaria in Gran Canaria Island is imported from endemic areas, mainly from African countries, observed mostly among young adult males, but clinical and epidemiological features may change among different groups of patients. The number of immigrants diagnosed with malaria is increasing in this area nowadays. © 2011 International Society of Travel Medicine.

  15. Imported and autochthonous leprosy presenting in Madrid (1989-2015): A case series and review of the literature.

    PubMed

    Norman, Francesca F; Fanciulli, Chiara; Pérez-Molina, José-Antonio; Monge-Maillo, Begoña; López-Vélez, Rogelio

    2016-01-01

    Leprosy remains infrequent in non-endemic areas. The objective of this study was to describe the cases of leprosy reviewed at a referral unit for imported diseases in Europe and to compare these findings with published data on imported leprosy. Cases of leprosy evaluated at a referral centre are described and salient features of autochthonous and imported cases are compared. A review of the literature on imported leprosy was performed. During the study period, 25 patients with leprosy were followed-up (10 were autochthonous cases and 15 were considered to be imported). Regarding imported cases, the majority were diagnosed in Latin American immigrants (10/15, 67%), mean age was 42 years, there were no differences in gender distribution, estimated average time from arrival in Spain to first visit at the unit was 3 years and from symptom onset to diagnosis was 2 years. Over 80% of imported cases had multibacillary disease and over one third of patients had been previously diagnosed with leprosy. One third had received alternate incorrect diagnoses initially, <50% of patients with imported leprosy completed standard therapy and were considered cured and over one third were lost to follow-up. Leprosy remains a complex disease for healthcare professionals unfamiliar with this infection. Manifestations are polymorphic so misdiagnoses and consequent delays in diagnosis are not infrequent and may lead to resulting disabilities. Early diagnosis and management are essential to prevent sequelae and possible transmission. Improving access to health care, especially for vulnerable groups, would be necessary to advance in the control of this disease. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. The first case of imported Borrelia miyamotoi disease concurrent with Lyme disease.

    PubMed

    Oda, Rentaro; Kutsuna, Satoshi; Sekikawa, Yoshiyuki; Hongo, Igen; Sato, Kozue; Ohnishi, Makoto; Kawabata, Hiroki

    2017-05-01

    Borrelia miyamotoi disease (BMD) is an emerging infectious disease caused by B. miyamotoi. Although BMD has been reported in the United States, Europe, and Japan, no case of imported BMD has been described in the world. Here, we report a 63-year-old American man living in Japan who presented with malaise, headache, myalgia, and arthralgia. We suspected Lyme disease because of his travel history to Minnesota and presence of erythema migrans. Serologic analysis supported our diagnosis, and doxycycline was administered for 14 days. However, we also suspected coinfection with BMD because of his fever, elevated liver function test results and his travel history. The patient was seropositive for the immunoglobulin M antibody to recombinant glycerophosphodiester phosphodiesterase, and was diagnosed with coinfection with BMD. This case suggests that BMD should be considered in febrile travelers returning from the Northeastern and Midwestern regions of the United States, and that BMD and Lyme disease coinfection should be considered to detect cases of imported BMD. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  17. [Sensitivity of four representative angular cephalometric measures].

    PubMed

    Xü, T; Ahn, J; Baumrind, S

    2000-05-01

    Examined the sensitivity of four representative cephalometric angles to the detection of different vectors of craniofacial growth. Landmark coordinate data from a stratified random sample of 48 adolescent subjects were used to calculate conventional values for changes between the pretreatment and end-of-treatment lateral cephalograms. By modifying the end-of-treatment coordinate values appropriately, the angular changes could be recalculated reflecting three hypothetical situations: Case 1. What if there were no downward landmark displacement between timepoints? Case 2. What if there were no forward landmark displacement between timepoints? Case 3. What if there were no Nasion change? These questions were asked for four representative cephalometric angles: SNA, ANB, NAPg and UI-SN. For Case 1, the associations (r) between the baseline and the modified measure for the three angles were very highly significant (P < 0.001) with r2 values no lower than 0.94! For Case 2, however, the associations were much weaker and no r value reached significance. These angular measurements are less sensitive for measuring downward landmark displacement than they are for measuring forward landmark displacement.

  18. Value Arguments in Science Research Articles: Making the Case for the Importance of Research

    ERIC Educational Resources Information Center

    Carter, Michael

    2016-01-01

    It is in the interest of scholarly journals to publish important research and of researchers to publish in important journals. One key to making the case for the importance of research in a scholarly article is to incorporate value arguments. Yet there has been no rhetorical analysis of value arguments in the literature. In the context of…

  19. Imported submicroscopic malaria in Madrid.

    PubMed

    Ramírez-Olivencia, Germán; Rubio, José Miguel; Rivas, Pablo; Subirats, Mercedes; Herrero, María Dolores; Lago, Mar; Puente, Sabino

    2012-09-12

    Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM.The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously described in endemic zones, and presence of

  20. Imported submicroscopic malaria in Madrid

    PubMed Central

    2012-01-01

    Background Submicroscopic malaria (SMM) can be defined as low-density infections of Plasmodium that are unlikely to be detected by conventional microscopy. Such submicroscopic infections only occasionally cause acute disease, but they are capable of infecting mosquitoes and contributing to transmission. This entity is frequent in endemic countries; however, little is known about imported SMM. The goals of this study were two-fold: a) to know the frequency of imported SMM, and b) to describe epidemiological, laboratorial and clinical features of imported SMM. Methods A retrospective study based on review of medical records was performed. The study population consisted of patients older than 15 years attended at the Tropical Medicine Unit of Hospital Carlos III, between January 1, 2002 and December 31, 2007. Routinely detection techniques for Plasmodium included Field staining and microscopic examination through thick and thin blood smear. A semi-nested multiplex malaria PCR was used to diagnose or to confirm cases with low parasitaemia. Results SMM was diagnosed in 104 cases, representing 35.5% of all malaria cases. Mean age (IC95%) was 40.38 years (37.41-43.34), and sex distribution was similar. Most cases were in immigrants, but some cases were found in travellers. Equatorial Guinea was the main country where infection was acquired (81.7%). Symptoms were present only in 28.8% of all SMM cases, mainly asthenia (73.3% of symptomatic patients), fever (60%) and arthromialgias (53.3%). The associated laboratory abnormalities were anaemia (27.9%), leukopaenia (15.4%) and thrombopaenia (15.4%). Co-morbidity was described in 75 cases (72.1%). Conclusions Results from this study suggest that imported SMM should be considered in some patients attended at Tropical Medicine Units. Although it is usually asymptomatic, it may be responsible of fever, or laboratory abnormalities in patients coming from endemic areas. The possibility of transmission in SMM has been previously

  1. A critical analysis of user satisfaction surveys in addiction services: opioid maintenance treatment as a representative case study.

    PubMed

    Trujols, Joan; Iraurgi, Ioseba; Oviedo-Joekes, Eugenia; Guàrdia-Olmos, Joan

    2014-01-01

    Satisfaction with services represents a key component of the user's perspective, and user satisfaction surveys are the most commonly used approach to evaluate the aforementioned perspective. The aim of this discursive paper is to provide a critical overview of user satisfaction surveys in addiction treatment and harm reduction services, with a particular focus on opioid maintenance treatment as a representative case. We carried out a selective critical review and analysis of the literature on user satisfaction surveys in addiction treatment and harm reduction services. Most studies that have reported results of satisfaction surveys have found that the great majority of users (virtually all, in many cases) are highly satisfied with the services received. However, when these results are compared to the findings of studies that use different methodologies to explore the patient's perspective, the results are not as consistent as might be expected. It is not uncommon to find that "highly satisfied" patients report significant problems when mixed-methods studies are conducted. To understand this apparent contradiction, we explored two distinct (though not mutually exclusive) lines of reasoning, one of which concerns conceptual aspects and the other, methodological questions. User satisfaction surveys, as currently designed and carried out in addiction treatment and harm reduction services, do not significantly help to improve service quality. Therefore, most of the enthusiasm and naiveté with which satisfaction surveys are currently performed and interpreted - and rarely acted on in the case of nonoptimal results - should be avoided. A truly participatory approach to program evaluation is urgently needed to reshape and transform patient satisfaction surveys.

  2. 76 FR 18291 - Culturally Significant Objects Imported for Exhibition Determinations: “Boris Mikhailov: Case...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-01

    ... Determinations: ``Boris Mikhailov: Case History'' SUMMARY: Notice is hereby given of the following determinations... the exhibition ``Boris Mikhailov: Case History,'' imported from abroad for temporary exhibition within... objects at the Museum of Modern Art, New York, New York, from on or about May 26, 2011, until on or about...

  3. Active Surveillance of Hansen's Disease (Leprosy): Importance for Case Finding among Extra-domiciliary Contacts

    PubMed Central

    Moura, Maria L. N.; Dupnik, Kathryn M.; Sampaio, Gabriel A. A.; Nóbrega, Priscilla F. C.; Jeronimo, Ana K.; do Nascimento-Filho, Jose M.; Miranda Dantas, Roberta L.; Queiroz, Jose W.; Barbosa, James D.; Dias, Gutemberg; Jeronimo, Selma M. B.; Souza, Marcia C. F.; Nobre, Maurício L.

    2013-01-01

    Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of Mycobacterium leprae. PMID:23516645

  4. Influences on food choice perceived to be important by nationally-representative samples of adults in the European Union.

    PubMed

    Lennernäs, M; Fjellström, C; Becker, W; Giachetti, I; Schmitt, A; Remaut de Winter, A; Kearney, M

    1997-06-01

    The purpose of this baseline survey was to obtain comparable data on perceived influences on food choice from EU member countries as the starting point for EU healthy eating promotion campaigns and programmes. A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union. 14331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state. The five most important factors influencing consumers food choice were 'quality or freshness' (74%), 'price' (43%), 'taste' (38%), 'trying to eat healthy' (32%) and 'family preferences' (29%). Subjects in different categories (age, sex, education and employment status) selected different factors as having major influence on their food choice. Demographic factors seemed to have greater effects on perceived influences than culture (country): 'quality/freshness', 'price', 'trying to eat healthy', 'family preferences' seemed to be most important in women, 'taste' and 'habit' in males. Females and older and more educated subjects were more likely than other subjects to select 'trying to eat healthy' as having a major influence. 'Price' seemed most important in unemployed and retired subjects.

  5. Non-imported malaria in non-endemic countries: a review of cases in Spain.

    PubMed

    Velasco, Emilia; Gomez-Barroso, Diana; Varela, Carmen; Diaz, Oliva; Cano, Rosa

    2017-06-29

    Spain declared the elimination of malaria in 1964. In non-endemic areas, the overwhelming majority of malaria cases are acquired abroad, and locally acquired infections are rare events. In Spain, malaria is a statutorily notifiable disease. During these fifty years more than ten thousand malaria cases have been reported, and about 0.8% of them did not have a history of recent travel. In this report, it was carried out a review of the ways in which malaria can be transmitted in non-endemic areas and a short description of the Spanish cases, aggregated by their transmission mechanisms. Four cases contracted malaria by mosquito bites; there were two autochthonous cases and two of "airport malaria". The other 28 cases were: congenital malaria cases, transfusion-transmitted malaria, post-transplant cases, nosocomial transmission and cases in intravenous drug users. In addition, in 1971 there was an outbreak of 54 cases due to exposure to blood or blood products. So, while malaria usually is an imported disease in non-endemic areas, it should not be excluded in the differential diagnosis of persons who have fever of unknown origin, regardless of their travel history.

  6. Imported fenproporex-based diet pills from Brazil: a report of two cases.

    PubMed

    Cohen, Pieter A

    2009-03-01

    Banned amphetamine-based anorectics are illicitly imported into the United States (US), but little is known regarding the harm these diet pills pose to US residents. A 26-year-old woman using imported diet pills presented with a two-year history of intermittent chest pains, palpitations, headaches and insomnia. Urine toxicology screen detected amphetamines and benzodiazepines. Fenproporex and chlordiazepoxide were detected in her pills. Her symptoms resolved after she stopped using diet pills. A 38-year-old man using imported diet pills presented after his occupational urine screen was significantly positive for amphetamine. Fenproporex and fluoxetine were detected in his pills. These cases illustrate the potential harm from imported prescription diet pills that combine fenproporex with benzodiazepines, antidepressants, diuretics, laxatives and other substances. Increasing physicians' awareness of imported diet pill use may improve care of patients suffering from the pills' many adverse effects.

  7. Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study.

    PubMed

    Brown, Kevin A; Jones, Makoto; Daneman, Nick; Adler, Frederick R; Stevens, Vanessa; Nechodom, Kevin E; Goetz, Matthew B; Samore, Matthew H; Mayer, Jeanmarie

    2016-06-21

    Although clinical factors affecting a person's susceptibility to Clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings. To obtain a comprehensive picture of individual and regional factors that affect C difficile incidence. Multilevel longitudinal nested case-control study. Veterans Health Administration health care regions, from 2006 through 2012. Long-term care residents. Individual-level risk factors included age, number of comorbid conditions, and antibiotic exposure. Regional risk factors included importation of cases of acute care C difficile infection per 10 000 resident-days and antibiotic use per 1000 resident-days. The outcome was defined as a positive result on a long-term care C difficile test without a positive result in the prior 8 weeks. 6012 cases (incidence, 3.7 cases per 10 000 resident-days) were identified in 86 regions. Long-term care C difficile incidence (minimum, 0.6 case per 10 000 resident-days; maximum, 31.0 cases per 10 000 resident-days), antibiotic use (minimum, 61.0 days with therapy per 1000 resident-days; maximum, 370.2 days with therapy per 1000 resident-days), and importation (minimum, 2.9 cases per 10 000 resident-days; maximum, 341.3 cases per 10 000 resident-days) varied substantially across regions. Together, antibiotic use and importation accounted for 75% of the regional variation in C difficile incidence (R2 = 0.75). Multilevel analyses showed that regional factors affected risk together with individual-level exposures (relative risk of regional antibiotic use, 1.36 per doubling [95% CI, 1.15 to 1.60]; relative risk of importation, 1.23 per doubling [CI, 1.14 to 1.33]). Case identification was based on laboratory criteria. Admission of residents with recent C difficile infection from non-Veterans Health Administration acute care sources was not considered. Only 25% of the variation in regional C difficile incidence in long

  8. A critical analysis of user satisfaction surveys in addiction services: opioid maintenance treatment as a representative case study

    PubMed Central

    Trujols, Joan; Iraurgi, Ioseba; Oviedo-Joekes, Eugenia; Guàrdia-Olmos, Joan

    2014-01-01

    Background Satisfaction with services represents a key component of the user’s perspective, and user satisfaction surveys are the most commonly used approach to evaluate the aforementioned perspective. The aim of this discursive paper is to provide a critical overview of user satisfaction surveys in addiction treatment and harm reduction services, with a particular focus on opioid maintenance treatment as a representative case. Methods We carried out a selective critical review and analysis of the literature on user satisfaction surveys in addiction treatment and harm reduction services. Results Most studies that have reported results of satisfaction surveys have found that the great majority of users (virtually all, in many cases) are highly satisfied with the services received. However, when these results are compared to the findings of studies that use different methodologies to explore the patient’s perspective, the results are not as consistent as might be expected. It is not uncommon to find that “highly satisfied” patients report significant problems when mixed-methods studies are conducted. To understand this apparent contradiction, we explored two distinct (though not mutually exclusive) lines of reasoning, one of which concerns conceptual aspects and the other, methodological questions. Conclusion User satisfaction surveys, as currently designed and carried out in addiction treatment and harm reduction services, do not significantly help to improve service quality. Therefore, most of the enthusiasm and naiveté with which satisfaction surveys are currently performed and interpreted – and rarely acted on in the case of nonoptimal results – should be avoided. A truly participatory approach to program evaluation is urgently needed to reshape and transform patient satisfaction surveys. PMID:24482571

  9. Conveyance Contact Investigation for Imported Middle East Respiratory Syndrome Cases, United States, May 2014

    PubMed Central

    Objio, Tina; Vonnahme, Laura; Washburn, Faith; Cohen, Nicole J.; Chen, Tai-Ho; Edelson, Paul J.; Gulati, Reena; Hale, Christa; Harcourt, Jennifer; Haynes, Lia; Jewett, Amy; Jungerman, Robynne; Kohl, Katrin S.; Miao, Congrong; Pesik, Nicolette; Regan, Joanna J.; Roland, Efrosini; Schembri, Chris; Schneider, Eileen; Tamin, Azaibi; Tatti, Kathleen; Alvarado-Ramy, Francisco

    2017-01-01

    In 2014, the Centers for Disease Control and Prevention conducted conveyance contact investigations for 2 Middle East respiratory syndrome cases imported into the United States, comprising all passengers and crew on 4 international and domestic flights and 1 bus. Of 655 contacts, 78% were interviewed; 33% had serologic testing. No secondary cases were identified. PMID:28820379

  10. Representing Learning With Graphical Models

    NASA Technical Reports Server (NTRS)

    Buntine, Wray L.; Lum, Henry, Jr. (Technical Monitor)

    1994-01-01

    Probabilistic graphical models are being used widely in artificial intelligence, for instance, in diagnosis and expert systems, as a unified qualitative and quantitative framework for representing and reasoning with probabilities and independencies. Their development and use spans several fields including artificial intelligence, decision theory and statistics, and provides an important bridge between these communities. This paper shows by way of example that these models can be extended to machine learning, neural networks and knowledge discovery by representing the notion of a sample on the graphical model. Not only does this allow a flexible variety of learning problems to be represented, it also provides the means for representing the goal of learning and opens the way for the automatic development of learning algorithms from specifications.

  11. Imported water risk: the case of the UK

    NASA Astrophysics Data System (ADS)

    Hoekstra, Arjen Y.; Mekonnen, Mesfin M.

    2016-05-01

    While the water dependency of water-scarce nations is well understood, this is not the case for countries in temperate and humid climates, even though various studies have shown that many of such countries strongly rely on the import of water-intensive commodities from elsewhere. In this study we introduce a method to evaluate the sustainability and efficiency of the external water footprint (WF) of a country, with the UK as an example. We trace, quantify and map the UK’s direct and indirect water needs and assess the ‘imported water risk’ by evaluating the sustainability of the water consumption in the source regions. In addition, we assess the efficiency of the water consumption in source areas in order to identify the room for water savings. We find that half of the UK’s global blue WF—the direct and indirect consumption of ground- and surface water resources behind all commodities consumed in the UK—is located in places where the blue WF exceeds the maximum sustainable blue WF. About 55% of the unsustainable part of the UK’s blue WF is located in six countries: Spain (14%), USA (11%), Pakistan (10%), India (7%), Iran (6%), and South Africa (6%). Our analysis further shows that about half of the global consumptive WF of the UK’s direct and indirect crop consumption is inefficient, which means that consumptive WFs exceed specified WF benchmark levels. About 37% of the inefficient part of the UK’s consumptive WF is located in six countries: Indonesia (7%), Ghana (7%), India (7%), Brazil (6%), Spain (5%), and Argentina (5%). In some source countries, like Pakistan, Iran, Spain, USA and Egypt, unsustainable and inefficient blue water consumption coincide. We find that, by lowering overall consumptive WFs to benchmark levels, the global blue WF of UK crop consumption could be reduced by 19%. We discuss four strategies to mitigate imported water risk: become more self-sufficient in food; diversify the import of water-intensive commodities, favouring

  12. A Case Study of the Importance of Practitioner Research for Teacher Development

    ERIC Educational Resources Information Center

    Bartlett, Steve; Burton, Diana; Buckley, Sue

    2005-01-01

    This article considers the important part that practitioner research can play in the professional development of teachers. The case study illustrates how a teacher's interests encouraged her to investigate particular areas of her practice. She read literature about emotional intelligence and devised strategies to enhance her classroom teaching.…

  13. Imported malaria including HIV and pregnant woman risk groups: overview of the case of a Spanish city 2004-2014.

    PubMed

    Fernández López, María; Ruiz Giardín, Jose Manuel; San Martín López, Juan Víctor; Jaquetti, Jerónimo; García Arata, Isabel; Jiménez Navarro, Carolina; Cabello Clotet, Noemi

    2015-09-17

    Arrival of inmigrants from malaria endemic areas has led to a emergence of cases of this parasitic disease in Spain. The objective of this study was to analyse the high incidence rate of imported malaria in Fuenlabrada, a city in the south of Madrid, together with the frequent the lack of chemoprophylaxis, for the period between 2004 and 2014. Both pregnant women and HIV risk groups have been considered. Retrospective descriptive study of laboratory-confirmed malaria at the Fuenlabrada University Hospital, in Madrid, during a 10-year period (2004-2014). These data were obtained reviewing medical histories of the cases. Relevant epidemiological, clinical and laboratory results were analysed, with focus on the following risk groups: pregnant women and individuals with HIV. A total of 185 cases were diagnosed (90.3 % Plasmodium falciparum). The annual incidence rate was 11.9/100,000 inhabitants/year. The average age was 30.8 years (SD: 14.3). Infections originating in sub-Saharan Africa comprised the 97.6 % of the cases. A total of 85.9 % were Visiting Friends and Relatives. Only a 4.3 % completed adequate prophylaxis. A total of 14.28 % of the fertile women were pregnant, and 8 cases (4.3 %) had HIV. None of them in these special groups completed prophylaxis. The incidence rate in Fuenlabrada is higher than in the rest of Spain, due to the large number of immigrants from endemic areas living in the municipality. However, the results are not representative of all the country. It seems to be reasonable to implement prevention and pre-travel assessment programs to increase chemoprophylaxis. Pregnancy tests and HIV serology should be completed for all patients to improve prophylactic methods.

  14. Imported Fenproporex-based Diet Pills from Brazil: A Report of Two Cases

    PubMed Central

    2008-01-01

    Banned amphetamine-based anorectics are illicitly imported into the United States (US), but little is known regarding the harm these diet pills pose to US residents. A 26-year-old woman using imported diet pills presented with a two-year history of intermittent chest pains, palpitations, headaches and insomnia. Urine toxicology screen detected amphetamines and benzodiazepines. Fenproporex and chlordiazepoxide were detected in her pills. Her symptoms resolved after she stopped using diet pills. A 38-year-old man using imported diet pills presented after his occupational urine screen was significantly positive for amphetamine. Fenproporex and fluoxetine were detected in his pills. These cases illustrate the potential harm from imported prescription diet pills that combine fenproporex with benzodiazepines, antidepressants, diuretics, laxatives and other substances. Increasing physicians’ awareness of imported diet pill use may improve care of patients suffering from the pills’ many adverse effects. PMID:19096898

  15. Status of imported malaria on Réunion Island in 2016.

    PubMed

    Pagès, Frédéric; Houze, Sandrine; Kurtkowiak, Brian; Balleydier, Elsa; Chieze, François; Filleul, Laurent

    2018-05-24

    Autochthonous malaria has been eliminated from Réunion in 1979. To prevent secondary transmission and re-emergence of autochthonous malaria, permanent epidemiologic and entomological surveillance and vector control measures are conducted around imported malaria cases. Results of local malaria surveillance (clinical data and results of epidemiological and entomological investigations around cases) were collected for 2013-2016 and were analysed according to historical data and to the exchanges with malaria-affected areas (estimated by airport data). Form 2013 to 2016, 95 imported malaria cases have been detected in Reunion Island: 42% of cases occurred in the area of repartition of Anopheles arabiensis, but Anopheles mosquitoes were present only around seven cases including one gametocyte carrier. No autochthonous or introduced case has occurred during this period. The lack of chemoprophylaxis or poor adherence was found in the majority (96%) of malaria cases between 2013 and 2016, regardless of trip type. Affinity tourism in Madagascar and Comoros was the cause of 65% of imported malaria cases. The incidence of imported malaria and the incidence rate per 100,000 travellers has continuously decreased since 2001. Now with the drastic decrease of malaria transmission in the Comoros archipelago, most of imported malaria cases in Reunion Island have been contaminated in Madagascar. Immigrants regularly resident in Reunion Island, which travel to malaria endemic countries (mainly Madagascar) to visit their friends and relatives (VFRs) represent a high-risk group of contracting malaria. VFRs, low adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis are the main drivers of imported malaria in Reunion Island. Furthermore as previously described, some general practitioners in Reunion Island are always not sufficiently aware of the official recommendations for prescriptions of prophylactic treatments. Social mobilization

  16. [An imported dengue Fever case in Turkey and review of the literature].

    PubMed

    Uyar, Yavuz; Aktaş, Eray; Yağcı Çağlayık, Dilek; Ergönül, Onder; Yüce, Ayşe

    2013-01-01

    Dengue fever is an acute viral disease that can affect all age groups in tropical and subtropical countries. The predominant vectors are the mosquitoes namely Aedes aegypti and A.albopictus. Although there have been no case reports in Turkey due to DF, there is seroepidemiological evidence indicating the presence of Dengue virus (DENV) in Turkey. In this case report we presented an imported dengue fever case. The patient was 40 years old, previously healthy male, Switzerland citizen. He had immigrated from Dubai to India two weeks ago and after one week from immigration he attended to a hospital in India because of high fever. The NS1 antigen test (Bio-Rad Laboratories, USA) was found positive and the patient was followed-up with diagnosis of dengue fever in India. During his visit to Turkey, he attended to the hospital for a routine control and his analysis revealed thrombocytopenia (PLT: 48.000/µl), leukopenia (white blood cell: 2800/µL) and elevated liver enzymes (AST: 76 U/L, ALT: 83 U/L). Fever was not detected in follow-up. The patient had petechial rash on his lower extremities. white blood cell and PLT count increased to 4100/µl and 93.000/µl, respectively. Liver function tests revealed a decrease in AST (63 U/L) and ALT (78 U/L) on the third day. The PLT count increased to 150.000/ml. Since the patient had no fever and had normal physical and laboratory findings, he was discharged from the hospital. For the confirmation of dengue fever diagnosis the serum sample was sent to National Public Health Center, Virology Reference and Research Laboratory where IgM and IgG antibodies against DENV types 1-4 were investigated by indirect immunofluorescence method (Euroimmun, Germany). The serum sample yielded positive result at the dilutions of 1/1000 for IgM and 1/10.000 for IgG. The last dilution of type 3 DENV IgM and IgG were determined high density of fluorescein, thus the serotype was identified as "DENV type 3". Travel-related diseases become important

  17. End-of-Life Care Decisions: Importance of Reviewing Systems and Limitations After 2 Recent North American Cases

    PubMed Central

    Burkle, Christopher M.; Benson, Jeffre J.

    2012-01-01

    Two recent and unfortunate North American cases involving end-of-life treatment highlight the difficulties surrounding medical futility conflicts. As countries have explored the greater influence that patients and their representatives may play on end-of-life treatment decisions, the benefits and struggles involved with such a movement must be appreciated. These 2 cases are used to examine the present systems existing in the United States and Canada for resolving end-of-life decisions, including the difficulty in defining medical futility, the role of medical ethics committees, and controversies involving surrogate decision making. PMID:23127734

  18. Imported chloroquine-resistant Plasmodium vivax in Singapore: case report and literature review.

    PubMed

    Lim, Poh Lian; Mok, Ying Juan; Lye, David C; Leo, Yee Sin

    2010-01-01

    Chloroquine-resistant Plasmodium vivax (CRPV) infection is emerging as a clinically significant problem. Detailed travel history is crucial to the management of imported malarial cases. We report a 58-year-old business traveler who returned from Indonesia and experienced relapse due to CRPV. The epidemiology and diagnostic challenges of CRPV for travel medicine clinicians are reviewed.

  19. Representing climate change on public service television: A case study.

    PubMed

    Debrett, Mary

    2017-05-01

    Publicly funded broadcasters with a track record in science programming would appear ideally placed to represent climate change to the lay public. Free from the constraints of vested interests and the economic imperative, public service providers are better equipped to represent the scientific, social and economic aspects of climate change than commercial media, where ownership conglomeration, corporate lobbyists and online competition have driven increasingly tabloid coverage with an emphasis on controversy. This prime-time snapshot of the Australian Broadcasting Corporation's main television channel explores how the structural/rhetorical conventions of three established public service genres - a science programme, a documentary and a live public affairs talk show - impact on the representation of anthropogenic climate change. The study findings note implications for public trust, and discuss possibilities for innovation in the interests of better public understanding of climate change.

  20. Characterization of Influenza A (H7N9) Viruses Isolated from Human Cases Imported into Taiwan

    PubMed Central

    Yang, Ji-Rong; Kuo, Chuan-Yi; Huang, Hsiang-Yi; Wu, Fu-Ting; Huang, Yi-Lung; Cheng, Chieh-Yu; Su, Yu-Ting; Wu, Ho-Sheng; Liu, Ming-Tsan

    2015-01-01

    A novel avian influenza A (H7N9) virus causes severe human infections and was first identified in March 2013 in China. The H7N9 virus has exhibited two epidemiological peaks of infection, occurring in week 15 of 2013 and week 5 of 2014. Taiwan, which is geographically adjacent to China, faces a large risk of being affected by this virus. Through extensive surveillance, launched in April 2013, four laboratory-confirmed H7N9 cases imported from China have been identified in Taiwan. The H7N9 virus isolated from imported case 1 in May 2013 (during the first wave) was found to be closest genetically to a virus from wild birds and differed from the prototype virus, A/Anhui/1/2013, in the MP gene. The other three imported cases were detected in December 2013 and April 2014 (during the second wave). The viruses isolated from cases 2 and 4 were similar in the compositions of their 6 internal genes and distinct from A/Anhui/1/2013 in the PB2 and MP genes, whereas the virus isolated from case 3 exhibited a novel reassortment that has not been identified previously and was different from A/Anhui/1/2013 in the PB2, PA and MP genes. The four imported H7N9 viruses share similar antigenicity with A/Anhui/1/2013, and their HA and NA genes grouped together in their respective phylogenies. In contrast with the HA and NA genes, which exhibited a smaller degree of diversity, the internal genes were heterogeneous and provided potential distinctions between transmission sources in terms of both geography and hosts. It is important to strengthen surveillance of influenza and to share viral genetic data in real-time for reducing the threat of rapid and continuing evolution of H7N9 viruses. PMID:25748033

  1. Case studies on employment-related health inequalities in countries representing different types of labor markets.

    PubMed

    Kim, Il-Ho; Muntaner, Carles; Chung, Haejoo; Benach, Joan

    2010-01-01

    The authors selected nine case studies, one country from each cluster of their labor market inequalities typology, to outline the macro-political and economic roots of employment relations and their impacts on health. These countries illustrate variations in labor markets and health, categorized into a global empirical typology. The case studies illustrated that workers' health is significantly connected with labor market characteristics and the welfare system. For a core country, the labor market is characterized by a formal sector. The labor institutions of Sweden traditionally have high union density and collective bargaining coverage and a universal health care system, which correlate closely with positive health, in comparison with Spain and the United States. For a semi-periphery country, the labor market is delineated by a growing informal economy. Although South Korea, Venezuela, and El Salvador provide some social welfare benefits, a high proportion of irregular and informal workers are excluded from these benefits and experience hazardous working conditions that adversely affect their health. Lastly, several countries in the global periphery--China, Nigeria, and Haiti--represent informal work and severe labor market insecurity. In the absence of labor market regulations, the majority of their workers toil in the informal sector in unsafe conditions with inadequate health care.

  2. The Case for Representative Democracy: What Americans Should Know about Their Legislatures.

    ERIC Educational Resources Information Center

    Rosenthal, Alan; Kurtz, Karl T.; Hibbing, John; Loomis, Burdett

    This guide is a revised and adapted version of a previous monograph, "A New Public Perspective on Representative Democracy: A Guide for Legislative Interns." The guide focuses on civic perspective: how citizens view the political institutions, processes, and people that are fundamental to representative democracy in the United States. It…

  3. [Epidemiological analysis of imported cases of dengue fever in Guangdong province and Hong Kong during 2004-2006 in China].

    PubMed

    Yang, Fen; Ma, Shao-Qiang; He, Jian-Feng; Mai, Zhao-Juan; Liang, Wen-Jia; Cai, Min-Xin; Luo, Hui-Ming

    2009-01-01

    To analyze the epidemiological characteristics of imported cases of dengue fever in Guangdong province (GD) and in Hong Kong (HK) during 2004-2006 to provide evidence for further cooperation in the prevention and control programs on dengue fever in the two places. Descriptive statistical analysis was performed on data obtained from dengue fever surveillance and reporting network in GD and from Centre for Health Protection, Department of Health, HK. Both from GD and HK 44 and 93 imported cases of Dengue fever were reported during 2004-2006. Most patients from GD acquired their infection from Singapore (13 cases), Indonesia (9 cases) or Cambodia (6 cases) while patients in HK mainly were imported from Indonesia (31 cases), the Philippines (16 cases) and Thailand (15 cases). The peak seasons of the two places were both from July to September. During the non-peak season period, the number of cases in Hong Kong was higher than that in Guangdong. Male/ female ratio was 1.2:1 in GD and 1.1:1 in HK. Age of patients in GD appeared to range from 6-80 years, with 63.6% (28/44) of them aged 20-39 years. 40.9% (18/44) of the cases were engaged in business, services, housework or unemployed. Those cases in HK were between 10-72 years of age, with 63.6% (28/ 44) of them aged 20-39 years while 47.3% (44/93) of the patients were with the occupation of business, services and industry. More cases in GD had a onset of disease before entering the border (27:17) than the cases in HK (35:57). The average time interval between onset and diagnosis were 7 and 9 days for GD and HK respectively. Frequent travel between Southeast Asia in summer among the working class appeared to be the main factor, causing imported cases of dengue fever in GD and HK. It is crucial to provide health education targeted at these high risk groups in order to prevent importation of dengue fever in the two areas.

  4. The interplay of climate, intervention and imported cases as determinants of the 2014 dengue outbreak in Guangzhou.

    PubMed

    Cheng, Qu; Jing, Qinlong; Spear, Robert C; Marshall, John M; Yang, Zhicong; Gong, Peng

    2017-06-01

    Dengue is a fast spreading mosquito-borne disease that affects more than half of the population worldwide. An unprecedented outbreak happened in Guangzhou, China in 2014, which contributed 52 percent of all dengue cases that occurred in mainland China between 1990 and 2015. Our previous analysis, based on a deterministic model, concluded that the early timing of the first imported case that triggered local transmission and the excessive rainfall thereafter were the most important determinants of the large final epidemic size in 2014. However, the deterministic model did not allow us to explore the driving force of the early local transmission. Here, we expand the model to include stochastic elements and calculate the successful invasion rate of cases that entered Guangzhou at different times under different climate and intervention scenarios. The conclusion is that the higher number of imported cases in May and June was responsible for the early outbreak instead of climate. Although the excessive rainfall in 2014 did increase the success rate, this effect was offset by the low initial water level caused by interventions in late 2013. The success rate is strongly dependent on mosquito abundance during the recovery period of the imported case, since the first step of a successful invasion is infecting at least one local mosquito. The average final epidemic size of successful invasion decreases exponentially with introduction time, which means if an imported case in early summer initiates the infection process, the final number infected can be extremely large. Therefore, dengue outbreaks occurring in Thailand, Singapore, Malaysia and Vietnam in early summer merit greater attention, since the travel volumes between Guangzhou and these countries are large. As the climate changes, destroying mosquito breeding sites in Guangzhou can mitigate the detrimental effects of the probable increase in rainfall in spring and summer.

  5. The interplay of climate, intervention and imported cases as determinants of the 2014 dengue outbreak in Guangzhou

    PubMed Central

    Spear, Robert C.; Marshall, John M.; Yang, Zhicong

    2017-01-01

    Dengue is a fast spreading mosquito-borne disease that affects more than half of the population worldwide. An unprecedented outbreak happened in Guangzhou, China in 2014, which contributed 52 percent of all dengue cases that occurred in mainland China between 1990 and 2015. Our previous analysis, based on a deterministic model, concluded that the early timing of the first imported case that triggered local transmission and the excessive rainfall thereafter were the most important determinants of the large final epidemic size in 2014. However, the deterministic model did not allow us to explore the driving force of the early local transmission. Here, we expand the model to include stochastic elements and calculate the successful invasion rate of cases that entered Guangzhou at different times under different climate and intervention scenarios. The conclusion is that the higher number of imported cases in May and June was responsible for the early outbreak instead of climate. Although the excessive rainfall in 2014 did increase the success rate, this effect was offset by the low initial water level caused by interventions in late 2013. The success rate is strongly dependent on mosquito abundance during the recovery period of the imported case, since the first step of a successful invasion is infecting at least one local mosquito. The average final epidemic size of successful invasion decreases exponentially with introduction time, which means if an imported case in early summer initiates the infection process, the final number infected can be extremely large. Therefore, dengue outbreaks occurring in Thailand, Singapore, Malaysia and Vietnam in early summer merit greater attention, since the travel volumes between Guangzhou and these countries are large. As the climate changes, destroying mosquito breeding sites in Guangzhou can mitigate the detrimental effects of the probable increase in rainfall in spring and summer. PMID:28640895

  6. Atypical P. vivax and P. ovale morphology in two imported cases of malaria in Spain.

    PubMed

    Vasallo Matilla, F; Perez Santos, M J; Ortega Moreno, E; Ortega Torres, M G; Diaz Molina, M; de Zulueta, J

    1997-03-01

    The finding of two imported cases of malaria in Spain is reported. Although their origin, their age and their clinical history were different, they both showed parasites of atypical morphology. One was diagnosed as P. vivax and the other as P. ovale, but the morphology observed in both cases does not correspond to what is considered as normal in the two species. In the first case forms similar to those of P. ovale were observed and in the second case P. vivax-like forms. The findings reported confirm the overlapping morphological variability of the two species.

  7. Does routinely collected patient-reported outcome data represent the actual case-mix of elective coronary revascularization patients?

    PubMed

    Oinasmaa, Salla; Heiskanen, Jari; Hartikainen, Juha; Hippeläinen, Mikko; Miettinen, Heikki; Martikainen, Janne; Roine, Risto P; Tolppanen, Anna-Maija

    2018-04-01

    Patient-reported outcomes (PROs) are valuable for effectiveness evaluation, but it is unknown whether the patient views obtained represent the actual case mix. We studied the representativeness of the responses obtained to a routinely administered health-related quality of life (HRQoL) questionnaire in a cardiology unit. Elective coronary artery bypass grafting (CABG; n = 404) and percutaneous coronary intervention (PCI; n = 738) patients operated during June 2012 to August 2014 in the Heart Center, Kuopio University Hospital. The characteristics of the patients with a baseline (n = 260 and 290 for CABG and PCI, respectively) or both baseline and follow-up HRQoL measurements (n = 203 and 189 for CABG and PCI, respectively) were compared with those who did not respond (n = 144 and 448 for CABG and PCI). Baseline questionnaires were less likely obtained from older CABG patients (odds ratio 0.51, 95% confidence interval 0.28-0.91) and those with more severe disease (0.20, 0.05-0.79). Among PCI patients, women (0.64, 0.45-0.91), smokers (0.74, 0.53-1.04), and those with more severe disease (0.26, 0.13-0.52) or more hospital days were underrepresented. Routinely collected PROs in cardiac patients may be biased towards younger and healthier patients. This needs to be recognized when evaluating the representativeness of such data. The routine collection of these data should be adequately resourced.

  8. The importance of work or productive activity in life care planning and case management.

    PubMed

    Reid, Christine; Riddick-Grisham, Susan

    2015-01-01

    The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities.

  9. Adaptive Importance Sampling for Control and Inference

    NASA Astrophysics Data System (ADS)

    Kappen, H. J.; Ruiz, H. C.

    2016-03-01

    Path integral (PI) control problems are a restricted class of non-linear control problems that can be solved formally as a Feynman-Kac PI and can be estimated using Monte Carlo sampling. In this contribution we review PI control theory in the finite horizon case. We subsequently focus on the problem how to compute and represent control solutions. We review the most commonly used methods in robotics and control. Within the PI theory, the question of how to compute becomes the question of importance sampling. Efficient importance samplers are state feedback controllers and the use of these requires an efficient representation. Learning and representing effective state-feedback controllers for non-linear stochastic control problems is a very challenging, and largely unsolved, problem. We show how to learn and represent such controllers using ideas from the cross entropy method. We derive a gradient descent method that allows to learn feed-back controllers using an arbitrary parametrisation. We refer to this method as the path integral cross entropy method or PICE. We illustrate this method for some simple examples. The PI control methods can be used to estimate the posterior distribution in latent state models. In neuroscience these problems arise when estimating connectivity from neural recording data using EM. We demonstrate the PI control method as an accurate alternative to particle filtering.

  10. Representing motion in a static image: constraints and parallels in art, science, and popular culture.

    PubMed

    Cutting, James E

    2002-01-01

    Representing motion in a picture is a challenge to artists, scientists, and all other imagemakers. Moreover, it presents a problem that will not go away with electronic and digital media, because often the pedagogical purpose of the representation of motion is more important than the motion itself. All satisfactory solutions evoke motion-for example, dynamic balance (or broken symmetry), stroboscopic sequences, affine shear (or forward lean), and photographic blur-but they also typically sacrifice the accuracy of the motion represented, a solution often unsuitable for science. Vector representations superimposed on static images allow for accuracy, but are not applicable to all situations. Workable solutions are almost certainly case specific and subject to continual evolution through exploration by imagemakers.

  11. A local outbreak of dengue caused by an imported case in Dongguan China

    PubMed Central

    2012-01-01

    Background Dengue, a mosquito-borne febrile viral disease, is found in tropical and sub-tropical regions around the world. Since the first occurrence of dengue was confirmed in Guangdong, China in 1978, dengue outbreaks have been reported sequentially in different provinces in South China transmitted by.peridomestic Ae. albopictus mosquitoes, diplaying Ae. aegypti, a fully domestic vector that transmits dengue worldwide. Rapid and uncontrolled urbanization is a characteristic change in developing countries, which impacts greatly on vector habitat, human lifestyle and transmission dynamics on dengue epidemics. In September 2010, an outbreak of dengue was detected in Dongguan, a city in Guangdong province characterized by its fast urbanization. An investigation was initiated to identify the cause, to describe the epidemical characteristics of the outbreak, and to implement control measures to stop the outbreak. This is the first report of dengue outbreak in Dongguan, even though dengue cases were documented before in this city. Methods Epidemiological data were obtained from local Center of Disease Control and prevention (CDC). Laboratory tests such as real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR), the virus cDNA sequencing, and Enzyme-Linked immunosorbent assay (ELISA) were employed to identify the virus infection and molecular phylogenetic analysis was performed with MEGA5. The febrile cases were reported every day by the fever surveillance system. Vector control measures including insecticidal fogging and elimination of habitats of Ae. albopictus were used to control the dengue outbreak. Results The epidemiological studies results showed that this dengue outbreak was initiated by an imported case from Southeast Asia. The outbreak was characterized by 31 cases reported with an attack rate of 50.63 out of a population of 100,000. Ae. albopictus was the only vector species responsible for the outbreak. The virus cDNA sequencing analysis showed

  12. Imported Chikungunya fever case in Greece in June 2014 and public health response

    PubMed Central

    Pervanidou, Danai; Papadopoulou, Elpida; Kavatha, Dimitra; Baka, Agoritsa; Koliopoulos, George; Badieritakis, Evangelos; Michaelakis, Antonios; Gavana, Elpida; Patsoula, Eleni; Tsimpos, Ioannis; Gioksari, Thalia; Kyriazopoulou, Evdoxia; Vakali, Annita; Pavli, Androula; Maltezou, Helena C.; Georgakopoulou, Theano; Hadjichristodoulou, Christos; Kremastinou, Jenny; Papa, Anna

    2016-01-01

    We report about the first imported case of Chikungunya fever in Greece in a Greek traveler returning from the Dominican Republic and the associated public health response. We investigated the case and performed focused epidemiological and entomological investigation in all areas the patient visited during the infectious period, to identify the targeted interventions needed. Entomological investigation revealed the occurrence of the competent vector Aedes albopictus (Diptera: Culicidae) in the environment surrounding the hospital where the patient was admitted and in her workplace. All captured mosquitoes tested negative for Chikungunya virus. We further conducted clinical and laboratory examination of the patient’s co-travelers, gave advice on appropriate personal preventive measures against mosquito bites to the patient and co-travelers and on vector control, and raised awareness among health professionals throughout Greece. The risk of introduction and local transmission of Chikungunya and other arboviruses in Greece and other European countries is present, as the competent vector exists in many parts of Europe. Public health professionals, travel medicine specialists and clinicians should maintain awareness regarding this possibility of importation of arbovirus cases in order to provide the appropriate advice, seek the prompt diagnosis, and implement appropriate interventions. Mobilization of various stakeholders will lead to enhanced epidemiological and entomological surveillance that will allow for improved risk assessment in each area. PMID:27159571

  13. The importance of work or productive activity in life care planning and case management

    PubMed Central

    Reid, Christine; Riddick-Grisham, Susan

    2015-01-01

    Abstract INTRODUCTION: The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. BACKGROUND: The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. PURPOSE: The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. CONCLUSION: Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities. PMID:26409330

  14. Representativeness of Tuberculosis Genotyping Surveillance in the United States, 2009-2010.

    PubMed

    Shak, Emma B; France, Anne Marie; Cowan, Lauren; Starks, Angela M; Grant, Juliana

    2015-01-01

    Genotyping of Mycobacterium tuberculosis isolates contributes to tuberculosis (TB) control through detection of possible outbreaks. However, 20% of U.S. cases do not have an isolate for testing, and 10% of cases with isolates do not have a genotype reported. TB outbreaks in populations with incomplete genotyping data might be missed by genotyping-based outbreak detection. Therefore, we assessed the representativeness of TB genotyping data by comparing characteristics of cases reported during January 1, 2009-December 31, 2010, that had a genotype result with those cases that did not. Of 22,476 cases, 14,922 (66%) had a genotype result. Cases without genotype results were more likely to be patients <19 years of age, with unknown HIV status, of female sex, U.S.-born, and with no recent history of homelessness or substance abuse. Although cases with a genotype result are largely representative of all reported U.S. TB cases, outbreak detection methods that rely solely on genotyping data may underestimate TB transmission among certain groups.

  15. Diagnostic challenges and case management of the first imported case of Plasmodium knowlesi in Sri Lanka.

    PubMed

    Dewanee Ranaweera, A; Danansuriya, Manjula N; Pahalagedera, Kusumawathie; de A W Gunasekera, W M Kumudunayana T; Dharmawardena, Priyani; Mak, Keng Wai; Wong, Pei-Sze Jeslyn; Li, Mei-Zhi Irene; Tan, Cheong Huat; Hapuarachchi, Hapuarachchige C; Herath, Hema D B; Fernando, Deepika

    2017-03-21

    Sri Lanka has achieved 'malaria-free' status and is now in the phase of prevention of re-introduction of malaria. Imported malaria remains a challenge to resurgence of the disease. The diagnostic challenges encountered and the rapid response initiated to manage a Plasmodium infection, which was later confirmed as Plasmodium knowlesi, the first reported case from Sri Lanka, is discussed. An army officer who returned from Malaysia in October 2016 was found to be positive for Plasmodium both by microscopy and rapid diagnostic test (RDT) by the Anti Malaria Campaign Sri Lanka (AMC) during his third visit to a health care provider. Microscopy findings were suspicious of P. knowlesi infection as the smears showed parasite stages similar to both Plasmodium malariae and Plasmodium falciparum. Nested PCR at AMC confirmed Plasmodium genus, but not the species. In the absence of species confirmation, the patient was treated as a case of P. falciparum. The presence of P. knowlesi was later confirmed by a semi-nested PCR assay performed at the Environmental Health Institute, National Environmental Agency in Singapore. The parasite strain was also characterized by sequencing the circumsporozoite gene. Extensive case investigation including parasitological and entomological surveillance was carried out. Plasmodium knowlesi should be suspected in patients returning from countries in the South Asian region where the parasite is prevalent and when blood smear results are inconclusive.

  16. Twenty-four cases of imported zika virus infections diagnosed by molecular methods.

    PubMed

    Alejo-Cancho, Izaskun; Torner, Nuria; Oliveira, Inés; Martínez, Ana; Muñoz, José; Jane, Mireia; Gascón, Joaquim; Requena-Méndez, Ana; Vilella, Anna; Marcos, M Ángeles; Pinazo, María Jesús; Gonzalo, Verónica; Rodriguez, Natalia; Martínez, Miguel J

    2016-10-01

    Zika virus is an emerging flavivirus widely spreading through Latin America. Molecular diagnosis of the infection can be performed using serum, urine and saliva samples, although a well-defined diagnostic algorithm is not yet established. We describe a series of 24 cases of imported zika virus infection into Catalonia (northeastern Spain). Based on our findings, testing of paired serum and urine samples is recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The Plasmodium vivax in China: decreased in local cases but increased imported cases from Southeast Asia and Africa.

    PubMed

    Feng, Jun; Xiao, Huihui; Zhang, Li; Yan, He; Feng, Xinyu; Fang, Wen; Xia, Zhigui

    2015-03-05

    Currently the local P. vivax was sharply decreased while the imported vivax malaria increased in China. Despite Southeast Asia was still the main import source of vivax malaria, the trend of Africa become serious, especially for west and central Africa. Herein we have clarified the trend of P. vivax in China from 2004-2012, and made some analysis for the differences of imported vivax back from different regions. There are significantly different of P. vivax between Southeast Asia and Africa, also the difference was observed for different regions in Africa. Additionally, we have explored the possibility for the difference of the P. vivax between migrant workers back from west and central Africa and the prevalence of local population. This reminds us that surveillance and training should be strengthened by medical staffs on the imported P. vivax cases reported especially from west and central Africa, in order to reduce the risk of malaria reintroduction and, specific tools should be developed, as well as the epidemiological study to avoid the misdiagnosis such as P. ovale and P. vivax.

  18. Determination Plastic Properties of a Material by Spherical Indentation Base on the Representative Stress Approach

    NASA Astrophysics Data System (ADS)

    Budiarsa, I. N.; Gde Antara, I. N.; Dharma, Agus; Karnata, I. N.

    2018-04-01

    Under an indentation, the material undergoes a complex deformation. One of the most effective ways to analyse indentation has been the representative method. The concept coupled with finite element (FE) modelling has been used successfully in analysing sharp indenters. It is of great importance to extend this method to spherical indentation and associated hardness system. One particular case is the Rockwell B test, where the hardness is determined by two points on the P-h curve of a spherical indenter. In this case, an established link between materials parameters and P-h curves can naturally lead to direct hardness estimation from the materials parameters (e.g. yield stress (y) and work hardening coefficients (n)). This could provide a useful tool for both research and industrial applications. Two method to predict p-h curve in spherical indentation has been established. One is use method using C1-C2 polynomial equation approach and another one by depth approach. Both approach has been successfully. An effective method in representing the P-h curves using a normalized representative stress concept was established. The concept and methodology developed is used to predict hardness (HRB) values of materials through direct analysis and validated with experimental data on selected samples of steel.

  19. Importation of dengue by soldiers returning from East Timor to north Queensland, Australia.

    PubMed

    Kitchener, Scott; Leggat, Peter A; Brennan, Leonard; McCall, Bradley

    2002-01-01

    Soldiers based in Townsville, Australia, returned from East Timor following peacekeeping operations during the wet season of 1999 to 2000. This represented the potential to import dengue virus into north Queensland, a dengue receptive area of Australia. This article seeks to outline the measures taken by the Australian Defence Force (ADF) to prevent local transmission and to present the outcomes. Soldiers returning to north Queensland were provided with education on dengue fever and in the fortnight before return, their living areas were subjected to intensive vector control measures, in order to reduce the risk of acquisition of dengue. They were further encouraged to present early with any febrile illness following their return to Townsville. Provisionally diagnosed dengue cases were notified to the state public health authorities immediately and cases were isolated until suitable vector control programs were implemented or the potentially viremic period exceeded. Serologic and virologic investigations were undertaken to identify the passage and probable serotype or confirm the presence and serotype of dengue virus. Nine serologically confirmed cases of dengue were identified as viremic in north Queensland. Six cases were identified as arising from dengue serotype 2, two were from serotype 3, and one case was ill defined. No dengue cases have been reported in the local population 4 months following these ADF cases. Local outbreaks of dengue fever have occurred in north Queensland following the importation of dengue virus in returned travelers. The successful prevention of local transmission in these circumstances was contributed to by early notification of cases and prevention of transmission through isolation of cases and collaboration between ADF and state and local public health authorities in vector control. The management of potentially viremic returning service personnel represents a future challenge for the ADF.

  20. Rethinking sources of representative controls for the conduct of case-control studies in minority populations.

    PubMed

    Bandera, Elisa V; Chandran, Urmila; Zirpoli, Gary; McCann, Susan E; Ciupak, Gregory; Ambrosone, Christine B

    2013-05-31

    Recruitment of controls remains a challenge in case-control studies and particularly in studies involving minority populations. We compared characteristics of controls recruited through random digit dialing (RDD) to those of community controls enrolled through churches, health events and other outreach sources among women of African ancestry (AA) participating in the Women's Circle of Health Study, a case-control study of breast cancer. Odds ratios and 95% confidence intervals were also computed using unconditional logistic regression to evaluate the impact of including the community controls for selected variables relevant to breast cancer and for which there were significant differences in distribution between the two control groups. Compared to community controls (n=347), RDD controls (n=207) had more years of education and higher income, lower body mass index, were more likely to have private insurance, and less likely to be single. While the percentage of nulliparous women in the two groups was similar, community controls tended to have more children, have their first child at a younger age, and were less likely to breastfeed their children. Dietary intake was similar in the two groups. Compared to census data, the combination of RDD and community controls seems to be more representative of the general population than RDD controls alone. Furthermore, the inclusion of the community group had little impact on the magnitude of risk estimates for most variables, while enhancing statistical power. Community-based recruitment was found to be an efficient and feasible method to recruit AA controls.

  1. Application of the dengue virus NS1 antigen rapid test for on-site detection of imported dengue cases at airports.

    PubMed

    Shu, Pei-Yun; Yang, Cheng-Fen; Kao, Jeng-Fong; Su, Chien-Ling; Chang, Shu-Fen; Lin, Chien-Chou; Yang, Wen-Chih; Shih, Hsiu; Yang, Shih-Yan; Wu, Ping-Fuai; Wu, Ho-Sheng; Huang, Jyh-Hsiung

    2009-04-01

    We used the dengue virus NS1 antigen (Ag) rapid test for on-site detection of imported dengue cases at airports. Among 22 positive cases of dengue identified from 850 patients with a fever suspected to have dengue, 17 were NS1 Ag test positive. These findings demonstrate the usefulness of the NS1 Ag rapid test in screening imported dengue cases at airports.

  2. Application of the Dengue Virus NS1 Antigen Rapid Test for On-Site Detection of Imported Dengue Cases at Airports▿

    PubMed Central

    Shu, Pei-Yun; Yang, Cheng-Fen; Kao, Jeng-Fong; Su, Chien-Ling; Chang, Shu-Fen; Lin, Chien-Chou; Yang, Wen-Chih; Shih, Hsiu; Yang, Shih-Yan; Wu, Ping-Fuai; Wu, Ho-Sheng; Huang, Jyh-Hsiung

    2009-01-01

    We used the dengue virus NS1 antigen (Ag) rapid test for on-site detection of imported dengue cases at airports. Among 22 positive cases of dengue identified from 850 patients with a fever suspected to have dengue, 17 were NS1 Ag test positive. These findings demonstrate the usefulness of the NS1 Ag rapid test in screening imported dengue cases at airports. PMID:19193828

  3. [Iditification of five imported cases of Plasmodium ovale wallikeri infection in Zhejiang Province].

    PubMed

    Zhang, Ling-ling; Ruan, Wei; Chen, Hua-liang; Lu, Qiao-yi; Yao, Li-nong

    2014-10-01

    To identify and analyze Plasmodium ovale wallikeri in 5 imported malaria cases, who were detected positive by microscopy and negative by conventional PCR. Epidemiological information and blood samples were collected from the five patients. The detection was conducted by microscopy, Rapid Diagnostic Test (RDT) and nested PCR with Plasmodium genus-specific, species-specific and Plasmodium ovale wallikeri-specific primers. The amplified products were sequenced and Blast analysis was performed on line in NCBI. The five patients returned from Africa, and all had a history of malaria. They were microscopically positive for Plasmodium sp., and two cases showed Pan positive RDT result. All blood samples were negative for four Plasmodium spp. by conventional nested PCR, but positive by nested PCR with Plasmodium ovale wallikeri-specific primers. Blast analysis showed that the amplified sequences of the five cases had complete homology with P. ovale wallikeri clone RSH10 18S ribosomal RNA gene (Accession No. KF219561.1). The five cases which classified as positive by microscopy while negative by conventional PCR have been confirmed as Plasmodium ovale wallikeri infection by nested PCR with P. ovale wallikeri-specific primers.

  4. Analysis and Visualization of Internet QA Bulletin Boards Represented as Heterogeneous Networks

    NASA Astrophysics Data System (ADS)

    Murata, Tsuyoshi; Ikeya, Tomoyuki

    Visualizing and analyzing social interactions of CGM (Consumer Generated Media) are important for understanding overall activities on the internet. Social interactions are often represented as simple networks that are composed of homogeneous nodes and edges between them. However, related entities in real world are often not homogeneous. Such relations are naturally represented as heterogeneous networks composed of more than one kind of nodes and edges connecting them. In the case of CGM, for example, users and their contents constitute nodes of heterogeneous networks. There are related users (user communities) and related contents (contents communities) in the heterogeneous networks. Discovering both communities and finding correspondence among them will clarify the characteristics of the communites. This paper describes an attempt for visualizing and analyzing social interactions of Yahoo! Chiebukuro (Japanese Yahoo! Answers). New criteria for measuring correspondence between user communities and board communites are defined, and characteristics of both communities are analyzed using the criteria.

  5. Dengue epidemiological trend in Oman: a 13-year national surveillance and strategic proposition of imported cases.

    PubMed

    Al Awaidy, Salah Thabit; Al Obeidani, Idris; Bawikar, Shyam; Al Mahrouqi, Salim; Al Busaidy, Suleiman Salim; Al Baqlani, Said; Patel, Prakash K

    2014-10-01

    Dengue fever has emerged as a major public health problem globally in the past three decades. A 13-year national surveillance data analysis was done to describe the epidemiology and its trend of dengue disease in Oman reported between 2001 and 2013. Laboratory-confirmed dengue virus infections reported were studied retrospectively during the study period. A total of 64 laboratory confirmed cases were reported. All the patients contracted the disease during their visit to South-East Asian countries, hence classified as imported cases. The majority of the cases were reported in the year 2012 (23.4%). The most important clinical characteristics were fever (90.6%), myalgia (35.9%) and rash/petechial rash (20.3%). Thrombocytopenia was seen in 31.2% of the study subjects. The mortality was nearly 4.6% and all other patients made a full recovery. The most effective measure for travellers is taking precautions to avoid mosquito bites. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  6. Is perception of quality more important than technical quality in patient video cases?

    PubMed

    Roland, Damian; Matheson, David; Taub, Nick; Coats, Tim; Lakhanpaul, Monica

    2015-08-13

    The use of video cases to demonstrate key signs and symptoms in patients (patient video cases or PVCs) is a rapidly expanding field. The aims of this study were to evaluate whether the technical quality, or judgement of quality, of a video clip influences a paediatrician's judgment on acuity of the case and assess the relationship between perception of quality and the technical quality of a selection of video clips. Participants (12 senior consultant paediatricians attending an examination workshop) individually categorised 28 PVCs into one of 3 possible acuities and then described the quality of the image seen. The PVCs had been converted into four different technical qualities (differing bit rates ranging from excellent to low quality). Participants' assessment of quality and the actual industry standard of the PVC were independent (333 distinct observations, spearmans rho = 0.0410, p = 0.4564). Agreement between actual acuity and participants' judgement was generally good at higher acuities but moderate at medium/low acuities of illness (overall correlation 0.664). Perception of the quality of the clip was related to correct assignment of acuity regardless of the technical quality of the clip (number of obs = 330, z = 2.07, p = 0.038). It is important to benchmark PVCs prior to use in learning resources as experts may not agree on the information within, or quality of, the clip. It appears, although PVCs may be beneficial in a pedagogical context, the perception of quality of clip may be an important determinant of an expert's decision making.

  7. [Clinical microbiology laboratory and imported parasitic diseases].

    PubMed

    Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen

    2010-12-01

    Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  8. Dermatological manifestations in onchocerciasis: A retrospective study of 400 imported cases.

    PubMed

    Puente, Sabino; Ramirez-Olivencia, German; Lago, Mar; Subirats, Mercedes; Perez-Blazquez, Eugenio; Bru, Fernando; Garate, Teresa; Vicente, Belén; Belhassen-Garcia, Moncef; Muro, Antonio

    2017-12-20

    Onchocerciasis is caused by Onchocerca volvulus and mainly leads to pruritus and skin and visual disorders, including blindness. Seventeen million people are infected in 38 countries; 31 of these are in sub-Saharan Africa, six in Latin America and one on the Arabian Peninsula. More than 99% of cases occur in sub-Saharan Africa where 120 million people are at risk of infection. Eye disorders have been well-documented; however, skin disorders have not been described accurately. The objective of our study was to describe the epidemiology, main skin manifestations and treatment of imported onchocerciasis. A retrospective study was thus conducted by analysing the main demographic, clinical and treatment data regarding a cohort of 400 patients attending a reference clinical unit over a 17-year period. Most patients were female (55%) with mean age 37.5±16.7 years. All the migrants came from sub-Saharan countries. The most frequently occurring dermatological symptom was pruritus. Ivermectin had been used as first-line therapy and adverse reactions had been described in 11 patients (3.2%). The results indicate the fact that there should be a clinical suspicion of onchocerciasis regarding immigrants from endemic areas having skin lesions compatible with the disease's profile or asymptomatic patients having eosinophilia or unexplained high IgE. Moreover, skin snips from the buttocks region were very fruitful and treatment with ivermectin was seen to be safe. This is the largest case series regarding imported onchocerciasis described up to the present time. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  9. Classic cases revisited: Mrs Janet Tracey, resuscitation and the importance of good communication.

    PubMed

    Szawarski, Piotr

    2015-05-01

    The prevalence of inappropriate care, defined as actions contrary to personal and professional beliefs, is high. This is a reflection of the reluctance of the society at large to acknowledge the biological certainty that is death. The case of Mrs Janet Tracey illustrates importance of good communication at the end of life, and the difficulties associated with making of DNACPR decisions. The case brings together two bioethical perspectives on the relationship between the patient and the physician namely the rights based approach, as emphasised by the Article 8 of the European Convention on Human Rights and the bioethical principles approach ephasising autonomy. In doing so it creates a medico-legal landmark for all those involved in management of the end of life.

  10. Zika virus infection: report of the first imported cases in a Paris travel centre.

    PubMed

    Sokal, Aurélien; D'Ortenzio, Eric; Houhou-Fidouh, Nadira; Brichler, Ségolène; Dorchies, Justine; Cabras, Ornella; Leparc-Goffart, Isabelle; Yazdanpanah, Yazdan; Matheron, Sophie

    2016-07-01

    We describe characteristics of 17 patients with a Zika virus (ZIKV) infection seen in a Travel Center in Paris during the 4 months following the WHO alert on ZIKV. Sixteen were imported cases, including 13 from the Caribbean. One was a women living in Paris infected through sexual transmission. One case was a pregnant woman. All cases were symptomatic with fever, fatigue and cutaneous rash in 15/17, 13/17, and 16/17, respectively. Leucopenia was observed in 6/17, thrombopenia in 2/17. Diagnosis was confirmed by ZIKV RT-PCR (plasma: 12/17; urine 15/17) or detection of ZIKV IgM (2/17). Two patients were hospitalized but all evolved well. © International Society of Travel Medicine, 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  11. Climate and the Timing of Imported Cases as Determinants of the Dengue Outbreak in Guangzhou, 2014: Evidence from a Mathematical Model

    PubMed Central

    Spear, Robert C.; Marshall, John M.; Yang, Zhicong; Gong, Peng

    2016-01-01

    As the world’s fastest spreading vector-borne disease, dengue was estimated to infect more than 390 million people in 2010, a 30-fold increase in the past half century. Although considered to be a non-endemic country, mainland China had 55,114 reported dengue cases from 2005 to 2014, of which 47,056 occurred in 2014. Furthermore, 94% of the indigenous cases in this time period were reported in Guangdong Province, 83% of which were in Guangzhou City. In order to determine the possible determinants of the unprecedented outbreak in 2014, a population-based deterministic model was developed to describe dengue transmission dynamics in Guangzhou. Regional sensitivity analysis (RSA) was adopted to calibrate the model and entomological surveillance data was used to validate the mosquito submodel. Different scenarios were created to investigate the roles of the timing of an imported case, climate, vertical transmission from mosquitoes to their offspring, and intervention. The results suggested that an early imported case was the most important factor in determining the 2014 outbreak characteristics. Precipitation and temperature can also change the transmission dynamics. Extraordinary high precipitation in May and August, 2014 appears to have increased vector abundance. Considering the relatively small number of cases in 2013, the effect of vertical transmission was less important. The earlier and more frequent intervention in 2014 also appeared to be effective. If the intervention in 2014 was the same as that in 2013, the outbreak size may have been over an order of magnitude higher than the observed number of new cases in 2014.The early date of the first imported and locally transmitted case was largely responsible for the outbreak in 2014, but it was influenced by intervention, climate and vertical transmission. Early detection and response to imported cases in the spring and early summer is crucial to avoid large outbreaks in the future. PMID:26863623

  12. Late post-treatment radiographic changes 3 years following chemoradiation for glioma: the importance of histopathology.

    PubMed

    Galante, Joao R; Rodriguez, Fausto; Grossman, Stuart A; Strowd, Roy E

    2017-07-18

    Treatment-related changes can mimic brain tumor progression both clinically and radiographically. Distinguishing these two entities represents a major challenge in neuro-oncology. No single imaging modality is capable of reliably achieving such distinction. While histopathology remains the gold standard, definitive pathological criteria are also lacking which can further complicate such cases. We report a patient with high-grade glioma who, after initially presenting with histopathologically confirmed pseudoprogression 10 months following treatment, re-presented 3 years following concurrent chemoradiation with clinical and radiographic changes that were most consistent with progressive disease but for which histopathology revealed treatment effects without active glioma. This case highlights the potential late onset of treatment-related changes and underscores the importance of histopathologic assessment even years following initial therapy.

  13. Estimation of the incubation period of influenza A (H1N1-2009) among imported cases: addressing censoring using outbreak data at the origin of importation.

    PubMed

    Nishiura, Hiroshi; Inaba, Hisashi

    2011-03-07

    Empirical estimates of the incubation period of influenza A (H1N1-2009) have been limited. We estimated the incubation period among confirmed imported cases who traveled to Japan from Hawaii during the early phase of the 2009 pandemic (n=72). We addressed censoring and employed an infection-age structured argument to explicitly model the daily frequency of illness onset after departure. We assumed uniform and exponential distributions for the frequency of exposure in Hawaii, and the hazard rate of infection for the latter assumption was retrieved, in Hawaii, from local outbreak data. The maximum likelihood estimates of the median incubation period range from 1.43 to 1.64 days according to different modeling assumptions, consistent with a published estimate based on a New York school outbreak. The likelihood values of the different modeling assumptions do not differ greatly from each other, although models with the exponential assumption yield slightly shorter incubation periods than those with the uniform exposure assumption. Differences between our proposed approach and a published method for doubly interval-censored analysis highlight the importance of accounting for the dependence of the frequency of exposure on the survival function of incubating individuals among imported cases. A truncation of the density function of the incubation period due to an absence of illness onset during the exposure period also needs to be considered. When the data generating process is similar to that among imported cases, and when the incubation period is close to or shorter than the length of exposure, accounting for these aspects is critical for long exposure times. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. Representativeness of Tuberculosis Genotyping Surveillance in the United States, 2009–2010

    PubMed Central

    Shak, Emma B.; Cowan, Lauren; Starks, Angela M.; Grant, Juliana

    2015-01-01

    Genotyping of Mycobacterium tuberculosis isolates contributes to tuberculosis (TB) control through detection of possible outbreaks. However, 20% of U.S. cases do not have an isolate for testing, and 10% of cases with isolates do not have a genotype reported. TB outbreaks in populations with incomplete genotyping data might be missed by genotyping-based outbreak detection. Therefore, we assessed the representativeness of TB genotyping data by comparing characteristics of cases reported during January 1, 2009–December 31, 2010, that had a genotype result with those cases that did not. Of 22,476 cases, 14,922 (66%) had a genotype result. Cases without genotype results were more likely to be patients <19 years of age, with unknown HIV status, of female sex, U.S.-born, and with no recent history of homelessness or substance abuse. Although cases with a genotype result are largely representative of all reported U.S. TB cases, outbreak detection methods that rely solely on genotyping data may underestimate TB transmission among certain groups. PMID:26556930

  15. [Methodology of psychiatric case histories].

    PubMed

    Scherbaum, N; Mirzaian, E

    1999-05-01

    This paper deals with the methodology of psychiatric case histories. Three types of case histories are differentiated. The didactic case history teaches about the typical aspects of a psychiatric disorder or treatment by using an individual patient as an example. In the heuristic case history the individual case gives rise to challenging established concepts or to generate new hypotheses. Such hypotheses drawn from inductive reasoning have then to be tested using representative samples. The focus of hermeneutic case histories is the significance of pathological behaviour and experience in the context of the biography of an individual patient. So-called psychopathographies of important historical figures can also be differentiated according to these types. Based on these methodological considerations, quality standards for the named types of case histories are stated.

  16. Revisiting the Importance of Knowledge: From Namibia, a Case for Promoting Knowledge by Campaigns to Reduce Stigma

    ERIC Educational Resources Information Center

    Chung, Adrienne H.; Rimal, Rajiv N.

    2015-01-01

    Reducing stigma against people living with HIV is key to encouraging HIV testing, which in turn is an important component in the treatment-as-prevention approach. We analyzed nationally representative survey data of participants aged 15 years and older in Namibia (N = 4,300) to determine whether knowledge about HIV and self-efficacy to protect…

  17. 78 FR 28124 - Registry for Attorneys and Representatives

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-14

    ... Appeals (BIA or Board). This notice provides additional instructions regarding the registration process... plan to create an electronic case access and filing system for the immigration courts and the Board... representative. This will increase efficiency by reducing system errors in scheduling matters and providing...

  18. Adaptation of Regional Representative Soil Project and Soil Judging for Cameroon

    ERIC Educational Resources Information Center

    Che, Celestine Akuma

    2013-01-01

    Representative regional soils have agricultural, cultural, economic, environmental, and historical importance to Cameroon. Twenty seven regional representative soils have been identified in Cameroon. A set of laboratory exercises, assignments and exam questions have been developed utilizing the Regional Representative Soil Project (RRSP) that…

  19. Emission of nitrous acid from soil and biological soil crusts represents an important source of HONO in the remote atmosphere in Cyprus

    NASA Astrophysics Data System (ADS)

    Meusel, Hannah; Tamm, Alexandra; Kuhn, Uwe; Wu, Dianming; Lena Leifke, Anna; Fiedler, Sabine; Ruckteschler, Nina; Yordanova, Petya; Lang-Yona, Naama; Pöhlker, Mira; Lelieveld, Jos; Hoffmann, Thorsten; Pöschl, Ulrich; Su, Hang; Weber, Bettina; Cheng, Yafang

    2018-01-01

    Soil and biological soil crusts can emit nitrous acid (HONO) and nitric oxide (NO). The terrestrial ground surface in arid and semiarid regions is anticipated to play an important role in the local atmospheric HONO budget, deemed to represent one of the unaccounted-for HONO sources frequently observed in field studies. In this study HONO and NO emissions from a representative variety of soil and biological soil crust samples from the Mediterranean island Cyprus were investigated under controlled laboratory conditions. A wide range of fluxes was observed, ranging from 0.6 to 264 ng m-2 s-1 HONO-N at optimal soil water content (20-30 % of water holding capacity, WHC). Maximum NO-N fluxes at this WHC were lower (0.8-121 ng m-2 s-1). The highest emissions of both reactive nitrogen species were found from bare soil, followed by light and dark cyanobacteria-dominated biological soil crusts (biocrusts), correlating well with the sample nutrient levels (nitrite and nitrate). Extrapolations of lab-based HONO emission studies agree well with the unaccounted-for HONO source derived previously for the extensive CYPHEX field campaign, i.e., emissions from soil and biocrusts may essentially close the Cyprus HONO budget.

  20. Molecular epidemiology of dengue fever cases imported into Romania between 2008 and 2013.

    PubMed

    Dinu, Sorin; Pănculescu-Gătej, Ioana R; Florescu, Simin A; Popescu, Corneliu P; Sîrbu, Anca; Oprişan, Gabriela; Bădescu, Daniela; Franco, Leticia; Ceianu, Cornelia S

    2015-01-01

    Dengue fever is the commonest arthropod-borne infection worldwide. In recent years, rapid growth in global air travel has resulted in a considerable increase in the incidence of imported cases. In Romania it is now the second most frequent cause for hospitalization (after malaria) in patients arriving from tropical regions. Serological and molecular diagnostics were applied to samples obtained between 2008 and 2013 from travelers with suspected dengue. Molecular typing was performed by RT-PCR followed by sequencing of the E-NS1 junction. Twelve of 37 suspected cases were confirmed and three remained probable. The infections were acquired in endemic regions in Asia, Africa and in Europe (Madeira Island). Dengue virus nucleic acid was detected and sequenced in nine cases. Phylogenetic analysis indicated that the viruses were of genotypes I and V of serotype 1, cosmopolitan genotype of serotype 2 and genotypes I and III of serotype 3. Romanian tourists traveling to dengue-endemic countries are at risk of acquiring dengue infection. Appropriate prevention measures prior to travel and upon return should be taken, particularly as the dengue secondary vector Aedes albopictus is now established in Bucharest. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Representing nursing guideline with unified modeling language to facilitate development of a computer system: a case study.

    PubMed

    Choi, Jeeyae; Choi, Jeungok E

    2014-01-01

    To provide best recommendations at the point of care, guidelines have been implemented in computer systems. As a prerequisite, guidelines are translated into a computer-interpretable guideline format. Since there are no specific tools to translate nursing guidelines, only a few nursing guidelines are translated and implemented in computer systems. Unified modeling language (UML) is a software writing language and is known to well and accurately represent end-users' perspective, due to the expressive characteristics of the UML. In order to facilitate the development of computer systems for nurses' use, the UML was used to translate a paper-based nursing guideline, and its ease of use and the usefulness were tested through a case study of a genetic counseling guideline. The UML was found to be a useful tool to nurse informaticians and a sufficient tool to model a guideline in a computer program.

  2. Rating long-term care facilities on pressure ulcer development: importance of case-mix adjustment.

    PubMed

    Berlowitz, D R; Ash, A S; Brandeis, G H; Brand, H K; Halpern, J L; Moskowitz, M A

    1996-03-15

    To determine the importance of case-mix adjustment in interpreting differences in rates of pressure ulcer development in Department of Veterans Affairs long- term care facilities. A sample assembled from the Patient Assessment File, a Veterans Affairs administrative database, was used to derive predictors of pressure ulcer development; the resulting model was validated in a separate sample. Facility-level rates of pressure ulcer development, both unadjusted and adjusted for case mix using the predictive model, were compared. Department of Veterans Affairs long-term care facilities. The derivation sample consisted of 31 150 intermediate medicine and nursing home residents who were initially free of pressure ulcers and were institutionalized between October 1991 and April 1993. The validation sample consisted of 17 946 residents institutionalized from April 1993 to October 1993. Development of a stage 2 or greater pressure ulcer. 11 factors predicted pressure ulcer development. Validated performance properties of the resulting model were good. Model-predicted rates of pressure ulcer development at individual long-term care facilities varied from 1.9% to 6.3%, and observed rates ranged from 0% to 10.9%. Case-mix-adjusted rates and ranks of facilities differed considerably from unadjusted ratings. For example, among five facilities that were identified as high outliers on the basis of unadjusted rates, two remained as outliers after adjustment for case mix. Long-term care facilities differ in case mix. Adjustments for case mix result in different judgments about facility performance and should be used when facility incidence rates are compared.

  3. Global importation and population risk factors for measles in New Zealand: a case study for highly immunized populations.

    PubMed

    Hayman, D T S; Marshall, J C; French, N P; Carpenter, T E; Roberts, M G; Kiedrzynski, T

    2017-07-01

    As endemic measles is eliminated through immunization, countries must determine the risk factors for the importation of measles into highly immunized populations to target control measures. Despite eliminating endemic measles, New Zealand suffers from outbreaks after introductions from abroad, enabling us to use it as a model for measles introduction risk. We used a generalized linear model to analyze risk factors for 1137 measles cases from 2007 to June 2014, provide estimates of national immunity levels, and model measles importation risk. People of European ethnicity made up the majority of measles cases. Age is a positive risk factor, particularly 0-2-year-olds and 5-17-year-old Europeans, along with increased wealth. Pacific islanders were also at greater risk, but due to 0-2-year-old cases. Despite recent high measles, mumps, and rubella vaccine immunization coverage, overall population immunity against measles remains ~90% and is lower in people born between 1982 and 2005. Greatest measles importation risk is during December, and countries predicted to be sources have historical connections and highest travel rates (Australia and UK), followed by Asian countries with high travel rates and higher measles incidences. Our results suggest measles importation due to travel is seeding measles outbreaks, and immunization levels are insufficient to continue to prevent outbreaks because of heterogeneous immunity in the population, leaving particular age groups at risk.

  4. Assessment of timeliness, representativeness and quality of data reported to Italy's national integrated surveillance system for acute viral hepatitis (SEIEVA).

    PubMed

    Tosti, M E; Longhi, S; de Waure, C; Mele, A; Franco, E; Ricciardi, W; Filia, A

    2015-05-01

    Periodic assessment of surveillance systems is recommended to verify whether they are appropriately monitoring the public health problem under surveillance. The aim of this study was to evaluate timeliness, data quality and representativeness of data reported to the Italian Integrated Epidemiological System for Acute Viral Hepatitis (SEIEVA). Cross-sectional analysis of surveillance data. Quantitative indicators were used to evaluate representativeness of reported cases, data quality, and timeliness between surveillance steps, for reports of acute viral hepatitis cases with date of onset of symptoms from 2009 to 2012 (N = 4516). Representativeness was 75%. Over 95% of records reported information on age, sex, city of residence, risk factors for hepatitis A and vaccination status. Information on risk factors for hepatitis B and C were reported less consistently (83%), as was information on early outcome (60%). Wide delays were found between surveillance steps. The system collects high quality data on acute viral hepatitis cases in Italy. Timeliness was found to be the main limit and needs to be improved by optimizing web-based reporting procedures, increasing communication with participating centres, improving feedback and increasing dissemination of surveillance results. The study highlights the importance of reporting timeliness to detect outbreaks of acute viral hepatitis. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  5. Evaluation of the effects of the Morgantown SES cooling system on spawning and nursery areas of representative important species. Final report

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

    Polgar, T.T.; Summers, J.K.; Haire, M.S.

    1979-10-01

    Power plant cooling system entrainment and plume entrainment may reduce the sizes of fish, benthic and other populations through the destruction of early life stages. This document has been prepared to estimate the potential effects and impacts of entrainment by the Morgantown (PEPCO) and Possum Point (VEPCO) steam electric generating stations. Maryland water quality regulation requires the determination of entrainment effects on spawning and nursery areas of consequence for the Representative Important Species (RIS) designated within the regulation. The purpose of this evaluation is to provide information for regulatory decisions regarding the need for alternative cooling modes at existing facilities.more » Caclulation schemes are presented to estimate the individual and cumulative entrainment effects due to the operations of both the Morgantown and Possum Point facilities. Potential adult population losses due to the entrainment of early life stages were estimated for 24 RIS populations.« less

  6. Public health response to an imported case of canine melioidosis.

    PubMed

    Ryan, C W; Bishop, K; Blaney, D D; Britton, S J; Cantone, F; Egan, C; Elrod, M G; Frye, C W; Maxted, A M; Perkins, G

    2018-06-01

    Melioidosis in humans presents variably as fulminant sepsis, pneumonia, skin infection and solid organ abscesses. It is caused by Burkholderia pseudomallei, which in the United States is classified as a select agent, with "potential to pose a severe threat to both human and animal health, to plant health or to animal and plant products" (Federal Select Agent Program, http://www.selectagents.gov/, accessed 22 September 2016). Burkholderia pseudomallei is found in soil and surface water in the tropics, especially South-East Asia and northern Australia, where melioidosis is endemic. Human cases are rare in the United States and are usually associated with travel to endemic areas. Burkholderia pseudomallei can also infect animals. We describe a multijurisdictional public health response to a case of subclinical urinary B. pseudomallei infection in a dog that had been adopted into upstate New York from a shelter in Thailand. Investigation disclosed three human contacts with single, low-risk exposures to the dog's urine at his residence, and 16 human contacts with possible exposure to his urine or culture isolates at a veterinary hospital. Contacts were offered various combinations of symptom/fever monitoring, baseline and repeat B. pseudomallei serologic testing, and antibiotic post-exposure prophylaxis, depending on the nature of their exposure and their personal medical histories. The dog's owner accepted recommendations from public health authorities and veterinary clinicians for humane euthanasia. A number of animal rescue organizations actively facilitate adoptions into the United States of shelter dogs from South-East Asia. This may result in importation of B. pseudomallei into almost any community, with implications for human and animal health. © 2018 Blackwell Verlag GmbH.

  7. [Species identification in 5 imported cases previously diagnosed as Vivax malaria by parasitological and nested PCR techniques].

    PubMed

    Yao, Li-Nong; Zhang, Ling-Ling; Ruan, Wei; Chen, Hua-Liang; Lu, Qiao-Yi; Yang, Ting-Ting

    2013-06-01

    To identify the species of malaria parasites in 5 imported cases previously diagnosed as vivax malaria. Epidemiological information and blood samples were collected from five patients who returned from Africa and were diagnosed as vivax malaria. The detection was conducted by microscopy, right VIEW rapid malaria test (RDTs) and nested PCR with Plasmodium genus-specific and species-specific primers. The amplified products were sequenced and Blast analysis was performed. Three of the 5 cases had a history of malaria attack. Microscopically, 4 cases were confirmed as Plasmodium ovale infection, 1 (case 1) was co-infected with P. vivax and P. ovale. All 5 cases showed negative RDT results. Nested PCR detection revealed that the 5 cases had a P. ovale-specific fragment (800 bp), while case 1 had a P. vivax-specific fragment (120 bp) concurrently. Blast analysis showed that the amplified sequence of the 5 cases had a high sequence homology (99%) with P. ovale gene for small subunit ribosomal RNA from GenBank, and that of case 1 also shared 99% homology with P. vivax isolate SV5 18S ribosomal RNA gene (GenBank accession number: JQ627157.1). Among the five cases, four were infected by Plasmodium ovale, and one was co-infected with both P. vivax and P. ovale.

  8. Is importing second-hand products a good thing? The cases of computers and tires in Cambodia

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

    Chanthy, Lay, E-mail: Lay.Chanthy@ait.ac.th; Nitivattananon, Vilas, E-mail: vilasn@ait.ac.t

    Is importing second-hand products (SHPs) good for Cambodia? To answer this question, one must seriously consider environmental and social effects. The main objective of this study is to identify and assess the economic, social, and environmental impacts of imported SHPs to determine whether or not Cambodia benefits. Imported second-hand computers (SHPCs) and second-hand tires (SHTs) were selected as cases for the study. The study used a scaling checklist to identify significant impacts of these two imported items. Significant impacts were ranked and rated into a single value (score) for integration. Integrated impact assessment showed that imported SHPCs create a verymore » small positive impact (+ 0.1 of + 5) and imported SHTs generate a large negative impact (- 2.83 of - 5). These scores are mainly the result of environmental impact, predominantly waste issues. Thus, current imports of SHPCs and SHTs do not really benefit Cambodia, but instead cause serious environmental problems from their waste issues. The import serves as a channel to transfer waste into developing countries.« less

  9. The Importance of Audience and Agency for Representation: A Case Study of an Urban Youth Media Community.

    PubMed

    Charmaraman, Linda

    2010-01-01

    PURPOSE: Urban youths' agency to represent their realities through media has been largely unexplored in the youth development literature. In this qualitative case study of an after-school youth media program in the Bay Area, expressions of youth agency and the role of audiences are explored during the process of producing videos for public consumption. METHODOLOGY: As participant observer of 14 ethnically diverse youth participants aged between 15 and 18 years over 18 months, I documented (a) the kind of agencies participants engaged in and (b) the impact of live and imagined future audiences on youths' creative processes. Analyses of field notes, semi-structured interviews, and media projects were conducted using thematic analysis to inductively generate emerging categories. FINDINGS: Themes included an agentive sense of self-efficacy, commitment, and responsibility, as well as perceived contributions to local audiences and an emerging collective identity. The youth demonstrated their increased sense of a social or civic duty to realistically represent youth of color to familiar and unfamiliar audiences. IMPLICATIONS: This case study demonstrated how one youth media organization fostered agency through youth authorship, production, distribution, and local community dialogue. By documenting the impact of audiences from conception to public reception, this study provides valuable insight into the agentive process of publicly "performing" a commitment to complete a social change video project. CONTRIBUTION: This chapter underscores the value of performance within youth development programs and the critical component of audiences as one form of authentic assessment in order to foster individual and collective agency.

  10. The Importance of Audience and Agency for Representation: A Case Study of an Urban Youth Media Community

    PubMed Central

    Charmaraman, Linda

    2010-01-01

    Purpose Urban youths' agency to represent their realities through media has been largely unexplored in the youth development literature. In this qualitative case study of an after-school youth media program in the Bay Area, expressions of youth agency and the role of audiences are explored during the process of producing videos for public consumption. Methodology As participant observer of 14 ethnically diverse youth participants aged between 15 and 18 years over 18 months, I documented (a) the kind of agencies participants engaged in and (b) the impact of live and imagined future audiences on youths' creative processes. Analyses of field notes, semi-structured interviews, and media projects were conducted using thematic analysis to inductively generate emerging categories. Findings Themes included an agentive sense of self-efficacy, commitment, and responsibility, as well as perceived contributions to local audiences and an emerging collective identity. The youth demonstrated their increased sense of a social or civic duty to realistically represent youth of color to familiar and unfamiliar audiences. Implications This case study demonstrated how one youth media organization fostered agency through youth authorship, production, distribution, and local community dialogue. By documenting the impact of audiences from conception to public reception, this study provides valuable insight into the agentive process of publicly “performing” a commitment to complete a social change video project. Contribution This chapter underscores the value of performance within youth development programs and the critical component of audiences as one form of authentic assessment in order to foster individual and collective agency. PMID:20671812

  11. Three cases of imported dengue virus infection from Madeira to Belgium, 2012.

    PubMed

    Cnops, Lieselotte; Franco, Leticia; Van Meensel, Britt; Van den Ende, Jef; Paz Sanchez-Seco, Maria; Van Esbroeck, Marjan

    2014-01-01

    We report three laboratory-confirmed dengue virus (DENV) infections imported to Belgium by travelers returning from Madeira (Portugal). Despite the use of a mosquito-repellent spray as reported by two patients, the infection could not be prevented. Diagnosis was made by antigen detection and real-time reverse transcriptase polymerase chain reaction (RT-PCR) in two cases and by serology 1 month after onset of symptoms in a third one. The responsible virus was identified as DENV serotype 1, American/African genotype (genotype V). The close relationship to isolates from Colombia supports the previous findings that a South American strain originated the outbreak in Madeira in 2012. © 2014 International Society of Travel Medicine.

  12. The legality of designating a union representative as the miners` walkaround representative at a non-unionized mine

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

    NONE

    Reflecting the need for miner participation in maintaining safe conditions in the nation`s mines, current federal law gives miners at each mining operation the right to appoint a representative to accompany federal inspectors on periodic mine inspections. The Federal Mine Safety and Health Act (Mine Act) grants the miners the right to choose this {open_quotes}walkaround{close_quotes} representative, and provides that the walkaround representative shall be given an opportunity to accompany a federal agent during an inspection of a mine for the purposes of aiding the inspection. The issue of the propriety of a non-employee union walkaround representative at a non-union minemore » was recently addressed in Kerr-McGee Coal Corp. v. Federal Mine Safety & Health Review Commission (Kerr-McGee) and Thunder Basin Coal Co. v. Federal Mine Safety & Health Review Commission (Thunder Basin). This Note is devoted to a discussion of Kerr-McGee and Thunder Basin. However, it is important to first briefly review the provision of the federal statutes that give rise to the controversy. The Note then explains how the statutes were interpreted by the Kerr-McGee and Thunder Basin courts. A reading of the two decisions makes it apparent that any group of employees of a non-unionized mine are free to select a non-employee union agent as their walkaround representative. Finally, the Note discusses the ramifications of the conclusions reached in Kerr-McGee and Thunder Basin on the future duties and behavior of mine operators, organized labor, and those designated as walkaround representatives.« less

  13. To What Extent Is Long-term Care Representative of Elderly Care? A Case Study of Elderly Care Financing in Lombardy, Italy

    PubMed Central

    Brenna, Elenka; Gitto, Lara

    2017-01-01

    The ageing of European population has been rapidly increasing during the last decades, and the problem of elderly care financing has become an issue for policy-makers. Long-term care (LTC) financing is considered a suitable proxy of the resources committed to elderly care by each government, but the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within each country. Since there is a broad heterogeneity in LTC funding, organization and setting among European States, it is difficult to find a common parameter representing the public resources destined to the elderly care. We address these topics employing as a case study an Italian region, Lombardy, which in terms of population, dimension, healthcare organization and economic development could be compared to other European countries. The method we suggest, which consists basically in a careful estimate of all the public resources employed in the provision of services exclusively destined to the elderly, could be applied, with the due differences, to other European countries or regions. PMID:28812846

  14. [Malaria--a tropical disease imported to Poland--case report].

    PubMed

    Salamon, Dominika; Garlicki, Aleksander

    2009-01-01

    We present a case of severe malaria caused by Plasmodium falciparum in a 54 year-old woman who stayed for a few of days in Western Africa. Following the case presentation the nature, the course, the diagnosis, the treatment and the prevention of malaria were discussed.

  15. On the moral import of the arts: The case of music.

    PubMed

    Gomila, Antoni; Christensen, Julia F

    2018-01-01

    There has been a controversy on the moral import of music and art in general. On the one hand, the moralist view contends that there is some sort of link between art and morality, even if the way to specify this link may be highly diverse. It comprises most of the classical views of art, from Schiller's view of the role of artistic education in moral development, to any view that declares a form of art as corrupt or degenerated, or enlightening. What it is assumed minimally in all of them is that the moral import of an artwork contributes to its aesthetic value. On the other hand, formalist views claim that the aesthetic value of an artwork is genuine and autonomous, and therefore it is independent of any other value. In this chapter we focus on music, as the most difficult case for the moralist standpoint, given the lack of representational content of music. We argue for a variety of the moralist's view according to which the moral import of a musical artwork is not derived from its content (obviously, as it lack any), but from its pragmatics: the context and the intentions that guide its composition and performance, by analogy with any other intentional action, and point to the emotional impact of music as the common ground that bridges moral and aesthetic values. As a provisional conclusion, we outline a research program for brain studies that follows from this proposal, as a way test its predictions, focusing both on the emotional grounds of valuation and their context-dependency. © 2018 Elsevier B.V. All rights reserved.

  16. An Ontology for Representing Geoscience Theories and Related Knowledge

    NASA Astrophysics Data System (ADS)

    Brodaric, B.

    2009-12-01

    Online scientific research, or e-science, is increasingly reliant on machine-readable representations of scientific data and knowledge. At present, much of the knowledge is represented in ontologies, which typically contain geoscience categories such as ‘water body’, ‘aquifer’, ‘granite’, ‘temperature’, ‘density’, ‘Co2’. While extremely useful for many e-science activities, such categorical representations constitute only a fragment of geoscience knowledge. Also needed are online representations of elements such as geoscience theories, to enable geoscientists to pose and evaluate hypotheses online. To address this need, the Science Knowledge Infrastructure ontology (SKIo) specializes the DOLCE foundational ontology with basic science knowledge primitives such as theory, model, observation, and prediction. Discussed will be SKIo as well as its implementation in the geosciences, including case studies from marine science, environmental science, and geologic mapping. These case studies demonstrate SKIo’s ability to represent a wide spectrum of geoscience knowledge types, to help fuel next generation e-science.

  17. Importance of relationship context in HIV transmission: results from a qualitative case-control study in Rakai, Uganda.

    PubMed

    Higgins, Jenny A; Mathur, Sanyukta; Eckel, Elizabeth; Kelley, Laura; Kelly, Laura; Nakyanjo, Neema; Sekamwa, Richard; Namatovu, Josephine; Ddaaki, William; Nakubulwa, Rosette; Namakula, Sylvia; Nalugoda, Fred; Santelli, John S

    2014-04-01

    We present results from life history interviews with 60 young adults from southern Uganda. Using a novel qualitative case-control design, we compared newly HIV-positive cases with HIV-negative controls matched on age, gender, marital status, and place of residence. Relationship context was the most salient theme differentiating cases from controls. Compared with HIV-negative respondents, recent seroconverters described relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. Results highlight the importance of dyadic approaches to HIV and possibly of couple-based interventions. Using HIV-matched pairs allowed additional understanding of the factors influencing transmission. This hybrid methodological approach holds promise for future studies of sexual health.

  18. Importance of Relationship Context in HIV Transmission: Results From a Qualitative Case-Control Study in Rakai, Uganda

    PubMed Central

    Mathur, Sanyukta; Eckel, Elizabeth; Kelly, Laura; Nakyanjo, Neema; Sekamwa, Richard; Namatovu, Josephine; Ddaaki, William; Nakubulwa, Rosette; Namakula, Sylvia; Nalugoda, Fred; Santelli, John S.

    2014-01-01

    We present results from life history interviews with 60 young adults from southern Uganda. Using a novel qualitative case-control design, we compared newly HIV-positive cases with HIV-negative controls matched on age, gender, marital status, and place of residence. Relationship context was the most salient theme differentiating cases from controls. Compared with HIV-negative respondents, recent seroconverters described relationships marked by poorer communication, greater suspicion and mistrust, and larger and more transitory sexual networks. Results highlight the importance of dyadic approaches to HIV and possibly of couple-based interventions. Using HIV-matched pairs allowed additional understanding of the factors influencing transmission. This hybrid methodological approach holds promise for future studies of sexual health. PMID:24524490

  19. Representative landscapes in the forested area of Canada.

    PubMed

    Cardille, Jeffrey A; White, Joanne C; Wulder, Mike A; Holland, Tara

    2012-01-01

    Canada is a large nation with forested ecosystems that occupy over 60% of the national land base, and knowledge of the patterns of Canada's land cover is important to proper environmental management of this vast resource. To this end, a circa 2000 Landsat-derived land cover map of the forested ecosystems of Canada has created a new window into understanding the composition and configuration of land cover patterns in forested Canada. Strategies for summarizing such large expanses of land cover are increasingly important, as land managers work to study and preserve distinctive areas, as well as to identify representative examples of current land-cover and land-use assemblages. Meanwhile, the development of extremely efficient clustering algorithms has become increasingly important in the world of computer science, in which billions of pieces of information on the internet are continually sifted for meaning for a vast variety of applications. One recently developed clustering algorithm quickly groups large numbers of items of any type in a given data set while simultaneously selecting a representative-or "exemplar"-from each cluster. In this context, the availability of both advanced data processing methods and a nationally available set of landscape metrics presents an opportunity to identify sets of representative landscapes to better understand landscape pattern, variation, and distribution across the forested area of Canada. In this research, we first identify and provide context for a small, interpretable set of exemplar landscapes that objectively represent land cover in each of Canada's ten forested ecozones. Then, we demonstrate how this approach can be used to identify flagship and satellite long-term study areas inside and outside protected areas in the province of Ontario. These applications aid our understanding of Canada's forest while augmenting its management toolbox, and may signal a broad range of applications for this versatile approach.

  20. Primary benign tumors in chiropractic practice and the importance of x-ray diagnosis: A report of two cases

    PubMed Central

    Pelletier, Jacques C.

    1987-01-01

    Two cases of primary benign bone tumors were diagnosed radiographically in a chiropractic practice. Although primary osseous tumors are somewhat uncommon, their potential presence emphasizes the importance of x-ray diagnosis as an essential adjunct to chiropractic practice. This procedure may preclude underlying lesions before considering treatment of seemingly uncomplicated injuries. Two such cases are presented: unicameral bone cyst and osteochondroma. ImagesFigure 1Figure 2Figure 3

  1. [Laboratory analysis of the first case of imported oval malaria in Rizhao City].

    PubMed

    Chao, Li; Ying, Zhang; Ting, Xiao

    2016-01-25

    To diagnose the first imported case of Plasmodium ovale infection by laboratory detection. The epidemiological data and blood samples of the case were collected, and the samples were detected by the microscopic examination, rapid diagnostic test (RDT) and nested PCR. The patient was a construction worker backing from Congo, Africa. He experienced the symptoms of irregular fever and weakness one month after returning in Lingyang Town, Junxian County. The results of RDT only suggested no- Plasmodium falciparum infection. Under the microscope, it was seen that the infected RBC were obviously disfigured and in irregular shape, the ring forms were thick and big, and also thick granulas in big trophozoite stage and schizont stage were found. The results of PCR showed that the size of amplified product was about 800 bp, which was conformed to that of P. ovale . Though microscopic examination is the golden standard for malaria diagnosis, as P. ovale is difficult to be identified under microscope, the microscopic method combined with PCR test can be used for definite diagnosis.

  2. The importance of actions and the worth of an object: dissociable neural systems representing core value and economic value.

    PubMed

    Brosch, Tobias; Coppin, Géraldine; Schwartz, Sophie; Sander, David

    2012-06-01

    Neuroeconomic research has delineated neural regions involved in the computation of value, referring to a currency for concrete choices and decisions ('economic value'). Research in psychology and sociology, on the other hand, uses the term 'value' to describe motivational constructs that guide choices and behaviors across situations ('core value'). As a first step towards an integration of these literatures, we compared the neural regions computing economic value and core value. Replicating previous work, economic value computations activated a network centered on medial orbitofrontal cortex. Core value computations activated medial prefrontal cortex, a region involved in the processing of self-relevant information and dorsal striatum, involved in action selection. Core value ratings correlated with activity in precuneus and anterior prefrontal cortex, potentially reflecting the degree to which a core value is perceived as internalized part of one's self-concept. Distributed activation pattern in insula and ACC allowed differentiating individual core value types. These patterns may represent evaluation profiles reflecting prototypical fundamental concerns expressed in the core value types. Our findings suggest mechanisms by which core values, as motivationally important long-term goals anchored in the self-schema, may have the behavioral power to drive decisions and behaviors in the absence of immediately rewarding behavioral options.

  3. Education and Work Councils: Four Case Studies.

    ERIC Educational Resources Information Center

    Prager, Audrey; And Others

    This collection of four case studies represents the conclusion of a two-phase study of a federal program to sponsor education and work councils. Following an outline of the history and concept of education and work councils as well as the findings of a study of such councils, the importance of council collaboration with selected sectors is…

  4. Risk Importance Measures in the Designand Operation of Nuclear Power Plants

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

    Vrbanic I.; Samanta P.; Basic, I

    This monograph presents and discusses risk importance measures as quantified by the probabilistic risk assessment (PRA) models of nuclear power plants (NPPs) developed according to the current standards and practices. Usually, PRA tools calculate risk importance measures related to a single ?basic event? representing particular failure mode. This is, then, reflected in many current PRA applications. The monograph focuses on the concept of ?component-level? importance measures that take into account different failure modes of the component including common-cause failures (CCFs). In opening sections the roleof risk assessment in safety analysis of an NPP is introduced and discussion given of ?traditional?,more » mainly deterministic, design principles which have been established to assign a level of importance to a particular system, structure or component. This is followed by an overview of main risk importance measures for risk increase and risk decrease from current PRAs. Basic relations which exist among the measures are shown. Some of the current practical applications of risk importancemeasures from the field of NPP design, operation and regulation are discussed. The core of the monograph provides a discussion on theoreticalbackground and practical aspects of main risk importance measures at the level of ?component? as modeled in a PRA, starting from the simplest case, single basic event, and going toward more complexcases with multiple basic events and involvements in CCF groups. The intent is to express the component-level importance measures via theimportance measures and probabilities of the underlying single basic events, which are the inputs readily available from a PRA model andits results. Formulas are derived and discussed for some typical cases. The formulas and their results are demonstrated through some practicalexamples, done by means of a simplified PRA model developed in and run by RiskSpectrum? tool, which are presented in the appendices. The

  5. 14 CFR 1274.906 - Designation of New Technology Representative and Patent Representative.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Designation of New Technology Representative... Conditions § 1274.906 Designation of New Technology Representative and Patent Representative. Designation of New Technology Representative and Patent Representative July 2002 (a) For purposes of administration...

  6. 75 FR 24510 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... VA facilities and the business relationships between VA staff and sales representatives promoting..., and provide sales representatives with a consistent standard of permissible business practice at VA... include suspension of a sales representative's access privileges, or, in extreme cases, denying access to...

  7. Personalizing and Contextualizing Multimedia Case Methods in University-based Teacher Education: An Important Modification for Promoting Technological Design in School Science

    NASA Astrophysics Data System (ADS)

    Bencze, Larry; Hewitt, Jim; Pedretti, Erminia

    2009-01-01

    Results of various studies suggest that multimedia ‘case methods’ (activities associated with case documentaries) have many benefits in university-based teacher education contexts. They can, for example, help to ‘bridge the gap’ between perspectives and practices held by academic teacher educators and those held by student-teachers - who may adhere to perspectives and practices commonly supported in schools. On the other hand, some studies, along with theoretical arguments, suggest that there are limits to the effectiveness of multimedia case methods - because, for example, they can never fully represent realities of teaching and learning in schools. Furthermore, often missing from multimedia case methods is the student-teacher in the role of teacher. To address these concerns, we modified an existing multimedia case method by associating it with a special practice teaching situation in a school context. Qualitative data analyzed using constant comparative methods suggest that student-teachers engaged in this modified multimedia case method developed relatively deep commitments to encouraging students to conduct technology design projects - a non-traditional practice in school science. Factors that appeared to influence development of this motivation included student-teachers’ pre-instructional perspectives about science and the personalization and contextualization inherent to the modified multimedia case method.

  8. Learning From Mistakes: Importance of a Multidisciplinary Group, A Case Report.

    PubMed

    Pezzulla, Donato; Scoglio, Claudio; Capasso, Raffaella; Cioce, Fabrizio; Sica, Assunta; Cappabianca, Salvatore

    2016-08-01

    There have been significant advances in the diagnosis and treatment of breast cancer over the past 20 years, due to increased knowledge about the biology and molecular changes in breast cancer. These advances have increased the complexity of treatment decision-making for individual women, and reinforced the need for a team approach to treatment decision-making. We report the case of an 80-year-old woman with a recidive invasive ductal breast carcinoma of high grade. In October 2015, she discovered an indolent breast bulk through self-examination and in the December of the same year, after the routine staging exams, she undergone a quadrantectomy and a limphoadenectomy. In March 2016, the patient was sent to our structure for a cycle of radiation therapy by her oncologist, even though a suspected lesion was seen on the thoracic wall on recent computed tomography scans. Our aim was to show an example about the importance of collaboration and multidisciplinary group in treating cancer.

  9. Learning From Mistakes: Importance of a Multidisciplinary Group, A Case Report

    PubMed Central

    Pezzulla, Donato; Scoglio, Claudio; Capasso, Raffaella; Cioce, Fabrizio; Sica, Assunta; Cappabianca, Salvatore

    2016-01-01

    There have been significant advances in the diagnosis and treatment of breast cancer over the past 20 years, due to increased knowledge about the biology and molecular changes in breast cancer. These advances have increased the complexity of treatment decision-making for individual women, and reinforced the need for a team approach to treatment decision-making. We report the case of an 80-year-old woman with a recidive invasive ductal breast carcinoma of high grade. In October 2015, she discovered an indolent breast bulk through self-examination and in the December of the same year, after the routine staging exams, she undergone a quadrantectomy and a limphoadenectomy. In March 2016, the patient was sent to our structure for a cycle of radiation therapy by her oncologist, even though a suspected lesion was seen on the thoracic wall on recent computed tomography scans. Our aim was to show an example about the importance of collaboration and multidisciplinary group in treating cancer. PMID:28983371

  10. [The importance of early diagnosis and intervention in children diagnosed with reading disorder. Case studies].

    PubMed

    Törö, Krisztina; Balázs, Judit

    2015-06-01

    Reading Disorder (RD) belongs to Specific Learning Disorders within the chapter of Neurodevelopmental Disorders in the Diagnostic and Statistic Manual of Mental Disorders 5th edition. Previous research shows that the time of the diagnosis of RD - early (before starting school) or late - has a great impact on the prognosis. In the current paper we present the cases of two children diagnosed with RD. Our cases demonstrate that if RD is diagnosed in early childhood, the child's and his/her family's quality of life can be influenced in a positive direction, while late recognition of RD might influence the child's and the family's quality of life negatively. For these reasons it is important that experts recognize RD in time, start appropriate treatment and give proper support to children diagnosed with RD and their families.

  11. Imported case of measles in a university setting leading to an outbreak of measles in Edinburgh, Scotland from September to December 2016.

    PubMed

    Kirolos, A; Waugh, C; Templeton, K; McCormick, D; Othieno, R; Willocks, L J; Stevenson, J

    2018-04-01

    In September 2016, an imported case of measles in Edinburgh in a university student resulted in a further 17 confirmed cases during October and November 2016. All cases were genotype D8 and were associated with a virus strain most commonly seen in South East Asia. Twelve of the 18 cases were staff or students at a university in Edinburgh and 17 cases had incomplete or unknown measles mumps rubella (MMR) vaccination status. The public health response included mass follow-up of all identified contacts, widespread communications throughout universities in Edinburgh and prompt vaccination clinics at affected campuses. Imported cases of measles pose a significant risk to university student cohorts who may be undervaccinated, include a large number of international students and have a highly mobile population. Public health departments should work closely with universities to promote MMR uptake and put in place mass vaccination plans to prevent rapidly spreading measles outbreaks in higher educational settings in future.

  12. The role of transnational mobility in the local spread of mosquito-borne disease: Measuring the determinants of spatial-temporal lags of imported dengue cases initiating indigenous epidemics in Taiwan

    NASA Astrophysics Data System (ADS)

    Wen, Tzai-Hung

    2014-05-01

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

  13. Latent tuberculosis infection in foreign-born communities: Import vs. transmission in The Netherlands derived through mathematical modelling.

    PubMed

    Korthals Altes, Hester; Kloet, Serieke; Cobelens, Frank; Bootsma, Martin

    2018-01-01

    While tuberculosis (TB) represents a significant disease burden worldwide, low-incidence countries strive to reach the WHO target of pre-elimination by 2035. Screening for TB in immigrants is an important component of the strategy to reduce the TB burden in low-incidence settings. An important option is the screening and preventive treatment of latent TB infection (LTBI). Whether this policy is worthwhile depends on the extent of transmission within the country, and introduction of new cases through import. Mathematical transmission models of TB have been used to identify key parameters in the epidemiology of TB and estimate transmission rates. An important application has also been to investigate the consequences of policy scenarios. Here, we formulate a mathematical model for TB transmission within the Netherlands to estimate the size of the pool of latent infections, and to determine the share of importation-either through immigration or travel- versus transmission within the Netherlands. We take into account importation of infections due to immigration, and travel to the country of origin, focusing on the three ethnicities most represented among foreign-born TB cases (after exclusion of those overrepresented among asylum seekers): Moroccans, Turkish and Indonesians. We fit a system of ordinary differential equations to the data from the Netherlands Tuberculosis Registry on (extra-)pulmonary TB cases from 1995-2013. We estimate that about 27% of Moroccans, 25% of Indonesians, and 16% of Turkish, are latently infected. Furthermore, we find that for all three foreign-born communities, immigration is the most important source of LTBI, but the extent of within-country transmission is much lower (about half) for the Turkish and Indonesian communities than for the Moroccan. This would imply that contact investigation would have a greater yield in the latter community than in the former. Travel remains a minor factor contributing LTBI, suggesting that targeting

  14. Detection of yellow fever virus genomes from four imported cases in China.

    PubMed

    Cui, Shujuan; Pan, Yang; Lyu, Yanning; Liang, Zhichao; Li, Jie; Sun, Yulan; Dou, Xiangfeng; Tian, Lili; Huo, Da; Chen, Lijuan; Li, Xinyu; Wang, Quanyi

    2017-07-01

    Yellow fever virus (YFV), as the first proven human-pathogenic virus, is still a major public health problem with a dramatic upsurge in recent years. This is a report on four imported cases of yellow fever virus into China identified by whole genome sequencing. Phylogenetic analysis was performed and the results showed that these four viruses were highly homologous with Angola 71 strains (AY968064). In addition, effective mutations of amino acids were not observed in the E protein domain of four viruses, thus confirming the effectiveness of the YFV-17D vaccine (X03700). Although there is low risk of local transmission in most part of China, the increasing public health risk of YF caused by international exchange should not be ignored. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. 22 CFR 91.3 - Assistance to Customs and Tariff Commission representatives.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Assistance to Customs and Tariff Commission representatives. 91.3 Section 91.3 Foreign Relations DEPARTMENT OF STATE LEGAL AND RELATED SERVICES IMPORT CONTROLS § 91.3 Assistance to Customs and Tariff Commission representatives. Consular officers shall render...

  16. Defining And Characterizing Sample Representativeness For DWPF Melter Feed Samples

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

    Shine, E. P.; Poirier, M. R.

    2013-10-29

    Representative sampling is important throughout the Defense Waste Processing Facility (DWPF) process, and the demonstrated success of the DWPF process to achieve glass product quality over the past two decades is a direct result of the quality of information obtained from the process. The objective of this report was to present sampling methods that the Savannah River Site (SRS) used to qualify waste being dispositioned at the DWPF. The goal was to emphasize the methodology, not a list of outcomes from those studies. This methodology includes proven methods for taking representative samples, the use of controlled analytical methods, and datamore » interpretation and reporting that considers the uncertainty of all error sources. Numerous sampling studies were conducted during the development of the DWPF process and still continue to be performed in order to evaluate options for process improvement. Study designs were based on use of statistical tools applicable to the determination of uncertainties associated with the data needs. Successful designs are apt to be repeated, so this report chose only to include prototypic case studies that typify the characteristics of frequently used designs. Case studies have been presented for studying in-tank homogeneity, evaluating the suitability of sampler systems, determining factors that affect mixing and sampling, comparing the final waste glass product chemical composition and durability to that of the glass pour stream sample and other samples from process vessels, and assessing the uniformity of the chemical composition in the waste glass product. Many of these studies efficiently addressed more than one of these areas of concern associated with demonstrating sample representativeness and provide examples of statistical tools in use for DWPF. The time when many of these designs were implemented was in an age when the sampling ideas of Pierre Gy were not as widespread as they are today. Nonetheless, the engineers and

  17. 14 CFR 1274.906 - Designation of New Technology Representative and Patent Representative.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Designation of New Technology... Conditions § 1274.906 Designation of New Technology Representative and Patent Representative. Designation of New Technology Representative and Patent Representative July 2002 (a) For purposes of administration...

  18. 14 CFR 1260.58 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Designation of new technology representative... of new technology representative and patent representative. Designation of New Technology... of this grant entitled “New Technology,” the following named representatives are hereby designated by...

  19. Selection of Representative Models for Decision Analysis Under Uncertainty

    NASA Astrophysics Data System (ADS)

    Meira, Luis A. A.; Coelho, Guilherme P.; Santos, Antonio Alberto S.; Schiozer, Denis J.

    2016-03-01

    The decision-making process in oil fields includes a step of risk analysis associated with the uncertainties present in the variables of the problem. Such uncertainties lead to hundreds, even thousands, of possible scenarios that are supposed to be analyzed so an effective production strategy can be selected. Given this high number of scenarios, a technique to reduce this set to a smaller, feasible subset of representative scenarios is imperative. The selected scenarios must be representative of the original set and also free of optimistic and pessimistic bias. This paper is devoted to propose an assisted methodology to identify representative models in oil fields. To do so, first a mathematical function was developed to model the representativeness of a subset of models with respect to the full set that characterizes the problem. Then, an optimization tool was implemented to identify the representative models of any problem, considering not only the cross-plots of the main output variables, but also the risk curves and the probability distribution of the attribute-levels of the problem. The proposed technique was applied to two benchmark cases and the results, evaluated by experts in the field, indicate that the obtained solutions are richer than those identified by previously adopted manual approaches. The program bytecode is available under request.

  20. Implant bone integration importance in forensic identification.

    PubMed

    De Angelis, Danilo; Cattaneo, Cristina

    2015-03-01

    Odontological identification consists of the comparison of antemortem dental information regarding a missing person with postmortem data from an unidentified corpse or human remains. Usually, the comparison concerns morphologic features that the operator chooses among all the visible characteristics because of inter-individual uniqueness; for this reason, implants can be of enormous assistance. A case concerning the recovery of a burnt oral implant, connected to a bone fragment, among 2780 charred bone fragments, suspected to have belonged to a victim of homicide, is presented to demonstrate that dental implants and their site of bone integration represent a very precious element for personal forensic identification. Because of their morphological invariability in time and because of their morphologic uniqueness, they were used as evidence to associate unidentified human charred remains to a missing person where DNA analysis failed to do so. The case illustrates the fundamental contribution, not yet described in literature, given by the clinical aspects of tooth replacement with dental implants to a forensic discipline. Clinical practitioners should therefore be aware of the great importance of their work and of dental records in a forensic identification scenario. © 2014 American Academy of Forensic Sciences.

  1. [Geniculate hemianopia. Diagnostic importance of retinal nerve fiber layer analysis using optical coherence tomography: case report].

    PubMed

    Moura, Frederico Castelo; Lunardelli, Patrícia; Leite, Cláudia Costa; Monteiro, Mário Luiz Ribeiro

    2005-01-01

    Lesions of the lateral geniculate body (LGB) are the most unusual lesions of the visual pathways. Imaging studies are very important in establishing the correct diagnosis. However, due to its small size and particular location, the lateral geniculate body and its lesions are sometimes difficult to detect in imaging studies possibly causing diagnostic confusion. The purpose of this paper is to document an unusual case of a lesion of the lateral geniculate body for which an optical coherence tomography study was very important in confirming the anatomic diagnosis of a lateral geniculate body lesion. A 39-year-old woman with a previous diagnosis of uveitis and central nervous system vasculitis was referred for investigation of a right temporal quadrantanopia. She had already been submitted to a magnetic resonance imaging (MRI) that did not show any lesion along the visual pathway. Ophthalmoscopy revealed retinal nerve fiber layer (RNFL) loss that was confirmed by optical coherence tomography. Such finding associated with the observations on the neurological examination strongly suggested a lateral geniculate body lesion. The patient was submitted to another new magnetic resonance imaging obtained with especially oriented thin sections and an ischemic lesion of the lateral geniculate body was observed establishing the correct diagnosis. This case serves to confirm the importance of optical coherence tomography in determining the pattern of retinal nerve fiber layer loss in neuro-ophthalmic diseases and therefore to help in locating a lesion along the visual pathway.

  2. The importance of laboratory re-evaluation in cases of suspected child abuse - A case report.

    PubMed

    Woydt, L; König, C; Bernhard, M K; Nickel, P; Dreßler, J; Ondruschka, B

    2017-09-01

    In order to accurately diagnose child abuse or neglect, a physician needs to be familiar with diseases and medical conditions that can simulate maltreatment. Unrecognized cases of abuse may lead to insufficient child protection, whereas, on the other hand, over-diagnosis could be the cause of various problems for the family and their potentially accused members. Regarding child abuse, numerous cases of false diagnoses with undetected causes of bleeding are described in the scientific literature, but, specifically concerning leukemia in childhood, only very few case reports exist. Here, for the first time, we report a case of a 2-year-old boy who got hospitalized twice because of suspicious injuries and psychosocial conspicuities, in a family situation known for repeated endangerment of the child's well-being. After his first hospitalization with injuries typical for child abuse, but without paraclinical abnormalities, medical inspections were arranged periodically. The child was hospitalized with signs of repeated child abuse again five months later. During second admission, an acute lymphoblastic leukemia was revealed by intermittent laboratory examination, ordered due to new bruises with changes in morphology, identifiable as petechial hemorrhages. This case elucidates the discussion of known cases of leukemia in childhood associated with suspected child abuse in order to provide an overview of possible diseases mimicking maltreatment. To arrange necessary supportive examinations, a skillful interaction between pediatrician and forensic pathologist is crucial in the differentiation between accidental and non-accidental injury. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Travel-related leptospirosis: a series of 15 imported cases.

    PubMed

    van de Werve, Charlotte; Perignon, Alice; Jauréguiberry, Stéphane; Bricaire, François; Bourhy, Pascal; Caumes, Eric

    2013-01-01

    Leptospirosis belongs to the spectrum of travel-related infections. We retrospectively studied all the consecutive cases of travel-related leptospirosis seen in our department between January 2008 and September 2011. Patients were included with a clinical picture compatible with the disease within 21 days after return, the presence of a thermoresistant antigen or IgM antibodies, Elisa ≥ 1 /400, and a positive microagglutination test (MAT) ≥ 1/100. Fifteen leptospirosis cases were evaluated. Exposure occurred in Asia (47%), Africa (20%), the Caribbean (20%), and Indian Ocean (13%). Fourteen patients were infected during water-related activities. On admission the most frequent symptoms were fever (100%), headache (80%), and digestive disorders (67%). Relevant laboratory findings included impaired liver function tests (100%), lymphocytopenia (80%), thrombocytopenia (67%), and elevated C-reactive protein (CRP) (67%). Our cases were confirmed by MAT that found antibodies against nine different serovars. Seven patients were cured with amoxicillin, four with doxycycline, two with ceftriaxone, one with ceftriaxone, doxycycline, and spiramycin, whereas one recovered spontaneously (retrospective diagnosis). Eight patients were hospitalized. All patients recovered. Our cases involved nine different serovars. They were related to travel in Asia, Africa, and the Caribbean. Bathing or other fresh-water leisure activities (canoeing, kayaking, rafting) are the most likely at-risk exposure. Any traveler with fever and at-risk exposure should be investigated for leptospirosis. © 2013 International Society of Travel Medicine.

  4. Latent tuberculosis infection in foreign-born communities: Import vs. transmission in The Netherlands derived through mathematical modelling

    PubMed Central

    Kloet, Serieke; Cobelens, Frank; Bootsma, Martin

    2018-01-01

    While tuberculosis (TB) represents a significant disease burden worldwide, low-incidence countries strive to reach the WHO target of pre-elimination by 2035. Screening for TB in immigrants is an important component of the strategy to reduce the TB burden in low-incidence settings. An important option is the screening and preventive treatment of latent TB infection (LTBI). Whether this policy is worthwhile depends on the extent of transmission within the country, and introduction of new cases through import. Mathematical transmission models of TB have been used to identify key parameters in the epidemiology of TB and estimate transmission rates. An important application has also been to investigate the consequences of policy scenarios. Here, we formulate a mathematical model for TB transmission within the Netherlands to estimate the size of the pool of latent infections, and to determine the share of importation–either through immigration or travel- versus transmission within the Netherlands. We take into account importation of infections due to immigration, and travel to the country of origin, focusing on the three ethnicities most represented among foreign-born TB cases (after exclusion of those overrepresented among asylum seekers): Moroccans, Turkish and Indonesians. We fit a system of ordinary differential equations to the data from the Netherlands Tuberculosis Registry on (extra-)pulmonary TB cases from 1995–2013. We estimate that about 27% of Moroccans, 25% of Indonesians, and 16% of Turkish, are latently infected. Furthermore, we find that for all three foreign-born communities, immigration is the most important source of LTBI, but the extent of within-country transmission is much lower (about half) for the Turkish and Indonesian communities than for the Moroccan. This would imply that contact investigation would have a greater yield in the latter community than in the former. Travel remains a minor factor contributing LTBI, suggesting that targeting

  5. Degradation analysis in the estimation of photometric redshifts from non-representative training sets

    NASA Astrophysics Data System (ADS)

    Rivera, J. D.; Moraes, B.; Merson, A. I.; Jouvel, S.; Abdalla, F. B.; Abdalla, M. C. B.

    2018-07-01

    We perform an analysis of photometric redshifts estimated by using a non-representative training sets in magnitude space. We use the ANNz2 and GPz algorithms to estimate the photometric redshift both in simulations and in real data from the Sloan Digital Sky Survey (DR12). We show that for the representative case, the results obtained by using both algorithms have the same quality, using either magnitudes or colours as input. In order to reduce the errors when estimating the redshifts with a non-representative training set, we perform the training in colour space. We estimate the quality of our results by using a mock catalogue which is split samples cuts in the r band between 19.4 < r < 20.8. We obtain slightly better results with GPz on single point z-phot estimates in the complete training set case, however the photometric redshifts estimated with ANNz2 algorithm allows us to obtain mildly better results in deeper r-band cuts when estimating the full redshift distribution of the sample in the incomplete training set case. By using a cumulative distribution function and a Monte Carlo process, we manage to define a photometric estimator which fits well the spectroscopic distribution of galaxies in the mock testing set, but with a larger scatter. To complete this work, we perform an analysis of the impact on the detection of clusters via density of galaxies in a field by using the photometric redshifts obtained with a non-representative training set.

  6. The importance of serological and molecular analyses for the diagnosis of measles cases and for meeting elimination targets in Turkey from 2007 to 2015.

    PubMed

    Cosgun, Yasemin; Guldemir, Dilek; Coskun, Aslihan; Yolbakan, Sultan; Kalaycioglu, Atila Taner; Korukluoglu, Gulay; Durmaz, Riza

    2018-04-01

    Measles is an important childhood infection targeted to be eliminated by the World Health Organization (WHO). Virus circulation has not been interrupted in the European Region because high vaccination rates could not be achieved among some countries of the WHO European Region including Turkey. The purpose of this study was to evaluate the laboratory findings of measles cases confirmed in the last nine years, to assess the epidemiological data of the cases, to determine the molecular genotyping studies and to emphasise the importance of laboratory-based surveillance in measles. From 2007 to 2010, only 18 imported cases were detected in Turkey. However, this number increased with a local outbreak of 111 cases in 2011, followed by another outbreak in 2012 in Istanbul that spread countrywide in the following two years; a total of 8661 laboratory-confirmed measles cases were reported from 2012 to 2015. After ELISA detection of a measles IgM-positive result in serum samples of potential measles cases, RT-PCR was performed with urine or nasopharyngeal swab samples of patients, and amplicons were subjected to sequencing. In the samples of 2010 and 2011, D4 and D9 genotypes were mainly detected; as of 2012, the D8 genotype has gained importance. Although D8 was also identified in 2014, in the same year genotype H1 viruses were detected in Turkey for the first time. Therefore, it is important to perform a genotypic analysis of the virus causing the outbreak, analyse epidemiological connections of the contact, determine the source of the outbreak and plan measures based on this information.

  7. Using Scientific Visualization to Represent Soil Hydrology Dynamics

    ERIC Educational Resources Information Center

    Dolliver, H. A. S.; Bell, J. C.

    2006-01-01

    Understanding the relationships between soil, landscape, and hydrology is important for making sustainable land management decisions. In this study, scientific visualization was explored as a means to visually represent the complex spatial and temporal variations in the hydrologic status of soils. Soil hydrology data was collected at seven…

  8. 31 CFR 360.60 - Payment to representative of an estate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Payment to representative of an estate. 360.60 Section 360.60 Money and Finance: Treasury Regulations Relating to Money and Finance... court, other proof of qualification. (2) Except in the case of corporate fiduciaries, the evidence must...

  9. 31 CFR 353.60 - Payment to representative of an estate.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Payment to representative of an estate. 353.60 Section 353.60 Money and Finance: Treasury Regulations Relating to Money and Finance... appointed by a court, other proof of qualification. Except in the case of corporate fiduciaries, the...

  10. A Representative Shuttle Environmental Control System

    NASA Technical Reports Server (NTRS)

    Brose, H. F.; Stanley, M. D.; Leblanc, J. C.

    1977-01-01

    The Representative Shuttle Environmental Control System (RSECS) provides a ground test bed to be used in the early accumulation of component and system operating data, the evaluation of potential system improvements, and possibly the analysis of Shuttle Orbiter test and flight anomalies. Selected components are being subjected to long term tests to determine endurance and corrosion resistance capability prior to Orbiter vehicle experience. Component and system level tests in several cases are being used to support flight certification of Orbiter hardware. These activities are conducted as a development program to allow for timeliness, flexibility, and cost effectiveness not possible in a program burdened by flight documentation and monitoring constraints.

  11. Reasoning with case histories of process knowledge for efficient process development

    NASA Technical Reports Server (NTRS)

    Bharwani, Seraj S.; Walls, Joe T.; Jackson, Michael E.

    1988-01-01

    The significance of compiling case histories of empirical process knowledge and the role of such histories in improving the efficiency of manufacturing process development is discussed in this paper. Methods of representing important investigations as cases and using the information from such cases to eliminate redundancy of empirical investigations in analogous process development situations are also discussed. A system is proposed that uses such methods to capture the problem-solving framework of the application domain. A conceptual design of the system is presented and discussed.

  12. Cranial Neuropathies and Neuromuscular Weakness: A Case of Mistaken Identity

    PubMed Central

    Adams, Daniel Z.; King, Andrew; Kaide, Colin

    2017-01-01

    We describe a case of wound botulism initially thought to represent Miller-Fisher variant Guillain-Barré syndrome (MFS). Botulism classically presents with the so-called “four D’s” (diplopia, dysarthria, dysphagia, dry mouth) with symmetric, descending weakness. MFS presents with a triad of limb-ataxia, areflexia, and ophthalmoplegia, with variable cranial nerve and extremity involvement. The distinction can be difficult but is important as early initiation of botulinum antitoxin is associated with improved patient outcomes in cases of botulism. Furthermore, it is important to recognize intravenous drug use as a risk factor in the development of botulism, especially given an increase in injection drug use. PMID:29849352

  13. Cranial Neuropathies and Neuromuscular Weakness: A Case of Mistaken Identity.

    PubMed

    Adams, Daniel Z; King, Andrew; Kaide, Colin

    2017-08-01

    We describe a case of wound botulism initially thought to represent Miller-Fisher variant Guillain-Barré syndrome (MFS). Botulism classically presents with the so-called "four D's" (diplopia, dysarthria, dysphagia, dry mouth) with symmetric, descending weakness. MFS presents with a triad of limb-ataxia, areflexia, and ophthalmoplegia, with variable cranial nerve and extremity involvement. The distinction can be difficult but is important as early initiation of botulinum antitoxin is associated with improved patient outcomes in cases of botulism. Furthermore, it is important to recognize intravenous drug use as a risk factor in the development of botulism, especially given an increase in injection drug use.

  14. [X-linked adrenoleukodystrophy: a report of three cases. The importance of early diagnosis].

    PubMed

    López Úbeda, Marta; de Arriba Muñoz, Antonio; Ferrer Lozano, Marta; Labarta Aizpún, José I; García Jiménez, María C

    2017-10-01

    X-linked adrenoleukodystrophy is the most common peroxisomal disorder. This disease is caused by a defect in the ABCD1 gen. Saturated very long chain fatty acids are accumulated in serum, adrenal cortex and central nervous system white matter. The clinical spectrum is characterized by progressive neurological dysfunction and adrenal insufficiency with a devastating prognosis. We report a first case of X-linked adrenoleukodystrophy with fatal evolution which identified two asymptomatic family members and established a preventive treatment. Although there is no definitive cure, we stress the importance of family study and evaluation of the individual in situation of risk to establish an early preventive treatment and to give in each particular situation suitable professional advice. Sociedad Argentina de Pediatría.

  15. The determination of the botanical origin in honeys with over-represented pollen: combination of melissopalynological, sensory and physicochemical analysis.

    PubMed

    Rodopoulou, Maria-Anna; Tananaki, Chrysoula; Dimou, Maria; Liolios, Vasilios; Kanelis, Dimitrios; Goras, Georgios; Thrasyvoulou, Andreas

    2018-05-01

    Pollen analysis of honey is the basic method for the determination of its botanical origin. However, the presence of over-represented pollen in honeys may lead the analysis to false results. This can be more severe if this pollen is present in unifloral under-represented honeys of commercial importance (e.g. thyme honey). In the present study, we investigated the abundance of over-represented pollen grains on several quality characteristics in honey samples. In particular, we mixed honeys characterised as over-represented, specifically chestnut and eucalyptus, with thyme honeys in different analogies, and we also analysed the melissopalynological, organoleptic, physicochemical (water content, electrical conductivity, colour) and volatile characteristics of the blends. The most sensitive parameters were the microscopic characteristics, followed by the organoleptic ones. Blends of thyme honey with an originally low percentage of thyme pollen were the most influenced and could not be characterised as unifloral regarding their melissopalynological characteristics, even when they were mixed with small quantities of honeys with over-represented pollen (i.e. 5%). The present study confirms that, in the case of presence of over-represented pollen in honeys, pollen analysis alone cannot give trustworthy results for the determination of the botanical origin, even though their exclusion during pollen analysis, when they are present in percentages of up to 30%, could provide more accurate results. Consequently, pollen analysis should also be combined with the other analyses, especially in honeys with under-represented and over-represented pollens, to give safer results for the botanical characterisation of honeys. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

  16. Definitions Are Important: The Case of Linear Algebra

    ERIC Educational Resources Information Center

    Berman, Abraham; Shvartsman, Ludmila

    2016-01-01

    In this paper we describe an experiment in a linear algebra course. The aim of the experiment was to promote the students' understanding of the studied concepts focusing on their definitions. It seems to be a given that students should understand concepts' definitions before working substantially with them. Unfortunately, in many cases they do…

  17. Using standardized patients versus video cases for representing clinical problems in problem-based learning.

    PubMed

    Yoon, Bo Young; Choi, Ikseon; Choi, Seokjin; Kim, Tae-Hee; Roh, Hyerin; Rhee, Byoung Doo; Lee, Jong-Tae

    2016-06-01

    The quality of problem representation is critical for developing students' problem-solving abilities in problem-based learning (PBL). This study investigates preclinical students' experience with standardized patients (SPs) as a problem representation method compared to using video cases in PBL. A cohort of 99 second-year preclinical students from Inje University College of Medicine (IUCM) responded to a Likert scale questionnaire on their learning experiences after they had experienced both video cases and SPs in PBL. The questionnaire consisted of 14 items with eight subcategories: problem identification, hypothesis generation, motivation, collaborative learning, reflective thinking, authenticity, patient-doctor communication, and attitude toward patients. The results reveal that using SPs led to the preclinical students having significantly positive experiences in boosting patient-doctor communication skills; the perceived authenticity of their clinical situations; development of proper attitudes toward patients; and motivation, reflective thinking, and collaborative learning when compared to using video cases. The SPs also provided more challenges than the video cases during problem identification and hypotheses generation. SPs are more effective than video cases in delivering higher levels of authenticity in clinical problems for PBL. The interaction with SPs engages preclinical students in deeper thinking and discussion; growth of communication skills; development of proper attitudes toward patients; and motivation. Considering the higher cost of SPs compared with video cases, SPs could be used most advantageously during the preclinical period in the IUCM curriculum.

  18. Evaluating Admission Criteria Effects for Under-Represented Groups

    ERIC Educational Resources Information Center

    Childs, Ruth A.; Ferguson, Amanda K.; Herbert, Monique B.; Broad, Kathryn; Zhang, Jingshun

    2016-01-01

    The effects that admission criteria may have for under-represented groups are an important concern for programs seeking to improve access to post-secondary education. Using data from a large preservice teacher education program in the Canadian province of Ontario, we demonstrate two approaches to evaluating the effects of admission criteria. The…

  19. The first imported case of Rift Valley fever in China reveals a genetic reassortment of different viral lineages.

    PubMed

    Liu, Jingyuan; Sun, Yulan; Shi, Weifeng; Tan, Shuguang; Pan, Yang; Cui, Shujuan; Zhang, Qingchao; Dou, Xiangfeng; Lv, Yanning; Li, Xinyu; Li, Xitai; Chen, Lijuan; Quan, Chuansong; Wang, Qianli; Zhao, Yingze; Lv, Qiang; Hua, Wenhao; Zeng, Hui; Chen, Zhihai; Xiong, Haofeng; Jiang, Chengyu; Pang, Xinghuo; Zhang, Fujie; Liang, Mifang; Wu, Guizhen; Gao, George F; Liu, William J; Li, Ang; Wang, Quanyi

    2017-01-18

    We report the first imported case of Rift Valley fever (RVF) in China. The patient returned from Angola, a non-epidemic country, with an infection of a new reassortant from different lineages of Rift Valley fever viruses (RVFVs). The patient developed multiorgan dysfunction and gradually recovered with continuous renal replacement therapy and a short regimen of methylprednisolone treatment. The disordered cytokines and chemokines in the plasma of the patient revealed hypercytokinemia, but the levels of protective cytokines were low upon admission and fluctuated as the disease improved. Whole-genome sequencing and phylogenetic analysis revealed that the imported strain was a reassortant comprising the L and M genes from lineage E and the S gene from lineage A. This case highlights that RVFV had undergone genetic reassortment, which could potentially alter its biological properties, cause large outbreaks and pose a serious threat to global public health as well as the livestock breeding industry.

  20. Selection of Worst-Case Pesticide Leaching Scenarios for Pesticide Registration

    NASA Astrophysics Data System (ADS)

    Vereecken, H.; Tiktak, A.; Boesten, J.; Vanderborght, J.

    2010-12-01

    The use of pesticides, fertilizers and manure in intensive agriculture may have a negative impact on the quality of ground- and surface water resources. Legislative action has been undertaken in many countries to protect surface and groundwater resources from contamination by surface applied agrochemicals. Of particular concern are pesticides. The registration procedure plays an important role in the regulation of pesticide use in the European Union. In order to register a certain pesticide use, the notifier needs to prove that the use does not entail a risk of groundwater contamination. Therefore, leaching concentrations of the pesticide need to be assessed using model simulations for so called worst-case scenarios. In the current procedure, a worst-case scenario represents a parameterized pesticide fate model for a certain soil and a certain time series of weather conditions that tries to represent all relevant processes such as transient water flow, root water uptake, pesticide transport, sorption, decay and volatilisation as accurate as possible. Since this model has been parameterized for only one soil and weather time series, it is uncertain whether it represents a worst-case condition for a certain pesticide use. We discuss an alternative approach that uses a simpler model that requires less detailed information about the soil and weather conditions but still represents the effect of soil and climate on pesticide leaching using information that is available for the entire European Union. A comparison between the two approaches demonstrates that the higher precision that the detailed model provides for the prediction of pesticide leaching at a certain site is counteracted by its smaller accuracy to represent a worst case condition. The simpler model predicts leaching concentrations less precise at a certain site but has a complete coverage of the area so that it selects a worst-case condition more accurately.

  1. [Epidemiology of imported infectious diseases in China, 2013-2016].

    PubMed

    Wang, Y L; Wang, X; Ren, R Q; Zhou, L; Tu, W W; Ni, D X; Li, Q; Feng, Z J; Zhang, Y P

    2017-11-10

    Objective: To describe the epidemic of imported infectious diseases in China between 2013 and 2016, including the kinds of infectious diseases, affected provinces, source countries and the epidemiological characteristics, and provide scientific information for the prevention and control of imported infectious diseases. Methods: Data of cases of imported infectious diseases in China from 2013 to 2016 were collected from national information reporting system of infectious diseases, Microsoft Excel 2010 and SPSS 18.0 were used to conduct data cleaning and analysis. Results: From 2013 to 2016, a total of 16 206 imported cases of infectious diseases were reported in China. Of all the cases, 83.12% (13 471 cases) were malaria cases, followed by dengue fever (2 628 cases, 16.22%). The majority of the imported cases were males (14 522 cases, 89.61%). Most cases were aged 20-50 years. Except Zika virus disease and yellow fever, which were mainly reported before and after spring festival, other imported infectious diseases mainly occurred in summer and autumn. The epidemic in affected provinces varied with the types of infectious diseases, and Yunnan reported the largest case number of imported infectious diseases, followed by Jiangsu, Guangxi and Guangdong. The imported cases were mainly from Asian countries, such as Burma, and African countries, such as Angola, Equatorial Guinea and Ghana, which also varied with the types of infectious diseases. Conclusions: We should pay more attention to imported infectious diseases and strengthen the prevention and control measures in our country. In order to reduce the incidence of imported infectious diseases, the health education should be enforced for persons who plan to travel abroad and the active surveillance should be strengthened for returned travelers.

  2. Importance of consumer perceptions in fiber-enriched food products. A case study with sponge cakes.

    PubMed

    Tarrega, Amparo; Quiles, Amparo; Morell, Pere; Fiszman, Susana; Hernando, Isabel

    2017-02-22

    Sponge cakes enriched with fiber from different sources (maltodextrin, wheat, apple, blackcurrant and a mixture of potato and Plantago ovata) were studied. Profiling of the different cakes was carried out, first using a check-all-that-apply (CATA) question then evaluating the consumers' likings using a hedonic scale. The consumers also completed a nutrition knowledge (NK) questionnaire that was used to classify them according to their NK level. The instrumental texture of the cakes was evaluated by the texture profile analysis (TPA) method. The consumers' response was not linked to their NK level, but it mainly depended on the importance they gave to the cakes' distinctive sensory characteristics. In general, liking increased for samples considered easy to chew, spongy, soft and sweet, and decreased for samples perceived as tasteless, dry or having a fruity or an odd flavor. The sponge cakes containing maltodextrin or wheat fiber, which mostly resembled a conventional cake, were the most liked in general. Those containing the other three fibers were rejected by part of the consumers, for being tasteless in the case of potato plus Plantago ovata fiber, for being dry and doughy in the case of apple fiber and for having an odd flavor in the case of blackcurrant fiber.

  3. Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia.

    PubMed

    Paudel, Prakash; Raina, C; Zwar, Nicholas; Seale, Holly; Worth, Heather; Sheikh, Mohamud; Heywood, Anita E

    2017-09-01

    Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia. Prospective enhanced surveillance of notified cases of typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014. Details of pre-travel health preparation and disease-specific risk behaviours were collected. Among 180 cases associated with international travel, 28% were <18 years, 65% were VFR travellers and 22% were frequent travellers, having travelled ≥5 times in the past 5 years. 25% had sought pre-travel advice from a healthcare provider, and 16% reported a pre-travel vaccine. Seeking pre-travel health advice did not differ by immigrant status ( P  = 0.22) or by reason for travel ( P  = 0.13) but was more commonly sought by first time travellers ( P  = 0.03). Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water ( P  < 0.001) and eating uncooked food ( P  = 0.03) during travel compared to other travellers. Pre-travel health advice seeking practices and vaccine uptake was suboptimal among cases of notified disease. The results of this study highlight the need for a better understanding of barriers to pre-travel health seeking, particularly among high risk travellers, to reduce the importation of infectious diseases into Australia. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  4. What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?

    PubMed

    de Snoo-Trimp, Janine; Widdershoven, Guy; Svantesson, Mia; de Vet, Riekie; Molewijk, Bert

    2017-05-01

    There has been little attention paid to research on the outcomes of clinical ethics support (CES) or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation (MCD), prior to MCD participation, and to compare results between respondents. This mixed-methods study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were 'more open communication', 'better mutual understanding', 'concrete actions', 'see the situation from different perspectives', 'consensus on how to manage the situation' and 'find more courses of action'. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. © 2017 John Wiley & Sons Ltd.

  5. Representing Thoughts, Words, and Things in the UMLS

    PubMed Central

    Campbell, Keith E.; Oliver, Diane E.; Spackman, Kent A.; Shortliffe, Edward H.

    1998-01-01

    The authors describe a framework, based on the Ogden-Richards semiotic triangle, for understanding the relationship between the Unified Medical Language System (UMLS) and the source terminologies from which the UMLS derives its content. They pay particular attention to UMLS's Concept Unique Identifier (CUI) and the sense of “meaning” it represents as contrasted with the sense of “meaning” represented by the source terminologies. The CUI takes on emergent meaning through linkage to terms in different terminology systems. In some cases, a CUI's emergent meaning can differ significantly from the original sources' intended meanings of terms linked by that CUI. Identification of these different senses of meaning within the UMLS is consistent with historical themes of semantic interpretation of language. Examination of the UMLS within such a historical framework makes it possible to better understand the strengths and limitations of the UMLS approach for integrating disparate terminologic systems and to provide a model, or theoretic foundation, for evaluating the UMLS as a Possible World—that is, as a mathematical formalism that represents propositions about some perspective or interpretation of the physical world. PMID:9760390

  6. Degradation analysis in the estimation of photometric redshifts from non-representative training sets

    NASA Astrophysics Data System (ADS)

    Rivera, J. D.; Moraes, B.; Merson, A. I.; Jouvel, S.; Abdalla, F. B.; Abdalla, M. C. B.

    2018-04-01

    We perform an analysis of photometric redshifts estimated by using a non-representative training sets in magnitude space. We use the ANNz2 and GPz algorithms to estimate the photometric redshift both in simulations as well as in real data from the Sloan Digital Sky Survey (DR12). We show that for the representative case, the results obtained by using both algorithms have the same quality, either using magnitudes or colours as input. In order to reduce the errors when estimating the redshifts with a non-representative training set, we perform the training in colour space. We estimate the quality of our results by using a mock catalogue which is split samples cuts in the r-band between 19.4 < r < 20.8. We obtain slightly better results with GPz on single point z-phot estimates in the complete training set case, however the photometric redshifts estimated with ANNz2 algorithm allows us to obtain mildly better results in deeper r-band cuts when estimating the full redshift distribution of the sample in the incomplete training set case. By using a cumulative distribution function and a Monte-Carlo process, we manage to define a photometric estimator which fits well the spectroscopic distribution of galaxies in the mock testing set, but with a larger scatter. To complete this work, we perform an analysis of the impact on the detection of clusters via density of galaxies in a field by using the photometric redshifts obtained with a non-representative training set.

  7. 14 CFR 1260.58 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Designation of new technology... of new technology representative and patent representative. Designation of New Technology... of this grant entitled “New Technology,” the following named representatives are hereby designated by...

  8. Representativeness of direct observations selected using a work-sampling equation.

    PubMed

    Sharp, Rebecca A; Mudford, Oliver C; Elliffe, Douglas

    2015-01-01

    Deciding on appropriate sampling to obtain representative samples of behavior is important but not straightforward, because the relative duration of the target behavior may affect its observation in a given sampling interval. Work-sampling methods, which offer a way to adjust the frequency of sampling according to a priori or ongoing estimates of the behavior to achieve a preselected level of representativeness, may provide a solution. Full-week observations of 7 behaviors were conducted for 3 students with autism spectrum disorder and intellectual disabilities. Work-sampling methods were used to select momentary time samples from the full time-of-interest, which produced representative samples. However, work sampling required impractically high numbers of time samples to obtain representative samples. More practical momentary time samples produced less representative samples, particularly for low-duration behaviors. The utility and limits of work-sampling methods for applied behavior analysis are discussed. © Society for the Experimental Analysis of Behavior.

  9. Representative Landscapes in the Forested Area of Canada

    NASA Astrophysics Data System (ADS)

    Cardille, Jeffrey A.; White, Joanne C.; Wulder, Mike A.; Holland, Tara

    2012-01-01

    Canada is a large nation with forested ecosystems that occupy over 60% of the national land base, and knowledge of the patterns of Canada's land cover is important to proper environmental management of this vast resource. To this end, a circa 2000 Landsat-derived land cover map of the forested ecosystems of Canada has created a new window into understanding the composition and configuration of land cover patterns in forested Canada. Strategies for summarizing such large expanses of land cover are increasingly important, as land managers work to study and preserve distinctive areas, as well as to identify representative examples of current land-cover and land-use assemblages. Meanwhile, the development of extremely efficient clustering algorithms has become increasingly important in the world of computer science, in which billions of pieces of information on the internet are continually sifted for meaning for a vast variety of applications. One recently developed clustering algorithm quickly groups large numbers of items of any type in a given data set while simultaneously selecting a representative—or "exemplar"—from each cluster. In this context, the availability of both advanced data processing methods and a nationally available set of landscape metrics presents an opportunity to identify sets of representative landscapes to better understand landscape pattern, variation, and distribution across the forested area of Canada. In this research, we first identify and provide context for a small, interpretable set of exemplar landscapes that objectively represent land cover in each of Canada's ten forested ecozones. Then, we demonstrate how this approach can be used to identify flagship and satellite long-term study areas inside and outside protected areas in the province of Ontario. These applications aid our understanding of Canada's forest while augmenting its management toolbox, and may signal a broad range of applications for this versatile approach.

  10. Using standardized patients versus video cases for representing clinical problems in problem-based learning

    PubMed Central

    2016-01-01

    Purpose: The quality of problem representation is critical for developing students’ problem-solving abilities in problem-based learning (PBL). This study investigates preclinical students’ experience with standardized patients (SPs) as a problem representation method compared to using video cases in PBL. Methods: A cohort of 99 second-year preclinical students from Inje University College of Medicine (IUCM) responded to a Likert scale questionnaire on their learning experiences after they had experienced both video cases and SPs in PBL. The questionnaire consisted of 14 items with eight subcategories: problem identification, hypothesis generation, motivation, collaborative learning, reflective thinking, authenticity, patient-doctor communication, and attitude toward patients. Results: The results reveal that using SPs led to the preclinical students having significantly positive experiences in boosting patient-doctor communication skills; the perceived authenticity of their clinical situations; development of proper attitudes toward patients; and motivation, reflective thinking, and collaborative learning when compared to using video cases. The SPs also provided more challenges than the video cases during problem identification and hypotheses generation. Conclusion: SPs are more effective than video cases in delivering higher levels of authenticity in clinical problems for PBL. The interaction with SPs engages preclinical students in deeper thinking and discussion; growth of communication skills; development of proper attitudes toward patients; and motivation. Considering the higher cost of SPs compared with video cases, SPs could be used most advantageously during the preclinical period in the IUCM curriculum. PMID:26923094

  11. Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast

    PubMed Central

    2014-01-01

    Background Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. Methods A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Results Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Conclusions Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment. PMID:25047177

  12. Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast.

    PubMed

    Dos-Santos, João C K; Angerami, Rodrigo N; Castiñeiras, Catarina M S; Lopes, Stefanie C P; Albrecht, Letusa; Garcia, Márcia T; Levy, Carlos E; Moretti, Maria L; Lacerda, Marcus V G; Costa, Fabio T M

    2014-07-22

    Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.

  13. Exploring the importance of quantum effects in nucleation: The archetypical Nen case

    NASA Astrophysics Data System (ADS)

    Unn-Toc, Wesley; Halberstadt, Nadine; Meier, Christoph; Mella, Massimo

    2012-07-01

    The effect of quantum mechanics (QM) on the details of the nucleation process is explored employing Ne clusters as test cases due to their semi-quantal nature. In particular, we investigate the impact of quantum mechanics on both condensation and dissociation rates in the framework of the microcanonical ensemble. Using both classical trajectories and two semi-quantal approaches (zero point averaged dynamics, ZPAD, and Gaussian-based time dependent Hartree, G-TDH) to model cluster and collision dynamics, we simulate the dissociation and monomer capture for Ne8 as a function of the cluster internal energy, impact parameter and collision speed. The results for the capture probability Ps(b) as a function of the impact parameter suggest that classical trajectories always underestimate capture probabilities with respect to ZPAD, albeit at most by 15%-20% in the cases we studied. They also do so in some important situations when using G-TDH. More interestingly, dissociation rates kdiss are grossly overestimated by classical mechanics, at least by one order of magnitude. We interpret both behaviours as mainly due to the reduced amount of kinetic energy available to a quantum cluster for a chosen total internal energy. We also find that the decrease in monomer dissociation energy due to zero point energy effects plays a key role in defining dissociation rates. In fact, semi-quantal and classical results for kdiss seem to follow a common "corresponding states" behaviour when the proper definition of internal and dissociation energies are used in a transition state model estimation of the evaporation rate constants.

  14. Global trade in ornamental fish from an Australian perspective: the case for revised import risk analysis and management strategies.

    PubMed

    Whittington, R J; Chong, R

    2007-09-14

    ) consistent with government objectives to prevent introduction of pests and diseases, promote development of future aquaculture industries or maintain biodiversity. It is concluded that the risk analysis process described by the Office International des Epizooties under the SPS agreement cannot be used in a meaningful way for current patterns of ornamental fish trade. Transboundary disease incursions will continue and exotic pathogens will become established in new regions as a result of the ornamental fish trade, and this will be an international phenomenon. Ornamental fish represent a special case in live animal trade where OIE guidelines for risk analysis need to be revised. Alternatively, for countries such as Australia with implied very high ALOP, the number of species traded and the number of sources permitted need to be dramatically reduced to facilitate hazard identification, risk assessment and import quarantine controls.

  15. Importation and circulation of poliovirus in Bulgaria in 2001.

    PubMed Central

    Kojouharova, Mira; Zuber, Patrick L. F.; Gyurova, Snejana; Fiore, Lucia; Buttinelli, Gabriele; Kunchev, Angel; Vladimirova, Nadejda; Korsun, Neli; Filipova, Radosveta; Boneva, Roumiana; Gavrilin, Eugene; Deshpande, Jagadish M.; Oblapenko, George; Wassilak, Steven G.

    2003-01-01

    OBJECTIVE: To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response. METHODS: Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhanced surveillance for acute flaccid paralysis, and conducted supplemental immunization activities. FINDINGS: The three cases of polio studied had not been vaccinated and lived in socioeconomically deprived areas of two cities. Four Roma children from the Bourgas district had antibody titres to serotype 1 poliovirus only, and wild type 1 virus was isolated from the faeces of two asymptomatic Roma children in the Bourgas and Sofia districts. Poliovirus isolates were related genetically and represented a single evolutionary lineage; genomic sequences were less than 90% identical to poliovirus strains isolated previously in Europe, but 98.3% similar to a strain isolated in India in 2000. No cases or wild virus isolates were found after supplemental immunization activities were launched in May 2001. CONCLUSIONS: In Bulgaria, an imported poliovirus was able to circulate for two to five months among minority populations. Surveillance data strongly suggest that wild poliovirus circulation ceased shortly after supplemental immunization activities with oral poliovirus vaccine were conducted. PMID:12973639

  16. The importance of early detection of lip cancer risk groups

    NASA Astrophysics Data System (ADS)

    Fratila, M.; Rosu, S.

    2014-03-01

    Oral maxillo-facial region cancer carries major importance in the tumour pathology of the organism being characterized by a high frequency as well as by the variety of the clinical anatomical and topographic forms through which it is presented. Over 60% of labial carcinoma begins as an asymptomatic ulceration, therefore patients do not pay due attention, considering it a "rebellious thrush" and they make a specialized medical appointment in an advanced stage of the tumor. In this study we pursued the frequency of the lip cancer pathology compared to the total CMF; the distribution the lip cancer by sex and age in patients who submitted to the specialized service; the originating environment of the patient with lip cancer; the anatomical location of the lip cancer; the frequency of relapses after treatment; the presence of adenopathy in the first consultation. The study was performed at the Clinic of Cranio-Maxillofacial Surgery, University of Medicine and Pharmacy "Victor Babes" Timişoara and pursued statistical aspects of the lip cancer incidence over a period of five years (2007-2012). Pre- and postoperative patients were monitored constantly, registering in individual sheets the evolution of the disease, monitoring the relapses after treatment and the presence of adenopathy in the first consultation. As shown in the statistics made in the last five years (2007-2012), from a total of 8135 cases with CMF pathology hospitalized in the Timisoara surgery clinic, 163 cases, or 2%, were cancer of the lip. Analyzing the gender distribution shows that males represent 81% of cases while the remaining 19% were found in women. From the study of age distribution, we found that the number of cases increases with age: 153 cases over 60 years old and 58 cases between 20 - 60 years. Personal statistics from the 212 cases of cancer of the lip reveal that 143 (67%) patients were from the rural areas and 69 (33%) from urban areas. Neoplastic pathology is constantly increasing both

  17. To What Extent Is Long-term Care Representative of Elderly Care? A Case Study of Elderly Care Financing in Lombardy, Italy.

    PubMed

    Brenna, Elenka; Gitto, Lara

    2017-02-25

    The ageing of European population has been rapidly increasing during the last decades, and the problem of elderly care financing has become an issue for policy-makers. Long-term care (LTC) financing is considered a suitable proxy of the resources committed to elderly care by each government, but the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within each country. Since there is a broad heterogeneity in LTC funding, organization and setting among European States, it is difficult to find a common parameter representing the public resources destined to the elderly care. We address these topics employing as a case study an Italian region, Lombardy, which in terms of population, dimension, healthcare organization and economic development could be compared to other European countries. The method we suggest, which consists basically in a careful estimate of all the public resources employed in the provision of services exclusively destined to the elderly, could be applied, with the due differences, to other European countries or regions. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  18. Multiple Instantons Representing Higher-Order Chern-Pontryagin Classes

    NASA Astrophysics Data System (ADS)

    Spruck, Joel; Tchrakian, D. H.; Yang, Yisong

    It has been shown in the work of Chakrabarti, Sherry and Tchrakian that the chiral SO+/-(4 p) Yang-Mills theory in the Euclidean 4 p (p>= 2) dimensions allows an axially symmetric self-dual system of equations similar to Witten's instanton equations in the classical 4-dimensional SU(2) SO+/-(4) theory and the solutions represent a new class of instantons. However the rigorous existence of these higher-dimensional instanton solutions has remained open except for the solution of unit charge representing a single instanton. In this paper we establish an existence and uniqueness theorem for multi-instantons of arbitrary charges in the case p>= 2. These solutions are the first known instantons, with the Chern-Pontryagin index greater than one, of the Yang-Mills model in higher dimensions. Our approach is a study of a nonlinear variational equation defined on the Poincaré half plane.

  19. Importance of electromyography and the electrophysiological severity scale in forensic reports.

    PubMed

    Bilgin, Nursel Gamsiz; Ozge, Aynur; Mert, Ertan; Yalçinkaya, Deniz E; Kar, Hakan

    2007-05-01

    Forensic reports on traumatic peripheral nerve injuries include dysfunction degrees of extremities, which are arranged according to the Turkish Penalty Code. The aim of this study is to discuss the role and importance of electromyography while preparing forensic reports in the cases of traumatic peripheral nerve injuries and the usefulness of scoring systems. A modified global scale, recommended by Mondelli et al., was used to assess the electrophysiological impairment of each peripheral nerve. Forensic reports of 106 patients, reported between 2002 and 2004, were evaluated. Thirty-four percent of the cases were reported as "total loss of function," 41.5% were reported as "functional disability," and there were no dysfunctions in the other cases in forensic reports that were prepared based on Council of Social Insurance Regulations of Health Processes and Guide prepared by the Council of Forensic Medicine and profession associations of forensic medicine. When we rearranged these forensic reports based on the electrophysiological severity scale (ESS), it was clearly found that all of the score 2 cases and 86.7% of the score 3 cases corresponded to "functional disability" and 91.4% of the score 4 cases correspond to "total loss of function." We found a significant correlation between the ESS and functional evaluation in peripheral nerve injury cases. Evaluation of functional disabilities in peripheral nerve injuries with the ESS represents a standardized and objective method used for forensic reports.

  20. Using semantics for representing experimental protocols.

    PubMed

    Giraldo, Olga; García, Alexander; López, Federico; Corcho, Oscar

    2017-11-13

    An experimental protocol is a sequence of tasks and operations executed to perform experimental research in biological and biomedical areas, e.g. biology, genetics, immunology, neurosciences, virology. Protocols often include references to equipment, reagents, descriptions of critical steps, troubleshooting and tips, as well as any other information that researchers deem important for facilitating the reusability of the protocol. Although experimental protocols are central to reproducibility, the descriptions are often cursory. There is the need for a unified framework with respect to the syntactic structure and the semantics for representing experimental protocols. In this paper we present "SMART Protocols ontology", an ontology for representing experimental protocols. Our ontology represents the protocol as a workflow with domain specific knowledge embedded within a document. We also present the S ample I nstrument R eagent O bjective (SIRO) model, which represents the minimal common information shared across experimental protocols. SIRO was conceived in the same realm as the Patient Intervention Comparison Outcome (PICO) model that supports search, retrieval and classification purposes in evidence based medicine. We evaluate our approach against a set of competency questions modeled as SPARQL queries and processed against a set of published and unpublished protocols modeled with the SP Ontology and the SIRO model. Our approach makes it possible to answer queries such as Which protocols use tumor tissue as a sample. Improving reporting structures for experimental protocols requires collective efforts from authors, peer reviewers, editors and funding bodies. The SP Ontology is a contribution towards this goal. We build upon previous experiences and bringing together the view of researchers managing protocols in their laboratory work. Website: https://smartprotocols.github.io/ .

  1. Food-borne botulism cases in Van region in eastern Turkey: importance of electromyography in the diagnosis.

    PubMed

    Anlar, O; Irmak, H; Tombul, T; Akdeniz, H; Caksen, H; Kose, D; Ceylan, A

    2003-09-01

    Food-borne botulism is an acute form of poisoning that results from ingestion of a toxin produced by Clostridium botulinum. Botulism toxin causes its major effect by blocking neuromuscular transmission in autonomic and motor nerve terminals. In this study, we present the features of eleven cases of food-borne botulism admitted to our hospital in 2001. All of the cases were caused by home-prepared foods; green beans. In these cases, the main symptoms and signs were generalized muscular weakness, dry mouth, dysphagia, disponea and diplopia. Electrophysiological studies were performed on four patients. Motor conduction studies showed that compound muscle action potentials were decreased with normal latencies and conduction velocities. The needle electromyography showed signs of denervation potentials like fibrillation and positive waves in four patients. Repetitive nerve stimulation with high frequency (20 Hz) induced an increment close to 100% in the amplitudes in 2 of 4 patients. Although toxin could not be detected in the patients, the electromyographic findings supported our diagnosis. We concluded that electromyography has an important role in diagnosis of botulism, especially in the condition that serologic tests are negative or cannot be performed.

  2. The Importance of Socio-Economic Versus Environmental Risk Factors for Reported Dengue Cases in Java, Indonesia.

    PubMed

    Wijayanti, Siwi P M; Porphyre, Thibaud; Chase-Topping, Margo; Rainey, Stephanie M; McFarlane, Melanie; Schnettler, Esther; Biek, Roman; Kohl, Alain

    2016-09-01

    Dengue is a major mosquito-borne viral disease and an important public health problem. Identifying which factors are important determinants in the risk of dengue infection is critical in supporting and guiding preventive measures. In South-East Asia, half of all reported fatal infections are recorded in Indonesia, yet little is known about the epidemiology of dengue in this country. Hospital-reported dengue cases in Banyumas regency, Central Java were examined to build Bayesian spatial and spatio-temporal models assessing the influence of climatic, demographic and socio-economic factors on the risk of dengue infection. A socio-economic factor linking employment type and economic status was the most influential on the risk of dengue infection in the Regency. Other factors such as access to healthcare facilities and night-time temperature were also found to be associated with higher risk of reported dengue infection but had limited explanatory power. Our data suggest that dengue infections are triggered by indoor transmission events linked to socio-economic factors (employment type, economic status). Preventive measures in this area should therefore target also specific environments such as schools and work areas to attempt and reduce dengue burden in this community. Although our analysis did not account for factors such as variations in immunity which need further investigation, this study can advise preventive measures in areas with similar patterns of reported dengue cases and environment.

  3. Do All X-ray Structures of Protein-Ligand Complexes Represent Functional States? EPOR, a Case Study.

    PubMed

    Corbett, Michael S P; Mark, Alan E; Poger, David

    2017-02-28

    Based on differences between the x-ray crystal structures of ligand-bound and unbound forms, the activation of the erythropoietin receptor (EPOR) was initially proposed to involve a cross-action scissorlike motion. However, the validity of the motions involved in the scissorlike model has been recently challenged. Here, atomistic molecular dynamics simulations are used to examine the structure of the extracellular domain of the EPOR dimer in the presence and absence of erythropoietin and a series of agonistic or antagonistic mimetic peptides free in solution. The simulations suggest that in the absence of crystal packing effects, the EPOR chains in the different dimers adopt very similar conformations with no clear distinction between the agonist and antagonist-bound complexes. This questions whether the available x-ray crystal structures of EPOR truly represent active or inactive conformations. The study demonstrates the difficulty in using such structures to infer a mechanism of action, especially in the case of membrane receptors where just part of the structure has been considered in addition to potential confounding effects that arise from the comparison of structures in a crystal as opposed to a membrane environment. The work highlights the danger of assigning functional significance to small differences between structures of proteins bound to different ligands in a crystal environment without consideration of the effects of the crystal lattice and thermal motion. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

  4. Representing, Running, and Revising Mental Models: A Computational Model

    ERIC Educational Resources Information Center

    Friedman, Scott; Forbus, Kenneth; Sherin, Bruce

    2018-01-01

    People use commonsense science knowledge to flexibly explain, predict, and manipulate the world around them, yet we lack computational models of how this commonsense science knowledge is represented, acquired, utilized, and revised. This is an important challenge for cognitive science: Building higher order computational models in this area will…

  5. The importance of socially responsible strategic planning

    NASA Astrophysics Data System (ADS)

    Štrukelj, Tjaša

    2017-10-01

    This paper researches the importance of social responsible strategic planning regardless of the sector and shows research results on the case example of the selected tourism sector, which has economic and employment potential and social and environmental implications. Tourism sector is closely interdependent with transport sector and influences it. Therefore, the more we develop the tourism sector, the more the transport sector is developing as well. Based on Mulej’s Dialectical Systems Theory (DST) we found out that enterprises should integrate sustainability and social responsibility into their strategic planning if they want the Earth to survive. This urged the European Union, ISO International Standards Organization, many other organisations and many researchers. To make strategic planning socially responsible, enterprise’s governors should request social responsibility in business policy, which represents their governance guidelines and is implemented through the strategies set up by top managers and realised in the basic realisation process - their business operations.

  6. A Method to Represent Heterogeneous Materials for Rapid Prototyping: The Matryoshka Approach.

    PubMed

    Lei, Shuangyan; Frank, Matthew C; Anderson, Donald D; Brown, Thomas D

    The purpose of this paper is to present a new method for representing heterogeneous materials using nested STL shells, based, in particular, on the density distributions of human bones. Nested STL shells, called Matryoshka models, are described, based on their namesake Russian nesting dolls. In this approach, polygonal models, such as STL shells, are "stacked" inside one another to represent different material regions. The Matryoshka model addresses the challenge of representing different densities and different types of bone when reverse engineering from medical images. The Matryoshka model is generated via an iterative process of thresholding the Hounsfield Unit (HU) data using computed tomography (CT), thereby delineating regions of progressively increasing bone density. These nested shells can represent regions starting with the medullary (bone marrow) canal, up through and including the outer surface of the bone. The Matryoshka approach introduced can be used to generate accurate models of heterogeneous materials in an automated fashion, avoiding the challenge of hand-creating an assembly model for input to multi-material additive or subtractive manufacturing. This paper presents a new method for describing heterogeneous materials: in this case, the density distribution in a human bone. The authors show how the Matryoshka model can be used to plan harvesting locations for creating custom rapid allograft bone implants from donor bone. An implementation of a proposed harvesting method is demonstrated, followed by a case study using subtractive rapid prototyping to harvest a bone implant from a human tibia surrogate.

  7. [Prehospital cardiac resuscitation in Queretaro, Mexico. Report of 3 cases. Importance of an integral emergency medical care system].

    PubMed

    Fraga-Sastrías, Juan Manuel; Aguilera-Campos, Andrea; Barinagarrementería-Aldatz, Fernando; Ortíz-Mondragón, Claudio; Asensio-Lafuente, Enrique

    2014-01-01

    In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  8. Union Learning Representatives: Facilitating Professional Development for Scottish Teachers

    ERIC Educational Resources Information Center

    Alexandrou, Alex; O'Brien, Jim

    2007-01-01

    In the United Kingdom, teachers' professional associations and labor organizations, notably in the form of trade unions have historically been involved in education and training in the workplace. Recently, in the United Kingdom this activity has gained greater credence and importance due to the emergence of trade union learning representatives who…

  9. 48 CFR 1852.227-72 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... technology representative and patent representative. 1852.227-72 Section 1852.227-72 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 1852.227-72 Designation of new technology representative...

  10. 48 CFR 1852.227-72 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... technology representative and patent representative. 1852.227-72 Section 1852.227-72 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 1852.227-72 Designation of new technology representative...

  11. 48 CFR 1852.227-72 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... technology representative and patent representative. 1852.227-72 Section 1852.227-72 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 1852.227-72 Designation of new technology representative...

  12. 48 CFR 1852.227-72 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... technology representative and patent representative. 1852.227-72 Section 1852.227-72 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 1852.227-72 Designation of new technology representative...

  13. 48 CFR 1852.227-72 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... technology representative and patent representative. 1852.227-72 Section 1852.227-72 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 1852.227-72 Designation of new technology representative...

  14. Human myiasis in New Zealand: imported and indigenously-acquired cases: the species of concern and clinical aspects.

    PubMed

    Derraik, Jose G B; Heath, Allen C G; Rademaker, Marius

    2010-09-10

    Reports of myiasis in humans in New Zealand are somewhat rare, and little attention has been paid to this issue in the local medical literature. A number of Diptera (fly) families present in New Zealand have been associated with cases of human myiasis: Calliphoridae (7 species), Fanniidae (2 species), Muscidae (3 species), Oestridae (4 species), Phoridae (3 species), Psychodidae (1 species), Sarcophagidae (2 species), Stratiomyidae (1 species) and Syrphidae (1 species). Despite these numbers, there have only been 6 published records and we obtained further 16 unpublished reports of myiasis acquired in New Zealand. Records of imported myiasis in humans are also rare, with only 2 published and 6 unpublished cases obtained. As many medical practitioners are unaware of myiasis or encounter it rarely, we provide a brief discussion of the clinical features and treatment.

  15. Prescribers prefer people: The sources of information used by doctors for prescribing suggest that the medium is more important than the message

    PubMed Central

    McGettigan, P; Golden, J; Fryer, J; Chan, R; Feely, J

    2001-01-01

    Aims The sources of prescribing information are legion but there is little knowledge about which are actually used in practice by doctors when prescribing. The aims of this study were to determine the sources of prescribing information considered important by doctors, establish which were used in practice, and investigate if hospital and primary care physicians differed in their use of the sources. Methods Two hundred general practitioners (GPs) and 230 hospital doctors were asked to rate information sources in terms of their importance for prescribing ‘old’ and ‘new’ drugs, and then to name the source from which information about the last new drug prescribed was actually derived. Results Among 108 GPs, the Drugs and Therapeutics Bulletin and medical journal articles were most frequently rated as important for information on both old and new drugs while pharmaceutical representatives and hospital/consultant recommendations were more important for information on new drugs, as opposed to old. In practice, information on the last new drug prescribed was derived from pharmaceutical representatives in 42% of cases and hospital/consultant recommendations in 36%, with other sources used infrequently. Among 118 hospital doctors, the British National Formulary (BNF) and senior colleagues were of greatest theoretical importance. In practice, information on the last new drug prescribed was derived from a broad range of sources: colleagues, 29%; pharmaceutical representatives, 18%; hospital clinical meetings, 15%; journal articles, 13%; lectures, 10%. GPs and hospital doctors differed significantly in their use of pharmaceutical representatives (42% vs 18%) and colleagues (7% vs 29%) as sources of prescribing information (P < 0.0001 for both). Conclusions The sources most frequently rated important in theory were not those most used in practice, especially among GPs. Both groups under-estimated the importance of pharmaceutical representatives. Most importantly, the

  16. Imported malaria in children in Madrid, Spain, 2007-2013.

    PubMed

    Sánchez, Beatriz Soto; Tato, L M Prieto; Martín, S Guillén; Pérez, E; Grasa, C; Valderrama, S; Augusto, I de; Sierra, M; Ros, M García; Aguado, I; Hortelano, M García López

    The majority of malaria cases diagnosed in Europe in the last few years have occurred in people living in non-endemic areas travelling back to their home country to visit friends and relatives (VFRs). Children account for 15-20% of imported malaria, with known higher risk of severe disease. A retrospective multicentre study was conducted in 24 hospitals in Madrid (Spain) including patients under 16 years diagnosed with malaria (2007-2013). A total of 149 episodes in 147 children were reported. Plasmodium falciparum was the species most commonly isolated. Twenty-five patients developed severe malaria and there was one death related to malaria. VFR accounted for 45.8% of our children. Only 17 VFRs had received prophylaxis, and 4 of them taken appropriately. They presented more frequently with fever (98% vs. 69%), a longer time with fever (55 vs. 26%), delay in diagnosis of more than three days (62 vs. 37%), and more thrombocytopenia (65 vs. 33%) than non-VFRs, and with significant differences (p<0.05). VFRs represent a large proportion of imported malaria cases in our study. They seldom took adequate prophylaxis, and delayed the visit to the physician, increasing the length of fever and subsequent delaying in diagnosis. Appropriate preventive measures, such as education and pre-travel advices should be taken in this population. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  17. The Importance of Socio-Economic Versus Environmental Risk Factors for Reported Dengue Cases in Java, Indonesia

    PubMed Central

    Chase-Topping, Margo; Rainey, Stephanie M.; McFarlane, Melanie; Schnettler, Esther; Biek, Roman; Kohl, Alain

    2016-01-01

    Background Dengue is a major mosquito-borne viral disease and an important public health problem. Identifying which factors are important determinants in the risk of dengue infection is critical in supporting and guiding preventive measures. In South-East Asia, half of all reported fatal infections are recorded in Indonesia, yet little is known about the epidemiology of dengue in this country. Methodology/Principal findings Hospital-reported dengue cases in Banyumas regency, Central Java were examined to build Bayesian spatial and spatio-temporal models assessing the influence of climatic, demographic and socio-economic factors on the risk of dengue infection. A socio-economic factor linking employment type and economic status was the most influential on the risk of dengue infection in the Regency. Other factors such as access to healthcare facilities and night-time temperature were also found to be associated with higher risk of reported dengue infection but had limited explanatory power. Conclusions/Significance Our data suggest that dengue infections are triggered by indoor transmission events linked to socio-economic factors (employment type, economic status). Preventive measures in this area should therefore target also specific environments such as schools and work areas to attempt and reduce dengue burden in this community. Although our analysis did not account for factors such as variations in immunity which need further investigation, this study can advise preventive measures in areas with similar patterns of reported dengue cases and environment. PMID:27603137

  18. Three Cases of Adolescent Childbearing Decision-Making: The Importance of Ambivalence

    ERIC Educational Resources Information Center

    Bender, Soley S.

    2008-01-01

    Limited information is available about the childbearing decision-making experience by the pregnant adolescent. The purpose of this case study was to explore this experience with three pregnant teenagers. The study is based on nine qualitative interviews. Within-case descriptions applying the theoretical model of decision-making regarding unwanted…

  19. A spatial framework for representing nearshore ecosystems

    NASA Astrophysics Data System (ADS)

    Gregr, Edward J.; Lessard, Joanne; Harper, John

    2013-08-01

    The shallow, coastal regions of the world's oceans are highly productive ecosystems providing important habitat for commercial, forage, endangered, and iconic species. Given the diversity of ecosystem services produced or supported by this ecosystem, a better understanding of its structure and function is central to developing an ecosystem-based approach to management. However this region - termed the ‘white strip' by marine geologists because of the general lack of high-resolution bathymetric data - is dynamic, highly variable, and difficult to access making data collection challenging and expensive. Since substrate is a key indicator of habitat in this important ecosystem, our objective was to create a continuous substrate map from the best available bottom type data. Such data are critical to assessments of species distributions and anthropogenic risk. Using the Strait of Georgia in coastal British Columbia, Canada, as a case study, we demonstrate how such a map can be created from a diversity of sources. Our approach is simple, quantitative, and transparent making it amenable to iterative improvement as data quality and availability improve. We evaluated the ecological performance of our bottom patches using observed shellfish distributions. We found that observations of geoduck clam, an infaunal species, and red urchins, a species preferentially associated with hard bottom, were strongly and significantly associated with our soft and hard patches respectively. Our description of bottom patches also corresponded well with a more traditional, morphological classification of a portion of the study area. To provide subsequent analyses (such as habitat models) with some confidence in the defined bottom type values, we developed a corresponding confidence surface based on the agreement of, and distance between observations. Our continuous map of nearshore bottom patches thus provides a spatial framework to which other types of data, both abiotic (e.g., energy) and

  20. Incubation period for campylobacteriosis and its importance in the estimation of incidence related to travel.

    PubMed

    Horn, B J; Lake, R J

    2013-10-03

    Differentiation between travel-related and domestic cases of infectious disease is important in managing risk. Incubation periods of cases from several outbreaks of campylobacteriosis in Canada, Europe, and the United States with defined exposure time of less than 24 hours were collated to provide information on the incubation period distribution. This distribution was consistent across the varied outbreaks considered, with 84% (702/832) of cases having an incubation period of four days or less and 1% having an incubation period of eight days or more. The incubation period distribution was incorporated into a model for the number of travel-related cases presenting with symptom onset at given dates after return to their country of residence. Using New Zealand notification data between 2006 and 2010 for cases who had undertaken foreign travel within 10 days prior to symptom onset, we found that 29.6% (67/227 cases; 95% confidence interval (CI): 28.3–30.8%) of these cases were likely to have been domestic cases. When cases with symptom onset prior to arrival were included, the probable domestic cases represented 11.8% (67/571; 95% CI: 11.2–12.3%). Consideration of incubation time distributions and consistent collection of travel start/end dates with symptom onset dates would assist attribution of cases to foreign travel.

  1. How well do meteorological indicators represent agricultural and forest drought across Europe?

    NASA Astrophysics Data System (ADS)

    Bachmair, S.; Tanguy, M.; Hannaford, J.; Stahl, K.

    2018-03-01

    Drought monitoring and early warning (M&EW) systems are an important component of agriculture/silviculture drought risk assessment. Many operational information systems rely mostly on meteorological indicators, and a few incorporate vegetation state information. However, the relationships between meteorological drought indicators and agricultural/silvicultural drought impacts vary across Europe. The details of this variability have not been elucidated sufficiently on a continental scale in Europe to inform drought risk management at administrative scales. The objective of this study is to fill this gap and evaluate how useful the variety of meteorological indicators are to assess agricultural/silvicultural drought across Europe. The first part of the analysis systematically linked meteorological drought indicators to remote sensing based vegetation indices (VIs) for Europe at NUTs3 administrative regions scale using correlation analysis for crops and forests. In a second step, a stepwise multiple linear regression model was deployed to identify variables explaining the spatial differences observed. Finally, corn crop yield in Germany was chosen as a case study to verify VIs’ representativeness of agricultural drought impacts. Results show that short accumulation periods of SPI and SPEI are best linked to crop vegetation stress in most cases, which further validates the use of SPI3 in existing operational drought monitors. However, large regional differences in correlations are also revealed. Climate (temperature and precipitation) explained the largest proportion of variance, suggesting that meteorological indices are less informative of agricultural/silvicultural drought in colder/wetter parts of Europe. These findings provide important context for interpreting meteorological indices on widely used national to continental M&EW systems, leading to a better understanding of where/when such M&EW tools can be indicative of likely agricultural stress and impacts.

  2. Echovirus-4 meningitis outbreak imported from India.

    PubMed

    Gobbi, Federico; Calleri, Guido; Spezia, Claudia; Lipani, Filippo; Balbiano, Rosanna; De Agostini, Maura; Milia, Maria Grazia; Caramello, Pietro

    2010-01-01

    We describe seven cases of meningitis in a group of young Italian travelers coming back from India. Virologic studies identified echovirus-4 as the cause of this cluster of cases, the first imported echovirus outbreak in Italy. Enteroviruses may play an important role in undiagnosed fevers in travelers.

  3. 75 FR 26160 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-11

    ... consistent standard of permissible business practice at VA facilities. It would also facilitate mutually... include suspension of a sales representative's access privileges, or, in extreme cases, denying access to... corrective action by the individual or company will suffice. In most cases, we expect that the infraction...

  4. A probable case of poliomyelitis imported to Malaysia.

    PubMed

    Tay, Chee Geap; Ong, Lai Choo; Goh, Khean Jin; Rahmat, Kartini; Fong, Choong Yi

    2015-12-01

    We report a previously well 10-month-old Somalian girl who acquired asymmetric lower limb weakness in July 2013 in Mogadishu, Banadir, before arriving in Malaysia at 12 months of age. In May 2013, there was a wild poliomyelitis outbreak in that area, as reported by the World Health Organization. Laboratory investigation, including cerebrospinal fluid, was unremarkable, and electrophysiological studies showed active axonal denervation in the left lower limb. The whole spine T2-weighted MRI revealed non-enhancing hyperintensities of the bilateral anterior horn cells, predominantly on the left side at T11-12. The viral isolations from two stool specimens at her presentation to our centre, 2 months after the onset of illness and 2 weeks apart, were negative. Despite lacking the acute virological evidence of poliomyelitis, in view of the girl's clinical, electrophysiological and classical spinal neuroradiological features, together with her temporal relationship with a World Health Organization reported wild poliomyelitis outbreak, we believe these findings are consistent with a diagnosis of imported poliomyelitis. A review at 30 months of age showed persistent left lower limb monoplegia with little recovery. Our patient reiterates the importance of maintaining awareness of wild polio importation, and keeping abreast of the latest news of global poliomyelitis outbreaks when treating patients with flaccid paralysis, even if they arrive from non-endemic poliomyelitis areas. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. A Method to Represent Heterogeneous Materials for Rapid Prototyping: The Matryoshka Approach

    PubMed Central

    Lei, Shuangyan; Frank, Matthew C.; Anderson, Donald D.; Brown, Thomas D.

    2015-01-01

    Purpose The purpose of this paper is to present a new method for representing heterogeneous materials using nested STL shells, based, in particular, on the density distributions of human bones. Design/methodology/approach Nested STL shells, called Matryoshka models, are described, based on their namesake Russian nesting dolls. In this approach, polygonal models, such as STL shells, are “stacked” inside one another to represent different material regions. The Matryoshka model addresses the challenge of representing different densities and different types of bone when reverse engineering from medical images. The Matryoshka model is generated via an iterative process of thresholding the Hounsfield Unit (HU) data using computed tomography (CT), thereby delineating regions of progressively increasing bone density. These nested shells can represent regions starting with the medullary (bone marrow) canal, up through and including the outer surface of the bone. Findings The Matryoshka approach introduced can be used to generate accurate models of heterogeneous materials in an automated fashion, avoiding the challenge of hand-creating an assembly model for input to multi-material additive or subtractive manufacturing. Originality/Value This paper presents a new method for describing heterogeneous materials: in this case, the density distribution in a human bone. The authors show how the Matryoshka model can be used to plan harvesting locations for creating custom rapid allograft bone implants from donor bone. An implementation of a proposed harvesting method is demonstrated, followed by a case study using subtractive rapid prototyping to harvest a bone implant from a human tibia surrogate. PMID:26120277

  6. Initial experience with imported Zika virus infection in Spain.

    PubMed

    Díaz-Menéndez, Marta; de la Calle-Prieto, Fernando; Montero, Dolores; Antolín, Eugenia; Vazquez, Ana; Arsuaga, Marta; Trigo, Elena; García-Bujalance, Silvia; de la Calle, María; Sánchez Seco, Paz; de Ory, Fernando; Arribas, Jose Ramón

    2018-01-01

    A considerable increase of imported Zika virus (ZIKV) infection has been reported in Europe in the last year. This is the result of the large outbreak of the disease in the Americas, along with the increase in the numbers of travellers and immigrants arriving from ZIKV endemic areas. A descriptive study was conducted in the Tropical Medicine Unit of Hospital La Paz-Carlos III in Madrid on travellers returning from an endemic area for ZIKV from January to April 2016. Demographic, clinical and microbiological data were analyzed. A total of 185 patients were screened for ZIKV (59.9% women, median age of 37.7±10.3 years). Main purpose of the travel was tourism to Colombia, Brazil, and México. Just under three-quarters (73%) were symptomatic, mostly with fever and headache. A total of 13 patients (7% of those screened) were diagnosed with ZIKV infections, of which four of them were pregnant. All of them were symptomatic patients, the majority immigrants, and mainly from Colombia. Diagnostic tests were based on positive neutralization antibodies (8 cases, 61.6%) and a positive RT-PCR in different organic fluids (7 cases, 53.8%) The four infected pregnant women underwent a neurosonography every 3 weeks, and no alterations were detected. RT-PCR in amniotic fluid was performed in three of them, with negative results. One of the children has already been born healthy. Our cases series represents the largest cohort of imported ZIKV to Spain described until now. Clinicians must increase awareness about the progression of the ZIKV outbreak and the affected areas so that they can include Zika virus infection in their differential diagnosis for travellers from those areas. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  7. A case of imported tungiasis in Scotland initially mimicking verrucae vulgaris.

    PubMed

    Wardhaugh, A D; Norris, J F

    1994-10-01

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

  8. Sequence- and Structure-Based Functional Annotation and Assessment of Metabolic Transporters in Aspergillus oryzae: A Representative Case Study

    PubMed Central

    Raethong, Nachon; Wong-ekkabut, Jirasak; Laoteng, Kobkul; Vongsangnak, Wanwipa

    2016-01-01

    Aspergillus oryzae is widely used for the industrial production of enzymes. In A. oryzae metabolism, transporters appear to play crucial roles in controlling the flux of molecules for energy generation, nutrients delivery, and waste elimination in the cell. While the A. oryzae genome sequence is available, transporter annotation remains limited and thus the connectivity of metabolic networks is incomplete. In this study, we developed a metabolic annotation strategy to understand the relationship between the sequence, structure, and function for annotation of A. oryzae metabolic transporters. Sequence-based analysis with manual curation showed that 58 genes of 12,096 total genes in the A. oryzae genome encoded metabolic transporters. Under consensus integrative databases, 55 unambiguous metabolic transporter genes were distributed into channels and pores (7 genes), electrochemical potential-driven transporters (33 genes), and primary active transporters (15 genes). To reveal the transporter functional role, a combination of homology modeling and molecular dynamics simulation was implemented to assess the relationship between sequence to structure and structure to function. As in the energy metabolism of A. oryzae, the H+-ATPase encoded by the AO090005000842 gene was selected as a representative case study of multilevel linkage annotation. Our developed strategy can be used for enhancing metabolic network reconstruction. PMID:27274991

  9. Sequence- and Structure-Based Functional Annotation and Assessment of Metabolic Transporters in Aspergillus oryzae: A Representative Case Study.

    PubMed

    Raethong, Nachon; Wong-Ekkabut, Jirasak; Laoteng, Kobkul; Vongsangnak, Wanwipa

    2016-01-01

    Aspergillus oryzae is widely used for the industrial production of enzymes. In A. oryzae metabolism, transporters appear to play crucial roles in controlling the flux of molecules for energy generation, nutrients delivery, and waste elimination in the cell. While the A. oryzae genome sequence is available, transporter annotation remains limited and thus the connectivity of metabolic networks is incomplete. In this study, we developed a metabolic annotation strategy to understand the relationship between the sequence, structure, and function for annotation of A. oryzae metabolic transporters. Sequence-based analysis with manual curation showed that 58 genes of 12,096 total genes in the A. oryzae genome encoded metabolic transporters. Under consensus integrative databases, 55 unambiguous metabolic transporter genes were distributed into channels and pores (7 genes), electrochemical potential-driven transporters (33 genes), and primary active transporters (15 genes). To reveal the transporter functional role, a combination of homology modeling and molecular dynamics simulation was implemented to assess the relationship between sequence to structure and structure to function. As in the energy metabolism of A. oryzae, the H(+)-ATPase encoded by the AO090005000842 gene was selected as a representative case study of multilevel linkage annotation. Our developed strategy can be used for enhancing metabolic network reconstruction.

  10. A population-based nested case control study on recurrent pneumonias in children with severe generalized cerebral palsy: ethical considerations of the design and representativeness of the study sample.

    PubMed

    Veugelers, Rebekka; Calis, Elsbeth A C; Penning, Corine; Verhagen, Arianne; Bernsen, Roos; Bouquet, Jan; Benninga, Marc A; Merkus, Peter J F M; Arets, Hubertus G M; Tibboel, Dick; Evenhuis, Heleen M

    2005-07-19

    In children with severe generalized cerebral palsy, pneumonias are a major health issue. Malnutrition, dysphagia, gastro-oesophageal reflux, impaired respiratory function and constipation are hypothesized risk factors. Still, no data are available on the relative contribution of these possible risk factors in the described population. This paper describes the initiation of a study in 194 children with severe generalized cerebral palsy, on the prevalence and on the impact of these hypothesized risk factors of recurrent pneumonias. A nested case-control design with 18 months follow-up was chosen. Dysphagia, respiratory function and constipation will be assessed at baseline, malnutrition and gastro-oesophageal reflux at the end of the follow-up. The study population consists of a representative population sample of children with severe generalized cerebral palsy. Inclusion was done through care-centres in a predefined geographical area and not through hospitals. All measurements will be done on-site which sets high demands on all measurements. If these demands were not met in "gold standard" methods, other methods were chosen. Although the inclusion period was prolonged, the desired sample size of 300 children was not met. With a consent rate of 33%, nearly 10% of all eligible children in The Netherlands are included (n = 194). The study population is subtly different from the non-participants with regard to severity of dysphagia and prevalence rates of pneumonias and gastro-oesophageal reflux. Ethical issues complicated the study design. Assessment of malnutrition and gastro-oesophageal reflux at baseline was considered unethical, since these conditions can be easily treated. Therefore, we postponed these diagnostics until the end of the follow-up. In order to include a representative sample, all eligible children in a predefined geographical area had to be contacted. To increase the consent rate, on-site measurements are of first choice, but timely inclusion is

  11. Identifying hospital-onset Escherichia coli bacteraemia cases from English mandatory surveillance: the case for applying a two-day post-admission rule.

    PubMed

    Davies, J; Johnson, A P; Hope, R

    2017-11-01

    A national voluntary surveillance programme has shown year-on-year increases in the number of bacteraemias caused by Escherichia coli. Mandatory surveillance of E. coli bacteraemia was introduced in 2011 with the aim of improving the quantity and quality of data collected. In contrast to the other national mandatory surveillance programmes, cases are not currently categorized based upon time of onset in relation to hospital admission. To assess the case for applying time-of-onset categorization to cases of E. coli bacteraemia in England. Data for all cases of E. coli bacteraemia reported to Public Health England between April 2012 and March 2016 were extracted from the national mandatory surveillance database. Cases were categorized as hospital-onset if positive blood cultures were obtained two or more days after admission. Approximately 21% of cases were categorized as hospital-onset. However, the proportion of hospital-onset cases decreased by 1% in each successive 12-month period, from 23% in 2012/13 to 20% in 2015/16 (P<0.001). Approximately one-fifth of E. coli bacteraemia cases reported via mandatory surveillance were identified as hospital-onset. Given that prevention and control strategies will vary by setting, the routine feedback of this information will prove important in informing infection prevention and control efforts. The categorization of this subset of cases represents an important step towards better understanding of the epidemiology of E. coli bacteraemia. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  12. The role of low-energy electrons in focused electron beam induced deposition: four case studies of representative precursors

    PubMed Central

    Thorman, Rachel M; Kumar T. P., Ragesh; Fairbrother, D Howard

    2015-01-01

    different nature and energy dependence of each process. We then explore the value of studying these processes through comparative gas phase and surface studies for four commonly-used FEBID precursors: MeCpPtMe3, Pt(PF3)4, Co(CO)3NO, and W(CO)6. Through these case studies, it is evident that this combination of studies can provide valuable insight into potential mechanisms governing deposit formation in FEBID. Although further experiments and new approaches are needed, these studies are an important stepping-stone toward better understanding the fundamental physics behind the deposition process and establishing design criteria for optimized FEBID precursors. PMID:26665061

  13. The role of low-energy electrons in focused electron beam induced deposition: four case studies of representative precursors.

    PubMed

    Thorman, Rachel M; Kumar T P, Ragesh; Fairbrother, D Howard; Ingólfsson, Oddur

    2015-01-01

    nature and energy dependence of each process. We then explore the value of studying these processes through comparative gas phase and surface studies for four commonly-used FEBID precursors: MeCpPtMe3, Pt(PF3)4, Co(CO)3NO, and W(CO)6. Through these case studies, it is evident that this combination of studies can provide valuable insight into potential mechanisms governing deposit formation in FEBID. Although further experiments and new approaches are needed, these studies are an important stepping-stone toward better understanding the fundamental physics behind the deposition process and establishing design criteria for optimized FEBID precursors.

  14. Representing Simple Geometry Types in NetCDF-CF

    NASA Astrophysics Data System (ADS)

    Blodgett, D. L.; Koziol, B. W.; Whiteaker, T. L.; Simons, R.

    2016-12-01

    The Climate and Forecast (CF) metadata convention is well-suited for representing gridded and point-based observational datasets. However, CF currently has no accepted mechanism for representing simple geometry types such as lines and polygons. Lack of support for simple geometries within CF has unintentionally excluded a broad set of geoscientific data types from NetCDF-CF data encodings. For example, hydrologic datasets often contain polygon watershed catchments and polyline stream reaches in addition to point sampling stations and water management infrastructure. The latter has an associated CF specification. In the interest of supporting all simple geometry types within CF, a working group was formed following an EarthCube workshop on Advancing NetCDF-CF [1] to draft a CF specification for simple geometries: points, lines, polygons, and their associated multi-geometry representations [2]. The draft also includes parametric geometry types such as circles and ellipses. This presentation will provide an overview of the scope and content of the proposed specification focusing on mechanisms for representing coordinate arrays using variable length or continuous ragged arrays, capturing multi-geometries, and accounting for type-specific geometry artifacts such as polygon holes/interiors, node ordering, etc. The concepts contained in the specification proposal will be described with a use case representing streamflow in rivers and evapotranspiration from HUC12 watersheds. We will also introduce Python and R reference implementations developed alongside the technical specification. These in-development, open source Python and R libraries convert between commonly used GIS software objects (i.e. GEOS-based primitives) and their associated simple geometry CF representation. [1] http://www.unidata.ucar.edu/events/2016CFWorkshop/[2] https://github.com/bekozi/netCDF-CF-simple-geometry

  15. The Importance of Decision Making: A Gifted Case Report

    ERIC Educational Resources Information Center

    Nauta, Noks; Ronner, Sieuwke; Groeneveld, Benno

    2009-01-01

    In this article the story of a fictional young university-educated woman is presented who struggles with making choices in her career and in her life. In this case report background information on gifted people at work is provided. In addition to that jobs and companies which are appropriate for highly gifted are mentioned. Besides that…

  16. 14 CFR 1274.906 - Designation of New Technology Representative and Patent Representative.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Designation of New Technology Representative and Patent Representative. 1274.906 Section 1274.906 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION COOPERATIVE AGREEMENTS WITH COMMERCIAL FIRMS Other Provisions and Special...

  17. 14 CFR 1274.906 - Designation of New Technology Representative and Patent Representative.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Designation of New Technology Representative and Patent Representative. 1274.906 Section 1274.906 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION COOPERATIVE AGREEMENTS WITH COMMERCIAL FIRMS Other Provisions and Special...

  18. The State's Case

    ERIC Educational Resources Information Center

    Calhoun, John W.

    1972-01-01

    Author is Assistant Attorney General in Wisconsin and represented the state in the Wisconsin vs. Yoder case. Cites other cases and decisions handed down by the United States Supreme Court in relation to compulsory education. (RB)

  19. Design Of Bioremediation Systems For Groundwater (Aerobic and Anaerobic Plus Representative Case Studies)

    EPA Science Inventory

    The attached presentation discusses the fundamentals of bioremediation in the subsurface. The basics of aerobic, cometabolic, and anaerobic bioremediation are presented. Case studies from the Delaware Sand & Gravel Superfund Site, Dover Cometabolic Research Project and the SABR...

  20. Study methods, recruitment, socio-demographic findings and demographic representativeness in the OPPERA study

    PubMed Central

    Slade, Gary D.; Bair, Eric; By, Kunthel; Mulkey, Flora; Baraian, Cristina; Rothwell, Rebecca; Reynolds, Maria; Miller, Vanessa; Gonzalez, Yoly; Gordon, Sharon; Ribeiro-Dasilva, Margarete; Lim, Pei Feng; Greenspan, Joel D; Dubner, Ron; Fillingim, Roger B; Diatchenko, Luda; Maixner, William; Dampier, Dawn; Knott, Charles; Ohrbach, Richard

    2011-01-01

    This paper describes methods used in the project “Orofacial Pain Prospective Evaluation and Risk Assessment” (OPPERA) and evaluates socio-demographic characteristics associated with temporomandibular disorders (TMD) in the OPPERA case-control study. Representativeness was investigated by comparing socio-demographic profiles of OPPERA participants with population census profiles of counties near study sites and by comparing age- and gender-associations with TMD in OPPERA and the 2007-09 US National Health Interview Survey. Volunteers aged 18-44 years were recruited at four US study sites: 3,263 people without TMD were enrolled into the prospective cohort study; 1,633 of them were selected as controls for the baseline case-control study. Cases were 185 volunteers with examiner-classified TMD. Distributions of some demographic characteristics among OPPERA participants differed from census profiles, although there was less difference in socio-economic profiles. Odds of TMD was associated with greater age in this 18-44 year range; females had three times the odds of TMD as males; and relative to non-Hispanic-Whites, other racial groups had one-fifth the odds of TMD. Age- and gender-associations with chronic TMD were strikingly similar to associations observed in the US population. Assessments of representativeness in this demographically diverse group of community volunteers suggest that OPPERA case-control findings have good internal validity. PMID:22074749

  1. An imported case of canine rabies in Aquitaine: Investigation and management of the contacts at risk, August 2004-March 2005.

    PubMed

    Servas, V; Mailles, A; Neau, D; Castor, C; Manetti, A; Fouquet, E; Ragnaud, J M; Bourhy, H; Paty, M C; Melik, N; Astoul, J; Cliquet, F; Moiton, M P; François, C; Coustillas, M; Minet, J-C; Parriaud, P; Capek, I; Filleul, L

    2005-11-01

    In August 2004, a case of rabies was diagnosed in a puppy that had been illegally imported from Morocco to Bordeaux (France). Because a great number of people and animals were thought to have come into contact with the puppy, extensive tracing measures were implemented, and an international alert was launched to trace and treat the contacts at risk. One hundred and eighty seven people received post-exposure treatment, eight of whom also received serovaccination, and 57 animals known to have been exposed to the puppy were tested. Six months after the death of the rabid animal, none of the people treated showed any signs of rabies, nor was any secondary animal case reported. The management of this crisis highlights the importance of the role of a rapid alert system at European level. Strict application of sanitary control regulations is essential for animals introduced into EU countries, and all necessary information must be made available to EU residents travelling to rabies enzootic areas.

  2. 14 CFR 1260.58 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Designation of new technology representative and patent representative. 1260.58 Section 1260.58 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.58 Designation...

  3. 14 CFR 1260.58 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Designation of new technology representative and patent representative. 1260.58 Section 1260.58 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.58 Designation...

  4. Bovine besnoitiosis in Switzerland: imported cases and local transmission.

    PubMed

    Basso, Walter; Lesser, Maren; Grimm, Felix; Hilbe, Monika; Sydler, Titus; Trösch, Luzia; Ochs, Hansueli; Braun, Ueli; Deplazes, Peter

    2013-12-06

    Bovine besnoitiosis is an economically important disease of cattle, caused by Besnoitia besnoiti (Protozoa, Apicomplexa). A considerable spreading of this parasitic infection has been observed in Europe in the last ten years, mainly related to animal trade. In order to investigate the possibility of B. besnoiti being unnoticed introduced and getting established in Switzerland through the import of breeding cattle from France, a total of 767 animals (650 cattle imported from France and 117 cattle that had contact with B. besnoiti positive cattle in Swiss farms) were screened for antibodies against B. besnoiti by both a commercial ELISA and by the indirect fluorescent antibody test (IFAT). A total of 101 (13.17%) samples showed a positive reaction in ELISA (cut-off: percent of positivity [PP] ≥ 15) and 16 (2.09%) samples had IFAT titers ≥ 1:100. Eight of those samples reacted positive in Western blot (WB), corresponding to five imported Limousin cattle (two cows and one bull from France and two cows from Germany) and to three cattle born in Switzerland (one Limousin heifer born from one of the positive German cows, and two adult Braunvieh cows, that had been in contact with one of the French cows at a Swiss farm). Seven of those animals were subclinically infected and one animal showed only very mild signs. They were subsequently slaughtered, and the serological diagnosis could be confirmed by real-time PCR and/or histopathology in seven animals. The most frequent parasite localizations were the tendons and surrounding connective tissue of the distal limbs and the skin of the head region. Furthermore, B. besnoiti could be successfully isolated in vitro from one French, one German and one Swiss cattle (isolates Bb-IPZ-1-CH, Bb-IPZ-2-CH and Bb-IPZ-3-CH). In the current situation in Switzerland, prophylactic and control measures should include a serological examination of cattle to be imported from endemic areas and the culling of all confirmed positive animals from

  5. On the importance of an atmospheric reference model: A case study on gravity wave-airglow interactions

    NASA Astrophysics Data System (ADS)

    Amaro-Rivera, Yolián; Huang, Tai-Yin; Urbina, Julio

    2018-06-01

    The atmospheric reference model utilized in an airglow numerical study is important since airglow emissions depend on the number density of the light-emitting species. In this study, we employ 2-dimensional, nonlinear, time-dependent numerical models, Multiple Airglow Chemistry Dynamics (MACD) and OH Chemistry Dynamics (OHCD), that use the MSISE-90, NRLMSISE-00, and Garcia and Solomon (GS) model data as atmospheric reference models, to investigate gravity wave-induced airglow variations for the OH(8,3) airglow, O2(0,1) atmospheric band, and O(1S) greenline emissions in the Mesosphere and Lower Thermosphere (MLT) region. Our results show that the OHCD-00 produces the largest wave-induced OH(8,3) airglow intensity variation (∼34%), followed by the OHCD-90 (∼30%), then by the OHCD (∼22%). For O(1S) greenline, the MACD produces the largest wave-induced variation (∼33%), followed by the MACD-90 (∼28%), then by MACD-00 (∼26%). As for O2(0,1) atmospheric band, the MACD produces the largest wave-induced variation (∼31%), followed by the MACD-90 and MACD-00 (∼29%). Our study illustrates the importance and the need for a good atmospheric reference model that can accurately represent the atmosphere.

  6. Importance of third mesial canals in mandibular molars: report of 2 cases.

    PubMed

    Yesilsoy, Cemil; Porras, Omar; Gordon, Wanda

    2009-07-01

    Most mandibular first molars have 2 mesial canals. Two cases of failed endodontically treated first mandibular molars are presented with 2 obturated mesial canals. The cases were retreated with a third mesial canal identified, and instrumented and obturated with resolution of the patients' signs and symptoms. These cases show that consideration must be made to recognize the possibility of a third mesial canal and perform complete treatment to minimize the possibility of failure.

  7. [Fundamental role of the workers' representative in preventive safety activity].

    PubMed

    Ossicini, A; Bindi, L; Casale, M C

    2003-01-01

    With the arrival of Legislative Decree 626/94 which brought into Italian law the EU directives on workers' health and safety at the workplace, our country has also introduced rules that make a break with the past in this area, with the creation of new professional roles. The workers' safety representative takes on a fundamentally important role in the management of prevention, safety and health for workers in their place of employment in accordance with article 19. In fact, before the introduction of this Legislative Decree, the "protection" of workers' health was essentially based on rules and regulations the application of which was left to the exclusive and direct responsibility of the relationship between the employer and doctor, leaving out any participation by the worker. Whereas in the past workers could only be considered the final receivers of instructions about the security measures to apply, with Law 626 the workers themselves became active participants in the assessment of risks at work and consequently in the implementing of all the safety and hygiene measures contributing to the reduction of risk levels. The new regulations now in force assign important tasks to the workers' safety representative; all tasks and responsibilities associated with that role are examined and discussed, especially those relating to rights to information and training, consultation and participation in the process of designing and promoting safety measures. The job of workers' representative today takes on a fundamentally important meaning and role in a self-regulating system of work safety, where he or she has a proper area responsibility, so becoming a reference point for the workers generally.

  8. [Advance directives. Representatives' opinions].

    PubMed

    Busquets I Font, J M; Hernando Robles, P; Font I Canals, R; Diestre Ortin, G; Quintana, S

    The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Estimating Regions of Oceanographic Importance for Seabirds Using A-Spatial Data.

    PubMed

    Humphries, Grant Richard Woodrow

    2015-01-01

    Advances in GPS tracking technologies have allowed for rapid assessment of important oceanographic regions for seabirds. This allows us to understand seabird distributions, and the characteristics which determine the success of populations. In many cases, quality GPS tracking data may not be available; however, long term population monitoring data may exist. In this study, a method to infer important oceanographic regions for seabirds will be presented using breeding sooty shearwaters as a case study. This method combines a popular machine learning algorithm (generalized boosted regression modeling), geographic information systems, long-term ecological data and open access oceanographic datasets. Time series of chick size and harvest index data derived from a long term dataset of Maori 'muttonbirder' diaries were obtained and used as response variables in a gridded spatial model. It was found that areas of the sub-Antarctic water region best capture the variation in the chick size data. Oceanographic features including wind speed and charnock (a derived variable representing ocean surface roughness) came out as top predictor variables in these models. Previously collected GPS data demonstrates that these regions are used as "flyways" by sooty shearwaters during the breeding season. It is therefore likely that wind speeds in these flyways affect the ability of sooty shearwaters to provision for their chicks due to changes in flight dynamics. This approach was designed to utilize machine learning methodology but can also be implemented with other statistical algorithms. Furthermore, these methods can be applied to any long term time series of population data to identify important regions for a species of interest.

  10. The importance of the complete history in the discovery of a potential suicide: a case report.

    PubMed

    Carter, Adam C; Nicholas, John J

    2003-03-01

    Suicidal ideation and completed suicides are an increasing problem among the elderly. In 1992, the elderly accounted for 13% of the population but represented 20% of all completed suicides. There are recognized risk factors for suicides in elderly patients, which include depression, deteriorating physical health, and loss of independent functioning. A complete history enables the examiner to establish a relationship with the patient and to formulate a diagnosis. Unfortunately, histories are often incomplete. Many factors can account for this, including financial pressures, patient volume, and overspecialization. The physiatric history is the integration of many parts. It incorporates not only the physiatrist's evaluation but those of other disciplines as well, for example, physical and occupational therapy. The physiatric history is a sensitive tool for assessing the state of being of the whole patient. We describe a case in which a careful and complete physiatric history and physical examination revealed an elderly patient with suicidal ideation and a plan. Copyright 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

  11. Genotype heterogeneity of Mycobacterium tuberculosis within geospatial hotspots suggests foci of imported infection in Sydney, Australia.

    PubMed

    Gurjav, Ulziijargal; Jelfs, Peter; Hill-Cawthorne, Grant A; Marais, Ben J; Sintchenko, Vitali

    2016-06-01

    In recent years the State of New South Wales (NSW), Australia, has maintained a low tuberculosis incidence rate with little evidence of local transmission. Nearly 90% of notified tuberculosis cases occurred in people born in tuberculosis-endemic countries. We analyzed geographic, epidemiological and genotypic data of all culture-confirmed tuberculosis cases to identify the bacterial and demographic determinants of tuberculosis hotspot areas in NSW. Standard 24-loci mycobacterium interspersed repetitive unit-variable number tandem repeat (MIRU-24) typing was performed on all isolates recovered between 2009 and 2013. In total 1692/1841 (91.9%) cases with confirmed Mycobacterium tuberculosis infection had complete MIRU-24 and demographic data and were included in the study. Despite some year-to-year variability, spatio-temporal analysis identified four tuberculosis hotspots. The incidence rate and the relative risk of tuberculosis in these hotspots were 2- to 10-fold and 4- to 8-fold higher than the state average, respectively. MIRU-24 profiles of M. tuberculosis isolates associated with these hotspots revealed high levels of heterogeneity. This suggests that these spatio-temporal hotspots, within this low incidence setting, can represent areas of predominantly imported infection rather than clusters of cases due to local transmission. These findings provide important epidemiological insight and demonstrate the value of combining tuberculosis genotyping and spatiotemporal data to guide better-targeted public health interventions. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. Case study of first episode schizophrenia in pregnancy and postpartum.

    PubMed

    Kast, Kristopher A; Agarkar, Smita

    2017-08-01

    Patients with first-episode psychosis of peripartum onset commonly prove to have a mood-disorder diathesis; however, a proportion of cases represent first-episode schizophrenia. We present such a case and discuss the clinical relevance of recognizing this small but important population of new mothers. These patients are at considerable risk of misdiagnosis, resulting in ineffective maintenance therapy, poorer recovery of function, and development of treatment resistance. Accurate diagnosis in the peripartum period will impact treatment decisions and long-term therapy. Clinicians need to be vigilant, especially during maintenance therapy, to identify these patients and ensure appropriate antipsychotic therapy is provided.

  13. 7 CFR 1219.58 - Importer associations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... may be composed of importers as well as representatives of foreign avocado exporting industries. An... AGREEMENTS AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE HASS AVOCADO PROMOTION, RESEARCH, AND INFORMATION Hass Avocado Promotion, Research, and Information Order Budgets, Expenses, and...

  14. Financial crisis, virtual carbon in global value chains, and the importance of linkage effects. The Spain-china case.

    PubMed

    López, Luis-Antonio; Arce, Guadalupe; Zafrilla, Jorge

    2014-01-01

    Trade has a disproportionate environmental impact, while the international fragmentation of production promotes different patterns of intermediate inputs and final goods. Therefore, we split up the balance of domestic embodied emissions in trade (BDEET) to assess it. We find that Spain has a significant emissions deficit with China between 2005 and 2011. The Global Financial Crisis of 2008 reduced Spanish imports of pollution-intensive inputs from China and slightly improved the BDEET. China primarily exports indirect virtual carbon, representing 86% of the total, especially from Production of electricity, gas, and water sector. These linkages effects in China indicate that post-Kyoto agreements must focus not only on traded goods but also on the environmental efficiency of all domestic production chains. The methodology proposed allows us to identify the agents responsible for this trade in both Spain and China, namely the sectors importing intermediate inputs (Construction and Transport equipment) and industries and consumers importing final goods (Textiles, Other manufactures, Computers, and Machinery). The relevant sectors uncertainties found when we compare the results for BDEET and emissions embodied in bilateral trade (BEET) lead us to recommend the former methodology to evaluate the implications of environmental and energy policy for different industries and agents.

  15. [Import and local transmission of Haemophilus ducreyi].

    PubMed

    Knudsen, Troels Bygum; Sand, Carsten; Jensen, Jørgen Skov

    2010-07-26

    Chancroid is a sexually transmitted disease characterized by painful ulcers with a soft margin, necrotic base and purulent exudate. Previously, only sporadic, imported cases have been reported in Denmark. The bacterium is difficult to culture and novel polymerase chain reaction (PCR)-based methods for direct demonstration of bacterial DNA have facilitated rapid verification of the clinical diagnosis. We report two cases which demonstrate import and subsequent local transmission in Denmark. In both cases, the clinical diagnosis was rapidly verified by a combined PCR testing for multiple causes of venereal ulcers.

  16. Permutation importance: a corrected feature importance measure.

    PubMed

    Altmann, André; Toloşi, Laura; Sander, Oliver; Lengauer, Thomas

    2010-05-15

    In life sciences, interpretability of machine learning models is as important as their prediction accuracy. Linear models are probably the most frequently used methods for assessing feature relevance, despite their relative inflexibility. However, in the past years effective estimators of feature relevance have been derived for highly complex or non-parametric models such as support vector machines and RandomForest (RF) models. Recently, it has been observed that RF models are biased in such a way that categorical variables with a large number of categories are preferred. In this work, we introduce a heuristic for normalizing feature importance measures that can correct the feature importance bias. The method is based on repeated permutations of the outcome vector for estimating the distribution of measured importance for each variable in a non-informative setting. The P-value of the observed importance provides a corrected measure of feature importance. We apply our method to simulated data and demonstrate that (i) non-informative predictors do not receive significant P-values, (ii) informative variables can successfully be recovered among non-informative variables and (iii) P-values computed with permutation importance (PIMP) are very helpful for deciding the significance of variables, and therefore improve model interpretability. Furthermore, PIMP was used to correct RF-based importance measures for two real-world case studies. We propose an improved RF model that uses the significant variables with respect to the PIMP measure and show that its prediction accuracy is superior to that of other existing models. R code for the method presented in this article is available at http://www.mpi-inf.mpg.de/ approximately altmann/download/PIMP.R CONTACT: altmann@mpi-inf.mpg.de, laura.tolosi@mpi-inf.mpg.de Supplementary data are available at Bioinformatics online.

  17. IMPORTANCE OF CONTEXTUAL DATA IN PRODUCING HEALTH TECHNOLOGY ASSESSMENT RECOMMENDATIONS: A CASE STUDY.

    PubMed

    Poder, Thomas G; Bellemare, Christian A

    2018-01-01

    Contextual data and local expertise are important sources of data that cannot be ignored in hospital-based health technology assessment (HTA) processes. Despite a lack of or unconvincing evidence in the scientific literature, technology can be recommended in a given context. We illustrate this using a case study regarding biplane angiography for vascular neurointervention. A systematic literature review was conducted, along with an analysis of the context in our setting. The outcomes of interest were radiation doses, clinical complications, procedure times, purchase cost, impact on teaching program, the confidence of clinicians in the technology, quality of care, accessibility, and the volume of activity. A committee comprising managers, clinical experts, physicians, physicists and HTA experts was created to produce a recommendation regarding biplane technology acquisition to replace a monoplane device. The systematic literature review yielded nine eligible articles for analysis. Despite a very low level of evidence in the literature, the biplane system appears to reduce ionizing radiation and medical complications, as well as shorten procedure time. Contextual data indicated that the biplane system could improve operator confidence, which could translate into reduced risk, particularly for complex procedures. In addition, the biplane system can support our institution in its advanced procedures teaching program. Given the advantages provided by the biplane technology in our setting, the committee has recommended its acquisition. Contextual data were of utmost importance in this recommendation. Moreover, this technology should be implemented alongside a responsibility to collect outcome data to optimize clinical protocol in the doses of ionizing delivered.

  18. A case of imported paracoccidioidomycosis: an awkward infection in The Netherlands.

    PubMed

    Van Damme, P A; Bierenbroodspot, F; Telgtt, D S C; Kwakman, J M; De Wilde, P C M; Meis, J F G M

    2006-02-01

    Paracoccidioidomycosis is an important endemic mycosis in South America. In Europe the disease is very rare and only found as infections in travelers to Latin America. We report here the first case encountered in the Netherlands for which the appropriate diagnosis was not attained for several months. A Dutch 60-year-old man presented with a painful ulceration in the buccal mandibular vestibular mucosa of three months duration. While his medical history was uneventful, he had worked, until 8 years prior to his presentation, as a carpenter for 25 years in the jungles of Peru and Ecuador. An aberrant chest radiograph, CT-scan of the lungs and increased erythrocyte sedimentation rate were suggestive of sarcoidosis or a bronchiolitis obliterans organizing pneumonia. There was no improvement in the patient's symptoms despite the use of budesonide and prednisone medication, as well as tuberculosis prophylaxis with isoniazide and rifampicin, and local use of miconazole. Quite to the contrary, as an irritated, irregular hyperemic mucosa and gingiva with ulceration were noticed during this period of time. These precipitated an incisional biopsy through which a mixed inflammatory cellular infiltrate and large yeast cells were found on histopathologic examination. Based on the patient's travel history and the multiple budding yeastlike cells revealed in the biopsy tissue, the diagnosis of paracoccidioidomycosis was finally made. This was supported by the isolation of Paracoccidioides brasiliensis in culture. Antimycotic oral therapy with itraconazole was started and continued for 15 months. At two and five year follow-ups, the patient was asymptomatic. In Europe, it may be expected that diseases that are endemic in other areas will be seen more frequently in countries where the diseases are not routinely encountered. It is most likely that the use of corticosteroid medication, with its inherent immunosuppressive effect, resulted in the reactivation of an infection acquired

  19. Celebrating the Smithsonian Soils Exhibit in the Classroom with the State/Representative Soil Project

    ERIC Educational Resources Information Center

    Mikhailova, E. A.; Post, C. J.; Koppenheffer, Andrea; Asbill, John

    2009-01-01

    State/representative soil is one of many symbols (e.g., tree, flower, bird, etc.) adopted by citizens to be recognized as an important item to their state. We have developed a set of laboratory exercises, assignments, and exam questions utilizing the state/representative soil that gives college students an opportunity to practice interpretation of…

  20. Perceived Safety and Value of Inpatient "Very Important Person" Services.

    PubMed

    Allen-Dicker, Joshua; Auerbach, Andrew; Herzig, Shoshana J

    2017-03-01

    Providing care to "very important person" (VIP) patients can pose unique moral and value-based challenges for providers. No studies have examined VIP services in the inpatient setting. Through a multi-institutional survey of hospitalists, we assessed physician viewpoints and behavior surrounding the care of VIP patients. A significant proportion of respondents reported feeling pressured by patients, family members, and hospital representatives to provide unnecessary care to VIP patients. Based on self-reported perceptions, as well as case-based questions, we also found that the VIP status of a patient may impact physician clinical decision-making related to unnecessary medical care. Additional studies to quantify the use of VIP services and its effect on cost, resource availability, and patient-specific outcomes are needed. Journal of Hospital Medicine 2017;12:177-179. © 2017 Society of Hospital Medicine.

  1. [Visiting friends and relatives (VFRs) role on imported malaria: a literature review].

    PubMed

    Casuccio, Alessandra; Immordino, Palmira

    2014-01-01

    In the last decades, increased numbers of travel to tropical destinations in combination with the enormous influx of immigrants have led to an increased number of imported malaria cases in developed countries. There is a group of immigrants regularly resident in malaria free areas, which travel to malaria endemic countries to visit their friends and relatives (VFRs). VFRs represent a high-risk group of contracting malaria. Publications presenting original data on malaria in VFRs were selected for a literature review. We considered all data regarding prevalence of malaria in VFRs compared to the other groups of travelers, length of trip, group characteristics such as age, sex, country visited, and adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis, where such information was available. Studies related to malaria importation in VFRs in children and pregnant women were also included. Review of the literature revealed significant variations in the proportion of VFRs among imported malaria cases which may be due to differences in immigrant populations across the reporting countries. However, in studies focused on those at higher risk such as children and pregnant women, the prevalence of imported malaria was significantly higher compared to other types of travelers. Adherence to adequate preventive measures was low in VFRs. Significant reasons for not seeking pre-travel advice were economic and cultural issues, fear of the side effects due to chemoprophylaxis, and misconception about life-long immunity against malaria, and consequently, a low awareness about malaria risk. In order to implement preventive strategies focused on this high-risk group, prospective studies, which better define determinants of the risk of malaria in VFRs, are needed.

  2. Paget Schroetter Syndrome: A case study of the chiropractor's role in recognizing and comanaging an important condition.

    PubMed

    Rowan, Tracy L; Kazemi, Mohsen

    2012-12-01

    To emphasize the importance for health care professionals to be knowledgeable of a relatively rare form of thoracic outlet syndrome, known as Paget Schroetter syndrome. The etiology, key signs and symptoms, and the importance of immediate referral are highlighted and an introduction to manual therapists' role within a multidisciplinary team is provided. Healthy athletes aged 15-30 are most commonly affected with 60-80% of patients reporting a history of repetitive or vigorous overhead activity prior to symptom onset. Manual therapists have a role in recognizing, referring, and providing symptomatic relief with soft tissue therapy, correcting abnormal biomechanics, manipulations, mobilizations, and a rehabilitative program, as seen in this case report. Early recognition and referral of Paget Schroetter syndrome are essential for optimal recovery. Manual therapists may prove to have a role in decreasing the need for surgical decompression and accelerating resumption of regular activities.

  3. [The importance of case reports in current pediatric endocrinology and metabolism literature--the analysis of publications indexed in Medline in the years 2004-2009].

    PubMed

    Kuchar, Ernest

    2010-01-01

    Case reports have been used as an educational tool in medicine for a long time, as they are usually the first kind of publications prepared by new authors. In compliance with the rules of the EBM, the evidence-based medicine, a clinical case report (which describes and analyses the manner of diagnosis and treatment) appears at the bottom of the hierarchy of scientific evidences. As a result, medical periodicals limit the publishing of case reports. The aim of the study is to assess how important case reports are in the modern pediatric literature, with special interests in endocrine and metabolic disorders. Searching Medline over the last 5 years (October 2004-October 2009) using key words "case report" was performed. The limitations: "human", age "all children: 0-18 years" and the kind of publication: "case report" were used. For the huge number of publications found, the number and language of the publication was analyzed, and the first 100 free full-text publications in field of endocrine and metabolic disorders in English (from 2007-2009) were rated depending on the kind of case and aim of the publication. A total of 55379 publications classified by Pubmed as case reports were found, including 48805 English, 1592 Spanish, 1538 French, 794 German, 370 Polish, 356 Chinese, 265 Russian and 135 Italian. The published case reports were more often informative than educational in character. The content of the published case reports deals more often with the notification of a new mutation, less frequently presentation of an interesting, rare, unusual case or a new illness or the description of a novel therapy. Less often the published case reports appear to be of educational character or those concerning diagnostic problems or treatment failure. Case reports remain an important contribution to the pediatric literature, mainly fulfilling an essential role in providing information about new medical problems. Medical literature published in Polish is relatively rich in

  4. Comparative genomics of biotechnologically important yeasts

    USDA-ARS?s Scientific Manuscript database

    Saccharomyces cerevisiae, is used in the vast majority of the world’s bioprocesses, and its economic significance is unchallenged. It, however, represents only a small slice of yeast physiological diversity. Many other yeasts, are used in lesser known, but commercially important processes that take ...

  5. Possible Rickettsia massiliae Infection in Greece: an Imported Case.

    PubMed

    Chochlakis, Dimosthenis; Bongiorni, Christine; Partalis, Nikolaos; Tselentis, Yannis; Psaroulaki, Anna

    2016-07-22

    Tick-borne rickettsioses are endemic in Greece; however, until recently, only Rickettsia typhi and R. conorii were tested routinely in human samples arriving at the National Reference Center. During the last few years, the identification of different rickettsia species in ticks led to the introduction of other spotted fever group rickettsiae in routine analysis. Under the new scheme, R. massiliae is now tested routinely in human samples; herein, we describe a human case of this infection.

  6. Intracystic breast carcinoma. An important differential diagnosis in postmenopausal patients presenting with a rapidly growing breast cyst. Management and literature review.

    PubMed

    Salemis, Nikolaos S

    2018-03-16

    Intracystic breast carcinoma is a rare clinical entity accounting for 0.5-2% of all breast cancers. It represents a distinctive clinical form rather a histological subtype of breast cancer and can either be in situ or invasive tumor. We herein describe a rare case of intracystic breast carcinoma arising from the wall of a cyst in a postmenopausal patient, who presented with a rapidly growing complex breast cyst. Diagnostic evaluation and management of the patient are discussed along with a review of the literature. Complex breast cysts may represent a diagnostic and therapeutic challenge. An underlying malignancy has been reported in 21-31% of the cases. Preoperative diagnosis is challenging. Complex breast cysts with thick wall, thick inner septations, and intracystic solid components should undergo histological evaluation in order to rule out an underlying malignancy. The cytological analysis may be inconclusive. Ultrasound-guided biopsy is the diagnostic modality of choice. The correlation of clinical features, with imaging and histopathological findings is very important for the optimal treatment. In cases of discordance, a complete surgical excision is necessary with careful assessment of the extent of the disease and appropriate treatment.

  7. An Analysis of Contracting Officer Technical Representative Training Requirements.

    DTIC Science & Technology

    1982-06-01

    AI and contract law . On the basis of the perceived need to eliminate superflu- ous material from the training of CA contract representatives and...Cost and pricing principles 3. Basic contract law 4. Types of contracts S. Definition of important terms 6. Understanding the terms and conditions--how...digesting and/or deletions to coincide with the learning objectives developed in Chapter III include: 1. Federal Acquisition Policy 2. Contract Law 3

  8. A CASE STUDY ILLUSTRATING THE IMPORTANCE OF ACCURATE SITE CHARACTERIZATION

    EPA Science Inventory

    Too frequently, researchers rely on incomplete site characterization data to determine the placement of the sampling wells. They forget that it is these sampling wells that will be used to evaluate the effectiveness of their research efforts. This case study illustrates the eff...

  9. Improving the management of imported schistosomiasis haematobia in China: lessons from a case with multiple misdiagnoses.

    PubMed

    Hua, Hai-Yong; Wang, Wei; Cao, Guo-Qun; Tang, Feng; Liang, You-Sheng

    2013-09-11

    Human Schistosoma haematobium infection that causes urinary schistosomiasis occurs in Africa and the eastern Mediterranean, and China is only endemic for S. japonicum. In this report, we reported an imported case with S. haematobium infection returning from Angola to Shaanxi Province, northwestern China, where S. japonicum is not endemic. The case was misdiagnosed as ureteral calculus, invasive urothelial carcinoma and eosinophilic cystitis in several hospitals, and was finally diagnosed by means of serological assay followed by microscopic examination of the urine sediment. The patient was then treated with praziquantel, and a satisfactory outcome was obtained. As S. haematobium is not indigenous to China, most Chinese doctors and medical technicians are unfamiliar with this introduced parasitic disease, therefore, they need to increase the awareness of its existence when they encounter persons who have visited or resided in endemic areas, and the techniques for detection of the parasite, so as to reduce the misdiagnosis. In addition, health education should be given to those who will go to the endemic areas to improve their knowledge and awareness on prevention and control of schistosomiasis haematobia, thereby reducing the risk of exposure to the infested freshwater.

  10. 22 CFR 901.22 - Representative.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Representative. 901.22 Section 901.22 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD GENERAL Meanings of Terms As Used in This Chapter § 901.22 Representative. Representative means the person(s) identified in writing to the Board as assisting the party or...

  11. 22 CFR 901.22 - Representative.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Representative. 901.22 Section 901.22 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD GENERAL Meanings of Terms As Used in This Chapter § 901.22 Representative. Representative means the person(s) identified in writing to the Board as assisting the party or...

  12. 22 CFR 901.22 - Representative.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Representative. 901.22 Section 901.22 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD GENERAL Meanings of Terms As Used in This Chapter § 901.22 Representative. Representative means the person(s) identified in writing to the Board as assisting the party or...

  13. 22 CFR 901.22 - Representative.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Representative. 901.22 Section 901.22 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD GENERAL Meanings of Terms As Used in This Chapter § 901.22 Representative. Representative means the person(s) identified in writing to the Board as assisting the party or...

  14. 22 CFR 901.22 - Representative.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Representative. 901.22 Section 901.22 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD GENERAL Meanings of Terms As Used in This Chapter § 901.22 Representative. Representative means the person(s) identified in writing to the Board as assisting the party or...

  15. An Arbitrary First Order Theory Can Be Represented by a Program: A Theorem

    NASA Technical Reports Server (NTRS)

    Hosheleva, Olga

    1997-01-01

    How can we represent knowledge inside a computer? For formalized knowledge, classical logic seems to be the most adequate tool. Classical logic is behind all formalisms of classical mathematics, and behind many formalisms used in Artificial Intelligence. There is only one serious problem with classical logic: due to the famous Godel's theorem, classical logic is algorithmically undecidable; as a result, when the knowledge is represented in the form of logical statements, it is very difficult to check whether, based on this statement, a given query is true or not. To make knowledge representations more algorithmic, a special field of logic programming was invented. An important portion of logic programming is algorithmically decidable. To cover knowledge that cannot be represented in this portion, several extensions of the decidable fragments have been proposed. In the spirit of logic programming, these extensions are usually introduced in such a way that even if a general algorithm is not available, good heuristic methods exist. It is important to check whether the already proposed extensions are sufficient, or further extensions is necessary. In the present paper, we show that one particular extension, namely, logic programming with classical negation, introduced by M. Gelfond and V. Lifschitz, can represent (in some reasonable sense) an arbitrary first order logical theory.

  16. Imported malaria in pregnant women: a retrospective pooled analysis

    PubMed Central

    Käser, Annina K.; Arguin, Paul M.; Chiodini, Peter L.; Smith, Valerie; Delmont, Jean; Jiménez, Beatriz C.; Färnert, Anna; Kimura, Mikio; Ramharter, Michael; Grobusch, Martin P.; Schlagenhauf, Patricia

    2015-01-01

    Summary Background Data on imported malaria in pregnant women are scarce. Method A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done, using data from 1977 to 2014 from 8 different collaborators in Europe, the United States and Japan. Most cases were from the period 1991–2014. National malaria reference centresas well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 632 cases were collated, providing information on Plasmodium species, region of acquisition, nationality, country of residence, reason for travel, age, gestational age, prophylactic measures and treatment used, as well as on complications and outcomes in mother and child. Results Datasets from some sources were incomplete. The predominant Plasmodium species was P. falciparum in 72% of cases. Among the 543 cases where information on the use of chemoprophylaxis was known, 471 (74.5%) did not use chemoprophylaxis or used incorrect or incomplete chemoprophylaxis. The main reason for travelling was “visiting friends and relatives” VFR (48.6%) and overall, most cases of malaria were imported from West Africa (85.9%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome was limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported. Conclusion Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa. Malaria prevention and treatment in pregnant travellers is a challenge for travel medicine due to few data on medication safety and maternal and foetal outcomes. International, collaborative efforts are needed to capture standardized data on imported malaria cases in pregnant women. PMID:26227740

  17. 14 CFR § 1274.906 - Designation of New Technology Representative and Patent Representative.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Designation of New Technology Representative and Patent Representative. § 1274.906 Section § 1274.906 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION COOPERATIVE AGREEMENTS WITH COMMERCIAL FIRMS Other Provisions and Special...

  18. Quality of malaria case management in Malawi: results from a nationally representative health facility survey.

    PubMed

    Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

    2014-01-01

    Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. In April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have

  19. [Constrained competition in parallel drug importation: the case of simvastatin in Germany, the Netherlands, and the United Kingdom].

    PubMed

    Costa-Font, Joan; Kanavos, Panos

    2007-01-01

    To examine the effects of parallel simvastatin importation on drug price in three of the main parallel importing countries in the European Union, namely the United Kingdom, Germany, and the Netherlands. To estimate the market share of parallel imported simvastatin and the unit price -both locally produced and parallel imported- adjusted by defined daily dose in the importing country and in the exporting country (Spain). Ordinary least squares regression was used to examine the potential price competition resulting from parallel drug trade between 1997 and 2002. The market share of parallel imported simvastatin progressively expanded (especially in the United Kingdom and Germany) in the period examined, although the price difference between parallel imported and locally sourced simvastatin was not significant. Prices tended to rise in the United Kingdom and Germany and declined in the Netherlands. We found no evidence of pro-competitive effects resulting from the expansion of parallel trade. The development of parallel drug importation in the European Union produced unexpected effects (limited competition) on prices that differ from those expected by the introduction of a new competitor. This is partially the result of drug price regulation scant incentives to competition and of the lack of transparency in the drug reimbursement system, especially due to the effect of informal discounts (not observable to researchers). The case of simvastatin reveals that savings to the health system from parallel trade are trivial. Finally, of the three countries examined, the only country that shows a moderate downward pattern in simvastatin prices is the Netherlands. This effect can be attributed to the existence of a system that claws back informal discounts.

  20. 14 CFR § 1260.58 - Designation of new technology representative and patent representative.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Designation of new technology representative and patent representative. § 1260.58 Section § 1260.58 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GRANTS AND COOPERATIVE AGREEMENTS General Special Conditions § 1260.58...

  1. Imported malaria in pregnant women: A retrospective pooled analysis.

    PubMed

    Käser, Annina K; Arguin, Paul M; Chiodini, Peter L; Smith, Valerie; Delmont, Jean; Jiménez, Beatriz C; Färnert, Anna; Kimura, Mikio; Ramharter, Michael; Grobusch, Martin P; Schlagenhauf, Patricia

    2015-01-01

    Data on imported malaria in pregnant women are scarce. A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done using data from 1991 to 2014 from 8 different collaborators in Europe, the United States and Japan. National malaria reference centres as well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 631 cases were collated, providing information on Plasmodium species, region of acquisition, nationality, country of residence, reason for travel, age, gestational age, prophylactic measures and treatment used, as well as on complications and outcomes in mother and child. Datasets from some sources were incomplete. The predominant Plasmodium species was P. falciparum (78.5% of cases). Among the 542 cases where information on the use of chemoprophylaxis was known, 464 (85.6%) did not use chemoprophylaxis. The main reason for travelling was "visiting friends and relatives" VFR (57.8%) and overall, most cases of malaria were imported from West Africa (57.4%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome were limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported. Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa. Malaria prevention and treatment in pregnant travellers is a challenge for travel medicine due to few data on medication safety and maternal and foetal outcomes. International, collaborative efforts are needed to capture standardized data on imported malaria cases in pregnant women. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. The importance of histopathology in the diagnosis of isolated renal sarcoidosis: a case report.

    PubMed

    Trindade Filho, João Onofre; Amaro, Kaline Daniele de Souza; Oliveira, Allana Desirée Teixeira de; Gomes, Cecília Neta Alves Pegado; Costa, Hermann Ferreira; Trajano, Vinicius Nogueira

    2018-06-18

    Sarcoidosis is a systemic inflammatory disease of unknown etiology, characterized by the presence of non-caseating granulomas in several organs; renal impairment alone is a rare condition. When it affects the kidneys, the most prevalent manifestations are hypercalcemia and hypercalciuria. This paper aims to address the topic of renal sarcoidosis, by means of a case report, and reinstate the importance of histopathology in its diagnosis. The data came from an observational clinical study with a qualitative approach, through an interview with the renal sarcoidosis patient and data from her medical records. Patient D.M.S., 50 years old, Caucasian, presented with reddish eyes and body pains lasting for fifteen days as first manifestations of the disease. Upon kidney ultrasound scan, we found renal parenchymal nephropathy. Serial renal function and metabolic tests reported anemia and progressive urea and creatinine changes, as well as hypercalcemia and hypercalciuria, confirming acute kidney failure (AKF). A histopathological examination suggested the diagnosis, which was confirmed by clinical, laboratory and histopathological data. There was therapeutic resolution after steroid therapy. The symptomatology of sarcoidosis is diverse and often non-specific. Renal manifestation, which usually occurs after organ involvement, is present in less than 5% of patients, and about 1% to 2% of these patients may develop AKF. The use of histopathology together with clinical and laboratory data to diagnose isolated renal sarcoidosis, rule out other etiologies and introduce early treatment is of paramount importance.

  3. 16 CFR 1630.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  4. 16 CFR 1630.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  5. 16 CFR 1630.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  6. 16 CFR 1631.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  7. 16 CFR 1630.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  8. 16 CFR 1631.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  9. 16 CFR 1631.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  10. 16 CFR 1631.31 - Reasonable and representative tests and recordkeeping requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., constructional units (needles, pitch, rows, shot, stitches, and weight), dye class, dyestuff, dyeing application... representative tests with respect to any quality of machine-made carpets or rugs are (1) at least one test performed upon commencement of production, importation, or other receipt thereof, (2) at least one test...

  11. 40 CFR 97.212 - Changing CAIR designated representative and alternate CAIR designated representative; changes in...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS CAIR Designated Representative for CAIR SO2 Sources § 97.212 Changing CAIR designated representative and alternate CAIR designated... representative and the owners and operators of the CAIR SO2 source and the CAIR SO2 units at the source. (b...

  12. Using CLIPS to represent knowledge in a VR simulation

    NASA Technical Reports Server (NTRS)

    Engelberg, Mark L.

    1994-01-01

    Virtual reality (VR) is an exciting use of advanced hardware and software technologies to achieve an immersive simulation. Until recently, the majority of virtual environments were merely 'fly-throughs' in which a user could freely explore a 3-dimensional world or a visualized dataset. Now that the underlying technologies are reaching a level of maturity, programmers are seeking ways to increase the complexity and interactivity of immersive simulations. In most cases, interactivity in a virtual environment can be specified in the form 'whenever such-and-such happens to object X, it reacts in the following manner.' CLIPS and COOL provide a simple and elegant framework for representing this knowledge-base in an efficient manner that can be extended incrementally. The complexity of a detailed simulation becomes more manageable when the control flow is governed by CLIPS' rule-based inference engine as opposed to by traditional procedural mechanisms. Examples in this paper will illustrate an effective way to represent VR information in CLIPS, and to tie this knowledge base to the input and output C routines of a typical virtual environment.

  13. Forensic evaluation of medical liability cases in general surgery.

    PubMed

    Moreira, H; Magalhães, T; Dinis-Oliveira, Rj; Taveira-Gomes, A

    2014-10-01

    Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  14. Business Process-Based Resource Importance Determination

    NASA Astrophysics Data System (ADS)

    Fenz, Stefan; Ekelhart, Andreas; Neubauer, Thomas

    Information security risk management (ISRM) heavily depends on realistic impact values representing the resources’ importance in the overall organizational context. Although a variety of ISRM approaches have been proposed, well-founded methods that provide an answer to the following question are still missing: How can business processes be used to determine resources’ importance in the overall organizational context? We answer this question by measuring the actual importance level of resources based on business processes. Therefore, this paper presents our novel business process-based resource importance determination method which provides ISRM with an efficient and powerful tool for deriving realistic resource importance figures solely from existing business processes. The conducted evaluation has shown that the calculation results of the developed method comply to the results gained in traditional workshop-based assessments.

  15. Recommendations for representative ballast water sampling

    NASA Astrophysics Data System (ADS)

    Gollasch, Stephan; David, Matej

    2017-05-01

    Until now, the purpose of ballast water sampling studies was predominantly limited to general scientific interest to determine the variety of species arriving in ballast water in a recipient port. Knowing the variety of species arriving in ballast water also contributes to the assessment of relative species introduction vector importance. Further, some sampling campaigns addressed awareness raising or the determination of organism numbers per water volume to evaluate the species introduction risk by analysing the propagule pressure of species. A new aspect of ballast water sampling, which this contribution addresses, is compliance monitoring and enforcement of ballast water management standards as set by, e.g., the IMO Ballast Water Management Convention. To achieve this, sampling methods which result in representative ballast water samples are essential. We recommend such methods based on practical tests conducted on two commercial vessels also considering results from our previous studies. The results show that different sampling approaches influence the results regarding viable organism concentrations in ballast water samples. It was observed that the sampling duration (i.e., length of the sampling process), timing (i.e., in which point in time of the discharge the sample is taken), the number of samples and the sampled water quantity are the main factors influencing the concentrations of viable organisms in a ballast water sample. Based on our findings we provide recommendations for representative ballast water sampling.

  16. The MP (Materialization Pattern) Model for Representing Math Educational Standards

    NASA Astrophysics Data System (ADS)

    Choi, Namyoun; Song, Il-Yeol; An, Yuan

    Representing natural languages with UML has been an important research issue for various reasons. Little work has been done for modeling imperative mood sentences which are the sentence structure of math educational standard statements. In this paper, we propose the MP (Materialization Pattern) model that captures the semantics of English sentences used in math educational standards. The MP model is based on the Reed-Kellogg sentence diagrams and creates MP schemas with the UML notation. The MP model explicitly represents the semantics of the sentences by extracting math concepts and the cognitive process of math concepts from math educational standard statements, and simplifies modeling. This MP model is also developed to be used for aligning math educational standard statements via schema matching.

  17. Shortfalls in the global protected area network at representing marine biodiversity

    PubMed Central

    Klein, Carissa J.; Brown, Christopher J.; Halpern, Benjamin S.; Segan, Daniel B.; McGowan, Jennifer; Beger, Maria; Watson, James E.M.

    2015-01-01

    The first international goal for establishing marine protected areas (MPAs) to conserve the ocean’s biodiversity was set in 2002. Since 2006, the Convention on Biological Diversity (CBD) has driven MPA establishment, with 193 parties committed to protecting >10% of marine environments globally by 2020, especially ‘areas of particular importance for biodiversity’ (Aichi target 11). This has resulted in nearly 10 million km2 of new MPAs, a growth of ~360% in a decade. Unlike on land, it is not known how well protected areas capture marine biodiversity, leaving a significant gap in our understanding of existing MPAs and future protection requirements. We assess the overlap of global MPAs with the ranges of 17,348 marine species (fishes, mammals, invertebrates), and find that 97.4% of species have <10% of their ranges represented in stricter conservation classes. Almost all (99.8%) of the very poorly represented species (<2% coverage) are found within exclusive economic zones, suggesting an important role for particular nations to better protect biodiversity. Our results offer strategic guidance on where MPAs should be placed to support the CBD’s overall goal to avert biodiversity loss. Achieving this goal is imperative for nature and humanity, as people depend on biodiversity for important and valuable services. PMID:26631984

  18. Shortfalls in the global protected area network at representing marine biodiversity.

    PubMed

    Klein, Carissa J; Brown, Christopher J; Halpern, Benjamin S; Segan, Daniel B; McGowan, Jennifer; Beger, Maria; Watson, James E M

    2015-12-03

    The first international goal for establishing marine protected areas (MPAs) to conserve the ocean's biodiversity was set in 2002. Since 2006, the Convention on Biological Diversity (CBD) has driven MPA establishment, with 193 parties committed to protecting >10% of marine environments globally by 2020, especially 'areas of particular importance for biodiversity' (Aichi target 11). This has resulted in nearly 10 million km(2) of new MPAs, a growth of ~360% in a decade. Unlike on land, it is not known how well protected areas capture marine biodiversity, leaving a significant gap in our understanding of existing MPAs and future protection requirements. We assess the overlap of global MPAs with the ranges of 17,348 marine species (fishes, mammals, invertebrates), and find that 97.4% of species have <10% of their ranges represented in stricter conservation classes. Almost all (99.8%) of the very poorly represented species (<2% coverage) are found within exclusive economic zones, suggesting an important role for particular nations to better protect biodiversity. Our results offer strategic guidance on where MPAs should be placed to support the CBD's overall goal to avert biodiversity loss. Achieving this goal is imperative for nature and humanity, as people depend on biodiversity for important and valuable services.

  19. Quality of Malaria Case Management in Malawi: Results from a Nationally Representative Health Facility Survey

    PubMed Central

    Steinhardt, Laura C.; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

    2014-01-01

    Background Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. Methods In April–May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. Results At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Conclusions Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case

  20. Comprehensive Report For Proposed Elevated Temperature Elastic Perfectly Plastic (EPP) Code Cases Representative Example Problems

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

    Hollinger, Greg L.

    Background: The current rules in the nuclear section of the ASME Boiler and Pressure Vessel (B&PV) Code , Section III, Subsection NH for the evaluation of strain limits and creep-fatigue damage using simplified methods based on elastic analysis have been deemed inappropriate for Alloy 617 at temperatures above 1200F (650C)1. To address this issue, proposed code rules have been developed which are based on the use of elastic-perfectly plastic (E-PP) analysis methods and which are expected to be applicable to very high temperatures. The proposed rules for strain limits and creep-fatigue evaluation were initially documented in the technical literature 2,more » 3, and have been recently revised to incorporate comments and simplify their application. The revised code cases have been developed. Task Objectives: The goal of the Sample Problem task is to exercise these code cases through example problems to demonstrate their feasibility and, also, to identify potential corrections and improvements should problems be encountered. This will provide input to the development of technical background documents for consideration by the applicable B&PV committees considering these code cases for approval. This task has been performed by Hollinger and Pease of Becht Engineering Co., Inc., Nuclear Services Division and a report detailing the results of the E-PP analyses conducted on example problems per the procedures of the E-PP strain limits and creep-fatigue draft code cases is enclosed as Enclosure 1. Conclusions: The feasibility of the application of the E-PP code cases has been demonstrated through example problems that consist of realistic geometry (a nozzle attached to a semi-hemispheric shell with a circumferential weld) and load (pressure; pipe reaction load applied at the end of the nozzle, including axial and shear forces, bending and torsional moments; through-wall transient temperature gradient) and design and operating conditions (Levels A, B and C).« less

  1. Listeriosis--a review of eighty-four cases.

    PubMed

    Paul, M L; Dwyer, D E; Chow, C; Robson, J; Chambers, I; Eagles, G; Ackerman, V

    1994-04-18

    To review the epidemiology, risk factors for acquisition, clinical features and outcomes of Listeria monocytogenes infection in Sydney. A retrospective study over the period 1983-1992 at four university teaching hospitals in Sydney. Cases were identified from microbiology laboratory records of the isolation of L. monocytogenes from sterile sites. Eighty-four cases were reviewed, with 72 patients (86%) having a predisposing underlying condition, including 13 perinatal patients (15%). Septicaemia (56%) and central nervous system disease (41%) were the major clinical presentations. Nineteen patients (23%) had hospital-associated infection. A mortality of 21% (18 patients) was directly attributable to L. monocytogenes infection, with another 10% (nine patients) dying of their underlying disease during admission. The 84 cases represented 80% of all L. monocytogenes cases occurring in Sydney during the study period. Listeriosis is predominantly a disease of the elderly or of immunosuppressed individuals, pregnant women and neonates. The presentation and outcome in these groups are similar to those reported in other Western countries. A significant feature of this study was the number of cases occurring in already hospitalised patients, suggesting that L. monocytogenes may be an important hospital-associated pathogen in immunocompromised patients.

  2. Radiological pitfalls of age estimation in adopted children: a case report.

    PubMed

    Gibelli, D; De Angelis, D; Cattaneo, C

    2015-04-01

    Age estimation has a relevant importance in assessing adopted children, also in cases where the age of the minor seems unquestioned, since pathological conditions may radically alter bodily growth. This may lead to an incorrect age evaluation, with consequent social and psychological problems linked to an inadequate collocation in public school. This study aims at exposing a case report concerning age estimation for a newly adopted child from Cambodia; previous clinical documentation reported information suggesting possible malnutrition, which was verified by the observation of a general disalignment of bone and dental structures. This example shows the importance of a thorough forensic evaluation of adopted children from other countries in order to verify the possible environmental modification of physiological growth even where it seems not to be needed, and represents a caveat for clinical and social personnel dealing with adoption procedures.

  3. Decision-Making by School Psychologists: Use of the Representativeness Heuristic and Importance of Assessment Data in Determination of Special Education Eligibility

    ERIC Educational Resources Information Center

    Wilson, Sharise Mavis

    2010-01-01

    The purpose of this project was to explore the decision-making approach and types of data that school psychologists use in determining special education classification. There were three research objectives: (a) to investigate the types of conditions and measures needed to test the use of the representativeness heuristic and assessment data, (b) to…

  4. Experiencing conceptual change about teaching: A case study from astronomy

    NASA Astrophysics Data System (ADS)

    Bailey, Janelle M.; Nagamine, Kentaro

    2012-06-01

    Understanding faculty motivations for and barriers to change is an important component of facilitating instructional reform efforts to improve student learning. This case study describes the process of adoption of learner-centered instructional strategies by an astronomy faculty member, Ken, as viewed through the lens of conceptual change. Specifically, we applied the Cognitive Reconstruction of Knowledge Model (CRKM) to understand why Ken was willing to change his instructional strategies, what barriers to and supports for change existed, and how he and his students were impacted by this change. Ken's statements and actions represented characteristics consistent with the CRKM. Notably, dissatisfaction, considered the primary motivator in many conceptual change models, was not of high importance in this case. Upon implementing learner-centered strategies, Ken's students performed better on a measure of knowledge about stellar properties, which served to reinforce his motivation to continue with learner-centered methods.

  5. Importance of pharmacogenetics in the treatment of children with attention deficit hyperactive disorder: a case report.

    PubMed

    Tan-Kam, Teerarat; Suthisisang, Chutamanee; Pavasuthipaisit, Chosita; Limsila, Penkhae; Puangpetch, Apichaya; Sukasem, Chonlaphat

    2013-01-01

    This case report highlights the importance of pharmacogenetic testing in the treatment of attention deficit hyperactive disorder (ADHD). A 6-year-old boy diagnosed with ADHD was prescribed methylphenidate 5 mg twice daily (7 am and noon) and the family was compliant with administration of this medication. On the first day of treatment, the patient had an adverse reaction, becoming disobedient, more mischievous, erratic, resistant to discipline, would not go to sleep until midnight, and had a poor appetite. The All-In-One PGX (All-In-One Pharmacogenetics for Antipsychotics test for CYP2D6, CYP2C19, and CYP2C9) was performed using microarray-based and real-time polymerase chain reaction techniques. The genotype of our patient was identified to be CYP2D6*2/*10, with isoforms of the enzyme consistent with a predicted cytochrome P450 2D6 intermediate metabolizer phenotype. Consequently, the physician adjusted the methylphenidate dose to 2.5 mg once daily in the morning. At this dosage, the patient had a good response without any further adverse reactions. Pharmacogenetic testing should be included in the management plan for ADHD. In this case, cooperation between the medical team and the patients' relatives was key to successful treatment.

  6. Computer re-sampling for demographically representative user populations in anthropometry: a case of doorway and clear floor space widths.

    PubMed

    Paquet, Victor; Joseph, Caroline; D'Souza, Clive

    2012-01-01

    Anthropometric studies typically require a large number of individuals that are selected in a manner so that demographic characteristics that impact body size and function are proportionally representative of a user population. This sampling approach does not allow for an efficient characterization of the distribution of body sizes and functions of sub-groups within a population and the demographic characteristics of user populations can often change with time, limiting the application of the anthropometric data in design. The objective of this study is to demonstrate how demographically representative user populations can be developed from samples that are not proportionally representative in order to improve the application of anthropometric data in design. An engineering anthropometry problem of door width and clear floor space width is used to illustrate the value of the approach.

  7. 43 CFR 45.10 - Who may represent a party, and what requirements apply to a representative?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Who may represent a party, and what requirements apply to a representative? 45.10 Section 45.10 Public Lands: Interior Office of the Secretary of the Interior CONDITIONS AND PRESCRIPTIONS IN FERC HYDROPOWER LICENSES Hearing Process Representatives...

  8. Representative Nature of Scientific Literacy Themes in a High School Chemistry Course: The Case of Zambia

    ERIC Educational Resources Information Center

    Mumba, Frackson; Hunter, William J. F.

    2009-01-01

    The purpose of this study was to find out how the scientific literacy themes are represented in the current Zambian high school chemistry syllabus, textbooks and grade twelve chemistry examination papers in an attempt to find out whether or not the chemistry course has adequate potential to contribute to the preparation of scientifically literate…

  9. The Force Exerted by the Membrane Potential During Protein Import into the Mitochondrial Matrix

    NASA Technical Reports Server (NTRS)

    Shariff, Karim; Ghosal, Sandip; Matouschek, Andreas

    2002-01-01

    The electrostatic force exerted on a targeting sequence by the electrical potential across the inner mitochondrial membrane is calculated and found to vary from 1.4 pN to 2.2 pN (per unit elementary charge) as the radius of the inner membrane pore (assumed aqueous) is varied from 12 to 6.5 Angstroms, its measured range. Since the pore is not very much wider than the distance between water molecules, the full shielding effect of water may not be present; the extreme case of a nonaqueous pore gives a force of 3.1 pN per unit charge, which represents an upper limit. When applied to mitochondrial import experiments on the protein harness, these results imply that a force of 11 plus or minus 4 pN is sufficient to catalyze the unfolding of harness during import. Comparison of these results with unfolding forces measured using atomic force microscopy suggests that the two are not inconsistent.

  10. Pharmaceutical representatives' beliefs and practices about their professional practice: a study in Sudan.

    PubMed

    Idris, K M; Mustafa, A F; Yousif, M A

    2012-08-01

    Pharmaceutical representatives are an important promotional tool for pharmaceutical companies. This cross-sectional, exploratory study aimed to determine pharmaceutical representatives' beliefs and practices about their professional practice in Sudan. A random sample of 160 pharmaceutical representatives were interviewed using a pretested questionnaire. The majority were male (84.4%) and had received training in professional sales skills (86.3%) and about the products being promoted (82.5%). Only 65.6% agreed that they provided full and balanced information about products. Not providing balanced information was attributed by 23.1% to doctors' lack of time. However, 28.1% confessed they sometimes felt like hiding unfavourable information, 21.9% were sometimes or always inclined to give untrue information to make sales and 66.9% considered free gifts as ethically acceptable. More attention is needed to dissemination of ethical codes of conduct and training about the ethics of drug promotion for pharmaceutical representatives in Sudan.

  11. My Vocational Situation (MVS): Case Example and Psychometric Review.

    PubMed

    Nitsch, Kristian P; Pedersen, Jessica; Miliotto, Alexandra; Petersen, Brett; Robbins, Samantha; Garcia, Ana; Hoisington, Molly Ansel; The, Kimberly J; Smiley, Jill; Janikowski, Timothy

    This case report provides an overview of the psychometric properties and clinical utility of the My Vocational Situation (MVS) instrument. The accompanying hypothetical case description illustrates how clinicians could use the MVS to evaluate vocational preferences and outcomes and how the MVS can be used to inform treatment planning and rehabilitation decision making. The information contained in this report is intended to familiarize clinicians with the administration and scoring of the MVS, the psychometric information necessary to interpret results obtained from the MVS, and how the results could be used to provide comprehensive, patient-centered care. It is important to note that the information provided represents only a sample of the available research literature on the MVS. Copyright © 2017 by the American Occupational Therapy Association, Inc.

  12. Representing life as opposed to being: the bio-objectification process of the HeLa cells and its relation to personalized medicine

    PubMed Central

    Svalastog, Anna Lydia; Martinelli, Lucia

    2013-01-01

    The immortal HeLa cells case is an intriguing example of bio-objectification processes with great scientific, social, and symbolic impacts. These cells generate questions about representation, significance, and value of the exceptional, variety, individuality, and property. Of frightening (a lethal cancer) and emarginated (a black, poor woman) origins, with their ability to “contaminate” cultures and to “spread” into spaces for becoming of extraordinary value for human knowledge, well-being, and economy advancements, HeLa cells have represented humanity, and emphasized the importance of individual as a core concept of the personalized medicine. Starting from the process leading from HeLa “cells” to HeLa “bio-objects,” we focus on their importance as high quality bio-specimen. We discuss the tension between phenomenological characteristic of fundamental biological research and the variety of material and methodologies in epidemiology and personalized medicine. The emerging methodologies and societal changes reflect present EU policies and lead toward a new paradigm of science. PMID:23986283

  13. Representativeness of shorter measurement sessions in long-term indoor air monitoring.

    PubMed

    Maciejewska, M; Szczurek, A

    2015-02-01

    Indoor air quality (IAQ) considerably influences health, comfort and the overall performance of people who spend most of their lives in confined spaces. For this reason, there is a strong need to develop methods for IAQ assessment. The fundamental issue in the quantitative determination of IAQ is the duration of measurements. Its inadequate choice may result in providing incorrect information and this potentially leads to wrong conclusions. The most complete information may be acquired through long-term monitoring. However it is typically perceived as impractical due to time and cost load. The aim of this study was to determine whether long-term monitoring can be adequately represented by a shorter measurement session. There were considered three measurable quantities: temperature, relative humidity and carbon dioxide concentration. They are commonly recognized as indicatives for IAQ and may be readily monitored. Scaled Kullback-Leibler divergence, also called relative entropy, was applied as a measure of data representativeness. We considered long-term monitoring in a range from 1 to 9 months. Based on our work, the representative data on CO2 concentration may be acquired while performing measurements during 20% of time dedicated to long-term monitoring. In the case of temperature and relative humidity the respective time demand was 50% of long-term monitoring. From our results, in indoor air monitoring strategies, there could be considered shorter measurement sessions, while still collecting data which are representative for long-term monitoring.

  14. 5 CFR 511.608 - Employee representatives.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Employee representatives. 511.608 Section... CLASSIFICATION UNDER THE GENERAL SCHEDULE Classification Appeals § 511.608 Employee representatives. An employee... appeal. An agency may disallow an employee's representative when the individual's activities as a...

  15. The importance of user centered design methods applied to the design of a new workstation: a case study.

    PubMed

    Duschenes, Ronaldo; Mendes, Andressa; Betiol, Adriana; Barreto, Suzana

    2012-01-01

    This paper presents a case study of the application of user centered design methodologies in the product development for a line of ergonomic office furniture. The study aimed to analyze the experience of using a workstation from the perspective of two groups of users, installers and end users. The observation of users in their natural context of use not only allowed the development team to identify key needs and strategies of the users, transforming them into design solutions, but mainly it warned them of the importance and impact of user involvement in the product development cycle.

  16. Designated Airworthiness Representatives

    DOT National Transportation Integrated Search

    1985-10-01

    This advisory circular (AC) contains information and guidance concerning the : selection and appointment of Designated Airworthiness Representatives (DAR's) and identifies the specific functions which may be delegated to DAR's as authorized by the Fe...

  17. Molecular characterization of NRXN1 deletions from 19,263 clinical microarray cases identifies exons important for neurodevelopmental disease expression

    PubMed Central

    Lowther, Chelsea; Speevak, Marsha; Armour, Christine M.; Goh, Elaine S.; Graham, Gail E.; Li, Chumei; Zeesman, Susan; Nowaczyk, Malgorzata J.M.; Schultz, Lee-Anne; Morra, Antonella; Nicolson, Rob; Bikangaga, Peter; Samdup, Dawa; Zaazou, Mostafa; Boyd, Kerry; Jung, Jack H.; Siu, Victoria; Rajguru, Manjulata; Goobie, Sharan; Tarnopolsky, Mark A.; Prasad, Chitra; Dick, Paul T.; Hussain, Asmaa S.; Walinga, Margreet; Reijenga, Renske G.; Gazzellone, Matthew; Lionel, Anath C.; Marshall, Christian R.; Scherer, Stephen W.; Stavropoulos, Dimitri J.; McCready, Elizabeth; Bassett, Anne S.

    2016-01-01

    Purpose The purpose of the current study was to assess the penetrance of NRXN1 deletions. Methods We compared the prevalence and genomic extent of NRXN1 deletions identified among 19,263 clinically referred cases to that of 15,264 controls. The burden of additional clinically relevant CNVs was used as a proxy to estimate the relative penetrance of NRXN1 deletions. Results We identified 41 (0.21%) previously unreported exonic NRXN1 deletions ascertained for developmental delay/intellectual disability, significantly greater than in controls [OR=8.14 (95% CI 2.91–22.72), p< 0.0001)]. Ten (22.7%) of these had a second clinically relevant CNV. Subjects with a deletion near the 3′ end of NRXN1 were significantly more likely to have a second rare CNV than subjects with a 5′ NRXN1 deletion [OR=7.47 (95% CI 2.36–23.61), p=0.0006]. The prevalence of intronic NRXN1 deletions was not statistically different between cases and controls (p=0.618). The majority (63.2%) of intronic NRXN1 deletion cases had a second rare CNV, a two-fold greater prevalence than for exonic NRXN1 deletion cases (p=0.0035). Conclusions The results support the importance of exons near the 5′ end of NRXN1 in the expression of neurodevelopmental disorders. Intronic NRXN1 deletions do not appear to substantially increase the risk for clinical phenotypes. PMID:27195815

  18. Molecular characterization of NRXN1 deletions from 19,263 clinical microarray cases identifies exons important for neurodevelopmental disease expression.

    PubMed

    Lowther, Chelsea; Speevak, Marsha; Armour, Christine M; Goh, Elaine S; Graham, Gail E; Li, Chumei; Zeesman, Susan; Nowaczyk, Malgorzata J M; Schultz, Lee-Anne; Morra, Antonella; Nicolson, Rob; Bikangaga, Peter; Samdup, Dawa; Zaazou, Mostafa; Boyd, Kerry; Jung, Jack H; Siu, Victoria; Rajguru, Manjulata; Goobie, Sharan; Tarnopolsky, Mark A; Prasad, Chitra; Dick, Paul T; Hussain, Asmaa S; Walinga, Margreet; Reijenga, Renske G; Gazzellone, Matthew; Lionel, Anath C; Marshall, Christian R; Scherer, Stephen W; Stavropoulos, Dimitri J; McCready, Elizabeth; Bassett, Anne S

    2017-01-01

    The purpose of the current study was to assess the penetrance of NRXN1 deletions. We compared the prevalence and genomic extent of NRXN1 deletions identified among 19,263 clinically referred cases to that of 15,264 controls. The burden of additional clinically relevant copy-number variations (CNVs) was used as a proxy to estimate the relative penetrance of NRXN1 deletions. We identified 41 (0.21%) previously unreported exonic NRXN1 deletions ascertained for developmental delay/intellectual disability that were significantly greater than in controls (odds ratio (OR) = 8.14; 95% confidence interval (CI): 2.91-22.72; P < 0.0001). Ten (22.7%) of these had a second clinically relevant CNV. Subjects with a deletion near the 3' end of NRXN1 were significantly more likely to have a second rare CNV than subjects with a 5' NRXN1 deletion (OR = 7.47; 95% CI: 2.36-23.61; P = 0.0006). The prevalence of intronic NRXN1 deletions was not statistically different between cases and controls (P = 0.618). The majority (63.2%) of intronic NRXN1 deletion cases had a second rare CNV at a prevalence twice as high as that for exonic NRXN1 deletion cases (P = 0.0035). The results support the importance of exons near the 5' end of NRXN1 in the expression of neurodevelopmental disorders. Intronic NRXN1 deletions do not appear to substantially increase the risk for clinical phenotypes.Genet Med 19 1, 53-61.

  19. 50 CFR 1.2 - Authorized representative.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PROVISIONS DEFINITIONS § 1.2 Authorized representative. Authorized representative means the subordinate official to which a principal official has delegated authority to act on a particular matter or a class of matters. The Director, U.S. Fish and Wildlife Service is frequently the authorized representative of the...

  20. 50 CFR 1.2 - Authorized representative.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PROVISIONS DEFINITIONS § 1.2 Authorized representative. Authorized representative means the subordinate official to which a principal official has delegated authority to act on a particular matter or a class of matters. The Director, U.S. Fish and Wildlife Service is frequently the authorized representative of the...

  1. 50 CFR 1.2 - Authorized representative.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PROVISIONS DEFINITIONS § 1.2 Authorized representative. Authorized representative means the subordinate official to which a principal official has delegated authority to act on a particular matter or a class of matters. The Director, U.S. Fish and Wildlife Service is frequently the authorized representative of the...

  2. 50 CFR 1.2 - Authorized representative.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... PROVISIONS DEFINITIONS § 1.2 Authorized representative. Authorized representative means the subordinate official to which a principal official has delegated authority to act on a particular matter or a class of matters. The Director, U.S. Fish and Wildlife Service is frequently the authorized representative of the...

  3. 50 CFR 1.2 - Authorized representative.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PROVISIONS DEFINITIONS § 1.2 Authorized representative. Authorized representative means the subordinate official to which a principal official has delegated authority to act on a particular matter or a class of matters. The Director, U.S. Fish and Wildlife Service is frequently the authorized representative of the...

  4. Early-stage gastric cancers represented as dysplasia in a previous forceps biopsy: the importance of clinical management.

    PubMed

    Park, Jin Seok; Hong, Su Jin; Han, Jae Pil; Kang, Myung Soo; Kim, Hee Kyung; Kwak, Jeong Ja; Ko, Bong Min; Cho, Joo Young; Lee, Joon Seong; Lee, Moon Sung

    2013-02-01

    Because histological examination of gastric lesions by forceps biopsy is of limited accuracy, management on the basis of histological results is occasionally controversial. We examined the characteristics of early gastric cancers that presented as dysplasia resulting from a previous forceps biopsy. Between April 2007 and December 2010, 341 gastric adenocarcinoma lesions from 330 patients previously diagnosed histologically via endoscopic submucosal dissection were examined. We retrospectively assessed the characteristics of early gastric cancer according to their initial forceps biopsy results. In total, 183 EGCs were diagnosed as dysplasia (53.7%; 89 low-grade and 94 high-grade) and 158 (46.3%) as carcinoma by forceps biopsy before endoscopic submucosal dissection. Significant differences were noted with respect to histologic differentiation of carcinomas, Lauren histologic type, depth of invasion, lymphovascular invasion, and en bloc resection between the dysplastic group and carcinoma group, based on forceps biopsy results. A forceps biopsy result is not fully representative of the entire lesion and, thus, endoscopic submucosal dissection should be considered for lesions diagnosed as dysplasia via forceps biopsy in order to avoid the risk of missed carcinomas. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  5. The Epidemiology of Imported Malaria in Taiwan between 2002–2013: The Importance of Sensitive Surveillance and Implications for Pre-Travel Medical Advice

    PubMed Central

    Chen, Shou-Chien; Chang, Hsiao-Ling; Chen, Kow-Tong

    2014-01-01

    The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20–5.74). The reproductive number under control (Rc) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan. PMID:24871257

  6. How do agents represent?

    NASA Astrophysics Data System (ADS)

    Ryan, Alex

    Representation is inherent to the concept of an agent, but its importance in complex systems has not yet been widely recognised. In this paper I introduce Peirce's theory of signs, which facilitates a definition of representation in general. In summary, representation means that for some agent, a model is used to stand in for another entity in a way that shapes the behaviour of the agent with respect to that entity. Representation in general is then related to the theories of representation that have developed within different disciplines. I compare theories of representation from metaphysics, military theory and systems theory. Additional complications arise in explaining the special case of mental representations, which is the focus of cognitive science. I consider the dominant theory of cognition — that the brain is a representational device — as well as the sceptical anti-representational response. Finally, I argue that representation distinguishes agents from non-representational objects: agents are objects capable of representation.

  7. Adolescent muscle dysmorphia and family-based treatment: a case report.

    PubMed

    Murray, Stuart B; Griffiths, Scott

    2015-04-01

    A growing body of evidence suggests that the prevalence of male body dissatisfaction and muscle dysmorphia is rising. To date, however, there is no published evidence on the efficacy of treatments for muscle dysmorphia. We present the case of a 15-year-old boy who met full diagnostic criteria for muscle dysmorphia, whose symptoms were treated into remission with eating disorder-focused, family-based treatment. The age of this patient fell within the time period in which symptoms of muscle dysmorphia are most likely to develop and this case represents the first published case report of family-based treatment for muscle dysmorphia in this age group. Thus, this case report has important implications for clinicians considering treatment options for presentations of muscle dysmorphia when first presenting in adolescence. Implications for the development of treatment guidelines for muscle dysmorphia and for the diagnostic debate surrounding muscle dysmorphia are also discussed. © The Author(s) 2014.

  8. Lower Response Rates on Alumni Surveys Might Not Mean Lower Response Representativeness

    ERIC Educational Resources Information Center

    Lambert, Amber D.; Miller, Angie L.

    2014-01-01

    The purpose of this research is to explore some possible issues with response representativeness in alumni surveys. While alumni surveys can provide important information, they often have lower response rates due to bad contact information and other reasons. In this study we investigate potential differences between responses on the National…

  9. Representing health and illness: thoughts for the 21st century.

    PubMed

    Gilman, Sander L

    2011-06-01

    The on-going discussion about a new empiricism in the study of the medical humanities has lead to a misapprehension about the problems attendant to representing health and illness. The difficulty in understanding the politics of health and illness as well as the concomitant new aestheticism that has arisen concerning its representation demands a rethinking of these categories in the 21st century. Obesity can provide a model for the importance of this problem today.

  10. Contracting Officer's Technical Representatives

    NASA Technical Reports Server (NTRS)

    Brisbin, Steve

    1997-01-01

    The Breakout Session is a traditional conference instrument used by the NASA Occupational Health Program (OHP) as a method to convene people with common interests. Typically these sessions provide discussion of current topics of high priority and currency and allow multiple views and opinions to be shared and evaluated by all participants. Since the Contracting Officer's Technical Representatives (COTRs) occupy the technical focus of support contract management, this particular group, attended by 20 representatives, addressed issues and topics at the forefront of operational concerns.

  11. Virtual water flows and water-footprint of agricultural crop production, import and export: A case study for Israel.

    PubMed

    Shtull-Trauring, E; Bernstein, N

    2018-05-01

    Agriculture is the largest global consumer of freshwater. As the volume of international trade continues to rise, so does the understanding that trade of water-intensive crops from areas with high precipitation, to arid regions can help mitigate water scarcity, highlighting the importance of crop water accounting. Virtual-Water, or Water-Footprint [WF] of agricultural crops, is a powerful indicator for assessing the extent of water use by plants, contamination of water bodies by agricultural practices and trade between countries, which underlies any international trade of crops. Most available studies of virtual-water flows by import/export of agricultural commodities were based on global databases, which are considered to be of limited accuracy. The present study analyzes the WF of crop production, import, and export on a country level, using Israel as a case study, comparing data from two high-resolution local databases and two global datasets. Results for local datasets demonstrate a WF of ~1200Million Cubic Meters [MCM]/year) for total crop production, ~1000MCM/year for import and ~250MCM/year for export. Fruits and vegetables comprise ~80% of Export WF (~200MCM/year), ~50% of crop production and only ~20% of the imports. Economic Water Productivity [EWP] ($/m 3 ) for fruits and vegetables is 1.5 higher compared to other crops. Moreover, the results based on local and global datasets varied significantly, demonstrating the importance of developing high-resolution local datasets based on local crop coefficients. Performing high resolution WF analysis can help in developing agricultural policies that include support for low WF/high EWP and limit high WF/low EWP crop export, where water availability is limited. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Gaussian membership functions are most adequate in representing uncertainty in measurements

    NASA Technical Reports Server (NTRS)

    Kreinovich, V.; Quintana, C.; Reznik, L.

    1992-01-01

    In rare situations, like fundamental physics, we perform experiments without knowing what their results will be. In the majority of real-life measurement situations, we more or less know beforehand what kind of results we will get. Of course, this is not the precise knowledge of the type 'the result will be between alpha - beta and alpha + beta,' because in this case, we would not need any measurements at all. This is usually a knowledge that is best represented in uncertain terms, like 'perhaps (or 'most likely', etc.) the measured value x is between alpha - beta and alpha + beta.' Traditional statistical methods neglect this additional knowledge and process only the measurement results. So it is desirable to be able to process this uncertain knowledge as well. A natural way to process it is by using fuzzy logic. But, there is a problem; we can use different membership functions to represent the same uncertain statements, and different functions lead to different results. What membership function do we choose? In the present paper, we show that under some reasonable assumptions, Gaussian functions mu(x) = exp(-beta(x(exp 2))) are the most adequate choice of the membership functions for representing uncertainty in measurements. This representation was efficiently used in testing jet engines to airplanes and spaceships.

  13. The Importance of Simulation in Nursing Education

    ERIC Educational Resources Information Center

    Eyikara, Evrim; Baykara, Zehra Gocmen

    2017-01-01

    Nursing education involves a practice-oriented curriculum in which emphasis is placed on both theoretical knowledge and psychomotor skills. In skill-based education, where learning through practice occupies a central role, it is important to ensure the integration of theoretical knowledge into practice. In this context, simulations represent an…

  14. Representing Color Ensembles.

    PubMed

    Chetverikov, Andrey; Campana, Gianluca; Kristjánsson, Árni

    2017-10-01

    Colors are rarely uniform, yet little is known about how people represent color distributions. We introduce a new method for studying color ensembles based on intertrial learning in visual search. Participants looked for an oddly colored diamond among diamonds with colors taken from either uniform or Gaussian color distributions. On test trials, the targets had various distances in feature space from the mean of the preceding distractor color distribution. Targets on test trials therefore served as probes into probabilistic representations of distractor colors. Test-trial response times revealed a striking similarity between the physical distribution of colors and their internal representations. The results demonstrate that the visual system represents color ensembles in a more detailed way than previously thought, coding not only mean and variance but, most surprisingly, the actual shape (uniform or Gaussian) of the distribution of colors in the environment.

  15. Representative Elementary Length to Measure Soil Mass Attenuation Coefficient

    PubMed Central

    Borges, J. A. R.; Pires, L. F.; Costa, J. C.

    2014-01-01

    With increasing demand for better yield in agricultural areas, soil physical property representative measurements are more and more essential. Nuclear techniques such as computerized tomography (CT) and gamma-ray attenuation (GAT) have been widely employed with this purpose. The soil mass attenuation coefficient (μ s) is an important parameter for CT and GAT analysis. When experimentally determined (μ es), the use of suitable sized samples enable to evaluate it precisely, as well as to reduce measurement time and costs. This study investigated the representative elementary length (REL) of sandy and clayey soils for μ es measurements. Two radioactive sources were employed (241Am and 137Cs), three collimators (2–4 mm diameters), and 14 thickness (x) samples (2–15 cm). Results indicated ideal thickness intervals of 12–15 and 2–4 cm for the sources 137Cs and 241Am, respectively. The application of such results in representative elementary area (REA) evaluations in clayey soil clods via CT indicated that μ es average values obtained for x > 4 cm and source 241Am might induce to the use of samples which are not large enough for soil bulk density evaluations (ρ s). As a consequence, ρ s might be under- or overestimated, generating inaccurate conclusions about the physical quality of the soil under study. PMID:24672338

  16. 29 CFR 417.19 - Assistant Secretary's representative.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 2 2012-07-01 2012-07-01 false Assistant Secretary's representative. 417.19 Section 417.19... Union To Take Appropriate Remedial Action Following Subpart A Procedures § 417.19 Assistant Secretary's representative. The Assistant Secretary shall appoint a representative or representatives whose functions shall...

  17. A case of stillbirth: the importance of placental investigation in medico-legal practice.

    PubMed

    Marchetti, Daniela; Belviso, Maura; Fulcheri, Ezio

    2009-03-01

    The authors present a case of stillbirth in which histologic examination of the placenta provides the opportunity to make a definitive diagnosis of a death due to fetal thrombotic vasculopathy (FTV). Establishing the etiology in cases of stillbirth may avoid medical malpractice litigation. The better knowledge of the cause of stillbirths also helped obstetricians to recognize factors that could have prejudiced future pregnancies.

  18. Dengue, chikungunya, and Zika virus infections imported to Paris between 2009 and 2016: Characteristics and correlation with outbreaks in the French overseas territories of Guadeloupe and Martinique.

    PubMed

    Vasquez, Victor; Haddad, Elie; Perignon, Alice; Jaureguiberry, Stéphane; Brichler, Ségolène; Leparc-Goffart, Isabelle; Caumes, Eric

    2018-07-01

    Dengue virus (DENV), chikungunya virus (CHIKV), and Zika virus (ZIKV) infections are rapidly expanding across countries and are being diagnosed in returned travellers who represent epidemiological sentinels. The French Territories of America (FTA) such as Guadeloupe and Martinique see high levels of tourism and have experienced three consecutive outbreaks by these viruses in the last decade. This study was performed to evaluate how ill returned travellers could have represented epidemiological sentinels for these three expanding arboviral diseases over eight consecutive years. The degree of correlation between the cases of ill returned travellers arriving at a French tertiary hospital in Paris and the three outbreaks that occurred in the FTA during the study period was estimated. All consecutive ill returned travellers diagnosed at the hospital in Paris with imported DENV, CHIKV, or ZIKV infections from January 2009 to December 2016 were included. Epidemiological and clinical variables were evaluated. Data concerning the incidence of arboviruses in the FTA, as well as the temporal relationship between the occurrence of imported cases and outbreaks in the FTA, were analyzed. Overall, 320 cases of arboviral infection were reported: 216 DENV, 68 CHIKV, and 36 ZIKV. Most of the patients presented with fever and exanthema. One hundred and fifteen patients were exposed in Guadeloupe or Martinique, which were the at-risk destinations in 25% of patients with DENV, 59% of patients with CHIKV, and 58% of patients with ZIKV. The occurrence of cases diagnosed in returning travellers followed the same time pattern as the outbreaks in these areas. A temporal correlation was found between newly diagnosed imported cases of arboviruses and the three corresponding outbreaks that occurred in Martinique and Guadeloupe during 8 consecutive years. Thus, ill returned travellers act as epidemiological sentinels from the beginning up to the end of outbreaks occurring in touristic locations

  19. 7 CFR 1.610 - Who may represent a party, and what requirements apply to a representative?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... ADMINISTRATIVE REGULATIONS Conditions in FERC Hydropower Licenses Hearing Process § 1.610 Who may represent a... may either represent himself or herself in the hearing process under this subpart or authorize an...

  20. Measuring Child-Staff Ratios in Child Care Centers: Balancing Effort and Representativeness

    ERIC Educational Resources Information Center

    Le, Vi-Nhuan; Perlman, Michal; Zellman, Gail L.; Hamilton, Laura S.

    2006-01-01

    Child-staff ratios are an important quality indicator. They are often collected by observing one randomly selected classroom several times during a 2-h period on a single day. However, it is unclear whether these measures represent the ratios that children actually experience during most of their time in care. This study compared ratio data…

  1. 40 CFR 96.212 - Changing CAIR designated representative and alternate CAIR designated representative; changes in...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS CAIR Designated Representative for CAIR SO2 Sources § 96.212 Changing CAIR designated representative and alternate... CAIR SO2 source and the CAIR SO2 units at the source. (b) Changing alternate CAIR designated...

  2. Melioidosis Imported from West Africa to Europe

    PubMed Central

    Cuadros, Juan; Gil, Horacio; Miguel, Julio De; Marabé, Graciela; Gómez-Herruz, Teresa Arroyo Peña; Lobo, Bruno; Marcos, Ruth; Anda, Pedro

    2011-01-01

    We report the first case of imported melioidosis in Spain from a diabetic immigrant who visited West Africa during the rainy season. Because of the unusual presentation of this disease in Africa, clinical and microbiological diagnosis of imported melioidosis from this continent can be very elusive. PMID:21813848

  3. Factorial inferential grid grouping and representativeness analysis for a systematic selection of representative grids

    NASA Astrophysics Data System (ADS)

    Cheng, Guanhui; Huang, Guohe; Dong, Cong; Xu, Ye; Yao, Yao

    2017-08-01

    A factorial inferential grid grouping and representativeness analysis (FIGGRA) approach is developed to achieve a systematic selection of representative grids in large-scale climate change impact assessment and adaptation (LSCCIAA) studies and other fields of Earth and space sciences. FIGGRA is applied to representative-grid selection for temperature (Tas) and precipitation (Pr) over the Loess Plateau (LP) to verify methodological effectiveness. FIGGRA is effective at and outperforms existing grid-selection approaches (e.g., self-organizing maps) in multiple aspects such as clustering similar grids, differentiating dissimilar grids, and identifying representative grids for both Tas and Pr over LP. In comparison with Pr, the lower spatial heterogeneity and higher spatial discontinuity of Tas over LP lead to higher within-group similarity, lower between-group dissimilarity, lower grid grouping effectiveness, and higher grid representativeness; the lower interannual variability of the spatial distributions of Tas results in lower impacts of the interannual variability on the effectiveness of FIGGRA. For LP, the spatial climatic heterogeneity is the highest in January for Pr and in October for Tas; it decreases from spring, autumn, summer to winter for Tas and from summer, spring, autumn to winter for Pr. Two parameters, i.e., the statistical significance level (α) and the minimum number of grids in every climate zone (Nmin), and their joint effects are significant for the effectiveness of FIGGRA; normalization of a nonnormal climate-variable distribution is helpful for the effectiveness only for Pr. For FIGGRA-based LSCCIAA studies, a low value of Nmin is recommended for both Pr and Tas, and a high and medium value of α for Pr and Tas, respectively.

  4. Epidemiology of Imported Leishmaniasis in Italy: Implications for a European Endemic Country

    PubMed Central

    Di Muccio, Trentina; Scalone, Aldo; Bruno, Antonella; Marangi, Massimo; Grande, Romualdo; Armignacco, Orlando; Gradoni, Luigi; Gramiccia, Marina

    2015-01-01

    In the past decade, the number of imported leishmaniasis cases has increased in countries of Western Europe. The trend is associated with increasing travels, ecotourism activity, military operations and immigration. While in endemic countries leishmaniasis is usually well diagnosed, accurate patient history and parasite identification are necessary to distinguish between autochthonous and imported cases. This is particularly important, as new Leishmania species/genotypes may be introduced and transmitted by local phlebotomine vectors without appropriate surveillance, with unpredictable consequences. We report on the surveillance of imported leishmaniasis performed by the Leishmania Identification Reference Centre of Rome from 1986 through 2012, involving health care centres from 16/20 Italian regions. Suspected imported cases were analyzed and conclusions were based on clinical, epidemiological and diagnostic findings. Over the years, different parasite identification methods were employed, including MultiLocus Enzyme Electrophoresis and molecular techniques combining disease diagnosis (SSU rDNA nested-PCR) and Leishmania typing (nuclear repetitive sequence and ITS-1 PCR-RFLPs). A total of 105 imported cases were recorded (annual range: 0-20) of which 36 were visceral (VL) (16 HIV-coinfections) and 69 cutaneous (CL) cases; 85 cases (52 CL) were from the Old World and 20 (17 CL) from the New World. Eight Leishmania species were identified, of which 7 were exotic to Italy. VL importation until 1995 was associated with the spread of Mediterranean Leishmania-HIV co-infections in early 1990s. Following the introduction of HAART treatment, such cases became occasional in Italians but relatively frequent among immigrants. In contrast, a steady increase of CL cases was observed from different areas of the Old and New Worlds, that in recent years included mainly immigrants ‘visiting friends and relatives’ and Italian tourists. This positive trend likely depends on

  5. Using abiotic variables to predict importance of sites for species representation.

    PubMed

    Albuquerque, Fabio; Beier, Paul

    2015-10-01

    In systematic conservation planning, species distribution data for all sites in a planning area are used to prioritize each site in terms of the site's importance toward meeting the goal of species representation. But comprehensive species data are not available in most planning areas and would be expensive to acquire. As a shortcut, ecologists use surrogates, such as occurrences of birds or another well-surveyed taxon, or land types defined from remotely sensed data, in the hope that sites that represent the surrogates also represent biodiversity. Unfortunately, surrogates have not performed reliably. We propose a new type of surrogate, predicted importance, that can be developed from species data for a q% subset of sites. With species data from this subset of sites, importance can be modeled as a function of abiotic variables available at no charge for all terrestrial areas on Earth. Predicted importance can then be used as a surrogate to prioritize all sites. We tested this surrogate with 8 sets of species data. For each data set, we used a q% subset of sites to model importance as a function of abiotic variables, used the resulting function to predict importance for all sites, and evaluated the number of species in the sites with highest predicted importance. Sites with the highest predicted importance represented species efficiently for all data sets when q = 25% and for 7 of 8 data sets when q = 20%. Predicted importance requires less survey effort than direct selection for species representation and meets representation goals well compared with other surrogates currently in use. This less expensive surrogate may be useful in those areas of the world that need it most, namely tropical regions with the highest biodiversity, greatest biodiversity loss, most severe lack of inventory data, and poorly developed protected area networks. © 2015 Society for Conservation Biology.

  6. Analysis of metallic medical devices after cremation: The importance in identification.

    PubMed

    De Angelis, Danilo; Collini, Federica; Muccino, Enrico; Cappella, Annalisa; Sguazza, Emanuela; Mazzucchi, Alessandra; Cattaneo, Cristina

    2017-03-01

    The recovery of a charred cadaver raises many issues concerning personal identification; the presence of prosthetic materials may provide very important and decisive information. Who is involved in the recovery of a charred body or of burnt human fragments, should therefore be able to recognize medical devices even if modified by fire effects. Metallic residues (585kg) that came from 2785 cremations were studied. Medical devices were then divided by type and material in order to esteem the representativeness of each typology. The study illustrates the great presence of metal medical devices that could be of great help in identifying bodies and underlines that metallic medical devices types and morphology should be known by forensic practitioner involved in identification cases and that this kind of material can still be identified by physician and dentists, even if exposed to very high temperatures. Copyright © 2016 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.

  7. [Diagnosing imported helminthiasis].

    PubMed

    Pardo, Javier; Pérez-Arellano, José Luis; Galindo, Inmaculada; Belhassen, Moncef; Cordero, Miguel; Muro, Antonio

    2007-05-01

    In recent years, there has been an increase in cases of imported helminthiasis in Spain because of two complementary causes: immigration and international travel. Although the prevalence of helminthiasis is high in the immigrant population, the risk of transmission to the Spanish population is low. In this review, we provide clues to aid in the diagnosis of the helminthiasis, highlighting the geographic characteristics, clinical findings and analytical results of the most frequent types. The low sensitivity of the classic parasitological diagnostic test, mainly in tissue helminthiasis, is described. In addition, the advantages and limitations of the common serological methods for detecting related circulating antigens and antibodies are presented. Certain molecular methods used in the diagnosis of imported helminthiasis and the best strategies for screening of this condition are discussed.

  8. Genome Sequences of 228 Shiga Toxin-Producing Escherichia coli Isolates and 12 Isolates Representing Other Diarrheagenic E. coli Pathotypes

    PubMed Central

    Strockbine, Nancy; Changayil, Shankar; Ranganathan, Satishkumar; Zhao, Kun; Weil, Ryan; MacCannell, Duncan; Sabol, Ashley; Schmidtke, Amber; Martin, Haley; Stripling, Devon; Ribot, Efrain M.; Gerner-Smidt, Peter

    2014-01-01

    Shiga toxin-producing Escherichia coli (STEC) are a common cause for food-borne diarrheal illness outbreaks and sporadic cases. Here, we report the availability of the draft genome sequences of 228 STEC strains representing 32 serotypes with known pulsed-field gel electrophoresis (PFGE) types and epidemiological relationships, as well as 12 strains representing other diarrheagenic E. coli pathotypes. PMID:25103754

  9. Imported malaria in Scotland--an overview of surveillance, reporting and trends.

    PubMed

    Unger, Holger W; McCallum, Andrew D; Ukachukwu, Vincent; McGoldrick, Claire; Perrow, Kali; Latin, Gareth; Norrie, Gillian; Morris, Sheila; Smith, Catherine C; Jones, Michael E

    2011-11-01

    Imported malaria cases continue to occur and are often underreported. This study assessed reporting of malaria cases and their characteristics in Scotland. Cases were identified at the study sites of Aberdeen, Edinburgh, Glasgow and Inverness. The number of cases identified in the period 2003-2008 was compared to surveillance databases from Health Protection Scotland (HPS) and the Malaria Reference Laboratory (MRL). Case characteristics were recorded and analysed. Of 252 cases of malaria diagnosed and treated, an estimated 235 (93.3%) were reported to the MRL. Between 2006 and 2008, 114 of 126 cases (90.5%) were reported to HPS. Plasmodium falciparum caused 173 cases (68.7%). Business and professional travel accounted for 35.3% of cases (higher in Aberdeen), followed by visiting friends and relatives (33.1%) and holiday makers (25.5%). The majority of infections were imported from West Africa and 65.7% of patients for whom data on prophylaxis was available had taken no or inappropriate prophylaxis. Reporting of malaria in Scotland can be improved. There is a continued need to optimise preventive measures and adherence to chemoprophylaxis amongst business travellers, those visiting friends and relatives, and holiday makers in endemic countries in order to reduce imported malaria cases. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Development of an Expert System for Representing Procedural Knowledge

    NASA Technical Reports Server (NTRS)

    Georgeff, Michael P.; Lansky, Amy L.

    1985-01-01

    A high level of automation is of paramount importance in most space operations. It is critical for unmanned missions and greatly increases the effectiveness of manned missions. However, although many functions can be automated by using advanced engineering techniques, others require complex reasoning, sensing, and manipulatory capabilities that go beyond this technology. Automation of fault diagnosis and malfunction handling is a case in point. The military have long been interested in this problem, and have developed automatic test equipment to aid in the maintenance of complex military hardware. These systems are all based on conventional software and engineering techniques. However, the effectiveness of such test equipment is severely limited. The equipment is inflexible and unresponsive to the skill level of the technicians using it. The diagnostic procedures cannot be matched to the exigencies of the current situation nor can they cope with reconfiguration or modification of the items under test. The diagnosis cannot be guided by useful advice from technicians and, when a fault cannot be isolated, no explanation is given as to the cause of failure. Because these systems perform a prescribed sequence of tests, they cannot utilize knowledge of a particular situation to focus attention on more likely trouble spots. Consequently, real-time performance is highly unsatisfactory. Furthermore, the cost of developing test software is substantial and time to maturation is excessive. Significant advances in artificial intelligence (AI) have recently led to the development of powerful and flexible reasoning systems, known as expert or knowledge-based systems. We have devised a powerful and theoretically sound scheme for representing and reasoning about procedural knowledge.

  11. The relative importance of macrophysical and cloud albedo changes for aerosol-induced radiative effects in closed-cell stratocumulus: insight from the modelling of a case study

    NASA Astrophysics Data System (ADS)

    Grosvenor, Daniel P.; Field, Paul R.; Hill, Adrian A.; Shipway, Benjamin J.

    2017-04-01

    Aerosol-cloud interactions are explored using 1 km simulations of a case study of predominantly closed-cell SE Pacific stratocumulus clouds. The simulations include realistic meteorology along with newly implemented cloud microphysics and sub-grid cloud schemes. The model was critically assessed against observations of liquid water path (LWP), broadband fluxes, cloud fraction (fc), droplet number concentrations (Nd), thermodynamic profiles, and radar reflectivities.Aerosol loading sensitivity tests showed that at low aerosol loadings, changes to aerosol affected shortwave fluxes equally through changes to cloud macrophysical characteristics (LWP, fc) and cloud albedo changes due solely to Nd changes. However, at high aerosol loadings, only the Nd albedo change was important. Evidence was also provided to show that a treatment of sub-grid clouds is as important as order of magnitude changes in aerosol loading for the accurate simulation of stratocumulus at this grid resolution.Overall, the control model demonstrated a credible ability to reproduce observations, suggesting that many of the important physical processes for accurately simulating these clouds are represented within the model and giving some confidence in the predictions of the model concerning stratocumulus and the impact of aerosol. For example, the control run was able to reproduce the shape and magnitude of the observed diurnal cycle of domain mean LWP to within ˜ 10 g m-2 for the nighttime, but with an overestimate for the daytime of up to 30 g m-2. The latter was attributed to the uniform aerosol fields imposed on the model, which meant that the model failed to include the low-Nd mode that was observed further offshore, preventing the LWP removal through precipitation that likely occurred in reality. The boundary layer was too low by around 260 m, which was attributed to the driving global model analysis. The shapes and sizes of the observed bands of clouds and open-cell-like regions of low areal

  12. A fatal case of Brazilian spotted fever in a non-endemic area in Brazil: the importance of having health professionals who understand the disease and its areas of transmission.

    PubMed

    Oliveira, Stefan Vilges de; Caldas, Eduardo Pacheco de; Colombo, Silvia; Gazeta, Gilberto Salles; Labruna, Marcelo Bahia; Santos, Fabiana Cristina Pereira Dos; Angerami, Rodrigo Nogueira

    2016-01-01

    Brazilian spotted fever (BSF) is caused by the bacterium Rickettsia rickettsii. Because of its high case-fatality rate and apparent increase in areas of transmission, it is considered to be the rickettsial illness of primary public health interest. Cases of this disease have historically occurred in Southeastern Brazil. This article reports the first fatal case of BSF in Southern Brazil. This case high lights the importance of BSF to be considered as a differential diagnosis for acute hemorrhagic fever in areas where cases of BSF may not be expected.

  13. Worst-Case Scenario Tsunami Hazard Assessment in Two Historically and Economically Important Districts in Eastern Sicily (Italy)

    NASA Astrophysics Data System (ADS)

    Armigliato, A.; Tinti, S.; Pagnoni, G.; Zaniboni, F.; Paparo, M. A.

    2015-12-01

    The portion of the eastern Sicily coastline (southern Italy), ranging from the southern part of the Catania Gulf (to the north) down to the southern-eastern end of the island, represents a very important geographical domain from the industrial, commercial, military, historical and cultural points of view. Here the two major cities of Augusta and Siracusa are found. In particular, the Augusta bay hosts one of the largest petrochemical poles in the Mediterranean, and Siracusa is listed among the UNESCO World Heritage Sites since 2005. This area was hit by at least seven tsunamis in the approximate time interval from 1600 BC to present, the most famous being the 365, 1169, 1693 and 1908 tsunamis. The choice of this area as one of the sites for the testing of innovative methods for tsunami hazard, vulnerability and risk assessment and reduction is then fully justified. This is being developed in the frame of the EU Project called ASTARTE - Assessment, STrategy And Risk Reduction for Tsunamis in Europe (Grant 603839, 7th FP, ENV.2013.6.4-3). We assess the tsunami hazard for the Augusta-Siracusa area through the worst-case credible scenario technique, which can be schematically divided into the following steps: 1) Selection of five main source areas, both in the near- and in the far-field (Hyblaean-Malta escarpment, Messina Straits, Ionian subduction zone, Calabria offshore, western Hellenic Trench); 2) Choice of potential and credible tsunamigenic faults in each area: 38 faults were selected, with properly assigned magnitude, geometry and focal mechanism; 3) Computation of the maximum tsunami wave elevations along the eastern Sicily coast on a coarse grid (by means of the in-house code UBO-TSUFD) and extraction of the 9 scenarios that produce the largest effects in the target areas of Augusta and Siracusa; 4) For each of the 9 scenarios we run numerical UBO-TSUFD simulations over a set of five nested grids, with grid cells size decreasing from 3 km in the open Ionian

  14. Nonsyndromic Familial Oligodontia with Multiple Dens Invaginatus: A Case Report of an Unusual Case

    PubMed Central

    Vinuth, D. P.; Agarwal, Poonam; Dube, Gunjan; Abhilash, S.; Dube, Pallavi

    2013-01-01

    Oligodontia is a rare dental anomaly with a prevalence of 0.3% in permanent teeth and much less frequency in the primary dentition. Familial oligodontia represents an absence of varying numbers of primary and/or secondary teeth as an isolated trait. It is a complex and multifactorial condition. Many explanations—evolutionary, genetic, and environmental—have been proposed as the etiology. Simultaneous with oligodontia are often the different positional changes of the existing teeth, their morphology, size, and growth disturbances of the maxillofacial skeleton. Early recognition is vital to provide adequate treatment and prevent squeal. Multidisciplinary referral or consultation is thus important in treatment planning to improve function and esthetics. The present paper reports a rare case of familial oligodontia associated with multiple dense invaginatus and microdontia. PMID:24319603

  15. Leadership Competencies: Do They Differ for Women and Under-Represented Minority Faculty Members?

    ERIC Educational Resources Information Center

    Skarupski, Kimberly A.; Levine, Rachel B.; Yang, Wan Rou; González-Fernández, Marlís; Bodurtha, Joann; Barone, Michael A.; Fivush, Barbara

    2017-01-01

    The literature on leadership competencies does not include an understanding of how stakeholders perceive competencies for women and under-represented minority faculty members. We surveyed three groups of leaders (N = 113) to determine their perceptions of the importance of 23 leadership competencies. All three groups endorsed the same five…

  16. Further occurrences of Dohrniphora cornuta (Bigot) (Diptera, Phoridae) in forensic cases indicate likely importance of this species in future cases.

    PubMed

    Disney, R Henry L; Garcia-Rojo, Ana; Lindström, Anders; Manlove, John D

    2014-08-01

    Dohrniphora cornuta (Bigot), an oriental species of scuttle fly, has been transported around the world by man. We report it from forensic cases in England, Spain and Sweden. It is likely to feature in forensic cases elsewhere in the world. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Urgent Implementation in a Hospital Setting of a Strategy To Rule Out Secondary Cases Caused by Imported Extensively Drug-Resistant Mycobacterium tuberculosis Strains at Diagnosis

    PubMed Central

    Pérez-Lago, Laura; Martínez-Lirola, Miguel; García, Sergio; Herranz, Marta; Mokrousov, Igor; Comas, Iñaki; Martínez-Priego, Llúcia; Bouza, Emilio

    2016-01-01

    Current migratory movements require new strategies for rapidly tracking the transmission of high-risk imported Mycobacterium tuberculosis strains. Whole-genome sequencing (WGS) enables us to identify single-nucleotide polymorphisms (SNPs) and therefore design PCRs to track specific relevant strains. However, fast implementation of these strategies in the hospital setting is difficult because professionals working in diagnostics, molecular epidemiology, and genomics are generally at separate institutions. In this study, we describe the urgent implementation of a system that integrates genomics and molecular tools in a genuine high-risk epidemiological alert involving 2 independent importations of extensively drug resistant (XDR) and pre-XDR Beijing M. tuberculosis strains from Russia into Spain. Both cases involved commercial sex workers with long-standing tuberculosis (TB). The system was based on strain-specific PCRs tailored from WGS data that were transferred to the local node that was managing the epidemiological alert. The optimized tests were available for prospective implementation in the local node 33 working days after receiving the primary cultures of the XDR strains and were applied to all 42 new incident cases. An interpretable result was obtained in each case (directly from sputum for 27 stain-positive cases) and corresponded to the amplification profiles for strains other than the targeted pre-XDR and XDR strains, which made it possible to prospectively rule out transmission of these high-risk strains at diagnosis. PMID:27682128

  18. Phylogeny of imported and reestablished wild polioviruses in theDemocratic Republic of the Congo from 2006 to 2011.

    PubMed

    Gumede, Nicksy; Jorba, Jaume; Deshpande, Jagadish; Pallansch, Mark; Yogolelo, Riziki; Muyembe-Tamfum, Jean Jacques; Kew, Olen; Venter, Marietjie; Burns, Cara C

    2014-11-01

    The last case of polio associated with wild poliovirus (WPV) indigenous to the Democratic Republic of the Congo (DRC) was reported in 2001, marking a major milestone toward polio eradication in Africa. However, during 2006-2011, outbreaks associated with WPV type 1 (WPV1) were widespread in the DRC, with >250 reported cases. WPV1 isolates obtained from patients with acute flaccid paralysis (AFP) were compared by nucleotide sequencing of the VP1 capsid region (906 nucleotides). VP1 sequence relationships among isolates from the DRC and other countries were visualized in phylogenetic trees, and isolates representing distinct lineage groups were mapped. Phylogenetic analysis indicated that WPV1 was imported twice in 2004-2005 and once in approximately 2006 from Uttar Pradesh, India (a major reservoir of endemicity for WPV1 and WPV3 until 2010-2011), into Angola. WPV1 from the first importation spread to the DRC in 2006, sparking a series of outbreaks that continued into 2011. WPV1 from the second importation was widely disseminated in the DRC and spread to the Congo in 2010-2011. VP1 sequence relationships revealed frequent transmission of WPV1 across the borders of Angola, the DRC, and the Congo. Long branches on the phylogenetic tree signaled prolonged gaps in AFP surveillance and a likely underreporting of polio cases. The reestablishment of widespread and protracted WPV1 transmission in the DRC and Angola following long-range importations highlights the continuing risks of WPV spread until global eradication is achieved, and it further underscores the need for all countries to maintain high levels of poliovirus vaccine coverage and sensitive surveillance to protect their polio-free status. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  19. Bilateral Breast Metastases from Vulvar Carcinoma: A Case Report and Literature Review

    PubMed Central

    Kalogerakos, K.; Dimopoulos, Johannes Carl Athanasios; Kalinoglou, N.

    2017-01-01

    Vulvar carcinoma is a rare disease that accounts for 3–5% of all gynecologic malignancies. Breast represents an unusual site of metastasis and only a few cases are reported. We describe the first case of bilateral metastatic breast carcinoma of vulvar origin, at an 80-year-old female patient. Six months after treatment of her primary disease, she presented with bilateral metastatic squamous cell breast carcinoma. Diagnosis was based on clinical, radiological, and histological facts. Breast although rare is another potential site of metastasis in vulvar cancer and thus mammary gland examination should be considered in the follow-up of these patients. Differential diagnosis between primary and metastatic lesions is of utmost importance for appropriate management. PMID:28487793

  20. Investigation of representing hysteresis in macroscopic models of two-phase flow in porous media using intermediate scale experimental data

    NASA Astrophysics Data System (ADS)

    Cihan, Abdullah; Birkholzer, Jens; Trevisan, Luca; Gonzalez-Nicolas, Ana; Illangasekare, Tissa

    2017-01-01

    Incorporating hysteresis into models is important to accurately capture the two phase flow behavior when porous media systems undergo cycles of drainage and imbibition such as in the cases of injection and post-injection redistribution of CO2 during geological CO2 storage (GCS). In the traditional model of two-phase flow, existing constitutive models that parameterize the hysteresis associated with these processes are generally based on the empirical relationships. This manuscript presents development and testing of mathematical hysteretic capillary pressure—saturation—relative permeability models with the objective of more accurately representing the redistribution of the fluids after injection. The constitutive models are developed by relating macroscopic variables to basic physics of two-phase capillary displacements at pore-scale and void space distribution properties. The modeling approach with the developed constitutive models with and without hysteresis as input is tested against some intermediate-scale flow cell experiments to test the ability of the models to represent movement and capillary trapping of immiscible fluids under macroscopically homogeneous and heterogeneous conditions. The hysteretic two-phase flow model predicted the overall plume migration and distribution during and post injection reasonably well and represented the postinjection behavior of the plume more accurately than the nonhysteretic models. Based on the results in this study, neglecting hysteresis in the constitutive models of the traditional two-phase flow theory can seriously overpredict or underpredict the injected fluid distribution during post-injection under both homogeneous and heterogeneous conditions, depending on the selected value of the residual saturation in the nonhysteretic models.

  1. Convectively Generated Gravity Waves In The Tropical Stratosphere: Case Studies And Importance For The Circulation Of The Middle Atmosphere

    NASA Technical Reports Server (NTRS)

    Pfister, Leonhard; Chan, Kwoklong R.; Gary, Bruce; Singh, Hanwant B. (Technical Monitor)

    1995-01-01

    The advent of high altitude aircraft measurements in the stratosphere over tropical convective systems has made it possible to observe the mesoscale disturbances in the temperature field that these systems excite. Such measurements show that these disturbances have horizontal scales comparable to those of the underlying anvils (about 50-100 km) with peak to peak theta surface variations of about 300-400 meters. Moreover, correlative wind measurements from the tropical phase of the Stratosphere-Troposphere Exchange Project (STEP) clearly show that these disturbances are gravity waves. We present two case studies of anvil-scale gravity waves over convective systems. Using steady and time-dependent linear models of gravity wave propagation in the stratosphere, we show: (1) that the underlying convective systems are indeed the source of the observed phenomena; and (2) that their generating mechanism can be crudely represented as flow over a time-dependent mountain. We will then discuss the effects gravity waves of the observed amplitudes have on the circulation of the middle atmosphere, particularly the quasi-biennial, and semiannual oscillations.

  2. [Hyperthyroidism in surgery at the Teaching Hospital Yalgado Ouedraogo Burkina Faso. About 95 cases].

    PubMed

    Traoré, S S; Zida, M; Bonkoungou, G P; Tierno, H; Coulidiati, U; Sano, D

    2007-01-01

    The authors pay in a retrospective study, 95 cases of hyperthyroidism, listed in the teaching hospital Yalgado Ouedraogo of Ouagadougou from January 2000 to June 2005. These hyperthyroidism represent 39% of the thyroid affections, with a female prevalence (97%), 32 years of average age, the urban source of the patients (90% of the cases) and the importance of self medication (73%). They stress the importance of sonography, allowing a classification in diffuse goiter (44%) and multi nodular (56%). They insist on a good preparation of the patient before the intervention and on the interest of the sub total thyroïdectomy. They estimate that a correct binding of the vessels, the dissection of recurring, the visualization and the dissection of parathyroid and their vascular pedicle should make it possible to reduce the post-operative complications: null morbidity and death rate 12.5%.

  3. Ebola Virus Imported from Guinea to Senegal, 2014.

    PubMed

    Ka, Daye; Fall, Gamou; Diallo, Viviane Cissé; Faye, Ousmane; Fortes, Louise Deguenonvo; Faye, Oumar; Bah, Elhadji Ibrahim; Diallo, Kadia Mbaye; Balique, Fanny; Ndour, Cheikh Tidiane; Seydi, Moussa; Sall, Amadou Alpha

    2017-06-01

    In March 2014, the World Health Organization declared an outbreak of Ebola virus disease in Guinea. In August 2014, a case caused by virus imported from Guinea occurred in Senegal, most likely resulting from nonsecure funerals and travel. Preparedness and surveillance in Senegal probably prevented secondary cases.

  4. The importance of Evolutionary Medicine in developing countries: A case for Pakistan's medical schools.

    PubMed

    Enam, Syed Faaiz; Hashmi, Shumaila

    2018-01-01

    Evolutionary Medicine (EM) is a fundamental science exploring why our bodies are plagued with disease and hindered by limitations. EM views the body as an assortment of benefits, mistakes, and compromises molded over millennia. It highlights the role of evolution in numerous diseases encountered in community and family medicine clinics of developing countries. It enables us to ask informed questions and develop novel responses to global health problems. An understanding of the field is thus crucial for budding doctors, but its study is currently limited to a handful of medical schools in high-income countries. For the developing world, Pakistan's medical schools may be excellent starting posts as the country is beset with communicable and non-communicable diseases that are shaped by evolution. Remarkably, Pakistani medical students are open to studying and incorporating EM into their training. Understanding the principles of EM could empower them to tackle growing health problems in the country. Additionally, some difficulties that western medical schools face in integrating EM into their curriculum may not be a hindrance in Pakistan. We propose solutions for the remaining challenges, including obstinate religious sentiments. Herein, we make the case that incorporating EM is particularly important in developing countries such as Pakistan and that it is achievable in its medical student body.

  5. Case Studies for Effective Business Instruction.

    ERIC Educational Resources Information Center

    McAlister-Kizzier, Donna

    This book is designed as a resource for educators who teach business content in a variety of instructional settings. It contains case studies representing all functional areas of business, including corporate training, for grades 7 through graduate education. Chapter 1 provides an overview of the case study method. The history of the case method,…

  6. A high-level object-oriented model for representing relationships in an electronic medical record.

    PubMed Central

    Dolin, R. H.

    1994-01-01

    The importance of electronic medical records to improve the quality and cost-effectiveness of medical care continues to be realized. This growing importance has spawned efforts at defining the structure and content of medical data, which is heterogeneous, highly inter-related, and complex. Computer-assisted data modeling tools have greatly facilitated the process of representing medical data, however the complex inter-relationships of medical information can result in data models that are large and cumbersome to manipulate and view. This report presents a high-level object-oriented model for representing the relationships between objects or entities that might exist in an electronic medical record. By defining the relationship between objects at a high level and providing for inheritance, this model enables relating any medical entity to any other medical entity, even though the relationships were not directly specified or known during data model design. PMID:7949981

  7. Pediatric Old World cutaneous leishmaniasis treated with oral fluconazole: A case series.

    PubMed

    Michelerio, Andrea; Barruscotti, Stefania; Bossi, Grazia; Brazzelli, Valeria

    2018-05-01

    Cutaneous leishmaniasis has an incidence of 0.7-1.2 million cases per year and represents a growing concern in the outpatient dermatologic practice in Europe because of imported cases due to increased travel to risk areas and to immigration phenomena. When dealing with children, the treatment can be challenging because of side effects and pain of classic antimonial therapy leading to poor rates of course completion and requirement of sedation for several children. We retrospectively studied three cases of cutaneous leishmaniasis in pediatric patients, between the ages of 3 and 6 years of age, treated with oral fluconazole. We examined the efficacy, the tolerability, the safety profile and the cosmetic result of fluconazole at a dose of 6 mg/kg/daily for 6 weeks. The patients had a complete resolution of their lesions with minimal scarring. No adverse effect was reported. The leishmaniasis species identified were L. major or L. tropica. Considering sides effects and the parents' and the clinician's concern for systemic treatment in the pediatric population, fluconazole represents a valid, safe and easily manageable option for Old World cutaneous leishmaniasis in pediatric outpatients caused by L. major or L. tropica. © 2018 Wiley Periodicals, Inc.

  8. 50 CFR 221.10 - Who may represent a party, and what requirements apply to a representative?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 10 2012-10-01 2012-10-01 false Who may represent a party, and what requirements apply to a representative? 221.10 Section 221.10 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS...

  9. 50 CFR 221.10 - Who may represent a party, and what requirements apply to a representative?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 9 2011-10-01 2011-10-01 false Who may represent a party, and what requirements apply to a representative? 221.10 Section 221.10 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS...

  10. Ebola Virus Imported from Guinea to Senegal, 2014

    PubMed Central

    Ka, Daye; Fall, Gamou; Diallo, Viviane Cissé; Fortes, Louise Deguenonvo; Faye, Oumar; Bah, Elhadji Ibrahim; Diallo, Kadia Mbaye; Balique, Fanny; Ndour, Cheikh Tidiane; Seydi, Moussa; Sall, Amadou Alpha

    2017-01-01

    In March 2014, the World Health Organization declared an outbreak of Ebola virus disease in Guinea. In August 2014, a case caused by virus imported from Guinea occurred in Senegal, most likely resulting from nonsecure funerals and travel. Preparedness and surveillance in Senegal probably prevented secondary cases. PMID:28518019

  11. Nanomaterial Case Study: A Comparison of Multiwalled ...

    EPA Pesticide Factsheets

    The draft document is intended to be used as part of a process to identify what is known and, more importantly, what is not yet known that could be of value in assessing the broad implications of specific nanomaterials. Like previous case studies (see History/ Chronology below), this draft case study on multiwalled carbon nanotubes (MWCNTs) is based on the comprehensive environmental assessment (CEA) approach, which consists of both a framework and a process. Unlike previous case studies this case study incorporates information about a traditional (i.e., “non-nano-enabled”) product, against which the MWCNT flame-retardant coating applied to upholstery textiles (i.e., the “nano-enabled” product) can be compared. The comparative element serves dual-purposes: 1) to provide a more robust database that facilitates identification of data gaps related to the nano-enabled product and 2) to provide a context for identifying key factors and data gaps for future efforts to evaluate risk-related trade-offs between a nano-enabled and non-nano-enabled product. This draft case study does not represent a completed or even a preliminary assessment of MWCNTs; rather, it uses the CEA framework to structure information from available literature and other resources (e.g., government reports) on the product life cycle, fate and transport processes in various environmental media, exposure-dose characterization, and impacts in human, ecological, and environmental receptors.

  12. 14 CFR 183.29 - Designated engineering representatives.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Designated engineering representatives. 183... § 183.29 Designated engineering representatives. (a) A structural engineering representative may approve structural engineering information and other structural considerations within limits prescribed by and under...

  13. 14 CFR 183.29 - Designated engineering representatives.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Designated engineering representatives. 183... § 183.29 Designated engineering representatives. (a) A structural engineering representative may approve structural engineering information and other structural considerations within limits prescribed by and under...

  14. 14 CFR 183.29 - Designated engineering representatives.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Designated engineering representatives. 183... § 183.29 Designated engineering representatives. (a) A structural engineering representative may approve structural engineering information and other structural considerations within limits prescribed by and under...

  15. 14 CFR 183.29 - Designated engineering representatives.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Designated engineering representatives. 183... § 183.29 Designated engineering representatives. (a) A structural engineering representative may approve structural engineering information and other structural considerations within limits prescribed by and under...

  16. 14 CFR 183.29 - Designated engineering representatives.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Designated engineering representatives. 183... § 183.29 Designated engineering representatives. (a) A structural engineering representative may approve structural engineering information and other structural considerations within limits prescribed by and under...

  17. A case of imported paracoccidioidomycosis in a German legionnaire.

    PubMed

    Horré, R; Schumacher, G; Alpers, K; Seitz, H M; Adler, S; Lemmer, K; De Hoog, G S; Schaal, K P; Tintelno, K

    2002-04-01

    We report on a case of the chronic form of paracoccidioidomycosis with swelling and ulcerations of the mouth in a German legionnaire who also suffered from a chronic bronchitis. The patient had worked for many years in Brazil, an area endemic for the disease. Infection due to Paracoccidioides brasiliensis was diagnosed in Germany, more than 10 years after the patient's return. Diagnosis was established by the presence of yeast cells with multipolar budding in the tissue of the oral lesion. Furthermore, the fungus was grown in a liquid Leishmania culture medium. Identification of the fungus was based on morphology and genetic sequencing. Furthermore, IgG antibodies against a 43-kDa antigen of P. brasiliensis were detected in a western blot. After itraconazole therapy (400 mg day(-1)) for 4 weeks, the lesions had disappeared almost completely, but the therapy was continued for further 5 months to avoid relapse of the infection.

  18. First case of imported Zika virus infection in Spain.

    PubMed

    Bachiller-Luque, Pablo; Domínguez-Gil González, Marta; Álvarez-Manzanares, Jesús; Vázquez, Ana; De Ory, Fernando; Sánchez-Seco Fariñas, M Paz

    2016-04-01

    We report a case of Zika virus (ZIKV) infection in a patient with diarrhea, fever, synovitis, non-purulent conjunctivitis, and with discreet retro-orbital pain, after returning from Colombia in January 2016. The patient referred several mosquito bites. Presence of ZIKV was detected by PCR (polymerase chain reaction) in plasma. Rapid microbiological diagnosis of ZIKV infection is needed in European countries with circulation of its vector, in order to avoid autochthonous circulation. The recent association of ZIKV infection with abortion and microcephaly, and a Guillain-Barré syndrome highlights the need for laboratory differentiation of ZIKV from other virus infection. Women with potential risk for Zika virus infection who are pregnant or planning to become pregnant must mention that fact during prenatal visits in order to be evaluated and properly monitored. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  19. Yellow fever cases in Asia: primed for an epidemic.

    PubMed

    Wasserman, Sean; Tambyah, Paul Anantharajah; Lim, Poh Lian

    2016-07-01

    There is currently an emerging outbreak of yellow fever in Angola. Cases in infected travellers have been reported in a number of other African countries, as well as in China, representing the first ever documented cases of yellow fever in Asia. There is a large Chinese workforce in Angola, many of whom may be unvaccinated, increasing the risk of ongoing importation of yellow fever into Asia via busy commercial airline routes. Large parts of the region are hyperendemic for the related Flavivirus dengue and are widely infested by Aedes aegypti, the primary mosquito vector of urban yellow fever transmission. The combination of sustained introduction of viraemic travellers, an ecology conducive to local transmission, and an unimmunized population raises the possibility of a yellow fever epidemic in Asia. This represents a major global health threat, particularly in the context of a depleted emergency vaccine stockpile and untested surveillance systems in the region. In this review, the potential for a yellow fever outbreak in Asia is discussed with reference to the ecological and historical forces that have shaped global yellow fever epidemiology. The limitations of surveillance and vector control in the region are highlighted, and priorities for outbreak preparedness and response are suggested. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  20. Generalised and abdominal adiposity are important risk factors for chronic disease in older people: results from a nationally representative survey.

    PubMed

    Hirani, V

    2011-06-01

    To look at the trends in prevalence of generalised (body mass index (BMI) ≥ 25 kg/m2) and abdominal obesity (waist circumference (WC) >102 cm, men; > 88 cm, women) among older people from 1993 to 2008, prevalence of chronic disease by overweight/obesity and WC categories in England 2005 and evaluate the association of these measures with chronic diseases. Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE). Non-institutionalised men and women aged ≥ 65 years (in HSE 2005, 1512 men and 1747 women). Height, weight, waist circumference, blood pressure measurements were taken according to standardised HSE protocols. Information collected on socio-demographic, health behaviour and doctor diagnosed health conditions. Generalised obesity and abdominal obesity increased among men and women from 1993 to 2008. In 2005, the HSE 2005 focussed on older people. 72% of men and 68% of women aged over 65 were either overweight or obese. Prevalence of raised WC was higher in women (58%) than in men (46%). The prevalence of diabetes and arthritis was higher in people with generalised obesity in both sexes. Men were more likely to have had a joint replacement and had a higher prevalence of stroke if they were overweight only but women were more likely to have had a joint replacement only if they were obese (13%) and had a higher risk of falls with generalised obesity. The pattern was similar for the prevalence of chronic diseases by raised WC. Multivariate analysis showed that generalised and abdominal obesity was independently associated with risk of hypertension, diabetes and arthritis in both men and women. In women only, there was an association between generalised obesity and having a fall in the last year (OR: 1.5), and between abdominal obesity and having a joint replacement (OR: 1.9, p=0.01). Complications of obesity such as diabetes, hypertension and arthritis, are more common in men and women aged over 65 who are

  1. 22 CFR 41.52 - Information media representative.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Information media representative. 41.52 Section... IMMIGRATION AND NATIONALITY ACT, AS AMENDED Business and Media Visas § 41.52 Information media representative. (a) Representative of foreign press, radio, film, or other information media. An alien is...

  2. 22 CFR 41.52 - Information media representative.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Information media representative. 41.52 Section... IMMIGRATION AND NATIONALITY ACT, AS AMENDED Business and Media Visas § 41.52 Information media representative. (a) Representative of foreign press, radio, film, or other information media. An alien is...

  3. 22 CFR 41.52 - Information media representative.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Information media representative. 41.52 Section... IMMIGRATION AND NATIONALITY ACT, AS AMENDED Business and Media Visas § 41.52 Information media representative. (a) Representative of foreign press, radio, film, or other information media. An alien is...

  4. 22 CFR 41.52 - Information media representative.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Information media representative. 41.52 Section... IMMIGRATION AND NATIONALITY ACT, AS AMENDED Business and Media Visas § 41.52 Information media representative. (a) Representative of foreign press, radio, film, or other information media. An alien is...

  5. 22 CFR 41.52 - Information media representative.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Information media representative. 41.52 Section... IMMIGRATION AND NATIONALITY ACT, AS AMENDED Business and Media Visas § 41.52 Information media representative. (a) Representative of foreign press, radio, film, or other information media. An alien is...

  6. 45 CFR 1801.14 - Faculty Representative.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Nominations § 1801.14 Faculty Representative. (a) Each institution... Representative to establish a process to publicize the scholarship, recruit candidates, select nominees, and...

  7. 45 CFR 1801.14 - Faculty Representative.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Nominations § 1801.14 Faculty Representative. (a) Each institution... Representative to establish a process to publicize the scholarship, recruit candidates, select nominees, and...

  8. 45 CFR 1801.14 - Faculty Representative.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Nominations § 1801.14 Faculty Representative. (a) Each institution... Representative to establish a process to publicize the scholarship, recruit candidates, select nominees, and...

  9. 45 CFR 1801.14 - Faculty Representative.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Nominations § 1801.14 Faculty Representative. (a) Each institution... Representative to establish a process to publicize the scholarship, recruit candidates, select nominees, and...

  10. 45 CFR 1801.14 - Faculty Representative.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Nominations § 1801.14 Faculty Representative. (a) Each institution... Representative to establish a process to publicize the scholarship, recruit candidates, select nominees, and...

  11. The Fender Stratocaster Electric Guitar: A Case Study for both Nontransferable and Transferable Skills Learning in a Generalist Electronic Engineering Cohort

    ERIC Educational Resources Information Center

    Joyce, M. J.

    2010-01-01

    A case-study approach to teaching electronics system design that has been used since 2004 to demonstrate the importance of both nontransferable and transferable design issues to first-year undergraduate students is described. The student cohort of relevance to this work represents a diverse group comprising both students studying for a four-year…

  12. Retention performance of green roofs in representative climates worldwide

    NASA Astrophysics Data System (ADS)

    Viola, F.; Hellies, M.; Deidda, R.

    2017-10-01

    The ongoing process of global urbanization contributes to an increase in stormwater runoff from impervious surfaces, threatening also water quality. Green roofs have been proved to be innovative stormwater management measures to partially restore natural states, enhancing interception, infiltration and evapotranspiration fluxes. The amount of water that is retained within green roofs depends not only on their depth, but also on the climate, which drives the stochastic soil moisture dynamic. In this context, a simple tool for assessing performance of green roofs worldwide in terms of retained water is still missing and highly desirable for practical assessments. The aim of this work is to explore retention performance of green roofs as a function of their depth and in different climate regimes. Two soil depths are investigated, one representing the intensive configuration and another representing the extensive one. The role of the climate in driving water retention has been represented by rainfall and potential evapotranspiration dynamics. A simple conceptual weather generator has been implemented and used for stochastic simulation of daily rainfall and potential evapotranspiration. Stochastic forcing is used as an input of a simple conceptual hydrological model for estimating long-term water partitioning between rainfall, runoff and actual evapotranspiration. Coupling the stochastic weather generator with the conceptual hydrological model, we assessed the amount of rainfall diverted into evapotranspiration for different combinations of annual rainfall and potential evapotranspiration in five representative climatic regimes. Results quantified the capabilities of green roofs in retaining rainfall and consequently in reducing discharges into sewer systems at an annual time scale. The role of substrate depth has been recognized to be crucial in determining green roofs retention performance, which in general increase from extensive to intensive settings. Looking at the

  13. 21 CFR 1404.915 - Agent or representative.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Agent or representative. 1404.915 Section 1404.915 Food and Drugs OFFICE OF NATIONAL DRUG CONTROL POLICY GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 1404.915 Agent or representative. Agent or representative means any person who acts...

  14. Urgent Implementation in a Hospital Setting of a Strategy To Rule Out Secondary Cases Caused by Imported Extensively Drug-Resistant Mycobacterium tuberculosis Strains at Diagnosis.

    PubMed

    Pérez-Lago, Laura; Martínez-Lirola, Miguel; García, Sergio; Herranz, Marta; Mokrousov, Igor; Comas, Iñaki; Martínez-Priego, Llúcia; Bouza, Emilio; García-de-Viedma, Darío

    2016-12-01

    Current migratory movements require new strategies for rapidly tracking the transmission of high-risk imported Mycobacterium tuberculosis strains. Whole-genome sequencing (WGS) enables us to identify single-nucleotide polymorphisms (SNPs) and therefore design PCRs to track specific relevant strains. However, fast implementation of these strategies in the hospital setting is difficult because professionals working in diagnostics, molecular epidemiology, and genomics are generally at separate institutions. In this study, we describe the urgent implementation of a system that integrates genomics and molecular tools in a genuine high-risk epidemiological alert involving 2 independent importations of extensively drug resistant (XDR) and pre-XDR Beijing M. tuberculosis strains from Russia into Spain. Both cases involved commercial sex workers with long-standing tuberculosis (TB). The system was based on strain-specific PCRs tailored from WGS data that were transferred to the local node that was managing the epidemiological alert. The optimized tests were available for prospective implementation in the local node 33 working days after receiving the primary cultures of the XDR strains and were applied to all 42 new incident cases. An interpretable result was obtained in each case (directly from sputum for 27 stain-positive cases) and corresponded to the amplification profiles for strains other than the targeted pre-XDR and XDR strains, which made it possible to prospectively rule out transmission of these high-risk strains at diagnosis. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  15. Models with Men and Women: Representing Gender in Dynamic Modeling of Social Systems.

    PubMed

    Palmer, Erika; Wilson, Benedicte

    2018-04-01

    Dynamic engineering models have yet to be evaluated in the context of feminist engineering ethics. Decision-making concerning gender in dynamic modeling design is a gender and ethical issue that is important to address regardless of the system in which the dynamic modeling is applied. There are many dynamic modeling tools that operationally include the female population, however, there is an important distinction between females and women; it is the difference between biological sex and the social construct of gender, which is fluid and changes over time and geography. The ethical oversight in failing to represent or misrepresenting gender in model design when it is relevant to the model purpose can have implications for model validity and policy model development. This paper highlights this gender issue in the context of feminist engineering ethics using a dynamic population model. Women are often represented in this type of model only in their biological capacity, while lacking their gender identity. This illustrative example also highlights how language, including the naming of variables and communication with decision-makers, plays a role in this gender issue.

  16. Identifying Training Needs to Improve Indigenous Community Representatives Input into Environmental Resource Management Consultative Processes: A Case Study of the Bundjalung Nation

    ERIC Educational Resources Information Center

    Lloyd, David; Norrie, Fiona

    2004-01-01

    Despite increased engagement of Indigenous representatives as participants on consultative panels charged with processes of natural resource management, concerns have been raised by both Indigenous representatives and management agencies regarding the ability of Indigenous people to have quality input into the decisions these processes produce. In…

  17. Salmon Gill Poxvirus, the Deepest Representative of the Chordopoxvirinae

    PubMed Central

    Yutin, Natalya; Tengs, Torstein; Senkevich, Tania; Koonin, Eugene; Rønning, Hans Petter; Alarcon, Marta; Ylving, Sonja; Lie, Kai-Inge; Saure, Britt; Tran, Linh; Dale, Ole Bendik

    2015-01-01

    ABSTRACT Poxviruses are large DNA viruses of vertebrates and insects causing disease in many animal species, including reptiles, birds, and mammals. Although poxvirus-like particles were detected in diseased farmed koi carp, ayu, and Atlantic salmon, their genetic relationships to poxviruses were not established. Here, we provide the first genome sequence of a fish poxvirus, which was isolated from farmed Atlantic salmon. In the present study, we used quantitative PCR and immunohistochemistry to determine aspects of salmon gill poxvirus disease, which are described here. The gill was the main target organ where immature and mature poxvirus particles were detected. The particles were detected in detaching, apoptotic respiratory epithelial cells preceding clinical disease in the form of lethargy, respiratory distress, and mortality. In moribund salmon, blocking of gas exchange would likely be caused by the adherence of respiratory lamellae and epithelial proliferation obstructing respiratory surfaces. The virus was not found in healthy salmon or in control fish with gill disease without apoptotic cells, although transmission remains to be demonstrated. PCR of archival tissue confirmed virus infection in 14 cases with gill apoptosis in Norway starting from 1995. Phylogenomic analyses showed that the fish poxvirus is the deepest available branch of chordopoxviruses. The virus genome encompasses most key chordopoxvirus genes that are required for genome replication and expression, although the gene order is substantially different from that in other chordopoxviruses. Nevertheless, many highly conserved chordopoxvirus genes involved in viral membrane biogenesis or virus-host interactions are missing. Instead, the salmon poxvirus carries numerous genes encoding unknown proteins, many of which have low sequence complexity and contain simple repeats suggestive of intrinsic disorder or distinct protein structures. IMPORTANCE Aquaculture is an increasingly important global

  18. Pandemic influenza A (H1N1) in Saudi Arabia: description of the first one hundred cases.

    PubMed

    AlMazroa, Mohammad A; Memish, Ziad A; AlWadey, Ali M

    2010-01-01

    In April 2009, the World Health Organization (WHO) declared pandemic influenza A (H1N1) "public health emergency of international concern". On June 11, 2009, WHO raised the pandemic alert level to phase 6, indicating a global pandemic. By December 2009, more than 208 countries and territories had reported swine flu cases. The descriptive epidemiology of the first reported 100 cases of this virus in Saudi Arabia are summarized in this report. Data were collected from 1 June to 3 July, 2009 using a predesigned questionnaire. Questionnaires were filled by Field Epidemiology Training Program residents. Data for the first 100 complete cases of confirmed pandemic influenza A (H1N1) were compiled and analyzed. The age of reported cases was in the range of 1 to 56 years. The highest percentage of cases was in the age group of 20 to 30 years followed by the age group of 1 to 10 years. Females represented 55% of the cases; imported cases represented 47%, 58% of whom had come via the King Khaled Airport. The most common nationalities most were from Saudi Arabia and the Philippines. The main symptoms were fever (56%), cough (54%), and sore throat and the number of cases was seen to peak from the 27 to 29 June. Pandemic influenza A (H1N1) is still a threat to Saudi Arabia. Thus, comprehensive and effective measures for surveillance and prevention of the disease are needed to control its spread.

  19. 45 CFR 2400.11 - Faculty representatives.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Faculty representatives. 2400.11 Section 2400.11 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Application § 2400.11 Faculty representatives. Each college and...

  20. 45 CFR 2400.11 - Faculty representatives.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Faculty representatives. 2400.11 Section 2400.11 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Application § 2400.11 Faculty representatives. Each college and...

  1. 45 CFR 2400.11 - Faculty representatives.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Faculty representatives. 2400.11 Section 2400.11 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Application § 2400.11 Faculty representatives. Each college and...

  2. 45 CFR 2400.11 - Faculty representatives.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Faculty representatives. 2400.11 Section 2400.11 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Application § 2400.11 Faculty representatives. Each college and...

  3. 45 CFR 2400.11 - Faculty representatives.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Faculty representatives. 2400.11 Section 2400.11 Public Welfare Regulations Relating to Public Welfare (Continued) JAMES MADISON MEMORIAL FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Application § 2400.11 Faculty representatives. Each college and...

  4. 40 CFR 436.32 - Effluent limitations guidelines representing the degree of effluent reduction attainable by the...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Construction Sand and Gravel Subcategory § 436.32 Effluent limitations guidelines representing the degree of... unaltered by man's activities, is or would be less than 6.0 and water quality criteria in water quality... adjusted downward to the pH water quality criterion for the receiving waters. In no case shall a pH...

  5. Imported Chikungunya Virus Strains, Taiwan, 2006–2014

    PubMed Central

    Yang, Cheng-Fen; Su, Chien-Ling; Hsu, Tung-Chien; Chang, Shu-Fen; Lin, Chien-Chou

    2016-01-01

    We identified 78 imported chikungunya cases in Taiwan during 2006–2014. Sixty-six (84.6%) cases were initially suspected to be dengue, which indicates the necessity for laboratory diagnostics in differentiation between dengue and chikungunya. Results also emphasize the need for active surveillance of febrile illness at points of entry. PMID:27767908

  6. 48 CFR 1830.7002-3 - Representative investment calculations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Representative investment... Representative investment calculations. (a) The calculation of the representative investment requires... accounting period, the contractor shall either: (1) Determine a representative investment for the cost...

  7. 48 CFR 1830.7002-3 - Representative investment calculations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Representative investment... Representative investment calculations. (a) The calculation of the representative investment requires... accounting period, the contractor shall either: (1) Determine a representative investment for the cost...

  8. Non-Relative Value Unit-Generating Activities Represent One-Fifth of Academic Neuroradiologist Productivity.

    PubMed

    Wintermark, M; Zeineh, M; Zaharchuk, G; Srivastava, A; Fischbein, N

    2016-07-01

    A neuroradiologist's activity includes many tasks beyond interpreting relative value unit-generating imaging studies. Our aim was to test a simple method to record and quantify the non-relative value unit-generating clinical activity represented by consults and clinical conferences, including tumor boards. Four full-time neuroradiologists, working an average of 50% clinical and 50% academic activity, systematically recorded all the non-relative value unit-generating consults and conferences in which they were involved during 3 months by using a simple, Web-based, computer-based application accessible from smartphones, tablets, or computers. The number and type of imaging studies they interpreted during the same period and the associated relative value units were extracted from our billing system. During 3 months, the 4 neuroradiologists working an average of 50% clinical activity interpreted 4241 relative value unit-generating imaging studies, representing 8152 work relative value units. During the same period, they recorded 792 non-relative value unit-generating study reviews as part of consults and conferences (not including reading room consults), representing 19% of the interpreted relative value unit-generating imaging studies. We propose a simple Web-based smartphone app to record and quantify non-relative value unit-generating activities including consults, clinical conferences, and tumor boards. The quantification of non-relative value unit-generating activities is paramount in this time of a paradigm shift from volume to value. It also represents an important tool for determining staffing levels, which cannot be performed on the basis of relative value unit only, considering the importance of time spent by radiologists on non-relative value unit-generating activities. It may also influence payment models from medical centers to radiology departments or practices. © 2016 by American Journal of Neuroradiology.

  9. IN CASE YOU MISSED IT: EPA Releases New Chemical Safety Guidelines Aimed at Curbing Animal Testing, Tracking Mercury Imports, and Facilitating the Sharing of Confidential Business Information

    EPA Pesticide Factsheets

    EPA News Release: IN CASE YOU MISSED IT: EPA Releases New Chemical Safety Guidelines Aimed at Curbing Animal Testing, Tracking Mercury Imports, and Facilitating the Sharing of Confidential Business Information

  10. Targeting imported malaria through social networks: a potential strategy for malaria elimination in Swaziland.

    PubMed

    Koita, Kadiatou; Novotny, Joseph; Kunene, Simon; Zulu, Zulizile; Ntshalintshali, Nyasatu; Gandhi, Monica; Gosling, Roland

    2013-06-27

    Swaziland has made great progress towards its goal of malaria elimination by 2015. However, malaria importation from neighbouring high-endemic Mozambique through Swaziland's eastern border remains a major factor that could prevent elimination from being achieved. In order to reach elimination, Swaziland must rapidly identify and treat imported malaria cases before onward transmission occurs. A nationwide formative assessment was conducted over eight weeks to determine if the imported cases of malaria identified by the Swaziland National Malaria Control Programme could be linked to broader social networks and to explore methods to access these networks. Using a structured format, interviews were carried out with malaria surveillance agents (6), health providers (10), previously identified imported malaria cases (19) and people belonging to the networks identified through these interviews (25). Most imported malaria cases were Mozambicans (63%, 12/19) making a living in Swaziland and sustaining their families in Mozambique. The majority of imported cases (73%, 14/19) were labourers and self-employed contractors who travelled frequently to Mozambique to visit their families and conduct business. Social networks of imported cases with similar travel patterns were identified through these interviews. Nearly all imported cases (89%, 17/19) were willing to share contact information to enable network members to be interviewed. Interviews of network members and key informants revealed common congregation points, such as the urban market places in Manzini and Malkerns, as well as certain bus stations, where people with similar travel patterns and malaria risk behaviours could be located and tested for malaria. This study demonstrated that imported cases of malaria belonged to networks of people with similar travel patterns. This study may provide novel methods for screening high-risk groups of travellers using both snowball sampling and time-location sampling of networks to

  11. International travel increase and malaria importation in Romania, 2008-2009.

    PubMed

    Neghina, Raul; Neghina, Adriana M; Marincu, Iosif; Iacobiciu, Ioan

    2011-09-01

    This report aims to assess the epidemiological characteristics of imported malaria in Romania in the context of international travel increase, and to compare them with the data reported by other European countries. Data on malaria cases were provided by the National Centre for Surveillance and Control of the Communicable Disease, whereas the data regarding international travels to and from Romania were retrieved from the Romanian Statistical Yearbook. The number of Romanian citizens who traveled to Africa in 2007 increased by over 600% as compared to the previous year. During the years 2008-2009, 25 cases of imported malaria were registered in Romania, with no fatalities. All patients were male and most of them (84%) acquired the infection in Africa. Plasmodium falciparum was involved in 68% of cases. The majority of the affected patients (41%) were aged 31 to 40 years. Labor was the main reason for traveling (72%), and 92% of cases took either partial or no chemoprophylaxis. The continuous growth of professional and leisure voyages to malaria-endemic regions may lead to a dramatic increase of imported cases, especially if prophylactic measures are not strictly followed.

  12. 40 CFR 89.606 - Inspection and testing of imported nonroad engines.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... engines. (a) In order to allow the Administrator to determine whether an ICI's production nonroad engines... imported by the ICI. The ICI must admit an EPA enforcement officer or authorized representative during... facility where any nonroad engine imported by the ICI under this subpart was or is being modified, tested...

  13. 40 CFR 89.606 - Inspection and testing of imported nonroad engines.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... engines. (a) In order to allow the Administrator to determine whether an ICI's production nonroad engines... imported by the ICI. The ICI must admit an EPA enforcement officer or authorized representative during... facility where any nonroad engine imported by the ICI under this subpart was or is being modified, tested...

  14. 40 CFR 89.606 - Inspection and testing of imported nonroad engines.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... engines. (a) In order to allow the Administrator to determine whether an ICI's production nonroad engines... imported by the ICI. The ICI must admit an EPA enforcement officer or authorized representative during... facility where any nonroad engine imported by the ICI under this subpart was or is being modified, tested...

  15. 40 CFR 89.606 - Inspection and testing of imported nonroad engines.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... engines. (a) In order to allow the Administrator to determine whether an ICI's production nonroad engines... imported by the ICI. The ICI must admit an EPA enforcement officer or authorized representative during... facility where any nonroad engine imported by the ICI under this subpart was or is being modified, tested...

  16. 40 CFR 89.606 - Inspection and testing of imported nonroad engines.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... engines. (a) In order to allow the Administrator to determine whether an ICI's production nonroad engines... imported by the ICI. The ICI must admit an EPA enforcement officer or authorized representative during... facility where any nonroad engine imported by the ICI under this subpart was or is being modified, tested...

  17. Diego Rivera's fresco and the case taken from Morgagni's De sedibus.

    PubMed

    Zampieri, Fabio; Zanatta, Alberto; Scattolin, Giuliano; Stramare, Roberto; Thiene, Gaetano

    2013-09-01

    The fresco by Diego Rivera (1886 to 1957) on the history of cardiology was displayed at the "Instituto Nacional de Cardiología" of Mexico City at the time of inauguration on April 14, 1944. Some of the most important masters of the Padua Medical School were depicted, namely Vesalius, Harvey, and Morgagni. There is a vivid description of the anatomoclinical method introduced by Giovanni Battista Morgagni (1682 to 1771), when he was professor of Theoretical Medicine first and then of Anatomy at the University of Padua (1711 to 1771). By reading Morgagni's De sedibus, we found the case of aortic syphilitic aneurysm that corresponds perfectly with the one represented in Diego Rivera's mural. In the Museum of Pathological Anatomy of the Padua University, an anatomical specimen that displays the same lesion is preserved, and we have performed a computed tomography scan to analyze the state of the heart and aneurysm, thus finding diffuse calcific deposits of aorta and pericardium. In conclusion, in Diego Rivera's fresco the clinicopathologic method of Morgagni is well represented and the case of syphilitic aneurysm, reported by Morgagni in his De sedibus, depicted.

  18. 37 CFR 1.31 - Applicant may be represented by one or more patent practitioners or joint inventors.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PATENT CASES National Processing Provisions Prosecution of Application and Appointment of Attorney Or Agent § 1.31 Applicant may be represented by one or more patent practitioners or joint inventors. An... by one or more patent practitioners or joint inventors. 1.31 Section 1.31 Patents, Trademarks, and...

  19. 40 CFR 74.4 - Designated representative.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Designated representative. 74.4 Section 74.4 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) SULFUR DIOXIDE OPT-INS Background and Summary § 74.4 Designated representative. (a) The provisions of...

  20. Evaluation of a case-based urology learning program.

    PubMed

    Mishra, Kirtishri; Snow-Lisy, Devon C; Ross, Jonathan; Goldfarb, David A; Goldman, Howard; Campbell, Steven C

    2013-12-01

    To address the challenges that today's trainees encounter, such as information overload and reduced immersion in the field, and recognizing their preference for novel educational resources, an electronic case-based urology learning program was developed. Each case was designed to illustrate the basic principles of the disease process and the fundamentals of evaluation and management using the Socratic method, recapitulating a prototypical patient encounter. A 21-question survey was developed after review of published reports of classroom and clinical learning environment surveys. The target group was 2 pilot urology training programs (the Cleveland Clinic and University Hospitals-Case Medical Center). The responses were entirely anonymous. A total of 32 trainees participated (8 fellows and 24 residents), representing a 53% response rate. Most trainees (79%) were able to process cases within an average of ≤ 10 minutes. Of the trainees, 91% reported referring back to particular cases for patient care, to review for examinations, or for studying. Most trainees believed a case-based urology learning program would be a potentially important resource for clinical practice (69%) and for preparing for the in-service (63%) or board (69%) examinations. Most trainees believed the program met its goals of illustrating the basics principles of the disease process (88%), outlining the fundamentals of evaluation and management (94%), and improving the trainees' knowledge base (91%). An electronic case-based urology learning program is feasible and useful and stimulates learning at all trainee levels. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Imported malaria in Spain (2009-2016): results from the +REDIVI Collaborative Network.

    PubMed

    Norman, Francesca F; López-Polín, Ana; Salvador, Fernando; Treviño, Begoña; Calabuig, Eva; Torrús, Diego; Soriano-Arandes, Antonio; Ruíz-Giardín, Jose-Manuel; Monge-Maillo, Begoña; Pérez-Molina, Jose-Antonio; Perez-Ayala, Ana; García, Magdalena; Rodríguez, Azucena; Martínez-Serrano, María; Zubero, Miren; López-Vélez, Rogelio

    2017-10-10

    Imported malaria is a frequent diagnosis in travellers and migrants. The objective of this study was to describe the epidemiological and clinical characteristics of patients diagnosed with imported malaria within a Spanish collaborative network registering imported diseases (+REDIVI). In addition, the possible association between malaria and type of case, gender, age or area of exposure was explored. Cases of imported malaria were identified among all cases registered in the +REDIVI database during the period October 2009-October 2016. Demographic, epidemiological and clinical characteristics were analysed. In total, 11,816 cases of imported infectious diseases were registered in +REDIVI's database between October 2009 and October 2016. Immigrants seen for the first time after migration accounted for 60.2% of cases, 21.0% of patients were travellers, and 18.8% were travellers/immigrants visiting friends and relatives (VFRs). There were 850 cases of malaria (850/11,816, 7.2%). Malaria was significantly more frequent in men than in women (56.8% vs 43.2%) and in VFR-immigrants (52.6%) as compared to travellers (21.3%), immigrants (20.7%) and VFR-travellers (5.4%) (p < 0.001). Although this data was not available for most patients with malaria, only a minority (29/217, 13.4%) mentioned correct anti-malarial prophylaxis. Sub-Saharan Africa was found to be the most common region of acquisition of malaria. Most common reason for consultation after travel was a febrile syndrome although an important proportion of immigrants were asymptomatic and presented only for health screening (27.3%). Around 5% of travellers presented with severe malaria. The most prevalent species of Plasmodium diagnosed was Plasmodium falciparum (81.5%). Malaria due to Plasmodium ovale/Plasmodium vivax was frequent among travellers (17%) and nearly 5% of all malaria cases in immigrants were caused by Plasmodium malariae. Malaria was among the five most frequent diagnoses registered in +REDIVI

  2. Spirituality and religiosity in psychotherapy--a representative survey among German psychotherapists.

    PubMed

    Hofmann, Liane; Walach, Harald

    2011-03-01

    We report a survey in a near-representative sample of 895 German psychotherapists. Fifty-seven percent of the respondents referred to themselves as either spiritual or religious. Psychotherapists estimated that on average 22% of their patients bring in topics around spirituality and religion during the course of therapy. Two-thirds thought that topics around spirituality and religion should be part of the postgraduate and/or graduate curriculum. There was a clear difference between therapeutic orientations regarding how they felt about such issues, with CBT and psychodynamically oriented therapists placing less emphasis on spiritual issues and integrative and humanistic therapists more. However, differences between schools were less important than commonalities. We conclude that spirituality and religiosity are important topics for training and further research.

  3. Representing Object Colour in Language Comprehension

    ERIC Educational Resources Information Center

    Connell, Louise

    2007-01-01

    Embodied theories of cognition hold that mentally representing something "red" engages the neural subsystems that respond to environmental perception of that colour. This paper examines whether implicit perceptual information on object colour is represented during sentence comprehension even though doing so does not necessarily facilitate task…

  4. 20 CFR 725.510 - Representative payee.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Representative payee. 725.510 Section 725.510 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND... AND HEALTH ACT, AS AMENDED Payment of Benefits General Provisions § 725.510 Representative payee. (a...

  5. Imported occupational lead poisoning: report of four cases.

    PubMed

    Petracca, M; Scafa, F; Boeri, R; Flachi, Daniela; Candura, S M

    2013-01-01

    In most industrialized countries, occupational lead poisoning has become increasingly rare, however this metal remains a serious health hazard in the rest of the world. We observedfour male patients (aged 35 / 54 years) who had suffered recurrent abdominal pain due to recent lead exposure (for 7 to 13 months) in two Chinese battery recycling plants. On their return to Italy, three of them presented normocytic, normochromic anaemia. The diagnosis was confirmed by high lead levels in the blood and urine, decreased erythrocyte delta-aminolevulinic acid dehydratase (ALA-D), raised erythrocyte zinc protoporphyrin (ZP), and elevated urinary excretion of b-aminolevulinic acid (ALA-U) and porphyrins. Chelation with EDTA resulted in increased urinary lead excretion, improvement of the clinical picture, decreased ZP, and progressive normalization of the other lead biomarkers (Pb-B, ALA-D, ALA-U, urinary porphyrins). Temporary work in developing countries may result in imported lead poisoning. Differential diagnosis of this unusual condition requires careful medical history collection and specific toxicological analysis. Preventive measures for workers going abroad are needed.

  6. Dynamic spatiotemporal trends of imported dengue fever in Australia

    PubMed Central

    Huang, Xiaodong; Yakob, Laith; Devine, Gregor; Frentiu, Francesca D.; Fu, Shiu-Yun; Hu, Wenbiao

    2016-01-01

    Dengue fever (DF) epidemics in Australia are caused by infected international travellers and confined to Northern Queensland where competent vectors exist. Recent analyses suggest that global trade and climate change could lead to the re-establishment of Ae. aegypti across the country and promote the spread of dengue nationally. This study aimed to describe the dynamic spatiotemporal trends of imported DF cases and their origins, identify the current and potential future high-risk regions and locate areas that might be at particular risk of dengue transmission should competent mosquito vectors expand their range. Our results showed that the geographical distribution of imported DF cases has significantly expanded in mainland Australia over the past decade. In recent years, the geographical distribution of source countries of DF has expanded from the Pacific region and Asia to include Africa and the Americas. Australia is now exposed to dengue importations from all of the regions involved in the current global pandemic. The public health implications of a range expansion of dengue mosquito vectors are severe. Enhanced mosquito surveillance in those areas that have high imported cases is called for to reduce emerging threats from this globally expanding pathogen. PMID:27460696

  7. In search of a representative sample of residential building work.

    PubMed

    Lobb, Brenda; Woods, Gregory R

    2012-09-01

    Most research investigating injuries in construction work is limited by reliance on work samples unrepresentative of the multiple, variable-cycle tasks involved, resulting in incomplete characterisation of ergonomic exposures. In this case study, a participatory approach was used including hierarchical task analysis and site observations of a typical team of house builders in New Zealand, over several working days, to obtain a representative work sample. The builders' work consisted of 14 goal-defined jobs using varying subsets of 15 task types, each taking from less than 1 s to more than 1 h and performed in a variety of postures. Task type and duration varied within and between participants and days, although all participants spent at least 25% of the time moving from place to place, mostly carrying materials, and more than half the time either reaching up or bending down to work. This research has provided a description of residential building work based on a work sample more nearly representative than those previously published and has demonstrated a simple, low-cost but robust field observation method that can provide a valid basis for further study of hazard exposures. Copyright © 2012 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  8. Representing Animal-Others in Educational Research

    ERIC Educational Resources Information Center

    Kuhl, Gail J.

    2011-01-01

    This paper encourages environmental and humane education scholars to consider the ethical implications of how nonhuman animals are represented in research. I argue that research representations of animals can work to either break down processes of "othering," or reinforce them. I explore various options for representing other animals, including…

  9. 20 CFR 725.510 - Representative payee.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Representative payee. 725.510 Section 725.510 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH... SAFETY AND HEALTH ACT, AS AMENDED Payment of Benefits General Provisions § 725.510 Representative payee...

  10. Akinetes May Be Representative of Past Nostocalean Blooms: a Case Study of Their Benthic Spatiotemporal Distribution and Potential for Germination in a Eutrophic Lake

    PubMed Central

    Le Jeune, Anne-Hélène; Colombet, Jonathan; Thouvenot, Antoine; Latour, Delphine

    2017-01-01

    ABSTRACT Monitoring of water and surface sediment in a French eutrophic lake (Lake Aydat) was carried out over a 2-year period in order to determine whether akinetes in sediment could be representative of the most recent bloom and to estimate their germination potential. Sediment analysis revealed two akinete species, Dolichospermum macrosporum and Dolichospermum flos-aquae, present in the same proportions as observed for the pelagic populations. Moreover, similar spatial patterns observed for vegetative cells in the water column and akinete distributions in the sediment suggest that akinetes in the sediment may be representative of the previous bloom. However, the relationship between akinetes in the sediment and vegetative cells in the water column was not linear, and other factors may interfere. For example, our results highlighted horizontal transport of akinetes during the winter. The benthic overwinter phase did not seem to influence the percentages of intact akinetes, which remained stable at approximately 7% and 60% for D. macrosporum and D. flos-aquae, respectively. These percentages may thus be the result of processes that occurred in the water column. The intact overwintering akinetes showed germination rates of up to 90% after 72 h for D. flos-aquae or 144 h for D. macrosporum. The difference in akinete germination rates between these two species demonstrates different ecological strategies, which serve to expand the window for germination in time and space and thus optimize colonization of the water column by nostocalean cyanobacteria. IMPORTANCE Cyanobacteria have the ability to proliferate and to form blooms. These blooms can then affect the local ecology, health, and economy. The akinete, a resistant cell type that persists in sediment, is an important intermediate phase between previous and future blooms. We monitored the water column and the surface sediment of a French eutrophic lake (Lake Aydat) to investigate the relationship between vegetative

  11. Clinical and economic outcomes among hospitalized patients with acute coronary syndrome: an analysis of a national representative Medicare population.

    PubMed

    Chen, Shih-Yin; Crivera, Concetta; Stokes, Michael; Boulanger, Luke; Schein, Jeffrey

    2013-01-01

    To evaluate the clinical and economic burden of acute coronary syndrome (ACS), a common cardiovascular illness, in the Medicare population. Data from the Medicare Current Beneficiary Survey were analyzed. Patients with incident hospitalization for ACS without similar events during the 6 months prior were included. Outcomes evaluated included inpatient mortality, 30-day mortality and readmission, subsequent hospitalization events, and total direct health care costs. Sample population weights were applied, accounting for multistage sampling design to obtain nationally representative estimates for the US Medicare population. Between March 1, 2002 and December 31, 2006, we identified 795 incident ACS patients (mean age 76 years; 49% male) representing 2,542,211 Medicare beneficiaries. The inpatient mortality rate was 9.71% and the 30-day mortality ranged from 10.96% to 13.93%. The 30-day readmission rate for surviving patients was 18.56% for all causes and 17.90% for cardiovascular disease (CVD)-related diagnoses. The incidence of death since admission was 309 cases per 1000 person-years. Among patients discharged alive, the incidence was 197 for death, 847 for CVD-related admission, and 906 for all-cause admission. During the year when the ACS event occurred, mean annual total direct health care costs per person were US$50,458, with more than half attributable to inpatient hospitalization ($27,609). In this national representative Medicare population, we found a substantial clinical and economic burden for ACS. These findings suggest a continuing unmet medical need for more effective management of patients with ACS. The continuous burden underscores the importance of development of new interventions and/or strategies to improve long-term outcomes.

  12. The general surgery chief resident operative experience: 23 years of national ACGME case logs.

    PubMed

    Drake, Frederick Thurston; Horvath, Karen D; Goldin, Adam B; Gow, Kenneth W

    2013-09-01

    The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year. To evaluate changes in operative experience for general surgery CRs. Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories. Total cases and defined categories were evaluated for changes over time. The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P < .001). Total CR cases dropped to their lowest following implementation of the 80-hour work week (236 cases), but rebounded in period 5. The percentage of residents' 5-year operative experience performed as CRs has decreased (30% in period 1 vs 25.6% in period 5, P < .001). Regarding case mix: thoracic, trauma, and vascular cases declined steadily, while alimentary and intra-abdominal operations increased. Recent graduates averaged 80 alimentary and 78 intra-abdominal procedures during their CR years. Compared with period 1, in which these 2 categories represented 47.1% of CR experience, in period 5, they represented 65.2% (P < .001). Endocrine experience has been relatively unchanged. Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief

  13. 25 CFR 1000.359 - What are the responsibilities of the Secretary's designated representative(s) after the annual...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... designated representative(s) after the annual trust evaluation? 1000.359 Section 1000.359 Indians OFFICE OF... THE TRIBAL SELF-GOVERNMENT ACT AMENDMENTS TO THE INDIAN SELF-DETERMINATION AND EDUCATION ACT Trust Evaluation Review Annual Trust Evaluations § 1000.359 What are the responsibilities of the Secretary's...

  14. Small-intestine pneumocystis jiroveci pseudotumor as an acquired immunodeficiency syndrome-presenting illness: report of a case and review of the literature.

    PubMed

    Zhou, Yi; Shetty, Jayarama; Pins, Michael R

    2012-09-01

    A Pneumocystis jiroveci infection-associated mass clinically mimicking a malignancy (ie, pseudotumor) is rare and usually occurs in the lung in association with Pneumocystis pneumonia. Pneumocystis jiroveci pseudotumors of the small intestine are extremely rare and represent an unusual form of disseminated P jiroveci infection. We present a case of small-intestine P jiroveci pseudotumor as an acquired immunodeficiency syndrome-presenting illness in a patient with coinfection with cytomegalovirus, no pulmonary symptoms, and no known risk factors for human immunodeficiency virus infection. This case reinforces the potential importance of cytomegalovirus coinfection in the disseminated form of Pneumocystis infection and illustrates the importance of an expanded differential diagnosis when confronted with a clinically atypical mass lesion.

  15. [A case of coccidioidomycosis in Turkey imported from the United States of America].

    PubMed

    Başaran, Seniha; Karabıçak, Nilgün; Şimşek Yavuz, Serap; Wiederhold, Nathan P; Şafak, Seda; Sarıbuğa, Aysun; Sutton, Deanna A; Bingöl, Züleyha; Çağatay, Atahan; Özsüt, Halit; Kılıçaslan, Zeki; Eraksoy, Haluk

    2017-04-01

    Coccidioidomycosis caused by Coccidioides immitis or Coccidioides posadasii is a rare infectious disease except in endemic regions. In this report the third documented imported case of coccidioidomycosis in Turkey was presented. A thirty-year-old male patient was admitted to our hospital with fever and purulent drainage from his chest tube. He had worked in Arizona, USA, until 4 months before this presentation. While in Arizona, he experienced cough and hemoptysis and was diagnosed as pulmonary coccidioidomycosis. He was treated with itraconazole for two months and he had no symptoms for 3 years. He then returned to Turkey and 2 months after his return to Turkey, he was admitted to another hospital in Istanbul with dyspnea and diagnosed as hydro-pneumothorax, and pleural fluid obtained from the inserted chest tube was found to be purulent. One gram of BID amoxicillin-clavulanate was given. Physical examination on admission revealed a purulent drainage on the right side chest tube, a temperature of 38.5°C and decreased breath sounds on the right lung. Piperacillin-tazobactam 3 x 4.5 g intravenous and fluconazole 400 mg intravenous once daily were started. Human immunodeficiency virus test was negative. Gram-negative diplococci and rods, gram-positive cocci and septate hyphae were seen in the Gram stain of his pleural fluid. Pleural fluid culture revealed Moraxella catarrhalis after 24 hours incubation and a mold after 72 hours of incubation. Anti-coccidioidal antibodies were found positive in a titer of 1/2. Hydro-pneumothorax, atelectasis and a 3 mm nodules in the right lung were seen in his thorax CT. The patient's pleural fluid and the culture plates were sent to the Public Health Institute of Turkey, Mycology Reference Laboratory (PHIT-MRL), with a clinical suspicion of coccidioidomycosis. The specimen and plates were submitted to the PHIT-MRL Bio Safety Level-3 laboratory for mycological evaluation. The microscopic examination of 15% KOH preparations of

  16. Aircraft Certification Service Representatives of the Administrator - General

    DOT National Transportation Integrated Search

    1991-09-26

    This order consolidates expired action notices (AN) and notices (N) concerning Designated Manufacturing : Inspection Representatives (DMIR), Designated Airworthiness Representatives (DAR), and Organizational Designated : Airworthiness Representatives...

  17. Warfarin monitoring in nursing homes assessed by case histories. Do recommendations and electronic alerts affect judgements?

    PubMed

    Teruel, Reyes Serrano; Thue, Geir; Fylkesnes, Svein Ivar; Sandberg, Sverre; Kristoffersen, Ann Helen

    2017-09-01

    Older adults treated with warfarin are prone to complications, and high-quality monitoring is essential. The aim of this case history based study was to assess the quality of warfarin monitoring in a routine situation, and in a situation with an antibiotic-warfarin interaction, before and after receiving an electronic alert. In April 2014, a national web-based survey with two case histories was distributed among Norwegian nursing home physicians and general practitioners working part-time in nursing homes. Case A represented a patient on stable warfarin treatment, but with a substantial INR increase within the therapeutic interval. Case B represented a more challenging patient with trimethoprim sulfamethoxazole (TMS) treatment due to pyelonephritis. In both cases, the physicians were asked to state the next warfarin dose and the INR recall interval. In case B, the physicians could change their suggestions after receiving an electronic alert on the TMS-warfarin interaction. Three hundred and ninety eight physicians in 292 nursing homes responded. Suggested INR recall intervals and warfarin doses varied substantially in both cases. In case A, 61% gave acceptable answers according to published recommendations, while only 9% did so for case B. Regarding the TMS-warfarin interaction in case history B, the electronic alert increased the percentage of respondents correctly suggesting a dose reduction from 29% to 53%. Having an INR instrument in the nursing home was associated with shortened INR recall times. Practical advice on handling of warfarin treatment and drug interactions is needed. Electronic alerts as presented in electronic medical records seem insufficient to change practice. Availability of INR instruments may be important regarding recall time.

  18. Dehydrogenase GRD1 Represents a Novel Component of the Cellulase Regulon in Trichoderma reesei (Hypocrea jecorina) ▿ † §

    PubMed Central

    Schuster, André; Kubicek, Christian P.; Schmoll, Monika

    2011-01-01

    Trichoderma reesei (Hypocrea jecorina) is nowadays the most important industrial producer of cellulase and hemicellulase enzymes, which are used for pretreatment of cellulosic biomass for biofuel production. In this study, we introduce a novel component, GRD1 (glucose-ribitol dehydrogenase 1), which shows enzymatic activity on cellobiose and positively influences cellulase gene transcription, expression, and extracellular endo-1,4-β-d-glucanase activity. grd1 is differentially transcribed upon growth on cellulose and the induction of cellulase gene expression by sophorose. The transcription of grd1 is coregulated with that of cel7a (cbh1) under inducing conditions. GRD1 is further involved in carbon source utilization on several carbon sources, such as those involved in lactose and d-galactose catabolism, in several cases in a light-dependent manner. We conclude that GRD1 represents a novel enhancer of cellulase gene expression, which by coregulation with the major cellulase may act via optimization of inducing mechanisms. PMID:21602376

  19. Imported Malaria in Turkey: The Importance of Diagnosis and Treatment of Plasmodium falciparum/Plasmodium vivax Mixed Infection.

    PubMed

    Tünger, Özlem; Çakmak, Akide; Özbilgin, Ahmet; Tunalı, Varol; Çetin, Çiğdem Banu

    2018-05-21

    The most common types of malaria in the world are Plasmodium vivax and P. falciparum. In countries where both species are endemic, P. vivax and P. falciparum coinfection also occurs. Thus, the possibility of mixed malaria in Turkey should always be considered in cases with a traveling history to these countries. Here, we report a case of P. vivax/P. falciparum mixed infection that was diagnosed as P. falciparum malaria in Ethiopia. However, the administered treatment was inadequate, and infection recurred because of the miss in the diagnosis of P. vivax malaria, for which an effective drug for hypnozoites was not administered. This case report emphasizes the importance of diagnosis, correct and adequate treatment of infections, and a close follow-up of diseases.

  20. Fungal endophyte assemblages from ethnopharmaceutically important medicinal trees.

    PubMed

    Tejesvi, Mysore V; Mahesh, Basavanna; Nalini, Monnanda S; Prakash, Harishchandra S; Kini, Kukkundoor R; Subbiah, Ven; Shetty, Hunthrike S

    2006-05-01

    Endophytic fungi represent an interesting group of microorganisms associated with the healthy tissues of terrestrial plants. They represent a large reservoir of genetic diversity. Fungal endophytes were isolated from the inner bark segments of ethnopharmaceutically important medicinal tree species, namely Terminalia arjuna, Crataeva magna, Azadirachta indica, Holarrhena antidysenterica, Terminalia chebula, and Butea monosperma (11 individual trees), growing in different regions of southern India. Forty-eight fungal species were recovered from 2200 bark segments. Mitosporic fungi represented a major group (61%), with ascomycetes (21%) and sterile mycelia (18%) the next major groups. Species of Fusarium, Pestalotiopsis, Myrothecium, Trichoderma, Verticillium, and Chaetomium were frequently isolated. Exclusive fungal taxa were recovered from five of the six plant species considered for the study of endophytic fungi. Rarefaction indices for species richness indicated the highest expected number of species for bark segments were isolated from T. arjuna and A. indica (20 species each) and from C. magna (18 species).

  1. [Imported dengue: an emerging arbovirosis in Spain].

    PubMed

    Ramos Geldres, T T; García López-Hortelano, M; Baquero-Artigao, F; Montero Vega, D; López Quintana, B; Mellado Peña, M J

    2015-01-01

    Dengue is caused by one of 4 serotypes of dengue virus. Only imported cases have been reported in Spain. The main clinical findings are fever and exanthema, although there may be severe forms, particularly in secondary infections. Five children with a primary, non severe dengue infection are presented. The diagnosis was based on clinical suspicion and epidemiological history, and confirmed by immunochromatography and ELISA tests. The outcome was favourable in all cases. It is important to consider this diagnosis in international travellers that present with fever within the 14 days of returning from an endemic area, in order to get an early diagnosis, adequate treatment and a good prognosis. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  2. Picturing and modelling catchments by representative hillslopes

    NASA Astrophysics Data System (ADS)

    Loritz, Ralf; Hassler, Sibylle; Jackisch, Conrad; Zehe, Erwin

    2016-04-01

    Hydrological modelling studies often start with a qualitative sketch of the hydrological processes of a catchment. These so-called perceptual models are often pictured as hillslopes and are generalizations displaying only the dominant and relevant processes of a catchment or hillslope. The problem with these models is that they are prone to become too much predetermined by the designer's background and experience. Moreover it is difficult to know if that picture is correct and contains enough complexity to represent the system under study. Nevertheless, because of their qualitative form, perceptual models are easy to understand and can be an excellent tool for multidisciplinary exchange between researchers with different backgrounds, helping to identify the dominant structures and processes in a catchment. In our study we explore whether a perceptual model built upon an intensive field campaign may serve as a blueprint for setting up representative hillslopes in a hydrological model to reproduce the functioning of two distinctly different catchments. We use a physically-based 2D hillslope model which has proven capable to be driven by measured soil-hydrological parameters. A key asset of our approach is that the model structure itself remains a picture of the perceptual model, which is benchmarked against a) geo-physical images of the subsurface and b) observed dynamics of discharge, distributed state variables and fluxes (soil moisture, matric potential and sap flow). Within this approach we are able to set up two behavioral model structures which allow the simulation of the most important hydrological fluxes and state variables in good accordance with available observations within the 19.4 km2 large Colpach catchment and the 4.5 km2 large Wollefsbach catchment in Luxembourg without the necessity of calibration. This corroborates, contrary to the widespread opinion, that a) lower mesoscale catchments may be modelled by representative hillslopes and b) physically

  3. How well do Reanalysis represent polar lows?

    NASA Astrophysics Data System (ADS)

    Zappa, G.; Shaffrey, L.; Hodges, K.

    2013-12-01

    Polar lows are intense maritime mesocyclones forming at high latitudes during polar air outbreaks. The associated high surface winds can be an important cause of coastal damage.They also seem to play a relevant role in the climate system by modulating the oceanic surface heat fluxes. This creates strong interest in understanding whether modern reanalysis datasets are able to represent polar lows, as well as how their representation may be sensitive to the model resolution. In this talk we investigate how ERA-Interim reanalysis represents the polar lows identified by the Norwegian meteorological services and listed in the STARS (Combination of Sea Surface Temperature and AltimeteR Synergy) dataset for the period 2002-2011. The sensitivity to resolution is explored by comparing ERA-Interim to the ECMWF operational analyses (2008-2011), which have three times higher horizontal resolution compared to ERA-Interim. We show that ERAI-Interim has excellent ability to capture the observed polar lows events with up to 90% of the observed events being found in the reanalysis. However, ERA-Interim tends to have polar lows of weaker dynamical intensity, in terms of both winds and vorticity, and with less spatial structure than in the ECMWF operational analyses (See Fig 1). Furthermore, we apply an objective feature tracking algorithm to the 3 hourly vorticity at 850 hPa with constraints on vorticity intensity and atmospheric static stability to objectively identify polar lows in the ERA-Interim reanalysis. We show that for the stronger polar lows the objective climatology shows good agreement with the STARS dataset over the 2002-2011 period. This allows us to extend the polar lows climatology over the whole ERA Interim period. Differences with another reanalysis product (NCEP-CFSR) will be also discussed. Fig 1: Composite of the tangential wind speed at 925 hPa for 34 polar lows observed in the Norwegian sea between 2008-2010 as represented by the ERA-Interim reanalysis (left

  4. Practical guidance on representing the heteroscedasticity of residual errors of hydrological predictions

    NASA Astrophysics Data System (ADS)

    McInerney, David; Thyer, Mark; Kavetski, Dmitri; Kuczera, George

    2016-04-01

    Appropriate representation of residual errors in hydrological modelling is essential for accurate and reliable probabilistic streamflow predictions. In particular, residual errors of hydrological predictions are often heteroscedastic, with large errors associated with high runoff events. Although multiple approaches exist for representing this heteroscedasticity, few if any studies have undertaken a comprehensive evaluation and comparison of these approaches. This study fills this research gap by evaluating a range of approaches for representing heteroscedasticity in residual errors. These approaches include the 'direct' weighted least squares approach and 'transformational' approaches, such as logarithmic, Box-Cox (with and without fitting the transformation parameter), logsinh and the inverse transformation. The study reports (1) theoretical comparison of heteroscedasticity approaches, (2) empirical evaluation of heteroscedasticity approaches using a range of multiple catchments / hydrological models / performance metrics and (3) interpretation of empirical results using theory to provide practical guidance on the selection of heteroscedasticity approaches. Importantly, for hydrological practitioners, the results will simplify the choice of approaches to represent heteroscedasticity. This will enhance their ability to provide hydrological probabilistic predictions with the best reliability and precision for different catchment types (e.g. high/low degree of ephemerality).

  5. The Importance of Identity in Policy: The Case for and of Children

    ERIC Educational Resources Information Center

    McDonald, Catherine

    2009-01-01

    This article draws out one of the core reasons why children should be conceived as active agents in research, particularly policy-related research. The main thesis is that policy inevitably projects and, to an extent, constitutes the subject identities of its intended objects--in this case, that of "children". Drawing on several bodies of…

  6. [Analysis of overseas imported malaria situation and implication for control in Jiangsu Province, PR China].

    PubMed

    Liu, Yao-Bao; Cao, Jun; Zhou, Hua-Yun; Wang, Wei-Ming; Cao, Yuan-Yuan; Gao, Qi

    2013-02-01

    To analyze the epidemiological characteristics of overseas imported malaria in Jiangsu Province and explore the strategies and priorities in prevention and control, so as to provide the evidence for improving the diagnosis, treatment and management of imported malaria. The data of overseas imported malaria as well as the case epidemiological investigation in Jiangsu Province from July 18, 2011 to June 30, 2012 were collected and analyzed descriptively for the species composition, original countries, population distribution, regional distribution, onset time, diagnosis and treatment, channels to go abroad, and counterparts returned together with the patients. A total of 233 overseas imported malaria cases were reported, and 226 cases (97.0%) were imported from African countries. A total of 208 cases (89.3%) were falciparum malaria, and 224 cases (96.1%) were laboratory-confirmed. The imported malaria cases were young adults who were mainly migrant farmer and skilled male workers. There was no significant seasonal variation for onset time. Totally 145 cases (62.2%) got malaria onset in 20 days after returning home. The median time from onset to seeing doctor was two days and the median time from seeing doctor to being diagnosed was one day. The first visit health facilities by the patients were relatively scattered and the diagnostic health facilities were mainly medical institutions and CDC at the county level and above (220 cases, accounting for 94.4%). The ratio of standard treatment after malaria diagnosis was 100%. A total of 205 cases (88.0%) were workers dispatched to abroad as labor export by the company, and 142 cases (60.9%) cases had counterparts returned together. The situation of overseas imported malaria in Jiangsu Province is severe. It is necessary to further strengthen the professional training and multi-sectoral cooperation, establish the collaborative investigation mechanism for high-risk groups, and take effective prevention and control measures

  7. Two- and Three-Dimensional Numerical Experiments Representing Two Limiting Cases of an In-Line Pair of Finger Seal Components

    NASA Technical Reports Server (NTRS)

    Braun, M. J.; Steinetz, B. M.; Kudriavtsev, V. V.; Proctor, M. P.; Kiraly, L. James (Technical Monitor)

    2002-01-01

    The work presented here concerns the numerical development and simulation of the flow, pressure patterns and motion of a pair of fingers arranged behind each other and axially aligned in-line. The fingers represent the basic elemental component of a Finger Seal (FS) and form a tight seal around the rotor. Yet their flexibility allows compliance with rotor motion and in a passive-adaptive mode complies also with the hydrodynamic forces induced by the flowing fluid. While the paper does not treat the actual staggered configuration of a finger seal, the inline arrangement represents a first step towards that final goal. The numerical 2-D (axial-radial) and 3-D results presented herein were obtained using a commercial package (CFD-ACE+). Both models use an integrated numerical approach, which couples the hydrodynamic fluid model (Navier-Stokes based) to the solid mechanics code that models the compliance of the fingers.

  8. Mentoring: A Representative Bibliography.

    ERIC Educational Resources Information Center

    Norton, Cheryl S.

    This annotated bibliography provides a representative sample of the available literature on mentoring. It reviews both qualitative and quantitative research, and covers specific mentoring programs, program implementation, and testimonials to the benefits of mentoring. Materials covered include 40 journal articles, conference papers, books, and…

  9. A Proposed Model for Assessing Defendant Competence to Self-Represent.

    PubMed

    White, Mitzi M S; Gutheil, Thomas G

    2016-12-01

    The increasing number of criminal defendants who are choosing to self-represent poses special challenges for legal systems with regard to the types of limits that should be placed on a defendant's basic human right to defend himself without the assistance of counsel. While courts strive to respect the dignity and autonomy of the defendant that are encompassed in this right, they also want to ensure that justice is delivered and the dignity of the courtroom is maintained. The Supreme Court of the United States, in its opinion in Indiana v. Edwards (2008), held that while the right to self-represent recognized in Faretta v. California (1975) remains, states and trial judges can place limits on a defendant's right to self-representation when a defendant lacks the mental capacities needed to prepare and conduct an adequate defense. Following the court's lead, we first examine the types and range of tasks that a defendant who chooses to self-represent must perform. Based on this analysis, we propose a five-part model that forensic practitioners can use as a conceptual framework for assessing whether a defendant has deficits that would affect his competence to perform critical self-representation tasks. The five areas that the model recommends practitioners assess are whether a defendant can engage in goal-directed behaviors, has sufficient communication skills, can engage in constructive social intercourse, can control his emotions in an adversarial arena, and has the cognitive abilities needed to argue his case adequately. It is recommended that practitioners use the model in their testimony to provide the trier of fact with a comprehensive report of the areas in which a defendant has deficits that will prevent him from protecting his interests in receiving a fair and equitable trial. © 2016 American Academy of Psychiatry and the Law.

  10. Morphologic variations of maxillary molars palatal root and the importance of its knowledge for endodontic practice: a case series.

    PubMed

    Scarparo, Roberta Kochenborger; Pereira, Leticia; Moro, Diana; Grundling, Grasiela; Gomes, Maximiliano; Grecca, Fabiana Soares

    2011-03-01

    The present report describes and discusses root canal variations in the internal morphology of maxillary molars. Dental internal anatomy is directly related to all the technical stages of the endodontic treatment. Even though, in some situations a typical anatomical characteristics can be faced, and the professional should be able to identify them. This clinical report describes five cases with different pulpar and periapical diagnostics where the endodontic treatment was performed, in which during the treatment the unusual occurrence of two or three canals in the palatal root 'or even two distinct palatal roots' of first and second maxillary molars, were described and important details for achieving treatment success were discussed. The knowledge of tooth internal anatomy must be considered during clinical and radiographic examinations. This should be valued not only to find atypical canals but also to enable calcified canals cleaning and shaping, once they are frequently omitted during endodontic therapy. Anatomic variations can occur in any tooth, and palatal roots of maxillary first and second molars are no exception. The complexity of the root canal system and the importance of identifying its internal anatomy for planning endodontic treatment increase the chances of success.

  11. Subthreshold and threshold DSM-IV generalized anxiety disorder in Singapore: Results from a nationally representative sample.

    PubMed

    Lee, Siau Pheng; Sagayadevan, Vathsala; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2015-05-01

    Previous nationally representative studies have reported prevalence of DSM-IV generalized anxiety disorder (GAD). However, subthreshold and threshold GAD expressions remain poorly understood. The current study examined the prevalence, correlates and co-morbidity of a broader diagnosis of GAD in Singapore. The Singapore Mental Health Study (SMHS) was an epidemiological survey conducted in the population (N=6616) aged 18 years and older. The Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to establish mental disorder diagnoses. The lifetime prevalence for subthreshold GAD (2.1%) and threshold GAD (1.5%) in the current sample was found to be lower than in Western populations. Younger age group, Indian ethnicity, previously married, chronic physical conditions, and being unemployed were associated with higher odds of having more severe expression of generalized anxiety. The relatively lower prevalence rate of subthreshold GAD expression suggests possible cultural interferences in the reporting and manifestation of anxiety symptomatology. Despite the low prevalence, significant impacts on functioning and comorbidity among subthreshold generalized anxiety cases indicate the importance of early treatment to ensure a better prognosis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Importance of anthropogenic climate impact, sampling error and urban development in sewer system design.

    PubMed

    Egger, C; Maurer, M

    2015-04-15

    Urban drainage design relying on observed precipitation series neglects the uncertainties associated with current and indeed future climate variability. Urban drainage design is further affected by the large stochastic variability of precipitation extremes and sampling errors arising from the short observation periods of extreme precipitation. Stochastic downscaling addresses anthropogenic climate impact by allowing relevant precipitation characteristics to be derived from local observations and an ensemble of climate models. This multi-climate model approach seeks to reflect the uncertainties in the data due to structural errors of the climate models. An ensemble of outcomes from stochastic downscaling allows for addressing the sampling uncertainty. These uncertainties are clearly reflected in the precipitation-runoff predictions of three urban drainage systems. They were mostly due to the sampling uncertainty. The contribution of climate model uncertainty was found to be of minor importance. Under the applied greenhouse gas emission scenario (A1B) and within the period 2036-2065, the potential for urban flooding in our Swiss case study is slightly reduced on average compared to the reference period 1981-2010. Scenario planning was applied to consider urban development associated with future socio-economic factors affecting urban drainage. The impact of scenario uncertainty was to a large extent found to be case-specific, thus emphasizing the need for scenario planning in every individual case. The results represent a valuable basis for discussions of new drainage design standards aiming specifically to include considerations of uncertainty. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. 29 CFR 1960.27 - Representatives of officials in charge and representatives of employees.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... attention of the Safety and Health Inspector any unsafe or unhealthful working condition which the employee... knowledge of any existing or potential unsafe or unhealthful working conditions. The representative of... SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) BASIC PROGRAM ELEMENTS FOR FEDERAL...

  14. Non-anastomotic strictures after transplanting a liver graft with an accidentally ligated and unflushed common bile duct: A case report.

    PubMed

    Meurisse, Nicolas; Pirenne, Jacques; Monbaliu, Diethard

    2017-01-01

    Non-anastomotic biliary strictures (NAS) represent a major cause of morbidity, graft loss, and mortality after liver transplantation (LTx). NAS can result from an ischemic/immune-mediated injury, or from the cytotoxic effect that bile salts have on the biliary mucosa under hypothermic conditions. For this reason it is crucial to flush the bile duct at the time of procurement. We report a case of an imported liver with an accidentally ligated and subsequently completely unflushed common bile duct. The recipient was a 60 year-old man suffering from hepatocellular carcinoma and post-alcoholic cirrhosis. Post-operative course was uneventful and the patient was discharged after 18days. Within 2 months post-transplantation, a rapidly evolving cholestasis was diagnosed. Endoscopic-retrograde-cholangio-pancreaticography revealed diffuse NAS. Due to the rapid clinical and biochemical deterioration there was no other option than re-transplantation. Suboptimally flushed bile ducts are often encountered and represent a risk factor for NAS after LTx. This unique case represented an extreme form where the biliary tree was not flushed at all. The dilemma of this unforeseen situation raised the question to transplant or discard this liver for transplantation? Given the organ shortage, the pressure to use less-than-ideal organs, the otherwise normal aspect of the liver and our incapacity to predict with certainty the development (or not) of NAS, we accepted this liver for transplantation. This case illustrates a contrario the importance of flushing the bile duct and risk of extensive dissection of the hepatic hilum at the time of procurement. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  15. A near miss: the importance of context in a public health informatics project in a New Zealand case study.

    PubMed

    Wells, Stewart; Bullen, Chris

    2008-01-01

    This article describes the near failure of an information technology (IT) system designed to support a government-funded, primary care-based hepatitis B screening program in New Zealand. Qualitative methods were used to collect data and construct an explanatory model. Multiple incorrect assumptions were made about participants, primary care workflows and IT capacity, software vendor user knowledge, and the health IT infrastructure. Political factors delayed system development and it was implemented untested, almost failing. An intensive rescue strategy included system modifications, relaxation of data validity rules, close engagement with software vendors, and provision of intensive on-site user support. This case study demonstrates that consideration of the social, political, technological, and health care contexts is important for successful implementation of public health informatics projects.

  16. [Listeriosis in Mexico: Clinical and epidemiological importance].

    PubMed

    Castañeda-Ruelas, Gloria; Eslava-Campos, Carlos; Castro-Del Campo, Nohelia; León-Félix, Josefina; Chaidez-Quiroz, Cristóbal

    2014-01-01

    Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there's a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

  17. Educational Game Development Approach to a particular case: the donor's evaluation.

    PubMed

    Borro Escribano, B; del Blanco, A; Torrente, J; Borro Mate, J M; Fernandez Manjon, B

    2015-01-01

    Serious games are a current trend nowadays. Almost every sector has used serious games in recent years for different educational purposes. The eLearning research team of the Complutense University of Madrid main focus of research is the development of low-cost serious games. During the past 10 years, we have been working with and developing serious games, paying special attention to those related to healthcare. From all these studies, a methodology was defined-the Educational Game Development Approach (EGDA)-to design, develop, and evaluate game-like simulations or serious games in healthcare. We present the application of the EGDA to a particular case, the development of a serious game representing the donor's evaluation in an intensive care unit from the point of view of a hospital coordinator following the EGDA methodology. In this simulation, we changed the strategy of selection of teaching cases by exponentially increasing the number of teaching cases. This kind of educational content provides several benefits to students as they learn while playing; they receive immediate feedback of mistakes and correct moves and an objective assessment. These simulations allow the students to practice in a risk-free environment. Moreover, the addition of game elements increases engagement and promotes the retention of important information. A game-like simulation has been developed through the use of this methodology. This simulation represents a complex medical procedure. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Reference materials and representative test materials to develop nanoparticle characterization methods: the NanoChOp project case

    NASA Astrophysics Data System (ADS)

    Roebben, Gert; Kestens, Vikram; Varga, Zoltan; Charoud-Got, Jean; Ramaye, Yannic; Gollwitzer, Christian; Bartczak, Dorota; Geißler, Daniel; Noble, James; Mazoua, Stéphane; Meeus, Nele; Corbisier, Philippe; Palmai, Marcell; Mihály, Judith; Krumrey, Michael; Davies, Julie; Resch-Genger, Ute; Kumarswami, Neelam; Minelli, Caterina; Sikora, Aneta; Goenaga-Infante, Heidi

    2015-10-01

    This paper describes the production and characteristics of the nanoparticle test materials prepared for common use in the collaborative research project NanoChOp (Chemical and optical characterisation of nanomaterials in biological systems), in casu suspensions of silica nanoparticles and CdSe/CdS/ZnS quantum dots. This paper is the first to illustrate how to assess whether nanoparticle test materials meet the requirements of a 'reference material' (ISO Guide 30:2015) or rather those of the recently defined category of 'representative test material' (ISO TS 16195:2013). The NanoChOp test materials were investigated with small-angle X-ray scattering (SAXS), dynamic light scattering (DLS) and centrifugal liquid sedimentation (CLS) to establish whether they complied with the required monomodal particle size distribution. The presence of impurities, aggregates, agglomerates and viable microorganisms in the suspensions was investigated with DLS, CLS, optical and electron microscopy and via plating on nutrient agar. Suitability of surface functionalization was investigated with attenuated total reflection Fourier transform infrared spectrometry (ATR-FTIR) and via the capacity of the nanoparticles to be fluorescently labeled or to bind antibodies. Between-unit homogeneity and stability were investigated in terms of particle size and zeta potential. This paper shows that only based on the outcome of a detailed characterization process one can raise the status of a test material to representative test material or reference material, and how this status depends on its intended use.

  19. The importance of pheochromocytoma case detection in patients with neurofibromatosis type 1: A case report and review of literature.

    PubMed

    Tate, Joshua M; Gyorffy, Janelle B; Colburn, Jeffrey A

    2017-01-01

    Neurofibromatosis type 1 is a complex, multi-system genetic disorder that is associated with an increased prevalence of pheochromocytoma and paraganglioma compared to the general population, 1.0%-5.7% versus 0.2%-0.6%, respectively. A delay in pheochromocytoma and paraganglioma diagnosis or undiagnosed pheochromocytoma and paraganglioma, as seen in normotensive and asymptomatic patients, may portend a significant morbidity and mortality risk due to excess catecholamine secretion. Currently, there are no generally accepted guidelines of screening for pheochromocytoma and paragangliomas in asymptomatic individuals of this population with approaches and practices varying considerably between physicians. Emerging data suggest benefit in routine pheochromocytoma and paraganglioma screening of all individuals with neurofibromatosis type 1. Herein, we present a case to highlight how routine case detection screening would have identified pheochromocytoma earlier in an active duty military member.

  20. Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder.

    PubMed

    Schiepek, Günter K; Stöger-Schmidinger, Barbara; Aichhorn, Wolfgang; Schöller, Helmut; Aas, Benjamin

    2016-01-01

    Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder. Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions. Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy. Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and

  1. Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases.

    PubMed

    Suárez-García, Inés; Jarrín, Inmaculada; Iribarren, José Antonio; López-Cortés, Luis Fernando; Lacruz-Rodrigo, José; Masiá, Mar; Gómez-Sirvent, Juan Luis; Hernández-Quero, José; Vidal, Francesc; Alejos-Ferreras, Belén; Moreno, Santiago; Del Amo, Julia

    2013-05-01

    The aim of this study was to investigate the incidence and risk factors for the development of AIDS-defining cancers (ADCs); and to investigate the effect of making different assumptions on the definition of incident cases. A multicentre cohort study was designed. Poisson regression was used to assess incidence and risk factors. To account for misclassification, incident cases were defined using lag-times of 0, 14 and 30 days after enrolment. A total of 6393 HIV-positive subjects were included in the study. The incidences of ADCs changed as the lag periods were varied from 0 to 30 days. Different risk factors emerged as the definition of incident cases was changed. For a lag time of 0, the risk of Kaposi sarcoma [KS] and non-Hodgkin lymphoma [NHL] increased at CD4 counts <200/ml. HAART was associated with lower risk of NHL and KS. Men who had sex with men had a higher risk of KS. KS and NHL were not associated with viral load, gender, or hepatitis B or C. The results were similar for a lag-time of 14 and 30 days; however, hepatitis C was significantly associated with NHL. This analysis shows the importance of the definition of incident cases in cohort studies. Alternative definitions gave different incidence estimates, and may have implications for the analysis of risk factors. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  2. Flow motifs reveal limitations of the static framework to represent human interactions

    NASA Astrophysics Data System (ADS)

    Rocha, Luis E. C.; Blondel, Vincent D.

    2013-04-01

    Networks are commonly used to define underlying interaction structures where infections, information, or other quantities may spread. Although the standard approach has been to aggregate all links into a static structure, some studies have shown that the time order in which the links are established may alter the dynamics of spreading. In this paper, we study the impact of the time ordering in the limits of flow on various empirical temporal networks. By using a random walk dynamics, we estimate the flow on links and convert the original undirected network (temporal and static) into a directed flow network. We then introduce the concept of flow motifs and quantify the divergence in the representativity of motifs when using the temporal and static frameworks. We find that the regularity of contacts and persistence of vertices (common in email communication and face-to-face interactions) result on little differences in the limits of flow for both frameworks. On the other hand, in the case of communication within a dating site and of a sexual network, the flow between vertices changes significantly in the temporal framework such that the static approximation poorly represents the structure of contacts. We have also observed that cliques with 3 and 4 vertices containing only low-flow links are more represented than the same cliques with all high-flow links. The representativity of these low-flow cliques is higher in the temporal framework. Our results suggest that the flow between vertices connected in cliques depend on the topological context in which they are placed and in the time sequence in which the links are established. The structure of the clique alone does not completely characterize the potential of flow between the vertices.

  3. Lifestyles through Expenditures: A Case-Based Approach to Saving

    PubMed Central

    Keister, Lisa A.; Benton, Richard; Moody, James

    2016-01-01

    Treating people as cases that are proximate in a behavior space—representing lifestyles—rather than as markers of single variables has a long history in sociology. Yet, because it is difficult to find analytically tractable ways to implement this idea, this approach is rarely used. We take seriously the idea that people are whole packages, and we use household spending to identify groups who occupy similar positions in social space. Using detailed data on household consumption, we identify eight positions that are clearly similar in lifestyle. We then study how the lifestyles we identify are associated with saving, an important measure of household well-being. We find that households cluster into distinct lifestyles based on similarities and differences in consumption. These lifestyles are meaningfully related in social space and save in distinct ways that have important implications for understanding inequality and stratification. PMID:27904877

  4. THE IMPORTANCE OF INSTRUMENT MAKERS FOR THE DEVELOPMENT OF EXPERIMENTAL PSYCHOLOGY: THE CASE OF ALFRED BINET AT THE SORBONNE LABORATORY.

    PubMed

    Nicolas, Serge

    2016-07-01

    The importance of instrument firms in the development of psychology, and science in general, should not be underestimated since it would not have been possible for various leading psychologists at the turn of the twentieth century to conduct certain experiments without the assistance of instrument makers, as is often the case today. To illustrate the historical perspective introduced here, the example of Alfred Binet is taken, as he is an interesting case of a psychologist working in close collaboration with various French instrument designers of the time. The objective of this article is twofold: (1) to show the considerable activity carried out by early psychologists to finalize new laboratory instruments in order to develop their research projects; (2) to reassess the work of a major figure in French psychology through his activity as a designer of precision instruments. The development of these new instruments would certainly have been difficult without the presence in Paris of numerous precision instrument manufacturers such as Charles Verdin, Otto Lund, Henri Collin, and Lucien Korsten, on whom Binet successively called in order to develop his projects in the field of experimental psychology. © 2016 Wiley Periodicals, Inc.

  5. Can Geostatistical Models Represent Nature's Variability? An Analysis Using Flume Experiments

    NASA Astrophysics Data System (ADS)

    Scheidt, C.; Fernandes, A. M.; Paola, C.; Caers, J.

    2015-12-01

    process information. They fall into three basic patterns: a channelized end member, a sheet flow end member, and one intermediate case. These represent the continuum between autogenic bypass or erosion, and net deposition.

  6. The importance of improving the quality of emergency surgery for a regional quality collaborative.

    PubMed

    Smith, Margaret; Hussain, Adnan; Xiao, Jane; Scheidler, William; Reddy, Haritha; Olugbade, Kola; Cummings, Dustin; Terjimanian, Michael; Krapohl, Greta; Waits, Seth A; Campbell, Darrell; Englesbe, Michael J

    2013-04-01

    Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a

  7. Potential Genetic Risk Factors for Chronic TMD: Genetic Associations from the OPPERA Case Control Study

    PubMed Central

    Smith, Shad B.; Maixner, Dylan; Greenspan, Joel; Dubner, Ron; Fillingim, Roger; Ohrbach, Richard; Knott, Charles; Slade, Gary; Bair, Eric; Gibson, Dustin G.; Zaykin, Dmitri V.; Weir, Bruce; Maixner, William; Diatchenko, Luda

    2011-01-01

    Genetic factors play a role in the etiology of persistent pain conditions, putatively by modulating underlying processes such as nociceptive sensitivity, psychological well-being, inflammation, and autonomic response. However, to date, only a few genes have been associated with temporomandibular disorders (TMD). This study evaluated 358 genes involved in pain processes, comparing allelic frequencies between 166 cases with chronic TMD and 1442 controls enrolled in the OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment) study cooperative agreement. To enhance statistical power, 182 TMD cases and 170 controls from a similar study were included in the analysis. Genotyping was performed using the Pain Research Panel, an Affymetrix gene chip representing 3295 single nucleotide polymorphisms, including ancestry-informative markers that were used to adjust for population stratification. Adjusted associations between genetic markers and TMD case status were evaluated using logistic regression. The OPPERA findings provided evidence supporting previously-reported associations between TMD and two genes: HTR2A and COMT. Other genes were revealed as potential new genetic risk factors for TMD, including NR3C1, CAMK4, CHRM2, IFRD1, and GRK5. While these findings need to be replicated in independent cohorts, the genes potentially represent important markers of risk for TMD and they identify potential targets for therapeutic intervention. PMID:22074755

  8. The Consulting Challenge: A Case Competition

    ERIC Educational Resources Information Center

    Sachau, Daniel A.; Naas, Patricia A.

    2010-01-01

    The Consulting Challenge is a yearly case competition in which teams of graduate students respond to a request for proposals (RFP) for consulting services. The case and RFP are based on a problem that a host organization has experienced. Over 3 days, students meet with representatives of the host organization, analyze data, prepare a proposal for…

  9. Impact of fluid-structure interaction on direct tumor-targeting in a representative hepatic artery system.

    PubMed

    Childress, Emily M; Kleinstreuer, Clement

    2014-03-01

    Direct targeting of solid tumors with chemotherapeutic drugs and/or radioactive microspheres can be a treatment option which minimizes side-effects and reduces cost. Briefly, computational analysis generates particle release maps (PRMs) which visually link upstream particle injection regions in the main artery with associated exit branches, some connected to tumors. The overall goal is to compute patient-specific PRMs realistically, accurately, and cost-effectively, which determines the suitable radial placement of a micro-catheter for optimal particle injection. Focusing in this paper on new steps towards realism and accuracy, the impact of fluid-structure interaction on direct drug-targeting is evaluated, using a representative hepatic artery system with liver tumor as a test bed. Specifically, the effect of arterial wall motion was demonstrated by modeling a two-way fluid-structure interaction analysis with Lagrangian particle tracking in the bifurcating arterial system. Clearly, rapid computational evaluation of optimal catheter location for tumor-targeting in a clinical application is very important. Hence, rigid-wall cases were also compared to the flexible scenario to establish whether PRMs generated when based on simplifying assumptions could provide adequate guidance towards ideal catheter placement. It was found that the best rigid (i.e., time-averaged) geometry is the physiological one that occurs during the diastolic targeting interval.

  10. The long case and its modifications: a literature review.

    PubMed

    Ponnamperuma, Gominda G; Karunathilake, Indika M; McAleer, Sean; Davis, Margery H

    2009-10-01

    This review provides a summary of the published literature on the suitability of the long case and its modifications for high-stakes assessment. Databases related to medicine were searched for articles published from 2000 to 2008, using the keywords 'long case', 'clinical examinations' and 'clinical assessment'. Reference lists of review articles were hand-searched. Articles related to the objective structured clinical examination were eliminated. Research-based articles with hard data were given more emphasis in this review than those based on opinion. Eighteen articles were identified. The main disadvantage of the long case is its inability to sample the curriculum widely, resulting in low reliability. The main advantage of the long case is its ability to assess the candidate's overall (holistic) approach to the patient. Modifications to the long case attempt to: structure the format and the marking scheme; increase the number of examiners; observe the candidate's behaviour, and increase the number of cases. The long case is a traditional clinical examination format for the assessment of clinical competence and assessment at this level is important. The starting point for the majority of recent research on the long case has been an acceptance of its low reliability and modifications to the format have been proposed. Further evidence of the efficacy of these modifications is required, however, before they can be recommended for summative assessment. If further research is to be undertaken on the long case, it should focus on finding practicable ways of sampling the curriculum widely to increase reliability while maintaining the holistic approach towards the patient, which represents the attraction of the long case.

  11. 5 CFR 9701.516 - Allotments to representatives.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Allotments to representatives. 9701.516 Section 9701.516 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Labor-Management Relations § 9701.516 Allotments to representatives...

  12. 22 CFR 23.4 - Representative value in exchange.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Representative value in exchange. 23.4 Section 23.4 Foreign Relations DEPARTMENT OF STATE FEES AND FUNDS FINANCE AND ACCOUNTING § 23.4 Representative value in exchange. Representative value in exchange for the collection of a fee means foreign...

  13. Medico-Legal Findings, Legal Case Progression, and Outcomes in South African Rape Cases: Retrospective Review

    PubMed Central

    Jewkes, Rachel; Christofides, Nicola; Vetten, Lisa; Jina, Ruxana; Sigsworth, Romi; Loots, Lizle

    2009-01-01

    Background Health services for victims of rape are recognised as a particularly neglected area of the health sector internationally. Efforts to strengthen these services need to be guided by clinical research. Expert medical evidence is widely used in rape cases, but its contribution to the progress of legal cases is unclear. Only three studies have found an association between documented bodily injuries and convictions in rape cases. This article aims to describe the processing of rape cases by South African police and courts, and the association between documented injuries and DNA and case progression through the criminal justice system. Methods and Findings We analysed a provincially representative sample of 2,068 attempted and completed rape cases reported to 70 randomly selected Gauteng province police stations in 2003. Data sheets were completed from the police dockets and available medical examination forms were copied. 1,547 cases of rape had medical examinations and available forms and were analysed, which was at least 85% of the proportion of the sample having a medical examination. We present logistic regression models of the association between whether a trial started and whether the accused was found guilty and the medico-legal findings for adult and child rapes. Half the suspects were arrested (n = 771), 14% (209) of cases went to trial, and in 3% (31) of adults and 7% (44) of children there was a conviction. A report on DNA was available in 1.4% (22) of cases, but the presence or absence of injuries were documented in all cases. Documented injuries were not associated with arrest, but they were associated with children's cases (but not adult's) going to trial (adjusted odds ratio [AOR] for having genital and nongenital injuries 5.83, 95% confidence interval [CI] 1.87–18.13, p = 0.003). In adult cases a conviction was more likely if there were documented injuries, whether nongenital injuries alone AOR 6.25 (95% CI 1.14–34.3, p = 0

  14. Spotlight on measles 2010: ongoing measles outbreak in Northern Ireland following an imported case, September-October 2010.

    PubMed

    Smithson, R; Irvine, N; Hutton, C; Doherty, L; Watt, A

    2010-10-28

    We report an ongoing outbreak of measles with five laboratory-confirmed and four epidemiologically linked cases in Northern Ireland as at 26 October 2010. The index case was an unvaccinated non-Northern Ireland resident with subsequent genotyping suggesting that infection originated in the usual country of residence of this case. Confirmed cases include one patient with a history of two measles-mumps-rubella vaccine doses.

  15. Case Studies on Educational Administration. Third Edition.

    ERIC Educational Resources Information Center

    Kowalski, Theodore J.

    This book contains 24 case studies selected to demonstrate the different types of challenges in contemporary educational leadership. It is intended to help prospective administrators develop decision-making skills. The cases are quite complex with multiple viewpoints and aspects. They represent a range of problems encountered by practitioners in…

  16. CaseWorld™: Interactive, media rich, multidisciplinary case based learning.

    PubMed

    Gillham, David; Tucker, Katie; Parker, Steve; Wright, Victoria; Kargillis, Christina

    2015-11-01

    Nurse educators are challenged to keep up with highly specialised clinical practice, emerging research evidence, regulation requirements and rapidly changing information technology while teaching very large numbers of diverse students in a resource constrained environment. This complex setting provides the context for the CaseWorld project, which aims to simulate those aspects of clinical practice that can be represented by e-learning. This paper describes the development, implementation and evaluation of CaseWorld, a simulated learning environment that supports case based learning. CaseWorld provides nursing students with the opportunity to view unfolding authentic cases presented in a rich multimedia context. The first round of comprehensive summative evaluation of CaseWorld is discussed in the context of earlier formative evaluation, reference group input and strategies for integration of CaseWorld with subject content. This discussion highlights the unique approach taken in this project that involved simultaneous prototype development and large scale implementation, thereby necessitating strong emphasis on staff development, uptake and engagement. The lessons learned provide an interesting basis for further discussion of broad content sharing across disciplines and universities, and the contribution that local innovations can make to global education advancement. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  17. Pollination syndromes ignored: importance of non-ornithophilous flowers to Neotropical savanna hummingbirds

    NASA Astrophysics Data System (ADS)

    Maruyama, Pietro K.; Oliveira, Genilda M.; Ferreira, Carolina; Dalsgaard, Bo; Oliveira, Paulo E.

    2013-11-01

    Generalization prevails in flower-animal interactions, and although animal visitors are not equally effective pollinators, most interactions likely represent an important energy intake for the animal visitor. Hummingbirds are nectar-feeding specialists, and many tropical plants are specialized toward hummingbird-pollination. In spite of this, especially in dry and seasonal tropical habitats, hummingbirds may often rely on non-ornithophilous plants to meet their energy requirements. However, quantitative studies evaluating the relative importance of ornithophilous vs. non-ornithophilous plants for hummingbirds in these areas are scarce. We here studied the availability and use of floral resources by hummingbirds in two different areas of the Cerrado, the seasonal savannas in Central Brazil. Roughly half the hummingbird visited plant species were non-ornithophilous, and these contributed greatly to increase the overall nectar availability. We showed that mean nectar offer, at the transect scale, was the only parameter related to hummingbird visitation frequency, more so than nectar offer at single flowers and at the plant scale, or pollination syndrome. Centrality indices, calculated using hummingbird-plant networks, showed that ornithophilous and non-ornithophilous plants have similar importance for network cohesion. How this foraging behaviour affects reproduction of non-ornithophilous plants remains largely unexplored and is probably case specific, however, we suggest that the additional energy provided by non-ornithophilous plants may facilitate reproduction of truly ornithophilous flowers by attracting and maintaining hummingbirds in the area. This may promote asymmetric hummingbird-plant associations, i.e., pollination depends on floral traits adapted to hummingbird morphology, but hummingbird visitation is determined more by the energetic "reward" than by pollination syndromes.

  18. Semantic bifurcated importance field visualization

    NASA Astrophysics Data System (ADS)

    Lindahl, Eric; Petrov, Plamen

    2007-04-01

    While there are many good ways to map sensual reality to two dimensional displays, mapping non-physical and possibilistic information can be challenging. The advent of faster-than-real-time systems allow the predictive and possibilistic exploration of important factors that can affect the decision maker. Visualizing a compressed picture of the past and possible factors can assist the decision maker summarizing information in a cognitive based model thereby reducing clutter and perhaps related decision times. Our proposed semantic bifurcated importance field visualization uses saccadic eye motion models to partition the display into a possibilistic and sensed data vertically and spatial and semantic data horizontally. Saccadic eye movement precedes and prepares decision makers before nearly every directed action. Cognitive models for saccadic eye movement show that people prefer lateral to vertical saccadic movement. Studies have suggested that saccades may be coupled to momentary problem solving strategies. Also, the central 1.5 degrees of the visual field represents 100 times greater resolution that then peripheral field so concentrating factors can reduce unnecessary saccades. By packing information according to saccadic models, we can relate important decision factors reduce factor dimensionality and present the dense summary dimensions of semantic and importance. Inter and intra ballistics of the SBIFV provide important clues on how semantic packing assists in decision making. Future directions of SBIFV are to make the visualization reactive and conformal to saccades specializing targets to ballistics, such as dynamically filtering and highlighting verbal targets for left saccades and spatial targets for right saccades.

  19. 20 CFR 209.11 - Employee representatives' reports.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Employee representatives' reports. 209.11 Section 209.11 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT RAILROAD EMPLOYERS' REPORTS AND RESPONSIBILITIES § 209.11 Employee representatives' reports. An individual...

  20. An approach to checking case-crossover analyses based on equivalence with time-series methods.

    PubMed

    Lu, Yun; Symons, James Morel; Geyh, Alison S; Zeger, Scott L

    2008-03-01

    The case-crossover design has been increasingly applied to epidemiologic investigations of acute adverse health effects associated with ambient air pollution. The correspondence of the design to that of matched case-control studies makes it inferentially appealing for epidemiologic studies. Case-crossover analyses generally use conditional logistic regression modeling. This technique is equivalent to time-series log-linear regression models when there is a common exposure across individuals, as in air pollution studies. Previous methods for obtaining unbiased estimates for case-crossover analyses have assumed that time-varying risk factors are constant within reference windows. In this paper, we rely on the connection between case-crossover and time-series methods to illustrate model-checking procedures from log-linear model diagnostics for time-stratified case-crossover analyses. Additionally, we compare the relative performance of the time-stratified case-crossover approach to time-series methods under 3 simulated scenarios representing different temporal patterns of daily mortality associated with air pollution in Chicago, Illinois, during 1995 and 1996. Whenever a model-be it time-series or case-crossover-fails to account appropriately for fluctuations in time that confound the exposure, the effect estimate will be biased. It is therefore important to perform model-checking in time-stratified case-crossover analyses rather than assume the estimator is unbiased.

  1. Prevalence and Correlates of Drug/Alcohol-Facilitated and Incapacitated Sexual Assault in a Nationally Representative Sample of Adolescent Girls

    ERIC Educational Resources Information Center

    McCauley, Jenna L.; Conoscenti, Lauren M.; Ruggiero, Kenneth J.; Resnick, Heidi S.; Saunders, Benjamin E.; Kilpatrick, Dean G.

    2009-01-01

    Incapacitated/drug-alcohol facilitated sexual assault (IS/DAFS) is rapidly gaining recognition as a distinct form of assault with unique public health implications. This study reports the prevalence, case characteristics, and associated health risks of IS/DAFS using a large, nationally representative sample of 1,763 adolescent girls. Results…

  2. Relationships Among Ecologically Important Dimensions of Plant Trait Variation in Seven Neotropical Forests

    PubMed Central

    Wright, Ian J.; Ackerly, David D.; Bongers, Frans; Harms, Kyle E.; Ibarra-Manriquez, Guillermo; Martinez-Ramos, Miguel; Mazer, Susan J.; Muller-Landau, Helene C.; Paz, Horacio; Pitman, Nigel C. A.; Poorter, Lourens; Silman, Miles R.; Vriesendorp, Corine F.; Webb, Cam O.; Westoby, Mark; Wright, S. Joseph

    2007-01-01

    Background and Aims When ecologically important plant traits are correlated they may be said to constitute an ecological ‘strategy’ dimension. Through identifying these dimensions and understanding their inter-relationships we gain insight into why particular trait combinations are favoured over others and into the implications of trait differences among species. Here we investigated relationships among several traits, and thus the strategy dimensions they represented, across 2134 woody species from seven Neotropical forests. Methods Six traits were studied: specific leaf area (SLA), the average size of leaves, seed and fruit, typical maximum plant height, and wood density (WD). Trait relationships were quantified across species at each individual forest as well as across the dataset as a whole. ‘Phylogenetic’ analyses were used to test for correlations among evolutionary trait-divergences and to ascertain whether interspecific relationships were biased by strong taxonomic patterning in the traits. Key Results The interspecific and phylogenetic analyses yielded congruent results. Seed and fruit size were expected, and confirmed, to be tightly related. As expected, plant height was correlated with each of seed and fruit size, albeit weakly. Weak support was found for an expected positive relationship between leaf and fruit size. The prediction that SLA and WD would be negatively correlated was not supported. Otherwise the traits were predicted to be largely unrelated, being representatives of putatively independent strategy dimensions. This was indeed the case, although WD was consistently, negatively related to leaf size. Conclusions The dimensions represented by SLA, seed/fruit size and leaf size were essentially independent and thus conveyed largely independent information about plant strategies. To a lesser extent the same was true for plant height and WD. Our tentative explanation for negative WD–leaf size relationships, now also known from other

  3. Plasmodium falciparum malaria importation from Africa to China and its mortality: an analysis of driving factors

    NASA Astrophysics Data System (ADS)

    Lai, Shengjie; Wardrop, Nicola A.; Huang, Zhuojie; Bosco, Claudio; Sun, Junling; Bird, Tomas; Wesolowski, Amy; Zhou, Sheng; Zhang, Qian; Zheng, Canjun; Li, Zhongjie; Tatem, Andrew J.; Yu, Hongjie

    2016-12-01

    Plasmodium falciparum malaria importation from Africa to China is rising with increasing Chinese overseas investment and international travel. Identifying networks and drivers of this phenomenon as well as the contributors to high case-fatality rate is a growing public health concern to enable efficient response. From 2011-2015, 8653 P. falciparum cases leading to 98 deaths (11.3 per 1000 cases) were imported from 41 sub-Saharan countries into China, with most cases (91.3%) occurring in labour-related Chinese travellers. Four strongly connected groupings of origin African countries with destination Chinese provinces were identified, and the number of imported cases was significantly associated with the volume of air passengers to China (P = 0.006), parasite prevalence in Africa (P < 0.001), and the amount of official development assistance from China (P < 0.001) with investment in resource extraction having the strongest relationship with parasite importation. Risk factors for deaths from imported cases were related to the capacity of malaria diagnosis and diverse socioeconomic factors. The spatial heterogeneity uncovered, principal drivers explored, and risk factors for mortality found in the rising rates of P. falciparum malaria importation to China can serve to refine malaria elimination strategies and the management of cases, and high risk groups and regions should be targeted.

  4. Pharmaceutical sales representatives and physicians: ethical considerations of a relationship.

    PubMed

    Peppin, J F

    1996-02-01

    Since their appearance in 1850, Pharmaceutical Sales Representatives (PSR) interactions with physicians have engendered intense emotional responses. The controversy has continued unabated since that time. Arguments in favor of the moral impermissibility of the PSR-physician relationship can be divided into four general categories; (1) influence, (2) patients pay but they do not choose, (3) violation of principlism, and (4) the erosion of the patient-physician relationship. None of the arguments that have thus far been proposed against the moral permissibility of these interactions gives sufficient warrant to avoid them (or pursue them). It may be the case that PSR-physician interactions place the patient-physician relationship in jeopardy. This would constitute enough warrant, from a pragmatic perspective, to shun such relationships. However, no research supports this contention. A careful evaluation of the literature leaves one ambivalent at best.

  5. Factors associated with physicians' reliance on pharmaceutical sales representatives.

    PubMed

    Anderson, Britta L; Silverman, Gabriel K; Loewenstein, George F; Zinberg, Stanley; Schulkin, Jay

    2009-08-01

    To examine relationships between pharmaceutical representatives and obstetrician-gynecologists and identify factors associated with self-reported reliance on representatives when making prescribing decisions. In 2006-2007, questionnaires were mailed to 515 randomly selected physicians in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network. Participants were asked about the information sources used when deciding to prescribe a new drug, interactions with sales representatives, views of representatives' value, and guidelines they had read on appropriate industry interactions. Two hundred fifty-one completed questionnaires (49%) were returned. Seventy-six percent of participants see sales representatives' information as at least somewhat valuable. Twenty-nine percent use representatives often or almost always when deciding whether to prescribe a new drug; 44% use them sometimes. Physicians in private practice are more likely than those in university hospitals to interact with, value, and rely on representatives; community hospital physicians tend to fall in the middle. Gender and age are not associated with industry interaction. Dispensing samples is associated with increased reliance on representatives when making prescribing decisions, beyond what is predicted by a physician's own beliefs about the value of representatives' information. Reading guidelines on physician-industry interaction is not associated with less reliance on representatives after controlling for practice setting. Physicians' interactions with industry and their familiarity with guidelines vary by practice setting, perhaps because of more restrictive policies in university settings, professional isolation of private practice, or differences in social norms. Prescribing samples may be associated with physicians' use of information from sales representatives more than is merited by the physicians' own beliefs about the value of pharmaceutical

  6. 25 CFR 17.5 - Minors represented at hearings.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Minors represented at hearings. 17.5 Section 17.5 Indians... Minors represented at hearings. Minor heirs at law, who by the terms of the will are devised a lesser... approval of the special attorney, be represented at the hearing by guardians ad litem. Such minors 14 years...

  7. 25 CFR 17.5 - Minors represented at hearings.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Minors represented at hearings. 17.5 Section 17.5 Indians... Minors represented at hearings. Minor heirs at law, who by the terms of the will are devised a lesser... approval of the special attorney, be represented at the hearing by guardians ad litem. Such minors 14 years...

  8. Evaluating adequacy of the representative stream reach used in invertebrate monitoring programs

    USGS Publications Warehouse

    Rabeni, C.F.; Wang, N.; Sarver, R.J.

    1999-01-01

    Selection of a representative stream reach is implicitly or explicitly recommended in many biomonitoring protocols using benthic invertebrates. We evaluated the adequacy of sampling a single stream reach selected on the basis of its appearance. We 1st demonstrated the precision of our within-reach sampling. Then we sampled 3 or 4 reaches (each ~20x mean width) within an 8-16 km segment on each of 8 streams in 3 ecoregions and calculated 4 common metrics: 1) total taxa; 2) Ephemeroptera, Plecoptera, and Trichoptera taxa; 3) biotic index; and 4) Sharmon's diversity index. In only 6% of possible cases was the coefficient of variation for any of the metrics reduced >10% by sampling additional reaches. Sampling a 2nd reach on a stream improved the ability to detect impairment by an average of only 9.3%. Sampling a 3rd reach on a stream additionally improved ability to detect impairment by only 4.5%. We concluded that a single well-chosen reach, if adequately sampled, can be representative of an entire stream segment, and sampling additional reaches within a segment may not be cost effective.

  9. Imported Malaria in Children in Industrialized Countries, 1992–2002

    PubMed Central

    Stäger, Katrin; Legros, Fabrice; Krause, Gérard; Low, Nicola; Bradley, David; Desai, Meghna; Graf, Simone; D’Amato, Stefania; Mizuno, Yasutaka; Janzon, Ragnhild; Petersen, Eskild; Kester, John; Steffen, Robert

    2009-01-01

    Children account for an appreciable proportion of total imported malaria cases, yet few studies have quantified these cases, identified trends, or suggested evidence-based prevention strategies for this group of travelers. We therefore sought to identify numbers of cases and deaths, Plasmodium species, place of malaria acquisition, preventive measures used, and national origin of malaria in children. We analyzed retrospective data from Australia, Denmark, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, the United Kingdom, and the United States and data provided by the United Nations World Tourism Organization. During 1992–2002, >17,000 cases of imported malaria in children were reported in 11 countries where malaria is not endemic; most (>70%) had been acquired in Africa. Returning to country of origin to visit friends and relatives was a risk factor. Malaria prevention for children should be a responsibility of healthcare providers and should be subsidized for low-income travelers to high-risk areas. PMID:19193261

  10. Outbreak of Shigella sonnei infection traced to imported iceberg lettuce.

    PubMed Central

    Kapperud, G; Rørvik, L M; Hasseltvedt, V; Høiby, E A; Iversen, B G; Staveland, K; Johnsen, G; Leitao, J; Herikstad, H; Andersson, Y

    1995-01-01

    In the period from May through June 1994, an increase in the number of domestic cases of Shigella sonnei infection was detected in several European countries, including Norway, Sweden, and the United Kingdom. In all three countries epidemiological evidence incriminated imported iceberg lettuce of Spanish origin as the vehicle of transmission. The outbreaks shared a number of common features: a predominance of adults among the case patients, the presence of double infections with other enteropathogens, and the finding of two dominant phage types among the bacterial isolates. In Norway 110 culture-confirmed cases of infection were recorded; more than two-thirds (73%) were adults aged 30 to 60 years. A nationwide case-control study comprising 47 case patients and 155 matched control individuals showed that the consumption of imported iceberg lettuce was independently associated with an increased risk of shigellosis. Epidemiological investigation of a local outbreak incriminated iceberg lettuce from Spain, consumed from a salad bar, as the source. The presence of shigellae in the suspected food source could not be documented retrospectively. However, high numbers of fecal coliforms were detected in iceberg lettuce from patients' homes. Three lettuce specimens yielded salmonellae. The imported iceberg lettuce harbored Escherichia coli strains showing resistance to several antimicrobial agents, including ampicillin, ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole. During the outbreak it is likely that thousands of Norwegians and an unknown number of consumers in other countries were exposed to coliforms containing antibiotic resistance genes. PMID:7751364

  11. Indeterminate Growth: Could It Represent the Ancestral Condition?

    PubMed Central

    Hariharan, Iswar K.; Wake, David B.; Wake, Marvalee H.

    2016-01-01

    Although we are used to the idea that many organisms stop growing when they reach a predictable size, in many taxa, growth occurs throughout the life of an organism, a phenomenon referred to as indeterminate growth. Our comparative analysis suggests that indeterminate growth may indeed represent the ancestral condition, whereas the permanent arrest of growth may be a more derived state. Consistent with this idea, in diverse taxa, the basal branches show indeterminate growth, whereas more derived branches arrest their growth. Importantly, in some closely related taxa, the termination of growth has evolved in mechanistically distinct ways. Also, even within a single organism, different organs can differ with respect to whether they terminate their growth or not. Finally, the study of tooth development indicates that, even at the level of a single tissue, multiple determinate patterns of growth can evolve from an ancestral one that is indeterminate. PMID:26216720

  12. Tinea pedis presenting as asymmetric purpuric papules on the sole of the foot: a case report.

    PubMed

    Chen, Jennifer Yan Fei; Stroz, Marianne J; Adam, David N

    2015-01-01

    In this report we describe a unique case of tinea pedis. A 29-year-old man presented with a 3-day history of asymptomatic purpuric papules predominantly on his left foot. Potassium hydroxide preparation demonstrated fungal hyphae and culture yielded Trichophyton mentagrophytes. This patient presented unusually with purpuric papules, unlike the three commonly described types of tinea pedis. Given the morphology, positive potassium hydroxide slide preparation, T. mentagrophytes on fungal culture and clinical response to ketoconazole cream, we conclude that this represents a unique variant of tinea pedis. We recognize that even common dermatological diagnoses can have unique presentations, and it is important for clinicians to maintain a broad differential for new dermatologic cases.

  13. Tinea Pedis Presenting as Asymmetric Purpuric Papules on the Sole of the Foot: A Case Report

    PubMed Central

    Chen, Jennifer Yan Fei; Stroz, Marianne J.; Adam, David N.

    2015-01-01

    In this report we describe a unique case of tinea pedis. A 29-year-old man presented with a 3-day history of asymptomatic purpuric papules predominantly on his left foot. Potassium hydroxide preparation demonstrated fungal hyphae and culture yielded Trichophyton mentagrophytes. This patient presented unusually with purpuric papules, unlike the three commonly described types of tinea pedis. Given the morphology, positive potassium hydroxide slide preparation, T. mentagrophytes on fungal culture and clinical response to ketoconazole cream, we conclude that this represents a unique variant of tinea pedis. We recognize that even common dermatological diagnoses can have unique presentations, and it is important for clinicians to maintain a broad differential for new dermatologic cases. PMID:25873874

  14. 42 CFR 102.44 - Representatives of requesters.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Representatives of requesters. 102.44 Section 102.44 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Procedures for Filing Request Packages § 102.44 Representatives of requesters. (a) Persons...

  15. 42 CFR 102.44 - Representatives of requesters.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Representatives of requesters. 102.44 Section 102.44 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Procedures for Filing Request Packages § 102.44 Representatives of requesters. (a) Persons...

  16. 42 CFR 102.44 - Representatives of requesters.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Representatives of requesters. 102.44 Section 102.44 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Procedures for Filing Request Packages § 102.44 Representatives of requesters. (a) Persons...

  17. 42 CFR 102.44 - Representatives of requesters.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Representatives of requesters. 102.44 Section 102.44 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Procedures for Filing Request Packages § 102.44 Representatives of requesters. (a) Persons...

  18. 42 CFR 102.44 - Representatives of requesters.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Representatives of requesters. 102.44 Section 102.44 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Procedures for Filing Request Packages § 102.44 Representatives of requesters. (a) Persons...

  19. Simplified and representative bacterial community of maize roots

    PubMed Central

    Niu, Ben; Paulson, Joseph Nathaniel; Zheng, Xiaoqi; Kolter, Roberto

    2017-01-01

    Plant-associated microbes are important for the growth and health of their hosts. As a result of numerous prior studies, we know that host genotypes and abiotic factors influence the composition of plant microbiomes. However, the high complexity of these communities challenges detailed studies to define experimentally the mechanisms underlying the dynamics of community assembly and the beneficial effects of such microbiomes on plant hosts. In this work, from the distinctive microbiota assembled by maize roots, through host-mediated selection, we obtained a greatly simplified synthetic bacterial community consisting of seven strains (Enterobacter cloacae, Stenotrophomonas maltophilia, Ochrobactrum pituitosum, Herbaspirillum frisingense, Pseudomonas putida, Curtobacterium pusillum, and Chryseobacterium indologenes) representing three of the four most dominant phyla found in maize roots. By using a selective culture-dependent method to track the abundance of each strain, we investigated the role that each plays in community assembly on roots of axenic maize seedlings. Only the removal of E. cloacae led to the complete loss of the community, and C. pusillum took over. This result suggests that E. cloacae plays the role of keystone species in this model ecosystem. In planta and in vitro, this model community inhibited the phytopathogenic fungus Fusarium verticillioides, indicating a clear benefit to the host. Thus, combined with the selective culture-dependent quantification method, our synthetic seven-species community representing the root microbiome has the potential to serve as a useful system to explore how bacterial interspecies interactions affect root microbiome assembly and to dissect the beneficial effects of the root microbiota on hosts under laboratory conditions in the future. PMID:28275097

  20. Simplified and representative bacterial community of maize roots.

    PubMed

    Niu, Ben; Paulson, Joseph Nathaniel; Zheng, Xiaoqi; Kolter, Roberto

    2017-03-21

    Plant-associated microbes are important for the growth and health of their hosts. As a result of numerous prior studies, we know that host genotypes and abiotic factors influence the composition of plant microbiomes. However, the high complexity of these communities challenges detailed studies to define experimentally the mechanisms underlying the dynamics of community assembly and the beneficial effects of such microbiomes on plant hosts. In this work, from the distinctive microbiota assembled by maize roots, through host-mediated selection, we obtained a greatly simplified synthetic bacterial community consisting of seven strains ( Enterobacter cloacae , Stenotrophomonas maltophilia, Ochrobactrum pituitosum, Herbaspirillum frisingense, Pseudomonas putida, Curtobacterium pusillum , and Chryseobacterium indologenes ) representing three of the four most dominant phyla found in maize roots. By using a selective culture-dependent method to track the abundance of each strain, we investigated the role that each plays in community assembly on roots of axenic maize seedlings. Only the removal of E. cloacae led to the complete loss of the community, and C. pusillum took over. This result suggests that E. cloacae plays the role of keystone species in this model ecosystem. In planta and in vitro, this model community inhibited the phytopathogenic fungus Fusarium verticillioides , indicating a clear benefit to the host. Thus, combined with the selective culture-dependent quantification method, our synthetic seven-species community representing the root microbiome has the potential to serve as a useful system to explore how bacterial interspecies interactions affect root microbiome assembly and to dissect the beneficial effects of the root microbiota on hosts under laboratory conditions in the future.