Health Education for Special Children: Primary EMR.

ERIC Educational Resources Information Center

Allen, Linda; And Others

Intended for teachers and administrators in special education, the curriculum guide offers information on planning a health education program for primary level educable mentally retarded students. Sections preceding the actual guide include information on specific goals of and elements necessary for a successful health education program, the…

Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display

PubMed Central

Clarke, M.A.; Steege, L.M.; Moore, J.L.; Koopman, R.J.; Belden, J.L.; Kim, M.S.

2014-01-01

Summary Background With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display. Method Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller’s and Cochran Q. Results Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians’ highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes. Conclusion A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly “not needed,” but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load. PMID:24734131

GEMINI-TITAN (GT)-9 - MOCKUP - ADAPTER EQUIPMENT SECTION - FUEL CELL - MSC

NASA Image and Video Library

1966-03-01

S66-22686 (March 1966) --- Mock-up of the adapter equipment section to be used on the Gemini-9 spaceflight. This section provides volume and attach points for several system modules, including Orbit Attitude Maneuver System, Environmental Control System primary oxygen supply, batteries, coolant, and electrical and electric components. This section will also hold the Astronaut Maneuvering Unit (AMU) backpack (center). Photo credit: NASA

Socioeconomic status and geographical factors associated with active listing in primary care: a cross-sectional population study accounting for multimorbidity, age, sex and primary care

PubMed Central

Ranstad, Karin; Midlöv, Patrik; Halling, Anders

2017-01-01

Background Socioeconomic status and geographical factors are associated with health and use of healthcare. Well-performing primary care contributes to better health and more adequate healthcare. In a primary care system based on patient’s choice of practice, this choice (listing) is a key to understand the system. Objective To explore the relationship between population and practices in a primary care system based on listing. Methods Cross-sectional population-based study. Logistic regressions of the associations between active listing in primary care, income, education, distances to healthcare and geographical location, adjusting for multimorbidity, age, sex and type of primary care practice. Setting and subjects Population over 15 years (n=123 168) in a Swedish county, Blekinge (151 731 inhabitants), in year 2007, actively or passively listed in primary care. The proportion of actively listed was 68%. Main outcome measure Actively listed in primary care on 31 December 2007. Results Highest ORs for active listing in the model including all factors according to income had quartile two and three with OR 0.70 (95% CI 0.69 to 0.70), and those according to education less than 9 years of education had OR 0.70 (95% CI 0.68 to 0.70). Best odds for geographical factors in the same model had municipality C with OR 0.85 (95% CI 0.85 to 0.86) for active listing. Akaike’s Information Criterion (AIC) was 124 801 for a model including municipality, multimorbidity, age, sex and type of practice and including all factors gave AIC 123 934. Conclusions Higher income, shorter education, shorter distance to primary care or longer distance to hospital is associated with active listing in primary care. Multimorbidity, age, geographical location and type of primary care practice are more important to active listing in primary care than socioeconomic status and distance to healthcare. PMID:28601827

22 CFR 141.3 - Discrimination prohibited.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Where a primary objective of the Federal financial assistance to a program to which this part applies is... facilities), including programs where a primary objective of the Federal financial assistance is: (i) To... program as an employee in accordance with paragraph (d) of this section. (vii) Deny a person the...

45 CFR 156.245 - Treatment of direct primary care medical homes.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Treatment of direct primary care medical homes. 156.245 Section 156.245 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING...

Prevention of childbirth injuries to the pelvic floor.

PubMed

Heit, M; Mudd, K; Culligan, P

2001-08-01

The majority of childbirth injuries to the pelvic floor occur after the first vaginal delivery. Cesarean sections performed after the onset of labor may not protect the pelvic floor. Elective cesarean section is the only true primary prevention strategy for childbirth injuries to the pelvic floor. Alternative primary prevention strategies include elective cesarean section for women with nonmodifiable risks for childbirth injuries to the pelvic floor, antepartum pelvic floor exercises, or intrapartum pudendal nerve monitoring. Secondary prevention strategies must focus on modifying obstetric practices that predispose women to pelvic floor injury. These factors are best delineated for anal incontinence and include restrictive use of episiotomy, mediolateral episiotomy when necessary, spontaneous over forceps-assisted vaginal delivery, vacuum extraction over forceps delivery, and antepartum perineal massage. Finally, tertiary prevention strategies should address the mode of delivery made for women with childbirth injuries to the pelvic floor who desire future fertility.

Use of Infrared Thermography for the Inspection of Welds in the Shop and Field

DOT National Transportation Integrated Search

2017-12-01

This report represents an initial, proof-of-concept study to explore the feasibility of infrared ultra-time domain (IR-UTD) technology for the detection of defects in welds. The report includes two primary sections. The first section provides some ba...

Issues of Authenticity of Spatial Data.

ERIC Educational Resources Information Center

McGlamery, Patrick

This paper discusses the authenticity of digital spatial data. The first section describes three formats for digital spatial data: vector, raster, and thematic. The second section addresses the integrity of spatial data, including six possible formats for the same information: (1) aerial photographic prints, time stamped, primary, remotely sensed…

Nursing contributions to chronic disease management in primary care.

PubMed

Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Tranmer, Joan

2014-02-01

As the prevalence of chronic diseases continues to increase, emphasis is being placed on the development of primary care strategies that enhance healthcare delivery. Innovations include interprofessional healthcare teams and chronic disease management strategies. To determine the roles of nurses working in primary care settings in Ontario and the extent to which chronic disease management strategies have been implemented. We conducted a cross-sectional survey of a random sample of primary care nurses, including registered practical nurses, registered nurses, and nurse practitioners, in Ontario between May and July 2011. Nurses in primary care reported engaging in chronic disease management activities but to different extents depending on their regulatory designation (licensure category). Chronic disease management strategy implementation was not uniform across primary care practices where the nurses worked. There is the potential to optimize and standardize the nursing role within primary care and improve the implementation of chronic disease management strategies.

46 CFR 154.431 - Model test.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 5 2010-10-01 2010-10-01 false Model test. 154.431 Section 154.431 Shipping COAST GUARD... Model test. (a) The primary and secondary barrier of a membrane tank, including the corners and joints...(c). (b) Analyzed data of a model test for the primary and secondary barrier of the membrane tank...

40 CFR 1045.625 - What requirements apply under the Diurnal Transition Program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... in this section only if you have primary responsibility for designing and manufacturing vessels and your manufacturing procedures include installing some engines in these vessels. Consider all U.S... under this section: (1) Percent-of-production allowances. You may produce up to 50 percent of your...

Factors associated with final year nursing students' desire to work in the primary health care setting: Findings from a national cross-sectional survey.

PubMed

Bloomfield, Jacqueline G; Aggar, Christina; Thomas, Tamsin H T; Gordon, Christopher J

2018-02-01

Registered nurses are under-represented in the primary health care setting both internationally and in Australia, and this shortage is predicted to worsen. To address the increasingly complex healthcare needs of an ageing population, it is vital to develop and sustain a primary health care nursing workforce, yet attracting nurses is challenging. In Australia, registered nurses graduating from university typically commence their careers in hospital-based transition to professional practice programs. Similar programs in primary health care settings may be a valuable strategy for developing the primary health care nursing workforce, yet little is known about nursing students desire to work in this setting, factors that influence this, or their expectations of primary health care-focused transition to professional practice programs. This study sought to identify factors associated with final year nursing students' desire to work in primary health care setting including demographic factors, expectations of future employment conditions, and job content. It also explored expectations of graduate transition programs based in primary health care. A cross-sectional survey design comprising a quantitative online survey. 14 Australian universities from all states/territories, both rural and urban. 530 final-year nursing students. Binary logistic regression identifying factors contributing to desire to work in primary health care. The desire of nursing students to work in primary health care is associated with older age, greater perceived value of employment conditions including flexibility, and less perceived importance of workplace support. Collaborative efforts from primary health care nurses, health professionals, academics and policy makers are needed to attract new graduate nurses to primary health care. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Hydrocarbon fluid, ejector refrigeration system

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

Kowalski, G.J.; Foster, A.R.

1993-08-31

A refrigeration system is described comprising: a vapor ejector cycle including a working fluid having a property such that entropy of the working fluid when in a saturated vapor state decreases as pressure decreases, the vapor ejector cycle comprising: a condenser located on a common fluid flow path; a diverter located downstream from the condenser for diverting the working fluid into a primary fluid flow path and a secondary fluid flow path parallel to the primary fluid flow path; an evaporator located on the secondary fluid flow path; an expansion device located on the secondary fluid flow path upstream ofmore » the evaporator; a boiler located on the primary fluid flow path parallel to the evaporator for boiling the working fluid, the boiler comprising an axially extending core region having a substantially constant cross sectional area and a porous capillary region surrounding the core region, the core region extending a length sufficient to produce a near sonic velocity saturated vapor; and an ejector having an outlet in fluid communication with the inlet of the condenser and an inlet in fluid communication with the outlet of the evaporator and the outlet of the boiler and in which the flows of the working fluid from the evaporator and the boiler are mixed and the pressure of the working fluid is increased to at least the pressure of the condenser, the ejector inlet, located downstream from the axially extending core region, including a primary nozzle located sufficiently close to the outlet of the boiler to minimize a pressure drop between the boiler and the primary nozzle, the primary nozzle of the ejector including a converging section having an included angle and length preselected to receive the working fluid from the boiler as a near sonic velocity saturated vapor.« less

Forward sweep, low noise rotor blade

NASA Technical Reports Server (NTRS)

Brooks, Thomas F. (Inventor)

1994-01-01

A forward-swept, low-noise rotor blade includes an inboard section, an aft-swept section, and a forward-swept outboard section. The rotor blade reduces the noise of rotorcraft, including both standard helicopters and advanced systems such as tiltrotors. The primary noise reduction feature is the forward sweep of the planform over a large portion of the outer blade radius. The rotor blade also includes an aft-swept section. The purpose of the aft-swept region is to provide a partial balance to pitching moments produced by the outboard forward-swept portion of the blade. The noise source showing maximum noise reduction is blade-vortex interaction (BVI) noise. Also reduced are thickness, noise, high speed impulsive noise, cabin vibration, and loading noise.

Higher sensitivity secondary ion mass spectrometry of biological molecules for high resolution, chemically specific imaging.

PubMed

McDonnell, Liam A; Heeren, Ron M A; de Lange, Robert P J; Fletcher, Ian W

2006-09-01

To expand the role of high spatial resolution secondary ion mass spectrometry (SIMS) in biological studies, numerous developments have been reported in recent years for enhancing the molecular ion yield of high mass molecules. These include both surface modification, including matrix-enhanced SIMS and metal-assisted SIMS, and polyatomic primary ions. Using rat brain tissue sections and a bismuth primary ion gun able to produce atomic and polyatomic primary ions, we report here how the sensitivity enhancements provided by these developments are additive. Combined surface modification and polyatomic primary ions provided approximately 15.8 times more signal than using atomic primary ions on the raw sample, whereas surface modification and polyatomic primary ions yield approximately 3.8 and approximately 8.4 times more signal. This higher sensitivity is used to generate chemically specific images of higher mass biomolecules using a single molecular ion peak.

Socioeconomic status and geographical factors associated with active listing in primary care: a cross-sectional population study accounting for multimorbidity, age, sex and primary care.

PubMed

Ranstad, Karin; Midlöv, Patrik; Halling, Anders

2017-06-09

Socioeconomic status and geographical factors are associated with health and use of healthcare. Well-performing primary care contributes to better health and more adequate healthcare. In a primary care system based on patient's choice of practice, this choice (listing) is a key to understand the system. To explore the relationship between population and practices in a primary care system based on listing. Cross-sectional population-based study. Logistic regressions of the associations between active listing in primary care, income, education, distances to healthcare and geographical location, adjusting for multimorbidity, age, sex and type of primary care practice. Population over 15 years (n=123 168) in a Swedish county, Blekinge (151 731 inhabitants), in year 2007, actively or passively listed in primary care. The proportion of actively listed was 68%. Actively listed in primary care on 31 December 2007. Highest ORs for active listing in the model including all factors according to income had quartile two and three with OR 0.70 (95% CI 0.69 to 0.70), and those according to education less than 9 years of education had OR 0.70 (95% CI 0.68 to 0.70). Best odds for geographical factors in the same model had municipality C with OR 0.85 (95% CI 0.85 to 0.86) for active listing. Akaike's Information Criterion (AIC) was 124 801 for a model including municipality, multimorbidity, age, sex and type of practice and including all factors gave AIC 123 934. Higher income, shorter education, shorter distance to primary care or longer distance to hospital is associated with active listing in primary care.Multimorbidity, age, geographical location and type of primary care practice are more important to active listing in primary care than socioeconomic status and distance to healthcare. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

40 CFR 142.20 - State-issued variances and exemptions under Section 1415(a) and Section 1416 of the Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... State must consider the availability of an alternative source of water, including the feasibility of... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER... responsibility may issue variances to public water systems (other than small system variances) from the...

Self-management support for chronic pain in primary care: a cross-sectional study of patient experiences and nursing roles.

PubMed

Lukewich, Julia; Mann, Elizabeth; VanDenKerkhof, Elizabeth; Tranmer, Joan

2015-11-01

The aim of this study was to describe chronic pain self-management from the perspective of individuals living with chronic pain in the context of primary care nursing. Self-management is a key chronic pain treatment modality and support for self-managing chronic pain is mainly provided in the context of primary care. Although nurses are optimally suited to facilitate self-management in primary care, there is a need to explore opportunities for optimizing their roles. Two cross-sectional studies. The Chronic Pain Self-Management Survey was conducted in 2011-2012 to explore the epidemiology and self-management of chronic pain in Canadian adults. The questionnaire was distributed to 1504 individuals in Ontario. In 2011, the Primary Care Nursing Roles Survey was distributed to 1911 primary care nurses in Ontario to explore their roles and to determine the extent to which chronic disease management strategies, including support for self-management, were implemented in primary care. Few respondents to the pain survey identified nurses as being the 'most helpful' facilitator of self-management while physicians were most commonly cited. Seventy-six per cent of respondents used medication to manage their chronic pain. Few respondents to the nursing survey worked in practices with specific programmes for individuals with chronic pain. Individuals with chronic pain identified barriers and facilitators to self-managing their pain and nurses identified barriers and facilitators to optimizing their role in primary care. There are several opportunities for primary care practices to facilitate self-management of chronic pain, including the optimization of the primary care nursing role. © 2015 John Wiley & Sons Ltd.

Pyrylium Salts as Reactive Matrices for MALDI-MS Imaging of Biologically Active Primary Amines

NASA Astrophysics Data System (ADS)

Shariatgorji, Mohammadreza; Nilsson, Anna; Källback, Patrik; Karlsson, Oskar; Zhang, Xiaoqun; Svenningsson, Per; Andren, Per E.

2015-06-01

Many neuroactive substances, including endogenous biomolecules, environmental compounds, and pharmaceuticals possess primary amine functional groups. Among these are catecholamine neurotransmitters (e.g., dopamine), many substituted phenethylamines (e.g., amphetamine), as well as amino acids and neuropeptides. In most cases, mass spectrometric (ESI and MALDI) analyses of trace amounts of such compounds are challenging because of their poor ionization properties. We present a method for chemical derivatization of primary amines by reaction with pyrylium salts that facilitates their detection by MALDI-MS and enables the imaging of primary amines in brain tissue sections. A screen of pyrylium salts revealed that the 2,4-diphenyl-pyranylium ion efficiently derivatizes primary amines and can be used as a reactive MALDI-MS matrix that induces both derivatization and desorption. MALDI-MS imaging with such matrix was used to map the localization of dopamine and amphetamine in brain tissue sections and to quantitatively map the distribution of the neurotoxin β- N-methylamino-L-alanine.

Computational study of duct and pipe flows using the method of pseudocompressibility

NASA Technical Reports Server (NTRS)

Williams, Robert W.

1991-01-01

A viscous, three-dimensional, incompressible, Navier-Stokes Computational Fluid Dynamics code employing pseudocompressibility is used for the prediction of laminar primary and secondary flows in two 90-degree bends of constant cross section. Under study are a square cross section duct bend with 2.3 radius ratio and a round cross section pipe bend with 2.8 radius ratio. Sensitivity of predicted primary and secondary flow to inlet boundary conditions, grid resolution, and code convergence is investigated. Contour and velocity versus spanwise coordinate plots comparing prediction to experimental data flow components are shown at several streamwise stations before, within, and after the duct and pipe bends. Discussion includes secondary flow physics, computational method, computational requirements, grid dependence, and convergence rates.

Emotion as the Amplifier and the Primary Motive: Some Theories of Emotion with Relevance to Language Learning

ERIC Educational Resources Information Center

Oxford, Rebecca L.

2015-01-01

Emotion is crucial to living and learning. The powerful intertwining of emotion and cognition ignites learning within a complex dynamic system, which, as several sections of this paper show, also includes societal and cultural influences. As "the primary human motive" (MacIntyre, 2002a, p. 61), emotion operates as an amplifier, which…

Apollo experience report guidance and control systems: Primary guidance, navigation, and control system development

NASA Technical Reports Server (NTRS)

Holley, M. D.; Swingle, W. L.; Bachman, S. L.; Leblanc, C. J.; Howard, H. T.; Biggs, H. M.

1976-01-01

The primary guidance, navigation, and control systems for both the lunar module and the command module are described. Development of the Apollo primary guidance systems is traced from adaptation of the Polaris Mark II system through evolution from Block I to Block II configurations; the discussion includes design concepts used, test and qualification programs performed, and major problems encountered. The major subsystems (inertial, computer, and optical) are covered. Separate sections on the inertial components (gyroscopes and accelerometers) are presented because these components represent a major contribution to the success of the primary guidance, navigation, and control system.

Curricular Guidelines in Gross Anatomy.

ERIC Educational Resources Information Center

Horn, Stanton D.; And Others

1981-01-01

An outline of AADS curricular guidelines for gross anatomy in dental education includes primary educational goals, prerequisites, core content, specific course objectives for each section of content, sequencing, faculty requirements, and facility and equipment needs. (MSE)

The Teaching-Learning Strategy of the Primary Science Project of the Science Education Programme for Africa. IIEP Seminar Paper 30.

ERIC Educational Resources Information Center

Dyasi, Hubert M.

This paper is concerned with the teaching-learning strategy of the Primary Science Project of the Science Education Program for Africa. It was presented in the 1976 seminar of the International Institute for Educational Planning (IIEP) of the UNESCO in Paris. The document includes six sections: (1) The concept of a strategy; (2) Description of the…

CW (Continuous Wave) Measurement System. Operating Manual

DTIC Science & Technology

1982-08-02

A probe calibration program for probes with analyti- cal transfer functions . Such probes include the EG&G MGL series of B-dot field sensors. Non ...response to the SIGNAL PROBE> prompt in the primary menu which appears during calibration of a non -analytic probe (see Section 5-3.2 for more...OPERATION AND CALIBRATION .......... 107 4-2.1 Operation in the Primary Configu- ration .............................. 107 4-2.2 Operation in the Secondary

Instrumental Music for Dyslexics: A Teaching Handbook. Second Edition.

ERIC Educational Resources Information Center

Oglethorpe, Sheila

This book is a guide for music teachers whose students of instrumental keyboard music include those with dyslexia. Chapter 1 is on recognizing dyslexia, including primary and secondary symptoms, multisensory teaching, and teaching to strengths. Chapter 2 focuses on communication between pupil and teacher with sections on music as communication and…

14 CFR Section 8 - General

Code of Federal Regulations, 2010 CFR

2010-01-01

... Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS... and infrequent occurrence. (7) Cumulative effect of changes in accounting principles. This primary classification (9800) shall include the cumulative effect of material changes in accounting principles. [ER-755...

Wide acceptance angle, high concentration ratio, optical collector

NASA Technical Reports Server (NTRS)

Kruer, Mark A. (Inventor)

1991-01-01

A cassegrain optical system provides improved collection of off-axis light yet is still characterized by a high concentration ratio. The optical system includes a primary mirror for collecting incoming light and reflecting the light to a secondary mirror which, in turn, reflects the light to a solar cell or other radiation collection device. The primary mirror reflects incoming on-axis light onto an annular section of the secondary mirror and results in the reflection of a substantial amount of incoming off-axis light onto the remainder of the secondary mirror. Thus light which would otherwise be lost to the system will be captured by the collector. Furthermore, the off-axis sections of the secondary mirror may be of a different geometrical shape than the on-axis annular section so as to optimize the amount of off-axis light collected.

Energy profiles of selected Latin American and Caribbean countries. Report series No. 2

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

Wu, K.

1994-07-01

Countries in this report include Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, Trinidad and Tobago, and Venezuela. These ten countries are the most important oil and gas producers in the Latin American and the Caribbean region. In the following sections, the primary energy supply (oil, gas, coal, hydroelectricity, and nuclear power whenever they are applicable), primary energy consumption, downstream oil sector development, gas utilization are discussed for each of the ten countries. The report also presents our latest forecasts of petroleum product consumption in each country toward 2000, which form the basis of the outlook for regional energy productionmore » and consumption outlined in Report No 1. Since the bulk of primary energy supply and demand is hydrocarbons for many countries, brief descriptions of the important hydrocarbons policy issues are provided at the end of the each country sections.« less

40 CFR 141.806 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 141.806 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Aircraft Drinking Water Rule § 141.806 Reporting... and routine disinfection and flushing frequency must be included in the aircraft water system...

Wireless power transfer system

DOEpatents

Wu, Hunter; Sealy, Kylee; Gilchrist, Aaron

2016-02-23

A system includes a first stage of an inductive power transfer system with an LCL load resonant converter with a switching section, an LCL tuning circuit, and a primary receiver pad. The IPT system includes a second stage with a secondary receiver pad, a secondary resonant circuit, a secondary rectification circuit, and a secondary decoupling converter. The secondary receiver pad connects to the secondary resonant circuit. The secondary resonant circuit connects to the secondary rectification circuit. The secondary rectification circuit connects to the secondary decoupling converter. The second stage connects to a load. The load includes an energy storage element. The second stage and load are located on a vehicle and the first stage is located at a fixed location. The primary receiver pad wirelessly transfers power to the secondary receiver pad across a gap when the vehicle positions the secondary receiver pad with respect to the primary receiver pad.

34 CFR 99.7 - What must an educational agency or institution include in its annual notification?

Code of Federal Regulations, 2014 CFR

2014-07-01

... or secondary education shall effectively notify parents who have a primary or home language other... 34 Education 1 2014-07-01 2014-07-01 false What must an educational agency or institution include in its annual notification? 99.7 Section 99.7 Education Office of the Secretary, Department of...

34 CFR 99.7 - What must an educational agency or institution include in its annual notification?

Code of Federal Regulations, 2013 CFR

2013-07-01

... or secondary education shall effectively notify parents who have a primary or home language other... 34 Education 1 2013-07-01 2013-07-01 false What must an educational agency or institution include in its annual notification? 99.7 Section 99.7 Education Office of the Secretary, Department of...

34 CFR 99.7 - What must an educational agency or institution include in its annual notification?

Code of Federal Regulations, 2012 CFR

2012-07-01

... or secondary education shall effectively notify parents who have a primary or home language other... 34 Education 1 2012-07-01 2012-07-01 false What must an educational agency or institution include in its annual notification? 99.7 Section 99.7 Education Office of the Secretary, Department of...

34 CFR 99.7 - What must an educational agency or institution include in its annual notification?

Code of Federal Regulations, 2011 CFR

2011-07-01

... or secondary education shall effectively notify parents who have a primary or home language other... 34 Education 1 2011-07-01 2011-07-01 false What must an educational agency or institution include in its annual notification? 99.7 Section 99.7 Education Office of the Secretary, Department of...

Does advanced operative obstetrics still have a place in contemporary practice?

PubMed

Tempest, Nicola; Navaratnam, Kate; Hapangama, Dharani Kosala

2015-04-01

This article reviews recent significant contributions to the literature concerning advanced operative obstetric procedures used for rotational vaginal deliveries and their alternative, primary caesarean section. Rising caesarean section rates are a global concern. Caesarean section in the second stage of labour is associated with high rates of maternal and fetal morbidity. Rotational vaginal deliveries may reduce the caesarean section rate without additional adverse effects on maternal and fetal outcomes. A recent national trainees' survey highlighted that training in the management of operative birth in the second stage of labour, especially when there is malposition of the fetal head, is a priority. There is a need for evidence-based guidelines, including standardized documentation of these advanced procedures. Training strategies for junior practitioners to acquire these skills and for experienced practitioners to maintain and disseminate their skills should be prioritized. The safety of rotational delivery methods versus primary caesarean section is likely to prove difficult to assess directly, in the context of a randomized controlled trial, but may be approximated via a national prospective audit.

The Multi-County Regional Educational Service Agency in Iowa. Part I, Section 1 (Chapters I-IV), The Intermediate Unit of School Administration in the United States. Final Report.

ERIC Educational Resources Information Center

Stephens, E. Robert; And Others

An extensive study, reported in three separately published sections, was made to determine primary aspects of the current consolidation and redistricting of local school districts. Basic procedures used to gather information included a survey of related literature, visitations to county and intermediate educational agencies in Iowa and other…

Outcomes Definitions and Statistical Tests in Oncology Studies: A Systematic Review of the Reporting Consistency.

PubMed

Rivoirard, Romain; Duplay, Vianney; Oriol, Mathieu; Tinquaut, Fabien; Chauvin, Franck; Magne, Nicolas; Bourmaud, Aurelie

2016-01-01

Quality of reporting for Randomized Clinical Trials (RCTs) in oncology was analyzed in several systematic reviews, but, in this setting, there is paucity of data for the outcomes definitions and consistency of reporting for statistical tests in RCTs and Observational Studies (OBS). The objective of this review was to describe those two reporting aspects, for OBS and RCTs in oncology. From a list of 19 medical journals, three were retained for analysis, after a random selection: British Medical Journal (BMJ), Annals of Oncology (AoO) and British Journal of Cancer (BJC). All original articles published between March 2009 and March 2014 were screened. Only studies whose main outcome was accompanied by a corresponding statistical test were included in the analysis. Studies based on censored data were excluded. Primary outcome was to assess quality of reporting for description of primary outcome measure in RCTs and of variables of interest in OBS. A logistic regression was performed to identify covariates of studies potentially associated with concordance of tests between Methods and Results parts. 826 studies were included in the review, and 698 were OBS. Variables were described in Methods section for all OBS studies and primary endpoint was clearly detailed in Methods section for 109 RCTs (85.2%). 295 OBS (42.2%) and 43 RCTs (33.6%) had perfect agreement for reported statistical test between Methods and Results parts. In multivariable analysis, variable "number of included patients in study" was associated with test consistency: aOR (adjusted Odds Ratio) for third group compared to first group was equal to: aOR Grp3 = 0.52 [0.31-0.89] (P value = 0.009). Variables in OBS and primary endpoint in RCTs are reported and described with a high frequency. However, statistical tests consistency between methods and Results sections of OBS is not always noted. Therefore, we encourage authors and peer reviewers to verify consistency of statistical tests in oncology studies.

Outcomes Definitions and Statistical Tests in Oncology Studies: A Systematic Review of the Reporting Consistency

PubMed Central

Rivoirard, Romain; Duplay, Vianney; Oriol, Mathieu; Tinquaut, Fabien; Chauvin, Franck; Magne, Nicolas; Bourmaud, Aurelie

2016-01-01

Background Quality of reporting for Randomized Clinical Trials (RCTs) in oncology was analyzed in several systematic reviews, but, in this setting, there is paucity of data for the outcomes definitions and consistency of reporting for statistical tests in RCTs and Observational Studies (OBS). The objective of this review was to describe those two reporting aspects, for OBS and RCTs in oncology. Methods From a list of 19 medical journals, three were retained for analysis, after a random selection: British Medical Journal (BMJ), Annals of Oncology (AoO) and British Journal of Cancer (BJC). All original articles published between March 2009 and March 2014 were screened. Only studies whose main outcome was accompanied by a corresponding statistical test were included in the analysis. Studies based on censored data were excluded. Primary outcome was to assess quality of reporting for description of primary outcome measure in RCTs and of variables of interest in OBS. A logistic regression was performed to identify covariates of studies potentially associated with concordance of tests between Methods and Results parts. Results 826 studies were included in the review, and 698 were OBS. Variables were described in Methods section for all OBS studies and primary endpoint was clearly detailed in Methods section for 109 RCTs (85.2%). 295 OBS (42.2%) and 43 RCTs (33.6%) had perfect agreement for reported statistical test between Methods and Results parts. In multivariable analysis, variable "number of included patients in study" was associated with test consistency: aOR (adjusted Odds Ratio) for third group compared to first group was equal to: aOR Grp3 = 0.52 [0.31–0.89] (P value = 0.009). Conclusion Variables in OBS and primary endpoint in RCTs are reported and described with a high frequency. However, statistical tests consistency between methods and Results sections of OBS is not always noted. Therefore, we encourage authors and peer reviewers to verify consistency of statistical tests in oncology studies. PMID:27716793

Curricular Guidelines for Neuroanatomy.

ERIC Educational Resources Information Center

Journal of Dental Education, 1981

1981-01-01

Presented are the curricular guidelines for Neuroanatomy developed by the Section on Anatomical Sciences of the American Association of Dental Schools for use by individual educational institutions as curriculum development aids. Included are recommendations for primary educational goals, prerequisites, scope, content, behavioral objectives,…

QUANTITATIVE ASSESSMENT OF PATHOGENS IN DRINKING WATER

EPA Science Inventory

The project has been summarized in a series of peer-reviewed published papers as outlined in the Publication section of this report. Pathogens capable of causing waterborne diseases include bacteria, protozoa, and viruses. Fecal indicator bacteria are the primary microorganisms u...

Science Education Newsletter, No. 51.

ERIC Educational Resources Information Center

British Council, London (England).

A variety of science and mathematics education activities are reported in two sections. These activities include: conferences (both past and future); innovative projects/programs and initiatives at the primary, secondary, and teacher-education levels; instructional materials development/use; instructional strategies; science education research;…

A new rapid immunohistochemical staining technique using the EnVision antibody complex.

PubMed

Kämmerer, U; Kapp, M; Gassel, A M; Richter, T; Tank, C; Dietl, J; Ruck, P

2001-05-01

Rapid immunohistochemical investigation, in addition to staining with hematoxylin and eosin, would be useful during intraoperative frozen section diagnosis in some cases. This study was undertaken to investigate whether the recently described EnVision system, a highly sensitive two-step immunohistochemical technique, could be modified for rapid immunostaining of frozen sections. Forty-five primary antibodies were tested on frozen sections from various different tissues. After fixation in acetone for 1 min and air-drying, the sections were incubated for 3 min each with the primary antibody, the EnVision complex (a large number of secondary antibodies and horseradish peroxidase coupled to a dextran backbone), and the chromogen (3,3'diaminobenzidine or 3-amino-9-ethylcarbazole). All reactions were carried out at 37C. Specific staining was seen with 38 antibodies (including HMB-45 and antibodies against keratin, vimentin, leukocyte common antigen, smooth muscle actin, synaptophysin, CD34, CD3, CD20, and prostate-specific antigen). A modification of the EnVision method allows the detection of a broad spectrum of antigens in frozen sections in less than 13 min. This method could be a useful new tool in frozen section diagnosis and research. (J Histochem Cytochem 49:623-630, 2001)

Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis.

PubMed

Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Gómez-Urquiza, Jose L; Albendín-García, Luis; Aguayo, Raimundo; Cañadas-De la Fuente, Guillermo A

2018-05-10

burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses. We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017. After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment. Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.

Fetal head circumference, operative delivery, and fetal outcomes: a multi-ethnic population-based cohort study

PubMed Central

2013-01-01

Background Operative delivery procedures, such as primary cesarean section, vacuum-assisted, and forceps-assisted vaginal delivery increase maternal and fetal morbidity, and the cost of care. We evaluated whether large fetal head circumference (FHC) independently increases risk of such interventions, as well as fetal distress or low Apgar score, in anatomically normal infants. Methods We conducted a population-based retrospective cohort study using Washington State birth certificate data. We included singleton, term infants born to nulliparous mothers from 2003–2009. We compared mode of delivery and fetal outcomes in 10,750 large-FHC (37-41 cm) infants relative to 10,750 average-FHC (34 cm) infants, frequency matched by birth-year. Results Large-FHC infants were nearly twice as likely to be delivered by primary cesarean section as average-FHC infants (unadjusted relative risk [RR] 1.84, 95% confidence interval [CI]: 1.77, 1.92). The RR for primary cesarean section associated with large-FHC was largest for mothers aged 19 years or less (RR 2.28; 95% CI: 1.99, 2.61), and smallest for mothers aged 35 years or greater (RR 1.51; 95% CI: 1.37, 1.66) [test of homogeneity, p < 0.001]. Large-FHC infants were at increased risk of vacuum-assisted vaginal delivery (RR 1.55; 95% CI: 1.43, 1.69), and forceps-assisted vaginal delivery (RR 1.61; 95% CI: 1.32, 1.97). There was no difference in risk of fetal distress (RR 0.97; 95% CI: 0.89, 1.07) for large-FHC versus average-FHC infants. Risk estimates were unaffected by adjustment for potential confounders. Conclusions Nulliparous mothers of large-FHC infants are at increased risk of primary cesarean section, vacuum-assisted and forceps-assisted vaginal delivery relative to mothers of average-FHC infants. Maternal age modifies the association between FHC and primary cesarean section. PMID:23651454

Role of radiology in the management of primary aldosteronism.

PubMed

Patel, Shilpan M; Lingam, Ravi K; Beaconsfield, Tina I; Tran, Tan L; Brown, Beata

2007-01-01

The diagnosis of primary aldosteronism, the most common form of secondary hypertension, is based on clinical and biochemical features. Although radiology plays no role in the initial diagnosis, it has an important role in differentiating between the two main causes of primary aldosteronism: aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). This distinction is important because APAs are generally managed surgically and BAH medically. Adrenal venous sampling is considered the standard of reference for determining the cause of primary aldosteronism but is technically demanding, operator dependent, costly, and time consuming, with a low but significant complication rate. Other imaging modalities, including computed tomography, magnetic resonance imaging, and adrenal scintigraphy, have also been used to determine the cause of primary aldosteronism. Cross-sectional imaging has traditionally focused on establishing the diagnosis of an APA, with that of BAH being one of exclusion. A high specificity for detecting an APA is desirable, since it will avert unnecessary surgery in patients with BAH. However, an overreliance on cross-sectional imaging can lead to the incorrect treatment of affected patients, mainly due to the wide variation in the reported diagnostic performance of these modalities. A combination of modalities is usually required to confidently determine the cause of primary aldosteronism. The quest for optimal radiologic management of primary aldosteronism continues just over a half century since this disease entity was first described. RSNA, 2007

47 CFR 36.361 - Depreciation and amortization expenses-Account 6560.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 6560. 36.361 Section 36.361 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON... expenses—Account 6560. (a) This account includes the depreciation expenses for telecommunications plant in... basis of the separation of the associated primary Plant Accounts or related categories. Customer...

23 CFR 657.13 - Certification requirement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Certification requirement. 657.13 Section 657.13 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS... Primary, Secondary, and Urban Systems, including the Interstate System, in accordance with 23 U.S.C. 127...

47 CFR 36.361 - Depreciation and amortization expenses-Account 6560.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 6560. 36.361 Section 36.361 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON... expenses—Account 6560. (a) This account includes the depreciation expenses for telecommunications plant in... basis of the separation of the associated primary Plant Accounts or related categories. Customer...

40 CFR 141.807 - Recordkeeping requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 141.807 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Aircraft Drinking Water Rule § 141.807 Recordkeeping... carrier must keep records of any disinfection and flushing for at least 5 years and must include the...

40 CFR 141.807 - Recordkeeping requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 141.807 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Aircraft Drinking Water Rule § 141.807 Recordkeeping... carrier must keep records of any disinfection and flushing for at least 5 years and must include the...

40 CFR 141.807 - Recordkeeping requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 141.807 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Aircraft Drinking Water Rule § 141.807 Recordkeeping... carrier must keep records of any disinfection and flushing for at least 5 years and must include the...

40 CFR 141.807 - Recordkeeping requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 141.807 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Aircraft Drinking Water Rule § 141.807 Recordkeeping... carrier must keep records of any disinfection and flushing for at least 5 years and must include the...

40 CFR 141.807 - Recordkeeping requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 141.807 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Aircraft Drinking Water Rule § 141.807 Recordkeeping... carrier must keep records of any disinfection and flushing for at least 5 years and must include the...

International Primary Care Respiratory Group (IPCRG) Guidelines: management of asthma.

PubMed

van der Molen, Thys; Østrem, Anders; Stallberg, Bjorn; Østergaard, Marianne Stubbe; Singh, Raj B

2006-02-01

Worldwide, most patients with asthma are treated in primary care. Optimal primary care management of asthma is therefore of considerable importance. This IPCRG Guideline paper on the management of asthma in primary care is fully consistent with GINA guidelines. It is split into two sections, the first on the management of adults and schoolchildren, and the second on the management of pre-school children. It highlights the treatment goals for asthma and gives an overview of optimal management including the topics which should be covered by the primary care health professional when educating a patient about asthma. It covers the classification of the disease, the stepwise approach to pharmacologic therapy, disease monitoring, the management of exacerbations, and the identification of patients at risk of asthma death.

Early Adolescence to Early Adulthood: Volume 5, The Best of ACLD. Selected Papers from the International Conference of the Association for Children and Adults with Learning Disabilities (20th, Washington, District of Columbia, 1983). First Edition.

ERIC Educational Resources Information Center

Cruickshank, William M., Ed.; Kliebhan, Joanne Marie, Ed.

Fifteen author-contributed papers focus on the learning disabled adolescent and young adult. The first section provides a general overview while subsequent sections address educational and social techniques, steps to employment, and programs for adolescents. The following titles and authors are included: "Prevention: Primary, Secondary, or…

Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note.

PubMed

Koopman, Richelle J; Steege, Linsey M Barker; Moore, Joi L; Clarke, Martina A; Canfield, Shannon M; Kim, Min S; Belden, Jeffery L

2015-01-01

Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers. The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter. Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer. © Copyright 2015 by the American Board of Family Medicine.

Modification and benchmarking of MCNP for low-energy tungsten spectra.

PubMed

Mercier, J R; Kopp, D T; McDavid, W D; Dove, S B; Lancaster, J L; Tucker, D M

2000-12-01

The MCNP Monte Carlo radiation transport code was modified for diagnostic medical physics applications. In particular, the modified code was thoroughly benchmarked for the production of polychromatic tungsten x-ray spectra in the 30-150 kV range. Validating the modified code for coupled electron-photon transport with benchmark spectra was supplemented with independent electron-only and photon-only transport benchmarks. Major revisions to the code included the proper treatment of characteristic K x-ray production and scoring, new impact ionization cross sections, and new bremsstrahlung cross sections. Minor revisions included updated photon cross sections, electron-electron bremsstrahlung production, and K x-ray yield. The modified MCNP code is benchmarked to electron backscatter factors, x-ray spectra production, and primary and scatter photon transport.

Optical source and apparatus for remote sensing

NASA Technical Reports Server (NTRS)

Coyle, Donald Barry (Inventor)

2011-01-01

An optical amplifier is configured to amplify an injected seed optical pulse. The optical amplifier may include two or more gain sections coupled to form a continuous solid waveguide along a primary optical path. Each gain section may include: (i) an optical isolator forming an input to that gain section; (ii) a doped optical fiber having a first end coupled to the optical isolator and having a second end; (iii) a plurality of pump laser diodes; (iv) a controller providing drive signals to each of the plurality, the controller being configured to provide at least pulsed drive signals; and (v) an optical coupler having a first input port coupled to the second end, and a second input port coupled to the plurality and an output port.

23 CFR 657.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Purpose. 657.1 Section 657.1 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS CERTIFICATION OF SIZE AND WEIGHT... part of the Federal-aid primary, Federal-aid secondary, or Federal-aid urban systems, including the...

40 CFR 35.298 - Award limitations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... STATE AND LOCAL ASSISTANCE Environmental Program Grants State Indoor Radon Grants (section 306) § 35.298 Award limitations. (a) The Regional Administrator shall not include State Indoor Radon funds in a... has the primary responsibility for radon programs as designated by the Governor of the affected State...

[Incorporation of Information and Communication Technologies and quality of primary healthcare in Brazil].

PubMed

Santos, Alaneir de Fátima Dos; Fonseca, Délcio; Araujo, Lucas Lobato; Procópio, Cristiane da Silva Diniz; Lopes, Érica Araújo Silva; Lima, Angela Maria de Lourdes Dayrell de; Reis, Clarice Magalhães Rodrigues Dos; Abreu, Daisy Maria Xavier de; Jorge, Alzira Oliveira; Matta-Machado, Antonio Thomaz

2017-06-05

Information and Communication Technologies (ICTs) are means to handle information, streamline communication, and contribute to patient care. This article describes the incorporation of Information and Communication Technologies in primary care and its association with quality, based on the Brazilian National Program for the Improvement of Access and Quality in Primary Care (PMAQ in portuguese). This was a cross-sectional study with 17,053 teams. An Index of Incorporation of ICTs was created, which included: information infrastructure, systems, and utilization. Regression analysis was used to assess associations. Only 13.5% of the teams had a high degree of ICTs. The strongest association was seen in the utilization of information. ICTs can contribute to improving quality of primary care.

Historical seismicity in the Middle East: new insights from Ottoman primary sources (sixteenth to mid-eighteenth centuries)

NASA Astrophysics Data System (ADS)

Tülüveli, Güçlü

2015-10-01

Considerable academic effort has been given to chart the history of the seismic activity in Middle East region. This short survey intends to contribute to these scientific attempts by analyzing Ottoman primary sources. There had been previous studies which utilized similar primary sources from Ottoman archives, yet 15 new earthquakes emerged from these sources. Moreover, the seismic impact of five known earthquakes will be analyzed in the light of new data from Ottoman primary sources. A possible tsunami case is also included in this section. The sources cover the period between sixteenth to the end of the eighteenth century. This article intends to foster interdisciplinary dialogue for the purpose of initiating further detailed studies on past seismic events.

Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review.

PubMed

Pfarrwaller, Eva; Sommer, Johanna; Chung, Christopher; Maisonneuve, Hubert; Nendaz, Mathieu; Junod Perron, Noëlle; Haller, Dagmar M

2015-09-01

Increasing the attractiveness of primary care careers is a key step in addressing the growing shortage of primary care physicians. The purpose of this review was to (1) identify interventions aimed at increasing the proportion of undergraduate medical students choosing a primary care specialty, (2) describe the characteristics of these interventions, (3) assess the quality of the studies, and (4) compare the findings to those of a previous literature review within a global context. We searched MEDLINE, EMBASE, ERIC, CINAHL, PsycINFO, The Cochrane Library, and Dissertations & Theses A&I for articles published between 1993 and February 20, 2015. We included quantitative and qualitative studies reporting on primary care specialty choice outcomes of interventions in the undergraduate medical curriculum, without geographic restrictions. Data extracted included study characteristics, intervention details, and relevant outcomes. Studies were assessed for quality and strength of findings using a five-point scale. The review included 72 articles reporting on 66 different interventions. Longitudinal programs were the only intervention consistently associated with an increased proportion of students choosing primary care. Successful interventions were characterized by diverse teaching formats, student selection, and good-quality teaching. Study quality had not improved since recommendations were published in 1995. Many studies used cross-sectional designs and non-validated surveys, did not include control groups, and were not based on a theory or conceptual framework. Our review supports the value of longitudinal, multifaceted, primary care programs to increase the proportion of students choosing primary care specialties. Isolated modules or clerkships did not appear to be effective. Our results are in line with the conclusions from previous reviews and add an international perspective, but the evidence is limited by the overall low methodological quality of the included studies. Future research should use more rigorous evaluation methods and include long-term outcomes.

Development and validation of the ExPRESS instrument for primary health care providers' evaluation of external supervision.

PubMed

Schriver, Michael; Cubaka, Vincent Kalumire; Vedsted, Peter; Besigye, Innocent; Kallestrup, Per

2018-01-01

External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. "External supervision: Provider Evaluation of Supervisor Support" (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test-retest design, the second for confirmatory factor analysis. We included 16 items in section A ('The most recent experience with an external supervisor'), and 13 items in section B ('The overall experience with external supervisors'). Item-content validity index was acceptable. In field test I, test-retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.

Revised geologic cross sections of parts of the Colorado, White River, and Death Valley regional groundwater flow systems, Nevada, Utah, and Arizona

USGS Publications Warehouse

Page, William R.; Scheirer, Daniel S.; Langenheim, V.E.; Berger, Mary A.

2006-01-01

This report presents revisions to parts of seven of the ten cross sections originally published in U.S. Geological Survey Open-File Report 2006-1040. The revisions were necessary to correct errors in some of the original cross sections, and to show new parts of several sections that were extended and (or) appended to the original section profiles. Revisions were made to cross sections C-C', D-D', E-E', F-F', G-G', I-I', and J-J', and the parts of the sections revised or extended are highlighted below the sections on plate 1 by red brackets and the word "revised," or "extended." Sections not listed above, as well as the interpretive text and figures, are generally unchanged from the original report. Cross section C-C' includes revisions in the east Mormon Mountains in the east part of the section; D-D' includes revisions in the Mormon Mesa area in the east part of the section; E-E' includes revisions in the Muddy Mountains in the east part of the section; F-F' includes revisions from the Muddy Mountains to the south Virgin Mountains in the east part of the section; and J-J' includes some revisions from the east Mormon Mountains to the Virgin Mountains. The east end of G-G' was extended about 16 km from the Black Mountains to the southern Virgin Mountains, and the northern end of I-I' was extended about 45 km from the Muddy Mountains to the Mormon Mountains, and revisions were made in the Muddy Mountains part of the original section. This report contains 10 interpretive cross sections and an integrated text describing the geology of parts of the Colorado, White River, and Death Valley regional groundwater flow systems in Nevada, Utah, and Arizona. The primary purpose of the report is to provide geologic framework data for input into a numerical groundwater model. Therefore, the stratigraphic and structural summaries are written in a hydrogeologic context. The oldest rocks (basement) are Early Proterozoic metamorphic and intrusive crystalline rocks that are considered confining units because of their low permeability. Late Proterozoic to Lower Cambrian clastic units overlie the crystalline rocks and are also considered confining units within the regional flow systems. Above the clastic units are Middle Cambrian to Lower Permian carbonate rocks that are the primary aquifers in the flow systems. The Middle Cambrian to Lower Permian carbonate rocks are overlain by a sequence of mainly clastic rocks of late Paleozoic to Mesozoic age that are mostly considered confining units, but they may be permeable where faulted. Tertiary volcanic and plutonic rocks are exposed in the northern and southern parts of the study area. In the Clover and Delamar Mountains, these rocks are highly deformed by north- and northwest-striking normal and strike-slip faults that are probably important conduits in transmitting groundwater from the basins in the northern Colorado and White River flow systems to basins in the southern part of the flow systems. The youngest rocks in the region are Tertiary to Quaternary basin-fill deposits. These rocks consist of middle to late Tertiary sediments consisting of limestone, conglomerate, sandstone, tuff, and gypsum, and younger Quaternary surficial units consisting of alluvium, colluvium, playa deposits, and eolian deposits. Basin-fill deposits are both aquifers and aquitards. The rocks in the study area were complexly deformed by episodes of Mesozoic compression and Cenozoic extensional tectonism. Some Cretaceous thrust faults and folds of the Sevier orogenic belt form duplex zones and define areas of maximum thickness for the Paleozoic carbonate rocks. Cenozoic faults are important because they are the primary structures that control groundwater flow in the regional flow systems.

Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review.

PubMed

Turton, Jessica L; Raab, Ron; Rooney, Kieron B

2018-01-01

Type 1 diabetes is an autoimmune condition characterised by pancreatic beta cell destruction and absolute insulin deficiency. The strongest predictor of diabetes complications is glycaemic control and achieving HbA1c ≤ 7.0% is the primary management target. However, standard treatment appears to be lacking and adjunctive strategies require consideration. A systematic review was conducted to examine the effect of low-carbohydrate diets on type 1 diabetes management. Four databases were searched from inception until 28 March 2017: MEDLINE; CINAHL; Cochrane Library; and EMBASE. All primary studies containing a methods section (excluding cross-sectional) were included. Reports had to quantitatively measure the effect(s) of a dietary intervention or observed intake over at least two weeks where carbohydrate is below 45% total energy in adults and/or children with type 1 diabetes. The primary outcome was HbA1c and secondary outcomes were severe hypoglycaemia, total daily insulin, BMI, quality of life and mean daily glucose. Seventy-nine full-text articles were assessed for eligibility and nine were included (two randomised controlled trials, four pre-post interventions, two case-series, one case-report). Eight studies reported a mean change in HbA1c with a low-carbohydrate diet. Of these, four reported a non-significant change (P ≥ 0.05) and three reported statistically significant reductions (P < 0.05). Two studies reported severe hypoglycaemia, five reported total insulin, three reported BMI, and one reported blood glucose. Due to the significant heterogeneity of included studies, an overall effect could not be determined. This review presents all available evidence on low-carbohydrate diets for type 1 diabetes and suggests an urgent need for more primary studies.

30 CFR 816.151 - Primary roads.

Code of Federal Regulations, 2011 CFR

2011-07-01

... accordance with the approved plan. (b) Safety Factor. Each primary road embankment shall have a minimum... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Primary roads. 816.151 Section 816.151 Mineral... roads. Primary roads shall meet the requirements of section 816.150 and the additional requirements of...

Hair treatment process providing dispersed colors by light diffraction

DOEpatents

Sutton, Richard Matthew Charles; Lamartine, Bruce Carvell; Orler, E. Bruce; Song, Shuangqi

2015-12-22

A hair treatment process for providing dispersed colors by light diffraction including (a) coating the hair with a material comprising a polymer, (b) pressing the hair with a pressing device including one or more surfaces, and (c) forming a secondary nanostructured surface pattern on the hair that is complementary to the primary nanostructured surface pattern on the one or more surfaces of the pressing device. The secondary nanostructured surface pattern diffracts light into dispersed colors that are visible on the hair. The section of the hair is pressed with the pressing device for from about 1 to 55 seconds. The polymer has a glass transition temperature from about 55.degree. C. to about 90.degree. C. The one or more surfaces include a primary nanostructured surface pattern.

Whole Language Discovery Activities for the Primary Grades.

ERIC Educational Resources Information Center

Riley, Margaret C.; Coe, Donna L.

For the K-3 teacher, this book presents hundreds of ready-to-use individual and group activities for developing reading, writing, listening, and speaking skills, all correlated with other curriculum areas and organized into nine monthly sections. The book includes teaching strategies, individual and group games, activity sheets, quizzes, writing…

Language Experiences. Developmental Skills Series, Booklet IV.

ERIC Educational Resources Information Center

University City School District, MO.

GRADES OR AGES: Not specified. It appears to be for kindergarten and primary grades. SUBJECT MATTER: Language and speech, including language patterns, accurate expression of ideas, creative expression of ideas, connection of sound with symbols, and speech improvement. ORGANIZATION AND PHYSICAL APPEARANCE: The guide is divided into five sections,…

Marketing the Arts: A Selected and Annotated Bibliography.

ERIC Educational Resources Information Center

Nakamoto, Kent, Comp.; Levin, Kathi, Comp.

Compiled from the marketing, arts, and arts management literature, this selected list includes materials ranging from theoretical articles and reports of studies to practical guides for marketing techniques. It consists of three sections: Primary Sources, Secondary Sources, and Surveys. Of particular interest to the arts administrator, the first…

The American Indian Digest.

ERIC Educational Resources Information Center

Russell, George

This guide provides a basic source of historical and contemporary Indian information from an American Indian perspective and includes study questions at the end of each section. The primary function of this guide is to be a quick-study reference handbook. Basic questions essential to understanding current problems and issues of American Indians…

16 CFR 1702.8 - Human experience data.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Human experience data. 1702.8 Section 1702.8... REQUIREMENTS § 1702.8 Human experience data. Human experience data constitutes the primary criterion used by... of all reasonably available reports pertaining to human use of the particular substance, including...

16 CFR § 1702.8 - Human experience data.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Human experience data. § 1702.8 Section Â... AND REQUIREMENTS § 1702.8 Human experience data. Human experience data constitutes the primary... compilation of all reasonably available reports pertaining to human use of the particular substance, including...

16 CFR 1702.8 - Human experience data.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Human experience data. 1702.8 Section 1702.8... REQUIREMENTS § 1702.8 Human experience data. Human experience data constitutes the primary criterion used by... of all reasonably available reports pertaining to human use of the particular substance, including...

16 CFR 1702.8 - Human experience data.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Human experience data. 1702.8 Section 1702.8... REQUIREMENTS § 1702.8 Human experience data. Human experience data constitutes the primary criterion used by... of all reasonably available reports pertaining to human use of the particular substance, including...

12 CFR 206.6 - Waiver.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Waiver. 206.6 Section 206.6 Banks and Banking... bank if the primary Federal supervisor of the bank advises the Board that the bank is not reasonably able to obtain necessary services, including payment-related services and placement of funds, without...

Near real-time traffic routing

NASA Technical Reports Server (NTRS)

Yang, Chaowei (Inventor); Xie, Jibo (Inventor); Zhou, Bin (Inventor); Cao, Ying (Inventor)

2012-01-01

A near real-time physical transportation network routing system comprising: a traffic simulation computing grid and a dynamic traffic routing service computing grid. The traffic simulator produces traffic network travel time predictions for a physical transportation network using a traffic simulation model and common input data. The physical transportation network is divided into a multiple sections. Each section has a primary zone and a buffer zone. The traffic simulation computing grid includes multiple of traffic simulation computing nodes. The common input data includes static network characteristics, an origin-destination data table, dynamic traffic information data and historical traffic data. The dynamic traffic routing service computing grid includes multiple dynamic traffic routing computing nodes and generates traffic route(s) using the traffic network travel time predictions.

Rocky Mountain Arsenal Chemical Index. Volume 2

DTIC Science & Technology

1988-08-01

Txi: Toxicity score, 1 (RTECS). I Included on taroet list(s): No Refernce: 10, 31, 128I I Primary Name: Nitrate Synonm: CAS RN: 14797558 Formula: NO3 i...Contamination Sources 1 (3). Monitorina history: Small concentrations at Well #81A (Section 36) and Well #65A (NW of Basin A perimeter, Section 35).i...Formula: HNO3 I Information sources: Shell/Army History of use. production. disposal & guantities: CAR, Site 1 36-17 (66, p. 28); CAR, Site 1 -5 (70, p

Primary borderline parovarian tumor in pregnancy

PubMed Central

Kim, Jong-Hyun

2015-01-01

There are few reports of pregnancy complicated by a primary borderline parovarian tumor. A 32-year-old pregnant woman was found to have an ovarian tumor. At 13 weeks of gestation, cystectomy was performed and a diagnosis of primary borderline parovarian tumor was made. At 38 weeks of gestation, she underwent cesarean section combined with a restaging operation. A normal infant was delivered and there were no signs of recurrence. Currently, the patient is being followed for 24 months after the initial treatment and all imaging data show no evidence of recurrence. This report includes a short review of the existing literature on this topic and documents this case in detail. This case demonstrates the appropriate procedure for evaluating and treating a primary borderline parovarian tumor during pregnancy. PMID:26623422

76 FR 38396 - Notice of Availability of Proposed Data Collection Standards for Race, Ethnicity, Primary...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... Standards for Race, Ethnicity, Primary Language, Sex, and Disability Status Required by Section 4302 of the... standards for race, ethnicity, sex, primary language and disability status, as required by Section 4302 of... collection standards for race, ethnicity, sex, primary language, and disability status. The law requires that...

Section 4 User Guide – Primary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics (OPPT) Section 4 application submission process. This document is the user guide for the Primary Support user of the Section 4 tool.

Utilization of Rural Primary Care Physicians' Visit Services for Diabetes Management of Public Health in Southwestern China: A Cross-Sectional Study from Patients' View.

PubMed

Miao, Yudong; Ye, Ting; Qian, Dongfu; Li, Jinlong; Zhang, Liang

2014-06-01

Primary care physicians' visit services for diabetes management are now widely delivered in China's rural public health care. Current studies mainly focus on supply but risk factors from patients' view have not been previously explored. This study aims to present the utilization of rural primary care physicians' visit services for diabetes management in the last 12 months in southwestern China, and to explore risk factors from patients' view. This cross sectional study selected six towns at random and all 385 diabetics managed by primary care physicians were potential participants. Basing on the inclusion and exclusion criteria, 374 diabetics were taken as valid subjects and their survey responses formed the data resource of analyses. Descriptive indicators, χ2 contingency table analyses and Logistic regression were used. 54.8% respondents reported the utilization of visit services. According to the multivariate analysis, the positive factors mainly associated with utilization of visit services include disease duration (OR=1.654), use of diabetic drugs (OR=1.869), consulting diabetes care knowledge (OR=1.602), recognition of diabetic complications (OR=1.662), needs of visit services (OR=2.338). The utilization of rural primary care physicians' visit services still remains unsatisfactory. Mass rural health policy awareness, support, and emphasis are in urgent need and possible risk factors including disease duration, use of diabetic drugs, consulting diabetes care knowledge, recognition of diabetic complications and needs of visit services should be taken into account when making rural health policy of visit services for diabetes management in China and many other low- and middle-income countries.

Assessment and management of risk factors for the prevention of lifestyle-related disease: a cross-sectional survey of current activities, barriers and perceived training needs of primary care physiotherapists in the Republic of Ireland.

PubMed

O'Donoghue, G; Cunningham, C; Murphy, F; Woods, C; Aagaard-Hansen, J

2014-06-01

To provide a snapshot of current activities, barriers and perceived training needs for the assessment and management of behavioural risk factors in physiotherapy practice in primary care settings in the Republic of Ireland. Cross-sectional survey of primary care physiotherapists. Two hundred and twenty primary care physiotherapists were invited to participate. Each received a questionnaire, consisting of 23 questions, within five key sections. Its main focus was the risk factor management practices of physiotherapists. Descriptive statistics and frequencies were used to analyse the data. A response rate of 74% (163/220) was achieved. Level of physical activity was the most common risk factor assessed at initial and follow-up visits (78%, 127/163), followed by dietary status (55%, 90/163). Few respondents included smoking status and alcohol consumption in their assessment; however, the majority considered them as risk factors that should be addressed. The main reasons why smoking status and alcohol consumption were not assessed were lack of time, limited knowledge and expertise, not traditionally viewed as the physiotherapist's role, and patient's lack of interest in changing their unhealthy behaviour. The findings highlight an untapped potential in relation to physiotherapists addressing lifestyle-related risk factors. A number of strategies are required to improve the systematic assessment and management of these risk factors. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Smoking prevalence, knowledge and attitudes among primary healthcare professionals: a study from Jordan.

PubMed

Alkhatatbeh, M J; Alefan, Q; Alzghool, M

2017-02-01

This was a questionnaire-based cross-sectional study of 400 healthcare professionals recruited from primary healthcare centres in northern Jordan between April and October 2015. The questionnaire included questions about smoking behaviour, risks, opinions and providing anti-smoking counselling. More than 80% of participants reported that smoking-free policies were not enforced at primary healthcare centres. Compared to hospitals and the general population, smoking was less prevalent among primary healthcare professionals and more prevalent in men. More than 90% of participants believed that smoking was dangerous and associated with cardiovascular and respiratory diseases. Around 92% believed that they should set a good example to patients by not smoking and advise them about smoking cessation. Only 15.3% of participants felt well prepared when counselling patients about smoking and 92.8% believed that they needed training. This study suggests that primary healthcare professionals should act as anti-smoking role models after receiving professional training.

Capabilities and Testing of the Fission Surface Power Primary Test Circuit (FSP-PTC)

NASA Technical Reports Server (NTRS)

Garber, Anne E.

2007-01-01

An actively pumped alkali metal flow circuit, designed and fabricated at the NASA Marshall Space Flight Center, is currently undergoing testing in the Early Flight Fission Test Facility (EFF-TF). Sodium potassium (NaK), which was used in the SNAP-10A fission reactor, was selected as the primary coolant. Basic circuit components include: simulated reactor core, NaK to gas heat exchanger, electromagnetic (EM) liquid metal pump, liquid metal flowmeter, load/drain reservoir, expansion reservoir, test section, and instrumentation. Operation of the circuit is based around a 37-pin partial-array core (pin and flow path dimensions are the same as those in a full core), designed to operate at 33 kWt. NaK flow rates of greater than 1 kg/sec may be achieved, depending upon the power applied to the EM pump. The heat exchanger provides for the removal of thermal energy from the circuit, simulating the presence of an energy conversion system. The presence of the test section increases the versatility of the circuit. A second liquid metal pump, an energy conversion system, and highly instrumented thermal simulators are all being considered for inclusion within the test section. This paper summarizes the capabilities and ongoing testing of the Fission Surface Power Primary Test Circuit (FSP-PTC).

Pregnancy outcomes in women with type 1 and type 2 diabetes mellitus in a retrospective multi-institutional study in Japan.

PubMed

Sato, Takahiro; Sugiyama, Takashi; Kurakata, Michiyo; Saito, Masatoshi; Sugawara, Junichi; Yaegashi, Nobuo; Sagawa, Norimasa; Sanaka, Mayumi; Akazawa, Shoichi; Anazawa, Sonoko; Waguri, Masako; Sameshima, Hiroshi; Hiramatsu, Yuji; Toyoda, Nagayasu

2014-01-01

The present study was performed to evaluate pregnancy outcomes in women with type 1 and type 2 diabetes mellitus (DM) in Japan. This multi-institutional retrospective study was conducted in 40 general hospitals in Japan during 2003-2009. We evaluated 369 and 579 pregnant women with type 1 and type 2 DM, respectively, and compared pregnancy outcomes between the two groups. Glycosylated hemoglobin levels in the first trimester did not differ significantly between the studied groups. Gestational weight gain was lower in type 2 DM than in type 1 DM. Although there were no significant differences in perinatal outcomes between the groups, the primary cesarean section rate was higher in type 2 DM than in type 1 DM. Multiple logistic regression analysis revealed that primigravida status, pre-gestational body mass index (BMI), gestational weight gain, chronic hypertension, and microvascular disease including diabetic retinopathy or nephropathy were associated with onset of pregnancy-induced hypertension. Further, pre-gestational BMI was associated with the need for primary cesarean section. This study demonstrated that no differences were observed in the rates of perinatal mortality and congenital malformation between pregnant women with type 1 DM and type 2 DM; however, women with type 2 DM displayed a higher risk of primary cesarean section.

The risk of placenta accreta following primary cesarean delivery.

PubMed

Zeevi, Gil; Tirosh, Dan; Baron, Joel; Sade, Maayan Yitshak; Segal, Adi; Hershkovitz, Reli

2018-05-01

To (a) evaluate the risk for placenta accreta following primary cesarean section (CS), in regard to the stage of labor, the cesarean section was taken (elective prelabor vs. unplanned during labor); and (b) investigate whether the association between placenta accreta and maternal and neonatal complications is modified by the type of the primary CS. In a population-based retrospective cohort study, we included all singleton deliveries occurred in Soroka University Medical Center between 1991 and 2015, of women who had a history of a single CS. The deliveries were divided into three groups according to the delivery stage the primary CS was carried out: 'Unplanned 1' (first stage-up to 10 cm), 'Unplanned 2' (second stage-10 cm) and 'Elective' prelabor CS. We assessed the association between the study group and placenta accreta using logistic generalized estimation equation (GEE) models. We additionally assessed maternal and neonatal complications associated with placenta accreta among women who had elective and unplanned CS separately. We included 22,036 deliveries to 13,727 women with a history of one CS, of which 0.9% (n = 207) had placenta accreta in the following pregnancies: 12% (n = 25) in the 'Unplanned 1' group, 7.2% (n = 15) in the ' Unplanned 2' group and 80.8% (n = 167) in the 'elective' group. We found no difference in the risk for subsequent placenta accreta between the groups. In a stratified analysis by the timing of the primary cesarean delivery, the risk for maternal complications, associated with placenta accreta, was more pronounced among women who had an unplanned CS (OR 27.96, P < 0.01) compared to women who had an elective cesarean delivery (OR 13.72, P < 0.01). The stage in which CS is performed has no influence on the risk for placenta accreta in the following pregnancies, women who had an unplanned CS are in a higher risk for placenta accrete-associated maternal complications. This should be taken into consideration while counselling women about their risk while considering trial of labor after cesarean section.

Section 8(e) Notice User Guide – Primary Support

EPA Pesticide Factsheets

This document is the user guide for the Primary Support user of the Section 8(e) Notice tool which is part of the Office of Pollution Prevention and Toxics (OPPT) ‘Section 8(e) Notice’ application submission process.

Microleakage of stainless steel crowns placed on intact and extensively destroyed primary first molars: an in vitro study.

PubMed

Seraj, Bahman; Shahrabi, Mahdi; Motahari, Pouria; Ahmadi, Rahil; Ghadimi, Sara; Mosharafian, Shahram; Mohammadi, Kaveh; Javad Kharazifard, Mohammad

2011-01-01

The purpose of this investigation was to evaluate the effect of residual tooth structure on the microleakage of stainless steel crowns cemented with glass ionomer on primary maxillary and mandibular first molars. Thirty extracted primary molars were divided into 2 groups: group 1 included intact teeth; and group 2 included extensively carious samples. Each tooth received standard preparation, and each crown was luted with G-CEM on its specific specimen. Teeth were loaded vertically and transferred to distilled water. After thermocycling and immersing in methylene blue solution, the teeth were sectioned and examined microscopically for microleakage. Data were analyzed using Mann-Whitney U and Wilcoxon signed-rank tests. All specimens (intact and damaged teeth) had microleakage, although most of these presented only minimum microleakage. No statistically significant differences were found in the microleakage of sound and extensively carious teeth on either the buccal (P=.62) or lingual (P=.65) side. Buccal (P=.73) and lingual (P=.63) surfaces showed similar microleakage scores in primary maxillary and mandibular molars. There was no significant difference in the microleakage of sound or extensively carious teeth and primary maxillary or mandibular first molars.

Psychological Impact of Primary Screening (PIPS) for HPV: a protocol for a cross-sectional evaluation within the NHS cervical screening programme.

PubMed

McBride, Emily; Marlow, Laura; Forster, Alice S; Moss, Sue; Myles, Jonathan; Kitchener, Henry; Patnick, Julietta; Waller, Jo

2016-12-23

The NHS Cervical Screening Programme is now using human papillomavirus (HPV) testing as the primary test in six sentinel sites in England, with the intention of rolling this out across the whole of England. Previous research evaluating HPV testing in the cervical screening context suggests that an HPV-positive result may increase anxiety beyond that associated with abnormal cytology, but this has not been explored in the context of primary HPV testing. The main aim of this study is to explore the impact of the HPV primary screening programme on anxiety and distress. A cross-sectional between-groups design (total N ∼ 673) will be employed to assess the psychological impact of different HPV and cytology results at three time points: shortly after receiving the results, and 6 and 12 months later. Women will fall into one of six groups based on their screening results. The primary outcomes will be anxiety and general distress. Secondary outcomes will include understanding of screening results, perceived risk of cervical cancer, psychosexual functioning, intention to attend future screening and knowledge of HPV. General linear modelling will be used to test for differences between groups and changes over the three time points. Health Research Authority approval was received on 26 September 2016. Ethical approval was received from London- Surrey Borders NHS Research Ethics Committee on 30 August 2016. Section 251 approval was received from the Confidentiality Advisory Group on 24 August 2016. Results will be disseminated via peer-reviewed publication and presentation at national and international conferences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Dauntless Women in Childhood Education, 1856-1931.

ERIC Educational Resources Information Center

Snyder, Agnes

The lives and contributions of nine women educators, all early founders or leaders of the International Kindergarten Union (IKU) or the National Council of Primary Education (NCPE), are profiled in this book. Their biographical sketches are presented in two sections. The Froebelian influences are discussed in Part 1 which includes the chapters on…

Spotlight on the Muslim Middle East - Issues of Identity. A Student Reader [and] Teacher's Guide.

ERIC Educational Resources Information Center

Greenberg, Hazel Sara, Ed.; Mahony, Liz, Ed.

These books offer primary source readings focusing on issues of identity and personality in the Middle East. Individual sections of the books examine a particular issue in personality development through the perspectives of Islamic religion and cultural tradition. The issues of identity include: (1) "Religion"; (2) "Community";…

GAMES AND PUZZLES FOR THE MORE ABLE STUDENT.

ERIC Educational Resources Information Center

GOLDSMITH, JOHN

SUCH MATHEMATICAL GAMES AS DOMINOES FOR PRIMARY NUMBER RECOGNITION AND AS MILK BOTTLE TOPS FOR ADDITION AND SUBTRACTION ARE LISTED. A LIST OF SEVERAL MATH PROBLEMS, PUZZLES AND BRAIN TEASERS FOLLOW. QUIET GAMES OF PAPER CUTTING AND CROSS WORD PUZZLES FOR MATH VOCABULARY ARE INCLUDED. THE NEXT SECTION OF GAMES CONCERNS LANGUAGE. THESE INCLUDE…

Data Sharing and Reuse within the Academic Pathways Study

ERIC Educational Resources Information Center

Toye, George; Sheppard, Sheri; Chen, Helen L.

2016-01-01

The Academic Pathway Study (APS) research program within National Science Foundation (NSF) Center for Advancement of Engineering Education (CAEE) ran from 2003-2010. It amassed a collection of longitudinal as well as cross-sectional data sets, of varying research method types and formats, from four different primary cohorts that included over…

Aids to English Language Teaching: Information Guide No. 4.

ERIC Educational Resources Information Center

British Council, London (England). English-Teaching Information Centre.

This is an annotated guide to English language instructional materials useful for both native and non-native speakers of English at primary and secondary levels. Materials relate to and are available in Great Britain; prices and addresses of publishers and suppliers are included. The sections cover: (1) Visual aids specifically designed for…

Children's After-School Physical Activity Participation in Hong Kong: Does Family Socioeconomic Status Matter?

ERIC Educational Resources Information Center

Cheung, Peggy PY

2017-01-01

Objective: This study aimed to examine the association between parental socioeconomic status (SES) and children's physical activity (PA) behaviour during after-school hours. Design: Cross-sectional study. Methods: Participants included 663 schoolchildren (aged between 10 and 13 years) and their parents from nine primary schools in Hong Kong.…

National Nutrition Education Clearing House Reference List, Secondary Teaching Materials and Teacher References.

ERIC Educational Resources Information Center

National Nutrition Education Clearing House, Berkeley, CA.

A reference list of teaching materials and teacher guides in the field of nutrition is compiled in this pamphlet. Primary emphasis is on resources for secondary grades. The section on teaching materials includes books, pamphlets, leaflets, posters, charts, transparencies, ditto masters, kits, games, films, filmstrips, records, TV videotapes, and…

Petroleum supply monthly, June 1999, with data for April 1999

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

NONE

Data presented in the Petroleum Supply Monthly (PSM) describe the supply and disposition of petroleum products in the US and major US geographic regions. The data series describe production, imports and exports, inter-Petroleum Administration for Defense (PAD) District movements, and inventories by the primary suppliers of petroleum products in the US (50 States and the District of Columbia). The reporting universe includes those petroleum sectors in primary supply. Included are: petroleum refiners, motor gasoline blenders, operators of natural gas processing plants and fractionators, inter-PAD transporters, importers, and major inventory holders of petroleum products and crude oil. When aggregated, the datamore » reported by these sectors approximately represent the consumption of petroleum products in the US. Data presented in the PSM are divided into two sections: Summary Statistics and Detailed Statistics. The tables and figures in the Summary Statistics section of the PSM present a time series of selected petroleum data on a US level. The Detailed Statistics tables of the PSM present statistics for the most current month available as well as year-to-date. 16 figs., 66 tabs.« less

Petroleum supply monthly, February 1999, with data for December 1998

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

NONE

Data presented in the Petroleum Supply Monthly (PSM) describes the supply and disposition of petroleum products in the United States and major US geographic regions. The data series describe production, imports and exports, inter-Petroleum Administration for Defense (PAD) District movements, and inventories by the primary suppliers of petroleum products in the United States (50 States and the District of Columbia). The reporting universe includes those petroleum sectors in primary supply. Included are: petroleum refiners, motor gasoline blenders, operators of natural gas processing plants and fractionators, inter-PAD transporters, importers, and major inventory holders of petroleum products and crude oil. When aggregated,more » the data reported by these sectors approximately represent the consumption of petroleum products in the United States. Data presented in the PSM are divided into two sections: Summary Statistics and Detailed Statistics. The tables and figures in the Summary Statistics section of the PSM present a time series of selected petroleum data on a US level. The Detailed Statistics tables of the PSM present statistics for the most current month available as well as year-to-date. 16 figs., 66 tabs.« less

Antihypertensive drugs for elderly patients: a cross- sectional study

PubMed Central

Lim, Ka Keat; Sivasampu, Sheamini; Khoo, Ee Ming

2015-01-01

INTRODUCTION As the population ages, the prevalence of hypertension also increases. Although primary care is usually the patient’s first point of contact for healthcare, little is known about the management of hypertension among elderly patients at the primary care level. This study aimed to determine the antihypertensive prescription trend for elderly patients, the predictors of antihypertensive use and any inappropriate prescribing practices in both public and private primary care settings. METHODS Data on patient demographics, diagnosis, prescription pattern, payment mode and follow-up was extracted from a cross-sectional study involving 122 public primary care clinics and 652 private primary care clinics in Malaysia. Encounters with hypertensive patients aged ≥ 60 years were included. RESULTS A total of 1,017 antihypertensive medications were prescribed – calcium channel blockers (27.1%), beta blockers (25.5%), diuretics (23.3%), angiotensin-converting enzyme inhibitors (14.9%) and angiotensin receptor blockers (6.3%). Out of the 614 patient encounters, 53.1% of the patients were prescribed monotherapy, 31.6% were prescribed dual therapy, 12.2% triple therapy, 2.8% quadruple therapy and 0.3% quintuple therapy. Type of primary care clinic and payment mode were significant predictors for the prescription of combination therapy and fixed-dose combination therapy, respectively. Four types of inappropriate prescriptions were identified. CONCLUSION Calcium channel blockers were the most common antihypertensive drug prescribed and more than half of the elderly patients were on monotherapy. Antihypertensive drug prescription was found to be associated with the type of primary care clinic and the payment mode, suggesting that prescription is influenced by the cost of the drug. PMID:25597751

Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms.

PubMed

Bhui, Kamaldeep; Bhugra, Dinesh; Goldberg, David; Sauer, Justin; Tylee, Andre

2004-09-01

Previous studies exploring the prevalence of depression among South Asians reported inconsistent findings. Research artefacts due to sampling bias, measurements errors and a failure to include ethnographic methods may all explain this. We estimated the prevalence of depression, and variations of prevalence with culture, cultural adaptation, somatic symptoms and physical disability in a cross-sectional primary care survey of Punjabi and English attendees. We included a culture specific screening instrument, culturally adapted the instruments and offered bilingual interviews. We found that, compared with their English counterparts, depressive diagnoses were more common among Punjabis, Punjabi women, Punjabis with physical complaints and, contrary to expectation, even Punjabis with low scores for somatic symptoms.

Fuel cell system combustor

DOEpatents

Pettit, William Henry

2001-01-01

A fuel cell system including a fuel reformer heated by a catalytic combustor fired by anode and cathode effluents. The combustor includes a turbulator section at its input end for intimately mixing the anode and cathode effluents before they contact the combustors primary catalyst bed. The turbulator comprises at least one porous bed of mixing media that provides a tortuous path therethrough for creating turbulent flow and intimate mixing of the anode and cathode effluents therein.

Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

PubMed

Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

2018-03-01

To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p < .0001). Healthcare providers perceived the interprofessional care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey.

PubMed

Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos

2017-01-01

Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

Factors that influence career choice in primary care among medical students starting social service in Honduras.

PubMed

Puertas, E Benjamín; Rivera, Tamara Y

2016-11-01

To 1) describe patterns of specialty choice; 2) investigate relationships between career selection and selected demographic indicators; and 3) identify salary perception, factors that influence career choice in primary care, and factors that influence desired location of future medical practice. The study used a mixed-methods approach that included a cross-sectional questionnaire survey applied to 234 last-year medical students in Honduras (September 2014), and semi-structured interviews with eight key informants (October 2014). Statistical analysis included chi-square and factor analysis. An alpha level of 0.05 was used to determine significance. In the qualitative analysis, several codes were associated with each other, and five major themes emerged. Primary care careers were the preferred choice for 8.1% of students, who preferred urban settings for future practice location. The perceived salary of specialties other than primary care was significantly higher than those of general practitioners, family practitioners, and pediatricians (P < 0.001). Participants considered "making a difference," income, teaching, prestige, and challenging work the most important factors influencing career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P = < 0.05). Logistic regression analysis found that factors related to patient-based care were statistically significant for selecting primary care (P = 0.006). The qualitative analysis further endorsed the survey findings, identifying additional factors that influence career choice (future work option; availability of residency positions; and social factors, including violence). Rationales behind preference of a specialty appeared to be based on a combination of ambition and prestige, and on personal and altruistic considerations. Most factors that influence primary care career choice are similar to those found in the literature. There are several factors distinctive to medical students in Honduras-most of them barriers to primary care career choice.

Multiplex Staining by Sequential Immunostaining and Antibody Removal on Routine Tissue Sections.

PubMed

Bolognesi, Maddalena Maria; Manzoni, Marco; Scalia, Carla Rossana; Zannella, Stefano; Bosisio, Francesca Maria; Faretta, Mario; Cattoretti, Giorgio

2017-08-01

Multiplexing, labeling for multiple immunostains in the very same cell or tissue section in situ, has raised considerable interest. The methods proposed include the use of labeled primary antibodies, spectral separation of fluorochromes, bleaching of the fluorophores or chromogens, blocking of previous antibody layers, all in various combinations. The major obstacles to the diffusion of this technique are high costs in custom antibodies and instruments, low throughput, and scarcity of specialized skills or facilities. We have validated a method based on common primary and secondary antibodies and diffusely available fluorescent image scanners. It entails rounds of four-color indirect immunofluorescence, image acquisition, and removal (stripping) of the antibodies, before another stain is applied. The images are digitally registered and the autofluorescence is subtracted. Removal of antibodies is accomplished by disulfide cleavage and a detergent or by a chaotropic salt treatment, this latter followed by antigen refolding. More than 30 different antibody stains can be applied to one single section from routinely fixed and embedded tissue. This method requires a modest investment in hardware and materials and uses freeware image analysis software. Multiplexing on routine tissue sections is a high throughput tool for in situ characterization of neoplastic, reactive, inflammatory, and normal cells.

Primary hypertension among a population of Nigerian secondary school adolescents: Prevalence and correlation with anthropometric indices: A cross-sectional study.

PubMed

Uwaezuoke, S N; Okoli, C V; Ubesie, A C; Ikefuna, A N

2016-01-01

To assess the prevalence of primary hypertension and its correlation with anthropometric indices among a population of Nigerian adolescents. A cross-sectional study of secondary school adolescents aged 10-19 years in Enugu, Nigeria, using multi-staged sampling method. Anthropometry and blood pressures were measured using standardized instruments. Data analysis was with the Statistical Package for Social Sciences (SPSS) Version 20.0 (Chicago, IL, USA). A total of 2419 adolescents (mean age, 14.80 ± 2.07 years) were included in the study. Prevalence of hypertension was 10.7%. Systolic and diastolic hypertension were observed in 232 (9.6%) and 85 (3.5%) of the participants, respectively. Forty-two of the 137 obese (30.7%) compared to 158 among the 1777 (7.7%) with normal body mass index (BMI) (P < 0.001) had systolic hypertension. Waist circumference (r = 0.37) and BMI (r = 0.37) significantly and positively correlated with systolic hypertension. Obese and overweight adolescents had higher prevalence of primary hypertension than their counterparts with normal BMI.

FEATURES, EVENTS, AND PROCESSES: SYSTEM-LEVEL AND CRITICALITY

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

D.L. McGregor

The primary purpose of this Analysis/Model Report (AMR) is to identify and document the screening analyses for the features, events, and processes (FEPs) that do not easily fit into the existing Process Model Report (PMR) structure. These FEPs include the 3 1 FEPs designated as System-Level Primary FEPs and the 22 FEPs designated as Criticality Primary FEPs. A list of these FEPs is provided in Section 1.1. This AMR (AN-WIS-MD-000019) documents the Screening Decision and Regulatory Basis, Screening Argument, and Total System Performance Assessment (TSPA) Disposition for each of the subject Primary FEPs. This AMR provides screening information and decisionsmore » for the TSPA-SR report and provides the same information for incorporation into a project-specific FEPs database. This AMR may also assist reviewers during the licensing-review process.« less

Systematic reviews do not adequately report or address missing outcome data in their analyses: a methodological survey.

PubMed

Kahale, Lara A; Diab, Batoul; Brignardello-Petersen, Romina; Agarwal, Arnav; Mustafa, Reem A; Kwong, Joey; Neumann, Ignacio; Li, Ling; Lopes, Luciane Cruz; Briel, Matthias; Busse, Jason W; Iorio, Alfonso; Vandvik, Per Olav; Alexander, Paul Elias; Guyatt, Gordon; Akl, Elie A

2018-07-01

To describe how systematic review authors report and address categories of participants with potential missing outcome data of trial participants. Methodological survey of systematic reviews reporting a group-level meta-analysis. We included a random sample of 50 Cochrane and 50 non-Cochrane systematic reviews. Of these, 25 reported in their methods section a plan to consider at least one of the 10 categories of missing outcome data; 42 reported in their results, data for at least one category of missing data. The most reported category in the methods and results sections was "unexplained loss to follow-up" (n = 34 in methods section and n = 6 in the results section). Only 19 reported a method to handle missing data in their primary analyses, which was most often complete case analysis. Few reviews (n = 9) reported in the methods section conducting sensitivity analysis to judge risk of bias associated with missing outcome data at the level of the meta-analysis; and only five of them presented the results of these analyses in the results section. Most systematic reviews do not explicitly report sufficient information on categories of trial participants with potential missing outcome data or address missing data in their primary analyses. Copyright © 2018 Elsevier Inc. All rights reserved.

Section 8(e) Notice User Guide – Primary Authorized Official

EPA Pesticide Factsheets

This document is the user guide for the Primary Authorized Official (AO) user of the Section 8(e) Notice tool which is part of the Office of Pollution Prevention and Toxics (OPPT) ‘Section 8(e) Notice’ application submission process.

Limnology of Sawtooth Valley Lakes in 1995

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

Luecke, C.; Slater, M.; Budy, P.

1996-05-01

Included in this section of the report on limnology of Lakes in the Snake River Plain are descriptions of the limnological characteristics of the four lakes in reference to their potential effect of growth and survival of juvenile sockeye salmon. Physical parameters included light penetration, Secchi transparency, and water temperature; chemical parameters included oxygen, and both dissolved and particulate forms of nitrogen and phosphorus. Phytoplankton parameters included chlorophyll concentration, biovolume of dominant taxa, and rates of primary production; zooplankton parameters included density and biomass estimate, length frequencies, and the number of eggs carried by female cladocerans. 11 figs., 5 tabs.

Mental health of Chinese primary care patients with lower urinary tract symptoms.

PubMed

Choi, Edmond P H; Lam, Cindy L K; Chin, Weng Yee

2016-01-01

The aim of this study was to evaluate the mental health of Chinese primary care patients with lower urinary tract symptoms (LUTS). This was a cross-sectional observational study. Five hundred and nineteen subjects with LUTS completed a structured questionnaire containing the Depression, Anxiety, and Stress Scale-Short Form, the International Prostate Symptom Score, the adapted International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and questions about socio-demographics. Overall, 17.7% of subjects reported depressive symptoms, 24.3% anxiety symptoms and 9.6% stress symptoms. In males, demographic factors associated with poorer mental health included being not married; clinical factors included higher LUTS severity, weak stream, straining and mixed urinary incontinence. In females, demographic factors associated with poorer mental health included being younger, not married and lower household income; clinical factors included higher LUTS severity, incomplete bladder emptying, urgency and weak stream. Chinese primary care patients with LUTS appear to be an at-risk group for poorer mental health with increased prevalence of anxiety and depressive symptoms and may require routine screening to identify those who may require more tailored interventions to address both their urinary symptoms and psychological distress.

Section 8(a) PAIR User Guide – Primary Authorized Official

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics (OPPT) ‘Section 8(a) PAIR’ application submission process. This document is the user guide for the Primary Authorized Official (AO) user of the Section 8(a) PAIR tool.

Emergence of Primary Teeth in Children of Sunsari District of Eastern Nepal

PubMed Central

Gupta, Anita; Hiremath, SS; Singh, SK; Poudyal, S; Niraula, SR; Baral, DD; Singh, RK

2007-01-01

This study assessed the timing and eruption sequence of primary teeth in children of Sunsari district of Eastern Nepal and compared the eruption pattern of males & females between various, ethnic groups. Method This cross-sectional study, included 501 subjects, aged 3 months to 60 months selected by simple random sampling method. The determinant variables such as age, gender, ethnicity, and eruption of teeth were recorded. Results This study provides a model data on emergence of primary teeth and number of deciduous teeth in these children. This is a first study of its kind in Nepal. The findings of this study will help as a reference data for optimal use in clinical, academic, and research activities, especially for children of Eastern Nepal. PMID:18523631

Medical Writing Competency Model - Section 2: Knowledge, Skills, Abilities, and Behaviors.

PubMed

Clemow, David B; Wagner, Bertil; Marshallsay, Christopher; Benau, Dan; L'Heureux, Darryl; Brown, David H; Dasgupta, Devjani Ghosh; Girten, Eileen; Hubbard, Frank; Gawrylewski, Helle-Mai; Ebina, Hiroko; Stoltenborg, Janet; York, J P; Green, Kim; Wood, Linda Fossati; Toth, Lisa; Mihm, Michael; Katz, Nancy R; Vasconcelos, Nina-Maria; Sakiyama, Norihisa; Whitsell, Robin; Gopalakrishnan, Shobha; Bairnsfather, Susan; Wanderer, Tatyana; Schindler, Thomas M; Mikyas, Yeshi; Aoyama, Yumiko

2018-01-01

This article provides Section 2 of the 2017 Edition 2 Medical Writing Competency Model that describes the knowledge, skills, abilities, and behaviors that professional medical writers need in order to perform effectively within the life sciences industry. What a medical writer should know, what they should be able to do, and how they should use this knowledge and these skills to facilitate their primary work function is a focus. Regulatory, publication, and other scientific writing as well as management of writing activities are covered. The full Model also includes Section 1, which covers the core work functions and associated tasks and activities related to professional medical writing within the life sciences industry; Section 1 is included in a companion article. The Model was developed to aid medical writers and managers within the life sciences industry regarding medical writing hiring, training, expectation and goal setting, performance evaluation, career development, retention, and role value sharing to cross-functional partners.

Elemental mapping of biological samples using a scanning proton microprobe

NASA Astrophysics Data System (ADS)

Watt, F.; Grime, G. W.

1988-03-01

Elemental mapping using a scanning proton microprobe (SPM) can be a powerful technique for probing trace elements in biology, allowing complex interfaces to be studied in detail, identifying contamination and artefacts present in the specimen, and in certain circumstances obtaining indirect chemical information. Examples used to illustrate the advantages of the technique include the elemental mapping of growing pollen tubes, honey bee brain section, a mouse macrophage cell, human liver section exhibiting primary biliary cirrhosis, and the attack by a mildew fungus on a pea leaf.

Work-Related Depression in Primary Care Teams in Brazil.

PubMed

da Silva, Andréa Tenório Correia; Lopes, Claudia de Souza; Susser, Ezra; Menezes, Paulo Rossi

2016-11-01

To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

[Ethics committees in the experience of the IMSS: a Latin American instance].

PubMed

Valdez-Martínez, Edith; Mata-Valderrama, Guadalupe; Bedolla, Miguel; Fajardo-Dolci, Germán Enrique

2015-01-01

The aim of this article is to identify the current state of hospital bioethics committees and local research ethics committees of the Mexican Institute of Social Security (IMSS). A descriptive cross-sectional study was performed that included all hospitals of the IMSS (N = 262). Two self-administered questionnaires were e-mailed between october and november 2014 to the hospital directors: one for hospital bioethics committees and another for local research ethics committees. Both questionnaires had five sections: committee location, date of committee set up, activity situation, composition, functions, and experience. The response rate was 85 %. It was reported 150 active hospital bioethics committees and 67 active local research ethics committees. In both groups physicians and executive directors dominated committees' membership, and lay people were reported only in seven hospital bioethics committees. The primary function of hospital bioethics committees was case consultation, and their primary goal "to improve the quality of medical care". Local Research Ethics Committees reported as primary function "to evaluate health research protocols and rule of them", and as their primary goal "to protect the rights and wellbeing of the research subjects". Both groups of committees ought to be assessed regularly through audit cycles in order to identify the educative actions that enhance their efficiency.

Quantum molecular dynamics and multistep-direct analyses of multiple preequilibrium emission

NASA Astrophysics Data System (ADS)

Chadwick, M. B.; Chiba, S.; Niita, K.; Maruyama, T.; Iwamoto, A.

1995-11-01

We study multiple preequilibrium emission in nucleon induced reactions at intermediate energies, and compare quantum molecular dynamics (QMD) calculations with multistep-direct Feshbach-Kerman-Koonin results [M. B. Chadwick, P. G. Young, D. C. George, and Y. Watanabe, Phys. Rev. C 50, 996 (1994)]. When the theoretical expressions of this reference are reformulated so that the definitions of primary and multiple emission correspond to those used in QMD, the two theories yield similar results for primary and multiple preequilibrium emission. We use QMD as a tool to determine the multiplicities of fast preequilibrium nucleons as a function of incident energy. For fast particle cross sections to exceed 5% of the inclusive preequilibrium emission cross sections we find that two particles should be included in reactions above 50 MeV, three above about 180 MeV, and four are only needed when the incident energy exceeds about 400 MeV.

10 CFR 504.5 - Prohibitions by order (certifying powerplants under section 301 of FUA, as amended).

Code of Federal Regulations, 2014 CFR

2014-01-01

... feasibility to use coal or another alternate fuel as a primary energy source in the unit. The informational... section 301 of FUA, as amended). 504.5 Section 504.5 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE... section 301 of the Act, as amended, the use of petroleum or natural gas as a primary energy source where...

10 CFR 504.5 - Prohibitions by order (certifying powerplants under section 301 of FUA, as amended).

Code of Federal Regulations, 2011 CFR

2011-01-01

... feasibility to use coal or another alternate fuel as a primary energy source in the unit. The informational... section 301 of FUA, as amended). 504.5 Section 504.5 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE... section 301 of the Act, as amended, the use of petroleum or natural gas as a primary energy source where...

10 CFR 504.5 - Prohibitions by order (certifying powerplants under section 301 of FUA, as amended).

Code of Federal Regulations, 2013 CFR

2013-01-01

... feasibility to use coal or another alternate fuel as a primary energy source in the unit. The informational... section 301 of FUA, as amended). 504.5 Section 504.5 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE... section 301 of the Act, as amended, the use of petroleum or natural gas as a primary energy source where...

10 CFR 504.5 - Prohibitions by order (certifying powerplants under section 301 of FUA, as amended).

Code of Federal Regulations, 2012 CFR

2012-01-01

... feasibility to use coal or another alternate fuel as a primary energy source in the unit. The informational... section 301 of FUA, as amended). 504.5 Section 504.5 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE... section 301 of the Act, as amended, the use of petroleum or natural gas as a primary energy source where...

Quality of Life in Patients with Spinal Cord Injury

ERIC Educational Resources Information Center

Gurcay, Eda; Bal, Ajda; Eksioglu, Emel; Cakci, Aytul

2010-01-01

The primary objective of this study was to assess the quality of life (QoL) in spinal cord injury (SCI) survivors. Secondary objectives were to determine the effects of various sociodemographic and clinical characteristics on QoL. This cross-sectional study included 54 patients with SCI. The Turkish version of the Short-Form-36 Health Survey was…

Safe, Effective Use of Pesticides, A Manual for Commercial Applicators: Fruit Pest Control.

ERIC Educational Resources Information Center

Brunner, J.; And Others

This manual is intended to assist pesticide applicators prepare for certification under the Michigan Pesticide Control Act of 1976. The primary focus of this publication is on fruit pest control. Sections included are: (1) Causes of fruit diseases; (2) Fruit fungicides and bactericides; (3) Insect and mite pests; (4) Insecticides and miticides;…

Primary care physicians' perceived barriers and facilitators to conservative care for older adults with chronic kidney disease: design of a mixed methods study.

PubMed

Tam-Tham, Helen; Hemmelgarn, Brenda; Campbell, David; Thomas, Chandra; Quinn, Robert; Fruetel, Karen; King-Shier, Kathryn

2016-01-01

Guideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care. Our objectives are to (1) interview primary care physicians to determine their perspectives of conservative care for older adults with stage 5 CKD and (2) survey primary care physicians to determine the prevalence of key barriers and facilitators to provision of conservative care for older adults with stage 5 CKD. A sequential exploratory mixed methods design was adopted for this study. The first phase of the study will involve fundamental qualitative description and the second phase will be a cross-sectional population-based survey. The research is conducted in Alberta, Canada. The participants are primary care physicians with experience in providing care for older adults with stage 5 CKD not planning on initiating dialysis. The first objective will be achieved by undertaking interviews with primary care physicians from southern Alberta. Participants will be selected purposively to include physicians with a range of characteristics (e.g., age, gender, and location of clinical practice). Interviews will be recorded, transcribed verbatim, and analyzed using conventional content analysis to generate themes. The second objective will be achieved by undertaking a population-based survey of primary care physicians in Alberta. The questionnaire will be developed based on the findings from the qualitative interviews and pilot tested for face and content validity. Physicians will be provided multiple options to complete the questionnaire including mail, fax, and online methods. Descriptive statistics and associations between demographic factors and barriers and facilitators to care will be analyzed using regression models. A potential limitation of this mixed methods study is its cross-sectional nature. This work will inform development of clinical resources and tools for care of older adults with stage 5 CKD, to address barriers and enable facilitators to community-based conservative care.

NASA Electronic Library System (NELS) database schema, version 1.2

NASA Technical Reports Server (NTRS)

Melebeck, Clovis J.

1991-01-01

The database tables used by NELS version 1.2 are discussed. To provide the current functional capability offered by NELS, nineteen tables were created with ORACLE. Each table lists the ORACLE table name and provides a brief description of the tables intended use or function. The following sections cover four basic categories of tables: NELS object classes, NELS collections, NELS objects, and NELS supplemental tables. Also included in each section is a definition and/or relationship of each field to other fields or tables. The primary key(s) for each table is indicated with a single asterisk (*), while foreign keys are indicated with double asterisks (**). The primary key(s) indicate the key(s) which uniquely identifies a record for that table. The foreign key(s) is used to identify additional information in other table(s) for that record. The two appendices are the command which is used to construct the ORACLE tables for NELS. Appendix A contains the commands which create the tables which are defined in the following sections. Appendix B contains the commands which build the indices for these tables.

Emotional exhaustion in primary care during early implementation of the VA's medical home transformation: Patient-aligned Care Team (PACT).

PubMed

Meredith, Lisa S; Schmidt Hackbarth, Nicole; Darling, Jill; Rodriguez, Hector P; Stockdale, Susan E; Cordasco, Kristina M; Yano, Elizabeth M; Rubenstein, Lisa V

2015-03-01

Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration. Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse. 515 veterans administration employees (191 PCCs and 324 other primary care staff). Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization. The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race. Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women.

Experimental and finite element investigation of the buckling characteristics of a beaded skin panel for a hypersonic aircraft. Ph.D. Thesis. Final Report

NASA Technical Reports Server (NTRS)

Siegel, W. H.

1978-01-01

As part of NASA's continuing research into hypersonics and 85 square foot hypersonic wing test section of a proposed hypersonic research airplane was laboratory tested. The project reported on in this paper has carried the hypersonic wing test structure project one step further by testing a single beaded panel to failure. The primary interest was focused upon the buckling characteristics of the panel under pure compression with boundary conditions similar to those found in a wing mounted condition. Three primary phases of analysis are included in the report. These phases include: experimental testing of the beaded panel to failure; finite element structural analysis of the beaded panel with the computer program NASTRAN; a summary of the semiclassical buckling equations for the beaded panel under purely compressive loads. Comparisons between each of the analysis methods are also included.

Space transfer vehicle concepts and requirements, volume 2, book 1

NASA Technical Reports Server (NTRS)

1991-01-01

The objective of the systems engineering task was to develop and implement an approach that would generate the required study products as defined by program directives. This product list included a set of system and subsystem requirements, a complete set of optimized trade studies and analyses resulting in a recommended system configuration, and the definition of an integrated system/technology and advanced development growth path. A primary ingredient in the approach was the TQM philosophy stressing job quality from the inception. Included throughout the Systems Engineering, Programmatics, Concepts, Flight Design, and Technology sections are data supporting the original objectives as well as supplemental information resulting from program activities. The primary result of the analyses and studies was the recommendation of a single propulsion stage Lunar Transportation System (LTS) configuration that supports several different operations scenarios with minor element changes. This concept has the potential to support two additional scenarios with complex element changes. The space based LTS concept consists of three primary configurations--Piloted, Reusable Cargo, and Expendable Cargo.

26 CFR 1.475(a)-4 - Valuation safe harbor.

Code of Federal Regulations, 2012 CFR

2012-04-01

... statement. See paragraph (m) of this section. (2) Example. Use of eligible and non-eligible methods. X uses... primary financial statement for that year if that primary financial statement is described in paragraph (h)(2)(i) of this section (concerning statements required to be filed with the SEC) or if that primary...

26 CFR 1.475(a)-4 - Valuation safe harbor.

Code of Federal Regulations, 2013 CFR

2013-04-01

... statement. See paragraph (m) of this section. (2) Example. Use of eligible and non-eligible methods. X uses... primary financial statement for that year if that primary financial statement is described in paragraph (h)(2)(i) of this section (concerning statements required to be filed with the SEC) or if that primary...

An analysis of characteristics of post-authorisation studies registered on the ENCePP EU PAS Register

PubMed Central

Carroll, Robert; Ramagopalan, Sreeram V.; Cid-Ruzafa, Javier; Lambrelli, Dimitra; McDonald, Laura

2017-01-01

Background: The objective of this study was to investigate the study design characteristics of Post-Authorisation Studies (PAS) requested by the European Medicines Agency which were recorded on the European Union (EU) PAS Register held by the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP). Methods: We undertook a cross-sectional descriptive analysis of all studies registered on the EU PAS Register as of 18 th October 2016. Results: We identified a total of 314 studies on the EU PAS Register, including 81 (26%) finalised, 160 (51%) ongoing and 73 (23%) planned. Of those studies identified, 205 (65%) included risk assessment in their scope, 133 (42%) included drug utilisation and 94 (30%) included effectiveness evaluation. Just over half of the studies (175; 56%) used primary data capture, 135 (43%) used secondary data and 4 (1%) used a hybrid design combining both approaches. Risk assessment and effectiveness studies were more likely to use primary data capture (60% and 85% respectively as compared to 39% and 14% respectively for secondary). The converse was true for drug utilisation studies where 59% were secondary vs. 39% for primary. For type 2 diabetes mellitus, database studies were more commonly used (80% vs 3% chart review, 3% hybrid and 13% primary data capture study designs) whereas for studies in oncology, primary data capture were more likely to be used (85% vs 4% chart review, and 11% database study designs). Conclusions: Results of this analysis show that PAS design varies according to study objectives and therapeutic area. PMID:29188016

Postoperative pain and neuropathy after caesarean operation featuring blunt or sharp opening of the fascia: a randomised, parallel group, double-blind study.

PubMed

Yazici Yilmaz, Fatma; Aydogan Mathyk, Begum; Yildiz, Serhat; Yenigul, Nefise Nazli; Saglam, Ceren

2018-03-21

The purpose of this study was to compare postoperative pain and neuropathy after primary caesarean sections with either blunt or sharp fascial expansions. A total of 123 women undergoing primary caesarean sections were included in the study. The sharp group had 61 patients, and the blunt group had 62. In the sharp group, the fascia was incised sharply and extended using scissors. In blunt group, the fascia was bluntly opened by lateral finger-pulling. The primary outcome was postoperative pain. The long-term chronic pain scores were significantly lower in the blunt group during mobilisation (p = .012 and p = .022). Neuropathy was significantly more prevalent in the sharp group at both 1 and 3 months postoperatively (p = .043 and p = .016, respectively). The odds ratio (OR) and 95%CI for postoperative neuropathy at 1 and 3 months were as follows; OR 3.71, 95%CI 0.97-14.24 and OR 5.67, 95%CI 1.18-27.08, respectively. The OR for postoperative pain after 3 months was 3.26 (95%CI 1.09-9.73). The prevelance of postsurgical neuropathy and chronic pain at 3 months were significantly lower in the blunt group. Blunt fascial opening reduces the complication rate of postoperative pain and neuropathy after caesarean sections. Impact statement What is already known on this subject? The anatomic relationship of the abdominal fascia and the anterior abdominal wall nerves is a known fact. The fascia during caesarean sections can be opened by either a sharp or blunt extension. Data on the isolated impact of different fascial incisions on postoperative pain is limited. What do the results of this study add? The postoperative pain scores on the incision area are lower in the bluntly opened group compared to the sharp fascial incision group. By extending the fascia bluntly, a decrease in trauma and damage to nerves was observed. What are the implications of these findings for clinical practice and/or future research? The lateral extension of the fascia during caesarean sections must be done cautiously to prevent temporary damage to nerves and vessels. The blunt opening of the fascia by lateral finger pulling might be a preferred method over the sharp approach that uses scissors. We included only primary caesarean cases, however, comparisons of blunt and sharp fascial incisions in patients with more than one abdominal surgery should be explored in future studies.

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey

PubMed Central

Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos

2017-01-01

Background: Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Methods: Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Results: Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Interpretation: Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers. PMID:28401141

Self-Reported Disability: Association With Lower Extremity Performance and Other Determinants in Older Adults Attending Primary Care.

PubMed

Silva, Anabela G; Queirós, Alexandra; Sa-Couto, Pedro; Rocha, Nelson P

2015-12-01

Measurement of function usually involves the use of both performance-based and self-report instruments. However, the relationship between both types of measures is not yet completely understood, in particular for older adults attending primary care. The main objective of the study was to investigate the association between the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Short Physical Performance Battery (SPPB) for older adults at primary care. A secondary objective was to determine the influence of sociodemographic and health-related variables on this relationship. This was a cross-sectional study. A total of 504 participants aged 60 years and older from 18 different primary care centers underwent a one-session assessment including: sociodemographic variables, comorbidities, performance, self-reported disability, pain, depressive symptoms, and physical activity. Performance was assessed using the SPPB, and self-reported disability was assessed using the WHODAS 2.0. The correlation between WHODAS 2.0 and SPPB scores was strong (r=.65). Regression analysis showed that the SPPB total score explained 41.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=41.6%). A second model including the SPPB subtests (balance, gait, and sit-to-stand), depressive symptoms, number of pain sites, pain intensity, and level of physical activity explained 61.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=60.4%). No model improvement was found when considering the 6 WHODAS 2.0 individual domains. The cross-sectional nature of the study does not allow inferences on causal relationships. This study's findings confirm that self-report and performance-based measures relate to different aspects of functioning. Further study is needed to determine if primary care interventions targeting lower extremity performance and depressive symptoms improve self-reported disability. © 2015 American Physical Therapy Association.

Safe, Effective Use of Pesticides, A Manual for Commercial Applicators: Home, Institutional, and Structural Pest Control.

ERIC Educational Resources Information Center

Extension Service (USDA), Washington, DC.

This manual is designed to assist pest control operators to prepare for certification under the Michigan Pesticide Control Act of 1976. The primary focus of this publication is on home, institutional, and structural pest control. The ten sections included describe: (1) Insect control; (2) Rodent control; (3) Special situation pest control; (4)…

A Poem a Day: 180 Thematic Poems and Activities That Teach and Delight All Year Long. Grades K-3.

ERIC Educational Resources Information Center

Moore, Helen H.

This collection of 180 poems was assembled with classroom needs in mind. Intended to delight students every day, the collection's poems span the school year from September to summertime. Its introduction gives teachers before-, during-, and after-reading ideas. Sections in the collection include: Me and My World, Primary Concepts, Seasons and…

Washback Effects of a High-Stakes Exam on Lower Secondary School English Teachers' Practices in the Classroom

ERIC Educational Resources Information Center

Kilickaya, Ferit

2016-01-01

The aim of the article is to investigate the effects of the foreign language section of TEOG (Transition Examination from Primary to Secondary Education) on language teacher practices in the classroom. The participants of the study include 30 English language teachers working at lower secondary schools in Turkey. The results of the study indicate…

Patient ethnicity and the identification of anxiety in elderly primary care patients.

PubMed

Kim, Yeowon A; Morales, Knashawn H; Bogner, Hillary R

2008-09-01

To examine the role of ethnicity and primary care physician (PCP) identification of anxiety in older adults. A cross-sectional survey conducted between 2001 and 2003. Primary care offices in the Baltimore, Maryland, area. A sample of 330 adults aged 65 and older from Maryland primary care practices with complete information on psychological status and physician assessments. PCPs were asked to rate anxiety on a Likert scale. Patient interviews included measures of psychological status and patient use of psychotropic medications. Older black patients were less likely than older white patients to be identified as anxious (unadjusted odds ratio (OR)=0.34, 95% confidence interval (CI)=0.18-0.64) and less likely to be taking psychotropic medications (unadjusted OR=0.40, 95% CI=0.20-0.81). In multivariate models that controlled for potentially influential characteristics including depression and anxiety symptoms, the association between identification (OR=0.30, 95% CI=0.15-0.61) with patient ethnicity remained significantly unchanged. PCPs were less likely to identify older black Americans as anxious than white patients. An understanding of the role of ethnicity in the identification of anxiety is important for the screening and management of anxiety in elderly people.

The strength of primary care in Europe: an international comparative study.

PubMed

Kringos, Dionne; Boerma, Wienke; Bourgueil, Yann; Cartier, Thomas; Dedeu, Toni; Hasvold, Toralf; Hutchinson, Allen; Lember, Margus; Oleszczyk, Marek; Rotar Pavlic, Danica; Svab, Igor; Tedeschi, Paolo; Wilm, Stefan; Wilson, Andrew; Windak, Adam; Van der Zee, Jouke; Groenewegen, Peter

2013-11-01

A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Evaluation of strength of primary care in Europe. International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.

Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section

PubMed Central

Yang, Y. Tony; Mello, Michelle M.; Subramanian, S. V.; Studdert, David M.

2011-01-01

Background Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior aimed at reducing obstetricians’ exposure to malpractice litigation. Objective To estimate the effects of malpractice pressure on rates of VBAC and cesarean section. Research Design, Subjects, Measures We used state-level longitudinal mixed-effects regression models to examine data from the Natality Detail File on births in the United States (1991–2003). Malpractice pressure was measured by liability insurance premiums and tort reforms. Outcome measures were rates of VBAC, cesarean section, and primary cesarean section. Results Malpractice premiums were positively associated with rates of cesarean section (β = 0.15, P = 0.02) and primary cesarean section (β = 0.16, P = 0.009), and negatively associated with VBAC rates (β = −0.35, P = 0.01). These estimates imply that a $10,000 decrease in premiums for obstetrician-gynecologists would be associated with an increase of 0.35 percentage points (1.45%) in the VBAC rate and decreases of 0.15 and 0.16 percentage points (0.7% and 1.18%) in the rates of cesarean section and primary cesarean section, respectively; this would correspond to approximately 1600 more VBACs, 6000 fewer cesarean sections, and 3600 fewer primary cesarean sections nationwide in 2003. Two types of tort reform—caps on noneconomic damages and pretrial screening panels—were associated with lower rates of cesarean section and higher rates of VBAC. Conclusions The liability environment influences choice of delivery method in obstetrics. The effects are not large, but reduced litigation pressure would likely lead to decreases in the total number cesarean sections and total delivery costs. PMID:19169125

Relationship between malpractice litigation pressure and rates of cesarean section and vaginal birth after cesarean section.

PubMed

Yang, Y Tony; Mello, Michelle M; Subramanian, S V; Studdert, David M

2009-02-01

Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior aimed at reducing obstetricians' exposure to malpractice litigation. To estimate the effects of malpractice pressure on rates of VBAC and cesarean section. We used state-level longitudinal mixed-effects regression models to examine data from the Natality Detail File on births in the United States (1991-2003). Malpractice pressure was measured by liability insurance premiums and tort reforms. Outcome measures were rates of VBAC, cesarean section, and primary cesarean section. Malpractice premiums were positively associated with rates of cesarean section (beta = 0.15, P = 0.02) and primary cesarean section (beta = 0.16, P = 0.009), and negatively associated with VBAC rates (beta = -0.35, P = 0.01). These estimates imply that a $10,000 decrease in premiums for obstetrician-gynecologists would be associated with an increase of 0.35 percentage points (1.45%) in the VBAC rate and decreases of 0.15 and 0.16 percentage points (0.7% and 1.18%) in the rates of cesarean section and primary cesarean section, respectively; this would correspond to approximately 1600 more VBACs, 6000 fewer cesarean sections, and 3600 fewer primary cesarean sections nationwide in 2003. Two types of tort reform-caps on noneconomic damages and pretrial screening panels-were associated with lower rates of cesarean section and higher rates of VBAC. The liability environment influences choice of delivery method in obstetrics. The effects are not large, but reduced litigation pressure would likely lead to decreases in the total number cesarean sections and total delivery costs.

Reasons for low influenza vaccination coverage – a cross-sectional survey in Poland

PubMed Central

Kardas, Przemyslaw; Zasowska, Anna; Dec, Joanna; Stachurska, Magdalena

2011-01-01

Aim To assess the reasons for low influenza vaccination coverage in Poland, including knowledge of influenza and attitudes toward influenza vaccination. Methods This was a cross-sectional, anonymous, self-administered survey in primary care patients in Lodzkie voivodship (central Poland). The study participants were adults who visited their primary care physicians for various reasons from January 1 to April 30, 2007. Results Six hundred and forty participants completed the survey. In 12 months before the study, 20.8% participants had received influenza vaccination. The most common reasons listed by those who had not been vaccinated were good health (27.6%), lack of trust in vaccination effectiveness (16.8%), and the cost of vaccination (9.7%). The most common source of information about influenza vaccination were primary care physicians (46.6%). Despite reasonably good knowledge of influenza, as many as approximately 20% of participants could not point out any differences between influenza and other viral respiratory tract infections. Conclusions The main reasons for low influenza vaccination coverage in Poland were patients’ misconceptions and the cost of vaccination. Therefore, free-of-charge vaccination and more effective informational campaigns are needed, with special focus on high-risk groups. PMID:21495194

Visual Literacy in Primary Science: Exploring Anatomy Cross-Section Production Skills

ERIC Educational Resources Information Center

García Fernández, Beatriz; Ruiz-Gallardo, José Reyes

2017-01-01

Are children competent producing anatomy cross-sections? To answer this question, we carried out a case study research aimed at testing graphic production skills in anatomy of nutrition. The graphics produced by 118 children in the final year of primary education were analysed. The children had to draw a diagram of a human cross section,…

Parental attitudes to the care of the carious primary dentition experience from a Nigerian tertiary hospital.

PubMed

Popoola, B O; Kolude, B; Denloye, O O

2013-03-01

To examine the factors associated with parents choices of dental care concerning carious primary teeth of their children. A structured, self administered questionnaire was issued to parents of children attending the paediatric dental clinic of the University College Hospital (UCH) Ibadan. Items in the questionnaire included a section on the past dental visit(s) of parents, reason(s) for the clinic attendance and treatment(s) received, the second section contained items on parental treatment preferences under two different clinical scenarios of child dental health; scenario 1, asymptomatic carious primary tooth and scenario 2, symptomatic carious primary tooth. The last section contained items on determinants of parents' choice of treatment. Majority of the accompanying parent were mothers (75.8%) with a mean age of 39.3 +/- 6.81, fathers were 20.8% with a mean age of 45.1 +/- 5.24 while others were 3.4% with a mean age of 51.2 +/- 1.09. Under the two clinical scenarios, majority of the parents preferred the dentist to determine the treatment of their children (scenario 1 = 53.7%; scenario 2 = 62.5%). The accompanying parents and their socioeconomic status had no significant effect on parental preferences under the two clinical scenarios while past parental dental treatment had the greatest influence on parental choice (scenario 1:x2 = 12.93; p = 0.03 for past fillings experience and scenario 2: X2 = 6.881. = X 0.001 for past extraction experience). The reliance of parents on dentist for decision on the choice of their children dental treatment and the dependence of parents choice on their past dental treatment experience suggested the need for dental health education to both parents and children on dental caries.

Section 8(d) Health Safety Data Reporting User Guide – Primary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics (OPPT) Section 8(d) Health & Safety Data Reporting application. This document is the user guide for the Primary Support user.

Innovation in the safety net: integrating community health centers through accountable care.

PubMed

Lewis, Valerie A; Colla, Carrie H; Schoenherr, Karen E; Shortell, Stephen M; Fisher, Elliott S

2014-11-01

Safety net primary care providers, including as community health centers, have long been isolated from mainstream health care providers. Current delivery system reforms such as Accountable Care Organizations (ACOs) may either reinforce the isolation of these providers or may spur new integration of safety net providers. This study examines the extent of community health center involvement in ACOs, as well as how and why ACOs are partnering with these safety net primary care providers. Mixed methods study pairing the cross-sectional National Survey of ACOs (conducted 2012 to 2013), followed by in-depth, qualitative interviews with a subset of ACOs that include community health centers (conducted 2013). One hundred and seventy-three ACOs completed the National Survey of ACOs. Executives from 18 ACOs that include health centers participated in in-depth interviews, along with leadership at eight community health centers participating in ACOs. Key survey measures include ACO organizational characteristics, care management and quality improvement capabilities. Qualitative interviews used a semi-structured interview guide. Interviews were recorded and transcribed, then coded for thematic content using NVivo software. Overall, 28% of ACOs include a community health center (CHC). ACOs with CHCs are similar to those without CHCs in organizational structure, care management and quality improvement capabilities. Qualitative results showed two major themes. First, ACOs with CHCs typically represent new relationships or formal partnerships between CHCs and other local health care providers. Second, CHCs are considered valued partners brought into ACOs to expand primary care capacity and expertise. A substantial number of ACOs include CHCs. These results suggest that rather than reinforcing segmentation of safety net providers from the broader delivery system, the ACO model may lead to the integration of safety net primary care providers.

Lidar Remote Sensing

NASA Technical Reports Server (NTRS)

McGill, Matthew J.; Starr, David OC. (Technical Monitor)

2002-01-01

The laser radar, or lidar (for light detection and ranging) is an important tool for atmospheric studies. Lidar provides a unique and powerful method for unobtrusively profiling aerosols, wind, water vapor, temperature, and other atmospheric parameters. This brief overview of lidar remote sensing is focused on atmospheric applications involving pulsed lasers. The level of technical detail is aimed at the educated non-lidar expert and references are provided for further investigation of specific topics. The article is divided into three main sections. The first describes atmospheric scattering processes and the physics behind laser-atmosphere interactions. The second section highlights some of the primary lidar applications, with brief descriptions of each measurement capability. The third section describes the practical aspects of lidar operation, including the governing equation and operational considerations.

Industry Collaboration and Primary Guest Authorship of High-Impact Randomized Clinical Trials: A Cross-Sectional Study.

PubMed

Roper, Nitin; Korenstein, Deborah

2015-10-01

Journals have increased disclosure requirements in recent years, in part to deter guest authorship. The prevalence of guest authorship among primary authors (first and last) in the current era of increased disclosure requirements is unknown. Our aim was to examine the self-reported prevalence of guest authorship among primary authors from a sample of randomized clinical trials with and without industry funding and industry collaboration in the design, analysis or reporting of trials. Cross-sectional analysis of randomized, drug/device clinical trials with published details on the "Role of the Funding Source/Sponsor" published in high-impact biomedical journals between 1 December 2011 and 31 November 2012. Phase 1 or 2 trials, secondary trial analyses, and trials that were not listed on ClinicalTrials.gov were excluded. Primary guest authorship was defined, based on International Committee of Medical Journal Editors (ICMJE) criteria, when neither the first nor last author contributed to either of the following: 1) the design of the trial or the analysis/interpretation of data; or 2) drafting part or all of the manuscript. One hundred and sixty-eight randomized clinical trials that met inclusion criteria were included. We measured differences in the prevalence of guest authorship between trials with neither industry funding nor collaboration and 1) trials with industry funding without collaboration, and 2) trials with industry funding with collaboration. The overall prevalence of primary guest authorship was 6 % (10/168). Primary guest authorship was significantly more common in trials with industry funding with collaboration than in those with neither industry funding nor collaboration [13.2 % (10/76) vs. 0 % (0/39); p < 0.02]. Primary guest authorship did not differ between trials with industry funding without collaboration and trials with neither industry funding nor collaboration. Among a sample of randomized, drug/device clinical trials in high-impact biomedical journals, primary guest authorship was overall uncommon and occurred exclusively among trials with industry funding with collaboration.

Sonographic Alteration of Basal Ganglia in Different Forms of Primary Focal Dystonia: A Cross-sectional Study

PubMed Central

Zhang, Ying; Zhang, Ying-Chun; Sheng, Yu-Jing; Chen, Xiao-Fang; Wang, Cai-Shan; Ma, Qi; Chen, Han-Bing; Yu, Li-Fang; Mao, Cheng-Jie; Xiong, Kang-Ping; Luo, Wei-Feng; Liu, Chun-Feng

2016-01-01

Background: Few studies have addressed whether abnormalities in the lenticular nucleus (LN) are characteristic transcranial sonography (TCS) echo features in patients with primary dystonia. This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia. Methods: cross-sectional observational study was performed between December 2013 and December 2014 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects. TCS was performed in patients and control subjects. Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups. Results: Thirteen individuals were excluded due to poor temporal bone windows, and two subjects were excluded due to disagreement in evaluation by sonologists. Totally, 70 patients (cervical dystonia, n = 30; blepharospasm, n = 30; oromandibular dystonia, n = 10) and 50 normal controls were included in the final analysis. LN hyperechogenicity was observed in 51% (36/70) of patients with primary focal dystonia, compared with 12% (6/50) of controls (P < 0.001). Substantia nigra hyperechogenicity did not differ between the two groups. LN hyperechogenicity was observed in 73% (22/30) of patients with cervical dystonia, a greater prevalence than in patients with blepharospasm (33%, 10/30, P = 0.002) and oromandibular dystonia (40%, 4/10, P = 0.126). LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls (73% vs. 12%, P < 0.001); however, no significant difference was detected in patients with blepharospasm (33% vs. 12%, P = 0.021) or oromandibular dystonia (40% vs. 12%, P = 0.088). Conclusions: LN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls. It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia. PMID:27064039

Medical errors in primary care clinics – a cross sectional study

PubMed Central

2012-01-01

Background Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. Methods This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. Results The majority of patient encounters (81%) were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0) of medical records and management errors in 53.2% (95% CI: 46.3, 60.2). For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4) of records, investigation errors in 21.7% (95% CI: 16.5, 26.8) and decision making errors in 14.5% (95% CI: 10.8, 18.2). A total of 39.9% (95% CI: 33.1, 46.7) of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1) of records. Nearly all errors (93.5%) detected were considered preventable. Conclusions The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors. PMID:23267547

Satisfaction of Patients Attending in Primary Healthcare Centers in Riyadh, Saudi Arabia: A Random Cross-Sectional Study.

PubMed

Almutairi, Khalid M

2017-06-01

This study aims to determine the level of satisfaction of patients who visit primary healthcare centers in Riyadh, Saudi Arabia. The investigation was a cross-sectional study conducted in twenty randomly selected primary healthcare centers in Riyadh, Saudi Arabia from October to December 2014. A descriptive data analysis was performed. Eligible participants had visited at least one of the selected primary healthcare centers within the past 12 months. A total of 1741 participants completed the survey, providing a response rate of 87 % (43 % male, 57 % female). The highest satisfaction rates were in the following areas: comprehensiveness and coordination 76.2 % (95 % CI 74.8 ± 77.5), communication 72.7 % (95 % CI 71.3 ± 74) and attitude of staff 73.4 % (95 % CI 72.1 ± 74.8) The areas of greatest concern expressed by the participants were the length of the wait and the quality of the facility 55.4 % (95 % CI 53.3 ± 57.5), 50.5 % (95 % CI 48.3 ± 52.7), respectively. The majority of the patients attending primary healthcare centers in Riyadh showed high levels of satisfaction; however, there are still some factors that need to be considered and improved upon. These include the accessibility of primary healthcare centers as well as waiting time of patients. The results of the current study showed relative improvement in other factors such as comprehensiveness and coordination, communication and attitude of staff. The level of satisfaction of patients and stakeholders shows the progress of the quality of care in healthcare facilities in Riyadh, Saudi Arabia.

Improving external cephalic version for foetal breech presentation

PubMed Central

Zandstra, H.; Mertens, H.J.M.M.

2013-01-01

Objectives: If success rate of external cephalic version (ECV) increases, the rate of primary caesarean sections declines. The aims of this retrospective cohort study were to evaluate the ECV and to identify factors associated with the success rate of ECV for breech presentation at term. The second aim of this study was to analyse the outcome of labour of all patients with a foetus in breech near term. Methods: All women with a foetus in breech near or at term were included. Logistic regression analyses were performed to identify the association between patient characteristics and success rate of ECV. Results: The overall rate of successful ECV’s was 19%. Foetal and maternal complications after ECV were negligible. BMI, type of breech and amount of amniotic fluid were significantly correlated with a successful ECV. The rate of primary caesarean sections for the group of patients who underwent an ECV was lower than the rate in the group who did not (52.9% vs. 79.6%). The rate of spontaneous deliveries was increased after ECV (36% versus 12%). After successful ECV the rate of spontaneous deliveries was 75%; after unsuccessful ECV 26.8%. Conclusion: The overall rate of successful ECV was low (19%). BMI, type of breech and amount of amniotic fluid were significantly correlated with a successful ECV. The rate of primary caesarean sections was significantly lower in patients with ECV (52.9% versus 79.6%). The rate of spontaneous deliveries was significantly higher (36% versus 12%). PMID:24753933

Improving external cephalic version for foetal breech presentation.

PubMed

Zandstra, H; Mertens, H J M M

2013-01-01

If success rate of external cephalic version (ECV) increases, the rate of primary caesarean sections -declines. The aims of this retrospective cohort study were to evaluate the ECV and to identify factors associated with the success rate of ECV for breech presentation at term. The second aim of this study was to analyse the outcome of labour of all patients with a foetus in breech near term. All women with a foetus in breech near or at term were included. Logistic regression analyses were -performed to identify the association between patient characteristics and success rate of ECV. The overall rate of successful ECV's was 19%. Foetal and maternal complications after ECV were negligible. BMI, type of breech and amount of amniotic fluid were significantly correlated with a successful ECV. The rate of primary caesarean sections for the group of patients who underwent an ECV was lower than the rate in the group who did not (52.9% vs. 79.6%). The rate of spontaneous deliveries was increased after ECV (36% versus 12%). After successful ECV the rate of spontaneous deliveries was 75%; after unsuccessful ECV 26.8%. The overall rate of successful ECV was low (19%). BMI, type of breech and amount of amniotic fluid were significantly correlated with a successful ECV. The rate of primary caesarean sections was significantly lower in patients with ECV (52.9% versus 79.6%). The rate of spontaneous deliveries was significantly higher (36% -versus 12%).

[Effect of a campaign to promote breast-feeding among women in the province of Malaga who had their babies by caesarean section].

PubMed

Gámez Requena, J J; Márquez Feu, T; Gómez Gómez, F J; Sánchez García, E

2004-05-31

To determine whether an intervention to foster breast-feeding did actually increase it and how long it lasted in nursing mothers who gave birth through caesarean section. Evaluation of a community intervention. Mother-and-Child Hospital in Málaga. Sample of 152 pregnant women who delivered their baby by caesarean section, 76 in 1996 and 76 in 1998. During 1997, activities to promote breast-feeding were organised in the health district. These included workshops aimed at primary care and specialist professionals, public events to promote breast-feeding (public feeds, photography competitions, media comment, etc), accords with institutions (university, nursing college inter al) and changes in the health services (improvement of services to new mothers and neonates; co-ordination between primary and hospital care). In 1996, only 28% of women who started feeding did so with serotherapy. In 1998 this became 85% (P<.0005). Length of breast-feeding also increased significantly (P<.215). There was greater involvement of nursing, though it was not statistically significant (P<.06), moving from 40% in 1996 to 65.2% in 1998. The campaign showed its efficacy as a method of promotion of breast-feeding, on achieving an earlier start in breast-feeding, longer duration of it and greater involvement of nurses. Practical applications included changes in hospital routines, professional training, working out of strategies and specific records for the ongoing assessment of breast-feeding.

Teacher's Digital Skills in Relation to Their Age, Gender, Time of Usage and Training with a Tablet

ERIC Educational Resources Information Center

Cantú-Ballesteros, Lorenia; Urías-Murrieta, Maricela; Figueroa-Rodríguez, Sebastián; Salazar-Lugo, Guillermo M.

2017-01-01

The present studies objective was to determine the digital level capabilities of primary school teachers and their relation with certain sociodemographic factors. The focus was quantitative and a cross-sectional survey design for two or more groups was used. The sample was non-probabilistic and included 88 fifth and sixth grade teachers from 32…

Electronic Collection Management and Electronic Information Services

DTIC Science & Technology

2003-04-01

compilation report, use: ADA415655 The component part is provided here to allow users access to individually authored sections f proceedings, annals...providers or as brokers between the user and the primary service provider. There has also been a significant reorientation from concept of "ownership...access. It will also look at the major trends in electronic user services including electronic information delivery and electronic reference. Finally, it

Persistent measles virus infection of the intestine: confirmation by immunogold electron microscopy.

PubMed Central

Lewin, J; Dhillon, A P; Sim, R; Mazure, G; Pounder, R E; Wakefield, A J

1995-01-01

This study sought to investigate persistent measles virus infection of the intestine: a novel protocol for immunogold electron microscopy was developed using a polyclonal anti-measles nucleoprotein antibody on reprocessed, formalin fixed paraffin wax embedded tissue sections. Antibody binding was detected using both immunoperoxidase and light microscopy on tissue sections, and 10 nm gold conjugated secondary antibody and electron microscopy on ultrathin sections. The techniques were validated using both measles infected vero cells and human tissues with established measles infection: these included brain affected by subacute sclerosing panencephalitis and acute measles appendicitis. The technique was applied subsequently to six untreated cases of granulomatous Crohn's disease, and two cases of ileocaecal tuberculosis, a granulomatous control. Mumps primary antibody--applied to both mumps infected vero cells, and measles infected vero cells and tissues studied by immunoperoxidase, and measles antibody on mumps infected cells studied by immunoperoxidase and immunogold--were used as specificity controls: the primary antibodies identified their respective target antigen and there was no antibody cross reactivity. Measles virus nucleocapsids labelled with gold conjugated antibody in both infected cells and tissues, including foci of granulomatous inflammation in five of six cases of Crohn's disease: in the fifth case, the granuloma could not be identified in ultrathin section. In one of the tuberculosis cases, a low level of signal was noted while the second case was negative. Labelling adopted a characteristic pattern in all infected tissues, strengthening the specificity of these findings. This study provides the first direct confirmation of persistent measles virus infection of the intestine. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:7737565

[Depression and burden on primary caregivers of elderly persons with physical dependence of the UMF 171].

PubMed

Navarro-Sandoval, Cristina; Uriostegui-Espíritu, Lizbeth Carlota; Delgado-Quiñones, Edna Gabriela; Sahagún-Cuevas, Minerva Natalia

2017-01-01

According to the National Health and Nutrition Survey of 2012, more than a quarter of older adults (26.9%) have some degree of disability, requiring a primary caregiver to perform basic activities of daily living. The aim is to determine the prevalence of depression and burden on primary caregivers of elderly persons with physical dependence. A descriptive cross-sectional study with non-probability sampling that included the primary caregivers of elderly patients with physical dependence. Barthel scale was applied as a tool to measure the level of physical dependence in elderly patients; while the primary caregivers were applied to the Beck Depression and Zarit scale for assessing the level of caregiver burden. A sample of 76 primary caregivers was calculated and descriptive statistical analysis was performed. Of the 76 primary caregivers, 55.3% were without depression, 32.9% had mild depression, and 11.8% with moderate depression. According to the Zarit scale, 40.8% had no burden, 44.7% had burden light, and 14.5% intense burden. The role of primary caregiver is a stressful task which can interfere with their family health; so our role is to provide care not only to the geriatric dependent patients, but also to their caregiver.

The Development and Validation of a Rapid Assessment Tool of Primary Care in China

PubMed Central

Mei, Jie; Liang, Yuan; Shi, LeiYu; Zhao, JingGe; Wang, YuTan; Kuang, Li

2016-01-01

Introduction. With Chinese health care reform increasingly emphasizing the importance of primary care, the need for a tool to evaluate primary care performance and service delivery is clear. This study presents a methodology for a rapid assessment of primary care organizations and service delivery in China. Methods. The study translated and adapted the Primary Care Assessment Tool-Adult Edition (PCAT-AE) into a Chinese version to measure core dimensions of primary care, namely, first contact, continuity, comprehensiveness, and coordination. A cross-sectional survey was conducted to assess the validity and reliability of the Chinese Rapid Primary Care Assessment Tool (CR-PCAT). Eight community health centers in Guangdong province have been selected to participate in the survey. Results. A total of 1465 effective samples were included for data analysis. Eight items were eliminated following principal component analysis and reliability testing. The principal component analysis extracted five multiple-item scales (first contact utilization, first contact accessibility, ongoing care, comprehensiveness, and coordination). The tests of scaling assumptions were basically met. Conclusion. The standard psychometric evaluation indicates that the scales have achieved relatively good reliability and validity. The CR-PCAT provides a rapid and reliable measure of four core dimensions of primary care, which could be applied in various scenarios. PMID:26885509

Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth

PubMed Central

2012-01-01

Background To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. Methods This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983). The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. Results Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5)]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p < .001). Among patients with placenta previa in the primary CS pregnancy, those who delivered preterm had a higher rate of recurrent spontaneous preterm birth regardless of the location of their placenta in the subsequent delivery [OR 3.09 (95% CI 2.1-4.6)]. In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5)]. Conclusions Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended. PMID:22876799

Preferred Healthy Food Nudges, Food Store Environments, and Customer Dietary Practices in 2 Low-Income Southern Communities.

PubMed

Jilcott Pitts, Stephanie B; Wu, Qiang; Sharpe, Patricia A; Rafferty, Ann P; Elbel, Brian; Ammerman, Alice S; Payne, Collin R; Hopping, Beth N; McGuirt, Jared T; Wall-Bassett, Elizabeth D

To examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index. Intercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages. Frequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02). Future studies should examine associations between elements of the in-store food environment, purchases, and consumption. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Prevalence and Characteristics of Hyperhidrosis in Sweden: A Cross-Sectional Study in the General Population.

PubMed

Shayesteh, Alexander; Janlert, Urban; Brulin, Christine; Boman, Jens; Nylander, Elisabet

2016-01-01

Hyperhidrosis is defined as excessive sweating which can be primary or secondary. Data about the prevalence of primary hyperhidrosis are scarce for northern Europe. Our aim was to investigate the prevalence of hyperhidrosis focusing on its primary form and describe the quality of life impairments for the affected individuals. Five thousand random individuals aged 18-60 years in Sweden were investigated. The individuals' addresses were obtained from Statens personadressregister, SPAR, which includes all persons who are registered as resident in Sweden. A validated questionnaire regarding hyperhidrosis including the Hyperhidrosis Disease Severity Scale (HDSS) and 36-item Short Form (SF-36) health survey was sent to each individual. The participants were asked to return the coded questionnaire within 1 week. A total of 1,353 individuals (564 male, 747 female and 42 with unspecified gender) with a mean age of 43.1 ± 11.2 years responded. The prevalence of primary hyperhidrosis was 5.5%, and severe primary hyperhidrosis (HDSS 3-4 points) occurred in 1.4%. Secondary hyperhidrosis was observed in 14.8% of the participants. Our SF-36 results showed that secondary hyperhidrosis causes a significant (p < 0.001) impairment of both mental and physical abilities while primary hyperhidrosis impairs primarily the mental health (p < 0.001). Hyperhidrosis affects individuals in adolescence as a focal form while occurring as a generalised form with increasing age. Further, the prevalence of primary hyperhidrosis described in our study is comparable to other studies from the western hemisphere. While secondary, generalised hyperhidrosis impairs both physical and mental aspects of life, primary hyperhidrosis, with the exception of severe cases, mainly affects the mental health. © 2016 S. Karger AG, Basel.

Effect of Primary Elective Cesarean Delivery on Placenta Accreta: A Case-Control Study.

PubMed

Shi, Xiao-Ming; Wang, Yan; Zhang, Yan; Wei, Yuan; Chen, Lian; Zhao, Yang-Yu

2018-03-20

Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa. A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups. The rate of primary elective CS (90.1% vs. 69.9%, P < 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P < 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P < 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68-6.58). Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa.

Effect of Primary Elective Cesarean Delivery on Placenta Accreta: A Case-Control Study

PubMed Central

Shi, Xiao-Ming; Wang, Yan; Zhang, Yan; Wei, Yuan; Chen, Lian; Zhao, Yang-Yu

2018-01-01

Background: Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa. Methods: A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups. Results: The rate of primary elective CS (90.1% vs. 69.9%, P < 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P < 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P < 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68–6.58). Conclusion: Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa. PMID:29521289

Geologic setting, petrophysical characteristics, and regional heterogeneity patterns of the Smackover in southwest Alabama. Draft topical report on Subtasks 2 and 3

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

Kopaska-Merkel, D.C.; Mann, S.D.; Tew, B.H.

1992-06-01

This is the draft topical report on Subtasks 2 and 3 of DOE contract number DE-FG22-89BC14425, entitled ``Establishment of an oil and gas database for increased recovery and characterization of oil and gas carbonate reservoir heterogeneity.`` This volume constitutes the final report on Subtask 3, which had as its primary goal the geological modeling of reservoir heterogeneity in Smackover reservoirs of southwest Alabama. This goal was interpreted to include a thorough analysis of Smackover reservoirs, which was required for an understanding of Smackover reservoir heterogeneity. This report is divided into six sections (including this brief introduction). Section two, entitled ``Geologicmore » setting,`` presents a concise summary of Jurassic paleogeography, structural setting, and stratigraphy in southwest Alabama. This section also includes a brief review of sedimentologic characteristics and stratigraphic framework of the Smackover, and a summary of the diagenetic processes that strongly affected Smackover reservoirs in Alabama. Section three, entitled ``Analytical methods,`` summarizes all nonroutine aspects of the analytical procedures used in this project. The major topics are thin-section description, analysis of commercial porosity and permeability data, capillary-pressure analysis, and field characterization. ``Smackover reservoir characteristics`` are described in section four, which begins with a general summary of the petrographic characteristics of porous and permeable Smackover strata. This is followed by a more-detailed petrophysical description of Smackover reservoirs.« less

Indian pharmaceutical patent prosecution: The changing role of Section 3(d).

PubMed

Sampat, Bhaven N; Shadlen, Kenneth C

2018-01-01

India, like many developing countries, only recently began to grant pharmaceutical product patents. Indian patent law includes a provision, Section 3(d), which tries to limit grant of "secondary" pharmaceutical patents, i.e. patents on new forms of existing molecules and drugs. Previous research suggests the provision was rarely used against secondary applications in the years immediately following its enactment, and where it was, was redundant to other aspects of the patent law, raising concerns that 3(d) was being under-utilized by the Indian Patent Office. This paper uses a novel data source, the patent office's first examination reports, to examine changes in the use of the provision. We find a sharp increase over time in the use of Section 3(d), including on the main claims of patent applications, though it continues to be used in conjunction with other types of objections to patentability. More surprisingly, see a sharp increase in the use of the provision against primary patent applications, contrary to its intent, raising concerns about potential over-utilization.

Impact of intratumoural heterogeneity on the assessment of Ki67 expression in breast cancer.

PubMed

Aleskandarany, M A; Green, A R; Ashankyty, I; Elmouna, A; Diez-Rodriguez, M; Nolan, C C; Ellis, I O; Rakha, E A

2016-07-01

In breast cancer (BC), the prognostic value of Ki67 expression is well-documented. Intratumoural heterogeneity (ITH) of Ki67 expression is amongst the several technical issues behind the lag of its inclusion into BC prognostic work-up. The immunohistochemical (IHC) expression of anti-Ki67 antibody (MIB1 clone) was assessed in four full-face (FF) sections from different primary tumour blocks and their matched axillary nodal (LN) metastases in a series of 55 BC. Assessment was made using the highest expression hot spots (HS), lowest expression (LS), and overall/average expression scores (AS) in each section. Heterogeneity score (Hes), co-efficient of variation, and correlation co-efficient were used to assess the levels of Ki67 ITH. Ki67 HS, LS, and AS scores were highly variable within the same section and between different sections of the primary tumour, with maximal variation observed in the LS (P < 0.001). The least variability between the different slides was observed with HS scoring. Although the associations between Ki67 and clinicopathological and molecular variables were similar when using HS or AS, the best correlation between AS and HS was observed in tumours with high Ki67 expression only. Ki67 expression in LN deposits was less heterogeneous than in the primary tumours and was perfectly correlated with the HS Ki67 expression in the primary tumour sections (r = 0.98, P < 0.001). In conclusion, assessment of Ki67 expression using HS scoring method on a full-face BC tissue section can represent the primary tumour growth fraction that is likely to metastasise. The association between Ki67 expression pattern in the LN metastasis and the HS in the primary tumour may reflect the temporal heterogeneity through clonal expansion.

Fluorescence of bioaerosols: mathematical model including primary fluorescing and absorbing molecules in bacteria.

PubMed

Hill, Steven C; Pan, Yong-Le; Williamson, Chatt; Santarpia, Joshua L; Hill, Hanna H

2013-09-23

This paper describes a mathematical model of fluorescent biological particles composed of bacteria, viruses, or proteins. The fluorescent and/or light absorbing molecules included in the model are amino acids (tryptophan, etc.); nucleic acids (DNA, RNA, etc.); coenzymes (nicotinamide adenine dinucleotides, flavins, and vitamins B₆ and K and variants of these); and dipicolinates. The concentrations, absorptivities, and fluorescence quantum yields are estimated from the literature, often with large uncertainties. The bioparticles in the model are spherical and homogeneous. Calculated fluorescence cross sections for particles excited at 266, 280, and 355 nm are compared with measured values from the literature for several bacteria, bacterial spores and albumins. The calculated 266- and 280-nm excited fluorescence is within a factor of 3.2 of the measurements for the vegetative cells and proteins, but overestimates the fluorescence of spores by a factor of 10 or more. This is the first reported modeling of the fluorescence of bioaerosols in which the primary fluorophores and absorbing molecules are included.

20 CFR 404.260 - Special minimum primary insurance amounts.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... 404.260 Section 404.260 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Special Minimum Primary... compute your primary insurance amount, if the special minimum primary insurance amount described in § 404...

Evaluation of cerebral maturation by visual and quantitative analysis of resting electroencephalography in children with primary nocturnal enuresis.

PubMed

Hallioğlu, O; Ozge, A; Comelekoglu, U; Topaloglu, A K; Kanik, A; Duzovali, O; Yilgor, E

2001-10-01

This study was undertaken to evaluate resting electroencephalographic (EEG) changes and their relations to cerebral maturation in children with primary nocturnal enuresis. Cerebral maturation is known to be important in the pathogenesis of this disorder. Twenty-five right-handed patients with primary nocturnal enuresis, aged 6 to 14 years, and 23 age- and sex-matched healthy children were included in this cross-sectional case-control study. The abnormalities detected using such techniques as hemispheral asymmetry, regional differences, and hyperventilation response in addition to visual and quantitative EEG analysis were examined statistically by multivariate analysis. A decrease in alpha activity in the left (dominant hemisphere) temporal lobe and in the frontal lobes bilaterally and an increase in delta activity in the right temporal region were observed. We concluded that insufficient cerebral maturation is an important factor in the pathogenesis of primary nocturnal enuresis, and EEG, as a noninvasive and inexpensive method, could be used in evaluating cerebral maturation.

Decision analytic model exploring the cost and cost-offset implications of street triage

PubMed Central

Heslin, Margaret; Callaghan, Lynne; Packwood, Martin; Badu, Vincent; Byford, Sarah

2016-01-01

Objectives To determine if street triage is effective at reducing the total number of people with mental health needs detained under section 136, and is associated with cost savings compared to usual police response. Design Routine data from a 6-month period in the year before and after the implementation of a street triage scheme were used to explore detentions under section 136, and to populate a decision analytic model to explore the impact of street triage on the cost to the NHS and the criminal justice sector of supporting people with a mental health need. Setting A predefined area of Sussex, South East England, UK. Participants All people who were detained under section 136 within the predefined area or had contact with the street triage team. Interventions The street triage model used here was based on a psychiatric nurse attending incidents with a police constable. Primary and secondary outcome measures The primary outcome was change in the total number of detentions under section 136 between the before and after periods assessed. Secondary analysis focused on whether the additional costs of street triage were offset by cost savings as a result of changes in detentions under section 136. Results Detentions under section 136 in the street triage period were significantly lower than in the usual response period (118 vs 194 incidents, respectively; χ2 (1df) 18.542, p<0.001). Total NHS and criminal justice costs were estimated to be £1043 in the street triage period compared to £1077 in the usual response period. Conclusions Investment in street triage was offset by savings as a result of reduced detentions under section 136, particularly detentions in custody. Data available did not include assessment of patient outcomes, so a full economic evaluation was not possible. PMID:26868943

40 CFR 81.338 - Oregon.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 18 2014-07-01 2014-07-01 false Oregon. 81.338 Section 81.338... AREAS FOR AIR QUALITY PLANNING PURPOSES Section 107 Attainment Status Designations § 81.338 Oregon. Oregon—1971 Sulfur Dioxide NAAQS (Primary and Secondary) Designated area Does not meet primary standards...

40 CFR 81.324 - Minnesota.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 18 2014-07-01 2014-07-01 false Minnesota. 81.324 Section 81.324... AREAS FOR AIR QUALITY PLANNING PURPOSES Section 107 Attainment Status Designations § 81.324 Minnesota. Minnesota—1971 Sulfur Dioxide NAAQS (Primary and Secondary) Designated area Does not meet primary standards...

40 CFR 81.306 - Colorado.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 18 2014-07-01 2014-07-01 false Colorado. 81.306 Section 81.306... AREAS FOR AIR QUALITY PLANNING PURPOSES Section 107 Attainment Status Designations § 81.306 Colorado. Colorado—1971 Sulfur Dioxide NAAQS (Primary and Secondary) Designated Area Does not meet primary standards...

Organisation and function of the primary motor cortex in chronic pain: protocol for a systematic review and meta-analysis.

PubMed

Chang, Wei-Ju; O'Connell, Neil E; Burns, Emma; Chipchase, Lucy S; Liston, Matthew B; Schabrun, Siobhan M

2015-11-30

Primary motor cortical (M1) adaptation in the form of altered organisation and function is hypothesised to underpin motor dysfunction observed in chronic pain. The aim of this review is to assess the evidence for altered M1 organisation and function in chronic pain. Systematic review and meta-analysis. We will search electronic databases with predetermined search terms to identify relevant studies and evaluate the studies for inclusion and risks of bias. Two independent reviewers will extract data. Any disagreement will be resolved through a third reviewer. Cross-sectional or prospective studies published in English before May 2015 that investigate M1 organisation and function in chronic pain will be included if they meet the eligibility criteria. Primary outcomes will include M1 cortical excitability, spatial cortical representation, the function of inhibitory and facilitatory intracortical networks, cortical reactivity and cortical glucose metabolism. Clinical measures such as pain and disability will be included where the correlation with the primary outcomes of M1 organisation and function were investigated in the included studies. This systematic review does not require ethical approval. The results of this review will be submitted for peer-reviewed publication regardless of outcome and will be presented at relevant conferences. Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42015014823). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Development and validation of the Vietnamese primary care assessment tool.

PubMed

Hoa, Nguyen Thi; Tam, Nguyen Minh; Peersman, Wim; Derese, Anselme; Markuns, Jeffrey F

2018-01-01

To adapt the consumer version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. A quantitative cross sectional study. 56 communes in 3 representative provinces of central Vietnam. Total of 3289 people who used health care services at health facility at least once over the past two years. The Vietnamese adult expanded consumer version of the PCAT (VN PCAT-AE) is an instrument for evaluation of primary care in Vietnam with 70 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. Sixteen other items from the original tool were not included in the final instrument, due to problems with missing values, floor or ceiling effects, and item-total correlations. All the retained scales have a Cronbach's alpha above 0.70 except for the subscale of Family Centeredness. The VN PCAT-AE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the consumer perspective. Additional work in the future to optimize valid measurement in all domains consistent with the original version of the tool may be helpful as the primary care system in Vietnam further develops.

LUTE telescope structural design

NASA Technical Reports Server (NTRS)

Ruthven, Gregory

1993-01-01

The major objective of the Lunar Ultraviolet Transit Experiment (LUTE) Telescope Structural Design Study was to investigate the feasibility of designing an ultralightweight 1-m aperture system within optical performance requirements and mass budget constraints. This study uses the results from our previous studies on LUTE as a basis for further developing the LUTE structural architecture. After summarizing our results in Section 2, Section 3 begins with the overall logic we used to determine which telescope 'structural form' should be adopted for further analysis and weight estimates. Specific telescope component analysis showing calculated fundamental frequencies and how they compare with our derived requirements are included. 'First-order' component stress analyses to ensure telescope optical and structural component (i.e. mirrors & main bulkhead) weights are realistic are presented. Layouts of both the primary and tertiary mirrors showing dimensions that are consistent with both our weight and frequency calculations also form part of Section 3. Section 4 presents our calculated values for the predicted thermally induced primary-to-secondary mirror despace motion due to the large temperature range over which LUTE must operate. Two different telescope design approaches (one which utilizes fused quartz metering rods and one which assumes the entire telescope is fabricated from beryllium) are considered in this analysis. We bound the secondary mirror focus mechanism range (in despace) based on these two telescope configurations. In Section 5 we show our overall design of the UVTA (Ultraviolet Telescope Assembly) via an 'exploded view' of the sub-system. The 'exploded view' is annotated to help aid in the understanding of each sub-assembly. We also include a two view layout of the UVTA from which telescope and telescope component dimensions can be measured. We conclude our study with a set of recommendations not only with respect to the LUTE structural architecture but also on other topics related to the overall feasibility of the LUTE telescope sub-system.

Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study

PubMed Central

Fletcher-Lartey, Stephanie; Yee, Melissa; Gaarslev, Christina; Khan, Rabia

2016-01-01

Objectives To describe the role patient expectations play in general practitioners (GPs) antibiotic prescribing for upper respiratory tract infections (URTI). Methods Concurrent explanatory mixed methods approach using a cross-sectional survey and semistructured interviews. Settings Primary care GPs in Australia. Participants 584 GPs (response rate of 23.6%) completed the cross-sectional survey. 32 GPs were interviewed individually. Outcome measure Prescribing of antibiotics for URTI. Results More than half the GP respondents to the survey in Australia self-reported that they would prescribe antibiotics for an URTI to meet patient expectations. Our qualitative findings suggest that ‘patient expectations’ may be the main reason given for inappropriate prescribing, but it is an all-encompassing phrase that includes other reasons. These include limited time, poor doctor–patient communication and diagnostic uncertainty. We have identified three role archetypes to explain the behaviour of GPs in reference to antibiotic prescribing for URTIs. The main themes emerging from the qualitative component was that many GPs did not think that antibiotic prescribing in primary care was responsible for the development of antibiotic resistance nor that their individual prescribing would make any difference in light of other bigger issues like hospital prescribing or veterinary use. For them, there were negligible negative consequences from their inappropriate prescribing. Conclusions There is a need to increase awareness of the scope and magnitude of antibiotic resistance and the role primary care prescribing plays, and of the contribution of individual prescribing decisions to the problem of antibiotic resistance. PMID:27798010

Patient-reported access to primary care in Ontario: effect of organizational characteristics.

PubMed

Muggah, Elizabeth; Hogg, William; Dahrouge, Simone; Russell, Grant; Kristjansson, Elizabeth; Muldoon, Laura; Devlin, Rose Anne

2014-01-01

To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics. Cross-sectional survey. One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres). Patients included were at least 18 years of age, were not severely ill or cognitively impaired, were not known to the survey administrator, had consenting providers at 1 of the participating primary care practices, and were able to communicate in English or French either directly or through a translator. Patient-reported access was measured by a 4-item scale derived from the previously validated adult version of the Primary Care Assessment Tool. Questions were asked about physician availability during and outside of regular office hours and access to health information via telephone. Responses to the scale were normalized, with higher scores reflecting greater patient-reported access. Linear regressions were used to identify characteristics independently associated with access to care. Established capitation model practices had the highest patient-reported access, although the difference in scores between models was small. Our multilevel regression model identified several patient factors that were significantly (P = .05) associated with higher patient-reported access, including older age, female sex, good-to-excellent self-reported health, less mental health disability, and not working. Provider experience (measured as years since graduation) was the only provider or practice characteristic independently associated with improved patient-reported access. This study adds to what is known about access to primary care. The study found that established capitation models outperformed all the other organizational models, including reformed capitation models, independent of provider and practice variables save provider experience. This suggests that the capitation models might provide better access to care and that it might take time to realize the benefits of organizational reforms.

Primary Immune Deficiency Treatment Consortium (PIDTC) report.

PubMed

Griffith, Linda M; Cowan, Morton J; Notarangelo, Luigi D; Kohn, Donald B; Puck, Jennifer M; Pai, Sung-Yun; Ballard, Barbara; Bauer, Sarah C; Bleesing, Jack J H; Boyle, Marcia; Brower, Amy; Buckley, Rebecca H; van der Burg, Mirjam; Burroughs, Lauri M; Candotti, Fabio; Cant, Andrew J; Chatila, Talal; Cunningham-Rundles, Charlotte; Dinauer, Mary C; Dvorak, Christopher C; Filipovich, Alexandra H; Fleisher, Thomas A; Bobby Gaspar, Hubert; Gungor, Tayfun; Haddad, Elie; Hovermale, Emily; Huang, Faith; Hurley, Alan; Hurley, Mary; Iyengar, Sumathi; Kang, Elizabeth M; Logan, Brent R; Long-Boyle, Janel R; Malech, Harry L; McGhee, Sean A; Modell, Fred; Modell, Vicki; Ochs, Hans D; O'Reilly, Richard J; Parkman, Robertson; Rawlings, David J; Routes, John M; Shearer, William T; Small, Trudy N; Smith, Heather; Sullivan, Kathleen E; Szabolcs, Paul; Thrasher, Adrian; Torgerson, Troy R; Veys, Paul; Weinberg, Kenneth; Zuniga-Pflucker, Juan Carlos

2014-02-01

The Primary Immune Deficiency Treatment Consortium (PIDTC) is a network of 33 centers in North America that study the treatment of rare and severe primary immunodeficiency diseases. Current protocols address the natural history of patients treated for severe combined immunodeficiency (SCID), Wiskott-Aldrich syndrome, and chronic granulomatous disease through retrospective, prospective, and cross-sectional studies. The PIDTC additionally seeks to encourage training of junior investigators, establish partnerships with European and other International colleagues, work with patient advocacy groups to promote community awareness, and conduct pilot demonstration projects. Future goals include the conduct of prospective treatment studies to determine optimal therapies for primary immunodeficiency diseases. To date, the PIDTC has funded 2 pilot projects: newborn screening for SCID in Navajo Native Americans and B-cell reconstitution in patients with SCID after hematopoietic stem cell transplantation. Ten junior investigators have received grant awards. The PIDTC Annual Scientific Workshop has brought together consortium members, outside speakers, patient advocacy groups, and young investigators and trainees to report progress of the protocols and discuss common interests and goals, including new scientific developments and future directions of clinical research. Here we report the progress of the PIDTC to date, highlights of the first 2 PIDTC workshops, and consideration of future consortium objectives. Published by Mosby, Inc.

Constitutive expression of HCA(2) in human retina and primary human retinal pigment epithelial cells.

PubMed

Yu, Alice L; Birke, Kerstin; Lorenz, Reinhard L; Welge-Lussen, Ulrich

2014-05-01

HCA2, a receptor of β-hydroxybutyrate and niacin, has recently been described in mouse retina and immortalized human retinal pigment epithelial (RPE) cell lines. As HCA2 might be a pharmacologic target, e.g. in diabetic retinopathy, we studied its expression in human retina and primary human RPE cells. Paraffin sections of human retina and primary human RPE cells were obtained from human donor eyes. Expression of HCA2 in human retina was investigated by immunohistochemistry of paraffin sections and by RT-PCR. HCA2 expression in primary human RPE cells was examined by immunocytochemistry and by Western-blot analysis. Positive immunohistochemical staining for HCA2 was found in paraffin sections of human retina, and positive immunocytochemical staining for HCA2 in primary human RPE cells. RT-PCR analysis detected mRNA expression of HCA2 in human retina. The expression of HCA2 protein was found in primary human RPE cells. Based on these results, HCA2 appears to be constitutively expressed in human retina and in primary human RPE cells. Although its functional role is still unknown, HCA2 may be potentially involved in the pathogenesis of various retinopathies and may offer a new therapeutic target.

Advanced gray rod control assembly

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

Drudy, Keith J; Carlson, William R; Conner, Michael E

An advanced gray rod control assembly (GRCA) for a nuclear reactor. The GRCA provides controlled insertion of gray rod assemblies into the reactor, thereby controlling the rate of power produced by the reactor and providing reactivity control at full power. Each gray rod assembly includes an elongated tubular member, a primary neutron-absorber disposed within the tubular member said neutron-absorber comprising an absorber material, preferably tungsten, having a 2200 m/s neutron absorption microscopic capture cross-section of from 10 to 30 barns. An internal support tube can be positioned between the primary absorber and the tubular member as a secondary absorber tomore » enhance neutron absorption, absorber depletion, assembly weight, and assembly heat transfer characteristics.« less

77 FR 23429 - Examples of Program-Related Investments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... in the recycling business in Q. Y's primary purpose in making the investment is to combat... private foundation's exempt purposes (a ``jeopardizing investment''). Section 4944(a) also imposes an.... The regulations under section 4944(c) define a PRI as an investment: (1) The primary purpose of which...

A Systematic Approach to In Situ Bioremediation in Groundwater Including Decision Trees on In Situ Bioremediation for Nitrates, Carbon Tetrachloride, and Perchlorate

DTIC Science & Technology

2002-08-01

and Disease Registry (ATSDR). When conducting risk assessments , primary and secondary contaminants must be incorporated into the exposure...industry; acid production; textile bleaching; petroleum refining; refrigeration; production of pulp , paper , and rubber; as a catalytic agent in...memorandum from Michael Honeycutt, Ph.D., Toxicology and Risk Assessment Section, Office of Permitting, Remediation and Registration, Texas Natural Resource

Aspects of U.S. Information Policy: An Annotated Bibliography of Federal Laws, Policies, Regulations, Congressional Hearings with Related Monographs, Serials and Studies from the Private Sector.

ERIC Educational Resources Information Center

National Commission on Libraries and Information Science, Washington, DC.

This annotated bibliography covers the period from 1974 to 1981, with primary emphasis on documents and publications produced between 1978 and 1981. The majority of the publications cited are U.S. government documents; however, the last section includes relevant monographs, journal articles, and conference papers that were selected by the National…

Toward a patient-centered ambulatory after-visit summary: Identifying primary care patients' information needs.

PubMed

Clarke, Martina A; Moore, Joi L; Steege, Linsey M; Koopman, Richelle J; Belden, Jeffery L; Canfield, Shannon M; Kim, Min S

2018-09-01

The purpose of this study was to determine the information needs of primary care patients as they review clinic visit notes to inform information that should be contained in an after-visit summary (AVS). We collected data from 15 patients with an acute illness and 14 patients with a chronic disease using semi-structured interviews. The acute patients reviewed seven major sections, and chronic patients reviewed eight major sections of a simulated, but realistic visit note to identify relevant information needs for their AVS. Patients in the acute illness group identified the Plan, Assessment and History of Present Illness the most as important note sections, while patients in the chronic care group identified Significant Lab Data, Plan, and Assessment the most as important note sections. This study was able to identify primary care patients' information needs after clinic visit. Primary care patients have information needs pertaining to diagnosis and treatment, which may be the reason why both patient groups identified Plan and Assessment as important note sections. Future research should also develop and assess an AVS based on the information gathered in this study and evaluate its usefulness among primary care patients. The results of this study can be used to inform the development of an after-visit summary that assists patients to fully understand their treatment plan, which may improve treatment adherence.

40 CFR 63.11166 - What General Provisions apply to primary beryllium production facilities?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Primary Nonferrous Metals Area Sources-Zinc, Cadmium, and Beryllium Primary Beryllium Production Facilities § 63.11166 What General Provisions apply to primary beryllium production facilities? (a) You must... primary beryllium production facilities? 63.11166 Section 63.11166 Protection of Environment ENVIRONMENTAL...

Effect of financial incentives on ethnic disparities in smoking cessation interventions in primary care: cross-sectional study.

PubMed

Hamilton, F L; Laverty, A A; Vamos, E P; Majeed, A; Millett, C

2013-03-01

Smoking cessation interventions are underprovided in primary care. Financial incentives may help address this. However, few studies in the UK have examined their impact on disparities in the delivery of smoking cessation interventions. Cross-sectional study using 2007 data from 29 general practices in Wandsworth, London, UK. We used logistic regression to examine associations between disease group [cardiovascular disease (CVD), respiratory disease, depression or none of these diseases], ethnicity and smoking outcomes following the introduction of the Quality and Outcomes Framework in 2004. Significantly, more CVD patients had smoking status ascertained compared with those with respiratory disease (89 versus 72%), but both groups received similar levels of cessation advice (93 and 89%). Patients with depression or none of the diseases were less likely to have smoking status ascertained (60% for both groups) or to receive advice (80 and 75%). Smoking prevalence was high, especially for patients with depression (44%). White British patients had higher rates of smoking than most ethnic groups, but black Caribbean men with depression had the highest smoking prevalence (62%). Smoking rates remain high, particularly for white British and black Caribbean patients. Extending financial incentives to include recording of ethnicity and rewarding quit rates may further improve smoking cessation outcomes in primary care.

Medication safety programs in primary care: a scoping review.

PubMed

Khalil, Hanan; Shahid, Monica; Roughead, Libby

2017-10-01

Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome measures. The objectives, inclusion criteria and methods for this scoping review were specified in advance and documented in a protocol that was previously published. This scoping review included nine studies published over an eight-year period that investigated or described the effects of medication safety programs in primary care settings. We classified each of the nine included studies into three main sections according to whether they included an organizational, professional or patient component. The organizational component is aimed at changing the structure of the organization to implement the intervention, the professional component is aimed at the healthcare professionals involved in implementing the interventions, and the patient component is aimed at counseling and education of the patient. All of the included studies had different types of medication safety programs. The programs ranged from complex interventions including pharmacists and teams of healthcare professionals to educational packages for patients and computerized system interventions. The outcome measures described in the included studies were medication error incidence, adverse events and number of drug-related problems. Multi-faceted medication safety programs are likely to vary in characteristics. They include educational training, quality improvement tools, informatics, patient education and feedback provision. The most likely outcome measure for these programs is the incidence of medication errors and reported adverse events or drug-related problems.

40 CFR 81.355 - Puerto Rico.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 18 2014-07-01 2014-07-01 false Puerto Rico. 81.355 Section 81.355... AREAS FOR AIR QUALITY PLANNING PURPOSES Section 107 Attainment Status Designations § 81.355 Puerto Rico. Puerto Rico—1971 Sulfur Dioxide NAAQS (Primary and Secondary) Designated area Does not meet primary...

Factors Associated with Primary School Teachers' Attitudes Towards the Inclusion of Students with Disabilities.

PubMed

Vaz, Sharmila; Wilson, Nathan; Falkmer, Marita; Sim, Angela; Scott, Melissa; Cordier, Reinie; Falkmer, Torbjörn

2015-01-01

Teachers' attitudes toward inclusion are often based on the practical implementation of inclusive education rather than a specific ideology and understanding of inclusiveness. This study aimed to identify the factors associated with primary school teachers' attitudes towards inclusion of students with all disabilities in regular schools. Seventy four primary school teachers participated in a cross-sectional survey conducted in Western Australia. Teachers' attitudes and efficacy toward integration of students with disabilities were measured using the Opinions Relative to Integration of Students with Disabilities scale and Bandura's Teacher Efficacy scale respectively. Four teacher attributes-age, gender, teaching self-efficacy and training collectively explained 42% of the variability in teachers' attitude toward including students with disabilities. The current study further contributes to the accumulation of knowledge that can unpack the complex pattern of factors that should be considered to promote positive attitudes towards inclusive schools.

Factors Associated with Primary School Teachers’ Attitudes Towards the Inclusion of Students with Disabilities

PubMed Central

Vaz, Sharmila; Wilson, Nathan; Falkmer, Marita; Sim, Angela; Scott, Melissa; Cordier, Reinie; Falkmer, Torbjörn

2015-01-01

Objective Teachers' attitudes toward inclusion are often based on the practical implementation of inclusive education rather than a specific ideology and understanding of inclusiveness. This study aimed to identify the factors associated with primary school teachers' attitudes towards inclusion of students with all disabilities in regular schools. Method Seventy four primary school teachers participated in a cross-sectional survey conducted in Western Australia. Teachers' attitudes and efficacy toward integration of students with disabilities were measured using the Opinions Relative to Integration of Students with Disabilities scale and Bandura's Teacher Efficacy scale respectively. Results Four teacher attributes—age, gender, teaching self-efficacy and training collectively explained 42% of the variability in teachers' attitude toward including students with disabilities. Conclusion The current study further contributes to the accumulation of knowledge that can unpack the complex pattern of factors that should be considered to promote positive attitudes towards inclusive schools. PMID:26317862

Primary and High School resources for teachers and students to improve the space physics education in Chile

NASA Astrophysics Data System (ADS)

Morales, P. V.; Pinto, V. A.; Stepanova, M. V.; Valdivia, J. A.

2011-12-01

Primary and High School educational programs in Chile include a wide geophysical section inside the natural sciences and physics courses. Unfortunately, teacher generally have a lack of preparation and knowledge in this field and there is small amount of available didactical material in the native languaje. This implies that in the reality the geophysical topics are ignored year after year in the school rooms. By the preparation of didactic material and web resources in magnetosphere, solar wind and solar topics, in accordance with the official programs of the Chilean Ministry of Education, we are collaborating to the outreach of the space physics in Chile. As the primary diffusion mechanism is the web, we hope that all the spanish talking community in Latin America can benefit from the public teaching resources that we are developing. There are a growing number of space scientist and graduate students volunteering for this endeavour.

40 CFR 63.11164 - What General Provisions apply to primary zinc production facilities?

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary zinc production facilities? 63.11164 Section 63.11164 Protection of Environment ENVIRONMENTAL... Primary Nonferrous Metals Area Sources-Zinc, Cadmium, and Beryllium Primary Zinc Production Facilities § 63.11164 What General Provisions apply to primary zinc production facilities? (a) If you own or...

40 CFR 63.11164 - What General Provisions apply to primary zinc production facilities?

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary zinc production facilities? 63.11164 Section 63.11164 Protection of Environment ENVIRONMENTAL... Primary Nonferrous Metals Area Sources-Zinc, Cadmium, and Beryllium Primary Zinc Production Facilities § 63.11164 What General Provisions apply to primary zinc production facilities? (a) If you own or...

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

Darling, Christopher Lynn

By determining the production cross sections for heavy flavor hadrons, we test the theoretical predictions from perturhative quantum chroma-dynamics (QCD). In the case of pion induced beauty production, the few published results do not resolve the issue of the applicability of perturbative QCD. This analysis is undertaken in order to help resolve this situation. We determine the total beauty and charm production cross sections using an analysis of single electron decay products. We extract the cross sections per nucleon from the two-dimensional distribution of electron p versus impact parameter ( d) to the primary vertex. We place an upper limit on the beauty production cross section of σ bmore » $$\\bar{b}$$ < 105 nb at the 90% confidence level, where the limit includes both statistical and systematic errors. The charm production cross section is determined to be σ cc = 13.9$$+2.4/atop{-2.3}$$ (stat) ± 1.8 (syst) μ.b, which is in good agreement with next-to-leading order QCD predictions and other measurements.« less

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

Darling, Christopher Lynn

By determining the production cross sections for heavy flavor hadrons, we test the theoretical predictions from perturhative quantum chroma-dynamics (QCD). In the case of pion induced beauty production, the few published results do not resolve the issue of the applicability of perturbative QCD. This analysis is undertaken in order to help resolve this situation. We determine the total beauty and charm production cross sections using an analysis of single electron decay products. We extract the cross sections per nucleon from the two-dimensional distribution of electronmore » $$p^2_{\\tau}$$ versus impact parameter (d) to the primary vertex. We place an upper limit on the beauty production cross section of $$\\sigma_{b\\overline{b}}$$ < 105 nb at the 90% confidence level, where the limit includes both statistical and systematic errors. The charm production cross section is determined to be $$\\sigma_{c\\overline{c}} = 13.9 ^{+2.4}_{-2.3}$$(stat)±l.8(syst) $$\\mu b$$, which is in good agreement with next-to-leading order QCD predictions and other measurements.« less

West Africa [in "State of the Climate in 2014"

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

Hagos, Samson M.; Ijampy, James A.; Sima, Fatou

This chapter provides summaries of the 2014 temperature and precipitation conditions across seven broad regions: North America, Central America and the Caribbean, South America, Africa, Europe, Asia, and Oceania. In most cases, summaries of notable weather events are also included. Local scientists provided the annual summary for their respective regions and, unless otherwise noted, the source of the data used is typically the agency affiliated with the authors. Please note that different nations, even within the same section, may use unique periods to define their normals. Section introductions will typically define the prevailing practices for that section, and exceptions willmore » be noted within the text. In a similar way, many contributing authors use languages other than English as their primary professional language. To minimize additional loss of fidelity through re-interpretation after translation, editors have been conservative and careful to preserve the voice of the author. In some cases, this may result in abrupt transitions in style from section to section.« less

[MRI findings and pathological features of occult breast cancer].

PubMed

Zhang, J J; Yang, X T; Du, X S; Zhang, J X; Hou, L N; Niu, J L

2018-01-23

Objective: To investigate the magnetic resonance imaging (MRI) findings and clinicopathological features of primary lesions in patients with occult breast cancer (OBC). Methods: The imaging reports from the Breast Imaging Reporting and Data System in 2013 were retrospectively analyzed to investigate the morphology and the time signal intensity curve (TIC) of breast lesions in patients with OBC. The clinical and pathological characteristics of these patients were also included. Results: A total of 34 patients were enrolled. Among these patients, 24 patients underwent modified radical mastectomy and 18 of them had primary breast carcinoma in pathological sections. MRI detected 17 cases of primary lesions, including six masse lesions with a diameter of 0.6-1.2 cm (average 0.9 cm), and 11 non-mass lesions with four linear distributions, three segmental distributions, three focal distributions, and one regions distribution. Five patients had TIC typeⅠprimary lesions, ten had TIC type Ⅱ primary lesions, and two had TIC type Ⅲ primary lesions. Among all 34 cases, 23 of them had complete results of immunohistochemistry: 11 estrogen receptor (ER) positive lesions (47.8%), tenprogesterone receptor (PR) positive lesions (43.5%), seven human epidermal growth factor receptor 2 (HER-2) positive lesions (30.4%), and 20high expression(>14%) of Ki-67 (87.0%). The proportion of type luminal A was 4.3%, type luminal B was 43.5%, triple negative breast cancer (TNBC) was 30.4%, and HER-2 over expression accounted for 21.7%. Conclusions: The primary lesions of OBC usually manifested as small mass lesions, or focal, linear or segmental distribution of non-mass lesions. The positive rate of ER and PR was low, but the positive rate of HER-2 and the proliferation index of Ki-67 was high. Type luminal B is the most common molecular subtype.

40 CFR 421.20 - Applicability: description of the primary aluminum smelting subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary aluminum smelting subcategory. 421.20 Section 421.20 Protection of Environment ENVIRONMENTAL... CATEGORY Primary Aluminum Smelting Subcategory § 421.20 Applicability: description of the primary aluminum... production of aluminum from alumina in the Hall-Heroult process. ...

Skin diseases in patients with primary psychiatric conditions: a hospital based study.

PubMed

Moftah, Nayera H; Kamel, Abeer M; Attia, Hussein M; El-Baz, Mona Z; Abd El-Moty, Hala M

2013-09-01

Although the relationship between skin diseases in patients with primary psychiatric conditions is important for patient management, studies on this issue are limited. To detect the frequency and type of cutaneous disorders among patients with primary psychiatric conditions. This analytic cross-sectional study was conducted on a total of 400 subjects - 200 patients with primary psychiatric disorders and 200 age and sex matched individuals free from primary psychiatric disorders. Patients included in the study were diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders (DMS IV) Criteria. A specially designed questionnaire including socio-demographic data, medical history, family history and dermatological examination was applied. The data were statistically analyzed. There was a significant statistical increase in the prevalence of skin diseases in general and infectious skin diseases in particular in psychiatric patients compared with non-psychiatric patients (71.5% versus 22%, P<0.001) and (48% versus 11%, P<0.001), respectively. Parasitic infestations (42.7%) were the most common infectious skin diseases in psychiatric patients (P<0.001). Infectious skin diseases in psychiatric patients were seen most in patients diagnosed with schizophrenia (83.6%) and least in obsessive compulsive disorders (30%)(P<0.001). Psychogenic skin disorders were found in 8.4% of psychiatric patients with skin diseases; delusional parasitosis was the most common (50%). Health education of psychiatric patients and/or of their caregiver and periodic monthly inspection of psychiatric patients are highly indicated for the prevention and control of infectious skin diseases in primary psychiatric patients. Copyright © 2013 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Employment status, employment functioning, and barriers to employment among VA primary care patients.

PubMed

Zivin, Kara; Yosef, Matheos; Levine, Debra S; Abraham, Kristen M; Miller, Erin M; Henry, Jennifer; Nelson, C Beau; Pfeiffer, Paul N; Sripada, Rebecca K; Harrod, Molly; Valenstein, Marcia

2016-03-15

Prior research found lower employment rates among working-aged patients who use the VA than among non-Veterans or Veterans who do not use the VA, with the lowest reported employment rates among VA patients with mental disorders. This study assessed employment status, employment functioning, and barriers to employment among VA patients treated in primary care settings, and examined how depression and anxiety were associated with these outcomes. The sample included 287 VA patients treated in primary care in a large Midwestern VA Medical Center. Bivariate and multivariable analyses were conducted examining associations between socio-demographic and clinical predictors of six employment domains, including: employment status, job search self-efficacy, work performance, concerns about job loss among employed Veterans, and employment barriers and likelihood of job seeking among not employed Veterans. 54% of respondents were employed, 36% were not employed, and 10% were economically inactive. In adjusted analyses, participants with depression or anxiety (43%) were less likely to be employed, had lower job search self-efficacy, had lower levels of work performance, and reported more employment barriers. Depression and anxiety were not associated with perceived likelihood of job loss among employed or likelihood of job seeking among not employed. Single VA primary care clinic; cross-sectional study. Employment rates are low among working-aged VA primary care patients, particularly those with mental health conditions. Offering primary care interventions to patients that address mental health issues, job search self-efficacy, and work performance may be important in improving health, work, and economic outcomes. Published by Elsevier B.V.

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

PubMed

Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

2010-04-01

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Hospice assist at home: does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study.

PubMed

de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm

2016-06-01

A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral. A retrospective cross-sectional evaluation study was performed (December 2014-March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification. Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy <1 year, were enrolled. Hospice assist at home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner-initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals. A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death. Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care. © The Author(s) 2016.

Factors affecting cardiac rehabilitation referral by physician specialty.

PubMed

Grace, Sherry L; Grewal, Keerat; Stewart, Donna E

2008-01-01

Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists. A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral. Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P < .001), lack of standardized referral forms (P < .001), inconvenience (P = .04), program quality (P = .004), and lack of discharge communication from CR (P = .001) as factors negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P < .001). Where differences emerged, primary care physicians were more likely to perceive factors that would impede CR referral, some of which are modifiable. Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.

Preliminary cross section of Englebright Lake sediments

USGS Publications Warehouse

Snyder, Noah P.; Hampton, Margaret A.

2003-01-01

Overview -- The Upper Yuba River Studies Program is a CALFED-funded, multidisciplinary investigation of the feasibility of introducing anadromous fish species to the Yuba River system upstream of Englebright Dam. Englebright Lake (Figure 1 on poster) is a narrow, 14-km-long reservoir located in the northern Sierra Nevada, northeast of Marysville, CA. The dam was completed in 1941 for the primary purpose of trapping sediment derived from mining operations in the Yuba River watershed. Possible management scenarios include lowering or removing Englebright Dam, which could cause the release of stored sediments and associated contaminants, such as mercury used extensively in 19th-century hydraulic gold mining. Transport of released sediment to downstream areas could increase existing problems including flooding and mercury bioaccumulation in sport fish. To characterize the extent, grain size, and chemistry of this sediment, a coring campaign was done in Englebright Lake in May and June 2002. More than twenty holes were drilled at 7 different locations along the longitudinal axis of the reservoir (Figure 4 on poster), recovering 6 complete sequences of post-reservoir deposition and progradation. Here, a longitudinal cross section of Englebright Lake is presented (Figure 5 on poster), including pre-dam and present-day topographic profiles, and sedimentologic sections for each coring site. This figure shows the deltaic form of the reservoir deposit, with a thick upper section consisting of sand and gravel overlying silt, a steep front, and a thinner lower section dominated by silt. The methodologies used to create the reservoir cross section are discussed in the lower part of this poster.

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

Elvado Environmental LLC; Environmental Compliance Department Environment, Safety, and Health Division Y-12 National Security Complex

This document presents the Groundwater Protection Program (GWPP) management plan for the U.S. Department of Energy (DOE) Y-12 National Security Complex (hereafter referenced as Y-12). The Y-12 GWPP functions as the primary point-of-contact for groundwater-related issues at Y-12, provides stewardship of the extensive network of groundwater monitoring wells at Y-12, and serves as a resource for technical expertise, support, and historical data for groundwater-related activities at Y-12. These organizational functions each serve the primary programmatic purpose of the GWPP, which is to ensure that groundwater monitoring activities within areas under Y-12 administrative control provide representative data in compliance with themore » multiple purposes of applicable state and federal regulations, DOE orders, and the corporate policies of BWXT Y-12, L.L.C. (hereafter referenced as BWXT), the Y-12 management and operations (M&O) contractor for DOE. This GWPP management plan addresses the requirements of DOE Order 450.1 (BWXT Y12 S/RID) regarding the implementation of a site-wide approach for groundwater protection at each DOE facility. Additionally, this plan is a ''living'' document that is reviewed annually, revised and reissued every three years, and is formatted to provide for updating individual sections independent of the rest of the document. Section 2 includes a short description of the groundwater system at Y-12, the history of groundwater monitoring at Y-12 and the corresponding evolution of the GWPP, and an overview of ongoing Y-12 groundwater monitoring activities. Section 3 describes the key elements of the GWPP management strategy. Organizational roles and responsibilities of GWPP personnel are outlined in Section 4. Section 5 presents an overview of the GWPP project plans for applicable programmatic elements. Section 6 lists the reports, plans, and documents that are referenced for technical and administrative details.« less

Analyzing and Comparing Reading Stimulus Materials across the "TOEFL"® Family of Assessments. "TOEFL iBT"® Research Report. TOEFL iBT-26. ETS Research Report No. RR-15-08

ERIC Educational Resources Information Center

Chen, Jing; Sheehan, Kathleen M.

2015-01-01

The "TOEFL"® family of assessments includes the "TOEFL"® Primary"™, "TOEFL Junior"®, and "TOEFL iBT"® tests. The linguistic complexity of stimulus passages in the reading sections of the TOEFL family of assessments is expected to differ across the test levels. This study evaluates the linguistic…

50 CFR 660.231 - Limited entry fixed gear sablefish primary fishery.

Code of Federal Regulations, 2011 CFR

2011-10-01

... sablefish primary fishery. This section applies to the sablefish primary season for the limited entry fixed... the sablefish primary season north of 36° N. lat. is governed by routine management measures imposed... sablefish primary season for the limited entry fixed gear fishery, unless at least one limited entry permit...

Malpractice premiums and primary cesarean section rates in New York and Illinois.

PubMed Central

Rock, S M

1988-01-01

The fear of malpractice liability is mentioned frequently as a cause of increased cesarean section rates, but without quantitative investigations. This perception may be studied at an aggregate level by comparing malpractice insurance premiums, a proxy for liability risk, with primary cesarean section rates. Both New York and Illinois are divided into territories for insurance rates; the premium was uniform within each territory over the period studied for each specialty. Premiums for obstetricians were linked to birth and procedure data from New York and Illinois hospitals for 1981 and 1983, respectively, to determine whether there was a correlation between premium levels and the primary cesarean section rate. A statistically significant difference was found between mean cesarean rates by insurance premium territories in each State. A correlation was observed between increased insurance rates among territories and increased cesarean section rates. Based on these results, a substantial impact was found on delivery decisions resulting from the fear of malpractice suits. PMID:3140270

40 CFR 421.50 - Applicability: Description of the primary electrolytic copper refining subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary electrolytic copper refining subcategory. 421.50 Section 421.50 Protection of Environment... POINT SOURCE CATEGORY Primary Electrolytic Copper Refining Subcategory § 421.50 Applicability: Description of the primary electrolytic copper refining subcategory. The provisions of this subpart apply to...

40 CFR 421.50 - Applicability: Description of the primary electrolytic copper refining subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary electrolytic copper refining subcategory. 421.50 Section 421.50 Protection of Environment... POINT SOURCE CATEGORY Primary Electrolytic Copper Refining Subcategory § 421.50 Applicability: Description of the primary electrolytic copper refining subcategory. The provisions of this subpart apply to...

Change in primary midwife-led care in the Netherlands in 2000–2008: A descriptive study of caesarean sections and other interventions among 807,437 low-risk births.

PubMed

Offerhaus, Pien M; de Jonge, Ank; van der Pal-de-Bruin, Karin M; Hukkelhoven, Chantal W P M; Scheepers, Peer L H; Lagro-Janssen, Antoine L M

2015-06-01

to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. nationwide descriptive study. The Netherlands Perinatal Registry. 807,437 births of nine year cohorts of women with low risk pregnancies in primary midwife-led care at the onset of labour between 2000 and 2008. primary outcome is the caesarean section rate. Vaginal instrumental childbirth, augmentation with oxytocin, and pharmacological pain relief are secondary outcomes. Trends in outcomes are described. We used logistic regression to explore whether changes in the planned place of birth and other maternal characteristics were associated with the caesarean section rate. the caesarean section rate increased from 6.2 to 8.3 per cent for nulliparous and from 0.8 to 1.1 per cent for multiparous women. After controlling for maternal characteristics the year by year increase in the caesarean section rate was still significant for nulliparous women (adj OR 1.03; 95% CI 1.02–1.03). The vaginal instrumental birth declined from 18.2 to 17.4 per cent for nulliparous women (multiparous women: 1.7–1.5 per cent). Augmentation of labour and/or pharmacological pain relief increased from 23.1 to 38.1 per cent for nulliparous women and from 5.4 to 9.6 per cent for multiparous women. the rise in augmentation of labour, pharmacological pain relief and electronic fetal monitoring in the period 2000–2008 among women in primary midwife-led care was accompanied by an increase in caesarean section rate for nulliparous women. The vaginal instrumental deliveries declined for both nulliparous and multiparous women. primary care midwives should evaluate whether they can strengthen the opportunities for nulliparous women to achieve a physiological birth, without augmentation or pharmacological pain relief. If such interventions are considered necessary to achieve a spontaneous vaginal birth, the current disadvantage of discontinuity of care should be reduced. In a more integrated care system, women could receive continuous care and support from their own primary care midwife, as long as only supportive interventions are needed.

Knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers in northern Iran.

PubMed

Kolahi, A-A; Ghorbanpur-Valukolaei, M; Abbasi-Kangevari, M; Farsar, A-R

2018-07-01

To assess knowledge, attitudes, and first-aid measures about epilepsy among primary school teachers. This cross-sectional study was conducted with participation of 342 primary school teachers during September 2016 to January 2017 in cities of Babol and Qaem-Shahr in Mazandaran Province in northern Iran. Primary schools were selected using simple random sampling. Data were collected through interviews using a structured questionnaire. The knowledge section included general knowledge, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section. Answers about first-aid measures were categorized as helpful or harmful. The level of total knowledge score of 25 (7.7%) teachers was very high, 140 (43.3%) high, 141 (43.8%) moderate, and 17 (5.2%) low. The mean score about general knowledge was as follows: 6.1 (1.9), range = 0-9; causes 6.3 (1.9), range = 0-10; symptoms of seizures 8.5 (2.5), range = 0-12; and first-aid measures 6.8 (2.0), range = 0-11. Some 83% knew not taking anticonvulsants regularly could trigger seizures, and all teachers said a person with epilepsy should go see a physician. Attitudes were generally positive except for marriage and having children. The level of first-aid measures score of 8 (7.2) teachers was very high, 79 (70.5) high, 25 (22.3) low. Teachers with teaching experience at special schools took more helpful measures CONCLUSIONS: The knowledge of teachers about epilepsy was insufficient, attitudes toward people with epilepsy were generally positive, and first-aid measures at the last witnessed seizure were fairly helpful. Having teaching experience in special schools had a positive influence over knowledge and taking appropriate first-aid measure at time of the last witnessed seizure. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Colorectal cancer screening practices of primary care providers: results of a national survey in Malaysia.

PubMed

Norwati, Daud; Harmy, Mohamed Yusoff; Norhayati, Mohd Noor; Amry, Abdul Rahim

2014-01-01

The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

Creatinine plasma at uncontrolled type 2 diabetes mellitus and controlled type 2 diabetes mellitus patients at primary health care in Binjai city, Indonesia

NASA Astrophysics Data System (ADS)

Rusdiana; Savira, M.; Syahputra, M.; Santoso, A.

2018-03-01

The aim of the study knowing the comparison creatinine plasma levels at uncontrolled type 2 diabetes mellitus and controlled type 2 diabetes mellitus patients at Primary Health Care in Binjai city of North Sumatera in Indonesia. This cross-sectional study was conductedon 40 type 2 Diabetes Mellitus patients who attended Primary Health Care in Binjai. Patients with age > 40 years old, (both sexes) were included in the study. We recorded different demographic parameter as age, Body Mass Index, Blood Pressure, and personal history status. And we examined the biochemicalparameters including Hba1c, Fasting Blood Sugar Levels (FBL) and creatinine serum. We separated into two groups base on HbA1c test, controlled type 2 diabetes mellitus and uncontrolled type 2 diabetes mellitus. We measured FBL by using the portable measuring instrument, and Thamrin clinical laboratory measured Hba1c, andwe measured creatinine plasmaby spectrophotometry in Biochemistry laboratory. With statistical analysis using T-test found that there was asignificant differencein creatinine plasma levels between uncontrolled type 2 diabetes mellitus with controlled type 2 diabetes mellitus (p<0.005).

SUBGR: A Program to Generate Subgroup Data for the Subgroup Resonance Self-Shielding Calculation

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

Kim, Kang Seog

2016-06-06

The Subgroup Data Generation (SUBGR) program generates subgroup data, including levels and weights from the resonance self-shielded cross section table as a function of background cross section. Depending on the nuclide and the energy range, these subgroup data can be generated by (a) narrow resonance approximation, (b) pointwise flux calculations for homogeneous media; and (c) pointwise flux calculations for heterogeneous lattice cells. The latter two options are performed by the AMPX module IRFFACTOR. These subgroup data are to be used in the Consortium for Advanced Simulation of Light Water Reactors (CASL) neutronic simulator MPACT, for which the primary resonance self-shieldingmore » method is the subgroup method.« less

Association between developmental enamel defects in the primary and permanent dentitions.

PubMed

Casanova-Rosado, A J; Medina-Solís, C E; Casanova-Rosado, J F; Vallejos-Sánchez, A A; Martinez-Mier, E A; Loyola-Rodríguez, J P; Islas-Márquez, A J; Maupomé, G

2011-09-01

To determine if the presence of developmental enamel defects (DED) in the primary dentition is a risk indicator for the presence of DED in the permanent dentition in children with mixed dentition, as well as others factors. A cross-sectional study was undertaken in 1296 school children ages six to 72 years. The DED [FDI; 1982] in both dentitions were identified by means of an oral exam scoring enamel opacities [classified as demarcated or diffused], and enamel hypoplasia. Sociodemographic and socioeconomic variables were collected through a questionnaire. Socioeconomic status (SES) was determined based on the occupation and maximum level of education of parents. Statistical analysis included logistic regression. Mean age of participants was 8.40 +/- 1.68; 51.6% were boys. DED prevalence was 7.5% in the permanent dentition and 10.0% in the primary dentition. The logistic regression model, adjusting for sociodemographic and socioeconomic variables, showed that for each primary tooth with DED, the odds of observing DED in the permanent dentition increased 7.38 times [95% CI = 1.17-1.64; p < 0.001]. An association between DED presence in both permanent and primary dentitions was observed. Further studies are necessary to fully characterise such relationship.

Bibliographic processes and products, and a bibliography of the published primary-source works of B. F. Skinner

PubMed Central

Morris, Edward K.; Smith, Nathaniel G.

2003-01-01

This paper introduces the nature and practice of bibliography (e.g., definition, history, and genres); it reviews the extant B. F. Skinner bibliographies (1958 to 2001); and it describes the methods used in constructing a new, comprehensive, and corrected bibliography of Skinner's primary-source published works. The bibliography includes 291 items from across 16 categories of publications (e.g., books, articles, chapters, monographs, book reviews, manuals, encyclopedia entries, letters to the editor) and lists them in chronological order (1930 to 1999). A discussion section addresses the bibliography's limitations, how it might be enlarged and expanded, its value for qualitative and quantitative historical inquiry, and the beginnings of a “Skinner industry.” PMID:22478394

13 CFR 108.120 - Economic development primary mission.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Economic development primary mission. 108.120 Section 108.120 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... Economic development primary mission. The primary mission of a NMVC Company must be economic development of...

40 CFR 421.300 - Applicability: Description of the primary and secondary titanium subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary and secondary titanium subcategory. 421.300 Section 421.300 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Titanium Subcategory § 421.300 Applicability: Description of the primary and secondary titanium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.300 - Applicability: Description of the primary and secondary titanium subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... primary and secondary titanium subcategory. 421.300 Section 421.300 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Titanium Subcategory § 421.300 Applicability: Description of the primary and secondary titanium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.300 - Applicability: Description of the primary and secondary titanium subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... primary and secondary titanium subcategory. 421.300 Section 421.300 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Titanium Subcategory § 421.300 Applicability: Description of the primary and secondary titanium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.300 - Applicability: Description of the primary and secondary titanium subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary and secondary titanium subcategory. 421.300 Section 421.300 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Titanium Subcategory § 421.300 Applicability: Description of the primary and secondary titanium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.300 - Applicability: Description of the primary and secondary titanium subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... primary and secondary titanium subcategory. 421.300 Section 421.300 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Titanium Subcategory § 421.300 Applicability: Description of the primary and secondary titanium subcategory. The provisions of this subpart are applicable to...

13 CFR 108.120 - Economic development primary mission.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Economic development primary mission. 108.120 Section 108.120 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... Economic development primary mission. The primary mission of a NMVC Company must be economic development of...

13 CFR 108.120 - Economic development primary mission.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Economic development primary mission. 108.120 Section 108.120 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... Economic development primary mission. The primary mission of a NMVC Company must be economic development of...

13 CFR 108.120 - Economic development primary mission.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Economic development primary mission. 108.120 Section 108.120 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... Economic development primary mission. The primary mission of a NMVC Company must be economic development of...

13 CFR 108.120 - Economic development primary mission.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Economic development primary mission. 108.120 Section 108.120 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... Economic development primary mission. The primary mission of a NMVC Company must be economic development of...

40 CFR 421.80 - Applicability: Description of the primary zinc subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary zinc subcategory. 421.80 Section 421.80 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Zinc Subcategory § 421.80 Applicability: Description of the primary zinc subcategory. The provisions of this subpart are applicable to discharges resulting from the production of primary zinc by either...

40 CFR 421.80 - Applicability: Description of the primary zinc subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary zinc subcategory. 421.80 Section 421.80 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Zinc Subcategory § 421.80 Applicability: Description of the primary zinc subcategory. The provisions of this subpart are applicable to discharges resulting from the production of primary zinc by either...

7 CFR 930.13 - Primary inventory reserve.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Primary inventory reserve. 930.13 Section 930.13... Handling Definitions § 930.13 Primary inventory reserve. Primary inventory reserve means that portion of handled cherries that are placed into handlers' inventories in accordance with any restricted percentage...

40 CFR 421.70 - Applicability: Description of the primary lead subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary lead subcategory. 421.70 Section 421.70 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Lead Subcategory § 421.70 Applicability: Description of the primary lead subcategory. The provisions of this subpart are applicable to discharges resulting from the production of lead at primary lead...

40 CFR 421.70 - Applicability: Description of the primary lead subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... primary lead subcategory. 421.70 Section 421.70 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Lead Subcategory § 421.70 Applicability: Description of the primary lead subcategory. The provisions of this subpart are applicable to discharges resulting from the production of lead at primary lead...

40 CFR 421.70 - Applicability: Description of the primary lead subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... primary lead subcategory. 421.70 Section 421.70 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Lead Subcategory § 421.70 Applicability: Description of the primary lead subcategory. The provisions of this subpart are applicable to discharges resulting from the production of lead at primary lead...

40 CFR 421.70 - Applicability: Description of the primary lead subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... primary lead subcategory. 421.70 Section 421.70 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Lead Subcategory § 421.70 Applicability: Description of the primary lead subcategory. The provisions of this subpart are applicable to discharges resulting from the production of lead at primary lead...

40 CFR 421.330 - Applicability: Description of the primary zirconium and hafnium subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary zirconium and hafnium subcategory. 421.330 Section 421.330 Protection of Environment ENVIRONMENTAL... CATEGORY Primary Zirconium and Hafnium Subcategory § 421.330 Applicability: Description of the primary zirconium and hafnium subcategory. The provisions of this subpart are applicable to discharges resulting...

40 CFR 421.70 - Applicability: Description of the primary lead subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary lead subcategory. 421.70 Section 421.70 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Lead Subcategory § 421.70 Applicability: Description of the primary lead subcategory. The provisions of this subpart are applicable to discharges resulting from the production of lead at primary lead...

40 CFR 421.210 - Applicability: Description of the primary molybdenum and rhenium subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... primary molybdenum and rhenium subcategory. 421.210 Section 421.210 Protection of Environment... POINT SOURCE CATEGORY Primary Molybdenum and Rhenium Subcategory § 421.210 Applicability: Description of the primary molybdenum and rhenium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.210 - Applicability: Description of the primary molybdenum and rhenium subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... primary molybdenum and rhenium subcategory. 421.210 Section 421.210 Protection of Environment... POINT SOURCE CATEGORY Primary Molybdenum and Rhenium Subcategory § 421.210 Applicability: Description of the primary molybdenum and rhenium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.210 - Applicability: Description of the primary molybdenum and rhenium subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... primary molybdenum and rhenium subcategory. 421.210 Section 421.210 Protection of Environment... POINT SOURCE CATEGORY Primary Molybdenum and Rhenium Subcategory § 421.210 Applicability: Description of the primary molybdenum and rhenium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.210 - Applicability: Description of the primary molybdenum and rhenium subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary molybdenum and rhenium subcategory. 421.210 Section 421.210 Protection of Environment... POINT SOURCE CATEGORY Primary Molybdenum and Rhenium Subcategory § 421.210 Applicability: Description of the primary molybdenum and rhenium subcategory. The provisions of this subpart are applicable to...

40 CFR 421.210 - Applicability: Description of the primary molybdenum and rhenium subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary molybdenum and rhenium subcategory. 421.210 Section 421.210 Protection of Environment... POINT SOURCE CATEGORY Primary Molybdenum and Rhenium Subcategory § 421.210 Applicability: Description of the primary molybdenum and rhenium subcategory. The provisions of this subpart are applicable to...

Dientamoeba fragilis colonization is not associated with gastrointestinal symptoms in children at primary care level.

PubMed

Holtman, Gea A; Kranenberg, Justin J; Blanker, Marco H; Ott, Alewijn; Lisman-van Leeuwen, Yvonne; Berger, Marjolein Y

2017-02-01

Dientamoeba fragilis is commonly identified in children in primary care and is suspected to cause gastrointestinal disease. To determine the association between D. fragilis colonization and gastrointestinal symptoms in children. We performed a cross-sectional study with children who presented in primary care with gastrointestinal symptoms. The associations between D. fragilis colonization and specific symptoms were explored by means of logistic regression analyses. Asymptomatic siblings of these cases were invited as control subjects for a case-control analysis, where we explored the association between D. fragilis and gastrointestinal symptoms with conditional logistic regression analysis. In the cross-sectional study, 107 children were included. Their median age was 9 years (interquartile range = 6-12) and 38 (35.5%) were boys. Colonization of D. fragilis was present in 59 children (55.1%). The absence of D. fragilis was associated with soft to watery stool [odds ratio (OR) = 0.29; 95% confidence interval (CI) = 0.10-0.85], chronic diarrhoea (OR = 0.42; 95% CI = 0.18-0.97) and fatigue (OR = 0.45; 95% CI = 0.20-0.99). The case-control analyses included 44 children in each group. Dientamoeba fragilis colonization was not observed more often in cases than in controls after adjustment for age and sex (OR = 1.02; 95% CI = 0.28-3.65). Dientamoeba fragilis is a common parasite in children with and without gastrointestinal symptoms. The anomalous finding of the association between the absence of D. fragilis with soft to watery stools, chronic diarrhoea and fatigue are inexplicable. Our study suggests that D. fragilis colonization does not increase the risk for gastrointestinal symptoms. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Interpreting stress responses during routine toxicity studies: a review of the biology, impact, and assessment.

PubMed

Everds, Nancy E; Snyder, Paul W; Bailey, Keith L; Bolon, Brad; Creasy, Dianne M; Foley, George L; Rosol, Thomas J; Sellers, Teresa

2013-01-01

Stress often occurs during toxicity studies. The perception of sensory stimuli as stressful primarily results in catecholamine release and activation of the hypothalamic-pituitary-adrenal (HPA) axis to increase serum glucocorticoid concentrations. Downstream effects of these neuroendocrine signals may include decreased total body weights or body weight gain; food consumption and activity; altered organ weights (e.g., thymus, spleen, adrenal); lymphocyte depletion in thymus and spleen; altered circulating leukocyte counts (e.g., increased neutrophils with decreased lymphocytes and eosinophils); and altered reproductive functions. Typically, only some of these findings occur in a given study. Stress responses should be interpreted as secondary (indirect) rather than primary (direct) test article-related findings. Determining whether effects are the result of stress requires a weight-of-evidence approach. The evaluation and interpretation of routinely collected data (standard in-life, clinical pathology, and anatomic pathology endpoints) are appropriate and generally sufficient to assess whether or not changes are secondary to stress. The impact of possible stress-induced effects on data interpretation can partially be mitigated by toxicity study designs that use appropriate control groups (e.g., cohorts treated with vehicle and subjected to the same procedures as those dosed with test article), housing that minimizes isolation and offers environmental enrichment, and experimental procedures that minimize stress and sampling and analytical bias. This article is a comprehensive overview of the biological aspects of the stress response, beginning with a Summary (Section 1) and an Introduction (Section 2) that describes the historical and conventional methods used to characterize acute and chronic stress responses. These sections are followed by reviews of the primary systems and parameters that regulate and/or are influenced by stress, with an emphasis on parameters evaluated in toxicity studies: In-life Procedures (Section 3), Nervous System (Section 4), Endocrine System (Section 5), Reproductive System (Section 6), Clinical Pathology (Section 7), and Immune System (Section 8). The paper concludes (Section 9) with a brief discussion on Minimizing Stress-Related Effects (9.1.), and a final section explaining why Parameters routinely measured are appropriate for assessing the role of stress in toxicology studies (9.2.).

Strength of primary care service delivery: a comparative study of European countries, Australia, New Zealand, and Canada.

PubMed

Pavlič, Danica R; Sever, Maja; Klemenc-Ketiš, Zalika; Švab, Igor; Vainieri, Milena; Seghieri, Chiara; Maksuti, Alem

2018-05-01

AimWe sought to examine strength of primary care service delivery as measured by selected process indicators by general practitioners from 31 European countries plus Australia, Canada, and New Zealand. We explored the relation between strength of service delivery and healthcare expenditures. The strength of a country's primary care is determined by the degree of development of a combination of core primary care dimensions in the context of its healthcare system. This study analyses the strength of service delivery in primary care as measured through process indicators in 31 European countries plus Australia, New Zealand, and Canada. A comparative cross-sectional study design was applied using the QUALICOPC GP database. Data on the strength of primary healthcare were collected using a standardized GP questionnaire, which included 60 questions divided into 10 dimensions related to process, structure, and outcomes. A total of 6734 general practitioners participated. Data on healthcare expenditure were obtained from World Bank statistics. We conducted a correlation analysis to analyse the relationship between strength and healthcare expenditures.FindingsOur findings show that the strength of service delivery parameters is less than optimal in some countries, and there are substantial variations among countries. Continuity and comprehensiveness of care are significantly positively related to national healthcare expenditures; however, coordination of care is not.

Development and validation of the Vietnamese primary care assessment tool

PubMed Central

2018-01-01

Objective To adapt the consumer version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. Design A quantitative cross sectional study. Setting 56 communes in 3 representative provinces of central Vietnam. Participants Total of 3289 people who used health care services at health facility at least once over the past two years. Results The Vietnamese adult expanded consumer version of the PCAT (VN PCAT-AE) is an instrument for evaluation of primary care in Vietnam with 70 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. Sixteen other items from the original tool were not included in the final instrument, due to problems with missing values, floor or ceiling effects, and item-total correlations. All the retained scales have a Cronbach’s alpha above 0.70 except for the subscale of Family Centeredness. Conclusions The VN PCAT-AE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the consumer perspective. Additional work in the future to optimize valid measurement in all domains consistent with the original version of the tool may be helpful as the primary care system in Vietnam further develops. PMID:29324851

Paleomagnetic and magnetostratigraphic investigations of the whitehorse group/quartermaster (Dewey Lake) formation (upper permian-lowermost triassic) in the Palo Duro basin, northwest Texas, USA

NASA Astrophysics Data System (ADS)

Collins, Dylan R.

In northwest Texas, upper Permian to lowermost Triassic hematite-cemented detrital sedimentary rocks, which include a small number of regionally extensive ash beds, were deposited during the time interval of the greatest mass extinction event sequences in Earth history. The magnetic polarity stratigraphy, as well as key rock magnetic properties, of the upper Whitehorse Group (WH) and Quartermaster formations (QM) at selected sections in the Palo Duro Basin, have been determined using thermal, and chemical demagnetization approaches and anisotropy of magnetic susceptibility, acquisition of isothermal remanent magnetization (IRM) and backfield demagnetization, and thermal demagnetization of three component IRM methods. Demagnetization results show that the WH/QM contains a primary/near-primary characteristic remanent magnetization at each level sampled and thus the magnetic polarity stratigraphy for each section can be compared with existing polarity time scales across the Permian-Triassic boundary. Estimated site mean directions yield a paleomagnetic pole for the latest Permian for North America of 57.8°N, 130.6°E from 38 sampled sites.

Perceptions of scientific research literature and strategies for reading papers depend on academic career stage.

PubMed

Hubbard, Katharine E; Dunbar, Sonja D

2017-01-01

Reading primary research literature is an essential skill for all scientists and students on science degree programmes, however little is known about how researchers at different career stages interact with and interpret scientific papers. To explore this, we conducted a survey of 260 undergraduate students and researchers in Biological Sciences at a research intensive UK university. Responses to Likert scale questions demonstrated increases in confidence and skill with reading the literature between individuals at each career stage, including between postdoctoral researchers and faculty academics. The survey indicated that individuals at different career stages valued different sections of scientific papers, and skill in reading the results section develops slowly over the course of an academic career. Inexperienced readers found the methods and results sections of research papers the most difficult to read, and undervalued the importance of the results section and critical interpretation of data. These data highlight a need for structured support with reading scientific literature at multiple career stages, and for senior academics to be aware that junior colleagues may prioritise their reading differently. We propose a model for the development of literature processing skills, and consider the need for training strategies to help inexperienced readers engage with primary literature, and therefore develop important skills that underpin scientific careers. We also encourage researchers to be mindful of language used when writing papers, and to be more inclusive of diverse audiences when disseminating their work.

Perceptions of scientific research literature and strategies for reading papers depend on academic career stage

PubMed Central

Dunbar, Sonja D.

2017-01-01

Reading primary research literature is an essential skill for all scientists and students on science degree programmes, however little is known about how researchers at different career stages interact with and interpret scientific papers. To explore this, we conducted a survey of 260 undergraduate students and researchers in Biological Sciences at a research intensive UK university. Responses to Likert scale questions demonstrated increases in confidence and skill with reading the literature between individuals at each career stage, including between postdoctoral researchers and faculty academics. The survey indicated that individuals at different career stages valued different sections of scientific papers, and skill in reading the results section develops slowly over the course of an academic career. Inexperienced readers found the methods and results sections of research papers the most difficult to read, and undervalued the importance of the results section and critical interpretation of data. These data highlight a need for structured support with reading scientific literature at multiple career stages, and for senior academics to be aware that junior colleagues may prioritise their reading differently. We propose a model for the development of literature processing skills, and consider the need for training strategies to help inexperienced readers engage with primary literature, and therefore develop important skills that underpin scientific careers. We also encourage researchers to be mindful of language used when writing papers, and to be more inclusive of diverse audiences when disseminating their work. PMID:29284031

Indian pharmaceutical patent prosecution: The changing role of Section 3(d)

PubMed Central

2018-01-01

India, like many developing countries, only recently began to grant pharmaceutical product patents. Indian patent law includes a provision, Section 3(d), which tries to limit grant of “secondary” pharmaceutical patents, i.e. patents on new forms of existing molecules and drugs. Previous research suggests the provision was rarely used against secondary applications in the years immediately following its enactment, and where it was, was redundant to other aspects of the patent law, raising concerns that 3(d) was being under-utilized by the Indian Patent Office. This paper uses a novel data source, the patent office’s first examination reports, to examine changes in the use of the provision. We find a sharp increase over time in the use of Section 3(d), including on the main claims of patent applications, though it continues to be used in conjunction with other types of objections to patentability. More surprisingly, see a sharp increase in the use of the provision against primary patent applications, contrary to its intent, raising concerns about potential over-utilization. PMID:29608604

Funding source and primary outcome changes in clinical trials registered on ClinicalTrials.gov are associated with the reporting of a statistically significant primary outcome: a cross-sectional study.

PubMed

Ramagopalan, Sreeram V; Skingsley, Andrew P; Handunnetthi, Lahiru; Magnus, Daniel; Klingel, Michelle; Pakpoor, Julia; Goldacre, Ben

2015-01-01

We and others have shown a significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. The objectives of this study were to investigate whether changes made to primary outcomes are associated with the likelihood of reporting a statistically significant primary outcome on ClinicalTrials.gov. A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 20 November 2014 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. 13,238 completed interventional trials were registered with ClinicalTrials.gov that also had study results posted on the website. 2555 (19.3%) had one or more statistically significant primary outcomes. Statistical analysis showed that registration year, funding source and primary outcome change after trial completion were associated with reporting a statistically significant primary outcome .  Funding source and primary outcome change after trial completion are associated with a statistically significant primary outcome report on clinicaltrials.gov.

Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China

PubMed Central

Wu, Dan; Wang, Yun; Lam, Kwok Fai; Hesketh, Therese

2014-01-01

Objective To explore the factors influencing doctors’ job satisfaction and morale in China, in the context of the ongoing health system reforms and the deteriorating doctor–patient relationship. Design Cross-sectional survey using self-completion questionnaires. Study setting The survey was conducted from March to May 2012 among doctors at the provincial, county and primary care levels in Zhejiang Province, China. Results The questionnaire was completed by 202 doctors. Factors which contributed most to low job satisfaction were low income and long working hours. Provincial level doctors were most dissatisfied while primary care doctors were the least dissatisfied. Three per cent of doctors at high-level hospitals and 27% of those in primary care were satisfied with the salary. Only 7% at high-level hospitals were satisfied with the work hours, compared to 43% in primary care. Less than 10% at high levels were satisfied with the amount of paid vacation time (3%) and paid sick leave (5%), compared with 38% and 41%, respectively, in primary care. Overall, 87% reported that patients were more likely to sue and that patient violence against doctors was increasing. Only 4.5% wanted their children to be doctors. Of those 125 who provided a reason, 34% said poor pay, 17% said it was a high-risk profession, and 9% expressed concerns about personal insecurity or patient violence. Conclusions Doctors have low job satisfaction overall. Recruitment and retention of doctors have become major challenges for the Chinese health system. Measures must be taken to address this, in order to ensure recruitment and retention of doctors in the future. These measures must first include reduction of doctors’ workload, especially at provincial hospitals, partly through incentivisation of appropriate utilisation of primary care, increase in doctors’ salary and more effective measures to tackle patient violence against doctors. PMID:25552614

Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study.

PubMed

Kontopantelis, Evangelos; Stevens, Richard John; Helms, Peter J; Edwards, Duncan; Doran, Tim; Ashcroft, Darren M

2018-02-28

UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of clinical computing systems and discuss the implications for the longevity and regional representativeness of these resources. Cross-sectional study. English primary care clinical computer systems. 7526 general practices in August 2016. Spatial mapping of family practices in England in 2016 by clinical computer system at two geographical levels, the lower Clinical Commissioning Group (CCG, 209 units) and the higher National Health Service regions (14 units). Data for practices included numbers of doctors, nurses and patients, and area deprivation. Of 7526 practices, Egton Medical Information Systems (EMIS) was used in 4199 (56%), SystmOne in 2552 (34%) and Vision in 636 (9%). Great regional variability was observed for all systems, with EMIS having a stronger presence in the West of England, London and the South; SystmOne in the East and some regions in the South; and Vision in London, the South, Greater Manchester and Birmingham. PCDs based on single clinical computer systems are geographically clustered in England. For example, Clinical Practice Research Datalink and The Health Improvement Network, the most popular primary care databases in terms of research outputs, are based on the Vision clinical computer system, used by <10% of practices and heavily concentrated in three major conurbations and the South. Researchers need to be aware of the analytical challenges posed by clustering, and barriers to accessing alternative PCDs need to be removed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A Cross-Sectional Comparison of Perceived Quality of Primary Care by Hypertensive Patients in Shanghai and Shenzhen, China

PubMed Central

Li, Haitao; Wei, Xiaolin; Wong, Martin Chi-Sang; Wong, Samuel Yeung-Shan; Yang, Nan; Griffiths, Sian M.

2015-01-01

Abstract Hypertension should be best managed under primary care settings. This study aimed to compare, between Shanghai and Shenzhen, the perceived quality of primary care in terms of accessibility, continuity, co-ordination, and comprehensiveness among hypertensive patients. A cross-sectional study was conducted in Shanghai and Shenzhen, China. Multistage random sampling method was used to select 8 community health centers. Data from primary care users were collected through on-site face-to-face interviews using the primary care assessment tool. Good quality standard was set as a value of 3 for each attribute and a value of 18 for total score. We included 568 patients in Shanghai and 128 patients in Shenzhen. Compared with those in Shenzhen, hypertensive patients in Shanghai reported a higher score in co-ordination of information (3.37 vs 3.66; P < 0.001), but lower scores in continuity of care (3.36 vs 3.27; P < 0.001), and comprehensiveness-service provision (3.26 vs 2.79; P < 0.001). There was no statistically significant difference in total scores between the 2 cities (18.19 vs 18.15). Over 3-quarters of hypertensive patients in both cities reported accessibility (97.2% vs 91.4%) and co-ordination of services (76.1% vs 80.5%) under good quality standard, while <1-quarter of them rated continuity of care (23.6% vs 22.7%), co-ordination of information (4.8% vs 21.1%), and comprehensiveness-service availability (15.1% vs 25.0%) under that standard. Compared with Shenzhen, the perceived quality of primary care for hypertensive patients in Shanghai was better in terms of co-ordination of information, but poorer on continuity of care and comprehensiveness-service provision. Our study suggests that there is room for quality improvement in both cities. PMID:26313780

Organizational culture predicts job satisfaction and perceived clinical effectiveness in pediatric primary care practices.

PubMed

Brazil, Kevin; Wakefield, Dorothy B; Cloutier, Michelle M; Tennen, Howard; Hall, Charles B

2010-01-01

In recent years, there has been a growing understanding that organizational culture is related to an organization's performance. However, few studies have examined organizational culture in medical group practices. The purpose of this study was to examine the relationship of organizational culture on provider job satisfaction and perceived clinical effectiveness in primary care pediatric practices. This cross-sectional study included 36 primary care pediatric practices located in Connecticut. There were 374 participants in this study, which included 127 clinicians and 247 nonclinicians. Office managers completed a questionnaire that recorded staff and practice characteristics; all participants completed the Organizational Culture Scale, a questionnaire that assessed the practice on four cultural domains (i.e., group, developmental, rational, and hierarchical), and the Primary Care Organizational Questionnaire that evaluated perceived effectiveness and job satisfaction. Hierarchical linear models using a restricted maximum likelihood estimation method were used to evaluate whether the practice culture types predicted job satisfaction and perceived effectiveness. Group culture was positively associated with both satisfaction and perceived effectiveness. In contrast, hierarchical and rational culture were negatively associated with both job satisfaction and perceived effectiveness. These relationships were true for clinicians, nonclinicians, and the practice as a whole. Our study demonstrates that practice culture is associated with job satisfaction and perceived clinical effectiveness and that a group culture was associated with high job satisfaction and perceived effectiveness.

Petroleum supply monthly, February 1991. [Glossary included

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

Not Available

1991-02-01

Data presented in the Petroleum Supply Monthly (PSM) describe the supply and disposition of petroleum products in the United States and major US geographic regions. The data series describe production, imports and exports, inter-Petroleum Administration for Defense (PAD) District movements, and inventories by the primary suppliers of petroleum products in the United States (50 States and the District of Columbia). The reporting universe includes those petroleum sectors in Primary Supply. Included are: petroleum refiners, motor gasoline blenders, operators of natural gas processing plants and fractionators, inter-PAD transporters, importers, and major inventory holders of petroleum products and crude oil. When aggregated,more » the data reported by these sectors approximately represent the consumption of petroleum products in the United States. Data presented in the PSM are divided into two sections (1) the Summary Statistics and (2) the Detailed Statistics. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary. 12 figs., 54 tabs.« less

Vitamin D deficiency in an Italian cohort of infertile women.

PubMed

Triggianese, Paola; Watad, Abdulla; Cedola, Francesca; Perricone, Carlo; Amital, Howard; Giambini, Ilio; Perricone, Roberto; Shoenfeld, Yehuda; De Carolis, Caterina

2017-10-01

The purpose of this study was to explore whether vitamin D might be a marker of female primary infertility in association with the presence of autoimmune diseases (ADs). The study was a cross-sectional descriptive study in consecutive outpatients of the Polymedical Center for Prevention of Recurrent Spontaneous Abortion (RSA), in Rome, Italy. Women were eligible if they received a diagnosis of primary infertility or RSA. Serum vitamin D, calcium, and PTH were analyzed. Women with primary infertility (n=70) or RSA/non-infertile (n=105) were enrolled; controls (n=250) were included. Infertile women presented lower vitamin D (P=0.03) and higher prevalence of AD (P=0.007) than non-infertile women. In the multivariate analysis, the presence of ADs is associated with higher odds of infertility (OR=2.2), while normal vitamin D was a protective factor (OR=0.9). We described that having vitamin D deficiency and suffering from an AD are independent risk factors for women primary infertility. Supplementation of vitamin D might be useful for pregnancy outcome. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

40 CFR 421.250 - Applicability: Description of the primary precious metals and mercury subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... primary precious metals and mercury subcategory. 421.250 Section 421.250 Protection of Environment... POINT SOURCE CATEGORY Primary Precious Metals and Mercury Subcategory § 421.250 Applicability: Description of the primary precious metals and mercury subcategory. The provisions of this subpart are...

40 CFR 421.250 - Applicability: Description of the primary precious metals and mercury subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary precious metals and mercury subcategory. 421.250 Section 421.250 Protection of Environment... POINT SOURCE CATEGORY Primary Precious Metals and Mercury Subcategory § 421.250 Applicability: Description of the primary precious metals and mercury subcategory. The provisions of this subpart are...

40 CFR 421.250 - Applicability: Description of the primary precious metals and mercury subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... primary precious metals and mercury subcategory. 421.250 Section 421.250 Protection of Environment... POINT SOURCE CATEGORY Primary Precious Metals and Mercury Subcategory § 421.250 Applicability: Description of the primary precious metals and mercury subcategory. The provisions of this subpart are...

40 CFR 421.250 - Applicability: Description of the primary precious metals and mercury subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... primary precious metals and mercury subcategory. 421.250 Section 421.250 Protection of Environment... POINT SOURCE CATEGORY Primary Precious Metals and Mercury Subcategory § 421.250 Applicability: Description of the primary precious metals and mercury subcategory. The provisions of this subpart are...

14 CFR 27.673 - Primary flight control.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Primary flight control. 27.673 Section 27... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Design and Construction Control Systems § 27.673 Primary flight control. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

14 CFR 29.673 - Primary flight controls.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Primary flight controls. 29.673 Section 29... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Design and Construction Control Systems § 29.673 Primary flight controls. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

14 CFR 29.673 - Primary flight controls.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Primary flight controls. 29.673 Section 29... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Design and Construction Control Systems § 29.673 Primary flight controls. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

14 CFR 27.673 - Primary flight control.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Primary flight control. 27.673 Section 27... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Design and Construction Control Systems § 27.673 Primary flight control. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

20 CFR 404.281 - Why your primary insurance amount may be recomputed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... recomputed. 404.281 Section 404.281 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Recomputing Your Primary... enacted. If a new method of computing or recomputing primary insurance amounts is enacted into law and you...

20 CFR 404.242 - Use of old-start primary insurance amount as guaranteed alternative.

Code of Federal Regulations, 2010 CFR

2010-04-01

... guaranteed alternative. 404.242 Section 404.242 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Old-Start Method of Computing Primary Insurance Amounts § 404.242 Use of old-start primary insurance amount as...

14 CFR 23.673 - Primary flight controls.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Primary flight controls. 23.673 Section 23... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.673 Primary flight controls. Primary flight controls are those used by the pilot for...

14 CFR 23.673 - Primary flight controls.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Primary flight controls. 23.673 Section 23... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.673 Primary flight controls. Primary flight controls are those used by the pilot for...

14 CFR 23.673 - Primary flight controls.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Primary flight controls. 23.673 Section 23... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.673 Primary flight controls. Primary flight controls are those used by the pilot for...

14 CFR 23.673 - Primary flight controls.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Primary flight controls. 23.673 Section 23... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.673 Primary flight controls. Primary flight controls are those used by the pilot for...

14 CFR 23.673 - Primary flight controls.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Primary flight controls. 23.673 Section 23... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.673 Primary flight controls. Primary flight controls are those used by the pilot for...

14 CFR 27.673 - Primary flight control.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Design and Construction Control Systems § 27.673 Primary flight control. Primary flight controls are those used by the pilot for immediate control of pitch, roll... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Primary flight control. 27.673 Section 27...

14 CFR 29.673 - Primary flight controls.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Design and Construction Control Systems § 29.673 Primary flight controls. Primary flight controls are those used by the pilot for immediate control of pitch, roll... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Primary flight controls. 29.673 Section 29...

40 CFR 421.270 - Applicability: Description of the primary rare earth metals subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... primary rare earth metals subcategory. 421.270 Section 421.270 Protection of Environment ENVIRONMENTAL... CATEGORY Primary Rare Earth Metals Subcategory § 421.270 Applicability: Description of the primary rare earth metals subcategory. The provisions of this subpart are applicable to discharges resulting from the...

40 CFR 421.270 - Applicability: Description of the primary rare earth metals subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary rare earth metals subcategory. 421.270 Section 421.270 Protection of Environment ENVIRONMENTAL... CATEGORY Primary Rare Earth Metals Subcategory § 421.270 Applicability: Description of the primary rare earth metals subcategory. The provisions of this subpart are applicable to discharges resulting from the...

40 CFR 421.270 - Applicability: Description of the primary rare earth metals subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... primary rare earth metals subcategory. 421.270 Section 421.270 Protection of Environment ENVIRONMENTAL... CATEGORY Primary Rare Earth Metals Subcategory § 421.270 Applicability: Description of the primary rare earth metals subcategory. The provisions of this subpart are applicable to discharges resulting from the...

40 CFR 421.270 - Applicability: Description of the primary rare earth metals subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary rare earth metals subcategory. 421.270 Section 421.270 Protection of Environment ENVIRONMENTAL... CATEGORY Primary Rare Earth Metals Subcategory § 421.270 Applicability: Description of the primary rare earth metals subcategory. The provisions of this subpart are applicable to discharges resulting from the...

40 CFR 421.270 - Applicability: Description of the primary rare earth metals subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... primary rare earth metals subcategory. 421.270 Section 421.270 Protection of Environment ENVIRONMENTAL... CATEGORY Primary Rare Earth Metals Subcategory § 421.270 Applicability: Description of the primary rare earth metals subcategory. The provisions of this subpart are applicable to discharges resulting from the...

30 CFR 817.151 - Primary roads.

Code of Federal Regulations, 2011 CFR

2011-07-01

... with the approved plan. (b) Safety factor. Each primary road embankment shall have a minimum static... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Primary roads. 817.151 Section 817.151 Mineral... roads. Primary roads shall meet the requirements of § 817.150 and the additional requirements of this...

Caregiver burden among primary caregivers of patients undergoing peripheral blood stem cell transplantation: a cross sectional study.

PubMed

Akgul, Nur; Ozdemir, Leyla

2014-08-01

This study aimed to identify caregiver burden and influencing factors on the burden in primary caregivers of peripheral blood stem cell transplantation patients within 2-12 months following transplant, indicating early recovery period after discharge. This descriptive cross sectional study was carried out at hematopoietic stem cell transplantation outpatient units of three university hospitals in Turkey. A total of 55 patient and caregiver dyads were recruited and interviewed. The data were collected using questionnaires developed by the researchers and caregiver burden was measured with the Zarit Burden Interview. The mean score of Zarit Burden Interview was 28.41 (SD = 13.90). Patients' symptoms including nausea and self depreciation feeling were related to greater caregiver burden. Self-depreciation was referred to feeling undervalued. The mean score of the tool was significantly higher in caregivers who have not been educated beyond primary school and also caregivers who had lower income. Caregivers who supported their patients to fulfill physical needs and who did not receive help for meeting patients' psychological needs had statistically more elevated levels of burden. Moreover, the extent of care giving activities undertaken was positively correlated with caregiver burden scores. While positive impact of the care giving process on family relations decreased caregiver burden; negative effect increased the burden. This study suggests that caregiver burden of primary caregivers caring for peripheral blood stem cell transplantation patients varies by education, income status, and the extent of care giving activities undertaken. Changes in family ties and relations due to care giving effected caregiver burden. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Prevalence of Chronic Kidney Disease in a Primary Care Setting: A Swiss Cross-Sectional Study

PubMed Central

Tomonaga, Yuki; Risch, Lorenz; Szucs, Thomas D.; Ambuehl, Patrice M.

2013-01-01

Chronic kidney disease (CKD) often remains clinically silent and therefore undiagnosed until a progressed stage is reached. Our aim was to estimate the prevalence of CKD in a primary care setting in Switzerland. A multicenter, cross-sectional study with randomly selected general practitioners was performed. Adults visiting their general physician’s cabinet during defined periods were asked to participate. Baseline information was reported on a questionnaire, urine and blood samples were analyzed in a central laboratory. Renal status was assessed using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. Extrapolation of results to national level was adjusted for age and gender. One thousand individuals (57% females) with a mean age of 57±17 years were included. Overall, 41% of the patients had normal estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR), whereas 36% of the subjects had slightly reduced excretory renal function with physiological albuminuria based on normal ACR. Almost one fourth of the subjects (23%) had either a substantially reduced eGFR or high levels of ACR. About 10% of the patients had a substantially reduced eGFR of <60 ml/min/1.73 m2, and 17% showed relevant proteinuria (ACR >30 mg/g creatinine). Extrapolation to national level suggests that about 18% of primary care patients may suffer from CKD. CKD prevalence in a primary care population is therefore high, and preventive interventions may be advisable, in particular as CKD prevalence is likely to rise over the next decades. PMID:23844110

Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial.

PubMed

McLachlan, H L; Forster, D A; Davey, M A; Farrell, T; Gold, L; Biro, M A; Albers, L; Flood, M; Oats, J; Waldenström, U

2012-11-01

To determine whether primary midwife care (caseload midwifery) decreases the caesarean section rate compared with standard maternity care. Randomised controlled trial. Tertiary-care women's hospital in Melbourne, Australia. A total of 2314 low-risk pregnant women. Women randomised to caseload received antenatal, intrapartum and postpartum care from a primary midwife with some care by 'back-up' midwives. Women randomised to standard care received either midwifery or obstetric-trainee care with varying levels of continuity, or community-based general practitioner care. caesarean birth. Secondary outcomes included instrumental vaginal births, analgesia, perineal trauma, induction of labour, infant admission to special/neonatal intensive care, gestational age, Apgar scores and birthweight. In total 2314 women were randomised-1156 to caseload and 1158 to standard care. Women allocated to caseload were less likely to have a caesarean section (19.4% versus 24.9%; risk ratio [RR] 0.78; 95% CI 0.67-0.91; P = 0.001); more likely to have a spontaneous vaginal birth (63.0% versus 55.7%; RR 1.13; 95% CI 1.06-1.21; P < 0.001); less likely to have epidural analgesia (30.5% versus 34.6%; RR 0.88; 95% CI 0.79-0.996; P = 0.04) and less likely to have an episiotomy (23.1% versus 29.4%; RR 0.79; 95% CI 0.67-0.92; P = 0.003). Infants of women allocated to caseload were less likely to be admitted to special or neonatal intensive care (4.0% versus 6.4%; RR 0.63; 95% CI 0.44-0.90; P = 0.01). No infant outcomes favoured standard care. In settings with a relatively high baseline caesarean section rate, caseload midwifery for women at low obstetric risk in early pregnancy shows promise for reducing caesarean births. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Association between registered nurse staffing and management outcomes of patients with type 2 diabetes within primary care: a cross-sectional linkage study

PubMed Central

Lukewich, Julia; Edge, Dana S.; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan

2016-01-01

Background: As the organization of primary care continues to evolve toward more interdisciplinary team structures, demonstrating effectiveness of care delivery is becoming important, particularly for nonphysician providers. Nurses are the most common nonphysician provider within primary care. The purpose of this study was to examine the relation between primary care delivery models that incorporate registered nurses and clinical outcomes of patients with type 2 diabetes. Methods: Patient data from the Canadian Primary Care Sentinel Surveillance Network were matched with survey data from 15 Family Health Team practices in southeastern Ontario. Included patients were adults with type 2 diabetes mellitus who had at least 1 primary care encounter at a Family Health Team practice that completed the organizational survey between Apr. 1, 2013, and Mar. 31, 2014. The clinical outcomes explored included hemoglobin A1c, fasting plasma glucose, blood pressure, low-density lipoprotein cholesterol and urine albumin:creatinine ratio. Results: Of the 15 practices, 13 (86.7%) had at least 1 registered nurse. The presence of 1 or more registered nurses in the practice was associated with increased odds of patients' having their hemoglobin A1c, fasting plasma glucose, blood pressure and low-density lipoprotein cholesterol values meet recommended targets. Practices with the lowest ratios of patients with diabetes to registered nurse had a significantly greater proportion of patients with hemoglobin A1c and fasting plasma glucose values on target than did practices with the highest ratios of patients to registered nurse (p < 0.01 and p = 0.03, respectively). Interpretation: The findings suggest that registered nurse staffing within primary care practice teams contributes to better diabetic care, as measured by diabetes management indicators. This study sets the groundwork for further exploration of nursing and organizational contributions to patient care in the primary care setting. PMID:27398372

Petroleum supply monthly, April 1991. [Glossary included

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

Not Available

1991-04-29

Data presented in the PSM (Petroleum Supply Monthly) describe the supply and disposition of petroleum products in the United States and major US geographic regions. The data series describe production, imports and exports, inter-Petroleum Administration for Defense (PAD) District movements, and inventories by the primary suppliers of petroleum products in the United States (50 States and the District of Columbia). The reporting universe includes those petroleum sectors in Primary Supply. Included are: petroleum refiners, motor gasoline blenders, operators of natural gas processing plants and fractionators, inter-PAD transporters, importers, and major inventory holders of petroleum products and crude oil. When aggregated,more » the data reported by these sectors approximately represent the consumption of petroleum products in the United States. The tables and figures in the Summary Statistics section of the PSM present a time series of selected petroleum data on a US level. Most time series include preliminary estimates for one month. The Detailed Statistics tables of the PSM present statistics for the most current month available as well as year-to-date. Industry terminology and product definitions are listed alphabetically in the Glossary. 14 figs., 65 tabs.« less

Outcrop Gamma-ray Analysis of the Cretaceous mesaverde Group: Jicarilla Apache Indian Reservation, New Mexico

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

Ridgley, Jennie; Dunbar, Robyn Wright

2001-04-25

This report presents the results of an outcrop gamma-ray survey of six selected measured sections included in the original report. The primary objective of this second study is to provide a baseline to correlate from the outcrop and reservoir model into Mesaverde strata in the San Juan Basin subsurface. Outcrop logs were generated using a GAD-6 gamma-ray spectrometer that simultaneously recorded total counts, potassium, uranium, and thorium data.

The Importance of Family History in Breast Cancer Patients in Primary Care Setting: a Cross-sectional Study.

PubMed

Kartal, Mehtap; Ozcakar, Nilgun; Hatipoglu, Sehnaz; Tan, Makbule Neslisah; Guldal, Azize Dilek

2018-06-01

Screening recommendations of physicians are important for women to raise awareness about their risk factors and to promote appropriate screening behaviors. However, it seems challenging for primary care physicians (PCPs) to balance disease prevention and diagnosis, treatment. The objective of this study was to describe physicians' breast cancer consultancy practice including family history, cancer prevention issues for the women they care. This cross-sectional study included 577 women aged above 45 years, free of breast cancer, during their visits to their PCPs. Nearly half of the women reported their visit to PCPs for an annual examination during the year. Among them, 36.1% had first-degree relatives with cancer and 7.3% with breast cancer. But they reported to be asked about family history of cancer and informed about cancer prevention issues 35.1 and 26.4%, respectively. Cancer still seems to be a hard issue to be discussed, even with women visiting PCPs for annual examination. Asking first-degree relative with breast cancer can give PCPs the chance of determining women with increased risk and support women's appropriate understanding of their own risk in relation to their family history. This routine can make shared-decision making for developing person-centered approach for breast cancer screening possible. Further studies are needed for better understanding of loss of consultancy leadership of physicians for breast cancer.

A descriptive qualitative study of the roles of family members in older men’s depression treatment from the perspectives of older men and primary care providers

PubMed Central

Hinton, Ladson; Apesoa-Varano, Ester Carolina; Unutzer, Jurgen; Dwight-Johnson, Megan; Park, Mijung; Barker, Judith C.

2014-01-01

OBJECTIVE To describe the roles of family members in older men’s depression treatment from the perspectives of older men and primary care physicians (PCPs). METHODS Cross-sectional, descriptive qualitative study conducted from 2008–2011 in primary care clinics in an academic medical center and a safety-net county teaching hospital in California’s Central Valley. Participants in this study were 1) 77 age ≥ 60, non-institutionalized men with a one-year history of clinical depression and/or depression treatment who were identified through screening in primary care clinics and 2) a convenience sample of 15 PCPs from same recruitment sites. Semi-structured, in-depth qualitative interviews were conducted and audiotaped, then transcribed and analyzed thematically. RESULTS Treatment-promoting roles of family included providing an emotionally supportive home environment, promoting depression self-management and facilitating communication about depression during primary care visits. Treatment impeding roles of family included triggering or worsening men’s depression, hindering depression care during primary care visits, discouraging depression treatment and being unavailable to assist men with their depression care. Overall, more than 90% of the men and the PCPs described one or more treatment-promoting roles of family and over 75% of men and PCPs described one or more treatment-impeding roles of family. CONCLUSIONS Families play important roles in older men’s depression treatment with the potential to promote as well as impede care. Interventions and services need to carefully assess the ongoing roles and attitudes of family members and to tailor treatment approaches to build on the positive aspects and mitigate the negative aspects of family support. PMID:25131709

Electronic health records and support for primary care teamwork.

PubMed

O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson

2015-03-01

Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

A descriptive qualitative study of the roles of family members in older men's depression treatment from the perspectives of older men and primary care providers.

PubMed

Hinton, Ladson; Apesoa-Varano, Ester Carolina; Unützer, Jürgen; Dwight-Johnson, Megan; Park, Mijung; Barker, Judith C

2015-05-01

The aim of this study is to describe the roles of family members in older men's depression treatment from the perspectives of older men and primary care physicians (PCPs). Cross-sectional, descriptive qualitative study conducted from 2008-2011 in primary care clinics in an academic medical center and a safety-net county teaching hospital in California's Central Valley. Participants in this study were the following: (1) 77 age ≥ 60, noninstitutionalized men with a 1-year history of clinical depression and/or depression treatment who were identified through screening in primary care clinics and (2) a convenience sample of 15 PCPs from the same recruitment sites. Semi-structured and in-depth qualitative interviews were conducted and audiotaped then transcribed and analyzed thematically. Treatment-promoting roles of family included providing an emotionally supportive home environment, promoting depression self-management and facilitating communication about depression during primary care visits. Treatment-impeding roles of family included triggering or worsening men's depression, hindering depression care during primary care visits, discouraging depression treatment and being unavailable to assist men with their depression care. Overall, more than 90% of the men and the PCPs described one or more treatment-promoting roles of family and over 75% of men and PCPs described one or more treatment-impeding roles of family. Families play important roles in older men's depression treatment with the potential to promote as well as impede care. Interventions and services need to carefully assess the ongoing roles and attitudes of family members and to tailor treatment approaches to build on the positive aspects and mitigate the negative aspects of family support. Copyright © 2014 John Wiley & Sons, Ltd.

[Patients' characteristics and clinical management of atrial fibrillation in primary healthcare in Spain: FIATE Study].

PubMed

Lobos-Bejarano, José María; del Castillo-Rodríguez, José Carlos; Mena-González, Amparo; Alemán-Sánchez, José J; Cabrera de León, Antonio; Barón-Esquivias, Gonzalo; Pastor-Fuentes, Agustín

2013-10-05

The main therapeutic objective in atrial fibrillation (AF) patients is stroke prevention. This study is aimed to determine whether the anticoagulant therapy may be appropriate regarding to the Guidelines and patients' profile in primary healthcare in Spain. A national, multicenter, cross-sectional study of AF patients attended in primary healthcare in Spain has been conducted. The study involved 185 family physicians whose patients were randomized. A total of 3,759 AF patients were randomized from the clinical records, and 2,070 were included in the study, at an average age of 74 (11) years old (50.7% female). Most of them (78%) had permanent AF and high comorbidity rates (hypertension 75%, obesity 30%, diabetes 27%, heart failure 20%, coronary heart disease 17%, and social risk 15%). Patients diagnosed in primary healthcare were more frequently asymptomatic than in hospital setting (36%; P<.001). The therapeutic strategy was based on the heart rate control in 4 out of 5 patients. Anticoagulation therapy was widely used (84%), more frequently in patients with permanent vs. non-permanent AF (91 vs. 60%, P<.001). Follow-up and monitoring was mainly performed in primary care (72%). The anticoagulation control was suboptimal, with a 66% of the international normalized ratio (INR) in therapeutic range, dropping to 33% when the last 3 available INR were included (P<.001). A high rate of patients with anticoagulant therapy in primary healthcare has been found in this research. INR control, however, remains suboptimal. Heart rate control is the most commonly used strategy. The decision about the anticoagulation should be based on the thromboembolic risk rather than in the arrhytmia type. Copyright © 2012 Elsevier España, S.L. All rights reserved.

The Next Phase of Title VII Funding for Training Primary Care Physicians for America’s Health Care Needs

PubMed Central

Phillips, Robert L.; Turner, Barbara J.

2012-01-01

Health care reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training. Title VII, Section 747 of the Public Health Service Act previously supported the growth of the health care workforce but has been severely cut over the past 2 decades. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. To accomplish these goals, Congress should act on the Council on Graduate Medical Education’s recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk. PMID:22412009

The next phase of Title VII funding for training primary care physicians for America's health care needs.

PubMed

Phillips, Robert L; Turner, Barbara J

2012-01-01

Health care reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training. Title VII, Section 747 of the Public Health Service Act previously supported the growth of the health care workforce but has been severely cut over the past 2 decades. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. To accomplish these goals, Congress should act on the Council on Graduate Medical Education's recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk.

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study

PubMed Central

Serrano-Gallardo, Pilar; Martínez-Marcos, Mercedes; Espejo-Matorrales, Flora; Arakawa, Tiemi; Magnabosco, Gabriela Tavares; Pinto, Ione Carvalho

2016-01-01

ABSTRACT Objective: to identify the students' perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning. Methods: analytical cross-sectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed. Results: the response rate was 91.8%. The most commonly identified tutoring process was "preceptor-professor" (45.2%). The clinical placement was assessed as "optimal" by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables "Academic year" (beta coefficient = 1.042 for third-year students), "Primary Health Care Area (PHC)" (beta coefficient = 0.308 for Area B) and "Clinical placement perception" (beta coefficient = - 0.204 for a suboptimal perception). Conclusions: timeframe within the academic program, location and clinical placement perception were associated with students' clinical learning. Students' perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance. PMID:27627124

Cross-sectional survey on awareness of colorectal cancer and a screening programme for primary health care professionals in Catalonia, Spain.

PubMed

Benito, L; García, M; Binefa, G; Mila, N; Vidal, C; Lluch, M T; Puig, M

2016-11-01

This study aimed to assess whether primary health care professionals have accurate information regarding colorectal cancer (CRC) screening procedures, surveillance recommendations and referral strategies. This cross-sectional descriptive study was based on a survey conducted among primary health care professionals in Barcelona, Spain. The questionnaire was used to gather information regarding CRC screening procedures as well as demographic and professional characteristics of the study subjects. A CRC and screening awareness score (ranging from 0 to 12) was created based on the survey questions. The response rate was 58.9% (206/305). The estimated mean score (standard deviation) was 8.43 (SD: 1.30). For four questions, more than 60% of the answers were incorrect: one related to risk factors, two concerning follow-up colonoscopy, and one related to surveillance. Only 30.8% of the participants believed that they were responsible for determining the appropriate surveillance intervals and for scheduling colonoscopies. Although the professionals had sufficient knowledge of CRC screening, professional knowledge of some aspects related to the major non-modifiable risk factors for the disease and surveillance colonoscopy procedures could be improved. Frequent communication with professionals is necessary to maintain updated screening-related information. Possible methods for facilitating communication could include continuous briefings, regular message reminders or educational websites. © 2016 John Wiley & Sons Ltd.

A 10-Year Cross-Sectional Analysis of Air Force Flight and Operational Medicine Clinic Health Care Services.

PubMed

Tvaryanas, Anthony P; Maupin, Genny M; Fouts, Brittany L

2016-05-01

This study described the patient population and the health care services delivered in the Air Force Flight and Operational Medicine Clinics (FOMCs) over the past 10 years. A cross-sectional analysis was performed on the retrospective cohort of patients who received care at a FOMC from 2003 to 2012. A total of 714,157 individuals, generating 4,829,626 encounters, were included in the cohort. They were predominately male service members under the age of 41. One-fifth of individuals were retirees and family members, with one-third being in the pediatric age range. The cohort accessed health care services for three primary reasons: health examinations (28%), occupational dispositions (18%), and primary care (54%). When primary care was sought, the predominate health conditions were upper respiratory infections, back problems, and nontraumatic joint disorders. When services and procedures were a component of the care, they were predominately associated with health examinations involving ophthalmologic, auditory, and cardiac screening tests. Individuals accessing the FOMCs had relatively low need for access to health care services, requiring a median of two annual encounters. This study provided insight into the health care delivered in FOMCs and establishes a foundation for future planning and management of FOMC health care delivery. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

47 CFR 64.2345 - Primary advertising classification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Primary advertising classification. 64.2345 Section 64.2345 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... advertising classification. A primary advertising classification is assigned at the time of the establishment...

47 CFR 64.2345 - Primary advertising classification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Primary advertising classification. 64.2345 Section 64.2345 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... advertising classification. A primary advertising classification is assigned at the time of the establishment...

47 CFR 64.2345 - Primary advertising classification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Primary advertising classification. 64.2345 Section 64.2345 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... advertising classification. A primary advertising classification is assigned at the time of the establishment...

47 CFR 64.2345 - Primary advertising classification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Primary advertising classification. 64.2345 Section 64.2345 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... advertising classification. A primary advertising classification is assigned at the time of the establishment...

47 CFR 64.2345 - Primary advertising classification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Primary advertising classification. 64.2345 Section 64.2345 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... advertising classification. A primary advertising classification is assigned at the time of the establishment...

12 CFR 619.9260 - Primary security.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Primary security. 619.9260 Section 619.9260 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM DEFINITIONS § 619.9260 Primary security. The basic collateral securing the loan. ...

12 CFR 619.9260 - Primary security.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Primary security. 619.9260 Section 619.9260 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM DEFINITIONS § 619.9260 Primary security. The basic collateral securing the loan. ...

History matters: childhood weight trajectories as a basis for planning community-based obesity prevention to adolescents.

PubMed

Ekberg, J; Angbratt, M; Valter, L; Nordvall, M; Timpka, T

2012-04-01

To use epidemiological data and a standardized economic model to compare projected costs for obesity prevention in late adolescence accrued using a cross-sectional weight classification for selecting adolescents at age 15 years compared with a longitudinal classification. All children born in a Swedish county (population 440 000) in 1991 who participated in all regular measurements of height and weight at ages 5, 10 and 15 years (n=4312) were included in the study. The selection strategies were compared by calculating the projected financial load resulting from supply of obesity prevention services from providers at all levels in the health care system. The difference in marginal cost per 1000 children was used as the primary end point for the analyses. Using the cross-sectional selection strategy, 3.8% of adolescents at age 15 years were selected for evaluation by a pediatric specialist, and 96.2% were chosen for population-based interventions. In the trajectory-based strategy, 2.4% of the adolescents were selected for intensive pediatric care, 1.4% for individual clinical interventions in primary health care, 14.0% for individual primary obesity prevention using the Internet and 82.1% for population-based interventions. Costs for the cross-sectional selection strategy were projected to USD463 581 per 1000 adolescents and for the trajectory-based strategy were USD 302 016 per 1000 adolescents. Using projections from epidemiological data, we found that by basing the selection of adolescents for obesity prevention on weight trajectories, the load on highly specialized pediatric care can be reduced by one-third and total health service costs for obesity management among adolescents reduced by one-third. Before use in policies and prevention program planning, our findings warrant confirmation in prospective cost-benefit studies.

Effect of air abrasion and polishing on primary molar fissures.

PubMed

Lenzi, T L; Menezes, L B R; Soares, F Z M; Rocha, R O

2013-04-01

To evaluate the effect of air abrasion and polishing on primary molar fissures under light microscopy. 15 exfoliated primary second molars were longitudinally sectioned and photographed under a stereomicroscope (40×; baseline evaluation). Sections were then randomly allocated into one of the two groups (n = 15) and treated by either air abrasion (aluminium oxide jet) or air polishing (sodium bicarbonate jet) for 30 s. After treatment, sections were washed with an air/water spray, dried with absorbent paper, and photographed as previously described (final evaluation). Baseline and final morphology were compared by two blinded examiners who evaluated changes in the width and depth of fissures. The percentage of changed fissures was analysed, and the two treatments were compared using the Mann-Whitney test (α = 0.01). Both air systems resulted in fissure changes in most (93.3 %) of the sections. No significant differences in fissure width changes were found between treatments, but when changes in fissure depth were evaluated, air polishing was found to be less damaging than air abrasion (p < 0.01). Air abrasion and polishing cause changes to the anatomical configuration of occlusal fissures of primary molars.

Macrosegregation and Grain Formation Caused by Convection Associated with Directional Solidification Through Cross-Section Increase

NASA Technical Reports Server (NTRS)

Ghods, Masoud; Lauer, Mark; Tewari, Surendra; Poirier, David; Grugel, Richard

2016-01-01

Cylindrical Al-7 wt% Silicon, Al-19 wt% Copper and Lead-6 wt% Antimony alloy samples were directionally solidified (DS) with liquid above, solid below, and gravity pointing down, in graphite crucibles having an abrupt cross-sectional increase. These alloys have similar solidification shrinkage but are expected to have different degrees of thermosolutal convection during solidification. Microstructures in the DS samples in the vicinity of the section change have been studied in order to examine the effect of convection associated with the combined influence of thermosolutal effects and solidification shrinkage. Extensive radial and axial macrosegregation associated with cross-section change is observed. It also appears that steepling and local primary alpha-phase remelting resulting from convection are responsible for stray grain formation at the reentrant corners. Preliminary results from a numerical model, which includes solidification shrinkage and thermosolutal convection in the mushy zone, indicate that these regions are prone to solutal remelting of dendrites.

Gaps in Capacity in Primary Care in Low-Resource Settings for Implementation of Essential Noncommunicable Disease Interventions

PubMed Central

Mendis, S.; Al Bashir, Igbal; Dissanayake, Lanka; Varghese, Cherian; Fadhil, Ibtihal; Marhe, Esha; Sambo, Boureima; Mehta, Firdosi; Elsayad, Hind; Sow, Idrisa; Algoe, Maltie; Tennakoon, Herbert; Truong, Lai Die; Lan, Le Thi Tuyet; Huiuinato, Dismond; Hewageegana, Neelamni; Fahal, Naiema A. W.; Mebrhatu, Goitom; Tshering, Gado; Chestnov, Oleg

2012-01-01

Objective. The objective was to evaluate the capacity of primary care (PC) facilities to implement basic interventions for prevention and management of major noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes. Methods. A cross-sectional survey was done in eight low- and middle-income countries (Benin, Bhutan, Eritrea, Sri Lanka, Sudan, Suriname, Syria, and Vietnam) in 90 PC facilities randomly selected. The survey included questions on the availability of human resources, equipment, infrastructure, medicines, utilization of services, financing, medical information, and referral systems. Results and Conclusions. Major deficits were identified in health financing, access to basic technologies and medicines, medical information systems, and the health workforce. The study has provided the foundation for strengthening PC to address noncommunicable diseases. There are important implications of the findings of this study for all low- and middle-income countries as capacity of PC is fundamental for equitable prevention and control of NCDs. PMID:23251789

40 CFR 141.535 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.535 Section 141.535 Protection of Environment... § 141.535 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone, or chlorine dioxide for primary disinfection, you must also...

40 CFR 141.535 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2011 CFR

2011-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.535 Section 141.535 Protection of Environment... § 141.535 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone, or chlorine dioxide for primary disinfection, you must also...

40 CFR 141.535 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2012 CFR

2012-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.535 Section 141.535 Protection of Environment... § 141.535 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone, or chlorine dioxide for primary disinfection, you must also...

40 CFR 141.535 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2014 CFR

2014-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.535 Section 141.535 Protection of Environment... § 141.535 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone, or chlorine dioxide for primary disinfection, you must also...

40 CFR 421.180 - Applicability: Description of the primary and secondary germanium and gallium subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... primary and secondary germanium and gallium subcategory. 421.180 Section 421.180 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Germanium and Gallium Subcategory § 421.180 Applicability: Description of the primary and secondary germanium and gallium subcategory. The provisions of this subpart are...

40 CFR 421.180 - Applicability: Description of the primary and secondary germanium and gallium subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... primary and secondary germanium and gallium subcategory. 421.180 Section 421.180 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Germanium and Gallium Subcategory § 421.180 Applicability: Description of the primary and secondary germanium and gallium subcategory. The provisions of this subpart are...

40 CFR 421.180 - Applicability: Description of the primary and secondary germanium and gallium subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... primary and secondary germanium and gallium subcategory. 421.180 Section 421.180 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Germanium and Gallium Subcategory § 421.180 Applicability: Description of the primary and secondary germanium and gallium subcategory. The provisions of this subpart are...

40 CFR 421.180 - Applicability: Description of the primary and secondary germanium and gallium subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... primary and secondary germanium and gallium subcategory. 421.180 Section 421.180 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Germanium and Gallium Subcategory § 421.180 Applicability: Description of the primary and secondary germanium and gallium subcategory. The provisions of this subpart are...

40 CFR 421.180 - Applicability: Description of the primary and secondary germanium and gallium subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... primary and secondary germanium and gallium subcategory. 421.180 Section 421.180 Protection of Environment... POINT SOURCE CATEGORY Primary and Secondary Germanium and Gallium Subcategory § 421.180 Applicability: Description of the primary and secondary germanium and gallium subcategory. The provisions of this subpart are...

45 CFR 96.47 - Primary care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Primary care. 96.47 Section 96.47 Public Welfare... and Tribal Organizations § 96.47 Primary care. Applications for direct funding of Indian tribes and tribal organizations under the primary care block grant must comply with 42 CFR Part 51c (Grants for...

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China

PubMed Central

Zeng, Jiazhi; Shi, Leiyu; Zou, Xia; Chen, Wen; Ling, Li

2015-01-01

Objectives China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China. Methods The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001). Conclusions This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. PMID:26474161

Differences in unmet healthcare needs between public and private primary care providers: A population-based study.

PubMed

Lindström, Christine; Rosvall, Maria; Lindström, Martin

2018-06-01

To investigate if any differences in unmet healthcare needs between persons registered at public and private primary care providers exist in Skåne (southernmost Sweden). The 2012 public health survey in Skåne was conducted with a postal questionnaire and included 28,029 respondents aged between 18 and 80 years. The study was cross-sectional. If the responder in the last three months had perceived oneself to be in need of medical care by a physician but did not seek it, this was used as a measure of unmet healthcare needs. Differences in unmet healthcare needs in relation to the primary care provider were investigated while adjusting for socioeconomic status and self-rated health in a logistic regression. Differences in unmet healthcare needs were small and non-significant when comparing public and private healthcare providers. Non-manual workers were to a somewhat higher extent using private providers while manual workers showed a reverse pattern. Unmet healthcare needs had decreased slightly since 2008, but so had the response rate. With the current primary care system, no significant differences in unmet healthcare needs seem to exist when comparing public and private providers. It is likely that the providers are similar in their organizational setup, accessibility and doctor-patient continuity. Still more studies need to be done, preferably in a way so that uncertainty about what type of primary care provider the respondent is listed at can be avoided and perhaps using a longer time interval for unmet needs so that more subjects could be included.

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

M. A. Wasiolek

The purpose of this report is to document the biosphere model, the Environmental Radiation Model for Yucca Mountain, Nevada (ERMYN), which describes radionuclide transport processes in the biosphere and associated human exposure that may arise as the result of radionuclide release from the geologic repository at Yucca Mountain. The biosphere model is one of the process models that support the Yucca Mountain Project (YMP) Total System Performance Assessment (TSPA) for the license application (LA), the TSPA-LA. The ERMYN model provides the capability of performing human radiation dose assessments. This report documents the biosphere model, which includes: (1) Describing the referencemore » biosphere, human receptor, exposure scenarios, and primary radionuclides for each exposure scenario (Section 6.1); (2) Developing a biosphere conceptual model using site-specific features, events, and processes (FEPs), the reference biosphere, the human receptor, and assumptions (Section 6.2 and Section 6.3); (3) Building a mathematical model using the biosphere conceptual model and published biosphere models (Sections 6.4 and 6.5); (4) Summarizing input parameters for the mathematical model, including the uncertainty associated with input values (Section 6.6); (5) Identifying improvements in the ERMYN model compared with the model used in previous biosphere modeling (Section 6.7); (6) Constructing an ERMYN implementation tool (model) based on the biosphere mathematical model using GoldSim stochastic simulation software (Sections 6.8 and 6.9); (7) Verifying the ERMYN model by comparing output from the software with hand calculations to ensure that the GoldSim implementation is correct (Section 6.10); and (8) Validating the ERMYN model by corroborating it with published biosphere models; comparing conceptual models, mathematical models, and numerical results (Section 7).« less

Analysis of Possible Explosions at Kennedy Space Center Due to Spontaneous Ignition of Hypergolic Propellants

NASA Technical Reports Server (NTRS)

Brown, Stephen

2010-01-01

NASA's Constellation Program plan currently calls for the replacement of the Space Shuttle with the ARES I & V spacecraft and booster vehicles to send astronauts to the moon and beyond. Part of the ARES spacecraft is the Orion Crew Exploration Vehicle (CEV), which includes the Crew Module (CM) and Service Module (SM). The Orion CM's main propulsion system and supplies are provided by the SM. The SM is to be processed off line and moved to the Vehicle Assembly Building (V AB) for stacking to the first stage booster motors prior to ARES move to the launch pad. The new Constellation Program philosophy to process in this manner has created a major task for the KSC infrastructure in that conventional QD calculations are no longer viable because of the location of surrounding facilities near the VAB and the Multi Purpose Processing Facility (MPPF), where the SM will be serviced with nearly 18,000 pounds of hypergolic propellants. The Multi-Payload Processing Facility (MPPF) complex, constructed by NASA in 1994, is located just off E Avenue south of the Operations and Checkout (O&C) building in the Kennedy Space Center industrial area. The MPPF includes a high bay and a low bay. The MPPF high bay is 40.2 m (132 ft) long x 18.9 m (60 ft) wide with a ceiling height of 18.9 m (62 ft). The low bay is a 10.4 m (34 ft) long x 10.4 m (34 ft) wide processing area and has a ceiling height of6.1 m (20 ft). The MPPF is currently used to process non-hazardous payloads. Engineering Analysis Inc. (EAI), under contract with ASRC Aerospace, Inc. in conjunction with the Explosive Safety Office, NASA, Kennedy Space Center (KSC), has carried out an analysis of the effects of explosions at KSC in or near various facilities produced by the spontaneous ignition ofhypergolic fuel stored in the CEV SM. The facilities considered included (1) Vehicle Assembly Building (VAB) (2) Multi-Payload Processing Facility (MPPF) (3) Canister Rotation Facility (CRF) Subsequent discussion deals with the MPPF analysis. Figure 1 provides a view of the MPPF from the northwest. An interior view ofthe facility is shown in Figure 2. The study was concerned with both blast hazards and hazardous fragments which exceed existing safety standards, as described in Section 2.0. The analysis included both blast and fragmentation effects and was divided into three parts as follows: (1) blast (2) primary fragmentation (3) secondary fragmentation Blast effects are summarized in Section 3.0, primary fragmentation in Section 4.0, and secondary fragmentation (internal and external) in Section 5.0. Conclusions are provided in Section 6.0, while references cited are included in Section 7.0. A more detailed description of the entire study is available in a separate document.

Correlates of self-efficacy for disease management in adolescent/young adult cancer survivors: A systematic review.

PubMed

Herts, Kate L; Khaled, Mona M; Stanton, Annette L

2017-03-01

The primary objective of this review was to summarize the literature regarding factors associated with self-efficacy for disease management (SEDM) in cross-sectional studies and the efficacy/effectiveness of psychosocial interventions that are designed to improve SEDM in adolescent and young adult (AYA) cancer survivors. The secondary aim was to assess the quality of included studies. We conducted a systematic review using PsycINFO and PubMed to identify studies for review. Eligible studies were conducted in AYA cancer survivors ages 15 to 39; included a measure of SEDM assessed as an outcome or in a cross-sectional analysis; and were published in a peer-reviewed, English-language journal. From the 2,910 records screened, 7 cross-sectional studies and 4 intervention studies met criteria for inclusion. Eleven of the 12 SEDM measures in the studies were author-constructed, limiting the ability to draw conclusions across studies. All cross-sectional studies met at least 21 of 26 relevant quality assessment criteria, and intervention studies met between 4 and 11 of 14 criteria. Cross-sectional findings indicate that SEDM is positively associated with health-promoting behaviors and inversely related to physical and mental health problems. The intervention studies demonstrated that behavioral and educational interventions have the potential to increase SEDM. Directions for research include the need for validated measures of SEDM for AYA cancer survivors, as well as interventions that target both the health care team's and the patient's role in promoting SEDM. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

What is the impact of primary care model type on specialist referral rates? A cross-sectional study.

PubMed

Liddy, Clare; Singh, Jatinderpreet; Kelly, Ryan; Dahrouge, Simone; Taljaard, Monica; Younger, Jamie

2014-02-03

Several new primary care models have been implemented in Ontario, Canada over the past two decades. These practice models differ in team structure, physician remuneration, and group size. Few studies have examined the impact of these models on specialist referrals. We compared specialist referral rates amongst three primary care models: 1) Enhanced Fee-for-service, 2) Capitation- Non-Interdisciplinary (CAP-NI), 3) Capitation - Interdisciplinary (CAP-I). We conducted a cross-sectional study using health administrative data from primary care practices in Ontario from April 1st, 2008 to March 31st, 2010. The analysis included all family physicians providing comprehensive care in one of the three models, had at least 100 patients, and did not have a prolonged absence (eight consecutive weeks). The primary outcome was referral rate (# of referrals to all medical specialties/1000 patients/year). A multivariable clustered Poisson regression analysis was used to compare referral rates between models while adjusting for provider (sex, years since graduation, foreign trained, time in current model) and patient (age, sex, income, rurality, health status) characteristics. Fee-for-service had a significantly lower adjusted referral rate (676, 95% CI: 666-687) than the CAP-NI (719, 95% confidence interval (CI): 705-734) and CAP-I (694, 95% CI: 681-707) models and the interdisciplinary CAP-I group had a 3.5% lower referral rate than the CAP-NI group (RR = 0.965, 95% CI: 0.943-0.987, p = 0.002). Female and Canadian-trained physicians referred more often, while female, older, sicker and urban patients were more likely to be referred. Primary care model is significantly associated with referral rate. On a study population level, these differences equate to 111,059 and 37,391 fewer referrals by fee-for-service versus CAP-NI and CAP-I, respectively - a difference of $22.3 million in initial referral appointment costs. Whether a lower rate of referral is more appropriate or not is not known and requires further investigation. Physician remuneration and team structure likely account for the differences; however, further investigation is also required to better understand whether other organizational factors associated with primary care model also impact referral.

Super low NO.sub.x, high efficiency, compact firetube boiler

DOEpatents

Chojnacki, Dennis A.; Rabovitser, Iosif K.; Knight, Richard A.; Cygan, David F.; Korenberg, Jacob

2005-12-06

A firetube boiler furnace having two combustion sections and an in-line intermediate tubular heat transfer section between the two combustion sections and integral to the pressure vessel. This design provides a staged oxidant combustion apparatus with separate in-line combustion chambers for fuel-rich primary combustion and fuel-lean secondary combustion and sufficient cooling of the combustion products from the primary combustion such that when the secondary combustion oxidant is added in the secondary combustion stage, the NO.sub.x formation is less than 5 ppmv at 3% O.sub.2.

Neutron capture reactions at DANCE

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

Bredeweg, T. A.

2008-05-12

The Detector for Advanced Neutron Capture Experiments (DANCE) is a 4{pi} BaF{sub 2} array consisting of 160 active detector elements. The primary purpose of the array is to perform neutron capture cross section measurements on small (> or approx.100 {mu}g) and/or radioactive (< or approx. 100 mCi) species. The measurements made possible with this array will be useful in answering outstanding questions in the areas of national security, threat reduction, nuclear astrophysics, advanced reactor design and accelerator transmutation of waste. Since the commissioning of DANCE we have performed neutron capture cross section measurements on a wide array of medium tomore » heavy mass nuclides. Measurements to date include neutron capture cross sections on {sup 241,243}Am, neutron capture and neutron-induced fission cross sections and capture-to-fission ratio ({alpha} = {sigma}{sub {gamma}}/{sigma}{sub f}) for {sup 235}U using a new fission-tagging detector as well as neutron capture cross sections for several astrophysics branch-point nuclei. Results from several of these measurements will be presented along with a discussion of additional physics information that can be extracted from the DANCE data.« less

Calibration of HYPULSE for hypervelocity air flows corresponding to flight Mach numbers 13.5, 15, and 17

NASA Technical Reports Server (NTRS)

Calleja, John; Tamagno, Jose

1993-01-01

A series of air calibration tests were performed in GASL's HYPULSE facility in order to more accurately determine test section flow conditions for flows simulating total enthalpies in the Mach 13 to 17 range. Present calibration data supplements previous data and includes direct measurement of test section pitot and static pressure, acceleration tube wall pressure and heat transfer, and primary and secondary incident shock velocities. Useful test core diameters along with the corresponding free-stream conditions and usable testing times were determined. For the M13.5 condition, in-stream static pressure surveys showed the temporal and spacial uniformity of this quantity across the useful test core. In addition, finite fringe interferograms taken of the free-stream flow at the test section did not indicate the presence of any 'strong' wave system for any of the conditions investigated.

Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

PubMed

Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

2016-11-01

This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described. Copyright © 2016 Elsevier Inc. All rights reserved.

Curriculum Guide for Spanish Language Arts, Primary Level A = Guia para la ensenanza de las artes del lenguaje espanol, primaria, nivel A.

ERIC Educational Resources Information Center

Chicago Board of Education, IL. Dept. of Curriculum.

The curriculum guide for teachers of Spanish language arts for native Spanish-speaking primary students in the Chicago public schools' bilingual education program is introduced by a section on preparing instructional material for this group and a section defining the areas to be emphasized in the program: word attack, comprehension skills, study…

Curriculum Guide for Spanish Language Arts, Primary Level B = Guia para la ensenanza de las artes del lenguaje espanol, primaria, nivel B.

ERIC Educational Resources Information Center

Chicago Board of Education, IL. Dept. of Curriculum.

The curriculum guide for teachers of Spanish language arts for native Spanish-speaking primary students in the Chicago public schools' bilingual education program is introduced by a section on preparing instructional material for this group and a section defining the areas to be emphasized in the program: word attack, comprehension skills, study…

40 CFR 50.2 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.2 Scope. (a) National primary and secondary ambient air quality standards under section 109 of the Act are set forth in this part. (b) National primary ambient air quality...

30 CFR 817.151 - Primary roads.

Code of Federal Regulations, 2010 CFR

2010-07-01

... section. (a) Certification. The construction or reconstruction of primary roads shall be certified in a... authorizes land surveyors to certify the construction or reconstruction of primary roads, a qualified registered professional land surveyor, with experience in the design and construction of roads. The report...

30 CFR 816.151 - Primary roads.

Code of Federal Regulations, 2010 CFR

2010-07-01

... this section. (a) Certification. The construction or reconstruction of primary roads shall be certified... State which authorizes land surveyors to certify the construction or reconstruction of primary roads, a qualified registered professional land surveyor with experience in the design and construction of roads. The...

Hyperbaric vs. isobaric bupivacaine for spinal anaesthesia for elective caesarean section: a Cochrane systematic review.

PubMed

Sng, B L; Han, N L R; Leong, W L; Sultana, R; Siddiqui, F J; Assam, P N; Chan, E S; Tan, K H; Sia, A T

2018-04-01

Both isobaric and hyperbaric bupivacaine have been used for spinal anaesthesia for elective caesarean section, but it is not clear if one is better than the other. The primary objective of this systematic review was to determine the effectiveness and safety of hyperbaric bupivacaine compared with isobaric bupivacaine administered during spinal anaesthesia for elective caesarean section. We included 10 studies with 614 subjects in the analysis. There was no evidence of differences either in the risk of conversion to general anaesthesia, with a relative risk (95%CI) of 0.33 (0.09-1.17) (very low quality of evidence), or in the need for supplemental analgesia, the relative risk (95%CI) being 0.61 (0.26-1.41) (very low quality of evidence). There was also no evidence of a difference in the use of ephedrine, the amount of ephedrine used, nausea and vomiting, or headache. Hyperbaric bupivacaine took less time to reach a sensory block height of T4, with a mean difference (95%CI) of -1.06 min (-1.80 to -0.31). Due to the rarity of some outcomes, dose variability, use of adjuvant drugs and spinal technique used, future clinical trials should look into using adequate sample size to investigate the primary outcome of the need for supplemental analgesia. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Forging the 10th Mountain Division for War, 1940-1945: How Innovation Created a Highly Adaptive Formation

DTIC Science & Technology

2017-06-09

provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid...context. The primary sources used to inform this section include two sources titled Neutrality for the United States and A Foreign Policy for the...headquarters outlined a directive program for the training of divisions.15The following month communications between LTG McNair and the Commander of

40 CFR 50.8 - National primary ambient air quality standards for carbon monoxide.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 2 2010-07-01 2010-07-01 false National primary ambient air quality standards for carbon monoxide. 50.8 Section 50.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.8 National primary ambient air quality standards for...

40 CFR 141.544 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.544 Section 141.544 Protection of Environment... Benchmark § 141.544 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone or chlorine dioxide for primary disinfection your system must...

40 CFR 141.544 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2014 CFR

2014-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.544 Section 141.544 Protection of Environment... Benchmark § 141.544 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone or chlorine dioxide for primary disinfection your system must...

40 CFR 141.544 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2012 CFR

2012-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.544 Section 141.544 Protection of Environment... Benchmark § 141.544 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone or chlorine dioxide for primary disinfection your system must...

40 CFR 141.544 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2011 CFR

2011-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.544 Section 141.544 Protection of Environment... Benchmark § 141.544 What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection? If your system uses chloramines, ozone or chlorine dioxide for primary disinfection your system must...

40 CFR 50.8 - National primary ambient air quality standards for carbon monoxide.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 2 2014-07-01 2014-07-01 false National primary ambient air quality standards for carbon monoxide. 50.8 Section 50.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.8 National primary ambient air quality standards for...

40 CFR 50.8 - National primary ambient air quality standards for carbon monoxide.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 2 2012-07-01 2012-07-01 false National primary ambient air quality standards for carbon monoxide. 50.8 Section 50.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS NATIONAL PRIMARY AND SECONDARY AMBIENT AIR QUALITY STANDARDS § 50.8 National primary ambient air quality standards for...

24 CFR 570.901 - Review for compliance with the primary and national objectives and other program requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... primary and national objectives and other program requirements. 570.901 Section 570.901 Housing and Urban... primary and national objectives and other program requirements. HUD will review each entitlement, Insular...)(3) that, consistent with the primary objective of the Act, not less than 70 percent of the aggregate...

Lamina cribrosa position and Bruch's membrane opening differences between anterior ischemic optic neuropathy and open-angle glaucoma.

PubMed

Rebolleda, Gema; Pérez-Sarriegui, Ane; Díez-Álvarez, Laura; De Juan, Victoria; Muñoz-Negrete, Francisco J

2018-06-01

To compare the optic nerve head morphology among primary open-angle glaucoma, non-arteritic anterior ischemic optic neuropathy eyes, their fellow healthy eyes and control eyes, using spectral-domain optical coherence tomography with enhanced depth imaging. Observational cross-sectional study including 88 eyes of 68 patients. In this study, 23 non-arteritic anterior ischemic optic neuropathy eyes, 17 fellow unaffected eyes, 25 primary open-angle glaucoma eyes, and 23 age-matched control eyes were included. Peripapillary retinal nerve fiber layer thickness and optic disk area were evaluated. Bruch's membrane opening diameter, optic cup depth, anterior lamina cribrosa depth, and prelaminar tissue thickness were assessed. Non-arteritic anterior ischemic optic neuropathy and primary open-angle glaucoma eyes had similar visual field mean deviation and peripapillary retinal nerve fiber layer thickness (P = 0.6 and P = 0.56, respectively). Bruch's membrane opening diameter was significantly larger in primary open-angle glaucoma eyes than in control eyes (P = 0.02). Lamina cribrosa and disk cup were deeper in eyes with primary open-angle glaucoma than both control and non-arteritic anterior ischemic optic neuropathy eyes (P < 0.001). Prelaminar tissue thickness was significantly thinner in primary open-angle glaucoma eyes than in non-arteritic anterior ischemic optic neuropathy eyes (P < 0.001). Lamina cribrosa was shallower in both non-arteritic anterior ischemic optic neuropathy and unaffected fellow eyes compared to healthy eyes (P < 0.001 and P = 0.04, respectively). No differences were found in the optic disk area. A forward lamina cribrosa placement and not a smaller disk could be involved in the pathogenesis of non-arteritic anterior ischemic optic neuropathy. A significantly larger Bruch's membrane opening diameter was found in primary open-angle glaucoma eyes compared with control eyes. This issue has clinical implications because Bruch's membrane opening has been considered a stable reference for disk-related measures.

Adhesion formation after previous caesarean section-a meta-analysis and systematic review.

PubMed

Shi, Z; Ma, L; Yang, Y; Wang, H; Schreiber, A; Li, X; Tai, S; Zhao, X; Teng, J; Zhang, L; Lu, W; An, Y; Alla, N R; Cui, T

2011-03-01

The optimal technique for performing caesarean section with respect to minimising postoperative adhesions has not been determined. To evaluate adhesion formation for three common caesarean section techniques in women undergoing repeat caesarean section surgeries. A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database and through contact with experts in this field from January 1990 to May 2010. Studies were included if they examined adhesion formation in repeat caesarean sections as a primary objective, delineated a clear study design, specified an adhesion scoring system, and had sufficient patient exclusion criteria. We abstracted data regarding adhesion formation. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio or inverse variance, along with 95% CI. Thirty-three qualified studies including 4423 women were analysed. There were 406 adhesions among 571 women and 238 adhesions among 596 women in the Stark's caesarean section (also known as Misgav-Ladach method) group and modified Stark's caesarean section group, respectively, with pooled OR 4.69 (95% CI 3.32-6.62; P < 0.01, 12 studies); 1173 adhesions among 1555 women and 1179 adhesions among 1625 women in Stark's caesarean section group and classic lower-segment caesarean section group, respectively, with pooled odds ratio 1.28 (95% CI 0.97-1.68; P = 0.08, 21 studies); and 29 adhesions from 102 women and 115 adhesions from 193 women in modified Stark's caesarean section group and classic lower-segment caesarean section group, respectively, with pooled odds ratio 0.28 (95% CI 0.10-0.82; P = 0.02, two studies). Closure of the peritoneum in modified Stark's caesarean section resulted in less adhesion formation and should be recommended. © 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

Primary Care Physicians' Experience with Disease Management Programs

PubMed Central

Fernandez, Alicia; Grumbach, Kevin; Vranizan, Karen; Osmond, Dennis H; Bindman, Andrew B

2001-01-01

OBJECTIVE To examine primary care physicians' perceptions of how disease management programs affect their practices, their relationships with their patients, and overall patient care. DESIGN Cross-sectional mailed survey. SETTING The 13 largest urban counties in California. PARTICIPANTS General internists, general pediatricians, and family physicians. MEASUREMENTS AND MAIN RESULTS Physicians' self-report of the effects of disease management programs on quality of patient care and their own practices. Respondents included 538 (76%) of 708 physicians: 183 (34%) internists, 199 (38%) family practitioners, and 156 (29%) pediatricians. Disease management programs were available 285 to (53%) physicians; 178 had direct experience with the programs. Three quarters of the 178 physicians believed that disease management programs increased the overall quality of patient care and the quality of care for the targeted disease. Eighty-seven percent continued to provide primary care for their patients in these programs, and 70% reported participating in major patient care decisions. Ninety-one percent reported that the programs had no effect on their income, decreased (38%) or had no effect (48%) on their workload, and increased (48%)) their practice satisfaction. CONCLUSIONS Practicing primary care physicians have generally favorable perceptions of the effect of voluntary, primary care-inclusive, disease management programs on their patients and on their own practice satisfaction. PMID:11318911

[Psychological distress and personality characteristics among individuals with primary exercise dependence].

PubMed

Guidi, Jenni; Clementi, Cecilia; Grandi, Silvana

2013-01-01

The aim of this study was to assess both psychological distress and personality characteristics associat with primary exercise dependence. A cross-sectional study was carried out with adult habitual physical exercisers. A total of 79 participants voluntarily completed a package of self-report questionnaires including the Exercise Dependence Questionnaire (EDQ), the Eating Disorder Inventory II (EDI-2), the Temperament and Character Inventory (TCI), the Attitude Toward Self scale (ATS), Muscle Dysmorphia Questionnaire (MDQ), and the Symptom Questionnaire (SQ). Significant differences were found in the EDQ exercise for weight control subscale with regard to gender, as well as in the EDI-2 total score and 5 of its subscales, with higher scores for females compared to males. Participants reporting primary exercise dependence (n=32) were more likely to present with disordered eating patterns than controls (n=47). They also showed higher levels of harm avoidance and persistence on the TCI, as well as lower self-directness. Furthermore, primary exercise dependents scored higher on the ATS dysmorphophobia subscale, as well as on the MDQ total score and the anxiety and hostility subscales of the SQ compared to controls. These findings highlight the importance of performing a clinical assessment of psychological symptoms and personality characteristics that might be associated with primary exercise dependence.

Variability in the performance of preventive services and in the degree of control of identified health problems: A primary care study protocol

PubMed Central

Bolíbar, Bonaventura; Pareja, Clara; Astier-Peña, M Pilar; Morán, Julio; Rodríguez-Blanco, Teresa; Rosell-Murphy, Magdalena; Iglesias, Manuel; Juncosa, Sebastián; Mascort, Juanjo; Violan, Concepció; Magallón, Rosa; Apezteguia, Javier

2008-01-01

Background Preventive activities carried out in primary care have important variability that makes necessary to know which factors have an impact in order to establish future strategies for improvement. The present study has three objectives: 1) To describe the variability in the implementation of 7 preventive services (screening for smoking status, alcohol abuse, hypertension, hypercholesterolemia, obesity, influenza and tetanus immunization) and to determine their related factors; 2) To describe the degree of control of 5 identified health problems (smoking, alcohol abuse, hypertension, hypercholesterolemia and obesity); 3) To calculate intraclass correlation coefficients. Design Multi-centered cross-sectional study of a randomised sample of primary health care teams from 3 regions of Spain designed to analyse variability and related factors of 7 selected preventive services in years 2006 and 2007. At the end of 2008, we will perform a cross-sectional study of a cohort of patients attended in 2006 or 2007 to asses the degree of control of 5 identified health problems. All subjects older than16 years assigned to a randomised sample of 22 computerized primary health care teams and attended during the study period are included in each region providing a sample with more than 850.000 subjects. The main outcome measures will be implementation of 7 preventive services and control of 5 identified health problems. Furthermore, there will be 3 levels of data collection: 1) Patient level (age, gender, morbidity, preventive services, attendance); 2) Health-care professional level (professional characteristics, years working at the team, workload); 3) Team level (characteristics, electronic clinical record system). Data will be transferred from electronic clinical records to a central database with prior encryption and dissociation of subject, professional and team identity. Global and regional analysis will be performed including standard analysis for primary health care teams and health-care professional level. Linear and logistic regression multilevel analysis adjusted for individual and cluster variables will also be performed. Variability in the number of preventive services implemented will be calculated with Poisson multilevel models. Team and health-care professional will be considered random effects. Intraclass correlation coefficients, standard error and variance components for the different outcome measures will be calculated. PMID:18691407

"Let him speak:" a descriptive qualitative study of the roles and behaviors of family companions in primary care visits among older adults with cognitive impairment.

PubMed

Vick, Judith B; Amjad, Halima; Smith, Katherine C; Boyd, Cynthia M; Gitlin, Laura N; Roth, David L; Roter, Debra L; Wolff, Jennifer L

2018-01-01

Cognitive impairment poses communication challenges in primary care. Although family "companions" commonly attend primary care visits of older adults with cognitive impairment, little is known about how their involvement affects communication. Therefore, we sought to understand how companion involvement affects the quality of primary care visit communication for older adults with cognitive impairment. Cross-sectional, descriptive qualitative study participants were as follows: (1) English-speaking adults age 65 or older with mild, moderate, or severe cognitive impairment; (2) family members or other unpaid companions who accompany older adults to primary care visits; and (3) primary care clinicians. Twenty semi-structured and in-depth qualitative interviews of older adults and their companions (N = 20 dyads) and two focus groups (N = 10 primary care clinicians) were conducted. Interviews and focus groups were transcribed and analyzed thematically. Family companions commonly facilitate communication by advocating for patients, ensuring the accuracy of information exchange and understanding, and preserving rapport. Significant communication challenges were also identified, including patient and companion role ambiguity, competing visit agendas, and primary care clinician confusion regarding the most accurate source of information. Patients, companions, and clinicians each identified strategies to improve communication, chief among them being to identify, differentiate, and respect both patient and companion priorities and perspectives. Family companions actively participate in primary care visits of older adults with cognitive impairment in ways that promote and inhibit effective communication. Findings suggest the need for strategies that more effectively and purposefully involve family in the care of primary care patients with cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Family-centered depression treatment for older men in primary care: a qualitative study of stakeholder perspectives.

PubMed

Hinton, Ladson; Sciolla, Andrés F; Unützer, Jürgen; Elizarraras, Edward; Kravitz, Richard L; Apesoa-Varano, Ester Carolina

2017-09-29

Family members often play important roles in the lives of depressed older men and frequently attend primary care visits with their loved ones, yet surprisingly little is known about how to most effectively engage and include family members in depression treatment. However, including family in depression treatment may be difficult due to several factors, such as depression stigma and family conflicts. The objective of this study was to describe challenges in engaging family members in older men's depression treatment and potential strategies to overcome those challenges. A cross-sectional, qualitative descriptive interview study was conducted in a safety-net, Federally Qualified Health Center in California's Central Valley. A total of 37 stakeholders were recruited, including 15 depressed older (i.e. age ≥ 60) men, 12 family members, and 10 clinic staff. Depressed men were identified through mail outreach, waiting room screening, and referral. Depressed men identified family members who were later approached to participate. We also recruited a purposeful sample of clinic staff. Interviews explored stakeholder perspectives on family involvement in men's depression treatment as part of a primary care intervention. Interviews were conducted using a semi-structured interview guide, tape-recorded, transcribed verbatim, and translated if the interview was conducted in Spanish. Four themes were identified representing core challenges: engaging men at the right time; preserving men's sense of autonomy; managing privacy concerns; and navigating family tensions. Stakeholders also provided practical suggestions and advice about how each of these challenges might be addressed. While engaging family is a promising approach to strengthen depression care for older men in primary care settings, several potential challenges exist. Family- centered depression intervention development and clinical practice need to anticipate these challenges and to develop approaches and guidelines to address them.

Serum Uric Acid Laboratory Test Request Patterns in Primary Care: How Panels May Contribute to Overutilization and Treatment of Asymptomatic Patients.

PubMed

Salinas, Maria; López-Garrigós, Maite; Flores, Emilio; Leiva-Salinas, Carlos

2017-12-22

To study the variability in the request of serum uric acid (SUA) in primary care. A cross-sectional study was designed and conducted at a main core laboratory. Spanish laboratories were invited to report their number of serum glucose (SG) and SUA tests requested from primary care during 2014. A survey was sent to every participant in November 2016 regarding the inclusion of SUA in order profiles/panels. The ratio of SUA/SG requests (SUA/SG) was calculated and compared between regions, and laboratories depending on whether SUA was included or not in a health check profile. 110 laboratories participated in the study (59.8% Spanish population). The median SUA/SG ratio was 0.82 (IQR: 0.25), and 41 laboratories had a ratio over 0.9. There was a significant regional variability (P = .008). Laboratories where SUA was not included in the "health check profile" had lower SUA/SG indicators (P = .003). There was significant regional variability in the request of SUA, and an overall over-request. Different regional customs or habits and the inclusion of SUA in the health check profile were probable causes behind the observed over-request. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Health promotion practices as perceived by primary healthcare professionals at the Ministry of National Guard Health Affairs, Saudi Arabia.

PubMed

Altamimi, Samar; Alshoshan, Feda; Al Shaman, Ghada; Tawfeeq, Nasser; Alasmary, May; Ahmed, Anwar E

2016-01-01

In recent years, several research studies have investigated health promotion practices in Saudi healthcare organizations, yet no published literature exists on health promotion practices of primary healthcare professionals working for the Ministry of National Guard Health Affairs (MNG-HA). A cross-sectional study was conducted in a convenience sample of 206 primary healthcare professionals at the MNG-HA. A self-reporting questionnaire was used to investigate the attitudes, awareness, satisfaction, and methods regarding health promotion practices of primary healthcare professionals. Of the 206 primary healthcare professionals surveyed, 58.1% reported awareness of health promotion programs conducted in the hospitals and 64.6% reported that the health promotion system in the hospitals needs to be improved. Language barriers and cultural beliefs were viewed as obstacles to carrying out effective health promotion by 65% and 64.6% of primary healthcare professionals, respectively. The majority (79.9%) of the primary healthcare professionals perceived themselves as having the necessary skills to promote health and 80.6% believed that printed educational materials are the most prevalent method of health promotion/education, whereas 55.8% reported that counseling was the most preferred method of health promotion. The awareness level of health promotion policies, strategies, and programs conducted in the hospitals was not found to be satisfactory. Therefore, widespread training programs are recommended to improve the health promotion system in the hospitals. These programs include facilitating behavioral change, introducing health promotion policies and strategies in hospitals, mandatory workshops, and systematic reminders.

Uterine Development After Estrogen Replacement Therapy in Women with Different Etiologies of Primary Hypogonadism.

PubMed

Kim, Hyo Jeong; Lee, Dong-Yun; Yoon, Byung-Koo; Choi, DooSeok

2016-08-01

To evaluate uterine development with estrogen replacement therapy in patients with primary amenorrhea due to hypogonadism. Retrospective study. Thirty-five women. Women who were younger than 20 years of age and who had primary amenorrhea and an immaturely shaped uterus were included. Changes in uterine cross-sectional area (UXA) and uterine maturity in pelvic ultrasound after 2 year of estrogen replacement therapy were assessed on the basis of the etiology of primary hypogonadism. Patients were classified into three groups according to the etiology of primary hypogonadism: Turner syndrome (n = 19), hypogonadotropic hypogonadism after brain surgery (n = 10), and premature ovarian insufficiency after cancer treatment (n = 6). Overall, the mean UXA significantly increased (from 3.1 ± 1.8 to 11.6 ± 4.9 cm(2)) after estrogen replacement therapy (P < .001), but the final UXA was significantly smaller in patients with premature ovarian insufficiency compared with other etiologies. In logistic regression analysis, etiology and the cumulative dose of estrogen were associated with uterine maturation (P = .011 and .004, respectively). Estrogen replacement therapy induced growth of the uterus in patients with primary hypogonadism. However, the response to estrogen replacement therapy varied on the basis of the total cumulative dose of estrogen and etiology of primary hypogonadism. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Palliative care case managers in primary care: a descriptive study of referrals in relation to treatment aims.

PubMed

van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Francke, Anneke L; Jansen, Wim J J; Vissers, Kris C; Deliens, Luc

2015-04-01

Three important elements of the World Health Organization (WHO) definition of palliative care are: 1) it includes patients who may have cure or life prolongation as treatment aims besides palliative care; 2) it is not exclusively for cancer patients; and 3) it includes attention to the medical, psychological, social, and spiritual needs of the patients and their families. Case managers (nurses with expertise in palliative care) may assist generalist primary care providers in delivery of good palliative care. This study investigates the referral of patients to case managers in primary care with regard to the three elements mentioned: diagnosis, treatment aims, and needs as reflected in reasons given for referral. In this cross-sectional survey in primary care among case managers and referrers to case management, case managers completed questionnaires for 687 patients; referrers completed 448 (65%). Most patients referred have a combination of treatment aims (69%). Life expectancy and functional status of patients are lower for those with a treatment aim of palliation. Almost all (96%) of those referred are cancer patients. A need for psychosocial support is frequently given as a reason for referral (66%) regardless of treatment aim. Referrals to case managers reflect two of three elements of the WHO definition. Mainly, patients are referred for support complementary to medical care, and relatively early in their disease trajectory. However, most of those referred are cancer patients. Thus, to fully reflect the definition, broadening the scope to reach other patient groups is important.

[Compliance with process indicators in people with type 2 diabetes and linking incentives in Primary Care].

PubMed

Pascual de la Pisa, Beatriz; Márquez Calzada, Cristina; Cuberos Sánchez, Carla; Cruces Jiménez, José Miguel; Fernández Gamaza, Manuel; Martínez Martínez, María Isabel

2015-03-01

Pay-for-performance programs to improve the quality of health care are extending gradually, particularly en Primary Health Care. Our aim was to explore the relationship between the degree of compliance with the process indicators (PrI) of type 2 diabetes (T2DM) in Primary Care and linkage to incentives. Cross-sectional, descriptive, observational study. Six Primary Health Care centers in Seville Aljarafe District randomly selected and stratified by population size. From 3.647 adults included in Integrated Healthcare Process of T2DM during 2008, 366 patients were included according sample size calculation by stratified random sampling. PrI: eye and feet examination, glycated hemoglobin, lipid profile, microalbuminuria and electrocardiogram. Confounding: Age, gender, characteristics town for patients and professional variables. The mean age was 66.36 years (standard deviation [DE]: 11,56); 48.9% were women. PrI with better compliance were feet examination, glycated hemoglobin and lipid profile (59.6%, 44.3% and 44%, respectively). 2.7% of patients had simultaneous compliance of the six PrI and 11.74% of patients three PrI linkage to incentives. Statistical association was observed in the compliance of the PrI incentives linked or not (P=.001). The degree of compliance with the PrI for screening chronic complications of T2DM is mostly low but this was higher on indicators linked to incentives. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Essential elements of professional nursing environments in Primary Care and their influence on the quality of care.

PubMed

Gea-Caballero, Vicente; Castro-Sánchez, Enrique; Júarez-Vela, Raúl; Díaz-Herrera, Miguel Ángel; de Miguel-Montoya, Isabel; Martínez-Riera, José Ramón

Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic

PubMed Central

Ambigapathy, Ranjini; Ng, Chirk Jenn

2016-01-01

Objective Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients’ role preference in decision-making and the associated factors. Design A cross-sectional study. Setting Study was conducted at an urban primary care clinic in Malaysia in 2012. Participants Patients aged >21 years were chosen using systematic random sampling. Methods Consenting patients answered a self-administered questionnaire, which included demographic data and their preferred and actual role before and after consultation. Doctors were asked to determine patients’ role preference. The Control Preference Scale was used to assess patients’ role preference. Primary outcome Prevalence of patients’ preferred role in decision-making. Secondary outcomes (1) Actual role played by the patient in decision-making. (2) Sociodemographic factors associated with patients’ preferred role in decision-making. (3) Doctors’ perception of patients’ involvement in decision-making. Results The response rate was 95.1% (470/494). Shared decision-making was preferred by 51.9% of patients, followed by passive (26.3%) and active (21.8%) roles in decision-making. Higher household income was significantly associated with autonomous role preference (p=0.018). Doctors’ perception did not concur with patients’ preferred role. Among patients whom doctors perceived to prefer a passive role, 73.5% preferred an autonomous role (p=0.900, κ=0.006). Conclusions The majority of patients attending the primary care clinic preferred and played an autonomous role in decision-making. Doctors underestimated patients’ preference to play an autonomous role. PMID:26729393

Women with breast cancer report substantially more disease- and treatment-related side or late effects than registered by clinical oncologists: a cross-sectional study of a standard follow-up program in an oncological department.

PubMed

Ellegaard, Mai-Britt Bjørklund; Grau, Cai; Zachariae, Robert; Jensen, Anders Bonde

2017-08-01

Follow-up after breast cancer treatment is standard due to the risk of development of new primary cancers and recurrent disease. The aim of the present study was to evaluate a standard follow-up program in an oncological department by assessing: (1) Symptoms or signs of new primary cancer or recurrent disease, (2) Disease- and treatment-related physical and psychosocial side or late effects, and (3) relevant actions by oncology staff. In a cross-sectional study, 194 women who came for follow-up visit after treatment for primary surgery were included. The clinical oncologists registered symptoms and signs of recurrent disease or new primary cancer. Side or late effects were both assessed by patient and the clinical oncologists. Loco-regional or distant signs of recurrent disease were suspected in eight (5%) patients. Further examinations revealed no disease recurrence. Most patients (93%) reported some degree of side or late effects. Statistically significant more side or late effects were reported by the women (average: 6.9) than registered by the clinical oncologists (average: 2.4), p < 0.001. The three most often patient-reported side or late effects were hot flushes (35%), fatigue (32%), and sleep disturbance (31%). None of the scheduled or additional visits resulted in detection of recurrent disease. Furthermore, the majority of patients reported side or late effects. Statistically significant more women reported side or late effects than registered by the clinical oncologists. This suggests the need for rethinking of the follow-up programs with more emphasis upon side or late effects of the treatment.

Identifying Drivers of Overall Satisfaction in Patients Receiving HIV Primary Care: A Cross-Sectional Study

PubMed Central

Dang, Bich N.; Westbrook, Robert A.; Rodriguez-Barradas, Maria C.; Giordano, Thomas P.

2012-01-01

Objective This study seeks to understand the drivers of overall patient satisfaction in a predominantly low-income, ethnic-minority population of HIV primary care patients. The study’s primary aims were to determine 1) the component experiences which contribute to patients’ evaluations of their overall satisfaction with care received, and 2) the relative contribution of each component experience in explaining patients’ evaluation of overall satisfaction. Methods We conducted a cross-sectional study of 489 adult patients receiving HIV primary care at two clinics in Houston, Texas, from January 13–April 21, 2011. The participation rate among eligible patients was 94%. The survey included 15 questions about various components of the care experience, 4 questions about the provider experience and 3 questions about overall care. To ensure that the survey was appropriately tailored to our clinic population and the list of component experiences reflected all aspects of the care experience salient to patients, we conducted in-depth interviews with key providers and clinic staff and pre-tested the survey instrument with patients. Results Patients’ evaluation of their provider correlated the strongest with their overall satisfaction (standardized β = 0.445, p<0.001) and accounted for almost half of the explained variance. Access and availability, like clinic hours and ease of calling the clinic, also correlated with overall satisfaction, but less strongly. Wait time and parking, despite receiving low patient ratings, did not correlate with overall satisfaction. Conclusions The patient-provider relationship far exceeds other component experiences of care in its association with overall satisfaction. Our study suggests that interventions to improve overall patient satisfaction should focus on improving patients’ evaluation of their provider. PMID:22912770

Use of email, cell phone and text message between patients and primary-care physicians: cross-sectional study in a French-speaking part of Switzerland.

PubMed

Dash, Jonathan; Haller, Dagmar M; Sommer, Johanna; Junod Perron, Noelle

2016-10-05

Physicians' daily work is increasingly affected by the use of emails, text messages and cell phone calls with their patients. The aim of this study was to describe their use between primary-care physicians and patients in a French-speaking part of Switzerland. A cross-sectional mail survey was conducted among all primary-care physicians of Geneva canton (n = 636). The questionnaire focused on the frequency of giving access to, type of use, advantages and disadvantages of email, cell phone calls and text messages communication between physicians and patients. Six hundred thirty-six questionnaires were mailed, 412 (65 %) were returned and 372 (58 %) could be analysed (37 refusals and three blanks). Seventy-two percent physicians gave their email-address and 74 % their cell phone number to their patients. Emails were used to respond to patients' questions (82 %) and change appointments (72 %) while cell phone calls and text messages were used to follow patients' health conditions. Sixty-four percent of those who used email communication never discussed the rules for email exchanges, and 54 % did not address confidentiality issues with their patients. Most commonly identified advantages of emails, cell phone calls and text messages were improved relationship with the patient, saving time (for emails) and improving the follow-up (for cell phone and text messages). The main disadvantages included misuse by the patient, interference with private life and lack of reimbursement. These tools are widely used by primary-care physicians with their patients. More attention should be paid to confidentiality, documentation and reimbursement when using email communication in order to optimize its use.

Metastatic patterns and metastatic sites in mucosal melanoma: a retrospective study.

PubMed

Grözinger, Gerd; Mann, Steven; Mehra, Tarun; Klumpp, Bernhard; Grosse, Ulrich; Nikolaou, Konstantin; Garbe, Claus; Clasen, Stephan

2016-06-01

Melanomas arising from mucosa are rare and associated with a poor prognosis. This study aims to provide an analysis of metastatic pathways, time intervals, factors influencing metastatic spread and organs for distant metastases. A total of 116 patients with mucosal melanomas of different sites were included. The mean follow-up interval was 47 ± 52 months. Patients were assigned to two different metastatic pathways, either presenting loco-regional lymph node metastases as first spread or direct distant metastases. The distribution of distant metastases was assessed. Twenty-six patients presented with a pre-existing metastatic spread and were not assigned to pathways. Of the included patients, 44 developed metastases after treatment of the primary tumour; 25 patients directly developed distant metastases; 16 patients developed regional lymph node metastases prior to distant metastases. Location of the primary tumour in the upper airway or GI tract and advanced T stage were significant risk factors of direct distant metastases. Distant metastases are mainly located in the lung, the liver and non-regional lymph nodes. Mucosal melanomas show a high rate of direct distant metastases rather than regional lymph node metastases. Thus the follow-up should always include a whole-body cross-sectional imaging in high-risk tumours. • Mucosal melanomas show a high rate of direct distant metastases. • T stage and primary location are predictors for direct distant metastases. • Distant metastases were mainly found in lung, liver and lymph nodes. • Follow-up of a high-risk mucosal melanoma should include whole-body imaging.

Argininosuccinate synthetase (ASS) deficiency in high-grade pulmonary neuroendocrine carcinoma: an opportunity for personalized targeted therapy.

PubMed

Walts, Ann E; Bomalaski, John S; Ines, Delma; Orsulic, Sandra

2015-08-01

Cells deficient in argininosuccinate synthetase (ASS) must absorb the arginine they need for growth from circulating blood. Treatment with pegylated arginine deiminase (ADI-PEG 20) selectively eliminates arginine from the circulation and has shown some efficacy against ASS-deficient tumors including small cell lung cancer (SCLC). We sought to assess ASS expression in a cohort of high-grade pulmonary neuroendocrine carcinomas (PNEC) which include SCLC and large cell neuroendocrine carcinoma (LCNEC). Sixty-nine PNEC (49 SCLC and 20 LCNEC) were retrieved from our pathology archives. Formalin-fixed paraffin-embedded sections of the 54 primary tumors, 15 metastases and appropriate positive and negative controls were immunostained using an ASS-specific monoclonal antibody. Positive staining in <30 % of the tumor was scored as weak; staining in ≥30 % of the tumor was scored as strong. The absence of staining in the tumor was recorded as ASS negative. 58 % of the PNEC including 61.2 % of the SCLC and 50 % of the LCNEC were ASS negative. These ASS-negative tumors included 63 % of the primary and 40 % of the metastatic lesions tested. More than 50 % of the high-grade PNEC tested lack immunohistochemically detectable ASS, suggesting that they are auxotrophic for arginine and potential candidates for arginine deprivation therapy. PNEC comprise about 25 % of primary lung cancers and have a 5-year overall survival of only 5-10 %, underscoring the need for new and more effective therapies. Immunostaining for ASS has potential to improve the selection of patients with PNEC for arginine deprivation therapy with ADI-PEG 20.

Barriers to the utilization of primary care services for mental health prolems among adolescents in a secondary school in malaysia.

PubMed

Aida, J; Azimah, Mn; Mohd Radzniwan, Ar; Y Iryani, Md; Ramli, M; Khairani, O

2010-01-01

To study the barriers toward the utilization of primary care services for mental health problems among adolescents in a secondary school in Hulu Langat, Selangor, Malaysia. This was a cross-sectional study conducted in July 2008 at a secondary school in Hulu Langat, Selangor. The respondents were selected using randomised cluster sampling among Form Four and Form Five students. Students were given self-administered questionnaire, consisting socio-demographic data and questions on their help-seeking barrier and behaviour. Help-seeking behaviour questions assess the use of medical facility and help-seeking sources. The formal help-seeking sources include from teachers, counsellors and doctors. The informal help-seeking sources include from friends, parents and siblings. A total of 175 students were included in the study. None of the students admitted of using the primary health care services for their mental health problems. Majority of the students were not aware of the services availability in the primary health care (97.1%). More than half of them thought the problems were due to their own mistakes (55.4%) and the problems were not that serious (49.1%). With regard to perception of the primary health care services, (43.2%) of the students were worried about confidentiality, half of them were concerned about other people's perception especially from their family members (44.6%) and friends (48.6%). Minority of them (10.8%) thought that nobody can help them. Few of them thought smoking (3.4%), alcohol (3.4%) and recreational drugs (1.1%) can solve their emotional problems. One of the major barriers identified in the students' failure to use the health care facilities was their unawareness of the availability of the service for them in the community. Thus there is a need to promote and increase their awareness on this issue.

14 CFR 29.673 - Primary flight controls.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Primary flight controls. 29.673 Section 29.673 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... flight controls. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

14 CFR 29.673 - Primary flight controls.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Primary flight controls. 29.673 Section 29.673 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... flight controls. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

14 CFR 27.673 - Primary flight control.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Primary flight control. 27.673 Section 27.673 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... flight control. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

14 CFR 27.673 - Primary flight control.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Primary flight control. 27.673 Section 27.673 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... flight control. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

50 CFR 14.131 - Primary enclosures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... same primary enclosure with an adult marine mammal other than its mother. Socially dependent animals (e... 50 Wildlife and Fisheries 1 2013-10-01 2013-10-01 false Primary enclosures. 14.131 Section 14.131 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING...

50 CFR 14.131 - Primary enclosures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... same primary enclosure with an adult marine mammal other than its mother. Socially dependent animals (e... 50 Wildlife and Fisheries 1 2012-10-01 2012-10-01 false Primary enclosures. 14.131 Section 14.131 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING...

Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study.

PubMed

Teles, Mariza Alves Barbosa; Barbosa, Mirna Rossi; Vargas, Andréa Maria Duarte; Gomes, Viviane Elizângela; Ferreira, Efigênia Ferreira e; Martins, Andréa Maria Eleutério de Barros Lima; Ferreira, Raquel Conceição

2014-05-15

Workers in Primary Health Care are often exposed to stressful conditions at work. This study investigated the association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. This cross-sectional study included all 797 Primary Health Care workers of a medium-sized city, Brazil: doctors, nurses, nursing technicians and nursing assistants, dentists, oral health technicians, and auxiliary oral hygienists, and community health workers. Data were collected by interviews. Quality of life was assessed using the WHOQOL-BREF; general quality of life, as well as the physical, psychological, social and environmental domains were considered, with scores from 0 to 100. Higher scores indicate a better quality of life. Poor quality of life was defined by the lowest quartiles of the WHOQOL score distributions for each of the domains. Adverse psychosocial work conditions were investigated by the Effort-Reward Imbalance model. Associations were verified using multiple logistic regression. Poor quality of life was observed in 117 (15.4%) workers. Workers with imbalanced effort-reward (high effort/low reward) had an increased probability of general poor quality of life (OR = 1.91; 1.07–3.42), and in the physical (OR = 1.62; 1.02–2.66), and environmental (OR = 2.39; 1.37–4.16) domains; those with low effort/low reward demonstrated a greater probability of poor quality of life in the social domain (OR = 1.82; 1.00–3.30). Workers with overcommitment at work had an increased likelihood of poor quality of life in the physical (OR = 1.55, 1.06–2.26) and environmental (OR = 1.69; 1.08–2.65) domains. These associations were independent of individual characteristics, job characteristics, lifestyle, perception of general health, or psychological and biological functions. There is an association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers.

Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study

PubMed Central

2014-01-01

Background Workers in Primary Health Care are often exposed to stressful conditions at work. This study investigated the association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. Methods This cross-sectional study included all 797 Primary Health Care workers of a medium-sized city, Brazil: doctors, nurses, nursing technicians and nursing assistants, dentists, oral health technicians, and auxiliary oral hygienists, and community health workers. Data were collected by interviews. Quality of life was assessed using the WHOQOL-BREF; general quality of life, as well as the physical, psychological, social and environmental domains were considered, with scores from 0 to 100. Higher scores indicate a better quality of life. Poor quality of life was defined by the lowest quartiles of the WHOQOL score distributions for each of the domains. Adverse psychosocial work conditions were investigated by the Effort-Reward Imbalance model. Associations were verified using multiple logistic regression. Results Poor quality of life was observed in 117 (15.4%) workers. Workers with imbalanced effort-reward (high effort/low reward) had an increased probability of general poor quality of life (OR = 1.91; 1.07–3.42), and in the physical (OR = 1.62; 1.02–2.66), and environmental (OR = 2.39; 1.37–4.16) domains; those with low effort/low reward demonstrated a greater probability of poor quality of life in the social domain (OR = 1.82; 1.00–3.30). Workers with overcommitment at work had an increased likelihood of poor quality of life in the physical (OR = 1.55, 1.06–2.26) and environmental (OR = 1.69; 1.08–2.65) domains. These associations were independent of individual characteristics, job characteristics, lifestyle, perception of general health, or psychological and biological functions. Conclusions There is an association between adverse psychosocial work conditions and poor quality of life among Primary Health Care workers. PMID:24884707

Physician wages across specialties: informing the physician reimbursement debate.

PubMed

Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Kravitz, Richard L

2010-10-25

Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

Advanced training for primary care and general practice nurses: enablers and outcomes of postgraduate education.

PubMed

Hallinan, Christine M; Hegarty, Kelsey L

2016-01-01

The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.

International Space Station Modal Correction Analysis

NASA Technical Reports Server (NTRS)

Fotz[atrocl. Lrostom; Grugoer. < ocjae; Laible, Michael; Sugavanam, Sujatha

2012-01-01

This paper summarizes the on-orbit modal test and the related modal analysis, model validation and correlation performed for the ISS Stage ULF4, DTF S4-1A, October 11,2010, GMT 284/06:13:00.00. The objective of this analysis is to validate and correlate analytical models with the intent to verify the ISS critical interface dynamic loads and improve fatigue life prediction. For the ISS configurations under consideration, on-orbit dynamic responses were collected with Russian vehicles attached and without the Orbiter attached to the ISS. ISS instrumentation systems that were used to collect the dynamic responses during the DTF S4-1A included the Internal Wireless Instrumentation System (IWIS), External Wireless Instrumentation System (EWIS), Structural Dynamic Measurement System (SDMS), Space Acceleration Measurement System (SAMS), Inertial Measurement Unit (IMU) and ISS External Cameras. Experimental modal analyses were performed on the measured data to extract modal parameters including frequency, damping and mode shape information. Correlation and comparisons between test and analytical modal parameters were performed to assess the accuracy of models for the ISS configuration under consideration. Based on the frequency comparisons, the accuracy of the mathematical models is assessed and model refinement recommendations are given. Section 2.0 of this report presents the math model used in the analysis. This section also describes the ISS configuration under consideration and summarizes the associated primary modes of interest along with the fundamental appendage modes. Section 3.0 discusses the details of the ISS Stage ULF4 DTF S4-1A test. Section 4.0 discusses the on-orbit instrumentation systems that were used in the collection of the data analyzed in this paper. The modal analysis approach and results used in the analysis of the collected data are summarized in Section 5.0. The model correlation and validation effort is reported in Section 6.0. Conclusions and recommendations drawn from this analysis are included in Section 7.0.

Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria.

PubMed

Chukwu, Emeka; Garg, Lalit; Eze, Godson

2016-05-17

Nigeria contributes only 2% to the world's population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. The purpose of this study was to document costs associated with a mobile technology-supported, community-based health insurance scheme. This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations and a telecom operator revealed high investment interests. Cost documentation analysis of income versus expenditure for the major maternal and child health service areas-antenatal care, routine immunization, and birth attendance for 1 year-showed that primary health facilities would still profit if technology-supported, health insurance schemes were adopted. This study demonstrates a case for the implementation of enrolment, encounter management, treatment verification, claims management and reimbursement using mobile technology for health insurance in Abuja, Nigeria. Available data show that the introduction of an electronic job aid improved efficiency. Although it is difficult to make a concrete statement on profitability of this venture but the interest of the health maintenance organizations and telecom experts in this endeavor provides a positive lead.

Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria

PubMed Central

Garg, Lalit; Eze, Godson

2016-01-01

Background Nigeria contributes only 2% to the world’s population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. Objective The purpose of this study was to document costs associated with a mobile technology–supported, community-based health insurance scheme. Methods This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. Results All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations and a telecom operator revealed high investment interests. Cost documentation analysis of income versus expenditure for the major maternal and child health service areas—antenatal care, routine immunization, and birth attendance for 1 year—showed that primary health facilities would still profit if technology-supported, health insurance schemes were adopted. Conclusions This study demonstrates a case for the implementation of enrolment, encounter management, treatment verification, claims management and reimbursement using mobile technology for health insurance in Abuja, Nigeria. Available data show that the introduction of an electronic job aid improved efficiency. Although it is difficult to make a concrete statement on profitability of this venture but the interest of the health maintenance organizations and telecom experts in this endeavor provides a positive lead. PMID:27189312

Medicare program; participation in CHAMPUS and CHAMPVA, hospital admissions for veterans, discharge rights notice, and hospital responsibility for emergency care--HCFA and OIG. Interim final rule with comment period.

PubMed

1994-06-22

We are revising requirements for Medicare participating hospitals by adding the following: A hospital must provide inpatient hospital services to individuals who have health coverage provided by either the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) or the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA), subject to limitations provided by regulations that require the hospital to collect the beneficiary's cost-share and accept payment from the CHAMPUS/CHAMPVA programs as payment in full. A hospital must provide inpatient hospital services to military veterans (subject to the limitations provided in 38 CFR 17.50 ff.) and accept payment from the Department of Veterans Affairs as payment in full. A hospital must give each Medicare beneficiary (or his or her representative) at or about the time of admission, a written statement of his or her rights concerning discharge from the hospital. A hospital (including a rural primary care hospital) with an emergency department must provide, upon request and within the capabilities of the hospital or rural primary care hospital, an appropriate medical screening examination, stabilizing treatment and/or an appropriate transfer to another medical facility to any individual with an emergency medical condition, regardless of the individual's eligibility for Medicare. The statute provides for the termination of a provider's agreement for violation of any of these provisions. These revisions implement sections 9121 and 9122 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (as amended by section 4009 of the Omnibus Budget Reconciliation Act of 1987), section 233 of the Veteran's Benefit Improvement and Health Care Authorization Act of 1986, sections 9305(b)(1) and 9307 of the Omnibus Budget Reconciliation Act of 1986, sections 6003(g)(3)(D)(xiv), 6018 and 6211 of the Omnibus Budget Reconciliation Act of 1989, and sections 4008(b), 4027(a), and 4027(k)(3) of the Omnibus Budget Reconciliation Act of 1990.

Updating national standards for drinking-water: a Philippine experience.

PubMed

Lomboy, M; Riego de Dios, J; Magtibay, B; Quizon, R; Molina, V; Fadrilan-Camacho, V; See, J; Enoveso, A; Barbosa, L; Agravante, A

2017-04-01

The latest version of the Philippine National Standards for Drinking-Water (PNSDW) was issued in 2007 by the Department of Health (DOH). Due to several issues and concerns, the DOH decided to make an update which is relevant and necessary to meet the needs of the stakeholders. As an output, the water quality parameters are now categorized into mandatory, primary, and secondary. The ten mandatory parameters are core parameters which all water service providers nationwide are obligated to test. These include thermotolerant coliforms or Escherichia coli, arsenic, cadmium, lead, nitrate, color, turbidity, pH, total dissolved solids, and disinfectant residual. The 55 primary parameters are site-specific and can be adopted as enforceable parameters when developing new water sources or when the existing source is at high risk of contamination. The 11 secondary parameters include operational parameters and those that affect the esthetic quality of drinking-water. In addition, the updated PNSDW include new sections: (1) reporting and interpretation of results and corrective actions; (2) emergency drinking-water parameters; (3) proposed Sustainable Development Goal parameters; and (4) standards for other drinking-water sources. The lessons learned and insights gained from the updating of standards are likewise incorporated in this paper.

Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample.

PubMed

Kodish, Tamar; Herres, Joanna; Shearer, Annie; Atte, Tita; Fein, Joel; Diamond, Guy

2016-05-01

Suicide is a serious public health concern for US youth. Research has established an association between bullying and suicide risk. However, several questions remain regarding this relationship. The present study examined (a) whether experiences of verbal, physical, and cyber bullying were uniquely associated with general suicide risk; (b) whether each specific form of bullying was related to suicide attempt; and (c) whether depression moderated the relationship between each type of bullying and suicide risk. The sample included medical records of 5,429 youth screened in primary care when providers had mental health concerns. Patients were screened using the Behavioral Health Screen (BHS), which assessed a range of mental health problems and behaviors, including bullying, depression, and suicide. All types of bullying were associated with suicide risk, but verbal bullying was uniquely associated with suicide attempt. Depression significantly moderated the relationship between each type of bullying and suicide risk. The study's limitations include the use of cross-sectional and self-data reports. When medical providers evaluate suicide risk, bullying should be considered as a possible precipitant, especially if the patient is depressed. Verbal bullying may be particularly important in understanding severity of suicide risk.

Waste receiving and processing plant control system; system design description

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

LANE, M.P.

1999-02-24

The Plant Control System (PCS) is a heterogeneous computer system composed of numerous sub-systems. The PCS represents every major computer system that is used to support operation of the Waste Receiving and Processing (WRAP) facility. This document, the System Design Description (PCS SDD), includes several chapters and appendices. Each chapter is devoted to a separate PCS sub-system. Typically, each chapter includes an overview description of the system, a list of associated documents related to operation of that system, and a detailed description of relevant system features. Each appendice provides configuration information for selected PCS sub-systems. The appendices are designed asmore » separate sections to assist in maintaining this document due to frequent changes in system configurations. This document is intended to serve as the primary reference for configuration of PCS computer systems. The use of this document is further described in the WRAP System Configuration Management Plan, WMH-350, Section 4.1.« less

Family Support, Self-Rated Health, and Psychological Distress

PubMed Central

Cano, Annmarie; Scaturo, Douglas J.; Sprafkin, Robert P.; Lantinga, Larry J.; Fiese, Barbara H.; Brand, Frank

2003-01-01

Background: Comprehensive health care is becoming an important issue; however, little is known about the complex relationships between perceived family support, self-rated health, and psychological distress in mixed middle-aged/older primary care patient samples. Method: In this cross-sectional and predominantly male sample of 137 patients attending their appointments at a primary care clinic in a Department of Veterans Affairs Medical Center, participants completed several questionnaires including the Family Adaptation, Partnership, Growth, Affection, and Resolve; the General Health Questionnaire-12; the Symptom Checklist-10; and the Primary Care Evaluation of Mental Disorders (PRIME-MD) screening questionnaire and interview. Data were collected in 1998. Eighteen percent of the participants were diagnosed with a mood disorder, and 15% were diagnosed with an anxiety disorder (PRIME-MD diagnoses). Results: Perceived family support and self-rated health were negatively associated with psychological symptoms and certain psychological disorders, while perceived family support and self-rated health were positively rated. In addition, the interaction between perceived family support and self-rated health was significant (p < .01) in relating to psychological symptoms such that psychological symptoms were most elevated in participants reporting dissatisfying family support combined with poor self-rated health. However, the cross-sectional nature of the study prevents causal conclusions from being made. Conclusions: Physicians and other health care professionals are encouraged to assess both the perceived family support and self-rated health in an effort to conceptualize their patients' problems in a more comprehensive manner. PMID:15154021

Association Between Hay Fever and High Myopia in United States Adolescents and Adults.

PubMed

Shafer, Brian M; Qiu, Mary; Rapuano, Christopher J; Shields, Carol L

2017-05-01

To investigate the relationship between hay fever and refractive error in a representative sample of adolescents and adults in the United States. This cross-sectional study included 5,744 participants aged ≥12 years from the 2005 to 2006 National Health and Nutrition Examination Survey who participated in the allergy questionnaire, completed objective refraction and keratometry in both eyes, and had immunoglobulin E (IgE) serology. The primary predictor variable, refractive error, was classified as emmetropia (-0.99 to +0.99 diopters [D]), low myopia (-1.00 to -2.99 D), moderate myopia (-3.00 to -5.99 D), high myopia (≥-6.00 D), or hyperopia (≥1.00 D). Covariates included age, gender, race, asthma, eczema, total serum IgE ≥120 kU/L, corneal steepness, and corneal astigmatism. The primary outcome was hay fever. The study population's mean age was 41.7 years; 48.8% of subjects were men and 51.2% were women. The prevalence of hay fever was 12.1% overall. High myopes had 2.7 times higher odds of hay fever compared to emmetropes (OR 2.67, CI, 1.57-4.51, P=0.001), which was independent of demographics, atopic conditions, IgE serology, and keratometry measurements. The association between hay fever and high myopia identified in this large cross-sectional study remains speculative and was not mediated through corneal steepness or corneal astigmatism. Further prospective studies may help elucidate the directionality of the association between hay fever and high myopia.

78 FR 26053 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Service Administration Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting In accordance with section... following meeting: Name: Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD...

78 FR 48440 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Service Administration Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting In accordance with section... following meeting: Name: Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD...

47 CFR 11.14 - Primary Entry Point (PEP) System.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Primary Entry Point (PEP) System. 11.14 Section 11.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EMERGENCY ALERT SYSTEM (EAS) General § 11.14 Primary Entry Point (PEP) System. The PEP system is a nationwide network of broadcast...

40 CFR 421.80 - Applicability: Description of the primary zinc subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 30 2012-07-01 2012-07-01 false Applicability: Description of the primary zinc subcategory. 421.80 Section 421.80 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS NONFERROUS METALS MANUFACTURING POINT SOURCE CATEGORY Primary Zinc Subcategory § 421.80 Applicability...

40 CFR 421.80 - Applicability: Description of the primary zinc subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 30 2013-07-01 2012-07-01 true Applicability: Description of the primary zinc subcategory. 421.80 Section 421.80 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS NONFERROUS METALS MANUFACTURING POINT SOURCE CATEGORY Primary Zinc Subcategory § 421.80 Applicability:...

40 CFR 421.80 - Applicability: Description of the primary zinc subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 29 2014-07-01 2012-07-01 true Applicability: Description of the primary zinc subcategory. 421.80 Section 421.80 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS NONFERROUS METALS MANUFACTURING POINT SOURCE CATEGORY Primary Zinc Subcategory § 421.80 Applicability:...

40 CFR 141.544 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.544 Section 141.544 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection...

40 CFR 141.535 - What if my system uses chloramines, ozone, or chlorine dioxide for primary disinfection?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., ozone, or chlorine dioxide for primary disinfection? 141.535 Section 141.535 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Profile...

47 CFR 11.14 - Primary Entry Point (PEP) System.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Primary Entry Point (PEP) System. 11.14 Section 11.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EMERGENCY ALERT SYSTEM (EAS) General § 11.14 Primary Entry Point (PEP) System. The PEP system is a nationwide network of broadcast...

9 CFR 3.113 - Primary enclosures used to transport marine mammals.

Code of Federal Regulations, 2012 CFR

2012-01-01

... marine mammals. 3.113 Section 3.113 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... the animals, their handlers, or other persons. (d) Marine mammals transported in the same primary... used. Within the primary enclosures used to transport marine mammals, the animals will be maintained on...

9 CFR 3.113 - Primary enclosures used to transport marine mammals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... marine mammals. 3.113 Section 3.113 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... the animals, their handlers, or other persons. (d) Marine mammals transported in the same primary... used. Within the primary enclosures used to transport marine mammals, the animals will be maintained on...

9 CFR 3.113 - Primary enclosures used to transport marine mammals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... marine mammals. 3.113 Section 3.113 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... the animals, their handlers, or other persons. (d) Marine mammals transported in the same primary... used. Within the primary enclosures used to transport marine mammals, the animals will be maintained on...

9 CFR 3.113 - Primary enclosures used to transport marine mammals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... marine mammals. 3.113 Section 3.113 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... the animals, their handlers, or other persons. (d) Marine mammals transported in the same primary... used. Within the primary enclosures used to transport marine mammals, the animals will be maintained on...

9 CFR 3.113 - Primary enclosures used to transport marine mammals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... marine mammals. 3.113 Section 3.113 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION... the animals, their handlers, or other persons. (d) Marine mammals transported in the same primary... used. Within the primary enclosures used to transport marine mammals, the animals will be maintained on...

Severity and management of psoriasis within primary care.

PubMed

Wade, Alan G; Crawford, Gordon M; Young, David; Leman, Joyce; Pumford, Neil

2016-10-14

Scottish Intercollegiate Guidelines Network and National Institute of Health and Care Excellence guidelines stress the importance of assessing patients with psoriasis for psoriatic arthritis, comorbidities associated with severe disease and quality of life (QoL). The purpose of the study was to evaluate the primary care management of psoriasis in relation to disease severity and QoL from a patient's perspective. A cross-sectional survey of adults (≥18 years) with psoriasis managed in primary care was conducted in Scotland over 1-year (2012-2013). Patients with psoriasis were identified and invited to participate in the online/telephone survey. The questionnaires included; Dermatology Life Quality Index (DLQI), Self-Administered Psoriasis Area and Severity Index (SAPASI), Psoriasis Epidemiology Screening Tool (PEST). The primary outcome measure was DLQI. Secondary outcomes included; demographics; comorbidities; involvement of different body sites; SAPASI and PEST scores. Relationships between measures were analysed using univariate analysis. The mean age of patients (n = 905) was 54.5 years (SD = 16.1), 436 (48.2 %) were men, and median DLQI and SAPASI scores were 4.0 and 6.0, respectively. Current psoriasis treatments were topical only (587, 64.9 %), oral medications or phototherapy (122, 13.5 %), biologics (26, 3 %) and none (156, 17.2 %). Despite SIGN recommendations, 256 of 391 patients (65.5 %) with a DLQI >5 (at least a moderate effect on QoL) had not seen a specialist during the past year. According to PEST scores, 259 patients (28.6 %) had symptoms suggestive of psoriatic arthritis requiring rheumatology referral. National recommendations are not being fully implemented in primary care in patients with psoriasis or psoriatic arthritis.

The causal role of fatigue in the stress-perceived health relationship: a MetroNet study.

PubMed

Maghout-Juratli, Sham; Janisse, James; Schwartz, Kendra; Arnetz, Bengt B

2010-01-01

We conducted a cross-sectional survey of 4 primary care MetroNet centers in metropolitan Detroit. Our objective was to describe the causal role of fatigue in the relationship among stress, stress resiliency, and perceived health in primary care. Fatigue is a public health problem that has been linked to stress and poor health. The causal role of fatigue between stress and perceived health is unknown. Four hundred surveys were distributed to adult patients in 4 primary care centers in metropolitan Detroit between 2006 and 2007. Internal consistency reliabilities and principal factor analyses were calculated for the key psychological scales. Perceived health is the primary outcome. Path models were used to study the relationship among stress, fatigue, and perceived health. We also modeled the impact of select stress resiliency factors including sleep, recovery, and social support. Of the 400 distributed surveys, 315 (78.7%) had a response rate of 70% or more and were included in the analysis. Respondents were predominantly middle aged (median age, 43 years); female (58.7%); and African American (52.0%). The majority worked full time (56.5%); did not have a college degree (77.7%); and were not married (55.2%). Fatigue was reported by 59% of respondents, 42.7% of which was unexplained. The path model supported the causal role of fatigue between stress and perceived health. The positive effects of sleep, recovery, and social support on fatigue, stress, and perceived health were validated. Fatigue was common in this metropolitan primary care environment and completely mediated the relationship between stress and poor perceived health. Therefore, stress, when significant enough to cause fatigue, may lead to poor health.

[Frequency of pain as a reason for visiting a primary care clinic and its influence on sleep].

PubMed

Calsina-Berna, Agnès; Moreno Millán, Nemesio; González-Barboteo, Jesús; Solsona Díaz, Luis; Porta Sales, Josep

2011-11-01

To determine the frequency of pain as a reason to visit a Primary Care doctor and to investigate the influence of pain on sleep disturbances. Cross-sectional descriptive study. Urban Primary Health Care Centre. The first five patients who came to the primary health care centre with an appointment were included. Those who came with pain were labelled as cases, the others as controls. Socio-demographic variables, background, use of co-analgesics, Pittsburgh Sleep Quality Index (a global PSQI score greater than 5 indicated "poor sleepers"). For the cases, pain intensity was also assessed, chronology and kind of pain, the system affected and treatment. A total of 206 patients were included and 31 excluded. The mean age was 50 years and 56% were women. Pain was the reason for consultation in 39% of the patients, of whom 78% had acute pain, 80% nociceptive, 75% incidental and 71% musculoskeletal. The average VAS score was 4.98. A total of 62% were receiving treatment according to the first step of the WHO pain ladder. Forty-five per cent of patients were categorized as "good sleepers". The multivariate analysis showed that acute pain (P=.022) and pain intensity (P=.035) in men appeared as independent factors of sleep disturbances; in women there were no statistically significant variables. In our study, a high percentage of patients came to the primary health care centre for pain, mainly musculoskeletal. In men, there is a clear relationship between sleep disturbances, pain intensity and acute pain. Further research is needed to study this topic in depth, in order to alleviate pain and improve the sleep quality in our patients. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings.

PubMed

Anskär, Eva; Lindberg, Malou; Falk, Magnus; Andersson, Agneta

2018-03-07

Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.

Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China.

PubMed

Wu, Dan; Wang, Yun; Lam, Kwok Fai; Hesketh, Therese

2014-12-31

To explore the factors influencing doctors' job satisfaction and morale in China, in the context of the ongoing health system reforms and the deteriorating doctor-patient relationship. Cross-sectional survey using self-completion questionnaires. The survey was conducted from March to May 2012 among doctors at the provincial, county and primary care levels in Zhejiang Province, China. The questionnaire was completed by 202 doctors. Factors which contributed most to low job satisfaction were low income and long working hours. Provincial level doctors were most dissatisfied while primary care doctors were the least dissatisfied. Three per cent of doctors at high-level hospitals and 27% of those in primary care were satisfied with the salary. Only 7% at high-level hospitals were satisfied with the work hours, compared to 43% in primary care. Less than 10% at high levels were satisfied with the amount of paid vacation time (3%) and paid sick leave (5%), compared with 38% and 41%, respectively, in primary care. Overall, 87% reported that patients were more likely to sue and that patient violence against doctors was increasing. Only 4.5% wanted their children to be doctors. Of those 125 who provided a reason, 34% said poor pay, 17% said it was a high-risk profession, and 9% expressed concerns about personal insecurity or patient violence. Doctors have low job satisfaction overall. Recruitment and retention of doctors have become major challenges for the Chinese health system. Measures must be taken to address this, in order to ensure recruitment and retention of doctors in the future. These measures must first include reduction of doctors' workload, especially at provincial hospitals, partly through incentivisation of appropriate utilisation of primary care, increase in doctors' salary and more effective measures to tackle patient violence against doctors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Assessing the relationship between Section 404 and wetland losses: a feasibility study

USGS Publications Warehouse

Gladwin, Douglas N.; Roelle, James E.; Asherin, Duane A.

1989-01-01

The primary objective of the Clean Water Act of 1977 (33 U.S.C. 1251) is to restore and maintain the physical, chemical, and biological integrity of the Nation's waters. Section 404 of the Act regulates the discharge of dredged or fill materials into wetlands and represents the primary Federal authority for regulation of wetland alterations. Since its inception, the Section 404 program has been controversial in regard to the extent to which it was intended to provide wetlands regulation. Section 404 requires those who wish to discharge dredged or fill material into waters of the United States, which include many wetlands, to first obtain a Federal permit. The Environmental Protection Agency (EPA) has overall responsibility for administration of the Section 404 program and promulgates guidelines that must be followed in issuing permits. In addition, EPA has the final authority to prohibit specific discharges if the environmental impacts are unacceptable. The U.S. Army Corps of Engineers (Corps) issues Section 404 permits, which can be of two types. Individual Permits are issued following case-by-case reviews of proposed discharges. General Permits, which can be either nationwide or regional in scope, are authorized by the Corps for categories of activities that are similar in nature and that have only minimal individual and cumulative adverse environmental impacts. EPA, the National Marine Fisheries Service (NMFS), the Fish and Wildlife Service (Service), and State natural resource agencies review and comment on permit applications and offer recommendations on appropriate mitigation measures. Although comments from the Service and other natural resource agencies are advisory in nature (EPA's veto authority excepted), they can serve as the basis for modifying, conditioning, or denying a Section 404 permit. In 1986, in a survey conducted by the National Ecology Research Center, Service personnel indicated interest in additional information concerning both wetland trends and the impacts of activities authorized by the Corps under Section 404 (Roelle 1986). Although there is some information concerning wetland losses for certain geographic areas and for the Nation as a whole (Frayer et al. 1983; Tiner 1984), there appears to be little information on how these losses relate to the Section 404 permitting process. The primary objective of this study was to determine the feasibility of estimating wetland losses in relationship to Individual and General Permits issued under Section 404. A secondary objective was to assemble data on acceptance and implementation of specific mitigation recommendations offered by the Service and other natural resource agencies in connection with development activities on wetlands examined. At present, 26 categories of Nationwide permits have been authorized by the Corps. Nationwide permit 26 was of particular interest in this study because it specifically authorizes discharges into wetlands under certain circumstances (see Figure 1 and related text for a more complete discussion of circumstances under which Nationwide Permit 26 is applicable). All subsequent references to Nationwide or General permits pertain to Nationwide Permit 26.

Comparison of CPP-ACP, Tri-Calcium Phosphate and Hydroxyapatite on Remineralization of Artificial Caries Like Lesions on Primary Enamel -An in vitro Study.

PubMed

Bajaj, Meghna; Poornima, P; Praveen, S; Nagaveni, N B; Roopa, K B; Neena, I E; Bharath, K P

To compare CPP-ACP, Tri-calcium phosphate and Hydroxyapatite on remineralization of artificial caries like lesions on primary enamel. Ten extracted Primary molars coated with nail varnish, leaving a window of 2×4 mm on buccal and lingual surface were immersed in demineralizing solution for 96 hours and sectioned longitudinally to obtain 40 sections (4 sections per tooth) and were randomly divided into 4 groups (A to D) n=10; Group A: negative control, Group B: CPP-ACP, Group C: Tri-calcium phosphate, Group D: Hydroxyapatite. Sections were subjected to pH cycling for 10 days and were evaluated by polarized light microscope before and after treatment. Intra group comparison of demineralization and remineralization was done by paired t-test. One way ANOVA was used for multiple group comparisons followed by post HOC TUKEY'S Test for group wise comparisons. Remineralization was found more with Group D followed by Group B, C and A. Hydroxyapatite showed better remineralization when compared to CPP-ACP and Tri-calcium phosphate.

Measurement of the muon antineutrino double-differential cross section for quasielastic-like scattering on hydrocarbon at Eν˜3.5 GeV

NASA Astrophysics Data System (ADS)

Patrick, C. E.; Aliaga, L.; Bashyal, A.; Bellantoni, L.; Bercellie, A.; Betancourt, M.; Bodek, A.; Bravar, A.; Budd, H.; Caceres v., G. F. R.; Carneiro, M. F.; Chavarria, E.; da Motta, H.; Dytman, S. A.; Díaz, G. A.; Felix, J.; Fields, L.; Fine, R.; Gago, A. M.; Galindo, R.; Gallagher, H.; Ghosh, A.; Gran, R.; Han, J. Y.; Harris, D. A.; Henry, S.; Hurtado, K.; Jena, D.; Kleykamp, J.; Kordosky, M.; Le, T.; Lu, X.-G.; Maher, E.; Manly, S.; Mann, W. A.; Marshall, C. M.; McFarland, K. S.; McGowan, A. M.; Messerly, B.; Miller, J.; Mislivec, A.; Morfín, J. G.; Mousseau, J.; Naples, D.; Nelson, J. K.; Norrick, A.; Nowak, G. M.; Nuruzzaman, Paolone, V.; Perdue, G. N.; Peters, E.; Ramírez, M. A.; Ransome, R. D.; Ray, H.; Ren, L.; Rodrigues, P. A.; Ruterbories, D.; Schellman, H.; Solano Salinas, C. J.; Sultana, M.; Sánchez Falero, S.; Teklu, A. M.; Valencia, E.; Wolcott, J.; Wospakrik, M.; Yaeggy, B.; Zhang, D.; Miner ν A Collaboration

2018-03-01

We present double-differential measurements of antineutrino charged-current quasielastic scattering in the MINERvA detector. This study improves on a previous single-differential measurement by using updated reconstruction algorithms and interaction models and provides a complete description of observed muon kinematics in the form of a double-differential cross section with respect to muon transverse and longitudinal momentum. We include in our signal definition zero-meson final states arising from multinucleon interactions and from resonant pion production followed by pion absorption in the primary nucleus. We find that model agreement is considerably improved by a model tuned to MINERvA inclusive neutrino scattering data that incorporates nuclear effects such as weak nuclear screening and two-particle, two-hole enhancements.

Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014.

PubMed

Burn, Edward; Edwards, Christopher J; Murray, David W; Silman, Alan; Cooper, Cyrus; Arden, Nigel K; Pinedo-Villanueva, Rafael; Prieto-Alhambra, Daniel

2018-01-27

To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Cross-sectional study using routinely collected data. National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Primary TKR, primary THR, revision TKR and revision THR. Length of stay and hospital reimbursement. 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Polyphenols in Colorectal Cancer: Current State of Knowledge including Clinical Trials and Molecular Mechanism of Action

PubMed Central

Alam, Md Nur; Almoyad, Muhammad

2018-01-01

Polyphenols have been reported to have wide spectrum of biological activities including major impact on initiation, promotion, and progression of cancer by modulating different signalling pathways. Colorectal cancer is the second most major cause of mortality and morbidity among females and the third among males. The objective of this review is to describe the activity of a variety of polyphenols in colorectal cancer in clinical trials, preclinical studies, and primary research. The molecular mechanisms of major polyphenols related to their beneficial effects on colorectal cancer are also addressed. Synthetic modifications and other future directions towards exploiting of natural polyphenols against colorectal cancer are discussed in the last section. PMID:29568751

Vaccinations in women.

PubMed

Sprabery, L R

2001-06-01

Obstetricians/gynecologists who deliver primary care have an opportunity to enhance the preventive care of their patients. At the first visit with each patient, the vaccination history should be taken. Systems should be developed to remind the physician and office staff of the need for influenza and pneumococcal vaccination, including prompts for patients. One should create or use forms already developed by the CDC to record vaccination data in the patient chart. Additional information is available on the Web at www.cdc.gov/nip provided by the National Immunization Program. The Facts and Comparisons section has a Web site with links to other sources: www.immunofacts.com. All current recommendations of the ACIP are included in the reference list.

Considerations for ceramic inlays in posterior teeth: a review

PubMed Central

Hopp, Christa D; Land, Martin F

2013-01-01

This review of ceramic inlays in posterior teeth includes a review of the history of ceramic restorations, followed by common indications and contraindications for their use. A discussion on the potential for tooth wear is followed by a review of recommended preparation design considerations, fabrication methods, and material choices. Despite the improved materials available for fabrication of porcelain inlays, fracture remains a primary mode of inlay failure. Therefore, a brief discussion on strengthening methods for ceramics is included. The review concludes with a section on luting considerations, and offers the clinician specific recommendations for luting procedures. In conclusion, inlay success rates and longevity, as reported in the literature, are summarized. PMID:23750101

40 CFR 50.15 - National primary and secondary ambient air quality standards for ozone.

Code of Federal Regulations, 2013 CFR

2013-07-01

... air quality standards for ozone. 50.15 Section 50.15 Protection of Environment ENVIRONMENTAL....15 National primary and secondary ambient air quality standards for ozone. (a) The level of the national 8-hour primary and secondary ambient air quality standards for ozone (O3) is 0.075 parts per...

40 CFR 50.15 - National primary and secondary ambient air quality standards for ozone.

Code of Federal Regulations, 2012 CFR

2012-07-01

... air quality standards for ozone. 50.15 Section 50.15 Protection of Environment ENVIRONMENTAL....15 National primary and secondary ambient air quality standards for ozone. (a) The level of the national 8-hour primary and secondary ambient air quality standards for ozone (O3) is 0.075 parts per...

40 CFR 50.15 - National primary and secondary ambient air quality standards for ozone.

Code of Federal Regulations, 2014 CFR

2014-07-01

... air quality standards for ozone. 50.15 Section 50.15 Protection of Environment ENVIRONMENTAL....15 National primary and secondary ambient air quality standards for ozone. (a) The level of the national 8-hour primary and secondary ambient air quality standards for ozone (O3) is 0.075 parts per...

40 CFR 50.15 - National primary and secondary ambient air quality standards for ozone.

Code of Federal Regulations, 2011 CFR

2011-07-01

... air quality standards for ozone. 50.15 Section 50.15 Protection of Environment ENVIRONMENTAL....15 National primary and secondary ambient air quality standards for ozone. (a) The level of the national 8-hour primary and secondary ambient air quality standards for ozone (O3) is 0.075 parts per...

40 CFR 50.15 - National primary and secondary ambient air quality standards for ozone.

Code of Federal Regulations, 2010 CFR

2010-07-01

... air quality standards for ozone. 50.15 Section 50.15 Protection of Environment ENVIRONMENTAL....15 National primary and secondary ambient air quality standards for ozone. (a) The level of the national 8-hour primary and secondary ambient air quality standards for ozone (O3) is 0.075 parts per...

42 CFR 438.804 - Primary care provider payment increases.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Primary care provider payment increases. 438.804 Section 438.804 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Participation § 438.804 Primary care provider payment increases. (a) For MCO, PIHP or PAHP contracts that cover...

Current Backpack Weight Status for Primary Schoolchildren in Colima, Mexico

ERIC Educational Resources Information Center

Olmedo-Buenrostro, Bertha Alicia; Delgado-Enciso, Iván; Sánchez-Ramírez, Carmen Alicia; Cruz, Sergio Adrián Montero; Vásquez, Clemente; Mora-Brambila, Ana Bertha; Rodríguez-Sánchez, Iram P.; Martínez-Fierro, Margarita L.

2016-01-01

The purpose of the study was to identify the current status of backpack weight in primary schoolchildren in Colima, Mexico, in relation to gender, school grade level, and body mass index. A cross-sectional study was conducted on 240 randomly selected children from 20 primary schools. The participating children's parents signed statements of…

75 FR 14446 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-25

... Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting In accordance with section... following meeting: Name: Advisory Committee on Training in Primary CareMedicine and Dentistry (ACTPCMD... Services Administration, Bureau of Health Professions, Division of Medicine and Dentistry. In the plenary...

77 FR 64116 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-18

... Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting In accordance with section... following meeting: Name: Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD... and Dentistry, Bureau of Health Professions, Health Resources and Services Administration, Room 9A-27...

76 FR 30951 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

... Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting In accordance with section... following meeting: Name: Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD.... Glass, M.D., Ph.D., Advisory Committee Executive Secretary, Division of Medicine and Dentistry, Bureau...

75 FR 64318 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-19

... Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting In accordance with section... following meeting: Name: Advisory Committee on Training in Primary Care, Medicine and Dentistry (ACTPCMD...., Ph.D., Advisory Committee Executive Secretary, Division of Medicine and Dentistry, Bureau of Health...

76 FR 64952 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-19

... Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting In accordance with section... following meeting: Name: Advisory Committee on Training in Primary Care, Medicine and Dentistry . Dates and... Dentistry (``Advisory Committee'') provides advice and recommendations to the Secretary of the U.S...

26 CFR 1.993-3 - Definition of export property.

Code of Federal Regulations, 2012 CFR

2012-04-01

... deduction for depletion under section 613 or 613A. (3) Primary product from oil, gas, coal, or uranium. A primary product from oil, gas, coal, or uranium is not export property. For purposes of this paragraph— (i... primary products from oil, gas, coal, or uranium described in subdivisions (i) through (iv) of this...

26 CFR 1.993-3 - Definition of export property.

Code of Federal Regulations, 2014 CFR

2014-04-01

... deduction for depletion under section 613 or 613A. (3) Primary product from oil, gas, coal, or uranium. A primary product from oil, gas, coal, or uranium is not export property. For purposes of this paragraph— (i... primary products from oil, gas, coal, or uranium described in subdivisions (i) through (iv) of this...

26 CFR 1.993-3 - Definition of export property.

Code of Federal Regulations, 2013 CFR

2013-04-01

... deduction for depletion under section 613 or 613A. (3) Primary product from oil, gas, coal, or uranium. A primary product from oil, gas, coal, or uranium is not export property. For purposes of this paragraph— (i... primary products from oil, gas, coal, or uranium described in subdivisions (i) through (iv) of this...

20 CFR 404.283 - Recomputation under method other than that used to find your primary insurance amount.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Recomputation under method other than that used to find your primary insurance amount. 404.283 Section 404.283 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts...

76 FR 38401 - Agency Information Collection Activities: Proposed Collection: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... page 35900, regarding Bureau of Primary Health Care (BPHC) Uniform Data System (OMB No. 0915-0193). FOR... section Proposed Project: Bureau of Primary Health Care (BPHC) Uniform Data System (OMB No. 0915-0193... annual reporting requirements for the cluster of primary care grantees funded by the Health Resources and...

Bullying and Victimization Behaviors in Boys and Girls at South Korean Primary Schools

ERIC Educational Resources Information Center

Yang, Su-Jin; Kim, Jae-Min; Kim, Sung-Wan; Shin, Il-Seon; Yoon, Jin-Sang

2006-01-01

Objective: To investigate the prevalence and correlates of bullying and victimization behaviors in boys and girls at South Korean primary schools. Method: In a cross-sectional survey, 1,344 fourth-grade primary school children completed a questionnaire on self-reported bullying and victimization behaviors, depression, anxiety, body image, coping…

42 CFR 414.66 - Incentive payments for physician scarcity areas.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Physician Scarcity Area (PSA) for primary or specialist care are eligible for a 5 percent incentive payment. (c) Primary care physicians furnishing services in primary care PSAs are entitled to an additional 5... section 1861(r)(1) of the Act, furnishing services in specialist care PSAs are entitled to an additional 5...

40 CFR 50.16 - National primary and secondary ambient air quality standards for lead.

Code of Federal Regulations, 2011 CFR

2011-07-01

... air quality standards for lead. 50.16 Section 50.16 Protection of Environment ENVIRONMENTAL PROTECTION... National primary and secondary ambient air quality standards for lead. (a) The national primary and secondary ambient air quality standards for lead (Pb) and its compounds are 0.15 micrograms per cubic meter...

40 CFR 50.12 - National primary and secondary ambient air quality standards for lead.

Code of Federal Regulations, 2013 CFR

2013-07-01

... air quality standards for lead. 50.12 Section 50.12 Protection of Environment ENVIRONMENTAL PROTECTION... National primary and secondary ambient air quality standards for lead. (a) National primary and secondary ambient air quality standards for lead and its compounds, measured as elemental lead by a reference method...

40 CFR 50.12 - National primary and secondary ambient air quality standards for lead.

Code of Federal Regulations, 2012 CFR

2012-07-01

... air quality standards for lead. 50.12 Section 50.12 Protection of Environment ENVIRONMENTAL PROTECTION... National primary and secondary ambient air quality standards for lead. (a) National primary and secondary ambient air quality standards for lead and its compounds, measured as elemental lead by a reference method...

40 CFR 50.12 - National primary and secondary ambient air quality standards for lead.

Code of Federal Regulations, 2011 CFR

2011-07-01

... air quality standards for lead. 50.12 Section 50.12 Protection of Environment ENVIRONMENTAL PROTECTION... National primary and secondary ambient air quality standards for lead. (a) National primary and secondary ambient air quality standards for lead and its compounds, measured as elemental lead by a reference method...

40 CFR 50.17 - National primary ambient air quality standards for sulfur oxides (sulfur dioxide).

Code of Federal Regulations, 2011 CFR

2011-07-01

... standards for sulfur oxides (sulfur dioxide). 50.17 Section 50.17 Protection of Environment ENVIRONMENTAL....17 National primary ambient air quality standards for sulfur oxides (sulfur dioxide). (a) The level of the national primary 1-hour annual ambient air quality standard for oxides of sulfur is 75 parts...

40 CFR 50.17 - National primary ambient air quality standards for sulfur oxides (sulfur dioxide).

Code of Federal Regulations, 2012 CFR

2012-07-01

... standards for sulfur oxides (sulfur dioxide). 50.17 Section 50.17 Protection of Environment ENVIRONMENTAL....17 National primary ambient air quality standards for sulfur oxides (sulfur dioxide). (a) The level of the national primary 1-hour annual ambient air quality standard for oxides of sulfur is 75 parts...

40 CFR 50.17 - National primary ambient air quality standards for sulfur oxides (sulfur dioxide).

Code of Federal Regulations, 2010 CFR

2010-07-01

... standards for sulfur oxides (sulfur dioxide). 50.17 Section 50.17 Protection of Environment ENVIRONMENTAL....17 National primary ambient air quality standards for sulfur oxides (sulfur dioxide). (a) The level of the national primary 1-hour annual ambient air quality standard for oxides of sulfur is 75 parts...

40 CFR 50.17 - National primary ambient air quality standards for sulfur oxides (sulfur dioxide).

Code of Federal Regulations, 2013 CFR

2013-07-01

... standards for sulfur oxides (sulfur dioxide). 50.17 Section 50.17 Protection of Environment ENVIRONMENTAL....17 National primary ambient air quality standards for sulfur oxides (sulfur dioxide). (a) The level of the national primary 1-hour annual ambient air quality standard for oxides of sulfur is 75 parts...

40 CFR 50.17 - National primary ambient air quality standards for sulfur oxides (sulfur dioxide).

Code of Federal Regulations, 2014 CFR

2014-07-01

... standards for sulfur oxides (sulfur dioxide). 50.17 Section 50.17 Protection of Environment ENVIRONMENTAL....17 National primary ambient air quality standards for sulfur oxides (sulfur dioxide). (a) The level of the national primary 1-hour annual ambient air quality standard for oxides of sulfur is 75 parts...

9 CFR 3.15 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.15 Section 3.15 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.138 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.138 Section 3.138 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.88 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.88 Section 3.88 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.62 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.62 Section 3.62 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.138 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.138 Section 3.138 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.138 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.138 Section 3.138 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.62 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.62 Section 3.62 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.138 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.138 Section 3.138 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.62 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.62 Section 3.62 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.15 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.15 Section 3.15 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.114 - Primary conveyances (motor vehicle, rail, air and marine).

Code of Federal Regulations, 2012 CFR

2012-01-01

..., rail, air and marine). 3.114 Section 3.114 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air and marine). (a) The animal cargo space of primary conveyances used in.... (e) The interiors of animal cargo spaces in primary conveyances must be kept clean. (f) Live marine...

9 CFR 3.88 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.88 Section 3.88 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.62 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.62 Section 3.62 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.88 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.88 Section 3.88 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.15 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.15 Section 3.15 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.62 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.62 Section 3.62 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.138 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.138 Section 3.138 Animals and Animal Products ANIMAL AND PLANT HEALTH... (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used in...

9 CFR 3.114 - Primary conveyances (motor vehicle, rail, air and marine).

Code of Federal Regulations, 2010 CFR

2010-01-01

..., rail, air and marine). 3.114 Section 3.114 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air and marine). (a) The animal cargo space of primary conveyances used in.... (e) The interiors of animal cargo spaces in primary conveyances must be kept clean. (f) Live marine...

9 CFR 3.114 - Primary conveyances (motor vehicle, rail, air and marine).

Code of Federal Regulations, 2013 CFR

2013-01-01

..., rail, air and marine). 3.114 Section 3.114 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air and marine). (a) The animal cargo space of primary conveyances used in.... (e) The interiors of animal cargo spaces in primary conveyances must be kept clean. (f) Live marine...

9 CFR 3.88 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.88 Section 3.88 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.114 - Primary conveyances (motor vehicle, rail, air and marine).

Code of Federal Regulations, 2014 CFR

2014-01-01

..., rail, air and marine). 3.114 Section 3.114 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air and marine). (a) The animal cargo space of primary conveyances used in.... (e) The interiors of animal cargo spaces in primary conveyances must be kept clean. (f) Live marine...

9 CFR 3.88 - Primary conveyances (motor vehicle, rail, air, and marine).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Primary conveyances (motor vehicle, rail, air, and marine). 3.88 Section 3.88 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air, and marine). (a) The animal cargo space of primary conveyances used to...

9 CFR 3.114 - Primary conveyances (motor vehicle, rail, air and marine).

Code of Federal Regulations, 2011 CFR

2011-01-01

..., rail, air and marine). 3.114 Section 3.114 Animals and Animal Products ANIMAL AND PLANT HEALTH... conveyances (motor vehicle, rail, air and marine). (a) The animal cargo space of primary conveyances used in.... (e) The interiors of animal cargo spaces in primary conveyances must be kept clean. (f) Live marine...

High-resolution imaging by scanning electron microscopy of semithin sections in correlation with light microscopy.

PubMed

Koga, Daisuke; Kusumi, Satoshi; Shodo, Ryusuke; Dan, Yukari; Ushiki, Tatsuo

2015-12-01

In this study, we introduce scanning electron microscopy (SEM) of semithin resin sections. In this technique, semithin sections were adhered on glass slides, stained with both uranyl acetate and lead citrate, and observed with a backscattered electron detector at a low accelerating voltage. As the specimens are stained in the same manner as conventional transmission electron microscopy (TEM), the contrast of SEM images of semithin sections was similar to TEM images of ultrathin sections. Using this technique, wide areas of semithin sections were also observed by SEM, without the obstruction of grids, which was inevitable for traditional TEM. This study also applied semithin section SEM to correlative light and electron microscopy. Correlative immunofluorescence microscopy and immune-SEM were performed in semithin sections of LR white resin-embedded specimens using a FluoroNanogold-labeled secondary antibody. Because LR white resin is hydrophilic and electron stable, this resin is suitable for immunostaining and SEM observation. Using correlative microscopy, the precise localization of the primary antibody was demonstrated by fluorescence microscopy and SEM. This method has great potential for studies examining the precise localization of molecules, including Golgi- and ER-associated proteins, in correlation with LM and SEM. © The Author 2015. Published by Oxford University Press on behalf of The Japanese Society of Microscopy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Prevalence of Primary Dysmenorrhea and Factors Associated with Its Intensity Among Undergraduate Students: A Cross-Sectional Study.

PubMed

Habibi, Nahal; Huang, Mary Soo Lee; Gan, Wan Ying; Zulida, Rejali; Safavi, Sayyed Morteza

2015-12-01

Primary dysmenorrhea is a womanhood problem around the world and negatively affects quality of life. This study was designed to investigate the prevalence of primary dysmenorrhea and to determine the factors associated with its intensity. A cross-sectional study was carried out among 311 undergraduate female students aged 18 to 27 years in Isfahan University of Medical Sciences, Iran. Socio-demographic characteristics and menstrual factors were obtained through interviews with the help of a pretested questionnaire. The prevalence of primary dysmenorrhea was 89.1%. Residing at home, younger age, lower number of years of formal education for the mother, positive family history of dysmenorrhea, higher severity of bleeding, and shorter menstrual period intervals were significantly associated with the higher intensity of primary dysmenorrhea. Primary dysmenorrhea is a common health concern among young women. Being aware of the factors that are associated with its intensity makes it possible for health professionals to organize better focused programs to reduce the adverse effects of dysmenorrhea. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Transverse occiput position: Using manual Rotation to aid Normal birth and improve delivery OUTcomes (TURN-OUT): A study protocol for a randomised controlled trial.

PubMed

de Vries, Bradley; Phipps, Hala; Kuah, Sabrina; Pardey, John; Ludlow, Joanne; Bisits, Andrew; Park, Felicity; Kowalski, David; Hyett, Jon A

2015-08-18

Fetal occiput transverse position in the form of deep transverse arrest has long been associated with caesarean section and instrumental vaginal delivery. Occiput transverse position incidentally found in the second stage of labour is also associated with operative delivery in high risk cohorts. There is evidence from cohort studies that prophylactic manual rotation reduces the caesarean section rate. This is a protocol for a double blind, multicentre, randomised, controlled clinical trial to define whether this intervention decreases the operative delivery (caesarean section, forceps or vacuum delivery) rate. Eligible participants will be ≥37 weeks pregnant, with a singleton pregnancy, and a cephalic presentation in the occiput transverse position on transabdominal ultrasound early in the second stage of labour. Based on a background risk of operative delivery of 49%, for a reduction to 35%, an alpha value of 0.05 and a beta value of 0.2, 416 participants will need to be enrolled. Participants will be randomised to either prophylactic manual rotation or a sham procedure. The primary outcome will be operative delivery. Secondary outcomes will be caesarean section, significant maternal mortality and morbidity, and significant perinatal mortality and morbidity. Analysis will be on an intention-to-treat basis. Primary and secondary outcomes will be compared using a chi-squared test. A logistic regression for the primary outcome will be undertaken to account for potential confounders. This study has been approved by the Ethics Review Committee (RPAH Zone) of the Sydney Local Health District, Sydney, Australia, (protocol number: X110410). This trial addresses an important clinical question concerning a commonly used procedure which has the potential to reduce operative delivery and its associated complications. Some issues discussed in the protocol include methods of assessing risk of bias due to inadequate masking of a procedural interventions, variations in intervention efficacy due to operator experience and the recruitment difficulties associated with intrapartum studies. This trial was registered with the Australian New Zealand Clinical Trials Registry (identifier: ACTRN12613000005752 ) on 4 January 2013.

Metallic Fuels Handbook

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

Janney, Dawn E.; Papesch, Cynthia A.; Burkes, Douglas E.

This is not a typical External Report--It is a Handbook. No Abstract is involved. This includes both Parts 1 and 2. The Metallic Fuels Handbook summarizes currently available information about phases and phase diagrams, heat capacity, thermal expansion, and thermal conductivity of elements and alloys in the U-Pu-Zr-Np-Am-La-Ce-Pr-Nd system. Although many sections are reviews and updates of material in previous versions of the Handbook [1, 2], this revision is the first to include alloys with four or more elements. In addition to presenting information about materials properties, the handbook attempts to provide information about how well each property is knownmore » and how much variation exists between measurements. Although it includes some results from models, its primary focus is experimental data.« less

Care standards for non-alcoholic fatty liver disease in the United Kingdom 2016: a cross-sectional survey.

PubMed

Sheridan, David A; Aithal, Guru; Alazawi, William; Allison, Michael; Anstee, Quentin; Cobbold, Jeremy; Khan, Shahid; Fowell, Andrew; McPherson, Stuart; Newsome, Philip N; Oben, Jude; Tomlinson, Jeremy; Tsochatzis, Emmanouil

2017-10-01

Guidelines for the assessment of non-alcoholic fatty liver disease (NAFLD) have been published in 2016 by National Institute for Health and Care Excellence and European Associations for the study of the Liver-European Association for the study of Diabetes-European Association for the study of Obesity. Prior to publication of these guidelines, we performed a cross-sectional survey of gastroenterologists and hepatologists regarding NAFLD diagnosis and management. An online survey was circulated to members of British Association for the Study of the Liver and British Society of Gastroenterology between February 2016 and May 2016. 175 gastroenterologists/hepatologists responded, 116 completing the survey, representing 84 UK centres. 22% had local NAFLD guidelines. 45% received >300 referrals per year from primary care for investigation of abnormal liver function tests (LFTs). Clinical assessment tended to be performed in secondary rather than primary care including body mass index (82% vs 26%) and non-invasive liver screen (86% vs 32%) and ultrasound (81% vs 37%). Widely used tools for non-invasive fibrosis risk stratification were aspartate transaminase (AST)/alanine transaminase (ALT) ratio (53%), Fibroscan (50%) and NAFLD fibrosis score (41%). 78% considered liver biopsy in selected cases. 50% recommended 10% weight loss target as first-line treatment. Delivery of lifestyle interventions was mostly handed back to primary care (56%). A minority have direct access to community weight management services (22%). Follow-up was favoured by F3/4 fibrosis (72.9%), and high-risk non-invasive fibrosis tests (51%). Discharge was favoured by simple steatosis at biopsy (30%), and low-risk non-invasive scores (25%). The survey highlights areas for improvement of service provision for NAFLD assessment including improved recognition of non-alcoholic steatohepatitis in people with type 2 diabetes, streamlining abnormal LFT referral pathways, defining non-invasive liver fibrosis assessment tools, use of liver biopsy, managing metabolic syndrome features and improved access to lifestyle interventions.

Perception and use of massive open online courses among medical students in a developing country: multicentre cross-sectional study

PubMed Central

Aboshady, Omar A; Radwan, Ahmed E; Eltaweel, Asmaa R; Azzam, Ahmed; Aboelnaga, Amr A; Hashem, Heba A; Darwish, Salma Y; Salah, Rehab; Kotb, Omar N; Afifi, Ahmed M; Noaman, Aya M; Salem, Dalal S; Hassouna, Ahmed

2015-01-01

Objectives To assess the prevalence of awareness and use of massive open online courses (MOOCs) among medical undergraduates in Egypt as a developing country, as well as identifying the limitations and satisfaction of using these courses. Design A multicentre, cross-sectional study using a web-based, pilot-tested and self-administered questionnaire. Settings Ten out of 19 randomly selected medical schools in Egypt. Participants 2700 undergraduate medical students were randomly selected, with an equal allocation of participants in each university and each study year. Primary and secondary outcome measures Primary outcome measures were the percentages of students who knew about MOOCs, students who enrolled and students who obtained a certificate. Secondary outcome measures included the limitations and satisfaction of using MOOCs through five-point Likert scale questions. Results Of 2527 eligible students, 2106 completed the questionnaire (response rate 83.3%). Of these students, 456 (21.7%) knew the term MOOCs or websites providing these courses. Out of the latter, 136 (29.8%) students had enrolled in at least one course, but only 25 (18.4%) had completed courses earning certificates. Clinical year students showed significantly higher rates of knowledge (p=0.009) and enrolment (p<0.001) than academic year students. The primary reasons for the failure of completion of courses included lack of time (105; 77.2%) and slow Internet speed (73; 53.7%). Regarding the 25 students who completed courses, 21 (84%) were satisfied with the overall experience. However, there was less satisfaction regarding student–instructor (8; 32%) and student–student (5; 20%) interactions. Conclusions About one-fifth of Egyptian medical undergraduates have heard about MOOCs with only about 6.5% actively enrolled in courses. Students who actively participated showed a positive attitude towards the experience, but better time-management skills and faster Internet connection speeds are required. Further studies are needed to survey the enrolled students for a better understanding of their experience. PMID:25564149

Risk factors for schistosomiasis transmission among school children in Gwanda district, Zimbabwe.

PubMed

Nyati-Jokomo, Zibusiso; Chimbari, Moses J

2017-11-01

A nationwide cross sectional schistosomiasis survey conducted in 2011 in 280 primary schools found a prevalence rate of 22.7%. This warranted an intervention with Mass Drug Administration at all schools in line with WHO guidelines. This study aimed to identify risk factors for schistosomiasis transmission among Grade 3 children at two primary schools in Gwanda district. A descriptive cross sectional survey which was part of a larger study on Malaria and Bilharzia in Southern Africa (MABISA) was conducted. Grade 3 children (n=120) attending two purposively selected rural primary schools in Dombo and Ntalale in Gwanda were respondents. Data on socio-demographic characteristics and risk factors which included knowledge and practices were collected using a pretested interviewer administered questionnaire. Of the 120 children, 98 (81.7%) of the children indicated that they did not consistently use the toilet. The other risk factors for schistosomiasis were bathing and swimming in rivers and dams 80 (66.7%), watering the vegetable gardens using unprotected water sources 77 (64.7%) and crossing rivers on their way to school barefooted 31.7%. History of schistosomiasis cases based on self-reporting indicated that of the 9 children 7 were girls. There was poor knowledge of schistosomiasis among the children with 54% of the children indicating that they had never heard about the disease. Misconceptions on the causes of schistosomiasis which included drinking dirty water, mosquitoes and flies as the causes of schistosomiasis were reported by the children. Parents were cited as the least disseminators of information on schistosomiasis with only 4 out of the 120 children having received information from their parents. Frequent contact with unprotected water sources, non-use of the toilet, and lack of information on schistosomiasis could predispose the children to infection. There is need to raise awareness about schistosomiasis in schools and the community to reduce the risk of contracting schistosomiasis due to risky behaviour. Copyright © 2017. Published by Elsevier B.V.

Cross-Cultural Validation of the Patient Perception of Integrated Care Survey.

PubMed

Tietschert, Maike V; Angeli, Federica; van Raak, Arno J A; Ruwaard, Dirk; Singer, Sara J

2017-07-20

To test the cross-cultural validity of the U.S. Patient Perception of Integrated Care (PPIC) Survey in a Dutch sample using a standardized procedure. Primary data collected from patients of five primary care centers in the south of the Netherlands, through survey research from 2014 to 2015. Cross-sectional data collected from patients who saw multiple health care providers during 6 months preceding data collection. The PPIC survey includes 59 questions that measure patient perceived care integration across providers, settings, and time. Data analysis followed a standardized procedure guiding data preparation, psychometric analysis, and included invariance testing with the U.S. dataset. Latent scale structures of the Dutch and U.S. survey were highly comparable. Factor "Integration with specialist" had lower reliability scores and noninvariance. For the remaining factors, internal consistency and invariance estimates were strong. The standardized cross-cultural validation procedure produced strong support for comparable psychometric characteristics of the Dutch and U.S. surveys. Future research should examine the usability of the proposed procedure for contexts with greater cultural differences. © Health Research and Educational Trust.

Underlying-event sensitive observables in Drell–Yan production using GENEVA

DOE PAGES

Alioli, Simone; Bauer, Christian W.; Guns, Sam; ...

2016-11-09

We present an extension of the Geneva Monte Carlo framework to include multiple parton interactions (MPI) provided by Pythia8. This allows us to obtain predictions for underlying-event sensitive measurements in Drell–Yan production, in conjunction with Geneva ’s fully differential NNLO calculation, NNLL' resummation for the 0-jet resolution variable (beam thrust), and NLL resummation for the 1-jet resolution variable. We describe the interface with the parton-shower algorithm and MPI model of Pythia8, which preserves both the precision of the partonic N-jet cross sections in Geneva as well as the shower accuracy and good description of soft hadronic physics of Pythia8. Wemore » present results for several underlying-event sensitive observables and compare to data from ATLAS and CMS as well as to standalone Pythia8 predictions. This includes a comparison with the recent ATLAS measurement of the beam thrust spectrum, which provides a potential avenue to fully disentangle the physical effects from the primary hard interaction, primary soft radiation, multiple parton interactions, and nonperturbative hadronization.« less

Staged marginal contoured and central excision technique in the surgical management of perianal Paget's disease.

PubMed

Möller, Mecker G; Lugo-Baruqui, Jose Alejandro; Milikowski, Clara; Salgado, Christopher J

2014-04-01

Extramammary Paget's disease (EMPD) is an adenocarcinoma of the apocrine glands with unknown exact prevalence and obscure etiology. It has been divided into primary EMPD and secondary EMPD, in which an internal malignancy is usually associated. Treatment for primary EMPD usually consists of wide lesion excision with negative margins. Multiple methods have been proposed to obtain free-margin status of the disease. These include visible border lesion excision, punch biopsies, and micrographic and frozen-section surgery, with different results but still high recurrence rates. The investigators propose a method consisting of a staged contoured marginal excision using "en face" permanent pathologic analysis preceding the steps of central excision of the lesion and the final reconstruction of the surgical defect. Advantages of this method include adequate margin control allowing final reconstruction and tissue preservation, while minimizing patient discomfort. The staged contoured marginal and central excision technique offers a new alternative to the armamentarium for surgical oncologists for the management of EMPD in which margin control is imperative for control of recurrence rates. Copyright © 2014 Elsevier Inc. All rights reserved.

Petroleum supply monthly, October 1993

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

Not Available

1993-10-26

The Petroleum Supply Monthly (PSM) is one of a family of four publications produced by the Petroleum Supply Division within the Energy Information Administration (EIA) reflecting different levels of data timeliness and completeness. The other publications are the Weekly Petroleum Status Report (WPSR), the Winter Fuels Report, and the Petroleum Supply Annual (PSA). Data presented in the PSM describe the supply and disposition of petroleum products in the United States and major US geographic regions. The data series describe production, imports and exports, inter-Petroleum Administration for Defense (PAD) District movements, and inventories by the primary suppliers of petroleum products inmore » the United States (50 States and the District of Columbia). The reporting universe includes those petroleum sectors in primary supply. Included are: petroleum refiners, motor gasoline blenders, operators of natural gas processing plants and fractionators, inter-PAD transporters, importers, and major inventory holders of petroleum products and crude oil. When aggregated, the data reported by these sectors approximately represent the consumption of petroleum products in the United States. Data presented in the PSM are divided into two sections: Summary Statistics and Detailed Statistics.« less

Underlying-event sensitive observables in Drell–Yan production using GENEVA

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

Alioli, Simone; Bauer, Christian W.; Guns, Sam

We present an extension of the Geneva Monte Carlo framework to include multiple parton interactions (MPI) provided by Pythia8. This allows us to obtain predictions for underlying-event sensitive measurements in Drell–Yan production, in conjunction with Geneva ’s fully differential NNLO calculation, NNLL' resummation for the 0-jet resolution variable (beam thrust), and NLL resummation for the 1-jet resolution variable. We describe the interface with the parton-shower algorithm and MPI model of Pythia8, which preserves both the precision of the partonic N-jet cross sections in Geneva as well as the shower accuracy and good description of soft hadronic physics of Pythia8. Wemore » present results for several underlying-event sensitive observables and compare to data from ATLAS and CMS as well as to standalone Pythia8 predictions. This includes a comparison with the recent ATLAS measurement of the beam thrust spectrum, which provides a potential avenue to fully disentangle the physical effects from the primary hard interaction, primary soft radiation, multiple parton interactions, and nonperturbative hadronization.« less

Petroleum supply monthly, January 1996

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

NONE

The Petroleum Supply Monthly (PSM) is one of a family of four publications produced by the Petroleum Supply Division within the Energy Information Administration (EIA) reflecting different levels of data timeliness and completeness. The other publications are the Weekly Petroleum Status Report (WPSR), the Winter Fuels Report, and the Petroleum Supply Annual (PSA). Data presented in the PSM describe the supply and disposition of petroleum products in the United States and major US geographic regions. The data series describe production, imports and exports, inter-Petroleum Administration for Defense (PAD) District movements, and inventories by the primary suppliers of petroleum products inmore » the United States (50 States and the District of Columbia). The reporting universe includes those petroleum sectors in primary supply. Included are: petroleum refiners, motor gasoline blenders, operators of natural gas processing plants and fractionators, inter-PAD transporters, importers, and major inventory holders of petroleum products and crude oil. When aggregated, the data reported by these sectors approximately represent the consumption of petroleum products in the United States. Data presented in the PSM are divided into two sections: Summary Statistics and Detailed Statistics.« less

Routine Cross-Sectional Head Imaging Before Electroconvulsive Therapy: A Tertiary Center Experience.

PubMed

Sajedi, Payam I; Mitchell, Jason; Herskovits, Edward H; Raghavan, Prashant

2016-04-01

Electroconvulsive therapy (ECT) is generally contraindicated in patients with intracranial mass lesions or in the presence of increased intracranial pressure. The purpose of this study was to determine the prevalence of incidental abnormalities on routine cross-sectional head imaging, including CT and MRI, that would preclude subsequent ECT. This retrospective study involved a review of the electronic medical records of 105 patients (totaling 108 imaging studies) between April 27, 2007, and March 20, 2015, referred for cranial CT or MRI with the primary indication of pre-ECT evaluation. The probability of occurrence of imaging findings that would preclude ECT was computed. A cost analysis was also performed on the practice of routine pre-ECT imaging. Of the 105 patients who presented with the primary indication of ECT clearance (totaling 108 scans), 1 scan (0.93%) revealed findings that precluded ECT. None of the studies demonstrated findings that indicated increased intracranial pressure. A cost analysis revealed that at least $18,662.70 and 521.97 relative value units must be expended to identify one patient with intracranial pathology precluding ECT. The findings of this study demonstrate an extremely low prevalence of findings that preclude ECT on routine cross-sectional head imaging. The costs incurred in identifying a potential contraindication are high. The authors suggest that the performance of pre-ECT neuroimaging be driven by the clinical examination. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Systematic review on the primary and secondary reporting of the prevalence of ghostwriting in the medical literature.

PubMed

Stretton, Serina

2014-07-14

Ghostwriting of industry-sponsored articles is unethical and is perceived to be common practice. To systematically review how evidence for the prevalence of ghostwriting is reported in the medical literature. MEDLINE via PubMed 1966+, EMBASE 1966+, The Cochrane Library 1988+, Medical Writing 1998+, The American Medical Writers Association (AMWA) Journal 1986+, Council of Science Editors Annual Meetings 2007+, and the Peer Review Congress 1994+ were searched electronically (23 May 2013) using the search terms ghostwrit*, ghostauthor*, ghost AND writ*, ghost AND author*. All publication types were considered; only publications reporting a numerical estimate of possible ghostwriting prevalence were included. Two independent reviewers screened the publications; discrepancies were resolved by consensus. Data to be collected included a numerical estimate of the prevalence of possible ghostwriting (primary outcome measure), definitions of ghostwriting reported, source of the reported prevalence, publication type and year, study design and sample population. Of the 848 publications retrieved and screened for eligibility, 48 reported numerical estimates for the prevalence of possible ghostwriting. Sixteen primary publications reported findings from cross-sectional surveys or descriptive analyses of published articles; 32 secondary publications cited published or unpublished evidence. Estimates on the prevalence of possible ghostwriting in primary and secondary publications varied markedly. Primary estimates were not suitable for meta-analysis because of the various definitions of ghostwriting used, study designs and types of populations or samples. Secondary estimates were not always reported or cited correctly or appropriately. Evidence for the prevalence of ghostwriting in the medical literature is limited and can be outdated, misleading or mistaken. Researchers should not inflate estimates using non-standard definitions of ghostwriting nor conflate ghostwriting with other unethical authorship practices. Editors and peer reviewers should not accept articles that incorrectly cite or interpret primary publications that report the prevalence of ghostwriting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Systematic review on the primary and secondary reporting of the prevalence of ghostwriting in the medical literature

PubMed Central

Stretton, Serina

2014-01-01

Background Ghostwriting of industry-sponsored articles is unethical and is perceived to be common practice. Objective To systematically review how evidence for the prevalence of ghostwriting is reported in the medical literature. Data sources MEDLINE via PubMed 1966+, EMBASE 1966+, The Cochrane Library 1988+, Medical Writing 1998+, The American Medical Writers Association (AMWA) Journal 1986+, Council of Science Editors Annual Meetings 2007+, and the Peer Review Congress 1994+ were searched electronically (23 May 2013) using the search terms ghostwrit*, ghostauthor*, ghost AND writ*, ghost AND author*. Eligibility criteria All publication types were considered; only publications reporting a numerical estimate of possible ghostwriting prevalence were included. Data extraction Two independent reviewers screened the publications; discrepancies were resolved by consensus. Data to be collected included a numerical estimate of the prevalence of possible ghostwriting (primary outcome measure), definitions of ghostwriting reported, source of the reported prevalence, publication type and year, study design and sample population. Results Of the 848 publications retrieved and screened for eligibility, 48 reported numerical estimates for the prevalence of possible ghostwriting. Sixteen primary publications reported findings from cross-sectional surveys or descriptive analyses of published articles; 32 secondary publications cited published or unpublished evidence. Estimates on the prevalence of possible ghostwriting in primary and secondary publications varied markedly. Primary estimates were not suitable for meta-analysis because of the various definitions of ghostwriting used, study designs and types of populations or samples. Secondary estimates were not always reported or cited correctly or appropriately. Conclusions Evidence for the prevalence of ghostwriting in the medical literature is limited and can be outdated, misleading or mistaken. Researchers should not inflate estimates using non-standard definitions of ghostwriting nor conflate ghostwriting with other unethical authorship practices. Editors and peer reviewers should not accept articles that incorrectly cite or interpret primary publications that report the prevalence of ghostwriting. PMID:25023129